💧Mary Kostakidis Profile picture
Sep 22, 2020 128 tweets 16 min read Read on X
Extradition September hearing Day 10 (12 incl Covid days)

On the video link waiting to cross to court room.

We will hear from both Defence & Prosecution medical experts over the next few days, as one of the arguments JA’s team will advance is that the extradition would be ..
“unjust and oppressive” due to his mental condition & high risk of suicide if he is extradited. This was taken into consideration in the refusal of extradition in the the case of Laurie Love.
Clearly findings will be contested & the judge will be asked to make a finding of fact.
In addition to challenging the basis of any diagnosis, the basis of any prediction of the impact of conditions in US prisons will also be significant.

The first witness, scheduled to take all day, is expected to be Prof of Neuropsychiatry at Kings College, Michael Kopelman for..
.. the Defence. He has visited JA in Belmarsh for numerous consultations.
He concludes JA presents a high suicide risk.
He also refers to a trauma specialist’s finding that JA has complex PTSD & another specialist who assessed JA’s cognitive decline in HMP Belmarsh.
All present, (incl Clair Dobbin for the Prosecution). Glimpse of JA, wearing a suit, demeanour tired. Judge in.
Kopelman in person in court. We see his back in the witness box. He prefers to stand because there is “a sort of chair here”.
Fitzgerald asks for the press to exercise discretion in reporting the personal matters.
2 report, one Dec 2019, severe depression with somatic symptoms - loss of sleep, weight loss, hallucinations, high risk of suicide.
13 Aug 2020 report on conditions in US prisons, improvements in Feb March to moderately depressed due to medication for hallucinations & moved out
of medical ward. I still consider the risk of suicide if it is decided he will be extradited... speaking about suicidal tendencies which he says would JA would find embarrassing to be revealed. Kopelman uses the Maudsley method.. JA has been to 37 schools.
Going over medication.
Effects of depression is a lessening of mental function - thinking, memorising, concentration which JA has complained of. (Personal family history I don’t feel I can report.)
(You will prob read about it in the MSM. Just the sort of thing they will be interested in. Hope I’m wrong.)
JA treated for depression while in the Embassy. He saw a psychotherapist in prison in addition to be put on medication. He has had somatic symptoms continuously while in prison. (I won’t go into the hallucination details, sorry).
JA talks about suicide. He also has an anxiety disorder picked up by a couple of doctors & PTSD. I suspected he had Aspergers but he also has warmth in his personal relationships so I had another opinion on that diagnosis. The imminence of extradition or actual extradition,
the risk of suicide would increase. Much more isolation he will be kept in the US. Quotes a US expert saying solitary is not recommended for people with depression. Suicide is 9 times as common in people with ASD but in his case the depression compounds this.
He would not be able to call family or anyone that might help him in detention in the US. There are an abundance of suicide risk factors. He has made suicide plans, begun writing letters to family and friends etc my prediction is he will deteriorate significantly
Refers to former warden’s report the doctor found helpful. He has taken a large amount of paracetamol on one occasion, “which does not surprise me..”
Lewis: refers to a couple of prosecution bundles, which K hasn’t seen at all before but wants to use his own bundle.
K says he his not a fan “ of those bloody books” in response to Lewis’ question about classification of mental disorders.
No I haven’t relied on those, I have made a clinical diagnosis.
Lewis: that’s the common standard.
K: I’ve served on committees that formulate this things & they are very political & vary in how good they are.
Lewis conducting a series of questions about how to describe mental disorders & their severity. (Oh dear, we shall all have to focus very hard here because I predict this cross examination won’t be riveting).
Lewis: episodes will last between 3 & 6 months & then recovery..
K: clinical judgement is critical.”DSM should not be used ... in a cook book fashion”
“By people with no clinical experience”
Lewis: asks him to close the book he is quoting/ reading from. K refuses.
K says I have the book, you just have a photocopy of certain pages.
Lewis: what’s the yardstick for your diagnosis?
K: my clinical assessment & the ISD (diagnostic guideline)
Lewis is insisting he closes the book & he refuses again
Lewis is going thru each classification & severity.
Lewis: sever with psychotic symptoms with hallucinations and delusions,
K: No. It’s not AND it’s OR. He doesn’t have delusions & you don’t need both.
