Ref: A00-300995 Case No. 871626 Macpherson II
Volume X, Pages 54-67, Tuesday 27th June, 1989
(In the presence of the jury)
DONALD JAMES WEST: Sworn
Examined by Mr. Beckman
Q. What is your full name? A. Donald James West.
Q. Your address? A. Thirty-two Fen Road, (inaudible)
Cambridge.
Q. Your occupation? A. I am a retired professor of clinical
criminology in the University of Cambridge.
Q. Your qualificiations? A. I am an MD and a Fellow of the
Royal College of Psychiatrists.
Q. How many years' experience on this sort of work have you?
A. I began working on a forensic psychiatry unit in 1950 and
I have been engaged on related work ever since.
Q. What are the documents and information that you have been
given in relation to this matter? A. I have been shown
Exhibits 3 and 4, which I understand were written by the
defendant. I have been shown several medical reports; I have
been shown the opinion of Dr. Herridge, and I have been shown
the views of the report of the pharmacologist, Dr. Ashton,
and I have also seen another psychiatric report.
Q. I think that is Dr. D'Orban. A. That is Dr. D'Orban and
another.
Q. Assuming that the reports of behaviour as you have them are
his behaviour, assuming the handwriting is his and from what
you have read from the medical reports, are you in a position
to suggest what he may have been suffering from at the time?
A. My opinion is he was suffering from a state called
hypomania; that is to say, a state just half way towards
mania.
Q. Can hypomania be endogenous or drug induced, or a combination
of both? A. It can be. As far as it is inside,
endogenous, or it can be induced by drugs or it can be a
combination of both.
Q. Would it be fair to say that it can be, as is suggested by
the prosecution, endogenous? A. Yes.
Q. Is it equally fair to say it could also be drug induced or a
situation enhanced or exacerbated on someone with a
predisposition, by drugs? A. I think that someone with a
predisposition, it would be likely to be exacerbated.
Q. What is your view - assuming you have seen the combination of
drugs that have been taken in this case, what is your view of
those upon a person - being taken by a person or withdrawing
from these drugs - in very general terms what is your view
upon a person who has no predisposition or has a predis-
position but has not behaved so bizarrely before? A. I
cannot give a definite opinion because I cannot actually
know. I don't know that anybody could really know what drugs
were consumed. I have studied the accounts of what were said
to have been given to him and also some of the statements
that he has made about what he himself has taken, but I would
say that if it is substantially correct, then it is quite
likely that these drugs would have induced a very abnormal
state. They were not normal, they were not the sort of
prescription which one would normally expect.
Q. Would they have produced, either in their immediate form or
by way of effect of withdrawal, the sort of things you have
read about in this case? A. Yes, I think that they would,
assuming that this man is somebody who could be precipitated
into a state of hypomania by that means.
Q. Again forgive me, but unfortunately with a professional
commitment we had to call you as it were first to save time
in this way, because everyone has seen Dr. Ashton's report.
Have you had an opportunity of carefully considering the
report in relation to other documents you have seen in the
case? A. Yes, I have.
Q. Do you agree or disagree with her? A. I agree with her.
Q. Can you just help us on some matters as to whether or not
this may support Dr. Ashton's views. Assuming that he no
longer indulges in bizarre behaviour, and in that sense, as a
result of recovery from such bizarre behaviour, he has made a
recovery - in prison there is no bizarre behaviour shown at
all - what would that indicate to you? A. It would
indicate that he had recovered.
Q. Would that or would that not indicate to you the bizarre
behaviour had been caused by drugs? A. If he recovered
swiftly when the drugs were withdrawn, that would be in
favour of the interpretation that the condition was largely
induced by drugs.
Q. We know that there was a depression earlier, as a result of
which he went to doctors in Cyprus and as a result of
marital, personal, possibly even sexual problems but we know
not come into this. The thing I want to know is this: there
being depression at an early stage, and even making all due
allowance for that, how does it affect you? There has been
no similar bizarre behaviour of this sort in his life before.
A. I think that it makes it clear that he was in an abnormal
mental state at the time of this bizarre behaviour. The
fact that he has had episodes of depression before actually
fits in with the diagnosis of a manic depressive psychosis
because this is a condition which sometimes fluctuates
between states of depression and states of excitement and
mania, so that that piece of evidence would be in favour of
the suggestion that he does have some predisposition to this
illness.
