REGULAR ARTICLE I’ll See You in Court...Again: Psychopathology and Hyperlitigious Litigants

C. Adam Coffey, MS, Stanley L. Brodsky, PhD, and David M. Sams, JD, LLM

Persistent litigation is a problem in many legal and is costly at individual and systemic levels. This phenomenon is referred to as “querulous” behavior in psychiatric literature, whereas legal discourse refers to it as “vexatious litigation.” We refer to this phenomenon as “hyperlitigious behavior” and those who engage in these actions as “hyperlitigious litigants.” Hyperlitigious litigants and hyperlitigious behavior were once the focus of a considerable amount of psychiatric literature, but research devoted to these topics has declined over the past half century. A review of the published literature on hyperlitigious behavior in European and English-speaking countries highlights geographic differences in the conceptualization and management of this behavior. We provide an alternative framework to consider the motivation to engage in hyperlitigious behavior and suggest three strategies for mental health professionals who interact with these individuals. Finally, we call for a revival of discussions and research within the English-speaking psychiatric community to facilitate more informed decisions regarding the management and treatment of hyperlitigious behavior.

J Am Acad Psychiatry Law 45:62–71, 2017

Again? How many times do you want me to sue them? If “Then there is Snell versus everybody else.” While memory serves me correctly, this will be the 17th time you have brought suit over the same issue!1 obviously comical, Snell’s character nicely illustrates the concept of the hyperlitigious person. Fans of the British TV comedy Kingdom,1 which Although the quote refers to a fictional character, it aired from 2007 to 2009, may recognize this quota- may have reminded you of a problem client or examinee tion. The show’s main character, Peter Kingdom with whom you have interacted or heard about over the played by Stephen Fry, speaks these words to the course of your career. Forensic mental health profes- show’s antihero, Sidney Snell. Snell is well known by sionals, , judges, and court clerks have little dif- the show’s other characters for his propensity to file ficulty conjuring up a story of at least one individual unmerited or futile lawsuits against members of the whom they have encountered who is like Sidney Snell. city council. When told that he has brought 17 suits These clients frequently inhabit the doorways of law against the city council, Snell quickly corrects Peter, offices and courthouses, each time with a new com- telling him he has actually filed 18 suits against them. plaint against an individual or a group of people. The After Snell leaves, Peter describes his case load to his cost or consequences of litigation are sometimes trivial secretary, colorfully portraying Snell’s character by to these clients, whereas retribution for a real or imag- listing a few of his current cases before quipping, ined slight or injustice is their foremost priority. These individuals and their behaviors are the sub- Mr. Coffey is a Student and Dr. Brodsky is Professor Emeritus and Scholar in Residence, Department of Psychology, The University of Alabama, ject of this article. The current article proposes a new, Tuscaloosa, AL, Mr. Sams is an attorney with the Community Tax Law nonpejorative label for the behavior and examines Project in Richmond, VA. Address correspondence to: C. Adam Coffey, Psychology Department, The University of Alabama; Tuscaloosa, Ala- historical and geographical differences in the concep- bama 35487-0348. E-mail: [email protected]. tualization of the phenomenon. An alternative con- Disclosures of financial or other potential conflicts of interest: None. ceptualization is proposed and discussed in the con-

