Tribunal Criminal Tribunal for the Former Yugoslavia

Page 4347

 1                          Monday, 14 January 2002

 2                          [Open session]

 3                          [The accused entered court]

 4                          [The witness entered court]

 5                          --- Upon commencing at 9.34 a.m.

 6            JUDGE HUNT:  Call the case, please.

 7            THE REGISTRAR:  Good morning, Your Honours.  Case number

 8    IT-98-32-T, the Prosecutor versus Mitar Vasiljevic.

 9            JUDGE HUNT:  Madam, would you please make the solemn

10    declaration in the document which the court usher has handed you?

11            THE WITNESS: [Interpretation] I solemnly declare that I will speak

12    the truth, the whole truth, and nothing but the truth.

13                          WITNESS:  VERA FOLNEGOVIC-SMALC

14                          [Witness answered through interpreter]

15            JUDGE HUNT:  Sit down, please.  Mr. Groome?

16            MR. GROOME:  Good morning, Your Honours.  The doctor has asked me

17    to point out a mistake in the English translation of her original report.

18    It's a minor one but it is one that would leave the report open for

19    misinterpretation.  It is on page 1 of the report.  And it is under the

20    section entitled, "The opinion is based on..."  And it's the third

21    paragraph, the number 3.  In that paragraph.  And the mistake is, she

22    interviewed the accused in detention unit 3 or Scheveningen 3, not on the

23    3rd.  She only interviewed the accused on the 11th and 12th of December.

24            JUDGE HUNT:  Thank you.

25                          Examined by Mr. Groome:

Page 4348

 1       Q.   Good morning, doctor, I'd ask you to tell us your name.

 2       A.   My name is Vera Folnegovic-Smalc.

 3       Q.   You can remain seated.

 4       A.   Oh, thanks.

 5       Q.   Now, Doctor, we are going to begin by discussing briefly your

 6    background, and I would ask maybe the usher to assist the doctor.  Some of

 7    this has been summarised on sheets of paper on the ELMO.  I would just ask

 8    the usher to help the doctor orient them on the ELMO properly.

 9            Doctor, I'd ask you to begin by describing for us briefly your

10    educational background.

11       A.   I graduated from the school of medicine, University of Zagreb, in

12    1968.  And by doing so, I gained a title of a general practitioner.  After

13    that for some time I worked as a general practitioner.

14       Q.   I think perhaps you could go a little bit slower we won't wear out

15    the interpreters this morning.

16       A.   Thank you.  So after that, I started my specialization in

17    neuropsychiatry and I completed that training in 1975.  And at that point,

18    I obtained a title of neuropsychiatrist.  Shortly thereafter, I started

19    post-graduate studies in psychiatric epidemiology and public health, and

20    in 1977, I defended my masters thesis and became a master of science.

21    During that entire time, I worked as a psychiatrist in the oldest Yugoslav

22    psychiatric hospital, Vrapce.

23            In 1983, I passed or defended my doctor's thesis in the area of

24    psychopathology of schizophrenia, and by doing so, I became a doctor of

25    science.  In addition to that, I attended many trainings, out of which I

Page 4349

 1    believe it is important to say that as an associate of the World Health

 2    Organization from Geneva, from 1978 until 1985, I attended training on the

 3    use of measurement, instruments, in diagnosing psychiatric disorders in

 4    various centres in Europe, such as Geneva, Munich and others.

 5       Q.   Now, Doctor, in addition to or during the course of your career as

 6    a psychiatrist, have you also had several positions teaching psychiatry?

 7       A.   My teaching experience began in 1991, officially, although even

 8    prior to that, I worked as an assistant to my professors, who were my

 9    bosses at that time.  But in 1991 and on, I started working as an

10    assistant professor in three schools in Belgrade:  One of them is the

11    school for rehabilitation; the second one is the school of -- faculty of

12    psychology, within the universities of Zagreb; and also at the faculty of

13    medicine at the universities of Zagreb, where I've been working since 1990

14    as an assistant professor.  And in 1991, when I became a tenured professor

15    in all of those schools, I continued working there, but now as a tenured

16    professor.  For a while, I also worked as a visiting professor for

17    psychiatry at the medical school in Rijeka, University of Rijeka.

18       Q.   Now, Doctor, can you briefly describe for us what publications, if

19    any, you have?

20            JUDGE HUNT:  Do we really need to have this given orally?  Is

21    there no list that we can just accept?

22            MR. GROOME:  There is a curriculum vitae, Your Honour, which if

23    the Court wishes -- some of her experience is directly on point to some of

24    the issues in this trial so I thought it might be helpful.

25            JUDGE HUNT:  If would certainly be good to have her tell us about

Page 4350

 1    those, but it's a fairly grim process going through any psychiatrist's

 2    list of published material because they publish an awful lot.

 3            MR. GROOME:  Your Honour, she was just going to tell us the number

 4    and draw our attention to two that have a particular importance.

 5            JUDGE HUNT:  All right.  If that's the way you're going to do it,

 6    that will help, thank you.

 7            MR. GROOME:  Also the sheets that are on the Elmo, I've made hard

 8    copies, if it's of assistance to the Court.  I've provided them to the

 9    Court staff.  I'd ask that they be furnished to the Chamber.

10            JUDGE HUNT:  We have got them, thank you.  This will save us from

11    having to write notes, certainly thank you.  That will be a very

12    convenient document but you don't want that as an exhibit.  This will only

13    reflect her evidence, is that it?

14            MR. GROOME:  Yes, Your Honour, just a demonstrative aid.

15       Q.   Would you please summarise the number of articles that you have

16    written and tell us about the important ones for the matter that you have

17    been asked to engage yourself in, in this case?

18       A.   Well, I've published more than 200 Articles in professional and

19    scientific journals in former Yugoslavia, Croatia, Germany, Britain and

20    U.S.  What is of importance for this expertise, perhaps, is that for a

21    long part of my life, I was involved in psychiatric epidemiology and

22    psychopathology so I have a number of articles from that field and also

23    psychiatric genetics.  What is important is that I wrote ten chapters in

24    various textbooks and scientific books and it is also important to say

25    that I authored a chapter in the most recent European psychiatric

Page 4351

 1    textbook, and just to add in the end that the latest textbook in

 2    psychiatry in Croatia for that textbook, I wrote a chapter on forensic

 3    psychiatry.

 4       Q.   Doctor, can you tell us the most significant professional

 5    organisations to which you belong?

 6       A.   Do you mean the institutions that I worked in or some other ones?

 7       Q.   No, professional organisations such as the Croatian psychiatric

 8    organisation.

 9       A. The professional organisations that I belong to, I listed only

10    three.  One is the Croatian psychiatric association, and I served for a

11    second term as a chairman of that association.  I'm also a board member of

12    forensic psychiatric association and also a member of several

13    international psychiatric associations, and several times, I attended and

14    was an invited lecturer at psychiatric congresses, international ones.  I

15    do not belong to any non-professional organisations.

16       Q.   Now, Doctor, I'd ask you to summarise for us the professional

17    positions that you have held in psychiatry.

18       A.   From 1975, until present time, I've been working as a general

19    psychiatrist which means that my daily work includes work with patients.

20    This takes place at the general emergency psychiatric ward.  In addition

21    to that, from 1976 until 1991, I worked as a forensic expert for Croatia

22    and other republics of the then Yugoslavia.

23       Q.   Now, Doctor, I'd ask to you describe for the Court what was the

24    nature of your responsibilities as a forensic expert to the courts of the

25    former Yugoslavia?

Page 4352

 1       A.   I was invited to various courts, and at that time I was a junior

 2    forensic expert, and in the beginning, I mostly worked for the

 3    municipality of Zagreb, which is where I live, but together with other

 4    experts, I was also invited to some courts in other parts of former

 5    Yugoslavia.

 6       Q.   And would you be called in the course of those duties to examine

 7    patients regarding their psychiatric condition for the court?

 8       A.   Yes.  That was one of my routine assignments during that entire

 9    time.  I would examine the patients, examine all those aspects that were

10    required of me and then finally give my opinion to the court.

11       Q.   Please continue, doctor.

12       A.   After 1991, I became psychiatric court expert in Croatia, and when

13    Croatia gained its independence and after I became a tenured professor, I

14    was appointed chief of forensic expertise at the Zagreb University in the

15    area of psychiatry, and this is one of the strongest and most important

16    institutions for forensic sciences in our country.  I wrote a total of

17    over 500 forensic opinions.  Most of them were in the area of criminal law

18    and about 50 of them in the area of civil law.

19       Q.   Doctor, presently, is there a more senior or higher level expert

20    in forensic psychiatry in Croatia than yourself?

21       A.   At this time, my position is such that I am chief psychiatric

22    forensic expert, which means that there is nobody above me in Zagreb.

23    There is a colleague of mine in Osijek who holds identical position to

24    mine there.

25       Q.   Doctor, at present, are you called from time to time to review the

Page 4353

 1    expert evaluation and opinions of other forensic psychiatric experts in

 2    the Republic of Croatia?

 3       A.   My function is such that I am verifying reports of others, and

 4    based on our law, a court can ask for an opinion of one expert or an

 5    opinion of an institution, and if the Court disagrees with an opinion of

 6    either of them, then it can send a report to the University of Zagreb and

 7    then I am head of a committee which comprises three persons; I'm a

 8    chairman of that committee, that investigates and checks that opinion.

 9       Q.   Doctor, I'd ask you to tell us were you a biological psychiatrist

10    beginning in 1978?

11       A.   Biological psychiatry is something that I've been involved with

12    for a long time.  I am a general psychiatrist, but in addition to that, I

13    have specific licences giving me an opportunity to get involved with

14    biological psychiatry and I've been doing this since 1978, and very

15    frequently, I have to give an expert opinion regarding pharmacotherapy

16    therapy.

17       Q.   What is your present position?

18       A.   My present position is director of university department, a clinic

19    for general forensic psychiatry and clinical electrophysiology at the

20    medical school of the Zagreb University which is located in the

21    psychiatric hospital, Vrapce.

22       Q.   And finally, Doctor, regarding your background, I would like to

23    ask you if you have conducted any research that is relevant to

24    the issues that were raised in this case, and if so, would you please

25    describe briefly what that research was?

Page 4354

 1       A.   Well, my master -- since I defended my master's thesis, I got

 2    involved in the psychiatric research, and I've listed only three articles

 3    here that have something to do with the expertise that we are discussing

 4    here today.  First of all, that is a research of genetic components of

 5    exogenous psychosis.  I worked in this research as a principal

 6    investigator for Croatia, and research was conducted under the auspices of

 7    Colombia University from New York.  The chief professor from Columbia in

 8    charge of this is Markin [phoen].  The research is still ongoing but we

 9    have already published several articles in the American Psychiatric

10    Journal regarding this research.

11            Other two researches that are important involve research of

12    functional psychosis, their genetic and epidemiological indicators.

13       Q.   Thank you, Doctor.  Now, Doctor, I'd ask you for the next few

14    minutes to maybe describe for the Chamber some of the basic concepts that

15    we need when we evaluate the remainder of your testimony.  I would ask you

16    to give us a simple basic definition of forensic psychiatry.  What is the

17    role of forensic psychiatry?

18       A.   Forensic psychiatry is one of subcategories in psychiatry which,

19    in order to assist courts in solving their cases and issues, uses

20    psychiatric methods and criteria and requires the expert to have

21    additional training in judicial matters needed to solve such issues and

22    problems.  That specifically means that the expert needs to be trained and

23    have knowledge in the area of criminal and civil law and give detailed

24    answers to questions put to him such as, for example, accountability,

25    necessary treatment, recommendations, procedural capacity, and so on.

Page 4355

 1       Q.   Now, Doctor, our primary interest here will be in the issue of

 2    accountability so I would ask you to give us a definition of

 3    accountability.

 4       A.   Accountability is an ability of a person to fulfil two

 5    requirements:  First, to understand the consequences and meaning of its

 6    actions, and the second one is that the person is able to control its own

 7    actions, understand and being able to control them.

 8       Q.   Now, based on your experience as a forensic expert in the courts

 9    of the former Yugoslavia, did you translate the essential question that's

10    posed to a forensic psychiatrist who is providing expertise or was

11    providing expertise to the courts at that time?

12       A.   Yes.  That's right.  According to former Yugoslav laws, the

13    definition of accountability read as follows:  The person is accountable

14    if it is able to understand the meaning of its actions and control and

15    manage its actions.  This is a verbatim translation of the provision.

16       Q.   Now, Doctor, how many different levels of accountability existed

17    under the law of the former Yugoslavia in the period of 1991-1992?

18       A.   In former Yugoslavia, a law in force divided accountability into

19    the following four categories:  The first category was that person was

20    fully accountable; the second one that the person had diminished

21    accountability but not significantly diminished; the third one was

22    significantly diminished accountability; and the fourth category was

23    incompetent

24       Q.   Now, let's talk about accountable, the first category.  Can you

25    please describe for us the criteria for determining that somebody is

Page 4356

 1    accountable and perhaps give us some examples of people who would be

 2    considered accountable for their actions despite some psychiatric

 3    condition?

 4            JUDGE HUNT:  But not significantly so.

 5            MR. GROOME:  I'm sorry, Your Honour, this is the first category.

 6            JUDGE HUNT:  It's the second category that she's used.  The first

 7    one was completely accountable.  The second one was not...

 8            MR. GROOME:  Diminished but not significantly.

 9            JUDGE HUNT:  Diminished but not significantly, so the third one

10    was significantly so the fourth one was incompetent.

11            MR. GROOME:  Yes, Your Honour.  I'm asking her now to describe the

12    first one, accountable, and the types of psychiatric conditions that the

13    person could have but still be accountable.

14            JUDGE HUNT:  Fully accountable.

15            MR. GROOME:  Yes.

16            JUDGE HUNT:  I'm sorry, I didn't see that you were getting to that

17    stage.

18            MR. GROOME:

19       Q.   Could you please describe for us what is the criteria for

20    determining that somebody is fully accountable?

21       A.   The main criteria for somebody to be fully accountable is that

22    this person is able to fully understand the consequence of an act held

23    responsible for, and in practice that means that that person does not have

24    any psychological condition, which means that that person has a diagnosis

25    of sine morbo psychico or that person can have a mild condition that only

Page 4357

 1    in a minor way influenced him in that he only to a minor degree could not

 2    understand his actions.  That person can have a very minor psychological

 3    condition such as a mild or moderate depression, also alcoholism, but

 4    alcoholism where the person is not fully inebriated.

 5            So in order to say that somebody is fully accountable, we should

 6    know what the person is charged with, we should know the psychiatric

 7    anamnesis and know whether that person had any conditions and what state

 8    that person was in at the time when the act was committed.  So we have to

 9    know the elements of that particular act and also psychological condition

10    of the perpetrator.  So these are the questions we have to answer for the

11    Court.

12            So the criteria is that there is no serious disorder in

13    understanding and comprehending actions and controlling actions.  And

14    there are also some conditions that are listed that can fall into this

15    category, and also, we can have a person that has absolutely no

16    psychological condition.  As a consequence, is that such person is

17    considered to be accountable and can be held responsible for the act

18    committed.

19       Q.   Now, Doctor, let's move to the second category, diminished but not

20    significantly.  Can you please describe for us what is the criteria that a

21    forensic psychiatrist would use in evaluating that somebody is of that

22    category?

23       A.   So the second category, category B, includes persons that can

24    understand the meaning of the act committed by them but there are certain

25    circumstances that reduce, in a minor degree, accountability.  An example

Page 4358

 1    of that can be alcoholism, inebriation, certain degrees of retardation,

 2    dementia, post traumatic stress disorder, and similar conditions.  Persons

 3    that fall within that diagnostic category are responsible for the act they

 4    were charged with but there is a recommendation that certain mitigative

 5    circumstances be taken into account when passing a sentence for them.

 6       Q.   Now, Doctor, let's move to the third category.  What is the

 7    criteria for determining that somebody is significantly diminished in

 8    their capacity?

 9       A.   When we say that a person is of significantly diminished

10    accountability, we enter into a new group of persons, persons who can have

11    a real mental illness, but at the time of the commission of the crime, the

12    person is in a state of remission.  This group would include manic

13    patients, seriously retarded patients, demented patients, and a typical

14    example of persons with significantly diminished accountability would be

15    a psychotic patient who commits a crime which does not fall within the

16    scope of his pathology.  For example, if we have a schizophrenic person

17    whose pathology consists in having feelings of being persecuted, of

18    someone trying to kill them, and that person has no money and wants to

19    order a drink and goes and steals money from another person, not the

20    person they imagine is trying to kill them, that would be a psychotic

21    person but the crime is such that is -- that the content of the crime is

22    not directly connected to the content of the psychosis, and the

23    consequences of this degree of accountability would be that the person is

24    not accountable and then the psychiatrist has to make a recommendation to

25    the Court as to what sort of treatment is recommended for that person.

Page 4359

 1    The person must be treated.

 2       Q.   Doctor I'd ask you, could you define for us what is meant by a

 3    life psychosis?

 4       A.   This is a very important term.  Life psychosis is an illness which

 5    starts at a certain point and is likely to last throughout the person's

 6    lifetime.  If it does not last throughout his lifetime because of

 7    treatment, then certain symptoms can still be seen.  Alcoholism would fall

 8    into this group, mental retardation also, because once a person has been

 9    diagnosed as mentally retarded, every psychiatrist throughout that

10    person's life will be able to confirm that diagnoses.  Schizophrenia,

11    bipolar disorder, dementia and a number of other psychiatric diagnoses

12    fall within this group.  This is very important because if we are

13    conducting a forensic examination of a person today and this refers to a

14    period of many years ago, we are able to deduce whether the illness

15    existed at the time or not.

16       Q.   Now, I'd ask you now to move to the fourth category of fully

17    incompetent or unaccountable for one's actions criminally.  What is the

18    criteria to assess or to determine that somebody falls into that

19    category?

20       A.   The fourth category is the simplest one for psychiatrists. It is

21    much easier to say that someone is suffering from a certain disease than

22    to prove that he has not suffered from it.  This means that a person is

23    unable to understand what a certain act means and in that case, these

24    persons are mostly acutely psychotic.  For example, acute schizophrenia,

25    delirium, patients with epilepsy who were having a seizure at the time,

Page 4360

 1    deeply demented patients and deeply agoraphobic patients.

 2            These persons are not responsible for the acts they are charged

 3    with under Yugoslav law, and they are never pronounced guilty.  The crime

 4    they are charged with is listed and they have to have mandatory treatment

 5    in psychiatric wards which have special security.  An amendment to the law

 6    says that the psychiatrist in charge has to send a report twice a year so

 7    that, in consultation with the court, the location and treatment of each

 8    individual case can be determined.

 9       Q.   And does that person remain in that facility until such time as

10    psychiatric experts determine that the person is in sufficient remission

11    that they may be released from that facility?

12       A.   Yes, yes.  And when such a person is released, the person still

13    has to go -- undergo treatment even when at liberty.

14            JUDGE HUNT:  Mr. Groome, I wonder if I could just ascertain where

15    one particular category, where one particular condition falls into which

16    of the first or second categories.  Have you finished with the

17    categories?

18            MR. GROOME:  I was going to move on to something else.

19            JUDGE HUNT:  This might be the best time to ask.  Doctor, what

20    about somebody who is intoxicated, who knows very well what they are

21    doing, the character of what they are doing, and they are able to control

22    themselves but by reason of the intoxication they do something which, had

23    they not been intoxicated, they would not have thought of doing?  In other

24    words, the bravado that the drunk sometimes has, into which of the first

25    or second categories would you say that that falls?

Page 4361

 1            THE WITNESS: [Interpretation] It is hard to say if I do not know

 2    what act the person is charged with and how foreign that act is to that

 3    person.  But that person would fall either into category one or two.

 4    These are the two categories that satisfy the criteria for alcoholism,

 5    both as a general diagnosis and in a specific case.  As a rule, we always

 6    produce an opinion for a particular crime.  Then we talk to the person, we

 7    see how far they are able to talk about it, what effects this has on them,

 8    and, of course, the person has to accept the fact that they committed this

 9    and they have to be able to talk about it.  So all I can say is that it

10    would fall either under category one or two.

11            JUDGE HUNT:  Well let us take a crime committed by somebody who

12    is, when sober, nonviolent, but when intoxicated is so inflamed by

13    the intoxication that he commits an act of violence, and let's make it

14    serious violence.  Into which category would that fall?  Are you able to

15    tell us that?

16            THE WITNESS: [Interpretation] If, for example, -- and I'm speaking

17    now in accordance with Yugoslav law, if someone does not expect to be

18    aggressive or maybe expects to be aggressive when drunk and then they get

19    drunk and they drive and they kill someone, they are held fully

20    accountable.  So the fact that they were drunk is not seen as a mitigating

21    circumstance.  However, if someone commits another sort of crime, I would

22    tend to place them in category two.

