The literature on Post Traumatic Stress Disorder (PTSD) over the past decade has expanded the concept of PTSD to include symptoms reported from extensive studies on bullying in the workplace done in the UK and Australia, ongoing research into Legal Abuse Syndrome, and the various conditions treated by the Department of Veterans’ Affairs. Current thinking is converging on the expanded concept of Complex PTSD. Complex PTSD refers to symptoms of PTSD that, untreated, may last a lifetime resulting from prolonged, negative stress profoundly affecting the quality of a person’s life. Van der Kolk’s research clearly demonstrates that no one greets a traumatic event in a vacuum. Early childhood trauma causes vulnerability toward succumbing to critical events by developing PTSD. It is important to note that all people experiencing the same event do not become equally symptomatic. This means any life altering, negative, prolonged stress can and does create hormonal, emotional, mental, and physical symptoms. This includes stress from litigation. (Van der Kolk, 2004 Kinchin, 2001 Huffer, 1995 Baker, 2005)

1. Published in part in Diogenes the magazine, Fall Edition, 2005 p.8 -10 and 34.
Judicial System Inaccessibility for Those with
Psychiatric Injury
Legal Abuse Syndrome as a Psychiatric Injury and
Diagnosable Subcategory of Post Traumatic Stress
Disorder
By
Karin Huffer, M.S., M.F.T. and Barbara Parrett, M.S., R.N., C.N.S.
Reader Summary
A population of legal consumers is emerging who, when needing to use the court
process, find that the process itself contributed to or created symptoms of PTSD.
Access to a fair hearing was denied either by symptoms that disadvantaged the
litigant, unbearable legal fees and costs, and/or an attitude of exclusivity among
judicial personnel discriminating against pro se or persistent litigants.
In this article, Huffer and Parrett find that distance treatment options are gaining
credibility allowing for services to be extended to litigants suffering from PTSD
(called Legal Abuse Syndrome if caused or exacerbated by the litigation). Courts
are accepting diagnoses of psychiatric injury as a subcategory of Post Traumatic
Stress Disorder and respecting psychological treatment provided by distance
services allowing for more accurate diagnoses and needs to be communicated to the
courts. Both Daubert and Frye standards have been met by focusing on access to
the court using creative means to accommodate PTSD sufferers. Medicare,
Medicaid and most insurance companies recognize and approve distance therapy by
qualified professionals as compensable.
New distance treatment options are being created to improve accessibility to the
courts for those with psychiatric injuries. The literature on Post Traumatic Stress
Disorder (PTSD) over the past decade has expanded the concept of PTSD to include
symptoms reported from extensive studies on bullying in the workplace done in the UK
and Australia, ongoing research into Legal Abuse Syndrome, and the various conditions
treated by the Department of Veterans’ Affairs. Current thinking is converging on the
expanded concept of Complex PTSD. Complex PTSD refers to symptoms of PTSD that,
untreated, may last a lifetime resulting from prolonged, negative stress profoundly
affecting the quality of a person’s life. Van der Kolk’s research clearly demonstrates that
no one greets a traumatic event in a vacuum. Early childhood trauma causes
vulnerability toward succumbing to critical events by developing PTSD. It is important
to note that all people experiencing the same event do not become equally symptomatic.
This means any life altering, negative, prolonged stress can and does create hormonal,
emotional, mental, and physical symptoms. This includes stress from litigation. (Van der
Kolk, 2004 Kinchin, 2001 Huffer, 1995 Baker, 2005)

2. Complex PTSD and physical threats from disasters, wartime or bullying are
clearly understood. However, there remains a population of Americans who are unable
to effectively use their judicial systems to attain reasonable protection when threatened
by disputes or conflicts. This population consistently reports symptoms of PTSD from
being bullied and traumatized in an invisible way during divorce and custody litigation,
contractual conflicts, disputes that can become irrational, even terrorizing due to various
frauds and assaults on character common in court proceedings.
A reporter for The Oklahoman newspaper, March 28, 2005 characterized this
rampant but invisible force in the following as her column. It is representative of the
increasingly popular attitude toward our American court system whether from
comedians’ jokes, or more than one million websites asking for legal reform, or the
positive peer reviews of Karin Huffer, M.S., M.F.T.’s research and thesis that
inadvertently the justice and legal enforcement systems can and often do cause Post
Traumatic Stress Disorder termed Legal Abuse Syndrome and may cause the Judicial
system, supported by taxpayers, to be inaccessible to the average person and
progressively less accessible as PTSD manifests with all the symptoms of psychiatric
injury:
A prosecutor once told me, "If it's funny, it's not a crime." I
had plenty of time to ponder that notion a few years ago
during a seemingly endless string of trial delays. I said to
myself: "Self, if you do not laugh ... then you are a victim."
Victims hope justice will prevail. Survivors know better.
So, I decided to become a survivor. In my spare time sitting
around the courthouse, I did a lot of deep thinking -- about
how life sometimes doesn't turn out the way we plan -- and
how mine was starting to resemble a really bad episode of
‘Roseanne.’ Also, I had time to write a best-selling, self-
help book: "Stalking for Dummies."
OK ... I admit ... it wasn't a best-seller. But it made me
laugh..., which technically, is not a crime .I, observed that
victims are like "eggs" in the pancake batter of our legal
system. Blending with other ingredients (i.e. judges,
lawyers & perpetrators), the mixture becomes hopelessly
convoluted, overpaid and undercooked when poured upon
the luke-warm griddle of American jurisprudence. Bad
breakfast analogies aside -- let's face it -- there are some
things in this life over which we have no control. Justice is
one of those things. The outcome of any court case isn't
necessarily based upon its merits, truth, the egregious
nature of a situation and/or the suffering of its victims,
many of whom become unwitting actors in a grotesquely
litigious theater of the absurd.

