1 Tuesday, 10th November, 1998
2 (Open session)
3 (The accused entered court)
4 (The witness entered court)
5 --- Proceedings commenced at 9:30 a.m.
6 THE REGISTRAR: Case number IT-95-17/1-T, the
7 Prosecutor versus Anto Furundzija.
8 JUDGE MUMBA: Can the accused hear me in a
9 language he understands?
10 THE ACCUSED: Yes, Your Honour.
11 JUDGE MUMBA: I think the parties are as
12 before. Can we proceed with cross-examination.
13 WITNESS: JEFFREY N. YOUNGGREN (Resumed)
14 MS. SELLERS: Good morning Your Honour. Good
15 morning, Dr. Younggren. Your Honour, my microphone is
16 exhibiting red. Am I being heard?
17 JUDGE MUMBA: Yes.
18 Cross-examined by Ms. Sellers:
19 Q. Dr. Younggren, I'd like to ask some more
20 questions relating to the Medica institution. There
21 was testimony you gave yesterday concerning
22 inexperience at Medica possibly impacting on Witness A;
23 isn't that correct?
24 A. Yes, I had concerns that individuals who are
25 inexperienced trying to treat serious traumatic
1 disorders could actually create problems for patients.
2 Q. And you were concerned also about the
3 institution; is that correct?
4 A. I had concerns about the goals of the
5 institution being inconsistent potentially with the
6 goals of therapy, if you will.
7 Q. Dr. Younggren, can I refer you to Defence
8 Exhibit number 25? Dr. Younggren, would you look at
9 the second paragraph on the first page, and the last
10 sentence of the second paragraph, doesn't it
11 read: "The reason why we decided to found the Medica
12 project is that we wanted to assure highly professional
13 help to female victims of the war in
15 A. Yes, that's what it says.
16 Q. And does the next sentence say: "The help we
17 offer is a combination of medical and psychological
18 treatment provided by highly professional local
20 A. Yes, it does.
21 Q. Dr. Younggren, I would like now to have you
22 turn your attention to Defence Exhibit number 22. I
23 would draw your attention, sir, to the bottom of that
24 page where it says, "There is no proven therapeutic
25 concept to help trauma victims who still have to live
1 in life-threatening conditions;" is that correct?
2 A. That's what it says, yes.
3 Q. Now, Dr. Younggren, in your experience, your
4 clinical experience, do people who have PTSD, are they
5 treated in that trauma situation usually?
6 A. Usually not. Actually, acute stress disorder
7 patients in combat situations are treated in the
8 setting but Post Traumatic Stress Disorder patients are
10 Q. They're usually removed from the situation,
11 is that what your testimony is, sir?
12 A. No, that's not really what my testimony is.
13 Individuals who experience combat stress reactions,
14 soldiers, if you will, tend to be treated at the site.
15 That is, they're removed briefly, given some rest and
16 sent back to the units they're involved with, because
17 we have learned that removing them from the situation
18 tends to make the emotional -- long-term emotional
19 reactions more severe. But in Post Traumatic Stress
20 Disorder patients, what you're saying is correct, they
21 are generally treated elsewhere because post traumatic
22 requires four weeks after the event or more, and so
23 generally these people are not in the situation that
24 they're normally exposed to.
25 Q. Sir, would you go to the next sentence after
1 the one I read to you before, and doesn't that say,
2 "This means that members of the psycho-team have
3 gradually developed their own concepts for therapeutic
4 practice in war?
5 A. That's what it says.
6 Q. Sir, to treat post traumatic stress patients
7 in a situation of war, as you've just stated, has its
8 own constraints; isn't that true?
9 A. Yes.
10 Q. And I would like to turn your attention,
11 therefore, back to document Defence Exhibit D25, the
12 first one, I believe, we looked at, and I would take
13 you to page 2, sir, where it says, "Problem
14 statement." It's at the bottom of page 2. And it
15 states that, "Medica's basic aim is to assist women and
16 girls having been raped and detained in war, as well as
17 to place women to find their psychic balance." Isn't
18 that what it states?
19 A. Yes, it does.
20 Q. So, sir, you understand that Medica was
21 treating patients at wartime, is that correct?
22 A. Yes, that's correct.
23 Q. They were treating patients that could have
24 been diagnosed for post traumatic stress related to
25 that war; isn't that correct, sir?
1 A. Yes.
2 Q. Sir, I'd like to turn your attention now to
3 D22, and if you would go to -- the pages,
4 unfortunately, aren't numbered, but the third page,
5 sir, and in the middle of the third page there is a
6 headline that says, "Safety In War." Sir, I would
7 direct your attention down to not the first but what
8 would be appear to be the second paragraph after that
9 phrase. It says, "In fact, and particularly, in 1993,
10 1994, Zenica was under grenade fire;" isn't that
12 A. Yes.
13 Q. And it says, "The women at Medica panicked
14 every time a grenade struck in the town;" isn't that
16 A. Yes.
17 Q. Dr. Younggren, we heard testimony yesterday
18 from Dr. Mujenznovic about Medica, and his testimony,
19 wasn't it, sir, that Medica was a highly respected
20 organisation within the region?
21 A. Yes.
22 Q. And wasn't it his testimony also that Medica
23 had staff, such as Dr. Sabic, who were highly regarded
24 among other medical professionals?
25 A. Apparently so, yes.
1 Q. Now, are you familiar with some of the
2 services that Medica offers?
3 A. As I indicated yesterday, the information
4 that I have about Medica is limited to these materials,
5 because apparently nothing else was available, and so
6 the discussion for me becomes, in some ways, a
7 theoretical discussion addressing these documents,
8 because while I feel strongly that Medica was doing
9 their best, it sounds like it, it doesn't mean that
10 they were doing it right, and the documents also put me
11 in a position of being concerned about whether their
12 goals politically are inconsistent with their treatment
13 goals for patients.
14 Q. Dr. Younggren, can I ask a couple of
15 questions, of course based on the documents, as you
16 state you have no other information, about some of the
17 things that Medica did do? Can we turn to D25 again,
18 to the second page, please, and, sir, at the beginning
19 of the second page it talks about organisational
20 profile; doesn't it?
21 A. I'm sorry, I don't see what you're --
23 A. Second page. I'm sorry. Yes.
24 Q. And doesn't it say that it was a women's
25 therapy centre?
1 A. It does.
2 Q. And doesn't it say that it offered
3 gynaecological outpatient services for women?
4 A. Yes, it does.
5 Q. And does it say it had general practitioners,
6 an internist, two anaesthesiologists and six nurses?
7 A. And two gynaecologists.
8 Q. Is that correct, sir?
9 A. Yes.
10 Q. Does it talk also about that it had other
11 staff such as -- apart from medical and paramedical,
12 such as administrative staff, a lawyer, a field
13 officer, kindergarten, pre-school teachers?
14 A. Yes.
15 Q. Sir, in that second section does it talk
16 about that it had an ambulance service, meaning a
17 mobile service for its services?
18 A. Yes, it does.
19 Q. Does it also include a children's programme,
21 A. It does indicate that.
22 Q. Yes. And that's a kindergarten and pre-school
23 service for refugee children; is that correct?
24 A. Yes.
25 Q. And in addition to that it talks about
1 psychological care, medical care, that it had a female
2 theologian, psychologist and a sociologist; is that
3 correct, sir?
4 A. That's correct.
5 Q. Sir, would you consider that a
6 multi-disciplinary service?
7 A. By definition, yes.
8 Q. Yes. Sir, have you seen anything of these
9 documents that says Medica is a rape crisis centre?
10 A. Not directly.
11 Q. Sir, have you seen anything in the documents
12 that it says that Medica is a rape crisis centre?
13 A. Not that I recall.
14 Q. Sir, would you like to look through the
15 documents to see if it says that Medica is a rape
16 crisis centre?
17 JUDGE MAY: Can I interrupt? If it doesn't
18 say so. Just put it rather than wasting time going
19 through the documents.
20 MS. SELLERS: Yes, Your Honour. I've
21 just asked the question--
22 JUDGE MAY: You know. Does it say it's a
23 rape crisis centre or not?
24 MS. SELLERS: Oh, no, I have not seen
25 anywhere in the documents where it says that. I
1 thought Dr. Younggren might.
2 JUDGE MAY: Yes. We'll accept that.
3 MS. SELLERS: Fine.
4 Q. Dr. Younggren, Dr. Mujenznovic testified
5 concerning the type of care that Dr. Sabic spoke about
6 at Medica. Do you remember that testimony?
7 A. Yes.
8 Q. And do you remember that he said that
9 Dr. Sabic said that their approach was to gradually
10 come into the subject concerning the trauma that a
11 patient might have? Do you remember that?
12 THE INTERPRETER: Madam President, could we
13 ask for counsel to slow down, please?
14 A. -- extensive testimony.
15 JUDGE MUMBA: Ms. Sellers, could you slow
16 down for the interpreters, please?
17 MS. SELLERS: Yes. Excuse me.
18 Q. Dr. Younggren, yesterday, I believe that you
19 were testifying concerning patients that you treat; is
20 that correct?
21 A. I testified that I treat patients who have
22 been exposed to trauma, yes, and also do forensic
23 assessments of trauma victims.
24 Q. And you stated, sir, in your testimony
25 yesterday, that you would try to establish the
1 therapeutic relationship and in some gradual and
2 supportive way work through the re-experiencing of
3 trauma. Do you remember that sir?
4 A. Yes, I do, and I still feel that way.
5 Q. That would be a correct manner of treating
6 someone who had suffered trauma?
7 A. In a very general sense, yes.
8 Q. And, sir, do you recall that Dr. Sabic also
9 said that the manner of treating trauma -- I'm sorry,
10 not Dr. Sabic. Dr. Mujenznovic, speaking of Dr. Sabic,
11 said the manner of treating trauma was to go in a very
12 slow way to reach the problem, to discuss the problem?
13 A. I'll say again I don't recall that
14 testimony. His testimony was extensive. I'll accept
15 it if you indicate he said it, but I don't recall that,
16 I'm sorry.
18 A. No, I don't.
19 Q. So you don't have any information concerning
20 their schooling?
21 A. As I indicated, all I have is the material
22 that I indicated earlier. I have no other
23 information. There's nothing available.
24 Q. Sir, we can't say that that was necessarily
25 an inexperienced psychologist, can we?
1 A. No, we can't.
2 Q. Do you have any information concerning any of
3 the academic qualifications or experience of the other
4 people who worked at Medica?
5 A. The only information I have is in these
6 documents, and there is information in these documents
7 that makes me concerned about the techniques they
8 utilised. I don't know specifically about the
9 qualifications of the therapists. I don't even know
10 what the definition of psychologist is, and I wouldn't
11 be able to testify about that.
12 Q. Sir, you have no information relating to
13 whether they were inexperienced or not? Yes or no,
15 A. No, I don't have any information except
16 that --
17 Q. Thank you.
18 MR. MISETIC: Your Honour, could the witness
19 be allowed to finish his answer to that question?
20 JUDGE MUMBA: Yes.
21 A. Except that one of the documents indicates,
22 in Medica's own statement, that they did not know what
23 they were doing when they started to do their work with
24 these victims, and that statement causes me to be very
1 MS. SELLERS:
2 Q. Sir, let's talk about these therapies that
3 you're concerned about. You mentioned before that the
4 group therapy might possibly contaminate someone; is
5 that correct, sir?
6 A. Yes.
11 Q. Sir, are you concerned about what was
12 mentioned as the dream therapy?
13 A. I don't know what that means, and I'll stay
14 with my testimony yesterday, that that concerns me
15 about dream therapy. Again, it becomes a theoretical
16 concern because I don't know what that means.
17 Q. Sir -- pardon me.
18 A. And it can be potentially risky therapy.
23 Q. Sir, you raised concerns about the imagery
25 A. Yes.
1 Q. Now, sir, haven't there been studies done
2 that shows imagery and cognitive interview
3 techniques -- excuse me. Let me stop. Can I ask you,
4 sir, are you familiar with cognitive interview
6 A. Yes, I understand what you're saying.
7 Q. Among the cognitive interview techniques,
8 isn't there something called "free recall"?
9 A. Yes.
10 Q. Are you familiar that studies done on imagery
11 and cognitive techniques such as free recall have
12 sometime given greater detail to events that have
13 happened during trauma?
14 A. Yes, I'm familiar with that, and also that
15 technique, utilised with individuals who take an active
16 guiding role, has been shown to contaminate memory, so
17 I don't know what they did, but while some studies show
18 that recall is enhanced, it also shows that therapists
19 utilising this technique can create distortions in
21 Q. Well, sir, wasn't that the therapist who used
22 this technique when -- actually, they were blitzing
23 information to children over the period of a year?
24 A. Well, there are multiple studies, and I'm not
25 sure which one you're making reference to.
1 Q. Well, sir, I'm making reference to the one
3 isn't it true that within their study they found that
4 details and accuracy did come forward with imagery
5 technique and free recall?
6 A. That's true and --
7 Q. Yes. And -- pardon me.
8 A. As I said, there are studies that also show
9 that improperly done, memory can be contaminated.
11 Q. Thank you, sir. Sir, you testified yesterday
12 concerning your own clinical experience, and your
13 testimony was that after the question was answered, "Do
14 you believe your own patients?" and your response was,
15 "Generally, yes." Is that correct?
16 A. Yes.
17 Q. So you did qualify that with "unless you get
18 into these extreme areas where I think it's not helpful
19 for people to carry around bizarre belief"; isn't that
21 A. Yes.
22 Q. And I think one of the extreme examples you
23 gave was the satanic cult; is that correct?
24 A. Actually, that was one of two. The other is
25 alien abductions.
1 Q. Alien abductions. That's right, sir. Those
2 are extreme beliefs, aren't they?
3 A. I believe so.
4 Q. And they would have no context in Southern
5 California; isn't that correct?
6 A. Many of them come from Southern California
7 but from the scientific perspective, they have no
9 Q. Sir, in a war situation, is it possible that
10 women are raped?
11 A. It's not possible, it happens.
12 Q. As a matter of fact, you certainly agree that
13 Witness A had horrific events occur to her; right?
14 A. I have to say it is emotionally upsetting to
15 read what happened to her.
16 Q. So in the context of Medica in Zenica, a
17 woman who was raped and detained, that's not a bizarre
18 incident, is it, sir?
19 A. No.
20 Q. And like you would do in Southern California
21 when a patient came, you would probably believe or
22 accept that that person believed what they were telling
23 you; right?
24 A. From a treatment perspective, yes,
25 absolutely, because it's very important to be
1 supportive of your patients. They feel alone and
2 damaged, and the whole sense of having an alliance with
3 somebody who cares and is going to walk through this
4 with you is most helpful, so believing them from an
5 emotional perspective is helpful therapeutically.
6 Q. Sir, you discussed yesterday when there can
7 be that conflict between the forensic role and the
8 therapeutic role; is that correct?
9 A. Yes.
10 Q. As a matter of fact, I believe that you said
11 that that conflict could be an ethical violation?
12 A. Yes, it can lead to ethical conflicts.
13 Q. Right. You're someone who testified
14 yesterday that you're fairly familiar with ethical
15 violations as they are pertain to California
16 United States, and I'll qualify that for the Judges.
17 A. I have spent twenty years dealing with them,
18 so I'm fairly familiar.
19 Q. But, sir, isn't that conflict when -- isn't
20 that conflict centred on when the same therapist is the
21 forensic therapist and the treating therapist; isn't
22 that the conflict?
23 A. Yes, that's true. The majority of the
24 articles address that, and I will extend it to
25 organisations only out of my concern that the goals of
1 an organisation may put pressure on a therapist to
2 accomplish certain ends that may not be in the best
3 interest of the patient. I'm not going to leap out and
4 say that Medica is unethical, but I do worry that their
5 goals may not be psychologically helpful for Witness A
6 if this is a part of those goals, and I don't know
7 that. I mean, I'm concerned about the e-mail -- I
8 don't know if I can talk --
9 MS. SELLERS: May I continue?
10 JUDGE MUMBA: It isn't part of the evidence.
11 MS. SELLERS: Thank you.
12 Q. But, Dr. Younggren, you do agree that some
13 institutions can have that dual function but it can't
14 be the same therapist having that dual function; is
15 that correct?
16 A. That's correct, and they need to be most
17 careful not to put pressure on the therapist to
18 accomplish those goals.
19 Q. Right. Sir, for example, you could have a
20 state hospital in California, let's say a psychiatric
21 hospital, that is treating patients, and then -- a
22 psychologist or psychiatrist who are treating patients,
23 but yet that same state hospital could have a reporting
24 function to the California court system concerning that
1 A. That's correct, and generally that reporting
2 function is separate from the treatment.
3 Q. So an institution can have those dual
4 functions but they shouldn't be mixed in one therapist;
5 is that what you're saying, sir?
6 A. What I'm saying is that they should not
7 pressure the therapist to try to accomplish the
8 political/social/forensic goal that could be
9 inconsistent with the treatment goal. So it is
10 possible to do that, and I'm sure organisations do, but
11 I also am sure that organisations don't. But it is
12 possible to separate those, and your point is correct,
13 that they can have those mixed roles.
14 Q. Dr. Younggren, I would like to turn your
15 attention back again to D25, and this would be on the
16 third page. I don't know whether you have numbers
18 A. I do. Let me ...
19 Q. I don't. Where it says "Goals and
20 Objectives," and, Dr. Younggren, doesn't it state that
21 "The main goals of our projects are: 1. To provide
22 gynaecological, general medical treatment to women and
23 girls who have been war-raped, detained, and held in
24 home custody or displaced"?
25 A. Yes, it does.
1 Q. Doesn't it say, "The goals and objectives are
2 -- to provide psychological/psychiatric treatment"?
3 A. Yes, it does.
4 Q. And it does say that, among the goals and
5 objectives, "To organise a shelter for refugee women
6 during war. Afterwards, in peace time, the centre
7 could be transformed into a shelter for raped women and
8 girls, if necessary"?
9 A. It does say that.
10 Q. And does it say, "To re-establish psychic
11 balance for women war victims, by running their own
12 households with support of Medica team, and by gaining
13 better qualification through education"?
14 A. It does.
15 Q. And does it say, "To do sociological and
16 analytical research"?