62 The Journal of the American Academy of Psychiatry and the Law Coffey, Brodsky, and Sams text of the psychiatric literature and real-world A subset of individuals may seemingly meet the examples. The role of the forensic clinician is exam- proposed definition, although they do not qualify as ined, including assessment and treatment of such in- hyperlitigious. That is, this definition does not in- dividuals. Finally, we encourage a revival of attention clude persons or entities that, because of their posi- and propose directions for future research about this tions or professions, are forced to be involved in a oft-neglected phenomenon. large number of lawsuits for a primarily occupational or legal purpose. For example, a state attorney’s office would not be considered hyperlitigious, because the Hyperlitigious Persons nature of the office requires numerous filings. Simi- Persistent litigation has been described across pro- larly, a large-scale residential landlord would not be fessions in different ways. Legally, it is referred to as considered hyperlitigious because of having to file “vexatious litigation,” whereas medically it has been numerous eviction actions. The state’s attorney and diagnosed as “querulous paranoia” and “litigious landlord examples lack the nonlegal, nonorganiza- paranoia.”12 Other critical names include “cranks,” tional purposes found in the excessive use of the “injustice collectors,” “serial pests,” and “wrecks of court system by a hyperlitigious litigant. Conversely, justice.”3 In general, these terms describe an individ- the nature of a person’s position or profession should ual who exhibits several of the following qualities: not exempt an actor from the application of the def- inition of hyperlitigious behavior if they exhibit some Initiates dozens or hundreds of suits. of the above traits in a manner incongruous to their Has a life that revolves around the development relevant professional standards. and progress of litigation. History of Hyperlitigious Behavior Is not deterred by repeated negative outcomes. Although it is referred to by different names in Files suits that are trivial or unfounded. different professional fields, as well as in different Invests great amounts of time in litigation. parts of the world, the concept of hyperlitigious be- havior is a well-documented phenomenon through- Is a known and persistent presence for lawyers, 4 judges, and clerks. out history. Recently, Benjamin Levy published a two-part article on the history of this behavior in For the purposes of this article, we will refer to which he discussed historical origins and geographi- these individuals as “hyperlitigious” persons. We cal differences in how excessive litigation has been formed this term by joining the prefix hyper, mean- conceptualized and researched. In Part 1 of his arti- ing over or excessive, and the word litigious, meaning cle, he traced the history of “paranoia querulans” and concerned with lawsuits or litigation. This term is the “litigant’s delusion” in France and in German- more neutral than previously used terms such as speaking countries. In Part 2 of the article, he dis- querulous, paranoid, and vexatious that are pejora- cussed the history of querulous behavior and vexa- tive and infer psychopathology. The term hyperliti- tious litigation in English-speaking countries: the gious is meant to be descriptive and free of inferences , the , and .5 regarding the behavior’s origins or the individual’s Before we delve further into our own conceptualiza- level of psychological functioning. tions of such litigants, we will recapitulate and ex- A hyperlitigious person is an individual who pand upon the Levy reviews. makes excessive and egregious use of the legal system for a primarily nonlegal purpose. It should be noted Germany: The Litigant’s Delusion and Paranoia that, although there is usually a legal purpose for Querulans their suits, the legal purpose is not paramount to the The first recorded reference to excessive involve- needs of the client. We also note that this is not a ment with the legal system was found in Aristo- single trait but rather a grouping of common charac- phanes’ play, The Wasps. Written in 422 BCE, the teristics of hyperlitigious behavior. A litigant may play depicted the statesman Philocleon who was la- exhibit only some of the above characteristics in an beled a “trialophile” because he was addicted to court exaggerated manner and still fall within the construct proceedings. This character would do anything to of the hyperlitigious person. serve on a jury because he enjoyed passing judgment.

Volume 45, Number 1, 2017 63 Psychopathology and Hyperlitigious Litigants

In Aristophanes’ original text, Philocleon recognized were driven to act by authentic legal injustices they the power given to him by jury service and proudly experienced rather than by delusional beliefs. There- exclaimed, “(t)he hand of power is on me.”6 In sub- fore, the querulants’ difficulties were psychogenic, sequent translations of this passage from The Wasps, suggesting psychological origins. Paranoia, by con- Philocleon declared a desire to “go with you to the trast, involved imagined events and was considered a law-court and do all the harm I can.”7 The play sat- constitutional disorder, which suggested physical irized the political climate of ancient Athens, which origins. Aristophanes believed was responsible for producing Attributing hyperlitigious behavior to psycholog- trialophiles.8 ical origins also implied that it could be treated and In 1668, French playwright Racine wrote and pro- managed by psychologists and psychiatrists. This duced The Litigants,9 which was based on Aristo- change was widely accepted, and scholars began to phanes’ work. Racine specifically acknowledged the explore new factors related to these individuals and pleasure he received in reading The Wasps and how it behaviors. Hyperlitigious behavior still receives was the model for his own play. In Racine’s rendition some attention in both the legal and psychological of the story, the main character was overly eager to literature.12 file lawsuits rather than to serve on juries. Racine depicted his main protagonist’s trialophilia as an in- France: Persecuted-Persecutors and Delusions of dividual character flaw rather than a product of the Revindication political climate, a portrayal that represents an ap- Although France is in geographical proximity to proximation of how future scholars would conceptu- Germany, the development of the concept of hyper- alize persistent and pathological litigation. litigious behavior evolved differently there. French German psychiatrist Johann Ludwig Casper10 psychiatrist Henri Taguet referred to these litigants would later refer to trialophilia as Querulantenwahn, as “persecuted-persecutors,” which became the ac- which translates as “litigant’s delusion.” Casper as- cepted nomenclature in French psychiatric litera- serted that all human beings strongly resent real or ture. Like Kraepelin, French scholars generally be- imagined threats to their basic rights, leading them to lieved hyperlitigious persons were exaggerating or take legal action to protect their rights when neces- distorting real events.13 Many early French research- sary. When these individuals are not granted the ers seemed to consider these behaviors to be evidence rights they desire or are otherwise displeased with the of long-standing personality defects rather than com- outcome of legal proceedings, they become fixated plications arising from one’s interpretation of an on attaining justice. This fixation begins a downward event. In addition, Benjamin Ball combined the ex- spiral that eventually results in a full-blown delu- isting views on listed features he believed to be com- sional disorder. German psychiatrist Richard von mon among all hyperlitigious individuals: relentless Krafft-Ebing4 added to Casper’s definition by classi- activity, outstanding tenacity, personal elation, fying these delusions as a kind of persecutory delu- of logic, intellectual and often physical resilience, and sion. These classifications laid the foundation for graphomania.14 subsequent German psychiatrists to study and debate The associated concept of reasoning mania fell out the concept of hyperlitigious behavior for the next of favor with many French scholars in the late 19th half century. century, and persecuted-persecutors disappeared Debates followed about whether litigant’s delu- from the research literature shortly thereafter.4 This sion should be classified as a subtype of paranoid or idea was replaced by what the French psychiatrist persecutory delusion, as a freestanding disorder, or as Benjamin Pailhas referred to as delusions of revindi- a variant of another psychological illness. When Ger- cation. Pailhas believed these individuals, unlike man psychiatrist Emil Kraepelin11 wrote Psychiatrie, those with paranoia querulans, who were said to be he departed from previous editions of the text that seeking more than their fair share of rights, perceived grouped litigant’s delusion with paranoia and perse- that they had lost things that rightfully belonged to cutory delusions. In the eighth edition, Kraepelin them and were bitterly revolting against the person noted what he considered to be key etiological differ- or entity responsible for the seizure.15 Gae¨tan De ences between paranoia and delusional disorders and Cle´rambault broadened this classification by describ- litigant’s delusion. He asserted that these litigants ing what he called “delusions of passion,” which in-