Lewis: A person with psychotic depression is unable to function
K: yes he is like this some of the time, particularly last year, and as his lawyers have found him to be. He is not completely unable to function, but the issue is whether he has hallucinations or delusions & he has.
Lewis: you are a neuropsychiatrist.
K: yes but not only a neuropsychiatry.
Lewis wants to talk about neuropsychiatry. .. & JA had a normal MRI. K reminds Lewis he has given forensic psychiatry in a case they worked on together. He also says Lewis wanted his services for this case, so it’s a bit rich trying to discredit his credentials. (Defence mirth)
Discussion about spotting malingering. K says every time I go to see someone in a prison, I am aware they may be exaggerating. Lewis Quotes (paraphrases) Polonius “Though this be madness yet there be method in it”
K points to his experience & prison reports. Lewis asks him to name articles he has read on malingering... exaggerating. K starts referring to articles, Lewis cuts him off, K says the critical issue is I had this very much in my head (ie the poss of malingering)
Lewis wants to ask him about an article he has in the bundle.. K says I haven’t read every article.. I didn’t know I was coming here for an O level test.
Lewis insists they stick to his script.. starts reading page in bundle.. K says Are you saying I don’t have the expertise to diagnose psychosis?
This author says clinical skills alone are not sufficient to diagnose malingering, K deals with it- it’s often inconsistencies that
give malingering away, & this is important in neuropsychiatry as well.
None of the psychiatrists have challenged whether JA has had hallucinations. Lewis disagrees, K wants to elaborate, L refuses referring him to the opportunity when being re-examined
K: there are more people with hallucinations in prisons than in the community.
Lewis: close observation is key rather than consultations.
K: it’s not always possible to have close observation “ by the clinical team” - you are putting words in my mouth.
Lewis: discussing ACCTV in prison .. & relying on what JA tells K about an incident in prison, the result of which is JA was placed in solitary for 4 days. You rely solely on what he has told you.
K: yes but there are other factors & you are quoting out of context
K: I don’t know it’s true, or untrue, nor have I seen all the CCTV.
Glimpse of JA. Lewis wants to know what type of razor blade it was because the type used in prison is not dangerous. K says he didn’t question him on the nature of razor blade. Lewis: why wasn’t it in the
prison notes? K: I should have prefaced it by this is what JA told me. Not everything goes in the notes. He told the psychologist who looked into it - she discussed it with prison authorities & did not conclude it was not true.
Lewis: why didn’t you tell the authorities?
K: not
not my role & it was not that recent.

10 min break
Someone has gone to speak with Julian. Kopelman wears spectacles & looks to be in his late 60s or 70.
More discussion about items JA had concealed that were found by prison staff, as reported by JA. K: whether true or not, he has clinical depression & is suicidal.
Lewis: When JA arrived in Belmarsh he was screened for intellectual disability & assed for mental disorder but was uncooperative, he was placed on suicide watch (ACCT), JA tells K that he had Aspergers. K: it may not have been a diagnosis, many people have said it of him.
Lewis doesn’t know what ideation is.. rattles off a list of things checked that K included in his report of the medical records made when JA was taken to Belmarsh. Asks why K omitted in his notes that JA said he wanted to consult his lawyer about whether he would see a psychiatri
.. or that he reads the British medical journal. K well he reads New Scientist & other journals. Lewis: surely alarm bells should have rung about potential exaggeration. K: Joseph Farrell told me JA is a bit hypochondriacal & likes to read about his ailments.
Lewis questions him about things K has left another consultant psychiatrist. K: he did not develop a relationship with JA & I don’t agree with everything he concluded.
Lewis: Dr Daily reported on 17 April “mood good”. Why didn’t you report that? K quotes his record of other facts.. medication changes etc. Lewis goes through other notes by Dailey (sp?) where JA lists his concerns, which different to the things recorded by K. Why didn’t you
Record all the things that show he had “normal” concerns. K: my report could have been twice as long but I have chosen to report what I think was psychiatrically important.
K lists the things he discussed with JA, saying he doesn’t discuss self harm with everyone.
Lewis is going through the Daileys prison records (a man who is relaxed, thinking of his case etc) & comparing them with K’s records.
