Self-Represented Litigants & Mental Disorders: The Legal System as an Agent of Healing The...

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Mental Disorders:Mental Disorders:The Legal System as an Agent of The Legal System as an Agent of

HealingHealingThe State-wide Conference on

Self-Represented Litigants Friday March 17, 2006, San Francisco, California

Lynn E. O’Connor, Ph.D.

Darryl Inaba, Pharm.D Judith Hirsch, Psy.D.

Agenda:Agenda:Agenda:Agenda:• The current crisis in medicine and mental health Stigma and its effects Clients/Customers who suffer from mental

illnesses The “difficult” customer The “dangerous” customer The “disorganized” customer

Major mental disorders are brain diseases Disorders: Brief Overview

Mood Disorders: Depression Bipolar I & II

Anxiety Disorders (OCD) Psychotic Disorders: Schizophrenia Summary: The Take Home Message

A Crisis in Mental Health Care…A Crisis in Mental Health Care… A Crisis in Mental Health Care…A Crisis in Mental Health Care…

• Self-help Centers functioning in context of collapsing medical system

• Jails and prisons filled with the mentally ill who should be in treatment centers

• 80% to 90% are incarcerated directly or indirectly because of substance abuse

• Social and economic factors are contributing to rise of mental illness -- the prevalence of disorders rising

• Funding for research and treatment of mental illness is rapidly disappearing

Mental Disorders Share: STIGMAMental Disorders Share: STIGMAMental Disorders Share: STIGMAMental Disorders Share: STIGMA

• Mental Illness brings to sufferers and their families the dark cloud of STIGMA• Blaming• Guilt-inducing• Shaming• Lowering of status & social ranking• “Secrets” even within the family

• Living with stigma may sometimes be as devastating as symptoms of the illness• People avoiding the “mentally ill” • Can’t get work• People showing “fear” • McGuire’s vervet monkeys

Stigma is always present…Stigma is always present…Stigma is always present…Stigma is always present…

• Those with mental illnesses and their families are stigmatized

• Despite the fact that:• THERE IS MENTAL ILLNESS IN

EVERY FAMILY• It may be hidden• A source of secrecy and shame• But it is there

Effects of Stigma on Mental Health Effects of Stigma on Mental Health Professionals: Professionals: A Case StudyA Case StudyEffects of Stigma on Mental Health Effects of Stigma on Mental Health Professionals: Professionals: A Case StudyA Case Study

• 170+ mental health professionals questioned about their own use of psychotherapy and medications (Godfredsen, 2004)

• 56% CURRENTLY using psychoactive medications• Same rates in all professions: psychiatrists,

psychologists, family counselors, social workers• While many freely disclose use of psychotherapy to

fellow professionals• Few disclose their use of psychoactive medication

• 30% hid medication use from spouses• Almost no one told their supervisors or fellow

professionals• And yet, this group is treating the “mentally ill”

• Saying “there is “nothing to feel ashamed of”• “Nothing to feel guilty about”• Don’t self-disclose because fear of harming their

families

Clients, Patients, & Customers Clients, Patients, & Customers with Mental Illnesses:with Mental Illnesses:Clients, Patients, & Customers Clients, Patients, & Customers with Mental Illnesses:with Mental Illnesses:

• They live with the stigma of mental illness • Are worried most of all about their families and loved

ones, often without conscious awareness

• Shame and guilt embedded in stigma• Shame about the self is secondary, and relates to:• The fear of shaming or otherwise harming the family

and loved ones• Stigma prevents people from getting help• Stigma depletes the sense of self-worth and

confidence

• An Example: Our soldiers in Iraq are suffering from psychological problems at in escalating numbers

• The suicide rate is alarming• Avoid getting help, because they are afraid of being

stigmatized, and harming their families

Working with Self-litigating Customers Working with Self-litigating Customers with Mental Disorders:with Mental Disorders: Working with Self-litigating Customers Working with Self-litigating Customers with Mental Disorders:with Mental Disorders:

