Dr. David B. Adams – Psychological Blog

Psychology of Illness, Pain, Anxiety and Depression

Depression As A Disease

a. Should an injured worker be given all possible assistance as well as protection from re-injury or exacerbation of his/her problems?
Answer: Of course

b. Is it not cruel to return a patient to work?
Answer: Absolutely not. A return to work in some capacity must be the goal of all care. This is sometimes a goal that cannot be realized such as in the case where the permanent and partial limitations/restrictions are too great.

The human animal finds purpose in productive activity. That can be broadly defined as spending a day engaged in meaningful and fulfilling activities. Sleeping late, sitting at home inactive, watching television, taking a large number of medications, surfing the internet and talking to friends on the telephone is not meaningful. It is not purposeful or goal directed. It is life without agenda, purpose or direction.

The cruelest thing that we can do is to perpetuate this inactivity.

It is of paramount importance to determine if the patient truly has the goal of returning to work when physically able. Some patients do not. Some have loathed or tired of their jobs. Some harbor deep resentment toward the employer and/or co-workers. They erroneously believe that not returning to work either provides them with relief from responsibility or that not returning to work is a punishment of their employer. In each case of injury, it is essential that we determine the patient’s goals. Quite often, that goal is not to return to work.

You cannot predict this by age, intelligence or education. But it can be predicted with reasonable certainty.

Additionally, the patient must understand the implications of not returning to work, what it will do to their quality of life, to their family relationships, to their economic status and to the potential for an empty and possibly meaningless existence.

Enabling a patient a dependent role in life may be the cruelest thing we could ever do.

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