Worklessness and disability: Expansion of the biopsychosocial perspective

This paper summarizes a novel conceptualization of the biopsychosocial processes that may characterize the injured worker's reaction to separation from the workplace following injury/illness. The hypotheses are based upon clinical observation and may, in the future, be supported by controlled experimental research. Protracted worklessness is not equivalent to lost time. Worklessness is a dynamic process producing psychological, occupational, social and iatrogenic problems that accelerate the development of long term disability. The occupational physician (as well as those involved in occupational restoration and rehabilitation) is in a unique position to monitor, assess, and ultimately prevent disability. An appreciation of the dynamics of worklessness, one predicated on understanding and expanding the current biopsychosocial occupational model, will facilitate meaningful therapeutic recommendations for the injured worker. Worklessness is conceptualized as a dynamic process involving three fundamental changes: the development of anxiety separation from the workplace, the erosion of skills and loss of opportunity occasioned by absenteeism and the propensity toward the medicalization of disabilities.