• Customers frightened • Used to being stigmatized

• Feel undeserving, feel toxic to others• Professionals motivated to help

• Motivated by altruism

• Feel sorry for customers• Feel survivor guilt, often below the

surface• The story of survivor guilt• How it effects us

• Every day feeling, out of awareness• May be defended against by anger,

frustration, blaming the victim

New Paradigm of Human Nature:New Paradigm of Human Nature:New Paradigm of Human Nature:New Paradigm of Human Nature:

• Its been assumed people are “self-centered” • A review of cognitive neuroscience & our

own research on depression and other problems supports a new paradigm of the mind,

• The new and highly social “non-conscious”• People non-consciously driven to hold

group and family together

• Non-conscious mind is organized, organizing, and prosocial towards the “ingroup”

The New Paradigm: The New Paradigm: Our Altruistic Human Our Altruistic Human NatureNatureEmpathy: The Neural System Built on Mirror Empathy: The Neural System Built on Mirror

NeuronsNeurons

The New Paradigm: The New Paradigm: Our Altruistic Human Our Altruistic Human NatureNatureEmpathy: The Neural System Built on Mirror Empathy: The Neural System Built on Mirror

NeuronsNeurons • Highly developed neural system of

empathy• Built upon “mirror neurons”• We feel others’ pain, seen in the brain• And they feel ours• Infants at 43 minutes imitate• Babies (and chimps) trying to help

• Crying at other babies cries• New research on helping

• In contrast to older theories, people profoundly “other-focused”• Always worried about harming others, loved

ones, families• People who suffer from mental disorders also

primarily “other-focused”• Exceptions are rare: the true “psychopath”

Working with Mentally Ill CustomersWorking with Mentally Ill CustomersWorking with Mentally Ill CustomersWorking with Mentally Ill Customers

• Difficult to manage the feelings of guilt at being better off than person you are helping• People come for help, wanting to “get better”

and to overcome their problems• Unconscious plan for how to use their time with

helpers

• In therapy, clients often test the therapist Want to change beliefs, feeling they are harmful Overly responsible, paralyzed with guilt• Want to pursue normal goals in life• Use the therapist to change

• They also use others who are helpers, for example people in the legal system

Problems in Helping:Problems in Helping:Problems in Helping:Problems in Helping:

• Customers who are “difficult”• “You aren’t really helping me”• “You don’t care at all, I’m just a

number”• “If I don’t get help soon -- you

know I have a temper”• “Nothing you’ve suggested has

worked out at all”• These are intended to make you

feel responsible, and like a failure• Imitation of what they felt in their

families, and in life

The Difficult Customer:The Difficult Customer:The Difficult Customer:The Difficult Customer:

• The difficult customer• The person who you can’t please enough• These are “tests” of the helper• Call them “omnipotent responsibility tests”• Intended to make you feel --briefly--

responsible, and like a failure• Imitation of what she/he felt in family and in

life, overly responsible, guilty• Wants the helper to “BE DIFFERENT”• To feel strong and helpful anyway, despite

feelings of guilt, or shame, or fear• To provide a model of another way of

reacting To the problems and stresses life presents To feeling responsible for others

Customers who are Frightening:Customers who are Frightening:Customers who are Frightening:Customers who are Frightening:

• Pay attention to your feelings• If frightened

• It might be a “test”• If might be the person is going out of

control with fear/guilt/anger• It might be impulse control problem

• Brain damage from being beaten• Drug effect

• DON’T TAKE A RISK• Play it safe• Take care of yourself first and foremost

• This is always most helpful

Disorganized Customers:Disorganized Customers: Disorganized Customers:Disorganized Customers:

• Often biological reason• Battered women study found over 85% suffered

(at least) mild traumatic brain injury (Mercontoni, 2003)• Symptoms of TBI include confusion• Disorganization• Failure at Planning• Don’t make appointments, lose papers

