PI Brief Update

When Brains Get Stuck - Dr Mark Burgin

29/07/26. Dr Mark Burgin explains the psychosocial processes that cause people to have fixed idea (idée fixe) and how doctors and lawyers can respond.

We have all met people who have become fixated on a problem. The vexatious litigant whose life is spent in courts, the expert who cannot revise their position and the lawyer who never resolves a case. We can recognise that something is wrong but it is difficult to say exactly what the problem is. Disability analysis explains coping mechanisms such as fixed idea (idée fixe) as a response to psychological stress. The fixation can persist for years or even decades before a functional decline. 

We can all choose a focus for thoughts out of the many possibilities that are offered to us. Some people will choose badly and waste their time, some will have great thoughts and some will get stuck without making progress. Alexandre Dumas fils stated ‘What distresses me is to see that human genius has limitations, and human stupidity has none’. Dumas’s insight was that there is a simple way of seeing the difference between a genius solution and a dead end.

Each of the neurodifferent brain types (OCD, dyslexia, ASD and ADHD) takes a separate approach to finding meaning. This means that there are different flavours of idée fixe masking the problem. They can appear to be persuasive and often highly productive as their focus allows them to dig deeply into the problem. They may have previously had significant success and even an impressive reputation. The façade fractures only when their ideas fail to develop, their limitations become apparent or they become stuck in a doom loop.

Falsifiability over Justification

As an expert I am often sent adversarial justifications as to why my opinions are wrong and I should see the evidence from a biased perspective. The exact wording varies but is usually on the lines of ‘the client says this…so you should ignore evidence to the contrary’. It is often unclear whether the mind that has become stuck is their client or the lawyer, but the effect is the same. There are multiple emails where I have to explain that my overriding duty is to the court, if they want me to change my opinion, then they should provide further evidence and the correct test is ‘on balance’ not possibly.

I have a scientific background and I understand the importance of creating a hypothesis and then testing it (falsifiability). I follow Dumas’s advice to recognise my limits and do not discount the possibility that the next piece of evidence will tip the balance in a way I did not expect. As an expert I might be only 51% certain of my opinions so I must use the tools given by the procedure rules such as using less certain language and range of opinions and limits to evidence.

Where the goalposts are constantly shifted it can take many hours to address each allegation separately. As these arguments often appear AI generated and contain a massive volume of weak or irrelevant points it can be tempting to respond with an AI generated reply. The problem is that even if the answers are fully answered and other hypotheses are fully falsified it may still not be possible to satisfy the person writing them. So called ‘Fake news’ arguments also occur in cross examination but there the expert’s role is strictly to assist the judge.

Adaptability

My training in disability analysis offers me an alternative understanding of the ‘idée fixe’. Looking at what is preventing the person from being adaptable to new information rather than the idea rephrases the issue as a functional restriction. A person with a disability may be correct about their point but be unable to express it a clear way. Furthermore, the person may have an unusual susceptibility to problems that tips the balance from the original opinion.

The disability concept of reasonable adjustments can allow the expert to address the ideas in a more adaptable way. A person who has functional restrictions may resist the standard approaches despite agreeing with the arguments. Rephrasing the opinions, altering formats or giving the person the time to vent can help them regain cognitive flexibility. The right reasonable adjustment may require an understanding of the likely brain pattern. The significance of a disability indicator often only makes sense in hindsight.

The four neurodifferent brain types each have their own pattern of fixation for OCD it is seeing symbols and signs, dyslexia it is analysis paralysis and combativeness, ASD the absolute need for structure and ADHD time blindness and self-neglect. The best approaches depend upon the pattern of problems and there are lists of reasonable adjustments that can be used. For those who do not have disability training the message is simple: ‘ask a friend’ for advice when dealing with someone who appears to be stuck.

Integration vs. Isolation

My cognitive approach to the world puts me at higher risk of isolation than the average person. I am more likely to accept what I am told and then try to solve the problem from that point. Where the initial problem is based upon fallacy this causes me to loop continuously unable to derive meaning from the problem so that I can break it down. This interesting phenomenon of fallacies can also be used in disability to probe people’s understanding and thinking problems.

Highly intelligent people often isolate themselves as part of focusing on their problem. In some ways this approach is effective as it can create the quiet, space and time needed to deep dive. However, the isolation also separates the person from the source of stimulation that they need to be creative. Creativity requires a certain level of noise to disrupt the patterns of focus so that the mind can explore a broader range of solutions.

Integration of thoughts connects disparate concepts in a series of stages. The ideas phase is about noise and generating possibilities. The planning stage is about quiet and working through all the possible alternatives. The insight stage is a period of reflection where the person’s mind is on something else, grounded in routine of life. Integration and isolation each have their roles in preventing a person from becoming stuck.

Conclusions

The model of fixed thoughts starts with the idea that the person has chosen to focus on that area. They have then run out of effective strategies and are looping on a particular approach that is not solving the issue. The process continues because they are unable to limit the effort that they put into that area and develop a sense of perspective. Getting stuck does not mean that they are wrong, just that they lack the tools to progress.

Whether the person has mental health problems that are causing them to get stuck or the act of getting stuck causes the mental health problems is unclear. However, it is not necessary to diagnose the underlying pathology to make progress towards a fair and just outcome. The fixed idea is a defence response and they will hold on harder if they are challenged. The best options are carrots (reducing cognitive resistance) rather than a stick (arguing).

For those with an artistic background this article gives some practical steps to the problem of a stuck client, expert or colleague. The key message is that there are many options and trying them one by one is an option. You will need to be adaptable to find enough options but are not likely to find them all. Asking a disability analyst for help can identify better options and reduce the length of the search.

Doctor Mark Burgin, BM BCh (oxon) MRCGP is a Disability Analyst and is on the General Practitioner Specialist Register.

Dr. Burgin can be contacted on This email address is being protected from spambots. You need JavaScript enabled to view it. and 01226 761937 websites drmarkburgin.co.uk and gecko-alligator-babx.squarespace.com

This is part of a series of articles by Dr. Mark Burgin. The opinions expressed in this article are the author's own, not those of Law Brief Publishing Ltd, and are not necessarily commensurate with general legal or medico-legal expert consensus of opinion and/or literature. Any medical content is not exhaustive but at a level for the non-medical reader to understand.

Image ©iStockphoto.com/Pavel_Korr