Ref: A00-300995 Case No. 871626 Macpherson II
Volume IX, Pages 61-72, Monday 26th June, 1989
(In the presence of the jury)
ALFRED WILLIAM BEARD: Recalled
Re-examined by Mr. Beckman
Q. Doctor, let me take the letter first: do you recall the
nature of the questions you were asked on the first of those
documents? A. About hypomania essentially, yes, I do
remember.
MR. BECKMAN: The way Mr. Temple put it was are we dealing with
someone suffering from hypomania; someone who might be in a
drug induced state? Is the person there showing knowledge
of what they are doing? Are they clearly responsible and
sensible, appreciating what they are doing? That is the
line Mr. Temple took, using the documents, using your
expertise, and you gave certain answers in answer to that.
I then asked you to look at the rest of the document. Can
you help us on the same lines? I am obviously fishing. We
had better know what your conclusions are.
MR. JUSTICE MACPHERSON: Doctor, before you answer, you do not
have to tell us anything about it if you think it is
impossible for you to do so without having seen him or heard
his evidence about it, but if you can help the jury, of
course you can answer the question. A. Yes, thank you.
Well, there is the first letter, as it were, from pages 5
to - there is the first letter from pages 5 to 18 and there
is a second copy of the letter from pages 24 to 36. Now on
the subject of hypomania, I don't feel that - I think that a
patient with hypomania is ordinarily too (inaudible) to
compose a document of this nature or of the second letter.
I think it really demands too much consistent thought for a
patient suffering from hypomania. In the same way I don't
think a patient who is confused could put together a document
which is apparently sensible.
Q. Confused by what? A. Confused by - I thought the
suggestion was made that he had been confused by the drugs
that he was taking.
Q. I simply wanted to confirm that you mean confused by drugs?
A. Yes. The feeling that I got about both of these letters
is the feeling - it really reinforced the feeling that I got
that these are the letters of a patient suffering from
paranoia if one has to put a psychiatric diagnosis on them.
Q. That might not be very good news for the patient, might it?
Is that a mental illness? A. Yes.
Q. He has been seen recently, or in 1987, and nobody said he
was paranoid. A. It is an extremely difficult condition to
diagnose.
Q. Well, there it is. A. It really differs from hypomania in
the sense if he had been suffering from hypomania he would
have recovered: if he was suffering from paranoia he would
not have recovered. It is an irreversible and untreatable
condition.
MR. BECKMAN: So is there anything else that you gather from that
letter before I ask you specific questions? A. When I said
it is not hypomania for various reasons, it is not confusion
for various reasons, but paranoia.
Q. When you say "not hypomania", that is a positive conclusion
and confusion, I suppose that would depend on the particular
state of a particular mind at the time, in relation to what
drugs he had, what state of withdrawal he was in and so on
and so forth? A. It would but surely to my mind a document
of this nature would take some time to compile.
Q. Can you help me as to this: do you come across - you as a
psychiatrist, I take it you also come across psycho-
pharmacology, the effect of drugs upon the mind? A. Yes.
Q. In the same way that you referred Mr. Koupparis to
Dr. Ashworth, I take it that a case where there could be a
problem of assessment in relation to a drug confused state,
that you could well refer a person to a psychopharmacologist?
A. If I were concerned about a patient then I would refer to
someone who knew more about psychopharmacology than I do
myself.
Q. Of course at the moment, as it has been rightly pointed out
more than once, you have not seen this man at the time, you
are dealing with a case as it were in theory, having just
been given the documents now. A. I am doing it purely on
the basis of the letters.
Q. A psychopharmacologist, I take it, would be someone who
should have more expertise on the effect of the inter-
relationship of drugs or withdrawal of drugs on the brain.
A. More than an idea certainly.
Q. Who are the leading psychopharmacologists in the country?
A. There are various professors of psychopharmacology.
(Inaudible) professor at the Maudsley Hospital, for example.
I think most teaching hospitals obviously have a professor of
pharmacology, some of whom know more about psychopharmacology
than others.
Q. I think Dr. Ashton has written several books, has she not?
A. I have heard the name.
Q. Is Dr. Ashton a fairly authoritative person in the field of
psychopharmacology? A. To the best of my knowledge.
Q. As paranoia has been raised I deal with it. As to the
question of possible paranoia, of course the best persons to
diagnose such a state would be those persons who saw him at
the time? A. Yes, it should be easier for them.
Q. So far as paranoia is concerned, is that consistent or
inconsistent with the proposition put forward as to knowledge
of what you are doing and responsibility for your actions?
A. I think a patient suffering from pure paranoia is not
responsible for his actions.
Q. Can you help me as to this: so far as Mr. Koupparis is
concerned, at the time you saw him there were no signs of
paranoia? A. Certainly not.
