EXAMINATION 2- Direct and Cross Exam of Expert Neurologist Witness in car accident case - Part 3
BY THE WITNESS:
A. In this case he claimed to have witnessed Napalm burns in Vietnam. I have done extensive work with Vietnam veterans. I asked him, “Could you please describe what the Napalm burns looked like that you saw in Vietnam.”
He said, “You know, Doc, it was kind of like I was looking at this guy and it was like Saran Wrap, like skin was coming off like Saran Wrap and it was all like stringy and falling off his arms.”
Well, I knew that he didn't know what a Napalm burn was. It's an incendiary gas device that causes massive burni?? and blistering of the skin. It doesn't peel off like Saran Wrap.
It gets cooked like fried chicken. That's the nature of the burn. So his description of seeing a Napalm burn is absolutely incorrect. And, therefore, he never had that experience or he's just flat out making it up.
In this case as it turned out as I concluded the interview he finally admitted to me he had never been in Vietnam, but he's claiming post-traumatic stress and used that as one of the examples and I found out that was inconsistent along with a dozen other inconsistencies he showed me that he didn't really have that experience.
So when we look at a person's response to trauma, we want to know what this pattern is. And more importantly, does it match up to the objective facts, you know.
If someone's in an airline crash, do we know what the crash was about? Do we know what happened in the crash? We have objective evidence for that.
So this is where the consistency is important to match up to the facts of what happened, what the trauma experience actually was. BY MR. LYMAN:
Q. And you applied that methodology to your opinions in this case; is that correct?
A. That's correct.
Q. Do you find - strike that.
Did you rely upon any information
that my office provided you in determining whether or not there were any inconsistencies in Mr. Gustafson's statements?
Q. And that would be the depositions, things of that nature?
A. Depositions and records, for example. All of the paramedics who were at the accident scene, medical records, hospital records. Notes of the other doctors and so forth, medical findings.
Q. Doctor, can you tell the ladies and gentlemen of the jury the type of questions that you and Dr. Moran would ask during your interview with Mr. Gustafson topically?
Q. From a topic standpoint.
MR. GARROW: Objection, your Honor, based on what somebody el?? asked.
THE COURT: The doctor's already established that he relies upon the fact events or series of events to formulate his opinion.
It is your opinion, not the opinion of anyone else, right?
THE WITNESS: Correct. THE COURT: Okay. Overruled.
BY THE WITNESS:
A. Would you repeat it for me?
BY MR. LYMAN:
Q. No problem. What type of topics would be involved in the interview that you and Dr. Moran had with Mr. Gustafson?
A. Oh, sure. The topics would include history, family history, education, work history, report of the accident , the account of the accident by Mr. Gustafson in this case, questions about interpersonal relationships, family, questions about post-event behaviors and symptoms, and including current behaviors and symptoms in regard to the aftermath of a - in this case, a motor vehicle accident.
Q. And you would use that information to form your opinions, correct?
Q. And to reach a diagnosis?
Q. Dr. Wilson, did you find any inconsistencies in the information that you garnered or had in your possession concerning Mr. Gustafson?
Q. Can you quantify - strike that. Were there a lot?
Q. Were there a few?
Q. Can you please describe for the ladies and gentlemen of the jury some of the inconsistencies that you discovered that were important to you in rendering your opinions in this case?
THE COURT: Inconsistencies as a result of your personal interview or inconsistencies as a result of a review of all the records?
THE WITNESS: All of the above.
THE COURT: Okay, think you. All the tests, all the interviews.
BY THE WITNESS:
A. Let me take them one at a time in categories and try to summarize them. I'd be happy to give specific examples if you like.
BY MR. LYMAN:
A. First of all, there's inconsistencies found in the psychological testing. Let me start first with what I referred to a minute ago as the M.M.P.I. 2.
It's a scientific instrument that measures a number of things, and the results of that which are computer scored - I don't score it; it's scored by a computer.
By nature it has a copyright and the computer then compares Mr. Gustafson's results for that of other known patients and populations who have ever taken this test, and it makes graphs which give us lines indicating different kinds of information.
And one of the things that came out on this one was that he had an invalid profile. And the analysis that was done suggested that he was exaggerating his symptoms and suggests that he may, in fact, be malingering or attempting to present a false claim of illness.