• Recovering addicts may have similar problem• Can’t make plans• Don’t show up• Disorganized and confused• Get no help, no recognition of the problem

• Others may have ADD, ADHD, since childhood, unrecognized, felt like failures, never treated

• THINK BIOLOGY ALWAYS, FIRST AND FOREMOST

Common Mental DisordersCommon Mental DisordersCommon Mental DisordersCommon Mental Disorders

• Mood Disorders• Unipolar Depression• Bipolar I & II Mood Disorder• So-called “Personality Disorders” may be

milder versions of same (I.e., a person who is diagnosed with “borderline personality may in fact suffer from Bipolar II, depressive type

• Anxiety Disorders• OCD, PTSD, Generalized Anxiety

• Psychotic Disorders• Schizophrenia, Schizoaffective

• Substance Abuse Disorders• Drug effects • Addiction • Withdrawal

Problems in DiagnosisProblems in DiagnosisReisberg, Lecture in PsychiatryReisberg, Lecture in Psychiatry

Problems in DiagnosisProblems in DiagnosisReisberg, Lecture in PsychiatryReisberg, Lecture in Psychiatry

Hypomania? Depression? Schizophrenia?

Euphoria Apathy Emotional bluntness

Restlessness Inertia Unconcern about own person/

personal hygiene

Impulsivity Unconcern Muteness

Depressiveness

thosethosethosethose

Copyright (c) Houghton Mifflin Company. All rights reserved.

Unipolar DepressiveDisorders

Bipolar Disorders

Psychotic Features?

Single Episode orRecurrent?

MelancholicFeatures?

Seasonal Pattern?

Major DepressiveDisorder

DysthymicDisorder

Bipolar IDisorder

Bipolar IIDisorder

Cyclothymic

Disorder

Recurrent MajorDepressive Episodes

with Hypomania

Mood DisordersMood Disorders

Single Manic Episode

Most RecentEpisode Hypomanic

Most RecentEpisode Manic

Most RecentEpisode Mixed

Most RecentEpisode Depressed

Most RecentEpisode

Unspecified

Mood DisordersMood DisordersMood DisordersMood Disorders

From Current Online ResearchFrom Current Online Research(O’Connor, Lewis & Berry, 20050(O’Connor, Lewis & Berry, 20050

From Current Online ResearchFrom Current Online Research(O’Connor, Lewis & Berry, 20050(O’Connor, Lewis & Berry, 20050

Self-Reported Diagnosis Frequency Percent Depression 109 17.6 Anxiety 34 5.5 Bipolar Disorder 18 2.9 ADHD 10 1.6 Insomnia 14 2.3 Addiction 4 .6 PTSD 1 .2 Anger 1 .2

Cost of Mood DisordersCost of Mood DisordersCost of Mood DisordersCost of Mood Disorders

• Epidemic in countries using the greatest per capita resources, (in form of energy)

• These countries also have the lowest birth rates

• How do we explain this?

Type of disability Cost (in DALYs)

Unipolar major depression

42,972

Tuberculosis 19,673

Road traffic accidents 19,625

Alcohol use 14,848

Self-inflicted injuries 14,645

Manic-depressive illness

13,189

War 13,134

Why the Epidemic of Mood Disorders?Why the Epidemic of Mood Disorders?Why the Epidemic of Mood Disorders?Why the Epidemic of Mood Disorders?

• Depression = Neuronal Death• In hippocampus, in prefrontal cortex• Shrinkage is visible

• Is depression sign of “Nature Deficiency?”• Wired for hunter-gather life-style• Today:

• Little exercise• Poor Western diet• Less than optimal social activity, connection

• BDNF (Brain-derived neurotrophic factor• Most of us have the “low BDNF” alleles• “high Neuroticism” alleles, V66/V66 or

V66/Met • Met is new• Higher levels of BDNF if Met/Met allele

Older Theory of SSRI Treatment:Older Theory of SSRI Treatment:Low SerotoninLow Serotonin

