Oscar Pistorius has General Anxiety Disorder, Needs Psychiatric Evaluation

Oscar PistoriusThe Oscar Pistorius trial took a dramatic turn this week when a forensic psychiatrist announced that Pistorius has a general anxiety disorder (GAD) that may have played a role in the killing of Reeva Steenkamp on Valentine’s Day last year. Based on this diagnosis, State Advocate Gerrie Nel, for the prosecution, told the Court he had no option but to apply for the blade runner to be sent to a State institution for 30 days for psychiatric evaluation in terms of the law.

Nel brought the action in terms of South Africa’s Criminal Procedure Act, stating that Dr. Merryl Voster, a respected forensic psychiatrist had diagnosed Pistorius with GAD, which is an accepted psychiatric disorder, and had given evidence that the diagnosis was “relevant to his actions on the day.” Nel questioned why the defense team had called this witness so late in the trial, pointing out that none of the previous witnesses had indicated that the accused suffered from “abnormal anxiety.” He also challenged that it might be a “fallback position” on the part of the defense since there were three different defenses that had been put forward so far. These were putative self-defense; a claim by Pistorius during his own evidence in chief that he acted automatically when he shot through the toilet door four times killing Reeva; and now the claim by Dr. Voster that a psychiatric disorder may have played a role.

“Confronted by at least three defenses, the Court should err on the side of caution,” he argued. He advised the Court that the prosecution would argue that the evidence of the accused, whom he stated “was not the most impressive witness,” be rejected. He also said the late timing of Dr. Voster being called to bring evidence, as well as the timing of her consultations with Pistorius less than two weeks ago, was important, and should be carefully considered by the Court.

Defense Advocate Barry Roux formally objected to the application and said it had “no merit.” It was also premature since the defense would be calling a further witness to discuss the issue of “flight or fight” in relation to the vulnerability of the accused. Judge Thokozile Masipa adjourned court early today, and said she would make her ruling tomorrow (Wednesday May 14) morning.

Forensic Psychiatrist Dr. Merryl Voster

Dr. Voster took the stand on Monday morning to give evidence for the defense. She is a registered forensic psychiatrist who worked at Sterkfontein Hospital for many years, and is currently employed by the University of the Witwatersrand (Wits). In addition she has a private practice and does medico-legal evaluations. Sterkfontein is a specialized psychiatric hospital associated with Wits, that provides forensic services including mental observations as well as the rehabilitation of patients who are committed as involuntary State patients. Dr. Voster has substantial experience relating to the observation of accused persons at the hospital.

She said she was asked to assess Pistorius on May 2, this year, after he had given evidence in his own defense. She also interviewed his aunt that day, and several other people including his brother, sister, and coach, on May 5. She interviewed Pistorius a second time last week, on May 7, and then drew up a report to bring psychiatric factors to the attention of the Court.

Psychiatric and Medical History of Oscar Pistorius

The psychiatrist gave the Court a run-down of Pistorius’ medical and psychiatric history, from when he had the lower part of his malformed legs amputated at 11 months, to his state of mind following the shooting of his girlfriend in the early hours of February 14 last year. She identified the surgery as the initial cause of GAD and said that he would have perceived it as “traumatic assault” because he would not have known what was happening to him at such a young age.

She told the Court about his parents’ disastrous relationship; how his father “was irresponsible and mostly absent,” and how his mother abused alcohol “intermittently.” Oscar’s mother slept with her firearm under her pillow, the psychiatrist said, and often called the police when she was concerned they might have been in trouble or threatened by intruders, even though they were not. As a result all the children (Oscar, his sister Aimee, and his older brother Carl) developed features of anxiety because they were “not soothed by their mother.” In fact, their mother would “add to the anxiety rather than try to relieve it.” Oscar’s older brother Carl was, she said, often tasked with looking after his younger siblings. Their paternal grandmother looked after Oscar financially.

Dr. Voster painted a picture of young Oscar being teased at primary school, and without emotional ties. She said he was “quite lonely” and at the age of 21, “broke ties” with his father after an argument. By this time he was financially independent, she said, but relied primarily on social media to maintain contact with siblings and friends.

She said that in her opinion Oscar Pistorius had an anxiety disorder and had to work exceptionally hard to control his environment so as to alleviate anxiety in his life. Following a strict diet and training regime helped him do this, she said. But, as he became more and more exposed to being famous, and as this attracted more and more media attention, it took more effort for him to do this. She said she believed he needed to achieve total independence to relieve his anxiety, and so he worked particularly hard to get sponsorships and in this way earn a lot of money. He always met his training targets irrespective of the condition of his stumps, she told the Court.