3. In courtrooms across America, the faint but persistent cry
for justice is barely audible over a cacophony of legal egos
-- and, in Oklahoma, at least one electronic sexual device.
Still, our capacity to render justice remains predicated
upon judicial power and restraint, or the lack thereof (refer
to previous paragraph). A failed system is no comfort to a
grieving, single dad whose little girl was snatched from her
bed and brutally slain by a convicted sex offender. It offers
no apologies to the innocent man who spent 20 years in
prison for a crime he didn't commit.
Nothing can fix the betrayal felt by a terminally ill boy
allegedly molested at the ands of his ‘hero’ -- a
narcissistic, hypochondriac pop star. The search for truth
has eluded heart-broken parents who waged a futile court
battle on behalf of their brain-damaged daughter. Instead,
‘justice’ sentenced them to endure the sight of her slowly
starving to death. Sadly, we live in a country where
common sense no longer applies ... where respect and
compassion have surrendered to self-reason and faulty
human logic. Judges, appellate courts and politicians
would rather be RIGHT, than do the right thing. Our
failure offers no consolation to those faithful, abiding souls
who dutifully walked America's halls of justice, only to
discover there was none. By Sally Allen Anti-News Editor
NewsOK.com
Sally Allen writes of current events in 2005 with a sarcastic twist. Huffer witnesses,
daily, American citizens who are living under the oppression of terror and whose cries for
help and justice are left unheard. Our systems too often fail to serve those suffering
PTSD as the following few examples portray:
Case A, involves a woman who married a man with fraud as the woman’s intent. She
romanced the man, married him, and learned how to manipulate the law enforcement
“hot buttons” of spousal abuse. She created scenes and falsely reported abuse causing the
man to be arrested. While he was in jail, she emptied his house and bank accounts and
left town. He lost his business, he is still fighting to regain his reputation. He has
unfairly spent time in jail leaving him with open emotional wounds and PTSD.
Case B, involves a woman who witnessed her husband-to-be abusing his children. She
ordered him to stop and reported him to the authorities. He threatened her, abused her,
and reported her for being “crazy” and violent. She was arrested. While in jail, she was
denied her medication, her pets died from neglect, she was told to leave the area and not
come back or face re-arrest. He now sits in the house and property she bought with her
funds, has not paid the mortgage and progressively damages her credit. She is still
fighting for a chance to have her case heard in a fair court.

4. Case C, involves a woman who lost custody of her children in a divorce proceeding. She
wants to reopen the matter. She pays child support when she can; however, every time
she gets work, her ex-husband and/or his overzealous attorney contact the employer and
inform them that they may be drawn into litigation if they employ her. Then when she is
unable to pay her child support, she is arrested. She can’t see her children, work, prepare
to go to court or even eat or sleep due to the terror of having been arrested and jailed for
what she could not control. The woman has never committed a crime.
Psychiatric injuries result from a person feeling in severe jeopardy while being held
helpless as to self-protection. The person suffering from Legal Abuse Syndrome will
present with or develop any combination of the following psychobiological
abnormalities. Think about it, PTSD/LAS is a psychobiosociolegal problem. Human
physiology keeps the score and explains the basis for traumatic reaction that follows a
severe usually invisible impact event in the Court. The event is usually traced to the
moment adjudication favors the side committing fraud on the court through
misinformation be used as strategy. There is no rational defense against a lie leaving the
one defrauded helpless in the face of jeopardy; the formula for PTSD.
Psychophysiological Effects
Flashbacks
Startle responses
Hyperreactivity/hyperarousal
Neurohormonal Effects
Hypervigilance, unable to relax or have peace due to intrusive thoughts/emotions
Stress Hormones reduced and down-regulation of receptors – numb/exhausted
Serotonin
Decreased activity inviting depression
Medication helpful but LAS sufferers often resist medication. They feel a
compulsion to affect societal correction and live with a sense of unfinished
business.
Memory
Amnesia/dissociation
Numbness/confusion/avoidance
Increased opioid response to trauma related stimuli
Neuroanatomical Effects
Decreased hippocampal volume
Decreased immune system inviting physical illness
Physical Effects
Weight gain or loss
Diminished immune system – succumb to any propensity for illness
Inflammatory conditions

5. Appetite problems
Insomnia (Van der Kolk, 96)
Recent studies have shown that victims of childhood abuse as well as combat
veterans actually experience physical changes to the hippocampus, a part of the brain
involved in learning and memory, as well as in the handling of stress. The hippocampus
also works closely with the medial prefrontal cortex, an area of the brain that regulates
our emotional response to fear and stress. PTSD sufferers often have impairments in one
or both of these brain regions. (Bremner, 1998) These disenfranchised people challenge
the standards and procedures of the court due to their inability to withstand the rigors and
requirements of putting an effective legal case together. Additionally, the sheer expense
of retaining an attorney and sustaining a court case is estimated to be an average of
$75,000. Litigant annual income average is $50,000, Huffer/Alexander, (2007).
The Court and PTSD/LAS
Hovering over the halls of justice has been a cloud of confusion about traumatic
stress and its place in legal processes. Post Traumatic Stress Disorder, PTSD is one of
the invisible afflictions that substantially affect the person’s ability to function
effectively, especially being able to bear up to the emotional and verbal demands of a
legal process. There exists a broad spectrum of attitudes toward traumatic stress whether
it is believed that one uses PTSD to sue for damages simply for profit or whether it is
observed that a litigant is slowly withering from the unrelenting stress and expense of the
process. About 80 per cent of litigants will wither as their immune systems fail and
severe physical symptoms take their toll.
A study of 4,000 participants conducted by Henry Miller and published in the
British Medical Journal in 1961 concluded that there were frequent clinical findings of
hysterical or anxiety-depressive symptoms he even coined the term “martyred gloom.”
This led to an attitude that litigants will create a “compensation neurosis” as explored by
Nay, (1975), when he claimed that, The patient gradually becomes involved in a
stubborn, unyielding struggle against those he blames. Noy goes on to say that the
illness is not healed due to unwillingness to give up the process of injury and
compensation. Others will accuse the PTSD sufferer of malingering in order to misuse
the court process for profit. (MPDLR, 1998, Noy, 1975.) The forensic pendulum swung
against accepting PTSD believing that if that door opened to consider PTSD in the
judicial system, frivolous cases would overwhelm the court.
Then in 1990, Americans with Disabilities Act, Title II, clearly covers PTSD as a
condition requiring appropriate accommodations when needed. In 1995, the U.S. Judicial
Conference adopted a policy on court access for individuals with communications
disabilities reported in the MPDLR 26:5, September/October 2002. It is clearly the intent
of this law that all persons have equal access to the courts. PTSD is one of the disorders
that create amnesia, hypervigilance, intrusive thoughts, hormone changes and somatic
symptoms all interfering with the kind of language delivery under stress that the court
demands. The Veterans Administration recognized PTSD validating the symptoms. The

