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Location: Takoma Park, Maryland, United States

I'm now a 52-year-old American male raised as an Episcopalian, veteran of submarines, Peace Corps, and State Department. I like teaching people about what they can do with computers and have gotten by as an independent Microsoft trainer teaching networking, but I really hope to someday find a way to make a living traveling on my motorcycle, camping, and writing about places and people I meet along the way.

Wednesday, May 10, 2006

Susan Lindauer's Trial: The Defense Witness

Susan's CJA attorney, Sanford Talken, called Dr. Goldstein from Columbia College of Physicians and Surgeons. Among Dr. Goldstein's credits was the fact that he was the Medical Director of the Supreme Court Psych. Clinic in 1970 to 1974.

Dr. Goldstein had his own diagnosis of Susan: Delusional Disorder, mixed type. This was different from the diagnosis that the Justice Department asserted, that was provided by the doctors who observed her within the Federal Bureau of Prisons, at Carswell. Carswell, we learned last Thursday, had diagnosed her as suffering from: Psychotic Disorder, not otherwise specified.

A delusional disorder of mixed type, Dr. Goldstein explained, included firmly held convictions that are irrational. Delusions of persecution and delusions of grandiosity are exhibited by patients with this medical condition. He pointed out that the delusions are irrational, but not bizarre--they are typically things that could be feasible as opposed to things that are impossible. It might be possible that somebody is trying to hurt you, but if you fear that and they really are not, then it is irrational. Bizarre would be believing that Martians are trying to hurt you.

Grandiose delusions could be thinking one has special talents, capabilities, relationships, and even spiritual gifts. The DSM code for the disease is DSM IV-TR.

Dr. Goldstein asserted that this was a proper diagnosis because it matched all of Susan's symptoms. His testimony described Carswell's diagnosis as a "Wastebasket" diagnosis. "Psychotic disorder not otherwise specified," he pointed out, "is a diagnosis that can be used if one cannot reach a more specific diagnosis.

He then testified about the article that Carswell had brought forward to justify their request for medicating Susan. The article, he pointed out, was not a publishing of scientific conclusions that were the result of any kind of double-blind testing or clinical trials such as one might expect. Rather the article was a review of other articles that described experiences some have had with patients being medicated. The problem with relying on such an article is that it is not scientifically rigourous. The number of patients described in the underlying articles was very small, too small a sample for good statistical conclusions. Most significantly, relying upon such alegorical evidence, one can be sure one is hearing mostly the good news about such treatments, as negative results tend not to become the subject of doctors publishing about their work. Moreover, the author of the article summarizing the medical treatments pointed out in his own disclaimers that the studies he had cited had very little to say about effect upon psychotic delusions.

He then went through the side effects of the medicines. They weren't pretty. Among the non-serious side effects was a category called EPS that included muscle spasms, Parkinsons-like symptoms, and other things extremely annoying to a patient. These were called non-serious because they, while extremely annoying, were not permanent or fatal. There were also fatal side effects.

Dr. Goldstein asserted that there is no medication that will effective treat Susan's condition. He concluded that as there were no benefits of such treatment and big risks that such a prescription should not be carried out.

It struck me that Susan's resistance to being medicated was perhaps more sane than the rush to medicate of doctors at Carswell. She might have delusions, but she is not stupid. It also caught my attention that the doctor, in describing delusions of grandiosity said they were merely irrational not bizarre, as one could have special spiritual capabilities. He said it pretty fast and didn't dwell upon it, but I wondered how we scientifically discern between actual spiritual gifts and imagined ones. Did Moses really see a burning bush? I'll go onto consider whether, if God talks to humans in ways that can seem delusional, it follows that by devine design there might be few possible countermeasures, and for good reason.

On cross examination, the prosecutor asked (hoping for an affirmative answer) whether side effects could be prevented by controlling dosage and monitoring. He was not prepared for Dr. Goldstein's negative reply. The evidence on side effects of psychotropic drugs shows that dosage is not much of a factor in whether or not side effects occur, although it might limit their severity, thus reducing some risk. He pointed out that once a fatal side effect has occured it may be too late.

It seemed to me that the point and methods of forcible medication is to inject time-released medicines. Monitoring for symptoms that develop due to exposure time would require a thouroughness and a level of professionalism that I would not expect to find in the Federal Bureau of Prisons. Private facilities are subject to accreditation and quality reviews by different regulatory entities. Medical facilities with the FBOP are reportedly not subject to such review and by many accounts a "nightmare." As we are allowing them to treat, in some cases, people like Susan who are not yet convicted of any crime, it seems to me that this borders on malpractice and malfeasance on the part of those who manage such systems. It is sort of like cruel and unusual punishment prior to a even having a trial--torture that one must survive to get to trial. How convienient to the Justice Department and the FBOP contractors that they can punish and make money on punishing citizens with mental disabilities indefinitely because the drugs they would inflict upon the delusional patient will NEVER render them fit for trial!

You should have seen the prosecutor's reaction to the testimony during cross-examination. His emotional follow-up questions drew objections from the defense that were quickly sustained. Once the judge asked him if wanted to phrase a proper question or withdraw it. He plunged ahead then quickly drew another objection.

He asked things like:

"You mean that if she has a medical condition that cannot be treated, we should just let her go?"

"You mean that the government should just let people walk around with medical conditions that we cannot treat?"

This gave me considerable insight into the culture and mindset of our Justice Department. Interesting to me, also, that there are people walking around who need psychotroopic medication, who without treatment have illnesses that will result in crimes, but the government is more interested in providing profits to political business constituents and punishing criminals than in providing a common medical program that will promote the common good and dissuade such crimes before they occur.

The judge then inquired of the prosecution whether, since Susan has served time in Carswell that might count toward any future ordered sentance, and because the illness she suffered from was the likely nexus of her crimes thus further mitigating any future sentance whether the risks of medication for what little sentance might result were worth it. The prosecutor grew quite flustered and reiterated the charges, describing actions that Susan still claims she carried out acting as an asset for those she knew in our inteligence community. Just because one is delusionsal doesn't mean one cannot or should not try to serve ones country.

Susan may have been close to being released on bail while awaiting trial, but because the judge asked questions of the defense witness that were not asked of prosecution witnesses, there will be a delay while the same questions are posed to the prosecution witnesses, and defense gets to review them. The hearing will be continued on June 6th. Meanwhile, Susan will be held in New York and not sent back to Carswell.


Blogger Andrew Marshall said...

This madness must be stopped.

You indicate that the next hearing is on June 6. I'd like to lend my support and attend. Which courthouse?

5:22 AM  
Blogger JB said...

I trust you won't do anything disruptive. It's at 500 Pearl Street in New York. Judge Mukassey's courtroom. Publicity and potential funding will help. If she is to be forcibly medicated, a private facility will have more competent medical help.

8:16 PM  

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