64 The Journal of the American Academy of Psychiatry and the Law Coffey, Brodsky, and Sams cluded delusions of revindication, erotomania, and Rowlands presented case studies of five individuals pathological jealousy.16 Those who exhibit evidence deemed “vexatious litigants” by the courts who were of delusions of passion become fixated on a goal and subsequently prohibited from engaging in future lit- feverishly pursue the goal to its end, which is remi- igation. Much like the German and French research- niscent of Casper’s early description of a litigant’s ers, she concluded that these individuals had justifi- delusion. Many scholars who studied delusions of cation for feeling wronged or slighted, but the passion agree that individuals typically present with infractions were not severe enough to warrant the various combinations of these delusions more often relentless pursuit engaged in by these litigants.2 Sub- than with a singular type of delusion, making the sequent English-speaking researchers formed conclu- study of pure forms of these delusions more diffi- sions about these individuals similar to those offered cult.17 This nosology of what we have labeled as hy- by French and German psychiatrists. Consistent perlitigious behavior is still widely accepted by with Benjamin Ball’s14 observation of French perse- French clinicians, even though the behavior itself or cuted-persecutors over 100 years earlier, Lester and the people who exhibit such behavior have not been colleagues20 in Australia found that unusually persis- the subject of empirical research since the late tent complainants submitted legal material that was 1930s.4 longer and contained more repetitive and pedantic discourse than a control group. They were also more English-Speaking Countries: Vexatious Litigants dissatisfied with the outcome of their case than were and Unusually Persistent Complainants average persons, resulting in additional complaints Following the lead of Levy, we now focus on hy- being filed. Building from this work, Mullen and perlitigious behavior in Australia, , and the Lester12 later expanded the scope of their research United States.5 Unlike in Germany and France, this and described querulous behavior. They distin- concept has received little attention from psychia- guished between three groups of individuals who ex- trists and psychologists in these countries. Most of hibited such behavior: vexatious litigants, unusually the research regarding hyperlitigious behavior has persistent complainants, and unusually persistent pe- been conducted by legal researchers who seek to de- titioners. The distinguishing features associated with termine its impact on the legal system. Despite being each subgroup are listed in Table 1. a neglected topic in psychological literature, hyperli- Hyperlitigious behavior is acknowledged in the tigious behavior is alluded to in the American Psy- two primary diagnostic manuals on mental illness chiatric Association’s Diagnostic and Statistical used worldwide, and extant psychological research Manual of Mental Disorders (DSM) and the World suggests similarities between English-speaking hy- Health Organization’s International Classification of perlitigious litigants and those in other countries. Diseases (ICD). The most recent version of the However, mental health professionals have had little DSM, DSM-5, describes a persecutory delusion in role in the management of hyperlitigious litigants in which the individual “may engage in repeated at- English-speaking countries. Levy5 offered two hy- tempts to obtain satisfaction by legal or legislative potheses about why persistent litigators in practice action.”18 The ICD-10 includes paranoia querulans are rarely seen as pathological in these countries. The as a freestanding persistent delusional disorder: that first is what scholars have deemed the “pro se phe- is, a disorder “in which the delusion or delusions are nomenon” in which individuals represent themselves accompanied by persistent hallucinatory voices or by in court far more often in the United States and other schizophrenic symptoms.”19 Each of these defini- English-speaking countries than anywhere else in the tions is similar to the German psychiatrists’ descrip- world.21 Because the right to defend oneself is such a tion of litigants’ delusions. Nonetheless, psychologi- strongly held value in these countries, applying path- cal research on this concept in English-speaking ological labels to even the most persistent litigators is countries remains modest. unlikely to ever be a widely accepted practice.6 The Few empirical articles have been published by psy- second reason is related to the depiction of legal ac- chologists or psychiatrists on hyperlitigious behavior tion in popular media. In many popular novels and in English-speaking countries. Only one of these ar- films, extended litigation is often associated with ticles, published by Michael Rowlands in 1988, de- meritorious legal issues and is enacted by well-ad- scribed hyperlitigious litigants in the United States. justed individuals.

