Vexatious Litigants - Litigants Who Won't Accept "No" (or "Yes") for an Answer

By Mark I. Levy MD, DLFAPA

Vexatious litigants[1] are individuals who burden the judicial process by repeatedly filing causes of action that are ultimately found to be without merit. Despite the considerable cost to the judicial system (and ultimately to society) little has been written about vexatious litigation and less has been done to understand the psychological motivations for vexatious litigation in order to better manage the problem. This is partly because in a constitutional democracy everyone is deemed to be "entitled to his (or her) day in court." The federal and state constitutions within the United States jealously protect citizens' right to submit their grievances to our judicial systems in order to resolve civil disputes in a timely and equitable manner. At the same time, the Court, already overburdened with the shear volume of litigation, is charged the responsibility to protect the integrity of our judicial system from abuse by a very small but very troublesome minority of litigants.

Internationally, notably few jurisdictions have attempted to formally address this problem(the exceptions being Australia, The United Kingdom and the State of California). Within the United States, only California has enacted statutory regulation of vexatious litigation.[2]

Forensic psychiatry is a subspecialty of the medical specialty of psychiatry that focuses upon the interface between law and the behavioral sciences. Since 1994, The American Board of Psychiatry and Neurology has offered qualified board certified psychiatrists the opportunity to be examined and if successful to obtain board certification in forensic psychiatry in addition to their certification in adult and/or child and adolescent psychiatry.

Like law, the profession of forensic psychiatry is practically divided between criminal and civil domains. Although there are many common elements between law and the practice of forensic psychiatry within civil and criminal matters, there are also several important differences. Within civil law, vexatious litigation has increasingly been recognized by the judiciary as a difficult problem to manage. Since vexatious litigants frequently represent themselves in propria persona, at least during some of the actions that they attempt to litigate, and since the judiciary has a responsibility to be more accommodating and helpful to such litigants who are not represented by licensed counsel, there Court is faced with a complex dilemma once it becomes apparent that a "pro per" litigant is in fact vexatious.

Only recently, however, have forensic psychiatrists begun to examine the motivations and possible psychopathology driving the litigious behavior of this individuals. The Courts' need to more effectively manage and legislatures' to more effectively regulate individuals who exhibit this problematical behavior. In order to assist the judiciary (as well as the legal profession) to more easily recognize the characteristics individuals fitting this profile, forensic psychiatrists and psychologists need to study and understand more fully the dynamics and motivations for this socially costly and troublesome behavior. This paper is an attempt to examine this infrequently explored terrain.

A triad of behavioral characteristics are frequently demonstrated by vexatious litigants:

1. A history of changing counsel more than once, coupled with at least one episode of representing themselves in Court in propria persona. Not surprisingly, competent counsel generally find a means to ethically remove themselves from the case after a period of poor client control. Sooner or later, usually after a time of appearing "pro per," these litigants find counsel who more or less identify with their client, presumably for reasons having to do with their own personal psychology. The result of this is an attorney-client dyad that is driven by a mission. No client control exists nor is it even recognized by plaintiff's counsel as lacking. Hence no settlement can ever occur.

2. Evidence of narcissistic and paranoid personality traits, obtained from psychiatric examination and psychological testing. These traits are generally manifested by attitudes expressed verbally or behaviorally (e.g., through physical appearance) conveying that the individual considers himself to be an exception, i.e., that the normal rules of behavioral conduct within a judicial process to which all litigants are expected to submit uniquely do not apply to him because he is allegedly special, having suffered abuse, humiliation and/or victimization unduly at the hands of alleged perpetrators, including judges, thereby entitling the vexatious litigant to exceptional status and accommodation by the Court. Not infrequently, although the source of alleged abuse is initially the defendant in a civil action, eventually the Court itself is drawn into this "dance" and is experienced from a paranoid perspective by the litigant, as itself also an abuser. Invariably, this is due to the Court attempting to impose a modicum of decorum on behavior of the litigant by invoking normal procedural requirements. As a result of this transformation of the Court, in the litigant's mind, from arbitrator to oppressor, the Court's responses may eventually be perceived as more persecutory and humiliating than was the alleged conduct of the original defendant.

3. A refusal to settle disputes through customary procedural channels of negotiation and even traditional litigation. These individuals wish to have their alleged suffering, humiliation and victimization witnessed on the stage of litigation. Their common fantasy is that unspecified "others" (the jury, initially the Court itself) will sympathize with suffering and offer some sort of illusoryl vindication and redemption. Consequently, not only do they characteristically refuse to accept negative judicial decisions, sometimes they will reject decisions in their own favor, if they believe that acceptance will terminate the litigation and their chances to obtain the imagined vindication. Although this may superficially appear to be perverse, it is in fact a direct product of their peculiar motivation to litigate in the first place, i.e., to have their alleged victimization witnessed, not to resolve conflict. Of course, such motivation leads to an endless quest because no degree of witnessing and acknowledgment of their pain can ever approach the unconditional love for which they long and thus "restore" the wounded narcissism and damaged self esteem of these individuals. If permitted to do so, they will attempt to appeal trial court decisions to the highest judicial levels.

Judicial Dilemma:

The judicial dilemma is to balance the rights of the individual to have his "day in Court" with the pressure to assure that justice for all is administered in a timely and expeditious manner by keeping judicial calendars moving and trying to urge disputing parties to utilize alternative methods of conflict resolution, To further complicate the task, as a result of a series of revisions of codes of judicial oversight and the evolution of commissions on judicial conduct during recent decades, trial court judges are charged with balancing their judicial demeanor with the requirement that they maintain decorum within the courtroom. When confronted by the behavior of a vexatious litigant, who behaves in a manner signifying that they are an exception to the usual rules of the Court, balancing judicial demeanor with courtroom decorum can present a formidable judicial challenge.

Two instances of where this complex dynamic can strain the litigation management skills of even the most experienced judge include civil cases brought by vexatious litigants and the emotionally charged disputes, including custody matters,  that are brought before a Family Court. In the former instance, as already mentioned, the litigant vehemently resists normal judicial suggestion and even the requirement that they engage in good faith in a process of alternative conflict resolution. Such efforts are perceived by these litigants as a threat to sustaining the ongoing litigation process which, as described above, for the vexatious litigant is an end unto itself. In the latter instance, custody battles and parental misconduct allegations are often presented in the service of punishing the other party. In the extreme, it is not unknown in family court for even a spousal batterer to attempt to highjack the Court proceedings as a way to continue their domination and victimization of their abused spouse.

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[1] Vexatious litigation is legal action which is brought, regardless of its merits, solely to harass or subdue an adversary. It may take the form of a primary frivolous lawsuit or may be the repetitive, burdensome, and unwarranted filing of meritless motions in a matter which is otherwise a meritorious cause of action. It is considered an abuse of the judicial process and almost always brings down sanctions on the offender.

