The Forensic Examiner Articles

Disability Proneness

Some employees have predispositions toward disabling diseases or illnesses. Disability proneness is a real and significant phenomenon antecedent to and at times a cause of many cases of chronic vocational disability. Individuals with particular work dysfunctions are more prone to occupational disability and claims of incapacity. It is believed by the authors that the workers’ compensation system in particular breeds the requisite conditions for learned helplessness and laziness, and that particular attributional styles make individuals more prone to developing chronic disability than others with different styles of causal attribution.

Illness Behavior

Illness behavior is frequently exhibited by individuals who are indeed sick. However, some individuals exhibit illness behavior that is abnormal or inappropriate to the situation. According to Pilowski (1978), abnormal or inappropriate illness behavior is “the persistence of an inappropriate or maladaptive mode of perceiving, evaluating, and acting in relation to one’s own state of health,” even though available evidence suggests that this illness behavior is unexpected or inappropriate. In other words, inappropriate illness behavior is thought to be exhibited if individuals are convinced that an organic disease is causing their pain or other symptoms but no evidence of organic disease exists or the illness behavior is inappropriate to the organic disease that does exist.

Illness behavior as a concept provides a framework for understanding the observed differences among pain patients. According to the Institute of Medicine (1987), “Illness behavior is a process that includes a perception of one’s own symptoms, and attribution of meaning to them (from something trivial to an ominous indicator of serious illness), and the way in which one seeks help in dealing with the symptoms. Such behavior is influenced by the person’s personality and coping style and by the surrounding culture and society. The fact that such factors can be strong influences on the pain or other symptoms that people experience does not, however, make pain any less real.”

The meanings a patient gives to an accident, sickness, personal suffering, or the relentless presence of pain affect subsequent illness behavior and help order experience in several ways. Patients form causal attributions to account for their perceived circumstances. Limitations imposed on a patient’s lifestyle by chronic pain may be significantly attenuated if the patient believes that he or she can control the pain or can, despite the pain, undertake activities without harm. In contrast, it has been observed that patients who believe they have little or no control over their health and well being (learned helplessness) endeavor less effectively to achieve rehabilitation (Pilowski, 1984). Finally, personal meaning of an illness or symptom may affect self-esteem either positively or negatively. Becoming an invalid, even briefly, can be a blow to a person’s selfesteem. Similarly, being unemployed or forced to accept employment at a lower wage or job status because of pain can be demeaning. However, for some patients embracing the sick role is seen as an elevation in status (i.e., honorably disabled).

These people value the nurturance and special consideration of friends, family, and neighbors that follow injury and the development of chronic pain. Personal meanings are likely to be influenced by the shared meanings of the group to which the individual belongs (Institute of Medicine, 1987).

At the same time, the meaning of work held by the individual and/or the group to which this individual belongs can be a powerful influence on the individual’s capacity or willingness to overcome illness behavior. When work is a central theme in the injured person’s life, chances are illness behavior and associated dysfunction will not lead to total vocational disability.

To be continued.