23            JUDGE HUNT:  Driving offences may arise simply because, by reason

24    of the intoxication, he didn't see somebody or thoughts he could make it

25    through the intersection in time.  I'm thinking of something more

Page 4362

 1    deliberately violent.  You'd say that would go into the second category?

 2            THE WITNESS: [Interpretation] Yes.

 3            JUDGE HUNT:  Thank you, Mr. Groome.  The distinction between the

 4    categories is not always easy to find and that's why I put that particular

 5    category.  Not necessarily because it results from anything happening in

 6    this case but it does explain it, at least to me, a little better.

 7            MR. GROOME:

 8       Q.   Doctor, maybe just to follow up on His Honour's question.  Can you

 9    give us an example or illustrate for us a person who was charged with

10    committing a very serious or very violent act, can you give us the level

11    of intoxication that you would have to find in that patient before that

12    person would be determined to be in the second category, diminished but

13    not significantly?

14       A.   The person would have to be drunk.  We have subcategories:  tipsy,

15    drunk and seriously intoxicated.  For someone to be drunk, the alcohol

16    level would have to be above 1.  In most cases, that person would be

17    placed in category two.  If I may add, these are not mathematically

18    precise tables so we cannot automatically place a person in one category

19    or another.  This is why expert opinion is made separately for each

20    person.  But alcoholism does not go beyond categories one and two.  So

21    this is the scope of the issue.

22       Q.   Would a person -- would you expect that a person who is

23    sufficiently intoxicated to be determined to be in category two, would you

24    expect that that intoxication would be readily apparent to witnesses to

25    the crime, witnesses that saw him at the time of the crime?

Page 4363

 1       A.   Yes.  Even lay persons would easily recognise someone who is

 2    drunk.  They might not recognise someone who is tipsy but they would

 3    easily recognise someone who is drunk.

 4       Q.   Thank you.  Now, Doctor, I'd like to ask you to -- can you please

 5    outline for us the primary psychiatric diagnoses and I'd ask you to begin

 6    with the old classifications used for psychiatric diagnoses.

 7       A.   Today there are several classification systems in psychiatry but I

 8    have listed here the traditional classification which is still used in

 9    forensic psychiatry today, and which has been retained because of the

10    interests of forensic psychiatry because it is very pragmatic.  This

11    classification is dichotomous and it places all disorders into one of two

12    categories; one of these is psychotic disorders and the other is

13    non-psychotic disorders.

14       Q.   Can you define for us the meaning of psychoses?

15       A.   To be psychotic means to be unable to test reality, not to have an

16    insight into what is happening around us, which means that the patient

17    cannot distinguish between his psychopathology, between his illness and

18    the reality tested by us who are healthy.

19       Q.   Now, I'd ask you to describe for us the current classification

20    system and I would ask you to begin with telling us what is endogenous

21    psychoses?

22       A.   Endogenous psychoses are psychoses for which we do not know the

23    epidemiological factor.  They are thought to be inherited.  However,

24    morphologically, there are no methods we can use to prove their existence.

25    This would include schizophrenia, paranoid psychosis, affective psychosis,

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Page 4365

 1    which are either unipolar or bipolar so that they can lead to manic or

 2    depressed states, and these illnesses are considered to be serious

 3    psychiatric illnesses and they are a paradigm of true psychiatric illness.

 4      They are so-called life disorders.

 5       Q.   Now, doctor is there another name for endogenous psychoses?

 6       A.   Functional, functional psychosis.

 7       Q.   And am I correct in understanding you that if a person has an

 8    endogenous --

 9            JUDGE HUNT:  Endogenous.

10            MR. GROOME:

11       Q.   Endogenous psychoses, that there is no readily apparent or

12    observable biological cause of that psychosis?

13       A.   We know that there is a biological disorder in the transmitters

14    but we cannot see it.  We recognise it through pharmacotherapy because we

15    know, for example, that schizophrenia is a disease that is due to the

16    increase in dopamine receptors but we cannot prove this because there

17    are no technical methods for us to see that someone has schizophrenia.  We

18    recognise it by its symptoms, and when we do recognise it, we administer

19    medicine that we have available and that we expect to help.  However,

20    magnetic resonance, for example, or a CT scan, will show nothing.  An

21    x-ray will show nothing.  We do not have any diagnostic aids to show us so

22    that we can say, "Ah-hah, this finding means that the person has

23    schizophrenia."

24       Q.   Doctor, could you briefly describe for us what schizophrenia is?

25       A.   Yes.  There are several categories.  The most frequent one is the

Page 4366

 1    paranoid hallucinatory type, where the person is not aware of reality.

 2    They have their own life.  They were drawn into themselves.  They lose

 3    their affective expression.  We say that their affects are flat.  When

 4    something is sad, the person will not be sad.  When something should cause

 5    happiness, the person will not be happy.  In other words, the person is

 6    autistic and the sequence of thoughts is disrupted.  It is disassociated,

 7    hard to follow.  This is very important because a schizophrenic patient

 8    has disassociated thoughts as opposed to organic psychosis, where thoughts

 9    are incoherent, and I'm saying this because the word "incoherent" is often

10    used.  However, this is the case with organic schizophrenia.

11            Then there are hallucinations, which are most frequently auditory

12    although they may also be visual.  The person, for example, if someone

13    enters a room here and there are 50 of us, if I were a schizophrenic, I

14    would think this person has entered the room because of me, in order to

15    hurt me, so that the person thinks that everything that happens in the

16    world is revolving around the person.  So they not only have ideas of

17    being persecuted, they also have ideas of being great.  I have patients

18    who think that they are the Empress Maria Teresa or people think they are

19    Napoleon.

20       Q.   And is schizophrenia a life psychosis?

21       A.   Yes.

22       Q.   And could schizophrenia in some cases be a basis for a finding

23    that a person is significantly diminished or incompetent under Yugoslav

24    law?

25       A.   A Schizophrenic person, in over 90 per cent of the cases, is

Page 4367

 1    totally incompetent, not accountable.  Only in cases of good or partial

 2    remission can we say that accountability is significantly reduced, but we

 3    never find that patient in the first or second category of accountability.

 4       Q.   Can you briefly describe for us what is paranoid psychosis?

 5       A.   Paranoid psychosis is prognostically better.  It does not destroy

 6    the personality to such an extent.  There is no emotional destruction of

 7    the person, but the person is intensively preoccupied in a mad way.  The

 8    person is always manic.  The person may be able to function well, for

 9    example, to do a manual job well.  But throughout this time, the person

10    believes that someone is following him or her, that someone is going to

11    harm him or her, and these persons are very prone to the commission of

12    crimes.  They retain their level of social activity longer and, as a rule,

13    they do not have hallucinations.

14       Q.   And Doctor, could somebody diagnosed with paranoid psychosis,

15    could that be the basis of a finding by a forensic psychiatrist of

16    significantly reduced accountability or incompetence?

17       A.   Yes.  These two categories are possible.  Most often, the person

18    is incompetent but if they, for example, steal something from someone,

19    that would mean that accountability was significantly reduced.

20       Q.   Doctor, you've described for us that affective psychosis really

21    has two sub categories:  One is manic psychosis and one is depressed

22    psychosis, and you also used the word bipolar and unipolar.  Can I take

23    from what you've said earlier that bipolar means that a person fluctuates

24    between both manic psychosis and depressed psychosis?

25       A.   Yes, yes, quite correct.

Page 4368

 1       Q.   And a person who is unipolar consistently just shows the symptoms

 2    of one of these two psychoses?

 3       A.   That's correct.  They also fluctuate but this is very rare, so

 4    bipolar is usually manic depressive.  Unipolar manias are very rare.

 5    Unipolar depressions are relatively frequent.

 6       Q.   Can you please describe for us the character or the primary

 7    characteristics of manic psychoses?

 8       A.   Manic psychosis is a situation in which a person appears to be

 9    infantile, very agitated in a psychomotor sense but very rarely are they

10    aggressive.  They are usually cheerful.  They have escapist ideas.  Each

11    one of us here would be able to recognise them.  If it's a woman, she

12    would be wearing a lot of jewellery, bows, she would be -- have heavy

13    makeup.  She would be wearing very loud colours such as purple, orange or

14    red.  The appearance of these people as soon as they enter a room shows

15    that they are not quite normal.  They will kiss everyone, give profuse

16    compliments which are often in bad taste.  They do not concentrate on

17    anything.  Their attention is very scattered.

18       Q.   And in certain instances, can manic psychosis be the basis for a

19    finding of significantly diminished responsibility or incompetence?

20       A.   Yes, for both categories.  However, in psychiatry, these people

21    are rarely sued because everyone sees that they are ill and what they do

22    is usually not very serious; it's either petty theft or prostitution,

23    soliciting.

24       Q.   Now, depressed psychosis, can you give us the basic

25    characteristics or definition of that psychosis?

Page 4369

 1       A.   In depressive psychosis, the main symptom is loss of vital and

 2    other instincts.  The persons seem deeply sad.  They are slow

 3    psychomotorically.  They do not have the capacity to do things.  They have

 4    no interests in anything.  They cannot enjoy things.  They do not enjoy

 5    doing things they enjoyed before.  They often sit very still, so that even

 6    a lay person can see that this is a person who is sad and who is ill.

 7    They may have an idea of guilt which is completely unfounded.  They

 8    complain or rather they say that they have committed a big sin and this is

 9    not true.  They are afraid that for this reason something will happen to

10    them.  They are often suicidal, and what is very important, lay people see

11    them more as physically ill than as psychologically ill.  Their activity

12    is reduced.

13       Q.   And is it true that a person who suffers from depressed psychoses

14    could be found in certain circumstances to fall into the last three

15    categories of accountability, accountable -- I'm sorry, diminished

16    accountability but not significant, diminished accountability,

17    significantly diminished accountability, and incompetence?  Is it true

18    that a person suffering from this psychosis could fall into those three

19    categories?

20       A.   Yes, yes, that's true.  Persons who are depressive very rarely

21    commit crimes.  In our experience in forensic psychiatry, we do not deal

22    with them very often because they are not active; they commit crimes very

23    rarely.  I had only one case in my life, and that was when a suicidal

24    mother jumped into the river Sava with her small child in her arms.  That

25    is the only patient of this type I have ever had in my forensic

Page 4370

 1    experience, and the mother was held not accountable at the time.

 2       Q.   So Doctor, what you are telling us is that somebody who suffers

 3    from depressed psychosis, it would be very rare for one of those people to

 4    commit a violent act against another human being; is that correct?

 5       A.   Yes.  If depressive persons are aggressive, then we say that they

 6    turn their aggression in on themselves, not against other people.

 7       Q.   Now, Doctor, I'd ask you to describe the next general category of

 8    psychosis, exogenous psychosis.  Can you please give us a definition what

 9    that is?

10       A.   Exogenous psychoses are psychoses where we can recognise and

11    establish an external cause which led to the psychosis, and the further

12    subclassification is based on the etiological factor that led to the

13    psychosis.  It is important to say that exogenous psychosis as a rule are

14    not a life disorder, they are a response to the etiological factor

15    causing them and they are divided into the following categories.

16       Q.   Before we go into those categories, there is one question I

17    neglected to ask you regarding the endogenous psychoses.  Would it be

18    correct that all of the endogenous psychoses are life psychoses?

19       A.   Yes.

20       Q.   So that as a forensic -- a competently trained forensic

21    psychiatrist should be able to recognise that somebody has one of those or

22    has suffered from that psychosis, even if it was 10 or 15 years prior to

23    the day of examination?

24       A.   Yes.

25       Q.   Please continue with exogenous psychoses.

Page 4371

 1       A.   Very important for us is the alcoholic psychosis because one of --

 2    this is one of the psychoses that both my colleague and I mentioned in our

 3    written reports and in our testimony.  This is a psychosis which is

 4    consistent with the organic psychosis in general, which means that the

 5    person does not test reality.  It is confused, can have hallucinations,

 6    and that alcohol is considered to be an etiological factor that led to

 7    it.  With such persons, accountability is not there.  That means that that

 8    person is usually incompetent or the accountability can be significantly

 9    reduced.  This type of psychosis is susceptible treatment.  It

10    starts usually in a very rough manner and it lasts up to six months.

11            In some rare cases, some patients can go from alcoholic psychosis

12    into real dementia, however, there is usually no dilemma posed here

13    because we know that that was induced by long-term drinking and this led

14    to psychosis which, in turn, led to dementia.

15       Q.   You said that a diagnosis of this could result in a person being

16    determined to be -- have significantly diminished responsibility or

17    incompetence.  I'd like to follow that up and ask you, is that true if the

18    person is suffering an acute phase of the psychosis at the time of the

19    crime or the time the crime is committed?  Is that correct?

20       A.   I apologise, I did not quite understand the meaning of your

21    question.  Did you want to know whether the person after a psychosis

22    enters the phase of incompetency?

23       Q.   Let me rephrase my question.  A person who has alcoholic

24    psychoses, you said that that person may be determined to be significantly

25    reduced or no accountability.  My question is, is that only true if the

Page 4372

 1    person is suffering from acute alcoholic psychoses at the time of the

 2    crime?

 3       A.   Yes.  Let me clarify this.  This psychosis is an acute stage, but

 4    if it should turn into dementia, then that person is incompetent

 5    again and this is something that can be easily proven in a psychiatric

 6    way.  Psychosis is a psychosis.  As soon as it ends, the person returns

 7    back to normal or reduced accountability.  Should the psychosis turn into

 8    dementia, then the person remains incompetent.  However, it is very

 9    easily clinically recognisable.  That kind of a person could not, for

10    example, deduct seven from 100.

11       Q.   Could you please move on to the next category of exogenous

12    psychoses, delirium?  Could you describe for us what that is?

13       A.   Delirium is a state that I will describe in more detail because I

14    believe, and this is something that I included in my report, that

15    Mr. Mitar Vasiljevic suffered delirium.  Delirium is a condition that can

16    emerge after a number of consequences.  It is usually induced by

17    alcoholism where a person reduces input of alcohol and that kind of

18    person can enter a state in which it has -- does not experience reality as

19    it is.  That person acts in a strange way, has hallucinations which are

20    usually very important; they are very vivid, they are very dynamic

21    hallucinations that confuse the patient who already has a disturbed

22    perception of reality.  And usually we describe this as a delirium state

23    of consciousness.  That person has no perception of reality.  That person

24    moves constantly, is very agitated, loses sleep or has disorders and sleep

25    rhythm, and that is a very dangerous medical condition.  It can be deadly

Page 4373

 1    if the person is not treated.  That person is dehydrated, usually develops

 2    other disorders.

 3            This delirium state is recognised easily even by laymen.  It can

 4    come about after either a cessation of drinking or can be induced by a

 5    severe medical illness, severe pain or surgery that an alcoholic

 6    undergoes.  These are usually the factors that lead to a state of

 7    delirium.

 8       Q.   Doctor, can I take from your answer that if there was a person

 9    present in the room with us now who was suffering from a state of

10    delirium, even the lay people among us, that would be apparent to us, as

11    well as to yourself, that the person is in a delirium state?

12       A.   Yes, most definitely.  This is one of the most easily recognised

13    conditions in -- among psychiatric disorders.

14       Q.   And according to Yugoslav law, under certain circumstances, could

15    a person in a delirious state be found to be significantly reduced or have

16     -- or be incompetent for the crime they were charged with?

17       A.   The fourth category is most frequent among such patients but even

18    a third one is possible.

19       Q.   Now, could you please describe for us or give us a definition of

20    reactive psychoses?

21       A.   Reactive psychosis is a psychotic condition with a non-typical

22    clinical picture and can be induced by some kind of intoxication.  It can

23    also be a consequence of another reason.  For example, a person can take a

24    medication, can confuse and take a wrong medication.  We usually see this

25    in suicide attempts, when people themselves select the medication they

Page 4374

 1    will take.  It is quite rare, and in forensic psychiatry, we don't see

 2    this very often so this reactive psychosis is quite rare.

 3       Q.   And in certain circumstances that could be the basis for a finding

 4    of diminished responsibility, correct?

 5       A.   No, no.  Here we have significantly reduced accountability or

 6    incompetency because this reactive psychosis has a level of psychosis.

 7       Q.   And finally, could you please describe for us what would be

 8    described as post traumatic psychoses?

 9       A.   I will say right away that this is a post psycho-traumatic

10    psychosis, although it is called post traumatic psychosis.  So let's not

11    confuse it.  This is psycho-traumatic.  This is a result of a physical

12    trauma to brain which can also be called wounding and leads to organic

13    changes in the brain tissue, and this is when we call this post traumatic

14    psychosis.  In this case, it does not apply at all.  It also leads either

15    to a significantly reduced accountability or incompetency.

16       Q.   And, Doctor, for those of us who may have heard of the concept of

17    post traumatic stress syndrome, that is something completely different

18    from post traumatic psychosis, correct?

19       A.   Yes, yes, that's right.  Post traumatic stress disorder is a

20    condition that has no visible organic reason.  It does not fall into the

21    category of psychosis.  In the beginning, if you remember, we said that it

22    usually leads either to category one or two accountability.  It does not

23    reach the level of psychosis.

24       Q.   I'd ask you to continue on now with your description of exogenous

25    mental illness.

Page 4375

 1       A.   Now, we have reached a group of psychotic conditions with a

 2    cognitive deficit, and here we have two group patients.  One is mental

 3    retardation.  Mentally retarded persons are those that have never in their

 4    life reached a such intellectual level.  This is not a case with our

 5    subject.  It is out of the question, cannot be applied here.  And the next

 6    category where we see cognitive deficit is a group we call dementia.

 7    Dementia are a deterioration of intellectual capacities which means that a

 8    person that has at one point reached its intellectual peak and then

 9    started deteriorating after that, can dement.  So this takes place

10    in a gradual way.  We have a strong, mild and minor dementia.  Our

11    subject also does not fall into this category.

12            And finally we have a fourth category.  These are dependencies.

13    They are quite widespread today in the entire world.  One of them is

14    alcoholism.  And it can be either something that goes with alcoholism as a

15    diagnosis, a chronic alcoholism, and within that we can also have an acute

16    state of inebriation.

17       Q.   Okay.  Now, can you describe for us what are the characteristics

18    of alcoholism without psychoses?  Can you describe that for us a bit more?

19       A.   Alcoholism which, as a rule, has no psychosis but we described

20    alcoholism with psychosis before.  Everything else can be described as an

21    urge to have alcohol.  A person in the beginning drinks less and then

22    develops dependency, and then once it becomes dependent, then we meet a

23    description that the subject used for himself.  When he started drinking,

24    he had a need to drink more.  In the beginning when he started drinking,

25    this need was not very strong, and as it grew, then he channelled all of

Page 4376

 1    his activities in the direction of obtaining more drinks.  In the

 2    beginning, he frequently got drunk, but alcoholism as a diagnostic

 3    category, as it progresses, the person loses all realistic criteria and

 4    can get inebriated more frequent.

 5            During that time, the person will develop his or her own state of

 6    habits and we call this -- we have a special name for this in psychiatry.

 7    That person does not change right away.  That person becomes more merry

 8    when in company, is usually popular but, however, with time, certain

 9    social norms become neglected.

10            Alcoholism can leave consequences in a number of organs, mostly

11    gastrointestinal system, liver.  Today we know for sure that there are

12    specific markers that can confirm chronic alcoholism.  So what I said

13    about schizophrenia, that we have no indicators for that illness, does not

14    apply here.  With alcoholism, we can find a number of indicators.  There

15    is an enzyme produced by liver that is usually increased.  There are very

16    frequent neurological changes that can be described as goose bumps, then

17    pain in lower extremities.  Those are usual symptoms we meet in

18    alcoholism.

19       Q.   Doctor, before we conclude your discussion of the different

20    classifications, there are some other classifications that we do not need

21    to go into because they are not relevant in this case, but there are some

22    other classifications of mental illness, correct?

23       A.   Yes.  That's true.  Here, under item 5, we listed miscellaneous

24    illnesses which fall into other categories but, however, they were not

25    brought up either by the colleague of mine that also did a report, nor

Page 4377

 1    has it been mentioned by your side so we did not detail -- we did not

 2    belabour that here in our report.

 3       Q.   But Doctor, before I ask you to describe for us the methodology

 4    that you followed in your examination and evaluation of Mr. Vasiljevic,

 5    can you please just give us the basic principles that a psychiatrist would

 6    use in the evaluation of a new patient, where the psychiatrist does not

 7    know any history or psychiatric history of the patient?

 8       A.   What we see here on this list is a school case example of how a

 9    psychological state is determined.  What we need to say is that we as

10    forensic psychiatrists are also serving as clinical psychiatrists because

11    the methodology that we use is a psychiatric one.  And it is also

12    something that we do in order to answer your question, which is to

13    describe accountability.  Psychiatry, just like other medical branches, is

14    a profession and a science which classifies the results of its work within

15    diagnosis.  We say also that diagnosis is a base for determining

16    accountability.  And in our daily clinical work, diagnosis is something

17    that we use in order to determine therapy.  So this is why we could say

18    that the objective of our expertise is to establish a diagnosis which,

19    afterwards, would follow by determination of therapy, prognosis,

20    determination of accountability and so on.