17 A. It says that.
18 Q. And, Dr. Younggren, in the end, when they're
19 explaining their goals, does it say that "staff as well
20 as patients belong to all three ethnic groups of former
21 Yugoslavia." And that's on that same page right
22 afterwards, and that "We want to stick to this
23 principle and maintain our independence although is
24 growing, even in Zenica's nationalistic pressure"?
25 A. That is a quote.
5 A. No. I'm just worried about it.
6 Q. Dr. Younggren, I'd like to ask a couple
7 questions about memory. You mentioned in your
8 testimony yesterday that you believe that rape had an
9 effect on memory; is that correct?
10 A. I think there's empirical evidence for that.
11 Q. Yes, and you cited the Koss study, sir; isn't
12 that correct?
13 A. That's correct.
14 Q. Sir, in the Koss study, which I have here,
15 under the section of "Memories," it says: "Relatively
16 modest magnitude for affecting those memories has been
17 caused by rape." Are you familiar with that part of
18 the study?
19 A. I have a copy of the study with me, and I'd
20 like to have that, if I could?
21 MR. MISETIC: I'm going to ask if we could
22 have copies of where she's citing from so that the
23 witness can also see the context.
24 MS. SELLERS:
25 Q. Do you have a copy of that study, sir?
1 A. Yes, I do.
2 Q. I'm sorry. Do you have it with you?
3 A. Yes, I do.
4 MR. MISETIC: He needs to go get it. It's
5 not with him, is it?
6 THE WITNESS: It's in my briefcase.
7 JUDGE MUMBA: Yes, the witness will be
8 allowed to get his copy so he can refer to it.
9 THE WITNESS: Thank you, Your Honour.
10 MS. SELLERS: Your Honour, could I offer the
11 witness a copy of my study?
12 JUDGE MUMBA: Then the witness can come back
13 and ...
14 MS. SELLERS:
15 Q. Dr. Younggren, you see there I have two
16 places highlighted in the study, and this is under the
17 section of "Memories"; isn't that correct?
18 A. Yes, that's correct.
19 Q. What those portions are saying, sir, isn't
20 it, that the effect on memory is of a relatively modest
21 magnitude after the occurrence of rape?
22 A. That -- that quote is correct in the context
23 of the rest of the paragraph.
24 Q. Right. And, sir, the second part that's
25 highlighted, doesn't it say "the effects were
1 inconsistent in direction and magnitude"?
2 A. Yes, and it also follows with the statement:
3 "There were large and positive effects" -- let me
4 see. "They were positive and large on the affect
5 factor and negative and somewhat smaller on both
6 clarity and sensitive."
7 Q. Sir, doesn't that really mean that some
8 things were remembered better and maybe some things
9 were remembered less?
10 A. Correct.
11 Q. Sir, I understand that that's what you mean
12 by the effect on memory when you testified yesterday.
13 A. That rape affects memory.
14 Q. Now, sir, you understand that that study was
15 done with a population of university women who had been
16 raped; is that correct?
17 A. Right. It's a large survey, and they
18 separated out those that were raped from individuals
19 who had memories of bad experiences.
20 Q. Right. And as a matter of fact, the
21 population that they studied was a population of
22 university women who were raped who were trying not to
23 think about the rape; is that correct?
24 A. That's correct.
25 Q. Now, sir, you've testified a bit about Post
1 Traumatic Stress Syndrome, and one of the symptoms of
2 Post Traumatic Stress Syndrome is intrusive memories;
3 isn't that correct?
4 A. It is intrusive memory and avoidance of the
5 stimuli, so that's one symptom, and you are correct.
6 Q. Yes. As a matter of fact, in terms of
7 intrusive memories, that means that memories come
8 back. You try to repress them but you can't repress
9 them; is that correct?
10 A. They're experienced in different ways but,
11 right, they pop through, if you will, the natural
12 defence to try to avoid thinking about them.
13 Q. And, sir, would you agree that this is a
14 study that looked at memory as affected by rape, not
15 memory as affected by Post Traumatic Stress Syndrome;
16 is that correct?
17 A. I will say the study doesn't address that.
18 It wasn't evaluating PTSD as such, it's a study about
20 Q. Right. Are all people who are raped also
21 sufferers of Post Traumatic Stress Syndrome?
22 A. No, not at all. There are many people that
23 recover. I mean, there are a variety of things that
24 occur. Not everyone develops PTSD.
25 Q. And, sir, also in this study, the population
1 of university women, to our knowledge, there was a
2 single incidence of rape, wasn't it, sir?
3 A. I believe so. I'd have to go back through
4 the study.
5 Q. And, sir, this study certainly did not take
6 in war conditions or imprisonment conditions or serial
7 or multiple rapes, did it, sir?
8 A. No, it's a study of the effects of rape upon
10 Q. Sir, I just have a couple more questions that
11 I would like to ask you, and one relates to your
12 summarised expert witness statement. Are you -- I do
13 have copies of this. I would like to ask the witness
14 -- and for the Court.
15 THE REGISTRAR: This would be marked as
16 Prosecution Exhibit number 5.
17 MS. SELLERS:
18 Q. Dr. Younggren, I'd like to direct you to your
19 summarised witness statement, first paragraph, please.
20 In the last sentence of the first paragraph, you
21 state: "This is true of memories of intense and
22 passive experiences, although intense experiences are
23 logically remembered more accurately because of our
24 tendency to attend to them more --"
25 THE INTERPRETER: Could counsel slow down,
2 A. Yes.
3 JUDGE MUMBA: Could you slow down, please?
4 Slow down.
5 MS. SELLERS: Sorry.
6 Q. Now, sir, I understand that in the preceding
7 sentence, to place this in context, haven't you stated
8 that memory is reconstructive, and it easily follows
9 that the longer the passage of time, the more
10 inaccurate memory?
11 A. That's what I believe the literature says.
12 Q. Sir, that's what you've written in your
13 summarised statement; right?
14 A. Yes.
15 Q. Then, sir, in the next sentence, you do say
16 that, "although intense experiences are logically
17 remembered more accurately because of our tendency to
18 attend to them more actively"; isn't that correct?
19 A. Yes.
25 A. Absolutely.
1 Q. Dr. Younggren, are you familiar with the
2 concept of gist and peripheral?
3 A. Yes.
4 Q. Would you agree that certain intense
5 experiences become the gist experience?
6 A. Yes.
7 Q. Dr. Younggren, do you know how tall I am?
8 A. Five seven.
9 Q. In centimetres?
10 A. Oh. No.
11 Q. Is that very important to me cross-examining
12 you, how tall I am?
13 A. No.
14 Q. Dr. Younggren, I want to turn to your
15 testimony yesterday and the testimony -- you stated
16 that Witness A had a recollection of the Defendant as
17 blond and short; isn't that correct?
18 A. That's correct.
19 Q. Now, sir, what do you base that information
21 A. On the 1995 testimony of the witness.
22 Q. You probably had a lot of information to
23 absorb, a lot of documents to read, a lot of details to
24 concentrate on before coming to give your testimony; is
25 that correct?
1 A. Yes.
2 MS. SELLERS: Dr. Younggren, I would like to
3 give you a copy of one page of the 1995 statement. I
4 have copies for the rest of the Court.
5 THE REGISTRAR: The document is marked
6 Prosecution Exhibit number 6.
7 MS. SELLERS:
8 Q. Dr. Younggren, I would like to turn your
9 attention to the next-to-the-last paragraph, and that
10 would be the last three sentences on that next-to-last
11 paragraph. Dr. Younggren, doesn't that say: "Anto was
13 A. Yes, it says that.
1 Q. Sir, you did not read in the documents --
2 JUDGE MAY: Let's have the answer to that.
3 What is 172 centimetres, please?
4 MS. SELLERS: Well --
5 JUDGE MAY: Do you know, Ms. Sellers?
6 MS. SELLERS: Beg your pardon, Your Honour?
7 JUDGE MAY: Do you know? What is 172
8 centimetres in feet and inches?
9 MS. SELLERS:
10 Q. Sir, might I ask -- Dr. Younggren, you are an
11 American, aren't you?
12 A. Yes, I am.
13 Q. So am I. Do you usually deal in centimetres
14 when you're talking about height?
15 A. No.
16 Q. 172 centimetres is about five foot seven.
17 A. I actually asked for the conversion to
18 understand the height, so I know it's five seven.
19 Q. Do you know in centimetres the difference
20 between 172 and 183 in terms of finger distance?
21 A. Approximately three, four inches.
22 Q. Sir, can you show me three or four inches
23 just with your ...
24 A. I'd say approximately this (indicating).
4 A. 172 centimetres, to me, is short for a man.
5 Q. Sir, you didn't read in this document or any
6 documents that you received that he was short with
7 blond hair, did you?
8 A. I did not read the word "short" in the
9 document, I read 172 centimetres. That is
10 approximately five foot seven inches tall, which is
11 short for a man. The "short" appraisal is my
12 appraisal. The document says tall, 172 centimetres.
13 JUDGE MUMBA: That's what I was about to
14 say: For which nation?
15 THE WITNESS: Beg your pardon, Your Honour?
16 JUDGE MUMBA: For which nation? If you say
17 that's short; for which nation?
18 A. Correct, Your Honour.
19 MS. SELLERS:
20 Q. Dr. Younggren, I would like to ask a couple
21 other questions about the documents that you've read.
22 You said that you are familiar with the transcripts of
23 the case that took place in June; isn't that correct?
24 A. That's correct.
11 Page 943 redacted.
11 Page 944 redacted. Private session.
1 Could you please tell me, what is the effect of
3 A. Corroboration tends to confirm evidence,
4 confirm memory. I mean, corroboration is a valuable
5 part of establishing reality in -- I guess, properly,
6 both a forensic and a clinical sense.
7 MS. SELLERS: Thank you, Dr. Younggren.
8 Your Honour, might I just have a minute,
10 JUDGE MUMBA: Yes.
11 MS. SELLERS:
3 A. No.
4 MS. SELLERS: Thank you, Dr. Younggren.
5 JUDGE MUMBA: Re-examination by the Defence?
6 MR. MISETIC: Yes, Your Honour, I have some
8 Re-examined by Mr. Misetic:
9 Q. Dr. Younggren, Ms. Sellers asked you about
10 Medica and about the fact that they were operating in a
11 wartime situation; is that right?
12 A. That's correct.
13 Q. Doctor, what is your opinion as to whether
14 treatment in a wartime situation, as opposed to a
15 peacetime situation, is more difficult? Is it more
17 A. I'm sure it's more difficult. Of course it's
18 more difficult. The stress level is substantially
19 higher, plus, frankly, treatment goals in wartime are
20 often very different from treatment goals in peacetime,
21 from triage on down.
22 Q. Would it be an unusual or an exceptional
23 situation then, based on what you just said?
24 A. Definitely.
25 Q. Given the fact that it is an exceptional
1 situation, would that require someone with even more
2 experience and understanding of treatment of trauma
3 than the average psychologist?
4 A. Certainly you would assume that. It's a very
5 complex situation, and I think that it would require a
6 careful tuning of the techniques to address the
7 prevalent stress that's going on under artillery fire
8 while you're doing therapy. That's a little
10 Q. And given the fact that that would require --
11 may require someone with even more experience, what
12 type of damage could be done to a person who is treated
13 by people with no knowledge in the area of trauma while
14 dealing in an exceptional situation?
15 A. As I said yesterday, you can damage patients
16 if you don't know how to deal with them. This is a
17 serious disorder of long-term consequence. We have VA
18 hospitals filled with veterans who have been exposed to
19 combat, and I truly believe that the individuals who
20 tried to help them did the best they could. I'm not so
21 sure they did the right thing, and obviously,
22 retrospectively, we know better now how to treat this
23 disorder than we did the in the mid '40s, but it's
24 clear that treating it wrong can have disastrous
1 Q. Thank you. Now, Ms. Sellers took you through
2 Defence 25 and read, basically, out of the document the
3 different types of services that were provided to (sic)
4 Medica. When you testified yesterday, were you
5 attacking Medica overall?
6 A. Absolutely not. I think that for a group of
7 individuals who go in a combat zone with the best of
8 intentions, to help a population of people under siege
9 that are starving, is laudatory.
10 Q. Ms. Sellers refreshed your recollection about
11 the testimony of Dr. Mujenznovic with respect to
12 Dr. Sabic, and referred you to the fact that
13 Dr. Mujenznovic recalls Dr. Sabic saying that you
14 gradually have the patient discuss the traumatic
15 event. Isn't that what happened on cross?
16 A. Thats exactly what happened
11 Page 949 redacted
25 A. It had to have been. That's the only way
1 they would have this information, unless someone else
2 told them about it.
3 Q. Now, do you know if California State
4 hospitals also have a political purpose?
5 A. I don't know that.
6 Q. Is it your experience that hospitals have, as
7 part of their stated objectives, the accomplishment of
8 any political or social objectives?
9 A. Actually, for many of the non-profit
10 hospitals, that would create some significant problems.
11 Q. Okay. And in your experience working in
12 hospitals, does any hospital you know ask a physician,
13 a therapist, et cetera, to also partake in any kind of
14 political objective?
15 A. Not that I know of.
16 Q. Now -- so would it be unusual, in your
17 experience, to have a treatment centre have as one of
18 its stated objectives the prosecution of war
20 MS. SELLERS: Objection, Your Honour. I
21 don't believe that that's contained within any of the
22 Medica documents, unless learned counsel would like to
23 refer us to where.
24 MR. MISETIC:
25 Q. I refer to D25, page 5 that we discussed
1 yesterday. Second to last page, Doctor. Under the
2 area of "Research." One of their objectives is, "While
3 our mobile teams visits the refugee camps, they also
4 collect data on refugees in order to understand and
5 analyse the full dimension of war violence against
6 women in ex-Yugoslavia." And in the next line is,
7 "Summon international law courts against war
9 A. That's a --
10 Q. Do you have any experience with any
11 institutions that have a similar objective with respect
12 to prosecuting, let's say, everyday criminals in
13 California, for example?
14 A. No.
15 Q. Thank you. Now, I'm going to give you the
16 opportunity to explain the sentence that Ms. Sellers
17 brought your attention to on cross-examination, and
18 that sentence was, "This is true of memories of intense
19 and passive experiences, although intense experiences
20 are logically remembered more accurately because of our
21 tendency to attend to them more actively." What do you
22 mean by that?
23 A. Well, simply put, if you have an experience
24 that is emotionally meaningful in the sense of intense,
25 it tends to be registered better than passing --
1 passive experiences like passing a stop sign while
2 you're driving, or, you know, people's dress in a
3 shopping centre and so forth. Those are obviously
4 memories. And I made that statement really addressing
5 the conflict between gist and peripheral as well, that
6 sometimes in the midst of very intense experiences, I
7 will say horribly intense experiences, there are pieces
8 of data that are more passive and are not stored
9 properly, and I will call these peripheral details. So
10 that the theme or the gist of intense experiences is
11 remembered better, and I think that research clearly
12 supports that.
13 The peripheral details are prone to
14 distortion, and we can get lost in a debate about what
15 is or isn't peripheral, but I think that there is
16 evidence in the materials, as well as in the testimony,
17 for the loss of peripheral detail about what occurred.
18 Q. On that same page, down at the bottom, you
19 made the statement, "This likely contaminated the
20 accuracy of her recollections of her experiences due to
21 the tendency of trauma victims to try to organise what
22 they experienced into something that is meaningful."
23 What does that mean?
24 A. Well, from a therapeutic perspective,
25 meaningful is important. I won't say it's important to
1 every victim, but for people to organise what happened
2 to them into something that's sensible and meaningful
3 is just simply helpful, because the confusion can be
4 emotionally destructive.
5 Q. Now, Doctor, is it your experience that
6 trauma patients have any disjointed memory, or is it in
7 the studies that trauma patients have scattered
8 memories about the events in question?
9 A. Frequently scattered.
10 Q. Is it possible that a victim of trauma could
11 have transposed one memory over the top of another
13 A. Yes, that's possible.
11 Page 954 redacted
6 A. That's exactly what that says.
7 Q. Now --
8 MS. SELLERS: Your Honour, excuse me for
9 interrupting. I'd like to ask could we go into closed
10 session at this point in time? We're getting into
11 details of the testimony that were not brought out.
12 MR. MISETIC: Your Honour, we went into
13 explicit detail in closing argument where no one had an
14 objection, where we were talking about what the issues
15 in the case were. Those closing arguments are
16 available on the Internet, and these are the exact same
17 issues that have been discussed over and over again and
18 are public. There's no reason, given the fact that
19 names will not be revealed, that these issues shouldn't
20 be made public.
21 MS. SELLERS: Your Honour, if I might say,
22 we've already had inadvertent admissions that have
23 occurred today. There's information that we got
24 yesterday that was not part of the public documents. I
25 would just ask, for the protection of the witness,
1 which this Court has granted complete and thorough
2 protection, that we try and be consistent and, I think,
3 to go into closed session as we go into these details.
4 JUDGE MUMBA: Yes. I think we'll go into
5 closed session, considering that the evidence of
6 Witness A was heard in closed session.
7 MR. MISETIC: Right, but --
8 THE REGISTRAR: Private session or closed
10 JUDGE MUMBA: Private session. We'll go into
11 private session, without pulling down the blinds.
12 (Private session)
11 Page 957 redacted. Private session.
11 Page 958 redacted. Private session.
11 Page 959 redacted. Private session.
23 (Open session)
24 THE WITNESS: I solemnly declare that I will
25 speak the truth, the whole truth, and nothing but the
2 WITNESS: CHARLES ALEXANDER MORGAN III
3 Examined by Mr. Davidson:
4 Q. Could you state your full name and spell your
5 last name for the court reporter, please?
6 A. My name is Charles Alexander Morgan,
7 M-O-R-G-A-N, the III.
8 Q. You are a doctor, sir?
9 A. Yes, I am.
10 Q. And of what?
11 JUDGE MUMBA: May I interrupt, Mr. Davidson?
12 We have the CV of this witness, and I would like to ask
13 the Prosecution whether they have an objection to
14 having it admitted into evidence, the CV only.