Volume 45, Number 1, 2017 65 Psychopathology and Hyperlitigious Litigants

Table 1 Mullen and Lester’s Categories of Querulous Behaviors12 Has been involved in at least five litigations other Term Querulous Behavior than small claims court within the previous seven Unusually persistent Pursue legal actions that seem trivial and years. complainants not worth the effort that goes into such a long campaign. Repeatedly relitigates or attempts to relitigate Pursue complaints longer, produce a against the same defendant after a disposition higher volume of materials, and have against the litigant. much greater difficulty reaching mutually agreeable terms. Repeatedly files unmeritorious motions and Demand public recognition for their claims and their willingness to struggle pleadings, conducts unnecessary discovery, or on behalf of the public. engages in other tactics that are frivolous or in- Vexatious litigants Largely pursue their grievances within tended to cause delay. the courts, unlike unusually persistent complainants and petitioners. Has been declared vexatious by any other state or Usually act pro se because they run out federal court based on the same or similar facts or of money or do not believe a 23 can adequately represent them. transactions. Consult internet websites for information In an effort to curtail vexatious and frivolous pro- about how to circumvent orders that declare them vexatious. ceedings, some states have created vexatious litigants Unusually persistent Submit petitions or written grievances to lists that are publicly available and can be accessed petitioners prominent people, including judges online. For example, as of the end of 2015, and congressmen. had the longest vexatious litigant list with more than Send voluminous and repeated requests 24 for help. 900 entries. Some of the names on California’s list View the public figure as either a savior have been identified by judges as aliases used by peo- or central impediment to their quest ple previously placed on the list in other jurisdic- for justice. tions. The use of aliases illustrates the lengths to which some of these individuals are willing to go to circumvent current management strategies and con- Current Management Strategies tinue to pursue litigation. The responsibility of managing vexatious litigants Hyperlitigious Persons in Real Life in the United Kingdom and in the United States is given to the courts, where various statutes have been We have spoken to judges, attorneys, and mental passed banning individuals from further litigation health professionals in our area about their experi- once they have been deemed vexatious. The first such ence with hyperlitigious persons. We have also ana- act, Britain’s Vexatious Litigant Act 1896, was en- lyzed publicly available legal documents associated acted after Alexander Chaffer filed 48 lawsuits with individuals placed on their state’s vexatious lit- against many high-ranking members of society, in- igants list. We present two cases of people who meet cluding the Speaker of the House of Commons and our definition of hyperlitigious litigants. 22 the Prince of Wales. This Act laid the foundation Case 1: The Judge is Out to Get Me for all subsequent Acts by beginning the process of formalizing the definition of vexatious litigation.6 Well-intentioned solutions can have unintended However, many of these Acts neglected to create con- consequences. In California, a woman filed a lawsuit crete guidelines concerning the number of suits in against a superior court judge because he added her which one must be involved to be considered vex- to the state’s vexatious litigant list. In her claims, she atious, and instead left this up to the discretion of made several accusations against the judge and other the judge. It should be noted that this designation members of her community. The following list con- occurs well before an individual reaches Chaffer’s tains verbatim examples of these accusations, taken observed level of litigiousness. In the United directly from a selection of the 23 claims she filed. States, some state statutes are more specific about She stated that the judge: when an individual may be deemed vexatious. For Had people harassing her, her, making example, in California, a litigant is considered vex- comments, tampering with her car, flattening atious if he: her car tires, making her car smell like gas and

66 The Journal of the American Academy of Psychiatry and the Law Coffey, Brodsky, and Sams

“had government jet planes leave exhaust lines in with identity protected, personal communication, the sky.” June 28, 2015).