6. climate is now changing to one of greater sensitivity toward those suffering after being
traumatized. Malingering can be ruled out by a thorough structured interview and case
history. Huffer, (1995)
What is Post Traumatic Stress Disorder/Legal Abuse Syndrome?
Huffer, (1995) used the DSM III, the official Diagnostic and Statistical
Manual accepted and used by doctors and mental health professionals, to diagnose a
mental condition. At that time, a criterion of Post Traumatic Stress Disorder leaned on
the sufferer having faced a single major life-threatening event. Diagnosis did not
formally allow for PTSD to result from "normal" events such as bereavement, business
failure, interpersonal conflict, bullying, harassment, stalking, marital disharmony, or
exposure to traumatic events. While most research and observation was done on veterans
of war, and victims of physically traumatic stress, Huffer saw increased symptoms in
patients who were involved in protracted litigation.
Validating Huffer’s observation, Post Traumatic Stress Disorder (PTSD) criteria
in the fourth edition, DSM-IV loosened the strict criteria from the traumatic event
causing the PTSD to be “outside the range of human experience to merely requiring that
the patient experience intense fear, helplessness, or horror. The diagnostic criteria for
Post Traumatic Stress Disorder (PTSD) are defined in DSM-IV as follows:
A. The person experiences a traumatic event in which both of the
following were present:
1. the person experienced or witnessed or was confronted
with an event or events that involved actual or threatened
death or serious injury, or a threat to the physical integrity
of self or others;
2. the person's response involved intense fear, helplessness,
or horror.
B. The traumatic event is persistently re-experienced in any of the
following ways:
1. recurrent and intrusive distressing recollections of the
event, including images, thoughts or perceptions;
2. recurrent distressing dreams of the event;
3. acting or feeling as if the traumatic event were recurring
(e.g. reliving the experience, illusions, hallucinations, and
dissociative flashback episodes, including those on
wakening or when intoxicated);
4. intense psychological distress at exposure to internal or
external cues that symbolize or resemble an aspect of the
traumatic event;
5. physiological reactivity on exposure to internal or

7. external cues that symbolize or resemble an aspect of the
traumatic event.
C. Persistent avoidance of stimuli associated with the trauma and
numbing of general responsiveness (not present before the trauma) as
indicated by at least three of:
1. efforts to avoid thoughts, feelings or conversations
associated with the trauma;
2. efforts to avoid activities, places or people that arouse
recollections of this trauma;
3. inability to recall an important aspect of the trauma;
4. markedly diminished interest or participation in
significant activities;
5. feeling of detachment or estrangement from others;
6. restricted range of affect (e.g. unable to have loving
feelings);
7. sense of a foreshortened future (e.g. does not expect to
have a career, marriage, children or a normal life span).
D. Persistent symptoms of increased arousal (not present before the
trauma) as indicated by at least two of the following:
1. difficulty falling or staying asleep;
2. irritability or outbursts of anger;
3. difficulty concentrating;
4. hypervigilance;
5. exaggerated startle response.
E. The symptoms on Criteria B, C and D last for more than one month.
F. The disturbance causes clinically significant distress or impairment in
social, occupational or other important areas of functioning. (APA,1994)
The words crazy, breakdown, mentally ill are often used to describe the symptoms
of mental collapse of someone who has been under intolerable strain. The court routinely
appoints a mental health professional to assess the targeted person. If the targeted person
is without funds, the perpetrator and the court may hire their own “expert” to render an
opinion as to mental stability of the targeted person. The court often misses the fact that
PTSD is in the picture and that the demands of the entire matter leading to the legal
process as well as the process itself can be creating a secondary, complex PTSD called
Legal Abuse Syndrome. Further the conditions for an assessment to be effective are
difficult to achieve in an adversarial environment. There has to be a degree of
psychological safety in order to perform a valid assessment. Psychological assessments
routinely ordered by the court are designed to measure mental illness. Complex PTSD is

8. a psychiatric injury not a mental illness. Therefore the assessment of this condition
expands the usual assessment parameters.
A stress collapse from a psychiatric injury is a normal reaction to an abnormal
situation. Nothing is more abnormal than being assaulted, as in the above cases
compounded by turning to the protective systems for help and finding oneself not only
initially assaulted but now assaulted by adversarial opponents and sometimes zealous
attorneys who wind up viciously intruding in every crevice of one’s life. The image of the
targeted person is changed in the community through character assassination, libel, and
slander destroying the person’s efforts to rebuild. These victims find themselves being
accused of wild and invalid wrongdoings. Having to face the source of the trauma over
and over for years in litigation intensifies cumulative PTSD. There is no rest, no closure,
and no “R&R” for these people. This condition is preventable and not to be confused
with mental illness. There are mental illnesses that cause what is known as a
“breakdown” wherein the individual loses contact with reality; however, the LAS type of
collapse is not a nervous breakdown or collapse indicating mental illness. The victim is
in stark reality, unable to believe that such unconscionable pain can be thrust upon him
with no helpful intervention from the court system his tax dollars support to protect him
(Huffer, 1995) (Kinchin,2001).
Baker and Alonso describe what Veterans Affairs considers the critical components
of a PTSD diagnosis.
What are the best ways to diagnose PTSD in light of the current trend? The
diagnostic validity of PTSD is a critical factor since the Americans With Disabilities Act
provides for accommodations in the courts. Also, PTSD greatly impacts directly upon
the content of the case and the strategies that will be used. It is important that the
professional doing the assessment be knowledgeable regarding complex and cumulative
PTSD.
First, there is what is considered a “gatekeeper” criterion. This means that the
person must have been exposed to a traumatic event. The person must have experienced
items one and two of the DSMIV criteria listed above. To summarize, the event(s)
experienced or witnessed must present actual or threatened death or serious injury, or a
threat to the physical integrity of oneself or others. The response must involve intense
fear, helplessness and horror. The description conjures thoughts of earthquakes, auto
accidents, 9/11, and other such horrors. However, also qualifying are situations where
the person is taken captive and loses control over the environment. Sensitive people in
these situations are threatened as to their physical integrity. Examples of these are sexual
assaults, kidnapping, or any traumatic stressor that removes the individual’s ability to
protect the self. The cases above illustrate how a person can be traumatized as to threat to
physical integrity and feeling intense fear, helplessness and horror. (Huffer, 1995) (Baker
& Alonso, 2005)
Equal to any terror from natural disasters, wartime or accidents are those kinds of
quiet and invisible kinds of terrorism to be found in cases A, B, and C wherein the

