Dr. David B. Adams – Psychological Blog

Psychology of Illness, Pain, Anxiety and Depression


angerAnger is an insidious process. Expressed or held in check, it influences what a patient says and does. What the patient does not express often emerges in new or increased physical symptoms often seemingly unrelated to injury.

When anger is unsafe to verbalize, the patient feels extremes of frustration and is preoccupied with an unfulfilled need to retaliate. Ultimately helpless to either resolve or discharge the aggression, the patient becomes physically symptomatic.

Case in point: The patient has a lumbar injury and six months later, winds up in the ER with chest pain, headaches and/or GI distress. He wants cardiology, neurology and gastroenterology consults, believing that these new symptoms are part of previously undiagnosed but injury-related problems or, at a minimum, he believes that the symptoms are arising from adverse side effects of prescribed medication.

In the ER, no one asks the patient, “are you depressed….are you angry…are there problems that you cannot resolve…” Instead, numerous, unnecessary and expensive diagnostic studies are ordered, and the patient is sent home with more prescriptions for symptomatic relief of the new complaints.

The patient arrives home, has worse injury-related pain from sitting in the ER, is frustrated by these new diffuse symptoms, feels powerless to address the underlying cause. He arises the following day and repeats the same process.

When these new symptoms do not improve, they become evidence to the patient that no one cares about him and/or it is impossible to have adequate care if you have been injured at work. Until/unless credence is given to the patient’s anger and frustration, and the causes are addressed, this becomes a cycle.

In the arena of work injuries, the person most likely to receive blame is the adjustor and nurse case manager followed by the primary provider who does not _fix_ them. Unfortunately, many patients feel that the solution to their problems, whether financial or medical, is being intentionally withheld from them. Asking direct questions can communicate a message of caring, as long as you are prepared to hear the answer and deal with it.

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