Ref: A00-300995 Case No. 871626 Macpherson II
Volume XI, Pages 1-70, Thursday, 29th June, 1989
(In the presence of the jury)
MR. BECKMAN: My Lord, I apologise about this, but your Lordship
is aware of the train problems. My one remaining witness of
importance is coming down from Huddersfield and will not be
effectively here until about eleven o'clock and then
unfortunately, because of her professional commitments, I
have not been able to meet her in person. I have spoken to
her several times on the telephone. I would like to speak to
her before she gives evidence. At least I can happily say
there are no other witnesses after her.
MR. JUSTICE MACPHERSON: Members of the jury, I thought it better
for you if I explained the matter in court. This case has
had all the troubles that it could have of this kind, but I
am afraid there is nothing we can do about that at all and it
would be quite wrong to force the defence to call her as soon
as she arrives, so we will adjourn for a time. What is the
best thing to do?
MR. BECKMAN: May I suggest, assuming - I am hoping and allowing
for a 15 minute delay on the trains - she would be here at
elevenish, we say 11.30?
MR. JUSTICE MACPHERSON: The trains left London on time this
morning I know. I would not think she would be a terribly
long witness.
MR. BECKMAN: She will be, my Lord.
MR. JUSTICE MACPHERSON: It is all about drugs. We have heard
her name foreshadowed several times as we have gone along;
now we will see what she looks like. Shall we say twelve
o'clock?
MR. BECKMAN: Your Lordship is being generous; I am happy to
accept that.
MR. JUSTICE MACPHERSON: I would rather do that than trickle back
and have to go away again. I think a longer wait now than a
shorter one and another misfire would be the best course to
adopt. We will compromise and make it quarter to twelve.
(The trial was adjourned for a short time)
MR. BECKMAN: My Lord, may I say how much I am obliged, not only
for the time you gave us, but for the generosity in giving us
that time.
CRYSTAL HEATHER ASHTON: Sworn
Examined by Mr. Beckman
Q. What is your full name? A. Crystal Heather Ashton.
Q. Your address? A. University of Newcastle-upon-Tyne.
Q. Your occupation? A. I am a Reader in Clinical
Psychopharmacology at the University and a consultant
physician.
Q. Forgive me for asking a lady this: how long have you been
doing that? A. Forty years at least - no, between 30 and
40 years.
Q. Can you tell us your full qualifications in terms of
experience? A. Since qualifying in medicine in Oxford in
1954, I have done the usual clinical house physician jobs in
various medical and surgical departments. I have then been a
research fellow and then went into academicism, where I have
been a member of the pharmacology department for about 20
years.
Q. Would it be right to say there are a number of publications
on the subject produced by you? A. Yes.
Q. How many, in terms of books? A. Well, I have written two
books myself, I have chapters in about 20 books, and I have
written nearly 100 papers on pharmacology.
Q. Would it be right or wrong to say that much of the work that
you have written is considered to be, at least in some
circles if not all circles, to be fairly authoritative?
A. I think so.
Q. My Lord, I intend to follow the order of her statement but
of course not go to all the references. (To the witness):
We need not go into the various things you saw for the
purpose of this case, but you were given certain basic
information, such as doctors' reports, a list of drugs from
the solicitor, information from the defendant and that sort
of thing that you were given for the purpose of looking into
this particular case? A. Yes.
Q. Can you tell us this: what were your terms of reference?
A. I was asked to give an opinion as to whether or not
Mr. Koupparis's mental state at the time he committed the
offence was either caused or aggravated by various drugs that
he had been prescribed.
MR. BECKMAN: First of all, before we go into details in relation
to this case, can you in general terms - keeping it as short
as possible, the best way possible to assist the jury - tell
us first of all what certain drugs are used for, and second
what their effects are or side-effects may be, following the
order of your report, and I am sure you can look at any
documents if you need to at any time.
MR. JUSTICE MACPHERSON: Did you ever see him? A. No, I have
never met Mr. Koupparis.
MR. BECKMAN: Forgive me, is it normal you should see him when
dealing with this particular exercise? A. No, it would not
really be relevant when his mental state had changed. If I
had seen him at the very time he had each type of drug it
might have been different, but afterwards it is a matter of
history.
Q. And depends to a large extent on what he tells you or what
comes from him? A. Yes.
Q. Can we also deal with the other thing you have looked at,
what comes from him, and that has been supplied to my learned
friend so he has that, and if there is anything there
inconsistent with the evidence he can deal with it. In
addition to that, did you see the doctors' reports?
A. Indeed, and descriptions of what they thought they needed
to treat and all the drugs they prescribed, and some of the
dosages.
Q. In addition to that, did you also see the opening note of the
case prepared by the prosecution, namely their description of
their own case? I think you will find that is item 2 of
your list. A. Yes.
Q. Were you shown certain documents, such as a copy report sent
to the President of Cyprus? A. Yes.
Q. A list of prescriptions from Dr. Sophocleous and Dr. Evdokas?
A. Yes.
Q. And a statement from (inaudible)? A. Yes.
Q. A statement from Mr. Georgiades? A. Yes.
Q. The prison medical records? A. Yes.
Q. And a report by Dr. Cheryl Ashworth? A. Yes.
Q. I think you saw some others but as they have not been
introduced I will not refer to those. That is together with
information supplied by Mr. Koupparis which my friend has.
A. That is true.
Q. Dealing with the specific drugs first of all, assuming them
to have been prescribed, and we have heard evidence in the
case, most of the drugs came under the category of what?
A. They were all psychotropic(?) drugs which are drugs which
affect the mind.
Q. What are they used for? A. There are three main
categories; one is called tranquillisers, which you are
probably familiar with, and they tend to be used for anxiety
states; another group are called antidepressants, and they
are used to alleviate the depressed mood in depressive
illnesses, and the third group are called antipsychotic
drugs, sometimes known as major tranquillisers. They are
used in severe psychotic states like schizophrenia and mania.
Q. Tranquillisers in this case, assuming they were prescribed
for Mr. Koupparis, they were of what? A. All the
tranquillisers were phenothiazines, which are a group of
drugs like Valium and Mogadon.
Q. Antidepressants? A. They were two types which have similar
effects, but they affect the brain by chemistry in different
ways. One are known as antidepressants and the other are
known as monoamine oxidase inhibitors.
Q. As far as antidepressants are used, what was the drug used?
A. This again is a big class, but mostly called
phenothiazines, and they have similar actions and side-
effects.
Q. As far as the use of psychotropic drugs are concerned,
generally speaking I take it that it is necessary that
psychiatrists and doctors should normally know what they do
and what may be the side-effects? A. Yes, certainly they
should.
Q. Do the side-effects or the effects upon people vary from one
person to another, or are they always the same? A. They
vary a lot because they do affect the mind, as I have said,
and obviously everybody's mind is different, so that they
could have quite a subtle difference, sometimes even opposite
effects, if you give the same dose to different people.
Q. Tranquillisers normally, I assume, have what?
A. Tranquillisers normally have a calming effect, calm down,
relax you, but some people can become really excited, even
manic, with them.
Q. Antidepressants? A. Again antidepressants usually lift the
mood if you are feeling very depressed, but sometimes they
can cause a mania. They can cause you to be over-excited,
over-active, and just the opposite to depressed.
Q. Antipsychotics? A. Well again, they are usually - if you
are having delusions, hallucinations and so forth, as you
might in, say, schizophrenia, they bring you back to normal
but in some subjects they can themselves induce delusions and
other psychotic states.
Q. Is it easy to predict a drug reaction upon any particular
patient? A. No, it is very difficult to predict this
because you do not know exactly the biochemistry of
everybody's mind and so you have to proceed very cautiously,
and especially in somebody who has an unusual personality, or
has a strong family history, or has a history of mental
illness before, etcetera.
Q. Is there any justification in prescribing drugs in the same
group at the same time; in other words, more than one of any
particular group? A. No, because all the drugs in each of
these three groups I have talked about all have similar
actions, also similar adverse effects, side-effects, and if
you prescribe several in one group you do not really know -
it is like giving an overdose to anyone. Although you are
adding on to the effects (both toxic effects and possibly
therapeutic effects) but you are likely to give an overdose
because the effects add up.
Q. Generally speaking, is it advisable to give combinations of
groups? A. No, it is not advisable because, as I said, one
lot calms you down, one puts you up, one has another effect,
and if you give two or three different groups together you
really confuse the brain, and you might end up with nothing
because you are upsetting so many mechanisms.
Q. Generally speaking, do all drugs have only beneficial
effects? A. Unfortunately the answer to that is no, and all
drugs have bad effects as well as good ones.
Q. Do those effects, in so far as they are bad effects, do they
increase or decrease with dosage? A. The higher the dosage
the more likely you are to get adverse effects.
Q. If you get two or more drugs of the same group? A. Again
the adverse effects add up.
Q. If they are from different groups? A. Sometimes they have
adverse effects in common and those too will add up, or
sometimes the effects of one will cancel out or make worse
the effects of the other. Again, this is unpredictable in
any individual.
Q. What is the best way to minimise the adverse effects?
A. The best way is to use the smallest possible dose of a
single drug which will control the condition you are trying
to treat.
Q. If you increase the dosage do you necessarily increase the
beneficial effect, or I think you call it the "therapeutic
effect"? A. No, there are some drugs, particularly anti-
depressants, where there is good evidence that you can - over
a certain level the therapeutic effects actually fall off, so
it is doing less good for the thing you want to treat. The
adverse effects increase, so they can lose the treatment
effect by giving too big a dose.
Q. Can we now turn to what are the adverse effects of psycho-
tropic drugs, starting with phenothiazines - forgive me if I
mispronounce them. So far as phenothiazines are concerned,
what effects do they have, bad effects? A. They are
tranquillising drugs. They in general have a sedative effect
but sometimes they are over-sedative so a person becomes
drowsy. He may lose his balance, his memory is bad, his
judgment [sic] is bad, he is sleepy, and they can actually cause
depression, quite severe depression. They can aggravate
depression if it is already present. In a few people they
make them aggressive and excited, as I have said, and they
also produce quite quickly drug dependence, and that means
that you get using to taking them. Your brain just - if you
suddenly stop them then you get a whole lot of withdrawal
symptoms which can be far worse than the original condition
you were treated for, and this can include several physical
symptoms, insommnia [sic], hallucinations and severe psychotic
reactions as well.
Q. If you take the withdrawal symptoms, that occurs presumably
when the drugs stop? A. Yes.
Q. Can it occur when the drug is reduced? A. It can also
occur if the dosage is reduced from what you have been used
to, also if you take them erratically, because they seem to
occur when your blood level is falling. If you take them
erratically your blood level is going up and down all the
time so you may go in and out of withdrawal symptoms even
though you continue taking the drugs in decreased dosage or
erratic amounts.
Q. What are the symptoms of withdrawal symptoms? A. Well, the
common ones are an increase of anxiety which may give rise
to panic attacks where there can be a terrible sensation of
fear, palpitations, tremor, terrible fear. This may spread
to agoraphobia. People get afraid to go out, they cannot
sleep, insommnia [sic]; if they do they have terrible dreams; all
sorts of physical symptoms, pins and needles, mostly weakness
symptoms, severe muscle cramps and pains and symptoms of
that - severe mental states, including manic states,
delusions, a schizophrenic picture. There are many others
but that is a few.
