There is no doubt that many injured workers are mistreated. They do not receive approval for diagnostic tests (i.e.MRI, CT etc.), treatment is intentionally delayed by the workcover insurance company, procedures are denied or cancelled, prescriptions are rebutted and financial compensation (i.e. weekly payments, reimbursements etc.) is not sent.
The injured worker, in a dependent position, grows resentful and also feels powerless…
When injury is used as vengeance
After months of enduring these frustrations, the injured worker (most often male) feels that the only alternative is “to get them like they have been getting me.” That is, they simply refuse to recover, refuse to consistently comply with prescribed or suggested treatment modalities, refuse to settle and refuse to “move on” and “let go”.
The injured worker -wrongly- feels that this passive-aggression (at times active-aggression!) will balance the scales and make others suffer as he feels he has.
This type of injured worker often sees the “system” simply as his workcover insurer, his employer, his case manager and his treating doctor(s). What’s more, after a while, the “system” will include friends, family members and even websites and blogs! The injured worker can only appreciate his own plight and does not see (nor particularly care) about administrative, clerical or “opinion”-related “problems”.
Often, however, there is an acceptance that passive-aggression has become the injured worker’s sole recourse…and many people close to such an injured worker will just “put up” with the constant aggression, until it becomes unbearable! The passive aggression escalates, the injured worker is so resentful and vengeful that he (she) starts taking it out on friends and family, who in his (her) opinion are somehow “pro-workcover” because they don’t always agree 200% with his/her extreme opinions, and whilst they’re only trying to help the injured person in their recovery.
Often the most important questions or findings is “what are the injured worker’s grievances that occurred after injury” rather than the seeking of obscure reasons for continued (often excessive) complaints.
Educating the injured worker as to why delays occur is usually in-effective. Equally ineffective is trying to rationalise your opinion an actions as it will further instigate and antagonise him/her.
All that can be done , or is left, is base administrative decisions, judgements, opinions and even clinical decisions solely on objective findings.
Underlying personality disorder and pain
While pain and depression are common and expected among injured workers and can be managed with appropriate pain clinic and pain specialist consultation, there are some injured workers who suffer from an underlying, severe character pathology (aka. personality disorders). Those represent an extreme challenge.
A study (Burton et al., 1997), found that up to 25% of the patients in a traditional multidisciplinary pain clinical have symptoms of borderline personality disorder (26% histrionic personality disorder and 22% of narcissistic personality disorder)
Another study (Polatin et al, 1993) reports that up to 5% of the injured workers in these settings are antisocial, having a pervasive pattern of disregard for, and violation of, the rights of others. Deceit, violence and a pattern of job, marital and legal problems are also often typical of this group. These are referred to as “Cluster B” or “dramatic” personality disorders.
Most of us dread interaction with borderline injured workers who tend to be impulsive, have unregulated emotions, and are unstable in their relationships with family, friends, lawyers, and even their medical practitioners. Histrionic people are attention seeking, markedly overly emotional and melodramatic. Narcissistic people lack empathy for those around them, have endless need for attention and admiration and see themselves as special with a strong sense of entitlement.
Psychological methods of coping – which were barely adequate prior to injury- now become grossly maladaptive in the presence of pain and the attention provided by others, including friend, family and support “blogs” / “websites”.
Compliance is spotty at best. Equally as problematic is that dramatic personality disorders are disruptive and damaging to therapeutic settings. The antisocial has a continuous potential for violence, and the histrionic’s aggressive demand for attention can never be adequately met. The narcissist needs to remain disabled to generate attention and will fly into a rage when they are forced to comply with rules (that they insist do not apply to them). The bordeline’s create an atmosphere of chaotic moods and demand the “impossible” to attempt to achieve emotional stability.
These type personalities will not only disrupt other injured people , but they will also fatigue and deplete professional and support staff, friends, family and support groups.
The key will always be to recognise these personality disturbances as having existed for almost all of the patient’s life and not mislabel them as the result of pain itself.
Why are we writing this?
Being heavily involved with injured workers, incl. support “group”, blog, forum etc., we have come across a (very) few injured workers who have turned their anger, rage, frustration and ‘vengeance’ against us! Initially we could not understand why any injured worker would “take it out” on us, on a blog, support group and/or the blog administrators; especially not after having gone to great lengths to try and help the injured person.
It is only later, through discussions with our own psychologists and psychiatrists, that the above picture emerged. Meaning that there are injured people with underlying personality disorder.
We believe that there are some carers, friends, spouses, partners, relatives, moms, dads, GPs and even other injured workers out there that relentlessly “cop it” from such unhappy injured workers, no matter what they do or say. This can cause feelings of hurt, defeat, abuse, depression, guilt, inadequacy in those who try so hard to offer support. We therefore believe it is important to be aware that some injured workers do, with no fault of theirs, suffer from underlying problems, including personality disorders and that those ought to be identified and treated.