Older Theory of SSRI Treatment:Older Theory of SSRI Treatment:Low SerotoninLow Serotonin

From Current Online ResearchFrom Current Online ResearchO’Connor, L., Berry, J.W., & Lewis, T. (2005). Emotions & O’Connor, L., Berry, J.W., & Lewis, T. (2005). Emotions & Personality, Personality, www.eparg.org www.eparg.org

From Current Online ResearchFrom Current Online ResearchO’Connor, L., Berry, J.W., & Lewis, T. (2005). Emotions & O’Connor, L., Berry, J.W., & Lewis, T. (2005). Emotions & Personality, Personality, www.eparg.org www.eparg.org

Gender

FemaleMale

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Depression & Predict

Dopamine/ Depression

Serotonin/ Depression

New Theories of SSRI TreatmentNew Theories of SSRI TreatmentNew Theories of SSRI TreatmentNew Theories of SSRI Treatment

• SSRIs, MAO Inhibitors, Mood Stabilizers, ECT, Exercise, Diet:

• All function by turning on genes that begin a chain of events

• Leading to increased BDNF, a protein that produces new neurons

• NEUROGENESIS

Bipolar I & II DisorderBipolar I & II DisorderBipolar I & II DisorderBipolar I & II Disorder• It affects 1-3% of population• About half untreated• Abnormalities in:

• Brain biochemistry • Structure or activity of certain brain

circuits• Both Serotonin & Dopamine “deficit”

• Results in:• Extreme shifts in mood, energy and

functioning• Untreated bipolar illness results in

suicide• 10 to 15 percent commit suicide

Genetics of Mood DisordersGenetics of Mood DisordersGenetics of Mood DisordersGenetics of Mood Disorders

FROM: Emily Pollard

• Identical twin bipolar:

•% chance of bipolar• 75% chance depression• 1st degree relative

(child, parent, sibling) bipolar:

• 8% chance bipolar•10% chance depression

• Two parents bipolar• 30-75% chance bipolar

•2nd degree relative •(aunt, uncle, cousin, grandparent) bipolar:• 1% chance bipolar• 5% chance depression

• No relatives bipolar •1% chance of bipolar• 5% chance of depression

50-60

Genetics

Environment

Mood Disorders in One FamilyMood Disorders in One FamilyEmily PollardEmily Pollard

Mood Disorders in One FamilyMood Disorders in One FamilyEmily PollardEmily Pollard

Bipolar Genes: Positive & NegativeBipolar Genes: Positive & NegativeBipolar Genes: Positive & NegativeBipolar Genes: Positive & Negative

GENE GENE EFFECTSMALL AMOUNT

TOO MUCH

A Connect unrelated ideas

Creativity Tangential, disorganized

B Seek novelty Fascinated by change, curious

Jumping from project to project

C Be aware of others' opinions

Socially polished Anxious, suspicious, paranoid

D High energy level Very productive Can't stop, slow downRacing thoughtsUnable to focusScattered activity

E Take risks Courageous Bad judgment about harm

Obsessive Compulsive DisorderObsessive Compulsive DisorderObsessive Compulsive DisorderObsessive Compulsive Disorder

• Brain imaging shows increased activity within the frontal lobes, basal ganglia, and cingulated area of the brain.

• The main pathway involved in OCD patients (shown at right) indicates a miscommunication within the cortical-limbic-basal ganglia-thalamic circuit (Epstein 1995, p.136).

• With all this combined, the receiving, gathering, and processing of information in an OCD patient is inadequate essentially causing the behaviour rituals to continue to loop (Epstein 1995, p.137).

• Abnormal output from cognitive/ emotional sensory processing areas of the brain may cause compulsions (Nigg, 1994).

• Leucotomy operations target the detachment of the orbital and frontal cortex from the limbic circuit. Seventy-five percent of the seventeen cases reported decreasing anxiety and obsessions (Nigg, 1994).