Q. Is there a particular adverse reaction that occurs sometimes
when you have strong what you term phenothiazines? A. Yes,
there are two which are particularly potent. One is called
Halcion or tricyclium [sic](?); the other is called (inaudible).
These are all extremely potent phenothiazines. They are 20
times as potent as Valium. They are short acting; they only
last for a few hours and they can produce again a hypomanic
state and even agitation when you are taking them, and also a
withdrawal reaction between doses, so those drugs are likely
to produce mental confusion, and I have read many papers and
seen patients who have had trouble with these two particular
drugs. Also lorazepam is also like that.
Q. Can you tell us about adverse effects of antidepressants,
tranquillising antidepressants? A. There are various
preparations of these. Some, in addition to their anti-
depressant action, are sedative and they can make you too
sleepy. Some, in addition to being antidepressants, are
stimulants. They can make you very excited so some patients
can get agitated on some of the preparations, and what they
can do, particularly in sensitive people or in even slight
overdoses for that person, they can precipitate mania. They
can vary right up through the sort of emotional scale so
you are given them for depression when you are very low; you
do not stop at being normal but you go right up and become
manic, hypomanic and psychotic in fact.
Q. Any other? A. You can also get dependent on antidepressants
and again, like tranquillisers, if you stop them suddenly or
even if you reduce the dosage, you can get the other swing,
with excitability, hypomanic states, various psychotic
delusional states as withdrawal from antidepressants, and
also very irritable and sometimes violent.
Q. What about the monoamine oxidase inhibitors? A. These
drugs have similar effects in depression but they are rather
dangerous because they interact with certain foods, so you
have to give the patient certain foods he cannot eat, which
includes cheese, broad beans and (inaudible). Apparently
some people eat them and it has produced a reaction. This
can give a severe rise in blood pressure and can lead to
cerebral haemorrhage. So you give them under supervision,
but, like phenothiazines, they can cause mania, excitability
confusion and dependence and withdrawal reactions.
Q. What about antipsychotic drugs; what effects can they have?
A. These are drugs which sort of detach you from reality.
These are actually drugs they reputedly use for brainwashing
in Russia because they cut you off from reality and in that
way have a calming effect if you were deluded or schizo-
phrenic or something, but they can, as you can see from that,
also cause confusion and excessive sedation, and in a few
people they can cause happy, excitable, manic states. They
can also cause depression; people feel very sad, unmotivated
and they have unpleasant effects in that they can cause
muscle - big changes in muscle tone and can make people make
funny movements which they cannot control, roll their eyes,
twitches and so forth, and for that reason very often they
have to be given another drug to control the muscle movements
as well as the drug - the antipsychotic for the psychotic
state.
Q. What about antichlorinergic [sic] drugs, and is there a particular
one? A. I said they sometimes have to have another drug to
control muscle movements. This antichlorinergic [sic] drug -
Akineton is the one I believe Mr. Koupparis was given - this
would be to - there are adverse effects of anti-psychotics.
There are muscle movements and that itself can also have
additive effects and also produce agitation, hypomania,
psychosis. All these drugs, because they affect the mind,
which is a delicately balanced structure, can push it out of
gear.
Q. What about lithium carbonate? A. That is a drug which is
relatively recently introduced, which is given for manic
states usually although it will also prevent recurrences of
depression, and that is a very toxic drug. It is one of the
few drugs you have to have regular blood tests to see your
blood level is exactly right because if it gets very slightly
over, you again get adverse effects, which includes
psychosis, muscle changes, liver damage, kidney damage, a
whole lot of other things. It is a dangerous drug.
Q. Can you give us some description of any mental states which
can be produced by the use or over-use of psychotropic drugs?
A. Well, I have been mentioning them all along, and of the
drugs that we have been talking about, probably the commonest
mental effect is to produce mania or hypomania.
Q. Anything else that it may produce, apart from hypomania?
A. Well, all the drugs, the other thing they can produce
schizophrenia, they can produce terrible anxiety, they can
produce depression and they can produce confusional states,
where you don't really know what you are doing.
Q. Dealing with the mania aspect of it, would the hypomania
aspect be the same or similar in these manifestations to a
doctor as hypomania endogenous? A. Exactly the same.
Hypomania and mania are descriptive terms but you cannot tell
whether someone was hypomanic or not because of that
(inaudible).
Q. Unless you had an analysis of what had happened to him
before; his family history and so on and so forth? A. Yes.
Q. Can you give us some ideas which may be of help to the case
how a person who has drug induced hypomania - but it matters
not which it is - in what way it would affect his mind, that
might be of relevance here? A. Well, he would tend to have
an elevated mood which might be jokey, might be quite
ecstatic, might vary a lot. He would be happy, active; he
would have a constant flow of ideas in that ideas chasing in
and out of his mind, and he would be likely to have grandiose
delusions and plans, even with a sense of omnipotence and
self-importance so everything seems possible and he was able
to do anything. Any great plan that came through his mind
he would be capable of doing it, and so he would embark on
plans, spend a lot of money, start business ventures, have
great ideas, wanting to become President or many things like
that.
MR. JUSTICE MACPHERSON: Have you seen the evidence or been told
of the evidence of Dr. Calne [sic], who saw this man on 15th May
1987, and Dr. D'Orban? A. I haven't ---
Q. It sounds so much like what they told us that --- A. I
haven't seen Dr. Calne's [sic] report. I have seen Dr. D'Orban's.
I imagine they have all read the same textbooks, including
mine.
Q. Actually they had not, but as I understand it, you have seen
Dr. D'Orban's report? A. Yes, that is a classic picture of
hypomania.
MR. BECKMAN: As far as Dr. D'Orban is concerned, you have seen
his report; that is a long time ago I think. Have you also
seen a full transcript of his evidence in this court?
A. No, I haven't got that in front of me.
Q. Have you seen it? A. Yes, I think I have glanced at it,
yes.
Q. That can be available if required. You have seen that this
morning, Dr. D'Orban's full evidence - or part of his
evidence at any rate? A. Yes.
Q. I think you touched upon grandiose delusions; what about
anxiety? A. The patient may stop - doesn't usually admit
that he is ill. In fact, you can get quite the opposite:
everything seems real and possible and has very little
anxiety when you have these grandiose delusions. You may be
able to point it out to him and say, "You cannot be Jesus
Christ", but he will say, "Oh no", but the next minute he
is - he actually lives his delusions.
Q. Can you get this varying; sometimes they can exercise control
and sometimes not? A. Yes, sometimes they can talk very
rationally and seem calm for a short time, but it tends to
fluctuate.
Q. Before I go on to psychotic states, I just want to mention
one thing. A moment ago you made a comment about having read
your books. I think it right to say Dr. Calne [sic] had not. He
is a general practitioner with psychiatric expertise, but the
psychiatrist, Dr. D'Orban, certainly knew about them. Can
we now turn to psychotic states? Can you tell us the sort
of psychotic states that you would have in this condition?
A. Yes, these are confusing psychiatric terms actually,
because mania - hypomania we have been talking about - is a
psychotic state but - and it can merge with a very similar
state you can see in schizophrenia, where again there are
delusions, often with grandeur, symptoms of persecution and
people again feel they could be omnipotent or people are
plotting against them. They tend to have voices telling them
to do things, so that merges in a way with hypomania.
Q. Would they have - I think the word "paranoia" has occurred in
this case. Looking at the document, would they have beliefs
that might be similar to paranoia? A. Indeed they would.
This is delusions of persecution; you think people against
you - are plotting against you. That is a paranoid state and
you can certainly get that in these psychotic states.
Q. Can you get the reverse of that, not that they are being
hunted but they are doing things themselves? A. Indeed,
you can get quite bizarre plots and delusions. They will do
something or take over a country or whatever, yes.
Q. I think you have told us about delusions of grandeur and, in
a different context, paranoia. A. Yes, they merge.
Q. Toxic confusional psychosis; can you explain that? A. Yes,
this is a state usually of confusion, as the word says,
caused by drugs where you have difficulty in maintaining
contact with reality. You are confused; you are floating in
and out of reality and fantasy and you do not really quite
have a base to stand on, but sometimes - again you can get
very fixed ideas, often disassociated with your
consciousness; going - being drowsy and like you are - when
you are very ill sometimes if your consciousness is clear.
Again, you can get strange ideas because you have trouble in
separating fact from fantasy.
Q. What are the particular symptoms? A. The symptons [sic] - well,
you can have - it can look just like the picture of
schizophrenia which we have been talking about, with fixed
delusional ideas of grandeur, paranoia; a very similar
clinical picture.
Q. Does consciousness remain constant? A. It tends to
fluctuate.
Q. What about mood change? A. Again fluctuation.
Q. Can you tell us what are the drugs that are known to cause
toxic confusional psychosis? A. All the drugs really we
have mentioned, tranquillisers, antidepressants, anti-
psychotics, and also antichlorinergic [sic] agents, plus other
drugs; alcohol can do it.
MR. BECKMAN: I now want to turn to the drugs that assuming -
only assuming of course, because the jury have to look at the
evidence and decide what they accept as to what he may or may
not have taken. What are the drugs you have considered in
possible relation to Mr. Koupparis, that he may have been
prescribed or obtained over the counter from the pharmacist?
MR. JUSTICE MACPHERSON: While this is happening, ladies and
gentlemen, it is probably useful for you to have available
what he says he actually took. (To the witness): You have
been given that, have you, Dr. Ashton? A. Yes, I have. I
think my list in my report differs slightly.
MR. BECKMAN: Can I tell you what that is, or perhaps you know.
Mr. Koupparis when giving evidence was having some difficulty
in remembering what he took and when in terms of giving
evidence, and was asked to prepare a list overnight and set
it down rather than sit here painfully going through it for a
long time, and that is what he did. Bear that in mind.
Tell us if anything in there in any way or any extent differs
from what you know if necessary, but do not make a particular
exercise of it. So far as you are concerned, what were the
items that he had taken as far as you were concerned for the
purpose of your report? We can add or subtract anything,
either by myself or this gentleman may cross-question you.
A. I have them listed by drug type, which might be easier.
Q. Tranquillisers first of all. A. I have some evidence that
he took at least nine tranquillisers of the Valium type.
Q. What were these? A. These included Ativan - I will go
through the proprietory [sic] names. (Inaudible) Valium, Xanax,
Halcion, Noctem [sic]; these are all similar drugs in the same
class.
Q. As a matter of interest, the names you have given here are
trade names as opposed to the generic names? A. That is
right.
Q. The trade names being those under which they are marketed by
the big pharmaceutical companies; the generic name you would
have in the medical world. Antidepressants? A. Anti-
depressants, he had at least 13. One was Parstelin, which is
a monoamine oxidase inhibitor; it is a mixture of
antidepressant and antipsychotic drug. That was one; then he
had three tricyclic antidepressants, Anafranil, Ludiomil and
Vivalan.
