Dr. David B. Adams – Psychological Blog

Psychology of Illness, Pain, Anxiety and Depression


separation“Separation of Powers” She has been released by you, but she has not been released by her surgeon.”

“A patient is referred to me because there are emotional and behavior concerns or complications to a physical injury. The patient is referred because it is believed that psychological factors will impede physical recovery.

While the psychological and physical injuries may have the same etiology (the injury itself), there may be separation and they may progress or resolve at different rates. Long after the emotional and behavioral aspects are resolved, the orthopedic complaints may well continue. Similarly, wounds may heal, but emotional suffering may continue.

A complicating factor is that those treating the physical and those treating the psychological may not communicate, coordinate or participate in each other’s care.

A common inquiry posed to me is “the orthopedist has released the patient, and we were wondering (actually meaning that they are concerned, appalled, annoyed and questioning) and you have not.”

We would prefer to assume that all involved in assisting this patient are equally invested in recovery and, ideally, a return to productivity. I shall address next time why that assumption can be faulty.

There is an additional complication: There is a high probability that the patient was suffering from a range of emotional, addictive and behavioral problems prior to, and at the time of, the injury. The injury may bring those problems to the forefront, and the problems will, in turn, complicate the course of the response to injury including such issues as compliance with care.

The take away is four part:

a. Accept that there may be a time disparity between physical and psychological recovery
b. Realize that there may or may not be a co-existing permanent and partial disability
c. It is reasonable to expect that all involved in the care of the patient should be solely motivated by seeing recovery as the goal
d. Know that a return to productivity is considered a feature of mental health and, where possible, the patient must be assisted in pursuing that goal.



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