It also suggested that there may be other things involved here including a severe personality deterioration unrelated to in this case post-traumatic stress disorder.
So that was the first inconsistency, and it was severe and very high showing a response tendency that suggests a deliberate attempt at faking on the instrument.
Secondly, in the MCMI test, the Milan Clinical Inventory that I referred to a minute ago, another test, scientific test objective also indicated the patient's response style may indicate a tendency to magnify illness, an inclination to complain as a result of an encounter with acute turmoi1.
So when he took this test too, there were inconsistencies suggesting a tendency to exaggerate or magnify his symptoms.
And then thirdly, on the impact - sorry, Trauma Center Inventory, the T.S.I. that I referred to a minute ago,?? contains a specific scale that measures inconsistency in reporting symptoms of post-traumatic stress disorder.
And likewise, it had an elevated score for inconsistency which means that you have to be careful when you're interpreting the results because of the inconsistent factor that's there.
Now, that's the first category of inconsistency, okay. The second one I'd like to talk about is there's inconsistency in his reporting to the different people that he talked to, et cetera.
He'll say one thing to one person about a situation and then give a different version to another. And this is a recurring theme.
For example, let me just give you a couple. One was he talked - when I asked him about the onset of his leg tremor, which as he told me, it occurred after his wheelchair had been taken away from him from Dr. Kandel.
Mr. Gustafson had purchased the wheelchair himself as he reported to me to help with pain he was experiencing. The physician who treated him took it away from him. He said he didn't need it.
He said that he developed then the tremor in his leg after the wheelchair was removed and he told me that tremor began in 1997. He said in his deposition that the tremor began in 1997.
However, when he spoke to Dr. Claude Hamilton, one of his treating doctors, he said he had the tremors since the time of the accident.
That's a clear inconsistency because September of ′97 is 18 months after the time of the accident. So there's a clear inconsistency there.
I'll give you another example. He refers to the accident as “the worst accident of my life.”
And yet, in his history, which he reported to me and to Dr. Moran and to the other psychologists that have treated him, there's a clear history of childhood abuse. He was assaulted with a baseball bat and rendered unconscious when he was a teenager.
He was assaul??d by a gang who threatened his life by pouring gasoline on him when he lived in Boston.
He's witnessed serious injury and death of co-workers on the job in Florida. And he's seen another co-worker who was actually paralyzed from an industrial accident.
And yet, in the accident in question here on March 16, 1996, no one's killed, no one's injured, no one's damaged medically at all.
There's no serious threat to life. There's no serious injury of any type whatsoever.
So him saying quote, “This is the worst accident in my life” seems to be a contradiction with all those other events which were clearly much more severe in nature.
Another one that's important, in describing the accident he indicated to me that - actually, let me go to my notes. Bear with me a second.
He said, “Everything is slowed down. My heart sank.” And then he describes the impact of the event, claims he was disoriented and saying he was in shock.
Now, to point out inconsistency, in the paramedic reports they indicate he was oriented in all three spheres, time, person and place. He knew who he was, where he was. He wasn't disoriented, that he could walk. He had no complaints other than a lower left back pain.
And yet, he says in another place more than one time this was hilarious, that it happened the way it happened.
Well, I don't see how you can have a description of it being hilarious and yet, at the same time claim to be disoriented and somehow very fearful of this.
Another inconsistency of that same type that bears on this point is there, in fact, is a photograph of him smiling and waving with Sharon right after the accident. This is an inconsistency.
Someone who has been severely traumatized in an accident is not going to pose for a photograph with a smile and a wave. That's not a trauma response, nor is it a description that it's hilarious the way it happened. So that's an inconsistency.
There are inconsistencies, for example, in the description of what actually happened.
When the limo was hit in some versions he claims he got up to protect Sharon and yet, in her deposition she says he fell on me.
And then there's a description by Ms. McKinnis' mother that Mark said he was kind of tossed onto Sharon.
This is another inconsistency, and there are many of those.
Q. Did you find any, doctor, concerning the premature gestation period of the baby?
A. There was another inconsistency that he reported that, you know, the baby was born prematurely, and yet, the medical records indicate - and I have them from the hospital - that they estimate her pregnancy between 34 to 37 weeks. 36 weeks is nine months. So she clearly was nine months pregnant at the time.