[2] Under California law (Code of Civil Procedure, section 391(b)) a vexatious litigant is someone in at least one of the following categories:

1. In the immediately preceding seven-year period has commenced, prosecuted, or maintained in propria persona at least five litigations other than in a small claims court that have been (i) finally determined adversely to the person or (ii) unjustifiably permitted to remain pending at least two years without having been brought to trial or hearing.

2. After a litigation has been finally determined against the person, (he or she) repeatedly relitigates or attempts to relitigate, in propria persona, either (i) the validity of the determination against the same defendant or defendants as to whom the litigation was finally determined or (ii) the cause of action, claim, controversy, or any of the issues of fact or law, determined or concluded by the final determination against the same defendant or defendants as to whom the litigation was finally determined.

3. In any litigation while acting in propria persona, repeatedly files unmeritorious motions, pleadings, or other papers, conducts unnecessary discovery, or engages in other tactics that are frivolous or solely intended to cause unnecessary delay.

4. Has previously been declared to be a vexatious litigant by any state or federal court of record in any action or proceeding based upon the same or substantially similar facts, transaction, or occurrence.

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What Psychological Factors Drive Civil Litigation?

What Drives Litigation? How Forensic Psychiatrists and Psychologists Assess Motivation

by Mark Levy, M.D.,

Forensic psychiatry and psychology is the application of psychiatric and psychological clinical knowledge and research to the practice of law where plaintiff’s (or criminal defendant’s) mental status is at issue. The forensic psychiatrist is an expert at making diagnostic and prognostic judgments that are informed by scientific research and clinical experience about whether a plaintiff’s subjectively experienced emotional distress and/or functional impairment can be plausibly related to the alleged accident, injury, or tort. In addition, the forensic psychiatrist considers whether and to what degree other factors (the patient’s pre-existing condition, the plaintiff’s motivation to seek compensation or to punish the defendant, the plaintiff’s legitimate righteous indignation at being wronged with an appropriate wish to seek justice and reparation, or some combination of any of the above) are entering into the plaintiff’s assertion that (s)he has been psychologically damaged and, were it not for the defendant’s action or conduct, the plaintiff would not be suffering from the particular condition that (s)he has alleged.

Forensic Psychiatry and Civil Law: Motivation

In addition to expertise in diagnosing mental disorders, the forensic psychiatrist has expertise in assessing motivation. A plaintiff’s motivation might be to seek damages to obtain necessary medical care and, as much as possible, restore his or her life to its pre-injury status and/or to punish the party that has injured him. At the opposite end of the spectrum, some plaintiffs engage in outright malingering (faking an injury or psychiatric illness) to make money. Sometimes, a plaintiff who is compelled to litigate, despite reasonable efforts at settlement, is driven by the desire to have his suffering witnessed (and thereby validated) on the stage of litigation while attempting to externalize all responsibility and punish the defendant whom he regards as responsible for all of his suffering. Not infrequently, various combinations of these factors are at work motivating the litigation. Teasing out the plaintiff’s motivation requires a considerable amount of clinical experience, skill, and acumen, as well as a familiarity with applicable state and federal law. A prospective client tells you he has suffered severe emotional stress (with or without physical injury) as a result of a car accident, or his employer’s actions, or his insurance company, or his doctor, or a drunk driver, or anyone who may have damaged, hurt, or injured him by accident through intentional or negligent conduct or for a variety of reason. If you are the attorney representing him, or if you are defending your client against his claim of personal injury, how do you assess whether or not the plaintiff is indeed suffering from a psychiatric disorder or injury and, if he is, whether it was causally related to the incident or alleged misconduct by the defendant? In essence, in order to adequately represent him (or defend against his allegations) the attorney seeks evidence based expert opinion to assess what is true and what is not about injuries and causation.. How do you determine what is the truth?

Questions to be Addressed by a Forensic Psychiatrist and Psychologist:

Only a forensic psychiatrist (or forensic psychologist) has the necessary training and experience to assess the plaintiff’s current psychological and psychiatric diagnosis, to make inferences about the plaintiff’s emotional state at the time of the accident or injury, and to determine if there is a plausible connection between that accident or injury and the plaintiff’s current mental state. The forensic psychiatrist has additional expertise to assess the possible medical (including medication) dimensions of the complaint. The forensic psychologist has unique training and experience to conduct objective psychological (and, if indicated, neuropsychological) tests of the plaintiff’s personality and, if appropriate, neurocognitive functioning. These two highly trained professionals work together in a complimentary fashion carefully seeking accurate, evidence based, diagnostic opinions and conclusions.

Among the questions usually addressed by a forensic psychiatrist conducting an IME in civil litigation are the following:

1. Is this particular plaintiff suffering from a recognized mental disorder? That is, what is the diagnosis, according to the Diagnostic and Statistical Manual of Psychiatric Disorders, Fourth Edition, Text Revision, 2000 (DSM-IV(TR)?
2. If (s)he is indeed suffering from a disorder, was that disorder caused or exacerbated by the events, incidents, or issues under dispute in the present lawsuit?
3. Were there pre-existing psychological problems or psychiatric illnesses in the plaintiff’s medical history that were likely to have caused present symptoms of “damages,” even if the event(s) under dispute had never occurred?
4. Specifically, does the plaintiff have a pre-existing personality disorder or other mental condition that predisposes the plaintiff to their current psychiatric symptoms and that may be at least as much the proximate cause of the current symptoms as were the incidents under dispute?
5. Or, was the plaintiff functioning adequately prior to the event and, were it not for the disputed incident(s) or event(s), would still be functioning adequately and without significant impairment? • What is the most appropriate type and duration of treatment recommended for the plaintiff’s mental disorder(s)? • What is the likely cost of such treatment?
6. To what extent (if any) and in what manner should the liability (and cost) of the plaintiff’s damages and future treatment be apportioned among various defendants, or between pre- and post-incident causative factors?

These can be weighty questions with significant financial and emotional consequences for both parties within a dispute. It goes without saying that the forensic psychiatrist must proceed cautiously and comprehensively when evaluating the entire range of data relevant to the plaintiff’s psychological complaints, including all medical records (including those predating the dispute), all relevant deposition transcripts, and other documentary evidence. Ultimately, the forensic psychiatrist must present the data and his conclusions with “reasonable medical probability” or “certainty” (i.e., with at least more than a fifty percent probability of accuracy).

