The Great Aggravator

In general, humiliation constitutes a preemptory dismissal of an individual’s voice, claims and entitlement to ordinary respect. In the context of workplace injuries, humiliations tend to take particular forms. Coworkers or a spouse may deride and publically ridicule the individual’s claim of pain and impairment. An employer may dishonestly disavow the injury or terminate the employee under a pretext. A physician may treat the patient in a dismissive manner or evade, minimize or peremptorily invalidate the individuals’ claim of injury, pain, distress or impairment.

Of course, once humiliation has taken place, the relationship between the injured worker and the humiliator becomes noxious and toxic. Thus, if the treating provider has been the humiliator, the doctor-patient relationship can become an especially toxic influence on recovery. Because humiliated individuals typically experience the sense that they have been unjustly degraded and that their voice has been overridden and shut down, they can harbor silent rage. In certain circumstances, severely humiliated individuals can become dangerous, to themselves and/or to others.

The adverse effect of such humiliations on medical outcomes is often overwhelming and nothing short of pernicious.

As the individuals with the highest authority in the determination of an individual’s medical status, medical providers are in a unique position to prevent and alleviate humiliations.³ Of course, treating the patient and the patient’s claims with respect is the core way to prevent humiliation. Other recommendations to prevent or alleviate humiliation include:

• If you assess the patient’s problem differently than how the patient sees it, recognize openly the difference (i.e., recognize the patient’s perspective) and explain the rationale behind your opinion.
• Recognize openly that which constituted a humiliation of the patient (e.g., derision from coworkers) and convey your opinion that it was wrong and uncalled for.
• Refer the patient for psychological assistance if he/she shows signs of depression, anxiety or unabating anger.

1 Kendler, Kenneth S.; Hettema, John M.; Butera, Frank; Gardner, Charles 0.; and Prescott, Carol A. (2003). Life Event Dimensions of Loss, Humiliation, Entrapment, and Danger in the Prediction of Onsets of Major Depression and Generalized Anxiety. In Archives of General Psychiatry, 60. pp. 789-796.
2 Torres, Walter J. and Bergner, Raymond M. (2010). Humiliation: Its nature and consequences. Journal of American Academy of Psychiatry and the Law, 38 (2). pp. 195,204
3 Lazare A.(1987). Shame and humiliation in the medical encounter. Arch Intern Med. 1987 Sep;147(9):1653-8.