OCD & Neurotransmitter HypothesisOCD & Neurotransmitter HypothesisOCD & Neurotransmitter HypothesisOCD & Neurotransmitter Hypothesis

• On the left: Normal functions, serotonin through synapse

• On the right, OCD functioning -- far less serotonin passing through synapse

• Serotonin hypothesis• Treat with Selective

Serotonin Reuptake Blockers

• Our research shows some evidence that Dopamine may also be low though not as dramatically

• Co-morbidity with Bipolar

“ocd.jpg”

“normal.jpg”

Obsessive Compulsive DisorderObsessive Compulsive DisorderObsessive Compulsive DisorderObsessive Compulsive Disorder

Pople with OCD use different brain circuitry in performing a cognitive task than people without the disorder (ocd2.jpg)

Schizophrenia was once thought to be Schizophrenia was once thought to be “caused” by the “schizophrenogenic mother”. “caused” by the “schizophrenogenic mother”. This false belief lingers on… This false belief lingers on…

Schizophrenia was once thought to be Schizophrenia was once thought to be “caused” by the “schizophrenogenic mother”. “caused” by the “schizophrenogenic mother”. This false belief lingers on… This false belief lingers on…

• Schizophrenics have visible anatomical changes

• Loss of gray matter of brain (up to 25%)

• Enlarged ventricles• Temporal and frontal

lobes• Same changes in

people who have been treated, and those who haven’t

• Laboratory of Neuro Imaging, UCLA,

Although a heritable brain disease, with visible Although a heritable brain disease, with visible anatomical changes, it is not hopeless. anatomical changes, it is not hopeless. Although a heritable brain disease, with visible Although a heritable brain disease, with visible anatomical changes, it is not hopeless. anatomical changes, it is not hopeless.

Cognitive and psychological abnormalities Cognitive and psychological abnormalities associated with anatomical changesassociated with anatomical changesCognitive and psychological abnormalities Cognitive and psychological abnormalities associated with anatomical changesassociated with anatomical changes

• Symptoms include:• Cognitive deficits

• Executive function• Short term memory• Declarative memory• Motor ability

• Hallucinations• Delusions• Bizarre thoughts• Hearing voices• Depression• Flat affect

• Schizophrenic patients experience emotions as we do, but don’t express them normally.

Schizophrenia affects 1% of the population Schizophrenia affects 1% of the population everywhere suggesting a positive functioneverywhere suggesting a positive functionSchizophrenia affects 1% of the population Schizophrenia affects 1% of the population everywhere suggesting a positive functioneverywhere suggesting a positive function

• Brain shrinkage twice as fast as normal

• Normal process accelerated?

• There is some evidence damage occurs near to birth, before or after

• Schizophrenia is heritable

• Not due to the family, although it effects the family profoundly

• Like autism was believed to be the falt of the “iceberg” mother,

Grey matter loss in adolescents with schizophrenia. Grey matter loss in adolescents with schizophrenia. Warmer colors denote regions with the most significant Warmer colors denote regions with the most significant losseslosses © 2001 National Academy of Sciences, USA© 2001 National Academy of Sciences, USA

Grey matter loss in adolescents with schizophrenia. Grey matter loss in adolescents with schizophrenia. Warmer colors denote regions with the most significant Warmer colors denote regions with the most significant losseslosses © 2001 National Academy of Sciences, USA© 2001 National Academy of Sciences, USA

Schizophenia & Bipolar may be RelatedSchizophenia & Bipolar may be RelatedWhen Seen on a ContinuumWhen Seen on a Continuum

Schizophenia & Bipolar may be RelatedSchizophenia & Bipolar may be RelatedWhen Seen on a ContinuumWhen Seen on a Continuum

Schizophrenia & Bipolar May be Schizophrenia & Bipolar May be Related:When Seen on a Related:When Seen on a

Continuum ContinuedContinuum Continued

Schizophrenia & Bipolar May be Schizophrenia & Bipolar May be Related:When Seen on a Related:When Seen on a

Continuum ContinuedContinuum Continued

Phenomenological ApproachPhenomenological ApproachPhenomenological ApproachPhenomenological Approach

The “Odd” or “Difficult” Clients who are The “Odd” or “Difficult” Clients who are often Diagnosed as “Personality often Diagnosed as “Personality Disordered”:Disordered”:May be suffering from an Axis I, clinical May be suffering from an Axis I, clinical disorder, I.e., a milder form of brain disorder, I.e., a milder form of brain disease.disease.