Had a Chinese dentist “drill holes in [her] An Alternative Conceptualization good teeth and then. . .filled with a metallic substance.” We acknowledge the similarities between hyperli- tigious persons and patients with delusional thought Was allegedly guilty of mass fraud, mayhem, patterns or evidence of paranoia. We agree with pre- false imprisonment, kidnaping, mass violation vious assertions that some hyperlitigious behavior “at all forms of employment like Wal-Mart.” arises from psychotic symptoms. One might specu- Committed conspiracy, assault and battery, late that this explanation applies to the woman dis- mass bodily injury with many unauthorized cussed in Case 1. However, psychotic symptoms do procedures. not seem to be common to all of these litigants. Whereas most patients with delusions present with Committed “hate crimes on a daily basis from disorganized or idiosyncratic beliefs, many hyperliti- wicked people that [she has] never met.” gious individuals present with a detailed and logical Programmed “dododododododod so loud that a account of their grievances.12 The common charac- person standing next to [her] can hear.” teristic in hyperlitigious individuals is a maladaptive Engaged in illegal slavery at “places of employ- pattern of behavior, and such patterns arise and are 25 maintained by a variety of factors. ment.” Our initial conceptualization was that one route of The woman’s claims against the judge were dis- emergence and maintenance of hyperlitigious behav- missed, and, at the time of this writing, she remains ior is the desire for attention and recognition. One on California’s vexatious litigant list. might hypothesize that the woman in Case 2 was driven by such a desire and may have been experienc- Case 2: Unrequited Love ing what De Cle´rambault16 deemed a delusion of When the woman came forth to the court for the passion. However, the desire for attention can extend seventh time with a lawsuit against a specific emer- beyond a desire for attention from one person. Some gency room physician, the judge was fed up. Over the hyperlitigious individuals seek attention on a larger scale. Our alternative explanation makes sense in past three years, the woman had filed lawsuits every 12 few months against the handsome young doctor who light of the observation of Mullen and Lester that was on duty in the emergency room at the commu- many of these litigants seek public recognition for nity hospital. The allegations varied widely. Some- their willingness to struggle on behalf of others. times she alleged that he had spent insufficient time There are several psychological syndromes that are characterized primarily by the need for attention. with her. Other times, she alleged that unnecessary These disorders include histrionic personality disor- and expensive tests had been ordered. On another der, narcissistic personality disorder, and factitious occasion, she alleged he had been unprofessional and disorder. Although hyperlitigious behaviors may be rude, exhibiting inappropriate behaviors that caused compared with each of these disorders, we drew the her mental anguish. clearest comparisons between hyperlitigious persons In each case, the woman represented herself and and patients with factitious disorder. personally deposed the doctor. Eventually, the Factitious disorder is a condition in which patients presiding judge summarily dismissed the cases. feign or exaggerate medical symptoms and seek help The plaintiff had stated repeatedly that the physi- from medical professionals.17 Individuals with facti- cian was in love with her and she with him. Ob- tious disorders travel from medical facility to medical servers noted that she seemed to take exceptional facility, presenting with complicated symptoms.26 pleasure being in his company during the deposi- They do not seek external rewards for their behavior. tions. After the seventh lawsuit, the judge issued They pursue being cared for by medical professionals an injunction against her filing additional suits by assuming the sick role, a sociological term that unless compelling and cogent information could defines how individuals who have an illness should be brought to the attention of the court (Judge, act and be treated by others.27 These individuals ben-

Volume 45, Number 1, 2017 67 Psychopathology and Hyperlitigious Litigants efit from assuming the sick role in society because of consistent with previous descriptions of hyperliti- the societal expectation that sick individuals are to be gious litigants, who often misinterpret the actions of cared for and nurtured back to health. In the context others and pursue litigation for far longer than a sit- of factitious disorders, the sick role is typically uation warrants.2,11 thought to be one variant of the “victim role” which Although motivated by similar events, the major has also been referred to as “playing the victim” or difference between patients with factitious disorder “victim syndrome.”28 Our initial impression of hy- and hyperlitigious litigants is the extent to which perlitigious litigants was that their behaviors signi- individuals perceive themselves to be in control of fied a desire to reap the benefits of assuming the role the ailment or complaint. Whereas patients with fac- of victim as well. We hypothesized that these indi- titious disorders typically feign symptoms or induce viduals viewed themselves as victims of someone illness in themselves, hyperlitigious litigants usually else’s negligence or wrongdoing and subsequently file suits over actions (or their absence) that they sought to receive sympathy or retribution for the believe have been taken to them and are largely be- hardships they faced, much as patients with factitious yond their control. A doctor who suspects a patient disorder seek sympathy and relief from their claimed has a factitious disorder is advised to be cautious and symptoms. not to overlook a genuine health concern that war- Additional comparisons readily appear between rants professional attention. We believe this is sound hyperlitigious litigants and patients with factitious advice for legal and mental health professionals who disorders. Patients with factitious disorder and hy- encounter hyperlitigious litigants, as well. perlitigious litigants use similar strategies when seek- ing professional assistance. Just as patients with fac- titious disorder go from hospital to hospital seeking Hyperlitigious Persons and the Forensic care, hyperlitigious litigants often go from attorney Clinician to attorney, looking for someone to lend a sympa- We have defined hyperlitigious behavior as not thetic and helpful ear. Patients with factitious disor- necessarily indicative of psychopathology. We are in- der are well versed in medical jargon and make efforts terested in behaviors, not disorders. Nevertheless, fo- to read and study medical textbooks.26 Similarly, hy- rensic clinicians may encounter hyperlitigious per- perlitigious litigants use legal jargon in verbal and sons in numerous contexts. The forensic clinician written communication, though they may not use may be less affected by the possibility of lawsuits the terms correctly.12 because of the quasi-judicial immunity afforded to Etiological comparisons between the two types of the clinician in most proceedings.30 behaviors can also be made. Two hypotheses have Although it is possible for anyone to file a lawsuit been offered to explain the origins of factitious dis- against a forensic clinician, the common bases for ordered behaviors. First, patients with factitious dis- such actions in general clinical practice are unlikely order often hold grudges against the medical system to apply to forensic practice. Inappropriate sexual stemming from previous negative outcomes or neg- actions and matters of privacy or privilege would ative interactions with doctors.26 This behavior is rarely apply. In his review of malpractice complaints consistent with observations made about the queru- in the context of child custody evaluations, Caudill31 lous in Germany, the persecuted-persecutors and pointed out that licensing board complaints are in- seekers of vindication in France, and vexatious liti- expensive and easy for disgruntled parents and pre- gants in English-speaking countries, who were driven sented a list of 11 possible complaints against custody to persistent litigation after an unfavorable event or evaluators, including bias and inadequate record legal outcome. A second hypothesis regarding the keeping. source of factitious disordered behaviors draws from For most forensic examiners, there appears to be somatosensory amplification theory. This theory little vulnerability for successful lawsuits. Quasi judi- posits that some individuals have a tendency to expe- cial immunity provides protection because the eval- rience sensory stimuli more intensely than the aver- uator is engaged in an activity that is essential to the age person.29 Thus, a minor nuisance to an average court. This immunity is most compelling in in- person would be portrayed as severe by such ampli- stances in which the evaluator is appointed by the fiers and overperceivers. Again, this explanation is court, but it appears to apply in most jurisdictions

