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Anxiety and panic and The Law. B...

Posted Oct 22 2008 6:16pm

Anxiety and panic and The Law.

Been a while, been busy. But I'm back.

Today's first post: a look at steps panic patients and the people/caregivers in their lives can take to ease stress when they have to appear in court or other official public hearings, from the excellent Anxiety Disorders - The Caregivers site. A snippet:

Due to the nature of Anxiety Disorders, those suffering from them can find themselves in almost impossible situations when called upon to give evidence in courts, insurance appeals, before semi-judicious bodies and hearings of all types...As they cannot handle the normal daily stress, a forced adversarial meeting such as in courtrooms, hearings, insurance appeals, etc., is devastating to them. It can be so devastating them that a number cannot even pursue insurance appeals - they just have to give up and walk away. (Unfortunately, it seems that a number of agencies, being aware of this, draw events out as long as possible.)

So what can be done to help these people?

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

Before the Event

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

During the Event

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

Good advice for those who work with folks with anxiety disorders, and worth showing to people who are working with you if you're a sufferer yourself.
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