K: he has been more revealing to me, one other doc
doctor & one or two of the nursing staff.
Lewis: On the way to court “patient says he is fine, no concerns”. Why didn’t you include that?
K: a quick assessment on the way to court did not strike me as relevant. (Me:Gosh, who would believe that given what JA is facing).
Lewis: asking about the various times Dailey notes
“Not suicidal”.
K: I might as well have photocopied all the prison notes...?
Lewis: you might have changed your opinion.
K: that’s what you’re hoping.
Lewis: JA says in the notes please give more oranges than milk” Does that sound like someone not concerned about his health?
K: given he eats too little that’s a good thing, they would want to know that.
Lewis quoting “he denied having any thoughts of self harm”.
Would the fact he was going cold turkey because he came of codeine which he was on in the Embassy, explain his low mood?
K: No. and JA didn’t want to talk to prison staff about his suicidal thoughts because he was
concerned he would be put on suicide watch.
K: reminds Lewis all the observations he is reporting were made before K started seeing him.
Lewis says JA was observed to be happy, played pool.
K: once. He played pool once.
Lewis: inconsistent with someone who has severe depression.
K has answered this previously by saying sometimes people with depression engage in an activity & then just collapse.
K: JA was embarrassed about talking about some of the symptoms.
Lewis: you’ve already agreed that close observation by a team is crucial.
K: it’s not crucial, it’s important & the quality of those observations can vary.
Lewis: “polite, friendly, went to chapel”
K: that report is from the period before I saw him.
Questions continue along this line.
K: the reason he didn’t tell them about his hallucinations was embarrassment & concern for what it may mean for his placement.
K: I don’t believe he has delusions. In light of his experience in the Embassy, his concerns about our conversations being listened to were entirely rational.
Lewis challenging K about the dose (ie “the dose was for sleep rather than hallucinations”).
K: no you only give very high doses to someone with very severe symptoms.
Lewis: Dr Suelette Dreyfus - why did you rely on her for a confirmation of depression?
K: it was given from the perspective of someone other than his family who has known him for a long time. She corroborated what JA & others have told me.
Lewis: they became friends when hewas 23
when he split up with his partner & they co-wrote a book.
Lewis: her confirmation was of an episode of depression prior to when she met him.
Fitzgerald points out K says that in his report.
K: she saw later depressions & described his symptoms & though milder the symptoms overlapped.
Lewis: the only diagnosis of depression we have is from Prof Mullen in OZ in 1999
K: also in notes in hospital in Melbourne. I knew Mullen & discussed JA with him.
Lewis: “mild depress
Depression with no psychotic symptoms” pre Belmarsh. (Me: and pre Embassy & the rest).
K: depression was recurrent, I didn’t say the psychosis was recurrent.
Lewis: you say Dr Dreyfus said he would commit suicide if he is extradited to the US. But that’s not what she said, did she. She said “ he would attempt suicide” according to your contemporaneous notes.
Lewis: you have embellished it.
K: no, she was convinced & was tearful
Lewis: but that’s not in your contemporaneous notes.
Lewis: you have a telephone call to her in OZ.. after she visited JA in prison
K: no, she had been to London but it’s very difficult to get in to Belmarsh
Lewis: you asked her about the hallucinations which she said he had when he was most stressed. Why don’t you mention they are music - auditory hallucinations & not depressed but stressed.
K: she uses stressed & depressed interchangeably. K lists the auditory hallucinations - not
just musical.

There is a long series of tweets in this thread where the statements are being interpreted by some as my statements. My fault. I got to a point where I forgot to type “K: “ at the beginning of each tweet. I would never make pronouncements about Aspergers - am not qualified.
But this is what happens when you are trying to keep up with what’s being said. I hope that clarifies things.
Lewis: turning now to Stella Morris
K: she asked me
Judge says listen to the Q
Lewis: did she tell you she was his current partner & mother of his children?
Why didn’t you put that in your report?
It wasn’t in the public domaine. It’s included in the second report.
Lewis: isn’t it relevant to whether he is a suicide risk?
K: yes
Lewis: the best protective factor
K: sometimes married people are more at risk
Lewis: Your duty to the court didn’t take first place over saving the couple embarrassment.