68 The Journal of the American Academy of Psychiatry and the Law Coffey, Brodsky, and Sams and circumstances when medicolegal matters are in sitive legal professionals. Some may be court ordered question. into treatment after real or threatened acts of vio- For potential litigants who have been ruled to be lence. Mullen and Lester12 observed that hyperliti- vexatious, further protection is in place. In the de- gious persons who were court ordered to their clinic scription by Mullen and Lester12 of the Problem were paradoxically ultracompliant therapy clients. Clinic model, the constraints against lawsuits are ex- Some voluntarily continued with treatment after the plicit and cogent. More generally, when a person is court order ended. Many never seemed to recognize placed on a vexatious litigants list, he is prohibited the futility of their claims, but their engrossment in from filing claims without the approval of a judge. In the claims decreased. many cases, the litigant is ordered to seek counsel. So, what can be done? Research on therapeutic These same outcomes occur in an evaluation of a management of these individuals has been limited. criminal defendant’s competency to waive the right Case reports and anecdotal accounts have offered to counsel. The fundamental question of whether some evidence supporting the efficacy of cognitive hyperlitigious persons are competent to appear pro se behavioral interventions.2,12 However, there are no is a matter in which forensic mental health profes- systematic investigations regarding how existing sionals can offer informed opinions. psychotherapeutic interventions may be applied to manage hyperlitigious behavior. The scant research The Question of Mental Health literature has examined management through medi- Treatment cation. In one study on managing these behaviors 32 Legal remedies reduce the burden placed on tar- with medication, Ungvari found that low doses of gets of vexatious proceedings and on the legal system, an antipsychotic medication reduced symptoms of but such remedies do not address the underlying mo- hyperlitigious behavior in a small sample of individ- tivations for this type of behavior. Even after facing uals with a diagnosis of “litigious paranoia.” Simi- 12 legal sanctions, many litigants find additional ways larly, Mullen and Lester offered anecdotal evidence to continue to harass others through misuse of the of improvements in hyperlitigious clients with whom legal system. Some of these litigants may end up su- they were working after a course of atypical antipsy- ing the parties whom they deem responsible for im- chotic medication. For the hyperlitigious persons posing legal sanctions. Unfortunately, legal remedies with delusional thought patterns or psychotic fea- do not address the mental health needs of individuals tures, these interventions seem reasonable. For those whose hyperlitigious behavior is part of a psycholog- without these features, who instead present only with ical disorder. For example, the woman in Case 1 was maladaptive patterns of behavior, other interven- placed on California’s vexatious litigants list after fil- tions seem more appropriate. ing multiple lawsuits against a superior court judge. Many hyperlitigious persons have presented with The bizarre content of her claims raised the suspicion obsessional traits.12 In the context of speculative that she may have had delusions and hallucinations, treatments, for the very small number of persons who but to our knowledge, she was not referred for mental have insight that their behaviors impair their lives, health assessment or treatment. Furthermore, legal the standard approaches to obsessive-compulsive remedies do not address the dysfunctional cognitions (OC) disorders may help. Exposure and response and behavioral patterns that define hyperlitigious- prevention therapies have a reasonable track record ness. In Case 2, the judge’s order may have limited with OC disorders, especially when used in combi- the woman’s litigious behavior, but it is possible that nation with mainstream antidepressant medica- she would have continued to harass the physician in tions.33,34 For the small minority of persons who other ways. seek treatment voluntarily, this strategy would ad- Hyperlitigious people often live unhappy, frus- dress preoccupation with the grievance and claims trated, difficult lives in which they obsess continu- process. ously about their pending lawsuits. Many are left Another subset of hyperlitigious people has aware- destitute by their relentless pursuits of justice.12 They ness that their lives are disrupted by their actions, but rarely seek therapy on their own, largely because of a are unwilling to seek professional treatment, in part pervasive belief that they stand with justice and fair- because of the stigma associated with such labeling. ness in a system of thwarted passageways and insen- In large cities, experimental peer help programs sim-

