Anxiety and the Law

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Anxiety Disorders - The Caregiver

information and support for family and friends of
those with anxiety disorders

From Dr. S. Shipko, California

I find this of great interest. I have seen hundreds of people with lawsuits related to their panic disorder. First of all, as a State Qualified Examiner, Appellate level Social Security Disability evaluator, Disability Evaluator for the LAPD and a few hundred worker's compensation cases, expert testimony for both the insurance and the plaintiff --- I think that people will benefit from your new website.

Synopsis

Due to the nature of Anxiety Disorders, those suffering from them can find themselves in almost impossible situations when called upon to give evidence in courts, insurance appeals, before semi-judicious bodies and hearings of all types. This page gives a number of suggestions which have been found to be of use in helping these people through these stressful situations. Those requiring more background on the nature of the disorders will find links on my title page "Anxiety Disorders - the Caregivers".

Background

Over the six years I have been maintaining this site, I have received numerous letters from people who were forced into these situations and suffered severely. The plea from them was, "Please publish this so others will not have to go through it." Recently, I have begun to receive information which indicates that at least some of the people in authority are beginning to understand and are taking steps to see that they are not further traumatized during the hearings, giving of evidence, etc.

Many of those with anxiety disorders find it difficult, if not impossible, to do many of the fun things they did prior to the onset of their disability. House parties, small gatherings, walks through malls, etc., can now produce so much anxiety and/or fear that they must be avoided. In extreme cases, their safe zones have become so restricted they cannot leave the house. Their lives are now centred around avoiding stressful situations.

While many are forced to function within these limitations, it does not mean they have given up striving for improvement or complete recovery. They are generally working daily to try to overcome the fear based restrictions which have been placed upon them. Some will heal in a few months, others may take years. Depending upon where they are in the healing process, some will be able to take virtually no stress, others can take a little while still, others, will find it uncomfortable but able to pull through - and all points in between. To push them too much beyond their limits could well set them back. The harm may not show immediately but they and their families could be faced with months or years of hardships from the resulting damage.

As they cannot handle the normal daily stress, a forced adversarial meeting such as in courtrooms, hearings, insurance appeals, etc., is devastating to them. It can be so devastating them that a number cannot even pursue insurance appeals - they just have to give up and walk away. (Unfortunately, it seems that a number of agencies, being aware of this, draw events out as long as possible.)

So what can be done to help these people?

Ideally, what they need is a non-threatening situation in which they feel they are in control - re: location, setting the pace, leaving, selecting seats near doors, etc. Below are a number of things which have been tried with success. Of course, not all suggestions will be possible nor, will everyone require as much support. Who is the best person to ask what type of support they need? The person with the anxiety disorder!

Before the Event

Allow the person to walk through the empty room, noting the position of doors, etc.
Explain the nature of the proceedings, who sits where, and estimated time lines.
Make it clear the person may leave by any door at any time. They probably won't have to leave but knowing the option is there can be beneficial.
Ask what can be done to make them feel more comfortable.
Assure them they may bring a support person with them and that they will not be on their own.
Officers of the court and major players should be made aware of the disorder and any restrictions that must be made for their "mental" protection should be discussed.
As these people are fear based, it is not unusual to find the person has an unreasonable fear of retaliation from anyone they give evidence against.
Ask the person what would make her feel more comfortable.
If one of their requests cannot be met, try to work out a compromise.