21            Other things you might inquire about is ability to stand trial,

22    recommendation that we could give to the patient, and so on.  I as a

23    forensic psychiatrist can also, upon finding that the patient has another

24    illness, will say that the patient needs to be treated for another

25    illness.  So this is how we would reach the diagnosis.  First of all, we

Page 4378

 1    need to determine anamnesis or the history, medical history.  This is what

 2    in psychiatry is established based on the interview with the patient and

 3    acquiring of various information, family information, any family

 4    illnesses, pregnancy, labour, whether it was complicated or not, early

 5    childhood, whether the patient was social, friendly, and so on, all the

 6    way up until today.  So we go through the whole life of the patient,

 7    regardless of whether something that we are called to establish took place

 8    yesterday or ten years ago.

 9            Why is it so?  Because we have excluding and including methods.

10    Inclusive methods are those that lead us to find symptoms that would

11    confirm the diagnosis, but if we find symptoms of something else, then we

12    would excludes this diagnosis and continue on with our work.

13       Q.   Doctor, can I take from your answer that the term "anamnesis"

14    refers to the personal history that a psychiatrist would take from the

15    person who they are evaluating?  Is that correct?

16       A.   That's right, that's right.

17       Q.   And would the psychiatrist believe or assume that every fact given

18    by the patient is true and accurate or would they attempt to determine

19    with other evidence whether or not the patient has given true and accurate

20    information?

21       A.   Yes.  This is a heteroanamnesis.  When we as forensic

22    psychiatrists work with patients, then what we usually see is that the

23    patients tell the whole truth because they come to see the doctor in order

24    for the doctor to help them.  So when we train our students and

25    psychiatrists in forensic psychiatry, then the most difficult part is to

Page 4379

 1    teach them how to discern what information is a truthful one.  That is

 2    actually a skill.

 3       Q.   Now, Doctor, can you tell us what the term heteroanamnesis means?

 4       A.   Well, this is how we reach the next degree, which is a

 5    heteroanamnesis, and that is a verification of information which patient

 6    gave us from somebody else, or perhaps this is something that the patient

 7    himself did not remember and we obtained from another person.  Most often

 8    that other person is a spouse, parents, children of the patient,

 9    colleagues from work, friends, classmates, et cetera.  So somebody who

10    knows the patient well is a very good person for providing

11    heteroanamnestic information.  This kind of information can be usually

12    very important when we have an acutely psychotic person that can give no

13    information on him or herself.

14       Q.   In addition to anamnesis and heteroanamnesis, what else would you

15    customarily evaluate or look at when evaluating a patient?

16       A.   Whether we evaluate the patient, then every medical documentation

17    is of great importance to us if it can tell us what is the medical

18    history of the patient.  It is also important with respect to mental

19    illnesses and physical ones.  What we in psychiatry consider to be most

20    important is listed under item 4, which is the patient's status.  This

21    status includes both physical and psychological one.  Physical status,

22    something that we in psychiatry consider to be sine qua non, where we base

23    on the facial expressions psychomotoric of the patient his line of

24    thoughts, his emotional state, his total cognitive intellectual mnestic

25    functions, together with anamnestic information, will lead to us determine

Page 4380

 1    diagnosis.  Psychological status in psychiatry is considered to be a base

 2    for establishing diagnosis.

 3       Q.   Doctor, can you please first spell the word mnestic and ask you

 4    describe what that means?  You used the word "mnestic" and can you

 5    describe what that means?  You used the word "mnestic" function.

 6       A.   In psychiatry, we divide or we say that everything that is a

 7    product of our brain is a cognitive side and those cognitive functions can

 8    be divided into intellectual and mnestic ones.  Mnestic ones refer to the

 9    ability to remember and retain information that we remember.  So that is

10    actually ability to intake new facts and retain them.  It is very

11    important with patients that suffer from dementia.

12       Q.   I ask you to spell that word in English so the reporters can

13    correctly record it in the transcript.

14       A.   Mnestic.

15            JUDGE HUNT:  I think that might be in B/C/S.  Have we got it

16    anywhere in this document or in the doctor's report?

17            MR. GROOME:  It's in the report, Your Honour, so...

18            JUDGE HUNT:  Perhaps so that the court reporters can get it right

19    from the wording, can you look it up?

20            MR. GROOME:  Yes, Your Honour.

21            THE WITNESS:  Maybe I can show it.  Yes, this one.

22            MR. GROOME:

23       Q.   M-n-e-s-t-i-k?

24       A.   Yes.

25       Q.   Thank you, Doctor.  Now, Doctor, what role do psychological tests

Page 4381

 1    play in the evaluation of a patient?

 2       A.   Psychological testing is a routine method, in psychiatric

 3    evaluation.  However, it is not also mandatory testing for all categories.

 4      Psychological testing would help in order to describe the personality of

 5    the subject.  Psychological methods are something that can be used to

 6    assess the level of aggression easier.  Psychological testing can also

 7    help us establish which facts were not truthful.  However, when evaluating

 8    a subject, psychological testing used -- psychological testing is

 9    something that is not entirely precise, that can tell us what is more

10    likely.

11            This testing can tell you that it is very likely that this person

12    has this personality or that personality but this testing cannot determine

13    with certainty what the personality exactly is.  What is very important is

14    the following:  Had I found that the subject or had I doubts that the

15    subject suffered mental retardation or dementia that could lead to a

16    change in his accountability, then I would call you up and say, "I'm

17    sorry, I cannot reach a conclusion without psychological testing."  So in

18    order to evaluate cognitive deterioration, we need a psychologist.  I

19    don't need a psychologist once I see that cognitive functions are okay.

20            For example, in my interview with my subject, we started off with

21    some basic questions, where are we, what the date is and so on, and then I

22    said, "Can you please tell me what 100 minus 7 is," and then I can measure

23    the speed, et cetera, of his answer.  Then he told me 93.  And then we

24    continued until I was sure that his cognitive functions were all right.

25    The subject also defined certain specific concepts and certain abstract

Page 4382












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Page 4383

 1    concepts to me.  So psychiatry has a sufficient area of methods in order

 2    to establish whether the person has a disorder or not.  However, if the

 3    person has a disorder, then we need psychological testing in order to

 4    establish what level of disorder there is.  So this is all I can tell you

 5    about psychological testing.

 6       Q.   Are you testifying or telling us that, based upon your initial

 7    interview with Mr. Vasiljevic, that you determined that additional

 8    psychological testing would not be necessary for you to answer the

 9    question that was put to you regarding Mr. Vasiljevic?

10       A.   I would say that I -- it wasn't necessary to me.  I didn't find

11    anything that I could not have solved without psychological testing.

12       Q.   Can you describe for us the role that routine laboratory tests

13    would play in the evaluation of a patient?

14       A.   Yes.  If we have a demented patient, then it is very important to

15    look for the level of B 12 vitamin to see whether there is an

16    insufficiency of it.  If I were to establish that the subject was

17    demented, then I would need a CT scan.  So we never use routinely magnetic

18    resonance but only when we have a clinical picture that would require

19    this.  It is important to run a routine lab test because we need always to

20    determine whether this medication is appropriate or not.

21            What is important with this subject is that his GT levels, gamma

22    GT levels were increased, and this was a further confirmation of my

23    clinical conclusion that he was a chronic alcoholic.  So we do run a

24    routine lab test, and then based on clinical picture and symptoms, we

25    determine the other factors that we need to know.

Page 4384

 1       Q.   Now, I want to ask you to tell us with specificity the different

 2    diagnostic steps that you took in your examination of Mr. Vasiljevic.  I

 3    would ask you at this stage just please to list them and perhaps, after

 4    the break, we will begin to go into each of the different steps that you

 5    took.  Okay?  So please just list the different steps that you took.

 6       A.   I here listed my work method in seven items.  First of all, I used

 7    information I gained from the documents provided to me by you, by the

 8    Tribunal.  I read it in detail and I attempted to gain as much as I could

 9    from them.  The second step was a part of psychiatric evaluation which is

10    a detailed anamnesis and it was a pleasure to work with this subject in

11    that area because he was a very cooperative subject.  I then proceeded to

12    determine his present status.  His physical status was not of great

13    importance because it had no great impact on his psychological status.  I

14    also researched the existing documentation of this subject from the

15    detention unit in Scheveningen, which means that I had the results of lab

16    tests and also information on his therapy from the day he arrived in

17    Scheveningen to the day we held an interview.  And finally, I also looked

18    into the opinion by Dr. Lopicic, who is a psychiatrist and who was the

19    first one to provide her expert opinion.

20       Q.   And I would ask you just before we break, can you describe for us

21    what you have as number 7, the most important aspect of the diagnosis or

22    determining a diagnosis of Mr. Vasiljevic?

23       A.   The most important, in fact, is that we, in addition to anamnestic

24    information, recognise and assess symptoms or indicators in the subject

25    that are key elements in order to determine diagnosis.  I can claim with

Page 4385

 1    certainty that what I have seen in this subject and what are used in

 2    order to determine diagnosis, was based primarily on the documentation

 3    provided to me by the Tribunal but also on the methods of the clinical

 4    psychiatrist who has an experience of including and including certain

 5    information and relevant knowledge, which means that this is what we

 6    have.  We saw the patient, we provide a diagnosis, and in order to

 7    diagnose the patient retroactively, I used documentation and also

 8    indicators of life-long diagnosis, which is something that helped me when

 9    using the methods of exclusion.

10            MR. GROOME:  Thank you, doctor.

11            JUDGE HUNT:  We will adjourn now until 11.30.

12                          --- Recess taken at 11.01 a.m.

13                          --- On resuming at 11.30 a.m.

14            JUDGE HUNT:  Mr. Groome?

15            MR. GROOME:  Thank you, Your Honour.

16       Q.   Doctor, I'd like to ask you to explain a little bit further -- in

17    a little bit greater detail something you said just before the break.  You

18    used the term indicators of life-long diagnoses.  Would I be correct in

19    saying that indicators would include both symptoms and signs?

20       A.   Yes.

21       Q.   Could you please describe for us what are symptoms?

22       A.   Symptoms are clinical signs which the patient experiences

23    subjectively and which must be recognised by a trained expert.  For

24    example, if someone has hallucinations, we shall see that his attention is

25    removed from the subject we are discussing and that the patient is

Page 4386

 1    actually hallucinating.  If I put a question to the patient, for example,

 2    and I see that the patient does not understand me, I will repeat my

 3    question and see whether his attention is disturbed or whether his whole

 4    system of understanding is disrupted.  These are symptoms which are very

 5    significant for the establishing of a psychiatric diagnosis.  If a patient

 6    is talking to me, I tell him to stick to a certain subject but he leaps

 7    from topic to topic, for me this is a significant symptom for the

 8    recognition of his mental illness.

 9            Signs, on the other hand, are for example whether someone has

10    tremour or whether his hands are trembling.  That would be a sign because

11    both lay person and a professional will notice it, but a professional will

12    notice whether only the fingers are trembling, whether the hand is

13    trembling only when the patient is still or when he reaches out to take a

14    cup of coffee.  A professional will distinguish several categories in this

15    trembling, each of which is specific to a particular diagnosis.  A symptom

16    is subjective, a sign is objective.

17       Q.   Now, in the treatment of a person with a diagnosed mental illness,

18    would it be important for the psychiatrist treating that person to record

19    somewhere the symptoms that they learned from the patient?

20       A.   Yes.  It's our duty to do so.  We have to document the reason why

21    we are prescribing a certain medicine.  In medicine, if something has not

22    been written down, it has not been done.

23       Q.   Now --

24       A.   This means excuse me, this means that if someone is delirious, I

25    give him Meprobamate but I did not write it down, tomorrow I will be held

Page 4387

 1    responsible if that patient dies as if I had not administered the drug at

 2    all.

 3       Q.   Doctor, I'd ask you just to say the name of the drug again and

 4    spell it for the people transcribing what you're saying?

 5       A.

 6       Q.   That's spelled M-e-p-r-o-b-a-m-a-t; is that correct?

 7       A.   Sorry, the third from the end is an "M".

 8       Q.   Thank you, doctor.  Now, Doctor, in trying to evaluate what the

 9    psychic condition of a person was at a time previously, and that -- I'm

10    sorry, the task is to determine what a person's psychic history was at

11    a previous period in time and in your anamnesis the patient describes for

12    you having certain symptoms, such as certain hallucinations or certain

13    different disturbances of thinking, would it be important to determine

14    whether or not at the time they were treated for that illness, whether or

15    not the treating psychiatrist recorded those symptoms?

16       A.   You see, in forensic psychiatry, this is very important, because

17    if someone was psychotic, in the former Yugoslavia, these persons were

18    always hospitalised, and if I want to establish with certainty that this

19    happened, I have to ask why he was not hospitalised, because psychoses

20    were always treated in hospital.

21       Q.   Okay.  But one of the diagnostic tasks that you describe for us

22    was to examine the history as provided by the patient against other

23    independent information to determine whether it's true and accurate,

24    correct?

25       A.   Yes.

Page 4388

 1       Q.   So part of that process would be to ascertain if symptoms

 2    reported by the patient were observed by other people back at the time

 3    they were treated for that illness, correct?

 4       A.   Correct.

 5       Q.   Now, Doctor, you've described the method that you used in

 6    examining Mr. Vasiljevic.  Did you examine Mr. Vasiljevic and did you

 7    write a report regarding his condition?

 8       A.   Yes, I did.

 9            MR. GROOME:  Your Honour, at this time the Prosecution would like

10    to tender three documents:  Prosecution document 168, which is the

11    Serbo-Croatian version, the original version, of the doctor's report;

12    document 168.1, which is the English translation of that report; and

13    document 173, an English version of the Doctor's CV provided by the Doctor

14    herself.

15            JUDGE HUNT:  Any objection, Mr. Domazet?

16            MR. DOMAZET:  No, Your Honour.

17            JUDGE HUNT:  You've got the B/C/S version of the CV?

18            MR. DOMAZET:  Yes, Your Honour.

19            JUDGE HUNT:  Thank you.  Should that be in evidence, the B/C/S

20    version?

21            MR. GROOME:  It's available here, Your Honour, and we can

22    certainly introduce it.  The English version, Your Honour, was not a

23    translation but one provided by the doctor.  That's why I wasn't entirely

24    sure we needed to put in both.

25            JUDGE HUNT:  All right.  Well, at this stage we will only put the

Page 4389

 1    English one in.  Exhibit 168 will be the B/C/S version of the doctor's

 2    report.  What was the date of the report?

 3            MR. GROOME:  Just a minute, Your Honour, the date of the report is

 4    the 17th of December, 2001.

 5            JUDGE HUNT:  Thank you.  Exhibit 168.1 -- sorry, P168.1 will be

 6    the English translation of that report.  Exhibit P173 will be the English

 7    translation of the witness's curriculum vitae.  Thank you.

 8            MR. GROOME:

 9       Q.   Now, Doctor, I'd like at this point in time to return to the

10    different types of mental illness or psychoses that you've described for

11    us and could you -- if you would name them for us and then describe for us

12    your findings after your evaluation of Mr. Vasiljevic.   And I would ask

13    you to begin with the endogenous or functional psychoses.

14       A.   As you can see here, we use the same order as was the order in the

15    classification.  We will begin with endogenous or functional psychosis.

16    The first of these is schizophrenia.  Based on a detailed examination, a

17    discussion of previous symptoms, an inspection of all previous medical

18    documents for three hospitalisations and an inspection of the therapy

19    administered in Scheveningen, I found no indication that Mr. Vasiljevic

20    ever suffered from schizophrenia.

21       Q.   Now, Doctor, you examined the medical records of Mr. Vasiljevic in

22    the detention centre, is that not correct?

23       A.   Yes.

24       Q.   And there is a psychiatrist assigned to the patients at the

25    detention centre; is that correct?

Page 4390

 1       A.   Yes.  Dr. Vera Popovic, whom I know personally.  She is a

 2    consulting psychiatrist in Scheveningen.

 3       Q.   And is she is psychiatrist in good standing in the Republic of

 4    Yugoslavia?

 5       A.   She is a very good psychiatrist in the former Yugoslavia.

 6       Q.   After examining the medical records from the detention centre,

 7    were you able to determine whether or not Mr. Vasiljevic is currently

 8    receiving any medication for schizophrenia?

 9       A.   Yes, I was able to do this, and to ascertain that Mr. Vasiljevic

10    is not receiving any antipsychotic therapy, either for schizophrenia or

11    paranoid psychosis or affective psychosis.  Mr. Mitar Vasiljevic now and

12    several months before my examination, has not been receiving any drugs

13    used to treat any mental illness or disorder.  A special group of drugs

14    are used for psychosis, antipsychotics.  Throughout the time of his stay

15    in Scheveningen, Mr. Mitar Vasiljevic never received antipsychotics.

16       Q.   I believe you told us before that schizophrenia is a life

17    psychosis.  Can we take from that that if Mr. Vasiljevic suffered from

18    schizophrenia in 1992, that at present, he should be receiving some

19    medication for that condition even today?

20       A.   Yes.  He should be receiving medication but I can say, with

21    certainty, that nowhere in any of the documents or in my conversation

22    with him or in his psychic status, nowhere have I found anything to

23    indicate that Mr. Vasiljevic may be suffering from schizophrenia.  And

24    this includes the fact that he is not receiving any therapy.

25       Q.   And if by some mistake, he was not receiving the appropriate

Page 4391

 1    drugs, would you expect to see some symptoms of schizophrenia in

 2    Mr. Vasiljevic today?

 3       A.   Yes.  Because he has been in detention for two years now, the

 4    period is too long for schizophrenic patient to remain in remission

 5    without therapy.

 6       Q.   Doctor, in your practice and your experience, have you ever come

 7    across exceptions to this principal that you are now describing for

 8    us, that in life psychosis we must always see either therapy, medication

 9    for the disease, or illness, or symptoms of the illness?  Have you ever

10    seen an exception to that principle?

11       A.   Never both.  I have never seen anyone who had schizophrenia who

12    lived for ten years without either symptoms or signs or therapy.

13       Q.   I'd ask you now, the next category of psychoses, paranoid

14    psychoses, and what were you able to determine regarding whether Mr.

15    Vasiljevic did or did not have paranoid psychoses back in 1992?

16       A.   As in the case of schizophrenia, I can assert that no description

17    of an event, no anamnestic datum, no symptom or sign or therapy, have

18    awakened a suspicion in me that Mr. Vasiljevic may be suffering from

19    paranoid psychosis.  During his two years of detention in Scheveningen, he

20    never received any drugs which are used to treat paranoid psychosis.

21       Q.   I'd ask you now to answer the same question regarding affective

22    psychoses.

23       A.   My answer is identical in the case of affective psychosis, all

24    the more so as the frequency of changes in the disorder is even greater

25    than is the case with schizophrenic and paranoid episodes.  That is why in

Page 4392

 1    modern psychiatry, apart from drugs to treat affective psychosis,

 2    so-called stabilisers of moods are also used, the function of which

 3    is not only to treat symptoms but also to protect the patient or rather to

 4    prevent the symptoms from reappearing.  I might say that it is almost the

 5    duty of the psychiatrist looking after the patient to continuously

 6    administer stabilisers of moods to a person who is suffering from

 7    affective psychosis.

 8       Q.   Doctor, before we move to exogenous psychoses, I want to ask you

 9    the same question regarding paranoid psychosis and affective psychosis

10    that I asked you about schizophrenia:  In your practice and experience,

11    have you ever come across an exception to the principle that you've

12    described here?

13       A.   No.

14       Q.   Now, Doctor, I'd ask you to move to your evaluation of

15    Mr. Vasiljevic regarding the exogenous or symptomatic psychoses.

16       A.   When talking of exogenous psychosis, we are entering into an area

17    which is relevant in the case of Mr. Vasiljevic.  On the basis of my

18    conversation, my interview with him and the anamnestic data and the

19    symptoms and signs, I endeavoured to establish a diagnosis for the period

20    that he spent in hospital several days after he broke his leg.  We now

21    arrive at the fact that my primary diagnosis is delirium.  I based this

22    diagnosis mainly on the medical documentation and only then on what I was

23    able to obtain from the gentleman.  Then and today, I feel that in the

24    days after he broke his leg, he was suffering from delirium.

25       Q.   Doctor, I think perhaps the best way for us to proceed, if we can

Page 4393

 1    go through the different illnesses and let's identify those illnesses

 2    which you found or determined that he did not have and then we will spend

 3    a significant amount of time on your diagnosis regarding the illnesses

 4    that you found he may have had, okay?

 5       A.   Okay.

 6       Q.   Alcoholic psychosis, can you just summarise in a sentence or two

 7    your findings regarding that?

 8       A.   I cannot say with certainty that he was not suffering from

 9    alcoholic psychosis, because some of the symptoms listed are specific to

10    alcoholic psychosis but they are not sufficient for me to establish a

11    diagnosis with certainty.  Alcoholic psychosis is one of the

12    possibilities, so he may have been suffering from it at the time.