Q. We know something from Dr. Ashworth so can we just deal with
this: assuming your particular expertise would be in
relation to hypomania and paranoia more than a drug induced
aspect --- A. That would be correct.
MR. BECKMAN: --- let us ask you questions about your personal
expertise.
MR. JUSTICE MACPHERSON: Remembering of course, Mr. Beckman, this
is re-examination. It really is important, is it not,
because if we investigate paranoia for much longer there will
be risks from your client's point of view?
MR. BECKMAN: I would have thought not at this stage in the case.
MR. JUSTICE MACPHERSON: I leave it to you, but I do think that
since you said at the beginning of your questions you would
be fishing, do you not have all you can from this witness?
MR. BECKMAN: The fishing is over; I am now dealing with specific
questions I have worked out carefully. Fishing was only in
the first few questions as to what he found in the documents.
MR. JUSTICE MACPHERSON: Very well, I see.
MR. BECKMAN: This is a theory based on a document reading; this
doctor is dealing with pure theory. (To the witness): Just
deal with this: so far as either hypomania or paranoia is
concerned, contra-indications would be if previous problems
manifested themselves? A. It would not necessarily be. It
is a condition that can develop; it could have developed
after I saw him.
Q. Is that the same with hypomania? A. No, completely
different.
Q. Let us deal with hypomania. As far as hypomania is
concerned, it is right to say it is inconsistent - that the
lack of previous symptoms is inconsistent with hypomania?
A. No, lack of previous symptoms is - he may or may not have
had hypomania before, but a person can get the first attack
of hypomania at any age.
Q. Is that the same with paranoia? A. Paranoia usually
develops in early middle life and it develops insidiously.
Q. Generally speaking, as far as hypomania is concerned, lack of
previous problems of hypomania, endogenous hypomania, is a
contra-indication; is that right or not? A. Lack of
previous attacks of hypomania is not a contra-indication to a
diagnosis of hypomania.
Q. Perhaps the word "contra-indication" is wrong. Does it help
you if there is a person - if you are trying to decide
whether a person has hypomania or not, and what happened may
be for another reason, is the fact there had been no previous
incidents of anything like hypomania of help to you in giving
a diagnosis? A. In general terms with hypomania a patient
has the first attack in the late teens or early twenties, but
a patient could have the first attack at any stage. So if
one is presented with a patient of 50 who is having a disease
which seems to be hypomania, the fact that he has not had
attacks of hypomania in the past would not mean that that
attack at the age of 50 was not hypomania. I think that one
would look into it more carefully, to exclude physical causes
for example, at the age of 50 than at the age of 20.
Q. Physical cases can be something that affects the chemical
infrastructure of the brain? A. Physical disease of the
brain or drugs, or anything.
Q. So in other words, it would make you look very carefully as
to the possibility that the diagnosis of hypomania was wrong?
A. It would.
Q. Can we move to the other side as it were. If a person who is
allegedly suffering from hypomania but there is a doubt about
it, if that person, after events where they think it might be
hypomania, is no longer hypomanic, what would that indicate
to you? A. Well, it would probably - it wouldn't
indicate - let me answer the question in a different way.
Patients suffering from hypomania, they almost invariably
recover completely after a period of weeks or months, but the
prognosis for hypomania is very good, or the prognosis for
the present attack is very good; indeed 99 per cent recovery
with or without treatment.
Q. If they thought hypomania - I will come to that separately.
With hypomania - can you make this clear - to what extent is
a person responsible for their actions? A. It is a
question of degree. A mild hypomanic will have complete
insight. I think that he would be completely responsible for
his actions. At the other extreme you get a patient admitted
to hospital in hypomania and they are devoid of insight and
they are completely not responsible for their actions, and
you get everything in between.
MR. JUSTICE MACPHERSON: Devoid of something? A. They would be
completely devoid of responsibility for their actions.
Q. That may be a question for the jury. You used another
expression, "devoid of insight"? A. If they were devoid of
insight.
MR. BECKMAN: One of the things my learned friend promised to
deal with - I do not criticise, he obviously forgot - was to
introduce this element, and that was the element assuming the
person concerned purports to be or he is different characters
at different times, what is that consistent with of the
matters we have discussed?
MR. JUSTICE MACPHERSON: How does that arise out of cross-
examination?
MR. BECKMAN: Your Lordship may recall my learned friend put the
proposition to the witness excluding split personality. I
asked him to say it was (inaudible). My learned friend
said what he would do was deal with it specifically later.
He forgot obviously; I am going to deal with it. (Pause)
My learned friend chose properly not to take that matter
further. My Lord, he raised it.
MR. JUSTICE MACPHERSON: If, Mr. Beckman - I do not believe it
does but if in your client's interests you want to ask him,
ask him. I do not believe it arises out of cross-examination
at all.