Q. What antipsychotics? A. The antipsychotics which he had
included Largactil, Redepton [sic], Stelazine, Melleril, Clopixol
perhaps and Navane perhaps. These are all drugs of the same
type, thioridazines [sic], and along with them Akineton (which was
the drug I mentioned) to counteract the adverse effects on
muscles.
Q. Was there any other drug as well? A. There are records
in the doctors' records of his having Priadel, which is
lithium carbonate, which I just mentioned.
Q. In view of the number of drugs taken and in relation to the
adverse effects you told us about, would Mr. Koupparis have
been vulnerable? A. I think it is highly likely that the
use of these drugs, which were given to him in quite
inappropriate mixtures and in incredibly large doses, would
have had a profound effect on anybody's mental state.
Q. Are there effects which would increase that risk? A. Yes,
well, yes. As I said, obviously people have different
vulnerabilities; some are very susceptible to drugs - to
effects of drugs - others are not, but the more the dosage
the more likely you would be to get adverse effects, and as I
previously explained, if you use mixtures together of several
different types you also - if you suddenly withdraw them or
change the doses again this would be highly likely to
precipitate adverse effects.
Q. I want to go from that to the medical history of
Mr. Koupparis, but only in relation to evidence we have heard
in this court, so I want to exclude evidence we have not
heard - that is Dr. Zeider - and just have the evidence we
have heard - that is Cheryl Ashworth and Dr. Beard - but only
so far as the factual aspects are concerned, not as experts.
It is agreed they were here only for the purpose of factual
evidence. Assuming their evidence to be correct - and there
is no reason to think otherwise - in 1981, assuming that to
be correct, what was his mental state so far as is relevant?
A. Perfectly normal, as shown by clinical impressions and a
number of recognised standard tests.
Q. These recognised standard tests which Cheryl Ashworth in fact
applied, that is (inaudible) questionnaire and so on, are
these tests which are well recognised? A. Yes, indeed they
are.
Q. Are they effective? A. They are very effective as far as
they can - I mean, how effective is a test? You never know
what you missed, but the Isonic [sic](?) personal questionnaire, I
have had a lot of experience with it and that does show who
is prone to anxiety conditions, who is prone to psychotic
conditions and it points out people with extreme personality
types which you can suggest they might react to drugs oddly
and behave oddly in certain situations, and the results of
Mr. Koupparis on this test were completely normal. It
showed he was a highly extroverted person; that means he was
sociable and liked to make contact, but that was normal and
showed no sign of any deviation at all.
Q. Tell me this: if in fact you do three tests - we know three
tests were taken and you have the evidence of the
psychiatrist, Dr. Beard, at the time and you have the
evidence of Dr. Ashworth. That being so when they all
coincide, how does that help you? A. Well, that is very
strong evidence of normality.
Q. I want to now ask you about - again this is making certain
assumptions - when was there a start, as far as you are
concerned, in the medical history? A. I have evidence that
after he saw Dr. Beard that it was suggested that he start
taking tranquillisers at that time to deal with a sleep
problem he had.
Q. What was the sleep problem, as far as you are aware, that he
had? A. Well, it is a condition which has several names,
but you will probably all recognise it because we have had
probably a minor variance. Just as you are dropping off to
sleep you have a sudden jerk and you sometimes hear a loud
bang or it feels as if there has been an explosion in your
head. Most people have it occasionally and think nothing of
it and go back to sleep. Sometimes they go on and on, and
just dropping off to sleep it happens again and again and
that has been called "exploding head syndrome" (inaudible)
hallucinations. It is well described in the literature. It
is not associated with a psychiatric abnormality although,
funnily enough, it can occur when taking drugs, particularly
tranquillisers; also when withdrawing from them.
Q. Having that condition, was he put on tranquillising medicine?
A. Yes, he was put at that time on benzodiazepine
tranquillisers. I think it was suggested that he have
Mogadon, which he took for a while, and then he went abroad
and this was changed to another one in the same group, called
diazepam, which he continued for several years.
MR. JUSTICE MACPHERSON: Mogadon was Normazine [sic]? A. Yes,
Normazine [sic] is the same as diazepam.
Q. That is the same thing, is it? A. Yes.
MR. BECKMAN: Your Lordship will see it at page 17, five lines
down. (To the witness): So Normazine [sic] is in fact the trade
name for diazepam, the generic name. If one is having doses
of these drugs and you have to suddenly stop, any problem?
A. Yes, that is, even when you have only been taking them in
therapeutic doses you can get a withdrawal syndrome from
suddenly stopping these drugs and that can be very severe.
I have described some of the characteristics, which can
include depression, insomnia, fear, panic, sweating, so
forth.
Q. Assuming that in 1985 Mr. Koupparis became depressed and
assuming then that he went to see Dr. Sophocleous - and in
fact you have seen and had various notes of Dr. Sophocleous,
have you not? A. Yes.
Q. Again we have heard evidence about this which is, so far as
it goes, unchallenged. From it did you get some idea - let
us put it no higher - of what drugs may have been prescribed
by Dr. Sophocleous? A. Yes, he certainly prescribed more
tranquillisers of the ones we have been talking about:
Lexotanil, which is on my list, was one of them which he gave
in rather maximal doses, and I think Mr. Koupparis was also
taking other ones of the same type. So that was one group of
drugs, and I have records which show in fact that he not only
prescribed Lexotanil, but also Noctem [sic] and Normazine [sic], which
are the same, all tranquillisers, and then in addition to
that he prescribed Parstelin, which is an antidepressant of
the monoamine oxidase inhibitor class which I mentioned
before, which is one that can give adverse reactions with
food and which, if you have a lot of it, can push you into a
manic state.
Q. Anything else that was given apart from drugs - intravenously
for example? A. Well, the records are not very clear, but
at a later stage they record that he also received Priadel or
lithium (they are different antipsychotic drugs) Akineton to
control muscular effects, and also some injections, which
according to the notes were Redeptin (which is another
antipsychotic drug) Clopixol (another antipsychotic drug) and
there is a question of whether or not he had insulin
injections and what these injections really were.
Q. I can come to that later, but at the moment can you tell us
this: from your expert viewpoint and especially what may
have been prescribed, were you happy about it? A. No. I
think this was quite extraordinary. Starting going through
them one by one, there were several tranquillisers which
added up to excessive doses, beyond what are recommended, and
Parstelin was prescribed in doses of four tablets a day which
contains - that would be an excessive dosage (inaudible)
which was continued for rather a long time, and then on top
of it were put antipsychotic drugs, so he was having a
mixture of three types of drugs and again in excessive
dosage.
Q. I would like now to see the effects in relation to individual
drugs, the possibility of them and whether or not the dosage
was reasonable, starting first of all with Lexotanil.
A. The dosage of that, according to the records, were a
total of 18 milligrammes daily.
MR. JUSTICE MACPHERSON: When you say "according to the records",
did you get those from Miss Postgate? A. Yes.
MR. BECKMAN: I want to canvass two things with you. We got it
from Miss Postgate; presumably she gave you the same
information she gave us, but in addition to that, did you
have any other documents? A. I had the pharmacist's
records. I cannot honestly remember if that was - it had any
dosage. I mean, yes, it was on it but the pharmacist didn't
keep good records. He didn't count how many tablets and how
long they lasted, so we do not have clear evidence.
Q. Did you have any other document by way of prescriptions or
the like? A. I have seen letters from Dr. Sophocleous.
Q. Can I just ask you this one thing: was there any basic
inconsistency so far as the totality of the documentation was
concerned? A. No.
Q. I think you are dealing with Lexotanil and you told us of
the dosage prescribed. I was going to ask you whether or not
it was a reasonable dosage. A. Yes, that was the maximum
dosage of that drug, but in addition he was receiving other
benzodiazepines which had the same effect, which included
(inaudible) and Normazine [sic], so if you put any more
benzodiazepines on that you would have an overdose.
Q. In other words, he was being prescribed excessive doses of
the benzodiazepines? A. Yes.
Q. Parstelin? Well, again, he was prescribed excessive doses
of that. An active ingredient of that one we are talking
about is an antidepressant called tranylcypromine sulphate
and each tablet of Parstelin contains 10 milligrammes of
tranylcypromine sulphate, and the total recommended dose is
30 milligrammes to start with but 10 milligrammes on
maintenance, but he is prescribed ten tablets of Parstelin
which would be 40 milligrammes a day, which is an excessive
dosage.
Q. Priadel? A. We haven't any record of how long he took it.
I have one note, 400 milligrammes at night. It is impossible
to say. That is a drug you would have to monitor blood
levels.
Q. Stelazine? A. Stelazine was prescribed - this is an anti-
psychotic in a dose of 10 milligrammes daily. The
recommended dose is 2 to 4 milligrammes for severe anxiety,
possibly 10 milligrammes for psychosis, so it depends what,
but certainly for severe anxiety you wouldn't give more than
4 milligrammes.
Q. Melleril? A. Again that would be the maximum. Melleril
is in the same group, so adding that in you would be
increasing the dosage.
Q. In other words, you are prescribing him well over the
recommended top? A. Yes, well over.
Q. Redeptin? A. Redeptin also adds to it.
Q. How much was he prescribed there? A. According to the
notes, it was 4 milligrammes by injection and yet maintenance
treatment in schizophrenia, where you use maximum doses, is
only 2 milligrammes at weekly intervals by injection.
Q. Is there any medical jurisdiction for using these three drugs
together? A. Absolutely none.
Q. Or for their combined dosage being excessive? A. No.
Q. What would be the effect? A. It would cause quite
unpredictable mental effects, but in anybody it would be
almost certain to affect their brain and their mind.
Q. I think there was a suggestion about this time that he
received some injection from Dr. Sophocleous. A. Yes.
Q. There has been some discussion about the words there.
Originally it was suggesting insulin, then it was said they
were B12, some vitamin extract. Are you able to assist us
which it is likely to have been from the information you
have? A. Not completely, but I would think it was most
unlikely they were a vitamin extract, vitamin B12, which is
what Dr. Sophocleous apparently implied, because you would
only give that once a month anyway in the case of pernicious
anaemia and it would not cause any side-effects where, as
history suggests that there were side-effects, that he was
given a lot of sweet drinks and things after these and it
was - his consciousness was impaired by this injection.
That certainly would not fit with vitamin B12. It is
possible it was (inaudible). There was also a note for
Redeptin which is another antipsychotic. It would be
difficult to tell which it was.
Q. How would you describe in general terms, then, the dosages of
antipsychotic drugs if he had those? A. Grossly excessive.
Q. And the insulin injections, what would you have to say about
that? A. Well, insulin injection is an old, outmoded
treatment for schizophrenia. What it did - it was called
insulin coma treatment. You had an injection of insulin
which lowered your blood sugar to such an extent you went
into a coma, and this was supposed to improve schizophrenia
because it used to be used a lot, but it has been out of date
for 20, 30 years and produces very adverse effects, as you
can imagine if you go into a coma every time you have an
injection.
Q. How long has the insulin treatment been obsolete in this
country? A. Thirty years.
Q. How long? A. Twenty or 30 years.
Q. Is there any justification in using this treatment as
described? A. No justification.
MR. JUSTICE MACPHERSON: Would it necessarily put you into a
coma? A. Depends how much they gave you, but there
wouldn't be any point in giving it according to the rationale
when it was used unless it did. It was supposed to rest
your brain.