K: you would have known he had a partner
and two children.
K: maybe I didn’t perform my duty to the court, I was being diplomatic.
Lewis: “Ms Morris believed he would definitely commit suicide if..” in your report but that’s not what was in your contemporaneous notes “ believes he would definitely be a suicidal risk if he loses the case”
K: it’s not that different.
Lewis arguing he should have used her exact words, he says her meaning was clear to me.
Lewis: Morris told you she was not aware of hallucinations.
K: she usually visited him with the children, perhaps a reason he didn’t tell her. K admits it’s an error of omission.
Lewis & K discussing details about his older son & the reason he changed his name which K says was
not relevant & he wanted to respect his privacy.
Lewis: you relied upon Nils Melzer’s report which is neither balanced or accurate.
K: he took a psychiatrist with him
Lewis: quotes Melzer.. commenting on the Chief Magistrate having a conflict of interest & calling JA a narcissist, read from a pre typed judgement.
K: I agree this is a political document. I summarised it & put exclamation marks in my report but I’m not relying on it to make a
Psychiatric report.
Lewis Quoting Melzer on the role of Sweden, calling Melzer’s conclusions “nonsense”
K: I didn’t quote all that anyway, I quoted the relevant bits about psychiatry.
Lewis quoting Melzer on the concerted effort by the govts of US, Uk & Sweden etc etc (me:you know, that quote)
K: why are you cross examining me on material I haven’t quoted? You need to ask all this of Professors of political science. Look at what I quoted - all of psychiatric
Lewis: you didn’t give context, that this is a biased report you are quoting from. Do you say it’s a balanced & accurate report?
K: not saying that about his political opinion but on the effects of long term confinement, yes.
Lewis arguing about K’s evaluation of JA’s cognitive assessment, putting to him JA has had not trouble paying attention to what happened in court.
K: it doesn’t mean his concentration & memory is as it should be.
Lewis quotes JA’s rhetorical slight of hand to the judge, his interjection, re the attack on his reputation, saying this proves he is competent mentally .
K: his slightly inappropriate interjection prob reflects his ASD
Lewis: do you think he is unable to engage with the legal process?
K: that doesn’t mean he is performing optimally
Now they are arguing about tests in malingering, K points out Lewis is wrong about the test.
Lewis: prison conditions now. . In your second report you quote other witnesses for the Defence.
K: yes, I’ve only recently received the Kromberg Declarations.
Lewis: why didn’t you ask for them earlier?
K: I was only made aware of them after reading the Defence witness reports
Lewis: you were aware there was a fierce disagreement on US prison conditions.
K: that will be argued by the relevant experts.
Lewis: you rely heavily for you opinion on these Defence experts in your report
Lewis: you say he is facing a potential life sentence.
K: I have taken part in other extradition proceedings & its remarkable how many US experts are prepared to say similar things about the US prison system.
Lewis: if the court finds in favour of Kromberg, you would have to
change your report.
K: it’s a matter for Kromberg to debate with experts who are testifying with opposing views.
K: those experts need to debate those issues rather that we psychiatrists.
Lewis: mental health problems didn’t prevent him for leaking US classified docs, running WikiLeaks as a global enterprise.
K: I have described a recurrence of depression, not while he was running WL but
his Aspergers would have affected the way he ran WL.
Lewis listing JA’s other achievements such as fronting a TV prog.
K: but I’m not saying he was depressed at the time.
Lewis quotes Kromberg on suicide protocols.
K: quotes others who disagree with Kromberg.
Lewis: why are you advocating a case?
Lewis wants the witness to admit that if Kromberg is right, his view of what would happen to JA & his mental health in the US would have to change.
Lewis: do you agree if the medical care is sufficient, your concerns disappear.
K: quotes other reports that describe a very different situation.
Lewis now arguing that the length of the sentence is in dispute & his opinion is based on life long sentence, sensory deprivation &
K: even if it were a shorter sentence, it will affect him adversely.
Lewis: what if he got 5 years, with no solitary.
K: this is all theoretical.
Judge wants to know if this would change his opinion
He doesn’t feel it is a fair question.
Lewis quoting Daly again. K says but he doesn’t have a good relationship with her.
