Dr. David B. Adams – Psychological Blog

Psychology of Illness, Pain, Anxiety and Depression

The Vacation

Vacation Imposed by Injury

VacationVacation mindset:  The path toward establishing a new habit is to repeat a behavior regularly until that behavior becomes part of a routine. This is how people develop skills, and how they can break bad habits. Anything done often enough soon becomes routine even a vacation.

We have a longstanding concept that an individual arises early, fights traffic, toils long and hard and fights traffic to return home. This concept includes having days off (weekend) and specific holidays and vacations. Although this is not inviolable, it is very much a part of our culture and forms our perception of what we shall do when we finish school.

When an individual is injured at work, this pattern is disrupted. Initially the worker is pre-occupied with care and treatment for the injury and does not experience the estrangement from the working world. S/he accepts that initially a return to work is not possible but expects this to be temporary. What passes next is not predictable in the strictest sense.

Some injured workers are inordinately uncomfortable, despite their injury, with the concept of others working, and their staying at home. Others see this as a welcome relief from the stress of having lived a productive life. But as the injured worker heals, and it is determined that s/he can perform either full, alternate or modified duty, resistance arises: For some injured workers, in a depressed economy for example, there simply is no job to which to return. The position may have been filled, the employer may have rolled back the workforce or the employer may have closed the business entirely.

For a large number of injured workers, the tasks performed at the time of injury are the only skills that s/he has, and these specific skills may be the only means of generating what the worker feels is a reasonable income. Thus, it is common for the recovering worker to feel that `while I can perform some kind of work…that work will pay me no more…or even less than I am receiving in benefits.’

S/he has developed a new habit pattern: Rather than receive a paycheck twice a month, they are now receiving benefits once a week. Their daily activity, including the times when they arise and times for sleep have changed. Their activity level may be markedly different. They may be markedly de-conditioned. These now become the new habits and new daily expectancies. And these habits, like the ones that preceded, are now deeply entrenched including sleep hours, caloric intake and sedentary days.

In a complex and arguably distressing fashion, the injured worker’s new “career” becomes insuring that his/her benefits continue to be received. Recovery slows, new complaints arise, and attempts to mobilize the patient are suddenly obstructed by what we assume, often incorrectly, to be noncompliance.

This is the clinical reason behind returning an injured worker to some form of modified duty, where possible, and as soon as possible, before those new, counterproductive habits can become ingrained.

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