Q. I only mention it because there is no evidence he was put
into a coma at all. A. No, that is why I wonder what it
was and whether he was given it at all if he was (inaudible).
I don't know what the reason would be.
MR. BECKMAN: Can I ask you this so there will be no doubt about
it later: the purpose of the injection in the old days for
the purpose of curing, I think you said schizophrenia, that
is why it was used and the purpose was to put the person in a
coma, but if it does not put you in a coma, does not have
that effect, it does not have that effect on everyone, or
does it? A. Well, when they used to use it they used to
give it and give it until you went into a coma.
Q. They gave you such doses until you went in? A. That's
right.
Q. What are the effects the injection would have on you if they
did not have sufficient to put you into a coma? A. That
would make you - anybody who is (inaudible) concerned know
they appear sleepy; your blood sugar falls; you get faint;
you get hungry; you get blurred vision; you feel very weak;
you get the tremor.
Q. I think we have referred to Redeptin, Clopixol and Melleril
and you said was a gross over-dosage. What is the effect
upon the patient? A. Of the antipsychotics?
Q. Yes. A. Mental confusion, bewilderment and, of course,
remember it was combined with other things, including a lot
of tranquillisers. I would think it would have made him
very sleepy and not in touch with reality.
Q. Assuming following the period of injection he continued to
receive Melleril, Roctinal [sic] and (inaudible), would that be
consistent with sleeping round the clock, being unable to
work, being very lethargic? A. Yes, that is exactly what
one would have expected.
MR. JUSTICE MACPHERSON: The days of the injection, we were given
that date, were round about December 1985. A. Yes.
(The trial was adjourned for a short time
CRYSTAL HEATHER ASHTON: Recalled
Further examined by Mr. Beckman
MR. BECKMAN: My Lord, we were about to turn to 1986, page 22.
MR. JUSTICE MACPHERSON: I do sympathise with you, ladies and
gentlemen, not having it in writing.
MR. BECKMAN: In 1986, again working from the information you
had, the treatment changes back to Parstelin and anti-
depressants? A. Yes.
Q. At least in part, and what else? A. Parstelin again in
four tablets daily, which was an excessive dosage as
explained this morning, and also some benzodiazepine
tranquillisers, which included probably at least three; one
was Lexotanil, which I mentioned before, in high dosage
(inaudible) and Valium, all three similar drugs. The dosage
of Valium is not stated but the whole lot together would have
been a high dosage.
Q. High or excessive? A. Excessive in fact, and at the same
time, according to the medical records and Mr. Koupparis'
statement, he was also receiving an antipsychotic drug,
Stelazine, and another one of the same group, Roctinal [sic], as
well as the antidote I mentioned to control the muscle
spasms.
Q. We have heard, I think, about this time he was sleeping most
of the day: is that consistent with that intake of drugs?
A. Again, I would have thought that the excessive dose of
tranquillisers and antipsychotics could well have produced
the state of somnambulance.
Q. Would that be consistent with not going out and (inaudible)
sensitivity? A. Yes, these are the withdrawal effects of
benzodiazepines, and as I said earlier, you could get
withdrawal effects while you are still on tranquillisers if
your blood level is changing because you have got erratic
dosage, which I think is probably what happened.
Q. Is that in a sense partly because you are getting used to it?
A. Yes, it is partly due to the tolerance; you get more and
more tolerant, so unless you keep increasing the dosage you
get withdrawal effects.
Q. We know there came a stage when Mr. Koupparis consulted
another psychiatrist, Dr. Evdokas. Do you have a list from
Dr. Evdokas in relation to the items which he prescribed?
A. Yes, I have.
Q. I think I may put it this way - I am not going to ask you to
deal with what Mr. Koupparis may have said but just this - is
there possibly some dispute as to what was taken at that
stage? A. Yes.
Q. When he first saw Dr. Evdokas what, as far as you are aware,
was he then taking? A. He was taking a mixture of
tranquillisers, antidepressants and antipsychotics in large
doses.
MR. BECKMAN: What about now so far as these three are concerned,
Valium, Roctinal [sic] and Normazine [sic]?
MR. JUSTICE MACPHERSON: Not in his list?
MR. BECKMAN: No, my Lord, I just indicated there is dispute. If
it helps your Lordship, page 23, I can go into the details
MR. JUSTICE MACPHERSON: It may be wrong, but I keep checking his
list because that is the only first-hand evidence we have.
(To the witness): You say there may have been an error about
Roctinal [sic]? A. It is on the list of Mr. Koupparis, No. 4,
the fourth drug down.
Q. No, on what he has done for us. That is Dr. Sophocleous,
you see. A. Right. That is what he was taking when he was
referred to Doctor ---
MR. BECKMAN: It is my fault, my Lord, because basically what I
was dealing with was what he was taking when he was referred.
Perhaps I did not make it clear, for which I apologise.
MR. JUSTICE MACPHERSON: Yes, thank you.
MR. BECKMAN: At the time he was referred he was taking Valium, 3
to 6 milligrammes, Roctinal [sic], 3 to 14 (inaudible) Normazine [sic]
and your view about that, it is a normal or excessive dose?
A. Excessive.
Q. At that time he may also have been taking some other drugs as
far as you are aware? A. Yes, he was also taking
antidepressants and antipsychotic drugs.
Q. Which were? A. Well, he was back on Parstelin and he was
taking Stelazine, Lexotanil, which are both antipsychotics.
Q. I do not want to deal with what Dr. Evdokas has said in any
document, but we have had evidence to the effect that he
stopped his medication for a period of something like two
weeks to three weeks, I think he told us. Assuming that to
be correct, what would you expect to happen? A. You would
expect an acute withdrawal reaction because all these drugs
can produce withdrawal effects, as we discussed earlier, and
suddenly stopping that level of medication can again cause an
acute psychotic state as well as a lot of physical symptoms,
withdrawal symptoms.
Q. If it was to be as he states, turned into a wild animal,
panic attacks, flushes, hot and cold sweats, palpitations
(inaudible) strange ideas and behaviour, would these sort of
symptoms from withdrawal be putting it too high, be accurate
or what? A. No, that would be accurate. I have seen
people in that state just withdrawing from normal dose
tranquillisers, let alone high doses.
Q. Again referring to your records, page 25, do you have the
position that Dr. Evdokas prescribes a new mixture of drugs
which are repeated and which goes up to about 2nd January the
following year? A. Yes.
Q. First of all, if you tell us what these drugs prescribed by
Dr. Evdokas included. A. Well, they included at least
three other antidepressants of the tricyclic variety and also
some more benzodiazepines, tranquillisers, some more
antipsychotic drugs.
Q. Can you give us the names of the things then prescribed?
A. Yes, according to the records that I received, he had
Fluanxol, which is an antipsychotic drug.
Q. Can you tell us the amount he was prescribed? A. He had 3
milligrammes of that daily and that is the sort of maximum
dose for anxiety state and even for schizophrenia that is
high. It is not in itself grossly toxic. He had Lexotanil
again, which is a tranquilliser, 6 milligrammes at night.
That was less than he had before. The maximum dose of that
is 18 but unless it is combined with other ones - he had
Rehapinol [sic](?) which is another tranquilliser. I have no
record of the dose. Going just through that group he had
Halcion, which is one of the very potent benzodiazepine
tranquillisers I mentioned, and he had at least half
milligramme tablets whereas the maximum recommended dose is a
quarter of a milligramme. He had Zanox [sic], again a very potent
benzodiazepine tranquilliser, 1 to one and a half
milligrammes daily - that is a high dose - so altogether he
was receiving excessive doses of benzodiazepine tranquil-
lisers in addition to the antipsychotics. Do you want me to
go through all the doses of them as well?
Q. Would you be so kind? A. (Inaudible) I have already
mentioned. He was also receiving Stelazine, another anti-
psychotic, 10 milligrammes - that is a reasonable dose on its
own; Roctinal [sic], 50 milligrammes at night - a reasonable dose
on its own; possibly Narvane [sic], which is another antipsychotic,
10 milligrammes - that is a high dose in itself, 2 to 4
milligrammes would be more reasonable. So if you added all
the antipsychotics together that would be a gross overdose as
well as a gross overdose of the tranquillisers. Then at
various times he had antidepressants and there is evidence he
had at least two of them at once, which again is combining
drugs in the same group. He had Anafranil, which is a
tricyclic antidepressant, 75 to 100 milligrammes - that is
about the maximum dose one would use for that. He had
Ludiomil, a similar drug, 75 milligrammes - again the maximum
dose for that - and Vivalan, 250 milligrammes daily - the
maximum dose again. If you add all three together they are
excessive doses.
Q. What about the combined effect of any particular amount at
any given time? A. It is very difficult to predict but it
would certainly cause grave mental (inaudible) lack of
ability of the brain to function.
Q. Could that in any way interrelate with the withdrawal from
any drugs he has been taken off? A. Yes, I mean, I should
think his brain was completely confused; it would not know
how to operate.
MR. JUSTICE MACPHERSON: That is on the basis that he was taking
all of these? A. Well, various combinations at various
times, at a time when he was unstable anyway due to
withdrawal symptoms.
MR. BECKMAN: If anyone wants to ask you about any particular
interrelationship or combination you are in a position to
answer that? A. So far as experience goes, which of course
this would be very unusual, to use so many drugs.
Q. Assuming that we have had some evidence he has agoraphobia,
does not leave the house, suffers anxiety, has vivid dreams,
becomes totally lethargic, short tempered and then on
occasions can go the other way, does that tie in? A. Yes,
that would be the unstable state which is really what one
would predict from these various combinations.
Q. At the end of 1986, from what you can see of the records, so
far as they help us, what was then happening so far as drugs
were concerned? A. The records suggest he was then taking
two antidepressant drugs, Anafranil and Ludiomil in ---
Q. In what doses? A. In 75 milligrammes Anafranil and 50
milligrammes Ludiomil. That is an excessive dosage and
could very well precipitate a manic state which is
characteristic of these antidepressant drugs.
Q. By just those two combined alone? A. Just those two
combined alone could do that.
Q. Again, if the evidence is accepted, there is a return to
being elated or (inaudible). A. Yes, it would be perfectly
to be expected from that dosage that you can precipitate a
manic state and change the depressed person into a very
hypomanic, irrational sort of person.
Q. Page 27. If there is any suggestion made he lost track of
reality at this time, would that be consistent or not?
A. Yes, it would.
Q. Of amnesia? A. Certainly the tranquillisers - and he was
then receiving these two strong ones, Halcion I mentioned and
Zanox [sic] - they are well known to produce amnesia. They are in
fact often used for minor operations for their amnesic
effect.
Q. Ideas bordering on the bizarre? A. Yes.
Q. Behaviour being highly eccentric? A. Yes.
Q. Delusions? A. Yes.
Q. About the time he came to London, again from the records that
you have, what was he taking? A. Well, I ---
Q. He came to London in March, towards the latter end of March
1987. A. I understand that from Dr. Evdokas' records, that
the drugs were suddenly reduced, both to tranquillisers and
the antidepressants but the pharmacist's records suggest he
had some drugs with him so it was very difficult to know
exactly what he took, but a sudden reduction again of all
that cocktail he was taking could again swing him into any
state almost, including a manic state, delusional state. You
cannot say really.
