When people first experience workplace problems of a psychological nature, they say something like:

“My boss is impossible, he never recognizes my efforts.”
or
“I can’t see how I’m ever going to finish everything my boss assigned.”

Whether the problem involves poor communication, lack of employee recognition or some perceived injustice, the issue is clear and specifically related to the context of work. However, if the problem is not resolved and things get worse—to the point where the employee considers going to the doctor to get a medical note for stress leave—then something strange happens. The initial crystal-clear issue that was the source of the problem fades into obscurity. When the medical note is written, the focus changes from an external problem to a personal issue in a now disabled employee.

Here’s a typical scenario.

As I said, the story always begins with some concrete work issue. However, if unaddressed, the worker’s distress increases. The distress can take many forms, but in my experience, worry and preoccupation are common signs. Unfortunately, both worry and preoccupation limit the amount of mental processing capacity for other activities. As a result, other work tasks become taxing, perhaps leading to performance decrements, and resulting in a loss of confidence.

The emotional distress can also provoke physical symptoms ranging from fatigue to heart palpitations. Often these physical symptoms become an additional source of stress, as the individual worries now about their physical and mental health.

Somewhere near this point, the individual likely contemplates making an appointment with a doctor to seek aid, and perhaps, a medical-granted leave from work. If you were to interview the employee at this stage, the specific work problem and the distress might be equally apparent.

However, once pronounced as “disabled,” the initial workplace issues fade into obscurity as the focus now is shifted to the “patient.” If the company or the disability insurance carrier questions the leave, the emphasis on the employee is even more intense as various professionals seek to determine whether the distress is valid or not.

It’s easy to see why this questioning occurs. Disability leaves for psychological reasons often draw battle lines. The employee’s doctor, observing only the distress and suffering, easily adopts the role of advocate arguing for a period of rest and recovery away from the workplace. The company, perhaps recognizing faults in the worker, or perhaps just in need of the employee’s services, is caught between the worker’s psychological welfare and the need to have a full staff complement. The disability insurance company, covering part, or all the employee’s salary, seeks a quick resolution to reduce salary-replacement costs.

The validity of the distress is debated by medical or psychological representatives of each stakeholder, often with the medical expert of the insurance company as the penultimate arbitrator before the issue winds up in court. However, in this quasi-legal process of examinations, medical experts and lengthy reports, there is a cost, not just economic.

The cost is often increased distress or anger on the part of the employee who is fully aware that the veracity of his or her distress is being questioned, exaggerated or even worse, feigned.

For many clients, it’s a no-win situation. They alternate between feeling angry for not being believed or hopeless that now, in addition, to a workplace issue they are also candidates for a psychiatric diagnosis. In my experience, the time and effort judging the legitimacy of the distress creates divisions among all the stakeholders, in addition to obscuring the triggering issues.

I think that things could be different.

Instead of a medical conceptualization, the major actors could develop a problem-solving approach. In this improved scenario, whether the client is really depressed or really anxious is secondary. What is important is the fact that the person is not at work because of a workplace problem. The central question becomes: how can we get the person successfully back to a satisfying work performance?


Of course, this problem-solving approach means that all the participants: the worker, the boss, the HR department, the doctor, and disability consultant from the insurance company, must work together. The methods used to aid the return-to-work should be creative, varied and aimed at all relevant stakeholders. For example, an intervention to augment the supervisory skills of a boss might be just as important in the process as teaching the employees about stress management skills. Removing the medical focus that herald bounds of patient confidentiality would allow for this joint collaborative approach. More generally, this de-medicalization philosophy would allow the workplace to move beyond a single-person focus to entertaining the possibility, that the problem can sometimes be organizational.