15 MR. BLAXILL: No objection at all, Your
17 JUDGE MUMBA: In which case it doesn't
18 require you to go into details of the CV. It is before
19 the Court. You can proceed with the substance of
21 MR. DAVIDSON: We will mark the CV as the
22 next Defence exhibit, which I believe is 26.
23 THE REGISTRAR: That's correct, D26.
24 MR. DAVIDSON: I have made extra copies for
25 the Judges if they want them. So with the stipulation
1 regarding the CV, I will go directly into substance
2 questions and not detail the witness's background.
3 JUDGE MUMBA: Yes.
4 MR. DAVIDSON:
5 Q. Dr. Morgan, how long have you been at Yale
7 A. I've been at Yale University for the past
8 nine years.
9 Q. And that is located where?
10 A. In New Haven, Connecticut in the United
11 States of America.
12 Q. Since 1989 have you specialised in the area
13 of Post Traumatic Stress Disorder?
14 A. Yes, I have. That's the area of my
15 speciality and the focus of all my research.
16 Q. As -- I'll use the term PTSD rather than
17 using Post Traumatic Stress Disorder on a constant
18 basis; all right?
19 Has PTSD been accepted as a diagnosable
20 mental disorder?
21 A. Yes, it has.
22 Q. And when was it so accepted?
23 A. Post Traumatic Stress Disorder, PTSD, was
24 officially accepted and recognised by the psychiatric
25 community in 1982, and was published in the Diagnostic
1 and Statistical Manual, the DSM III, and after that DSM
2 IIIR and now DSM IV.
3 Q. I take it the definition of PTSD has changed
4 over the years till today?
5 A. There have been some minor modifications in
6 how we describe the traumatic event and the ordering of
7 specific symptoms of PTSD, and also one modification
8 that emphasises that a clinician must note significant
9 impairment in an individual's life to make the
11 Q. Now, have you prepared any chart for us today
12 relating to the details -- or the definition of Post
13 Traumatic Stress Disorder?
14 A. Yes, I have.
15 Q. What I would like to do, Your Honours, if I
16 may, is to have the witness put on the ELMO a chart,
17 strictly to help the parties follow the testimony as he
18 gives the definition of PTSD. And I have extra copies
19 here and I would like to mark them as Defence Exhibit
20 26 . Twenty seven?
21 THE REGISTRAR: 27.
22 A. I'm slightly un -- I'm unfamiliar with how to
23 work this.
24 Q. Dr. Morgan can you tell the Trial Chamber
25 what PTSD is and take us through each of the elements
1 so we understand what PTSD is as a basis for my later
2 questions in this case?
3 A. Yes. Post Traumatic Stress Disorder is a
4 name that's given to a specific condition that can be
5 diagnosed in people exposed to a traumatic event. So
6 I've put on the chart as event number 1, exposure to a
7 traumatic event. The event must be, according to the
8 early definition, had to be a catastrophic or
9 overwhelming event. The most recent definitions
10 according to DSM 4 are more precise and so the person
11 must believe that their physical integrity or life is
12 directly threatened and that they may have intense
13 feelings of horror, shock or helplessness.
14 Q. You have to slow down a little bit?
15 A. Sorry. Examples of traumatic events are
16 things like rape, war trauma, seeing people shot, blown
17 up. It could be something like a tornado destroying
18 someone's home, mud slides, events where people die and
19 where a person fears that they themselves may be
20 killed. It is not typically used to describe a
21 condition where someone loses their pet, where their
22 pet animal may die. It is not used as a definition for
23 the loss of the -- what's considered to be the expected
24 loss of a family member, someone dying of old age in
25 the family. If someone's child should suddenly die and
1 it's unexpected that would be categorised as a
2 traumatic event, but there are certain events that are
3 not included in this definition.
4 The next item is symptom clusters, and I've
5 done that -- and I've put three items below that,
6 re-experiencing, avoidance and numbing, and
7 hyperarousal. Those are the three broad terms that
8 describe the symptoms that a person with PTSD may
9 exhibit. The re-experiencing simply refers to things
10 like having uncontrollable thoughts. So, for example
11 if a woman has been raped, she may describe the
12 symptoms of; "I can't stop thinking about things, it
13 keeps coming back into my mind when I don't want it
14 to." Having nightmares or bad dreams about the
15 traumatic event. A combat veteran may say, "I keep
16 dreaming of the shells exploding or seeing my buddy
17 blown up." An extreme form of remembering a trauma is
18 called "a flashback," and that refers to a condition
19 where someone feels as if the trauma is happening all
20 over again. They feel that they can see the event and
21 possibly smell what was going on and hear what was
22 going on.
23 The avoidance and numbing items are typically
24 described as, people may say, "I feel as though I can't
25 go on living, I feel like I want to die, I can't feel
1 close to other people," there's an estrangement from
2 other people. They also describe symptoms of
3 avoidance, trying to stay away from things that remind
4 them of what's happened to them. So, for example,
5 someone may say, "When I see my body where I was
6 injured or I see a film about war, I get these thoughts
7 in my head that are very uncomfortable and I try to put
8 them out of my mind right away. I try and stay busy, I
9 try and stay focused because I don't want to think
10 about what's happened to me because it's very
11 upsetting." Those types of symptoms go under
12 "avoidance" and "numbing." To clinicians who may not
13 be familiar with Post Traumatic Stress Disorder, these
14 symptoms can look very much like the symptoms of
16 The hyperarousal cluster is a group of
17 symptoms where people describe things like "Everything
18 irritates me, I'm jumpy when I hear loud sounds,"
19 feeling angry, having sleeping trouble, difficulty
20 falling asleep, difficulty concentrating.
21 The duration criterion is to help clinicians
22 pay attention to how long a person has had these
23 symptoms. So they make sure a person has experienced a
24 traumatic event, they look at the symptoms that they're
25 describing, and then they find out how long they've had
1 them. If a person has had these symptoms for at least
2 a month, for four weeks, then they can receive a
3 diagnosis of Post Traumatic Stress Disorder, not
5 If they have the symptoms after three months,
6 at least three months and longer, then we make it a
7 little more clear when we refer to Post Traumatic
8 Stress Disorder and we say it's Post Traumatic Stress
9 Disorder of a chronic type, meaning that it's lasted
10 longer. The distinction is important because chronic
11 Post Traumatic Stress Disorder reflects a more severe
12 form of the disorder.
13 The clinical impairment item I put on there
14 because it's also one of the newer emphases in DSM IV
15 reminding clinicians to make an assessment as to
16 whether or not the traumatic event, the experience of
17 being traumatised, has changed someone's life; for
18 example, are they no longer able to work as they used
19 to? Are they no longer able to feel close to other
20 people in the way that they used to? Do they not keep
21 up their person, their grooming, their everyday life?
22 Do they view the world differently? It's to get a
23 sense of how hard the experience has been on their
25 Q. So when a person meets all of these standards
1 and it lasts for longer than three months, it is
2 diagnosed as chronic PTSD?
3 A. That's correct.
4 Q. Is there any known cure for chronic PTSD?
5 A. To the best of our knowledge, no, there is
6 not a known cure for chronic Post Traumatic Stress
8 Q. Have there been any studies reflecting the
9 length of time that a person will suffer from chronic
11 A. There have been a large number of studies on
12 that, and they have mainly been studies looking at
13 combat veterans from World War II, from the Vietnam
14 war, but more recently there are studies that have
15 included more women, women who have suffered from
16 sexual assault and rape and who have Post Traumatic
17 Stress Disorder as a result of that. Taken together,
18 those studies suggest that people may have chronic PTSD
19 for at least up to 30 to 40 and now, in World War II
20 veterans, maybe 50 years after they've been
22 Q. Is there a series of waxing and waning of the
24 A. You mean does it sort of get worse and
25 sometimes better? Oh, yes. A number of studies now
1 show that at any given time over the years, a person
2 may appear more sick than at other times. In general,
3 the -- sometimes, in some people, those periods of
4 looking worse happen spontaneously. There doesn't seem
5 to be a reason why they suddenly feel worse.
6 What we do know for sure is that people will
7 get worse when we put them around reminders of the
8 event. So for veterans, it may be Veterans' Day or
9 Armistice Day, maybe seeing a movie or a parade.
10 You can see an increase in the symptoms if someone
11 maybe has a death in the family or a crisis, something
12 stressful kicks up the body's stress response and they
13 feel worse.
14 Q. Even when that event is unassociated with the
15 original trauma?
16 A. Absolutely.
17 Q. Such as the death of a mother might bring
18 back symptoms relating to an earlier trauma?
19 A. Yes. We now know that to be true, that a
20 person's PTSD symptoms can increase when they are
21 confronted with a stress that is unrelated to their
22 previous trauma.
23 Q. Dr. Morgan, in preparing for testimony here
24 today, did you review the documents which have been
25 admitted into evidence relating to Witness A's
1 interviews and diagnosis at Medica?
2 A. Yes, I have.
3 Q. So you've reviewed the Medica documents?
4 A. Yes, I have.
5 Q. What do those documents reflect, if anything,
6 with respect to Medica's diagnosis of Witness A's
7 psychological condition?
8 A. My reading of the documents suggest that the
9 people who evaluated her concluded that she was
10 suffering from Post Traumatic Stress Disorder and that
11 they were -- it appears they were relying on DSM IV
13 My reading of the document also suggests to
14 me that someone did history-taking, they took a history
15 in some way. There's a very detailed description at
16 the beginning of the document about what Witness A
17 experienced as her traumatic event where it mentions
18 the names of two individuals who sexually abused her,
19 raped her; and following that description, there is a
20 mentioning of specific symptoms, such as, as I
21 mentioned under re-experiencing, there are segments of
22 the document that refer to "uncontrolled thoughts"
23 about the event; there are symptoms of avoidance where
24 there's reference to Witness A trying not to think
25 about the events; there are symptoms of sleep
13 THE INTERPRETER: Could the witness speak a
14 little more slowly, please?
15 JUDGE MUMBA: If the witness -- can you speak
16 more slowly? The interpreters have to follow.
17 A. I'm sorry. The clinical impairment items are
18 also suggested to me in that document where someone's
19 come for treatment and they believe she's in need of
21 MR. DAVIDSON: I'm waiting for the
22 translation to catch up.
23 Q. Dr. Morgan, have there been any studies with
24 respect to the biological and psychological factors of
25 persons suffering from chronic PTSD?
1 A. Yes, there have.
2 Q. Have the majority of those studies been with
3 people with chronic PTSD vis-ā-vis acute PTSD, that is,
4 that PTSD which hasn't lasted three months?
5 A. Yes, yes. The majority of studies have been
6 in chronic PTSD because people started studying combat
7 veterans, and by the very definition, they'd been out
8 of the war for more than three months, so they had
9 chronic Post Traumatic Stress Disorder.
10 Q. Can you tell the Trial Chamber what the
11 studies have revealed with respect to the psychological
12 factors associated with persons with chronic PTSD?
13 A. Yes, I can.
14 Q. Go ahead.
15 A. Taken together, the studies that have been
16 conducted in World War II veterans, Vietnam
17 veterans, rape victims, adults with Post Traumatic
18 Stress Disorder from child abuse that they've never
19 forgotten about have all shown -- and this is now
20 reflected in DSM -- that the psychological symptoms of
21 PTSD are the same regardless of how people got Post
22 Traumatic Stress Disorder. You get the same disorder
23 whether or not you were in a horrible car accident or
24 if you were in a horrible spot in a war zone or if you
25 were raped and held in captivity, the symptoms are the
1 same, and that's why, under the DSM, there is no
2 provisional statement that says PTSD due to car
3 accident, PTSD due to rape, PTSD due to trauma X. Our
4 profession and our colleagues recognise that the
5 illness is the same.
6 The other thing that we have learned from
7 studies for the psychological aspects of chronic Post
8 Traumatic Stress Disorder is that people who have
9 developed chronic PTSD are usually the people who early
10 on, while the trauma was happening or shortly
11 thereafter, had the greatest number of symptoms of PTSD
12 and who had high levels of shock, disorientation, and
13 confusion. Technically, in our field, we refer to
14 those symptoms as "dissociation" or "dissociative
15 symptoms," and there are examples of that in Witness
16 A's statement where she refers to losing track of the
17 time, where things happen in a moment or a moment takes
18 forever or she sat frozen and still, not feeling
19 anything, no fear, no nothing, not feeling her body,
20 and if you want the precise words, I'll have to get the
21 document and read it, but those are examples of
22 dissociative symptoms; and we know that people who have
23 higher levels of those kind of symptoms early on in a
24 traumatic event are most likely to be the people who
25 have gone on to develop chronic Post Traumatic Stress
2 Q. Can you tell the Trial Chamber about those
3 studies which deal with the biological factors of
4 persons suffering from chronic PTSD?
5 A. Yes. I will summarise the findings of the
6 enormous number of studies because there's an enormous
7 amount of research now. In our institution, at the
8 National Center
9 and we do an enormous amount of research on this.
10 Taken together, we know a couple of things
11 for sure. It's not speculative, it's firmly accepted
12 in the scientific community. We know for sure that in
13 people with PTSD, there are abnormalities in their
14 bodies' stress response, in the amount of stress
15 hormones they produce under stress, and in their
16 bodies' reaction to those stress hormones. We know
17 specifically that people with PTSD have abnormal
18 functioning in the adrenaline systems of the body and
19 we know specifically that they have an abnormality in
20 their bodies' stress hormone response to
21 glucocorticoids. I'll spell that.
22 G-L-U-C-O-R-T-I-C-O-I-D-S (sic). Glucocorticoids and
23 adrenaline are necessary for our body to respond to
24 stress. When we're under stress and we're frightened,
25 our body produces a -- those chemicals.
1 We know in a normal setting, those chemicals
2 are helpful. They help us pay attention, they orient
3 us to danger, and they help us remember what's going
4 on. However, we also know that under extraordinary
5 circumstances, where there's a life-threatening event,
6 the levels of these hormones are very high, and we know
7 that they can cause damage and actually destroy
8 areas -- brain cells and damage areas of the brain. We
9 know that from animal studies, we know that now in
10 studies in humans. Specifically we know that high
11 levels of adrenaline disrupt attention, and without
12 proper attention, your brain does not properly record
14 We know that high levels of glucocorticoids
15 damage the specific areas of the brain that are
16 responsible for making memories for fearful things
17 and -- I'll stop there. What's the damage? What do we
19 JUDGE MUMBA: Can we stop there? It's time
20 for our break. It is 11.05, we shall have a break for
21 30 minutes and resume at 11.35.
22 MR. DAVIDSON: Thank you, Your Honour.
23 --- Recess taken at 11.05 a.m.
24 --- On resuming at 11.35 a.m.
25 JUDGE MUMBA: Yes. We may continue.
1 MR. DAVIDSON: Yes.
2 Q. Doctor, I think we left off, just before the
3 break, with respect to your testimony relating to
4 possible brain damage.
5 A. Yes.
6 Q. Can you pick it up from there, sir?
7 A. Yes. What I had mentioned was that an area
8 of the brain called the hippocampus, that's responsible
9 for how we learn specific things in memory, is damaged
10 by high levels of stress hormones. What that area of
11 the brain does is it let's us know the timing, and the
12 context and characteristics of an event. It sort of
13 puts it in a setting. And we know that in ample
14 studies, if that area is damaged, the animal, if it's
15 learned where something bad happened to it or how to
16 travel through a maze, can't do it properly.
17 We know in humans -- we don't damage people's
18 brains to do research -- but there's a very elegant
19 study done by a man named Kirschbaum who gave healthy
20 subjects high levels of glucocorticoids and wanted to
21 see what happened to their memory. So he had them
22 learn several different kinds of memory tests, not only
23 what they could recall about what they'd learned on a
24 test, but could they actually remember where things
25 were in a room, how many objects, and actually redraw
1 it and correctly give that information back?
2 His study has shown that when you increase --
3 the people who got the glucocorticoids in high doses
4 were significantly less able, in other words, they did
5 much more poorly on these specific tests, on their
6 memory performance on the tests, and that's one of the
7 most direct ways we can measure the effects of
8 glucocorticoids in healthy subjects.
9 Now, in PTSD -- in people with PTSD, since
10 they've already been traumatised, the studies have sort
11 of been worked a little bit in the opposite direction,
12 because we're starting with someone who's already been
13 through a trauma, and, we assume, already had those
14 high levels of stress hormones.
15 There are a number of several studies now in
16 people with PTSD from rape, in combat veterans with did
17 PTSD, that just in giving them neurologic testing on
18 recall memory, asking them to learn words, learn
19 information and then recall it back, on their free
20 recall they actually score more poorly than people
21 without Post Traumatic Stress Disorder. And that
22 points to a specific problem in that area of the
23 brain. We know that's the area that's responsible.
24 A second line of research that doesn't ask
25 people directly what they know is my specific area of
1 research, is in the human startle reflex. It is a
2 direct way of measuring what that area of the brain is
3 recording. It's a direct reflex that is the same in
4 humans and in animals.
5 What we have found is that people with PTSD
6 cannot distinguish between a dangerous stimulus in the
7 room and a non-dangerous stimulus in the room, and I'd
8 like to explain that. It was -- it's a study. What I
9 do is called fear conditioning. I teach people to
10 learn that a light in the room will be associated with
11 an electric shock on the wrist, and it's very
12 unpleasant. People learn very quickly that the purple
13 light is bad, that when the purple light comes into the
14 room they get an electric shock. Healthy people
15 quickly learn that when the yellow light comes into the
16 room that there is no shock, and that there is no
17 possibility that they will get a shock.
18 We do these studies to look at how quickly or
19 well people learn something, and then we re-test them a
20 week later to see what they remember.
