How Courts Play With Your Life: Litigation Stress Syndrome

Litigation Stress Syndrome is as real as a heart attack and can be fatal too. It's a crude form of posttraumatic stress disorder, PTSD,²⁴ and was only proposed as a psychological disorder in 1989 by Paul R. Lees-Haley, PhD.²⁵ Doctors sued for malpractice often suffer a medically labeled variation called medical malpractice stress syndrome (MMSS).

The stigma and stress associated with a malpractice suit or any litigation often results in anxiety and depression, fatigue and emotional exhaustion, difficulty concentrating, irritability, changes in appetite and libido, apathy, anger, feelings of shame and guilt, fear of reputational fallout, insomnia, burnout, loss of confidence in decision-making, substance abuse, strain on personal and professional relationships, and even suicidal ideation.²⁶ Let's explore a case study where litigation killed a man:

A fifty-seven-year-old male spine surgeon was sued for a failed anterior cervical discectomy and fusion. After five years of depositions, interrogatories, pretrial motions, and delays, the trial was finally scheduled. The history, obtained from his close colleagues and friends, revealed that anticipation of the trial "completely took over every waking moment." After prolonged sitting for five days in court during jury selection and preliminary motions, he developed mild nonspecific chest discomfort, which he attributed to stress.

Approximately thirty-six hours before the trial was to begin, he met with one of his closest friends. At that time, he was visibly distressed, anxious, apprehensive, and depressed—more than he had ever been observed to be before. He admitted to insomnia, lack of appetite, and anger at the whole experience. The accusations of professional negligence and incompetence were highly publicized in the local media. He correctly believed that his reputation as a nationally recognized premier sports medicine surgeon was under attack.

Because of pretrial stress and the required time for trial preparation, beginning a few weeks before the actual trial, he neglected his usual daily one hour or so of aerobic and resistance workout. He was on no medications, had no history of cardiac or pulmonary disease or risk factors for clotting disorders, and was in general excellent health. He did not smoke or use alcohol.

Beyond his numerous publications and professional accomplishments, he was known to be dedicated to the highest medical ethics and was firmly committed to what was in the best interest of his patients. He was known to have boundless energy, a brilliant medical mind, and skilled hands.

The friend stated that throughout his career the physician always "kept it together" and was "as cool as ice" under pressure. So, his behavior and mood then were very atypical.

On the morning of the first day of trial, he walked to his car and suddenly fell to the ground and died. The autopsy revealed multiple pulmonary thromboembolisms, well organized and adherent, occluding the bilateral lower lobar pulmonary arteries, which probably caused the nonspecific chest discomfort prior to the trial. Also, there was a large non-adherent saddle embolus occluding the main pulmonary arteries that resulted in sudden death.²⁷ The judicial process whacked the athletic healthy doctor.

There is even a book written for doctors, Physicians Survival Guide to Litigation Stress. Understanding, Managing, and Transcending a Malpractice Crisis, but make no mistake about it, this syndrome, or at least some of its symptoms, will affect most folks who litigate. It's not about having a victim mentality. It's more about the physiological responses triggered by the stress inherent in litigation.

If one has other stressors or medical conditions, they are often exacerbated. Ulcers and acid reflux pop up and erupt like sprouts and volcanoes. Cognitive disruptions, such as problems with concentration and attention, are common. Irrational thoughts associated with "catastrophizing" and "awfulizing" are common, along with rumination about potentially disastrous outcomes.

Marital and family conflicts are very common consequences of litigation stress. Pre-existing strains in these relationships are magnified. As one would expect, it is not uncommon for the use of alcohol, tobacco, and caffeine to increase during this time of stress. The risk for abuse of these substances increases, along with various prescription medications, especially pain medications, anti-anxiety drugs, and sleep medication.²⁸ The very process of adjudication, the legal system itself, at best inflicts harm and at worst kills and maims people. The verdict, financial losses, or lousy custody arrangements all pale in comparison to the emotional, psychological, and physical anguish wrought by the legal system's machine. In the case study explored earlier, the litigation was this doctor's death knell, literally the premature nail in his coffin.

So, folks, there you have it. Litigation is a meat grinder. It's a plague of heart attacks, strokes, and other fatal or debilitating calamities. If you are lucky, you will survive. Whether you're sitting at the plaintiff's or defendant's table, litigation takes a toll on your mental and physiological health, and let it be known that I warned you: litigation is a health risk.