Book Review of Wounded Workers: Tales from a Working Man's Shrink

By Hon. Susan V. Hamilton, Former Assistant Secretary and Deputy Commissioner, California Workers’ Compensation Appeals Board

A must read for those interested in workplace injuries

Springtime is here bringing us warmer weather, longer days and pleasant thoughts of fast-approaching summer. Summer—that magical, carefree time when we can toss our worries aside, if only for a while, and bask in the glowing sun with a book at our side. No doubt you have already made a list of the books you want to read this summer. Well, there is one more book to add to that list: Wounded Workers: Tales from A Working Man’s Shrink by Dr. Bob Larsen. It is an engaging, informative and empathetic “must read” especially for those with an interest or experience in occupational medicine and/or work-related injuries. It is also a literal page-turner.

The name, Dr. Robert C. Larsen (a.k.a. “Dr. Bob”), is well-known in occupational medicine and workers’ compensation circles. Dr. Bob is a highly respected psychiatrist, a former clinical professor of psychiatry at the University of California San Francisco (UCSF), founder of the Center for Occupational Psychiatry, and a renowned Agreed Medical Evaluator. He also served as the President of the California Society of Industrial Medicine and Surgery and was appointed to the Industrial Medical Council where he developed guidelines for the treatment and evaluation of industrially injured workers. His preeminence as a treater and evaluator is without question. Now Dr. Bob can add the word “author” to his impressive curriculum vitae.

Wounded Workers chronicles Dr. Bob’s journey as a working-class kid from Chicago to his foray into occupational medicine as a treating and evaluating psychiatrist. In many respects, his journey is serendipitous. Dr. Bob didn’t grow up with the ambition to become a prominent occupational psychiatrist. Yes, as a youngster he was a self-described “nerd,” a “mathlete” who competed in math competitions and proudly wore a slide rule encased in leather suspended from his belt. He also played in the concert band and was a budding actor who had the courage to play the role of Humpty Dumpty in a high school play. For that role he dressed up in an egg costume complete with yellow tights. While on a trip to Colorado with the band, Dr. Bob fell in love with the Rocky Mountains and selected Colorado University for his undergraduate education. His fascination with molecular and cellular biology could well have led to a career in that field, but then Dr. Bob’s life took a different turn.

That turn initially took Dr. Bob to Northwestern University Medical School and later westward to California where, smitten by San Francisco, he accepted the offer of a four-year residency program at the Langley Porter Psychiatric Institute, UCSF. After completion of UCSF’s rigorous psychiatry residency program and a two-year fellowship, Dr. Bob was asked to teach forensic psychiatry to third year residents. Not surprisingly, Dr. Bob went on to become a clinical professor in UCSF’s prestigious Forensic Psychiatry Fellowship program. That Dr. Bob would gain notoriety as an occupational psychiatrist and forensic psychiatrist seems almost inevitable. His own working-class roots gave him a deep appreciation for working men and women and their struggles. Would Dr. Bob have left the field entirely if he had been selected to be Commissioner of Major League Baseball? You will have to draw your own conclusions on that question. (See Chapter 19, “The National Pastime” to learn more.)

Wounded Workers is sprinkled with insights and wisdom inspired by Dr. Bob’s long career treating and evaluating injured workers and in providing consulting services to employers. At some point in our work lives most of us have experienced a co-worker whose arrogant, antagonistic behavior has created an unpleasant work environment. Dr. Bob explains how a technique he calls “slapping therapy” can be effective by enabling the annoying employee to see the reality of their behavior and adjust the offensive aspects to make cooperative work with others possible. But, as Dr. Bob cautions, the technique does not always work since “character pathology that is well established is not easily given up.” An “asocial jerk” may not be capable of seeing themself as the problem.

Dr. Bob shares the stories of employees faced with the challenge of workplace events through fascinating vignettes. One example is of “Mr. Jones,” a welder, who sustained first- and second-degree burns over 80% of his body surface that required him to undergo more than 40 surgical procedures, including reconstructive surgery of facial tissue. Notwithstanding chronic pain, physical limitations, post-traumatic stress and depression, psychological counseling and antidepressant medication enabled Mr. Jones to view himself as a survivor. Through Mr. Jones and others, Dr. Bob helps us understand the multifaceted complexity of burn injuries and the psychological aftermath that many burn victims experience.

One might presume that as a psychiatrist, Dr. Bob would manifest a bias towards psychological counseling and/or psychotropic medication as the most appropriate forms of further medical treatment. Nothing could be further from the truth. The stories of “Jim,” “Jose” and “Ms. Pham” each illustrate that while psychiatric treatment is often necessary and beneficial, other forms of treatment may be just as important. Jim, a logger, sustained a crush injury resulting in the amputation of his leg. Jose, a tortilla maker, lost his dominant hand when it became entangled in an industrial mixer. Ms. Pham, a food scientist, loss the use of her hand while attempting to dislodge bits of meat tissue that had become caught on the side of a meat grinder. The loss of a limb not only devastated but forever altered the lives of each of these employees. Jose was left with chronic pain and was embarrassed by his appearance. Ms. Pham felt herself unlovable. Jim began to self-medicate with illegal substances. In addition to psychiatric treatment, Dr. Bob advocated that each of these employees be provided with functional, state-of-the-art prosthetic devices and his advice was accepted. Jim received a titanium prosthesis with an ankle shock that made it possible for him to jog. The prosthetic treatment recommended by Dr. Bob enabled each of these workers to move forward in their lives, finally able to envision a future beyond their industrial losses.

The real-life scenarios Dr. Bob presents help us better understand such matters as the importance of psychological testing, whether an individual should be considered a “malingerer,” post-traumatic stress disorders, and the ability of some to have resilience even in the face of unimaginable tragedy. The latter is the story of “Charles,” a respiratory therapist who nearly died from an infection caused by exposure to a hospital pathogen. To say that Charles’ story is both heartbreaking and heartwarming at the same time is not a contradiction. The ability of Charles to accept his significant physical disabilities without self-pity or anger is truly inspirational. Spoiler alert: If you can’t wait to read about Charles, jump directly to Chapter 35, “Overcoming Victimization.” In that chapter you will also meet “Officer Young,” whose courage, determination and positivity in the face of adversity is nothing short of remarkable.

There are so many other stories, so much more to Wounded Workers than this brief review can convey. But it wouldn’t be fair to give away all of the secrets and deprive you of the pleasure of reading this thoroughly engrossing book yourself. You will be grateful that you made it your summer read.

The book can be found on Amazon.com.

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