21 The startle reflex is a direct way of
22 measuring what they know. You don't have to ask them,
23 you bring-- you just turn on the purple light and the
24 startle reflex will only increase in the presence of
25 the light that was paired with shock, and it will only
1 increase when they're tested in the context where they
2 received the shock if they get back in that same chair
3 where they were sitting when got they got the shock on
4 the wrist. We've done this in animal studies. Animals
5 get foot shocks. People, we give them a shock on the
7 What we find in people with PTSD when we
8 compared them to people without PTSD, we found that
9 they were unable to tell the difference between which
10 light gave them -- was associated with shock. They
11 were also unable to predict the timing. So this was
12 another area of research that let us know that the area
13 of the brain in animals and in people that is
14 responsible for people being able to tell the
15 difference is the hippocampus. So that was another
16 piece of evidence saying -- here is another body of
17 research saying there's damage in this area of the
19 Finally, several of my colleagues at Yale do
20 brain imaging studies, and there are a number of other
21 investigators over the States who have done brain
22 imaging studies where they actually do pictures of the
23 brain to measure what these areas of the brain look
24 like. There are at least four published studies, and I
25 know a fifth that is in the process of being published,
1 it's now being presented at an international
2 conference, that the hippocampus is significantly
3 damaged, it's smaller, it's shrunk in people with Post
4 Traumatic Stress Disorder.
5 So putting aside any other issue of people
6 talking to patients or whatnot, just from a statement
7 of biology, research in the field of PTSD says that the
8 area of the brain that helps us learn these things and
9 sort this kind of information out has been damaged.
10 Q. Now, in 1997 and 1998, were there any
11 controlled studies relating to persons with PTSD,
12 whether the PTSD was acute or chronic, vis-ā-vis the
13 recitations of these persons with reported memory?
14 A. Yes, there have been a number of studies.
15 Q. But prior to 1997, were there any studies
16 relating to the stability of traumatic memories using
17 as subjects persons with PTSD?
18 A. To my knowledge there are no studies that
19 specifically used persons with Post Traumatic Stress
21 Q. Prior to 1997, were there any studies
22 relating to the stability of traumatic memories with
23 persons who had heard or had knowledge about traumatic
24 events but which persons did not have PTSD?
25 A. Yes, there are.
1 Q. And can you describe to the Trial Chamber the
2 nature of those studies?
3 A. Yes, I can.
4 Prior to 1997, several studies had been done
5 that were trying to answer the question of do people
6 remember terrible things better than neutral things,
7 better than everyday events. A very famous study in
8 1970's and early '80's was by Brown and Kulik, Brown
9 and his colleagues, Dr. Brown and Kulik, who
10 interviewed people and asked them what they remembered
11 when the United States President John F. Kennedy was
13 They asked people, "Do you remember where you
14 were, do you remember what you were doing, do you
15 remember what you were feeling?"
16 They were struck by the fact that the
17 subjects they interviewed provide a lot of detail about
18 where they were, what they were doing, and seemed to be
19 very sure of their recollections for how they heard
20 about the assassination and what they thought. And
21 they took the clarity of those recollections and the
22 conviction on the part of the subjects as evidence that
23 people remember bad things better than neutral things,
24 and they coined the term "Flashbulb memories". They
25 felt that going through or hearing about a terrible
1 thing just imprinted the memory in a person's mind like
2 a photographic plate. That's why they referred to this
3 as flashbulb.
4 After their study, another group, Winograd
5 and her group, did a replication of the study. They
6 too asked people about what they recalled, about where
7 they were, how they got the information when President
8 Kennedy was assassinated. I believe in their study
9 they also asked about some other events. I believe the
10 assassination of Martin Luther King was also in that
11 study. I'm not sure. I'd have to check for that.
12 They too found that people were very sure
13 where they were, what they were thinking and what they
14 were feeling. Those researchers concluded that people
15 were very sure, and that they provided detail, and they
16 made a point in their paper saying, "We have no idea if
17 this is accurate at all, but we are impressed that
18 people provide detail."
19 After those studies, people got interested in
20 pursuing this idea that memories for trauma were
21 flashbulb in nature, or photographic in nature. And
22 there is a series of studies that asked people where
23 they were and how they heard about the explosion of the
24 space shuttle Challenger. There is a series of
25 studies. Some of the studies interviewed college
1 students shortly after the explosion, and then
2 re-interviewed them approximately a year later.
3 Another study caught up with people a couple of years
5 What they found was that people were highly
6 inconsistent, that the second time they were
7 interviewed they changed where they were. So, for
8 example, some students said, "I know exactly where I
9 was. I was in class. I heard the news. I was with
10 friend so and so, and I'm sure of it." When they
11 re-interviewed them, they found that people said, "No.
12 I heard about it when I was home and I wasn't with
14 So people began to question this flashbulb
15 nature of memory, and they said, well, they've got some
16 element right. They knew the space shuttle blew up,
17 but they were struck by the fact that people's stories
18 had changed.
19 A similar study was done around looking at
20 how citizens in Sweden remembered the assassination of
21 Olof Palme. They were interviewed, I think,
22 approximately six weeks after the assassination, and I
23 believe close to a year later but sometime later, and
24 the author in that study had two conclusions. His main
25 conclusion was that people remembered that there had
1 been an assassination, but depending on how you defined
2 a flashbulb memory, it was either a little over 50 per
3 cent accuracy or 90 per cent accurate.
4 If you defined flashbulb memory as just
5 saying you remembered the source of your information
6 and what happened, people were pretty good. Ninety per
7 cent, still 10 per cent didn't get that right. But if
8 you pushed for detail, it dropped to 50 per cent. Now,
9 these were people who, as far as we know, do not have
10 Post Traumatic Stress Disorder and were not patients.
11 So the criticism of those studies was that
12 these studies don't tell us anything about traumatic
13 memories, because those people were not personally
14 threatened. They heard about horrible things on the
15 news, but their lives were not in danger. And so those
16 studies, they're fine, they're nice. They tell us
17 that, yeah, people remember bad things better than
18 neutral things, but it doesn't tell us anything about
19 trauma and memory.
20 So we decided to conduct a study in people
21 whose lives had been personally threatened in a war
22 zone, and I've prepared a chart --
23 Q. Let me ask you, in 1997 and 1998, how many
24 studies were there relating to persons with PTSD, both
25 chronic and acute, vis-ā-vis their recitations of
1 reported memory?
2 A. There have been four studies in 1997, 1998.
3 Three of those studies are published. The fourth study
4 is currently in review and being evaluated for
5 publication, and has been presented at two
6 international conferences.
7 Q. Let me ask a few questions concerning the
8 studies before we go directly to the studies?
9 A. Yes.
10 Q. Were all four of the studies about which
11 you're going to testify controlled studies?
12 A. Yes, they are.
13 Q. Can you explain to us what you mean by a
14 controlled study?
15 A. A controlled study is a study where a person
16 has been interviewed, or asked questions or assessed
17 more than once. In other words, it's a test-retest
18 study. And at both time points, in order to make it a
19 scientific study, a controlled study will use the same
20 assessment procedure. You'll use the same measure so
21 that you can answer the question of, "Do people tell me
22 the same thing if I ask them exactly the same questions
23 at two different time points?"
24 The distinction is important, because a
25 number of people have conducted studies, but they have
1 not been controlled. In other words, they might have
2 researched in the past to find some information about
3 someone and then used that as support to say their
4 memory's accurate, but, in fact, different people did
5 the earlier questions, may not have asked the questions
6 in the same way, and as a result, scientifically, our
7 conclusions on those studies must be limited. So in a
8 controlled study, we want to make sure we use the same
9 criteria, the same rules each time we assess the
10 person's memory or whatever we're assessing.
11 The studies in 1997 and 1998 have used that
12 methodology. In each of the studies, people in those
13 studies were interviewed or assessed shortly after
14 experiencing life-threatening personal events. Either
15 seeing people shot beside them, being shot at, being
16 injured in a war zone, or people who had survived a
17 mass shooting in Texas in the United States.
18 At each of those time points, the people in
19 the studies were reassessed using the same methods that
20 they had been assessed -- that had been used on them in
21 their first interview.
22 Q. Doctor, how did the subjects in the tests in
23 1997 and 1998 differ from those persons who were used
24 in the tests prior to 1997?
25 A. Subjects in these studies were different in
1 that, one, their lives were personally threatened,
2 there was a real risk they could die, and that people
3 did die around them in the events they experienced, and
4 they too believed that they might die. That's very
5 different than in the other studies.
6 They were people who have never forgotten in
7 terms of saying, "I was there," in terms of saying,
8 "Yes, I was at the shoot-out at Texas," "Yes, I was in
9 Desert Storm." So this is very different from the
10 field of recovered memory, where in that field that is
11 a separate area of investigation from studies in Post
12 Traumatic Stress Disorder. And I would like to say
13 this, because I think sometimes people confuse the
14 fields; in the recovered memory field, we're talking
15 about people who at some point in time meet with a
16 therapist and have symptoms, and then they go looking
17 for a trauma to explain the symptoms.
18 In our work at the National Centre for Post
19 Traumatic Stress Disorder and in the DSM IV guidelines,
20 you must start with a traumatic event and then examine
21 symptoms relating to that traumatic event.
22 So our studies and the studies I'm going to
23 talk about are about people who were in these events as
24 adults, who were exposed to life-threatening events as
25 adults, and who have been assessed while they're adults
1 using the same methodology.
2 Q. The person -- are all the persons in the
3 tests people with PTSD?
4 A. Oh, no.
5 Q. Explain why people without PTSD are included
6 in the test group.
7 A. Well, first it's the way of things. Not
8 everyone gets Post Traumatic Stress Disorder. It is a
9 widely held misconception that everyone gets PTSD. In
10 fact, there are at least three large epidemiological
11 studies in the United States, from inner cities, that
12 show that the rates of PTSD are approximately nine per
13 cent. So many people have a misconception that
14 everyone exposed to trauma gets PTSD. It is absolutely
15 not true.
16 When you look in a particular group of
17 people, people who have suffered rape or people who
18 have been tortured, although that represents a minority
19 of cases of PTSD, it's more likely that a person will
20 get PTSD from rape than from a car accident. The risk
21 of getting it is much more great, and people believe
22 that because the person's life was more directly
23 threatened in some way by another human being.
24 However, three different studies have been
25 conducted and have documented that of all the women who
1 experience rape, when they are assessed three months
2 after their rape, less than half have PTSD. The
3 highest figure I have been able to find is 47 per
4 cent. Clearly that's a lot of people, but it is less
5 than half.
6 Q. Let's turn to -- what was the first test of
7 the kind that you've described conducted in 1997?
8 A. All right. I've prepared a chart.
9 Q. First, tell me what the test was.
10 A. Oh, the test was we -- we interviewed men and
11 women from an army unit who had been in the Gulf War,
12 from the United States, and whose unit had in some way
13 experienced trauma and they came back with fewer unit
14 members. We knew for sure that people had died in the
16 Q. Who was the author of that study?
17 A. The first author of that study is my boss
18 Professor Stephen Southwick from Yale University, and
19 it was with him -- he and I conducted the study.
20 Q. I would like to have the witness use this on
21 the ELMO. I have extra copies for the Court, I have
22 copies for the Prosecution.
23 THE REGISTRAR: Exhibit D28.
24 MR. DAVIDSON: D28.
25 THE INTERPRETER: Interpreters would like to
1 ask the witness to speak slowly, please.
2 [Note: Interpreter's comments obliterates
3 Mr. Davidson's question]
4 JUDGE MUMBA: Witness, the interpreter would
5 like you to speak slowly.
6 A. Thank you. I'm sorry. The slide I've
7 prepared mentions the first author, Dr. Southwick.
8 Under the word "Subjects," that indicates that we had
9 interviewed men and women who were in the army unit and
10 that these individuals, we met with them and gave them
11 a particular set of questionnaires one month after they
12 came back from the Gulf War and during the same month
13 two years later.
14 On the next slide, I put a brief comment that
15 our questionnaires were designed to ask them specific
16 things that they may or may not have experienced in the
17 Gulf, and those specific things were questions like:
18 Was your unit ambushed? Was it overrun? Did you see
19 someone killed? Did you witness the death of a
20 friend? Did you see the bizarre disfigurement of other
21 humans? Questions like that. And the subjects in the
22 study could indicate "Yes" or "No," they did or didn't
23 experience those things, and they could also indicate
24 how many times, so we would be able to look at
25 whether -- how many times they had had an event happen.
1 On the next page, the total score. This was
2 a way of summing up the points on the questionnaires,
3 and that was made by adding up every time they said
4 "Yes, this happened to me."
5 What we found is that from one month to two
6 years, their score increased, and this indicated that
7 their answers had changed significantly. When we
8 looked at it, we found that 88 per cent of our subjects
9 changed at least one item, 61 per cent changed two or
10 more. Now, that didn't sound like very many things to
11 change on a questionnaire until we started looking at
12 the items, and we found that people changed every kind
13 of item on the questionnaire.
14 So, for example, down below, it says "No" to
15 "Yes" around 70 per cent of our subjects categorically
16 went from saying "No, I did not experience this" to
17 "Yes, I did --" I'm too fast. All right.
18 MR. DAVIDSON:
19 Q. Go ahead.
20 A. And 46 per cent, nearly half of our subjects,
21 a bit less than half, said, "No, I did not experience
22 this" when we asked them at the two-year time point.
23 On the last page, I've listed the five items
24 that were the most commonly changed, and as you will
25 notice, some of them seem a little more subjective than
1 others, whether or not a person felt that there was an
2 extreme threat to their personal safety, whereas others
3 seemed more objective, did they or did they not see
4 someone killed or see somebody wounded or experience a
5 mine or a booby trap.
6 We also found that people with PTSD changed
7 their answers much more and that they were more likely,
8 when we interviewed them at the two-year time point, to
9 say they had seen more trauma.
10 This surprised us because we had not expected
11 that people's reports of traumatic memories would
12 change. In our field, we had been working on the
13 assumption that, if you go through something terrible,
14 you don't forget it. So these results caught our
15 attention right away because they do not support the
16 idea that memory or reported memory for a traumatic
17 event stays the same.
18 The next study that was done was not by our
19 group, it was done by a Dr. Roemer, and I've prepared a
21 Q. I have extra copies --
22 A. Oh, okay.
23 Q. -- and we'll hand them to the registrar, a
24 copy for each member of the Court, and he has an extra
1 THE REGISTRAR: Exhibit D29.
2 MR. DAVIDSON: D29.
3 THE WITNESS: I believe I am missing my slide
4 of Dr. Roemer. It's all right --
5 MR. DAVIDSON: We have one. I want it on the
6 ELMO. Thank you.
7 A. Thank you very much. Dr. Roemer --
8 Q. First of all, can you tell us who Dr. Roemer
10 A. Yes. Dr. Roemer is a scientist who conducts
11 research in Post Traumatic Stress Disorder up at Boston
13 Q. Can you tell us the nature of her study and
14 the results therefrom?
15 A. Yes. The nature of her study was very
16 similar to our first study. She assessed the reports
17 of what people saw and experienced at two time points.
18 Specifically, she asked questions of 460 men and women
19 who had been deployed to Somalia from the United
20 States. She too found that 33 per cent of the subjects
21 were significantly inconsistent, they reported
22 something different when they filled out the same
23 questionnaires 21 months later.
24 She also found that the more symptoms of PTSD
25 and the people that had PTSD changed their answers the
1 most. So this study confirmed our findings.
2 Q. Doctor, let me ask you, in the studies that
3 you have just gone through and those which you are
4 going to go through, they deal with inconsistencies;
6 A. Yes, that's correct.
7 Q. Is there a difference here in the terminology
8 between inconsistencies and accuracies in terms of what
9 these tests are measuring?
10 A. I believe there is, and I should say
11 something about that. In interviewing people and
12 asking them what they saw and what they did, we don't
13 know of any way of actually determining exactly what
14 happened in a war zone. We did know from the news that
15 in the units that we studied that people were killed --
16 and we knew that because they were from Connecticut and
17 their bodies were returned to Connecticut -- however,
18 we had no independent objective source of information
19 against which we could compare their reports. So we
20 believe that we would simply document whether or not
21 there were changes in what people said without knowing
22 how accurate any of their responses were.
23 Q. Please slow down.
24 A. Now, consistencies or inconsistencies provide
25 an indirect way of looking at accuracy in this sense:
1 Some of the responses are mutually exclusive where
2 someone says "I was shot," "No, I was not shot." We
3 felt that the two would be mutually exclusive, so it
4 was possible that that would be an inaccurate
5 statement. However, we also know that even if a person
6 says the same thing both times, if they're consistent,
7 that they could be wrong both times. So that looking
8 at inconsistencies only provides us an indirect way at
9 times of examining accuracy in the absence of some
10 external source of information.
11 I think Dr. Roemer and her group experienced
12 the same problem: They found they could not get an
13 independent report from the United States government on
14 exactly what happened and they too concluded that
15 inconsistency was the best anyone could do since we
16 can't know exactly what people know.
17 Q. The next report was done by Professor North?
18 A. Yes.
19 MR. DAVIDSON: Let me mark that -- do you
20 have a copy there?
21 A. No, those are the two I'm missing, actually.
22 I'm sorry.
23 THE REGISTRAR: Exhibit D30.
24 A. Dr. Carol North conducted a study, a
25 controlled study, and she interviewed people who had
1 experienced the shoot-out in Texas
2 into a store or a restaurant and began shooting
3 people. She interviewed the survivors approximately a
4 month after they had witnessed the event, and she
5 re-interviewed the survivors one year later.
6 What is striking about her study is that 21
7 per cent of her subjects and nearly half of the
8 subjects with PTSD, when interviewed one year later,
9 denied ever having nightmares, ever having
10 uncontrollable thoughts about the shooting, ever having
11 irritability, they denied ever trying not to think
12 about it; in other words, they denied ever having been
14 At one month, those were people who had
15 clearly said to the interviewer, because they were
16 doing direct interviews to make the diagnoses, they
17 would have had to say things like "Yes, I have
18 nightmares," "Yes, I can't stop thinking about this,"
19 "Yes, I have startle," "Yes, I have irritability," or
20 "Yes, everything irritates me"; and when
21 re-interviewed a year later said, "No, I never had
22 uncontrollable thoughts," "No, I don't know what you're
23 talking about. I've never been sick." "No, I don't
24 really have sleeping trouble" or "No, I'm not irritated
25 by everyone or any thing." And I have to tell you, as
1 I sat in this courtroom yesterday and listened to
2 Witness A, all I could think about was this study,
3 because my understanding, after reading her statements,
4 reading the statements from Medica, and listening to
5 the doctor who testified yesterday morning, was that
6 here is someone who was diagnosed with Post Traumatic
7 Stress Disorder and who listed symptoms and who, in the
8 courtroom yesterday, said, "No, I never had this. I
9 never had uncontrollable thoughts, I never had
10 irritability. I never felt this way." To me, that's
11 completely compatible with this study. This is what
12 Dr. North also found, and she found that in her
13 subjects who had Post Traumatic Stress Disorder.
