1 Monday, 14 January 2002
2 [Open session]
3 [The accused entered court]
4 [The witness entered court]
5 --- Upon commencing at 9.34 a.m.
6 JUDGE HUNT: Call the case, please.
7 THE REGISTRAR: Good morning, Your Honours. Case number
8 IT-98-32-T, the Prosecutor versus Mitar Vasiljevic.
9 JUDGE HUNT: Madam, would you please make the solemn
10 declaration in the document which the court usher has handed you?
11 THE WITNESS: [Interpretation] I solemnly declare that I will speak
12 the truth, the whole truth, and nothing but the truth.
13 WITNESS: VERA FOLNEGOVIC-SMALC
14 [Witness answered through interpreter]
15 JUDGE HUNT: Sit down, please. Mr. Groome?
16 MR. GROOME: Good morning, Your Honours. The doctor has asked me
17 to point out a mistake in the English translation of her original report.
18 It's a minor one but it is one that would leave the report open for
19 misinterpretation. It is on page 1 of the report. And it is under the
20 section entitled, "The opinion is based on..." And it's the third
21 paragraph, the number 3. In that paragraph. And the mistake is, she
22 interviewed the accused in detention unit 3 or Scheveningen 3, not on the
23 3rd. She only interviewed the accused on the 11th and 12th of December.
24 JUDGE HUNT: Thank you.
25 Examined by Mr. Groome:
1 Q. Good morning, doctor, I'd ask you to tell us your name.
2 A. My name is Vera Folnegovic-Smalc.
3 Q. You can remain seated.
4 A. Oh, thanks.
5 Q. Now, Doctor, we are going to begin by discussing briefly your
6 background, and I would ask maybe the usher to assist the doctor. Some of
7 this has been summarised on sheets of paper on the ELMO. I would just ask
8 the usher to help the doctor orient them on the ELMO properly.
9 Doctor, I'd ask you to begin by describing for us briefly your
10 educational background.
11 A. I graduated from the school of medicine, University of Zagreb, in
12 1968. And by doing so, I gained a title of a general practitioner. After
13 that for some time I worked as a general practitioner.
14 Q. I think perhaps you could go a little bit slower we won't wear out
15 the interpreters this morning.
16 A. Thank you. So after that, I started my specialization in
17 neuropsychiatry and I completed that training in 1975. And at that point,
18 I obtained a title of neuropsychiatrist. Shortly thereafter, I started
19 post-graduate studies in psychiatric epidemiology and public health, and
20 in 1977, I defended my masters thesis and became a master of science.
21 During that entire time, I worked as a psychiatrist in the oldest Yugoslav
22 psychiatric hospital, Vrapce.
23 In 1983, I passed or defended my doctor's thesis in the area of
24 psychopathology of schizophrenia, and by doing so, I became a doctor of
25 science. In addition to that, I attended many trainings, out of which I
1 believe it is important to say that as an associate of the World Health
2 Organization from Geneva, from 1978 until 1985, I attended training on the
3 use of measurement, instruments, in diagnosing psychiatric disorders in
4 various centres in Europe, such as Geneva, Munich and others.
5 Q. Now, Doctor, in addition to or during the course of your career as
6 a psychiatrist, have you also had several positions teaching psychiatry?
7 A. My teaching experience began in 1991, officially, although even
8 prior to that, I worked as an assistant to my professors, who were my
9 bosses at that time. But in 1991 and on, I started working as an
10 assistant professor in three schools in Belgrade: One of them is the
11 school for rehabilitation; the second one is the school of -- faculty of
12 psychology, within the universities of Zagreb; and also at the faculty of
13 medicine at the universities of Zagreb, where I've been working since 1990
14 as an assistant professor. And in 1991, when I became a tenured professor
15 in all of those schools, I continued working there, but now as a tenured
16 professor. For a while, I also worked as a visiting professor for
17 psychiatry at the medical school in Rijeka, University of Rijeka.
18 Q. Now, Doctor, can you briefly describe for us what publications, if
19 any, you have?
20 JUDGE HUNT: Do we really need to have this given orally? Is
21 there no list that we can just accept?
22 MR. GROOME: There is a curriculum vitae, Your Honour, which if
23 the Court wishes -- some of her experience is directly on point to some of
24 the issues in this trial so I thought it might be helpful.
25 JUDGE HUNT: If would certainly be good to have her tell us about
1 those, but it's a fairly grim process going through any psychiatrist's
2 list of published material because they publish an awful lot.
3 MR. GROOME: Your Honour, she was just going to tell us the number
4 and draw our attention to two that have a particular importance.
5 JUDGE HUNT: All right. If that's the way you're going to do it,
6 that will help, thank you.
7 MR. GROOME: Also the sheets that are on the Elmo, I've made hard
8 copies, if it's of assistance to the Court. I've provided them to the
9 Court staff. I'd ask that they be furnished to the Chamber.
10 JUDGE HUNT: We have got them, thank you. This will save us from
11 having to write notes, certainly thank you. That will be a very
12 convenient document but you don't want that as an exhibit. This will only
13 reflect her evidence, is that it?
14 MR. GROOME: Yes, Your Honour, just a demonstrative aid.
15 Q. Would you please summarise the number of articles that you have
16 written and tell us about the important ones for the matter that you have
17 been asked to engage yourself in, in this case?
18 A. Well, I've published more than 200 Articles in professional and
19 scientific journals in former Yugoslavia, Croatia, Germany, Britain and
20 U.S. What is of importance for this expertise, perhaps, is that for a
21 long part of my life, I was involved in psychiatric epidemiology and
22 psychopathology so I have a number of articles from that field and also
23 psychiatric genetics. What is important is that I wrote ten chapters in
24 various textbooks and scientific books and it is also important to say
25 that I authored a chapter in the most recent European psychiatric
1 textbook, and just to add in the end that the latest textbook in
2 psychiatry in Croatia for that textbook, I wrote a chapter on forensic
4 Q. Doctor, can you tell us the most significant professional
5 organisations to which you belong?
6 A. Do you mean the institutions that I worked in or some other ones?
7 Q. No, professional organisations such as the Croatian psychiatric
9 A. The professional organisations that I belong to, I listed only
10 three. One is the Croatian psychiatric association, and I served for a
11 second term as a chairman of that association. I'm also a board member of
12 forensic psychiatric association and also a member of several
13 international psychiatric associations, and several times, I attended and
14 was an invited lecturer at psychiatric congresses, international ones. I
15 do not belong to any non-professional organisations.
16 Q. Now, Doctor, I'd ask you to summarise for us the professional
17 positions that you have held in psychiatry.
18 A. From 1975, until present time, I've been working as a general
19 psychiatrist which means that my daily work includes work with patients.
20 This takes place at the general emergency psychiatric ward. In addition
21 to that, from 1976 until 1991, I worked as a forensic expert for Croatia
22 and other republics of the then Yugoslavia.
23 Q. Now, Doctor, I'd ask to you describe for the Court what was the
24 nature of your responsibilities as a forensic expert to the courts of the
25 former Yugoslavia?
1 A. I was invited to various courts, and at that time I was a junior
2 forensic expert, and in the beginning, I mostly worked for the
3 municipality of Zagreb, which is where I live, but together with other
4 experts, I was also invited to some courts in other parts of former
6 Q. And would you be called in the course of those duties to examine
7 patients regarding their psychiatric condition for the court?
8 A. Yes. That was one of my routine assignments during that entire
9 time. I would examine the patients, examine all those aspects that were
10 required of me and then finally give my opinion to the court.
11 Q. Please continue, doctor.
12 A. After 1991, I became psychiatric court expert in Croatia, and when
13 Croatia gained its independence and after I became a tenured professor, I
14 was appointed chief of forensic expertise at the Zagreb University in the
15 area of psychiatry, and this is one of the strongest and most important
16 institutions for forensic sciences in our country. I wrote a total of
17 over 500 forensic opinions. Most of them were in the area of criminal law
18 and about 50 of them in the area of civil law.
19 Q. Doctor, presently, is there a more senior or higher level expert
20 in forensic psychiatry in Croatia than yourself?
21 A. At this time, my position is such that I am chief psychiatric
22 forensic expert, which means that there is nobody above me in Zagreb.
23 There is a colleague of mine in Osijek who holds identical position to
24 mine there.
25 Q. Doctor, at present, are you called from time to time to review the
1 expert evaluation and opinions of other forensic psychiatric experts in
2 the Republic of Croatia?
3 A. My function is such that I am verifying reports of others, and
4 based on our law, a court can ask for an opinion of one expert or an
5 opinion of an institution, and if the Court disagrees with an opinion of
6 either of them, then it can send a report to the University of Zagreb and
7 then I am head of a committee which comprises three persons; I'm a
8 chairman of that committee, that investigates and checks that opinion.
9 Q. Doctor, I'd ask you to tell us were you a biological psychiatrist
10 beginning in 1978?
11 A. Biological psychiatry is something that I've been involved with
12 for a long time. I am a general psychiatrist, but in addition to that, I
13 have specific licences giving me an opportunity to get involved with
14 biological psychiatry and I've been doing this since 1978, and very
15 frequently, I have to give an expert opinion regarding pharmacotherapy
17 Q. What is your present position?
18 A. My present position is director of university department, a clinic
19 for general forensic psychiatry and clinical electrophysiology at the
20 medical school of the Zagreb University which is located in the
21 psychiatric hospital, Vrapce.
22 Q. And finally, Doctor, regarding your background, I would like to
23 ask you if you have conducted any research that is relevant to
24 the issues that were raised in this case, and if so, would you please
25 describe briefly what that research was?
1 A. Well, my master -- since I defended my master's thesis, I got
2 involved in the psychiatric research, and I've listed only three articles
3 here that have something to do with the expertise that we are discussing
4 here today. First of all, that is a research of genetic components of
5 exogenous psychosis. I worked in this research as a principal
6 investigator for Croatia, and research was conducted under the auspices of
7 Colombia University from New York. The chief professor from Columbia in
8 charge of this is Markin [phoen]. The research is still ongoing but we
9 have already published several articles in the American Psychiatric
10 Journal regarding this research.
11 Other two researches that are important involve research of
12 functional psychosis, their genetic and epidemiological indicators.
13 Q. Thank you, Doctor. Now, Doctor, I'd ask you for the next few
14 minutes to maybe describe for the Chamber some of the basic concepts that
15 we need when we evaluate the remainder of your testimony. I would ask you
16 to give us a simple basic definition of forensic psychiatry. What is the
17 role of forensic psychiatry?
18 A. Forensic psychiatry is one of subcategories in psychiatry which,
19 in order to assist courts in solving their cases and issues, uses
20 psychiatric methods and criteria and requires the expert to have
21 additional training in judicial matters needed to solve such issues and
22 problems. That specifically means that the expert needs to be trained and
23 have knowledge in the area of criminal and civil law and give detailed
24 answers to questions put to him such as, for example, accountability,
25 necessary treatment, recommendations, procedural capacity, and so on.
1 Q. Now, Doctor, our primary interest here will be in the issue of
2 accountability so I would ask you to give us a definition of
4 A. Accountability is an ability of a person to fulfil two
5 requirements: First, to understand the consequences and meaning of its
6 actions, and the second one is that the person is able to control its own
7 actions, understand and being able to control them.
8 Q. Now, based on your experience as a forensic expert in the courts
9 of the former Yugoslavia, did you translate the essential question that's
10 posed to a forensic psychiatrist who is providing expertise or was
11 providing expertise to the courts at that time?
12 A. Yes. That's right. According to former Yugoslav laws, the
13 definition of accountability read as follows: The person is accountable
14 if it is able to understand the meaning of its actions and control and
15 manage its actions. This is a verbatim translation of the provision.
16 Q. Now, Doctor, how many different levels of accountability existed
17 under the law of the former Yugoslavia in the period of 1991-1992?
18 A. In former Yugoslavia, a law in force divided accountability into
19 the following four categories: The first category was that person was
20 fully accountable; the second one that the person had diminished
21 accountability but not significantly diminished; the third one was
22 significantly diminished accountability; and the fourth category was
24 Q. Now, let's talk about accountable, the first category. Can you
25 please describe for us the criteria for determining that somebody is
1 accountable and perhaps give us some examples of people who would be
2 considered accountable for their actions despite some psychiatric
4 JUDGE HUNT: But not significantly so.
5 MR. GROOME: I'm sorry, Your Honour, this is the first category.
6 JUDGE HUNT: It's the second category that she's used. The first
7 one was completely accountable. The second one was not...
8 MR. GROOME: Diminished but not significantly.
9 JUDGE HUNT: Diminished but not significantly, so the third one
10 was significantly so the fourth one was incompetent.
11 MR. GROOME: Yes, Your Honour. I'm asking her now to describe the
12 first one, accountable, and the types of psychiatric conditions that the
13 person could have but still be accountable.
14 JUDGE HUNT: Fully accountable.
15 MR. GROOME: Yes.
16 JUDGE HUNT: I'm sorry, I didn't see that you were getting to that
18 MR. GROOME:
19 Q. Could you please describe for us what is the criteria for
20 determining that somebody is fully accountable?
21 A. The main criteria for somebody to be fully accountable is that
22 this person is able to fully understand the consequence of an act held
23 responsible for, and in practice that means that that person does not have
24 any psychological condition, which means that that person has a diagnosis
25 of sine morbo psychico or that person can have a mild condition that only
1 in a minor way influenced him in that he only to a minor degree could not
2 understand his actions. That person can have a very minor psychological
3 condition such as a mild or moderate depression, also alcoholism, but
4 alcoholism where the person is not fully inebriated.
5 So in order to say that somebody is fully accountable, we should
6 know what the person is charged with, we should know the psychiatric
7 anamnesis and know whether that person had any conditions and what state
8 that person was in at the time when the act was committed. So we have to
9 know the elements of that particular act and also psychological condition
10 of the perpetrator. So these are the questions we have to answer for the
12 So the criteria is that there is no serious disorder in
13 understanding and comprehending actions and controlling actions. And
14 there are also some conditions that are listed that can fall into this
15 category, and also, we can have a person that has absolutely no
16 psychological condition. As a consequence, is that such person is
17 considered to be accountable and can be held responsible for the act
19 Q. Now, Doctor, let's move to the second category, diminished but not
20 significantly. Can you please describe for us what is the criteria that a
21 forensic psychiatrist would use in evaluating that somebody is of that
23 A. So the second category, category B, includes persons that can
24 understand the meaning of the act committed by them but there are certain
25 circumstances that reduce, in a minor degree, accountability. An example
1 of that can be alcoholism, inebriation, certain degrees of retardation,
2 dementia, post traumatic stress disorder, and similar conditions. Persons
3 that fall within that diagnostic category are responsible for the act they
4 were charged with but there is a recommendation that certain mitigative
5 circumstances be taken into account when passing a sentence for them.
6 Q. Now, Doctor, let's move to the third category. What is the
7 criteria for determining that somebody is significantly diminished in
8 their capacity?
9 A. When we say that a person is of significantly diminished
10 accountability, we enter into a new group of persons, persons who can have
11 a real mental illness, but at the time of the commission of the crime, the
12 person is in a state of remission. This group would include manic
13 patients, seriously retarded patients, demented patients, and a typical
14 example of persons with significantly diminished accountability would be
15 a psychotic patient who commits a crime which does not fall within the
16 scope of his pathology. For example, if we have a schizophrenic person
17 whose pathology consists in having feelings of being persecuted, of
18 someone trying to kill them, and that person has no money and wants to
19 order a drink and goes and steals money from another person, not the
20 person they imagine is trying to kill them, that would be a psychotic
21 person but the crime is such that is -- that the content of the crime is
22 not directly connected to the content of the psychosis, and the
23 consequences of this degree of accountability would be that the person is
24 not accountable and then the psychiatrist has to make a recommendation to
25 the Court as to what sort of treatment is recommended for that person.
1 The person must be treated.
2 Q. Doctor I'd ask you, could you define for us what is meant by a
3 life psychosis?
4 A. This is a very important term. Life psychosis is an illness which
5 starts at a certain point and is likely to last throughout the person's
6 lifetime. If it does not last throughout his lifetime because of
7 treatment, then certain symptoms can still be seen. Alcoholism would fall
8 into this group, mental retardation also, because once a person has been
9 diagnosed as mentally retarded, every psychiatrist throughout that
10 person's life will be able to confirm that diagnoses. Schizophrenia,
11 bipolar disorder, dementia and a number of other psychiatric diagnoses
12 fall within this group. This is very important because if we are
13 conducting a forensic examination of a person today and this refers to a
14 period of many years ago, we are able to deduce whether the illness
15 existed at the time or not.
16 Q. Now, I'd ask you now to move to the fourth category of fully
17 incompetent or unaccountable for one's actions criminally. What is the
18 criteria to assess or to determine that somebody falls into that
20 A. The fourth category is the simplest one for psychiatrists. It is
21 much easier to say that someone is suffering from a certain disease than
22 to prove that he has not suffered from it. This means that a person is
23 unable to understand what a certain act means and in that case, these
24 persons are mostly acutely psychotic. For example, acute schizophrenia,
25 delirium, patients with epilepsy who were having a seizure at the time,
1 deeply demented patients and deeply agoraphobic patients.
2 These persons are not responsible for the acts they are charged
3 with under Yugoslav law, and they are never pronounced guilty. The crime
4 they are charged with is listed and they have to have mandatory treatment
5 in psychiatric wards which have special security. An amendment to the law
6 says that the psychiatrist in charge has to send a report twice a year so
7 that, in consultation with the court, the location and treatment of each
8 individual case can be determined.
9 Q. And does that person remain in that facility until such time as
10 psychiatric experts determine that the person is in sufficient remission
11 that they may be released from that facility?
12 A. Yes, yes. And when such a person is released, the person still
13 has to go -- undergo treatment even when at liberty.
14 JUDGE HUNT: Mr. Groome, I wonder if I could just ascertain where
15 one particular category, where one particular condition falls into which
16 of the first or second categories. Have you finished with the
18 MR. GROOME: I was going to move on to something else.
19 JUDGE HUNT: This might be the best time to ask. Doctor, what
20 about somebody who is intoxicated, who knows very well what they are
21 doing, the character of what they are doing, and they are able to control
22 themselves but by reason of the intoxication they do something which, had
23 they not been intoxicated, they would not have thought of doing? In other
24 words, the bravado that the drunk sometimes has, into which of the first
25 or second categories would you say that that falls?
1 THE WITNESS: [Interpretation] It is hard to say if I do not know
2 what act the person is charged with and how foreign that act is to that
3 person. But that person would fall either into category one or two.
4 These are the two categories that satisfy the criteria for alcoholism,
5 both as a general diagnosis and in a specific case. As a rule, we always
6 produce an opinion for a particular crime. Then we talk to the person, we
7 see how far they are able to talk about it, what effects this has on them,
8 and, of course, the person has to accept the fact that they committed this
9 and they have to be able to talk about it. So all I can say is that it
10 would fall either under category one or two.
11 JUDGE HUNT: Well let us take a crime committed by somebody who
12 is, when sober, nonviolent, but when intoxicated is so inflamed by
13 the intoxication that he commits an act of violence, and let's make it
14 serious violence. Into which category would that fall? Are you able to
15 tell us that?
16 THE WITNESS: [Interpretation] If, for example, -- and I'm speaking
17 now in accordance with Yugoslav law, if someone does not expect to be
18 aggressive or maybe expects to be aggressive when drunk and then they get
19 drunk and they drive and they kill someone, they are held fully
20 accountable. So the fact that they were drunk is not seen as a mitigating
21 circumstance. However, if someone commits another sort of crime, I would
22 tend to place them in category two.
23 JUDGE HUNT: Driving offences may arise simply because, by reason
24 of the intoxication, he didn't see somebody or thoughts he could make it
25 through the intersection in time. I'm thinking of something more
1 deliberately violent. You'd say that would go into the second category?
