Tribunal Criminal Tribunal for the Former Yugoslavia

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          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

Page 912

          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

         14  Bosnia-Herzegovina"?

         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

         19  staff"?

         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

Page 913

          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

          9  not.

         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

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          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?

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          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

         11  correct?

         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

         15  correct?

         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.

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          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 --

         22       Q.   Sir, document D25, the second page.

         23       A.   Second page.  I'm sorry.  Yes.

         24       Q.   And doesn't it say that it was a women's

         25  therapy centre?

Page 917

          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,

         20  sir?

         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

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          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

Page 919

          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

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          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.

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         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?

Page 922

          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,

         14  sir?

         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

         25  concerned.

Page 923

          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.

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         10  (redacted)

         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.

         19  (redacted)

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         23       Q.   Sir, you raised concerns about the imagery

         24  therapy.

         25       A.   Yes.

Page 924

          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

          5  techniques?

          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

         20  memory.

         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.

Page 925

          1       Q.   Well, sir, I'm making reference to the one

    2  from your university by Dr. Giselman and Dr. Fisher, and

          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.

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         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

         20  correct?

         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.

Page 927

          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

          8  support.

          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

Page 928

          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 and the

         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

Page 929

          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

         25  patient?

Page 930

          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

         17  there.

         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.

Page 931

          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.

Page 932

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          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?

Page 933

          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

Page 934

          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

Page 935

          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

         19  rape.

         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

Page 936

          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

          9  memory.

         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,

Page 937

          1  please?

          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.

         20  (redacted)

         21  (redacted)

         22  (redacted)

         23  (redacted)

         24  (redacted)

         25  (redacted)

Page 938

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          3  (redacted)

          4  (redacted)

          5  (redacted)

          6  (redacted)

          7  (redacted)

          8  (redacted)

          9  (redacted)

         10  (redacted)

         11  (redacted)

         12  (redacted)

         13  (redacted)

         14  (redacted)

         15  (redacted)

         16  (redacted)

         17  (redacted)

         18  (redacted)

         19  (redacted)

         20  (redacted)

         21  (redacted)

         22  (redacted)

         23  (redacted)

         24  (redacted)

         25       A.   Absolutely.

Page 939

          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

         20  upon?

         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?

Page 940

          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

         12  tall"?

         13       A.   Yes, it says that.

         14  (redacted)

         15  (redacted)

         16  (redacted)

         17  (redacted)

         18  (redacted)

         19  (redacted)

         20  (redacted)

         21  (redacted)

         22  (redacted)

         23  (redacted)

         24  (redacted)

         25  (redacted)

Page 941

          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).

         25  (redacted)

Page 942

          1  (redacted)

          2  (redacted)

          3  (redacted)

          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.

         25  (redacted)

Page 943

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Page 944

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Page 945

          1  Could you please tell me, what is the effect of

          2  corroboration?

          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,

          9  please?

         10            JUDGE MUMBA:  Yes.

         11            MS. SELLERS:

         12  (redacted)

         13  (redacted)

         14  (redacted)

         15  (redacted)

         16  (redacted)

         17  (redacted)

         18  (redacted)

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         21  (redacted)

         22  (redacted)

         23  (redacted)

         24  (redacted)

         25  (redacted)

Page 946

          1  (redacted)

          2  (redacted)

          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

          7  questions.

          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

         16  difficult?

         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

Page 947

          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

          9  distracting.

         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

         25  effects.

Page 948

          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.  That’s exactly what happened

         17  (redacted)

         18  (redacted)

         19  (redacted)

         20  (redacted)

         21  (redacted)

         22  (redacted)

         23  (redacted)

         24  (redacted)

         25  (redacted)

Page 949

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24

25       A.   It had to have been.  That's the only way

Page 950

          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

         19  criminals?

         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

Page 951

          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

          8  criminals."

          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 --

Page 952

          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

Page 953

          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

         12  one?

