Dr. David B. Adams – Psychological Blog

Psychology of Illness, Pain, Anxiety and Depression


consequencesConsequences: Attempting to keep all as events separate and distinct, in a complex life, is sometimes arbitrary. Do you want a divorce because of abuse or infidelity or compulsive gambling or drug use or his refusal to work?  The answer can be “yes.”

I was asked recently if the patient were depressed or was it the “kind of depression one gets when injured?” What?  I believe that the question may have been something to the effect that all people become depressed when injured, and, therefore, this depression is normal and expected.  I am assuming that behind the question is whether or not all injured workers are depressed and how is his worse than what would be expected?  (Hint: sadness is not a disorder; depression is).

A patient had a significant knee injury when tripping in a warehouse carrying buckets of machine parts.  Each bucket weighed 30 lbs.  She stumbled and landed upon her right knee.   She was returned to light duty (light duty is defined as “regular duty in which you perform the exact same tasks but wince in pain thereby annoying supervisors and coworkers), one of the consequences of injury.

She found while she was still required to carry two buckets of machine parts, she was unable to do so with weight bearing on her right leg (knee).  She, therefore, complied with the work demand by carrying both buckets with one arm:  a bucket held by one hand and the other bucket looped through the same arm.  Thus, she was now carrying 60 lbs with one arm combined with one hand/wrist.

After four days of this light duty, she had severe elbow pain from an entrapped ulnar nerve.  Since this is not the knee injury, there was some balking as to whether and who would be authorized to seek care for this new complaint; additional consequences.

A similar event unfolds when a patient with a low back injury, becomes sedentary, obese, and then while attempting to descend a stairway at home while holding a railing, slips, falls and tears her rotator cuff.  That second injury did not occur at work although it turned out to be the more limiting injury with great consequences.

There was a patient who was working as a roofer. He was the father of five.  He fell 22 feet and sustained greater than a dozen serious fractures including facial, C-spine, L-spine, bi-lateral knee, wrist, shoulder and foot injuries. The surgery schedule was impressively oppressive. He was quite depressed about his pain, their financial plight, his capacity to be a husband and father.  His wife solved some of his concern by having an affair with his best friend of ~25 years.  The question became “yes, but was it these massive injuries or his wife’s infidelity” that resulted in the worsening of his depression over time.

Then, again, was the infidelity of the aforementioned wife in any way caused by the chronicity and limitations imposed by injuries.

There is an attempt to fractionate care and culpability after injury.  For how much is the employer responsible, how can we separate injury-independent variables from the tissue damage.

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