9. targeted person develops PTSD/LAS. A woman on the run from an abusive husband,
who stalks her, and uses the court as a weapon, is every bit as terrorized as any victim of
the worst imaginable natural disaster. Whenever the stressor involves intimate violence,
emotional abuse, stalking, and fraud the stressor threatens over a long period of time. Our
police and judicial systems are impotent protectors in the case of non violent types of
terrorism. Power structures are even used as a weapon against such victims leaving the
person with no one to call for protection and in these cases. The Boston Phoenix in
January 2003 wrote a ten thousand- word, front-page feature story profiling the severe
malfunction of the family court. Cases were cited wherein protective parents reporting
abuse have been punished by being denied custody, even denied visitation and in extreme
cases mothers are serving months in jail for simply protecting their children Neustein &
Lesher,( 2005.)
Some of the litigants who experience a collapse from the stress of legal
proceedings, will be treated as if they have had a mental breakdown; they are sent to a
psychiatrist, prescribed drugs used to treat mental illness, and may be encouraged -
sometimes coerced into becoming patients in a psychiatric hospital. The sudden
transition from a being a professional in a working environment to being confined in a
mental ward containing schizophrenics, drug addicts and other people with genuine long-
term mental health problems adds to rather than alleviates the trauma. Worse, the person
is forever, stigmatized and invalidated. The perpetrator will often see to it that the news
is broadcast and the damages become permanent. These legal abuses demonstrate the
line between psychiatric injury versus mental illness. The line between judge and
psychologist improperly overlaps with abusive lawyers, evaluators and judges practicing
psychology or medicine without a license from the bench or the bar.
How is injury vs. illness determined? A critical feature of mental illness is that
the sufferer is unaware of the reality of the situation. In a psychiatric injury caused by
prolonged, severe stress, (1) the sufferer is fully aware of not only the symptoms and
circumstances but; (2), moreover, the sufferer actively cares and tries to right the wrongs
for self and society. This is not related to psychosis of any kind. To put it simply, Legal
Abuse Syndrome is the result of an abuse of power differential. The legal system
represents the power to take a life, incarcerate a person, remove a person’s children,
family or property. A court being twisted and used as a weapon can force compliance
with outrageous orders in cases where lives are put on the line, children are returned to
abusers, or misinformation is allowed to distort the picture rendering the judge unable to
know the truth or being able to produce an informed and wise decision. The literature
supports that conditions that cause Legal Abuse Syndrome come from often inadvertent
but officially sanctioned bullying. When the trauma inflicted by another person, is
especially intense, or the traumatized person is extremely close to the trauma, the
severity of traumatization may be especially profound. Scaer,( 2001)
Etiology of PTSD/LAS

10. The focus of PTSD has been a single life-threatening event or threat to integrity.
However, as we have shown, the symptoms of traumatic stress also arise from an
accumulation of small incidents rather than one major incident according to (Scaer, &
Kinchin, 2001.) Examples of stressors impacting Legal Abuse Syndrome include:
• Prolonged and stressful exposure to horrific memories as required by the court
throughout years of litigation, production of evidence complicated by an
adversarial setting;
• Court forces involvement for years with a perpetrator or the source of pain and
conflict that brought one to court in the first place seeking to end contact with the
perpetrator or find a resolution;
• Years spent waiting for news from the Trier of Fact or Judge as to outcome of
critical events - anticipation as well as the delivery of bad news;
• Repeated violations to one’s psyche, the law, or personal boundaries such as in
verbal abuse, emotional abuse, mischaracterization, invasive discovery as is
rampant in our adversarial court system;
• Legal system allows intrusion and permits violation of the rules set up to ensure
fairness. Violations of restraining orders, judges warnings, common decency,
ambushes designed to strip one of the ability to fight back are routine;
• Being forced into economic disaster, inability to earn a living by interference with
the means and energy required in gaining and sustaining employment.
Impairment in social, occupational or other important areas of functioning is a key
factor in the final determination of a diagnosis of PTSD.
 Held hostage/abuser uses emotional captivity,
 Official Power used to hold hostage to the case with no means of escape,
 Entrapment/tricked,
 Repeated violation of personal boundaries,
 Betrayal of trust,
 Isolation, family, friends, resources weary of long legal battles
 Stunned, disillusioned – the rules don’t apply as anticipated,
 Hope turns to helplessness
 Loss of control over every facet of life
 Forced compliance with outrage leaves one beyond rage
 Mounting debt
 Grief over cumulative losses, listed in Huffer, 1995, p63: property, opportunity,
relationships, money, material possessions, credit, social standing, pride,
patriotism, the American Dream, family, home, pets, time, friends, reputation,
businesses, borrowing power, networking power, health, earned lifestyle,
trust/faith, lawsuits, hope, faith in any protective agency, faith in public servants,
faith in professionals (attorneys), life’s time to build for the future.
 Health consequences
Huffer describes it as taking the person hostage. Abuse always emanates from
power differential. It is the overwhelming nature of the events and the inability of the

11. person to deal with those events that leads to the development of Complex PTSD.
Situations which might give rise to PTSD/LAS include bullying, harassment, abuse, by
attorneys, judges, police officers usually motivated by misinformation designed to
slander and damage the target individual.
In cases of domestic violence the perpetrator has claimed the power, often taken
the assets and holds the family hostage. When both sides present their cases to the court,
very often the perpetrator has controlled the finances and can posture with power using
counsel and misinformation in the court. The victim runs out of money, must act pro se,
and is in a state of trauma lessening the victim’s chance of being effective in the court.
Stalkers love the court system. They play with protective orders and taunt the victim
frustrating police and finally causing the victim to look like they call law enforcement
with invalid complaints. If stalkers are told to stay 500 feet away from the victim, they
will park 505 feet from the victim. They will enter the victim’s premises and leave
private proof of their invasion. Yet, when the victim calls for help, there is no visible
proof. The victim remains bullied and terrorized. Huffer, (1995 )
The very fact of going to court creates expense that amounts to more than the
annual income of most litigants. Studies show that the average cost of litigation with 200
persons sampled was $78,000. And seventy per cent of those were unable to complete
their cases due to losing their attorneys for lack of funds.
A key feature of Complex PTSD/LAS is the aspect of captivity. The individual
experiencing trauma by degree is unable to escape the situation. False arrest or threat of
arrest for the law abiding and sensitive person either captures or threatens to capture the
person. Litigants being jailed due to misinformation or court-created circumstances is a
distinct, preventable, cause of PTSD/LAS. An example of court-created LAS is found as
follows: the demands of court involvement; overzealous counsel; use of character
assassination; slander in the community; damage to the adversary causing the person to
be unable to get references; to interview competitively; and be reliable on a job without
interference from the adversary or court calendar contributes to problems that can affect
payment of child support. Jailing the victim suffering from these kinds of harassments
and assaults is an etiology of PTSD/LAS.
Assessment of PTSD
The Department of Veterans Affairs National Center for PTSD puts forth the follow
criteria for assessing PTSD. The evaluator may not need or take a long period of time to
assess PTSD depending upon the evaluator’s experience. The first criteria are to
determine the traumatic event(s) and to assess the effects it has had on the person’s life.
For forensic purposes, it is desirable to have a more complete assessment if it can be
financially afforded. Structured interview is generally at the basis of a PTSD assessment.

