Dr. David B. Adams – Psychological Blog

Psychology of Illness, Pain, Anxiety and Depression

Infliction of Guilt

If those who cause work-related injury experience guilt or remorse, it is rarely expressed to the patient. The role where guilt comes into play, surprisingly enough, is in the worker himself.

In most cases, families are supportive of injured workers and strive to accept the financial impact of the injury and the change in assigned roles and household tasks. However, in some families, there is bitter resentment and blame, regardless of the preventability of the injury.

The change of roles is unpalatable to some families. The husband does not want to take on the roles of children and household in the wake of his wife’s injury. The nonworking wife resents having to seek employment and be sole support of the family after her husband’s injury.

In both cases, the children and extended family may resent the lack of funding for everything from household needs to luxuries and vacations. In these families, the resentment associated with dealing with less income boils over into increased irritability, bitterness and blame. The family sees the injured worker sleeping away the day, watching television, taking mood dysregulating narcotics and offering no promise of a return to what they consider normalcy.

While it would be assumed that this lack of family support could serve as a motivator to increase the mobilization of the injured worker, this is often not the case. These negative emotional factors combine and adversely impact the patient’s motivation to participate in his own rehabilitation.

Since the patient will not automatically disclose this to the case manager or authorized treating physician, these issues become background noise eroding the patient’s compliance with prescribed care. The patient is often held solely responsible for the unwillingness to struggle against the injury without fully understanding the obstacles that exist in his household.

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