By Susan Kendi
Dominic Ongwen’s trial resumed from a 12-day break on Monday, March 19, 2018 with an expert witness on the stand and a dramatic episode following in the afternoon session.
Ongwen interrupted the hearing as the expert witness, Prof Gillian Clare Mezey, was testifying about her understanding of his mental state to lay a basis for the testimony of various prosecution witnesses on their interactions with him. Ongwen is facing 70 charges of war crimes and crimes against humanity at the International Criminal Court for his role in the Lord’s Resistance Army in Uganda.
Prof Mezey, told the Trial Chamber IX of the ICC at The Hague that there is a discrepancy between Ongwen’s day-to-day presentation and the (medical) interview he had with Dr de Jong. This presentation is incompatible with someone who is severely depressed.
Testifying in open court, during the morning session, the expert told Judges Bertram Schmitt (presiding), Raul Pangalangan and Péter Kovács that it is possible for an individual to fake symptoms of Post-Traumatic Stress Disorder (PTSD) for the purpose of gaining compensation. She added that there was a psychological reason for why one may try to appear worse than they really are (as in the Ongwen case) because it can be used to their advantage. She claimed that Dr de Jong’s presentation was not psychologically coherent.
“…Perhaps I can jump in and ask you to look at Extract Six. (Reading out an extract on Mr Ongwen detailed reporting about the weapons he had found) What does that suggest?” Prosecutor Colin Black asked Prof Mezey.
Mezey: That he was functioning normally; that there was no obvious disorder to process, engage and make decisions and interact.
Black: Do you expect that someone with dissociative disorder can have a report this detailed?
Mezey: If Mr Ongwen was dissociated or affected, he would not be able to recall or relate the details of what happened.
Prof Mezey said that depression is associated with negative events such as bereavement, loss of one’s home, values and feeling under threat. Considering that Ongwen was living in different cultures and environments all that can be considered are risk factors for developing anxieties.
She noted that it was unclear from other expert reports what dissociative order they were refereeing to. Dr de Jong’s report, she told the Court, needed the expert to show their working, moving from a historical diagnosis to the current one and show the chronological development of depression. She said she was not able to find any methodology of such an approach in Dr de Jong’s report.
Here are excerpts from the examination of the expert by Prosecutor Colin Black:
Black: What do you see in Post-Traumatic Stress Disorder (PTSD)?
Mezey: They (the individuals) are often at the edge of their seats. They are at the stage of high arousal, they are very sensitive to environmental threats and they tend to react. People with PTSD are hyperactive to stimuli and react to them as if they are a threat. They are often restless; they cannot relax, sleep, settle and they cannot calm themselves down. These symptoms are severe and intrusive and stop individuals from carrying out day-to-day activities — they cannot work, they cannot go to school. All their functioning is significantly impaired.
Judge Schmitt: How can you assess if it happened years ago?
Mezey: It can certainly be done. There are many studies, which look at the individuals, how the PTSD develops and how long it lasts. There are two ways: by examination of the mental state. It is possible when you talk to an individual who has experienced trauma and you encourage the individual to describe their sleep, thinking, emotions and behaviour. It becomes difficult the longer the time that lapses between the trauma and examination. You cannot establish accurate results.
Judge Schmitt: Thank you. Mr Pangalangan.
Judge Pangalangan: Is it possible for the victim to fake it? In that he might be crazy and smart to lead you on to concluding that he has the PTSD (Post-Traumatic Stress Disorder)?
Mezey: It is possible for an individual to fake symptoms for the purpose of gaining compassion. It is possible to fake the symptoms — they are quite known and rehearsed so you don’t take the answers of the individuals alone. The important thing is to be critical, challenging and the need to cross-reference what you are told with other sources of information and what they say. The criteria for PTSD stay the same. PTSD may be altered by age, gender and culture.
(Black refers to a document, and asks a question to Professor Mezey)
Black: What is psychopathy?
Mezey: It is the term developed to describe individuals who have no regards of other people’s feelings. Individuals who seek to gain gratification for themselves in terms of other people’s punishment or consequences. It does not represent a mental illness; it is closer to a personality structure.
Black: What is psychopathology?
Mezey: It is the study of a whole range of mental disorders.
Black: Another kind of mental disorder in the excerpts is clinical disorder. What is the difference between PTSS (Post-Traumatic Stress Syndrome) and PTSD?
Mezey: Very often an individual who has experienced trauma may fail to meet the threshold criteria. Maybe the symptoms are not persistent enough or cannot meet the number. PTSS described in the records reflects someone who has a few symptoms similar to PTDS but the clinically disorder and symptoms don’t meet the threshold of PTSD.