12. What are some of the common instruments used to assess PTSD?
In addition to structured interview, self-report questionnaires are the next most
used instruments in determining PTSD according to Veterans Affairs. Widely used self-
report measures are the Impact of Event Scale-Revised (IES-R), the Keane PTSD Scale
of the MMPI-2, which is the selection of Karin Huffer, M.S., M.F.T., Huffer, (1995.)
This is the instrument of choice due to the number of cases involved in ongoing research
providing greater validity and reliability of this instrument and maintaining a consistent
pattern for statistical analysis.
Other self-report instruments recommended by The Department of Veterans
Affairs are: The Mississippi Scale for Combat Related PTSD and the Mississippi Scale
for Civilians; the Posttraumatic Diagnostic Scale (PDS); the Penn Inventory for
Posttraumatic Stress; and the Los Angeles Symptom Checklist (LASC) Department of
Veterans Affairs, Nat’l Ctr for PTSD, (2005).
The Clinician Administered PTSD Scale (CAPS) was developed by National
Center for PTSD staff and is among the most widely used types of interviews. It has a
format that requests information about the frequency and intensity of the core PTSD
symptoms and of some common associated symptoms, which may have important
implications for treatment and recovery. Another widely used interview is the Structured
Clinical Interview for DSM (SCID). The SCID can be used to assess a range of
psychiatric disorders including PTSD. Other interview instruments include the Anxiety
Disorders Interview Schedule-Revised (ADIS), the PTSD-Interview, the Structured
Interview for PTSD (SI-PTSD), and the PTSD Symptom Scale Interview (PSS-I). Each
has unique features that might make it a good choice for a particular evaluation
Department of Veterans Affairs, Nat’l Ctr for PTSD,(2005).
Huffer uses a debriefing method developed by the Department of Justice for use
by the FBI combined with aspects from Bard and Sangrey, Selye and Zegan’s Handbook
of Stress, Theoretical and Clinical Aspects. Also used is a copyrighted graphic sheet that
assists in therapy, self-help, and communication with attorneys as to actual losses and
pain and suffering (Bard and Sangrey,),(1986, Zegan,1982), (Selye,1956), (Huffer, 1995.)
This method is due to longitudinal research being conducted by Huffer, therefore, the
consistency and longevity of these instruments lends to scientific value and reliability and
validity.
Overcoming Distance and Financial Barriers Faced by PTSD/LAS
Sufferers
Usual psychological assessments are accomplished by meeting with the client
face-to-face and performing, structured interview, self-reporting checklists and any other
assessments that create and ideal review. Then cues can be perceived from the client,
rapport built, and a professional relationship established in a setting designed for the
purpose. In the matters of cases like those listed above, an attitude of flexibility may have
to adjust the usual and preferred patterns of assessment, diagnosis and therapy. LAS and

13. the traumatic stress that emanates from the experiences of the LAS victim usually render
the client economically devastated and unable to travel or pay for psychological services.
Congress responded to this need and the requirements of the ADA by passing the
Balanced Budget Act (BBA), of 1997. This opened the area of internet counseling and
assessment as well as telephone contact, text contact, and the breadth of new technology
was introduced into the delivery of mental health services.
Access Improved by Distance Services
Third party insurance payment was given a boost by the federal government when
TeleHealth and TeleMedicine was accepted as part of the Balanced Budget Act (BBA)
that was introduced to congress on March 3, 1997 Balanced Budget Act, (1997).
According to the Federal Register (1998):
In section 4206 of the Balanced Budget Act of 1997, the Congress required that, not later
than January 1, 1999, Medicare Part B pay for professional consultations by a physician
via interactive telecommunications systems. Under section 4206(a) of BBA payment may
be made under Medicare Part B, provided the teleconsultation service is furnished to a
beneficiary who resides in a county in a rural area designated as a Health Profession
Shortage Area (5E). Federal Register, (1998).
The fee structure for TeleMedicine was broken down into 75% of the set fee
would go to the professional doing the consultation and the other 25% would be for the
referring practitioner Federal Register, (1998). The Clinical Social Worker and the
Clinical Psychologist would be eligible to collect the fee as the referring practitioner. For
example, a Clinical Social Worker in a Health Profession Shortage Area has a client who
needs psychiatric services. The Social Worker could make a referral to a Psychiatrist who
has this technology and assist the client with accessing help. Psychiatry is a covered
service under Medicare Part B so both parties would be reimbursed Health Care
Financing Administration, (1999).
Technology can greatly assist in reaching people who are unable to access
legal and mental health services in the customary ways. Legislation as referenced
above is a giant step in causing private insurers to develop proper policies and add
telehealth services to their covered benefits. Fourteen states have already
expanded their Medicaid programs to include telehealth Services.
TeleMedicine, TeleHealth and technology in general has the potential for
increasing access to quality health care, including mental health for all. Very simply the
telephone by itself is proving to be a much overlooked and invaluable tool in assisting
those who may otherwise not be able to receive the full range of mental health services or
to make services more effective. The Journal of the American Medical Association
published the first major look at treating depression with psychotherapy over the phone in
August of 2004. Gregory Simon, the psychiatrist who led the research on 600 patients at
Group Health Cooperative in Seattle reports 80 percent of patients who received phone
therapy along with antidepressants said their depression was "much improved" six

14. months later, compared with 55 percent of those who received the pills alone. The future
of including telehealth techonologies is promising when considering people who have
suffered from severe negative stress and have withdrawn from vital interactions as a
result. TeleMedicine has the potential to improve the delivery of health care in the
United States by bringing a vast array of services such as mental health services to under
served communities TeleMedicine Report to Congress, (1997).
These changes have given birth to new standards being set for use of technology
in therapy. The International Society for Mental Health Online is an organization that is
setting standards to mental health services delivered in the new telehealth context. The
results of their case research suggest that online mental health services while being
traditional in many ways will evolve into new and innovative forms that are very
different than the familiar face-to-face approaches. Communicating electronically from
one individual to another--or to a group of individuals simultaneously, relying on the
Internet, computer monitors, and written language skills rather than on one's eyes and
ears and oral language shift the rapport normally established in the clinician’s office to a
time-altered, less spontaneous method of interaction.
There are clear disadvantages ranging from clinician observation to treatment,
which in cases of traumatic stress may include techniques such as EMDR, which cannot
be done unless one is face to face. On the other hand advantages seem to free up the
client allowing clients to relate without certain restraints emanating from shame-based
feelings. The biggest advantage is economical and geographic. Clients who have limited
funds, conditions that keep them housebound or restricted, or who are in delicate legal
situations that prevent them from utilizing local mental health services are provided
enhanced accessibility to legal and mental health services by these non traditional
methods. The client also can communicate with therapist at any time rather than wait for
an appointed time.
Special Accessibility Issues for PTSD/LAS Clients
Why isn’t more action taken to pursue actions to prevent psychiatric injury caused
or exacerbated by the legal system or to compensate the injured for the damages? Why
hasn’t it been identified and dealt with as a public health crisis? The following common
symptoms of PTSD/LAS illustrate the fact that the more a person qualifies to pursue a
claim for personal injury for psychiatric injury by satisfying PTSD DSM-IV diagnostic
criteria, the more they are emotionally unable to pursue a claim.
When basic trust is violated, there is an overwhelming sense of betrayal and
inability to trust anyone. Trust is lost for professionals, for systems or even those who
are close to you. Emotional, physical and mental exhaustion overwhelm any desire to
take action immobilizing the litigant. Huffer dramatizes how shame consumes the
responsible and conscience-centered person, while the wrongdoer does not know shame
and can thrive in the litigation milieu leaving PTSD/LAS sufferers in his wake.