13       Q.   Delirium, I believe, you've given us a brief summary of your

14    findings there.  I'd ask you to move to reactive psychosis.

15       A.   I did not find any symptoms or signs which would indicate that the

16    gentleman was suffering from reactive psychosis.

17       Q.   Can you tell us about post traumatic psychosis?

18       A.   We can exclude this with the greatest certainty because the

19    gentleman did not suffer from any trauma to the brain.  This was not in

20    his anamnesis and he had no symptoms or signs that he was suffering from

21    this psychosis.

22       Q.   Can you please tell us what your findings are regarding any

23    disorders related to cognitive deficits?

24       A.   The subject is now older than he was at the time of the commission

25    of the crimes he is charged with.  So that if he now has no signs of

Page 4394

 1    cognitive deficit, it is quite logical to conclude that he did not have

 2    them at the time.  I do not mean to say that his cognitive capacity is now

 3    the same as it was when he was 20 years old, but in psychiatric terms, his

 4    cognitive capacity corresponds to his age and his education.

 5            JUDGE HUNT:  Mr. Groome, I wonder whether cognitive capacity is

 6    meant to be some sort of a permanent state or whether it can be

 7    affected, for example, by alcohol.  I'm sorry to keep coming back to that

 8    but it seems to me we have got to have it made very clear to us,

 9    especially as we are dealing with what the law is in somewhere that we are

10    not familiar with.

11            MR. GROOME:

12       Q.   Doctor, can you please describe for us the relationship between

13    cognitive ability and alcoholism and intoxication?

14       A.   When we speak of cognitive capacity, this is something that is

15    a permanent characteristic of our capacity.  We cannot say that cognitive

16    capacity is reduced by intoxication but we can say that a person who has

17    taken alcohol has reduced attention, which is one of the elements of the

18    cognitive functions.  This means that a person under the influence of

19    alcohol does not have full attention capacity.  Cognitive capacity would

20    then seem to be deficient but not because of an a priori capacity but

21    because attention is diminished and the ability of the subject to test and

22    to carry out his tests is reduced.  So the basic capacity remains the same

23    and is unchanged but the results of evaluation under the influence of

24    alcohol may be altered because the attention is altered.

25       Q.   And putting actual intoxication aside for a minute, can you

Page 4395

 1    describe for us the interaction between alcoholism and cognitive ability?

 2       A.   When alcohol is consumed over a long period of time, that is in

 3    chronic alcoholism, cognitive functions may deteriorate and this is

 4    something that I bore in mind during my examination, and for this reason,

 5    I put certain questions to the subject, questions which we put in cases

 6    of a possible deterioration.  This is, first of all, the mini mental test

 7    where the gentleman has to reply to questions such as what is love, what

 8    is happiness.   He has to define concrete terms.  I examined the basic

 9    mathematical processes.  The gentleman even drew a pentagram.  We have

10    criteria by which we can evaluate whether his cognitive capacity has

11    deteriorated or not, and the gentleman passed all these tests

12    successfully.

13       Q.   And did you see anything when you conducted these mini cognitive

14    tests to indicate that perhaps additional psychometric testing was needed?

15       A.   No, I did not.  If I had found this, if I had been unable to reach

16    a conclusion, I would have told the Court.  I would have asked for this to

17    be done before I signed my expert opinion.

18       Q.   Doctor, let me take you back to the original two questions you

19    said were the key questions to be answered by a forensic psychiatrist.

20    Assuming that a person had sufficient cognitive ability to understand the

21    consequences of his actions and to control his behaviour, how would the

22    level of intoxication affect the answer to those two questions?

23       A.   Intoxication as such can influence the second part, control of

24    one's actions, and that is why an acutely intoxicated person is classified

25    under category two, that is, diminished responsibility.

Page 4396

 1       Q.   So an acutely intoxicated person would always maintain the

 2    capacity to understand the consequences of their action; is that correct?

 3       A.   Yes, that is correct.  There is a diminishing.  That is why that

 4    person can be placed in category two.

 5       Q.   And that's diminished but not significantly, correct?

 6       A.   Yes.

 7       Q.   Now, Doctor, I'd ask you to return to what, if any, findings you

 8    made regarding Mr. Vasiljevic in the area of dependencies.

 9       A.   You mean alcoholism?

10       Q.   Yes.  Would you please discuss that?

11       A.   According to all the criteria, Mr. Mitar Vasiljevic satisfies the

12    criteria for the diagnosis of chronic alcoholism.  One of the tests that

13    confirmed this is the test that the doctor who did the expert opinion

14    before mine did.  Then everything that the gentleman himself told me, and

15    I have described this in my report, this is fully consistent with a

16    diagnosis of alcoholism.  And this is -- this also includes the increased

17    gamma GT values which I found in his medical records in Scheveningen.  So

18    I have no doubts and I can say with certainty that Mr. Mitar Vasiljevic

19    meets all the criteria to be diagnosed as a chronic alcoholic, and this

20    can be seen from his medical records both from his first and his second

21    hospitalisation.  I have no doubts about this.

22       Q.   Doctor, we have now gone through all of the categories of mental

23    illness that we've discussed earlier and am I correct in saying that the

24    only two mental illnesses which you conceive a possibility that

25    Mr. Vasiljevic suffered from at a prior time in his life are delirium and

Page 4397

 1    alcoholic psychosis?

 2       A.   Yes.  I do not have any dilemmas as to whether he suffered from

 3    them.  I only have doubts as to whether which one of the two he suffered

 4    from.

 5       Q.   Doctor, I'd ask you now to move to the next sheet and let's talk

 6    in greater detail about both of these diagnoses.  In your opinion, which

 7    is the most probable of the two?

 8       A.   Based on my opinion, the most probable diagnosis is delirium.

 9    Delirium in the classification is described as a state where a person is

10    completely disturbed and meets the requirements and symptoms needed for

11    delirium.  In modern classification, there are two types of delirium,

12    among others, and those two types are delirium caused by alcohol

13    deprivation, which I think to be the most likely case here.  The subject

14    went -- underwent surgical operation.  And the other kind of delirium is

15    induced in alcoholics when they have some kind of a somatic illness.  So

16    Mr. Vasiljevic was an alcoholic.  At one point he came to a hospital due

17    to a fracture of two bones on his leg, and he was fixated because of that.

18    He wasn't able to acquire any more quantities of alcohol.  He himself has

19    told us that he was able to obtain some small quantities of alcohol in

20    the beginning but that wasn't possible later on.  So that means that he

21    first reduced the quantity of alcohol and then he completely ceased taking

22    alcohol.  So he also underwent a very complicated surgery, he experienced

23    severe pain, and also had alcohol deprivation.  Symptoms appeared all of a

24    sudden.  He came to the hospital and no signs of any mental illness were

25    observed.  And then an orthopaedist who was in charge of him recognised

Page 4398

 1    him as a pre-delirious patient and also said that he was agitated and

 2    confused and had incoherent ductus, which is something that I have said

 3    before today that is specific for this type of psychosis, and he was -- he

 4    received a therapy which is not entirely consistent with a delirious state

 5    but in consultation with another doctor, I received a very satisfying

 6    explanation, which is that in that period of time, they had a great

 7    shortage of medication, so they treated patients with whatever they had

 8    and not with optional medication.  So based on that, I believe that Mr.

 9    Vasiljevic entered a delirious state in which, based on the requirement of

10    an orthopaedist, he was transferred to the psychiatric ward.

11       Q.   Doctor, I want to go step by step of different aspects of the

12    conclusions that you drew.  First question I want to ask you:  Are the

13    observable symptoms of delirium, are they the same or similar whether it's

14    caused by alcohol or caused by -- you describe the physical injury and

15    subsequent treatment.  Are the symptoms the same or similar?

16       A.   Clinical picture is identical.

17       Q.   Can we just confine ourselves now, can you give us a detailed

18    description of those symptoms?  What would a psychiatrist be able to

19    observe in the patient and, for any of those symptoms which would be

20    observable to a lay person, would you please also describe those?

21       A.   Both a psychiatrist and a layman would very soon be able to

22    recognise a clinical picture of a disturbance, of a very strong

23    psychomotor restlessness.  The person was sweating profusely, asking for

24    things from people.  The person was confused.  And what is very important

25    is that the person almost always has visible hallucinations.  This person

Page 4399

 1    gives a manifestation of those hallucinations, shows reactions, wonders,

 2    tries to communicate.  So this person is out of touch with reality.

 3            What is most important is that this person not only has

 4    hallucinations but is also susceptible to suggestions which means the

 5    person has illusions.  A person in delirious state, you can give this

 6    person, for example, a white piece of paper and ask him what can he see?

 7    And then he will probably not answer, and then if you asked him well,

 8    isn't your name written on this paper, then the person will most likely

 9    confirm this.  So this person can be easily influenced and is susceptible

10    to suggestions.  And this is what we usually look for in cases where a

11    will is disputed.  We are looking for this.

12            Persons in delirious states usually have tremour, which is

13    trembling of fingers.  So this is one of signs of delirium.

14            A person does not test reality and cannot control his or her

15    actions.

16       Q.   Before I move away from the symptoms, have you told us all of the

17    common symptoms of delirium?  Are there any other ones you wish to add?

18       A.   Something that can be of importance is the duration of these

19    symptoms.  Delirium comes on suddenly and quickly, and a patient, if

20    appropriately treated, will fall asleep and, upon being awakened, the

21    patient will lose these productive symptoms or these hallucinations or

22    illusions.  The person will look tired and exhausted.

23       Q.   Now, in the medical records that you looked at regarding

24    Mr. Vasiljevic, a physician describes him on the 8th of July or sometime

25    in July, I believe it's the 8th, as having pre-delirium state.  Are there

Page 4400












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Page 4401

 1    symptoms which are recognisable just prior to the onset of full delirium?

 2    I'm sorry, the date was the 5th of July.

 3       A.   You see this is a state described by my colleague, and is easily

 4    recognisable.  Not all of the symptoms have been met for delirium but some

 5    that were important to him were met.  He unfortunately did not list all

 6    the symptoms, but when he wrote pre-delirium signs, I recognised that to

 7    be agitation, disorientation, confusion and tremour, because tremour is a

 8    sign.  So if my colleague put in a sign, then that means that he had in

 9    mind tremour, although unfortunately he did not specify so.

10       Q.   Also in the record is the term "incoherent ductus".  Can you

11    please describe for us what that means?

12       A.   Incoherent ductus is something that points more to delirium than

13    to psychosis because we in the traditional psychopathology, when we meet

14    a patient with a disturbed line of thoughts, then we have something

15    that is specific for endogenous psychosis which is an unspecified --

16    dissociated ductus, and the other one is typical for dementia and for

17    delirium.

18            Let me give you an example.  Both of them are confused but in a

19    disassociated ductus, a person will drift away from a topic, get another

20    topic which means get a new association, which will turn in lead to

21    another association, so the person will get more and more distant from the

22    original topic.  When we have an incoherent ductus, the person will jump

23    from topic to topic but will remain within the bounds and eventually go

24    back to the primary association.

25            The textbooks describe incoherent ductus as a broken mirror that

Page 4402

 1    remains within the frame and its pieces are not shattered but have

 2    remained within the frame.  And this is one of the skills taught in

 3    psychiatry so that we can recognise this easier and quicker than somebody

 4    who is not a specialist. So incoherent ductus is significant for organic,

 5    short term and provisional disorder, and the other one is a life-long

 6    diagnosis.  Disassociated ductus is a lifetime diagnosis and this is

 7    something that we use very widely to determine our opinions.

 8       Q.   Can you explain for us why is it that incoherent ductus is more

 9    indicative of delirium than alcoholic psychosis?

10       A.   Because delirium is a more intense state, and a consequence of

11    changes unfamiliar to us but nevertheless intense organic changes in the

12    body, whereas psychosis is somewhat less intense and mostly has manic

13    contents than contents that have to do with attention and brevity.

14       Q.   Now, Doctor, I'd ask you to explain in greater detail what you

15    found to be the causes of this delirium in the accused, Mr. Vasiljevic.

16       A.   I would agree that both important reasons led to delirium.  On one

17    hand, we had alcohol deprivation, and the other one was the pain caused by

18    a fracture and ensuing surgery, and pain associated with that.  Both

19    criteria were present and both are fully sufficient to induce a delirium.

20    And since both of those factors were present, then it is acceptable to me

21    that both of them participated in determining a clinical picture that was

22    presented to us.

23       Q.   Could the treatment of an injury in which a patient was fixed in

24    traction, unable to move, could that also be a contributing factor to the

25    delirium?

Page 4403

 1       A.   No, I wouldn't say so.  In the -- our sources, this was not

 2    listed as such.  Indirectly, it could have led to that because he wasn't

 3    able to obtain alcohol and it was difficult to obtain it in hospital.  But

 4    hypothetically speaking, had he not been fixed, perhaps he would have

 5    gone and obtained some quantities of alcohol.  So if abstinence is to

 6    blame, then this would have been prevented.

 7       Q.   I want to take each of those causes that you've described for us

 8    separately.  Let's take alcohol abstinence first.  What period of time in

 9    your experience transpires between the last consumption of alcohol and the

10    first signs of on set of delirium in a person with Mr. Vasiljevic's

11    alcoholic history?

12       A.   As a general rule, we are usually taught that the duration can be

13    within several hours to several days.  Additional definition says, as a

14    rule, less than seven days.

15       Q.   Now, let's look at the other case, the case of physical injury.

16    In your experience, what would you expect to be the time period between

17    the time of the physical injury and the first signs of the onset of

18    delirium?

19       A.   Also from several hours to several days.  They did not specify how

20    many days here, and in our textbooks we are usually told several -- up to

21    several days.

22       Q.   Are you able to tell us when it is that Mr. Vasiljevic suffered or

23    when was the onset of this delirious state?

24       A.   Well, based on documentation available to us from the third

25    history, patient's history, one of doctors wrote that the date was -- just

Page 4404

 1    a second, please -- it says here on the 8th.  Let me quote, please.  "The

 2    history, patient's history tells us that the first decursis morbi was

 3    registered on the 8th of July, 1992, in which it says the patient, on a

 4    previous day, was transferred from an orthopaedic ward.  On an additional

 5    piece of paper dated 5th of July, Dr. Stojkovic says the following.  I

 6    quote:  On the 5th of July, 1992, at 0900 hours, a psychiatric examination

 7    was requested.  Patient showing signs of a pre-delirium stage.

 8            Based on that, I can conclude that pre-delirium or delirium

 9    commenced on the 4th or 5th of July, 1992.  I am not able to give any

10    other interpretation.  This is the only thing that I can take as an

11    indication of an onset of this state.

12       Q.   Was there anything in the medical records that indicated to you

13    the state of the -- of Mr. Vasiljevic's psyche at the time he was

14    admitted to the hospital?

15       A.   I will also quote to you.  Dr. Jovicevic, an orthopaedist, said

16    the following:  The patient was admitted as an urgent case, condition on

17    admittance:  conscious, oriented, does not have fever, actively immobile.

18       Q.   And what do you conclude from that observation of Mr. Jovicevic?

19       A.   I concluded that as far as psychiatric elements are concerned, the

20    patient was all right, his consciousness was fine, he was oriented, which

21    means that he perceived reality well, both as far as he's concerned and

22    the environment around him, and that this disorder commenced on the 4th

23    or on the 5th, when his treating orthopaedist asked for an assistance from

24    psychiatrist and then transferred him to a psychiatric ward due to his

25    psychological condition, which, as I said, is consistent either with

Page 4405

 1    delirium or alcoholic psychosis.  I believe it was delirium but I cannot

 2    with certainty exclude the possibility of alcoholic psychosis, although I

 3    believe it to be less likely based on everything that is available to me

 4    right now.

 5       Q.   Doctor, a few answers ago, you used the term decursis morbi,

 6    and that's d-e-c-u-r-s-i-s morbi, m-o-r-b-i.  Can you please define that

 7    term for us?

 8       A.   I apologise for using medical terms.  It's a term we typically

 9    use for every patient who is in a post operative stage or is at an

10    intensive care unit.  For example, if I have psychiatric patient, then we

11    have an obligation to at least once a day, or now even twice a day, give

12    brief description of a patient's condition.  So I'm not going to repeat

13    every time patient is calm, "patient is calm."  I am instead going to list

14    the pathology that I find.  So I as a psychiatric -- forensic psychiatrist

15    don't believe it to be significant when the patient is showing more

16    symptoms because we as a routine will list only the pathology.  So I'm not

17    going to always write, for example, "the patient is calm," no, but I'm

18    going to write it down if he's not calm.  So this is what we normally call

19    decursis morbi.  This is a daily description of changes, if we can call

20    them that, in patients's condition.  We will always write what is

21    important.  We will always write any new elements and whatever needs to be

22    treated.  These are the things that we will normally list.

23       Q.   Now, Doctor, you are -- received your medical training in

24    Yugoslavia.  Are doctors in the ordinary course, before they specialise,

25    are they trained to recognise conditions such as delirium?

Page 4406

 1       A.   Yes.  I will describe that with just a few sentences.  Every

 2    doctor in the former Yugoslavia, and these laws have not been changed yet

 3    either in Croatia or in Croatia or in any other part of the former

 4    Yugoslavia, so doctors have to graduate from the school of medicine.  They

 5    have to become general practitioners first.  Then they take a state

 6    examination and become qualified to conduct routine work with patients,

 7    routine work in all specialties of medicine.  We have to detect, we have

 8    to discover, disorders.  We don't have to give a precise diagnosis.

 9    However, we have to be able to recognise what is going on, write it down

10    and then send the patient on to a specialist, if needed.  But some of the

11    disorders which are not urgent can also be treated by the general

12    practitioner himself.  So after this basic training, doctors will

13    proceed on to specialize.  So my basic training from the area of surgery,

14    for example, is not detailed.  But if my patient, for example, falls down,

15    then I have to determine whether the patient, for example, has a fracture,

16    because I am a general practitioner as well.  And this applies to all

17    doctors in the former Yugoslavia.

18       Q.   Based upon your experience, is it possible that Dr. Jovicevic, at

19    the time he admitted this person into the hospital, is it possible that

20    the person could have been suffering from delirium but Dr. Jovicevic just

21    failed to recognise that?

22       A.   No.  I cannot assume that, because the colleague, my colleague

23    wrote something down.  He didn't write down much but he did write,

24    conscious and oriented.  Basic symptoms in psychotic disorders is that

25    persons are disoriented.  So if the doctor had not written down

Page 4407

 1    anything then I perhaps could question whether this was present or not but

 2    now I don't have any dilemmas because he recognised this state.  It's

 3    written down here that the patient was conscious and oriented, so I have

 4    to believe what's written there.  It's a document.

 5       Q.   I want to now ask you about alcoholic psychosis.  Can you briefly

 6    describe -- you've talked about it in the context of talking about

 7    delirium.  Is there anything else that you would like to add regarding

 8    your diagnosis that that possibly also could have been present during this

 9    time period you are now telling us about?

10       A.   Well, you see, in my written opinion, I elaborated in great

11    detail possibilities whether there was a delirium or psychosis there.

12    Let me explain why I believe this was a delirium, because his confusion

13    was greater so this implies to delirium.  Patients who are experiencing

14    psychosis have hallucinations but they are not as intense, their

15    illusions are not as intense.  So I lean towards the diagnosis of

16    delirium.  But, however, the doctor that released him from the hospital

17    but a diagnosis of unspecified psychosis, so I am prepared to accept that

18    diagnosis as possible as well.  All the more so because we are now

19    examining this patient not because we need to treat him but because we

20    need to assess his accountability at the relevant time.  Accountability is

21    important both for delirium and alcoholic psychosis.

22            For you, as the Court, this dilemma is not as important perhaps as

23    it would be for somebody else who would be analysing all this but from a

24    practical point of view for the Court, this is not the most important

25    thing.  What is important here?  It's important to establish the day the

Page 4408

 1    disorder commenced.  And the number of symptoms, I don't think is that

 2    relevant right now.  This is why I wrote in my opinion that this was more

 3    likely delirium than psychosis but both of these diagnoses would bring me

 4    to a conclusion that at the relevant time, as the patient was suffering

 5    from this, he was unable to control his acts and to understand the meaning

 6    of the acts committed to him at that time.  So accountability will not

 7    change whether it is one or the other diagnosis.

 8            Based on the intensity of the disorder, these two diagnoses are

 9    almost identical and would lead to the same conclusion.  At the time when

10    the patient was suffering from this, which is several days prior to coming

11    to the hospital and up until his release from there, he was in a condition

12    of psychological incompetency.

13       Q.   Doctor, just so that we are clear, you've told us about when you

14    believe the onset of delirium was.  Is there a possibility that alcoholic

15    psychosis had a different onset or have you found that it's the same

16    onset?

