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Defense mechanisms are (largely) unconscious ways we use to defend ourselves against anxiety. Simply “not thinking” (repression) about our bad marriage or failing to accept we drink too much (denial) keeps us from becoming upset.
Somatization, the act of focusing upon bodily complaints rather than dealing with real life issues, is common among injured workers. They become angry at doctors and employers/insurers rather than themselves.
Their bodily complaints are either unfounded or grossly exaggerated.
Their unconscious goal is to keep themselves from realizing and dealing with what they may have done to their own lives: They never achieved enough education or pursued a career path that would support them in event of lost time from work or job change. They (somatize) focus upon their injury as a way of repressing the fact that they are ultimately responsible for their own lives and their own future.
Friday, June 19. 2009
Alexithymia (ah-lex-eh-thy-mee-uh)
Many individuals (males more than females) cannot express their feelings verbally. They either act them out (destructively) or hold them in (intrapunitive and equally destructive).
These people are referred to as “alexithymic.” They are more prone to somatoform (excess focus upon bodily) complaints. They are also more prone to psychosomatic (physical destruction arising from psychological) disorders.
It is possible to psychologically examine these patients and determine that they have a pervasive pattern of inability to healthily express emotions.
Family members will often refer to the patient having this problem. For many of these patients, their bodily focus will decrease when they have the opportunity (with assistance) to discover what they truly feel and how to appropriately deal with these feelings.
These people are referred to as “alexithymic.” They are more prone to somatoform (excess focus upon bodily) complaints. They are also more prone to psychosomatic (physical destruction arising from psychological) disorders.
It is possible to psychologically examine these patients and determine that they have a pervasive pattern of inability to healthily express emotions.
Family members will often refer to the patient having this problem. For many of these patients, their bodily focus will decrease when they have the opportunity (with assistance) to discover what they truly feel and how to appropriately deal with these feelings.
Thursday, June 18. 2009
Impotent Rage
For many males working in blue collar, labor-intensive positions, their power, strength, stamina and (often) tenuous financial position is the only evidence of their masculine identity.
They are angered that this has been “taken away” by their injury. They are angry with their doctors, angry with their nurse case manager, angry with their adjustor…angry with their family. Often, the anger is due to their belief that they are now seen as less masculine, as weak, as dependent, and they feel their masculinity has been impugned.
They are, in fact, now quite dependent upon others, and this often enrages them. But they can do little with their rage since to express the anger would threaten their needs being met.
So they sit on the anger and are often misidentified as being depressed because the symptoms (irritability, sleeplessness, overeating, etc) are similar.
If the underlying problem were impotent rage, treating it as though it were depression would not be effective.
They are angered that this has been “taken away” by their injury. They are angry with their doctors, angry with their nurse case manager, angry with their adjustor…angry with their family. Often, the anger is due to their belief that they are now seen as less masculine, as weak, as dependent, and they feel their masculinity has been impugned.
They are, in fact, now quite dependent upon others, and this often enrages them. But they can do little with their rage since to express the anger would threaten their needs being met.
So they sit on the anger and are often misidentified as being depressed because the symptoms (irritability, sleeplessness, overeating, etc) are similar.
If the underlying problem were impotent rage, treating it as though it were depression would not be effective.
Saturday, June 13. 2009
Disabling Conditions
The Diagnostic & Statistics Manual of Mental Disorders lists the known psychological disorders and the symptoms that are necessary for that diagnosis to apply.
In the introduction of that manual, it clearly states: “…mental disorders may not be wholly relevant to legal judgments…individual responsibility, disability determination and competency.”
The most potentially disabling disorders such as schizophrenia and other psychotic disorders are highly improbable to arise as a result of industrial injury. But there are individuals with these disorders, and ongoing appropriate treatment, who are able to function in jobs albeit sometimes in sheltered environments.
Adjustment Disorders, anxiety disorders, mood disorders and addictive disorders are the most common consequence of injury. BUT the mere diagnosis of a disorder does not mean that the individual cannot, should not, and/or would not benefit from working. Indeed, often return to work is the most therapeutic offering we can make to the patient.
In the introduction of that manual, it clearly states: “…mental disorders may not be wholly relevant to legal judgments…individual responsibility, disability determination and competency.”
The most potentially disabling disorders such as schizophrenia and other psychotic disorders are highly improbable to arise as a result of industrial injury. But there are individuals with these disorders, and ongoing appropriate treatment, who are able to function in jobs albeit sometimes in sheltered environments.
Adjustment Disorders, anxiety disorders, mood disorders and addictive disorders are the most common consequence of injury. BUT the mere diagnosis of a disorder does not mean that the individual cannot, should not, and/or would not benefit from working. Indeed, often return to work is the most therapeutic offering we can make to the patient.
Tuesday, June 9. 2009
The Purpose of Work
If work is solely for money, then money can replace work. However, when an individual is out of work, his/her role in the family and society changes.
Not aggressively returning a patient to productivity is arguably the greatest disservice we can do to them. Most of us spend the first 2+ decades learning how to work, the next 4+ decades performing that work, and the final stage of life determining our own sense of accomplishment for having done the work.
Work is not simply productivity for the sake of society. Work is also where the individual learns social skills, emotional interaction, economic planning, cooperation in task completion, a sense of purpose and a meaning to his/her existence.
I do not see us as arbitrarily attempting to return patients to work because it is our job to do so. I see it as universally true of humans that work creates a mission to life. For some, it is simply the creation of income so that the individual and family can survive.
For many, however, the entirety of life, from choosing a career path to determining when/if retirement occurs, is based upon the concept of work. Work adds meaning and identity to life.
How often do we ask “now, what is it that you do?” Or even more often, “oh, so you are a dentist…an architect…a plumber…” We define people by the tasks they complete. And we define ourselves in the same terms.
If the patient’s mission in life is to be the work he/she performed, then our mission in life is to insure that their mission is complete.
Not aggressively returning a patient to productivity is arguably the greatest disservice we can do to them. Most of us spend the first 2+ decades learning how to work, the next 4+ decades performing that work, and the final stage of life determining our own sense of accomplishment for having done the work.
Work is not simply productivity for the sake of society. Work is also where the individual learns social skills, emotional interaction, economic planning, cooperation in task completion, a sense of purpose and a meaning to his/her existence.
I do not see us as arbitrarily attempting to return patients to work because it is our job to do so. I see it as universally true of humans that work creates a mission to life. For some, it is simply the creation of income so that the individual and family can survive.
For many, however, the entirety of life, from choosing a career path to determining when/if retirement occurs, is based upon the concept of work. Work adds meaning and identity to life.
How often do we ask “now, what is it that you do?” Or even more often, “oh, so you are a dentist…an architect…a plumber…” We define people by the tasks they complete. And we define ourselves in the same terms.
If the patient’s mission in life is to be the work he/she performed, then our mission in life is to insure that their mission is complete.
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