TBI SUPPORT GROUPS: SHIELD OR SWORD?  [ back to List of Articles ]
Harvey A. Hyman, Esq.

For persons with traumatic brain injury (TBI), support groups provide solidarity, a sense of finally being understood and belonging. Through mirroring, they bring self-awareness. They provide opportunities to teach others, and learn adaptive techniques to overcome their disabilities. They foster friendships, and the development of a functioning network of support in crisis. Thus, they serve as a shield of protection in the struggle for survival following a TBI.

Recently, however, I have seen TBI support groups being used as a sword by the defense in litigation. Many "independent" physical and mental examinations conducted on behalf of liability insurers, have adopted the idea of making TBI support groups the fall guy. A typical report will say the plaintiff suffered only a "mild" concussion which should have resolved completely within days or weeks; yet a year or more later she continues to complain of the full spectrum of post-concussion syndrome (PCS) symptoms. "Why?" they ask disingenuously. They then provide the answer that the plaintiff is anxiety ridden, worried, suggestible and gullible, and has latched onto a TBI support group in hopes of confirming her worst fear, the fear she has severe and permanent brain damage. The final step in their thesis that the support group coddles and enables her fears, and ends up providing the sought after confirmation, which hardens into a new identity, that of a permanently brain injured person.

What these so-called "independent doctors" do not explain is why support would do this, how they would benefit and how they would accomplish this under the scrutiny of a licensed psychologist whose job is to help, if possible, but never to do harm? Are support groups so open, so accepting, so non-judgmental and so blindly validating of anyone's fears, that they might inadvertently convince brain healthy people that they are permanently brain damaged? Does the old saying "misery loves company" apply to such groups, and drive them to accept unsuitable people as members?

In seeking an informed answer to these questions, I contacted an experienced neuropsychologist in my geographic area named Dan Mayclin. Dr. Mayclin currently practices in two northern California communities, Los Gratos and Santa Cruz. He has been working with persons with TBI for 20 years, and has integrated a TBI support group into his individual counseling practice. He has run a group for the past 4 years. Nearly all members of his group are referred by a hospital and pre-screened. Very few are self-referred. Dr. Mayclin has no "litmus test" for who may join. He has perceived that disability does not correlate well with duration of loss of consciousness (LOC). Dr. Mayclin remarked it is not unusual to see a patient with LOC of 5 minutes display greater difficulties than a patient who was in coma for two weeks. This is because coma is more reflective of brain stem trauma than frontal lobe damage.

When asked about the possibility that persons with very mild head injuries might enter his group and use the group's feedback to confirm or amplify their subjective complaints, he was skeptical. Dr. Mayclin stated that he and his trained co-facilitator carefully observe what goes on in the group. If someone's story does not ring true or their behavior is inconsistent with what happened to them, the group simply ignores them. Dr. Mayclin will then take that person aside and urge her to go elsewhere for help. Neither he, nor the group, would benefit from reinforcing a story they did not believe. Complainers distract the group from their main purpose of learning coping skills and waste the group's time. People who come to group sessions in order to whine soon leave, because the group is not there to share sob stories. The focus of the group is self-help and acquiring the cognitive skills to increase functionality. While it is true, some members want to discuss what is going on with their lawyers and litigation, the group spends very little time on that topic, because it is also viewed as a distraction. They are encouraged to discuss that topic between themselves on their own time outside of meetings. In short, TBI groups are not hand holding sessions, where any lost soul can gain an audience and get approval. The people who make the effort to come to group are looking for practical solutions to practical issues, like how can I organize my calendar to get to important appointments in time or how can I regulate my responses to situations so I am less frustrated and angry? There is no need to defend the legitimacy of your client's involvement in a TBI support group if that involvement is not attacked or impugned by the defense. However, you should be prepared to mount such a defense in your cases. Read the defense IME report very carefully to see if Dr. Defense has made negative comments about the plaintiff's support group activities. In deposition, ask Dr. Defense whether he has opinions about your client's involvement in a support group, what those opinions are and the basis for them. Find out if Dr. Defense has ever run a support group or referred his patients to one. Find out if Dr. Defense is relying on pure mythology or has some sort of data (even if just personal experiences) to support his negative views. If you do see a defense effort underway to mischaracterize the plaintiff's relationship with the support group, and penalize her for belonging to the group, then talk to the neuropsychologist who runs the group and the treater who referred your client to the group. Question them about the topics dealt with in this article, and prepare them to explain the true clinical purposes of the group, how the group really operates and what the group really accomplishes, so that the defense attack will be properly discredited. Now that certain defense myths about TBI have been discredited by mainstream medicine (e.g., that TBI requires LOC or a positive CT or MRI), rest assured new myths will be created for the courtroom. The myth that TBI support groups "brainwash" suggestible people into believing themselves to be brain injured appears to be one example.