Re Gleeson
[2007] QMHC 26
•1 October 2007
MENTAL HEALTH COURT
CITATION:
Re Gleeson [2007] QMHC 026
PARTIES:
REFERENCE BY THE DEFENDANT’S LEGAL REPRESENTATIVE IN RESPECT OF SHARYN GLEESON
PROCEEDING:
Proceeding No 0232 of 2006
DELIVERED ON:
1 October 2007
DELIVERED AT:
Brisbane
HEARING DATE:
17 and 19 September 2007
JUDGE:
Philippides J
ASSISTING
PSYCHIATRISTS:Dr J F Wood
Dr J M LawrenceFINDINGS AND ORDER:
1. At the time of the alleged offences, the defendant was not of unsound mind as described in Schedule 2 to the Mental Health Act 2000 (Qld);
2. The defendant is fit for trial;
3. Proceedings against the defendant are to be continued according to law.
CATCHWORDS:
MENTAL HEALTH – DECLARATION OR FINDING OF MENTAL ILLNESS OR INCAPACITY – where defendant charged with numerous fraud offences – where defendant suffered from a borderline personality disorder – where expert opinion differed as to whether defendant suffered from Dissociative Identity Disorder – whether defendant suffered from a disease of the mind – whether defendant was deprived of a relevant capacity at the time of the alleged offences
Mental Health Act 2000 (Qld), Schedule 2
COUNSEL:
Mr J Farmer for the defendant
Mr J Tate for the Director of Mental HealthMs L Clare for the Director of Public Prosecutions
SOLICITORS:
Legal Aid Queensland for the defendant
Crown Law for the Director of Mental HealthDirector of Public Prosecutions (Qld)
PHILIPPIDES J: The defendant, Sharyn Gleeson, a 34 year old woman, is charged with numerous fraud offences, including attempt to dishonestly obtain a benefit, forgery and uttering, impersonation, and possession of thing with intent to forge a document, occurring from 1 January 2005 through to 2 June 2006. The defendant’s mental condition at the time of the alleged offence has been referred to this court.
Circumstances of the Offence
On 1 December 2005, police attended the defendant’s residence to locate two DVD recorders that the defendant had paid for by cheque in November 2005, but for which she had insufficient funds in her account to cover the cheque. In the process of searching the defendant’s house for the DVD recorders, police located a large amount of other paperwork involving fraudulent transactions and forgery. The fraud charges involve the defendant falsely representing herself to be another person to gain a benefit. Amongst the forged documents discovered by police there were forged birth certificates in several names; a loan application for $100,000 in a false name; Austar television and Telstra telephone accounts in false names; and forged pay slips and council rates notices. A number of forged documents had also been uttered in an attempt to clear a negative credit history with Bay Corp Advantage. The charges also include unlawfully possessing items (including a computer, scanner printer and laminator) with intent to use them to forge documents.
When police asked the defendant if she had forged the documents, she stated “I may have”, but that she could not recall forging the documents or uttering any forged documents. She indicated that she has another personality and this other personality must have been responsible for the criminal acts and that she could not remember the past two months. However, she reportedly was able to tell police what she had had for breakfast the day before and where she last went grocery shopping. When discussing the offences with Professor Middleton, one of the reporting psychiatrists, the defendant stated that she was “trying to get money, but I was using different names”. The defendant reported hearing voices in her head “for ages” and also described hearing externalised voices. The voices, amongst other things, tell her “to do silly stuff, like fraud”. The defendant also described other sensory phenomena such as seeing and smelling “burning fires everywhere” and experiencing a sensation of “a lot of pins jabbing into [her] through the day and night”. She reports repeatedly finding herself in places with no memory of how she came to be there.
Forensic/Psychiatric History
The defendant suffers from a number of medical problems. She contracted meningitis at the age of 3 months and has suffered from cerebral palsy, osteoarthritis, bilateral thalamic infarcts with abnormal pain disorder, seizures and functional psychosis. She was also diagnosed with epilepsy in her younger years and with anorexia. The defendant’s childhood was characterised by frequent surgical procedures as a consequence of her cerebral palsy and she has been seen by many doctors over the years including Dr Flanagan and Dr Yvonne White in 1999, Dr Astill in 1996 and Dr Fisher in 1997. She was referred to Dr Zimmerman in 2004.