2 THE WITNESS: [Interpretation] Yes.
3 JUDGE HUNT: Thank you, Mr. Groome. The distinction between the
4 categories is not always easy to find and that's why I put that particular
5 category. Not necessarily because it results from anything happening in
6 this case but it does explain it, at least to me, a little better.
7 MR. GROOME:
8 Q. Doctor, maybe just to follow up on His Honour's question. Can you
9 give us an example or illustrate for us a person who was charged with
10 committing a very serious or very violent act, can you give us the level
11 of intoxication that you would have to find in that patient before that
12 person would be determined to be in the second category, diminished but
13 not significantly?
14 A. The person would have to be drunk. We have subcategories: tipsy,
15 drunk and seriously intoxicated. For someone to be drunk, the alcohol
16 level would have to be above 1. In most cases, that person would be
17 placed in category two. If I may add, these are not mathematically
18 precise tables so we cannot automatically place a person in one category
19 or another. This is why expert opinion is made separately for each
20 person. But alcoholism does not go beyond categories one and two. So
21 this is the scope of the issue.
22 Q. Would a person -- would you expect that a person who is
23 sufficiently intoxicated to be determined to be in category two, would you
24 expect that that intoxication would be readily apparent to witnesses to
25 the crime, witnesses that saw him at the time of the crime?
1 A. Yes. Even lay persons would easily recognise someone who is
2 drunk. They might not recognise someone who is tipsy but they would
3 easily recognise someone who is drunk.
4 Q. Thank you. Now, Doctor, I'd like to ask you to -- can you please
5 outline for us the primary psychiatric diagnoses and I'd ask you to begin
6 with the old classifications used for psychiatric diagnoses.
7 A. Today there are several classification systems in psychiatry but I
8 have listed here the traditional classification which is still used in
9 forensic psychiatry today, and which has been retained because of the
10 interests of forensic psychiatry because it is very pragmatic. This
11 classification is dichotomous and it places all disorders into one of two
12 categories; one of these is psychotic disorders and the other is
13 non-psychotic disorders.
14 Q. Can you define for us the meaning of psychoses?
15 A. To be psychotic means to be unable to test reality, not to have an
16 insight into what is happening around us, which means that the patient
17 cannot distinguish between his psychopathology, between his illness and
18 the reality tested by us who are healthy.
19 Q. Now, I'd ask you to describe for us the current classification
20 system and I would ask you to begin with telling us what is endogenous
22 A. Endogenous psychoses are psychoses for which we do not know the
23 epidemiological factor. They are thought to be inherited. However,
24 morphologically, there are no methods we can use to prove their existence.
25 This would include schizophrenia, paranoid psychosis, affective psychosis,
12 Blank page inserted to ensure pagination corresponds between the French and
13 English transcripts.
1 which are either unipolar or bipolar so that they can lead to manic or
2 depressed states, and these illnesses are considered to be serious
3 psychiatric illnesses and they are a paradigm of true psychiatric illness.
4 They are so-called life disorders.
5 Q. Now, doctor is there another name for endogenous psychoses?
6 A. Functional, functional psychosis.
7 Q. And am I correct in understanding you that if a person has an
8 endogenous --
9 JUDGE HUNT: Endogenous.
10 MR. GROOME:
11 Q. Endogenous psychoses, that there is no readily apparent or
12 observable biological cause of that psychosis?
13 A. We know that there is a biological disorder in the transmitters
14 but we cannot see it. We recognise it through pharmacotherapy because we
15 know, for example, that schizophrenia is a disease that is due to the
16 increase in dopamine receptors but we cannot prove this because there
17 are no technical methods for us to see that someone has schizophrenia. We
18 recognise it by its symptoms, and when we do recognise it, we administer
19 medicine that we have available and that we expect to help. However,
20 magnetic resonance, for example, or a CT scan, will show nothing. An
21 x-ray will show nothing. We do not have any diagnostic aids to show us so
22 that we can say, "Ah-hah, this finding means that the person has
24 Q. Doctor, could you briefly describe for us what schizophrenia is?
25 A. Yes. There are several categories. The most frequent one is the
1 paranoid hallucinatory type, where the person is not aware of reality.
2 They have their own life. They were drawn into themselves. They lose
3 their affective expression. We say that their affects are flat. When
4 something is sad, the person will not be sad. When something should cause
5 happiness, the person will not be happy. In other words, the person is
6 autistic and the sequence of thoughts is disrupted. It is disassociated,
7 hard to follow. This is very important because a schizophrenic patient
8 has disassociated thoughts as opposed to organic psychosis, where thoughts
9 are incoherent, and I'm saying this because the word "incoherent" is often
10 used. However, this is the case with organic schizophrenia.
11 Then there are hallucinations, which are most frequently auditory
12 although they may also be visual. The person, for example, if someone
13 enters a room here and there are 50 of us, if I were a schizophrenic, I
14 would think this person has entered the room because of me, in order to
15 hurt me, so that the person thinks that everything that happens in the
16 world is revolving around the person. So they not only have ideas of
17 being persecuted, they also have ideas of being great. I have patients
18 who think that they are the Empress Maria Teresa or people think they are
20 Q. And is schizophrenia a life psychosis?
21 A. Yes.
22 Q. And could schizophrenia in some cases be a basis for a finding
23 that a person is significantly diminished or incompetent under Yugoslav
25 A. A Schizophrenic person, in over 90 per cent of the cases, is
1 totally incompetent, not accountable. Only in cases of good or partial
2 remission can we say that accountability is significantly reduced, but we
3 never find that patient in the first or second category of accountability.
4 Q. Can you briefly describe for us what is paranoid psychosis?
5 A. Paranoid psychosis is prognostically better. It does not destroy
6 the personality to such an extent. There is no emotional destruction of
7 the person, but the person is intensively preoccupied in a mad way. The
8 person is always manic. The person may be able to function well, for
9 example, to do a manual job well. But throughout this time, the person
10 believes that someone is following him or her, that someone is going to
11 harm him or her, and these persons are very prone to the commission of
12 crimes. They retain their level of social activity longer and, as a rule,
13 they do not have hallucinations.
14 Q. And Doctor, could somebody diagnosed with paranoid psychosis,
15 could that be the basis of a finding by a forensic psychiatrist of
16 significantly reduced accountability or incompetence?
17 A. Yes. These two categories are possible. Most often, the person
18 is incompetent but if they, for example, steal something from someone,
19 that would mean that accountability was significantly reduced.
20 Q. Doctor, you've described for us that affective psychosis really
21 has two sub categories: One is manic psychosis and one is depressed
22 psychosis, and you also used the word bipolar and unipolar. Can I take
23 from what you've said earlier that bipolar means that a person fluctuates
24 between both manic psychosis and depressed psychosis?
25 A. Yes, yes, quite correct.
1 Q. And a person who is unipolar consistently just shows the symptoms
2 of one of these two psychoses?
3 A. That's correct. They also fluctuate but this is very rare, so
4 bipolar is usually manic depressive. Unipolar manias are very rare.
5 Unipolar depressions are relatively frequent.
6 Q. Can you please describe for us the character or the primary
7 characteristics of manic psychoses?
8 A. Manic psychosis is a situation in which a person appears to be
9 infantile, very agitated in a psychomotor sense but very rarely are they
10 aggressive. They are usually cheerful. They have escapist ideas. Each
11 one of us here would be able to recognise them. If it's a woman, she
12 would be wearing a lot of jewellery, bows, she would be -- have heavy
13 makeup. She would be wearing very loud colours such as purple, orange or
14 red. The appearance of these people as soon as they enter a room shows
15 that they are not quite normal. They will kiss everyone, give profuse
16 compliments which are often in bad taste. They do not concentrate on
17 anything. Their attention is very scattered.
18 Q. And in certain instances, can manic psychosis be the basis for a
19 finding of significantly diminished responsibility or incompetence?
20 A. Yes, for both categories. However, in psychiatry, these people
21 are rarely sued because everyone sees that they are ill and what they do
22 is usually not very serious; it's either petty theft or prostitution,
24 Q. Now, depressed psychosis, can you give us the basic
25 characteristics or definition of that psychosis?
1 A. In depressive psychosis, the main symptom is loss of vital and
2 other instincts. The persons seem deeply sad. They are slow
3 psychomotorically. They do not have the capacity to do things. They have
4 no interests in anything. They cannot enjoy things. They do not enjoy
5 doing things they enjoyed before. They often sit very still, so that even
6 a lay person can see that this is a person who is sad and who is ill.
7 They may have an idea of guilt which is completely unfounded. They
8 complain or rather they say that they have committed a big sin and this is
9 not true. They are afraid that for this reason something will happen to
10 them. They are often suicidal, and what is very important, lay people see
11 them more as physically ill than as psychologically ill. Their activity
12 is reduced.
13 Q. And is it true that a person who suffers from depressed psychoses
14 could be found in certain circumstances to fall into the last three
15 categories of accountability, accountable -- I'm sorry, diminished
16 accountability but not significant, diminished accountability,
17 significantly diminished accountability, and incompetence? Is it true
18 that a person suffering from this psychosis could fall into those three
20 A. Yes, yes, that's true. Persons who are depressive very rarely
21 commit crimes. In our experience in forensic psychiatry, we do not deal
22 with them very often because they are not active; they commit crimes very
23 rarely. I had only one case in my life, and that was when a suicidal
24 mother jumped into the river Sava with her small child in her arms. That
25 is the only patient of this type I have ever had in my forensic
1 experience, and the mother was held not accountable at the time.
2 Q. So Doctor, what you are telling us is that somebody who suffers
3 from depressed psychosis, it would be very rare for one of those people to
4 commit a violent act against another human being; is that correct?
5 A. Yes. If depressive persons are aggressive, then we say that they
6 turn their aggression in on themselves, not against other people.
7 Q. Now, Doctor, I'd ask you to describe the next general category of
8 psychosis, exogenous psychosis. Can you please give us a definition what
9 that is?
10 A. Exogenous psychoses are psychoses where we can recognise and
11 establish an external cause which led to the psychosis, and the further
12 subclassification is based on the etiological factor that led to the
13 psychosis. It is important to say that exogenous psychosis as a rule are
14 not a life disorder, they are a response to the etiological factor
15 causing them and they are divided into the following categories.
16 Q. Before we go into those categories, there is one question I
17 neglected to ask you regarding the endogenous psychoses. Would it be
18 correct that all of the endogenous psychoses are life psychoses?
19 A. Yes.
20 Q. So that as a forensic -- a competently trained forensic
21 psychiatrist should be able to recognise that somebody has one of those or
22 has suffered from that psychosis, even if it was 10 or 15 years prior to
23 the day of examination?
24 A. Yes.
25 Q. Please continue with exogenous psychoses.
1 A. Very important for us is the alcoholic psychosis because one of --
2 this is one of the psychoses that both my colleague and I mentioned in our
3 written reports and in our testimony. This is a psychosis which is
4 consistent with the organic psychosis in general, which means that the
5 person does not test reality. It is confused, can have hallucinations,
6 and that alcohol is considered to be an etiological factor that led to
7 it. With such persons, accountability is not there. That means that that
8 person is usually incompetent or the accountability can be significantly
9 reduced. This type of psychosis is susceptible treatment. It
10 starts usually in a very rough manner and it lasts up to six months.
11 In some rare cases, some patients can go from alcoholic psychosis
12 into real dementia, however, there is usually no dilemma posed here
13 because we know that that was induced by long-term drinking and this led
14 to psychosis which, in turn, led to dementia.
15 Q. You said that a diagnosis of this could result in a person being
16 determined to be -- have significantly diminished responsibility or
17 incompetence. I'd like to follow that up and ask you, is that true if the
18 person is suffering an acute phase of the psychosis at the time of the
19 crime or the time the crime is committed? Is that correct?
20 A. I apologise, I did not quite understand the meaning of your
21 question. Did you want to know whether the person after a psychosis
22 enters the phase of incompetency?
23 Q. Let me rephrase my question. A person who has alcoholic
24 psychoses, you said that that person may be determined to be significantly
25 reduced or no accountability. My question is, is that only true if the
1 person is suffering from acute alcoholic psychoses at the time of the
3 A. Yes. Let me clarify this. This psychosis is an acute stage, but
4 if it should turn into dementia, then that person is incompetent
5 again and this is something that can be easily proven in a psychiatric
6 way. Psychosis is a psychosis. As soon as it ends, the person returns
7 back to normal or reduced accountability. Should the psychosis turn into
8 dementia, then the person remains incompetent. However, it is very
9 easily clinically recognisable. That kind of a person could not, for
10 example, deduct seven from 100.
11 Q. Could you please move on to the next category of exogenous
12 psychoses, delirium? Could you describe for us what that is?
13 A. Delirium is a state that I will describe in more detail because I
14 believe, and this is something that I included in my report, that
15 Mr. Mitar Vasiljevic suffered delirium. Delirium is a condition that can
16 emerge after a number of consequences. It is usually induced by
17 alcoholism where a person reduces input of alcohol and that kind of
18 person can enter a state in which it has -- does not experience reality as
19 it is. That person acts in a strange way, has hallucinations which are
20 usually very important; they are very vivid, they are very dynamic
21 hallucinations that confuse the patient who already has a disturbed
22 perception of reality. And usually we describe this as a delirium state
23 of consciousness. That person has no perception of reality. That person
24 moves constantly, is very agitated, loses sleep or has disorders and sleep
25 rhythm, and that is a very dangerous medical condition. It can be deadly
1 if the person is not treated. That person is dehydrated, usually develops
2 other disorders.
3 This delirium state is recognised easily even by laymen. It can
4 come about after either a cessation of drinking or can be induced by a
5 severe medical illness, severe pain or surgery that an alcoholic
6 undergoes. These are usually the factors that lead to a state of
8 Q. Doctor, can I take from your answer that if there was a person
9 present in the room with us now who was suffering from a state of
10 delirium, even the lay people among us, that would be apparent to us, as
11 well as to yourself, that the person is in a delirium state?
12 A. Yes, most definitely. This is one of the most easily recognised
13 conditions in -- among psychiatric disorders.
14 Q. And according to Yugoslav law, under certain circumstances, could
15 a person in a delirious state be found to be significantly reduced or have
16 -- or be incompetent for the crime they were charged with?
17 A. The fourth category is most frequent among such patients but even
18 a third one is possible.
19 Q. Now, could you please describe for us or give us a definition of
20 reactive psychoses?
21 A. Reactive psychosis is a psychotic condition with a non-typical
22 clinical picture and can be induced by some kind of intoxication. It can
23 also be a consequence of another reason. For example, a person can take a
24 medication, can confuse and take a wrong medication. We usually see this
25 in suicide attempts, when people themselves select the medication they
1 will take. It is quite rare, and in forensic psychiatry, we don't see
2 this very often so this reactive psychosis is quite rare.
3 Q. And in certain circumstances that could be the basis for a finding
4 of diminished responsibility, correct?
5 A. No, no. Here we have significantly reduced accountability or
6 incompetency because this reactive psychosis has a level of psychosis.
7 Q. And finally, could you please describe for us what would be
8 described as post traumatic psychoses?
9 A. I will say right away that this is a post psycho-traumatic
10 psychosis, although it is called post traumatic psychosis. So let's not
11 confuse it. This is psycho-traumatic. This is a result of a physical
12 trauma to brain which can also be called wounding and leads to organic
13 changes in the brain tissue, and this is when we call this post traumatic
14 psychosis. In this case, it does not apply at all. It also leads either
15 to a significantly reduced accountability or incompetency.
16 Q. And, Doctor, for those of us who may have heard of the concept of
17 post traumatic stress syndrome, that is something completely different
18 from post traumatic psychosis, correct?
19 A. Yes, yes, that's right. Post traumatic stress disorder is a
20 condition that has no visible organic reason. It does not fall into the
21 category of psychosis. In the beginning, if you remember, we said that it
22 usually leads either to category one or two accountability. It does not
23 reach the level of psychosis.
24 Q. I'd ask you to continue on now with your description of exogenous
25 mental illness.
1 A. Now, we have reached a group of psychotic conditions with a
2 cognitive deficit, and here we have two group patients. One is mental
3 retardation. Mentally retarded persons are those that have never in their
4 life reached a such intellectual level. This is not a case with our
5 subject. It is out of the question, cannot be applied here. And the next
6 category where we see cognitive deficit is a group we call dementia.
7 Dementia are a deterioration of intellectual capacities which means that a
8 person that has at one point reached its intellectual peak and then
9 started deteriorating after that, can dement. So this takes place
10 in a gradual way. We have a strong, mild and minor dementia. Our
11 subject also does not fall into this category.
12 And finally we have a fourth category. These are dependencies.
13 They are quite widespread today in the entire world. One of them is
14 alcoholism. And it can be either something that goes with alcoholism as a
15 diagnosis, a chronic alcoholism, and within that we can also have an acute
16 state of inebriation.
17 Q. Okay. Now, can you describe for us what are the characteristics
18 of alcoholism without psychoses? Can you describe that for us a bit more?
19 A. Alcoholism which, as a rule, has no psychosis but we described
20 alcoholism with psychosis before. Everything else can be described as an
21 urge to have alcohol. A person in the beginning drinks less and then
22 develops dependency, and then once it becomes dependent, then we meet a
23 description that the subject used for himself. When he started drinking,
24 he had a need to drink more. In the beginning when he started drinking,
25 this need was not very strong, and as it grew, then he channelled all of
1 his activities in the direction of obtaining more drinks. In the
2 beginning, he frequently got drunk, but alcoholism as a diagnostic
3 category, as it progresses, the person loses all realistic criteria and
4 can get inebriated more frequent.
5 During that time, the person will develop his or her own state of
6 habits and we call this -- we have a special name for this in psychiatry.
7 That person does not change right away. That person becomes more merry
8 when in company, is usually popular but, however, with time, certain
9 social norms become neglected.
10 Alcoholism can leave consequences in a number of organs, mostly
11 gastrointestinal system, liver. Today we know for sure that there are
12 specific markers that can confirm chronic alcoholism. So what I said
13 about schizophrenia, that we have no indicators for that illness, does not
14 apply here. With alcoholism, we can find a number of indicators. There
15 is an enzyme produced by liver that is usually increased. There are very
16 frequent neurological changes that can be described as goose bumps, then
17 pain in lower extremities. Those are usual symptoms we meet in
19 Q. Doctor, before we conclude your discussion of the different
20 classifications, there are some other classifications that we do not need
21 to go into because they are not relevant in this case, but there are some
22 other classifications of mental illness, correct?
23 A. Yes. That's true. Here, under item 5, we listed miscellaneous
24 illnesses which fall into other categories but, however, they were not
25 brought up either by the colleague of mine that also did a report, nor
1 has it been mentioned by your side so we did not detail -- we did not
2 belabour that here in our report.
3 Q. But Doctor, before I ask you to describe for us the methodology
4 that you followed in your examination and evaluation of Mr. Vasiljevic,
5 can you please just give us the basic principles that a psychiatrist would
6 use in the evaluation of a new patient, where the psychiatrist does not
7 know any history or psychiatric history of the patient?
8 A. What we see here on this list is a school case example of how a
9 psychological state is determined. What we need to say is that we as
10 forensic psychiatrists are also serving as clinical psychiatrists because
11 the methodology that we use is a psychiatric one. And it is also
12 something that we do in order to answer your question, which is to
13 describe accountability. Psychiatry, just like other medical branches, is
14 a profession and a science which classifies the results of its work within
15 diagnosis. We say also that diagnosis is a base for determining
16 accountability. And in our daily clinical work, diagnosis is something
17 that we use in order to determine therapy. So this is why we could say
18 that the objective of our expertise is to establish a diagnosis which,
19 afterwards, would follow by determination of therapy, prognosis,
20 determination of accountability and so on.
