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Cross-Examination of Dr. Lewis

MR WALLACE: Dr Lewis, please assist us as lay people, all of these symptoms you have described, perhaps not so much recurrent thoughts of death, but the other symptoms are symptoms which ordinary people encounter in their ordinary day-to-day life, from time-to-time, when they are under stress or pressure, how from a clinical point of view, do you determine that they are of such magnitude that it is proper to make a diagnosis of depression as opposed to somebody who is just living with the vicissitudes of life?

DR LEWIS: I think that is a very important question. What we need to do is to see that these symptoms have led to an impairment in functioning, either social functioning, academic functioning or functioning in one's career, and in addition to that, these symptoms should have been present for at least two weeks and of enough severity to cause discomfort to the patient.

MR WALLACE: And, taking that criteria of a two week period, let us say, let's say one of the factors, loss of interest and pleasure, how intense does that have to be during the two week period for you to be concerned, clinically concerned about the condition?

DR LEWIS: Well, the symptoms of loss of pleasure and the symptoms of depression, one or both of those need to be present and most importantly they need to be present most of the day, for more days than not.

MR WALLACE: Is there a scale against which we can measure the level of depression and against which you can describe the level of depression being suffered by Mr Cronje, in your view?

DR LEWIS: Well, in my view, giving that he had either seven or eight of the diagnostic criteria and that they were leading to significant impairment in his functioning, I would say that he had a severe depression.

MR WALLACE: And after you had made your diagnosis and you referred to the report by your colleague, Dr Jordaan, was his diagnosis similar to yours?

DR LEWIS: Yes, it was.

MR WALLACE: Mr Commissioner, I am aware that you have a copy of Dr Jordaan's report anyway, but perhaps formally I should make that available to the Commission and to the other legal representatives.

Dr Jordaan had seen Mr Cronje almost precisely a month before you?

DR LEWIS: That is correct.

MR WALLACE: And he had prescribed medication for the condition?

DR LEWIS: That is correct.

MR WALLACE: Were you able to make any assessment as to how effective that medication had been in the period of a month which elapsed between the two consultations?

DR LEWIS: Well, typically we only begin to see an improvement after about two to four weeks, when somebody has commenced on an anti-depressant, and it was difficult not having seen him on the first occasion, to establish really what the change had been, however Mr Cronje's own report was that he felt that he had been a bit better on the medication.

MR WALLACE: Can we turn to the affairs of this Commission. In your view, does Mr Cronje's illness preclude him from giving evidence before the Commission?

DR LEWIS: No, I feel that he is capable of giving evidence.

MR WALLACE: Do you believe that his evidence and particularly his evidence under cross-examination in the usual form, with questioning and so on, may be affected by his condition in any way?

DR LEWIS: I think it is important to realise that he has as symptoms of his depression, difficulty with concentration, and difficulty with thinking and in addition to that, the depression interferes with memory. So I think it is likely that he might find for example complex questions difficult to follow at times, that he might show some degree of lapse in concentration at times. And also, what has been apparent both when I interviewed him and subsequently when he has given evidence here on Thursday, was that he tends to show a degree of fatigue as the proceedings progress.

MR WALLACE: When you are talking about fatigue, that is presumably more than the usual fatigue which any participant will experience in the course of the Commission?

DR LEWIS: That is correct, the fatigue is a symptom of the depression, but what I think I am talking about more is a kind of a mental fatigue as things go on.

MR WALLACE: And your concern as far as his ability to respond to questions is concerned, would be what?

DR LEWIS: Well, I am concerned that at time, again particularly with complex questions, he might not fully understand the question or he might address only part of the question. My concern is that that might appear to be in some way, evasive, when in fact that is not what he is doing.

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