Ref: A00-300995 Case No. 871626 Macpherson II
Volume IX, Pages 37-54, Monday 26th June, 1989
(In the presence of the jury)
MR. BECKMAN: My Lord, Dr. Beard was the doctor I was calling
first of all, purely on a question affecting fact, but I have
just been given two documents which possibly, if I decided to
use them in relation to Dr. Beard, would make him at least in
part an expert. My Lord I can take ---
MR. JUSTICE MACPHERSON: That is all right, I am sure we will not
worry about that. Do you think, Mr. Temple, if he gives a
bit of expert evidence ---
MR. TEMPLE: I would not complain.
MR. BECKMAN: Your Lordship has gone a bit ahead of me. I have
just been given these documents. I have not had time to
register the contents because they only just arrived and have
been handed to me, that are produced by Dr. Beard as being
something which may arise. I do not know without looking at
them, digesting them and speaking to him. I can either call
the evidence I intended to call and when we finish the
evidence ask him to wait and go and see him, or deal with it
now.
MR. JUSTICE MACPHERSON: I think we will do the former and if
there is anything additionally you need you can recall him
tomorrow morning.
MR. BECKMAN: My Lord, he would have difficulty coming tomorrow.
What I would ask your Lordship to do is to go and see him
when we finish and speak to him together with this document,
and decide whether or not I want anything further from him.
MR. JUSTICE MACPHERSON: Yes.
MR. BECKMAN: I am obliged.
MR. JUSTICE MACPHERSON: What is the topic?
MR. BECKMAN: My Lord, the normality of my client when he saw him
for other purposes, in order to establish whether this is
endogenous or drug related.
ALFRED WILLIAM BEARD: Sworn
Examined by Mr. Beckman
Q. Dr. Beard, may I say immediately I have received two
documents which have been given to me this morning. I am not
going to deal with them now. When you have given evidence
contained in your statement later on I shall discuss this
matter with you and decide whether we introduce it or not.
Just so you know exactly what the position is because I may
not have time to digest it. What is your full name?
A. Alfred William Beard.
Q. Your private address? A. Fifteen Upper Wimpole Street,
London W1.
Q. Your qualifications? A. I am a Fellow of the Royal College
of Physicians of London, Fellow of the Royal College of
Psychiatrists and I hold a Diploma in Psychological Medicine.
Q. You have met as a patient this man Mr. Panos Koupparis?
A. Yes.
Q. It is some time now; do you specifically recall meeting him?
A. Pardon.
Q. It is some time ago now; do you recall specifically meeting
him? A. No.
Q What you are dealing with, as it were, is taken from your
records? A. Yes.
Q. He was originally referred to you by his general practitioner
Dr. Paul Zider [sic] on 7th May 1981? A. Yes.
MR. BECKMAN: I take it there is no objection to the good doctor
referring to his records?
MR. JUSTICE MACPHERSON: No, of course not. (To the witness):
You can use any record you made at the time, Doctor.
A. Thank you, my Lord.
MR. BECKMAN: I think at that time you were practising as a
consultant psychiatrist at Middlesex Hospital from which you
retired in September 1985? A. Yes.
Q. For the purpose of the evidence you are about to give, the
report or statement you gave, you looked through your notes
which you kept at Middlesex at the time? A. Yes.
Q. In that connection I think you have actually looked at
letters you sent to the consultant thoracic surgeon,
Mr. Surridge [sic]? A. Yes.
Q. And also letters to Dr. Zider [sic] as general practitioner on
7th May 1981? A. Yes.
Q. When you spoke to Mr. Koupparis for the purpose he had been
referred to you originally by Dr. Zider [sic]? A. Yes.
Q. Why had he been referred to you by Dr. Zider [sic]? A. In his
referral letter Dr. Zider [sic] said that Mr. Koupparis
complained of paroxysmal tachycardia, which is attacks of
rapid heartbeat coming on in paroxysms. He was investigated
by Dr. Swinton - Dr. Swinton is a heart specialist at
Middlesex Hospital - who was unable to find any cause for his
symptoms. "He now complains of a blocked lung and burning
sensation under his arm. He denies any stress."
MR. JUSTICE MACPHERSON: Blocked ---? A. "Blocked lung and
burning sensation under his arm. (Inaudible) of myocardial
infarction. In view of continuing problems I would
appreciate your opinion."