Black: PTSD, does it develop immediately after psychological trauma or after?
Mezey: It develops immediately. Delayed PTSD is recognized as a phenomenon. The symptoms that appear in six months or later are very rare. There might be symptoms in the past but sometime later individuals take over from a post-traumatic trauma to developing a full disorder. The majority of cases you see, the disorder in its full form appears within a few weeks or months after that.
Black: What of someone who has been exposed to several traumas?
Mezey: An example is of the Vietnam (war) veterans who present a most delayed picture of PTSD after they had been removed from battle. That is because when in a war zone you have to mount coping methods so the disorder is masked for survival. Having said that, one would normally expect to see evidence of distress or dysfunction; that that person was under severe stress. If they are not expressing feelings of helplessness at the time they will not develop PTSD.
Black: Dr Atkins and Ovuga’s reports refer to Mr Ongwen being given 80 strokes of the cane, carrying heavy loads. Could that cause PTSD to Mr Ongwen?
Black: Professor, can you explain what psychotic depression is?
Mezey: It is the lowering of mood, unreasonable feelings of worthlessness and lack of hope. There is a high risk of suicide associated with the disorder. Symptoms include: Reduction of appetite, loss of weight, no sleep, variation of mood with severe, social withdrawal (the individuals) tend to lose interest in interacting with people. There is a distraction of the person’s cognition; they think more slowly than usual; retardation in their speech — their speech is slowed down and movements are slowed as well. They often express unreasonable feelings of low self-esteem and guilt that to an extreme extent they feel guilty about something they cannot be held accountable for, such as wars and hunger. Psychotic depression is used interchangeably with severe depression (individuals with) psychotic depression experience: they can hear voices that are telling them they are a burden to their family, (they experience) depressive delusions about themselves or the world. They can smell themselves rotting from inside. They feel responsible for the world coming to an end. However hard you try to challenge the individual with a different belief you cannot change their belief.
Black: What are the requirements for diagnosis?
Mezey: They manifest symptoms. They are levels: mild, moderate and severe, which include the psychotic state. All these have an effect on individual functionality on a day-to-day basis. There are some tools that can confirm clinical disorder … Thinking whether Mr Ongwen had depressive disorder in 2002-2005, I read the reports [to see] whether they occurred in the period and whether they were described by Mr Ongwen. The information might tell me whether he was perceived to be tearful, not able to function, highly aroused or reacted in a bizarre manner to the people around him.
Black: In Dr de Jong’s report, Professor, if you look at Page 5 and 6, he refers to Harvard Trauma Questionnaire and Patient Questionnaire; what are those?
Mezey: Measures of cases to assess anxiety and trauma.
Black: What does ‘validated’ mean?
Witness: They demonstrate what they are set up to demonstrate. It does not matter who applies or what content you apply, the measure to; it will give you an accurate record to diagnose a condition.
Black: In paragraph 52 of your record, you noted that Dr de Jong’s report noted that Ongwen scored 24 in PH 29.That is the maximum score, is that correct?
Mezey: 27 is the maximum score. There is a discrepancy between Mr Ongwen’s day-to-day basis representation and the interview. This presentation is incompatible with someone who is severely depressed.
Black: May Mr Ongwen be concealing his symptoms?
Mezey: I suggest it is not possible for two reasons. Individuals suffering severe mental disorder of any degree, the individual has no control over their symptoms, for example: insomnia. The notion that one may conceal his symptoms is not psychologically coherent. Second issue, if one is to speculate one’s symptoms, you may go forward to why the individual may want to conceal their symptoms. There is a psychological reason that one may try to appear to be worse in a case like this because it can be to their advantage and because his presentation is so inconsistent with the measure, Mr de Jong’s presentation is not psychologically coherent.
Black: Would it be possible that even if you assumed that Mr Ongwen suffered depression, that does not mean that he suffered depression in 2002 to 2005. Is there a way to acquire?
Mezey: In a report of this kind, it is important to show your working, to be very clear on what is a historical versus current diagnosis and demonstrate chronological development of that depression. Unfortunately, I was not able to find any methodology of that approach in Mr de Jong’s report.
Black: Were there other facts that may have led to depression — his current detention, him being far from his family?
Mezey: Depression is associated with negative events: Loss, bereavement, loss of one’s values, home, and threat are all associated with depression. He (Ongwen) is living under different culture, environment and there are uncertainties. All that can be considered as risk factors of developing anxieties.
Black: Explain what is dissociative disorder?