Q. Let us take it that way in the first instance: looking at
it from the viewpoint of the doctor, withdrawal from drugs,
would that create such a state? A. Yes.
Q. Looking from the viewpoint - assuming the pharmacist's
prescriptions indicate the position, what was he taking,
according to that? A. He was then taking, according to the
pharmacist, two antidepressants, Vivalan and Anafranil in
excessive doses - three antidepressants, Ludiomil as well,
again adding up to an excessive dosage, and three tranquil-
lisers, Halcion, Zanox [sic], two very potent ones, and Valium.
Q. The effect of these, if those were the ones? A. It could
have pushed him either way, into a mania, manic state or into
a depressed state.
Q. Taking them all together would be --- A. Would be most
likely to produce a manic state.
Q. What about any particular combination with withdrawal effects
of the drugs he stopped? A. The three antidepressants in
combination, in excessive dosage, would tend to produce the
mania; withdrawal from excessive dosage of benzodiazepines
would also do that.
Q. So that if, by the time he came to London, he was living in a
fantasy world, an unreal world, does that tally? A. That
tallies.
Q. Would he be able to distinguish between fantasy and fiction?
A. Very possibly not.
Q. If he had created characters or was reading an awful lot of
romantic stuff, is it possible or impossible he could become
those characters? A. It is very possible because there
would be no boundaries in his brain, thoughts would be
flashing across, and I think it would be very difficult to
keep a grasp on reality.
Q. This is the period we are now dealing with, the period March
to April as it were. Put a conclusion in very general terms
upon his condition at the time, if that information be
correct, at the time that the offences were alleged to have
been committed. A. Can you repeat that question?
Q. Can you put a very general conclusion about his condition in
March or April? A. From the drugs or from what I have
read? I'm sorry, I mean ---
Q. The interrelationship of them. A. I mean, I think it was
highly likely he was confused and he certainly couldn't
distinguish reality from fantasy, and his brain was just not
functioning like a rational organism.
Q. I want to turn - page 29 - to his mental state in relation to
psychotropic drugs. I think we dealt with it in 1981. In
1981 you told us there was nothing abnormal found. A. Yes.
Q. And I think you told us psychopathic (sic) drugs, the use of
it, first appears in 1981? A. Yes.
Q. There is a medical problem in 1984. What do you think
that - there is a state of depression in 1984. What do you
think that may have been - if it was drug induced as opposed
to reactive, what may have caused it? A. It could have
been due to sudden withdrawal, which is reported, of his
tranquillisers which can cause depression even so severe as
to cause suicide, so it could have precipitated a depressive
state.
Q. By the time he attended Dr. Sophocleous, as far as the
reports show, was there a problem which might have been drug
related in any way? A. Yes, the report and the initial
prescription suggests that Mr. Koupparis was depressed, and
another effect of tranquilliser withdrawal is also to make
you very vulnerable to stress, and it looked as if he was
both depressed and stressed when he first saw
Dr. Sophocleous.
Q. Your firm conclusion about what his condition may have been
if there was mania, confused psychosis by 1985, what that may
have been caused by? A. I think the drugs prescribed,
which was Parstelin, a monoamine oxidase inhibitor
(presumably to counteract the depression) was prescribed in
excessive dosage, as I have already suggested, and flipped
him over into a toxic hypomanic state which is a well known
effect.
MR. BECKMAN: I think we are now dealing with - if I am looking
at this, really wrapping up what you have already said, so I
am coming ---
MR. JUSTICE MACPHERSON: Yes, you have dealt with that.
MR. BECKMAN: It is really this paragraph.
MR. JUSTICE MACPHERSON: What I have in front of me is repetition
really.
MR. BECKMAN: My Lord, indeed it is wrapping up what is said in
the report, I respectfully agree. (To the witness):
Therefore, by the time period we are concerned about, when
the alleged offence is concerned, he was suffering from what,
if the information you had is accurate or accurate in part?
A. The information we have suggests that, while it is vague,
but he could have been suffering from either or both an acute
withdrawal state from tranquillisers and antidepressants,
plus excessive doses of particularly strong tranquillisers,
Zanox [sic], Halcion, and the tricyclic antidepressants, and both
those conditions can cause the same mental state by upsetting
the balance of the brain's biochemistry.
Q. In that condition could he seem to operate in a relatively
rational manner, or not, to some people from time to time?
A. From time to time, yes, he could.
Q. Would that be helped by his prior knowledge and experience
of matters scientific, computers, electronics, that sort of
thing? A. Yes, because he would be - that would be the
lines upon which his brain was naturally and easily running.
Q. You have given us the history and I do not think the rest -
am I right - if you can just help me, you deal with the
conclusion, the first part of the conclusion - items 1 to 7
effectively merely summarising what we have been discussing?
A. That is correct.
Q. So I need not refer you to that again. Can you tell us by
way of an analogy what the effect of the high doses of drugs
would have upon him? A. Well, he virtually underwent what
you might call a brainwashing procedure because his brain was
bombarded with high doses and erratic dosage of a number of -
large number of very powerful drugs, and this would really
cause him to lose control of his brain functions and of his
grasp of reality, which is really what the brain does.
Q. What about emotional reactions? A. The same; he would have
completely lost control.
Q. What about judgement? A. Judgement would be one of the
first things to go; it is a very high cognisant function.
Q. What about unreal, paranoid ideas? A. These would be
likely to be precipitated.
Q. I think you have, in so far as it matters, turned your mind,
in so far as it matters, in deciding whether or not what he
was suffering from was endogenous or drug induced. You come
to which conclusion? A. Drug induced.
Q. Can you just summarise what particular other factors, apart
from the matters you told us about, brought you to that
conclusion? A. First there was absolutely clear evidence
that he was mentally normal in 1981, having undergone very
extensive psychological tests and a psychiatric examination,
so we know he was normal. Then secondly, the time
association between his use of psychotropic drugs and his
various changes in mental condition, particularly depression,
where you would expect it following the use of
tranquillisers, and then elation or hypomania following the
use of antidepressants, and in fact his mental state followed
his drug prescriptions, and then, when he got elated he was
prescribed further antidepressants, and so things to down him
and things to up him, so his course follows his drug use.
Then thirdly, the fact that when his drugs were stopped and
he got no psychiatric treatment whatsoever after he was
apprehended, he returned to normal, and the third factor is a
complete absence of any family history, as far as we can make
out, of any kind of depressive manic mood or other
psychiatric disorder.
MR. BECKMAN: I think the jury at least have the advantage of
seeing his mother and two brothers; they have seen them in
court. There are two matters I think I should include so my
learned friend can ask you about them. I had dealt, you may
remember, with various things and then I went quickly and one
thing I certainly have missed out - I think it right I should
mention it - is this: I have mentioned about living in a
fantasy world and so on. The additional matter is this: at
that time did you have information that is very important and
one must be, as we have been told, careful about what he told
us as opposed to the other reports as well, but you were also
told at that time he had massive doses of Vivalan and
Halcion? A. Yes, that was in one of his letters.
MR. BECKMAN: Those are the letters, all of which were sent to my
learned friend and I gather you want them back.
MR. JUSTICE MACPHERSON: You mean a letter to him? A. A letter
from Mr. Koupparis to me.
MR. BECKMAN: My Lord, there are a number of letters.
MR. JUSTICE MACPHERSON: I just wanted to know to whom they were
written.
MR. BECKMAN: There are a number, all of which have been shown to
the prosecution.
MR. JUSTICE MACPHERSON: He told me that he was taking a great
deal of Vivalan and Halcion. A. Yes, in one of his
statements - I'm not sure whether it was the original letter
to me that he did, and I should think by that time his
judgement as to what he was taking and what he was not taking
in the way of drugs when he was having lots of symptoms -
people tend to take anything they think is going to control
the symptom, so he could have taken a massive overdose of
Vivalan, which is an antidepressant, which would have made
him even more manic and less in touch with reality.
MR. BECKMAN: And Halcion? A. Halcion the same thing.
Q. Would he necessarily have done that if he was not in the
state which he told us? A. I think it is highly unlikely
but when you are desperately ill and you have lost the edges
of reality you don't really know what you are doing. I think
it is amazing he remembers so many of the drugs he took.
Q. And accepted unknown drugs. A. Yes, he could very well
have done that.
Q. We know he moved around that circle of young people for a
certain time, including large or good amounts of cannabis as
well. A. He may well have done that and the amount of
cannabis on the brain is to produce a delusional state even
with grandiose delusions - a picture of schizophrenia in
fact.
Q. Together with other items. A. It would have additive
effects - also alcohol.
CROSS-EXAMINED BY MR. TEMPLE
Q. Just remind me as to a little bit of background: you have
never personally seen this defendant? A. I have never seen
him, no.
Q. Have you interviewed any members of his family? A. No, I
have not.
Q. Your practice, no doubt, also includes not just academic but
also practical as well? A. Yes, I do clinics with patients
as well.
Q. Are these weekly or daily? A. Twice a week, and I also
have from time to time patients in hospital.
Q. I think we can shorten it to this effect really: your basis,
your conclusions are formed almost exclusively or certainly
relying very heavily upon what he has told you by way of
report? A. From the hospital yes; any patient one talks to
the hospital, but there is documentary evidence from the
doctors and prescriptions of his mental state when they saw
him.
Q. There is documentary evidence of what may have been
prescribed. It is a different step and a new step to take;
because it was prescribed therefore it was taken. A. That,
of course, is true, but they also described his mental state
for which it was prescribed and changes in his mental state
when they next saw him.
Q. Do you accept that patients who you see for drug induced
problems or drink induced problems are unreliable when asked
as to their consumption of alcohol or drugs? A. That is
true.
Q. As an example, would it surprise you to know that there is
evidence before us that this defendant had told his brother
that he decided to stop taking drugs whilst in London?
A. That wouldn't surprise me. I mean, his dosage has been
erratic all along and he has been also advised by doctors at
various times to stop taking them.
Q. He told you his dosage was erratic? A. Yes.
Q. You do not know personally, you are reliant on what is
reported back to you? A. I know his prescriptions from the
doctors were erratic and changeable.
Q. What I really want to do is try and look with you at his
behaviour in London particularly, and try to ask you to help
us as to whether or not he would appreciate what he was
doing. No doubt you have had an opportunity to listen to
some tapes of telephone calls made in this case? A. No, I
have not.
Q. You have not? A. No.
Q. Do you know about them? A. I knew he made telephone calls;
I have not heard any tapes or transcriptions.
Q. Do you not think it might have been useful for you to be
able to relate the contents of those telephone calls to the
overall background of the case? A. I don't think it would
have made a lot of difference because I was asked to comment
as to what drugs could do to the mental state and the mental
state is indistinguished [sic] whether it is due to drugs or
whether it is due to some other purpose - other reason.
Q. Are you saying that you as an expert witness can simply wave
your hands as it were and say the content of the tapes does
not concern you? A. No, I have seen the written text and I
have seen psychiatrists' reports. Everybody agrees that he
suffered at one time from a state of hypomania. I don't
think that is controversial.