14 MR. DAVIDSON:
15 Q. Now, the fourth study was conducted when, and
16 who participated in that study?
17 A. The fourth study was conducted by me and by
18 Dr. Steven Southwick, and we conducted this study
19 because I wanted to double-check our findings. I told
20 you earlier we did this study and interviewed people
21 one month and two years after they got back from the
22 war, and I didn't know why people had changed their
23 answers and I wanted to try and find out why.
24 We recontacted our subjects --
25 Q. Let me mark this.
1 A. Mm-hmm.
2 MR. DAVIDSON: It would be D31.
3 THE REGISTRAR: Yes, D31.
4 MR. DAVIDSON:
5 Q. Do you have a copy there?
6 A. I do.
7 Q. Put it on the ELMO, please. Can you tell us
8 the nature of the study and the results that were
10 A. The nature of the study is it's a controlled
11 study, we're using the same assessment procedure, and
12 it's conducted by the same researchers in the same
13 subjects. We used an additional questionnaire. The
14 first time, when I told you about our results, I
15 mentioned the Desert Storm Trauma Questionnaire, DSTQ.
16 The CES are the initials for the Combat Exposure Scale,
17 and it is considered the standard in the field of
18 psychiatry for assessing exposure to trauma and we've
19 used it as the standard in research for Post Traumatic
20 Stress Disorder.
21 One of the criticisms of our first study was
22 that we had used a scale that people didn't know very
23 well so they didn't know how to understand our data.
24 This time, we included the Combat Exposure Scale after
25 people had completed the Desert Storm questionnaire.
1 Finally, after people had completed the
2 questionnaires, I interviewed them. I surprised them
3 and said, "I'd like to spend some time now and talk to
4 you." And I showed them their questionnaires from one
5 month and from two years and asked them to help me
6 understand the changes on the questionnaires. Once
7 they had given me their explanation, I then showed them
8 their six-year questionnaire and asked them to help me
9 understand the significant changes that happened across
10 all three time points.
11 On the next slide, I believe it's this slide
12 here --
13 Q. Slow down a little bit.
14 A. Just to summarise about -- compared these
15 findings to the earlier findings. Once again, we found
16 significant numbers of people changed categorically
17 from two years to six years. Forty-one per cent of the
18 subjects in the study went from saying "No" to "Yes"
19 and from "Yes" to "No." Seventy-two per cent of the
20 subjects did either. So we're not talking about a tiny
21 fraction of people in the study. People were changing
22 answers all over.
23 They did it on both questionnaires, and you
24 can see by the percentages, they're not very different
25 from one another. Changes are going on. People are
1 going from saying "Yes, this happened to me," "No, this
2 did not."
3 We had an example multiple times of people
4 saying, "Yes, I saw five people killed." At the
5 two-year time point they'd say, "No, I didn't see
6 anyone killed," and at six years they'd say, "Yes, I
7 saw one person killed."
8 Another person said to me, "I saw no one
9 killed. I did not see a friend killed." At the
10 two-year time point, he had put, "Yes, I saw two
11 friends killed." At the six-year time point, he said,
12 "I saw one person killed."
13 I remember asking him, and he said to me, he
14 said, "Well, maybe the first time they weren't my
15 friends, and so I said 'No, no one was killed.' But
16 maybe by two years later, I thought, we were all in the
17 war zone, people died, they were probably my friends
18 'cause we're all in the army, so I said two people."
19 He had no explanation as to why he changed his answer
20 at the last time point.
21 Another person who had gone from saying "No,
22 I didn't see anybody killed" -- or, excuse me, from
23 "Yes, I did" to "No, I did not" back to -- and then
24 stated "No" explained that he had been shown a
25 photograph, and he assumed that he must have somehow
1 confused the photograph in his mind with what he
2 actually did or did not experience.
3 Other subjects told me that listening to the
4 news, listening to the radio, talking to friends may
5 have altered their reports.
6 Now, as someone who has been focused in
7 neurobiology of PTSD, my first thought is we know that
8 stress can damage the brain and these are the sorts of
9 changes that you might predict based on knowing what
10 that area of the brain does, it alters the context and
11 the timing, but the subjects didn't appeal to brain
12 pathology, they said, no, they appealed to other social
13 things like the radio, the news, the television, or
14 talking to people. Some even said, "I just must have
15 forgot." And you'd say, "Well then, later on, you
16 endorsed it," and they had no explanation. They were
17 very frustrated in trying to come up with explanations
18 for the discrepancies on these papers.
19 The one thing that was absolutely clear is
20 that all but one subject was certain that the six-year
21 report was the most accurate. They said that was the
22 most accurate account of what happened to them. One
23 person differed and she said, "No, the two-year and the
24 six-year report are the most accurate," and they
25 differed from one another, and I asked her how that
1 could be true and she said that the two-year was the
2 most emotionally accurate but the six-year was the most
3 factually accurate. I do not know if any of it is
4 accurate because they clearly are inconsistent with one
6 What we did find when we had people who were
7 not in the study come and look at our data, soldiers
8 who were in the Gulf who did not partake of our study,
9 just to look at the data, and we asked them, we said,
10 "What do you think? How would you explain this?"
11 They were convinced that the first report would be the
12 most accurate, and they also assured me that if they
13 had done the study, they would never have changed an
15 So we were struck by that as researchers,
16 feeling that people are always absolutely sure of what
17 they would do or they can be very sure of what they
18 said they went through, but apart from any independent
19 evidence, we were completely convinced that people are
20 significantly wrong or inaccurate or inconsistent. The
21 precise term I should say would be they are
22 significantly inconsistent because we do not know
23 what's true.
24 Q. Doctor, let's turn now -- we have about 15
25 minutes here before the 12.30 break -- and let's turn
1 now to Witness A's treatment at Medica. That's one of
2 the issues that we are here at this hearing to discuss.
3 You have had an opportunity, and I think you
4 have been provided there at the witness table,
5 documents which are marked 22, 24, and 25 that relate
6 to Medica and, specifically, I think it's 22 that deals
7 with her interviews at Medica. Maybe that's 24.
8 A. I believe it's 24 -- 24 on mine is marked
9 from Medica, the report from Medica.
10 Q. Before I ask you a question, just a thought
11 occurred to me, that in the studies that -- in all four
12 of the studies that you've discussed here today, you
13 had people with both PTSD and people without PTSD. In
14 all four of those studies, was there any consistency
15 with respect to whether the people -- there were more
16 inconsistencies with one group rather than another?
17 A. Yes. I did neglect to say this. In our
18 first study, in Dr. Roemer's study, and in our second
19 study, we have found that people with PTSD have
20 significantly more inconsistencies than people without
21 PTSD. We also found that it is along a spectrum: The
22 more symptoms somebody has, we now find the more
23 inconsistent they are, but the PTSD patients were at
24 the high end of who changed their answers the most.
25 So all three studies now, the two published,
1 and this one's currently in review, but the data
2 support this idea that PTSD and memory are complicated
3 but that what people say they remember may really be a
4 symptom of how bad they're feeling rather than being
5 something independent, and for a long time in our field
6 we've assumed that the report of trauma is independent
7 of how sick you are: either you had it or you didn't.
8 And now we're finding that the report of what people
9 say they experienced is just the other -- it's another
10 way of saying "How sick do you feel?" "How distressed
11 do you feel?"
12 In our latest study -- and I have to say it
13 has not been published, so you may want to consider
14 this in a slightly different weight -- we actually
15 found that people with PTSD changed their answers in
16 both directions: That the sicker they were, the more
17 they changed their answers. But it went up or down.
18 It wasn't necessarily true that they always said, "Oh,
19 I saw more trauma." But all three studies are
20 consistent in that they show that the sicker you are,
21 the more your answers change.
22 Q. Let's go back to the Medica reports. Based
23 upon your review of the reports regarding Medica, do
24 you have an opinion, Doctor, as to the type of therapy
25 Witness A was receiving, according to those reports, at
2 A. Yes, I do.
3 Q. Would you tell the Trial Chamber, please,
4 what your opinion is?
5 A. The document is limited in what can be
6 determined from it, but my reading of this tells me
7 that whatever therapy was done, someone met with
8 Witness A and tried to establish a diagnosis, so they
9 took a history, and the evidence for that is this
10 rather detailed description. It is possible, I think
11 as Dr. Younggren testified earlier, that this
12 information may have been given to them by someone
13 else, but my reading of it suggests to me that someone
14 interviewed Witness A as one would normally do in a
16 Q. What is the purpose of doing that to begin
17 the treatment?
18 A. Well, to make a diagnosis. I mean, in any
19 area of medicine, the best way to find out why
20 someone's come in is to talk to them and ask them
21 what's brought them in, what's wrong, what has happened
22 to them in order to start thinking about diagnoses.
23 Q. And after the diagnosis is made in a place
24 like Medica, according to the documents here, what then
25 is done? What kind of therapy is done? Was there any
1 medical therapy? Was there psychotherapy, talking
3 A. After a diagnosis is made, a clinician will
4 think about what kind of treatment is recommended. If
5 the therapist is a physician and can prescribe
6 medication, they may do that, and we would call that a
7 medication therapy.
8 Also, talking therapies where -- which, a
9 broad term for saying that you sit and talk to someone
10 to try and find a way of relieving their psychological
11 distress. Many different theories about it, many
12 different schools of talking therapy, but essentially
13 the procedure is to do a verbal exchange with someone.
14 In the document, there is a specific
15 reference to "supportive and therapeutic work." I do
16 not know what they mean by that. In the field in
17 general, supportive psychotherapy is a therapy that
18 tries to build on whatever strengths a person has and
19 help them hold things together by emphasising either
20 their connection to other people, or to support them
21 and also to try and minimise the thoughts and feelings
22 that they may be having that are causing them distress,
23 reassuring them, making them feel safe by having them
24 start to talk about what's gone on, what's happened.
25 "Therapeutic work," the term in here
1 indicates to me that the therapists were engaging in
2 some talking relationship to Witness A with the goal of
3 relieving distress. I personally wouldn't know how
4 else to interpret the term "therapeutic work."
5 Q. Was there an effect of talking-based
6 therapies on the recitation of traumatic events by
7 chronic PTSD victims?
8 A. A researcher named Dr. Foa has actually
9 examined this question in women who have been raped.
10 She has actually studied the impact of doing a form of
11 talking therapy on how people describe their
12 experiences. She was not interested in examining the
13 question of whether or not memories for trauma change.
14 So in reading her study it's important not to overread
15 information that's not there.
16 What is in her study is evidence that the way
17 people tell their story changes significantly. What I
18 mean by that is, they often begin with fragments, bits
19 and pieces of a story that don't hold together, and
20 they search for a way of organising the information and
21 adding detail and filling things in so that there is
22 more of a story over time. Foa recognises that this
23 means that inconsistencies in the narrative will emerge
24 because people drop out some elements and they add new
1 My understanding of her research is that she
2 is someone who has not said a lot about the idea of
3 whether or not memories for trauma change, but now
4 knowing what we know from three published studies on
5 the fact that people with PTSD change what they say
6 they've either personally experienced or the symptoms
7 of PTSD, I understand that data now, I believe more
8 completely, to show that when people are in therapy,
9 their story changes significantly, and that what they
10 report several weeks after being in therapy or after
11 several sessions may be very different from what they
12 said early on. I admit, I would never know which
13 aspect of a story was true or at which point in time it
14 would be any more accurate.
15 But in her research, and in the research
16 there's a nice article by Dr. Bessel van der Kolk where
17 people have recognised that when we're making memories
18 under highly stressful life-threatening experiences,
19 the memories are not well-organised, that it's really
20 fragmented, and I think people in the field are
21 beginning to recognise that we've made some assumptions
22 in our work that may not, in fact, be true. Our
23 assumption has been that people recorded these
24 photographic images, that they never forget, and that's
25 clearly not the case.
1 So when someone engages in therapy, I would
2 expect that there's a couple of possibilities: Their
3 story will change and they may become much more
4 inconsistent over time. I measure consistency as
5 comparing what the person said at one point in time to
6 another point in time. It's also possible that they
7 would become more consistent over time as they find a
8 comfortable way of telling their story.
9 The goal in therapy is not fact-finding. I
10 mean, as a clinician, the goal in therapy is to try and
11 help someone feel relief, to make them feel less pain
12 and suffering. If a person comes into the clinic and
13 tells a story that then they're more comfortable with,
14 a therapist accepts that story because the goal is
15 relief, not creating more distress. So the story could
16 become consistent and stay the same over time and
17 simply be a reflection of the fact that the person has
18 become more comfortable.
19 I would like to give you one example, if I
20 may, about how a story may change?
21 Someone may have experienced a rape. A woman
22 may come in and say, "I went on a date and I was
23 raped." In interviewing the woman, she may say that
24 she feels responsible or she may say that she feels she
25 was too provocative on the date, maybe her dress was
1 too low or it was inappropriate, and she may say, "I
2 feel guilty. It's my fault." I should be clear, not
3 every patient may say this. And the therapist would
4 work with the patient to help them shift that kind of
5 thinking because the person's distressed. And at the
6 end of the therapy, the patient may say, "You know, it
7 wasn't my fault at all. Whether or not I wore such and
8 such a dress does not justify what this other person
9 did to me. In fact, my dress was not suggestive, it was
10 not provocative, and this person was responsible for
11 containing their own behaviour." So there can be a
12 dramatic shift in not only how they interpret what
13 happened but how they perceive what happened.
14 Once again, the goal is to help people find
15 relief. The therapist doesn't say, "Could you bring me
16 in the dress and I'll decide if it's provocative." You
17 know, if we don't do that -- our goal is to help people
18 get better. But the account, the thinking and feeling
19 about the account can change dramatically. Actually,
20 we count on that as a therapist. I really hope that
21 people find a new way of feeling and thinking about
22 things to get on with their life, to feel better.
23 MR. DAVIDSON: Your Honours, I have about
24 another 20, 25 minutes of testimony from the doctor
25 before we're completed. Should we break for lunch, or
1 whatever the Trial Chamber --
2 JUDGE MUMBA: Yes. It's time to break off
3 for lunch, and we shall resume the afternoon sitting at
4 14.30 hours.
5 --- Luncheon recess taken at 12.30 p.m.
1 --- On resuming at 2.30 p.m.
2 JUDGE MUMBA: Yes. The Defence is continuing
3 with Dr. Morgan.
4 MR. BLAXILL: Pardon the interruption, Your
5 Honours. We are joined in court at this point in time
6 by an intern lady who is working with our team and --
7 in the Tribunal. This is Suellen Ratliff. She is
8 seated at the back of court. We hope Your Honours
9 would have no objection to her remaining during the
10 proceedings. I understand my friend has no objection.
11 JUDGE MUMBA: That's okay.
12 MR. BLAXILL: Obliged, ma'am.
13 MR. DAVIDSON: At this point in time, we're
14 going to ask the witness to discuss the testimony of
15 Witness A in terms of the tests that he has conducted
16 and has testified here today about. To that extent, I
17 think because it does relate to her testimony, we might
18 want to consider going into a closed session.
19 JUDGE MUMBA: Yes, we should go into closed
20 session -- or private session, as called by the
22 MR. DAVIDSON: As long as the TV camera isn't
23 on the boards. We have some five boards behind the
25 JUDGE MUMBA: Which may be demonstrated
1 during the testimony of the witness?
2 MR. DAVIDSON: Yes.
3 JUDGE MUMBA: In that case then, we'll close
4 the blinds. Closed session then.
5 (Closed session)
11 Pages 1014-1029 redacted. Closed session.
7 (Open session).
8 JUDGE MUMBA: We are in open session. You
9 may proceed.
10 MR. BLAXILL: I'm obliged. Thank you, Madam
12 Q. Dr. Morgan, I believe there have been
13 essentially four articles that have emerged from the
14 Desert Storm study, is that correct, that have been
15 printed except for the last one?
16 A. You'd have to refresh me on which four you
17 are referring to.
18 Q. Well, sir -- yes, I do have copies for the
19 Court and for the witness.
20 THE REGISTRAR: Prosecution Exhibit number 7.
21 MR. BLAXILL:
22 Q. That, Dr. Morgan, is, I believe, the first
23 result or the preliminary report from the Desert Storm
24 research; is that correct?
25 A. The document I have in front of me does
1 appear to be a copy of our first published study on the
2 Desert Storm veterans, yes.
3 Q. Presumably Dr. Southwick is the gentleman you
4 referred to earlier, I believe, your boss; yes?
5 A. That's correct.
6 Q. And the Andrew Morgan M.D. there is yourself,
8 A. That is me.
9 Q. Thank you. In that particular report, the
10 initial method was described involving some 84 National
11 Guards reservists; is that so?
12 A. That's correct.
13 Q. Sir, shortly after that -- I say "shortly,"
14 two years later, there was a two-year follow-up study;
15 is that correct?
16 A. That's correct.
17 THE REGISTRAR: Prosecution Exhibit number 8
18 Prosecution Exhibit number 9.
19 MR. BLAXILL:
20 Q. So, Dr. Morgan, we now see the two-year
21 follow-up, and I believe the method is then relating to
22 62 National Guards people, and would that be, in fact,
23 simply that you had had a loss of people between the
24 two points?
25 A. Oh, naturally. Longitudinal studies, you
1 expect each year to lose subjects, and most people
2 assume that, as you go over time, fewer people will be
3 involved in a study. It's well-known in the field.
4 Q. And therefore, sir, presumably, to follow
5 that line, when you include it with an article in
6 February 1997, which was a consistency of memory
7 article relating to that study overall, you referred to
8 59 National Guards reservists. Were those just the 59
9 people who were consistent to your study throughout at
10 that point?
11 A. Those 59 individuals would have been people
12 who had participated in the study that we had data --
13 those were people who had completed the data
14 questionnaires at each of those time points.
15 Q. So what you're saying that, in fact, as a
16 result, 59 in total completed both questionnaires at
17 both points in time; yeah?
18 A. For this paper, yes. This paper reports on
19 the data from 59 people from both of those time points,
20 that's correct.