One such person emailed us the following (excerpts)
An injured worker posted what we believed was inappropriate “advice” and we said so; in response we received:
“By [our blog] providing false hope, chin up, keep going, advice, it just digs them further in the hole that is inescapable”
Following our decision to hide some forum posts from the preying eyes of workcover et.al (posts only viewable by those who register, registration is instant and free).
“… regardless of how much you enable people to feel better through having a support group, the end result will not be people getting fairer outcomes, rather, the game will evolve to take advantage of the fact you’re organising to play their stupid administrative games, and the people who now don’t join in the support group get even further hung out to dry… ”
Is that how the forums are gonna run, anyone who doesn’t say what you want them to say, just boot them off? I thought it was workcover who acted like that….”
“You’ve got a nice little support group going, and they’re busy attacking me for having a problem with politics, and voicing that opinion. Meanwhile I get stuck with no support from anyone. Toughen up, get back to work ya lazy prick….”
Following numerous comments from injured workers that this person’s advice was inappropriate:
” I’m talking politics, and people are misinterpreting my words as personal attacks or someshit. The socially-correct thing for me to do is dilute what I say down so I don’t say anything, but fuck that shit…”
“No need for a lynchmob, or threats of censorship”
Personality Disorders explained
Personality is merely a term used to describe the sum total of characteristics that make us each unique. We each have a personality which is our style of interacting with our world.
There are, however, “personality disorders” in which the individual has developed a pattern of maladaptive ways of interacting that results in some degree of occupational and social impairment.
People with a personality disorder do not feel that they necessarily have a problem. They do feel that there is something wrong with everyone else.
The individual may, for example, have a paranoid personality disorder. Such individuals, when injured, expect the worst and look for it continually. They hire a lawyer to protect themselves and end up not trusting the lawyer. They anticipate betrayal from family, friends and doctors.
They live in a world where they are defending themselves against others whom they perceive undermines their authority. They attribute to others the very characteristics that actually may define themselves. They believe that others are scheming against them. They feel that they will have to defend themselves, and they cannot readily relinquish control to others.
Communicating with those type of personalities can be very difficult; most say to peep conversations brief and always directed toward the point/topic. Do not respond to accusations because defending yourself will have no positive impact. Anticipate that you will not be trusted no matter what you do (and be prepared to document all of your actions).
Be certain that others are aware of this pattern of behaviour so that he/she can assure that s/he does not fall prey to the same chaotic interactions.
Be aware that you will not be successful in changing a personality disorder, but you can learn to anticipate how someone with, for example, a paranoid personality disorder does respond.
And, by the way, a personality disorder cannot be caused by injury.
Personality disorders are interesting, but since they cannot arise from injury, why would we care if an injured worker has one?
The interest is in attempting to return a patient to baseline functioning…how they were before they were injured, says the psychiatrist.
If they have a personality disorder of which you are unaware, your efforts to return them to what you consider to be “normal” will ultimately fail.
Thus, if they are pathologically dependent or pathologically avoidant by virtue of a developmental personality disorder, and you are unaware of this, you can exhaust yourself in an attempt to restore them to a level of functioning which they have never had.
Additionally, if they have even more dysfunctional personality disorders such as paranoid, or borderline, much of what you believe is arising from injury is actually the way they have (poorly) functioned for much, if not all, of their adult lives.
Think of personality as a foundation upon which our lives are built. A personality disorder can then be considered a weak foundation for the development of adequate social and occupational functioning.
An injured worker is verbally abusive and physically threatening to several people. He appears to have no boundaries. It is highly probable is that he suffers from longstanding Intermittent “Explosive Disorder”. This could be determined by determining if he has had recurrent physical confrontations and destruction of property when provoked. Such individuals often have a history of domestic violence recurrently in their lives.
While depressed people can be irritable and overly responsive, and they may even launch into brief verbal tirades for which they feel guilt and remorse, those with intermittent explosive disorder,for example, simply do not tolerate disappointment or frustration.
“I have seen this occur when a patient is offered a settlement amount that was not what he expected” says the psychiatrist we interviewed.
Some injured people will attempt to cover their explosiveness and assaultive behaviors by stating “I was depressed” to avoid responsibility. Also, they may quickly learn that to try to claim it as due from injury may increase the perceived financial value of their claim.
Conclusion: sometimes, no matter what you try and do to help your injured friend, spouse, family member, colleague etc, nothing will work. Sometimes you may find that YOU are the one being abused, attacked and ‘mentally assaulted” for trying to help. It is NOT your fault. Don’t blame yourself, don’t feel guilty. Chances are that your injured friend suffers from a personality disorder- aggravated by his/her injury.
[Post entered by w/C Victim3 on behalf of W/C Victim]