Choice Theory (42 page)

This incident, and the thousands like it that occur day after day all over the world, is typical of a boss-managed workplace. No one had ever sat down with that man and explained to him
what his job was and worked with him supportively to help him understand it and do it better. By the time I talked with him, that kind of an intervention might have been too late. He would take any intervention as criticism and might do less than the little he was doing. Because of the pleasant way this man dealt with his inadequacy, I think he was not being too severely boss managed—managed by neglect may be the more accurate description—and his manager might be quite open to making this change. Still for lead management to work its way into a workplace will require a lot of effort. Putting a whole new psychology and the skill to use it into place is a big step. But if that step was taken, the hotel would make a lot more money than it is making now.

Although most of the tangible workplace problems could be substantially reduced by a change to lead management, the problem of how to deal with pain, weakness, or the more obvious psychological complaints that accompany or follow an injury on the job is more complicated. The better the relationship the workers have with their managers, the less these complaints will surface or persist, but good relationships will not prevent all injuries. When an injury occurs, there is always the problem of how to tell if the complaint is actually part of the physical injury or is the worker’s way of restraining the anger at being injured. Or the way the worker is asking for more help or more compensation than he or she is being offered. Or if the worker is using the complaint to avoid having to go back to a job he or she hated and/or feared.

The present way to deal with these complaints is adversarial. The insurance company tries to settle the complaint with no further treatment or to fight it if it is seen as excessive. The worker tries to get better treatment or more compensation for his or her injury. I spent nine years early in my career treating these situations, and I can say that the adversarial way they were and are still handled does not serve the injured worker very well. The
worker’s physicians, lawyers, and psychiatrists do battle with the insurance company’s equivalents. In my experience, the worker’s interests are often subordinated to those of his defenders and their opponents.

While I worked for insurance companies, I kept the workers’ interests in mind. I told the companies it would cost them less if they would allow me to work honestly with the injured workers, arrive at some conclusion about the cases, and then back me up. Some did, and I was able to do a lot with those workers using reality therapy and trying to persuade each one to look beyond immediate compensation to what was best for him or her in the long run. But whether or not the insurance company agreed, I was always honest and I was still able to help many of them.

One man who had injured his back on the job had been hospitalized for a while but still suffered pain and was not able to return to work as a laborer. He didn’t have much education and had a hard time grasping what was going on. He was especially confused by the adversarial system he was immersed in. I was called in by the insurance company to try to get him to go back to work. But I was also allowed to work with him to think about settling, although I never negotiated an actual settlement.

I first saw him during one of his many hospitalizations. I worked with him for about six weeks, talking to him once a week. He was about forty-five years old, divorced, and living alone. He had worked as a laborer for a construction company and had injured his back picking up some heavy concrete forms. He had not worked since the injury a year before and was struggling to live on his temporary compensation. This was his fifth or sixth hospitalization. There was not enough X-ray or physical evidence to consider back surgery.

“John, I’m Dr. Glasser. I’m the psychiatrist here, and your insurance company asked me to see you. I’d like to hear your story.”

I made no effort to hide the fact that I worked for the insurance company, but I also did not ask him how he felt. He did not seem to be in any acute pain. He was able to walk into my office
from his room in the hospital, and I did not want to suggest, by asking that common question, that I expected him to tell me how much it was hurting. I also told him I wanted to hear his story. In most of the cases I dealt with, the lawyers sent these people to physicians who tended immediately to focus on the pain and, by this focus, emphasize the patient’s inability to work. I was going to be different. He said, “You’re another psychiatrist. Why do you have to see me? I hurt my back, I’m not crazy.”

“I see people who have been injured and are also very unhappy. Pain is usually a part of that unhappiness. But I want to hear the whole story. I want to know what you think about all that’s happened, not just where it hurts. And I want to hear what you want. It can’t hurt you to tell me.”

“Are you trying to take away my money?”

“That’s not up to me. I’m trying to find out if I can help you. If you tell me your story, maybe I can.”

He was reassured by my telling him I could not take away his money. He was also reassured by the fact that I wanted to listen to his whole story. In the area of workers’ injuries, for workers of his educational level, my offer was unusual, and I was sure that he wanted to tell it to somebody. His story was simple. He had bent over to pick up the concrete form and as he started to lift it, he heard a “snap” and the pain started. That was the last day he worked. That story, including the “snap,” was the typical story of a man living alone who had only a few friends to have a beer or two with. He had no money, a minimal apartment, an old car, and no family. He had not liked his job that much but he did miss going to work.

“If your back didn’t hurt, would you like to go back to work?”

“Not on that job. It was too hard. I’m getting too old to do that kind of work.”

“OK, not on that job. What kind of job would you like?”

“I can’t work; it’s my back, it hurts too much.”

“I’m not talking about what you can’t do. I’m talking about what you’d like to do. Do you ever want to work again?”

“Of course I want to work. I grew up on a farm; I’ve been
working since I was a kid. I wasn’t good in school but I always did a good job where I worked.”

“I can see that. You look like a working man.”

That was the truth. He just told me that he had always worked and that he’d done a good job. Most of the laborers who were injured told me a similar story. This persistent back pain puzzled him, but there was still a picture of him working in his quality world. I then went through his positive past with him and asked him to tell me when he had worked hard and felt good about himself and was convinced he had done a lot of good work. I thought that there might be someone on this job whom he had not gotten along with and that this relationship might have something to do with his injury. It was a common element in these cases.

“I am a working man, that’s it. I’m going nuts sitting around. My lawyer says I should be real careful, to get a lot of rest. That’s all Iget is rest.”

