Dr. David B. Adams – Psychological Blog

Psychology of Illness, Pain, Anxiety and Depression

The Injury Process

I want to provide you a very concise summary as to what you have learned about events before and after injury, regardless of injury and regardless of the State in which the injury occurs.

Every worker lives in a state of denial.

In order to function in any job, especially those which have risk, the worker cannot continually process dangers, and how he/she would respond to an injury (or in some cases, an assault) if it occurred at work. The workers must live in denial.

When injury occurs, therefore, that denial gives way to the trauma. The initial stages of trauma include shock, recoil and disbelief.

Regardless of the degree of physical damage, the worker believes that care will be timely and effective; that all will be resolved in short order.

As reality sets in, the worker finds that he/she will return to work in short order or perhaps after several weeks of recovery or possibly after many months of care and, in some cases, that return simply will not occur.

It is rare, at the onset of the injury, for patient, employer, physician or insurer to know with certainty when return to productivity will occur.

But there is a greater complication that pre-dates all injuries, every single one, and that is the amount of baggage that the patient carries into the accident.

As we have discussed, this can range from legal and financial problems to marital and family problems to other health problems, educational deficits, intellectual limitations and varying degrees of motivation to fight against obstacles. Everyone has baggage.

And guess what: the injury creates its own degree of baggage…anger, resentment, dependencies, fears, isolation, frustrations, and arguably all human emotions. …and a few which are not so human.

It is not possible to determine the amount of baggage through physical examination and treatment of the patient. Simply put, patients are rarely truthful. They are often in denial of their problems or unquestionably embarrassed by them. They are not forthcoming.

Patients will use their injuries, whether deliberately or unconsciously, to address the baggage that they carry.

Those treating the patient falsely believe that injured tissue can be treated, and the baggage can be ignored.

This does not work, and the unclaimed baggage increases.

Those authorizing tests, those paying the bills, and those interfacing with the patient, all live in their own denial, both of the patient_s baggage and their own. They believe that they can sidestep all of this baggage without tripping. They cannot.

It is this baggage that directs the course of care and recovery. And interestingly, this baggage always seems to make it past the security checks.

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