MR. BECKMAN: Doctor, I want to introduce that element. You
recall we had that little element before that a man assumes
to be several different characters. A. Assumes to be?
Q. Believes to be or purports to be different characters at the
same time, different individuals with different identities.
Does that help you in any way? A. If a person believes
himself to be different characters, I don't think that helps
in any way in any diagnosis.
Q. How does that affect if - assuming if he genuinely believes
himself to be three different characters and then acts the
part of the different characters, how does it affect any of
the matters you have been discussing? (Pause) A. Very
difficult in the sense that it is - it isn't a symptom that
one - it isn't a symptom that one encounters in hypomania.
It is a symptom that sometimes one encounters in symptoms of
schizophrenia or hysteria, but not hypomania.
Q. Or in drug induced psychosis? A. Possibly in drug induced
psychosis I think.
Q. When you say this letter has a paranoid quality and you are
not - just to deal with what my Lord said, we are not dealing
with an assessment of the man because you never saw him, we
are talking about the letter - can you give us some example -
the best example - of where you say the letter exhibits a
paranoid quality? A. Forgive me, but it is the letter as a
whole rather than a particular sentence. If I may clear up
what I meant by paranoia perhaps?
Q. Please do. A. There are different conditions that one
encounters of paranoid illness. There is paranoid
schizophrenia where the patient has hallucinations and they
have delusions that MI5 are after them, etcetera, which is
easy to diagnose and common. You then get a condition
called paraphrenia where patients have delusions but the
delusions are they are unworthy. They get hallucinations but
the hallucinations are depressive hallucinations; that they
can smell rotting pools and the like. Paranoia is the most
difficult because they don't have these things. They don't
have hallucinations. The delusions are generally grandiose.
They are difficult to diagnose because if you have a patient
who has specialised in some particular field - he may be an
economist and think he has got some scheme for putting the
economy right and he may write tracts and books. He will
write to the Prime Minister; he will write to the Chancellor
of the Exchequer but otherwise lead a normal life, but it is
pedantic detail of what is to an expert nonsense to a
non-expert may appear to be sensible.
Q. And to the person writing it at the time real? A. To him
it is real, yes.
Q. You said these letters seem logical but I do not think you
finished that? A. The letters?
Q. The letter seemed logical but I do not think you finished
with it. A. It is internally logical but I would think - I
mean, I don't know, I would think the whole thing is
nonsense. There is a sort of pseudo quality about the letter
ref CN/FM and PS/CY. Well, it is written - assuming letters
of this nature need a complicated reference. Everything
about it is pedantic and it is really down to the last detail
of how, for example, these moneys shall be paid.
Q. You then said something about it looks like someone has been
watching James Bond. Can you take that a little further?
A. Well, I thought as far as I could gather, the scheme is
something like a sort of Spectre scheme villain rather than
James Bond. In other words, fantastical.
MR. BECKMAN: There are two other matters I want to ask you; one
refers to delusional state followed by a degree of logic,
something of that sort. Can you tell us what you mean by
there being a delusional state followed by logic?
MR. JUSTICE MACPHERSON: To what is this relevant?
MR. BECKMAN: It is cross-examination.
MR. JUSTICE MACPHERSON: I have lost a lot of this case. I am
not sure you are on the letter or him. (To the witness):
Are you still dealing with the letter? A. Purely with the
letter.
MR. BECKMAN: I am only asking about the letter.
MR. JUSTICE MACPHERSON: I thought you finished with the letter;
you had some carefully worded questions on other matters.
MR. BECKMAN: No, my Lord, the only matters he was asked about in
cross-examination were the letter and I would not be allowed
to ask about ---
MR. JUSTICE MACPHERSON: What did you mean by "delusional
state"? A. Delusional state is a false belief.
MR. BECKMAN: Followed by logic. You got this out of the letter.
A. Well it has internal logic in the sense if one assumes
that Di-Tox B7 does everything it is supposed to do, then a
lot of the letter follows logically from that.
Q. In other words, you have a delusion in the first place, then
logic, then you go back to another delusion? A. I mean, I
assume that Di-Tox B7 doesn't do everything it is alleged to
do in the letter, but I may be wrong.
Q. I want to ask you one last question. He may know what he is
doing - referring to the theoretical writer of the letter, he
may know what he is doing but not appreciate the results to
him. That is the question the learned judge put to you; do
you recall? A. I think that he realised that what he was -
that the writing of this letter - and it is very difficult
for me to say from the letter itself, but I would think he
would know at the time that it might bring him to his present
position.
Q. In other words, he would appreciate the result, that it may
bring him to his present position from the mere writing of
the letter, whether or not he intended to make a demand?
A. I think he would realise it, yes.
(The witness withdrew)
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