So there's that kind of another inconsistency in the reporting. And there are many of those, many of those.
And one other??ea I'd like to comment on, and that has to do with the question of post-traumatic stress disorder, is when asking him questions about post-traumatic stress disorder, his answer most of the time never referred back to the accident. They referred to other things.
So one, if a person is suffering from post-traumatic stress disorder, when they talk about their complaints, their symptoms, their problems, you know, their pains, the distress from their trauma, they're always going back and talking about where it came from in the trauma.
So if they have - here is another example. If a person has post-traumatic stress and are having horrible nightmares in which they're reliving what they went through in the trauma, they're going to wake up and be distressed.
And if you're their partner, you say, what's the matter honey? Oh, my God, I was back in Vietnam again. I saw the brains on my chest. Oh, it's horrible, you know. It's always going back to the trauma.
When I asked Mark about his nightmares, I asked him, as did my associate
Dr. Mora?? on three separate occasion, what's the content of your nightmares? What are you dreaming about?
He never ever once referenced the accident. He talked about being chased, being in fights, people out to get him. There was no reference to the accident in his dreams.
Well, that's an inconsistency certainly with having post-traumatic stress disorder.And likewise, there are other areas of post-traumatic stress where his question - the answers to my questions about a symptom cluster never went back to talk about the accident.
When people suffer a traumatic event and they get post-traumatic stress disorder, they're going to keep going back and talk about that trauma. And he didn't do that. He didn't do that.
Q. As a matter of fact, he told Dr. Hull he was chased by bumble bees, correct?
A. In his dreams, correct. Okay. So those are some examples of the inconsistencies. There are many many more of them, but the point I'm establishing is there's inconsistency between what he reports happened in the traumatic and his reported symptoms of post-traumatic stress disorder.
There's inconsistency in what he's saying to different doctors at different times about the accident and about his symptoms.
And there's, in fact, inconsistency in response to the psychological testing.
When you triangulate all three of those, there's very clearly been established a pattern of inconsistency to the people evaluating him.
Q. How does that affect a psychologist's ability to diagnose a mental disorder in a patient?
A. It affects it in this way. What has to be answered is No. 1, what is this inconsistency about? You know, what's the reason for the inconsistency.
Is it - sometimes people could be inconsistent in this way because they're suffering from a more severe mental illness, but it certainly wouldn't be a post-traumatic illness.
Sometimes there's inconsistencies of this type in which there's marked discrepancy over time and in the reporting of facts about the accident , about the status of the pregnant girlfriend at the time, about the nature of the accident , what he tells doctors about his symptoms, what he claims about the onset of certain symptoms and so on.
But when there's so much consistency to the inconsistency, if you will, when there's so much inconsistency, it leads us to be suspect of the validity of the report and the reliability of the report.
And one possibility is it suggests the person is malingering or they're exaggerating symptoms or they're simply not reporting faithfully what's happening with them to the people that they're talking to.
Q. You had the opportunity to review Dr. Hull's and Dr. Kessler's notes, didn't you?
A. Yes, I did.
Q. Did you find anywhere in their notes that they undertook or pursued any efforts to determine inconsistencies in Mr. Gustafson's reporting?
Q. Should these incons?? cencies be important to Dr. Kessler and Dr. Hull?
Q. And they should be important to
Dr. Kessler and Dr. Hull to determine what trauma is causing a condition or mental disorder, correct?
MR. GARROW: Objection, your Honor.
I don't believe this witness can testify to what's important to someone else.
THE COURT: Rephrase.
BY MR. LYMAN:
Q. Is it important in your area of - in your specialty in psychology to know that there are or are not inconsistencies in determining or diagnosing a mental condition?
Q. Would you expect a psychologist in your field to undertake certain efforts to determine if there are, in fact, inconsistencies?
A. They may or may not depending on their orientation.
Q. But they should do it?
Q. Doctor, do you - did you - strike that.
Did you rely upon the Diagnostic Statistical Manual of Mental Disorders in formulating your opinion?
Q. And is that the fourth edition?
Q. We've heard throughout this trial that is the A through F criteria?
Q. Would you please explain for the ladies and gentlemen of the jury what that criteria is and what it's meant to accomplish?
