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There is a documented link between being out of work and poor mental health.

Modern medicine routinely fails to consider social factors when treating patients.

Taking someone off work has considerable mental health and physical consequences.

Individually and collectively addressing social factors must become a high priority—soon!

There is a documented link between being out of work and poor mental health. Joblessness can create severe psychological distress (and vice versa).

Modern medicine routinely fails to consider social factors when treating patients.

Taking someone off work has considerable consequences.

Addressing social factors must become a high medical priority–soon!

In 2012, NBC News reported a haunting wave of suicides among Italian workers devastated by the economic downturn.1 The notes they left behind were not complex. "I can't live without work." "I am a failure." "My business is like my family—if it fails, I fail with it."

These are not the words of people who simply lost a paycheck. They are the words of people who lost themselves.

As a spine surgeon for 33 years, I often removed myself from conversations about mental health. At that time, I had no idea that chronic mental pain and physical pain are the same entity arising from dysfunction at the cellular level. I felt that all pain was structural, and if I could not identify an anatomical source, there was nothing I could do.

Work was either possible or it wasn't. When it wasn't, I took patients off the job, and I felt I was helping them. It was also easier than navigating the details of light duty, modified hours, or the messy intersection of a person's life and their diagnosis. What I failed to understand for far too long is that removing someone from work is never a neutral act. It can be—and often is—its own form of harm.

What is ironic and now disturbing to me is that people with any type of disability are often labeled as "difficult", “less than,” and not wanting to return to work. They may be quickly dismissed from care and often don’t feel heard. I was taught that the way to solve the disability crisis was to be tougher and push people back to work. And I did.

It hit me hard about seven years into my practice that a major reason patients on disability were often difficult was that they were so angry from being trapped by pain and the system. As their hopes were repeatedly dashed by yet another medical visit, despair would set in. It is the reason that I call this scenario “The Abyss.” It is a very dark hole without an apparent way........

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