Q. How does it relate to what we are concerned with on the
predisposition? How does it relate to the fact of there
being no bizarre behaviour at all - previously depression
yes, but the bizarre behaviour we have heard about here,
really unusual behaviour that has never occurred before, how
do we explain that? A. Bizarre behaviour appears to be a
symptom of a state of hypomania and that could have been
precipitated in a person of vulnerable personality or a
predisposition.
Q. By what? A. By drugs.
Q. As far as we can see, would it be right or wrong to say that
the behaviour, bizarre behaviour not seen before or since,
was likely to have been caused by drugs? A. It was likely
to have been induced by the drugs he was said to have taken.
MR. JUSTICE MACPHERSON: The state of hypomania? A. Yes.
MR. BECKMAN: Would he have behaved in that fashion from what you
have seen one - can never be certain, would it be likely he
would have behaved in that fashion if he had not had the
drugs? A. I would find it difficult to make a definite
statement about that. If indeed he suffered from a manic
depressive psychosis independent of taking drugs, the answer
would be yes. We have no evidence that I know of that he
did.
Q. Does it help you to know that no-one in his family has
suffered from anything of the sort? A. It is a point in
favour of the condition not being endogenous - that is to say
something inherent in the individual - because in such cases
there commonly is a family history of similar troubles.
Q. Would a psychiatrist reading the documents have any
difficulty as a general rule in being able to pick up the
possibility of a problem; let me put it no higher than that?
A. Reading the exhibits that were shown to me, I would say
they appear to be loquacious and flamboyant and arrogant, and
of the kind one would associate with a state of hypomania,
yes.
Q. Would this be fair or unfair, that whatever his predis-
position, the behaviour during that period would seem to be
out of character? A. If it is reported that he has not
behaved in that way otherwise, yes.
Q. Can you tell us - the hypomania may well have been drug
induced or whether be endogenous or whether be a combination
of both, can you please tell us what are the typical
symptoms? A. The typical symptoms are mood change in the
direction of elation amd excitement, and activity which
manifests itself in what is (inaudible). The change of mood
and attitude towards over-confidence and arrogance and loss
of judgment, so that the affected person does not fully
appreciate the consequences of what he does and acts very
impulsively. Quite commonly it is reported in such cases
that people will recklessly spend money that they haven't got
and do other reckless things because of their extreme lack of
judgment in this state.
Q. With this lack of judgement - can you take that a bit
further, "lack of judgment" effectively meaning what?
A. It means that they do not exercise normal judgment and
restraint that they would when they are in a healthy and fit
state, and that they may therefore behave recklessly towards
themselves and others, in a way that they would not do in a
normal state.
Q. Can I ask you this: lack of judgment, would they have, could
they have comprehension of what they were doing? A. I
think that they would understand, for instance, the literal
meaning of the words that they wrote or said, but they would
not have a full appreciation of the consequences because they
would not simply stop to think of what it meant, what they
were doing, and also it may be that - in fact I think it is -
that in some conditions of mania the distinction between what
is fantasy and what is reality is blurred in the mind of the
excited person.
Q. Can it involve a person thinking they are persons that they
are not? A. Certainly when the condition gets into a more
acute phase, when it becomes what you might call manic,
people indeed have what are then very obviously delusions,
delusions of grandeur, and the behaviour of grandiose and
arrogance which is observed in hypomania is only as it were
one stage towards this acute condition.
Q. In a sense the intellectual parts of the mind are fractured?
A. Yes.
Q. So they could have comprehension, an intellectual ability to
comprehend what they are doing. Would they necessarily
comprehend the effect upon others? A. I think they would
not be in a condition to consider it in the way that they
would in a normal state; they wouldn't stop to think.
Q. Would they necessarily comprehend the effect in due course
upon others? A. I think not, otherwise they wouldn't
behave so recklessly.
Q. Separating the intellectual aspect - I am using this in the
legal term not just in pure English - but separating as it
were the intellectual capacity to sit down and understand
what they are doing, would they have the capacity to -
definitely have the capacity to have intent to do what it is
that they are doing? Do you follow? A. I think in a
common sense way they wouldn't have the full capacity of
normal intent, and an analogy is even drawn between hypomania
and somebody who is in a state of alcohol intoxication, acute
alcohol intoxication, but they would say and do things they
would never do in their normal state.
MR. JUSTICE MACPHERSON: You were not here when Dr. D'Orban gave
evidence, were you? A. No, I was not.
Q. You have read his report? A. Yes.
Q. He plumps for endogenous rather than drug induced I think,
but he accepts entirely what you say, that it might be both.