In 2004, the defendant was charged with attempted fraudulent appropriation of power, forge a document with intent to defraud and utter a forged document following an attempt by her to purchase a property in her aunt’s name. She was convicted on 25 July 2005 and sentenced to 18 months’ imprisonment wholly suspended for three years.
The defendant reported that after the 2004 charges she sought assistance by arranging to be admitted to Belmont Private Hospital, because she “knew [she] had a problem”. She reported also being diagnosed with Schizophrenia at this time.
Reporting Psychiatrists
Professor Middleton
Professor Middleton interviewed the defendant on 30 July 2006 and provided reports dated 22 September 2006 and 22 August 2007. He diagnosed the defendant with Dissociative Identity Disorder (“DID”). The diagnostic criteria for DID listed in the DSM-IV-TR (2000) are:
A.the presence of two or more distinct identities or personality states (each with its own relatively enduring pattern of perceiving, relating to, and thinking about the environment and self).
B.At least two of these identities or personality states recurrently take control of the person’s behaviour.
C.Inability to recall important personal information that is too extensive to be explained by ordinary forgetfulness.
D.The disturbance is not due to the direct physiological effects of a substance (eg, blackouts or chaotic behaviour during Alcohol Intoxication) or general medical condition (eg, complex partial seizures).
To Professor Middleton, the defendant described a number of alters – the host Sharyn, baby Sharyn, Sandi, Stephanie and Anne. Professor Middleton reported that when the defendant was describing the police search of her house to him, she underwent a spontaneous switch to another ego state, stating loudly “Go away! Go away! There’s people over there…”. She reportedly then switched back to the state she was in when recounting the police visit, only to again switch into a state in which she again loudly said “Go away!”. When asked the identity of the entity who was uttering this, Professor Middleton reports that the defendant stated:
“You’re talking to Sandi … I’m the one who helped Sharyn …by getting the stuff she needs. She needs money and protection so I protect her from her husband … I get a pair of scissors or a knife. I put them to him. If Sharyn’s not good I put them to her”.
In the ego state of Sandi, the defendant reportedly acknowledged needing money, stating:
“Of course. Doesn’t everybody? The bank won’t give it to her because of her disability. She’s naughty. She’s got problems. That’s naughty … She shouldn’t have problems … I tell Sharyn what to do. She obeys me because she knows the consequences. She gets cut or put down.”
At a later point in the interview, Professor Middleton decsribed that the defendant again switched into a different ego state, volunteering an identity as “Baby Sharyn”, and later as “Stephanie”. The ego state “Stephanie” said stealing was “good”. The defendant also referred to another girl called “Anne”. Professor Middleton stated that switching between dissociatively based personality states was particularly florid in the defendant’s case. The alleged offences were said to have been associated with the Stephanie alter.
According to Professor Middleton, the defendant completed the Dissociative Experiences Scale-II (of Eve Bernstein Carlson and Frank Putnam) with Professor Middleton and scored 90, which put her in the highly dissociative end of the spectrum of patients with DID. The defendant also completed the Somatoform Dissociation Questionnaire-20 (of Nijenhuis, van der Hart and van der Linden). She scored 78 out of 100, yielding a figure consistent with somebody highly somatising, highly dissociative and in keeping with somebody who would have DID. Professor Middleton’s evidence was that DID constituted a disease of the mind.
Professor Middleton accepted that the defendant may have elaborated or embellished her symptoms at times and that “it may be that even in her host state, she does not exhibit meticulous honesty”. Professor Middleton accepted also that the defendant suffered from a personality disorder. Nevertheless, he saw the defendant’s alleged offending as occurring in the context of DID.