Psychological Testing:

Psychological (and, when indicated, neurocognitive) testing is of enormous diagnostic value when conducting a forensic assessments. In our civil forensic practice, regardless of which side has retained us, virtually all plaintiffs are administered a battery of psychological tests including both “endorsement” type personality tests (such as the Minnesota Multifactorial Personality Inventory -2, the Personality Assessment Inventory, and others), and a projective test (The Rorschach Inkblot Test). Many examinees are also administered cognitive screening tests (such as selected subtests from the Wechsler Adult Intelligence Scale). Those who present with overt complaints of cognitive impairment or those for whom head trauma and possible traumatic brain injury are features of their medical history, are also administered a battery of neurocognitive tests. All of the psychological and neurocognitive test data is carefully analyzed by a forensic psychologist and/or neuropsychologist. An active process of collaboration between the forensic psychiatrist and psychologist (known colloquially as “case conferencing” in medicine) enables the forensic psychiatrist or psychologist to provide, evidence-based diagnostic conclusions with a high level of specificity and accuracy. The expert who has arrived at diagnostic conclusions in this manner is well prepared to confidently testify about evidence based diagnostic, causal and prognostic conclusions.

Mark Levy, M.D., a Distinguished Life Fellow of the American Psychiatric Association, is a psychoanalyst and, for more than thirty years, has been in full-time private practice of general and forensic psychiatry in Mill Valley, California. He is the medical director of Forensic Psychiatric Associate Medical Corporation (www.fpamed.com) and is certified by the American Board of Psychiatry and Neurology in both General Psychiatry and Forensic Psychiatry. He is an assistant clinical professor within the Department of Psychiatry at the University of California-San Francisco, where he teaches in the Forensic Psychiatry Fellowship. He can be reached at mlevy@fpamed.com and welcomes your inquiries.

Subsequent posts to “What’s News” will, among other topics, feature psychological and neuropsychological discussions about the utility and limitations of particular psychological and neuropsychological test instruments.

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The Assessment of Malingering in Civil Litigation

The Assessment of Malingering in Civil Litigation

by Sarah A. Hall, PhD

The assessment of the likelihood that a plaintiff or claimant may be exaggerating, feigning, or malingering cognitive and/or emotional impairment is of paramount importance in a variety of civil and criminal cases. These include personal injury lawsuits and sentencing hearings, as well as disputes regarding medical disability and workers compensation cases.

There are a variety of approaches that forensic psychologists and neuropsychologists can use to help distinguish between more valid symptoms and complaints as opposed to those that are more consistent with exaggeration, feigning or malingering. Validity scales embedded in various tests of personality, such as the highly popular MMPI-2 or MMPI-2-RF (Minnesota Multiphasic Personality Inventory-2nd Ed. Minnesota Multiphasic Personality Inventory-2nd Ed.-Revised Format) or the Personality Assessment Inventory (PAI) can help to identify patterns of responding that raise concerns about the honesty or sincerity of a claimant’s self-report.

Performances on psychological and neuropsychological tests or tasks that involve overlapping cognitive functions can be analyzed for unlikely discrepancies or patterns of responding. Similarly, performances on formal tests and reported activities and functioning at work and/or home can be examined for unusual or unlikely discrepancies. Medical tests and exams, such as brain scans and evaluations done at the time of injury can be compared with self-reported symptoms as well as with performances on psychological and neuropsychological reports in order to find inconsistencies and/or unlikely patterns of results.

In addition, several tests, such as the Test of Memory Malingering (TOMM) and the Word Memory Test (WMT) have been developed which were designed specifically to help identify feigned or malingered memory impairment. Low scores on these tests, which can be completed successfully by most brain-injured individuals, help to identify individuals who are putting forth poor effort, exaggerating, or malingering cognitive impairment. Test performances can be analyzed for random responding, as well compared with average scores for groups of cognitively intact, as well as the average scores for brain injured and demented subjects.

The appropriate and overlapping use of these approaches can be quite successful in helping to identify those claimants who are exaggerating or feigning cognitive and/or emotional injuries. In combination with a thorough and detailed interview examination that includes personal, educational, employment and physical and mental health histories, as well as a comprehensive review of all available records, exaggerated or feigned claims frequently can be identified and disputes more easily resolved.

Sarah A. Hall, PhD
Adult and Pediatric Neuropsychologist
Forensic Psychiatric Associates Medical Corporation
shall@fpamed.com

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Assessing the Truth: How Forensic Psychiatrists & Psychologists Evaluate Litigants

Forensic psychiatrist Mark Levy MD and forensic neuropsychologist Ronald Roberts, PhD co-authored an article for San Francisco Attorney Magazine, Spring, May 2008. In it, they explain the process and methods used by forensic behavioral experts when conducting an evaluation of an individual as part of a legal proceeding. Download a pdf version of the article here.

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Moms Who Kill: When Depression Turns Deadly

by Mark I. Levy, MD, Deborah Michelle Sanders, Esq. and Stacy Sabraw
Psychology Today
December 2002
reprinted with permission

Summary: Postpartum mood disorders are more common than we realize: Up to 80 percent of new mothers experience mild depression within a year of giving birth. If the "baby blues" persist, depression can escalate to dangerous levels, influencing some women to experience psychosis and-in rare and tragic cases-to kill their offspring.

Postpartum mood disorders are more common than we realize: Up to 80 percent of new mothers experience mild depression within a year of giving birth. If the "baby blues" persist, depression can escalate to dangerous levels, influencing some women to experience psychosis and-in rare and tragic cases-to kill their offspring.

During the first six weeks after giving birth, Jennifer Moyer was grateful for her beautiful new son and supportive husband. Yet she wasn't herself. She felt somewhat irritable and was having difficulty sleeping. And just after her first postpartum physical checkup, things began to unravel-and fast. The feeling that some unnamed harm was coming to her son overwhelmed her; she became hyperprotective, not allowing anyone-even her husband-to hold the baby. One month later, after three sleepless nights, anxiety and fear consumed her to a point where her son had to be physically removed from her, and she was forcibly taken to the hospital. Moyer was in the throes of postpartum psychosis.

The focus of a lot of media attention recently, this illness gained a voice largely due to the story of Andrea Yates, the woman found guilty of drowning her five children in a bathtub in Texas last year. Yates, who has a long history of mental illness, confessed to jurors that Satan had ordered her to kill her children. Though diagnosed with postpartum psychosis, she was judged capable of discerning right from wrong and sentenced to life in prison.

Despite considerable research into the nature of postpartum mood disorders, there is still no clear medical consensus on what causes it and how it should be treated. "Having grown up expecting motherhood to be one of the best times of life, many women suffer alone, feeling miserable but unaware that postpartum mood disorders have a name," explains Karen Kleiman, M.S.W., founder and director of the Postpartum Stress Center in Philadelphia.