A. In terms of post-traumatic stress disorder?
Q. In terms of post-traumatic stress disorder.
A. Okay. In the diagnostic manual, the DSM 4, fourth edition, the Psychiatric Association's definition for post-traumatic stress disorder there are categories actually for every mental category. There's an algorithm or decision-making process.
They have letters to them, A, B, C, D and E, and these refer to criteria and symptoms for any given mental disorder, ok??
Now, for post-traumatic stress disorder, the first criteria in order to make a decision of post-traumatic stress disorder, the person must fulfill the prime criteria for establishing post-traumatic stress and that is an A-l or an A-2.
There are two different components. The first one is really important. The first component defines, defines what a traumatic event is and we call that the A-l criteria.
And bear with me a second. I want to read it to you.
MR. GARROW: Your Honor, I would object. This is clearly - the witness isn't even responding to questions. He's off on these narratives on his own, and he's not being responsive to any questioning.
MR. LYMAN: Quite to the contrary. THE COURT: Overruled. He can - I don't think that's the case.
MR. LYMAN: Thank you, Judge.
BY THE WITNESS:
A. Okay. So the first thing is that in order to make a decision of post traumatic stress disorder the person has to meet this first criteria. And what it means is that they have to have had a traumatic experience, okay, and it's defined in this way.
This is A-l criteria. The person experienced, witnessed or was confronted with an event or events that involved actual or threatened death or serious injury or a threat to the physical integrity of self or other people.
Now, that's the definition of a traumatic experience. So if that doesn't - if the person doesn't meet that, you cannot make a diagnosis of post-traumatic stress disorder.
BY MR. LYMAN:
Q. Is that criteria important to us in this case?
A. It's very important to us in this case. The second A-2 criteria of the first cluster is that the person's response involved fear, helplessness or horror.
So that's the second prong to the first criteria. The one is you've got to have the event. The other is if you've had the event, you must manirest fear, helplessness horror.
Q. Is that second prong important to us in this case?
A. Yes. That's the A criteria. The B criteria is what I told you about a minute ago. That's where they have to have so many symptoms out of five different categories.
The C category is the one I talked about in terms of avoidance and numbing and denial and ways of pushing away the trauma.
And that category has seven sections, seven groups of symptoms, and they have to have three of the seven to qualify.
And then the D category are that group of symptoms I was talking about that reflect psychobiological changes that weren't present before trauma, like the sleep disturbance and irritability and hypervigilance, startle response and so on.
Those are the categories of A, B, C, D, and then there's two more. E and F.
And that is that the symptoms have to last for more than a month to call it post-traumatic stress, assuming they've fulfilled the criteria.
And the last one is if once the symptoms are present, does it impair their functioning in different ways.
That's the decision-making tree for post-traumatic stress disorder.
Q. And would you agree with Dr. Hull and Dr. Kessler who told the ladies and gentlemen of the jury that if Mr. Gustafson does not fall into all of those categories, then you cannot reach a decision of post-traumatic stress disorder?
Q. So if, for instance, the A criteria, one of those, actually the first prong or the second prong in the A criteria, Mr. Gustafson doesn't fall within that criteria, you cannot diagnose him with post-traumatic stress disorder, correct?
Q. Doctor, based upon a reasonable degree of certainty in your field of psychology do you have an opinion as to whether or not Mr. Gustafson meets all of those criteria?
A. Yes, I have an opinion.
Q. And what is that opinion?
A. He does not meet the criteria.
Q. Which criteria does??e not meet?
A. He does not meet A, he does not meet C. I have questions about whether he meets B, and I have questions about whether he meets D as well.
Q., And what is your basis for the opinion that Mr. Gustafson does not meet the A criteria?
A. Because the nature of the accident does not involve in any way the criteria defined. There was no - there was no death. There was no threat of death directly. No one was injured. No one was seriously threatened with their life. There was no serious injury.
There was no threat to the physical integrity of self or others by the nature of the accident. The A-l criteria is not met.
Q. Do the photographs that you reviewed of - does the photograph of Mr. Gustafson support that opinion?
A. Yes. You mean the photograph where he's smiling and waving?
Q. In what way?
A. Well, the way it's??st clear, if someone's been through a trauma, they've been through a major trauma that's life-threatening to themselves or others, they're not going to be smiling, they're not going to wave to a camera.
They're going to be in a daze, in a shock. They're going to be overwhelmed. They may be terrified.