Volume 45, Number 1, 2017 69 Psychopathology and Hyperlitigious Litigants ilar to Alcoholics Anonymous might be initiated. involved a sample from the United States or referred These peer groups also have a reasonable track record to workings within the United States legal system. in promoting reductions or cessations in problematic Genn39 warned that the absence of first-hand data substance use when used in conjunction with indi- regarding the hyperlitigious creates gaps in knowl- vidualized treatment.35 We could envision a group of edge that are filled with anecdotes that may not be Hyperlitigators Anonymous (HLA?) that could work accurate representations of such persons. Although together to address the behaviors that have some el- this absence is problematic, perhaps insights about ements of an addiction. hyperlitigious individuals can be gained by systemat- Hyperlitigious individuals and the judicial system ically examining experiences with them, as well as may benefit from using management techniques interviewing and assessing such persons directly. similar to those intended to assist persons with men- tal illness who face criminal charges. Over the past 20 years, many jurisdictions have established mental Conclusion health courts that are meant to promote therapeutic Hyperlitigious behaviors pose significant chal- healing by addressing the root causes of behaviors 36 lenges for legal professionals and the judicial systems that bring individuals to the courts. These courts across the United States and worldwide. The last stipulate that an individual must complete court- half-century has seen these individuals nearly disap- monitored assessments and a treatment plan before 37 pear from the psychological literature. Ongoing re- their legal case is addressed and resolved. In many search on them is being conducted predominantly in states, these courts have produced numerous positive 38 European countries and is largely unavailable to cli- outcomes for those involved. nicians in the United States. We believe it is worth- Existing statues allow the mental health court par- while to revive discussion within the English-speak- adigm to lend itself to the management of hyperliti- ing psychiatric community about hyperlitigious gious litigants. Many of the statutes that are intended individuals and how mental health professionals may to keep hyperlitigious litigants at bay allow a judge to assist in their management. We have proposed a non- decide whether and when an individual deemed vex- pejorative way to conceptualize the motivations be- atious is allowed to engage in future litigation. Re- hind this type of behavior, as well as three treatment quiring hyperlitigious litigants to participate in a strategies for mental health professionals who may similar program before being allowed to pursue fur- interact with hyperlitigious litigants. ther litigation may help to alleviate some of the load A needed research task is to elicit feedback from these individuals place on overtaxed judicial systems. professionals who have dealt with these individuals The prospect of being removed from vexatious liti- to gain insight into how their behaviors develop and gant lists may also serve as leverage and a positive are maintained over time. Empirical testing of hy- reinforcement that leads hyperlitigious persons to potheses about hyperlitigiousness is warranted. The agree to participate in treatment. All three of the best way to do this may be to locate and speak directly suggested strategies also allow for data to be gathered to hyperlitigious persons, though this is an inherently directly from litigants, enabling forensic psychiatrists difficult task, given the nature of the behavior. Still, and the judicial system to gain greater understanding hyperlitigious litigants both cause and likely experi- of the mechanisms that contribute to the develop- ence a great deal of dysfunction as a result of their ment and maintenance of relentless litigation. Sisyphean pursuits of justice. Our intent is not to conclude prematurely that these individuals are af- What We Don’t Know flicted with some form of psychopathology. Rather, The conclusions that have been offered about hy- our goal is to develop a better understanding of perlitigious litigants, including our own, are largely them and their behavior so that informed decisions speculative. Hyperlitigious litigants and behaviors may be made regarding how these behaviors can be have been neglected in the psychological literature addressed. over the past half-century. To date, no empirical data have been gathered directly from these individuals. Acknowledgments In fact, only a handful of empirical articles have been The authors thank Michelle A. Jones for her help in revisions of published about them, and only one of those studies earlier versions of this article.

