A psychological disorder by definition exists when there is an impairment in social and occupational functioning. The individual cannot perform work duties and meeting family responsibilities. To believe that a person has no pre-existing, concurrent or resultant family problems after injury, is akin to believing that diabetes has no impact upon wound healing. All are interwoven.
We simply have to accept and acknowledge that in many cases an injury is a further complication in a life which the patient was already unable to manage.
Neighbors, problems with children, financial strain, marital conflict and problems with in-laws and friends do not improve due to an injury.
(In the rare cases in which an injury appears to solve such problems, it is a matter of *primary gain*; those applying pressure to the patient have temporarily backed-off. In these cases, the patient must maintain the victim role to insure that the/she is not again confronted with the interpersonal problems.)
In the vast majority of cases, however, pre-existing financial and interpersonal problems will rapidly worsen following injury. A patient who may never considered seeking psychological care for these problems of living may readily see injury-related care as a means of seeking assistance with all of life’s problems.
What a patient needs to hear: “You have had many problems confronting you, some of which have existed for a long time. Our mission is to help you recover from your work-injury. Along the way, we may have to touch upon these longstanding problems. This is inevitable, but with the time allotted us, we shall not be able to resolve these problems; merely understand how they are making your recovery more difficult.
A competent initial psychological examination will reveal the totality of the patient’s problems, both recent and distant. A less competent report will suggest that all problems began on the day of injury.
The complexities of life can be altered by the occurrence of injury, but rarely is an injury the sole cause of the patient’s problems. Patients can be assisted in understanding this.
Past problems are a reality, but are not a threat to case management.