21 Other things you might inquire about is ability to stand trial,
22 recommendation that we could give to the patient, and so on. I as a
23 forensic psychiatrist can also, upon finding that the patient has another
24 illness, will say that the patient needs to be treated for another
25 illness. So this is how we would reach the diagnosis. First of all, we
1 need to determine anamnesis or the history, medical history. This is what
2 in psychiatry is established based on the interview with the patient and
3 acquiring of various information, family information, any family
4 illnesses, pregnancy, labour, whether it was complicated or not, early
5 childhood, whether the patient was social, friendly, and so on, all the
6 way up until today. So we go through the whole life of the patient,
7 regardless of whether something that we are called to establish took place
8 yesterday or ten years ago.
9 Why is it so? Because we have excluding and including methods.
10 Inclusive methods are those that lead us to find symptoms that would
11 confirm the diagnosis, but if we find symptoms of something else, then we
12 would excludes this diagnosis and continue on with our work.
13 Q. Doctor, can I take from your answer that the term "anamnesis"
14 refers to the personal history that a psychiatrist would take from the
15 person who they are evaluating? Is that correct?
16 A. That's right, that's right.
17 Q. And would the psychiatrist believe or assume that every fact given
18 by the patient is true and accurate or would they attempt to determine
19 with other evidence whether or not the patient has given true and accurate
21 A. Yes. This is a heteroanamnesis. When we as forensic
22 psychiatrists work with patients, then what we usually see is that the
23 patients tell the whole truth because they come to see the doctor in order
24 for the doctor to help them. So when we train our students and
25 psychiatrists in forensic psychiatry, then the most difficult part is to
1 teach them how to discern what information is a truthful one. That is
2 actually a skill.
3 Q. Now, Doctor, can you tell us what the term heteroanamnesis means?
4 A. Well, this is how we reach the next degree, which is a
5 heteroanamnesis, and that is a verification of information which patient
6 gave us from somebody else, or perhaps this is something that the patient
7 himself did not remember and we obtained from another person. Most often
8 that other person is a spouse, parents, children of the patient,
9 colleagues from work, friends, classmates, et cetera. So somebody who
10 knows the patient well is a very good person for providing
11 heteroanamnestic information. This kind of information can be usually
12 very important when we have an acutely psychotic person that can give no
13 information on him or herself.
14 Q. In addition to anamnesis and heteroanamnesis, what else would you
15 customarily evaluate or look at when evaluating a patient?
16 A. Whether we evaluate the patient, then every medical documentation
17 is of great importance to us if it can tell us what is the medical
18 history of the patient. It is also important with respect to mental
19 illnesses and physical ones. What we in psychiatry consider to be most
20 important is listed under item 4, which is the patient's status. This
21 status includes both physical and psychological one. Physical status,
22 something that we in psychiatry consider to be sine qua non, where we base
23 on the facial expressions psychomotoric of the patient his line of
24 thoughts, his emotional state, his total cognitive intellectual mnestic
25 functions, together with anamnestic information, will lead to us determine
1 diagnosis. Psychological status in psychiatry is considered to be a base
2 for establishing diagnosis.
3 Q. Doctor, can you please first spell the word mnestic and ask you
4 describe what that means? You used the word "mnestic" and can you
5 describe what that means? You used the word "mnestic" function.
6 A. In psychiatry, we divide or we say that everything that is a
7 product of our brain is a cognitive side and those cognitive functions can
8 be divided into intellectual and mnestic ones. Mnestic ones refer to the
9 ability to remember and retain information that we remember. So that is
10 actually ability to intake new facts and retain them. It is very
11 important with patients that suffer from dementia.
12 Q. I ask you to spell that word in English so the reporters can
13 correctly record it in the transcript.
14 A. Mnestic.
15 JUDGE HUNT: I think that might be in B/C/S. Have we got it
16 anywhere in this document or in the doctor's report?
17 MR. GROOME: It's in the report, Your Honour, so...
18 JUDGE HUNT: Perhaps so that the court reporters can get it right
19 from the wording, can you look it up?
20 MR. GROOME: Yes, Your Honour.
21 THE WITNESS: Maybe I can show it. Yes, this one.
22 MR. GROOME:
23 Q. M-n-e-s-t-i-k?
24 A. Yes.
25 Q. Thank you, Doctor. Now, Doctor, what role do psychological tests
1 play in the evaluation of a patient?
2 A. Psychological testing is a routine method, in psychiatric
3 evaluation. However, it is not also mandatory testing for all categories.
4 Psychological testing would help in order to describe the personality of
5 the subject. Psychological methods are something that can be used to
6 assess the level of aggression easier. Psychological testing can also
7 help us establish which facts were not truthful. However, when evaluating
8 a subject, psychological testing used -- psychological testing is
9 something that is not entirely precise, that can tell us what is more
11 This testing can tell you that it is very likely that this person
12 has this personality or that personality but this testing cannot determine
13 with certainty what the personality exactly is. What is very important is
14 the following: Had I found that the subject or had I doubts that the
15 subject suffered mental retardation or dementia that could lead to a
16 change in his accountability, then I would call you up and say, "I'm
17 sorry, I cannot reach a conclusion without psychological testing." So in
18 order to evaluate cognitive deterioration, we need a psychologist. I
19 don't need a psychologist once I see that cognitive functions are okay.
20 For example, in my interview with my subject, we started off with
21 some basic questions, where are we, what the date is and so on, and then I
22 said, "Can you please tell me what 100 minus 7 is," and then I can measure
23 the speed, et cetera, of his answer. Then he told me 93. And then we
24 continued until I was sure that his cognitive functions were all right.
25 The subject also defined certain specific concepts and certain abstract
12 Blank page inserted to ensure pagination corresponds between the French and
13 English transcripts.
1 concepts to me. So psychiatry has a sufficient area of methods in order
2 to establish whether the person has a disorder or not. However, if the
3 person has a disorder, then we need psychological testing in order to
4 establish what level of disorder there is. So this is all I can tell you
5 about psychological testing.
6 Q. Are you testifying or telling us that, based upon your initial
7 interview with Mr. Vasiljevic, that you determined that additional
8 psychological testing would not be necessary for you to answer the
9 question that was put to you regarding Mr. Vasiljevic?
10 A. I would say that I -- it wasn't necessary to me. I didn't find
11 anything that I could not have solved without psychological testing.
12 Q. Can you describe for us the role that routine laboratory tests
13 would play in the evaluation of a patient?
14 A. Yes. If we have a demented patient, then it is very important to
15 look for the level of B 12 vitamin to see whether there is an
16 insufficiency of it. If I were to establish that the subject was
17 demented, then I would need a CT scan. So we never use routinely magnetic
18 resonance but only when we have a clinical picture that would require
19 this. It is important to run a routine lab test because we need always to
20 determine whether this medication is appropriate or not.
21 What is important with this subject is that his GT levels, gamma
22 GT levels were increased, and this was a further confirmation of my
23 clinical conclusion that he was a chronic alcoholic. So we do run a
24 routine lab test, and then based on clinical picture and symptoms, we
25 determine the other factors that we need to know.
1 Q. Now, I want to ask you to tell us with specificity the different
2 diagnostic steps that you took in your examination of Mr. Vasiljevic. I
3 would ask you at this stage just please to list them and perhaps, after
4 the break, we will begin to go into each of the different steps that you
5 took. Okay? So please just list the different steps that you took.
6 A. I here listed my work method in seven items. First of all, I used
7 information I gained from the documents provided to me by you, by the
8 Tribunal. I read it in detail and I attempted to gain as much as I could
9 from them. The second step was a part of psychiatric evaluation which is
10 a detailed anamnesis and it was a pleasure to work with this subject in
11 that area because he was a very cooperative subject. I then proceeded to
12 determine his present status. His physical status was not of great
13 importance because it had no great impact on his psychological status. I
14 also researched the existing documentation of this subject from the
15 detention unit in Scheveningen, which means that I had the results of lab
16 tests and also information on his therapy from the day he arrived in
17 Scheveningen to the day we held an interview. And finally, I also looked
18 into the opinion by Dr. Lopicic, who is a psychiatrist and who was the
19 first one to provide her expert opinion.
20 Q. And I would ask you just before we break, can you describe for us
21 what you have as number 7, the most important aspect of the diagnosis or
22 determining a diagnosis of Mr. Vasiljevic?
23 A. The most important, in fact, is that we, in addition to anamnestic
24 information, recognise and assess symptoms or indicators in the subject
25 that are key elements in order to determine diagnosis. I can claim with
1 certainty that what I have seen in this subject and what are used in
2 order to determine diagnosis, was based primarily on the documentation
3 provided to me by the Tribunal but also on the methods of the clinical
4 psychiatrist who has an experience of including and including certain
5 information and relevant knowledge, which means that this is what we
6 have. We saw the patient, we provide a diagnosis, and in order to
7 diagnose the patient retroactively, I used documentation and also
8 indicators of life-long diagnosis, which is something that helped me when
9 using the methods of exclusion.
10 MR. GROOME: Thank you, doctor.
11 JUDGE HUNT: We will adjourn now until 11.30.
12 --- Recess taken at 11.01 a.m.
13 --- On resuming at 11.30 a.m.
14 JUDGE HUNT: Mr. Groome?
15 MR. GROOME: Thank you, Your Honour.
16 Q. Doctor, I'd like to ask you to explain a little bit further -- in
17 a little bit greater detail something you said just before the break. You
18 used the term indicators of life-long diagnoses. Would I be correct in
19 saying that indicators would include both symptoms and signs?
20 A. Yes.
21 Q. Could you please describe for us what are symptoms?
22 A. Symptoms are clinical signs which the patient experiences
23 subjectively and which must be recognised by a trained expert. For
24 example, if someone has hallucinations, we shall see that his attention is
25 removed from the subject we are discussing and that the patient is
1 actually hallucinating. If I put a question to the patient, for example,
2 and I see that the patient does not understand me, I will repeat my
3 question and see whether his attention is disturbed or whether his whole
4 system of understanding is disrupted. These are symptoms which are very
5 significant for the establishing of a psychiatric diagnosis. If a patient
6 is talking to me, I tell him to stick to a certain subject but he leaps
7 from topic to topic, for me this is a significant symptom for the
8 recognition of his mental illness.
9 Signs, on the other hand, are for example whether someone has
10 tremour or whether his hands are trembling. That would be a sign because
11 both lay person and a professional will notice it, but a professional will
12 notice whether only the fingers are trembling, whether the hand is
13 trembling only when the patient is still or when he reaches out to take a
14 cup of coffee. A professional will distinguish several categories in this
15 trembling, each of which is specific to a particular diagnosis. A symptom
16 is subjective, a sign is objective.
17 Q. Now, in the treatment of a person with a diagnosed mental illness,
18 would it be important for the psychiatrist treating that person to record
19 somewhere the symptoms that they learned from the patient?
20 A. Yes. It's our duty to do so. We have to document the reason why
21 we are prescribing a certain medicine. In medicine, if something has not
22 been written down, it has not been done.
23 Q. Now --
24 A. This means excuse me, this means that if someone is delirious, I
25 give him Meprobamate but I did not write it down, tomorrow I will be held
1 responsible if that patient dies as if I had not administered the drug at
3 Q. Doctor, I'd ask you just to say the name of the drug again and
4 spell it for the people transcribing what you're saying?
6 Q. That's spelled M-e-p-r-o-b-a-m-a-t; is that correct?
7 A. Sorry, the third from the end is an "M".
8 Q. Thank you, doctor. Now, Doctor, in trying to evaluate what the
9 psychic condition of a person was at a time previously, and that -- I'm
10 sorry, the task is to determine what a person's psychic history was at
11 a previous period in time and in your anamnesis the patient describes for
12 you having certain symptoms, such as certain hallucinations or certain
13 different disturbances of thinking, would it be important to determine
14 whether or not at the time they were treated for that illness, whether or
15 not the treating psychiatrist recorded those symptoms?
16 A. You see, in forensic psychiatry, this is very important, because
17 if someone was psychotic, in the former Yugoslavia, these persons were
18 always hospitalised, and if I want to establish with certainty that this
19 happened, I have to ask why he was not hospitalised, because psychoses
20 were always treated in hospital.
21 Q. Okay. But one of the diagnostic tasks that you describe for us
22 was to examine the history as provided by the patient against other
23 independent information to determine whether it's true and accurate,
25 A. Yes.
1 Q. So part of that process would be to ascertain if symptoms
2 reported by the patient were observed by other people back at the time
3 they were treated for that illness, correct?
4 A. Correct.
5 Q. Now, Doctor, you've described the method that you used in
6 examining Mr. Vasiljevic. Did you examine Mr. Vasiljevic and did you
7 write a report regarding his condition?
8 A. Yes, I did.
9 MR. GROOME: Your Honour, at this time the Prosecution would like
10 to tender three documents: Prosecution document 168, which is the
11 Serbo-Croatian version, the original version, of the doctor's report;
12 document 168.1, which is the English translation of that report; and
13 document 173, an English version of the Doctor's CV provided by the Doctor
15 JUDGE HUNT: Any objection, Mr. Domazet?
16 MR. DOMAZET: No, Your Honour.
17 JUDGE HUNT: You've got the B/C/S version of the CV?
18 MR. DOMAZET: Yes, Your Honour.
19 JUDGE HUNT: Thank you. Should that be in evidence, the B/C/S
21 MR. GROOME: It's available here, Your Honour, and we can
22 certainly introduce it. The English version, Your Honour, was not a
23 translation but one provided by the doctor. That's why I wasn't entirely
24 sure we needed to put in both.
25 JUDGE HUNT: All right. Well, at this stage we will only put the
1 English one in. Exhibit 168 will be the B/C/S version of the doctor's
2 report. What was the date of the report?
3 MR. GROOME: Just a minute, Your Honour, the date of the report is
4 the 17th of December, 2001.
5 JUDGE HUNT: Thank you. Exhibit 168.1 -- sorry, P168.1 will be
6 the English translation of that report. Exhibit P173 will be the English
7 translation of the witness's curriculum vitae. Thank you.
8 MR. GROOME:
9 Q. Now, Doctor, I'd like at this point in time to return to the
10 different types of mental illness or psychoses that you've described for
11 us and could you -- if you would name them for us and then describe for us
12 your findings after your evaluation of Mr. Vasiljevic. And I would ask
13 you to begin with the endogenous or functional psychoses.
14 A. As you can see here, we use the same order as was the order in the
15 classification. We will begin with endogenous or functional psychosis.
16 The first of these is schizophrenia. Based on a detailed examination, a
17 discussion of previous symptoms, an inspection of all previous medical
18 documents for three hospitalisations and an inspection of the therapy
19 administered in Scheveningen, I found no indication that Mr. Vasiljevic
20 ever suffered from schizophrenia.
21 Q. Now, Doctor, you examined the medical records of Mr. Vasiljevic in
22 the detention centre, is that not correct?
23 A. Yes.
24 Q. And there is a psychiatrist assigned to the patients at the
25 detention centre; is that correct?
1 A. Yes. Dr. Vera Popovic, whom I know personally. She is a
2 consulting psychiatrist in Scheveningen.
3 Q. And is she is psychiatrist in good standing in the Republic of
5 A. She is a very good psychiatrist in the former Yugoslavia.
6 Q. After examining the medical records from the detention centre,
7 were you able to determine whether or not Mr. Vasiljevic is currently
8 receiving any medication for schizophrenia?
9 A. Yes, I was able to do this, and to ascertain that Mr. Vasiljevic
10 is not receiving any antipsychotic therapy, either for schizophrenia or
11 paranoid psychosis or affective psychosis. Mr. Mitar Vasiljevic now and
12 several months before my examination, has not been receiving any drugs
13 used to treat any mental illness or disorder. A special group of drugs
14 are used for psychosis, antipsychotics. Throughout the time of his stay
15 in Scheveningen, Mr. Mitar Vasiljevic never received antipsychotics.
16 Q. I believe you told us before that schizophrenia is a life
17 psychosis. Can we take from that that if Mr. Vasiljevic suffered from
18 schizophrenia in 1992, that at present, he should be receiving some
19 medication for that condition even today?
20 A. Yes. He should be receiving medication but I can say, with
21 certainty, that nowhere in any of the documents or in my conversation
22 with him or in his psychic status, nowhere have I found anything to
23 indicate that Mr. Vasiljevic may be suffering from schizophrenia. And
24 this includes the fact that he is not receiving any therapy.
25 Q. And if by some mistake, he was not receiving the appropriate
1 drugs, would you expect to see some symptoms of schizophrenia in
2 Mr. Vasiljevic today?
3 A. Yes. Because he has been in detention for two years now, the
4 period is too long for schizophrenic patient to remain in remission
5 without therapy.
6 Q. Doctor, in your practice and your experience, have you ever come
7 across exceptions to this principal that you are now describing for
8 us, that in life psychosis we must always see either therapy, medication
9 for the disease, or illness, or symptoms of the illness? Have you ever
10 seen an exception to that principle?
11 A. Never both. I have never seen anyone who had schizophrenia who
12 lived for ten years without either symptoms or signs or therapy.
13 Q. I'd ask you now, the next category of psychoses, paranoid
14 psychoses, and what were you able to determine regarding whether Mr.
15 Vasiljevic did or did not have paranoid psychoses back in 1992?
16 A. As in the case of schizophrenia, I can assert that no description
17 of an event, no anamnestic datum, no symptom or sign or therapy, have
18 awakened a suspicion in me that Mr. Vasiljevic may be suffering from
19 paranoid psychosis. During his two years of detention in Scheveningen, he
20 never received any drugs which are used to treat paranoid psychosis.
21 Q. I'd ask you now to answer the same question regarding affective
23 A. My answer is identical in the case of affective psychosis, all
24 the more so as the frequency of changes in the disorder is even greater
25 than is the case with schizophrenic and paranoid episodes. That is why in
1 modern psychiatry, apart from drugs to treat affective psychosis,
2 so-called stabilisers of moods are also used, the function of which
3 is not only to treat symptoms but also to protect the patient or rather to
4 prevent the symptoms from reappearing. I might say that it is almost the
5 duty of the psychiatrist looking after the patient to continuously
6 administer stabilisers of moods to a person who is suffering from
7 affective psychosis.
8 Q. Doctor, before we move to exogenous psychoses, I want to ask you
9 the same question regarding paranoid psychosis and affective psychosis
10 that I asked you about schizophrenia: In your practice and experience,
11 have you ever come across an exception to the principle that you've
12 described here?
13 A. No.
14 Q. Now, Doctor, I'd ask you to move to your evaluation of
15 Mr. Vasiljevic regarding the exogenous or symptomatic psychoses.
16 A. When talking of exogenous psychosis, we are entering into an area
17 which is relevant in the case of Mr. Vasiljevic. On the basis of my
18 conversation, my interview with him and the anamnestic data and the
19 symptoms and signs, I endeavoured to establish a diagnosis for the period
20 that he spent in hospital several days after he broke his leg. We now
21 arrive at the fact that my primary diagnosis is delirium. I based this
22 diagnosis mainly on the medical documentation and only then on what I was
23 able to obtain from the gentleman. Then and today, I feel that in the
24 days after he broke his leg, he was suffering from delirium.
25 Q. Doctor, I think perhaps the best way for us to proceed, if we can
1 go through the different illnesses and let's identify those illnesses
2 which you found or determined that he did not have and then we will spend
3 a significant amount of time on your diagnosis regarding the illnesses
4 that you found he may have had, okay?
5 A. Okay.
6 Q. Alcoholic psychosis, can you just summarise in a sentence or two
7 your findings regarding that?
8 A. I cannot say with certainty that he was not suffering from
9 alcoholic psychosis, because some of the symptoms listed are specific to
10 alcoholic psychosis but they are not sufficient for me to establish a
11 diagnosis with certainty. Alcoholic psychosis is one of the
12 possibilities, so he may have been suffering from it at the time.
13 Q. Delirium, I believe, you've given us a brief summary of your
14 findings there. I'd ask you to move to reactive psychosis.