70 The Journal of the American Academy of Psychiatry and the Law Coffey, Brodsky, and Sams

References 19. World Health Organization: ICD-10 Version: 2015, Geneva: Author, 2015 1. Wheeler S, Whiting A: Kingdom (television show). Produced by 20. Lester G, Wilson BW, Griffin L, et al: Unusually persistent com- Lowe G. Episode 1.1, April 22, 2007 plainants. Br J Psychiatry 184:352–6, 2004 2. Rowlands MW: Psychiatric and legal aspects of persistent litiga- 21. Swank DA: The pro se phenomenon. BYU J Pub L 19:373–86, tion. Br J Psychiatry 153:317–23, 1988 3. Bedford N, Taylor M: Model no more: querulent behavior, vex- 2004 atious litigants and the vexatious proceedings act 2005. J Judicial 22. Taggart M: Alexander Chaffers and the genesis of the Vexatious Admin 24:46–60, 2014 Actions Act 1896. Cambridge L J 63:656–84, 2005 4. Levy B: From paranoia querulans to vexatious litigants: a short 23. California Vexatious Litigant Statute, Cal. Civ. Proc. § 391 study on madness between psychiatry and the law, Part 1. Hist (1963) Psychiatry 25:299–316, 2014 24. Judiciary of California: Vexatious Litigant List. Available at 5. Levy B: From paranoia querulans to vexatious litigants: a short http://www.courts.ca.gov/documents/vexlit.pdf/ Accessed March study on madness between psychiatry and the law, Part 2. Hist 28, 2016 Psychiatry 26:36–49, 2015 25. Latronica v. Superior Court of California, 1:09cv1162 AWI DLB 6. Mitchell T: The Wasps of Aristophanes, with Notes Critical and (E.D. Cal. 2009) Explanatory, London: J. Murray, 1835 26. Maxmen JS, Ward NG, Kilgus M: Essential psychopathology and 7. Stevenson DC: The internet classics archives: The Wasps by its treatment (ed 3). New York: W.W. Norton Company, 2009 Aristophanes (ebook). Available at http://classics.mit.edu/ 27. Parsons T: Illness and the role of the physician: a sociological Aristophanes/wasps.html. Accessed June 24, 2015 perspective. Am J Orthopsychiatry 21:452–60, 1951 8. Potter B: Aristophanes’ The Wasps. 2015. Retrieved from: http:// 28. Manfred FR, de Vries K: Are you a victim of the victim syndrome? classicalwisdom.com/wp-content/uploads/2015/ebooks/Wasps. Organizational Dyn 43:130–7, 2014 pdf 29. Barsky AJ, Goodson JD, Lane RS, et al: The amplification of 9. Borowitz A: The wasps and the litigants: Courtroom satires of somatic symptoms. Psychosomatic Med 5:510–9, 1988 Aristophanes and Racine. Legal Studies Forum 25:247–62, 2001 30. Willick D, Weinstock R, Garrick T: Liability of the forensic psy- 10. Casper JL: Practisches Handbuch der gerichtliche Medizin [Prac- chiatrist, in Principles and Practice of Forensic Psychiatry. Edited tical Handbook of Judicial Medicine]. Berlin: Hirschwald, 1857 by Rosner R. Boca, Raton, FL: CRC Press, 2003 pp 73–94 11. Kraeplin E: Psychiatrie, ein kurzes Lehrbuch fur Studirende und 31. Caudill OB: Avoiding malpractice in child forensic assessment, in Aerzte (8th ed). [Clinical Psychiatry: A Textbook for Students and Forensic Mental Health Assessment of Children and Adolescents. Physicians, Leipzig: Barth, 1909 Edited by Sparta SN and Koocher GP. New York: Oxford Uni- 12. Mullen PE, Lester G: Vexatious litigants and unusually persistent versity Press, 2006, pp 74–87 complainants and petitioners: from querulous paranoia to queru- 32. Ungvari GS: Successful treatment of litigious paranoia with pimo- lous behavior. Behav Sci & Law 24:333–49, 2006 zide. Can J Psychiatry 38:4–8, 1993 13. Workman J: Bonfigli on Moral Insanity, in The American Journal 33. Abramowitz JS: Effectiveness of psychological and pharmacolog- of Insanity. Edited by Medical Officers of the New York State ical treatments for obsessive-compulsive disorder: a quantitative Lunatic Asylum. Utica, New York: Roberts & Co. Printers, pp review. J Consult Clin Psychol 65:44–52, 1997 476–96, 1879 34. Picinelli M, Pini S, Bellantuono C, et al: Efficacy of drug treat- 14. Ball B: Du de´lire des persecutions, ou maladie de Lase´gue ment in obsessive-compulsive disorder: a meta-analytic review. [Delirium of persecutions, or Lase´gue disease]. Paris: Asselin et Br J Psychiatry 166:424–43, 1995 Houzeau, 1890 35. Humphreys K, Wing S, McCarty D, et al: Self-help organizations 15. Pailhas B: Etats monomaniaques lies a une deviation de l’instinct for alcohol and drug problems: toward evidence-based practice de conservation de la propriete; leur interet au point de vue med- and policy. J Substance Abuse Treat 26:151–8, 2004 ico-legal [Monomaniac states related to a deviation of the property 36. Casey PM, Rottman DB: Problem-solving courts: models and of self-preservation: their interest from a forensic standpoint]. trends. Williamsburg, VA: National Center for State Courts, Albi, France: Amalric, 1895 2003 16. De Cle´rambault GG: Les de´lires passionnels: e´rotomanie, reven- 37. Bureau of Justice Assistance: Mental Health Courts: A Primer for dication, jalousie [Delusions of passion: erotomania, revindica- Policymakers and Practitioners. New York: Council of State Gov- tion, delusional jealousy]. Bulletin de la Socie´te´ Clinique de Me´- ernment Justice Center, 2008 decine Mentale 9: 61–71, 1921 38. Moore ME, Hiday VA: Mental health court outcomes: a compar- 17. Berrios GE, Kennedy N: Erotomania: a conceptual history. Hist ison of re-arrest and re-arrest severity between mental health court Psychiatry 13:381–400, 2002 and traditional court participants. Law & Hum Behav 30:659– 18. American Psychiatric Association: Diagnostic and Statistical 74, 2006 Manual of Mental Disorders, Fifth Edition. Washington, DC: 39. Genn H: Do-it-yourself law: access to justice and the challenge of American Psychiatric Association, 2013 self-representation. Civil Just Q 32:411–44, 2013

Volume 45, Number 1, 2017 71