If they're physically injured, they're going to be preoccupied with their physical injury.
If they're not physically injured and yet it's life threatening, they will be emotionally traumatized. They may be numb or dazed or out of touch with reality for awhile because of the power of the trauma to the impact.
I've never seen anybody smile and wave after they've been in a trauma. It's not the nature of the beast. It doesn't work that way.
Q. Do the paramedic reports and the hospital records of Sharon McKinnis support that opinion?
Q. In what way?
A:- Well, the paramedical report for Mark says that he had slight pain in his lower back, that he was ambulatory.
It's very hard to read this. He has motor and sensation in all extremities. So there's no sign at this point of anything wrong.
And he's oriented in all three spheres, meaning he knows who he is, where he is and what's going on.
There's no indication here of injury taken by the paramedic. And likewise for Sharon, it says that again that she was ambulatory at the scene. No pain, no complaints, only wanted to be checked out.
That's the only thing noted in the paramedic records.
Q. It's important to look to Sharon because the criteria calls for the trauma being a state of creating fear or fear from imminent harm to self or potentially to others?
Q. It doesn't necessarily have to be to self?
A. You had two prongs to it. I didn't finish answering your question about the hospital records.
MR. GARROW: Objection, your Honor. May I approach on this?
THE COURT: Yes. Fine.
(Whereupon, the following proceedings were held outside the presence and hearing of the jury.)
THE COURT: What we talked about in our motions in limine was whether or not you were going to be able to provide testimony that the fetal monitor of the child indicated there may not be any breath sounds and that that knowledge caused him to do what he did and/or that knowledge or the knowledge of that event caused the child to be induced - I'm sorry, the pregnancy to be induced and the baby delivered on that day.
And I said you couldn't do it without some competent medical testimony to say, in fact, that happened and as a result of it it was necessary to induce her labor and have the child born. That's what I said.
MR. GARROW: He's not an M.D. and he's going to talk about that whole process.
MR. LYMAN: Try to -
THE COURT: Based upon his review of the paramedics' record, what the paramedic testified that she had no complaints and walked and so on, so forth based upon the hospital record that, you know, the facts that are contained in that record that leads him to believe it wasn't a serious event as he thinks is necessary to qualify for the A criteria.
I don't see any problem with that. He's not going to get into the medical detail that she had or didn't have this, right?
MR. LYMAN: That is correct.
THE COURT: I don't see where that's a problem.
MR. GARROW: I've got to make a record.
THE COURT: That's fine.
(Whereupon, further proceedings were held in open court.)
THE COURT: Let's get a new question. BY MR. LYMAN:
Q. Doctor, do you rely upon the hospital records of Sharon McKinnis in your opinion -
Q. - that the A criteria has not been met?
Q. In what way, Doctor?
A. Because upon admission to the hospital she has no complaints. The evaluation which was at 1:05 in the afternoon a couple hours after the event shows that all of her physical assessments are normal.
Her temperature, pulse, respiration, blood pressure all normal and she subjectively doesn't complain upon being examined.
Q. Doctor, did you review any document or record in the voluminous documents that you've told the ladies and gentlemen about that indicates to you at all that this trauma fits within the A criteria?
Q. Is it your opinion, Doctor, that this event, this trauma clearly falls outside of the A criteria?
Q. Now, you also, Doctor, told us that you didn't believe that Mr. Gustafson fell within the C criteria. Do you recall that?
Q. And is that an opinion that you made based upon a reasonable degree of certainty in your area of expertise?
Q. What is the basis for that opinion?
A. Well, to meet the C criteria you have to have three of seven symptom clusters. And he doesn't have any of them. That's the simple part.
The first one is that people try to avoid talking about the situation, the event, the place, what happened, avoid going to the places where it might have happened.
And he said to me and to Dr. Moran and to others including his wife that, you know, he could talk about it all the time.
In fact, he said to me it's not even an issue anymore, but he does freely talk about it so he's not trying to avoid talking about it.
The only thing I found initially - initially I mean in the immediate month or so after the accident , he said he had a hard time being around 55th and Cicero Avenue where it occurred, but that's gone, that's not there now.
The criteria is the ability - inability to remember what happened. He doesn't meet that criteria.
The next criteria is a change in many significant activities. What this is asking is after the trauma, do you stop doing things you used to do and enjoy. I couldn't find evidence for that.
