After a back injury put Irene Ansher in the hospital for several weeks, she could feel herself slipping slowly into a permanent disability.
"I didn't want that," she says. Now she's trying to rescue others threatened as she was. "The world changes when you have an injury."
Disabled workers, she says, can get caught in a cycle of recurring pain, depression and loss of self-esteem that blocks them from returning to the job. This is particularly true if the recovery period, like hers, is prolonged. The cost is high, emotionally and financially, to themselves, their families and their employers.
For Ansher, 45, the problem began suddenly about two years ago. "I was shoveling snow. My back went out."
She tried at first to ignore it because she was so busy: psychology teacher at Einstein High School in Kensington, part-time career counselor, doctoral candidate at George Washington University, wife and mother of three. "But my back kept getting worse. I was holding with it."
By June, when school let out, "the pain in my leg was so bad they put me in the hospital." Initially she was in traction, but finally she was operated on for a "ruptured disk." Her stay had lengthened to four weeks.
After she was discharged, "I thought I would be able to pick up my life." Within a couple of weeks, the pain resumed. With it came an undefined fear. "I had never been sick. I couldn't believe this was happening to me."
Medical advisers told her not to make a bed, not to vacuum, never to lift anything. By September, "when I was ready to go back to work, I couldn't. I hurt."
She reentered the hospital and spent two more weeks in traction, taking pain pills, but with little change in her condition. "I finally signed myself out. I didn't see any reason to stay."
She eventually consulted Bethesda psychiatrist and orthopedic surgeon Bruce Smoller, who told her she "didn't seem to be a chronic pain case." He asked if she would counsel some of his patients who had been off the job for several years because of back problems.
The request, she says, produced "an amazing turnaround in my head. From a fear of the future," her attitude changed "to one of confidence."
Since then, her career-guidance work with the disabled caught the eye of Reliance Insurance, Columbia, Md., which asked her to help with long-time recipeints of workers' compensation benefits. Each claimant who returns to work, says claims supervisor Tim Gray, can save the company up to tens of thousands of dollars in future benefit payments.
Long-term claims make up only about 10 percent of Reliance's total workers' comp cases, says Gray. "But they make up 90 percent of money paid out. And they make up 90 percent of my headaches."
Ansher sees a pattern in injured workers who wind up on the long-time disability rolls. Her goal in a reserch project with Reliance is to intervene early -- within 30 days of the injury -- to break that pattern.
In the beginning, inury victims are the center of attention. "People come to see you and bring flowers." But as the recuperative period lengthens at home, "after a while, nobody wants to hear your hospital stories again."
The victim may only have contact with family members. "It's a desperate situation," says "Ansher. "They don't have anything interesting to talk about. They don't find themselves interesting, and their spoused don't" either. Marriages break up.
"Plans to return to work are based on the amount of pain, so that the patient is constantly assessing that pain."
As the time away from work grows, "It's threatening to go back." In some cases, because of the nature of the injury, they can't go back to the same job or even the same firm. For people whose "identities are tied to jobs, not working triggers dependency. Once someone is out of a job for six months, the chances of going back decrease significantly."
People need structure in their lives, and often, says Ansher, going to the doctor's office provides it. "Getting up, eating breakfast, dressing, transportation. You can stretch it out for a whole day. Long-term disability may become a way of life."
Often victims are unskilled or semi-skilled in construction fields, but they may have been earning good money. Psychiatrist Brian Schulman points out, if an injury prohibits them from returning to heavy physical labor, they may have difficulty finding a sedentary job at comparable pay.
Adds lawyer Larry Pascal of Ashcraft and Gerel, one of the nation's largest firms representing injured workers in claims suits: "A carpenter or a brick mason feels he's a professional. Often counselors want him to return to work to do anything, such as parking cars or taking tickets." A worker who takes a job he doesn't like risks losing disability payments if he or she quits.
Incentives to retrain for a new job diminish if workers' compensation will pay more, says Schulman. So, it becomes important for the victims "to maintain the pain" rather than fight it.
"I've got a guy," says Schulman, "who's done the same work for 20 years. The idea that you have to do something else is devastating."
Smoller sees his and Ansher's work as complementary. He teaches patients where possible, how to master their pain through self-knowledge and tension-reducing techniques. Her function is to give them the skills -- and along the way, the incentive -- to find a job.
One of Ansher's early clients was a 35-year-old used-car salesman who had been out of work for six years after falling down the steps at work and injuring his back. During that time, he collected thousands of dollars in workers' comp while undergoing extensive medical treatment. Five months after beginning her program, he reported to work again in a job placement firm.
Another client, a 27-year-old construction worker who fell off a scaffold and hurt his back six years ago, is now exploring auto repair shops.
An important aspect in Ansher's counseling is getting clients "to begin taking charge of their life. 'Do-me' therapies should be replaced with 'Here's-how-to-do-it-for-yourself-with-some-help' therapies.
"Progress is not measured only by how fast clients return to gainful employment," she says, "but by their more frequent laughter and increases in self-esteem and self-respect, which may come from seemingly small achievements. Active involvement in one's own good," she is convinced, "speeds up recuperation and lessons pain."
While helping with resumes, Ansher -- who also conducts regular career/life-planning workshops -- sends clients on data-gathering missions to determine jobs available. "Instead of being passive and dependent, the seeker is actively involved at a time when he's not doing anything else."
Along wiht counseling on such things as assertiveness, time-management, leisure, pain-minimizing movements, she also coaches them in responding to the inevitable employer question: "What have you been doing for the past few years?"