MR. BECKMAN: You then saw Mr. Koupparis and in the normal way,
before doing whatever examination you thought fit, you found
out about his previous history? A. Yes.
Q. Can you tell us so far as his previous history is relevant,
what you asked him and what you were told, or indeed what you
were told will do. A. I saw him on 7th May 1981, and he
said that since the previous August he had been getting
attacks just before he went to sleep or just after he had
fallen asleep, and in this context he would wake up and he
had lost control of his arms. He was unable to speak; he
couldn't recognise things in front of him; he had weakness of
the left side of the body or he couldn't feel the left side
of the body, and this could happen up to 20 times in one
night.
He said that a sensation like an electric shock centred
over the heart and went up into the throat or down into the
stomach and at that time his heart beat fast. He told me
that he had been sent to Dr. Swinton three months before
and his heart was normal. He said this happened three nights
out of four and was often severe. For example, on the
previous night he had had ten such attacks and did not drop
off to sleep until 6.00 a.m. The attacks always occurred in
bed. These attacks started the preceding August and at that
time they occurred once or twice a week, but he said that
they were getting more severe and more frequent. Until
August he had had no attacks and on questioning there were no
obvious precipitating causes in the nature of stress or
change in circumstances.
Q. Did you enquire into his previous history? A. Yes, he
told me that the only thing of significance in his previous
history was that in 1974 he complained of headaches and he
was referred to Professor Gilliat, who is a consultant
neurologist at the Middlesex Hospital. Professor Gilliat
diagnosed migraine and put him on to Cafergot, which is one
of the approved medications and he had been well since.
Mr. Koupparis also told me that all his migraine attacks had
occurred on the left side.
Q. Presumably you went into his previous history as to his work
and so on and his family? A. Yes. So far as his family
was concerned, he told me that his father had died five years
before at the age of 65, of myocardial infarction. His
mother at that time was aged 56, alive and well and lived in
Plumstead. At that time he had two brothers aged 15 and 12.
His wife was aged 22; they had been married four years and
they got on well together.
So far as Mr. Koupparis himself was concerned, he was
born in England at St. Mary's Hospital and had lived in
London all his life. His childhood was happy and uneventful.
He had left school at the age of 16 and he had then gone into
advertising for the following seven years, until the age of
23. He then worked in a darkroom and studio, of which he
eventually became manager. He then went into electronics,
particularly as a consultant of closed circuit television,
and he had done that since 1974.
Q. Did you discover any previous history, either in the family
or himself of relevance? A. No.
Q. Did you then examine him? A. A psychiatrist does not
ordinarily conduct a physical examination.
Q. I did not mean it in physical terms; I am aware of that.
Shall we say, what did you find in terms of what your
questioning was? What word do you use? Do you not call
your questioning your examination? A. I think that what
one is interested in is the occurrence of any psychiatric
phenomena such as hallucinations, delusions and the like.
One is interested in whether he is depressed or anxious about
his sleeping. His eating and his sleeping was good apart
from the attacks; his appetite was good and he was putting on
weight despite eating only one meal a day. He was not
depressed or not anxious apart from his symptoms, and
basically there were no psychiatric phenomena. My conclusion
was there was no evidence of a neurotic personality.
Q. Then were you able to discover what was actually causing
this particular problem? A. No.
Q. You were not. Having discovered as far as you were
concerned there was nothing basically - having looked at him
carefully, you took the view there was nothing wrong from the
psychiatric viewpoint? A. Yes.
Q. What did you then do? A. As far as medication was
concerned, I put him on to Mogadon or nitrazepam, which is a
mild hypnotic sleeping drug. I thought if he had a hypnotic
it might break up the pattern of attacks. I also, in order
to make sure I was not missing anything, referred him to
Dr. Cheryl Ashworth, who at that time was a clinical
psychologist at the Middlesex Hospital.
Q. What was the purpose of referring him to Dr. Ashworth as a
psychologist, you having examined him as a psychiatrist?
A. A psychologist looks at a patient differently from a
psychiatrist and sometimes a psychologist might find
something by means of tests that the psychiatrist has missed
in his clinical examination, and I really wanted to make sure
so far as possible I wasn't missing anything.
Q. So in other words it was a test of verification in the sense
you wanted to make sure from a psychiatric or mental
viewpoint you had missed nothing? A. Yes.
Q. You were basically looking to see whether there was anything
wrong in his mental makeup? A. Yes.