The “Odd” or “Difficult” Clients who are The “Odd” or “Difficult” Clients who are often Diagnosed as “Personality often Diagnosed as “Personality Disordered”:Disordered”:May be suffering from an Axis I, clinical May be suffering from an Axis I, clinical disorder, I.e., a milder form of brain disorder, I.e., a milder form of brain disease.disease.

Copyright (c) Houghton Mifflin Company. All rights reserved.

Unipolar DepressiveDisorders

Bipolar Disorders

Psychotic Features?

Single Episode orRecurrent?

MelancholicFeatures?

Seasonal Pattern?

Major DepressiveDisorder

DysthymicDisorder

Bipolar IDisorder

Bipolar IIDisorder

Cyclothymic

Disorder

Recurrent MajorDepressive Episodes

with Hypomania

Mood DisordersMood Disorders

Single Manic Episode

Most RecentEpisode Hypomanic

Most RecentEpisode Manic

Most RecentEpisode Mixed

Most RecentEpisode Depressed

Most RecentEpisode

Unspecified

Bipolar Disorder I & IIBipolar Disorder I & IIBipolar Disorder I & IIBipolar Disorder I & II

• Often misdiagnosed as “major (unipolar) depression”

• Wrong medications (e.g. SSRIs may set off manic episode

• Explains suicidal ideation associated with SSRIs (wrong diagnosis, not the drug per se)

• Bipolar I more severe in manic states, maybe be psychotic

• Bipolar II less “manic” or hypomanic

• Demonstrating symptoms of severe depression

• Suicide rate high iBipolar II, depressive type.

Genetics

Environment

Mental Disorders: A Summary:Mental Disorders: A Summary:Mental Disorders: A Summary:Mental Disorders: A Summary:

• Chronic• Relapsing• Disabling• Stigmatized• Frightening to person with disorder, to

families, and friends• Isolating• Misunderstood• Many are highly treatable• Mental Disorders are Brain Diseases

• Complex polygenetic diseases• Environmental factors

• With huge psychological ramifications

The Burden on the Legal The Burden on the Legal SystemSystem The Burden on the Legal The Burden on the Legal SystemSystem

• Staff of prisons, county and state jails, courts, self-help centers, and depleted community mental health agencies:• Taking care of chronically mentally ill• Taking care of drug addicted populations• Taking care of those without resources

• What belongs in forensics, and what belongs in the realm of “the mental health clinic”?

• What to do with people who are in trouble, needing help, far beyond what the court has done traditionally

• Legal system has become the front line of mental health treatment

To Take Home: To Remember (1):To Take Home: To Remember (1):To Take Home: To Remember (1):To Take Home: To Remember (1):

• Many of your customers have some form of severe, diagnosable, and treatable mental disorder

• Mood disorders• Anxiety disorders• “Personality disorders”• Substance abuse disorders• Psychotic disorders

• Most severe mental disorders are biological (genetic, neurotoxins etc.) in etiology, and in “basic nature”• Most mental disorders are treatable with a combination

of medication and psychotherapy• Many of your customers need medication and

psychotherapy• Although mental disorder may be biological in origin• Severe psychological ramifications:

• History of failures • Poor social relationships• Effects of stigmatization.