15 A. I did not find any symptoms or signs which would indicate that the
16 gentleman was suffering from reactive psychosis.
17 Q. Can you tell us about post traumatic psychosis?
18 A. We can exclude this with the greatest certainty because the
19 gentleman did not suffer from any trauma to the brain. This was not in
20 his anamnesis and he had no symptoms or signs that he was suffering from
21 this psychosis.
22 Q. Can you please tell us what your findings are regarding any
23 disorders related to cognitive deficits?
24 A. The subject is now older than he was at the time of the commission
25 of the crimes he is charged with. So that if he now has no signs of
1 cognitive deficit, it is quite logical to conclude that he did not have
2 them at the time. I do not mean to say that his cognitive capacity is now
3 the same as it was when he was 20 years old, but in psychiatric terms, his
4 cognitive capacity corresponds to his age and his education.
5 JUDGE HUNT: Mr. Groome, I wonder whether cognitive capacity is
6 meant to be some sort of a permanent state or whether it can be
7 affected, for example, by alcohol. I'm sorry to keep coming back to that
8 but it seems to me we have got to have it made very clear to us,
9 especially as we are dealing with what the law is in somewhere that we are
10 not familiar with.
11 MR. GROOME:
12 Q. Doctor, can you please describe for us the relationship between
13 cognitive ability and alcoholism and intoxication?
14 A. When we speak of cognitive capacity, this is something that is
15 a permanent characteristic of our capacity. We cannot say that cognitive
16 capacity is reduced by intoxication but we can say that a person who has
17 taken alcohol has reduced attention, which is one of the elements of the
18 cognitive functions. This means that a person under the influence of
19 alcohol does not have full attention capacity. Cognitive capacity would
20 then seem to be deficient but not because of an a priori capacity but
21 because attention is diminished and the ability of the subject to test and
22 to carry out his tests is reduced. So the basic capacity remains the same
23 and is unchanged but the results of evaluation under the influence of
24 alcohol may be altered because the attention is altered.
25 Q. And putting actual intoxication aside for a minute, can you
1 describe for us the interaction between alcoholism and cognitive ability?
2 A. When alcohol is consumed over a long period of time, that is in
3 chronic alcoholism, cognitive functions may deteriorate and this is
4 something that I bore in mind during my examination, and for this reason,
5 I put certain questions to the subject, questions which we put in cases
6 of a possible deterioration. This is, first of all, the mini mental test
7 where the gentleman has to reply to questions such as what is love, what
8 is happiness. He has to define concrete terms. I examined the basic
9 mathematical processes. The gentleman even drew a pentagram. We have
10 criteria by which we can evaluate whether his cognitive capacity has
11 deteriorated or not, and the gentleman passed all these tests
13 Q. And did you see anything when you conducted these mini cognitive
14 tests to indicate that perhaps additional psychometric testing was needed?
15 A. No, I did not. If I had found this, if I had been unable to reach
16 a conclusion, I would have told the Court. I would have asked for this to
17 be done before I signed my expert opinion.
18 Q. Doctor, let me take you back to the original two questions you
19 said were the key questions to be answered by a forensic psychiatrist.
20 Assuming that a person had sufficient cognitive ability to understand the
21 consequences of his actions and to control his behaviour, how would the
22 level of intoxication affect the answer to those two questions?
23 A. Intoxication as such can influence the second part, control of
24 one's actions, and that is why an acutely intoxicated person is classified
25 under category two, that is, diminished responsibility.
1 Q. So an acutely intoxicated person would always maintain the
2 capacity to understand the consequences of their action; is that correct?
3 A. Yes, that is correct. There is a diminishing. That is why that
4 person can be placed in category two.
5 Q. And that's diminished but not significantly, correct?
6 A. Yes.
7 Q. Now, Doctor, I'd ask you to return to what, if any, findings you
8 made regarding Mr. Vasiljevic in the area of dependencies.
9 A. You mean alcoholism?
10 Q. Yes. Would you please discuss that?
11 A. According to all the criteria, Mr. Mitar Vasiljevic satisfies the
12 criteria for the diagnosis of chronic alcoholism. One of the tests that
13 confirmed this is the test that the doctor who did the expert opinion
14 before mine did. Then everything that the gentleman himself told me, and
15 I have described this in my report, this is fully consistent with a
16 diagnosis of alcoholism. And this is -- this also includes the increased
17 gamma GT values which I found in his medical records in Scheveningen. So
18 I have no doubts and I can say with certainty that Mr. Mitar Vasiljevic
19 meets all the criteria to be diagnosed as a chronic alcoholic, and this
20 can be seen from his medical records both from his first and his second
21 hospitalisation. I have no doubts about this.
22 Q. Doctor, we have now gone through all of the categories of mental
23 illness that we've discussed earlier and am I correct in saying that the
24 only two mental illnesses which you conceive a possibility that
25 Mr. Vasiljevic suffered from at a prior time in his life are delirium and
1 alcoholic psychosis?
2 A. Yes. I do not have any dilemmas as to whether he suffered from
3 them. I only have doubts as to whether which one of the two he suffered
5 Q. Doctor, I'd ask you now to move to the next sheet and let's talk
6 in greater detail about both of these diagnoses. In your opinion, which
7 is the most probable of the two?
8 A. Based on my opinion, the most probable diagnosis is delirium.
9 Delirium in the classification is described as a state where a person is
10 completely disturbed and meets the requirements and symptoms needed for
11 delirium. In modern classification, there are two types of delirium,
12 among others, and those two types are delirium caused by alcohol
13 deprivation, which I think to be the most likely case here. The subject
14 went -- underwent surgical operation. And the other kind of delirium is
15 induced in alcoholics when they have some kind of a somatic illness. So
16 Mr. Vasiljevic was an alcoholic. At one point he came to a hospital due
17 to a fracture of two bones on his leg, and he was fixated because of that.
18 He wasn't able to acquire any more quantities of alcohol. He himself has
19 told us that he was able to obtain some small quantities of alcohol in
20 the beginning but that wasn't possible later on. So that means that he
21 first reduced the quantity of alcohol and then he completely ceased taking
22 alcohol. So he also underwent a very complicated surgery, he experienced
23 severe pain, and also had alcohol deprivation. Symptoms appeared all of a
24 sudden. He came to the hospital and no signs of any mental illness were
25 observed. And then an orthopaedist who was in charge of him recognised
1 him as a pre-delirious patient and also said that he was agitated and
2 confused and had incoherent ductus, which is something that I have said
3 before today that is specific for this type of psychosis, and he was -- he
4 received a therapy which is not entirely consistent with a delirious state
5 but in consultation with another doctor, I received a very satisfying
6 explanation, which is that in that period of time, they had a great
7 shortage of medication, so they treated patients with whatever they had
8 and not with optional medication. So based on that, I believe that Mr.
9 Vasiljevic entered a delirious state in which, based on the requirement of
10 an orthopaedist, he was transferred to the psychiatric ward.
11 Q. Doctor, I want to go step by step of different aspects of the
12 conclusions that you drew. First question I want to ask you: Are the
13 observable symptoms of delirium, are they the same or similar whether it's
14 caused by alcohol or caused by -- you describe the physical injury and
15 subsequent treatment. Are the symptoms the same or similar?
16 A. Clinical picture is identical.
17 Q. Can we just confine ourselves now, can you give us a detailed
18 description of those symptoms? What would a psychiatrist be able to
19 observe in the patient and, for any of those symptoms which would be
20 observable to a lay person, would you please also describe those?
21 A. Both a psychiatrist and a layman would very soon be able to
22 recognise a clinical picture of a disturbance, of a very strong
23 psychomotor restlessness. The person was sweating profusely, asking for
24 things from people. The person was confused. And what is very important
25 is that the person almost always has visible hallucinations. This person
1 gives a manifestation of those hallucinations, shows reactions, wonders,
2 tries to communicate. So this person is out of touch with reality.
3 What is most important is that this person not only has
4 hallucinations but is also susceptible to suggestions which means the
5 person has illusions. A person in delirious state, you can give this
6 person, for example, a white piece of paper and ask him what can he see?
7 And then he will probably not answer, and then if you asked him well,
8 isn't your name written on this paper, then the person will most likely
9 confirm this. So this person can be easily influenced and is susceptible
10 to suggestions. And this is what we usually look for in cases where a
11 will is disputed. We are looking for this.
12 Persons in delirious states usually have tremour, which is
13 trembling of fingers. So this is one of signs of delirium.
14 A person does not test reality and cannot control his or her
16 Q. Before I move away from the symptoms, have you told us all of the
17 common symptoms of delirium? Are there any other ones you wish to add?
18 A. Something that can be of importance is the duration of these
19 symptoms. Delirium comes on suddenly and quickly, and a patient, if
20 appropriately treated, will fall asleep and, upon being awakened, the
21 patient will lose these productive symptoms or these hallucinations or
22 illusions. The person will look tired and exhausted.
23 Q. Now, in the medical records that you looked at regarding
24 Mr. Vasiljevic, a physician describes him on the 8th of July or sometime
25 in July, I believe it's the 8th, as having pre-delirium state. Are there
12 Blank page inserted to ensure pagination corresponds between the French and
13 English transcripts.
1 symptoms which are recognisable just prior to the onset of full delirium?
2 I'm sorry, the date was the 5th of July.
3 A. You see this is a state described by my colleague, and is easily
4 recognisable. Not all of the symptoms have been met for delirium but some
5 that were important to him were met. He unfortunately did not list all
6 the symptoms, but when he wrote pre-delirium signs, I recognised that to
7 be agitation, disorientation, confusion and tremour, because tremour is a
8 sign. So if my colleague put in a sign, then that means that he had in
9 mind tremour, although unfortunately he did not specify so.
10 Q. Also in the record is the term "incoherent ductus". Can you
11 please describe for us what that means?
12 A. Incoherent ductus is something that points more to delirium than
13 to psychosis because we in the traditional psychopathology, when we meet
14 a patient with a disturbed line of thoughts, then we have something
15 that is specific for endogenous psychosis which is an unspecified --
16 dissociated ductus, and the other one is typical for dementia and for
18 Let me give you an example. Both of them are confused but in a
19 disassociated ductus, a person will drift away from a topic, get another
20 topic which means get a new association, which will turn in lead to
21 another association, so the person will get more and more distant from the
22 original topic. When we have an incoherent ductus, the person will jump
23 from topic to topic but will remain within the bounds and eventually go
24 back to the primary association.
25 The textbooks describe incoherent ductus as a broken mirror that
1 remains within the frame and its pieces are not shattered but have
2 remained within the frame. And this is one of the skills taught in
3 psychiatry so that we can recognise this easier and quicker than somebody
4 who is not a specialist. So incoherent ductus is significant for organic,
5 short term and provisional disorder, and the other one is a life-long
6 diagnosis. Disassociated ductus is a lifetime diagnosis and this is
7 something that we use very widely to determine our opinions.
8 Q. Can you explain for us why is it that incoherent ductus is more
9 indicative of delirium than alcoholic psychosis?
10 A. Because delirium is a more intense state, and a consequence of
11 changes unfamiliar to us but nevertheless intense organic changes in the
12 body, whereas psychosis is somewhat less intense and mostly has manic
13 contents than contents that have to do with attention and brevity.
14 Q. Now, Doctor, I'd ask you to explain in greater detail what you
15 found to be the causes of this delirium in the accused, Mr. Vasiljevic.
16 A. I would agree that both important reasons led to delirium. On one
17 hand, we had alcohol deprivation, and the other one was the pain caused by
18 a fracture and ensuing surgery, and pain associated with that. Both
19 criteria were present and both are fully sufficient to induce a delirium.
20 And since both of those factors were present, then it is acceptable to me
21 that both of them participated in determining a clinical picture that was
22 presented to us.
23 Q. Could the treatment of an injury in which a patient was fixed in
24 traction, unable to move, could that also be a contributing factor to the
1 A. No, I wouldn't say so. In the -- our sources, this was not
2 listed as such. Indirectly, it could have led to that because he wasn't
3 able to obtain alcohol and it was difficult to obtain it in hospital. But
4 hypothetically speaking, had he not been fixed, perhaps he would have
5 gone and obtained some quantities of alcohol. So if abstinence is to
6 blame, then this would have been prevented.
7 Q. I want to take each of those causes that you've described for us
8 separately. Let's take alcohol abstinence first. What period of time in
9 your experience transpires between the last consumption of alcohol and the
10 first signs of on set of delirium in a person with Mr. Vasiljevic's
11 alcoholic history?
12 A. As a general rule, we are usually taught that the duration can be
13 within several hours to several days. Additional definition says, as a
14 rule, less than seven days.
15 Q. Now, let's look at the other case, the case of physical injury.
16 In your experience, what would you expect to be the time period between
17 the time of the physical injury and the first signs of the onset of
19 A. Also from several hours to several days. They did not specify how
20 many days here, and in our textbooks we are usually told several -- up to
21 several days.
22 Q. Are you able to tell us when it is that Mr. Vasiljevic suffered or
23 when was the onset of this delirious state?
24 A. Well, based on documentation available to us from the third
25 history, patient's history, one of doctors wrote that the date was -- just
1 a second, please -- it says here on the 8th. Let me quote, please. "The
2 history, patient's history tells us that the first decursis morbi was
3 registered on the 8th of July, 1992, in which it says the patient, on a
4 previous day, was transferred from an orthopaedic ward. On an additional
5 piece of paper dated 5th of July, Dr. Stojkovic says the following. I
6 quote: On the 5th of July, 1992, at 0900 hours, a psychiatric examination
7 was requested. Patient showing signs of a pre-delirium stage.
8 Based on that, I can conclude that pre-delirium or delirium
9 commenced on the 4th or 5th of July, 1992. I am not able to give any
10 other interpretation. This is the only thing that I can take as an
11 indication of an onset of this state.
12 Q. Was there anything in the medical records that indicated to you
13 the state of the -- of Mr. Vasiljevic's psyche at the time he was
14 admitted to the hospital?
15 A. I will also quote to you. Dr. Jovicevic, an orthopaedist, said
16 the following: The patient was admitted as an urgent case, condition on
17 admittance: conscious, oriented, does not have fever, actively immobile.
18 Q. And what do you conclude from that observation of Mr. Jovicevic?
19 A. I concluded that as far as psychiatric elements are concerned, the
20 patient was all right, his consciousness was fine, he was oriented, which
21 means that he perceived reality well, both as far as he's concerned and
22 the environment around him, and that this disorder commenced on the 4th
23 or on the 5th, when his treating orthopaedist asked for an assistance from
24 psychiatrist and then transferred him to a psychiatric ward due to his
25 psychological condition, which, as I said, is consistent either with
1 delirium or alcoholic psychosis. I believe it was delirium but I cannot
2 with certainty exclude the possibility of alcoholic psychosis, although I
3 believe it to be less likely based on everything that is available to me
4 right now.
5 Q. Doctor, a few answers ago, you used the term decursis morbi,
6 and that's d-e-c-u-r-s-i-s morbi, m-o-r-b-i. Can you please define that
7 term for us?
8 A. I apologise for using medical terms. It's a term we typically
9 use for every patient who is in a post operative stage or is at an
10 intensive care unit. For example, if I have psychiatric patient, then we
11 have an obligation to at least once a day, or now even twice a day, give
12 brief description of a patient's condition. So I'm not going to repeat
13 every time patient is calm, "patient is calm." I am instead going to list
14 the pathology that I find. So I as a psychiatric -- forensic psychiatrist
15 don't believe it to be significant when the patient is showing more
16 symptoms because we as a routine will list only the pathology. So I'm not
17 going to always write, for example, "the patient is calm," no, but I'm
18 going to write it down if he's not calm. So this is what we normally call
19 decursis morbi. This is a daily description of changes, if we can call
20 them that, in patients's condition. We will always write what is
21 important. We will always write any new elements and whatever needs to be
22 treated. These are the things that we will normally list.
23 Q. Now, Doctor, you are -- received your medical training in
24 Yugoslavia. Are doctors in the ordinary course, before they specialise,
25 are they trained to recognise conditions such as delirium?
1 A. Yes. I will describe that with just a few sentences. Every
2 doctor in the former Yugoslavia, and these laws have not been changed yet
3 either in Croatia or in Croatia or in any other part of the former
4 Yugoslavia, so doctors have to graduate from the school of medicine. They
5 have to become general practitioners first. Then they take a state
6 examination and become qualified to conduct routine work with patients,
7 routine work in all specialties of medicine. We have to detect, we have
8 to discover, disorders. We don't have to give a precise diagnosis.
9 However, we have to be able to recognise what is going on, write it down
10 and then send the patient on to a specialist, if needed. But some of the
11 disorders which are not urgent can also be treated by the general
12 practitioner himself. So after this basic training, doctors will
13 proceed on to specialize. So my basic training from the area of surgery,
14 for example, is not detailed. But if my patient, for example, falls down,
15 then I have to determine whether the patient, for example, has a fracture,
16 because I am a general practitioner as well. And this applies to all
17 doctors in the former Yugoslavia.
18 Q. Based upon your experience, is it possible that Dr. Jovicevic, at
19 the time he admitted this person into the hospital, is it possible that
20 the person could have been suffering from delirium but Dr. Jovicevic just
21 failed to recognise that?
22 A. No. I cannot assume that, because the colleague, my colleague
23 wrote something down. He didn't write down much but he did write,
24 conscious and oriented. Basic symptoms in psychotic disorders is that
25 persons are disoriented. So if the doctor had not written down
1 anything then I perhaps could question whether this was present or not but
2 now I don't have any dilemmas because he recognised this state. It's
3 written down here that the patient was conscious and oriented, so I have
4 to believe what's written there. It's a document.
5 Q. I want to now ask you about alcoholic psychosis. Can you briefly
6 describe -- you've talked about it in the context of talking about
7 delirium. Is there anything else that you would like to add regarding
8 your diagnosis that that possibly also could have been present during this
9 time period you are now telling us about?
10 A. Well, you see, in my written opinion, I elaborated in great
11 detail possibilities whether there was a delirium or psychosis there.
12 Let me explain why I believe this was a delirium, because his confusion
13 was greater so this implies to delirium. Patients who are experiencing
14 psychosis have hallucinations but they are not as intense, their
15 illusions are not as intense. So I lean towards the diagnosis of
16 delirium. But, however, the doctor that released him from the hospital
17 but a diagnosis of unspecified psychosis, so I am prepared to accept that
18 diagnosis as possible as well. All the more so because we are now
19 examining this patient not because we need to treat him but because we
20 need to assess his accountability at the relevant time. Accountability is
21 important both for delirium and alcoholic psychosis.
22 For you, as the Court, this dilemma is not as important perhaps as
23 it would be for somebody else who would be analysing all this but from a
24 practical point of view for the Court, this is not the most important
25 thing. What is important here? It's important to establish the day the
1 disorder commenced. And the number of symptoms, I don't think is that
2 relevant right now. This is why I wrote in my opinion that this was more
3 likely delirium than psychosis but both of these diagnoses would bring me
4 to a conclusion that at the relevant time, as the patient was suffering
5 from this, he was unable to control his acts and to understand the meaning
6 of the acts committed to him at that time. So accountability will not
7 change whether it is one or the other diagnosis.
8 Based on the intensity of the disorder, these two diagnoses are
9 almost identical and would lead to the same conclusion. At the time when
10 the patient was suffering from this, which is several days prior to coming
11 to the hospital and up until his release from there, he was in a condition
12 of psychological incompetency.
13 Q. Doctor, just so that we are clear, you've told us about when you
14 believe the onset of delirium was. Is there a possibility that alcoholic
15 psychosis had a different onset or have you found that it's the same
17 A. No.
18 Q. So that it is the same onset?
19 A. Yes, yes. I believe that it was the same onset but there were
20 perhaps some differences in the clinical picture, but as far as the onset
21 is concerned, whether it is delirium or a psychosis, this all falls within
22 the description of -- that is given to us by the doctors that treated him
23 at the time.
