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05 September 2012

Dewani: start from scratch

The shocking news about the possible collaboration of the psychiatrists in the Dewani extradition trial means it's back to square one, says CyberShrink.

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Cybershrink explains why the British court ought to reject all the questionable psychiatric evidence thus far presented to it about the supposed state of Shrien Dewani, and start again with a properly independent, expert and sceptical re-assessment of the man and the entire medical case.

It somehow didn't surprise me to hear this week that the British legal authorities are at long last starting to investigate the background to the bizarre evidence that has been given thus far in Shrien Dewani's legal struggle to prevent himself from standing trial in South Africa. 

Lack of independent assessments
A very large and highly significant anomaly has been found in the essence of the evidence seen to date. There should be a thorough investigation of all aspects of the independence or otherwise. and the possibilities of undue influence on the doctors who have testified so oddly about Mr Dewani's health and needs.

It's essential that they be cleared or face the consequences of any improprieties which might be uncovered.  But while that is proceeding, it is already crystal clear from evidence readily available online, that there has been a very serious breach of proper procedures and a very clear conflict of interest affecting both the shrinks who have testified: their testimony can no longer be accepted as objective or definitive, or as the basis for any sensible or fair court decisions. The courts that have been absurdly credulous and naïve so far, and need to wake up and start being more rigorous.

The company we keep? 
What's this recent problem?  It has been discovered that the two supposedly independent psychiatrists providing testimony so far in the case (one is doubly qualified, in medicine and law) not only know each other well, but have been collaborating closely and formed a formal partnership of a special sort (an LLP) which limits personal financial liability and has some tax advantages. It’s somewhere between a partnership and a corporation, and popular for a gathering and co-operation of professionals who are not allowed to form companies.

The problem is that these supposedly fully independent experts were clearly working together in the formation of this partnership (devoted, with their other colleagues, to providing forensic reports for courts) and soon after doing so, submitted a joint report to the court, showing a surprising degree of agreement on everything. Not only did this show an obvious conflict of interests, but should, by any normal legal and professional procedure, have been promptly and fully disclosed to the court. And it wasn't.

Where were the depression and PTSD experts? 
I have previously wondered why this particular pair of doctors were chosen to provide evidence in this case, because, though they have distinguished careers in other aspects of medicine (one is certainly a major expert on the effects of physical brain damage on memory), neither of them are recognised as particularly expert in either depression or PTSD, the two conditions central to Mr Dewani's attempts to evade extradition to stand trial here in South Africa, for the murder of his wife.

It can be argued that both these doctors should be reported to, and investigated by, the British General Medical Council for possible unprofessional behaviour in not disclosing to the court how their assumed independence had been compromised. Their existing reports should be treated with extreme scepticism and scrutinised by genuinely independent experts, if not discarded entirely.

The Dewani legal team should be required by the Court to appoint a new expert genuinely independent of both these men, and so should the British prosecutors. The South African Government, which has been disappointingly tame and inactive, should become more bold in demanding that the case begin to be handled properly.

Unanswered  questions
The initial diagnoses announced to the court in the early days of the case were technically invalid, but this was never challenged properly. There was never any explanation demanded for why a man supposedly so profoundly depressed as to be inactive and mute, and unable to even advise his lawyers or take part in court proceedings, was able to engage in such vigorous physical exercise as to alarm at least those of the ward staff who were paying attention.

We still don't know why, apparently on the basis of a transient, mild rise in muscle enzymes most likely to have been caused by this excessive exercise, it was assumed that Dewani was suffering from a rare hypersensitivity to antidepressants. This is supposed to have interfered with his proper treatment, and according to some reports, to the unnecessary stopping of his antidepressant and failure to replace it with alternative drugs or even ECT. A recent report mentions him as being on medication so perhaps the necessary drugs have been resumed, but nothing is clear from the unnecessarily limited information available to the public.

Such severe depression is rarely the result of the loss of a new wife, and PTSD still seems unlikely as according to his own apparent story he himself was not exposed to severe or prolonged realistic threat of death.

Unique in medical  history?
Nobody has yet explained, and explanation certainly is needed, as to why this man, almost uniquely in medical history, is claimed to have remained unchangeably profoundly depressed and tormented by PTSD despite various attempts at treatment, such as to render him unable to follow court proceedings or work with his lawyers on his defence, for over 18 months now.

Even totally untreated  depression almost always remits or at least improves sufficiently to enable the person to face trial, within half of this time. Similarly, I have never seen PTSD so severe as to make trial impossible, or which didn't vary a jot for nearly two years. His doctors owe us an article in the medical journals to describe this very special case, as soon as possible.

The evidence offered so far shouldn't just be tossed aside lightly - it should be thrown away with great force.

(Professor M.A. Simpson, aka CyberShrink, September 2012)
 

Read more:

Shrien Dewani: CyberShrink comments

Will Dewani really get extradited?
 

 
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