A psychiatrist's reflections on the workers' compensation system

In the ‘looking‐glass land’ of workers' compensation psychiatry, symptoms are not always what they seem, treatments may have little or no positive effect, and workers' claims of continued disability may puzzle and perplex. Disability is in part a social role, and a simple medical model cannot explain the complex interactions of sociology, psychology, anthropology, medicine, economics, and law characteristic of the workers' compensation system. Psychiatrists functioning within and reciprocally shaped by this semi‐adversarial system will rarely encounter an ‘ideal’ patient. Factors in all areas of workers' lives, including those integral to the workers' compensation system, influence their movement along a health‐illness, ableddisabled axis. This paper identifies a number of interacting factors that may prolong, or even subvert, the recovery process following a work‐incurred injury or illness.