Discerning Symptoms

As many as 50 to 80 percent of all women experience some degree of emotional "letdown" following childbirth-the so-called "baby blues." Fortunately, its more extreme sister disorder, postpartum psychosis, is rare, affecting only about one in 1,000 new mothers.

The baby blues, though, are common for numerous reasons. The baby's crying and the mother's interrupted sleep and soreness from breast-feeding are enough to make any woman feel irritable, if not overwhelmed and tearful. These feelings typically begin three to four days after the baby is born, according to Kleiman, but normally dissipate on their own within a few weeks.

If the blues last for more than two weeks, however, the new mother may be suffering from a condition of intermediate severity, postpartum depression (PPD), a mood disorder on par with clinical depression. Twelve to 16 percent of women experience PPD, which results in feelings of despondency, inadequacy as a mother, impaired concentration or memory and/or loss of interest or pleasure in activities.

Some women, like Moyer, also become paralyzed with fear and concern for the baby's safety. If such symptoms appear, it is important to seek professional consultation to help differentiate PPD from other conditions such as obsessive-compulsive disorder. Symptoms of anxiety are frequently an aspect of clinical depression, but true obsessive-compulsive symptoms signify a different disorder that needs proper diagnosis and treatment.

Shoshana Bennett, Ph.D., a special-education teacher, began suffering from these types of anxious feelings almost immediately after giving birth. "I felt helpless and hopeless," Bennett says now. "I was so afraid someone was going to hurt my baby that every day after my husband went to work, I would place all movable furniture behind the front door."

Though debilitating, the emotional reactions to being a new mom that signify depression are not as severe as those associated with postpartum psychosis, of which the predominant symptom is a "break" with reality-a loss of the ability to discern what is real from what is not. For instance, a woman with PPD may experience violent thoughts about her baby but recognizes that those thoughts are wrong and potentially dangerous. In that case, she will not act on them.

A woman with full-fledged psychosis, however, has temporarily lost the judgment needed to make this assessment. Very often, a woman with psychosis experiences a frightening sense of merging-she can't differentiate between where she ends and where her baby begins. Psychotic merger is so terrifying that she may try to avoid losing her sense of self by either committing suicide or infanticide, also known as suicide by proxy.

This was the case with Andrea Yates, whose suicide attempts ended with the deliberate drowning of her children. Perhaps, in her mind, to prevent the "loss of self," she was compelled to kill her children or herself, or both.

Infanticide is a very rare phenomenon; only about 4 percent of women who become psychotic kill their babies. Perhaps even fewer tragedies would occur if proper education and treatment were more readily available.

Researchers who study infanticide distinguish several different groups of parents who murder their offspring. Some kill as a result of psychotic delusions-the dread of parent-child merger or the belief that the child is trying to harm or kill them. Others murder their children out of profound depression and hopelessness. Often they carry strong religious ideas that killing their child will enable them both to enter an afterlife more peaceful than their current life. Susan Smith, the South Carolina mother who attempted to drown herself and her children by driving her automobile into a lake, may be an example of someone in this group. Although Smith ended up killing her children but not herself.

Tragically, there are also parents who kill their children out of vengeance and rage against the other parent. They want to hurt the other parent by depriving them of their most cherished relationship. This type of infanticide is committed far more frequently by fathers.

Assessing the Source

As with most mental illnesses, what causes the onset of postpartum mood disorders is still a matter of research and debate. Much of the medical community believes these syndromes may be caused by chemical imbalances in the brain-specifically shifts in hormone levels. According to Postpartum Support International (PSI), a network of mental health professionals and others concerned with promoting postpartum mental health and social support, the most well-researched theory to date suggests that a sharp drop in estrogen and progesterone following delivery is the culprit.

Research currently under way at the National Institute of Mental Health is examining these hormone-mediated mood shifts and Victor Pop, Ph.D., of the University of Tilburg in the Netherlands, recently presented his own findings at the annual meeting of London's Royal College of Psychiatrists, suggesting that women who produce certain thyroid antibodies during pregnancy were nearly- three times more likely to experience depression after childbirth.

"I think there will be a role for hormones in treating postpartum illnesses in the future," says Valerie Raskin, M.D., clinical associate professor at the University of Chicago. "[Hormones] will probably be used as a treatment first, then later as a preventive measure. The reproductive process may be the kindling, and the drop in hormones after childbirth may be the ember that starts the fire."

Various nonhormonal factors may also contribute to postpartum disorders of mood. Some studies suggest a relationship between a traumatic obstetric experience and PPD. Women who had caesarean deliveries, for instance, were significantly more susceptible to mood disorders as noted in one study appearing in the Australian and New Zealand Journal of Psychiatry.

Thyroid disease may also be a physiological trigger, suggests research by Stephen Pariser, M.D., a psychiatrist and mood-disorders specialist at Ohio State University Medical Center. Women's thyroid levels drop significantly after giving birth, and low thyroid levels have long been associated with depression-like symptoms. Having a personal or family history of mood disorders also increases the odds of developing PPD, pointing to a possible genetic factor.

Women who develop PPD or postpartum psychosis following delivery have a significantly greater risk of developing these conditions after subsequent childbirth. These women should be counseled about future pregnancies. If they do conceive additional children, careful psychiatric monitoring is mandatory.

Certainly, social elements also play an integral role in postpartum well-being. One important factor is a lack of social support, which includes poor relationships with others and insufficient childcare during the pre- and postnatal period. Strong support systems can help nurture and maintain self-esteem at stressful times, Kleiman asserts. "In turn, high levels of self-esteem are linked with adaptive coping behaviors-feeling entitled to ask for help, for example."

As a society, we tend to romanticize motherhood, creating a disparity between a woman's expectations and the reality that she will experience. "Society reinforces the myth of the perfect baby in the arms of the perfect mother, with all her maternal instincts intact," says Kleiman. "When there is a significant discrepancy between what a woman anticipates and what she actually experiences, guilt, confusion and great unhappiness can result."

In addition to societal pressures, personal adversities such as loss of a loved one, marital conflict or lack of financial security, can put some women at greater risk, according to PSI. Lifestyle and role changes also create internal conflict and stress: A new mother may lose the independence, spontaneity, personal time, sleep and physical shape that she once had, along with her role as an attention-drawing pregnant woman or as a career woman. Finally, she may simply miss adult company in general. "Women with PPD will find adapting to these losses especially difficult," Kleiman notes, "because of their increased vulnerability."

Mending Mothers

Most experts agree that combining talk therapy with medication seems the most successful approach to treating PPD. "Medication is warranted," Raskin explains, "because the situation is urgent and the quickest treatment makes sense." Depending upon the patient, psychotherapy may be combined with both group support and medication, which is prescribed according to the patient's individual symptoms while monitoring the various drugs' side effects.

