Dr. David B. Adams – Psychological Blog

Psychology of Injury, Pain, Anxiety and Depression


resentmentResentment:  The vast majority of patients that are referred to me “in pain and depressed” have notable anger. Frequently, anger is the driving force behind the depression since the patient feels unable to express the emotion, has become bitter and displaces this upon primary provider, staff and insurer.

Adjustors and nurse case managers will sometimes express relief that this patient hire, an attorney who now must deal with this anger.

In either case, male patients are much more willing to express anger and resentment than they are to express fear, yet symptoms can be quite alarming; pain inescapable and the source not property explained to the patient…or not completely understood by the authorized treating physician.

I have noted before that if a provider has never had serious pain, lingering pain, and/or pain of unknown origin, this is readily clear to the patient, who begins to see pain as almost a spiritual belief; something only they and very few others can comprehend. The patient sees those assigned to treating and compensating them as more concerned with their medications and their capacity for alternate duty work. The patient may be seen as a productivity drain to their employer, burden to their provider, and emotional drain upon their family.

So, the case manager is tasked with placing the injured worker into a role that the patient believes is an irritant and likely a path toward job loss.

Resentment provoking situations:

  1. Employer discouraged the injury being reported and insisted that the patient continue to work
  2. Injured worker believes that s/he is being treated via an inaccurate diagnosis or under-diagnosis
  3. Occupational medicine does not permit establishing a primary relationship
  4. Nurse case manager and adjustor do not reply immediately to all telephone calls
  5. No one has the limitations of the patient, the delays, and the financial burden
  6. Role in social group and family has been severely compromised
  7. Belief that no one can explain the patient’s degree of discomfort nor when/if this will ever resolve

When the patient is unable to express this desperation and frustration, it presents as resentment and becomes diffusely expressed towards many people.

When the patient feels that all of this is futile, withdrawal occurs, and “depression” is suspected to be the root cause rather than the result. This is one reason why medication alone fails to reverse depressive complaints. Patients need to voice their concerns; those that can be managed, those that are unreasonable, and those that are impeding recovery.

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