The Forensic Examiner Articles

Disability Without Disease and the Process of Disability

After spending many years treating injured autoworkers, Behan and Hirschfeld set forth their idea that injured employees can exhibit disability without disease or accident (1966). Borrowing on this concept, Weinstein delineated the process of disability in 1978.

Weinstein (1978) graphically portrayed the stages of the disability process. He reasoned that the troubled worker, when faced with negative feedback regarding his or her performance, would eventually reach a stage where tension build-up would become overwhelming and viewed as an unacceptable disability. Weinstein argued that an accident or illness, seen retrospectively as an explanatory event, would allow the unacceptable disability to become acceptable and stabilize with medical explanations, diagnostic studies, and eventually unnecessary interventions, such as surgery or chronic pain management involving crippling medications. Behan and Hirschfeld (1966, p. 659) concluded, “This remarkable capacity of disability to seize an accident as its apparent cause results in terrible chronicity.”
Learned Helplessness (and Laziness)

Walker (1992) offered the concept of learned helplessness as a useful framework in understanding how injured workers perceive loss of control in the workers’ compensation system—a system that simultaneously rewards and punishes injured workers. Learned helplessness is caused by repeated experiences of aversive, uncontrollable situations. The person caught in a learned-helplessness syndrome exhibits passive, resigned, and inflexible behavior associated with dysphoric feelings of depression. Walker described how the workers’ compensation system breeds conditions ripe for injured worker helplessness. However, he also pointed out that the very same system often financially rewards people non-contingently, thereby also inducing learned laziness by making a return to work financially impractical or disadvantageous for the workers’ compensation claimants. Walker argued that injured workers, trapped in the quagmire of workers’ compensation systems as they are designed (i.e., to make a person whole), generally manifest amotivational behaviors and surrender their will to work. After proposing learned helplessness as a model for depression and motivational disturbances, Seligman (1975) reformulated the learned helplessness model to include the concept of attributional style. That is, individuals with particular attributional styles are more susceptible to learning helplessness.

Co-Malingering

Lost time from work may be a function of either medical restrictions that are related to impairment as determined by physicians or dysfunction associated with behavior and social relationships that develop both before and after the accident/injury. At times, injured workers are accused of malingering, the falsification of symptoms to avoid responsibility, including work. Only 10% of compensable lost time is due solely to medically imposed restrictions (Mitchell & Leclaire, 1993). “All other reasons for lost time are due to employerand employee-controlled impediments for return-to-work, such as inflexible supervisory decisions, poor injury management practices, breakdowns in communications, and/or employer failures to make reasonable work accommodations.”

These employment situations may represent a form of co-malingering that Kenneth Mitchell, who coined the term, described as “the mutual actions of employers and employees that extend [the] disability duration and impede early return to productive employment” (Mitchell & Leclaire, 1993). Co-malingering is also sometimes referred to as negotiated disability. “Employees incur 100% of lost time; employers control 90% of it” (Mitchell & Leclaire). However, for many years now, we have recognized that other members of the lost-time community can also function in relation to the injured employee as co-malingerers, and those other parties include physicians, lawyers, and family members. Co-malingering appears to be much more common than malingering in lost-time cases.

To be continued.