Dr. David B. Adams – Psychological Blog

Psychology of Injury, Pain, Anxiety and Depression

The Role of Frustration in Recovery

There is a body of research on frustration-instigated-aggression. In effect, frustrated individuals remain passive initially but then mobilize their anger. Among injured workers this may take the form of anything from domestic violence to simply being vile toward case managers and physicians.

There are no data to support your belief that frustration is a positive motivator. And there are no data to support the contention that frustrating an individual will return them work. Frustration is not a motivator; it is an instigator of aggression.

Individuals frustrated by the course or delay of their care become even more entrenched in their symptoms. They will seek validation that their complaints are real, substantial and disabling. You are creating a condition wherein the patient feels that he must compete with you to prove his own sincerity. Whether the symptoms are real or feigned, the patient is placed in the role of responding to your challenge.

This is arguably most clearly demonstrated when a patient sees his primary provider, is told that his complaints suggest a specific and potentially serious problem, the physician orders diagnostic studies. You then decline authorization and tell the physician that you have alternate work within objective limitations.

The physician believing that this to be accurate, does not proceed with diagnostic plans and releases the patient to return to alternate duty. The “new” job turns out to be the old job with little if any modifications. The patient is understandably confused by this, angered by it, and suspicious that collusion had occurred. The physician may, for the most part be blameless, having received erroneous data. However, the patient is angry at him nonetheless.

The end product is a patient who is now less willing to participate in rehabilitative efforts and unquestionably less willing to believe that others are working on his behalf.”

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