During the Event

If the person is a witness, do not keep her in a small isolation room from which she cannot leave. Being trapped is a big part of panic attacks. Certainly, don't keep the person there alone.
Make sure the person is not seated so as to look out a window which is high off the ground.
If the person must be in a witness stand, it should not be isolated nor off the ground. In fact, it may be easier to just have the person sitting in a regular chair at a table with other people. Some have found that a conference room table with people sitting around it, is much less stressful. The less they feel the centre of attention, the better it is.
It may be necessary to have the caregiver sitting very close to the person while she gives testimony. This gives them a safe anchor.
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It is frequently not possible to tell if the person is having a panic attack or an almost uncontrollable desire to run. Either the caregiver should be given a free hand to make the decision or else those in charge may gently and quietly ask from time to time if they are OK. However, in some, asking the person if she is OK can bring on an attack. It is obviously best to have worked something out ahead of time.
External signs of panic attack MAY include, sweating, a change of pallor, not seeming to be with it, being very snappy. Most can be very subtle and the caregiver who knows the person well may be the only person to recognize the rise in anxiety to the point of almost not functioning..
However, many people with anxiety disorders do extremely well giving testimony when their anxiety is high. The problem is recognizing the point at which they move from high anxiety into 'mental' exhaustion. How long does that take? It varies from person to person but my own experience with people would indicate that about 3/4 of an hour is the limit for many. Again, this is extremely variable from person to person. It may just be a few minutes or over an hour.
By their very nature, many people with anxiety are perfectionists. They will not forgive themselves for making small mistakes. Catastrophizing the results of the mistake can occupy them for a very long period of time. It is, therefore, important to be sure the person is not in too high a state of anxiety. When they are in a high state they can almost be in a state of dissociation and may agree with almost any statement made to them. Later, when the anxiety level lowers they will realize they agreed but knew that was incorrect and either will want to correct the statement or, if they cannot, they will be haunted by it for some time. During this time they can sound to be very confused and may even appear to be contradictatory.
In short, the adversarial system may not be one in which they can freely give of their knowledge. The person in charge must make certain the "witness is not being badgered."

As one person put it to me,
"Damn it!. If I had a broken foot they would not allow someone to keep irritating it. But, because I have an anxiety disorder, no one stops them from using it against me.

Those Severely Disabled by Anxiety Disorders

Some people are so severely disabled by anxiety disorders they may not be able to function at all outside of their safe zones. Some are even confined to their homes.
In cases such as this, various officials have found it necessary to treat them just they would anyone else who was too sick to attend. Meeting at the home, video taping, etc. have all been used.
Sometimes it is not necessary to go that extreme. Finding a meeting place within their safe zone, changing the location of a hearing, court case or appeal to a room on the bottom floor, have all been found to be beneficial. It is really a matter of discussion with the person, practicality, understanding, and compassion.

A Few Footnotes

Depression can frequently accompany anxiety. People should be aware it can also be present and is an additional limiting factor.
A problem with juries has been noted. The manner in which these people may give their testimony has been interpreted by jury members as 'not being sure', 'stretching the truth', 'outright lies' , etc.
The adrenalin flow which occurs during high anxiety frequently causes the person to be very tired. After an appearance they will probably be sleeping for the next few days and/or worrying big time that the car may have been going at 55 and not the 60 they indicated. Therefore, having them return to give further testimony may not be a realistic option.
People with anxiety disorders are frequently peace makers and people pleasers. They do not want (as opposed to need) to be treated any differently than anyone else. As a result of this, they will frequently attempt to go far beyond their capabilities.
In addition to being snappy, a person may become angry. This is a redirection from anxiety to another type of outlet. While a person may exhibit anger, there is no excuse whatsoever for the person to be rude or insulting.
It is unfortunate that some people use the anxiety problem to their benefit making them sound confused and so on. I have little polite to say to these people but there is a flip side. I have been amazed how the person's behaviour can change when they become really angry. In some cases they have suddenly shown the sharp clear minds they normally have and cut the feet out from someone who thought they had them to the point of near self-destruction.
Likewise, I can think of no term to describe some disability insurance companies who insist that to pursue the claim for being housebound with agoraphobia, they must present themselves at some place there is no hope of them being able to attend. In one case when a court order was issued to have the hearing at the person's house, the insurance company appealed it.
There is one school of thought which claims people with an anxiety disorder can attend anywhere and can be treated as any other person. The person may be able to force herself to do it but the down stream damage can be long lasting and severe.

In Summary

The above is not a Christmas wish list. They are suggestions from people who tried the various "aids" to help those with anxiety. The severity of disorder and the degree of accommodation varies from person to person. Certainly not all of the above will apply to everyone or even anyone. It should be done on an individual basis through discussion with the person and her caregiver.

Finally

I would like to end with a cute excerpt I received from a very frustrated court officer who was looking for a solution. It seems a crime was committed in front of a group of people who were just leaving an anxiety support group meeting. Most of them had extreme difficulties in giving evidence.

The court officer's email contained the following:

Here come de judge,
Here come de judge.
There go de witnesses,
There go de witnesses.

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