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Cross-Examination of Dr. Lewis

IAN STORM LEWIS: (sworn states)

EXAMINATION BY MR WALLACE: Dr Lewis, just by way of background, you are a qualified Medical Practitioner, qualified in 1987 and a specialist in psychiatry, you completed your four years' specialisation in 1996?

DR LEWIS: That is correct.

MR WALLACE: And you practice as a part time consultant at Victoria Hospital in Wynberg and in addition, as a private practitioner in Cape Town?

DR LEWIS: That is correct.

MR WALLACE: Now, you first consulted with Mr Cronje on the 13th of June 2000?

DR LEWIS: That is correct.

MR WALLACE: In your professional capacity?

DR LEWIS: That is correct.

MR WALLACE: Would you tell the Commission the background to that reference, at whose instance were you asked to consult with Mr Cronje?

DR LEWIS: Mr Cronje's legal team asked that I assess him, they were concerned about his psychological well-being particularly given the stress that he was under.

MR WALLACE: And did you then have an assessment consultation with Mr Cronje on the 13th of June?

DR LEWIS: That is correct.

MR WALLACE: Might I just interpose Mr Commissioner, as being unfamiliar to these proceedings, if I inadvertently leave my microphone on while Dr Lewis is answering, does that cause a problem with the recording?

COMMISSIONER: Well, it is a criminal offence hindering the Commission of course, but whether it interferes with the recording, is something that is beyond my ken - no.

MR WALLACE: Well, being an elderly Senior Counsel, I, if I hinder the Commission, it is totally unintentional, so it is not criminal.

Dr Lewis, were you furnished at that conference with a report written by your colleague, Dr Jordaan, who had seen Mr Cronje in Bloemfontein, on the 14th of May this year?

DR LEWIS: That is correct.

MR WALLACE: Did you nonetheless make an independent assessment of his medical condition?

DR LEWIS: I first assessed Mr Cronje and subsequently read the report from Dr Jordaan.

MR WALLACE: So your assessment took place without any preconceptions or any input, prior input from Dr Jordaan?

DR LEWIS: That is correct.

MR WALLACE: Perhaps it would help us if you were first of all to tell us what diagnosis you arrived at at the end of your assessment?

DR LEWIS: I believed that Mr Cronje was suffering from a major depressive disorder, in other words clinical depression.

MR WALLACE: Were you able to identify the nature and source of that depression?

DR LEWIS: It is difficult to work out exactly what the source of the depression was, rather my assessment was whether he had depression or not, and in addition, whether he had any evidence of having responded to anti-depressant medication that had been started a month previously by Dr Jordaan.

MR WALLACE: Just, if you could help us with the background, what is the approach to determining whether a patient is suffering from depression and what are the criteria against which you make your clinical judgement in that regard?

DR LEWIS: What we do is to look at clinical symptoms and often these are as reported by the patient. We look at nine clusters of symptoms and and in general, if somebody has five or more of these symptoms, and if these symptoms have been present for more than a two week period, we then make the diagnosis of depression.

MR WALLACE: Are those nine clusters of symptoms universally accepted in the field of psychiatry as being the benchmarks against which you consider whether to make a diagnosis of depression?

R LEWIS: That is correct. The criteria appear in the Diagnostic Statistical Manual, which is a publication by the American Psychiatric Institute.

MR WALLACE: Now, would you tell us in your clinical judgement, which of those symptoms were manifested by Mr Cronje?

DR LEWIS: I think that Mr Cronje had either seven or eight of the nine criteria, in other words he fulfilled the criteria for a major depressive disorder, and the symptoms that he experienced and described to me were firstly depressed mood, particularly with irritability; next he had loss of concentration and difficulty with thinking clearly; he had a loss of pleasure and of interest in things and this was present for most days, more days that not; he also experienced low energy and fatigue; he had a sense of worthlessness which went with low self-esteem; he in addition had thoughts of death and of dying, although I should point out at the stage that I saw him, he had received a number of death threats, so that would put that in the forefront of his mind; he also had loss of appetite, and had described a weight loss of about four kilograms during the two months leading up to my consultation with him and he had in the past, and according to Dr Jordaan's report, had insomnia and this was the characteristic insomnia of depression, which is that one goes to sleep all right, but wakes in the early hours of the morning. But at the time that I saw Mr Cronje, I should point out that he was on sleeping tablets, and so no longer had a problem with insomnia.

Just for completeness sake, the ninth symptom is described as psycho-motor retardation or agitation, this means really a feeling of restlessness or alternatively a slowing down and although Dr Jordaan had noticed that Mr Cronje had these symptoms, at the time that I had seen him, which again was on medication, he no longer had these symptoms.

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