Mezey: It is quite difficult from the reports of other experts to be clear on what dissociative disorder they were refereeing to. Dissociation means the disruption to the person’s identity, agency. Dissociative disorder essentially represents a fragmentation of individuals psychological wellbeing — their emotions, behaviour. Dissociative identity disorder characteristically is a disruption of a person’s identity. There are a distinct number of personalities operating. That is classic dissociative identity disorder. One sees discontinuity in a person’s sense, there is alteration in memory. There are personalities operating independently and in different universes from each other. The person does not know he has the disorder but people realize it. It is an injuring condition because it does not relapse like other illnesses. It is stable, static and injuring. In my 30 years of practising as a psychiatrist, I have seen one case of dissociative identity disorder.
Black: It is also called multiple personality disorder?
Black: Do healthy people also dissociate?
Mezey: Simple example is that you might be driving and the road looks unfamiliar. It is lack of noticing, registering what’s going on. It is an entirely known pathological condition.
Black: What is required for it to be severe?
Mezey: Level of stress experienced. It also has to do with the extent to which the disorder interferes with the individual’s ability to process information and communicate.
Black: How long do dissociative episodes tend to last?
Mezey: It is chronic and injuring. There are dissociative disorders that do not all amount to dissociative identity disorder. There is a short-lived dissociative disorder that lasts for hours that is characterised by individuals not being in touch with themselves, or their surrounding. Derealisation, you feel like you are looking at the world through a net… The world seems unreal.Depersonalization is usually when the individual has been placed under extreme stress. It is short-lived and precipitated by an external event.
Black: Professor de Jong in his report uses the label ‘other specialized dissociative disorders’. Is it different from dissociative disorder?
Mezey: His report does not make that clear.
Black: The defence experts on Page 13 of their report, mentioned “Multiple personality disorder” and on Page 14. During an episode of dissociation, does this assume another personality from knowing right or wrong?
Mezey: Is this Dr Atkins’ report?
Black: Yes. They are talking about dissociative identity disorder. Is anyone with dissociative identity disorder not able to distinguish right or wrong?
Mezey: No, that does not occur.
Black: Are all the identities ill?
Mezey: As I said, each personality is unaware of the existence of the other personality. The personalities know what they are doing. It is just not accessible to the other individual (personality). What dissociation does, it cuts off or dissociates your memory so that you cannot register or retain what you were doing at the time. Amnesia is necessary for a dissociative state or disorder.
Black: As you know, some of the crimes continue, how likely is it that a person would be in a dissociative state for months?
Mezey: It would not happen. It does not persist for a year. What would persist is multiple personality disorder. With dissociative personality disorder, the individual would be aware that they are committing the act; it’s just that the other personality would not know about it.
Black: If a person has identity A and B, and a crime lasts for three years, what is the possibility that one would be identity A or B?
Mezey: It would be impossible. They are separate distinct personalities. They tend to have different career and family structures. They operate as separate people.
Black: Is one example that of religious possession?
Mezey: Yes. That is one.
Black: What is a conversion disorder?
Mezey: It is when an individual is conflicted to opposing values they have. Rather than articulate, the conflict is expressed through a physical manifestation. An example, a person who is going to war may develop a paralysis of their right leg that has no basis but helps them excuse themselves from war, but also retains a degree of respect. It is an expression of mental disorder to physical manifestation.
Black: Mr de Jong tested Mr Ongwen for narcissism. What is that?
Mezey: Narcissistic disorder is one of the disorders manifested to the person’s sensitivity to criticism. They feel like they have an important part of a mission that people don’t understand.
Black: That is all for the vocabulary. Turn to Tab 4. Do you remember receiving an email from the prosecution with an attachment?
Black: The email sent by Mr Gumpert asking you to reviewanything that might illustrate or cast doubt. Help the judges to review.
Mezey: I have read it carefully.
Black: Are there any extracts you would like to comment on?
Mezey: I found no evidence on the transcript you sent me on any mental stability being reported on any of the abstracts.
Black: “…Perhaps I can jump in and ask you to look at Extract Six. (Reading out an extract on Mr Ongwen detailed reporting about the weapons he had found) What does that suggest?”
Mezey: Ongwen was functioning normally. There was no disorder that would have hindered him to process, engage and make decisions and interact.
Black: Do you expect that someone with dissociative disorder to have a report this detailed?
Obhof: Objection, your Honour.
Judge Schmitt: When it comes to the testimony of the expert, most are hypotheses. Please answer.
Mezey: If Mr Ongwen was dissociated or affected, he would not be able to recall or relate the detail of what happened.
(Judge Schmitt asks the Defence team how long it might take them to question the witness. Lead Defence lawyer Krispus Ayena Odongo stands up)
Odongo: Upon reasonable consideration, we might take up to three sessions.
The hearing resumes on Tuesday, March, 20, 2018.