A. Yes, that is my understanding.
Q. His evidence, as I read it, is almost a carbon copy of yours.
Did you disagree with anything that you saw in his report?
A. No, I did not
CROSS-EXAMINED BY MR. TEMPLE
Q. In those circumstances, I think I have little to put to you.
However, can I take you up on almost the last sentence or
two you spoke when being asked questions by Mr. Beckman. You
drew analogies rather like an alcoholic who can say and do
things that he would never do in a normal state. That does
not relate just to an alcoholic; many of us when in the state
of drink do and say things we regret afterwards. Is it the
same? Are you saying that in those circumstances, although a
person who has taken drink his judgment may be clouded, he
will still know what he is doing? A. I think that depends
upon the level of intoxication, and the main difference
between this and in alcohol intoxication is of course that
this is more loss. It is induced by - it can be induced by a
drug but it would continue - it may continue after the drug
is withdrawn.
Q. Put it another way: let us come back to this alcohol. A
man can have, when sober, an intent to kill and he can just
as well have a drunken intent to kill. The judgment may be
clouded but he still has an intent. A. He may formulate
intellectually an intent but he may have done so when drunk,
when he would not do so when sober.
Q. Exactly, but he has a drunken intent? A. As I understand
what you say, yes.
Q. Coming back to what you now say with regard to hypomania, in
the context - again I appreciate a lack of judgment may be
present but your evidence is, I think, he would understand
the literal meaning. In other words, you think in this case
a person would understand the literal meaning of a blackmail
demand? A. Yes.
Q. Let us be plain about it, he knew it was a blackmail demand?
A. I think if he were asked that question he might have
said, "Yes".
Q. Let us take it one stage further, and perhaps the final
stage: you have said to this jury that he would not
necessarily comprehend the effect on others. A. Yes.
Q. That is a very broad general statement, is it not? A. Yes.
Q. Have you seen this defendant? A. I have not.
Q. Have you heard the telephone calls he made, having originally
sent up the demand document to the Cyprus Government? A. I
have not; I have only seen the documents I mentioned.
Q. If I were to tell you in summary that, having sent up the
demand document to the Cyprus Government, he made some 22
telephone calls, the broad effect of which was he was saying,
"This is a serious matter, you would not want Cyprus to be
contaminated. I suggest you pay up", and then he would go
into details as to how the money might be collected, if you
were to bear that summary in mind would that then lead to the
inference that he certainly did comprehend the effect on
others? A. I certainly think that he must have understood
the meaning of what he was saying and understood that it was
a threat, but I would go back and say that I don't believe he
would have made such threats or behaved in such a way had he
been in a normal condition.
Q. Which takes us back to our drunk, does it not? A. Could I
make one distinction between this and my analogy with
somebody who had become drunk through taking alcohol, and it
is that somebody who had become drunk from taking alcohol did
take the alcohol presumably knowing what its effect might be,
whereas I don't think that was the case in this instance.
Q. Can I tell you that not half an hour ago we heard evidence
to the effect that when the defendant was in London at the
start he did take his pills then he decided not to. Does
that alter your comment? A. No.
Q. Not at all? A. I said earlier that it is difficult to know
exactly what he was taking, but looking at the range of drugs
and the doses which he was said to have been taking, they
were sufficient to, I think, cause an abnormal state of mind.
Q. Finally, can you assume for the purpose of the question that
he in fact is taking, as it were, the worst possible
combination of the drugs of which you have been given a
list - assume that by way of background - and he was taking
that combination, say, up to the day of his arrest which was
in mid May 1987, can you further assume that the finding of
hypomania in such circumstances was entirely due to drugs;
i.e. this was because of drug induced hypomania. In those
circumstances, after he had been arrested and in prison in
a settled regime and under medical supervision, how quickly
would the effects of these drugs by weaned from him?
A. If he had a predisposition to this illness and the drugs
had induced a bout of this illness, it might indeed take
weeks or even a month or two to subside.
Q. Let us be generous, at least three months? A. One would
expect it to subside in three months.
Q. If the theory is advanced that this was an entirely drug
induced hypomania and if he is arrested in mid May, certainly
by 25th November of that same year he would not be suffering
any effects from the drugs? A. One would not really expect
it to last so long, unless he had a serious predisposition to
this ailment.
Q. Of which it was pointed out he has none. A. I have not
pointed out that.
Q. But you have seen reports which suggest it? A. Yes.
RE-EXAMINED BY MR. BECKMAN
Q. Professor, can you tell me one thing first of all: you know
Dr. Ashton in her report speaks of the effect of withdrawal
from drugs as well as the actual effect of drugs themselves?
