Calling Down the Storm

by Peter Murphy

  ‘Thank you, Doctor. Is it possible for shock to be caused by a trauma of some kind?’

  ‘Certainly. It’s not uncommon, for example, for shock to be observed in a patient who’s been involved in a car accident, or who has simply witnessed some shocking event.’

  ‘What would be the physical cause of shock in such a case?’

  ‘It depends. If the patient has been injured in the accident, for example, it could be due to the injury itself, or some neurological damage. But it’s not necessary for there to be any injury. Sometimes shock can occur simply by the body reacting to something the patient has witnessed.’

  ‘So the cause could be psychological?’

  ‘Partly psychological. There would still be some physical reaction that reduces the flow of blood.’

  ‘Dr Harvey, have you been asked by the prosecution to evaluate and give an opinion about some evidence relating to Henry Lang in this case?’

  ‘I have.’

  ‘Let me ask you this first. Have you ever examined or spoken to Henry Lang?’

  ‘No. I have not.’

  ‘What have you relied on in forming your opinions?’

  ‘I have read the witness statements: particularly those of the police officers, DI Webb and his colleagues, who attended the scene; and the welfare officer Mrs Cameron. I have read the statement of Sergeant Miller, who was in charge of Mr Lang while he was in custody at the police station. I have read the report of the police physician, Dr Moynihan, and I have a copy of Mr Lang’s file from his stay at Barts.’

  ‘Based on those materials, and of course on your many years of professional experience, have you reached any opinion as to whether Henry Lang may have been suffering from shock at any time on the 28 April, the day on which he killed his wife, or on the following day?’

  ‘I have.’

  ‘Please tell my Lord and the jury what you have concluded.’

  Dr Harvey turned over a number of pages in his file.

  ‘Well, the first thing I should say is that I worked backwards in this case to some extent. The only medical evidence I had to rely on was Dr Moynihan’s examination, and the examination at Barts, all of which took place after the event. Dr Moynihan noted that Mr Lang, though conscious and alert, and apparently responsive to touch and vocal stimuli, was not engaging with those around him; also, his blood pressure was low. Dr Moynihan also noted a severe reduction in body temperature. All of those symptoms are consistent with a diagnosis of trauma-induced shock. I should add that Sergeant Miller had also observed the low body temperature, and his reaction in dealing with it using blankets and then calling for medical help was highly commendable.’

  ‘Did Sergeant Miller contribute to the successful treatment of Mr Lang’s condition?’

  ‘Undoubtedly. If he had simply assumed that Mr Lang would warm up again, and done nothing, the consequences could have been very serious. The Barts file notes the same symptoms, and records that Mr Lang was warmed with thermal blankets, and that they succeeded in getting him to drink some hot tea, and later hot soup. He was also somewhat dehydrated, and an IV line was used to rehydrate him. With that treatment, the symptoms subsided, and he was fit to return to police custody by the Friday morning. Barts also gave him a thorough physical examination, of course, and did the usual tests, and they note that no neurological injury was observed.’

  ‘How does that medical evidence relate to the police evidence about his behaviour at the scene?’

  ‘The police evidence is quite consistent with the medical evidence. Mr Lang suffered no neurological injury. He was conscious and alert, and was able to respond to physical stimuli, for example: releasing whatever grip he had on the knife; standing up, and placing his arms in a position to be handcuffed; and walking to the police car when he was arrested. At the same time, he was probably already suffering from the symptoms observed by Sergeant Miller and Dr Moynihan; we can safely assume that they didn’t start spontaneously when he got to the police station. His apparent immobility, his lack of reaction to what was going on around him, and his failure to say anything, are all consistent.’

  ‘And your conclusion from all that evidence…?’

  ‘My conclusion is that Mr Lang was suffering from trauma-induced shock on the 28 and 29 April, and there is obviously a very high probability that the trauma that caused this condition was his act of stabbing his wife, launching a violent and prolonged attack on her, and then witnessing the consequences of what he had done.’

  ‘So, it was a genuine case of shock?’

  ‘Oh, yes. I don’t think there can be any doubt about that at all.’

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  ‘Now, Dr Harvey,’ Andrew continued. ‘I want to ask you about something rather different. Have you been made aware, through your reading of the documents, and through your conversations with me, that Mr Lang did not give the police any account of what happened on 28 April, and that he claimed to have no memory of any events after leaving home some two hours before he stabbed his wife?’

  ‘I am aware of his claim of amnesia, yes.’

  ‘And once again – because all of us in court probably think we know what amnesia is, but it may be that we really don’t – would you please give us the clinical definition of amnesia?’

  Dr Harvey smiled. ‘Actually, the popular concept of amnesia is quite close to the clinical view of it. For our purposes today, amnesia is simply the loss of memory of certain events or certain periods of time preceding the onset of the amnesia. That’s the kind of amnesia most people are familiar with. Technically, it’s called retrograde amnesia. There is a different kind of amnesia called anterograde amnesia, which refers to an inability to create new memories because of brain damage, but we’re not concerned with that.’

  ‘Doctor, what can cause a person to suffer from the condition of retrograde amnesia?’