24 Q. And you've told us that you believe -- well, let me ask you in
25 this manner: This acute psychosis of delirium, did it end upon, in your
1 view, upon his discharge from the psychiatric ward of Uzice hospital?
2 A. Yes. I have to conclude that based on what the subject told me.
3 He told me that during last two days, he had observed that he was in a
4 better shape than other patients there, that he did not belong there any
5 more, and when his wife came to see him, he asked to be released. In the
6 medical documentation on the day he was discharged, it says the
7 following: 28th of July, 1992, patient looks normal, calm. Based on
8 spouse's request, he is discharged.
9 So the doctor that discharged him from the hospital did not write
10 down anything that would indicate that there were persistent mental
12 Q. Now, Doctor, to ask you hypothetically, if this case were
13 presented to you back in the former Yugoslavia and you were called upon to
14 make a determination regarding the accused's accountability for crimes
15 that he is charged with during the month of June, prior to the
16 hospitalisation, would you have an opinion regarding his accountability?
17 A. You see, I take the dates on the face of what is given to us in
18 the medical history. If we should accept that he was admitted on the day
19 he is -- he is admitted, then I would reply the following. For the period
20 prior to hospitalisation, I believe that for certain acts, the subject
21 could be accountable and have accountability either in the first category
22 or in the second category or in his acutely inebriated state for the
23 acts that he is charged with. So we had alcoholism in the beginning which
24 could have been either constant or could have been an acute intoxication,
25 in which case his accountability would fall into category two. And in the
1 alcoholism itself, his accountability would fall into category one.
2 Q. Based upon your findings, is there anything to lead you to believe
3 that prior to his hospitalisation, that he may have had a mental illness
4 which would have made him significantly unaccountable -- I'm sorry,
5 significantly diminished accountability or completely incompetent?
6 A. I have to state what I learned from Mr. Mitar Vasiljevic himself
7 here. In an exhaustive conversation about this period, he stated that at
8 that time, he suffered from a certain fear, he was afraid for his
9 children, and Mr. Mitar Vasiljevic was a person who cared very much for
10 his children. He was worried that something might happen to him after
11 certain problems, he returned to the town, he was cleaning the town
12 again. He was no longer as afraid for himself as he had been before when
13 he felt that the route he was taking was very dangerous and that his life
14 was threatened, but this fear was not of an intensity that would justify
15 our saying that it was not normal, because it was normal to be afraid
16 during wartime.
17 Mr. Mitar Vasiljevic was someone who always looked after
18 his children. He moved to Belgrade, they moved to Belgrade. He visited
19 them. He was concerned for them. And certainly under wartime conditions,
20 this was stressful for him. He told us that he used to go to work
21 cheerfully but that when the war broke out, he was under the impression of
22 wartime. However, there is nothing in the medical documentation to
23 indicate a disorder that would take him beyond the first or second
24 categories of accountability.
25 Q. Can I summarise your answer in the following way: That had
1 you been presented this case as an expert for the courts of Yugoslavia,
2 based on your evaluation, you would not have found him to have either a
3 significantly diminished accountability or to be incompetent at the
4 time prior to his hospitalisation?
5 A. Correct.
6 Q. Now, Doctor, in assessing the onset of these psychoses, is it
7 important in your anamnesis to find out from the subject what their
8 recollection is of the day of the crime and certain facts that they can
9 provide around the time of the crime? Is that important?
10 A. I have to say that Mr. Mitar Vasiljevic denies committing the
11 crime and the only response I got from him was that he did not take part
12 in it. Are you referring to his description of the day in question?
13 Q. Yes. What I'm asking you now is his descriptions regarding his
14 interaction with other people, despite whatever denials he makes, are they
15 important in your evaluation? Is his memory about that day important and
16 can you tell us what are your findings if they are?
17 A. Yes. When you read my expert opinion, it is quite clear that I
18 describe in great detail two days where I tried to show fully what
19 Mr. Mitar Vasiljevic told me. I had a professional goal when I did this,
20 and that was to show that, on those days, he did certain things logically
21 in accordance with his usual mechanisms. He remembers details. Had he
22 been demented at the time, there would be gaps in his memory. Had he been
23 psychotic, his attention would have been different, but the gentleman
24 describes very coherently who he was with, whom he saw, why he went to
25 look for a horse, what the horse was like. He remembers the cries of the
1 children commenting him on a horse. He remembers the fall. He remembers
2 that the ambulance driver arrived. So this is told in chronological
3 order. There is no confusion. There are no gaps in the memory. There is
4 nothing to indicate that he was not testing reality. He remembers being
5 brought to the hospital. He remembers there was no ambulance available,
6 that they were waiting for them. So it's not just a question of cognitive
7 functions but his attention, and this is always disturbed when there is a
8 psychosis, but he was able to pay attention and to register, to remember
9 what events followed what other events in sequence. So I cannot talk
10 about the crime because he is denying it, but I can say that on that day,
11 he -- his accountability is certainly not beyond category two. He told me
12 that he drank quite a lot on that day. He told me what he drank and with
13 whom, but he himself thinks that he was tipsy rather than drunk.
14 Q. Let me ask you a specific question about his own perception of
15 himself as tipsy rather than drunk. What precise time period was he
16 referring to when he said he was tipsy rather than drunk?
17 A. That day. The day in question.
18 Q. Is that the same day that he says he fell off the horse?
19 A. When he fell, yes, yes.
20 Q. And a person who was, as you describe, tipsy, that level of
21 intoxication, where would that make that person fall in the category?
22 A. Less than if he were drunk.
23 Q. But would they be fully accountable or diminished --
24 A. Well, you see, when the patient says this about himself, we take
25 it with a certain reserve. Let's say that he was drunk, let's take the
1 worse version. He would still be in category two. In view of what he
2 said he drank on that day, I would say that he was drunk and that his
3 accountability was diminished but not significantly.
4 Q. If we were to accept Mr. Vasiljevic's own assessment that he
5 wasn't drunk but tipsy, would he still be in category two or would he be
6 in category one?
7 A. Well, that depends on the level. Since we do not know, I would
8 put him in category two because he listed all the things that he had
9 drunk. I don't remember the name of the person he drank with but the
10 chronology of the day and all the drinks he had, I think, would put him in
11 a drunk state.
12 Q. Doctor, I want to move to some other, more isolated, issues that
13 have arisen regarding the psychic condition of Mr. Vasiljevic at the time
14 of these crimes. A witness by the name of Dr. Vasiljevic, Radomir
15 Vasiljevic, a local doctor in Visegrad, reported that in the early part of
16 June, that when he treated Mr. Vasiljevic, that he observed some symptoms,
17 including Mr. Vasiljevic or the accused hearing voices and other symptoms
18 that he perceived to be evidence of psychosis. I'd ask you to comment on
19 Dr. Radomir Vasiljevic's observations of the accused.
20 A. Well, you see, Dr. Vasiljevic, as far as I understand, was a
21 general practitioner. And he was a relative of Mr. Vasiljevic's, is this
23 Q. Yes.
24 A. I'll tell you what the rule is in the former Yugoslavia, what the
25 rule was, what a practitioner recognising a psychosis would do. The only
1 thing he would have to do for a psychotic patient is to call an ambulance
2 and send him to hospital. A psychotic patient by definition is a person
3 who is not accountable, a person who is unable to take care of him or
4 herself, to control his or her actions. So the only justified course of
5 action and the mandatory course of action would be for the general
6 practitioner to take him to hospital.
7 Let me add that if he was a relative, he would know that his --
8 the patient's mother committed suicide. When studying the genesis of
9 mental illness, then we know that a family member of a patient is at high
10 risk and if the person is psychotic, there is a great risk that they will
11 end their own lives. This is an additional factor which I feel is so
12 strong that there is no justification if someone has recognised a
13 psychosis as a doctor and as a relative, not to have taken the patient to
15 JUDGE HUNT: Mr. Groome, my recollection is that the doctor agreed
16 he must be a relative but he did not consider that he was a close one. I
17 don't know if that affects the answer. It certainly wouldn't affect the
18 first part of the answer but I hope my recollection is correct.
19 MR. GROOME: Yes, Your Honour. I believe it's as you have put
21 Q. Doctor, let's put aside -- since there is uncertainty about the
22 closeness of the relationship, let's put that aside for a minute. You
23 said in your answer that it would be mandatory for a general practitioner
24 observing, making such observations in a patient, to secure the immediate
25 hospitalisation of that patient. When you say mandatory, what exactly do
1 you mean?
2 A. That everything that happens after this is the responsibility of
3 the doctor, because the doctor has taken responsibility for everything
4 that happens to the patient. The patient might have tried to commit
5 suicide. In that case, the doctor would be responsible for what the
6 patient tried to do.
7 Q. Would it have been sufficient for this general practitioner to
8 have simply suggested to the accused that at some point in the near
9 future, he should visit a hospital? Would that have been a sufficient and
10 proper course of action?
11 A. If the doctor found that the patient was psychotic, he would have
12 to have taken measures to hospitalise him, himself. That means calling an
13 ambulance, administering appropriate therapy, and then he would have
14 fulfilled his duty.
15 Q. Now, during this same period of time that Dr. Vasiljevic has
16 spoken about, the beginning of June, in your conversations with
17 Mr. Vasiljevic, the accused, did he describe for you any symptoms which
18 could be classified as psychotic during that period of time?
19 A. I said this. He complained of fear for his children, for example,
20 but none of the descriptions he gave me indicated a psychotic state.
21 Q. Can you describe for us how do you, as a psychiatrist, distinguish
22 between normal fear and fear that could indicate a psychotic state?
23 A. Yes. We ask what he is afraid of. If he says that the front line
24 moved, that every day he had to go to territory where there was a hostile
25 army, he was going alone, then his fear is justified. I asked him what
1 could have happened, if he is describing a real situation. And there is
2 no unrealistic interpretation, then for me this is real fear. If he had
3 told me then, for example, that he saw strange things happening in the
4 woods which were not actually enemy soldiers, then this would be manic
5 fear. So everything that he told me about his fears in that period were
6 worry, concern, more for others than for himself. I'm referring to his
7 wife and especially his children. And this was realistic. This was a
8 real fear, a realistic fear.
9 He told me how afraid they all were at that time because there was
10 a war on. For example, the episode described by him when he visited his
11 daughter in Belgrade, when his daughter did not come home on time, the
12 whole family was afraid. In wartime, people lived under special
13 conditions, but these were not specific just to him but to everybody
14 living in wartime conditions. And this was real fear. Many people were
15 killed. These were abnormal living conditions. And of course a certain
16 degree of fear existed. But he said very clearly that throughout the
17 wartime period, this was the case. He did not show any symptoms that
18 would lead me to judge that he was psychotic at the time. And finally, the
19 doctor who admitted him confirms this also.
20 Q. It seems that what you're describing is that fear is a normal and
21 rational response in given situations; is that correct?
22 A. Yes, yes.
23 Q. Does the fact that Mr. Vasiljevic had fears for the safety of his
24 family, in particular his children, does the fact that he sent them to
25 live in Serbia itself in an area that he thought to be safer, does that
1 indicate whether or not his fears were rational or were irrational?
2 A. They were rational. A large number of people did this at the
3 time. The inhabitants of the former Yugoslavia moved -- a large
4 percentage of people removed their children elsewhere. I do not think
5 there is anything psychotic in this fear, anything that would make him
6 different from most people living in that situation, under those
8 Q. Can you describe for us -- I know you have eliminated depressive
9 psychosis, that Mr. Vasiljevic did not have that, but I would ask you to
10 describe in greater detail because it is an issue in this case, the
11 symptoms that you would expect to find if somebody did suffer from that,
12 and tell us whether or not you found them in Mr. Vasiljevic.
13 A. No. I have already said that I found no symptoms that would
14 indicate that Mr. Vasiljevic had a depressive psychosis.
15 Q. And can you briefly tell us what those symptoms would have been,
16 or what are the symptoms of depressive psychosis?
17 A. I will tell you what the symptoms of depressive psychosis are. A
18 depressive psychotic person has a feeling of guilt. The -- this is not a
19 realistic fear. It's manic. They are preoccupied with these thoughts.
20 They are afraid that they have done something bad and will suffer the
21 consequences. But this is all manic. It's not fear of an enemy army.
22 It's something unrealistic. The person is tense. They sit still. They
23 are not interested in any activities. They don't smile. They have
24 disorders in eating. The sexual drive is diminished. And even a
25 layperson can recognise such a person as ill.
12 Blank page inserted to ensure pagination corresponds between the French and
13 English transcripts.
1 Q. Now, I'd ask you to shift to the sheet marked number 11, move to
2 the next sheet, and I'd ask you to draw your attention to heredity.
3 Heredity as the source of psychosis is something which you are quite
4 familiar with; is that not true, doctor?
5 A. Yes. Heredity or the genetic factor are one of my major research
6 interests, and I am taking part in two projects currently where we are
7 studying heredity in psychosis, and I can say that heredity is a very
8 significant factor, and the fact that the subject, after adolescence, lost
9 his mother, who committed suicide, this was a fact that I bore in mind
10 questioning him.
11 On the basis of the information that we have about his mother, we
12 could not conclude with certainty whether she suffered from schizophrenia
13 or from depressive psychosis because the conditions in the countries of
14 the former Yugoslavia are such that people do not discuss mental illness
15 willingly, so that even Mr. Vasiljevic is not sure what symptoms his
16 mother had before her death. However, then if this was so, this is
17 certainly very significant in his life. If his mother suffered from
18 depressive psychosis or a bipolar disorder, then the chances that someone
19 in the general population suffered -- is suffering from this disorder
20 would be between 0.5 to 1 per cent, so in the general population, every
21 100th child on the average will suffer from schizophrenia and every
22 50th -- 150th will suffer from bipolar disorder. If one of us has a
23 positive hereditary, which means that one of our parents suffered, for
24 example, from schizophrenia, then the chances that the child will suffer
25 from schizophrenia, while the data and the literature differ from author
1 to author, but the chances are 20 times greater for schizophrenia, which
2 means that, theoretically, out of 100 children issuing from that parent,
3 20 will have a chance of becoming schizophrenic. If the parent did not
4 suffer from the disease, out of 100 of his offspring, only one will suffer
5 from schizophrenia, and the data is -- the chances are even greater in the
6 other disorder.
7 Q. Doctor, I'd like to ask you to focus on this particular case, and
8 based on your experience and your research into heredity as a contributing
9 factor or the role it plays in psychiatric illnesses, I would ask you to
10 describe how does -- assuming that Mr. Vasiljevic's mother did commit
11 suicide, and assuming that two female members of his family, not immediate
12 family but of his family, an aunt and a cousin, both suffered from mental
13 illness, what does that information -- or how does that information impact
14 upon your conclusions or your findings in this case?
15 A. Allow me only to add -- I was just going to add that the -- Mr.
16 Mitar does not have positive heredity only through the mother's maternal
17 line but also through the paternal line, so the percentage is even
18 greater, the chances that he will be ill is even greater because there is
19 also positive heredity on the paternal side. This means that when someone
20 comes to us for counselling and they ask whether a mother should bear a
21 child under these circumstances, we would say that the chances were
22 greater that her child would suffer from the same illness as she and the
23 family on the father's side than would be the case if the family did not
24 have this history.
25 When the person is developing, then we are very sensitive to the
1 symptoms, to this, and we try to recognise the symptoms as early as
2 possible because it is easier to treat the disorder if it is recognised
3 early. So that in a psychiatric or psychological clinic, we put these
4 children in the high-risk category and we observe them in greater detail
5 than other children. We base a diagnosis on symptoms and signs. If these
6 are absent, then we consider the person to be healthy. We warn the person
7 that the possibility of heredity still exists in the next generation,
8 because they can pass on a genetic disorder. We are still not sure how,
9 and the research we are doing with Columbia University is research into
10 this transfer, whether it depends on gender and so on, but what is
11 currently known in modern psychiatry, this is that a diagnosis is based on
12 symptoms and the information on heredity is very important in prevention,
13 in family planning, in counselling in maternity centres, and if the person
14 was psychotic, then his symptoms would have to be similar or identical to
15 the symptoms of his mother. If she committed suicide, and we have this
16 information, then we would have to watch over this person carefully
17 because this person is in a high-risk category for suicide. All this is
18 not so important until the symptoms appear.
19 Q. In your evaluation of Mr. Vasiljevic, did you see any symptoms
20 that would indicate to you that he was in a high risk for suicide?
21 A. No. The gentleman is not depressive. I asked him directly
22 whether he had ever thought of suicide, and his answer was, "There were
23 times in my life when I would have preferred not to exist," but this was
24 always a response to a real situation, and I did not find that he is in a
25 high-risk category for suicide.
1 Q. Now, Doctor, I want to clarify something you said. Is it possible
2 that somebody could have mental illness in their family, that they
3 themselves could inherent the gene for that mental illness, never in their
4 life show any symptoms of that mental illness but simply pass that gene on
5 to their children? Is that correct?
6 A. Science is not quite sure but we believe this is so. There are
7 many more arguments to show that this is the way you have said, rather
8 than not. Practice has shown that some generations skip the disease and
9 then it turns up again. But it can take a collateral route. So the
10 symptoms may appear not in him but in one of his brothers or sisters and
11 then his children can get it. However, we have not yet deciphered this
13 MR. GROOME: Thank you, doctor.
14 JUDGE HUNT: We will resume at 2.30, but before we adjourn, may I
15 draw your attention to a statement which the doctor has on page 12 of this
16 summary, in paragraph 2, "The diagnoses that Dr. Lopicic gave were not
17 described with symptoms." That may be an accurate description of the
18 report, but Thursday's evidence was replete with evidence of symptoms. I
19 don't know whether the doctor has had an opportunity of seeing the
20 transcript of that. Perhaps you may have to put them to her, although I
21 notice that she has English as one of her languages. The transcript is
22 available. But Dr. Lopicic had to be stopped from repeating the symptoms
23 that she relied upon, several times, I notice.
24 MR. GROOME: Yes, Your Honour.
25 JUDGE HUNT: So it may be just as well if we have the views of
1 this doctor on the symptoms which were described by Dr. Lopicic.
2 MR. GROOME: I'm sorry, Your Honour, would it be appropriate --
3 the doctor was provided a copy of Mr. Lopicic's testimony to review those
4 symptoms. I'm not sure whether she has them with her. Would it be --
5 would the Court consider it appropriate for me to provide her with an
6 additional copy to review over lunch?
7 JUDGE HUNT: Yes, she is entitled to read the transcript. It will
8 save a lot of time, because you are entitled to have her comment upon the
9 evidence as it was given, which went beyond what was in her report.
11 --- Luncheon recess taken at 1.03 p.m.
1 --- On resuming at 2.31 p.m.
2 JUDGE HUNT: Mr. Groome?
3 MR. GROOME:
4 Q. Good afternoon, Doctor. I want to apologise. I misspoke
5 before the break. It wasn't you that were provided a transcript. It was
6 another expert. I realise you were provided a transcript of Dr. Lopicic's
7 testimony for the first time over the lunch break. I will in some of my
8 remaining questions be asking you to respond or comment on specific
9 observations and findings that Dr. Lopicic made. Before we do that, I
10 would like to ask you, can you talk very concretely what you believe the
11 impact of the heredity in the Vasiljevic family has upon your findings
12 regarding Mitar Vasiljevic in this case?
13 A. Taking into account everything that modern science knows about
14 heredity, I conducted a very precise interview with Mr. Vasiljevic,
15 knowing that he falls into a very high risk category, that he has a mental
16 illness. I did not find any signs or symptoms that could confirm this.
17 Therefore, he may have certain fears, fears that he will develop a mental
18 disease, but I do not find anything in him indicating that he is presently
20 Q. Your two findings of -- that at a certain limited period of time,
21 he suffered from delirium and from alcoholic psychosis, is it your belief
22 that either one of these, that a contributing factor to either one of
23 these was his heredity?
