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The relationship between the psychiatrists who testified in the Dewani case is being seriously questioned. At the time of the court case, Professor Michael Simpson, aka CyberShrink had the following very interesting and uncanny observations to make:
Britain's high court has ruled that Shrien Dewani's extradition to South Africa to face charges relating to his wife's murder should be halted on mental health grounds, according to News24.
Below is an article psychiatrist Professor Michael Simpson, aka CyberShrink, wrote last year on the claims being made regarding Shrien Dewani's state of mental health.
Shrien Dewani and PTSD
Mr Shrien Dewani failed to appear in court on Monday 18 July, citing post-traumatic stress disorder (PTSD) as the reason for his non-appearance. This is interesting in the light of the article below, which was written in February 2011 by CyberShrink about the probable development of this case.
The state of Mr Shrien Dewani's mental health is likely to become increasingly significant. According to the BBC website, the next hearing has been postponed until May 3rd, after another preliminary hearing on March 23.
But it is reported that his diagnoses have been very significantly revised, now saying that he "is suffering from severe post-traumatic stress disorder and clinical depression". When the January hearing was postponed, the court was told that he had been diagnosed by a psychiatrist as having an acute stress disorder and a depressive adjustment disorder.
Where a court needs to be cautious
Any court, of course, should be exceedingly cautious about accepting too readily any diagnosis that is proposed by the defence lawyers, and which is particularly convenient to their defence. Of course it may be a most valid and relevant diagnosis, but the court should be suitably sceptical. And it should expect it to be based on internationally recognised diagnostic criteria.
If the case is important, the court can also insist that the accused should have been assessed by an appropriate psychiatric expert proposed by the defence as well as by one proposed by the prosecution. It would be wise if such matters were not decided entirely on the basis of a doctor selected by the defence.
Legal utility of psychiatric diagnoses
Shrien Dewani's counsel has said that the case against extradition would be based on SA prison conditions, whether a fair trial was possible, possible abuse of process and conduct in SA, and his "mental and physical condition."
Nothing has been said so far of any problems with his physical condition. His counsel also said he was having great difficulty communicating with his client and his ongoing ill health was preventing him from taking instruction from him. It is considered essential that the accused be at least able to understand the essence of the proceedings, and to give relevant instructions to his lawyers about how he wishes to proceed, so this could be a considerable obstacle.
Having worked on legal cases where the accused had notable PTSD, and depression, I have never yet found it interfered significantly with their ability to communicate with their lawyers - if they sincerely wished to do so. It would be highly unusual if someone with acute stress disorder (as was claimed at the last hearing) could not adequately take part in proceedings and instruct their counsel.
Such diagnoses could also be handy to try to create sympathy for the accused, and to imply innocence by implying that someone would have to be innocent, to have been so traumatised by the events of the crime.
In fact, though, witnesses to a crime where someone else was killed, may develop trauma problems, and there have even been some reports of PTSD in murderers. In a case such as this where many have found the absence of physical injury to Dewani to be suspicious, it may be thought desirable to emphasise his degree of psychological damage.
They may also be used to prepare the ground if there were to be any later attempt to claim in some form that the accused is not guilty by reason of insanity or at least at sentencing, to call for mitigation on similar grounds.
Advantages of postponements
If health reasons can obtain postponement of a case, this can have numerous advantages for the defence. They get more time in which to prepare their case. Witnesses' memories may become more unreliable, and new evidence might turn up. In this case, where the local police chief has caused major embarrassment by hasty and ill-considered remarks, which potentially helped the defence claim Dewani couldn't get a fair trial in South Africa, any postponement might provide further opportunities for more inadvertent assistance.
Where key witnesses are either free or on bail but living in dangerous communities, or in jail but still vulnerable to attack, intimidation and even death, delay could also reduce the chances of some witnesses being able to appear for the prosecution.
His claimed illness could also be used as an argument for him to be granted bail while awaiting extradition, if extradition is ordered, and even to postpone actual extradition.
Available defences
There are only two defences against extradition open to him at this stage, and it looks as though he may try to use both.
One would be to prove that there are "substantial grounds to believe that" if he were extradited, his human rights or rights to a fair trial would be "flagrantly violated". The other would be to claim that he would be subject to "cruel, inhuman or degrading treatment or conditions".
South African prisons do not have a great reputation for excellent facilities, and it may be argued that his supposedly fragile psychiatric state would make him especially vulnerable to such conditions, and much more readily degraded by them. It might be argued that he could not receive adequate treatment in a SA prison. It would be unfair for South Africa to promise to ensure that Dewani, if convicted, would be held in greatly better conditions than the average SA prisoner; though there could be a possible guarantee that he'd be held in a single cell, or even that he could serve his sentence in Britain if convicted.
If the Dewani family are as rich as they are reputed to be, there are endless possibilities for delaying procedures by appealing to higher courts, up to the Supreme Court. Though if the process becomes unduly delayed, one would expect his psychiatrist(s), if competent, to be able to treat him sufficiently effectively for the ill-health issues to become moot.
Adjustment disorder: but not grief?
The diagnosis of a "depressive adjustment disorder" is almost trivial and not of any real forensic significance here. It means that someone is in a stressful life situation, and is reacting to it and adjusting to it, by being to some extent depressed.
It is essentially a temporary and not very severe condition, otherwise major depression would need to be diagnosed instead, as is apparently now the case. Indeed, one would not usually make this diagnosis if one had already diagnosed an acute stress disorder. Of course, he's not at all likely to be feeling well and happy. In assessing someone in such a situation, one has to be very careful not to mistake common and normal reactions, such as self-pity and worry about the potential result of the case, for pathological psychiatric symptoms.
It's interesting that his psychiatrist is not known to have diagnosed grief (which one might expect in someone who has been declared a tragic "a 30-year-old widower") because it is essential in diagnosing even the most minor of depressive disorders, to differentiate it from normal grief, and from the sadness anyone might normally feel when confronting accusations of murder, and the prospect of trial and even conviction.
We must not allow someone to claim special treatment on the basis of essentially normal reactions to the situation in which he sits. Otherwise we steer close to the guy who murdered both of his parents, and then claimed mitigation as he was an orphan.
Acute stress disorder
Let's look at the diagnosis of acute stress disorder. Anxiety and other symptoms arise within a month of an extreme traumatic stressor event; and it lasts a maximum of four weeks. In ASD, the person may find it hard to concentrate, be dazed, and less able to handle important tasks of life. They may have some difficulty remembering some specific details of the traumatic event.
How convenient this could be for someone on trial for alleged involvement in a murder plot, helping them claim they don't remember what actually happened. We don't know exactly when this problem was diagnosed in Mr Dewani, but his 4 weeks would long since have been up.
I'm puzzled. The murder was in November, so an ASD would have had to be diagnosed by 13 December, and would be over well before the January hearing at which he was said to be suffering from it. This doesn't make sense.
By the way, there is no such thing as "Post Traumatic Stress" which one often sees cited in the media by people who are ignorant of this condition. That would be a stress arising after something nasty had happened, like the ambulance staff dropping the stretcher when you got to hospital.
What is not happening
He is not suffering from "oppressive adjustment disorder”, as stated on the Independent on Sunday web-page, nor does such a condition exist. He was also reported as receiving "constant medical treatment" which would, if accurate, be seriously exhausting. Presumably they mean on-going or continuing treatment. It would be useful to know exactly what form of treatment he was receiving.
(Professor M.A. Simpson, aka CyberShrink, February 2011)