The only thing he reported to me was that he used to ride motorcycles and enjoyed it and he stopped doing it. On the other hand, his wife reported he sold the motorcycles to raise money.
Q. His girlfriend -
A. I'm sorry. Having feelings of detachment from other people. He clearly indicated he loves his children, his wife. He's not detached or estranged from those closest to him.
Having a rest??cted range of emotional expression. And clearly he's got a full range from anxiety to anger to talking lovingly about his relationship with his children, so he doesn't meet that criteria.
And the last one out of the seven was having a sense of foreshortened future, thinking you don't have much time left in life. He doesn't meet any of the C criteria.
Q. In that last one he doesn't expect to have a career, marriage, children or a normal life span, correct?
Q. And Mr. Gustafson has had additional children since this accident ?
A. That's true, yes.
Q. Would Sharon McKinnis' statement to the ladies and gentlemen of the jury yesterday that Mark talks about this accident all the time support your finding that Mr. Gustafson doesn't fit into the C criteria?
Q. You told us also, Doctor, that you had some questions whether or not he fits into the B and, I believe the D criteria?
Q. Can you explain those to us, please?
Q. Again, the B criteria first refers to the way people relive the trauma. There's at least five different categories in the diagnostic manual.
The first one really refers to what we commonly call flashbacks where people have unwanted memories, traumatic flashbacks to what they experienced and he doesn't report any of that.
He does have memory of the event, but that's not what the criteria is. The criteria is the person has recurrent intrusive, meaning unwanted distressing recollections of the experience and he didn't report that to roe nor did he report it to Dr. Moran as well. So I don't think he meets that criteria.
The second criteria are nightmares of the trauma. And when I ask him as did my associate Dr. Moran about nightmares, he says he has nightmares but none of the content goes back to the accident.
It's about being at war and fighting and being chased and things like that. None of the content of the dreams has anything to do with the accident so he doesn't meet that criteria.
The third criteria is acting or feeling as if the traumatic event were going to recur.
And I asked him about that, and I didn't get any sense from him whatsoever that he's ever had that or currently has now a sense that it's going to happen all over again. So that's not met.
And then the other two criteria for this cluster, the B cluster is intense psychological distress at exposure to events that resemble an aspect of the event. Okay.
This is the B-4 criteria so it's intense psychological distress at exposure. He did report to me that initially when he would see a limo or see something on television that would remind him of the accident , that he became distressed.
But that dissipated. That's gone. I didn't see any evidence that it's here now. You know, it might have been a little bit in the immediate wake of the accident.
Then finally, the fifth one and last one is physiological reactivity to internal or external cues that resemble an aspect of the traumatic event meaning when you see something that reminds you of the trauma, your body starts to respond, your heartbeat goes up, you breathe fast and so on. I could find no evidence of that either.
So in direct response to your question, the reason I said I had doubts about the B criteria when I examined him and when Dr. Moran did, most of the time when we would ask him followup questions about the criteria, he would talk about something other than the accident.
And the nature of the diagnosis of post-traumatic stress disorder, the symptoms are always tied into what happened in the trauma. And that wasn't the case here.
Q. Which is typical in Vietnam veterans, correct?
A. The fact that they're going back to it.
Q. Goes back to Vietnam?
Q. Doctor, does the length of this condition cause you any concern that we are now five years post accident ?
A. Absolutely does.
Q. In what way?
A. It's highly unlikely, most improbable in my experience that anybody would continue to experience anything resembling post-traumatic stress disorder from an accident as minor as this one.
That anybody would have five years worth of continuing symptoms from a minor accident is just not plausible. I've never seen it in my entire career.
If anything, what I would expect is that you'd see if there's any distress, it would be short term.
By short term I mean maybe a month at the outside, but not five years of persistence.
I know of nothing in the scientific literature that shows that any kind of traumatic stress response would persist for five years in exposures to a minor stressful event in which no one's injured, killed or threatened or dead.
I know of no evidence scientifically that would support, chis. It's not plausible.
Q. Doctor, do you have an opinion based upon a reasonable degree of psychological certainty as to whether or not Mark Gustafson suffers from post-traumatic stress disorder?