Q. Your conclusion was - I think you have already said it -
there was no problem with his mental makeup? A. Yes.
Q. That is in June 1981? A. Yes.
Q. You had seen him in May and then he went to see Dr. Ashworth
and no doubt you had the results of Dr. Ashworth's tests?
A. Yes.
Q. Dr. Ashworth is here; she can tell us about that herself.
Doctor, when you saw him again and as a result of what you
were told by Dr. Ashworth, together with anything that you
saw, did you change your view as to his mental state?
A. No.
Q. You saw him again in fact on 12th June 1981? A. Eleven
June.
Q. Anything you spoke to about him or heard from her or saw in
any other reports change your view his mental state was
normal? A. No.
MR. BECKMAN: That is the factual aspect; that is all I have to
ask.
MR. JUSTICE MACPHERSON: Did you ever discover from any doctor
what was wrong with him, if anything, or did you conclude
that there was nothing wrong with him, because he was
complaining of - he actually called it "sleep jumping" when
he gave his evidence. Did you discover from anybody whether
there was anything diagnosed as wrong? A. No, I also
referred him to Mr. Surridge [sic], who is a chest consultant at
the Middlesex Hospital, who found nothing abnormal and he
also arranged for a chest X-ray. Mr. Surridge [sic] sent him to
Mr. Williams, who is an ear, nose and throat specialist, who
also found no abnormality.
MR. BECKMAN: I am reminded I left something out and that is you
saw him again on 9th July 1981? A. Yes.
Q. Again no change as to your views? A. No change.
MR. JUSTICE MACPHERSON: For what it is worth, Doctor, he told
the jury and me that he was told to try a sleeping pill and
was given Ativan. That made him feel drowsy and he changed
to Mogadon. Is there any significance in that? A. By me
he was given initially Mogadon.
Q. I think the evidence I have is after he had seen Dr. Ashworth
it was suggested that he should try a sleeping pill and he
took Ativan and changed to Mogadon. A. No, on the first
occasion he was given Mogadon; on the second occasion he was
given chlormezanone [sic].
Q. Is that July? A. He was given chlormezanone [sic] on 11th June
when I saw him. He was not given any medication on 9th July.
Q. Have you a note of him being given Ativan at all? A. No.
CROSS-EXAMINED BY MR. TEMPLE
Q. Doctor, presumably you are well versed in hypomania?
A. Yes.
Q. Perhaps you could just help us a little: are we right in
assuming that hypomania can be endogenous or, by contrast, it
can be drug induced? A. Correct.
Q. With regard to endogenous hypomania, would you agree that
the classic symptoms would be perhaps changes of mood, swings
of mood? A. Yes.
Q. Ideas flitting around, one from another? A. Yes.
Q. Heightened activity generally? A. Yes.
Q. A fondness for using puns and plays on words? A. Sometimes.
Q. Not a characteristic? A. No.
Q. In all these cases is it the general position, so far as one
can ever look into a man's mind, that such a hypomanic would
know what he was doing? A. It depends; it depends. I
would say some do. Mild cases of hypomania, they have
insight, they know that they are acting high and they
restrain themselves, but more severe cases of hypomania, they
do not have insight and they might, for example, spend large
sums of money that they do not have. They do very foolish
things.
Q. This insight into their condition - supposing, for instance,
one has a man suffering from hypomania who announces that he
wants to, for instance, invent a new parking clamp. He says
to his friends, "I have invented this new parking clamp", or
"I am going to invent a new parking clamp", and he writes
letters to the appropriate authorities. In those
circumstances is it a reasonable inference to draw that in
his mind he wants to invent a parking clamp? A. Hm.
Q. Have you seen the demand document in this case? A. No.
Q. Have you seen any documentation in this case at all?
A. No.
Q. Would it be a reasonable course of enquiry that if we wanted
to find out what was in a man's mind to look at his actions
to see what he is writing? A. Yes.
Q. I am going to invite you to look at some documentation we
have in this case. Would you please have in front of you
what we know as the exhibit bundle? (Handed to the witness)
Would you turn to page 5. I think the easiest thing is
perhaps to invite you to read that page to yourself.
A. That is the page beginning, "The economy"?
Q. No, page 5 at the bottom headed, "Private and confidential".
A. The page headed, "Private and confidential", written on
13/3/87?
Q. Yes. Would you be good enough to read that through to
yourself? (Pause) On the face of it, looking at that
document, would you agree it has a certain logic to it in the
way that it is set out and written? A. Yes.