21 Q. Did you deploy any other questionnaire than
22 your own 19-question document? Did you deploy that on
23 the first occasion, at one month, any other form of
25 A. Yes, there were additional scales.
1 Q. Which did you apply on that occasion, sir?
2 A. Well, I think it's mentioned in the first
4 Q. Could you perhaps remind us, please?
5 A. I think I'd prefer to read it to you, if
6 you'd like? I don't want to misquote it.
7 Q. Please do.
8 A. The questionnaire included a PTSD symptom
9 scale based on DSM IIIR criteria for Post Traumatic
10 Stress Disorder. Subjects rated the following 17
11 DSM IIIR criteria for PTSD. They rated the following
12 17 DSM IIIR symptoms, and these are taken from
13 DSM IIIR: intrusive memories, nightmares, flashbacks,
14 feeling worse with war reminders, avoidance of thinking
15 about the war, avoidance of war reminders, amnesia with
16 respect to war --
17 THE INTERPRETER: Would the witness read
18 slowly, please?
19 A. -- decreased interest, feeling cut off from
20 other people.
21 JUDGE MUMBA: Can you read slowly for the
22 interpreters, please?
23 A. All right. Feeling less strongly about
24 things, feeling numb, sleep disturbance, irritability,
25 decreased concentration, being watchful or on guard,
1 increased startle -- or increased startle response,
2 excuse me, and reactivity toward reminders.
3 Symptoms were analysed as individual items
4 and as parts of the three symptom clusters and the
5 degree -- the three symptom clusters I mentioned
6 earlier: re-experiencing, avoidance, and
7 hyperarousal. The degree of severity of each symptom
8 during the preceding month was rated on a scale on
9 which zero equals none, one equals slight, two equals
10 moderate, three equals considerable, and four equals
11 extreme. A total PTSD score was calculated by summing
12 the ratings for each symptom. The end -- allowing for
13 a total possible score of 68.
14 The independence of time, time one versus
15 time two, and symptom severity, a rating of less than
16 two versus a rating of two or higher, was tested using
17 matched pairs chi squared analyses for each of the 17
19 The next section talks about the Mississippi
20 scale. If you want me to read it in detail, I will.
21 Q. No, sir. Thank you.
22 A. It's kind of slow, actually.
23 Q. What I would like, if you will be so kind, is
24 to say, did you -- to confirm whether you actually
25 applied the Mississippi scale in that particular study?
1 A. I think it's obvious. We report on the
2 findings in all of our papers.
3 Q. Did you also apply another scale then, the
4 Combat Experience Scale?
5 A. Yes, we did. It's stated right in the paper.
6 Q. Did you apply all three of those scales at
7 each stage of your research?
8 A. The Mississippi, the Desert Storm Trauma
9 Questionnaire, and the Combat Exposure Scale were
10 applied certainly at the one-month time point and the
11 two-year time point and at the six-year time point. At
12 the six-month time point, there were a certain number
13 of subjects who did not receive the Combat Exposure
14 Scale and therefore they were not included in the
16 Q. Now, you state that you used a 19-item
17 questionnaire of your own; that is correct? The Desert
18 Storm questionnaire?
19 A. Yes.
20 Q. And how many of the questions in that related
21 to what would be termed "directly experienced trauma"
22 in terms of being the direct victim of an event or
23 directly involved in?
24 A. Well, our research group had to come to a
25 consensus on that and -- you know, as a research group,
1 people would agree that a certain number of the items
2 were unmistakably objective, such as sitting with the
3 dying, being injured, seeing someone killed, and that a
4 certain number of items, there would be some
5 flexibility around subjective perception, like
6 threatened personal safety. I really can't tell you
7 off the top of my head how we actually rated each
8 item. It would be unfair.
9 Q. And I understand that the questionnaire
10 essentially would pose such questions. Let us take an
11 example of whether one had been in an aeroplane over
12 enemy air space, something of that nature; would that
13 be correct?
14 A. Yes. They flew to the Gulf.
15 Q. As opposed to one where: Have you ever been
16 shot down in an aeroplane?
17 A. Yeah, I believe one item is: Did the
18 aeroplane receive enemy fire?
19 Q. You say, obviously, it seems from the
20 approach you use, it was a "Yes"-"No" situation?
21 A. I think I stated before it's "Yes," "No," and
22 they had an opportunity to indicate the number of times
23 for each item.
24 Q. Number of times. That was not, though, quite
25 clearly, the methodology was not to take a kind of
1 interview, a witness statement, and actually get all
2 the surrounding facts relating to an event at that
3 stage; that would be correct, sir?
4 A. We weren't evaluating witnesses, we were
5 interviewing veterans coming back from a war zone.
6 Q. When you got to the six-year study, I believe
7 you referred to having some 32 participants remaining
8 in the exercise; is that correct?
9 A. For the consistency of memory at six years,
10 that's correct.
11 Q. And I believe you described the sample group
12 at -- in one part of the report it says 27 men and 7
13 women. I don't think that adds up to 30 but ...
14 A. I wouldn't know without looking back at the
15 paper, actually.
16 Q. I could -- we can show you that, sir.
17 THE REGISTRAR: Prosecution Exhibit number
19 MR. BLAXILL:
20 Q. I'm just wondering, Dr. Morgan, if there is
21 any statistical significance why the figures don't
22 appear to add up precisely?
23 A. Yes, there would be, and by looking at the
24 statistical analyses, it's obvious that the paragraph
25 under "Methods" has a misstatement in it about the
1 number of women. The statistical analyses, from that
2 you can derive the number of people in the subject. As
3 I say, this is a paper that is currently in review, and
4 those kinds of typographical errors in a paper are what
5 are caught by editors. So thank you.
6 Q. Now, I understand, if I understand correctly,
7 that at the two-year point, when you used the
8 Mississippi scale -- and believe me, sir, I'm no expert
9 in these matters -- but you made a reference to the
10 changes in responses in the questionnaire being "not
11 statistically significant." Was that a correct
12 observation in relation -- on my part, is that a
13 correct observation?
14 A. You're asking me whether or not the --
15 Q. I believe that you stated that the
16 differences shown on the Mississippi
17 two-year point -- one of your --
18 A. Oh, in the two-year paper is what you're
19 referring to?
20 Q. The two-year paper, yes, sir.
21 A. All right. All right.
22 Q. You actually refer that it was not
23 statistically significant, the changes measured on that
24 scale; is that right?
25 A. I will check the findings right now on the
2 Actually, in our second-year paper, the
3 Mississippi scale score did increase significantly over
4 time, and that's on page 1153 of the publication.
5 Q. Dr. Morgan, how many subjects exhibited or
6 were qualified for a diagnosis of chronic PTSD at the
7 point of your second year, the two-year survey?
8 A. I believe we've stated that as well in the
9 paper. Depending on which criteria are used, and
10 you'll notice at one point we use the criteria on the
11 PTSD symptoms scale and we also provide the information
12 as measured by the Mississippi scale. We do both
13 because one of the questions in our field and one of
14 the jobs at the National Centre is to establish
15 criteria for PTSD, and this paper is written to inform
16 about that, which is why we provide different ways of
17 making the diagnosis.
18 Q. But in point of fact, just how many people
19 was it at that point out of your sample who still had
21 A. Oh, yes. I think -- I can read it out loud
22 or you can, if you'd like. When a cut-off score of 89
23 was used on the Mississippi scale, in the second-year
24 paper, we had two subjects who met criteria at one
25 month for Post Traumatic Stress Disorder. In addition
1 to those two subjects, two more met criteria for PTSD
2 at six months. These four and two more met criteria
3 for PTSD at two years. So when you add them up, it
4 matches the prevalence in the general population of
5 between 9 and 10 per cent of the total sample which is
6 a nice reminder that the paper is a reliable reflection
7 of both the prevalence of PTSD in a natural group and
8 supports the validity of our findings.
9 Q. Sir, how many people remained in -- were PTSD
10 sufferers at the six-year point?
11 A. At the six-year time point, out of the
12 subjects that we saw, I'm aware of three people who met
13 full criteria for PTSD, and once again, three out of 30
14 to 32 subjects -- re-check the data -- in between 9 and
15 10 per cent, once again, a very accurate reflection of
16 what we find in the population. I should point out, so
17 it's not misinterpreted, we looked at the full
18 continuum, and so did Dr. Roemer in her study of 460
19 subjects, and the findings are, in fact, the same. The
20 more symptoms of PTSD, the more inconsistencies, and
21 the individuals with PTSD had the most
22 inconsistencies. The three subjects in our six-year
23 study were the three individuals who change nearly
24 every response on their questionnaire. So I would
25 caution people from paying attention to small numbers.
1 These are numbers in people we've evaluated
2 consistently over time and it's now been replicated in
3 larger studies.
4 Q. Suffice it to say for the purposes of the
5 conclusions subsequently drawn in these studies, we do
6 have a variation in the sample group, do we not, sir,
7 and, in fact, from the original 84 we start with, we
8 ended up with 32; is that broadly fair to say?
9 A. No, it would not be scientifically fair to
10 say at all. In longitudinal samples, you have a
11 representative sample and you submit it to peer review
12 and your peers let you know whether or not it is a
13 valid representation of the data. They've been
14 published. People accept our data. We know what we're
15 doing. I mean, I think people who don't understand
16 that just don't understand this kind of research. I
17 don't know what else to say except that anyone who does
18 longitudinal studies should expect to see half their
19 subjects have left the study within four years. If you
20 don't see that when you evaluate a paper, you need to
21 ask a question about what did they do? People have
22 documented this kind of a finding over the last 20 in
23 years in longitudinal research.
24 Q. There is one thing however, to move on. You
25 have stated throughout it's a question of consistency;
1 is that right? It's just consistency.
2 A. That's precisely what I said.
3 Q. This is consistency of the memory. Is it not
4 true -- sorry, sir.
5 A. It's consistency of reported memory, and I
6 believe I tried to be very clear on that this morning.
7 Q. Indeed. And I'm moving on to that very point
8 because is it not so you conceded in your studies that
9 the reliability and validity of the questionnaire in
10 factual terms was never established or verified; is
11 that so?
12 A. For the Desert Storm trauma questionnaire,
13 that is true. For the War Stress questionnaire, that
14 is not true. Neither is it true for the Combat
15 Exposure Scale which are well-validated. The good news
16 is that they all match, the percentages are the same,
17 and people in the field of PTSD are content with that.
18 Q. And that, sir, obviously, on the issue of
19 consistency. But as regards the issue of the factual
20 accuracy of a human memory, you could not say that that
21 model of yours tested factual accuracy.
22 A. I know of no model in the world that can
23 directly measure what anyone knows in their mind.
24 Perhaps startle is the closest you can get. But I know
25 of no way of measuring what people actually remember.
1 People can misstate, they can forget, they can be
2 mistaken, they can lie, they can do all sorts of
3 things. I said this morning I think that apart from
4 other objective independent evidence like photographs,
5 hard data that can't be shifted, consistency of
6 reported memory is all anyone has ever measured.
7 Q. But I believe you've actually stated in your
8 research, did you not, Doctor, that the self-rated
9 questionnaire, as I believe you called it, you deemed
10 to have its limitations in that respect.
11 A. Absolutely. That's why I was delighted to
12 see Carol North's study and I've also seen a study by
13 Dr. Goodman who used direct interviews with people and
14 found highly similar results. People were inconsistent
15 whether they filled out a form or whether they were
16 directly interviewed and asked about their symptoms.
17 But, absolutely, anyone who does this research knows
18 that giving people paper and pencil tests is a valid
19 way of measuring data, but when you can, you get a
20 direct interview. It's not always possible.
21 Q. I believe you did precisely that to the
22 extent of interviewing your subjects at the six-year
23 point; is that correct, Dr. Morgan?
24 A. Yes.
25 Q. Am I correct in suggesting to you, sir, that
1 one method that is approved of in such research is the
2 use of what they call a blind interviewer, i.e. someone
3 who is not involved in the research; is that correct?
4 A. Yes, that's correct.
5 Q. Is that a preferred and approved way of
6 trying to be as impartial and even-handed as possible
7 in the research?
8 A. Yes, it is, and we've indicated that in our
9 paper. Dr. Steven Southwick actually interviewed the
10 other half of the subjects, and we had a third person,
11 a Dr. Goldstein, independently rate the record of our
12 interviews with the subjects and make her evaluation on
13 the data. So we did just that. We took turns
14 interviewing people, we did not compare our notes, and
15 we had a third party evaluate them. It's the best way
16 to do the research.
17 Q. There were, I believe, certain responses that
18 you received in relation to the reasons for an apparent
19 inconsistency of memory; is that correct?
20 A. We had people tell us why they thought their
21 answers changed.
22 Q. And I believe you've disclosed in your work
23 that one person made a change of his response because
24 of basically his interpretation of the word "friends"
25 or "friend," whether the person or persons killed would
1 be a friend; is that correct?
2 A. I believe I also mentioned that this morning
3 in testimony.
4 Q. Yes, indeed you did, sir. I believe another
5 response was to do with the impression of being close
6 to enemy lines; is that right?
7 A. There is a statement in our paper about being
8 close to enemy lines, that's correct.
9 Q. I believe there, sir, the gentleman, in
10 civilian life, commuted that distance daily and
11 thought, in fact, it was quite a long way but --
12 A. Yes. Oh, yes.
13 Q. But he still remembered quite clearly as a
14 fact, did he not, the presence of the enemy lines?
15 They had been there.
16 A. You know, that was the question we had when
17 we sat with him, and we tried to get at that, and what
18 he said, and I believe it is in the paper, he said,
19 "Well, we were close to enemy lines, 30 miles is close
20 when it's the enemy, but I drive 30 miles to work every
21 day, so that's a long way."
22 Q. Exactly, sir. And, in fact, therefore he was
23 working, was he not, from a memory that recalled two
24 salient facts: one was the fact of enemy lines and the
25 other was the fact they were 30 miles away?
1 A. Oh, I don't know. I actually put in the
2 paper as well that the explanations the subjects gave
3 us would include that possibility, but more
4 importantly, we concluded that none of the explanations
5 may be true, and that's because people, when you
6 confront them with inconsistencies in their reports,
7 get anxious, they get upset. We found in our subjects,
8 people got defensive and they would say things like,
9 "Well, that's not my handwriting. I didn't do this."
10 And we would say, "Well, is it your handwriting?" And
11 they would then say "Yes." And so we suggest in our
12 paper that one possibility for their answers is that
13 they feel they have to come up with an answer. They
14 need to find something that makes sense to make it
15 logically consistent.
16 We concluded at the end of our paper that
17 most of the subjects were unable to be satisfied with
18 their responses, and we concluded that sometimes maybe
19 the pressure or the demand characteristic, is how we
20 refer to it in scientific studies, that the pressures
21 on a person sitting with someone like a doctor or a
22 scientist, that that sort of -- that pressure
23 influences them to come up with something, and rather
24 than say, "You know, I don't know," or "I lied" or "I'm
25 completely inconsistent," they would come up with some
1 meaningful explanation. So we try to emphasise in our
2 paper that we, in fact, don't know if any of the
3 explanations people gave us were true.
4 Q. Dr. Morgan, it seems rather strange, though,
5 that the people, simply for assisting you in a
6 psychological research, feel so threatened if taken to
7 task over a response? Was there anything about the
8 circumstances that would be threatening to them?
9 A. We were not aware of anything that would be
10 threatening to them, but most researchers do agree that
11 for an individual to come in and meet scientists, there
12 may be demand characteristics, just like someone coming
13 in, meeting an attorney, meeting a judge, meeting a
14 police officer, it isn't their sort of everyday
15 experience, and we had to --
16 THE INTERPRETER: I apologise, but this
17 really is too fast.
18 JUDGE MUMBA: Please be slower. There is
19 interpretation that has to go on.
20 A. I'm sorry. So we had to consider that the
21 explanations were possible explanations but perhaps not
22 true explanations of our data.
23 MR. BLAXILL:
24 Q. But equally then, if one is going to
25 speculate in that direction, one can speculate the
1 other way, that they were simple, logical, truthful
2 responses in the sense of accuracy?
3 A. You know, our subjects didn't agree with us
4 on that, but that is a possible way of interpreting the
5 data. It's harder when we looked at the items about
6 people being injured and shot.
7 Q. Well, I will quote one last example of that
8 which I believe was a man who corrected his response
9 about seeing a woman killed --
10 A. Mm-hmm.
11 Q. -- because he said what really happened was
12 he heard the blast and then moments later saw the body
13 and associated the two. Would that not be a very
14 logical and sensible response?
15 A. You're referring to the fellow who said he
16 had seen a photograph later and then said --
17 Q. No, I'm not.
18 A. There's an example in our paper of a fellow
19 who believed he had seen the nurse in the unit killed
20 and then he said, "I couldn't have seen it because I
21 heard the blast and then saw the body," and he later
22 believed that he had, in fact, seen her.
23 Q. Well, we'll verify that point, Dr. Morgan.
24 A. I don't know which one you're referring to.
25 I'd have to look and you can show me in the paper, but
1 I know in our paper there's the example of the fellow
2 who believed he had seen someone killed and later said
3 it was because he had seen a photograph and that he
4 had -- he had been around the explosion but, in fact,
5 he did not see her. He had seen her body later. He
6 came to believe that the photograph of her, the picture
7 in his head, he said, was the picture in the
8 photograph. That was striking to us, because we had
9 understood from post-event information studies that
10 this phenomenon occurs.
11 Q. Well, if I can move on from that point,
12 Dr. Morgan, we can verify that.
13 Pardon the interruptions, Your Honours.
14 I'm quoting from your own six-year study
15 here. It is page 2079.
16 A. Okay.
17 Q. The second paragraph down says, "I must have
18 focused on the word 'seen.' I must have taken that to
19 mean I actually saw her the moment she died. I only
20 heard the blast then saw her a few seconds afterward.
21 I guess it all depends on what you mean by 'seen.'"
22 A. Yes. I see where you are. And the question
24 Q. Again, was that not very probably or possibly
25 a perfectly logical and actual -- accuracy memory based
1 response from somebody?
2 A. I believe that it's not a measure of
3 accuracy. It does seem to demonstrate logic on the
4 part of the subject, but, in fact, the subject wasn't
5 pleased with the answer. They weren't sure of their
6 answers. These are ways they were trying to come to
7 grips with it.