Q. And what is your opinion, Doctor?
A. He does not.
Q. Now, Doctor, we talked earlier about conversion disorder. Do you recall that?
Q. Do you have an opinion based upon a reasonable degree of medical certainty as to whether - I'm sorry, based upon psychological certainty in your field of expertise as to whether or not Mr. Gustafson suffers from a conversion disorder?
Q. And what is that opinion?
A. My opinion is that he suffers from a conversion disorder.
Q. Doctor, do you have an opinion based upon a reasonable degree of psychological certainty as to the cause as to whether or.ot the motor vehicle accident on March 16, 1996 caused that conversion disorder?
A. Yes, I have an opinion.
Q. And what is that opinion?
A. My opinion is that the motor vehicle accident on March 16, 1996 did not cause his conversion disorder.
Q. Do you know with the vast amount of documents and information that you have what caused the conversion disorder?
A. I don't know that I can actually say. There's so many different possibilities.
Q. Can you explain that for the jury?
A. Okay. A conversion disorder again is where the person is converting emotional problems into physical symptoms.
In his case he has a leg tremor. That's the physical symptom. That leg tremor in my opinion is not caused by this accident. It's caused by something else in the mind of Mr. Gustafson.
And the reason I say that is he has such “a significant history of prior trauma, prior abuse, prior difficulties in life that those are the kinds of problems and anxieties and worries and concerns about, you know, how to cope in life that I believe are causing him psychological distress.
And I think the way that he deals with that is that he takes that distress that's internal not related to the accident , that internal emotional psychological distress, and it gets converted into a physical symptom, in this case the tremor of his leg.
And it's very functional. That's the other part of it. I'd like the jury to understand that by having the tremor, it gives him a focal point of attention which takes off focus on other things like why you're not working or why you're not doing other kinds of things you might possibly do in life.
And one of the things we know about conversion disorders is that it's as fascinating as they are as psychological phenomena. They're also extremely functional because when the patient has the symptom, that symptom often allows them sympathy, attention, not working, compassion, all sorts of other things that come to them that's known scientifically as secondary gain.
That by having the symptom, something else happens for you and that's the conversion factor that we see in this case I believe.
Q. Did all the information you have assist you in and did you rely upon that in reaching your diagnosis that Mr. Gustafson has a conversion disorder?
Q. Would it be reasonable, Doctor, in your opinion for a psychologist who has treated Mr. Gustafson on three occasions for three hours to reach an opinion concerning a conversion disorder?
A. Would it be reasonable?
A. Yes. If they have some experience with understanding conversion disorder, sure.
Q. Would it be reasonable without doing any further investigation such as Dr. Kessler?
A. Well, I think you need additional investigation. You need to get a lot of history and also get some snapshots like through psychological testing to look at what's the way in which this particular person is coping with what demands are being placed on them in life right now that cause them stress and cause them anxiety.
Q. Does the onset - strike that.
If I understood your testimony correctly, the tremor or the shaking is converting something that is inside Mr. Gustafson?
Q. And in order to find that this automobile caused that, we would then be saying that this automobile accident caused that and that's what's being converted, correct?
Q. And you're unable to do that?
A. I can't do that.
Q. Doctor, have you told me all the opinions that you have in this case? A. Yes.
MR. LYMAN: Thank you very much. I appreciate your time.
THE WITNESS: Thank you.
THE COURT: Ladies and gentlemen, before we do the cross-examination of the doctor, since it is the noon hour, and I expect the examination as being quite lengthy, why don't we take our lunch break.
And it's a very nice day; you might be tempted to go outside. Could we keep to maybe an hour or do you want more time?
Let's reassemble here at 1:15 at which time we'll continue with the examination of Dr. Wilson.
(Whereupon, further proceedings were adjourned, to be reconvened on the 23rd day of March at 1:15 p.m.)
STATE OF ILLINOIS)
COUNTY OF C O O K)
I, ROSEMARIE A. JUSKENAS, do hereby certify that I am a court reporter doing business in the City of Chicago, County of Cook, and State of Illinois; that I reported by means of machine shorthand the proceedings held in the foregoing cause on the 23rd day of March, 2001, and that the foregoing is a true and correct transcript of my shorthand notes so taken as aforesaid.
ROSEMARIE A. JUSKENAS, CSR, RPR,
CSR License No. 084-002523
Notary Public, Cook County, IL