There are cases in which the patient is depressed but does not want treatment. Being lost in the health care delivery system is demeaning for us all. Health care has become depersonalized, and care is fragmented across multiple offices.
The injured worker is in a role he never felt he would have to accept, and that role may be in sharp contrast to the hard work and independence that has characterized his life.
He is now living on a fraction of his past income, and savings are being depleted. He has moved from a position of strength and independence to one of having to ask for assistance.
When the surgeon referred him to my office, the patient can feel minimized and trivialized. He knows that he needs care, but he feels that to accept this is to admit defeat. He believes that depression is a weakness and that even more status will be lost by having it treated.
His eating, sleeping and ability to concentrate have been altered. He is irritable and forgetful. He knows that he is depressed, but he fears that if he acknowledges the depression, “then they will think the problems are all in my head and stop looking for the cause of my pain.”
These patients often comply with antidepressants if they know that understand their brain chemistry has changed and that addressing depression also increases their ability to manage pain.
They may be more acceptant of psychological care if they see it as a way to spare their family from having to discuss painful topics.
They must be show that psychological care is a means of putting them back in control of their emotions, thus restoring a measure of lost independence.
There will still be the patient who refuses care completely. For this person, all that can be offered is an open door should they change their mind. And sometimes, this is enough.”