24 A. Most certainly not to a significant degree.
25 Q. Why is that, doctor?
1 A. Because in the whole world, psychiatric diagnosis is established
2 based on the existence of symptoms and not on the basis of expectations
3 that such symptoms might appear. That specifically means that he falls
4 into a high risk category, and if he was a younger man now, I would say
5 that he still has a chance to develop one of these illnesses, but in view
6 of the -- of his age, he is beyond the stage where such illnesses can
7 develop, and since he has no symptoms or signs, which is a condition sine
8 qua non in psychiatry for diagnosis, I believe that in his case,
9 fortunately, heredity factor skipped him over.
10 A further answer to your question why is this: We either have an
11 illness or we do not have it. The modern medicine today doesn't only
12 treat patients, it's also a science, so in order to determine a diagnosis
13 we have to specifically list some ten or -- any number of symptoms that is
14 needed for a diagnosis. So classification will tell us that typical
15 symptoms for this and that illness are the following. And then it will
16 list ten symptoms and specify that, out of those ten, at least six need to
17 be present in order to determine diagnosis. So these symptoms are either
18 present or not present. We are psychiatric experts here and we cannot
19 say, for example, this symptom is lacking. I can tell you that something
20 is lacking in somebody else's written experience -- in somebody else's
21 written opinion, but when we are talking about symptoms, that all I can
22 say is that those symptoms are either present or absent.
23 Q. Doctor, in your answer, you seem to be suggesting that there is a
24 particular age at which, as a psychiatrist, you would expect to see some
25 symptom of a mental disease that a person had a heredity disposition
1 towards. Can I ask you to give us the range or the approximate age that
2 that is?
3 A. Well, you see, it is not my assessment. This is simply a fact.
4 This is how it is. In the former version of American classification,
5 which was DSM-III, we had this listed that one of the main criteria for
6 schizophrenia, which is not a criterion of including but an excluding
7 criteria, that if a person does not develop symptoms until the age of 45,
8 then the person will not develop an illness. In addition to that, we have
9 information, we have knowledge that says that illness usually develops
10 between the ages of 17 and 25 and very seldom beyond the age of 30. And
11 this is simply a line that illustrates this. This is how it is in our
12 profession. So if our subject is older than 45, then it means that he's
13 not likely to develop such an illness.
14 Q. When you said that 30 was an important age, and my question is, is
15 the fact that the accused was 38 at the time of -- that these crimes were
16 committed, would that indicate to you that it was less likely that he was
17 suffering the onset of some heredity mental illness at that time?
18 A. It does say so but it's not a key factor for me. What is
19 important for me is that none of the symptoms that would be important to
20 me were described, not a single symptom or a group of symptoms, in order
21 to determine -- to establish this diagnosis. All other factors would help
22 us or lead us, point to this diagnosis, but in order to establish this
23 diagnosis, we need to have a specific cluster of symptoms.
24 Q. And you did not find those in this case; is that correct?
25 A. I did not find them. If you allow me, I will give a suggestion.
1 I can fax you or send you clusters of symptoms for each of these
2 diagnostic categories which are very specific in modern psychiatry and
3 they are very easy to apply. They list symptoms that a patient needs to
4 have. They also indicate the requisite duration and this is something
5 that basically removes any doubts that we might encounter.
6 Q. What you're proposing to send us, is it published in a medical
8 A. Yes, yes. This is something that has been accepted throughout the
9 world, this classification, and we use it in our daily work. Every
10 psychiatrist has two books on their table, both clinical and theoretical
11 psychiatrists. One is an ICD-10 classification, and the other one is
12 DSM-IV. We use both of them. Both books have been translated in Croatia,
13 in Serbia, throughout the former Yugoslavia. They have been translated
14 into our languages, and in the countries of the former Yugoslavia, this
15 was used both before and today. These are official classifications that
16 we use.
17 Q. And if the Chamber was so inclined to ask you to go ahead and fax
18 this excerpt from the book, would it be something that we could look at
19 and understand without your assistance, without expert assistance? Would
20 a layman understand the material that you wish to send?
21 JUDGE HUNT: It would be preferable if we got the English version,
22 Mr. Groome.
23 MR. GROOME: Yes, Your Honour.
24 THE WITNESS: [Interpretation] Please let me do some boasting.
25 We have just translated English version into Croatian in our clinic so I
1 can send you both the English version, which seems to be more important to
2 you, and the Croatian one.
3 JUDGE HUNT: Thank you.
4 MR. GROOME:
5 Q. Doctor, if you would fax it and if the Court wishes to see it, it
6 will be available for them.
7 Now, Doctor, in the family history of Mr. Vasiljevic, it seems
8 that all three people that have suffered from mental illness have all been
9 women, and from what we know of the men in his family, there has been no
10 other evidence other than that Mr. Vasiljevic himself suffered a mental
11 illness. Does this tell you anything about the hereditary factor involved
13 A. During the break, I read in detail the findings of his cousin and
14 I saw that it was more likely that she was schizophrenic than affective.
15 Schizophrenia is something that is equally frequently found in men and in
16 women, unlike depression, which is more frequent in women than in men.
17 So if we had only an affective psychosis, then my response would be yes.
18 But since I saw that this was a case of schizophrenia, then my reply is
19 such that schizophrenia is equally passed on to men and women, whereas
20 affective psychosis is more frequently passed on to women than men.
21 Q. Is the fact that there are both schizophrenia and affective
22 disorders in the family history of Mr. Vasiljevic, does that indicate to
23 us that there are two separate genes, if you will, or does the same
24 genetic influence, can the same genetic influence manifest itself either
25 as a schizophrenia or as an affective disorder?
1 A. If I could give you a reply to this question, then I would
2 probably be awarded the Nobel Prize. This is one of the hottest issues in
3 today's science. I participate, but only as a member, in a project where
4 we are trying to prove exactly your thesis but there are many more of
5 those that argue against this thesis than those who support it. Based on
6 clinical pictures, those are quite different illnesses, significantly
7 different illnesses. They are both severe and deep illnesses. They are
8 both hereditary illnesses, but based on the type of symptoms, they are
9 quite different. So what I've just told you are the results of research,
10 but in a clinical practice, we usually can always see whether somebody has
11 a bipolar disorder or schizophrenia. Symptoms are equally deep but their
12 content is significantly different.
13 Q. Doctor, I'd like to ask you -- as you know from your examination
14 of this case, a cousin who the -- Mr. Vasiljevic says he was quite close
15 to died somewhere near the beginning of June. Can you describe for us
16 what, if any, opinion or findings you have regarding that fact?
17 A. Mr. Vasiljevic told me about this, and I think that this was a
18 psychological trauma that must have, and probably did, cause him to go
19 through mourning. The death of anyone who is close to us, who is dear to
20 us, would cause us to go through this mourning. Psychiatry calls this
21 normal mourning. I think that Mr. Vasiljevic had sufficient reasons to go
22 into this process of mourning, which in psychiatry is defined as a
23 psychological state, a reaction to -- that was expected, a reaction to the
24 death of somebody close, and I accept this as something that in fact did
25 take place.
1 Q. In your view, could that have been some kind of contributing
2 factor to the eventual psychosis that you found he suffered sometime after
3 his hospitalisation?
4 A. Theoretically speaking, it is possible because his whole body was
5 in a less active state at that time. However, it shouldn't have
6 significant practical consequences and we should not see this as a --
7 something that led to his disease. I think that Mr. Vasiljevic's illness
8 is clearly recognisable, clearly defined, and there are sufficient reasons
9 not to make a direct link between this event and his illness. He did
10 suffer because of this relative's death but it was a suffering caused by
12 Q. Doctor, have you had an opportunity to read the report of Dr.
14 A. Yes.
15 Q. I would ask you to place on the ELMO as a demonstrative aid
16 showing your comments regarding Dr. Lopicic's report.
17 A. I will start with general comments. The whole array of
18 description that were given very eloquently by Dr. Lopicic are,
19 psychiatrically speaking, completely acceptable. She gave information
20 that does not differ from mine. She gave headings that are almost
21 identical to mine, and when there are no significant differences between
22 my colleague's description and mine. What I believe needs to be improved
23 in my colleague's report, and this is aside of all the things that are
24 good in her report, is that she did not specify the diagnosis of Mr.
25 Vasiljevic, either present one or past one. We saw in several instances
1 that diagnosis is something that we use in our work. Just like you here
2 in the court use such terms as "guilty," "not guilty," "competent" or
3 "incompetent," in the same way we use in psychiatry "diagnosis." So
4 after reading my colleague's opinion, I was unable to determine what was
5 her diagnosis, how she diagnosed Mr. Vasiljevic at any time.
6 My second comment stems from the first one. Dr. Lopicic in her
7 opinion says, and I quote now, "Possible affective or paranoid
8 disorders." My colleague is a psychiatrist just like I am. We can make a
9 distinction between two diagnostic types and then opt for one based on
10 our conclusion. This is especially wrong because paranoid and affective
11 disorders are quite different; their picture is different. It's almost a
12 dichotomy, not a clear one but almost one. A person in an affective state
13 has a multitude of expressions. A person that lives in their own paranoid
14 world have an affect that is under the influence of their manic state, and
15 this is expressed in the way they express their emotions. And after that,
16 my colleague says, "Psychotic period." I have to wonder what this
17 psychotic period was induced by. In addition to that, my colleague does
18 not list symptoms that would corroborate her conclusions.
19 Further on, logically speaking, I am not clear, based on what --
20 which diagnostic entity my colleague determined the degree of
21 accountability of Mr. Vasiljevic. So I found -- I find these three things
22 to be three main deficiencies and they all pertain to establishing or not
23 establishing diagnosis.
24 Furthermore, I would like to talk about stressors. Stressors are
25 events in somebody's life that can provoke positive or negative
1 reactions. Stressors cause stress. And this stress can make us grow up
2 and become a better person in a moral sense, or that stress can be so
3 intense that it can lead to a disorder. All of us in our lives have many
4 stressors and they are an integral part of living. So in order for
5 psychiatry to distinguish between normal or so-called normal stressors
6 that all of us experience, for example, a failure at the exam or a death
7 of a cousin and a number of others, so in order to distinguish them from
8 those that can lead to very serious disorder, we have a very strict
9 definition and this definition says that a disorder will be induced by
10 stressor which is so intense that in a great majority of people it would
11 lead to a psychological disorder. And then further, they define it which
12 is, for example, something as unexpected endangerment of personal lives or
13 witnessing a rape or witnessing some other very stressful events. So
14 intensity of stressors have to be above average and unexpected in order to
15 lead to a disorder, and based on what Mr. Vasiljevic told me, I don't know
16 that he went through an experience of that kind, other than witnessing the
17 killing of those people by the river that he described.
18 In addition, it is well known that stressors of that intensity
19 can lead to a very specific state which is called either a reaction to
20 stress or post-traumatic stress disorder.
21 Q. Doctor, if somebody -- let's take the example of witnessing a very
22 violent act and that being what induced the stress, what would be the
23 period of time that you would expect to see between the violent act that
24 was witnessed and the onset of some indication that this stress has been
25 of a type sufficient to induce psychiatric illness?
1 A. Modern psychiatric classification has defined that as well, and we
2 say that acute reaction to stressor commences within a month. So within a
3 month. And if it lasts longer than a month, then we call it a post
4 traumatic stress disorder. Post-traumatic stress disorder is a mental
5 disorder that is very specifically defined, and I examined Mr. Vasiljevic
6 [Realtime transcript read in error "Mr. Disorder"] for any symptoms of
7 that, and based on my interview with him, he does not have and he did not
8 have a post-traumatic stress disorder. None of the
9 colleagues mentioned any of symptoms which are typical for post traumatic
10 stress disorder. So based on my examination, I can say that he did not go
11 through a post-traumatic stress disorder.
12 I wish to add one more thing.
13 Q. Just let me correct the record, it's Mr. Vasiljevic that you
14 examined for the post-traumatic stress disorder, correct? I believe there
15 is a mistake in the transcript.
16 A. Yes.
17 Q. Please continue to tell us.
18 A. I listed this as one of the examples so we can have it
19 theoretically, when I spoke about accountability. What is important is
20 that post-traumatic stress disorder is not an illness that has psychotic
22 Q. Can I conclude from what you're saying now that in terms of the
23 levels of accountability, post-traumatic stress disorder would never give
24 rise to the highest two classifications of significant diminishment and
25 incompetence; is that correct?
1 A. That's correct.
2 Q. Do you have an opinion whether the mental illness that you believe
3 Mr. Vasiljevic suffered after going into the hospital, do you have any
4 opinion whether that was a reaction to the stress of seeing some people be
5 killed approximately around the 7th of June?
6 A. No.
7 Q. And why?
8 A. Because a stressor like that would lead to a specific clinical
9 picture, specific symptoms. And Mr. Vasiljevic did not describe that to
10 me. In our interview, he told me in detail how the killing at the river
11 impacted him. He had a state of acute excitement. He felt very uneasy.
12 He said that he felt ill, that he had to put his head under cold running
13 water, and what is typical, and what we meet frequently in psychiatry, is
14 that after telling his wife about it, he felt a certain relief and then he
15 felt an even greater relief after describing this to somebody else the
16 following day. So in a sense, he was able to get some relief, to express
17 his trauma, to let off some steam. And in psychiatry this is something
18 that we call anxiety, and this lasted for a certain time, it had a certain
19 clinical picture. After that, he experienced relief after he acted out,
20 and told his wife and then somebody else about this event.
21 Q. Can you briefly describe for us what the clinical picture would
22 have looked like if his psychiatric illness had been a result of the
23 stress of witnessing such an event?
24 A. This state is called post-traumatic stress disorder.
25 Post-traumatic stress disorder has five key characteristics. The first
1 one is that in the anamnesis there is a stressor, and we said how intense
2 that stressor has to be. The second one is that the patient has -- sees
3 this as a recurring theme so this theme would be going -- coming back to
4 him and every time would cause a very intense uneasiness in that person.
5 The second cluster of symptoms are symptoms of increased excitability.
6 These persons become aggressive, agitated, they have a very lowered
7 threshold of -- for frustrations. They become irritable. They develop
8 sleeping disorders, and have difficulty in communication with everyone
9 except those persons who were with them during their trauma. And finally,
10 a third cluster of symptoms or a fourth group. So first we describe the
11 stressor and then three clusters, and the fourth cluster of symptoms are
12 the so-called symptoms of evasion. The person will try to evade anything
13 that is linked to the stressor. They will try not to go to the same
14 street that reminds them of the event. They will try to avoid people that
15 they have not identified with them -- that they have not identified with
16 and were with them during this event. They will not wear the same clothes
17 they wore during the event, and they will not have anything to do with
18 anything that reminds them of that event. If the event took place in a
19 room in their apartment, they will avoid going into that room. So these
20 are three clusters of symptoms that are specific for post-traumatic stress
21 disorders and for the stressor factor.
22 In the American classification, unlike European one, there is
23 another one, another factor, that people become unable to work or
24 partially unable to work after the event. They have difficulty
25 concentrating. They have difficulty sitting for eight hours in the same
12 Blank page inserted to ensure pagination corresponds between the French and
13 English transcripts.
1 area. They have difficulty carrying out their tasks, and based on the
2 experience of Vietnam veterans, American science developed these factors
3 whereas they are not accepted in the European modern science.
4 Q. Doctor, would it be significant if the person, or Mr. Vasiljevic
5 in this case, if he maintained a close relationship with one of the people
6 who committed the killing of the people that he witnessed, would the fact
7 that he committed -- or maintained a close relationship in the subsequent
8 years indicate to you that his -- any mental illness he suffered was not
9 of a reactive type?
10 A. Well, actually, yes. Although I cannot assert this with 100 per
11 cent certainty because this is one of the symptoms that should be
12 present. If I found it in the subject and if we had time to do an
13 experiment, then this would be very significant. However, I did not see
14 any signs of the existence of PTSD in the subject so I would not expect
15 him to have this symptom, but had he had PTSD, then this would be a very
16 important factor in establishing this.
17 Q. Doctor, based upon your experience as an expert for the courts of
18 Yugoslavia, would a report such as Dr. Lopicic's which -- absent a
19 specific diagnosis and absent an inclusion in that report of the symptoms
20 supporting that diagnosis, in your experience, would such a report have
21 been used as a basis by the courts of Yugoslavia to determine that a
22 person accused of a crime had significantly diminished accountability or
23 was incompetent?
24 A. It is my opinion that the doctor would have to add to her opinion
25 and answer the questions concerning the diagnosis, and on the basis of
1 what diagnosis she had reached, her assessment of diminished
2 accountability or incompetence.
3 Q. Absent doing that, would it be -- would the report be accepted for
4 a finding of accountability?
5 A. I think not.
6 Q. Now, I want to ask you some specific questions regarding some of
7 Dr. Lopicic's testimony. In one portion of her testimony, she
8 described a pre-psychotic period in which she believed that somebody would
9 not be or may not be accountable under Yugoslavian law. Have you ever
10 heard of this pre-psychotic period and, if so, can you describe for us its
11 role or definition under Yugoslav law?
12 A. A pre-psychotic period is not a term that is used in forensic
13 psychiatry but it is used in psychiatric practice. This is a situation in
14 which a person does not meet the criteria for a psychosis but some of the
15 potential symptoms may be present. What is important, however, is that a
16 pre-psychotic period is not psychotic. That is how it is in practice.
17 When one symptom is psychotic, which means that the patient does not test
18 reality, then the patient is psychotic. As a rule, we say that a
19 pre-psychotic period is a period when a person who is at high risk and who
20 is undergoing any sort of psychological difficulty. In the case of
21 Mr. Vasiljevic, we could speak of a pre-psychotic period because he is a
22 high risk person, and the psychosis may be expected. However, this is not
23 a psychosis, and in that case, it must be stated precisely on the basis of
24 what symptom or sign a certain period has been labelled pre-psychotic.
25 What is important to say is that a pre-psychotic period is not a psychotic
1 period. Its very name tells us that.
2 Q. In your experience, has a court in Yugoslavia ever made a finding
3 that somebody's accountability was significantly diminished or incompetent
4 because at the time of a crime, they were in a pre-psychotic stage?
5 A. I have no such experience.
6 Q. Doctor, I want to read a portion of Dr. Lopicic's testimony in
7 which she describes some of the symptoms that Mr. Vasiljevic described for
8 her, and it was the first time he had described these symptoms to anyone,
9 and I will read that portion and I will ask you to comment on those
10 symptoms. And I'm reading from the transcript from the 9th, and it's page
11 100, the middle of the page: What I obtained from the interview with the
12 patient and that is certain changes in the thinking process. This is some
13 unclear psychopathology where he had exaggerated ideas about the
14 significance of, shall we say, birds. If he sees a crow, it's a bad
15 omen. If he sees a dove, it's a good sign. And this, these various
16 actions of his, could be attributed to this paranoid disorder, like he
17 said that he could communicate with his wife subconsciously. So this is
18 what I attribute to provoking these reactions on his part.
19 There are two symptoms mentioned in here which are not discussed
20 in the report. One is the significance of the different coloured birds
21 and one is his ability to communicate with his wife subconsciously.
22 Assuming that he did, in fact, suffer those symptoms at the relevant
23 period here, would you please comment on their significance?
24 A. The subject told me also about those symptoms. He told me that
25 this would happen to him and that he was very afraid because of this
1 during his stay in hospital. I asked him when this happened, and he told
2 me that he experienced this during his hospital treatment. The
3 communication with his wife, the feeling of confusion, and this whole
4 state was something that fitted in with the delirium that he went through
5 in hospital. When I asked him what happened before that, what symptoms he
6 had before that, he only spoke of fear. His memory of the delirium is
7 unclear, and his interpretation of it is confused. Within this context, I
8 recognised this as part of his delirium.