The most commonly prescribed are the newer antidepressants including Prozac, Zoloft, Paxil, Celexa, Wellbutrin, Serzone and Effexor, as well as anti--anxiety drugs such as Ativan, Lorazepam and Klonopin. When the underlying cause of PPD is bipolar affective disorder, mood stabilizers-Lithium or Depakote, for instance-are also appropriate.

For women experiencing postpartum psychosis, more aggressive treatment is required. These mothers may be a threat to both themselves and their babies. Psychiatric hospitalization, as well as anti-psychotic and other psychiatric medications, is standard treatment along with individual, group or cognitive behavioral psychotherapy.

And because at least half of women with PPD experience a recurrence of the illness after having another child, responsible parenting necessitates careful thought and medical planning before deciding to get pregnant again. Once PPD is present, "all resources must go toward treating the mother," advises Raskin. "Stress of any sort, including the stress of caring for children, will prevent the mother from healing."

Preventing PPD

Effective prevention would help render treatment less necessary, avert emotional damage to children and potentially save lives. Shoshana Bennett is one mother who might have benefited from preventive measures. Instead, her childbirth classes concentrated on breathing techniques and what to pack for the hospital. And during her first postpartum checkup, Bennett's obstetrician glossed over her weight gain of 40 pounds and uncontrollable weepiness.

When Bennett mentioned to her family that she was having a difficult time, her mother-in-law-a postpartum nurse for 20 years-told Bennett's husband, "Shoshana is a mother now. She needs to stop complaining and just do it." Bennett's own mother was supportive but, despite her background in therapy, failed to recognize the signs of serious emotional illness. Bennett also began seeing a psychologist, who only probed for issues in her past. Eventually, about two years after the birth of each of her two children, Bennett's obsessive concerns finally faded on their own.

Several years later, Bennett happened to see a television program on postpartum depression. "I cried for an hour, looked at my husband and said, 'That's me!'" she says. Afterward, she earned her Ph.D. in clinical psychology and founded a self-help group for postpartum disorder sufferers. Then in 1992, she was named president of the Post-partum Health Alliance, a California state organization.

Today, the discussion of postpartum mood disorders is often inadequate in reference manuals. General physicians can find the terms postnatal depression, postpartum depression and puerperal psychosis in the International Classification of Diseases manual, says Cheryl Meyer, Ph.D., J.D., an associate psychology professor at Wright State University in Dayton, Ohio. "However, they may only use these diagnoses for patients whose symptoms do not meet criteria for other disorders, such as depression," she explains.

Jennifer Moyer, now a coordinator for PSI and a postpartum support consultant, understands firsthand why medical professionals need to pay more attention to postpartum mood disorders. For her, recovery came after two years of medication, therapy and family support, and she believes that talking to someone who has experienced a severe postpartum mood disorder firsthand is essential for recovery. She now combines her own experience with her background in health care marketing to advocate for education and prenatal and postnatal screening.

Until the health insurance industry and government agencies are willing to allocate sufficient resources to guarantee the presence of skilled psychiatrists and psychologists on pre- and postnatal-care teams, assessing and treating postpartum mood disorders will continue to fall through the cracks. Both Moyer and Bennett join other health care professionals in the hope that efforts to focus on women's emotional needs before and after pregnancy will gain momentum. This effort will help other women and their families avoid disabling yet treatable illnesses or, tragically, from having to endure another preventable murder of an innocent infant.

Mark Levy, M.D., FAPA, is an assistant clinical professor of psychiatry at the University of California at San Francisco.

Attorney Deborah Sanders, Esq., practices law in San Francisco.

Stacy Sabraw is a freelance journalist based in New York City.

© Copyright 2001-2002 Sussex Publishers

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The "Eggshell Plaintiff" Revisited: Causation of Mental Damages in Civil Litigation

The Commission on Mental and Physical Disability Law Reporter
by Mark I. Levy, MD, FAPA and Saul E. Rosenberg, PhD

Download EggshellPlaintiff.pdf

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The Stigma of Mental Illness in the United States

By Mark I. Levy, M.D.

America today is plagued with a pandemic prejudice against those suffering with mental illness that is crippling our nation. Our society equates mental illness with moral weakness, causing individuals to deny their mental suffering out of fear that they will appear to be morally culpable for it.  In so doing, we are telling these individuals that they are inadequate and not meeting socially acceptable standards

We don't moralize about physical pain.  For example, when someone has a broken leg, we don't advise him to, "Shake it off."  Yet, if the same individual describes his symptoms of depression, we encourage him to, "Get out and exercise...pull yourself up by your bootstraps...you'll get over it."  Such advice is useless, inappropriate and blames the sufferer for his illness.

Rather than give in to the great desire to deny the disability caused by mental illness, we need to acknowledge that mental illness is just as valid as physical illness.  We need to view emotional symptoms with the same clinical, objective manner as physical symptoms.  Only then, can we reach out to provide the treatment that will help those suffering and aid them to become contributing members of our society.

Face the Facts of Mental Illness

No. of Americans Suffering from Mental Illness

• As many as 80 percent of people suffering from mental illnesses can effectively return to normal, productive lives if they receive appropriate treatment.
• During any one-year period, up to 50 million Americans, more than 22 percent, suffer from a clearly diagnosable mental disorder involving a degree of incapacity that interferes with employment, attendance at school or daily life.

Cost of Mental Illness to Society

• The direct costs of support and medical treatment of mental illnesses total $55.4 billion a year.
• The indirect costs, such as lost employment, reduced productivity, criminal activity, vehicular accidents and social welfare programs increase the total cost of mental and substance abuse disorders to more than $273 billion a year.

Efficacy of Treatment for Mental Disorders

• Medications relieve acute symptoms of schizophrenia in 80 percent of cases, but only about half of all people with schizophrenia seek treatment.
• With therapy, 80 to 90 percent of the people suffering from depressive disorders can get better, but fewer than one-third of those suffering seek treatment.
• Refinements of lithium carbonate, used in treating manic-depressive (bipolar) disorder, have led to an estimated annual savings of $8 billion in treatment costs and lost productivity associated with bipolar disorder.
• Studies of psychotherapy by the National Institute of Mental Health have shown it to be very effective in treating mild to moderate depression.

Statistics gathered from the American Psychiatric Association's web site: www.psych.org.

To interview Dr. Lamia on the topic of social interaction and radio talk shows or Dr. Levy regarding the stigma of mental illness in our society, please call Mary Tressel, Media Consultant, at 925-686-2958.

News Room is published as a service to the media by the San Francisco Foundation for Psychoanalysis.