17       A.   No.

18       Q.   So that it is the same onset?

19       A.   Yes, yes.  I believe that it was the same onset but there were

20    perhaps some differences in the clinical picture, but as far as the onset

21    is concerned, whether it is delirium or a psychosis, this all falls within

22    the description of -- that is given to us by the doctors that treated him

23    at the time.

24       Q.   And you've told us that you believe -- well, let me ask you in

25    this manner:  This acute psychosis of delirium, did it end upon, in your

Page 4409

 1    view, upon his discharge from the psychiatric ward of Uzice hospital?

 2       A.   Yes.  I have to conclude that based on what the subject told me.

 3    He told me that during last two days, he had observed that he was in a

 4    better shape than other patients there, that he did not belong there any

 5    more, and when his wife came to see him, he asked to be released.  In the

 6    medical documentation on the day he was discharged, it says the

 7    following:  28th of July, 1992, patient looks normal, calm.  Based on

 8    spouse's request, he is discharged.

 9            So the doctor that discharged him from the hospital did not write

10    down anything that would indicate that there were persistent mental

11    disorders.

12       Q.   Now, Doctor, to ask you hypothetically, if this case were

13    presented to you back in the former Yugoslavia and you were called upon to

14    make a determination regarding the accused's accountability for crimes

15    that he is charged with during the month of June, prior to the

16    hospitalisation, would you have an opinion regarding his accountability?

17       A.   You see, I take the dates on the face of what is given to us in

18    the medical history.  If we should accept that he was admitted on the day

19    he is -- he is admitted, then I would reply the following.  For the period

20    prior to hospitalisation, I believe that for certain acts, the subject

21    could be accountable and have accountability either in the first category

22    or in the second category or in his acutely inebriated state for the

23    acts that he is charged with.  So we had alcoholism in the beginning which

24    could have been either constant or could have been an acute intoxication,

25    in which case his accountability would fall into category two.  And in the

Page 4410

 1    alcoholism itself, his accountability would fall into category one.

 2       Q.   Based upon your findings, is there anything to lead you to believe

 3    that prior to his hospitalisation, that he may have had a mental illness

 4    which would have made him significantly unaccountable -- I'm sorry,

 5    significantly diminished accountability or completely incompetent?

 6       A.   I have to state what I learned from Mr. Mitar Vasiljevic himself

 7    here.  In an exhaustive conversation about this period, he stated that at

 8    that time, he suffered from a certain fear, he was afraid for his

 9    children, and Mr. Mitar Vasiljevic was a person who cared very much for

10    his children.  He was worried that something might happen to him after

11    certain problems, he returned to the town, he was cleaning the town

12    again.  He was no longer as afraid for himself as he had been before when

13    he felt that the route he was taking was very dangerous and that his life

14    was threatened, but this fear was not of an intensity that would justify

15    our saying that it was not normal, because it was normal to be afraid

16    during wartime.

17            Mr. Mitar Vasiljevic was someone who always looked after

18    his children.  He moved to Belgrade, they moved to Belgrade.  He visited

19    them.  He was concerned for them.  And certainly under wartime conditions,

20    this was stressful for him.  He told us that he used to go to work

21    cheerfully but that when the war broke out, he was under the impression of

22    wartime.  However, there is nothing in the medical documentation to

23    indicate a disorder that would take him beyond the first or second

24    categories of accountability.

25       Q.   Can I summarise your answer in the following way:  That had

Page 4411

 1    you been presented this case as an expert for the courts of Yugoslavia,

 2    based on your evaluation, you would not have found him to have either a

 3    significantly diminished accountability or to be incompetent at the

 4    time prior to his hospitalisation?

 5       A.   Correct.

 6       Q.   Now, Doctor, in assessing the onset of these psychoses, is it

 7    important in your anamnesis to find out from the subject what their

 8    recollection is of the day of the crime and certain facts that they can

 9    provide around the time of the crime?  Is that important?

10       A.   I have to say that Mr. Mitar Vasiljevic denies committing the

11    crime and the only response I got from him was that he did not take part

12    in it.  Are you referring to his description of the day in question?

13       Q.   Yes.  What I'm asking you now is his descriptions regarding his

14    interaction with other people, despite whatever denials he makes, are they

15    important in your evaluation?  Is his memory about that day important and

16    can you tell us what are your findings if they are?

17       A.   Yes.  When you read my expert opinion, it is quite clear that I

18    describe in great detail two days where I tried to show fully what

19    Mr. Mitar Vasiljevic told me.  I had a professional goal when I did this,

20    and that was to show that, on those days, he did certain things logically

21    in accordance with his usual mechanisms.  He remembers details.  Had he

22    been demented at the time, there would be gaps in his memory.  Had he been

23    psychotic, his attention would have been different, but the gentleman

24    describes very coherently who he was with, whom he saw, why he went to

25    look for a horse, what the horse was like.  He remembers the cries of the

Page 4412

 1    children commenting him on a horse.  He remembers the fall.  He remembers

 2    that the ambulance driver arrived.  So this is told in chronological

 3    order.  There is no confusion.  There are no gaps in the memory.  There is

 4    nothing to indicate that he was not testing reality.  He remembers being

 5    brought to the hospital.  He remembers there was no ambulance available,

 6    that they were waiting for them.  So it's not just a question of cognitive

 7    functions but his attention, and this is always disturbed when there is a

 8    psychosis, but he was able to pay attention and to register, to remember

 9    what events followed what other events in sequence.  So I cannot talk

10    about the crime because he is denying it, but I can say that on that day,

11    he -- his accountability is certainly not beyond category two.  He told me

12    that he drank quite a lot on that day.  He told me what he drank and with

13    whom, but he himself thinks that he was tipsy rather than drunk.

14       Q.   Let me ask you a specific question about his own perception of

15    himself as tipsy rather than drunk.  What precise time period was he

16    referring to when he said he was tipsy rather than drunk?

17       A.   That day.  The day in question.

18       Q.   Is that the same day that he says he fell off the horse?

19       A.   When he fell, yes, yes.

20       Q.   And a person who was, as you describe, tipsy, that level of

21    intoxication, where would that make that person fall in the category?

22       A.   Less than if he were drunk.

23       Q.   But would they be fully accountable or diminished --

24       A.   Well, you see, when the patient says this about himself, we take

25    it with a certain reserve.  Let's say that he was drunk, let's take the

Page 4413

 1    worse version.  He would still be in category two.  In view of what he

 2    said he drank on that day, I would say that he was drunk and that his

 3    accountability was diminished but not significantly.

 4       Q.   If we were to accept Mr. Vasiljevic's own assessment that he

 5    wasn't drunk but tipsy, would he still be in category two or would he be

 6    in category one?

 7       A.   Well, that depends on the level.  Since we do not know, I would

 8    put him in category two because he listed all the things that he had

 9    drunk.  I don't remember the name of the person he drank with but the

10    chronology of the day and all the drinks he had, I think, would put him in

11    a drunk state.

12       Q.   Doctor, I want to move to some other, more isolated, issues that

13    have arisen regarding the psychic condition of Mr. Vasiljevic at the time

14    of these crimes.  A witness by the name of Dr. Vasiljevic, Radomir

15    Vasiljevic, a local doctor in Visegrad, reported that in the early part of

16    June, that when he treated Mr. Vasiljevic, that he observed some symptoms,

17    including Mr. Vasiljevic or the accused hearing voices and other symptoms

18    that he perceived to be evidence of psychosis.  I'd ask you to comment on

19    Dr. Radomir Vasiljevic's observations of the accused.

20       A.   Well, you see, Dr. Vasiljevic, as far as I understand, was a

21    general practitioner.  And he was a relative of Mr. Vasiljevic's, is this

22    correct?

23       Q.   Yes.

24       A.   I'll tell you what the rule is in the former Yugoslavia, what the

25    rule was, what a practitioner recognising a psychosis would do.  The only

Page 4414

 1    thing he would have to do for a psychotic patient is to call an ambulance

 2    and send him to hospital.  A psychotic patient by definition is a person

 3    who is not accountable, a person who is unable to take care of him or

 4    herself, to control his or her actions.  So the only justified course of

 5    action and the mandatory course of action would be for the general

 6    practitioner to take him to hospital.

 7            Let me add that if he was a relative, he would know that his --

 8    the patient's mother committed suicide.  When studying the genesis of

 9    mental illness, then we know that a family member of a patient is at high

10    risk and if the person is psychotic, there is a great risk that they will

11    end their own lives.  This is an additional factor which I feel is so

12    strong that there is no justification if someone has recognised a

13    psychosis as a doctor and as a relative, not to have taken the patient to

14    hospital.

15            JUDGE HUNT:  Mr. Groome, my recollection is that the doctor agreed

16    he must be a relative but he did not consider that he was a close one.  I

17    don't know if that affects the answer.  It certainly wouldn't affect the

18    first part of the answer but I hope my recollection is correct.

19            MR. GROOME:  Yes, Your Honour.  I believe it's as you have put

20    it.

21       Q.   Doctor, let's put aside -- since there is uncertainty about the

22    closeness of the relationship, let's put that aside for a minute.  You

23    said in your answer that it would be mandatory for a general practitioner

24    observing, making such observations in a patient, to secure the immediate

25    hospitalisation of that patient.  When you say mandatory, what exactly do

Page 4415

 1    you mean?

 2       A.   That everything that happens after this is the responsibility of

 3    the doctor, because the doctor has taken responsibility for everything

 4    that happens to the patient.  The patient might have tried to commit

 5    suicide.  In that case, the doctor would be responsible for what the

 6    patient tried to do.

 7       Q.   Would it have been sufficient for this general practitioner to

 8    have simply suggested to the accused that at some point in the near

 9    future, he should visit a hospital?  Would that have been a sufficient and

10    proper course of action?

11       A.   If the doctor found that the patient was psychotic, he would have

12    to have taken measures to hospitalise him, himself.  That means calling an

13    ambulance, administering appropriate therapy, and then he would have

14    fulfilled his duty.

15       Q.   Now, during this same period of time that Dr. Vasiljevic has

16    spoken about, the beginning of June, in your conversations with

17    Mr. Vasiljevic, the accused, did he describe for you any symptoms which

18    could be classified as psychotic during that period of time?

19       A.   I said this.  He complained of fear for his children, for example,

20    but none of the descriptions he gave me indicated a psychotic state.

21       Q.   Can you describe for us how do you, as a psychiatrist, distinguish

22    between normal fear and fear that could indicate a psychotic state?

23       A.   Yes.  We ask what he is afraid of.  If he says that the front line

24    moved, that every day he had to go to territory where there was a hostile

25    army, he was going alone, then his fear is justified.  I asked him what

Page 4416

 1    could have happened, if he is describing a real situation.  And there is

 2    no unrealistic interpretation, then for me this is real fear.  If he had

 3    told me then, for example, that he saw strange things happening in the

 4    woods which were not actually enemy soldiers, then this would be manic

 5    fear.  So everything that he told me about his fears in that period were

 6    worry, concern, more for others than for himself.  I'm referring to his

 7    wife and especially his children.  And this was realistic.  This was a

 8    real fear, a realistic fear.

 9            He told me how afraid they all were at that time because there was

10    a war on.  For example, the episode described by him when he visited his

11    daughter in Belgrade, when his daughter did not come home on time, the

12    whole family was afraid.  In wartime, people lived under special

13    conditions, but these were not specific just to him but to everybody

14    living in wartime conditions.  And this was real fear.  Many people were

15    killed.  These were abnormal living conditions.  And of course a certain

16    degree of fear existed.  But he said very clearly that throughout the

17    wartime period, this was the case.  He did not show any symptoms that

18    would lead me to judge that he was psychotic at the time. And finally, the

19    doctor who admitted him confirms this also.

20       Q.   It seems that what you're describing is that fear is a normal and

21    rational response in given situations; is that correct?

22       A.   Yes, yes.

23       Q.   Does the fact that Mr. Vasiljevic had fears for the safety of his

24    family, in particular his children, does the fact that he sent them to

25    live in Serbia itself in an area that he thought to be safer, does that

Page 4417

 1    indicate whether or not his fears were rational or were irrational?

 2       A.   They were rational.  A large number of people did this at the

 3    time.  The inhabitants of the former Yugoslavia moved -- a large

 4    percentage of people removed their children elsewhere.  I do not think

 5    there is anything psychotic in this fear, anything that would make him

 6    different from most people living in that situation, under those

 7    conditions.

 8       Q.   Can you describe for us -- I know you have eliminated depressive

 9    psychosis, that Mr. Vasiljevic did not have that, but I would ask you to

10    describe in greater detail because it is an issue in this case, the

11    symptoms that you would expect to find if somebody did suffer from that,

12    and tell us whether or not you found them in Mr. Vasiljevic.

13       A.   No.  I have already said that I found no symptoms that would

14    indicate that Mr. Vasiljevic had a depressive psychosis.

15       Q.   And can you briefly tell us what those symptoms would have been,

16    or what are the symptoms of depressive psychosis?

17       A.   I will tell you what the symptoms of depressive psychosis are.  A

18    depressive psychotic person has a feeling of guilt.  The -- this is not a

19    realistic fear.  It's manic.  They are preoccupied with these thoughts.

20    They are afraid that they have done something bad and will suffer the

21    consequences.  But this is all manic.  It's not fear of an enemy army.

22    It's something unrealistic.  The person is tense.  They sit still.  They

23    are not interested in any activities.  They don't smile.  They have

24    disorders in eating.  The sexual drive is diminished.  And even a

25    layperson can recognise such a person as ill.

Page 4418












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Page 4419

 1       Q.   Now, I'd ask you to shift to the sheet marked number 11, move to

 2    the next sheet, and I'd ask you to draw your attention to heredity.

 3    Heredity as the source of psychosis is something which you are quite

 4    familiar with; is that not true, doctor?

 5       A.   Yes.  Heredity or the genetic factor are one of my major research

 6    interests, and I am taking part in two projects currently where we are

 7    studying heredity in psychosis, and I can say that heredity is a very

 8    significant factor, and the fact that the subject, after adolescence, lost

 9    his mother, who committed suicide, this was a fact that I bore in mind

10    questioning him.

11            On the basis of the information that we have about his mother, we

12    could not conclude with certainty whether she suffered from schizophrenia

13    or from depressive psychosis because the conditions in the countries of

14    the former Yugoslavia are such that people do not discuss mental illness

15    willingly, so that even Mr. Vasiljevic is not sure what symptoms his

16    mother had before her death.  However, then if this was so, this is

17    certainly very significant in his life.  If his mother suffered from

18    depressive psychosis or a bipolar disorder, then the chances that someone

19    in the general population suffered -- is suffering from this disorder

20    would be between 0.5 to 1 per cent, so in the general population, every

21    100th child on the average will suffer from schizophrenia and every

22    50th -- 150th will suffer from bipolar disorder.  If one of us has a

23    positive hereditary, which means that one of our parents suffered, for

24    example, from schizophrenia, then the chances that the child will suffer

25    from schizophrenia, while the data and the literature differ from author

Page 4420

 1    to author, but the chances are 20 times greater for schizophrenia, which

 2    means that, theoretically, out of 100 children issuing from that parent,

 3    20 will have a chance of becoming schizophrenic.  If the parent did not

 4    suffer from the disease, out of 100 of his offspring, only one will suffer

 5    from schizophrenia, and the data is -- the chances are even greater in the

 6    other disorder.

 7       Q.   Doctor, I'd like to ask you to focus on this particular case, and

 8    based on your experience and your research into heredity as a contributing

 9    factor or the role it plays in psychiatric illnesses, I would ask you to

10    describe how does -- assuming that Mr. Vasiljevic's mother did commit

11    suicide, and assuming that two female members of his family, not immediate

12    family but of his family, an aunt and a cousin, both suffered from mental

13    illness, what does that information -- or how does that information impact

14    upon your conclusions or your findings in this case?

15       A.   Allow me only to add -- I was just going to add that the -- Mr.

16    Mitar does not have positive heredity only through the mother's maternal

17    line but also through the paternal line, so the percentage is even

18    greater, the chances that he will be ill is even greater because there is

19    also positive heredity on the paternal side.  This means that when someone

20    comes to us for counselling and they ask whether a mother should bear a

21    child under these circumstances, we would say that the chances were

22    greater that her child would suffer from the same illness as she and the

23    family on the father's side than would be the case if the family did not

24    have this history.

25            When the person is developing, then we are very sensitive to the

Page 4421

 1    symptoms, to this, and we try to recognise the symptoms as early as

 2    possible because it is easier to treat the disorder if it is recognised

 3    early.  So that in a psychiatric or psychological clinic, we put these

 4    children in the high-risk category and we observe them in greater detail

 5    than other children.  We base a diagnosis on symptoms and signs.  If these

 6    are absent, then we consider the person to be healthy.  We warn the person

 7    that the possibility of heredity still exists in the next generation,

 8    because they can pass on a genetic disorder.  We are still not sure how,

 9    and the research we are doing with Columbia University is research into

10    this transfer, whether it depends on gender and so on, but what is

11    currently known in modern psychiatry, this is that a diagnosis is based on

12    symptoms and the information on heredity is very important in prevention,

13    in family planning, in counselling in maternity centres, and if the person

14    was psychotic, then his symptoms would have to be similar or identical to

15    the symptoms of his mother.  If she committed suicide, and we have this

16    information, then we would have to watch over this person carefully

17    because this person is in a high-risk category for suicide.  All this is

18    not so important until the symptoms appear.

19       Q.   In your evaluation of Mr. Vasiljevic, did you see any symptoms

20    that would indicate to you that he was in a high risk for suicide?

21       A.   No.  The gentleman is not depressive.  I asked him directly

22    whether he had ever thought of suicide, and his answer was, "There were

23    times in my life when I would have preferred not to exist," but this was

24    always a response to a real situation, and I did not find that he is in a

25    high-risk category for suicide.

Page 4422

 1       Q.   Now, Doctor, I want to clarify something you said.  Is it possible

 2    that somebody could have mental illness in their family, that they

 3    themselves could inherent the gene for that mental illness, never in their

 4    life show any symptoms of that mental illness but simply pass that gene on

 5    to their children?  Is that correct?

 6       A.   Science is not quite sure but we believe this is so.  There are

 7    many more arguments to show that this is the way you have said, rather

 8    than not.  Practice has shown that some generations skip the disease and

 9    then it turns up again.  But it can take a collateral route.  So the

10    symptoms may appear not in him but in one of his brothers or sisters and

11    then his children can get it.  However, we have not yet deciphered this

12    exactly.

13            MR. GROOME:  Thank you, doctor.

14            JUDGE HUNT:  We will resume at 2.30, but before we adjourn, may I

15    draw your attention to a statement which the doctor has on page 12 of this

16    summary, in paragraph 2, "The diagnoses that Dr. Lopicic gave were not

17    described with symptoms."  That may be an accurate description of the

18    report, but Thursday's evidence was replete with evidence of symptoms.  I

19    don't know whether the doctor has had an opportunity of seeing the

20    transcript of that.  Perhaps you may have to put them to her, although I

21    notice that she has English as one of her languages.  The transcript is

22    available.  But Dr. Lopicic had to be stopped from repeating the symptoms

23    that she relied upon, several times, I notice.

24            MR. GROOME:  Yes, Your Honour.

25            JUDGE HUNT:  So it may be just as well if we have the views of

Page 4423

 1    this doctor on the symptoms which were described by Dr. Lopicic.

 2            MR. GROOME:  I'm sorry, Your Honour, would it be appropriate --

 3    the doctor was provided a copy of Mr. Lopicic's testimony to review those

 4    symptoms.  I'm not sure whether she has them with her.  Would it be --

 5    would the Court consider it appropriate for me to provide her with an

 6    additional copy to review over lunch?

 7            JUDGE HUNT:  Yes, she is entitled to read the transcript.  It will

 8    save a lot of time, because you are entitled to have her comment upon the

 9    evidence as it was given, which went beyond what was in her report.

10            2.30.

11                          --- Luncheon recess taken at 1.03 p.m.















Page 4424

 1                          --- On resuming at 2.31 p.m.

 2            JUDGE HUNT:  Mr. Groome?

 3            MR. GROOME:

 4       Q.   Good afternoon, Doctor.  I want to apologise.  I misspoke

 5    before the break.  It wasn't you that were provided a transcript.  It was

 6    another expert.  I realise you were provided a transcript of Dr. Lopicic's

 7    testimony for the first time over the lunch break.  I will in some of my

 8    remaining questions be asking you to respond or comment on specific

 9    observations and findings that Dr. Lopicic made.  Before we do that, I

10    would like to ask you, can you talk very concretely what you believe the

11    impact of the heredity in the Vasiljevic family has upon your findings

12    regarding Mitar Vasiljevic in this case?

13       A.   Taking into account everything that modern science knows about

14    heredity, I conducted a very precise interview with Mr. Vasiljevic,

15    knowing that he falls into a very high risk category, that he has a mental

16    illness.  I did not find any signs or symptoms that could confirm this.

17    Therefore, he may have certain fears, fears that he will develop a mental

18    disease, but I do not find anything in him indicating that he is presently

19    ill.