  ‘Again, just as in the case of shock, it can be caused by neurological damage, a head trauma, a brain injury of some kind, damage to the tissue of the brain; or by a very serious pathological event such as a stroke or cardiac arrest which results in loss of consciousness; we would call that kind of amnesia, “traumatic amnesia”. But amnesia can also have a psychological origin, as a result of a person being involved in or witnessing some traumatic event, while not actually suffering any physical trauma oneself. That often takes the form of dissociative trauma, meaning that the mind will not allow the patient to access certain memories, to protect the patient from the pain those memories may cause.’

  ‘Assuming that Mr Lang’s claim of amnesia is genuine – and you understand, I’m sure, that the prosecution do not accept that it is genuine: on the basis of the evidence you have studied, what kind of amnesia are we dealing with in Mr Lang’s case?’

  ‘On the basis of the evidence, including the lack of any evidence of head trauma or neurological injury, I would assume that the claim would be one of dissociative retrograde amnesia. He witnessed the consequences of his attack on his wife, and the trauma of what he saw – and possibly heard, or even smelled – were such as to cause some limited retrograde amnesia.’

  ‘Dr Harvey, are there any methods or procedures for determining whether a patient’s claim of dissociative retrograde amnesia is genuine or otherwise?’

  Dr Harvey thought for some time.

  ‘There are a number of matters to consider there. First, unlike shock, which has obvious physical symptoms, a claim of amnesia is essentially subjective.’

  ‘Meaning that we only have the patient’s word for it?’

  ‘Yes, and in a forensic setting such as a criminal prosecution, the patient may think it’s in his own best interests to claim that he can’t remember a particular event. For example, someone driving a car at the time of a fatal accident may choose to say that he doesn’t remember what happened because he thinks it would look bad for him if he told the truth. But, of course, it’s imp
ortant to stress that the amnesia can be perfectly genuine, even under those circumstances; the accident may be just as traumatic for someone who is at fault, perhaps even more so than for an innocent victim.’

  ‘Are there any possible indicators? For example, what kind of memory is generally lost? Would it be the memory of a particular event, or could it extend to the memory of your own circumstances – your identity, your family, your job, and so on – or the general knowledge you have accumulated during your lifetime?’

  Dr Harvey considered for some time.

  ‘There are documented examples of all of those things. Total retrograde amnesia, including loss of memory of one’s identity and personal circumstances, is extremely rare. But there are such cases, and there are cases of so-called dissociative fugues, which are recurring episodes of loss of memory, during which the patient may set out on apparently illogical journeys, appearing not to know who he is, or where he is going, or why he is going anywhere. It’s also very rare for a patient to experience loss of his ability to write, or do arithmetic, or get dressed in the morning, because those long-term learned skills are stored in a different part of the brain which seems to be less affected by transient events. So those kinds of memory loss are not usually involved in dissociative amnesia.

  ‘On the other hand, the loss of memory of a specific event, for example an accident in which the patient has been involved, is quite common, and it’s usually no more than the body protecting us from the pain of reliving an event of that kind. That’s the kind of memory loss one would expect to find in a case of dissociative amnesia, and it’s the kind that Mr Lang claims to have suffered.’

  ‘Are there any features of Mr Lang’s claim that you find in any way suspicious?’

  Dr Harvey smiled. ‘I hesitate to use the word “suspicious” because, as a doctor, I am naturally inclined to take the patient’s symptoms at face value, especially in an area such as this, where the nature and extent of memory loss can legitimately vary considerably from case to case.’

  Andrew returned the smile. ‘I keep forgetting to suppress my natural instinct to question everything –’

  ‘No, I’m sure that’s a quality you need in your line of work, just as I need a certain degree of mutual trust in mine. You must bear in mind that my concern is to treat the patient’s condition, and I am asking myself how I might be able to restore his memory – assuming that it is desirable to restore it.’

  ‘Of course. Let me ask it this way. Are there any features of Mr Lang’s account of his amnesia that would lead you, as a doctor concerned about his treatment, to ask further questions?’

  ‘Yes. One thing that struck me as odd was the fact that his claim of amnesia goes back some two hours before he stabbed his wife, to the time when he left his house. This means that he doesn’t remember how he got from home to Mrs Cameron’s house, what they talked about during the meeting –’

  ‘Why he took a large kitchen knife with him from home?’ Andrew interjected.

  Ben stood at once.

  ‘My Lord, I think the jury already have that point, since my learned friend has gone back over it time and time again, but if not, he will have plenty of opportunity to return to it yet again at the proper time.’

  Mr Justice Rainer looked up abruptly.

  ‘Yes… let’s keep to… shall we?’

  Andrew glanced at Ben.

  ‘Yes, my Lord. Dr Harvey, why did that strike you as odd?’

  ‘Because dissociative amnesia generally operates from a moment immediately before the traumatic event itself. For example, a driver may well remember setting out from home, driving along the road, seeing the oncoming headlights, but have no memory of the collision that occurred seconds after that last memory. The loss of memory may then extend forward to subsequent events; for example, the patient may have no memory of being thrown clear of the car, of being attended to by passers-by, of the ambulance arriving, and so on. His next memory may be of something happening in hospital. But in Mr Lang’s case, there is something odd about the amnesia beginning such a long time before the event. In fact, I have never known another case where that has been claimed.’