Professor Middleton did not contend that the defendant was deprived of the capacity to know she ought not to do the acts or of the capacity to understand what she was doing at the relevant times. However, he was of the view that the defendant’s ability to control her conduct was “sufficiently compromised” by her longstanding mental impairment so that she was unable to control her conduct at the time of the alleged offences. When asked during his oral evidence to expand on his understanding of the defendant’s inability to control her conduct, Professor Middleton stated that he understood the deprivation of control to relate to the defendant’s inability to control her transformation into the Stephanie persona in that she could not control the process by which she is spontaneously transformed into the Stephanie state. He stated:
“… she has as far as I can tell no definitive ability to stop herself seemingly at fairly random going into the Stephanie state and in that Stephanie state no other part of her seemingly is able to exert enough control to actually stop the commission of these acts which are by their nature angry and self destructive.”
Dr Zimmerman
Dr Zimmerman provided a report dated 10 November 2006. At that time, he had been the defendant’s treating psychiatrist for approximately two years. She had been referred to him for assessment following “suicidal ideation, bizarre thoughts and behaviour, auditory hallucinations”. Dr Zimmerman diagnosed the defendant with a severe personality disorder with “possible dissociative periods”.
He considered that the defendant had a tendency at times of exaggerating both her symptoms as well as exaggerating the loss of control she exhibits. He reported:
“[the defendant] claimed to have amnesia for the recent alleged fraudulent behaviour. I note that these activities took place over a period of up to 12 months and were not an isolated brief event. For this reason, I believe it is implausible that she is truly amnesic for her behaviour if it indeed took place while in a period of dissociation, which clearly would have had to have been repeated without Ms Gleeson being aware of what was taking place, whilst there was physical evidence of the alleged fraudulent activity in her house and on her computer files, which should have aroused her curiosity at the very least; if indeed this behaviour was part of dissociation.”
Dr Zimmerman’s opinion, on the balance of probabilities, was that there was no deprivation of any of the relevant capacities during the events in question; the defendant was aware of her actions, knew they were wrong and was able to control her actions. That opinion clearly places him at variance with Professor Middleton’s conclusions.
Dr Varghese
Dr Varghese interviewed the defendant on 4 April 2007 and provided a report dated 29 May 2007. He considered Ms Gleeson’s presentation at the interview as “hysteria” and noted it as hysterical periods of dementia. He considered this was not a medical “illness” but rather a “behaviour”. Further, he observed:
“Ms Gleeson’s behaviour can be understood as one of taking up a role wherein she is attempting to portray to the interviewer that she has severe neurological disease and moreover that she is either severely retarded or severely demented and moreover that she is psychotic and also that she may have more than one personality. The behaviour can be seen as a maladaptive response to the unfortunate situation she finds herself in but it is at the same time a maladaptive attempt to get out of the situation she is in. The behaviour will continue as long as the contingencies that reinforce the behaviour continue and ought to cease when the contingencies no longer operate.”
Dr Varghese commented in his evidence on the defendant’s presentation on examination as bizarre, but more to the point that it had an element of “silliness” about it reminiscent of hebephrenia. However, Dr Varghese excluded a diagnosis of Schizophrenia. He agreed with Dr Yvonne White that in respect of the defendant’s reports of auditory hallucinations since the age of five or six, it was unlikely that she could have had Schizophrenia from such an age. Rather he considered that the “voices” mentioned by the defendant might represent thoughts or ruminations that may be experienced as fully formed mental images, observing that such phenomena are not uncommon in individuals who lack coherence in their sense of identity. He considered that there was a very significant disorder of personality with borderline, histrionic and dependent traits and also antisocial traits. Dr Varghese observed that it is a common phenomenon in borderline personality and people with a disorder of self to experience internal states as if they were external.
With respect to the diagnosis of DID, Dr Varghese observed that the defendant certainly behaved so as to present a situation that there was more than one personality present, just as she behaved so as to represent that she was severely demented or mentally retarded and had severe neurological disease, as indicated by the movements and spasms during the interview and the pseudo‑epilepsy noted by others.