Scientific Editor: Mark Levy, M.D. (415) 388-8040

Executive Director: Sandra Schaaf (415) 563-6065

Managing Editor: Mary Tressel (925) 686-2958

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Overcoming Obstacles to the Independent Examination of Emotional Damages Defense

Comment
Spring 2004
by Saul Rosenberg, PhD & Mark Levy, MD

Download OvercomingObstacles.pdf

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Shrink in the Courtroom: Forensic Psychiatry and Law

by Mark Levy, M.D.

This is the first in a series of articles about forensic psychiatry as it is utilized in civil litigation. In this article, I will describe how a forensic psychiatrist can be useful to trial attorneys in civil litigation whenever there are allegations of emotional damages.

What Is Forensic Psychiatry?

Forensic psychiatry is the application of psychiatric clinical knowledge and research to the practice of law where plaintiff’s (or criminal defendant’s) mental status is at issue. The forensic psychiatrist is an expert at making diagnostic and prognostic judgments that are informed by scientific research and clinical experience about whether a plaintiff’s subjectively experienced emotional distress and/or functional impairment can be plausibly related to the alleged accident, injury, or tort. In addition, the forensic psychiatrist considers whether and to what degree other factors (the patient’s pre-existing condition, the plaintiff’s motivation to seek compensation or to punish the defendant, the plaintiff’s legitimate righteous indignation at being wronged with an appropriate wish to seek justice and reparation, or some combination of any of the above) are entering into the plaintiff’s assertion that (s)he has been psychologically damaged and, were it not for the defendant’s action or conduct, the plaintiff would not be suffering from the particular condition that (s)he has alleged.

Forensic Psychiatry and Civil Law: Motivation

In addition to expertise in diagnosing mental disorders, the forensic psychiatrist has expertise in assessing motivation. A plaintiff’s motivation be outright malingering (faking an injury or psychiatric illness) to make money to wanting to financially and judicially punish the defendant for alleged moral wrongs. At the opposite end of the spectrum, an injured plaintiff seeks damages to obtain necessary medical care and, as much as possible, restore his or her life to its pre-injury status. Not infrequently, a combination of these factors are at work. Teasing out the plaintiff’s motivation requires a considerable amount of clinical experience, skill, and acumen, as well as a familiarity with applicable law.

A prospective client tells you he has suffered severe emotional stress (with or without physical injury) as a result of a car accident, or his employer’s actions, or his insurance company, or his doctor, or a drunk driver, or anyone who has damaged, hurt, or injured him by accident, through negligent conduct or any other reason. If you are deciding whether to represent him, or if you are defending your client against his claim of personal injury, how do you assess whether or not the plaintiff is indeed suffering from a psychiatric disorder or injury and, if he is, how do you assess whether it was causally related to the alleged incident or conduct by the defendant? In essence, you have questions about causation and psychological damages. How do you determine the truth?

Only a forensic psychiatrist (or forensic psychologist) has the necessary training and experience to assess the plaintiff’s psychological and psychiatric status at the present time, to make inferences about the plaintiff’s emotional state at the time of the accident or injury, and to determine if there is a plausible connection between that accident or injury and the plaintiff’s current mental state. Among the questions usually addressed by a forensic psychiatrist I in civil litigation are the following:

• Is this particular plaintiff suffering from a recognized mental disorder? That is, what is the diagnosis, according to the Diagnostic and Statistical Manual of Psychiatric Disorders, Fourth Edition, Text Revision, 2000 (DSM-IV(TR)?
• If (s)he is indeed suffering from a disorder, was that disorder caused or exacerbated by the events, incidents, or issues under dispute in the present lawsuit?
• Were there pre-existing psychological problems or psychiatric illnesses in the plaintiff’s medical history that were likely to have caused present symptoms of “damages,” even if the event(s) under dispute had never occurred?
• Specifically, does the plaintiff have a pre-existing personality disorder or other mental condition that predisposes the plaintiff to their current psychiatric symptoms and that may be at least as much the proximate cause of the current symptoms as were the incidents under dispute?
• Or, was the plaintiff functioning adequately prior to the event and, were it not for the disputed incident(s) or event(s), would still be functioning adequately and without significant impairment?
• What is the most appropriate type and duration of treatment recommended for the plaintiff’s mental disorder(s)?
• What is the likely cost of such treatment?
• To what extent (if any) and in what manner should the liability (and cost) of the plaintiff’s damages and future treatment be apportioned among various defendants, or between pre- and post-incident causative factors?

These can be weighty questions with significant financial and emotional consequences for both parties in a dispute. It goes without saying that the forensic psychiatrist must proceed cautiously and comprehensively when evaluating the entire range of data relevant to the plaintiff’s psychological complaints, including all medical records (including those predating the dispute), all relevant deposition transcripts, and other documentary evidence. Ultimately, the forensic psychiatrist must present the data and his conclusions with reasonable medical certainty (i.e., with more than a fifty percent probability of accuracy).

The “Crumbling Skull” Plaintiff

Paget’s Disease of Bone is the prototype for the “crumbling skull” plaintiff. In Paget’s Disease, a progressive, degenerative condition of the skeletal system, bones become fragile and break repeatedly in the normal course of daily activities of living, such as something as innocuous as bumping into a doorway. Consequently, whether or not the event(s) alleged to have “caused” a fracture actually occurred, the Paget’s Disease plaintiff will continuously suffer broken bones over time regardless of what traumatic events do or do not befall them.

There are chronic, pre-existing psychiatric conditions that metaphorically mimic this bone disease. For example, a schizophrenic passenger in a bus collision may experience hallucinations and delusions after the accident. However, to argue that the accident was the proximate cause of his psychotic symptoms is to ascend a slippery and dangerous slope. In all likelihood, the chronic mentally ill plaintiff experienced similar mental symptoms prior to the accident and would have continued to do so throughout the course of his life, whether or not the bus collision had ever occurred.

The “Thin Skull” Plaintiff

Another bone disease, Osteogenesis Imperfecta (in which bone tissue is congenitally thin, fragile, and subject to easy fracture in particular places), is the prototype for “thin skull” plaintiffs.

For example, an attractive, seductively dressed thirty-something female sales employee of a large corporation is allegedly exposed to off-color sexual banter and subsequently overt sexual propositions by her middle-aged, male supervisor. Eventually, they date and have sexual intercourse on several occasions. While an employee, she never files a complaint of sexual harassment with the firm’s human resources department. However, during a period of company cost reduction, she is terminated. She sues alleging wrongful termination, sexual harassment, sexual abuse, and gender discrimination. She argues that she was fired when several male co-workers were retained due to gender discrimination, that she was subjected to a hostile work environment, and that her sexual activity with her supervisor was a quid pro quo that she believed was necessary in order to keep her job. The supervisor argues that she was sexually seductive toward him in her dress and behavior, that there was never any harassment or coercion, that their subsequent sexual activity was entirely consensual, and that she was terminated from her position due to her marginal sales performance. In essence, it is her word against his.

