Dr. David B. Adams – Psychological Blog

Psychology of Illness, Pain, Anxiety and Depression

Do Cases "Turn" Psychological

An injured who sustained a minor fall from four feet, an ankle sprain and now says that he cannot ever again work as a roofer. He has found some psychologist who says he has PTSD because he dreads being on the roof again.

This may be an accurate diagnosis or simply an opportunity to consider other career options. A thorough examination, in many cases, reveals that the supposed PTSD is little more than a dread of doing the same job for the rest of his productive years. The problem is that it is rare that such examinations occur.

Men in their forties often grow very weary of work that they have done for almost 25 years. Women in their forties often grow very resentful of having been a breadwinner when they would have preferred to stay home and raise their children. When either group is injured, they look at what opportunities are created by the accident.

You become concerned that they may be drug seeking or seeking a large settlement to fund their lifestyle, but quite often, it is merely a time in life when an individual thinks “once I feel better, do I really want to go back to that type of work or go back to work at all?”

With regard to the diagnosed PTSD, this is quite a complexity. In reality, PTSD is an often overlooked disorder that arises following accident and injury. It can be a miserable disorder from which to suffer.

However, it is equally often a misdiagnosis. What is diagnosed as posttraumatic stress disorder may actually be a recently detected, but longstanding, depression. Or it may be an adjustment to this injury (situation) and will resolve with some assistance in making effective future decisions.

The patient’s life has been miserable for several years. Once injured, some of this emotional misery stops. Conflicts with the boss, competition with coworkers, long hours, boredom and dangerous work conditions suddenly cease. Although the rate of (disability) compensation is low, it is tax free money with no commitment. The injured worker does not even need to reliably show for scheduled appointments. He/she gets to sleep late, watch TV, read, nap and engage in hobbies. For some, it is a paid vacation and opportunity to think (and perhaps fund) what can be done with a future. Don’t forget that at midlife, many individuals no longer have childrearing responsibility. It is a funded fresh start.

Thorough examinations appear to rarely occur. Thorough in this sense would mean that whoever examines the patient looks at what needs are being met by being in the injury role.

It is difficult to enlist cooperation if it is, indeed, seen as a paid vacation and a chance for career change…or early retirement.

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