The Stressful, Hostile, and Toxic Workplace: An Advanced Understanding of a Common Clinical Complaint

摘要

Patients frequently attribute symptoms and distress to their workplace. Such workplaces are characterized as "stressful," "hostile," or "toxic." Such phrases cannot serve as a substitute for clinical assessment of the patient's work problem. Proper assessment entails understanding the situation at the workplace and the patient's reaction to the situation. This article discusses several ways in which legal and psychiatric frameworks used to assess workplace problems can be mutually incompatible. Poor clinical and functional outcomes, such as chronic anxiety or depressive symp- toms, separation from the workplace facilitated by prolonged claims of work incapacity, long-term unemployment, and patient involvement in protracted litigation, can occur in the absence of informed and proactive clinical engagement. This article identifies steps to consider when a patient presents with work complaints. Active and skillful engagement with patients who present with a workplace problem not only mitigates negative clinical and functional outcomes but also promotes the psychological, social, and economic well-being of the patient.