Q. No, but my question directed to you is this: are you saying
that you can safely ignore the contents of 22 telephone
conversations? A. I have a written document. I know the
general drift, but I don't know if I can ignore them or not
since I haven't been offered to see them.
Q. Supposing one was able to draw an inference that there was no
indication of confusion within these telephone calls and that
there was a pattern to it, a pattern which matched the basis
of the demand documents, do you think that would alter your
views? A. How long was each telephone call?
Q. They varied from being very short to very long. I put it to
you in this way: one or two of the telephone calls were
almost an hour and a half; some were ten minutes; some were
even less. A. In a hypomanic state it is certainly
possible to appear rational, to talk rationally for periods
of time and also in that state the mood fluctuates and varies
and so does the length of consciousness.
Q. About what period of time are we talking when you say
"appears rational for a period of time? A. Well, up to
hours - well, up to a couple of hours anyway.
Q. Have you had an opportunity to appreciate the pattern of this
blackmail demand with the telephone calls? Do you
appreciate that they covered six weeks? A. I appreciate
they covered six weeks.
Q. Do you appreciate the pattern of interconnection between the
telephone calls and the demand documents? A. No, I don't
appreciate the pattern.
Q. Looking at the demand document in a moment, I just want you
to reflect upon what you have told us. If the drugs taken
have been truthfully reported to you, what we are looking at,
what his condition would be in March 1987 would be completely
confused; his brain would be completely confused. A. With
relation to a grasp on reality it could well be.
Q. Do you adhere to your statement that his brain would be
completely confused? A. Yes, but it depends what you mean
by "confusion".
Q. You help us, please. A. I mean that the brain is an organ
to translate reality into terms such as the consequences of
actions and so on. If you cannot do that you are confused.
Q. Just give me that definition again; translate "reality".
A. The reality of your actions with their possible
consequences; indeed, actions on the rest of the environment
and the effects on you.
MR. TEMPLE: I am sorry, I am getting confused. Let us go
back ---
MR. BECKMAN: Can she develop it in her own way?
MR. TEMPLE: I want to give her an opportunity to do it. (To
the witness): You used the expression "was completely
confused". Take your time; what do you mean by that in clear
terms? A. I am trying to be clear. The brain is a very
complex organism. One of its functions is to keep hold on
reality so as it can see the outside world in relation to the
individual; can forecast the results of any actions; can see
interactions that would have with other people and on oneself
and the long term consequences, and as well as serving many
other functions of course, language, mood and so on and so
forth, but if this contact with reality is lost that is a
sign of mental confusion.
Q. Let us see if we can translate that in a moment to the
realities of life as it were. Before I do so the evidence
you gave that you think his brain was completely confused and
the qualification you put on the word "confused", that you
say would occur if he was taking the drugs prescribed?
A. It could occur whether he was taking them, whether he was
taking some of them, whether he was actually withdrawn from
some of them.
Q. If he is telling the truth we have to take into account
copious amounts of cannabis and heavy drinking. A. Yes.
Q. This man is not going to be in a position to do anything, is
he? A. Well, I have seen people under any of these drugs,
including cannabis, who are able to - who are living in a
very vivid dream or fantasy world in which every detail is
correct, and the thing that is missing is the contact with
the environment, but the world itself can be very clear, very
organised and very complex.
Q. Are you saying in these circumstances the patient - let us
call him "the patient" - would be able to put together and
formulate over a period of six weeks, not only writing and
sending a demand document, but also these telephone calls?
A. Yes, I do. In a hypomanic state, apart from one thing,
you are very happy in relation to you can work all through
the night; secondly your brain is flowing along, it is full
of ideas and this delusion or whatever the idea is -
absolutely fills your mind and it can be clear in every
detail and there are facts, details, you have only to look in
the box.
Q. In this case would a man know he was writing a blackmail
demand, his mind was sharp and functioning? A. In a sort
of way he would know he had this great plan which involved
getting money; whether he would put that word on it is
another matter because that is another face with reality.
Q. What other interpretation do you put on the words of that
document? A. I think it is a grandiose plan which is also
a bit of a joke. I mean, he has marvellous phrases like
"PIGs" in it, which is very characteristic of a hypomanic
state, the great idea that he could be President of Cyprus or
whatever.
MR. TEMPLE: Can I ask you to come back to my question ---
MR. BECKMAN: Can she finish?
MR. TEMPLE: Would he know that it was a blackmail demand?
A. Not in those terms, no.
Q. What would he think it was? A. He would think it was a
plan to become great, outwit people and he would know really
basically - for example, asking for $200 bills when it wasn't
real and it wasn't really working because nobody can give him
$200 bills.
Q. If that inclusion was a deliberate error, his mind was
obviously functioning, was it not? A. Clear along the
lines I said, yes.
Q. If his mind was functioning in that aspect how on earth can
you draw the distinction between whether or not it was
functioning in any other aspect? A. Because it is typical
of a grandiose delusion which, having observed people with
it, you realise that they really haven't carried the plan
through to its practical conclusions and probably would not.
Q. Do you know what he did after the original demand documents
were sent off to Cyprus? A. No. I may do, I don't know
which one you are referring to.
Q. Let me put this to you: there were some telephone
conversations to the Presidential Palace of Cyprus. A. Yes.
Q. In effect wanting to know whether the documents had arrived.
A. Hm hm.
Q. Some days later - contrary to fact because the documents had
arrived - the Cypriot authorities were saying to the
defendant, "No, we haven't received the documents", and he is
asked to send off some copies. A. He is asked to ---?
Q. He is asked to send copies, but he does a little more than
just sending a copy of the documents, he enclosed a copy
telex saying in effect, "I suggest you pay the demand and
there is also another man you can see", between the telex and
some of the subsequent telephone calls. Can you keep that
summary in your mind? A. I think so.
MR. JUSTICE MACPHERSON: You did not know about that? A. No,
not in detail.
MR. TEMPLE: Let me take you through it in a little more detail.
Would you have the document bundle in front of you, please.
I should also ask you to have a copy of the telephone
transcripts. (Handed to the witness)
MR. BECKMAN: Can the jury have the green bundle with the
additions to that item which we introduced? (Handed to the
jury)
MR. TEMPLE: Members of the jury, what you have been given are
some retyped copies of the telephone transcripts; what I will
ask you to do is keep to the original ones. Would you also
have available to you, as it were by reference, document page
159.
THE WITNESS: I am not sure which document.
MR. TEMPLE: The fat bundle. Let us just recap: on 23rd March
the original demand document is sent off to Cyprus. There
are these telephone conversations effectively saying, "Have
you received the document?" Answer from the Cypriot
Government: "No, we have not, please send a copy".
Arrangements were made to send a copy of the demand document
to the Cypriot High Commission in London. When they arrived
the documents had page 3 included in the bundle and you see
that last paragraph:
"We have a man inside FM now in deep cover
so please keep matter dark. Expect to move
on next operation and detain group, including
Commander Nemo. Suggest you pay demand which
shall be recovered once danger has been
eliminated."
If you look at the top of the document can you see the date
6th April 1987? A. Yes.
Q. Then followed a whole series of telephone calls and the
effect of the 'phone calls was essentially this: look at the
man who sent that purported telex, Digsby, at page 3. A
number of 'phone calls are made in Digsby's name and Digsby
is saying to the Cypriot authorities, "This is serious,
suggest you pay. I, Digsby, can help you further. I think
I can get in touch with a Cypriot who is an expert in these
matters and he can try to help you find the source of the
alleged gas containers". That in turn introduces a man by
the name of Symeon [sic] Cambanellos [sic], and Symeon [sic] Cambanellos [sic]
effectively rings up and says, "I am Symeon [sic] Cambanellos [sic]; I
can help you. I want a sum of money and some equipment in
order to carry out my task. Will you please arrange for the
money and a false passport to be ready for me at the Cypriot
High Commission in London."
Within these 22 'phone calls the defendant has to be
Digsby and he has to be Symeon [sic] Cambanellos [sic], and he has to
remember who he is all the time and remember the respective
roles. Will you accept it from me that there are no
mistakes; he does not get it wrong? He walks out of the
Cypriot High Commission thinking in his mind he has got
œ25,000. Did you know about those matters? A. Not in
detail, no, but it is consistent with the fact that he is
living this in his mind.
Q. Is it also consistent with in his mind he knew perfectly well
he was engaged in a blackmail plot? A. I think it was.
You can say if you read the book you are engaged in a
blackmail plot that is fictional in the book, but I think he
was living the plot in his mind. That is what I mean by the
distinction from relating it to reality.
Q. In his mind he is blackmailing the Cypriot Government, is he
not? A. As a story in a book, yes, as if he were writing a
story in a book about it. He is living the story.
Q. We are engaged on one of the most difficult exercises one
can, looking in the mind of the man. Would he know that such
a matter was wrong? A. I don't think he would think in
these aspects. He would be in that world; he would be living
that story as if it were - he were a character in a book.
Q. Supposing, just as a little example, that he had to make
copies of the original demand document. He did it
deliberately so the girl in the photostat shop could not see
what he was copying; that is an indication that he might have
something to hide. A. But people, you know - if you are in
a paranoid state you are trying to hide everything.
Q. It is an indication, is it not, the man in the street is
going to come to that conclusion, or may come to that
conclusion? A. Yes, although again it would be in
character with the whole story. He couldn't do anything else
if he thought he was Digsby or whoever this other man was.
Q. Supposing there was evidence which you had in front of you to
say that he was being asked about the typing of the telex on
page 3. He made the remark that he was composing as he goes
along. That would be an indication that he was thinking
about what he was doing, would it not? A. Yes, of course
he is thinking - I mean, people in the state of thinking,
thinking very fast, very volatile ideas but not necessarily
relating them to real life.
Q. Will you please turn to page 159 of your document bundle.
Can I just read it with you and can I tell you that the
evidence is that the defendant upon his oath in November 1987
told us that he had written this in England, after his
arrival here.
"Dear Sir, You have now had (so many) weeks
to evaluate our offer. The time for hesitation
is now over. You must now act. A copy of
the report is enclosed in the event that you
have lost the original. Don't laugh, you
have succeeded in losing half your island.
Understand that you are now on the point of
no return. You now have a few days in which
to decide your fate. You have reached the
point of no return, you must now prepare
yourselves to carry out the instructions on
page 12" -
that is a reference to the demand document -
"or face the consequences. Our next
communication, which will follow shortly,
will decide the time and place. The rest
is up to you."
There is nothing confused about that, is there? A. It is
repetitive. There is a lot of crossing out. I mean, the
message is certainly clear.
Q. Is there anything confused about the message? A. On paper
no, but as I keep saying, the real effect of it may be
confused.
MR. JUSTICE MACPHERSON: The real what? A. The real
consequences of it.
MR. TEMPLE: There is absolutely nothing confusing on the face of
the blackmail demand, is there? A. Asking for the money in
specific - no, it is beautifully structured.
Q. Exactly, and that must have been the product of a lot of time
and thought. A. That has raced through incredibly quickly,
but yes.
Q. Is it fair to suggest that was the product of a lot of time
and thought? A. Possibly.
