Dr. David B. Adams – Psychological Blog

Psychology of Injury, Pain, Anxiety and Depression


Some call it resistance, noncompliance or just being inconsistent, but there are some injured workers who elect not to participate in their own rehabilitation process. They inconsistently show for physical therapy, take (or refuse to take) their medications in opposition to what they are instructed to do, and they defer control of the course of their care to non-medical people. They allow friends, family and various agents to dictate what they do, or fail to do, despite the irrational nature of such a decision. While these outside sources rarely have health care licenses or even training, advice places them in positions of control, and, therefore, advice is readily available.

It is usually of questionable utility and rarely given in all sincerity.

However, armed with the assurance that they need, deserve or otherwise must have some specific care, patients become fixated on obtaining it. Instead of fighting against their injury or symptoms, they become embroiled in fighting against the system, and the quest for a specific person or care becomes more important than the goal of recovery. When they finally achieve that particular referral or whatever it is they have been told they want, the quest is over. It is now time to focus on the work of recovery. Unfortunately, their quest has derailed them from that focus. They have lost sight of worthwhile goals of recovery and productivity. They have no internal incentive and find that they are no better off than they were before, but they are more fatigued and deconditioned and have less money than ever. And it is back to square one.

Participation in one’s own rehabilitation requires that the patient commit to a single focus: There is some job, somewhere, that he/she should be able to perform, and the goal must be to recover sufficiently to function in that job.

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