Q. Would you agree that it is clearly the product of someone who
has thought about what he is writing? A. Yes.
Q. And you also further agree that the paragraph which begins,
"The only way to stop this attack is by the payment of
US $15 million is a clear implication of blackmail? A. Yes.
Q. If we can marry up the answers you have given us with regard
to this documentation, would it just, by way of example, be
perfectly reasonable to assume that even if the person who
wrote this letter was suffering from hypomania, endogenous
hypomania, he would know what he is doing; he would know what
he is writing, his blackmail demand? (Pause) A. Forgive
me, I am thinking.
Q. Of course, take your time. A. This letter - I mean, this
letter to me, just as a letter it has - apart from the
hypomanic qualities - has a paranoid quality to it. Now,
there are patients who - patients who are hypomanic and can
write letters which are - or patients who are paranoid can
write letters which are in themselves completely logical but
the whole thing is a nonsense.
Q. Does it come to this: is the question I have put to you
something which in the final analysis can equally well be
answered by a jury of laymen and lay women who can look at
all the facts and all the circumstances surrounding the
sending of this particular letter? A. I am sorry?
Q. Do you agree one of the hardest exercises in the world is to
look into a man's mind? A. Hm hm.
Q. Obviously we can be assisted to an extent by a professional
such as yourself, but does it also come down to this: when
dealing with hypomania and when dealing with the question,
did the man know what he was doing, the jury can equally well
answer the question as a doctor? A. The preamble - whilst
it may be difficult to look into a man's mind, it is
generally easy to diagnose hypomania. A layman can generally
diagnose a person is odd whilst not being able to diagnose
hypomania. I mean, I don't know whether an ordinary person,
looking at this man, looking at this letter, would think this
man was sane or not. However, the letter is in itself
logical but as a whole ---
Q. If it is logical clearly that is a point made as to its
composition. Is there anything you can point to to indicate
the writer of this letter did not know he was making a
blackmail demand? A. I think a patient can be psychotic
and at the same time know what he is writing, but not perhaps
know what he is writing is nonsense.
Q. Why is it nonsense to write a letter of blackmail? A. Well,
it is possible that if he has done all these things - but I
would have thought it is more an action of someone who has
been watching James Bond films.
Q. Is there anything to which you can point to say that the man
who wrote this letter did not know he was making a blackmail
demand? A. He knew he was making what I would have
regarded as a rather ridiculous blackmail demand.
Q. Never mind about the qualification of "ridiculous". Are we
now agreed that it would point to the fact he knew he was
making a blackmail demand? A. Taking the letter as it is
and disregarding the reasonableness or otherwise of it, yes.
MR. TEMPLE: Supposing we were to take it further, supposing the
person who sent this letter was to make frequent telephone
calls, the basic purport being (a) to ask whether or not the
Cyprus Government had received the letter, and secondly to
say - again I am summarising - "I suggest you pay this
demand", would that not be further evidence to say that he
knew that a blackmail demand had been made?
MR. BECKMAN: Would you forgive me, but my friend should
introduce the element of split personality as well.
MR. TEMPLE: We will come to that.
MR. BECKMAN: As long as it is introduced.
MR. TEMPLE: Dr. Beard? A. I think it would, but at the same
time I think the frequent telephone calls could also be
evidence of hypomania.
Q. Of course, Dr. Beard, let me make it quite clear ---
A. Until I came into this court I hadn't heard the
suggestion that Mr. Koupparis was suffering from hypomania.
Q. It is the Crown's case that he was; the Crown do not suggest
anything to the contrary. The thrust of my question to you
is really on the basic premise that as a general rule those
who suffer from hypomania are perfectly well able to judge
and know what they are doing; their judgement may be clouded,
their judgement may not be of the best, but they know what
they are doing? A. It is a question of degree whether or
not they have insight or whether or not they have lost it.
I mean, in the sense a person who is hypomanic may well spend
money that he doesn't have or spend his whole fortune on
ridiculous things that he doesn't need or doesn't want and in
the process lose his fortune. I mean, does he know what he
is doing? Of course he does.
MR. JUSTICE MACPHERSON: He does what he is doing although he
must appreciate what the results may be to him? A. Exactly,
your Honour.
MR. TEMPLE: In view of that answer, can I ask you one final
question: do you have experience of drug induced hypomania?