Q. Does it not speak for itself? A. Well people - I don't
know if you have ever seen anybody in a manic state. They
are incredibly efficient once they don't go too high, and
they can do things that might take us several days, and
thoughts come up very quickly and clearly in a (inaudible)
way.
Q. Is it consistent with the amount of drugs which you were told
this man was taking, plus cannabis, plus drink? Is it
consistent that he should be able to produce such a plan and
maintain its sequence for six weeks? A. I think it is.
We don't know exactly his drug taking pattern.
Q. Forgive me for suggesting it, I am sure you must have it in
mind, but it may be that you have been misled as to the true
amount of drugs he was actually taking. Had you considered
that? A. Well, of course I had.
Q. Have you rejected it? A. I have thought it unlikely
because once you start taking these drugs it is in fact very
hard to stop taking them altogether, and we do know that he
certainly started on them; we do know that his mental state
altered exactly as would be predicted from the drugs he took,
so there is circumstantial evidence. Nobody can ever know
whether he took them or not, but there is a lot of
circumstantial evidence he did take at least some of them
which were prescribed, which produced the effects and which,
once you had started doing it, it would be very difficult to
stop because they are all drugs that cause dependance [sic]. So on
the balance of probabilities I think it is likely that he
took large amounts - some of the amount of the drugs that he
was prescribed.
Q. Let me ask you another question: you remember I asked you
about a little incident in the shop where he would not let
the girl see. Supposing you had some further evidence to
say his fingerprints were on a lot of documents found at his
home in Cyprus and also on documents found at his home in
London, and those prints, certainly so far as London are
concerned, were found on further copies of the demand
document, and yet when he was arrested, in his briefcase was
found a pair of rubber gloves and there was a total lack of
his fingerprints on the demand document which had been sent
to Cyprus and the copy which had been sent to London. The
inference obviously is he may have taken steps to remove
fingerprints from the document. The second inference is he
knew that what he was doing was wrong. Is there a flaw in
that reasoning? A. Only that if you are taking part in a
story or a play which is real in your mind, you take
appropriate steps. If he really thought he was Commander
Nemo, Captain Digsby, whatever he was, he would act
appropriately.
Q. So once again in his mind he knows he is doing something
wrong? A. In the book, but he doesn't necessarily know the
book is in the world.
Q. The book is something he simply told you, is it not?
A. No, we haven't got a book, what he did is the book.
Q. When you say "the book" --- A. I mean the whole fictional -
the whole idea of PIG and everything, science fiction.
MR. JUSTICE MACPHERSON: It may be a matter for the jury, but
surely --- A. Well, we know ---
Q. Just hang on a minute. Surely the snag in that is that it
was not a book but he did it as Commander Nemo or as Colonel
Digsby. It was not a book at all. He may have thought it
was but he actually did it and he could have killed or he
could have stolen? A. Yes.
Q. That would not have been in a book, that would have been what
he actually did. A. Well, my Lord, I submit that nobody
who was not in a hypomanic state would do that sort of thing.
Q. I think that is accepted, certainly by the other doctors who
absolutely accept he would not have been doing it if he had
not been hypomanic. That does not mean he is not capable of
being guilty; it could be excellent mitigation. You
understand that is the thing for which I am searching
eventually to help the jury. A. Yes, my Lord, but can I
say if I am in a hypomanic state that is what I am referring
to as being a book, because it is not real.
Q. I think I understand it; people living in a real fantasy
world. What is missing is a contact with the environment.
They are living as Captain Nemo? A. Yes.
MR. TEMPLE: Really I was coming on. Do you accept that in
general terms madness and badness - horrible phrase that
it is - can co-exist? A. Yes, in general terms, but ---
MR. TEMPLE: Let us try to phrase it a little more ---
MR. BECKMAN: Can she finish? You asked her a question; please
let her finish it.
MR. TEMPLE: You were about to add ---? A. It can co-exist but
if you are really mad it is actually quite difficult - in the
mad sense we are talking about it is difficult to be bad
because you cannot assess the consequences of what you are
doing in these things we are talking about.
Q. The gist is madness and badness can co-exist. One can phrase
it a little differently: eccentricity and criminal behaviour
can co-exist? A. Yes.
Q. And hypomania and a capacity to commit crime can co-exist?
A. Now that I would doubt. Capacity to commit crime can
exist in a person who later or previously is a hypomanic, but
I don't think a capacity to realise you are committing a
crime is possible in a hypomanic state because that is not
the way you think.
Q. Are you saying that nobody who is suffering from hypomania
has the capacity to commit crime? A. At the time that they
are actually suffering from hypomania no, which is a short
condition. At other times in their life they are
incompatible because I don't think you can think in these
terms when your brain is taken over in this psychotic way.
Q. I want to ask you about another matter now and come back to
that if need be. If you are right, summarising it, you are
saying, "I have come to the conclusion this is clearly a drug
induced hypomania". A. Yes.
Q. And in such circumstances, bearing in mind he was arrested on
14th May, and assuming he was in custody thereafter, when do
you think he would be free in effect of drugs? A. It might
be a matter of months; again difficult to predict exactly.
When you say "in effect", again difficult but over months he
was improved.
Q. And after, say, four months? A. He would be showing the -
beginning to show some signs of improvement but not
necessarily in all directions at once.
Q. By six months would he know what was going on? A. Yes,
unless the drugs had induced a particular - any irreversible
state which is possible. You really cannot predict that, but
you would expect him gradually to improve as the months went
by.
Q. Would you expect him in normal circumstances to be able to
know precisely what the position was at the end of six
months? A. Probably.
Q. Can I ask you just to look at one other set of documents - I
am going to hand you two sets. (Handed to the witness)
Would you read them through to yourself. (Pause) A. Yes,
I have scanned it; I find it a bit difficult to understand.
Q. Do take your time. A. Yes. (Pause)
Q. Do you accept that these two documents obviously are the
product of thought and they are well constructed? A. Yes,
but odd.
Q. They are well constructed? A. Well written, yes.
Q. Would you confirm, if it is the case, that they are clearly
a product of thought? A. Yes, but if I got them I would
immediately think that this person isn't normal.
Q. You would immediately think ---? A. That the person who
wrote them wasn't in a normal state of mind.
Q. Why do you say that? A. Because it is bizarre and it is
almost sinister or jokey. It doesn't seem to be real.
Q. What would you find first of all sinister about it? A. The
fact that by reading the whole page, the first page, parking
tag, one still doesn't have a clear picture, however well
constructed, of what the person is liable to produce. One
wonders whether it is a joke, a pun on the Denver Boot.
Q. Does that make it sinister? A. That was my impression when
I read it just now for the first time.
Q. Sinister; why is it sinister? A. Well, you have a method
of manufacturing a version of something to control illegal
parking which is called a Denver Boot. It seemed to me that
the insinuations of that were rather similar to "PIG" and for
example - and then it doesn't say.
Q. "Denver Boot" was a phrase commonly used in the press.
A. Was it? Oh, I didn't know that.
MR. JUSTICE MACPHERSON: Perhaps you do not have them in the
north. A. Maybe we don't.
Q. That is what it is actually called. A. I was thinking of
a boot.
MR. TEMPLE: Can I, because this may be very interesting,
unwittingly --- A. I am too literal.
MR. TEMPLE: Do you think you are perhaps arguing from
(inaudible). One of the manifestations ---
MR. BECKMAN: Can she not answer that question?
MR. TEMPLE: One of the manifestations of hypomania is an ability
to play on words, is it not? A. It is.
Q. Did you think this was playing on words because this case is
concerned with hypomania? A. I did, especially after what
I read.
Q. Is that why you jumped to that conclusion? A. I don't know
whether - partly my northern ignorance - it may have been
because I haven't heard of the Denver Boot.
Q. It just shows that there may be more than one side to this
particular little bit of correspondence. A. Oh, indeed.
Q. There may be more than one side to the interpretation one
puts on the sequence of events surrounding that blackmailing
letter. A. There always is.
RE-EXAMINED BY MR. BECKMAN
Q. Doctor, can I start with the Denver Boot that does not exist
in Newcastle, I am glad to hear, and look at these letters,
first of all, the letters to Melville. A. Yes.
Q. Now, this is a letter which purports to come from an
organisation which has created some magnificent prototype
which will be better than the boot. A. Yes.
Q. Does it affect your analysis to know no such organisation
existed, no such prototype existed, nothing at all had been
done? A. As I said, my initial impression was that it was
woolly and that doesn't suprise [sic] me. This letter is not
normal.
Q. The fact that these things referred to did not exist, it
was just a grandiose scheme to replace it but nothing existed
in fact, how does that affect your conclusions about the
writer? A. I would say he was in a hypomanic state with
grandiose delusions.
Q. What about the system - he also was telling people he could
create gold from seawater. A. That is a grandiose
delusion.
Q. What if he told people, at the same time all this is
happening, he is Commander Nemo and Digsby and so on; how
would that affect if he told people he could cure AIDS?
A. Again, the same grandiose delusions.
Q. Can I just take you now to the telex, page 3. Have you read
that through to yourself? A. Yes.
Q. Impression of the writer? A. Again grandiose delusions.
Deluded, fictional.
Q. Going to page 159, which is the letter, looking for example
at the phrase in the middle, "Don't laugh, you have succeeded
in losing half your island". A. Yes.
Q. Your impression of the writer? A. Well, that is a typical
kind of macabre joke that you get in hypomanic states.
Q. Do you remember you were told by my learned friend, no doubt
in excellent precis, of what you described - the 23 'phone
calls - about the pattern; do you recall? A. Yes.
MR. BECKMAN: Let us come to the pattern and look at the actual
'phone calls. Members of the jury, page 51 of your document.
MR. JUSTICE MACPHERSON: Is it the summary about which you are
talking?
MR. BECKMAN: It is the summary.
MR. JUSTICE MACPHERSON: The summary starts at page 1.
MR. BECKMAN: Page 13, my Lord, I am sorry.
MR. TEMPLE: I wonder if I can ask whether the jury have this
document?
MR. JUSTICE MACPHERSON: I think it is the summary that they
have. It is headed "Summary of conversations made on tape".
It goes from page 1 to page 17.
MR. BECKMAN: Do you have page 13? A. Yes.
Q. Here is a man making a 'phone call. You remember it has a
sinister and intelligible pattern. Now look at what he
said. Do you remember he was purporting to be
Mr. Cambanellos [sic]? He claimed to be an expert in the
following fields: medicine, chemistry, physics, electronics,
computers, telephones and another 100 subjects. What do you
make of the state of mind of a person who, in the course of
what is said to be a series of blackmail demands - what do
you make of the state of mind of someone who says that?
A. It is certainly a gross over-estimate of anybody and
fictional, grandiose, deluded.
Q. Hypomanic or --- A. It is a psychotic claim. No normal
person would claim that.
Q. Turn to page 14. How does it help you that he tells these
victims, from whom he is going to take 30 million, he is
using his mother's telephone for the call? What do you make
of that? A. Using his mother's ---
Q. Yes, if you look towards the bottom of the page he states he
is using his mother's telephone to make the telephone call.
A. Yes, that does seem incongruous and not very well
reasoned.