20       Q.   Your two findings of -- that at a certain limited period of time,

21    he suffered from delirium and from alcoholic psychosis, is it your belief

22    that either one of these, that a contributing factor to either one of

23    these was his heredity?

24       A.   Most certainly not to a significant degree.

25       Q.   Why is that, doctor?

Page 4425

 1       A.   Because in the whole world, psychiatric diagnosis is established

 2    based on the existence of symptoms and not on the basis of expectations

 3    that such symptoms might appear.  That specifically means that he falls

 4    into a high risk category, and if he was a younger man now, I would say

 5    that he still has a chance to develop one of these illnesses, but in view

 6    of the -- of his age, he is beyond the stage where such illnesses can

 7    develop, and since he has no symptoms or signs, which is a condition sine

 8    qua non in psychiatry for diagnosis, I believe that in his case,

 9    fortunately, heredity factor skipped him over.

10            A further answer to your question why is this:  We either have an

11    illness or we do not have it.  The modern medicine today doesn't only

12    treat patients, it's also a science, so in order to determine a diagnosis

13    we have to specifically list some ten or -- any number of symptoms that is

14    needed for a diagnosis.  So classification will tell us that typical

15    symptoms for this and that illness are the following.  And then it will

16    list ten symptoms and specify that, out of those ten, at least six need to

17    be present in order to determine diagnosis.  So these symptoms are either

18    present or not present.  We are psychiatric experts here and we cannot

19    say, for example, this symptom is lacking.  I can tell you that something

20    is lacking in somebody else's written experience -- in somebody else's

21    written opinion, but when we are talking about symptoms, that all I can

22    say is that those symptoms are either present or absent.

23       Q.   Doctor, in your answer, you seem to be suggesting that there is a

24    particular age at which, as a psychiatrist, you would expect to see some

25    symptom of a mental disease that a person had a heredity disposition

Page 4426

 1    towards.  Can I ask you to give us the range or the approximate age that

 2    that is?

 3       A.   Well, you see, it is not my assessment.  This is simply a fact.

 4    This is how it is.  In the former version of American classification,

 5    which was DSM-III, we had this listed that one of the main criteria for

 6    schizophrenia, which is not a criterion of including but an excluding

 7    criteria, that if a person does not develop symptoms until the age of 45,

 8    then the person will not develop an illness.  In addition to that, we have

 9    information, we have knowledge that says that illness usually develops

10    between the ages of 17 and 25 and very seldom beyond the age of 30.  And

11    this is simply a line that illustrates this.  This is how it is in our

12    profession.  So if our subject is older than 45, then it means that he's

13    not likely to develop such an illness.

14       Q.   When you said that 30 was an important age, and my question is, is

15    the fact that the accused was 38 at the time of -- that these crimes were

16    committed, would that indicate to you that it was less likely that he was

17    suffering the onset of some heredity mental illness at that time?

18       A.   It does say so but it's not a key factor for me.  What is

19    important for me is that none of the symptoms that would be important to

20    me were described, not a single symptom or a group of symptoms, in order

21    to determine -- to establish this diagnosis.  All other factors would help

22    us or lead us, point to this diagnosis, but in order to establish this

23    diagnosis, we need to have a specific cluster of symptoms.

24       Q.   And you did not find those in this case; is that correct?

25       A.   I did not find them.  If you allow me, I will give a suggestion.

Page 4427

 1    I can fax you or send you clusters of symptoms for each of these

 2    diagnostic categories which are very specific in modern psychiatry and

 3    they are very easy to apply.  They list symptoms that a patient needs to

 4    have.  They also indicate the requisite duration and this is something

 5    that basically removes any doubts that we might encounter.

 6       Q.   What you're proposing to send us, is it published in a medical

 7    textbook?

 8       A.   Yes, yes.  This is something that has been accepted throughout the

 9    world, this classification, and we use it in our daily work.  Every

10    psychiatrist has two books on their table, both clinical and theoretical

11    psychiatrists.  One is an ICD-10 classification, and the other one is

12    DSM-IV.  We use both of them.  Both books have been translated in Croatia,

13    in Serbia, throughout the former Yugoslavia.  They have been translated

14    into our languages, and in the countries of the former Yugoslavia, this

15    was used both before and today.  These are official classifications that

16    we use.

17       Q.   And if the Chamber was so inclined to ask you to go ahead and fax

18    this excerpt from the book, would it be something that we could look at

19    and understand without your assistance, without expert assistance?  Would

20    a layman understand the material that you wish to send?

21            JUDGE HUNT:  It would be preferable if we got the English version,

22    Mr. Groome.

23            MR. GROOME:  Yes, Your Honour.

24            THE WITNESS: [Interpretation] Please let me do some boasting.

25    We have just translated English version into Croatian in our clinic so I

Page 4428

 1    can send you both the English version, which seems to be more important to

 2    you, and the Croatian one.

 3            JUDGE HUNT:  Thank you.

 4            MR. GROOME:

 5       Q.   Doctor, if you would fax it and if the Court wishes to see it, it

 6    will be available for them.

 7            Now, Doctor, in the family history of Mr. Vasiljevic, it seems

 8    that all three people that have suffered from mental illness have all been

 9    women, and from what we know of the men in his family, there has been no

10    other evidence other than that Mr. Vasiljevic himself suffered a mental

11    illness.  Does this tell you anything about the hereditary factor involved

12    here?

13       A.   During the break, I read in detail the findings of his cousin and

14    I saw that it was more likely that she was schizophrenic than affective.

15    Schizophrenia is something that is equally frequently found in men and in

16    women, unlike depression, which is more frequent in women than in men.

17    So if we had only an affective psychosis, then my response would be yes.

18    But since I saw that this was a case of schizophrenia, then my reply is

19    such that schizophrenia is equally passed on to men and women, whereas

20    affective psychosis is more frequently passed on to women than men.

21       Q.   Is the fact that there are both schizophrenia and affective

22    disorders in the family history of Mr. Vasiljevic, does that indicate to

23    us that there are two separate genes, if you will, or does the same

24    genetic influence, can the same genetic influence manifest itself either

25    as a schizophrenia or as an affective disorder?

Page 4429

 1       A.   If I could give you a reply to this question, then I would

 2    probably be awarded the Nobel Prize.  This is one of the hottest issues in

 3    today's science.  I participate, but only as a member, in a project where

 4    we are trying to prove exactly your thesis but there are many more of

 5    those that argue against this thesis than those who support it.  Based on

 6    clinical pictures, those are quite different illnesses, significantly

 7    different illnesses.  They are both severe and deep illnesses.  They are

 8    both hereditary illnesses, but based on the type of symptoms, they are

 9    quite different.  So what I've just told you are the results of research,

10    but in a clinical practice, we usually can always see whether somebody has

11    a bipolar disorder or schizophrenia.  Symptoms are equally deep but their

12    content is significantly different.

13       Q.   Doctor, I'd like to ask you -- as you know from your examination

14    of this case, a cousin who the -- Mr. Vasiljevic says he was quite close

15    to died somewhere near the beginning of June.  Can you describe for us

16    what, if any, opinion or findings you have regarding that fact?

17       A.   Mr. Vasiljevic told me about this, and I think that this was a

18    psychological trauma that must have, and probably did, cause him to go

19    through mourning.  The death of anyone who is close to us, who is dear to

20    us, would cause us to go through this mourning.  Psychiatry calls this

21    normal mourning.  I think that Mr. Vasiljevic had sufficient reasons to go

22    into this process of mourning, which in psychiatry is defined as a

23    psychological state, a reaction to -- that was expected, a reaction to the

24    death of somebody close, and I accept this as something that in fact did

25    take place.

Page 4430

 1       Q.   In your view, could that have been some kind of contributing

 2    factor to the eventual psychosis that you found he suffered sometime after

 3    his hospitalisation?

 4       A.   Theoretically speaking, it is possible because his whole body was

 5    in a less active state at that time.  However, it shouldn't have

 6    significant practical consequences and we should not see this as a --

 7    something that led to his disease.  I think that Mr. Vasiljevic's illness

 8    is clearly recognisable, clearly defined, and there are sufficient reasons

 9    not to make a direct link between this event and his illness.  He did

10    suffer because of this relative's death but it was a suffering caused by

11    mourning.

12       Q.   Doctor, have you had an opportunity to read the report of Dr.

13    Lopicic?

14       A.   Yes.

15       Q.   I would ask you to place on the ELMO as a demonstrative aid

16    showing your comments regarding Dr. Lopicic's report.

17       A.   I will start with general comments.  The whole array of

18    description that were given very eloquently by Dr. Lopicic are,

19    psychiatrically speaking, completely acceptable.  She gave information

20    that does not differ from mine.  She gave headings that are almost

21    identical to mine, and when there are no significant differences between

22    my colleague's description and mine.  What I believe needs to be improved

23    in my colleague's report, and this is aside of all the things that are

24    good in her report, is that she did not specify the diagnosis of Mr.

25    Vasiljevic, either present one or past one.  We saw in several instances

Page 4431

 1    that diagnosis is something that we use in our work.  Just like you here

 2    in the court use such terms as "guilty," "not guilty," "competent" or

 3    "incompetent," in the same way we use in psychiatry "diagnosis."  So

 4    after reading my colleague's opinion, I was unable to determine what was

 5    her diagnosis, how she diagnosed Mr. Vasiljevic at any time.

 6            My second comment stems from the first one.  Dr. Lopicic in her

 7    opinion says, and I quote now, "Possible affective or paranoid

 8    disorders."  My colleague is a psychiatrist just like I am.  We can make a

 9    distinction between two diagnostic types and then opt for one based on

10    our conclusion.  This is especially wrong because paranoid and affective

11    disorders are quite different; their picture is different.  It's almost a

12    dichotomy, not a clear one but almost one.  A person in an affective state

13    has a multitude of expressions.  A person that lives in their own paranoid

14    world have an affect that is under the influence of their manic state, and

15    this is expressed in the way they express their emotions.  And after that,

16    my colleague says, "Psychotic period."  I have to wonder what this

17    psychotic period was induced by.  In addition to that, my colleague does

18    not list symptoms that would corroborate her conclusions.

19            Further on, logically speaking, I am not clear, based on what --

20    which diagnostic entity my colleague determined the degree of

21    accountability of Mr. Vasiljevic.  So I found -- I find these three things

22    to be three main deficiencies and they all pertain to establishing or not

23    establishing diagnosis.

24            Furthermore, I would like to talk about stressors.  Stressors are

25    events in somebody's life that can provoke positive or negative

Page 4432

 1    reactions.  Stressors cause stress.  And this stress can make us grow up

 2    and become a better person in a moral sense, or that stress can be so

 3    intense that it can lead to a disorder.  All of us in our lives have many

 4    stressors and they are an integral part of living.  So in order for

 5    psychiatry to distinguish between normal or so-called normal stressors

 6    that all of us experience, for example, a failure at the exam or a death

 7    of a cousin and a number of others, so in order to distinguish them from

 8    those that can lead to very serious disorder, we have a very strict

 9    definition and this definition says that a disorder will be induced by

10    stressor which is so intense that in a great majority of people it would

11    lead to a psychological disorder.  And then further, they define it which

12    is, for example, something as unexpected endangerment of personal lives or

13    witnessing a rape or witnessing some other very stressful events.  So

14    intensity of stressors have to be above average and unexpected in order to

15    lead to a disorder, and based on what Mr. Vasiljevic told me, I don't know

16    that he went through an experience of that kind, other than witnessing the

17    killing of those people by the river that he described.

18            In addition, it is well known that stressors of that intensity

19    can lead to a very specific state which is called either a reaction to

20    stress or post-traumatic stress disorder.

21       Q.   Doctor, if somebody -- let's take the example of witnessing a very

22    violent act and that being what induced the stress, what would be the

23    period of time that you would expect to see between the violent act that

24    was witnessed and the onset of some indication that this stress has been

25    of a type sufficient to induce psychiatric illness?

Page 4433

 1       A.   Modern psychiatric classification has defined that as well, and we

 2    say that acute reaction to stressor commences within a month.  So within a

 3    month.  And if it lasts longer than a month, then we call it a post

 4    traumatic stress disorder.  Post-traumatic stress disorder is a mental

 5    disorder that is very specifically defined, and I examined Mr. Vasiljevic

 6    [Realtime transcript read in error "Mr. Disorder"] for any symptoms of

 7    that, and based on my interview with him, he does not have and he did not

 8    have a post-traumatic stress disorder.  None of the

 9    colleagues mentioned any of symptoms which are typical for post traumatic

10    stress disorder.  So based on my examination, I can say that he did not go

11    through a post-traumatic stress disorder.

12            I wish to add one more thing.

13       Q.   Just let me correct the record, it's Mr. Vasiljevic that you

14    examined for the post-traumatic stress disorder, correct?  I believe there

15    is a mistake in the transcript.

16       A.   Yes.

17       Q.   Please continue to tell us.

18       A.   I listed this as one of the examples so we can have it

19    theoretically, when I spoke about accountability.  What is important is

20    that post-traumatic stress disorder is not an illness that has psychotic

21    intensity.

22       Q.   Can I conclude from what you're saying now that in terms of the

23    levels of accountability, post-traumatic stress disorder would never give

24    rise to the highest two classifications of significant diminishment and

25    incompetence; is that correct?

Page 4434

 1       A.   That's correct.

 2       Q.   Do you have an opinion whether the mental illness that you believe

 3    Mr. Vasiljevic suffered after going into the hospital, do you have any

 4    opinion whether that was a reaction to the stress of seeing some people be

 5    killed approximately around the 7th of June?

 6       A.   No.

 7       Q.   And why?

 8       A.   Because a stressor like that would lead to a specific clinical

 9    picture, specific symptoms.  And Mr. Vasiljevic did not describe that to

10    me.  In our interview, he told me in detail how the killing at the river

11    impacted him.  He had a state of acute excitement.  He felt very uneasy.

12    He said that he felt ill, that he had to put his head under cold running

13    water, and what is typical, and what we meet frequently in psychiatry, is

14    that after telling his wife about it, he felt a certain relief and then he

15    felt an even greater relief after describing this to somebody else the

16    following day.  So in a sense, he was able to get some relief, to express

17    his trauma, to let off some steam.  And in psychiatry this is something

18    that we call anxiety, and this lasted for a certain time, it had a certain

19    clinical picture.  After that, he experienced relief after he acted out,

20    and told his wife and then somebody else about this event.

21       Q.   Can you briefly describe for us what the clinical picture would

22    have looked like if his psychiatric illness had been a result of the

23    stress of witnessing such an event?

24       A.   This state is called post-traumatic stress disorder.

25    Post-traumatic stress disorder has five key characteristics.  The first

Page 4435

 1    one is that in the anamnesis there is a stressor, and we said how intense

 2    that stressor has to be.  The second one is that the patient has -- sees

 3    this as a recurring theme so this theme would be going -- coming back to

 4    him and every time would cause a very intense uneasiness in that person.

 5    The second cluster of symptoms are symptoms of increased excitability.

 6    These persons become aggressive, agitated, they have a very lowered

 7    threshold of -- for frustrations.  They become irritable.  They develop

 8    sleeping disorders, and have difficulty in communication with everyone

 9    except those persons who were with them during their trauma.  And finally,

10    a third cluster of symptoms or a fourth group.  So first we describe the

11    stressor and then three clusters, and the fourth cluster of symptoms are

12    the so-called symptoms of evasion.  The person will try to evade anything

13    that is linked to the stressor.  They will try not to go to the same

14    street that reminds them of the event.  They will try to avoid people that

15    they have not identified with them -- that they have not identified with

16    and were with them during this event.  They will not wear the same clothes

17    they wore during the event, and they will not have anything to do with

18    anything that reminds them of that event.  If the event took place in a

19    room in their apartment, they will avoid going into that room.  So these

20    are three clusters of symptoms that are specific for post-traumatic stress

21    disorders and for the stressor factor.

22            In the American classification, unlike European one, there is

23    another one, another factor, that people become unable to work or

24    partially unable to work after the event.  They have difficulty

25    concentrating.  They have difficulty sitting for eight hours in the same

Page 4436












12   Blank page inserted to ensure pagination corresponds between the French and

13   English transcripts.













Page 4437

 1    area.  They have difficulty carrying out their tasks, and based on the

 2    experience of Vietnam veterans, American science developed these factors

 3    whereas they are not accepted in the European modern science.

 4       Q.   Doctor, would it be significant if the person, or Mr. Vasiljevic

 5    in this case, if he maintained a close relationship with one of the people

 6    who committed the killing of the people that he witnessed, would the fact

 7    that he committed -- or maintained a close relationship in the subsequent

 8    years indicate to you that his -- any mental illness he suffered was not

 9    of a reactive type?

10       A.   Well, actually, yes.  Although I cannot assert this with 100 per

11    cent certainty because this is one of the symptoms that should be

12    present.  If I found it in the subject and if we had time to do an

13    experiment, then this would be very significant.  However, I did not see

14    any signs of the existence of PTSD in the subject so I would not expect

15    him to have this symptom, but had he had PTSD, then this would be a very

16    important factor in establishing this.

17       Q.   Doctor, based upon your experience as an expert for the courts of

18    Yugoslavia, would a report such as Dr. Lopicic's which -- absent a

19    specific diagnosis and absent an inclusion in that report of the symptoms

20    supporting that diagnosis, in your experience, would such a report have

21    been used as a basis by the courts of Yugoslavia to determine that a

22    person accused of a crime had significantly diminished accountability or

23    was incompetent?

24       A.   It is my opinion that the doctor would have to add to her opinion

25    and answer the questions concerning the diagnosis, and on the basis of

Page 4438

 1    what diagnosis she had reached, her assessment of diminished

 2    accountability or incompetence.

 3       Q.   Absent doing that, would it be -- would the report be accepted for

 4    a finding of accountability?

 5       A.   I think not.

 6       Q.   Now, I want to ask you some specific questions regarding some of

 7    Dr. Lopicic's testimony.  In one portion of her testimony, she

 8    described a pre-psychotic period in which she believed that somebody would

 9    not be or may not be accountable under Yugoslavian law.  Have you ever

10    heard of this pre-psychotic period and, if so, can you describe for us its

11    role or definition under Yugoslav law?

12       A.   A pre-psychotic period is not a term that is used in forensic

13    psychiatry but it is used in psychiatric practice.  This is a situation in

14    which a person does not meet the criteria for a psychosis but some of the

15    potential symptoms may be present.  What is important, however, is that a

16    pre-psychotic period is not psychotic.  That is how it is in practice.

17    When one symptom is psychotic, which means that the patient does not test

18    reality, then the patient is psychotic.  As a rule, we say that a

19    pre-psychotic period is a period when a person who is at high risk and who

20    is undergoing any sort of psychological difficulty.  In the case of

21    Mr. Vasiljevic, we could speak of a pre-psychotic period because he is a

22    high risk person, and the psychosis may be expected.  However, this is not

23    a psychosis, and in that case, it must be stated precisely on the basis of

24    what symptom or sign a certain period has been labelled pre-psychotic.

25    What is important to say is that a pre-psychotic period is not a psychotic

Page 4439

 1    period.  Its very name tells us that.

 2       Q.   In your experience, has a court in Yugoslavia ever made a finding

 3    that somebody's accountability was significantly diminished or incompetent

 4    because at the time of a crime, they were in a pre-psychotic stage?

 5       A.   I have no such experience.

 6       Q.   Doctor, I want to read a portion of Dr. Lopicic's testimony in

 7    which she describes some of the symptoms that Mr. Vasiljevic described for

 8    her, and it was the first time he had described these symptoms to anyone,

 9    and I will read that portion and I will ask you to comment on those

10    symptoms.  And I'm reading from the transcript from the 9th, and it's page

11    100, the middle of the page:  What I obtained from the interview with the

12    patient and that is certain changes in the thinking process.  This is some

13    unclear psychopathology where he had exaggerated ideas about the

14    significance of, shall we say, birds.  If he sees a crow, it's a bad

15    omen.  If he sees a dove, it's a good sign.  And this, these various

16    actions of his, could be attributed to this paranoid disorder, like he

17    said that he could communicate with his wife subconsciously.  So this is

18    what I attribute to provoking these reactions on his part.

19            There are two symptoms mentioned in here which are not discussed

20    in the report.  One is the significance of the different coloured birds

21    and one is his ability to communicate with his wife subconsciously.

22    Assuming that he did, in fact, suffer those symptoms at the relevant

23    period here, would you please comment on their significance?

24       A.   The subject told me also about those symptoms.  He told me that

25    this would happen to him and that he was very afraid because of this

Page 4440

 1    during his stay in hospital.  I asked him when this happened, and he told

 2    me that he experienced this during his hospital treatment.  The

 3    communication with his wife, the feeling of confusion, and this whole

 4    state was something that fitted in with the delirium that he went through

 5    in hospital.  When I asked him what happened before that, what symptoms he

 6    had before that, he only spoke of fear.  His memory of the delirium is

 7    unclear, and his interpretation of it is confused.  Within this context, I

 8    recognised this as part of his delirium.