         13       A.   Yes, that's possible.

         14  (redacted)

         15  (redacted)

         16  (redacted)

         17  (redacted)

         18  (redacted)

         19  (redacted)

         20  (redacted)

         21  (redacted)

         22  (redacted)

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Page 954

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Page 955

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          4  (redacted)

          5  (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,

Page 956

          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

          9  session?

         10            JUDGE MUMBA:  Private session.  We'll go into

         11  private session, without pulling down the blinds.

         12                 (Private session)

         13  (redacted)

         14  (redacted)

         15  (redacted)

         16  (redacted)

         17  (redacted)

         18  (redacted)

         19  (redacted)

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Page 957

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         23                 (Open session)

         24            THE WITNESS:  I solemnly declare that I will

         25  speak the truth, the whole truth, and nothing but the

Page 961

          1  truth.

          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

         16  Honour.

         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

         20  evidence.

         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

Page 962

          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

          6  University?

          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

Page 963

          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

         10  diagnosis.

         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

Page 964

          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

Page 965

          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

Page 966

          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

         15  depression.

         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

Page 967

          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

          4  before.

          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

         24  life.

         25       Q.   So when a person meets all of these standards

Page 968

          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

          7  Disorder.

          8       Q.   Have there been any studies reflecting the

          9  length of time that a person will suffer from chronic

         10  PTSD?

         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

         21  traumatised.

         22       Q.   Is there a series of waxing and waning of the

         23  symptoms?

         24       A.   You mean does it sort of get worse and

         25  sometimes better?  Oh, yes.  A number of studies now

Page 969

          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

Page 970

          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

         12  criteria.

         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

Page 971

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          4  (redacted)

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          7  (redacted)

          8  (redacted)

          9  (redacted)

         10  (redacted)

         11  (redacted)

         12  (redacted)

         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

         20  treatment.

         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?

Page 972

          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 combat

         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

Page 973

          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

Page 974

          1  Disorder.

          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 for PTSD, that's one of our main goals

          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.

Page 975

          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

         13  information.

         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

         18  know?

         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.

Page 976

          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

Page 977

          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

Page 978

          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

Page 979

          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

          6  wrist.

          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

         18  brain.

         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,

Page 980

          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

         20  Disorder.

         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.

Page 981

          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

         12  assassinated.

         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

Page 982

          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

Page 983

          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

          4  later.

          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

         13  anybody."

         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

Page 984

          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

Page 985

          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

Page 986

          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

Page 987

          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

Page 988

          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

Page 989

          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

         15  unit.

         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

Page 990

          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.

Page 991

          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

Page 992

          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

         20  slide.

         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

         25  one.

Page 993

          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

          9  is?

         10       A.   Yes.  Dr. Roemer is a scientist who conducts

         11  research in Post Traumatic Stress Disorder up at Boston

         12  University.

         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

Page 994

          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;

          5  correct?

          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:

Page 995

          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

Page 996

          1  experienced the shoot-out in Texas.  Someone had come

          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

         13  ill.

         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

Page 997

          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.

Page 998

          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

          9  reached?

         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.

Page 999

          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

Page 1000

          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

Page 1001

          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

Page 1002

          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

          5  another.

          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

         14  answer.

         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

Page 1003

          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,

Page 1004

          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

Page 1005

          1  Medica?

          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

         15  clinic.

         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

Page 1006

          1  medical therapy?  Was there psychotherapy, talking

          2  therapies?

          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

Page 1007

          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

         25  elements.

Page 1008

          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.

Page 1009

          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

Page 1010

          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

Page 1011

          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.

 6  

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Page 1012

          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

         21  registrar.

         22            MR. DAVIDSON:  As long as the TV camera isn't

         23  on the boards.  We have some five boards behind the

         24  witness.

         25            JUDGE MUMBA:  Which may be demonstrated

Page 1013

          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)

          6  (redacted)

          7  (redacted)

          8  (redacted)

          9  (redacted)

         10  (redacted)

         11  (redacted)

         12  (redacted)

         13  (redacted)

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         19  (redacted)

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Page 1014

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11 Pages 1014-1029 redacted. Closed session.

