By: Dr. Brian Grant, Founder and Chair, Medical Consultants Network (MCN)
A theme that I have come to see with patients in treatment and those whom I have evaluated for various claims is the concept of “Locus of Control (LOC).” This is defined in the following web reference as: “An individual’s generalized expectations concerning where control over subsequent events resides. In other words, who or what is responsible for what happens. It is analogous to, but distinct from, attributions.” (http://wik.ed.uiuc.edu/index.php/Locus_of_control.)
For a variety of developmental and environmental reasons, people can be divided into two divergent camps in this regard. There are those who view themselves as largely in control of their lives, and in turn are responsible for what has and will happen to them. Think of them as “personal or internal LOC.” And there are those who see themselves as victims of circumstances not under their control and are helpless in the face of such matters. This latter group is one of “external LOC.”
In the context of injury claimants, there is a higher incidence of passivity among those with chronic complaint patterns. There is a tendency for a wish or hope that others “make me better” and a lower recognition that change and improvement will likely require individual participation, action and responsibility. Social histories of such individuals often reveal a sense and belief that things happen to them rather than that they played a role in the events that transpired in their lives and the choices that were made. When a catastrophic accident happens to an individual who accepts responsibility for their life and who has a history of success, their prognosis for improvement and positive adaptation to what may be a significant impairment may be higher than the individual who may have a minor injury, sees his/herself as helpless, and proceeds to a claim and lifestyle of significant disability.
Those with an external LOC may take a more passive role in many important actions. They are less likely to engage in a treatment that requires personal engagement and prefer to have things done to them. They are less likely to question authority and more likely to accept the directions and orders of others so long as they don’t have to assume responsibility for the outcome.
Those with internal LOC see themselves as impactful and powerful. They may take responsibility for actions that are done to them by others. The external LOC person could be robbed and may blame the thief. Those with an internal LOC may blame themselves for not being more mindful of where they were walking and how much money they were flashing. An external LOC person might blame their partner for the problems in their relationship or cause for their divorce. An internal LOC might look to themselves for their choice of partner and their own behaviors once in the relationship. Of course there may be many nuances in between.
One might understandably ask whether it is fair or just to blame the victim where misfortune, pain, or even violence is visited upon another person? Of course not, but that is not the point. The point is that in many situations, the victim can’t control the perpetrator and taking that position would render them helpless. Even those who have lived through significant horrors often survived by finding some thread of hope and control. Individuals may assume accountability for their own decisions in life in the many more mundane choices and decisions that are made each day. Paradoxically, I believe that the internal LOC who takes responsibility for what happens to him/herself to the degree practical is an individual who implies and creates personal power and control relative to the external LOC. The stationary objects of difficult people, places, and circumstances can be recognized and either avoided or managed when one takes control of the process. In contrast, those victims who have the external LOC outlook will find an infinite supply of misfortune to attribute their problems to and chronically fail to achieve positive life outcomes and relationships as a result.
As parents, it is our responsibility to teach our children the concept of personal responsibility and prudence. As employers, physicians, and claims managers it is our role to recognize the concept of LOC and how it impacts the employees, patients, and claims that we see. As individuals and members of society it is in our interest to exercise compassion towards those who seemingly can’t control major aspects of their lives, and gently suggest that there may be other options.
About Dr. Brian Grant
Brian L. Grant, MD is the founder and chair of Medical Consultants Network (MCN). He is Board certified in general and forensic psychiatry. He is a 1974 graduate of the University of Michigan and received his MD from Michigan State. His post-graduate training was completed at the University of Washington, where he holds the position of clinical associate professor. Among his many interests are workplace function and the medical and social drivers that impact it.
MCN was founded in Seattle in 1985 and currently has offices in eight states to serve our clientele nationwide. MCN provides medical judgment services including independent medical evaluations and peer reviews. Clients include insurance, legal, health care, and government entities. MCN operates with a highly structured and scalable information system backbone and leads the industry in technology and leadership. The company contracts with over 16,000 consulting physicians in all fifty states to perform assessments.