Dr Varghese stated that the status of DID as a psychiatric disorder was controversial, as was acknowledged in the DSM-IV where the term first appears in any official classification with a suggestion that it may be culture specific. He observed that it was previously called Multiple Personality Disorder (MPD), and Multiple Personality and classified as a Hysterical Neurosis and grouped with other hysterical disorders such as Conversion Hysteria. He noted that the ICD‑10 does not have a category of DID, but includes MPD as a subcategory of Dissociative Disorders which subcategory still includes Conversion Disorder. He noted that the underlying psychopathological mechanisms are similar in conversion and dissociation. In his report he made the following observations:
“… DID or MPD can be regarded as a secular version of “demonic possession”. Just as demonic possession will not emerge except in cultures or subcultures where there is an acceptance that such phenomena can and do occur, DID will not emerge other than in the social context where there is belief about the syndrome. This has led most mainstream Psychiatrists to consider that the syndrome is essentially iatrogenic. Certainly the doctor patient relationship is critical in its emergence and the form it takes.
Whether or not DID is iatrogenic or emerges spontaneously it cannot be regarded as “illness” and certainly not a “state of mental disease”. Rather it is a form of “behaviour” and could be regarded as a variant of “abnormal illness behaviour”. In other words DID is not something an individual “has” but rather something they “do”. Thus an individual with DID is behaving as if they have several independent identities or alters within them in the same way that a person with Conversion Disorder, say with conversion paralysis of an arm, is behaving as if his arm is paralysed and as if he has a neurological condition when no such neurological condition is present.
The reasons why an individual behaves in a particular way may be quite complex but there is usually a hidden or obvious gain. The behaviour will continue as long as the contingencies that reinforce the behaviour continue and will cease when the contingencies no longer operate. The behaviour of one’s doctor or therapist is an important contingency but may not be the only reinforcing or validating agent.”
Dr Varghese did not consider that the defendant was of unsound mind at the time of the alleged offences, essentially because he saw the defendant as suffering from a personality disorder and not a disease of the mind. He rejected the diagnosis of DID, which he described as “a non-falsifiable paradigm”. But in addition, his opinion was that, in any event, there was no deprivation of capacity. As with Dr Zimmerman, he saw the changing of alters as comprising a voluntariness of behaviour. He also noted that there was a contradiction in Professor Middleton’s contention as to the incapacity of control of transformation into an alter state when compared with his acceptance of the view that the defendant was fit for trial, in the sense that there appeared to be an acceptance that the process of switching alters could be brought under control in a court situation.
Conclusion
I do not consider that it is necessary for the purposes of this case to resolve the controversy in psychiatry as to the status of the diagnosis of DID. Even on the basis of the diagnosis urged on the Court by Professor Middleton of DID and even accepting it as a disease of the mind, Professor Middleton was only able to isolate the capacity of control as being “sufficiently compromised”. In his report, Professor Middleton did not explicitly state that there was a deprivation of capacity in this regard. In his oral evidence, it was apparent, as already mentioned, that he accepted that the inability to control related not to the actual acts the subject of the charges, but rather to the transformation to the Stephanie alter. And in that regard he qualified his comments by referring to the defendant “seemingly” being unable to exert enough control over the Stephanie state to stop the commission of the alleged offences.
That was not a view embraced by either Drs Varghese or Zimmerman, both of whom remarked on the element of deliberateness and consciousness in the presentation of another alter. Indeed, both doctors were clear in their view that there was no deprivation of any capacity. They saw the defendant’s conduct in terms of a personality disorder, a condition which Professor Middleton also accepted as a co-morbid diagnosis. Certainly, that diagnosis had the support of both the assisting psychiatrists, as did the opinion that there was no deprivation of any capacity. Professor Middleton placed some emphasis on the self-punishing, self-destructive aspect of the conduct in question in promoting the diagnosis of DID, but, as Dr Wood observed, such behaviour is also a recognised part of Borderline Personality Disorder and can be understood without resort to the construct of DID.
Having considered all the evidence, I am unable to conclude that the defendant was of unsound mind at the relevant times; I am unable to be persuaded on the facts of this case that the defendant suffered from a disease of the mind, or that there was a deprivation of any relevant capacity.
The defendant is fit for trial. The proceedings will continue according to law.
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