Q. Can you tell us how it helps us in this matter when he also
tells the victim that he, who is taking all these efforts to
disguise himself, is actually going to appear at - the next
day, 13th May, which he did? A. That shows that he isn't
consistent in his ideas.
MR. BECKMAN: This is the third summary if this could be
distributed to the jury. (Handed to the jury)
MR. JUSTICE MACPHERSON: Did we hear all this?
MR. BECKMAN: No, these are the agreed ---
MR. JUSTICE MACPHERSON: It looks to me as if we heard some of
it; the first page. It is headed, "More extracts from the
telephone calls". You are going to be asked to look at it.
MR. BECKMAN: With respect, we did not hear the first page
either.
MR. JUSTICE MACPHERSON: I remember the bit about 007. I am
absolutely certain I heard that; I am absolutely certain I
did.
MR. BECKMAN: No, my Lord, that is in cross-examination of the
witness: 007, I did it; we did not actually hear the tape.
MR. JUSTICE MACPHERSON: Yes.
MR. BECKMAN: I think in my cross-examination. (To the witness):
Page 8, you remember he has been telling us different names
in the telephone calls. He is Nemo, he is Digsby, he is
Cambanellos [sic] and so on. Here he is telling the alleged
victims he is one of the most secretive pesons [sic]; he is
describing his other personality:
"He is one of the most secretive persons I
have ever come across; his family don't know
what he is doing most of the time. Even
hotels he stays at are under a false name ...
(reading inaudibly) ... to find him."
How does that affect the impression of analysis you were
asked to do. A. I'm sorry, is that in this or is it what
has just been handed, in which case I didn't get one?
Q. I am sorry, let the witness have one. (Handed to the
witness) (To the witness):
"He is one of the most secretive persons I
have ever come across; his family don't know
what he is doing most of the time. Even
hotels he stays at are under a false name.
We finally found him in London. It took 200
of our people three weeks to find him."
A. That is again grandiose, having 200 people looking for
three weeks. It doesn't sound real.
Q. Can I now take you to something else - page 10. Do you
recall reading the demand note when he says that the chemical
Di-Tox B7 is most dangerous to mankind? A. Yes.
Q. What do you make of this when he knows (inaudible) is saying
at the bottom of page 10? It is complete nonsense, this
chemical does not exist. A. Yes, that is part of this joke
business that often occurs in grandiose delusions.
Q. Would you take it a little bit further. Above that, when
during the conversation he finds it necessary to say to the
alleged victims - to ask Mr. Demetriades - that is the
gentleman in fact who is using a false name himself - whether
he has ever heard of President Reagan or Mr. Gorbachov. How
do you think that fits in with the (inaudible) with a man in
a hypomanic state? A. No, it sounds crazy.
Q. You will recall - and I have told my learned friend I am
going to deal with this - you will recall you were asked had
you listened to the tapes or not, and so on and so forth.
You were called here, it is common ground, amongst other
things, to dispute the views held by doctors who were going
to be called by the prosecution, agree or disagree as you
thought professionally fit. A. Yes.
Q. Were you given a report from a doctor who was going to be
called by the prosecution - but unfortunately was not well -
who was going to deal with the very subject you have dealt
with, Dr. Herridge? A. I was sent a letter used by
Dr. Herridge.
Q. In that letter was it clearly set out by Dr. Herridge what it
was he had seen and heard for the purpose of coming to his
opinion? A. Yes.
Q. By all means have a look at it. Madam shorthand writer,
are you keeping up with this?
THE SHORTHAND WRITER: I was until you interrupted me,
Mr. Beckman.
THE WITNESS: I have Dr. Herridge's psychiatric opinion.
MR. BECKMAN: Pardon? A. This is Dr. Herridge's psychiatric
opinion on the case; yes, I have it.
Q. You were asked whether or not you had seen the defendant.
Would it be right or wrong from what you saw from his report,
Dr. Herridge had not seen the defendant? A. That's
correct, he hadn't seen him.
Q. You were asked if you had seen the tapes. Is it right or
wrong Dr. Herridge had not heard the tapes? A. He
certainly doesn't mention them.
Q. The sum total of what he had was by way of various medical
reports and given certain information by the prosecution?
A. Yes.
Q. My learned friend wants me to make something clear and I am
happy to do so. His terms of reference were to do that
whether or not the man was suffering from hypomania?
A. Yes.
Q. The very issue you are dealing with, except you say it is
drug induced hypomania; put it that way? A. Yes.
Q. Certainly you have seen some of the written tapes, I believe,
and transcripts of some of them? A. Yes.
Q. Tell me this: when dealing with the threats we have heard
evidence from certain experts which the jury will have to
evaluate, but assuming the threats were grandiose but totally
unrealistic in practice how would that fit in? A. This
would be what you expect in a grandiose delusional state.
There would be - and this is a marvellous picture but it
wouldn't ever actually be put into practice.
Q. When you have used the phrase which implied that he would not
have contact with the environment, by "environment" - I want
an answer "Yes" or "No", how you put it, but by
"environment", was that reality or not? A. Yes.
Q. Do you remember how it was put to you on the basis that when
he had a copy of a document made, according to a witness he
may well have put the document in such a way as to hide the
contents from the person there present; do you recall that?
A. Yes.
Q. It was suggested that was indicative of a calculated, clever,
intelligent man who knows exactly what he is doing. You
told us that can be part and parcel of paranoia effectively.
How does it affect you if the man concerned not only did
that, but at the same time came in in a trilby hat, dark
glasses and wearing one glove on one hand, the same man?
A. That was again playing some part.
Q. Did you see - the terminology - you told us about the demand
note which you read. What does your general impression of
the terminology of it, that you described briefly,
constructed? A. Well, it is grandiose, flowery, I think
has hidden jokes in it, or only partially hidden, and I am
not a psychiatrist but I have enough experience to say
anybody with psychiatric experience reading it would
immediately say, "This man is in an abnormal mental state".
Q. What do you make of such phrases which are contained in it
such as "double or quits"? A. That sort of slang
(inaudible) they are very common, they crop up a lot in this
condition.
Q. Does the document speak for itself - in so far as it does
speak for itself, as a good lawyer and asking you as a
psychiatrist, in speaking for itself what does it tell you
about the writer? A. It tells you about the writer that he
is living in a world of fiction and that the whole thing is
some grandiose idea which would be the sort of thing you
would see if he had delusions of grandeur.
Q. Tell me this finally: you remember again it was suggested
that there was something sinister about the finding of
fingerprints but not on Document "B". Can I tell you
another scenario: you know Commander Nemo who was supposed to
be a mysterious man who does not appear; how does it affect
your approach if at the same time as this is going on he is
going out with a group of adolescents, out to nightclubs,
hither and thither, out to hotels and freely using the name
Captain Nemo to all and sundry? A. I think he is acting
all sorts of parts and this flight of ideas is racing through
his brain, and he is now one character, now another but he
has it cleverly constructed into one big plan, which is not
unusual, one comes across a delusion with a lot of characters
in it.
Q. Can you help me as to this finally - I said "finally" once
before, I am sorry. Page 120, that is the application form.
You remember it has been said he was highly intelligent,
secretive and so on. How does it affect your analysis if at
one and the same time he has put "Commander Nemo" - I think
it is "Captain Nemo" - at the top and signing "Panos
Koupparis"? A. Well, it is obviously not a rational thing
to do.
Q. Does it indicate to you someone who does not know what he is
doing or someone who is clearly trying to disguise his
identity? A. Someone who is not fully knowing what he is
doing.
MR. JUSTICE MACPHERSON: Did you say you were a psychiatrist? I
thought you --- A. No, I am not a psychiatrist.
Q. I thought you said you were; you said you were not a
psychiatrist? A. No, I said I am not.
MR. BECKMAN: How would you describe yourself, so we get it
right?
MR. JUSTICE MACPHERSON: You told us at the beginning that you
are a psychopharmacologist, you are a consultant physician of
30 or 40 years' experience.
MR. BECKMAN: Yes, and that Dr. D'Orban who we saw and know - you
have heard of Dr. D'Orban, I take it? A. By repute, yes.
Q. By repute he is an excellent man? A. Yes.
Q. And Professor West? A. Yes.
Q. When they both say in a matter relating to drugs they would
go for expert help to someone like you, would you have reason
to disagree with that? A. No.
Q. If a matter has a drugs aspect and needs expert assistance,
who would a psychiatrist go to for help? A. They do go to
a psychopharmacologist and I do get requests from
psychiatrists for advice about drug matters.
MR. JUSTICE MACPHERSON: There is just one thing about which I
want to ask you because I am troubled about one aspect of
your evidence; the rest of it I think I understand.
Hypomania does not mean a man is insane in legal terms,
because otherwise that might have drastic consequences for
this man; you understand that. That is what I have been
told by the psychiatrist. Do you agree with that?
A. Yes, I mean, there is a range of mental conditions that
go from normality on a probably smooth spectrum up to
madness. It is a matter of definition where you put it.
Q. Hypomania is not as florid as mania and, it is said, below
that. A. Yes.
Q. Otherwise the jury might have to consider whether this man
was guilty but insane; do you understand? A. I understand.
Q. That is absolutely out of the case, I am glad to tell you.
Are you saying people suffering from hypomania cannot commit
a crime? That may be your view. I do not believe you are
because otherwise the world would be very dangerous place.
A. No, I am saying they are not always in a position to
understand in the terms we rationally think, consequences
and the moral side of what they are doing. They have an
overwhelming ---
Q. I fully understand that. I think that entirely tallies with
what Dr. D'Orban told us.
MR. BECKMAN: Can I ask something out of that?
MR. JUSTICE MACPHERSON: I thought it was risky for me to ask
the question, but I suppose so. I have not got away with it
yet. Please do not say "finally" three times this time.
MR. BECKMAN: I have forgotten what I want to ask.
MR. JUSTICE MACPHERSON: Perhaps you do not. (Pause)
MR. BECKMAN: The word "intent"; we are here dealing with crimes
of specific intent, both of them, do you follow? A. Yes.
Q. Obviously I do not want you to go into the meaning of
intent - that is a matter for my Lord and the jury - but in
so far as intent has an English meaning, can you relate it to
the sort of - you said a drug induced state of hypomania.
Can we relate it to that? How would you relate the question
of intent as a matter of English to a state of hypomania that
is a conscious, willing, deliberate intent to do something?
A. I would say that it was not conscious or willing and that
you may be very involved in a fantasy world; in fact you
would not translate that world into total action, so that
although you may say you were going to do it and make
threats, things, I don't think you would ever actually do it,
and it is not an aspect that would come into your mind. If
you were involved in a grandiose plan you wouldn't be
thinking, "Do I intend to do this?" You lack free will
really.
Q. One other matter I want to ask you about, because my Lord
referred to the question of consequences that can follow and
which does not arise in this case: from the beginning the
evidence you gave - as opposed to those who suggested some
form of endogenous hypomania - the evidence you gave is a
drug induced state which is similar to hypomania. A. Yes.
Q. Provided drugs are no longer there, is that a temporary or
permanent state? A. A temporary state; with the drugs no
longer there the condition should not be.
(The witness withdrew)
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