Dr. David B. Adams – Psychological Blog

Psychology of Illness, Pain, Anxiety and Depression

Injury as Punishment

Eighty percent of those who need care, never seek it. And many who seek it, do not benefit.

Most patients who are referred to my office have been out of work for 6+ months. The referral question is often a. is the patient depressed; b. are there issues of secondary gain; c. does this patient have PTSD, or d. is this patient a candidate for surgery or SCS implant.

However, what I often find upon examination is a de-conditioned person with marginal education and job skills. Often there is a history of arrest ranging from DUI to spousal abuse and more.

There may have been frequent job changes without a specific career track. The patient feels that the injury was preventable, coworkers were to blame, and that the _unsympathetic_ employer obstructed access to quality care.

To these patients, the primary provider is seen as a tool of the insurer, and they believe their attorney is competent to choose physicians, specialties and procedures.

The patient_s days are spent tracking numerous medications, often supplementing them with recreational and prescription drugs from family and friends. These may be mixed with alcohol. There is poor quality of sleep at night, napping during the day, no exercise, a high caffeine intake and impressive nicotine dependence.

While the patient may once have needed psychological care in order to return to work, such care may have been obstructed, or the referral was not made to a skilled clinician. The resultant care may span many months without productive change while the patient continues to deteriorate. As income dwindles, others advise the patient to maximize complaints toward the goal of a larger financial outcome.

Comments for this post are closed.

ICE Candidates

ICE: The concept: Insurance companies are requiring an evaluation to determine whether a patient is psychologically a good …
Read Blog Post

Psych-IME as a Functional Capacity Exam

Actually, I refer to a psychological exam as _an in vivo mini-functional capacity exam,_ and a side benefit for a Psych-IME. …
Read Blog Post



The histrionic patient is melodramatic and flighty. The patient is not malingering, not consciously attempting to deceive. …
Read Blog Post