  ‘Is there anything else that struck you as odd?’

  ‘Well, of course, I was intrigued by the fact that his memory returned last Thursday afternoon, just as his trial was about to begin. But I must stress that I haven’t really had much chance to consider that question.’

  ‘No. In fact, were you unaware that Mr Lang’s memory was said to have returned until I informed you of it this morning?’

  ‘Indeed so.’

  ‘In general terms, Doctor, for how long does a loss of memory of a particular event last in cases of dissociative retrograde amnesia?’

  ‘There is no general rule at all. Each case is different. In the vast majority of cases, memory returns spontaneously, but the timing varies considerably. Sometimes the memory returns within a matter of an hour or two; sometimes it doesn’t return for weeks, or months, or even years in a very severe case. In the absence of physical injury, a lot depends on how traumatic the event was, and how firmly the brain has repressed the memory to spare the patient the pain of remembering it.’

  ‘What kinds of things can help in restoring memory?’

  ‘Well, the most obvious treatment is to confront the patient with the facts of whatever it is he can’t remember, and see if that jogs his memory. Often, it does. You can show him a photograph, or let him talk to other people involved in the accident, and so on, and very often that does the trick almost immediately. In this case, Mr Lang was confronted with the facts by the police, and no doubt by his own legal advisers, so on the face of it there is nothing inconsistent with his memory returning at any particular time. The only comment I would make is that, given that degree of confrontation and the stress of the circumstances in which he found himself – in custody, charged with the murder of his wife – it is surprising that his memory loss continued for some five months.’

  ‘And that his memory returned on the eve of trial?’

  ‘Quite so.’

  ‘Thank you, Dr Harvey. Wait there, please. There may be further questions.’

  ‘Dr Harvey,’ Ben began, ‘in psychiatric work, where you are dealing with mental illness or an emotional imbalance, it’s important to speak with the patient, isn’t it?’

  Dr Harvey hesitated.

  ‘Yes, in general, I would agree with that.’

  ‘It’s an important tool in making a psychiatric diagnosis, isn’t it, to listen to what the patient says?’

  ‘Yes, it certainly can be.’

  ‘Can be?’ Ben picked up a blue hardback book from the bench top. ‘I was quoting from your introduction to the fifth edition of the Handbook of Psychiatric Diagnosis, published in 1969, in which you say, “Listening to the patient is always an important tool in psychiatric diagnosis”. Have you changed your mind about that since 1969?’

  Dr Harvey smiled and nodded in acknowledgement.

  ‘No. I would agree with that.’

  ‘You haven’t spoken to Henry Lang, have you?’

  ‘No. I was told by the prosecuting solicitor that, as he had already been charged, it would not be possible for me to see him.’

  ‘Were you? Did you know that Mr Lang is represented by a solicitor, Mr Barratt Davis, the gentleman sitting behind me?’

  ‘I assumed he had a solicitor, of course.’

  ‘Would it have been possible for you, or the prosecuting solicitor, to contact Mr Davis and ask if you could see Mr Lang? He was in custody, wasn’t he? He wasn’t going anywhere.’

  ‘As I say, I was told that it would not be appropriate after he had been charged.’

  ‘It wouldn’t have been appropriate to give Mr Lang and his solicitor the chance to arrange a consultation if they thought it might help? Did you question the prosecuting solicitor abou
t it, ask him to take Treasury Counsel’s opinion?’

  ‘No. But I would like to add that the only psychiatric diagnosis of Mr Lang I made was one of trauma-induced shock, which I understand is not disputed.’

  It was said defensively, almost petulantly. Ben paused.

  ‘But your diagnosis of shock is not the only observation you’ve made about Henry Lang, is it, Dr Harvey? When my learned friend gave you the chance, you jumped in enthusiastically to support the prosecution’s theory that Mr Lang’s amnesia is not genuine, didn’t you?’

  ‘No. I said that there are some parts of his account that I find odd.’

  ‘“Find odd” meaning that you don’t believe it?’

  ‘Not necessarily.’

  ‘Well, do you believe it, or don’t you?’

  ‘I have insufficient data to say whether I believe it or not. I find some of it odd, that’s all.’

  ‘Is the fact that you haven’t spoken to Mr Lang one reason why you have insufficient data?’

  ‘It might have assisted to some extent to speak to him. I can’t say. This isn’t a diagnosis.’

  ‘Without speaking to Mr Lang, your finding that something about the account he gave is odd is essentially speculation, isn’t it?’

  ‘I wouldn’t go that far.’

  ‘Well, let’s look at it, shall we? One thing you find odd is that his loss of memory goes back to the time when he left home, some two hours before he killed his wife? You find that odd?’

  ‘Yes.’

  ‘Did it occur to you that if the use of the kitchen knife to stab his wife was part of the trauma he experienced on 28 April, then picking up the knife at home in the first place might have been part of the trauma?’

  Dr Harvey looked startled.

  ‘No, that did not occur to me.’

  ‘Can you rule that possibility out?’