A. Yes.
Q. A very general proposition - and it may be so general that
you feel you cannot give a proper answer and I am sure you
will say so, but let us assume we have here a patient who is
not suffering from endogenous hypomania but from hypomania
which has been induced by grossly excessive over-prescribed
taking of drugs. In those circumstances would you expect
the patient to become thoroughly confused? A. It would
depend on the drug. I think if the drug were, for example,
Dexedrine, the patient need not necessarily become confused.
I think that if the drug were a sedative drug one would
expect him to be confused.
Q. Let me hand you a document (handed to the witness). My
Lord, neither the Court nor the jury have this document but
I think in the first analysis I can ask my questions of
Dr. Beard, then we can reduce it to a clear form for your
Lordship and the jury as we progress. (To the witness):
Doctor, do you see at the top of the page there is a list of
drugs? A. Yes.
Q. You see the various information given about dosages?
A. Yes.
Q. Let us assume that the patient is taking a grossly excessive
combination of that type of drug, would you then expect
confusion? A. Those doses in themselves, by themselves are
not excessive as single drugs, or perhaps a combination of
two or even three.
Q. Are you saying those doses seen on that page are not
excessive? A. In themselves. I mean, if someone took
them I agree they would be grossly unsafe, but as each
individual drug - some of these drugs are hypnotics, some are
tranquillisers, some anti-psychotics, some are
antidepressants.
Q. Does it come to this: any one of these drugs have the
individual, correct dosage? A. Yes.
Q. The second proposition, that if these drugs were taken in
combination, perhaps in dosages larger than we see there,
then problems will begin? A. I think it would depend upon
the combination in the sense that one commonly prescribes an
antidepressant currently with a tranquilliser, currently with
a hypnotic. In other words, these three, it is a common
combination but if the patient is taking three hypnotics then
that is not a good combination.
Q. Let me see if I can approach it in this direction: supposing
we have a position where the patient is taking grossly
excessive doses of drugs in the wrong combination, such as is
going to lead to the worst type of confusion, starting with
that proposition what type of confusion can we expect to see?
What would be the classic symptoms? A. Drowsiness,
irrationality, perhaps physically staggering, bad gait and
the like appear immediately.
Q. Would there be an inability to put together and hold to a
plan which would need to be operated over, say, a month or
so? A. Over that sort of period, yes, I think
MR. BECKMAN: My Lord, bearing in mind that the doctor has been
asked to express his views (inaudible) I would ask the doctor
to read the document through. May I ask he be given time to
do that?
MR. JUSTICE MACPHERSON: Yes. You have another witness you can
call meanwhile?
MR. BECKMAN: Yes, except ---
MR. JUSTICE MACPHERSON: Would you take the bundle with you; you
know the page you were at. Take it away with you, sit at the
back and read to page 18. Do you understand these are the
documents you will be asked about before you go. Can I ask
you one thing because I do not want to introduce into this
case anything unnecessary, you used the words "paranoid
quality". What does that mean in a sentence or two for the
jury and myself? Can you help me? A. Yes, there are
patients whose paranoia consists of a delusional symptom
which is in itself logical provided you grant the first
proposition as it were. If you grant the first proposition,
then everything deduced from that is logical. Well, that is
it, they have a complex delusional symptom which is in itself
internally consistent.
Q. I do not think anyone says here that he was suffering from a
paranoid illness (or whatever the right term may be) in 1987,
but you might have been looking for that if you had been
examining him; that is what you mean? A. If I had seen the
letter.
MR. BECKMAN: Your Lordship, when I say "Yes" I was finishing a
sentence. The sentence was going to be this: yes, but the
next witness who is Dr. Ashworth logically sequentially
follows upon this witness and if possible I would prefer as
it were to call Dr. Ashworth when this witness is complete.
I do not suppose it will take him - seeing the speed at which
he read the first page, I do not suppose it will take him
more than ten minutes to read it because he is not examining
the chemistry or electronics.
MR. JUSTICE MACPHERSON: It is a question of not taking up more
of the jury's time. Could we not have Dr. Ashworth on what
she found?
MR. BECKMAN: We can, my Lord, it is just ---
MR. JUSTICE MACPHERSON: I think that is the right thing.
MR. BECKMAN: If I can just say it has a better impact, but if
your Lordship so requires, having made the point, so it is
not lost, it was logical to call them in that order in order
to assist the Court, I will call Dr. Ashworth.
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