9 Q. Did you find any evidence in your conversations with him that the
10 symptoms existed prior to his hospitalisation?
11 A. No.
12 Q. There is another symptom that he told Dr. Lopicic about, and I'm
13 quoting from the record, the urge to blink involuntarily, and then when
14 she described this, she said, "This can be a symptom whereby he was
15 relieving himself of fear." I'd ask you to comment on that symptom, if
16 you would.
17 I'm sorry, let me just give you one more piece of information.
18 His interpretation of blinking was as follows: If he blinked and it was
19 dark when he blinked, somebody would get killed.
20 A. The subject also spoke to me about this. I understood this as him
21 seeing sparks in front of his eyes, and this is a frequent sign of
22 delirium tremens. We call these flashes. Of course, a person who is
23 undergoing a psychosis may have different explanations for this but this
24 is a relatively frequent symptom. We have pins and needles, we have
25 something that our patients describe as seeing stars in front of their
1 eyes, little stars, and this fits in fully with the picture of delirium.
2 If he experienced something like this, and he most probably did, then his
3 explanation of it while in a state of psychosis might be different.
4 Q. And of what significance is the meaning that he attributed to this
5 so that if it was dark, somebody may be getting killed somewhere?
6 A. Well, you see, I do not wish to go on to the interpretation of
7 this. The gentleman certainly has his cultural habits. We have students
8 -- if we were to say that every student who found a four leaf clover
9 before taking an exam is psychotic, we would be wrong. If they were to
10 give an exaggerated importance to this, we might call it psychotic, but I
11 see nothing here that would depart from psychosis, which I believe he had,
12 and certain beliefs which I cannot go into now, because it's hard for me
13 to say. Every milieu, every community has its cultural beliefs, which
14 perhaps we will not admit to believing, but if someone is in a state of
15 psychosis and also in a state of fear, every situation, everything that
16 happens requires an explanation. So in my view, his explanations fit in
17 fully with the situation he was in and the state he was in.
18 Q. Doctor, what would you -- or what significance would you attribute
19 to the fact that at the time of his hospitalisation in the psychiatric
20 ward, he was receiving neuroleptics?
21 A. In an agitated state, we have to give strong medication. If they
22 did not have strong Bensodiazepins, and they probably didn't because we
23 didn't have them in Croatia either at that time, and if our colleagues who
24 testified before me said that they were short of medicines, I myself might
25 use some of the medicines administered by that colleague in such a
2 Q. Doctor, could I ask you to perhaps write down "Bensodiazepin"
3 on a piece of paper and put it on the ELMO so that we can spell it out for
4 the transcript writers?
5 A. [Writes]
6 Q. That would be B-e-n-s-o-d-i-a-z-e-p-i-n; is that correct?
7 A. Absolutely.
8 Q. Now, Doctor, are you saying that a person suffering delirium to
9 the extent that Mr. Vasiljevic was suffering it, that the preferred drug
10 therapy would have been to have given him Bensodiazepin; is that correct?
11 A. Yes, yes.
12 Q. At this time, in your practice in Croatia, are you saying that
13 this particular medication was unavailable to you in Croatia?
14 A. Very often, very often, it was unavailable.
15 Q. And would a neuroleptic drug help you achieve some of the same
16 desired results as Bensodiazepin?
17 A. Certainly, yes.
18 Q. One of the other assertions that Dr. Lopicic made, and I would
19 like to get your opinion regarding it, she said that alcoholism could mask
20 the outbreak of a possible affective or schizophrenic disorder in the
21 accused. What is your opinion regarding that assertion?
22 A. The claim is acceptable at a layman's level. In the culture of
23 the former Yugoslavia, it was felt to be shameful to be mentally ill, and
24 some families, whether they saw that a person was psychotic or odd, would
25 give that person alcohol because they were not ashamed of having an
1 alcoholic in the family but they were ashamed of having a mentally ill
2 person in the family. So the masking of mental illness by alcoholism is
3 acceptable for a time, for a layperson, but alcoholism does not treat the
4 disease. It can mask the psychotic behaviour of a person but it does not
5 cure the person, and this would vary. But someone who had a steady job,
6 someone who did not spend their life on a farm in the field but working
7 with people, would not find this a long-term solution, not for more than a
9 Q. Doctor, I want to take you back to the admission of Mr.
10 Vasiljevic, and Dr. Jovicevic's observation of him, and put the question
11 to you, could the fact that he had alcohol that day have masked the
12 symptoms of psychosis and made it impossible for Dr. Jovicevic to
13 recognise that he was psychotic at that time?
14 A. No, no, for two reasons, in my opinion. The first reason is that
15 the doctor, the orthopaedist, did not write down that the patient was
16 drunk and he would certainly have done so if he had observed it, not just
17 for the patient's sake but for his own sake. He was about to operate on
18 him, and if there were any complications, it would have been very
19 important for him to have written down that the patient was inebriated.
20 Secondly, a state of intoxication would not change psychotic
21 symptoms, and if he asked him something to do with orientation, he would
22 have recognised the symptoms even had the patient been drunk.
23 Q. I want to put another statement that Dr. Lopicic made to you and
24 ask for your comment, and I'm reading from the record of the 9th on page
25 79: "I had the feeling that this simply was not just a delirium tremens
1 but a much stronger psychosis as a result of certain pathological
2 potential he carries inside."
3 A. I am unable to interpret the meaning of this sentence, because
4 delirium tremens has such a wealth of symptoms and it is so strong that I
5 do not know what could be stronger. It is hard for me to imagine what the
6 doctor could have been referring to.
7 Q. Now, when asked to fix the point in time when Mr. Vasiljevic
8 became significantly -- had significantly diminished accountability for
9 his acts, the doctor fixed it at a time, and I will read, "Before he went
10 to prison. This act of imprisonment is a moment when his behaviour
11 significantly changed." And this is prison back in the beginning of June,
12 1992. Can I ask for your comments on that assertion?
13 A. It is hard for to us say when it started if we have no documents.
14 We have a doctor's diagnosis here. For us doctors, this is a document. I
15 really could not say that one's accountability changed as a result of
16 psychic illness in the period when these two descriptions were given
17 and my colleague and I wrote down nearly the same description of what
18 Mr. Vasiljevic told us about his experience on the Drina. There was not
19 a single word or sentence that would indicate a psychotic disorder in that
20 period. It is hard for me to put all these days in chronological order
22 his description of the shooting on the Drina is a description given by a
23 man who was not mentally ill at the time.
24 Q. Doctor, finally, I'd ask you, there is a drawing or diagram which
25 summarises your testimony. I'd ask you to place that on the ELMO and if
1 you would please describe that for us.
2 A. On this diagram, we can see that the subject was born in 1954,
3 that his childhood and adolescence was not significantly different from
4 that of his peers. He had some crises when he went to school outside
5 Visegrad, when a stepmother entered his house. This was a small crisis
6 because he describes her as a good woman, but up to 1973, we find no
7 relevant information pointing to a disorder.
8 In 1973, the subject started working and started drinking. This
9 is the beginning of his phase of alcoholism which, after a certain period,
10 assumed a stronger form, and he can be diagnosed as suffering from chronic
11 alcoholism. And this has been marked until the year 2000 or 2002, because
12 we view alcoholism as a life diagnosis although we know that the gentleman
13 has not been drinking in prison and probably just before going to prison,
14 but we call this alcoholism in remission, alcoholism without alcohol.
15 The period which we describe as existing after he broke his leg
16 and was admitted to the orthopaedic ward, where there was a certain
17 abstinence from alcohol, this is the period where, in my view, he
18 developed the picture of alcoholic delirium due to abstinence or due to
19 illness and the operation. This is the period I consider to be the period
20 of delirium, or let us call it a psychotic state, and this lasted probably
21 until the date of his discharge from hospital, and this is the period in
22 which I consider him to have been not accountable.
23 MR. GROOME: Thank you, Doctor. I have no further questions, Your
25 JUDGE HUNT: Mr. Domazet?
1 Cross-examined by Mr. Domazet:
2 MR. DOMAZET: Thank you, Your Honour.
3 Q. [Interpretation] Good day.
4 A. Good day.
5 Q. My name is Vladimir Domazet and I will put question to you as the
6 lead Defence counsel for Mitar Vasiljevic in these proceedings. What you
7 have just said to Mr. Groome, referring to the period, I think you said
8 that he was not aware of his acts during his hospital treatment, but you
9 said that this also depends on the crime in question. In your view, was
10 the significance of this such that regardless of the kind of crime
11 involved, he was not accountable under the law?
12 A. You have put a very good question to me, because when evaluating
13 accountability, we have to know what crime is involved, because
14 accountability is not the same regardless of the crime. However, the
15 state of the subject a few days before the admission was so strong that he
16 was not accountable even for the elementary acts he committed or whatever
17 he did. Whatever he did in that period, he would very likely have been
18 held not accountable or minimally accountable. We -- if we are in a
19 dilemma, we always tended to give the higher level of non-accountability.
20 He was confused. He did a number of things that were foreign to his usual
21 behaviour, and in general, we can say that in that period, whatever he
22 did, whether he committed crimes or did anything else, he was not
23 accountable. In psychiatric terms, he was simply not testing reality.
24 Q. Thank you. I would now like to start from the beginning. You
25 have submitted a written analysis of all these illnesses and given us a
1 classification, but before I put questions to you about some of these
2 matters, I will ask you about something else you touched upon and which I
3 believe is significant. I would like you to expand upon it. You said,
4 and you may have noticed that Dr. Lopicic also said this, you said
5 something about the meaning of clinical psychologist and that this is an
6 additional factor in an examination of this kind. You talked about
7 psychological tests, clinical psychological tests, and you said that you
8 decided that this was not necessary and you supported this with reasons.
9 If the structure of a personality can be better determined by this, for a
10 person accused of very serious crimes, do you not feel that in this case,
11 it would have been better for a clinical psychologist to also produce
13 A. I fully agree with you, and before I started my expert opinion, I
14 asked the Court who would be doing the psychological testing or rather
15 whether it would be done, because in the countries of the former
16 Yugoslavia, it was usual before a psychiatrist even started working,
17 psychological testing would be carried out. The reply I received was,
18 no. Then I said immediately that if there was something that I found
19 doubtful, I would draw attention to it. During my work, however, I had no
20 diagnostic dilemmas. However, I still agree that a psychologist would be
21 able to give a much better description of the structure of the personality
22 and its defence mechanism than I or my colleague have given.
23 Q. In spite of this, you, yourself, did some of these tests. One of
24 them, if I'm not mistaken, was similar to the one given by Dr. Lopicic to
25 do with alcoholism but you also performed some other tests. You said that
1 the first one produced identical results so I will not go into it but as
2 for the others, since we cannot see from the opinion what was established
3 by them, I would like to ask you to comment on them, to comment your
5 A. Thank you. In the sources I listed, the methods I used, and I
6 even submitted these findings for translation, and I also have some
7 materials here that I photocopied and I can show them to you. The test I
8 discussed, I will put it on the ELMO here. This is one of the tests used
9 both by psychologists and psychiatrists. I administered this test to
10 Mr. Vasiljevic and there are these triangles here and Mr. Vasiljevic had
11 to copy them, and I will show you a positive result there, a satisfactory
12 result, meaning that the images were identical, they had an identical
13 number of lines and angles and that none -- none of the angles were
14 sticking out. This is a satisfactory result and this is one of the more
15 complicated tests. Mr. Vasiljevic wrote down here -- I wanted to see
16 whether he could distinguish between abstract and specific concepts. And
17 Mr. Vasiljevic said that he would be happy if he left the prison as an
18 innocent man. I also asked him about something that I --
19 JUDGE HUNT: Just a moment, Doctor, what was the writing on the
20 bottom of that? Was that yours or his? That diagram you showed us.
21 THE WITNESS: [Interpretation] This is what Mr. Vasiljevic wrote.
22 JUDGE HUNT: And can you just read the precise words or at least
23 translate them? You read them and they will be translated for us.
24 THE WITNESS: [Interpretation] Yes, I will. "To leave prison as
25 an innocent man."
1 JUDGE HUNT: Thank you. Just keep them to one side because I
2 think they will have to be marked in some way as evidence in the case.
3 You have some more of those, do you?
4 THE WITNESS: [Interpretation] I enclosed these pages together with
5 my opinion. However, I could leave this to you. I don't need this any
7 JUDGE HUNT: We are just checking to see whether we've got the
8 originals, Doctor.
9 THE WITNESS: [Interpretation] This is actually the only original
10 done by Mr. Vasiljevic and the rest are his answers to questions put to
11 him. So this is what he did by his own hand. He copied this and he wrote
12 this, and the rest is my taking down of his answers. For example, 100
13 minus 7 is 93, and so on. And then I measured the speed. And this is how
14 this is done. The other questions were, for example, can you explain to
15 me what happiness is? I offered him five abstract and five concrete
16 concepts that he had to define for me and I wrote it down myself, whereas
17 the other ones is something that he wrote himself.
18 JUDGE HUNT: Just wait a moment, Mr. Domazet while we find out
19 whether we have got the original document.
20 MR. GROOME: I've just checked with both of my assistants and
21 nobody knows about the documents.
22 JUDGE HUNT: I'm sorry, I'm interrupting you and causing trouble
23 for the interpreters. I got into trouble last week for that. Doctor,
24 could we borrow the document you showed us on the ELMO? We'll get a copy
25 made of it and we'll give you the original back.
1 THE WITNESS: [Interpretation] I don't need the originals. I only
2 have copies but I have two sets of it.
3 JUDGE HUNT: We'll give it back to you shortly. You proceed,
4 Mr. Domazet.
5 MR. DOMAZET: Thank you, Your Honour.
6 Q. [Interpretation] If I understood you well, Madam, as you said,
7 this was the only original that Mr. Vasiljevic wrote down himself, and the
8 rest are your tests or tests that contained only his replies. So these
9 other ones, did you also enclose them with your opinion or not?
10 A. I enclosed everything.
11 Q. So you believe that this should be part of the opinion?
12 A. Well, this is how we normally do it. There is no reason to do it
13 otherwise. The second part of Hamilton's test is the one where I went
14 through questions to see what his answers were and the results were
15 negative, but, however, I think that that needs to be filed.
16 Q. Well, I asked you because it is obvious that we don't have those
17 papers and it seems that we will be provided them at a later stage. I am
18 also interested in this and this is something that I did not receive
19 together with the opinion because apparently it was subsequently sent.
20 Could you tell us, briefly, what were the results of those tests according
21 to you?
22 A. None of the findings showed anything pathological except for the
23 tests for alcoholism.
24 Q. Another examination was suggested by Dr. Lopicic for possible
25 brain damage which she believed was possible in Mr. Vasiljevic in view of
1 the long duration of his alcoholism and his general condition. I think
2 that professionally this is called EEG or something like that. So do you
3 believe that it was necessary to run such a test or could this be
4 determined by other means?
5 A. Well, it is very difficult for me to give an answer to that.
6 Routinely speaking, an EEG would have its justification but my colleague
7 and I, prior to signing our opinion, did not require this. Had we
8 considered this to be essential, we probably would have said to the Court
9 so. I don't think that we would obtain a result that would differ greatly
10 from one within normal limits. Based on my long clinical experience, I
11 don't expect that such a test would give us anything new.
12 Q. Well, do I understand you well when you say that you would not
13 expect this to find anything new, you basically don't expect this to show
14 any pathology?
15 A. Yes, I don't expect this to show any pathology.
16 Q. When you talked about alcoholism, tipsiness and intoxication in
17 the beginning, you said at one point that you believed that a level of 100
18 is needed. I assume that you meant 1 per mil or above. Since this is a
19 very technical issue, could you please tell us in practical terms how much
20 would a person need to drink in order to reach this level? We know that
21 , theoretically speaking, when it comes to hard liquor, a certain amount
22 is needed to reach this level.
23 A. Well, this would correspond to two or three drinks of hard
24 liquor. It also depends on the amount of food consumed, on the duration
25 of alcohol consummation and also on the amount of fluids taken by the
2 JUDGE HUNT: Doctor, because you and Mr. Domazet are both speaking
3 the same language, it's very difficult for the interpreters unless you
4 pause at the end of the question before you answer it. So please, if you
5 could remember to do so.
6 THE WITNESS: [Interpretation] I apologise.
7 MR. DOMAZET: [Interpretation]
8 Q. When you said two or three drinks of liquor, Madam, you probably
9 meant the usual glasses in which liquor is served. Did you have in mind
10 0.3 or 0.5 decilitres?
11 A. 0.3.
12 Q. I'm waiting to ensure that your answer has been recorded in the
13 transcript. Madam, when you said that it also depended on whether the
14 person ate enough food or drank sufficient amount of fluids, you probably
15 meant in the period during which the concentration would reach its highest
16 level. So when a person is not eating, this concentration can reach its
17 highest level quite quickly, in half an hour or an hour, and it is quite
18 different if the person is eating. However, the final level is always the
19 same, it just differs as to the amount of time needed to reach that level,
20 isn't that so?
21 A. Yes.
22 Q. Madam, on page 5 of your findings, the ones I received today,
23 where you explained two kinds of psychosis --
24 A. Which one do you have in mind, the Croatian or English version?
25 Q. I don't mean your opinion. I meant the material that was enclosed
1 together with your CV. When you discuss affective psychosis and its two
2 types, manic and depressed psychosis, you described how the patients who
3 have manic psychosis look, and you also said that a layman would easily
4 recognise such a person based on their behaviour, also the way they
5 dressed themselves and act and so on. Did I understand you well?
6 A. Yes, you did.
7 Q. My question is the following one: Is this true of everyone who
8 suffers from this psychosis or is it true for most of them and can
9 everyone be considered to have this illness based on this type of
10 behaviour? Or let me put it differently: Would it be possible for
11 somebody to have this illness, yet behave in a different manner?
12 A. Well, this is what I can reply. If a person suffers from manic
13 psychosis and has not been treated, then the person will behave in a way
14 described by me and you just now. A person with this diagnosis and who is
15 treated or is in remission can act in a different way as well, and not
16 show these drastic symptoms.
17 Q. When you discussed the paragraph B(2), which is exogenous or
18 symptomatic psychosis, you mentioned that this was not a life diagnosis,
19 if I remember well.
20 A. Yes, you do.
21 Q. Does this mean that these are illnesses that can emerge and then
22 disappear and that this is why you believe them not to be a life
23 diagnosis? Or what do you mean under life diagnosis?
24 A. Just what you said. This illness can emerge and then disappear.
25 It has its cause, its duration, and its cessation. For example, if
12 Blank page inserted to ensure pagination corresponds between the French and
13 English transcripts.
1 Mr. Vasiljevic never drank again, he would never experience delirium again
2 if his delirium was caused by alcohol abstinence.
3 Q. So when we are talking about alcoholic psychosis, you said that it
4 would be possible for a person to be free of this illness in future?
5 A. Yes. And this is what life diagnosis means.
6 Q. I think that you also spoke about treatment and duration of
7 treatment, of successful one. You mentioned six months. Did you mean
8 hospital treatment or perhaps outpatient treatment, and is this a
9 successful way to treat such illnesses?
10 A. It doesn't needs to be hospital treatment, but we need to have an
11 intensive pharmacotherapy that can be done on an outpatient basis, and
12 what is most important is a very strict alcohol abstinence.
13 Q. Since one of your final conclusions was that Mr. Vasiljevic could
14 have possibly had an alcoholic psychosis, is this consistent with the fact
15 that he's been here for two years, has not suffered any crises, so could
16 it be possible that this illness, if he ever had it, has completely
18 A. Yes, that's right.
19 Q. Madam, when you spoke about delirium, and this is paragraph
20 2(B)(2) -- B(2)(B), you discussed the duration needed for it and you said
21 it was a very dangerous medical condition. And you said that even a
22 layman could easily recognise this condition.
