Dr. David B. Adams – Psychological Blog

Psychology of Illness, Pain, Anxiety and Depression

Injury as Vengeance

I strongly believe that any lost time injured worker should be referred for evaluation if they are 3-6 months post injury and not progressing. There are unquestionably factors that are impacting this patient, and just as obviously, no one as yet knows how to address them or even what they are.

However, I very often am referred patients for care simply because the authorized treating physician believes: a. the patient is depressed and b. since he/she is depressed, they can, therefore, benefit from psychological care.

The reality is that there are a substantial number of lost-time cases for whom psychological care (as well as physical therapy or even routine medical visits) are incorporated into their lives as “recreation.”

These are bored, lonely and empty individuals who once filled their time with work, family and recreation. Now they spend endless, meaningless days, often uncomfortable and having few financial resources to permit them to entertain themselves.

They eagerly accept a psychological referral because “it is somebody to talk to,” but it is very quickly obvious that they see their appointments as a way of leisurely way of spending their surplus time. They do not understand the purpose, do not invest energy into the process and are not pusuing goals. They are not seeking to understand and resolve conflicts; they are simply looking for companionship.

These are, of course, also the patients who wind up in open-ended psychological care without productive change.

It is very difficult to communicate this to the authorized treating physician, the nurse case manger or adjustor; all of whom make the referral in good faith. They had not considered that the patient is actually not in conflict. They are not truly anxious or depressed. They are simply leading empty and meaningless lives, and for this group, psychological care may not be of value.

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