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Page 1030

          1  (redacted)

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          4  (redacted)

          5  (redacted)

          6  (redacted)

          7                 (Open session).

          8            JUDGE MUMBA:  We are in open session.  You

          9  may proceed.

         10            MR. BLAXILL:  I'm obliged.  Thank you, Madam

         11  President.

         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

Page 1031

          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,

          7  sir?

          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

Page 1032

          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

         24  scale?

         25       A.   Yes, there were additional scales.

Page 1033

          1       Q.   Which did you apply on that occasion, sir?

          2       A.   Well, I think it's mentioned in the first

          3  publication.

          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,

Page 1034

          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

         18  items.

         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?

Page 1035

          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

         15  analysis.

         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,

Page 1036

          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

Page 1037

          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

         18  10.

         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

Page 1038

          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 scale at the

         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

Page 1039

          1  paper.

          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

         20  PTSD?

         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

Page 1040

          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.

Page 1041

          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;

Page 1042

          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.

Page 1043

          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

Page 1044

          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

Page 1045

          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?

Page 1046

          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

Page 1047

          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

Page 1048

          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

Page 1049

          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

         23  was?

         24       Q.   Again, was that not very probably or possibly

         25  a perfectly logical and actual -- accuracy memory based

Page 1050

          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

         13  same.

         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,

Page 1051

          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

Page 1052

          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

Page 1053

          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

         12  happen?

         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.

Page 1054

          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

         16  traumas?

         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.

Page 1055

          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,

Page 1056

          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

          7  better.

          8       Q.   I'm saying that at this stage, sir, it was

          9  560 [stenographer error] per cent increase in

         10  information.

         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

         21  witnessed?

         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,

Page 1057

          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

         20  Stress.

         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

Page 1058

          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,

Page 1059

          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

          6  definition?

          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

Page 1060

          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 --

Page 1061

          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

         24  trauma.

         25            We are not talking about people who say,

Page 1062

          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.

Page 1063

          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

          4  true?

          5       A.   Once again, it depends what you mean by the

          6  event.

          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,

Page 1064

          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

          8  memories?

          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

Page 1065

          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

Page 1066

          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.

Page 1067

          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

          7  haired."

          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

         18  correct?

         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,

Page 1068

          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

         23  say.

         24            JUDGE MUMBA:  We would appreciate it if you

         25  would --

Page 1069

          1            MR. BLAXILL:  I will do my level best, Your

          2  Honour.

          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

Page 1070

          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

Page 1071

          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

         19  statements?

         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

Page 1072

          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

Page 1073

          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

          4  experience?

          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

         11  detail?

         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

         24  events.

         25       Q.   In that situation, the person who is held by

Page 1074

          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

         10  experience?

         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.

Page 1075

          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,

         21  Ma'am.

         22                 (Private session)

         23  (redacted)

         24  (redacted)

         25  (redacted)

Page 1076

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Page 1093

          1  (redacted)

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          7  (redacted)

          8  (redacted)

          9  (redacted)

         10  (redacted)

         11  (redacted)

         12  (redacted)

         13  (redacted)

         14  (redacted)

         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

Page 1094

          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 Adaptation to Post

         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

Page 1095

          1  to tell you the exact numbers of studies.  I can only

          2  mention some of the more famous studies and well-known

          3  studies.

          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

          8  referring.

          9       Q.   Would they be the general groups who have

         10  been used as your subjects -- or the subjects for

         11  that?

         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 veterans?

         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

Page 1096

          1  assault related PTSD.

          2       Q.   Dealing with the Vietnam veteran cases, is it

          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

Page 1097

          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

Page 1098

          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

         13  corroboration.

         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

         22  individual.

         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

Page 1099

          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

Page 1100

          1  paper.

          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.

Page 1101

          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

          8  questions.

          9            May I refer you to Exhibit D24, which you

         10  should have in front of you.  D24, it's the Medica

         11  report.

         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, 31st of

         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

Page 1102

          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

         17  symptoms.

         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

         24  session?

         25            JUDGE CASSESE:  Private session.

Page 1109

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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.

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