8 Q. I believe you subsequently commented in your
9 six-year article, Dr. Morgan, that you recommended a
10 closer focus on the use of words in future research to
11 avoid these problems?
12 A. Oh, yes. And Dr. Goodman has recommended the
14 Q. So isn't it, therefore -- sorry. Isn't it,
15 therefore, possibly the tools that have caused the
16 problem there? There have been misimpressions from the
17 nature of questions asked?
18 A. Well, I think in our paper and in
19 Dr. Roemer's paper we do raise that issue for our field
20 in trauma studies, that the way we assess people may
21 influence the way they answer, and we believe that's
22 very similar across settings. However, the data from
23 Dr. North is not -- was done with direct interviews,
24 and she too found significant inconsistencies, people
25 denying their -- in fact, their illness, the symptoms,
1 nightmares and illness that are supposed to be
2 indelible of their traumatic event.
3 So I think taken together, the studies are
4 not supportive of the idea that this is a problem with
5 questionnaires. In doing research in the field, we
6 would like to improve questionnaires. We always like
7 to improve techniques. Medicine is like that. We
8 always like to improve how we work with people in
9 diagnosing them, but it's not an explanation for the
10 data that's held up.
11 Q. Dr. Morgan, did you make any observation at
12 the end of your studies relating to the responses of
13 healthy, non-treatment seeking individuals?
14 A. Yes.
15 Q. And what was your general view as to the
16 presence of any inconsistency amongst such people?
17 A. Our view is that a single source of
18 information for reported memory is not scientifically
19 reliable independent of external corroborating
20 evidence, and I -- and I believe that we stress that,
21 which is why we encourage people to remember this is
22 not -- this is not about recovered memory, this is
23 about consistency of reporting.
24 Q. Indeed so. It's about consistency of
25 reporting. And I believe you did indicate that
1 inconsistency is also pretty common amongst people
2 without PTSD, normal, healthy people?
3 A. I think that's evident in the paper, in that
4 the PTSD people did it significantly more.
5 Q. Now, turning to the question of accuracy of
6 memory, accuracy is, indeed, is it not, a different
7 dimension of memory to that of consistency?
8 A. People have argued that this is. I do not
9 know, in fact, whether or not that is demonstrated in
10 the field of PTSD.
11 Q. But it's generally a matter of human memory,
12 that accuracy is separate element of memory compared to
13 ability for completeness or for consistency?
14 A. I need to be specific. Accuracy is a term
15 that I know to be associated with a neurologic test,
16 like a memory test, where a person is presented with
17 specific information against which their responses can
18 be compared, and investigators feel comfortable saying
19 you're accurate or not, if you get the items.
20 However, apart from a neurologic test in word
21 recall, I do not know of a way to assess accuracy for
22 traumatic events.
23 Q. Let us look, if we can, at the situation of
24 people who do suffer from PTSD. I believe under DSM
25 IV, this is the sort of diagnostic criteria, is it not
1 true that it's the development of characteristic
2 symptoms following exposure to an extreme traumatic
3 stressor? Is that correct?
4 A. I wouldn't want to quote it verbatim, but if
5 you --
6 Q. I can show you a copy of that.
7 A. I would agree with the statement, but I'd
8 like to make sure it's being quoted correctly.
9 Q. And included in that diagnosis, sir, in DSM
10 IV, they include such things as direct personal
11 experience of an event. Is that one of things that can
13 A. In DSM IV, one of the two prongs for the
14 traumatic event is that the individual must be exposed
15 to something that is personally threatening,
16 threatening to their personal integrity.
17 Q. And as a matter of interest of your studies,
18 sir -- Dr. Morgan, did you not find that the scores
19 relating to those subjected to direct stress or direct
20 trauma were, in fact, a little more consistent than
21 those who suffered indirect trauma when you compared
22 the studies in your Desert Storm research?
23 A. No. I think what we reported is that people
24 with Post Traumatic Stress Disorder made many more
25 changes in their report. They were more inconsistent.
1 Q. Then let me put it another way. Did you see
2 more consistency in responses in relation generally to
3 direct trauma as opposed to the indirect trauma across
4 people generally?
5 A. I'm a little confused by your question,
6 because I do not recall, in any of our papers, making a
7 distinction of that kind in the statistical analyses or
8 reporting in that way. If you --
9 Q. I don't think it was --
10 A. -- want to refresh my memory, but we didn't
11 say that.
12 Q. I don't think it was an analytical
13 conclusion. I'm saying was it that the scores in
14 relation to the direct traumas indicated perhaps a
15 greater consistency than in respect of the indirect
17 A. Once again, I'm saying we didn't -- we didn't
18 compare direct and indirect statistically, so it would
19 be impossible to affirm or negate what you're saying.
20 We showed that the more trauma symptoms they had the
21 more inconsistent they were, the more sicker they were,
22 the more changes in their report.
23 Q. Now, if we move on then to traumatic events,
24 Dr. Morgan.
25 A. Uh-huh.
1 Q. When other studies in connection with the
2 business of traumatic memory as such --
3 A. I described four of them this morning.
4 Q. And would that be -- include such things --
5 would that be including the studies of John Yuille and
6 the events of impact? You're familiar with that, sir,
7 aren't you?
8 A. Yes.
9 Q. Is it not true that in 1986 John Yuille and
10 others actually dealt with a real life event of a
11 shoot-out at a gun store, I believe; is that correct?
12 A. To the best of my recollection of his study,
13 that is correct.
14 Q. I will verify it to you later, sir, but I
15 believe they carried out interviews of the exact -- the
16 actual witnesses to this event, and researchers did so
17 five or six months after the event, so they've been
18 police interviewed and researched. Is that, to your
19 recollection, correct?
20 A. Once again, I'd have to look at the study
21 directly. It's not a study on Post Traumatic Stress
22 Disorder, or memory in people with post traumatic
23 stress, so it hasn't been relevant to the work we've
24 been doing, but I would review it for you if you like.
25 Q. Well, if I could just give you some detail,
1 sir, and obviously we will produce this to you in
2 fullness of time to verify. If I would suggest to you,
3 sir, that there was, in fact, something like a 60 per
4 cent increase in additional information observed six
5 months after the event?
6 A. You mean, they went from poor to slightly
8 Q. I'm saying that at this stage, sir, it was
9 560 [stenographer error] per cent increase in
11 A. Relevant to what?
12 MR. BLAXILL: My friend for the Defence
13 indicates there may be a problem on the transcript. It
14 says 560.
15 JUDGE MUMBA: Yes, you did say 60 per cent.
16 MR. BLAXILL:
17 Q. Dr. Morgan, if I could just suggest this to
18 you, and I will provide you with the article in due
19 course, that this was new information on the part of
20 witnesses in respect of the events of the robbery they
22 A. Uh-huh.
23 Q. And apparently accuracy rates were very high,
24 between 85 and 90 per cent, for the factual information
25 recalled. And this included details of the action,
1 which I believe were about 82 per cent, descriptions of
2 the robbers at 76 per cent and so forth?
3 A. So about 1 in 4 were not accurate.
4 Q. In respect of --
5 A. You said 76 per cent, so approximately 25 per
6 cent, 1 in 4, of the description were is inaccurate.
7 That's actually like what I reported this morning, that
8 inaccuracies look to be in the range of 30 to 40 per
9 cent on the yes to no, and no to yes changes. But once
10 again that, to my knowledge, and I will review it later
11 if you'll give me the paper, the assessment time points
12 are not identical. They're not given the same
13 instrument. So it's not a controlled study.
14 And, two, it's not a study of people with
15 Post Traumatic Stress Disorder. So it's really not
16 relevant to what I presented this morning, but if you
17 give me the paper I'd be happy to critically review
18 it. It's been reviewed and summarised in -- well, in
19 Dr. Charney's book, Neurobiological Consequences of
21 Q. Dr. Morgan, the -- is it not true that there
22 is a body of opinion that the emotionally experienced
23 memory is perhaps more vividly encoded than other
24 memories of a more normal learning process?
25 A. Yes. There's -- there's substantial evidence
1 from animals and from people that we remember
2 emotionally meaningful things better than neutral
3 things, and I think, as I said this morning, it sort of
4 makes sense if you're threatened by something, your
5 body produces adrenaline. We know adrenaline helps our
6 memory. When people get overwhelmed in
7 life-threatening events the stress hormones are no
8 longer helpful and they disrupt memory. But I think
9 everyone knows, from their own personal life
10 experience, they remember a party that was fun. They
11 remember an unpleasant argument with someone. So they
12 remember unpleasant things more than neutral things.
13 Where they left paper clips this morning.
14 Q. Indeed. And on the basis, therefore, that
15 this might be a stronger memory, would it be more
16 likely to be a more enduring memory?
17 A. Well, we all know that's not true. That, in
18 fact, was our assumption when we began our studies. We
19 had actually predicted that the memories in the
20 veterans, and so did Dr. Roemer and Dr. North,
21 predicted that people's memories for these
22 life-threatening events, people getting killed beside
23 them, bombs blowing up, people shooting other people in
24 front of them, that those would not change. And in
25 fact, in her study, and our study and Carol North's,
1 people's reports change. We've had to rethink what we
2 think the gist of a memory is. The major event that's
3 threatening to people changes in their report.
4 Q. Well, Dr. Morgan, you've just referred to the
5 expression "gist." What do you mean by that, what
7 A. It's not a scientific term, in my view,
8 because it's imprecise. I know that it is used as a
9 layman's term for people generally implying, "You got
10 the main intent of my message."
11 Now, in our studies, if what we mean by gist
12 is that our subjects knew they went to the Gulf War,
13 then the gist was correct. If we wanted to say that
14 people knew they'd been in that shoot-out in Texas, then
15 the gist was correct. However, if we're going to say
16 that the gist is, "Did you or did you not see somebody
17 injured or shot or killed," we know for a fact those
18 items change. The gist, I don't know.
19 Q. You are aware, sir, that there is, again, a
20 body of study that would indicate that gist is the more
21 memorable than periphery detail? Would you agree with
22 that proposition at all?
23 A. I am aware of a body of study that cannot be
24 legitimately related to studies in Post Traumatic
25 Stress Disorder where gist is referred to, and I'm
1 speaking of the literature on recovered memory. That
2 literature cannot be scientifically compared to
3 literature on Post Traumatic Stress Disorder for this
4 reason: According to DSM IV, to make a diagnosis of
5 Post Traumatic Stress Disorder, you have to first
6 establish a traumatic event. After establishing the
7 traumatic event by the person's report, you make a
8 diagnosis based on symptoms that are present.
9 In the field of recovered memory, individuals
10 are assessed by therapists, who complain of symptoms
11 and who work backwards from those symptoms and go in
12 search of a trauma that the patient can't remember, and
13 they search until they find one. We call that recall
14 bias, retrospective bias. It is not a scientifically
15 valid way of doing research these days, and looking at
16 the effects of stress on the brain and understanding
17 what we know about brain functioning.
18 I am aware that many people would like to
19 compare these two fields. At the National Centre --
20 the National Centre is the premier institution in the
21 United States and the international system. It is a
22 large group of investigators. The National Centre and
23 the International Society for Traumatic Stress Studies
24 are both clear. The recovered memory issue is not to
25 be compared with the research and our understanding --
1 THE INTERPRETER: We apologise. This is too
2 fast for interpretation.
3 JUDGE MUMBA: Please speak slowly. Too fast
4 for interpreters.
5 A. I think this does a disservice to research in
6 Post Traumatic Stress Disorder, and it does disservice
7 to people suffering from Post Traumatic Stress Disorder
8 to equate the two. And I don't want to give the Court
9 the impression that these studies that purportedly show
10 that memory for recovered memories, whether it's ritual
11 satanic abuse or whatever, alien abductions, whatever,
12 I wouldn't want the Court to have the impression that
13 that is considered in the same realm of science as the
14 work we do with victims of rape, you know, victims of
15 trauma, victims of war. That's why I feel very
16 strongly about that. Part of our mission is education
17 from the National Centre, and there has been a vigorous
18 debate in the United States, in the court systems, over
19 this recovered memory debate, and we really owe it to
20 the public to say these are apples and oranges, two
21 different kinds of things. People who know they've
22 been traumatised, they've known that they've been
23 traumatised and who are sick as a result of that
25 We are not talking about people who say,
1 "Well, I feel ill," and then meet with the therapist
2 and other time suddenly discover that horrible things
3 they never ever remembered before had occurred to them
4 in childhood.
5 Q. Dr. Morgan, you made reference at the outset
6 of your last remarks about the sort of flashbulb
7 situation of a traumatic memory. Now, for those who
8 have tested that theory, are you aware of the areas in
9 which they found any inconsistency or loss of recall of
10 accuracy in relation to those events? Are you aware of
11 that, sir, or not? You can answer yes or no.
12 A. I don't understand the question.
13 Q. Very well. Let me put it this way: The
14 flashbulb research took place generally in respect of
15 very notable historical public events; is that correct?
16 A. I mentioned this morning --
17 Q. Just say yes or no.
18 A. -- the assassination of John F. Kennedy.
19 Q. Indeed. John F. Kennedy, the Challenger
20 disaster, I believe.
21 A. That's correct.
22 Q. I believe the death of the Premier in Sweden
23 on one -- was one study as well--
24 A. Yes. I believe I referred to that.
25 Christensen's study as well.
1 Q. Is it not true that in respect of those kinds
2 of memories, whatever the subsequent inconsistency, the
3 fact is people still remembered the event? Is that
5 A. Once again, it depends what you mean by the
7 Q. The event. If we take the assassination of
8 John Kennedy --
9 A. It's everything to my answer. If you phone
10 someone back up and say, "You're in our study because
11 we're asking you about the assassination of JFK or the
12 Challenger," they're reminded of the event in
13 question. But we can't forget the gist of the study.
14 The gist of the study reminds them what you're going to
15 ask about.
16 Q. Is it not true that those studies showed that
17 they might have remembered the event and the place,
18 whereas they would not remember necessarily the
19 circumstances they were in when they heard the news?
20 That's what I'm trying to get at.
21 A. I am aware that many of the subjects were
22 unable to report where they were and what they were
23 doing, and were significantly inconsistent. I am aware
24 that a number of subjects were consistent. I'm also
25 aware that the authors of those studies concluded that,
1 in fact, they didn't support the notion of flashbulb
2 memories, and one author went so far as to then
3 redefine what a flashbulb memory would be. They
4 decided 60 per cent was good enough. A hundred per
5 cent down to 60 per cent.
6 Q. Dr. Morgan, is it true that people who suffer
7 PTSD sometimes suffer from a delayed recovery of their
9 A. In my experience, I have never found that to
10 be the case.
11 Q. So you would expect, in the case of PTSD, the
12 person would have continuing memory, would you, from
13 shortly after the event?
14 A. Based on what we know from combat veterans,
15 from rape victims, from victims of natural disasters,
16 we have generally found that people know they were in a
17 war zone, they know they had a rape, and they have not
18 reported extended periods of amnesia for those events.
19 Although, I have treated veterans who believed they
20 were in Vietnam and remembered their experiences, and
21 we have now been informed by the government that they
22 were not, in fact, deployed to Vietnam. So they, in
23 fact, have memories for traumatic events that could not
24 have occurred in Vietnam.
25 So the consistency of reporting trauma is not
1 a measure of accuracy, it's a reflection of how sick
2 people feel.
3 Q. Presumably by diagnosing those symptoms and
4 the fact that these people are sick, they have clearly
5 undergone a trauma.
6 A. That's putting the cart before the horse. We
7 don't reason backwards and say since they have symptoms
8 they must have been traumatised, no.
9 Q. If you have researched somebody and made the
10 diagnosis that they have Post Traumatic Stress
11 Disorder, is it not logical that there must obviously
12 have been the presence of the stress or trauma?
13 A. It does depend on the clinician. No. At the
14 National Centre, you have to verify now that a person
15 has been deployed in the army theatre where they were
16 deployed. In fact, very little additional information
17 is often available in military records.
18 For rape victims who come in, since it's a
19 clinic, we don't ask the rape victim to provide
20 evidence of where they were raped, and we do not ask
21 them to provide evidence that they were raped. Since
22 it's a clinic, we take that at face value, and I think
23 as was explained yesterday and by me this morning, the
24 therapeutic perspective is we accept people how they
25 come into the clinic. It's different than how you do
1 scientific studies on memory.
2 Q. On that basis, sir, you would say obviously
3 you would let them relay to you what they say they
4 recall of the rape?
5 A. As a clinician?
6 Q. Uh-huh.
7 A. You let them say what they say.
8 Q. Exactly. And, therefore, if -- so if
9 somebody comes in and gives that account, you will
10 simply accept that as being their memories at that
11 time? I presume that's fair to say.
12 A. We accept what the patient says and proceed
13 from there for therapy. We don't have to believe that
14 it's accurate.
15 Q. And as you say, the studies that you have
16 conducted generally do not give any insight into
17 accuracy other than you've referred to an indirect
18 insight into accuracy?
19 A. I stated earlier that consist -- studying
20 consistency provides an indirect and yet limited way of
21 viewing accuracy. I say that because there are times
22 when people give two diametrically opposed reports.
23 The example, I think it was mentioned yesterday, is --
24 the reference was, was Mr. Furundzija tall and dark or
25 short and blonde? Can't be both.
1 Now, I don't know -- now that I've seen him
2 he looks tall and dark, but I didn't know that reading
3 documents, so I would have no idea which account or
4 description was accurate. I would know they weren't
5 consistent, and would I say to myself, "Can't be both,
6 it's possible that he's neither. He could be red
8 So in that sense, consistency is a role of
9 indirectly getting an impression of accuracy. But
10 it -- I know of no method for measuring accuracy in
11 every day life, in the real world situation for
12 studying trauma.
13 Q. Indeed. Dr. Morgan, certain studies and
14 authorities supplied to us, initially as a basis for
15 your testimony, included some of those of Dr. Loftus
16 and others, and one of those was, I believe, a
17 laboratory experiment in respect of accuracy; is that
19 A. I don't know to what you're referring. I
20 didn't turn in any references by Dr. Loftus, so I'm not
21 sure what you're talking about.