More To Take Home: To More To Take Home: To Remember (2):Remember (2):More To Take Home: To More To Take Home: To Remember (2):Remember (2):

• Your customers often treat you as “psychotherapists

• They suffer from pathogenic beliefs• Pathogenic beliefs from family of origin• Pathogenic beliefs from suffering from mental

disorder• They test you in order to change pathogenic

beliefs, to overcome their problems• They test you much as they test their therapists

(when available)• Test you by:

• 1) Acting as if you were the parent• Doing TO you what they did to their parents that they

believe caused their parents to behave in ways that deeply upset or even traumatized them

• 2) Imitating their parents• Doing TO you what their parents did TO them, that

was deeply upsetting or traumatizing

More To Take Home, To Remember More To Take Home, To Remember (3):(3):More To Take Home, To Remember More To Take Home, To Remember (3):(3):

• When customers are testing you• By treating you as a parent

• For example acting as if you and you alone can “save them”

• Acting unrealistically “needy”

• By imitating a parent• For example, throwing temper tantrums

• You need to:• Remain calm • Remain accepting• Refuse to accept omnipotent

responsibility for customer

More to Take Home, to Remember More to Take Home, to Remember (4):(4):More to Take Home, to Remember More to Take Home, to Remember (4):(4):

• This provides:• A new “model” of how to be in the world• How to be when they are faced with difficult

people• How to be when faced internally with memory

of traumatizing parent

• And finally: • Always pay attention to your own

feelings• This is how you know how your customer is

testing you • This informs you of how you should respond


• Trust your feelings • Trust your motivations• Your “non-conscious” mind

• Is fundamentally altruistic• Including when when you believe you are being

“selfish”• Is engaged in information processing

• What seems like magical “intuition”• Is a manifestation of your highly adaptive and

social non-conscious

• Your own responses, feelings• Will not fail you• Are like a guide book to what is going on


• Whenever possible• When working with difficult customers

• Talk to colleagues (in your office etc.) To brain storm To problem solve To get support To develop strategies of how to best respond To work together instead of working in

isolation

• You are working in difficult conditions, with very vulnerable and difficult customers


• Because the people you are serving • May often be difficult• Present multiple problems

• If possible:• Discuss setting up a regularly scheduled

“support group” or group consultation for your office

• Discuss getting a consultant for your office• If no one available locally, do it by conference

calls • In setting up consultation, once again trust your

feelings• If a “helper” or consultant makes you feel

inadequate, guilty, angry, or ashamed, do not use that person as a consultant

• You help the most disadvantaged, stigmatized, and mistreated populations

• Therefore your job is very difficult• You deserve all the support possible


• Those working in the self-litigating court system deserve a thank you from those of us who benefit directly and indirectly from the work you do, on a daily basis

• To conclude:• We thank you, lawyers, office workers,

paralegal professionals, judges, and all the other court workers who are taking “legal care”of those who suffer from mental disorders and who by necessity are representing themselves, with your help, in our courts

Self-Represented Litigants & Mental DisordersSelf-Represented Litigants & Mental Disorders: : The Legal System as an Agent of Healing The Legal System as an Agent of Healing

The State-wide Conference on Self-Represented Litigants Friday March 17, 2006, San Francisco, California

Self-Represented Litigants & Mental DisordersSelf-Represented Litigants & Mental Disorders: : The Legal System as an Agent of Healing The Legal System as an Agent of Healing

The State-wide Conference on Self-Represented Litigants Friday March 17, 2006, San Francisco, California

Lynn E. O’Connor, Ph.D.Lynn E. O’Connor, Ph.D.

Professor, The Wright Institute Associate Professor, The Wright Institute Associate Clinical Professor, UC BerkeleyClinical Professor, UC Berkeley

Emotion, Personality & Altruism Emotion, Personality & Altruism Research Group (EPARG):Research Group (EPARG):

www.eparg.org

Research, Evaluation, Assessment & Research, Evaluation, Assessment & Supervision, & Psychotherapy Supervision, & Psychotherapy

Consultation Consultation

E-Mail: [email protected]: (415) 821-4760

California Psych Lic 13759

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