15. Fear of retaliation or consequences also play into LAS victims’ ability to
do something about the situation. They have usually been ambushed and then
official powers mobilized against them. LAS sufferers live in a state of terror
while being held as emotional hostages. Hostages rarely take action against their
captors.
Typically with LAS this hostage stage eventually gives away to
responsibility. The victim wants to take action to fix the system, improve society,
and prevent a similar fate befalling others to follow. LAS sufferers typically have
great empathy and are prone to identifying with other people's suffering. A
sensitive person being in a helpless posture causes profound erosion of self-
esteem as the person does not want to be seen as disabled and fights to regain
independence.
Obsession then drives the desire to educate and perfect the system. A few
imbalanced victims will succumb to revenge acts. However, most LAS sufferers
focus on responsible actions Regardless of positive intentions they are usually
limited by the economic burden of legal action leaving LAS sufferers, in most
cases, financially broke, emotionally and psychiatrically damaged and with no
effective way to pursue or protect their right to pursue happiness as promised in
this nation. There is emerging a growing population of walking wounded who
have been cast out of dynamic life. They exist saving their legal papers in boxes
and suitcases with faint hope that someday someone, some agency, some court
will care and listen and help them to attain justice. They are sentenced to lives of
varying combinations of the following symptoms impairing all normal
functionality.
• Hyper vigilance (feels like but is not paranoia)
• Exaggerated startle response
• Irritability
• Sudden angry or violent outbursts
• Flashbacks, nightmares, intrusive recollections
• Sleep disturbance
• Exhaustion and chronic fatigue
• Reactive depression
• Guilt
• Avoidance along with numbness
• Unable to relax
• Cannot laugh or cry or feel passion
• Physical symptoms, lowered immune system
• Overwhelming sense of injustice strong desire to do something about it
but blocked.
Complicating the above list of usual symptoms are the following when LAS
exists.

16.  The prolonged (chronic) negative stress resulting from protracted litigation can
lead to threat or loss of job, career, health, and livelihood, often also resulting in
threat to marriage and family life. The families of litigants are the unseen victims
of litigation.
 Symptoms of PTSD/LAS are mental, emotional, and physical exhaustion along
with reactive depression, which can lead to isolation and even suicide. Anxiety
also goes off the scale even leading to panic attacks.
 Excessive stress depresses the immune system.
 Intrusive thoughts and memories disrupting concentration and relaxation.
 Sleep disturbances, nightmares,
 Terror is common. When protective systems that taxpayers support and depend
upon their world becomes an invisible hotbed of terror.
 Avoidance and numbness is concurrent. All reminders are avoided.
 The sufferer becomes frozen in time, unable to have fond memories, plan for the
future, or enjoy the present.
 Obsession takes over as the LAS sufferer tries to regain control of their
environment and may focus on reliving the hostage experience.
 Feelings of withdrawal and isolation are common; the person just wants to be left
alone. Huffier describes it as having layers of cellophane wrapped around the
person. You can see them, they might be present at an event physically but their
emotional scar tissue keeps them isolated.
The person loses personality dynamics. Numbness reigns. They are unable to
laugh or cry and feel like love has left them.
 After losses of their life’s earnings and lifestyle, dreams of a future become too
painful to experience. Careers are stunted, creativity is blocked, and society loses
the contributions of the LAS sufferer.
 Nighttime is hellish. Sleep is disturbed, filled with nightmares and a sense of
unbearable vulnerability leaves the LAS sufferer exhausted.
 Concentration is impaired to the point of precluding preparation for legal action,
study, work, or search for work.
 The person is on constant alert because their fight or flight mechanism has
become permanently activated.
The person has become hyper sensitized and now unwittingly and
inappropriately perceives almost any remark as critical. For many, social life
ceases and work becomes impossible; the overwhelming need to earn a living
combined with the inability to work deepens the trauma. The literature in the
1990’s opened the entire concept of traumatic stress, recognizing that
prolonged negative stress creates symptoms of Post Traumatic Stress
Disorder. The incidence of PTSD is must greater than first recognized in the
1960’s. It is thought that 5% of males and 10% of females will develop PTSD
in their lifetime says the National Institute for Clinical Excellence (NICE).
Economy is impacted by loss of ability to work, plan a career, have hope,
inspiration, trust, and the response to PTSD of “fight,” “flight,” or “freeze.”

17. Summary and Conclusions
With the prevalence of chronic complex trauma and the consistent reports of cases
such as our Cases A, B, & C, it is shocking how little research has been done on this
population whose quality of life is preventably devastated by the insensitive, toxic,
and unrelenting demands of the forensic experience. PTSD over the decades has been a
misunderstood and a slowly evolving concept as our society caught on that human beings
do not experience battlefields, earthquakes, childhood abuse, and bullying or prolonged
litigation with no predisposing factors in play. Whether an attorney in practice who
believes in representing clients in the spirit of attaining justice against the established
brotherhood of attorneys who intimidate and frustrate*; or a case of false arrest due to
political power being able to distort our law enforcement and justice systems twisting
them into weapons to be used against persons targeted as a result of doing no wrong but
knowing the wrong people, each human being presents for mental health treatment or
presents in the court for a resolution with a unique emotional history.
Rather than staying rigidly with the DSM IV which is merely a helpful guide to
clinical practice open to dynamic change and dialogue, it would seem to be advisable to
accept the concept of Complex PTSD and err on the side of human service and sensitivity
if one must err. The mental health professions exist as an inexact science therefore
leaning more on the good will, effort to empirically measure as much as possible, and
then to abide by the Americans with Disabilities Act in our Courts to ensure accessibility
to all. Once accepted as a psychiatric injury, PTSD/LAS can be treated and
accommodated by the court allowing all those who use the courts of law to have a
humane and manageable experience rather than the devastation of their lives. Attorneys
also suffer compassion fatigue when they are helpless to affect the court toward promised
justice.
“Clearly while the study of war neuroses, motor vehicle accidents, hurricanes and
other non-interpersonal traumas has become respectable, investigating that darkest side of
human nature: our capacity to horribly abuse and neglect our own offspring and
intimates continues to rife with controversy.” Van der Kolk, (2001). Worse yet is the
challenge of abuse of power differential between systems and the human beings they are
intended to serve. Huffer is conducting continual longitudinal research that validates the
experiences and symptoms above reported by attorneys and citizens who simply turned to
their established systems for a right and reasonable solution to a critical problem. They
found that instead of help, they wound up with Post Traumatic Stress Disorder of the
Legal Abuse Syndrome subcategory plus a host of other impairments to daily functioning
that can only be described as:
1. the person experienced or witnessed or was confronted
with an event or events that involved actual or threatened
death or serious injury, or a threat to the physical integrity
of self or others;
2. the person's response involved intense fear, helplessness,
or horror. (DSMIV, 1994)