“On this last job, the one where you got hurt, tell me about the guy you worked for. What kind of a guy was he?”

“He was OK. He didn’t talk to me much. There was always work, and I did it. Sometimes I needed some help; some of those forms were real heavy. When I asked for help, he said, I’ll see, but nothing ever happened. The funny thing is that the day I got hurt I wasn’t lifting that much; it just went
snap.
”

Another common story. Lonely, not much help from the boss—just a pair of hands doing a hard, lonely job. That snap is something that back-injured people talk a lot about. I heard about many
snaps
when I dealt with them. It seems to be more a sign of psychological than physical involvement.

“Anyone else get hurt on that job?”

“Yeah, a few weeks before I got hurt, a guy fell when some scaffolding collapsed. Not far but he got hurt. He hasn’t been back. Kind of like me; I haven’t been back either.”

All the pieces are in place. Lonely, no help, no interest from the boss, a guy got hurt. He knew about injuries and compensation, not much, but it could all add up. He’s probably not too hurt to do some kind of work, but since he doesn’t think he’ll find anything,
he needs the injury; it’s all that allows him to keep the picture of himself as a man who has worked and still wants to work in his quality world. And he’s also tired of doing hard, lonely work. Unless he can see himself doing something else, this will be his last job. I won’t talk about this laboring job anymore. There’s nothing there for him. There may be nothing anywhere for him.

Staying in the hospital was costing five hundred dollars a day. There was no reason for him to stay longer except to talk to me, so I agreed to see him as an outpatient. He could drive in, and I arranged for the insurance company to give him twenty-five dollars to drive himself in and back. He could use the little money he would have left over. Each week he talked a little more about what he would like to do and less about his back pain. He liked seeing me, but he couldn’t see me too much longer. I couldn’t help him as long as his case was pending. It was costing money that might be better used in the settlement, but insurance companies do not look at it this way. I also got the feeling that he was ready to make some kind of a settlement, but the case had to go to a hearing and one was scheduled. We had a good relationship, and he was happy I was going to testify at the hearing. I told him that I was going to recommend that he was able to do some kind of light work but I didn’t know what. I asked him if that was OK.

He said, “It’s OK. You do what you have to do.”

“The other doctor is going to say that you can’t work. He may be right. None of us knows. You know we don’t know. If you could be helped by any one of us, we wouldn’t be talking.”

There was no anger in the man. He was totally confused and tired of the whole thing. I believed that what I did was good for him, but I thought that if he could get out from under the whole thing, he’d be better off, both psychologically and physically. I decided to recommend that the insurance company give him enough money so he could stay out of the hospital for a while. The hospital was costly and bad for him, but each time he ran out of money, his pain got worse and he was readmitted.

Two weeks later I went to the hearing. When John was put on the stand, his attorney questioned him about how he was doing.
He said that his back still hurt. His attorney then asked if he thought he needed more medical care. John’s response threw the room in an uproar. He pointed to me and said, “I don’t need any more doctors. They can’t help. That doctor, Dr. Glasser, he’s the only one who cares about me. He says he can’t help, but if I see anyone, he’s the only one I want to see.”

The hearing officer told John to keep quiet and get down from the chair. John again pointed to me, repeated what he had said, and then got down. His attorney told him to keep quiet and looked at me as if I had done something terrible. The insurance attorney suggested that a settlement should be worked out, and the two attorneys went to work on it. The insurance attorney told me I would not have to testify. John got up, thanked me, and shook my hand. He told me again I was the only one who cared.

I didn’t feel very good. I was worried that I had screwed up his case. But the insurance attorney said what I did wouldn’t affect the settlement. I would talk to these men in a caring way and suggest that they could do something more than they were doing. My care was not phony, I was not protecting the insurance company. These men were the victims of an external control adversarial system that does not care about injured people. The more adversarial it gets, the worse it is for the patients. I have no suggestions except that the sooner I see people like him, the more effective I can be. The man was injured, and by the time I saw him, he was choosing paining. That the pain was psychological does not make it hurt any less.

John’s boss was not a cruel man. He did what he had always done with the people he hired. He had no idea how important half a minute of attention a week could be to this lonely man. That job was the only picture in John’s quality world that he had a chance of satisfying, but he still needed a little attention if he was to satisfy it and hang on successfully to that hard job. Is it too much to ask that people who manage workers learn enough choice theory to give them this small amount of attention? A few minutes a day doesn’t cost anything.

When John got injured, his boss had to spend more time on this claim and going over the site with the safety engineer than the minute or two that might have prevented or shortened the pain. The lawyers and doctors who made a living fighting over his pain were of no value to him or to anyone else. Greed was very much alive on all but his side in this case. John was not greedy. He deserved better than what he got at work and after his injury. The whole procedure has been distorted to the point that it no longer does what it was designed to do. But as long as external control is the psychology of the workplace, it is all we will have.

Deming is supposed to have said,
No human being should ever evaluate another human being.
I totally ascribe to this belief. He meant that no person with some power should ever make a formal evaluation of a subordinate. Obviously, no one can stop any of us from doing so informally; we do it all day long. We’d be much better off if we didn’t, but that is not what I am trying to explain here.

No matter how much a manager tries to lead manage when he gives the usual annual revue to a subordinate, he is cast into the role of boss manager. This yearly obligatory task that many companies, private and public, large and small, insist that a manager perform may undo a great deal else that the manager has been trying to do all year. All workers hate these evaluations, as do most managers. Only unthinking bosses like to do evaluations; it gives them the feeling of power that means so much to them, especially since they can disguise their real motives under the pretense:
I’m trying to help you.