22 Q. I can ask you another way then Dr. Morgan.
23 Are you aware of the Loftus and Burns study of 1990 --
24 I'm sorry, 1982, based on a robbery scenario?
25 A. You'd have to show me the study. Once again,
1 Dr. Loftus's work has not been about Post Traumatic
2 Stress Disorder, and it has not been about the nature
3 of memory in people with PTSD, so I would have to
4 review a paper before to comment on it.
5 JUDGE MUMBA: Mr. Blaxill, we've reached our
6 break time.
7 MR. BLAXILL: Yes, Ma'am.
8 JUDGE MUMBA: Before we break for this
9 afternoon, I would wish to announce that tomorrow the
10 proceedings will start at 10.30, because the Trial
11 Chamber is involved in other cases from 9.00 hours on.
12 So these proceedings will start tomorrow at 10.30
13 hours. So we will break for 30 minutes.
14 --- Recess taken at 4.00 p.m.
15 --- On resuming at 4.27 p.m.
16 JUDGE MUMBA: Yes, Mr. Blaxill?
17 MR. BLAXILL: Thank you, Your Honours.
18 JUDGE MUMBA: Can you please wrap up? I
19 wonder how long you have to go.
20 MR. BLAXILL: I can't be certain. I could
21 imagine we would probably be the better part of another
22 half to three-quarters of an hour minimum, I'm sorry to
24 JUDGE MUMBA: We would appreciate it if you
25 would --
1 MR. BLAXILL: I will do my level best, Your
3 JUDGE MUMBA: Yes.
4 MR. BLAXILL:
5 Q. Dr. Morgan, I mentioned a study just before
6 the break, but I do not propose to put that to you now,
7 save us a little time.
8 Prior to that, we were talking -- I talked
9 briefly about emotional memories and memories for
10 traumatic events. Now, if you absent Post Traumatic
11 Stress Disorder, it would be true to say, would it not,
12 that such memories would tend to be stronger and more
13 positively retained; is that so?
14 A. It's generally agreed that in humans, they
15 will remember emotional things better than neutral
16 things; that is not to say that memory for an
17 overwhelming event will be remembered better than a
18 memory for a non-life-threatening traumatic event.
19 People I think in general know that some
20 stress enhances performance. For example, an athlete
21 preparing for a game may have an increase in adrenaline
22 or someone performing on a test may have an increase in
23 adrenaline and be able to pay more attention and do
24 better in the sport or on a test or remember
25 something. But we know clearly from 50 years of
1 research, since Canon's work in the early part of the
2 century, that it's a curve in that as stress increases,
3 performance is enhanced; but as stress gets higher and
4 higher and higher, performance diminishes.
5 Common experience might be being too stressed
6 out. People then start not to pay attention if a test
7 gets too stressful or if a competition gets too
8 overwhelming. I think the common viewing of that, like
9 on television, would be watching the Olympics and
10 seeing very fine athletes who have done that
11 performance thousands of times but who arrive at the
12 competition and perhaps can't do the behaviour they've
13 been training to do, they can't get it right, and in
14 the realm of sports psychology, people are agreed that
15 that's because people differ in their ability to manage
16 the stress under -- to manage the stress of the
17 competition and performance falls off.
18 So that in everyday life, there is a
19 relationship that is positive between enhanced
20 performance and an increase in stress, but it is not
21 true that when stress becomes overwhelming that you
22 necessarily see enhanced performance.
23 There are a lot of studies in animals and in
24 people that show, as you increase some stress, people
25 remember things a bit better; but as the stress gets
1 higher, they don't. So it's not what we call a linear
2 relationship, it's not just as stress keeps increasing,
3 you just get better and better and better and better,
4 there's just no end point. It's a curve that kind of
5 looks like an "n" that as stress goes up, performance
6 goes up but then falls away. Memory appears to behave
7 in the same way, that as stress increases slightly, we
8 remember a little better; as it increases more, we
9 don't remember so well.
10 Q. Dr. Morgan, you have analysed a number of --
11 or, sorry, you have reviewed a number of the statements
12 made by the witness in this case; that's correct?
13 A. I have.
14 Q. Yes. And you have seen elements of events
15 repeated over a period of time; that is correct?
16 A. I'm sorry. Could you ask me that again?
17 Q. You have seen elements of certain events that
18 occurred over a period of time set out in those
20 A. Can you tell me what you mean by "elements"
21 and then I would know how to answer your question?
22 Q. Various factual incidents, because you've
23 actually compared -- you've made comparison charts from
24 that information.
25 A. Mm-hmm. I have made comparisons between
1 statements. I do not know if they're facts and I don't
2 want to imply to people that I pretend to know whether
3 they are true or not true.
4 "Elements" is a broad word. I think what
5 I'm comfortable saying is I reviewed the statements and
6 I have noted inconsistencies and there are, obviously,
7 consistencies. Witness A has said all along that she
8 was in captivity, that she suffered rape, that she was
9 held against her will, that she was frightened, that
10 she was sort of frozen and shocked and disoriented.
11 Those are consistent statements. I don't know whether
12 or not they're accurate.
13 Q. Would such experiences generally qualify as
14 events that would impact heavily on the memory?
15 A. Being confronted with a threat of rape --
16 Q. Let me take you through. For instance, being
17 seized by a group of armed soldiers, taken and held
18 somewhere; would that be an intense emotion? Would it
19 be like gist? Would it be gist of the story?
20 A. Being seized by enemy soldiers would be -- I
21 would reasonably assume that that would be an alarming
22 event. I do not know -- I would want to know from the
23 person seized whether they were alarmed by it --
24 Q. Can I ask you this then -- if we can use a
25 "Yes"-"No" basis? Would you consider it to be, for
1 want of a better word, traumatic for such a woman to be
2 taken into captivity and then stripped of her
3 clothing? Would that be an intense emotional
5 A. I think so.
6 Q. Yes.
7 A. I think that would fit into a category of a
8 potentially stressful event.
9 Q. Would the presence of an interrogator in that
10 particular situation be a significant, an intense
12 A. I think, once again, that would depend on
13 what was happening.
14 Q. Then if the interrogator added threats to the
15 lives of the children of that person, would that be an
16 intense experience?
17 A. Are you asking me if someone says to someone,
18 "I would harm your children --"
19 Q. In that scenario, would you -- from your
20 experience, would you put that on the side of an
21 intense experience?
22 A. I think that reasonably falls into the realm
23 of things that could be Category A events, threatening
25 Q. In that situation, the person who is held by
1 armed soldiers, interrogated, if they add the threat
2 of, say, genital mutilation with a knife, would that be
3 an additional element that would be again intense?
4 A. That's a possibility, yes.
5 Q. A possibility.
6 A. Well, those are the things in DSM IV that
7 listed: sexual assaults --
8 Q. Would then to suffer repeated rape in such
9 circumstances, would that also be an intense
11 A. I would consider that as an intense
12 experience, yes.
13 Q. If that took place in front of someone who
14 was also being held, who was acquainted with you, would
15 that add to that tension and trauma?
16 A. I don't know if that would add. I think most
17 people would assume that the rape itself would be
18 traumatic and would not know how to answer the question
19 as to whether or not someone was more worried about
20 someone watching while they were getting raped. I
21 think most victims would be concerned with what was
22 happening to them.
23 Q. And in those circumstances, sir, would you
24 agree that the potential is there obviously for PTSD?
25 A. There's a potential for PTSD, yes.
1 Q. And is it not true that the symptoms of PTSD
2 include, quite often, intrusive, recurring memories?
3 A. Intrusive, recurring memories are one of the
4 symptoms listed for Post Traumatic Stress Disorder.
5 Q. And I believe you made a reference earlier
6 about the absence of uncontrollable thoughts denied by
7 the -- pardon me a moment.
8 My learned colleague does advise me that, of
9 course, certain matters were in closed session, and I'm
10 trying to be careful not to step over that boundary
11 without alerting the Chamber, but I don't know if Your
12 Honours feel maybe we are getting close enough to that
13 issue. I will be making some references in due course
14 to the charts as well.
15 JUDGE MUMBA: Well, in that case, then it's
16 safer to be in closed session.
17 MR. BLAXILL: I think it would be safer to go
18 now, Ma'am. I've kept it to as late as possible.
19 JUDGE MUMBA: "Private session," so called.
20 MR. BLAXILL: I'm obliged to you for that,
22 (Private session)
11 Pages 1076-1092 redacted. Private session.
15 (Open session).
16 JUDGE MUMBA: Yes, we're in open session now.
17 MR. BLAXILL: Obliged, Ma'am.
18 Q. You've testified to the effect of certain
19 things released in the human body under stress which
20 may affect parts of the brain; is that correct?
21 A. I've mentioned only two of a great number of
22 stress hormones; that's correct.
23 Q. And of these two stress hormones, you suggest
24 they cause some damage to the hippocampus?
25 A. I believe I stated that adrenaline is known
1 to disrupt concentration and attention which are vital
2 to forming memory.
3 Q. And if someone -- sorry, please?
4 A. I was waiting for the translator. And I also
5 said that the glucocorticoids have been demonstrated to
6 produce cell damage in the hippocampus.
7 I did not mention beta endorphins,
8 e-n-d-o-r-p-h-i-n, it's the body's natural pain-killer,
9 and their effect at reducing memory, and they too are
10 released under conditions of high stress.
11 Q. And in what kind of studies have these
12 effects been researched?
13 A. In both animal and in human studies.
14 Q. And how many studies are human studies?
15 A. For which hormone?
16 Q. I'm no expert in hormones, sir, but the
17 effects of stress generally on memory?
18 A. This is really the focus of several books.
19 To my knowledge, the most comprehensive book to date is
20 edited by Matthew Friedman, Ariel Deutsch and Dennis
21 Charney, and it is called the Neurobiological
22 Consequences of Stress from Normal
23 Traumatic Stress Disorder, and it reflects thousands of
24 studies if you count the animal studies and then
25 looking at the human studies, and I would not be able
1 to tell you the exact numbers of studies. I can only
2 mention some of the more famous studies and well-known
4 Q. Is one of those well-known studies that of I
5 believe a Dr. Bremner?
6 A. Dr. Bremner has actually done more than 30 to
7 40 studies. I'd have to know to which ones you're
9 Q. Would they be the general groups who have
10 been used as your subjects -- or the subjects for
12 A. The general groups are trauma victims for
13 Dr. Bremner's work. He studies trauma victims, men and
14 women who have Post Traumatic Stress Disorder from
15 adult and childhood trauma.
16 Q. Would you, sir, not place --
17 JUDGE MUMBA: Mr. Blaxill, can we move on?
18 We've done too much on general studies.
19 MR. BLAXILL: I will be through very shortly
20 I can now assure you, Your Honours, I really will.
21 Q. Was one of those studies that you placed
22 considerable reliance on involving Vietnam
23 Is that correct?
24 A. Once again, Dr. Bremner has done most of his
25 work in Vietnam veterans and in women with sexual
1 assault related PTSD.
2 Q. Dealing with the Vietnam
3 not true that amongst the research group there is a
4 high rate of prior alcohol dependency history?
5 A. It is true that in men with Post Traumatic
6 Stress Disorder from a war zone, many men have a
7 problem with alcohol. Fortunately, the studies looking
8 at the hippocampus in women with Post Traumatic Stress
9 Disorder have taken that factor into account.
10 Q. Can I just -- but as for those studies, you
11 would concede, would you, it would be a factor, a
12 potential factor?
13 A. I will defer to the top journal of science in
14 the world, the journal Science, who published an
15 update, a report for the world on the effects of stress
16 on the brain. It's entitled Why Stress is Bad for Your
17 Brain. Dr. Sapolsky is the author of report in
18 Science, and he and the rest of the science community
19 have accepted the findings of the four published
20 studies -- the four studies that I know are published
21 on hippocampal brain damage in people with PTSD, and
22 that is not counting the three additional studies that
23 are currently in press that have not only replicated
24 the four previous studies but have actually increased
25 our knowledge that the brain damage is much more
1 significant than we had thought.
2 The early studies showed that the hippocampus
3 may be significantly reduced up to 8 per cent in its
4 volume. The new studies that have now been presented
5 at conferences and that are in review show that up to
6 18 per cent of the hippocampus is damaged. To give a
7 comparison, people who suffer from Alzheimer's disease,
8 a condition well recognised for its disturbances and
9 its effect on the mind, those patients have a 25 per
10 cent reduction in the hippocampus. So that people with
11 Post Traumatic Stress Disorder have at least an 8 per
12 cent reduction. It now appears it may be as high as 18
13 per cent. But there is no question in the field that
14 these findings are consistent and reliable. So I --
15 that's all I have to say.
16 Q. All right. In conclusion, Dr. Morgan, you --
17 you stated that in your research you had single-source
18 information; correct? Self-reported, single source?
19 A. As in the case that I've looked at here for
20 the Court --
21 Q. Absolutely.
22 A. -- we had subjects from whom we obtained
23 multiple reports.
24 Q. Yes, sir. In other words, you had single
25 people answering the questions. And some of those
1 clearly did have PTSD that was diagnosed; yes?
2 A. Yes.
3 Q. Right. Now, sir, what would you consider the
4 impact of the existence of corroboration when you take
5 it alongside those findings?
6 A. It depends on what kind of corroboration. In
7 our study, we interviewed each of the members of the
8 military units who were deployed to the same places in
9 their respective units. It was not helpful for us to
10 compare their reports to one another, in that they too
11 were inconsistent between one another as well as within
12 their own reports. So it would depend on what kind of
14 Q. But would you say that if anyone is satisfied
15 that there is corroboration in a situation, clearly
16 that would assist in establishing the accuracy and
17 indeed the consistency of memory, but certainly
18 accuracy, would it not?
19 A. I think an objective, independent source of
20 corroborative evidence would be essential in trying to
21 evaluate multiple inconsistent reports from an
23 Q. And, in fact, isn't it so that you concluded,
24 sir, your six-year replication -- you concluded that,
25 did you not, with the sentence, "Thus, the current data
1 suggests that inconsistencies in reports of trauma
2 should not automatically imply that a victim..." --
3 sorry, "... a witness, victim or patient is
4 unreliable." Those are the words?
5 A. Oh, yes, indeed, those are the words. And
6 they're there for a very important reason.
7 Dr. Southwick and I worked very hard on the
8 wording of our paper, to prevent people from
9 automatically assuming that because someone has
10 suffered trauma that they're an unreliable witness.
11 However, we -- and we wanted to remind people that we
12 were not interested in getting into the recovered
13 memory debate.
14 We felt we went to great lengths at the end
15 of our paper to keep clinicians, first of all, from
16 using inconsistent reports against their own patients.
17 We're actually concerned that people may misinterpret
18 our findings and then say to patients, "You're lying,"
19 or, "You're wrong." And we believe that that would be
20 harmful in a clinic setting to a patient.
21 So in our paper we said we do not want these
22 findings to be automatically applied to a courtroom
23 setting. We would hope that people would have other
24 evidence other than inconsistent reports, and that's
25 why we stated it very carefully and at the end of our
2 Our paper is most likely to be coming out in
3 a journal that's read by clinicians, not only research
4 scientists, and we don't think that they should use the
5 inconsistencies to doubt their patients or to convey
6 doubt and lack of trust in the patients.
7 So I really agree with the statement, and I
8 don't think anyone should be automatically, without
9 looking at all evidence --
10 Q. Finally, sir --
11 A. -- be rejected as a patient or as a witness.
12 Q. Finally, Dr. Morgan, did you not express
13 studies, generally at this stage, you felt were not, in
14 fact, ready for court related use? Is that correct?
15 Could you just answer yes or no to that, sir?
16 A. It would not be truthful answer if I answer
17 yes or no, but I can answer yes or no. I would prefer
18 not to.
19 Q. Very well, sir. I'm happy with that.
20 I have no further questions, Your Honours.
21 Thank you very much.
22 JUDGE MUMBA: Thank you. I suppose the
23 Defence will want to re-examine.
24 MR. DAVIDSON: We have nothing on redirect.
25 That's fine.
1 JUDGE MUMBA: Thank you. The Court has some
2 questions for you.
3 A. Yes.
4 JUDGE CASSESE: Dr. Morgan, I have one or two
5 questions which are naive, of course, naive questions.
6 I am trained in law and have no knowledge of psychology
7 or psychiatry, so I apologise for asking naive
9 May I refer you to Exhibit D24, which you
10 should have in front of you. D24, it's the Medica
12 A. Yes, the Medica document.
13 JUDGE CASSESE: Yes, the Medica document.
14 Now, it is clear from this document that it
15 consists of two parts. One is page 1, the reply of the
16 Medica centre.
17 A. Uh-huh.
18 JUDGE CASSESE: It's a two-page report. Then
19 as a sort of attachment we may read the three reports
20 made respectively on the 24th of December, '93
21 December, '93 and 11th of July, '95.
22 A. Yes.
23 JUDGE CASSESE: Now, if I read this document,
24 particularly in the first document, "Reply", I have the
25 feeling, and I wonder whether this is correct, that in
1 a way it was only in '98, when this reply was drafted
2 and sent to us, that Witness A was formally diagnosed
3 with PTSD, and this diagnosis was based, if I read this
4 document correctly, on the reports prepared in '93, '93
5 and '95, because actually, on the first page, they
6 clearly say, "We feel that the Witness A was suffering
7 of Post Traumatic Stress Disorder -- Post Traumatic
8 Stress Syndrome on the report based in '93, and for
9 this purpose ...", they go on to say, "... we have
10 underlined, in the report of 24th of December, '93 the
11 relevant sentences," which in a way disclose symptoms
12 of this syndrome. We can see them on page 3. "She was
13 released from the camp. When she was released from the
14 camp she could not sleep."
15 Can you see it? These are the sentences
16 which are underlined. So I assume those are the
18 MR. BLAXILL: Excuse the interruption, Your
19 Honour. I'm just wondering if again we might be
20 straying into areas that are referring to matters that
21 were in closed session.
22 JUDGE MUMBA: You're right.
23 JUDGE MUMBA: So we're going into closed
25 JUDGE CASSESE: Private session.
11 Pages 1103-1109 redacted. Private session.
17 --- Whereupon proceedings adjourned at
18 5.40 p.m., to be reconvened on
19 Wednesday, the 11th day of November,
20 1998, at 10.30 a.m.