 9       Q.   Did you find any evidence in your conversations with him that the

10    symptoms existed prior to his hospitalisation?

11       A.   No.

12       Q.   There is another symptom that he told Dr. Lopicic about, and I'm

13    quoting from the record, the urge to blink involuntarily, and then when

14    she described this, she said, "This can be a symptom whereby he was

15    relieving himself of fear."  I'd ask you to comment on that symptom, if

16    you would.

17            I'm sorry, let me just give you one more piece of information.

18    His interpretation of blinking was as follows:  If he blinked and it was

19    dark when he blinked, somebody would get killed.

20       A.   The subject also spoke to me about this.  I understood this as him

21    seeing sparks in front of his eyes, and this is a frequent sign of

22    delirium tremens.  We call these flashes.  Of course, a person who is

23    undergoing a psychosis may have different explanations for this but this

24    is a relatively frequent symptom.  We have pins and needles, we have

25    something that our patients describe as seeing stars in front of their

Page 4441

 1    eyes, little stars, and this fits in fully with the picture of delirium.

 2    If he experienced something like this, and he most probably did, then his

 3    explanation of it while in a state of psychosis might be different.

 4       Q.   And of what significance is the meaning that he attributed to this

 5    so that if it was dark, somebody may be getting killed somewhere?

 6       A.   Well, you see, I do not wish to go on to the interpretation of

 7    this.  The gentleman certainly has his cultural habits.  We have students

 8    -- if we were to say that every student who found a four leaf clover

 9    before taking an exam is psychotic, we would be wrong.  If they were to

10    give an exaggerated importance to this, we might call it psychotic, but I

11    see nothing here that would depart from psychosis, which I believe he had,

12    and certain beliefs which I cannot go into now, because it's hard for me

13    to say.  Every milieu, every community has its cultural beliefs, which

14    perhaps we will not admit to believing, but if someone is in a state of

15    psychosis and also in a state of fear, every situation, everything that

16    happens requires an explanation.  So in my view, his explanations fit in

17    fully with the situation he was in and the state he was in.

18       Q.   Doctor, what would you -- or what significance would you attribute

19    to the fact that at the time of his hospitalisation in the psychiatric

20    ward, he was receiving neuroleptics?

21       A.   In an agitated state, we have to give strong medication.  If they

22    did not have strong Bensodiazepins, and they probably didn't because we

23    didn't have them in Croatia either at that time, and if our colleagues who

24    testified before me said that they were short of medicines, I myself might

25    use some of the medicines administered by that colleague in such a

Page 4442

 1    situation.

 2       Q.   Doctor, could I ask you to perhaps write down "Bensodiazepin"

 3    on a piece of paper and put it on the ELMO so that we can spell it out for

 4    the transcript writers?

 5       A.   [Writes]

 6       Q.   That would be B-e-n-s-o-d-i-a-z-e-p-i-n; is that correct?

 7       A.   Absolutely.

 8       Q.   Now, Doctor, are you saying that a person suffering delirium to

 9    the extent that Mr. Vasiljevic was suffering it, that the preferred drug

10    therapy would have been to have given him Bensodiazepin; is that correct?

11       A.   Yes, yes.

12       Q.   At this time, in your practice in Croatia, are you saying that

13    this particular medication was unavailable to you in Croatia?

14       A.   Very often, very often, it was unavailable.

15       Q.   And would a neuroleptic drug help you achieve some of the same

16    desired results as Bensodiazepin?

17       A.   Certainly, yes.

18       Q.   One of the other assertions that Dr. Lopicic made, and I would

19    like to get your opinion regarding it, she said that alcoholism could mask

20    the outbreak of a possible affective or schizophrenic disorder in the

21    accused.  What is your opinion regarding that assertion?

22       A.   The claim is acceptable at a layman's level.  In the culture of

23    the former Yugoslavia, it was felt to be shameful to be mentally ill, and

24    some families, whether they saw that a person was psychotic or odd, would

25    give that person alcohol because they were not ashamed of having an

Page 4443

 1    alcoholic in the family but they were ashamed of having a mentally ill

 2    person in the family.  So the masking of mental illness by alcoholism is

 3    acceptable for a time, for a layperson, but alcoholism does not treat the

 4    disease.  It can mask the psychotic behaviour of a person but it does not

 5    cure the person, and this would vary.  But someone who had a steady job,

 6    someone who did not spend their life on a farm in the field but working

 7    with people, would not find this a long-term solution, not for more than a

 8    year.

 9       Q.   Doctor, I want to take you back to the admission of Mr.

10    Vasiljevic, and Dr. Jovicevic's observation of him, and put the question

11    to you, could the fact that he had alcohol that day have masked the

12    symptoms of psychosis and made it impossible for Dr. Jovicevic to

13    recognise that he was psychotic at that time?

14       A.   No, no, for two reasons, in my opinion.  The first reason is that

15    the doctor, the orthopaedist, did not write down that the patient was

16    drunk and he would certainly have done so if he had observed it, not just

17    for the patient's sake but for his own sake.  He was about to operate on

18    him, and if there were any complications, it would have been very

19    important for him to have written down that the patient was inebriated.

20            Secondly, a state of intoxication would not change psychotic

21    symptoms, and if he asked him something to do with orientation, he would

22    have recognised the symptoms even had the patient been drunk.

23       Q.   I want to put another statement that Dr. Lopicic made to you and

24    ask for your comment, and I'm reading from the record of the 9th on page

25    79:  "I had the feeling that this simply was not just a delirium tremens

Page 4444

 1    but a much stronger psychosis as a result of certain pathological

 2    potential he carries inside."

 3       A.   I am unable to interpret the meaning of this sentence, because

 4    delirium tremens has such a wealth of symptoms and it is so strong that I

 5    do not know what could be stronger.  It is hard for me to imagine what the

 6    doctor could have been referring to.

 7       Q.   Now, when asked to fix the point in time when Mr. Vasiljevic

 8    became significantly -- had significantly diminished accountability for

 9    his acts, the doctor fixed it at a time, and I will read, "Before he went

10    to prison.  This act of imprisonment is a moment when his behaviour

11    significantly changed."  And this is prison back in the beginning of June,

12    1992.  Can I ask for your comments on that assertion?

13       A.   It is hard for to us say when it started if we have no documents.

14    We have a doctor's diagnosis here.  For us doctors, this is a document.  I

15    really could not say that one's accountability changed as a result of

16    psychic illness in the period when these two descriptions were given

17    and my colleague and I wrote down nearly the same description of what

18    Mr. Vasiljevic told us about his experience on the Drina.  There was not

19    a single word or sentence that would indicate a psychotic disorder in that

20    period.  It is hard for me to put all these days in chronological order

21    but

22    his description of the shooting on the Drina is a description given by a

23    man who was not mentally ill at the time.

24       Q.   Doctor, finally, I'd ask you, there is a drawing or diagram which

25    summarises your testimony.  I'd ask you to place that on the ELMO and if

Page 4445

 1    you would please describe that for us.

 2       A.   On this diagram, we can see that the subject was born in 1954,

 3    that his childhood and adolescence was not significantly different from

 4    that of his peers.  He had some crises when he went to school outside

 5    Visegrad, when a stepmother entered his house.  This was a small crisis

 6    because he describes her as a good woman, but up to 1973, we find no

 7    relevant information pointing to a disorder.

 8            In 1973, the subject started working and started drinking.  This

 9    is the beginning of his phase of alcoholism which, after a certain period,

10    assumed a stronger form, and he can be diagnosed as suffering from chronic

11    alcoholism.  And this has been marked until the year 2000 or 2002, because

12    we view alcoholism as a life diagnosis although we know that the gentleman

13    has not been drinking in prison and probably just before going to prison,

14    but we call this alcoholism in remission, alcoholism without alcohol.

15            The period which we describe as existing after he broke his leg

16    and was admitted to the orthopaedic ward, where there was a certain

17    abstinence from alcohol, this is the period where, in my view, he

18    developed the picture of alcoholic delirium due to abstinence or due to

19    illness and the operation.  This is the period I consider to be the period

20    of delirium, or let us call it a psychotic state, and this lasted probably

21    until the date of his discharge from hospital, and this is the period in

22    which I consider him to have been not accountable.

23            MR. GROOME:  Thank you, Doctor.  I have no further questions, Your

24    Honour.

25            JUDGE HUNT:  Mr. Domazet?

Page 4446

 1                          Cross-examined by Mr. Domazet:

 2            MR. DOMAZET:  Thank you, Your Honour.

 3       Q.   [Interpretation] Good day.

 4       A.   Good day.

 5       Q.   My name is Vladimir Domazet and I will put question to you as the

 6    lead Defence counsel for Mitar Vasiljevic in these proceedings.  What you

 7    have just said to Mr. Groome, referring to the period, I think you said

 8    that he was not aware of his acts during his hospital treatment, but you

 9    said that this also depends on the crime in question.  In your view, was

10    the significance of this such that regardless of the kind of crime

11    involved, he was not accountable under the law?

12       A.   You have put a very good question to me, because when evaluating

13    accountability, we have to know what crime is involved, because

14    accountability is not the same regardless of the crime.  However, the

15    state of the subject a few days before the admission was so strong that he

16    was not accountable even for the elementary acts he committed or whatever

17    he did.  Whatever he did in that period, he would very likely have been

18    held not accountable or minimally accountable.  We -- if we are in a

19    dilemma, we always tended to give the higher level of non-accountability.

20    He was confused.  He did a number of things that were foreign to his usual

21    behaviour, and in general, we can say that in that period, whatever he

22    did, whether he committed crimes or did anything else, he was not

23    accountable.  In psychiatric terms, he was simply not testing reality.

24       Q.   Thank you.  I would now like to start from the beginning.  You

25    have submitted a written analysis of all these illnesses and given us a

Page 4447

 1    classification, but before I put questions to you about some of these

 2    matters, I will ask you about something else you touched upon and which I

 3    believe is significant.  I would like you to expand upon it.  You said,

 4    and you may have noticed that Dr. Lopicic also said this, you said

 5    something about the meaning of clinical psychologist and that this is an

 6    additional factor in an examination of this kind.  You talked about

 7    psychological tests, clinical psychological tests, and you said that you

 8    decided that this was not necessary and you supported this with reasons.

 9    If the structure of a personality can be better determined by this, for a

10    person accused of very serious crimes, do you not feel that in this case,

11    it would have been better for a clinical psychologist to also produce

12    findings?

13       A.   I fully agree with you, and before I started my expert opinion, I

14    asked the Court who would be doing the psychological testing or rather

15    whether it would be done, because in the countries of the former

16    Yugoslavia, it was usual before a psychiatrist even started working,

17    psychological testing would be carried out.  The reply I received was,

18    no.  Then I said immediately that if there was something that I found

19    doubtful, I would draw attention to it.  During my work, however, I had no

20    diagnostic dilemmas.  However, I still agree that a psychologist would be

21    able to give a much better description of the structure of the personality

22    and its defence mechanism than I or my colleague have given.

23       Q.   In spite of this, you, yourself, did some of these tests.  One of

24    them, if I'm not mistaken, was similar to the one given by Dr. Lopicic to

25    do with alcoholism but you also performed some other tests.  You said that

Page 4448

 1    the first one produced identical results so I will not go into it but as

 2    for the others, since we cannot see from the opinion what was established

 3    by them, I would like to ask you to comment on them, to comment your

 4    results.

 5       A.   Thank you.  In the sources I listed, the methods I used, and I

 6    even submitted these findings for translation, and I also have some

 7    materials here that I photocopied and I can show them to you.  The test I

 8    discussed, I will put it on the ELMO here.  This is one of the tests used

 9    both by psychologists and psychiatrists.  I administered this test to

10    Mr. Vasiljevic and there are these triangles here and Mr. Vasiljevic had

11    to copy them, and I will show you a positive result there, a satisfactory

12    result, meaning that the images were identical, they had an identical

13    number of lines and angles and that none -- none of the angles were

14    sticking out.  This is a satisfactory result and this is one of the more

15    complicated tests.  Mr. Vasiljevic wrote down here -- I wanted to see

16    whether he could distinguish between abstract and specific concepts.  And

17    Mr. Vasiljevic said that he would be happy if he left the prison as an

18    innocent man.  I also asked him about something that I --

19            JUDGE HUNT:  Just a moment, Doctor, what was the writing on the

20    bottom of that?  Was that yours or his?  That diagram you showed us.

21            THE WITNESS: [Interpretation] This is what Mr. Vasiljevic wrote.

22            JUDGE HUNT:  And can you just read the precise words or at least

23    translate them?  You read them and they will be translated for us.

24            THE WITNESS: [Interpretation] Yes, I will.  "To leave prison as

25    an innocent man."

Page 4449

 1            JUDGE HUNT:  Thank you.  Just keep them to one side because I

 2    think they will have to be marked in some way as evidence in the case.

 3    You have some more of those, do you?

 4            THE WITNESS: [Interpretation] I enclosed these pages together with

 5    my opinion.  However, I could leave this to you.  I don't need this any

 6    more.

 7            JUDGE HUNT:  We are just checking to see whether we've got the

 8    originals, Doctor.

 9            THE WITNESS: [Interpretation] This is actually the only original

10    done by Mr. Vasiljevic and the rest are his answers to questions put to

11    him.  So this is what he did by his own hand.  He copied this and he wrote

12    this, and the rest is my taking down of his answers.  For example, 100

13    minus 7 is 93, and so on.  And then I measured the speed.  And this is how

14    this is done.  The other questions were, for example, can you explain to

15    me what happiness is?  I offered him five abstract and five concrete

16    concepts that he had to define for me and I wrote it down myself, whereas

17    the other ones is something that he wrote himself.

18            JUDGE HUNT:  Just wait a moment, Mr. Domazet while we find out

19    whether we have got the original document.

20            MR. GROOME:  I've just checked with both of my assistants and

21    nobody knows about the documents.

22            JUDGE HUNT:  I'm sorry, I'm interrupting you and causing trouble

23    for the interpreters.  I got into trouble last week for that.  Doctor,

24    could we borrow the document you showed us on the ELMO?  We'll get a copy

25    made of it and we'll give you the original back.

Page 4450

 1            THE WITNESS: [Interpretation] I don't need the originals.  I only

 2    have copies but I have two sets of it.

 3            JUDGE HUNT:  We'll give it back to you shortly.  You proceed,

 4    Mr. Domazet.

 5            MR. DOMAZET:  Thank you, Your Honour.

 6       Q.   [Interpretation] If I understood you well, Madam, as you said,

 7    this was the only original that Mr. Vasiljevic wrote down himself, and the

 8    rest are your tests or tests that contained only his replies.  So these

 9    other ones, did you also enclose them with your opinion or not?

10       A.   I enclosed everything.

11       Q.   So you believe that this should be part of the opinion?

12       A.   Well, this is how we normally do it.  There is no reason to do it

13    otherwise.  The second part of Hamilton's test is the one where I went

14    through questions to see what his answers were and the results were

15    negative, but, however, I think that that needs to be filed.

16       Q.   Well, I asked you because it is obvious that we don't have those

17    papers and it seems that we will be provided them at a later stage.  I am

18    also interested in this and this is something that I did not receive

19    together with the opinion because apparently it was subsequently sent.

20    Could you tell us, briefly, what were the results of those tests according

21    to you?

22       A.   None of the findings showed anything pathological except for the

23    tests for alcoholism.

24       Q.   Another examination was suggested by Dr. Lopicic for possible

25    brain damage which she believed was possible in Mr. Vasiljevic in view of

Page 4451

 1    the long duration of his alcoholism and his general condition.  I think

 2    that professionally this is called EEG or something like that.  So do you

 3    believe that it was necessary to run such a test or could this be

 4    determined by other means?

 5       A.   Well, it is very difficult for me to give an answer to that.

 6    Routinely speaking, an EEG would have its justification but my colleague

 7    and I, prior to signing our opinion, did not require this.  Had we

 8    considered this to be essential, we probably would have said to the Court

 9    so.  I don't think that we would obtain a result that would differ greatly

10    from one within normal limits.  Based on my long clinical experience, I

11    don't expect that such a test would give us anything new.

12       Q.   Well, do I understand you well when you say that you would not

13    expect this to find anything new, you basically don't expect this to show

14    any pathology?

15       A.   Yes, I don't expect this to show any pathology.

16       Q.   When you talked about alcoholism, tipsiness and intoxication in

17    the beginning, you said at one point that you believed that a level of 100

18    is needed.  I assume that you meant 1 per mil or above.  Since this is a

19    very technical issue, could you please tell us in practical terms how much

20    would a person need to drink in order to reach this level?  We know that

21    , theoretically speaking, when it comes to hard liquor, a certain amount

22    is needed to reach this level.

23       A.   Well, this would correspond to two or three drinks of hard

24    liquor.  It also depends on the amount of food consumed, on the duration

25    of alcohol consummation and also on the amount of fluids taken by the

Page 4452

 1    person.

 2            JUDGE HUNT:  Doctor, because you and Mr. Domazet are both speaking

 3    the same language, it's very difficult for the interpreters unless you

 4    pause at the end of the question before you answer it.  So please, if you

 5    could remember to do so.

 6            THE WITNESS: [Interpretation] I apologise.

 7            MR. DOMAZET: [Interpretation]

 8       Q.   When you said two or three drinks of liquor, Madam, you probably

 9    meant the usual glasses in which liquor is served.  Did you have in mind

10    0.3 or 0.5 decilitres?

11       A.   0.3.

12       Q.   I'm waiting to ensure that your answer has been recorded in the

13    transcript.  Madam, when you said that it also depended on whether the

14    person ate enough food or drank sufficient amount of fluids, you probably

15    meant in the period during which the concentration would reach its highest

16    level.  So when a person is not eating, this concentration can reach its

17    highest level quite quickly, in half an hour or an hour, and it is quite

18    different if the person is eating.  However, the final level is always the

19    same, it just differs as to the amount of time needed to reach that level,

20    isn't that so?

21       A.   Yes.

22       Q.   Madam, on page 5 of your findings, the ones I received today,

23    where you explained two kinds of psychosis --

24       A.   Which one do you have in mind, the Croatian or English version?

25       Q.   I don't mean your opinion.  I meant the material that was enclosed

Page 4453

 1    together with your CV.  When you discuss affective psychosis and its two

 2    types, manic and depressed psychosis, you described how the patients who

 3    have manic psychosis look, and you also said that a layman would easily

 4    recognise such a person based on their behaviour, also the way they

 5    dressed themselves and act and so on.  Did I understand you well?

 6       A.   Yes, you did.

 7       Q.   My question is the following one:  Is this true of everyone who

 8    suffers from this psychosis or is it true for most of them and can

 9    everyone be considered to have this illness based on this type of

10    behaviour?  Or let me put it differently:  Would it be possible for

11    somebody to have this illness, yet behave in a different manner?

12       A.   Well, this is what I can reply.  If a person suffers from manic

13    psychosis and has not been treated, then the person will behave in a way

14    described by me and you just now.  A person with this diagnosis and who is

15    treated or is in remission can act in a different way as well, and not

16    show these drastic symptoms.

17       Q.   When you discussed the paragraph B(2), which is exogenous or

18    symptomatic psychosis, you mentioned that this was not a life diagnosis,

19    if I remember well.

20       A.   Yes, you do.

21       Q.   Does this mean that these are illnesses that can emerge and then

22    disappear and that this is why you believe them not to be a life

23    diagnosis?  Or what do you mean under life diagnosis?

24       A.   Just what you said.  This illness can emerge and then disappear.

25    It has its cause, its duration, and its cessation.  For example, if

Page 4454












12   Blank page inserted to ensure pagination corresponds between the French and

13   English transcripts.













Page 4455

 1    Mr. Vasiljevic never drank again, he would never experience delirium again

 2    if his delirium was caused by alcohol abstinence.

 3       Q.   So when we are talking about alcoholic psychosis, you said that it

 4    would be possible for a person to be free of this illness in future?

 5       A.   Yes.  And this is what life diagnosis means.

 6       Q.   I think that you also spoke about treatment and duration of

 7    treatment, of successful one.  You mentioned six months.  Did you mean

 8    hospital treatment or perhaps outpatient treatment, and is this a

 9    successful way to treat such illnesses?

10       A.   It doesn't needs to be hospital treatment, but we need to have an

11    intensive pharmacotherapy that can be done on an outpatient basis, and

12    what is most important is a very strict alcohol abstinence.

13       Q.   Since one of your final conclusions was that Mr. Vasiljevic could

14    have possibly had an alcoholic psychosis, is this consistent with the fact

15    that he's been here for two years, has not suffered any crises, so could

16    it be possible that this illness, if he ever had it, has completely

17    disappeared?

18       A.   Yes, that's right.

19       Q.   Madam, when you spoke about delirium, and this is paragraph

20    2(B)(2) -- B(2)(B), you discussed the duration needed for it and you said

21    it was a very dangerous medical condition.  And you said that even a

22    layman could easily recognise this condition.

