Psychological factors consistently emerge in five areas:
1. Patient complains of problems with intimacy but is found to be hypertensive and/or diabetic. He is forgetting/failing/refusing/cannot afford his medication. Additionally, either pre-dating his problems with genital function or as a consequence of it, he suspects his wife is unfaithful. Not infrequently, those suspicions are well-founded and based upon her past indiscretions. Those concerns for function and fidelity are now obsessive concerns for the patient.
2. Patient is being hounded by bill-collectors, has lost vehicles and appears to be losing the house. With some inquiry, it is learned that the patient was working several jobs, some for cash, and even with multiple sources of income was financially extended. As soon as he/she began receiving workers_ compensation, bills began to mount. Rather than liquidate toys and trinkets, the financial peril was ignored until bills became insurmountable. The patient now ruminates throughout the day as to how financial recovery can ever occur.
3. Patient had intended to complete a GED or obtain some training that would permit job flexibility and the capacity to work in safer and less oppressive settings. The job being held was solely for income. It paid well because it was an unpleasant job that few would work. Since the injury, the patient now reflects continually as to how much that job was dreaded and hated.
4. The patient has never been treated for drug or alcohol addiction. The patient does not think of himself/herself as having substance abuse problems. Yet, a careful history reveals that he/she has had several DUI arrests, and regularly engaged in binge drinking on weekends. When with friends, marijuana and occasional cocaine have been used for recreation. Patient is offended that there is reluctance to give him ready access to prescribed narcotics and does not connect his past behavior to the restrictions placed on his pain medication.
5. Patient does not understand the primary diagnosis, how it leads to pain, how it limits activities and/or what the diagnostic procedures have revealed (and failed to reveal) or the procedures being recommended. Each procedure is being approached as though it will resolve all pain with horrible disappointment that it does not do so. Referrals to doctors, information about his/her condition and the ways in which to deal with this role in workers_ compensation come from individuals lacking in training and often having nefarious motives for what they are telling the patient.
These are psychological “issues” or “factors;” they are not disorders. Yet, it is these very issues that drive the majority of cases.