A. Yes.
Q. Did you make allowance for that in what you were dealing
with just now? A. I am aware of the fact withdrawal,
particularly from benzodiazepine, which featured prominently
in what he was taking, do have the effect of producing
agitation.
Q. When you were talking a moment ago to my learned friend about
the period of time it might take, were you talking about the
effect of drugs or withdrawal from the drugs. A. Well, I
was talking about both in effect. It is known that
withdrawal from benzodiazepine can take a long time in some
cases.
Q. Can vary from a person with a predisposition - would it be a
gradual effect or is it a sudden effect? A. It would be a
gradual effect.
Q. Can I ask you this: if we required specialist advice on the
question of the effect of drugs upon the brain in
circumstances such as this, can we do better than someone
like Dr. Ashton? A. I would have thought not. I wouldn't
claim to be an expert on the effects of such a cocktail of
drugs as he was said to have been taking.
Q. If you, in your capacity of criminology and forensic matters,
were asked by prosecutor or defender to give a definitive
answer, presumably would you or would you not refer the
matter to a psychopharmacologist such as Dr. Ashton? A. I
would refer it to a psychopharmacologist.
Q. In order to get the best advice? A. Indeed.
Q. Can I come to the question of telephone calls. You remember
my learned friend referred to the 23 telephone calls that
took place? A. Yes.
Q. Does it make any difference to your analysis that during the
course of the 23 telephone calls different personalities were
used by the same person, Mr. Koupparis? A. It seems to
fit in with the rather elaborate, implausible fantasy he was
advancing.
Q. Tell me this: does it help you in any way to know, for
example, one of the names used was Commander Nemo? A. It
adds to the ridiculousness of it.
Q. Does it help you to know in any way, for example, one of the
names used was Colonel Digsby at MI5 or MI6? A. That
doesn't mean anything to me.
MR. JUSTICE MACPHERSON: You have not heard the tapes, have you?
A. No.
MR. BECKMAN: My Lord, I was asking about the personalities;
none of us have heard - we have only heard part of the tapes.
MR. JUSTICE MACPHERSON: We have heard him posing as Colonel
Digsby.
MR. BECKMAN: Yes, my Lord, but I am asking the witness as to
whether ---
MR. JUSTICE MACPHERSON: I was simply asking him whether he had
heard the tapes, that is all.
MR. BECKMAN: Sorry, my Lord. (To the witness): Can you
help me as to this: you have been asked about blackmail.
I want to give you two possibilities of the person in a
hypomanic state, whether drug induced or endogenous. What is
more consistent with hypomania - because if they are agreed
that is what he was suffering at the time, what is more
consistent with it, blackmail or a belief that he could save
the Island of Cyprus? A. I really cannot say. My way of
answering that, implausible and crazy ideas are very common
in hypomania.
Q. Would a belief to save or assist the Island of Cyprus or
that he would become President of Cyprus, would that fit in?
A. That would fit in; that would be the kind of grandiose
delusion, if you like, that is well known - a well known
feature.
Q. Is something like blackmail as well known as a grandiose
delusion in relation to hypomania? A. No.
Q. Is it normal or abnormal to find - you told us it is normal
to find delusions of grandeur like becoming President, saving
the Island, doing good as symptomatic of hypomania; would
something like blackmailing someone on a grand scale be
symptomatic or not? A. I suppose a formulation of some
type of crime, including blackmail, might be a feature of
such a condition, yes.
Q. More or less likely - in other words, believing that he can
be President or he can be in a delusion, is more likely to be
the sort of thing hypomania can manifest, or he can commit
some such crime which is more likely in my eyes because
(inaudible). A. Grandiose ideas free from crime are more
likely.
MR. JUSTICE MACPHERSON: I just want to confirm something that
you said; it is not elaboration but I want to make sure I got
it. "I certainly think that he must have understood the
meaning of what he was saying and that it amounted to a
threat, but I do not think he would have done it in a normal
condition." A. The literal meaning of what he said, yes.
Q. "But I do not think he would have done what he did in a
normal condition"? A. Yes, that is my opinion.
MR. JUSTICE MACPHERSON: That is almost word for word what
Dr. D'Orban said. I wanted to confirm that those were your
words.
MR. BECKMAN: Can I ask your Lordship to make a note of the word
"literal" in particular, because that introduced a very
important aspect of the case.
(The witness withdrew)
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