K: I have said the depression had improved a little but the suicidal ideas & despair was still there. Sometimes when people get better, they suicide. I suspect his planning, preparations, will
result in suicide once he is extradited.
K: moving him out of isolation into a ward helped improved his situation at that time. Depression doesn’t usually lead to an outside referral, that is for schizophrenia.

10mins break while Lewis checks what the prison doctors say about that.
Glimpse of JA. Even at middle distance, with a mask on, you can see the expression in his eyes - he looks pained, sad, regretful. It can’t be easy having all this paraded in public, particularly after all else that has been said about him over the last 10 years.
I was just told “your call will be disconnected “
Waiting to see if that has happened to everyone on the video link
Yes, others too
They will try to reconnect us
We now see the court next door with 4 people visible, presumably journalists
And court officials
Oh, back in the right court
Lewis: I have no further questions.
So K was correct on that last point.
Fitzgerald now asking him about the main difference between his & the other psychiatric report.
K: Prof Mullen & I agree. Went went out to see JA together.
Characteristic depressive hallucinatory experiences consistent with depression.
Fitzgerald: re your recoding of the razor blade was uncorroborated.
What if it were corroborated.
Lewis: object, we don’t dispute that some form or razor was found. If it was a pure safety razor, it explains why it was not in the notes.
Fitzgerald: we are going to confirm the true situation.
Judge clarifies with F they will do that, but not today.
Fitzgerald: Lewis stated you left out in your report observations that there were improvements. Fitzgerald now lists all the instances in K’s report where K mentions improvements & does quote Dr Daly as opposed to leaving him out.
K: most of what I was asked about this morning was about JA before I started seeing him. When I started seeing him, he would asleep when I arrived because she didn’t sleep at night & he was in isolation in the medical ward.
Fitzgerald: lists the many times JA asked for the Samaritans’ phone in K’s report, comment about JA struggling in a single cell, sad & lacking in energy with impaired cognitive function.
K: JA was tearful, slept on the floor..
I phoned Dreyfus when I was in Australia about the depression because she had implied the depression was brief but dodging from their book it lasted about 6 months. I spoke to his mother, his father but Dr Mullen also recorded it in the
1990s in the context of a custody case.
Fitzgerald: there have been a number of depressive episodes.
K confirms reports of this.
Fitzgerald: is rational thinking inconsistent with depression?
K: No. I’d say he has severe depression with hallucinations rather than psychotic.
Fitzgerald: my learned friend said there is only one test for malingering. What would you say to that?
K: Nonsense
Fitzgerald: Lewis suggested your opinion is based on your knowledge of prison conditions in the US.
K: my opinion was not based on that
F: if he is extradited &
separated from his family..
K: plus his depression & anxiety, are enough to trigger a suicide attempt.
F: if he is detained in isolation, would that exacerbate the suicide risk.
K: yes
F: raises Laurie Love.
K refers to Epstein
F: refers to Manning suicide attempt
K: JA said if Manning did this just before a potential bail, you can imagine how bad conditions are. If extradited he would be in a permanent state of depression, in isolation.
F: you wanted to comment on suicide protocols.. can they prevent suicide?
K: no
K: all the experts think he will be in the Alexandria jail, under SAMs. Undertakings have been given in previous cases which have not been kept. If he receives a prolonged detention that will be detrimental. I wrote a report about indefinite detention, that it should not be legal
(That report was as an expert to the UK Parl’t, not to do with JA case).

He has finished.
Judge asks for a list for the witnesses. Lewis wants to read it out, the judge wants it electronically.
Fitzgerald: Daly tomorrow & Mullens in Australia in the afternoon
Summers reading a list of future witnesses.. audio not great.
Judge says she has received a one line request regarding the report for the press. Fitzgerald says the Defence would not support that. Judge asks which parts of the report they want withheld. Lewis says it’s complicated & the journalist would have to argue why it advances open
justice. Both Prosecution & Defence agree the medical reports should not be made available & they would have to argue the legal points which we would have to spend time researching.
In this thread, my own comments are generally in brackets.
Where I am reporting a lengthy delivery over numerous tweets, there are not quotation marks at the start of each tweet and use of the personal pronoun “I” refers to the person delivering the information ie the witness.

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