23 A. A layman would not necessarily say that it was a delirium but
24 would be able to see that the patient is disturbed.
25 Q. I omitted to ask you, in the beginning, you described in detail
1 the court material, and other materials used in your work, and I saw that
2 you also read the transcript and the findings of Dr. Lopicic. However, I
3 did not understand whether you had an opportunity to read the transcript,
4 containing the testimonies of witnesses heard here, namely doctors from
5 Uzice hospital who worked at the psychiatric ward in the Uzice hospital at
6 the time when Mr. Vasiljevic was treated?
7 A. Yes. I was given some transcripts way back and some were given to
8 me just now.
9 Q. I would like to ask you whether you saw in their testimonies - and
10 here I mean Dr. Simic, who was a treating doctor of Mr. Vasiljevic, then
11 Dr. Jevtovic, who was responsible for treatment, and Dr. Martinovic - all
12 of whom said the same, that they did not recognise the signs of delirium
13 and said that the behaviour exhibited at the time did not have elements
14 that are typical for delirium. Were you able to see that in the
16 A. Well, they said that tremour was not listed anywhere, and I agree
17 with this, and precisely this lack of tremour indication, at least a
18 direct one, albeit there is an indication of a pre-delirious state, there
19 is the reason that I on purpose did not speak of delirium tremens later on
20 as a definite diagnosis but rather spoke of delirium caused by a surgical
21 intervention and not only alcohol abstinence. I also allowed the
22 possibility of an alcoholic psychosis, because I did not establish
23 diagnosis based on my findings but based on findings received from other
24 experts, none of whom were certain of diagnosis because they diagnosed him
25 as having 298. So this is not something that I can use to give a specific
1 diagnosis, but instead of that, I, in a very detailed manner, demonstrated
2 the dilemma that I as an expert faced, and I listed all the things that --
3 all the diagnoses that were possible in this case.
4 Q. So if I understand you well, these testimonies also influenced
5 your findings, and due to them, you allowed for the possibility that this
6 was an alcoholic psychosis and not necessarily delirium. So I understood
7 you; is this so?
8 A. Yes.
9 Q. In paragraph before, when you spoke of alcoholism and acute
10 alcoholism, you mentioned consequences and liver damage. Is this
11 something that you were able to discern based on lab results and the
12 results describing liver function, all of which was caused by long-term
13 alcohol abuse?
14 A. Yes.
15 Q. When you spoke of basic principles which are applied when meeting
16 every new patient, as far as anamnesis is concerned, this is exactly the
17 method you followed in the case of Mr. Vasiljevic, didn't you?
18 A. Yes.
19 Q. Paragraph 2, heteroanamnesis is something that you could not
20 directly verify, but I guess that all the material that -- all the
21 supporting material that you had at your disposal is something that helped
22 you compile this; isn't that right?
23 A. Yes.
24 Q. When talking of illnesses listed by you under Roman numeral VII,
25 you also said -- you explained why you believed that Mr. Vasiljevic did
1 not have schizophrenia and paranoid psychosis. However, did you perhaps
2 notice that in the statements of Dr. Simic and Dr. Vasiljevic, they
3 allowed for the possibility of a manic psychosis based on their
4 observations, so they mentioned the symptoms of manic psychosis as well?
5 A. Yes. I've read that, but unfortunately, those doctors did not
6 list symptoms. They simply gave a diagnosis without corroborating it with
8 Q. So you believe that it would be impossible to verify this without
9 specific facts?
10 A. Yes.
11 Q. However, you've mentioned Dr. Stojkovic as someone whose report
12 you have read, and his entry in the medical history of Mr. Vasiljevic, and
13 you also mentioned that he wrote in his history, "Pre-delirious state."
14 You probably saw that Dr. Stojkovic was an orthopaedist, not a
15 psychiatrist. What I'm interested here is this doctor probably was able
16 to assess certain signs, but would it be medically correct to discharge a
17 patient who is believed to be in this condition, or to promise this
18 patient that he would be discharged? This is information that we found in
19 this document.
20 A. I did not see that this doctor, orthopaedist, discharged him from
21 the hospital. However, usually, when patients are transferred from one
22 ward to another, the entry made in their medical history usually says,
23 "Discharged from the orthopaedic ward." So the way I interpreted this is
24 that orthopaedist wrote that Mr. Vasiljevic was discharged from the
25 orthopaedic ward and transferred to the psychiatric one.
1 Q. You probably don't have it before you, but this doctor even
2 mentioned that a discharge letter had been written but that the patient
3 did not go home. We can't know what this doctor meant at the time but you
4 believe this not to be a situation where the patient was discharged to go
5 home but was rather transferred to another ward?
6 A. Yes, I believe that to be the case.
7 JUDGE HUNT: Just before we adjourn, that diagram drawn by the
8 accused, that should be shall be Exhibit P168.2. That's the one which
9 the doctor produced a short time ago.
10 Well, Mr. Groome, your hopes have been dashed, I'm afraid, but
11 we obviously should finish tomorrow, don't you think?
12 MR. GROOME: Certainly, Your Honour.
13 JUDGE HUNT: There is no point in us, as I announced on Friday,
14 sitting an extra hour and putting everybody's resources under strain. So
15 we will adjourn now until tomorrow at 9.30.
16 MR. GROOME: Just one quick matter. Just to let the Court know
17 the Prosecution will be applying for protective measures for the next two
18 witnesses, so perhaps first thing tomorrow morning or whenever it's
19 convenient for the Court, we can address that matter.
20 JUDGE HUNT: If you just produce a document with the orders
21 sought, if there is some opposition to it, then you can let us know the
22 basis for it.
23 MR. GROOME: Thank you, Your Honour.
24 THE WITNESS: [Interpretation] I apologise. I have to leave
25 tomorrow. I have some pressing business in Zagreb and I didn't count on
1 staying longer. Unfortunately, I cannot stay longer.
2 JUDGE HUNT: What time do you have to leave tomorrow, Doctor?
3 THE WITNESS: [Interpretation] My plane leaves at 11.20 from
5 JUDGE HUNT: You have to book in at least an hour ahead for a
6 continental flight. That puts a great deal of pressure on it. It's all
7 right, Doctor, we understand the problem. Is there no later plane you
8 can catch to still keep up with those commitment?
9 THE WITNESS: [Interpretation] Unfortunately, not.
10 JUDGE HUNT: Well, I think the only thing to do, then, is to
11 appeal to the interpreters and the court reporters to see whether we can
12 take that extra hour. Is there any problem?
13 THE INTERPRETER: The interpreters agree to stay for an extra
15 JUDGE HUNT: The court reporters? All right. We will adjourn for
16 half an hour and resume at 4.30.
17 --- Recess taken at 4.03 p.m.
18 --- On resuming at 4.30 p.m.
19 JUDGE HUNT: Mr. Domazet, I don't want to place any pressure upon
20 you at all, but have you got some idea of how long you'll need for your
22 MR. DOMAZET: [Interpretation] Your Honour, in view of this
23 situation, I do not wish Mrs. Folnegovic to have problems. I have
24 shortened and reduced my questions and I believe we shall be finished
25 before the end of the session today, the extended session.
1 JUDGE HUNT: Well, as I say, I don't want to put any pressure on
2 you. If you need more time, please say so.
3 MR. DOMAZET: No, thank you, it's no pressure.
4 JUDGE HUNT: You go ahead.
5 MR. DOMAZET: [Interpretation]
6 Q. Madam, when you spoke of a period for which you believe you have
7 reliable proof, and that was the 4th and the 5th of July, you identified
8 this period according to the notes of Dr. Stojkovic, and this is probably
9 the basis upon which you take this time as certain, in view of his
10 situation, his state at the time. Do you have any information that he
11 caused similar incidents earlier or, rather, he had -- he caused such
12 incident earlier, and had this been recorded, would this have changed your
13 opinion as to the time period?
14 A. I will give you a precise answer. I cannot personally ascertain
15 the date. It is based exclusively on the data I found in the case history
16 for the third hospitalisation of Mr. Vasiljevic.
17 Q. When you spoke of doctors in general and said that all doctors,
18 once they graduate from medical school become general practitioners, which
19 is certainly true, but for the sake of all the people in this courtroom
20 who do not know of the practice in former Yugoslavia, is it not true that
21 there are doctors who specialize in general practice?
22 A. That is correct. I do not know when the specialisation in general
23 practice started in the former Yugoslavia. It has not existed forever,
24 but it did start at some point. I don't know when exactly. However, it
25 is true that in every country of the former Yugoslavia, there is a
1 specialization in general practice.
2 Q. To the question concerning fear, the fear Mitar Vasiljevic felt
3 for certain -- for various reasons because of the wartime situation,
4 because of his own situation, the situation of his family, I think you
5 said that people experience fear differently, but the fear he could have
6 had, I think you put in a category of normal fear, normal for the time,
7 that is for wartime; is that correct?
8 A. Yes.
9 Q. However, when speaking of what preceded his detention in Uzamnica,
10 in Visegrad, and what Dr. Vasiljevic said, and what formed the basis for
11 the conclusions of Dr. Lopicic, some of her conclusions, you said, on the
12 one hand, that it was less likely that a doctor would miss something like
13 this. But before I ask you about this, let me ask you, do you think that
14 he could have been suffering from greater fear if he was in detention
15 because he had returned his weapon and refused to go to the front line, so
16 he was risking serious punishment, even the most serious punishment?
17 Could that have affected his fear at the time?
18 A. It could have intensified his fear.
19 Q. Your assessment of Dr. Vasiljevic's method, and you mentioned that
20 he was a relative but he's a distant relative so he had no close relations
21 with the family, so he couldn't know much about the family as a doctor.
22 He was a general practitioner. However, you say that as a doctor, in such
23 a situation, he would have had to ask for him to be hospitalised. When
24 you said this, were you aware of the fact that Mitar Vasiljevic was in
25 prison and that this was not a real prison but an improvised prison,
1 because there was no prison in Visegrad and the detention facility was in
2 the former barracks and it would have been impossible for him to be
3 transferred to the hospital and released from prison based on a doctor's
5 A. If you are asking me what I would have done and what in my view
6 was the doctor's duty, it was his duty to write down that he should be
7 hospitalised and to tell those in charge to call an ambulance because he
8 would not only be helping the patient in this way but taking the
9 responsibility off his own shoulders. So it was his duty to write down
10 that the patient had to be hospitalised urgently.
11 JUDGE HUNT: Mr. Domazet, I don't recall any evidence about that,
12 the state of the prison in Visegrad. It probably isn't important, bearing
13 in mind the answer which has been given, but if you want to rely upon that
14 fact, you may have to give evidence about it. I've pointed this out
15 before. A question is not in itself evidence. It's the answer which is
17 MR. DOMAZET: [Interpretation] Your Honour, I remember asking
18 witnesses from Visegrad whether Visegrad had a prison or not, and the
19 replies were that there was no prison in Visegrad but that there was one
20 in Foca and that Uzamnica was a temporary prison at that time. I can find
21 this in the transcripts. We asked people from Visegrad this question.
22 However --
23 JUDGE HUNT: I accept what you say, Mr. Domazet, about the
24 evidence. But that still doesn't include the description you've given of
25 it. As I say, it probably isn't necessary for you to worry about it. I
1 do get very worried, however, when counsel start asserting evidence from
2 the bar table.
3 MR. DOMAZET: [Interpretation]
4 Q. Speaking of heredity, and quite a lot has been said about it
5 today, you spoke of the possibility that persons could inherit or not
6 inherit a disorder from their ancestors. You gave us some percentages as
7 to the likelihood. However, did I understand you well when you said that
8 someone can either be ill or absolutely healthy, that it was not possible
9 for someone to have some sort of consequences but not the same as his
10 ancestor had? Did I understand you correctly?
11 A. Modern psychiatry holds this view, that an illness is either
12 inherited or not inherited. We are speaking within the framework of a
13 diagnosis. In order to say that an illness exists, it has to meet the
14 required criteria which define the illness.
15 Q. You saw that Dr. Lopicic broke her report into two -- into three
16 elements, heredity, alcohol and stress, and you seem to be referring to
17 the same factors, but you either give less importance to the first and
18 third factors, or you feel that, in this case, they are less important in
19 relation to the importance attached to them by Dr. Lopicic?
20 A. That is correct.
21 Q. So the factors are the same but the interpretation of their
22 significance in this particular case differs; is that right?
23 A. Yes.
24 Q. Dr. Simic and Dr. Martinovic spoke and testified here that
25 psychoses, according to them, have a prehistory which may last for a month
1 or two before the psychosis. Do you agree with these opinions, and have
2 you any comments about this?
3 A. I have a very important comment on this. When we are talking
4 about psychosis as psychiatrists, we have to be very precise as to which
5 psychosis we are talking about. If you are asking me about a period of
6 development of a schizophrenic psychosis, it can last two or three years.
7 If you're asking me about alcoholic psychosis or delirium, then the times
8 are different.
9 If you read my written opinion where I quoted from the
10 international classification, they list different symptoms and the
11 different course of the illness for each psychosis, so I do not agree to
12 talking about psychosis in general. When you talk about a psychosis in
13 general, then this period can be from several hours to several years. But
14 no one mentioned a specific psychosis. Each one has a different clinical
15 picture, a different onset, a different treatment, and a different course.
16 Q. It's true they did not say what psychosis they were referring to,
17 but if it was an alcoholic psychosis, how would things be?
18 A. It has a sudden onset, which begins from its immediate cause up to
19 a few weeks later. So this is not strictly defined, but the definition is
20 that it begins within a relatively short period of time.
21 Q. When you spoke of acute intoxication and the day when Mitar
22 Vasiljevic was injured and the state he was in, you spoke of the state he
23 was in and said that it was closer to the second degree of accountability,
24 according to your information. It seems that the decisive factor you
25 mention is -- in cases of significantly diminished accountability, is
1 dementia or not remembering what he did that day, and you say that he
2 remembered quite well what he did that day.
3 My question about that day is as follows. He told you, and you
4 saw, that he was able to remember his riding the horse, the drinks he had
5 with the person in Pionirska street, and this is true, but my question
6 is: Is it possible that he can remember some of these things so well, or
7 maybe they were described by other eyewitnesses and entered his memory as
8 he listened to their testimony in court?
9 A. I understand your question. The gentleman spoke of this in
10 identical terms to the Court, to the doctor who interviewed him before me,
11 and to me. If he had forgotten about it and received information from
12 someone else about it, then the chances are minimal that he would have
13 repeated the story in the same way. You know, they say, "If I don't want
14 to be recognised, I mustn't lie." If someone confabulates and fills in
15 the gaps in their memory with things that he heard from other people, then
16 the chances are minimal that he will be able to repeat the story in the
17 same way again.
18 Q. On the basis of your experience in this sort of forensic work -
19 and you certainly have a lot of experience - do you feel that Mitar
20 Vasiljevic answered all the questions you put to him sincerely and
22 A. This question can be answered on the basis of psychological
23 testing. I personally did not have a feeling that anything that the
24 gentleman told me when describing these events was not authentic. He made
25 an effort to support things with facts, details, illustrations. He
1 enumerated things that helped him to remember. So I had no reason not to
2 believe what he told me.
3 Q. When speaking of the date, you mentioned when he remembers a lot
4 of details and is able to repeat them. In one part of the story, when he
5 speaks of what happened in Pionirska Street, he drank brandy with a man he
6 knew, but he probably wasn't able to give you a lot of information, and
7 here before the Court, we have heard testimonies of people who said that
8 first he walked down the street, called on people to join in the cleaning
9 of the street, used strange words, he was saying, "Your street is one of
10 the cleanest in the town, but come out and clean it." Then he had a
11 conversation with a group of people who say he gave them instructions
12 where they should go, how they should do this, that he wrote a sort of
13 letter of guarantee and gave it to someone, and he does not remember this
14 at all, while several witnesses have mentioned this in different ways.
15 What could this indicate in this case?
16 A. I couldn't reply to that. I have too little information, because
17 what you have just said is something I'm hearing for the first time.
18 Q. Of course, if this has been represented correctly by the other
19 side and he doesn't remember it and -- but these are all events that are
20 interconnected and logical?
21 A. The context of his interview with me was not -- what he told me
22 was not the story of someone who had gaps in his memory. He told me --
23 when he spoke of his time in hospital, "I came to hospital and then some
24 time seems to be lost." A person who has gaps in their memory knows they
25 do not remember things, if they were drunk. He says, "Well, up to that
1 point in time, I remember what happened. After that, I don't." And he
2 remembers the falls from the horse. I would not see this as pathological.
3 Q. When you say he remembers some things and then not others and then
4 the fall from the horse, do you mean that he remembers things that
5 happened before other things, he remembers what happened in the end? Is
6 that what you're referring to?
7 A. Yes.
8 Q. According to what you said -- what he said and what the witnesses
9 spoke of that day, he rode a horse, a horse he had seen for the first time
10 in his life, without a saddle, without stirrups, the horse was unshod and
11 he rode it in the direction of town, through the town centre, while it was
12 raining and that he rode quite fast and then the accident happened. Do
13 all these circumstances indicate that he was perhaps drunk or do they
14 indicate something else in view of the fact that he did all this, as he
15 himself has told us and as some witnesses have testified?
16 A. Well, he told me all of this in great detail. He thought it was
17 not a very wise thing to do. He gave his critical comments on this. I
18 think he did all this under the influence of alcohol, among other things.
19 I don't know what kind of rider he is. He rode as a child. He fell from
20 a horse. That was in his case history. He seems to be a very good rider.
21 So I am unable to estimate how unwise this was to ride in this way, but he
22 himself told me it was unwise and he took a critical attitude to this.
23 And I think that to a large extent, this could have followed from the fact
24 that he was under the influence of alcohol.
25 Q. What you have just told us, does it indicate that it's more likely
1 that he was in the second category of accountability, according to his
2 behaviour that day?
3 A. Yes.
4 Q. And to conclude, when you spoke of the way accountability was
5 classified in the former Yugoslavia, into four categories -- in the
6 English text this is Roman numeral III, A, B, C, and D. Would you please
7 look at III(C)? It says here, and I think you testified to this today,
8 that a person with significantly diminished accountability is not
9 criminally responsible?
10 A. That's correct.
11 Q. Unfortunately, we diverge completely here. I don't know if there
12 have been some changes in Croatia but in Yugoslavia at that time and now,
13 significantly diminished accountability, to my regret because I would
14 prefer it to be otherwise, I would prefer it to be as you say, but
15 significantly diminished accountability influences only the sentencing and
16 not the criminal responsibility, which is excluded only in the fourth
17 case, in case of incompetency. I wanted to see whether this was
18 perhaps a lapse, an omission. We have expert opinions of criminal lawyers
19 on this. I would prefer it to be so but it is not so. Unless there have
20 been changes in Croatia, but I don't think so personally. This is a legal
21 question. I don't know if you can comment on it but this is what I would
22 like to say.
23 A. Thank you for what you have said. I do have a comment. I am not
24 absolutely sure of this. I wrote this classification down here. There
25 may be some confusion because the law has changed in Croatia and this is
1 your field of expertise. I accept that things are as you say. The second
2 -- the recommendations are made by us as psychiatrists but you are the
3 expert on this and this is your domain. Thank you for your comment.
4 JUDGE HUNT: Mr. Groome?
5 MR. GROOME: No questions, Your Honour.
6 JUDGE HUNT: Well, thank you, Doctor, for coming along to give
7 evidence and for the evidence you've given. I hope you catch your plane
8 all right in the morning, but you are now free to leave, as are we.
9 THE WITNESS: [Interpretation] Thank you.
10 [The witness withdrew]
11 JUDGE HUNT: So we will adjourn now until 9.30 in the morning.
12 --- Whereupon the hearing adjourned at
13 4.58 p.m., to be reconvened on Tuesday,
14 the 15th day of January, 2002, at 9.30 a.m.