Defense argues that plaintiff had no objection to the sexual activity prior to being fired, that the allegations of sexual harassment and discrimination were manufactured, and that the filing of her lawsuit was either simple retaliation for being fired with cause or frank malingering in order to obtain monetary compensation. They do not retain a forensic psychiatric expert. Plaintiff’s counsel does retain a forensic psychiatrist who, in the course of conducting an in-depth independent psychiatric examination, learns that as a child, plaintiff was regularly molested by her alcoholic stepfather over a period of seven years, and that she complied with his sexual demands in order to keep the peace in the family and protect her mother and younger brother from his alcoholic rages and physical abuse. The records of a child protection service investigation report on plaintiff’s childhood abuse are produced during discovery.

As a result of the forensic psychiatric expert’s report, plaintiff’s counsel argues that his client is a psychologically “thin skull” plaintiff who was particularly vulnerable to the sexual overtures of a male supervisor because her childhood experiences had “taught” her to comply with the sexual overtures of male authority figures in order to prevent more frightening consequences from occurring. Should the defense make a substantial offer to try and settle this case? Who is a jury likely to believe?

The Paranoid Litigant

A trial attorney once quipped to me when I was discussing my interest in paranoid litigants, “Is there any other kind?” Despite the possible truth in this somewhat cynical remark, paranoid litigants need to be identified and correctly understood in order to cautiously screen their allegations before taking them on as clients and in order to effectively defend their lawsuits. Regrettably, they may contribute to the crowding of judicial calendars, cost the courts and their communities substantial sums of money, represent themselves pro se and not infrequently sue their former counsel. In addition, they are also excellent examples of psychologically “crumbling skull” plaintiffs.

Paranoid and narcissistic personality disorders are a special category of psychiatric “crumbling skull” plaintiffs. Those litigants with these DSM-IV Axis II diagnoses have long standing, psychological difficulties, often exhibit self-defeating strategies of living, feel chronically victimized, suffer from fragile self-esteem, and consistently externalize blame and responsibility for difficulties that befall them, even when they have instigated the very conditions by which they feel victimized. A paranoid plaintiff who, while representing herself pro se after firing one attorney and before retaining the next, provocatively insulted the judge in a law and motion hearing by calling him “senile,” but subsequently felt persecuted and enraged when the judge decided most of the motions presented in favor of the defense.

Paranoid litigants aggressively appeal adverse decisions to the highest judicial levels if permitted and consequently cost themselves, their families, and the judicial system considerable amounts of time and money. They frequently represent themselves pro se, at least during a portion of their litigation, and when they eventually do retain counsel, they not infrequently replace their attorneys during the course of litigation. It is not unheard of for them to sue their former counsel over disputed billing or alleged acts of legal malpractice.

When their complaints include emotional damages, they invariably cite DSM-IV Axis I, acute psychiatric disorders such as Post Traumatic Stress Disorder or Major Depression. They never attribute their alleged suffering to their underlying, long-standing, personality disorder. Nevertheless, it is in fact their paranoid and narcissistic personalities that inevitably drive their litigious activities. This dimension of their psychological make-up must be delineated and addressed by a forensic psychiatric expert in order to present to presentan effective defense of their allegations.

Personality disorders are pathological, long-standing, chronic, fixed mental conditions. Plaintiffs with paranoid and/or narcissistic personality disorders may attempt to use the judicial system to seek external remedies for their own internal psychological problems. Short of declaring a plaintiff a “vexatious litigant,” the courts and public agencies are relatively helpless to defend their crowded calendars and fixed budgets against judicial abuse by paranoid litigants because of the overarching legal value that “everyone deserves his day in court.”

Unfortunately, plaintiffs who suffer from a paranoid or narcissistic personality disorder almost never seek psychological treatment for their underlying problem. Rather, they attempt to externalize blame via litigation in an ongoing quest for external restitution and vindication of their internal psychological wounds. Furthermore, these “wrongs” are frequently experienced by the plaintiff as a “moral” assault, which in turn fuels the plaintiff’s sense of righteous indignation. As trial attorneys know from bitter experience, client control can be difficult with these plaintiffs, and seeking a settlement can feel like playing against a perpetually moving goal post.

During the litigation process itself, these plaintiffs are subject to bouts of emotional instability, anxiety, and narcissistic rage whenever others, including the court itself, oppose their self-declared “just” cause, or simply do not interpret events, the law, or even reality, exactly as the plaintiffs believe they should. Paranoid and narcissistic plaintiffs tend to see the world, including the judicial world, in strictly black and white terms and have little tolerance for ambiguity, uncertainty, or even their own frustration.

It is therefore important for plaintiff’s counsel to consider these issues when seeking an evaluation of a client in order to separate those litigants who have the above personal traits, without a reasonable cause of action, from plaintiffs who may have entirely legitimate grievances as well as a pre-existing personality disorder. A plaintiff may have a paranoid personality, and may also have been legitimately wronged; telling the difference between that type of litigant and one who merely believes they were wronged and is engaged in an endless quest to seek restitution for old hurts and insults requires expert evaluation and judgment.

The forensic psychiatrist has a crucial role in civil litigation where alleged psychiatric illness and motivation are important issues. In retaining a forensic psychiatrist, counsel should look for highly experienced clinicians who are familiar with legal issues, can weigh evidence and present logical and compelling explanations for their opinions based on the evidence in the case and the background of scientific knowledge pertaining to mental disorders and human motivation.

This article is the first in a series. Subsequent articles will examine such topics as expert psychological testing and opinion; federal anti-discrimination and entitlement laws, including the Americans with Disabilities Act (ADA), The Fair Housing Amendment Act, The Age Discrimination and Employment Act (ADEA), The Individuals with Disabilities Education Act (IDEA), and the Social Security Laws; determinations of testamentary capacity; questions of civil commitment and involuntary hospitalization and treatment; evaluation of children being adjudicated within the juvenile court system; child abuse and neglect; and child custody in divorce.

I wish to particularly thank my colleague and friend Saul Rosenberg, Ph.D. for his considerable assistance with the preparation of this article.

Mark Levy, M.D., a Fellow of the American Psychiatric Association, is a psychoanalyst and for more than twenty-five years has been in full-time private practice of general and forensic psychiatry in Mill Valley, California. He is certified by the American Board of Psychiatry and Neurology in both General Psychiatry and Forensic Psychiatry. He is on the clinical faculty of the Department of Psychiatry at the University of California-San Francisco, where he teaches in the Forensic Psychiatry Fellowship. He also maintains a website on law and psychiatry at www.lawandpsychiatry.com. He can be reached at mark@levymd.com. Please feel write to him care of San Francisco Attorney with particular questions, comments, or topical requests.

