Dr. David B. Adams – Psychological Blog

Psychology of Illness, Pain, Anxiety and Depression

Fitness for Duty


A diagnosis of a mood, anxiety, addictive and other mental disorder is not a statement of disability. The diagnosis is a statement of the need for treatment. Without question, many anxious, depressed and addicted individuals do continue to work.

You can, however, create a disability by rewarding a disorder.

Regardless of the nature of the disorder: psychological, neurological or orthopedic, the patient’s self-perception of disability may be reinforced by being rewarded for symptoms. This includes financial remuneration.

This is why the same injury at work vs. at home may result in quite different patient presentations and quite different lost time.

Reward any behavior, and you are more likely to see it continue or even amplify.

Examine the environment in which the injury occurred (work vs. non-work). Also, consider this disorder or condition fits in the context of this particular patient’s life.

Some feel that they must remain productive in the workforce. It is central to their self-image. They will reject being designated as “disabled.”

There are others who feel that they have struggled too hard and too long in life and deserve a break. They will seek out a disability determination.

When asked if they will return to work, the first group will say “Of course…I must…it is what I do…too many people are counting on me…”

The latter group will say “Well, I would like to…I wish I could…but can’t see how…not certain what I’ll do…”

Concurrent issues to examine:
Is the depression the result of the injury or a recurrent disorder with which the patient has suffered?
Is the depression the result of having to return to the job itself, a job that has become increasingly negative?
Is the depression the result of events which followed injury including the course of care itself?

These are the questions to be answered, and the issues that must be managed, for the depressed patient to return to work.

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