23       A.   A layman would not necessarily say that it was a delirium but

24    would be able to see that the patient is disturbed.

25       Q.   I omitted to ask you, in the beginning, you described in detail

Page 4456

 1    the court material, and other materials used in your work, and I saw that

 2    you also read the transcript and the findings of Dr. Lopicic.  However, I

 3    did not understand whether you had an opportunity to read the transcript,

 4    containing the testimonies of witnesses heard here, namely doctors from

 5    Uzice hospital who worked at the psychiatric ward in the Uzice hospital at

 6    the time when Mr. Vasiljevic was treated?

 7       A.   Yes.  I was given some transcripts way back and some were given to

 8    me just now.

 9       Q.   I would like to ask you whether you saw in their testimonies - and

10    here I mean Dr. Simic, who was a treating doctor of Mr. Vasiljevic, then

11    Dr. Jevtovic, who was responsible for treatment, and Dr. Martinovic - all

12    of whom said the same, that they did not recognise the signs of delirium

13    and said that the behaviour exhibited at the time did not have elements

14    that are typical for delirium.  Were you able to see that in the

15    transcript?

16       A.   Well, they said that tremour was not listed anywhere, and I agree

17    with this, and precisely this lack of tremour indication, at least a

18    direct one, albeit there is an indication of a pre-delirious state, there

19    is the reason that I on purpose did not speak of delirium tremens later on

20    as a definite diagnosis but rather spoke of delirium caused by a surgical

21    intervention and not only alcohol abstinence.  I also allowed the

22    possibility of an alcoholic psychosis, because I did not establish

23    diagnosis based on my findings but based on findings received from other

24    experts, none of whom were certain of diagnosis because they diagnosed him

25    as having 298.  So this is not something that I can use to give a specific

Page 4457

 1    diagnosis, but instead of that, I, in a very detailed manner, demonstrated

 2    the dilemma that I as an expert faced, and I listed all the things that --

 3    all the diagnoses that were possible in this case.

 4       Q.   So if I understand you well, these testimonies also influenced

 5    your findings, and due to them, you allowed for the possibility that this

 6    was an alcoholic psychosis and not necessarily delirium.  So I understood

 7    you; is this so?

 8       A.   Yes.

 9       Q.   In paragraph before, when you spoke of alcoholism and acute

10    alcoholism, you mentioned consequences and liver damage.  Is this

11    something that you were able to discern based on lab results and the

12    results describing liver function, all of which was caused by long-term

13    alcohol abuse?

14       A.   Yes.

15       Q.   When you spoke of basic principles which are applied when meeting

16    every new patient, as far as anamnesis is concerned, this is exactly the

17    method you followed in the case of Mr. Vasiljevic, didn't you?

18       A.   Yes.

19       Q.   Paragraph 2, heteroanamnesis is something that you could not

20    directly verify, but I guess that all the material that -- all the

21    supporting material that you had at your disposal is something that helped

22    you compile this; isn't that right?

23       A.   Yes.

24       Q.   When talking of illnesses listed by you under Roman numeral VII,

25    you also said -- you explained why you believed that Mr. Vasiljevic did

Page 4458

 1    not have schizophrenia and paranoid psychosis.  However, did you perhaps

 2    notice that in the statements of Dr. Simic and Dr. Vasiljevic, they

 3    allowed for the possibility of a manic psychosis based on their

 4    observations, so they mentioned the symptoms of manic psychosis as well?

 5       A.   Yes.  I've read that, but unfortunately, those doctors did not

 6    list symptoms.  They simply gave a diagnosis without corroborating it with

 7    symptoms.

 8       Q.   So you believe that it would be impossible to verify this without

 9    specific facts?

10       A.   Yes.

11       Q.   However, you've mentioned Dr. Stojkovic as someone whose report

12    you have read, and his entry in the medical history of Mr. Vasiljevic, and

13    you also mentioned that he wrote in his history, "Pre-delirious state."

14    You probably saw that Dr. Stojkovic was an orthopaedist, not a

15    psychiatrist.  What I'm interested here is this doctor probably was able

16    to assess certain signs, but would it be medically correct to discharge a

17    patient who is believed to be in this condition, or to promise this

18    patient that he would be discharged?  This is information that we found in

19    this document.

20       A.   I did not see that this doctor, orthopaedist, discharged him from

21    the hospital.  However, usually, when patients are transferred from one

22    ward to another, the entry made in their medical history usually says,

23    "Discharged from the orthopaedic ward."  So the way I interpreted this is

24    that orthopaedist wrote that Mr. Vasiljevic was discharged from the

25    orthopaedic ward and transferred to the psychiatric one.

Page 4459

 1       Q.   You probably don't have it before you, but this doctor even

 2    mentioned that a discharge letter had been written but that the patient

 3    did not go home.  We can't know what this doctor meant at the time but you

 4    believe this not to be a situation where the patient was discharged to go

 5    home but was rather transferred to another ward?

 6       A.   Yes, I believe that to be the case.

 7            JUDGE HUNT:  Just before we adjourn, that diagram drawn by the

 8    accused, that should be shall be Exhibit P168.2.  That's the one which

 9    the doctor produced a short time ago.

10            Well, Mr. Groome, your hopes have been dashed, I'm afraid, but

11    we obviously should finish tomorrow, don't you think?

12            MR. GROOME:  Certainly, Your Honour.

13            JUDGE HUNT:  There is no point in us, as I announced on Friday,

14    sitting an extra hour and putting everybody's resources under strain.  So

15    we will adjourn now until tomorrow at 9.30.

16            MR. GROOME:  Just one quick matter.  Just to let the Court know

17    the Prosecution will be applying for protective measures for the next two

18    witnesses, so perhaps first thing tomorrow morning or whenever it's

19    convenient for the Court, we can address that matter.

20            JUDGE HUNT:  If you just produce a document with the orders

21    sought, if there is some opposition to it, then you can let us know the

22    basis for it.

23            MR. GROOME:  Thank you, Your Honour.

24            THE WITNESS: [Interpretation] I apologise.  I have to leave

25    tomorrow.  I have some pressing business in Zagreb and I didn't count on

Page 4460

 1    staying longer.  Unfortunately, I cannot stay longer.

 2            JUDGE HUNT:  What time do you have to leave tomorrow, Doctor?

 3            THE WITNESS: [Interpretation] My plane leaves at 11.20 from

 4    Amsterdam.

 5            JUDGE HUNT:  You have to book in at least an hour ahead for a

 6    continental flight.  That puts a great deal of pressure on it.  It's all

 7    right, Doctor, we understand the problem.  Is there no later plane you

 8    can catch to still keep up with those commitment?

 9            THE WITNESS: [Interpretation] Unfortunately, not.

10            JUDGE HUNT:  Well, I think the only thing to do, then, is to

11    appeal to the interpreters and the court reporters to see whether we can

12    take that extra hour.  Is there any problem?

13            THE INTERPRETER:  The interpreters agree to stay for an extra

14    hour.

15            JUDGE HUNT:  The court reporters?  All right.  We will adjourn for

16    half an hour and resume at 4.30.

17                          --- Recess taken at 4.03 p.m.

18                           --- On resuming at 4.30 p.m.

19            JUDGE HUNT:  Mr. Domazet, I don't want to place any pressure upon

20    you at all, but have you got some idea of how long you'll need for your

21    cross-examination?

22            MR. DOMAZET: [Interpretation] Your Honour, in view of this

23    situation, I do not wish Mrs. Folnegovic to have problems.  I have

24    shortened and reduced my questions and I believe we shall be finished

25    before the end of the session today, the extended session.

Page 4461

 1            JUDGE HUNT:  Well, as I say, I don't want to put any pressure on

 2    you.  If you need more time, please say so.

 3            MR. DOMAZET:  No, thank you, it's no pressure.

 4            JUDGE HUNT:  You go ahead.

 5            MR. DOMAZET: [Interpretation]

 6       Q.   Madam, when you spoke of a period for which you believe you have

 7    reliable proof, and that was the 4th and the 5th of July, you identified

 8    this period according to the notes of Dr. Stojkovic, and this is probably

 9    the basis upon which you take this time as certain, in view of his

10    situation, his state at the time.  Do you have any information that he

11    caused similar incidents earlier or, rather, he had -- he caused such

12    incident earlier, and had this been recorded, would this have changed your

13    opinion as to the time period?

14       A.   I will give you a precise answer.  I cannot personally ascertain

15    the date.  It is based exclusively on the data I found in the case history

16    for the third hospitalisation of Mr. Vasiljevic.

17       Q.   When you spoke of doctors in general and said that all doctors,

18    once they graduate from medical school become general practitioners, which

19    is certainly true, but for the sake of all the people in this courtroom

20    who do not know of the practice in former Yugoslavia, is it not true that

21    there are doctors who specialize in general practice?

22       A.   That is correct.  I do not know when the specialisation in general

23    practice started in the former Yugoslavia.  It has not existed forever,

24    but it did start at some point.  I don't know when exactly.  However, it

25    is true that in every country of the former Yugoslavia, there is a

Page 4462

 1    specialization in general practice.

 2       Q.   To the question concerning fear, the fear Mitar Vasiljevic felt

 3    for certain -- for various reasons because of the wartime situation,

 4    because of his own situation, the situation of his family, I think you

 5    said that people experience fear differently, but the fear he could have

 6    had, I think you put in a category of normal fear, normal for the time,

 7    that is for wartime; is that correct?

 8       A.   Yes.

 9       Q.   However, when speaking of what preceded his detention in Uzamnica,

10    in Visegrad, and what Dr. Vasiljevic said, and what formed the basis for

11    the conclusions of Dr. Lopicic, some of her conclusions, you said, on the

12    one hand, that it was less likely that a doctor would miss something like

13    this.  But before I ask you about this, let me ask you, do you think that

14    he could have been suffering from greater fear if he was in detention

15    because he had returned his weapon and refused to go to the front line, so

16    he was risking serious punishment, even the most serious punishment?

17    Could that have affected his fear at the time?

18       A.   It could have intensified his fear.

19       Q.   Your assessment of Dr. Vasiljevic's method, and you mentioned that

20    he was a relative but he's a distant relative so he had no close relations

21    with the family, so he couldn't know much about the family as a doctor.

22    He was a general practitioner.  However, you say that as a doctor, in such

23    a situation, he would have had to ask for him to be hospitalised.  When

24    you said this, were you aware of the fact that Mitar Vasiljevic was in

25    prison and that this was not a real prison but an improvised prison,

Page 4463

 1    because there was no prison in Visegrad and the detention facility was in

 2    the former barracks and it would have been impossible for him to be

 3    transferred to the hospital and released from prison based on a doctor's

 4    order?

 5       A.   If you are asking me what I would have done and what in my view

 6    was the doctor's duty, it was his duty to write down that he should be

 7    hospitalised and to tell those in charge to call an ambulance because he

 8    would not only be helping the patient in this way but taking the

 9    responsibility off his own shoulders.  So it was his duty to write down

10    that the patient had to be hospitalised urgently.

11            JUDGE HUNT:  Mr. Domazet, I don't recall any evidence about that,

12    the state of the prison in Visegrad.  It probably isn't important, bearing

13    in mind the answer which has been given, but if you want to rely upon that

14    fact, you may have to give evidence about it.  I've pointed this out

15    before.  A question is not in itself evidence.  It's the answer which is

16    evidence.

17            MR. DOMAZET: [Interpretation] Your Honour, I remember asking

18    witnesses from Visegrad whether Visegrad had a prison or not, and the

19    replies were that there was no prison in Visegrad but that there was one

20    in Foca and that Uzamnica was a temporary prison at that time.  I can find

21    this in the transcripts.  We asked people from Visegrad this question.

22    However --

23            JUDGE HUNT:  I accept what you say, Mr. Domazet, about the

24    evidence.  But that still doesn't include the description you've given of

25    it.  As I say, it probably isn't necessary for you to worry about it.  I

Page 4464

 1    do get very worried, however, when counsel start asserting evidence from

 2    the bar table.

 3            MR. DOMAZET: [Interpretation]

 4       Q.   Speaking of heredity, and quite a lot has been said about it

 5    today, you spoke of the possibility that persons could inherit or not

 6    inherit a disorder from their ancestors.  You gave us some percentages as

 7    to the likelihood.  However, did I understand you well when you said that

 8    someone can either be ill or absolutely healthy, that it was not possible

 9    for someone to have some sort of consequences but not the same as his

10    ancestor had?  Did I understand you correctly?

11       A.   Modern psychiatry holds this view, that an illness is either

12    inherited or not inherited.  We are speaking within the framework of a

13    diagnosis.  In order to say that an illness exists, it has to meet the

14    required criteria which define the illness.

15       Q.   You saw that Dr. Lopicic broke her report into two -- into three

16    elements, heredity, alcohol and stress, and you seem to be referring to

17    the same factors, but you either give less importance to the first and

18    third factors, or you feel that, in this case, they are less important in

19    relation to the importance attached to them by Dr. Lopicic?

20       A.   That is correct.

21       Q.   So the factors are the same but the interpretation of their

22    significance in this particular case differs; is that right?

23       A.   Yes.

24       Q.   Dr. Simic and Dr. Martinovic spoke and testified here that

25    psychoses, according to them, have a prehistory which may last for a month

Page 4465

 1    or two before the psychosis.  Do you agree with these opinions, and have

 2    you any comments about this?

 3       A.   I have a very important comment on this.  When we are talking

 4    about psychosis as psychiatrists, we have to be very precise as to which

 5    psychosis we are talking about.  If you are asking me about a period of

 6    development of a schizophrenic psychosis, it can last two or three years.

 7    If you're asking me about alcoholic psychosis or delirium, then the times

 8    are different.

 9            If you read my written opinion where I quoted from the

10    international classification, they list different symptoms and the

11    different course of the illness for each psychosis, so I do not agree to

12    talking about psychosis in general.  When you talk about a psychosis in

13    general, then this period can be from several hours to several years.  But

14    no one mentioned a specific psychosis.  Each one has a different clinical

15    picture, a different onset, a different treatment, and a different course.

16       Q.   It's true they did not say what psychosis they were referring to,

17    but if it was an alcoholic psychosis, how would things be?

18       A.   It has a sudden onset, which begins from its immediate cause up to

19    a few weeks later.  So this is not strictly defined, but the definition is

20    that it begins within a relatively short period of time.

21       Q.   When you spoke of acute intoxication and the day when Mitar

22    Vasiljevic was injured and the state he was in, you spoke of the state he

23    was in and said that it was closer to the second degree of accountability,

24    according to your information.  It seems that the decisive factor you

25    mention is -- in cases of significantly diminished accountability, is

Page 4466

 1    dementia or not remembering what he did that day, and you say that he

 2    remembered quite well what he did that day.

 3            My question about that day is as follows.   He told you, and you

 4    saw, that he was able to remember his riding the horse, the drinks he had

 5    with the person in Pionirska street, and this is true, but my question

 6    is:  Is it possible that he can remember some of these things so well, or

 7    maybe they were described by other eyewitnesses and entered his memory as

 8    he listened to their testimony in court?

 9       A.   I understand your question.  The gentleman spoke of this in

10    identical terms to the Court, to the doctor who interviewed him before me,

11    and to me.  If he had forgotten about it and received information from

12    someone else about it, then the chances are minimal that he would have

13    repeated the story in the same way.  You know, they say, "If I don't want

14    to be recognised, I mustn't lie."  If someone confabulates and fills in

15    the gaps in their memory with things that he heard from other people, then

16    the chances are minimal that he will be able to repeat the story in the

17    same way again.

18       Q.   On the basis of your experience in this sort of forensic work -

19    and you certainly have a lot of experience - do you feel that Mitar

20    Vasiljevic answered all the questions you put to him sincerely and

21    correctly?

22       A.   This question can be answered on the basis of psychological

23    testing.  I personally did not have a feeling that anything that the

24    gentleman told me when describing these events was not authentic.  He made

25    an effort to support things with facts, details, illustrations.  He

Page 4467

 1    enumerated things that helped him to remember.  So I had no reason not to

 2    believe what he told me.

 3       Q.   When speaking of the date, you mentioned when he remembers a lot

 4    of details and is able to repeat them.  In one part of the story, when he

 5    speaks of what happened in Pionirska Street, he drank brandy with a man he

 6    knew, but he probably wasn't able to give you a lot of information, and

 7    here before the Court, we have heard testimonies of people who said that

 8    first he walked down the street, called on people to join in the cleaning

 9    of the street, used strange words, he was saying, "Your street is one of

10    the cleanest in the town, but come out and clean it."  Then he had a

11    conversation with a group of people who say he gave them instructions

12    where they should go, how they should do this, that he wrote a sort of

13    letter of guarantee and gave it to someone, and he does not remember this

14    at all, while several witnesses have mentioned this in different ways.

15    What could this indicate in this case?

16       A.   I couldn't reply to that.  I have too little information, because

17    what you have just said is something I'm hearing for the first time.

18       Q.   Of course, if this has been represented correctly by the other

19    side and he doesn't remember it and -- but these are all events that are

20    interconnected and logical?

21       A.   The context of his interview with me was not -- what he told me

22    was not the story of someone who had gaps in his memory.  He told me --

23    when he spoke of his time in hospital, "I came to hospital and then some

24    time seems to be lost."  A person who has gaps in their memory knows they

25    do not remember things, if they were drunk.  He says, "Well, up to that

Page 4468

 1    point in time, I remember what happened.  After that, I don't."  And he

 2    remembers the falls from the horse.  I would not see this as pathological.

 3       Q.   When you say he remembers some things and then not others and then

 4    the fall from the horse, do you mean that he remembers things that

 5    happened before other things, he remembers what happened in the end?  Is

 6    that what you're referring to?

 7       A.   Yes.

 8       Q.   According to what you said -- what he said and what the witnesses

 9    spoke of that day, he rode a horse, a horse he had seen for the first time

10    in his life, without a saddle, without stirrups, the horse was unshod and

11    he rode it in the direction of town, through the town centre, while it was

12    raining and that he rode quite fast and then the accident happened.  Do

13    all these circumstances indicate that he was perhaps drunk or do they

14    indicate something else in view of the fact that he did all this, as he

15    himself has told us and as some witnesses have testified?

16       A.   Well, he told me all of this in great detail.  He thought it was

17    not a very wise thing to do.  He gave his critical comments on this.  I

18    think he did all this under the influence of alcohol, among other things.

19    I don't know what kind of rider he is.  He rode as a child.  He fell from

20    a horse.  That was in his case history.  He seems to be a very good rider.

21    So I am unable to estimate how unwise this was to ride in this way, but he

22    himself told me it was unwise and he took a critical attitude to this.

23    And I think that to a large extent, this could have followed from the fact

24    that he was under the influence of alcohol.

25       Q.   What you have just told us, does it indicate that it's more likely

Page 4469

 1    that he was in the second category of accountability, according to his

 2    behaviour that day?

 3       A.   Yes.

 4       Q.   And to conclude, when you spoke of the way accountability was

 5    classified in the former Yugoslavia, into four categories -- in the

 6    English text this is Roman numeral III, A, B, C, and D.  Would you please

 7    look at III(C)?  It says here, and I think you testified to this today,

 8    that a person with significantly diminished accountability is not

 9    criminally responsible?

10       A.   That's correct.

11       Q.   Unfortunately, we diverge completely here.  I don't know if there

12    have been some changes in Croatia but in Yugoslavia at that time and now,

13    significantly diminished accountability, to my regret because I would

14    prefer it to be otherwise, I would prefer it to be as you say, but

15    significantly diminished accountability influences only the sentencing and

16    not the criminal responsibility, which is excluded only in the fourth

17    case, in case of incompetency.  I wanted to see whether this was

18    perhaps a lapse, an omission.  We have expert opinions of criminal lawyers

19    on this. I would prefer it to be so but it is not so.  Unless there have

20    been changes in Croatia, but I don't think so personally.  This is a legal

21    question.  I don't know if you can comment on it but this is what I would

22    like to say.

23       A.   Thank you for what you have said.  I do have a comment.  I am not

24    absolutely sure of this.  I wrote this classification down here.  There

25    may be some confusion because the law has changed in Croatia and this is

Page 4470

 1    your field of expertise.  I accept that things are as you say.  The second

 2    -- the recommendations are made by us as psychiatrists but you are the

 3    expert on this and this is your domain.  Thank you for your comment.

 4            JUDGE HUNT:  Mr. Groome?

 5            MR. GROOME:  No questions, Your Honour.

 6            JUDGE HUNT: Well, thank you, Doctor, for coming along to give

 7    evidence and for the evidence you've given.  I hope you catch your plane

 8    all right in the morning, but you are now free to leave, as are we.

 9            THE WITNESS: [Interpretation] Thank you.

10                          [The witness withdrew]

11            JUDGE HUNT:  So we will adjourn now until 9.30 in the morning.

12                          --- Whereupon the hearing adjourned at

13                          4.58 p.m., to be reconvened on Tuesday,

14                          the 15th day of January, 2002, at 9.30 a.m.