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All in the Office 'Family'

Los Angeles Times  5/18/98
CAREERS / ADVERSITY AND CONFLICT

Employees and bosses sometimes reenact childhood family dynamics on the job. Is your workplace dysfunctional? Read up on these relating styles and find out.

By: SUSAN VAUGHN -  SPECIAL TO THE TIMES

The successful executive in psychiatrist Mark Levy's office was complaining of deja vu. "He had a critical father he couldn't please, who'd told him he was little and inconsequential," recalled the San Francisco-based psychoanalyst. "And now he found himself with a superior who was belittling him just as his father had. In response, he was becoming submissive and enraged, just like in childhood."

West Los Angeles-based psychologist Marion Solomon was consulted by a real estate firm president whose subordinates seemed ready to mutiny. "He didn't understand why everybody was complaining about him," she said.

"In fact, he felt under appreciated."

The entrepreneur had grown up in a chaotic household where he was forced to take care of his family's needs. "Now he was trying to 'parent' his employees too," Solomon said. "But he was coming across as terribly controlling."

Reenacting childhood family dynamics in the workplace is not unusual, according to many human behavioral behavior experts. "We learn how to connect to people from our mothers, fathers, sisters and brothers," Solomon said. "And we develop certain patterns of relating, based on these early interactions. Unless something comes along that makes us question our behaviors, we tend to replay the dynamics over and over."

"Workplace families," like nuclear families, can be rife with sibling rivalry, mom-vs.-dad power struggles, tyrannical over-parenting and adolescent rebellion. Or they can be Ozzie-and-Harriet havens, where personnel interact peacefully. Stress, agreed Solomon and Levy, is the single most influential factor that may provoke regressive behaviors in employed adults.

Most people are not aware that they're acting out old scripts with new players, Levy said. "It's a universal phenomenon that occurs over and over in the workplace and in other group functions."

How can workers tell when they are regressing into familial patterns?

"When you find yourself in a situation that's evoking more emotion than what's reasonable, that's a giveaway," Solomon said. "Break away and ask yourself, 'What's really going on here?' You may be caught in an old story . . . or if someone else is reacting strongly to you, it could be that you're in their old story."

Solomon recalled a female client -- "this very strong powerhouse attorney" -- who experienced deja vu during an annual review. She had sought counseling after she burst into tears in front of her firm's senior partner. "She had been widely perceived as capable, tough and extremely ambitious," Solomon said. "But when the partner expressed just a little doubt about her and told her to do something better, she began to cry."

It was a scene from her long-ago past. Decades before, the attorney-to-be had been sharply upbraided by her father about her perceived shortcomings. "He'd yell at her until she was in tears," Solomon said. "So it's not a surprise that the child from long ago reemerged when she was criticized by a superior."

Sigmund Freud believed that family relationships influenced individuals' character development. In the late 1940s, British psychiatrist John Bowlby further explored this theory in his exhaustive treatise, "Attachment and Loss," which examined the effects of the early infant-mother bond upon the developing child.

Some children who had difficult relationships with their caretakers experienced similar problems relating to others, according to Bowlby. But mental health professionals today stress that a rough childhood is not an automatic sentence for an unhappy adulthood. "People can transcend disappointing childhood by forging healthy relationships with other caring adults through marriage, friendship and, in some cases, psychotherapy," Levy said.

Nonetheless, some dysfunctional office "family" behavior may be the vestige of long-ingrained relating styles. Solomon illustrates a few of these:

* 'Avoidant' Style

This employee may be a skilled, dedicated worker who is intimidated by others. He prefers to work alone, has few or no friends, and often becomes frustrated when he can't ask for what he needs. He gravitates toward occupations that offer him independence and solitude.

The avoidant-style boss seems unapproachable. He is likely to appoint an assistant to interact with others on his behalf.

"In the avoidant person's childhood," Solomon said, "he may have felt that his caretaker wasn't available, so he stopped trusting people. Now he may feel that it's safer to keep a shell around himself."

* Ambivalent Style

This worker wants to be close to her co-workers and boss but can't. She may first idealize them, then later feel betrayed by them because they've disappointed her in some way. An ambivalent-style employee may obsess about perceived grievances. She is likely to blame others for her difficulties.

The ambivalent-style boss may have a revolving door for incoming and outgoing employees. At first, she may rave about her subordinates' work, but then will notice "glaring shortcomings." Sometimes this boss surrounds herself with non-threatening, less competent staff because she worries that those who are skilled and ambitious may compete for her job.

"This person may have been very close and loving with a parent, but then something happened that caused her to lose trust -- maybe the parent died or there was a divorce," Solomon said. "So she's unable to trust in relationships because she fears she'll be hurt again."

* Abusive Style

The abusive-style employee gets into lots of trouble at work. He argues with co-workers, ignores corporate policy and may be insubordinate.

The abusive-style boss requires very little provocation in order to lose his temper. He may bully subordinates into doing what he wants and punish them for perceived wrongdoings.

"A person who behaves in these ways may have felt abused in childhood," Solomon said. "He could have been told there was something wrong with him, or witnessed or been victim to physical abuse. Some who have this history become victims themselves, and act out passive-aggressively in their workplaces. They may complain, create conflict between co-workers and be covertly abusive to those whom they don't like."

If a business "family's" dynamics are dysfunctional, its "members" should examine their own behaviors to determine if they're reenacting familial conflicts.

"If a person repeats a scenario over and over -- such as progressing so far in a firm, then quitting or getting fired -- it's not a flashing yellow light but a flashing red light to seek help," Levy said. "You may not understand why this is happening, and not fully remember its origin, but you'll be aware that your difficulties keep reoccurring.

"The problem," Levy said, "is that in all but the most enlightened firms, nobody asks for help until there's already a three-alarm fire -- a senior partner gets so abusive that a woman files a sexual harassment suit or a worker is so stressed that he's throwing paperweights through a wall."

If one employee is disrupting interactions in the company, Levy recommends that management encourage the worker to seek professional help. But if a company's "extended family" seems to be relating in a dysfunctional manner, Levy suggests that the people in charge look closely at their "managing/parenting" styles.

"Leadership styles tend to define organizational styles," he said. "So if a manager is paranoid, everyone in the office probably will be looking behind their backs. And if the manager is schizoid and has discomfort with interpersonal relationships, information won't be shared."

Like healthy families, functional corporate families should stress values such as honesty, open communication, security, teamwork and loyalty. "A synergy occurs in the workplace when people are interdependent," Solomon said. "They know people are there for them, and this helps them do their jobs better."

Copyright (c) 1998 Times Mirror Company

Note: May not be reproduced or retransmitted without permission. To talk to our permissions department, call: (800) L

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