18. Or some just called it “Cruel and Unusual Punishment.”
*Statistics regarding the health consequences of being an attorney suggest that the milieu in and around the court system is toxic.
According to the Journal of Occupational Medicine, attorneys in the United States suffer depression at a rate 3.6 times the national
average. A 1991 Johns Hopkins University study of depression in 105 professions ranks attorneys first among all professions in the
incidence and prevalence of clinical depression. According to other published studies, as many as 20 percent of all practicing attorneys
experience clinical depression in any given year. Drinking problems correlated with length of practice: 18 percent of problem drinkers
were found in those who had practiced two to 20 years, 25 percent in those who had practiced more than 20 years
Recommended Readings and Citations
American Psychiatric Association, Diagnostic and Statistical Manual of Mental
Disorders, 4th
end, revised (DSM IV-R) APA, Washington D.C., 1994.
Baker, Claudia, M.S.W., MPH & Alonso, Cessie, LCSW. Forensic Validity of a PTSD
Diagnosis Department of Veterans Affairs National Center for PTSD.
Barak, A., & Buchanan, T. (2004). Internet-based psychological testing and
assessment.In R. Kraus, J. Zack & G. Stricker (Eds.), Online counseling: A handbook for
mental health professionals (pp. 217-239). San Diego, CA: Elsevier Academic Press.
Barak, A., & English, N. (2002). “Prospects and limitations of psychological testing on
the Internet.” Journal of Technology in Human Services, 19 (2/3), 65-89.
Bard, Morton, and Dawn Sangrey. The Crime Victims Book. New York:
Brunner/Mazel, Inc., 1986.
Bremner JD, Narayan M (1998): “The effects of stress on memory and the hippocampus
throughout the life cycle: Implications for childhood development and aging.” Develop
Psychopath 10:871-886.
Brown, James T. “Avoiding Litigation Neurosis: A Practitioner’s Guide to Defending
Post Traumatic Stress Disorder Claims.” The American Journal of Trial Advocacy. Vol.
20, Number 1, Center for Advocacy and Clinical Education, Cumberland School of Law,
Samford University, Birmingham, AL, Fall 1996

19. Goleman, Daniel. “Key to Post Traumatic Stress Lies in Brain Chemistry, Scientist
Finds.” New York Times, 12 June 1990.
Herman, Judith L. Trauma and Recovery. New York: Basic Books, 1997.
Huffer, Karin, M.S,, M.F.T. Overcoming the Devastation of Legal Abuse Syndrome.
Fulkort Press,
Las Vegas, NV, 1995 pp 20-26, 69-77.
Hurder, Alex J. “ABA Urges Equal Access to Courts for Individuals with Disabilities.”
September/October, 2002 26:5 MPDLR.
The International Society for Mental Health Online
Johnston, Joni, Psy.D. “ShrinkRap Investigating PTSD in Psychological Injury Claims”
LexisONE
A reporter for The Oklahoman Newspaper, March 28, 2005 By Sally Allen Anti-News
Editor NewsOK.com
Neustein, Amy & Lesher, Michael. From Madness to Mutiny. The Northeastern
University Press, Boston, MA: 2005
Why zebras don't get ulcers: an updated guide to stress, stress-related diseases, and
coping, Robert M Sapolsky, Freeman, 1998, ISBN 0-7167-3210-6
Scaer, , Robert C MD The Body Bears the Burden: Trauma, Dissociation and Disease,
The Haworth Medical Press, NY, 2001.
Kinchin, David, Post Traumatic Stress Disorder: the invisible injury, 2001 edition,
Success Unlimited, UK 2001,
The European Journal of Work and Organizational Psychology (EJWOP), 1996, 5(2),
(whole issue devoted to bullying and its effects, including PTSD.) Published by
Psychology Press, 27 Church Road, Hove, East Sussex BN3 2FA, UK.
O'Brien, Dr John T, MRCPsych, British Journal of Psychiatry, The 'glucocorticoid
cascade' hypothesis in man: prolonged stress may cause permanent brain damage,
Department of Psychiatry and Institute for the Health of the Elderly, University of
Newcastle (1997), 170, 199-201.
Tuttle, David, Cortisol - Keeping a Dangerous Hormone in Check, LE Magazine July
2004
Keane, T.M., P.F. Malloy and J.A. Fairbank). “Empirical development of an MMPI
subscale for the assessment of combat-related post-traumatic stress disorder.” Journal of
Consulting and Clinical Psychology, 52, 888-891.

20. Nadel, L., & Jacobs, W.J. “The Role of the Hippocampus in PTSD, Panic, and Phobia.”
In Nobumasa Kato, ed. Hippocampus: Functions and Clinical Relevance. Amsterdam:
Elsevier, 1996.
Reese, James, James Horn, and Christine Dunning. Critical Incidents in Policing.
Washington, D.C.: U.S. Department of Justice, 1991.
Pert, Candace, Phd. The Molecules of Emotion, New York:Scribner Books, 1999.
Selye, Hans. The Stress of Life. New York: McGraw-Hill, Inc., 1956.
Van der Kolk, Bessel, M.D. Yehuda, Rachel, Ed. The Assessment and Treatment of
Complex PTSD Chapter 7, Traumatic Stress, American Psychiatric Press, 2001
van der Kolk, Bessel, “In the Eye of the Storm,” The Psychotherapy Networker, Jan/Feb
2004 pp45,66.
van der Kolk, Bessel A., Alexander C. McFarlane, and Lars Weisaeth, eds. Traumatic
Stress. New York: Guildford, 1996.
Zegan, L.S. Handbook of Stress, Theoretical and Clinical Aspects. Ed.
Goldberger and Breznitz, New York: Free Press, 1982.
Internet resources:
www.bazelon.org
http://www.giftfromwithin.org/html/counting.html
www.traumacenter.org
www.legalabusesyndrome.org or www.legalabusesyndrome.com
.(Health Care Financing Administration, 1999).
http://www.cms.hhs.gov/medicaid/default.asp?
http://www.ismho.org/A nonprofit organization formed in 1997 to promote the
understanding, use and development of online communication, information and
technology for the international mental health community.
Internet Mental Health (www.mentalhealth.com) copyright © 1995-2005 by Phillip W.
Long, M.D.
Essentials for litigating Post Traumatic Stress Disorder (PTSD) claims:
http://www.lawandpsychiatry.com/html/Litigating%20PTSD%20Claims%20-
%20Final.pdf
http://www.va.gov/
http://home.earthlink.net/~hopefull/trauma.htm

21. http://www.wellcome.ac.uk/en/genome/tacklingdisease/hg12b004.html The National
Institute for Clinical Excellence (NICE) makes national recommendations on best
practice in medical treatment and care, with the aim of ensuring an equal and effective
service across the NHS in England and Wales.
Gillian Kelly, barrister at law, looks at the development of Post Traumatic Stress
Disorder and the legal recognition thereof on her web site at
http://www.telecoms.net/law/index.html as a recognised psychiatric illness, the
condition has been demonstrated, in the course of the past 140 years, to be as
worthy of compensation at law as any physical injury inflicted through
negligence.
1.
Appendix I
Differences between mental illness and psychiatric injury
Kinchin, 2001, has illustrated clearly how a psychiatric injury is different from mental
illness. It is done in the context of employment bullying but if considered in the light of
complex PTSD and the official bullying that exists in Legal Abuse Syndrome, it can help
clarify for the litigant and the court the differences. The first graphic shows the difference
between paranoia and hypervigilance and the second graphic illustrates psychiatric injury
versus mental illness.
Paranoia Hypervigilance
• paranoia is a form of mental illness;
the cause is thought to be internal,
• is a response to an external event
(violence, accident, disaster,

22. eg a minor variation in the balance
of brain chemistry
violation, intrusion, bullying, etc)
and therefore an injury
• paranoia tends to endure and to not
get better of its own accord
• wears off (gets better), albeit slowly,
when the person is out of and away
from the situation which was the
cause
• the paranoiac will not admit to
feeling paranoid, as they cannot see
their paranoia
• the hypervigilant person is acutely
aware of their hypervigilance, and
will easily articulate their fear, albeit
using the incorrect but popularised
word "paranoia"
• sometimes responds to drug
treatment
• drugs are not viewed favourably by
hypervigilant people, except in
extreme circumstances, and then
only briefly; often drugs have no
effect, or can make things worse,
sometimes interfering with the
body's own healing process
• the paranoiac often has delusions of
grandeur; the delusional aspects of
paranoia feature in other forms of
mental illness, such as schizophrenia
• the hypervigilant person often has a
diminished sense of self-worth,
sometimes dramatically so
• the paranoiac is convinced of their
self-importance
• the hypervigilant person is often
convinced of their worthlessness and
will often deny their value to others
• paranoia is often seen in conjunction
with other symptoms of mental
illness, but not in conjunction with
symptoms of PTSD
• hypervigilance is seen in
conjunction with other symptoms of
PTSD, but not in conjunction with
symptoms of mental illness
• the paranoiac is convinced of their
plausibility
• the hypervigilant person is aware of
how implausible their experience
sounds and often doesn't want to
believe it themselves (disbelief and
denial)
• the paranoiac feels persecuted by a • the hypervigilant person is

23. person or persons unknown (eg
"they're out to get me")
hypersensitized but is often aware of
the inappropriateness of their
heightened sensitivity, and can
identify the person responsible for
their psychiatric injury
• sense of persecution
• heightened sense of vulnerability to
victimisation
• the sense of persecution felt by the
paranoiac is a delusion, for usually
no-one is out to get them
• the hypervigilant person's sense of
threat is well-founded, for the serial
bully is out to get rid of them and
has often coerced others into
assisting, eg through mobbing; the
hypervigilant person often cannot
(and refuses to) see that the serial
bully is doing everything possible to
get rid of them
• the paranoiac is on constant alert
because they know someone is out to
get them
• the hypervigilant person is on alert
in case there is danger
• the paranoiac is certain of their
belief and their behaviour and
expects others to share that certainty
• the hypervigilant person cannot
bring themselves to believe that the
bully cannot and will not see the
effect their behaviour is having; they
cling naively to the mistaken belief
that the bully will recognise their
wrongdoing and apologise
Other differences between mental illness and psychiatric injury include:
Mental illness Psychiatric injury
• the cause often cannot be identified
• the cause is easily identifiable and
verifiable, but denied by those who
are accountable
• the person may be incoherent or
what they say doesn't make sense
• the person is often articulate but
prevented from articulation by being
traumatised

24. • the person may appear to be
obsessed
• the person is obsessive, especially in
relation to identifying the cause of
their injury and both dealing with
the cause and effecting their
recovery
• the person is oblivious to their
behaviour and the effect it has on
others
• the person is in a state of acute self-
awareness and aware of their state,
but often unable to explain it
• the depression is a clinical or
endogenous depression
• the depression is reactive; the
chemistry is different to endogenous
depression
• there may be a history of depression
in the family
• there is very often no history of
depression in the individual or their
family
• the person has usually exhibited
mental health problems before
• often there is no history of mental
health problems
• may respond inappropriately to the
needs and concerns of others
• responds empathically to the needs
and concerns of others, despite their
own injury
• displays a certitude about
themselves, their circumstances and
their actions
• is often highly sceptical about their
condition and circumstances and is
in a state of disbelief and
bewilderment which they will easily
and often articulate ("I can't believe
this is happening to me" and "Why
me?)"
• may suffer a persecution complex
• may experience an unusually
heightened sense of vulnerability to
possible victimisation (ie
hypervigilance)
• suicidal thoughts are the result of
despair, dejection and hopelessness
• suicidal thoughts are often a logical
and carefully thought-out solution or
conclusion

25. • exhibits despair • is driven by the anger of injustice
• often doesn't look forward to each
new day
• looks forward to each new day as an
opportunity to fight for justice
• is often ready to give in or admit
defeat
• refuses to be beaten, refuses to give
up