Dr. Voster highlighted his amputations at 11 months – when he was fitted with his first prostheses – as well as his “ongoing stump pathology.” She told the Court how he had encephalitis as a child and as a result now suffers from chronic headaches. She brought up the boat accident that Oscar Pistorius discussed in his own evidence, reminding the Court of his facial injuries and mild concussion, all of which she said had added to his history of anxiety.

She said that while he was able to keep up with his friends as an able-bodied person, he felt the need to be hyper-vigilant which was a feature of anxiety. Additionally, he appeared to be a “distrustful person.” Although Pistorius did not normally drink while training, she said, he did admit, during her interviews with him that he sometimes drank excessively when not training and became intoxicated.

Dr Voster also addressed the issue of so-called feigned retching and vomiting that has been seen many times in Court during the current murder trial. If it was faked, she said, he would have been red-faced and would have had a hoarse voice. Instead he became pale and sweaty. This, she maintained was a true manifestation of anxiety. He perspired heavily when she interviewed him, and his face was largely expressionless. This, she said was a typical feature of depression, and since the fatal shooting Oscar Pistorius had been on antidepressants.

He was devastated that he had killed his girlfriend. Dr. Merryl Voster, forensic psychiatrist

She told the Court that when she asked Pistorius to remove his prosthesis he was embarrassed and his physical vulnerability was immediately apparent. She maintained that this feeling of vulnerability makes him more anxious, and makes him want to “conceal his physical vulnerability.” Linked to this was the fact that he would be more likely to respond with a “fight response” rather than a “flight response.”

Pistorius Recognizes Right From Wrong

Asked by Nel in cross-examination if somebody suffering from general anxiety disorder who owned guns would be a danger to society, she answered, “Yes.” However, she said, Oscar Pistorius was able to recognize the difference between right and wrong, and he showed remorse for what he had done. But, asked Nel, if someone was to kill their partner in anger, they would be capable of deep remorse later; to which she replied, “Yes that is true!” Apart from a psychopath, he continued, if they killed their partner in a fit of rage, you would expect that person to have deep remorse later? Her response was: “That is correct.” In terms of the suggested psychiatric evaluation, she said there was “no harm in it because the Court would get the benefit of a second opinion.”

This morning Nel questioned Dr Voster at length about GAD that she insisted was not “an uncommon” disorder. In fact between one and six percent of the population suffered from it, many coping and living a totally normal life. It was though more serious than ordinary anxiety, was pervasive, and usually carried on for extended periods of time. She said that with GAD, normal anxieties become out of proportion to reality and are usually associated with other symptoms including sleep and appetite disorders, vomiting, sweating, an inability to concentrate, distractibility and irritability, as well as a host of others.

Security Issues For Oscar Pistorius

Nel also questioned her about security issues that she had earlier described as “excessive.” These included moving to a secure housing estate with guards at the perimeter after he had been burgled in a previous house. But once he discovered there had been burglaries in this estate (Silver Woods Estate in Pretoria where he shot Reeva dead) he got dogs, had a burglar alarm system with exterior beams installed, and would lock himself in his bedroom at night. Even this was not enough, said Dr. Voster, so he intended moving to Johannesburg to a property with a gatehouse and double-gated access. These security measures were greater than those taken by average South Africans, she maintained, although he was not “paranoid” about security.

Nel argued that most people in South Africa have burglar alarms and dogs, and that many have beams. Neighbors had given evidence that they too locked themselves in their bedrooms at night. He also drew attention to the fact that there was a window in Pistorius’ house that had been broken for some time, even though there were no bars on the windows. Pistorius also allowed building contractors to leave ladders on the premises and had given evidence that the alarm system was not working properly. The night before he shot Reeva, he went to sleep with the balcony door open.

Asked by Nel if GAD would have “played a role” if Pistorius had known that Reeva was in the toilet, Dr. Voster said it could have if he was “anxious about losing a relationship.” It would have played a role in the build-up, she said, not in the shooting itself.

If there had been an argument about the relationship a person with GAD would have been more anxious. Dr. Merryl Voster, forensic psychiatrist

GAD she said was a disorder that developed over time and Pistorius presented as having the disorder. While he was coping socially, he described himself as a lonely person. He did not have friends that he could confide in, and his sexual relationships appeared to have been quite short in duration.

Dr. Vorster said the accused told her he had fired at a noise in the toilet, and agreed that if he shot thinking it was an intruder then general anxiety disorder did play a role in the incident. Nel pointed out that Pistorius had denied firing at the noise and asked if this did not set “red lights flickering.” She said it appeared there were inconsistencies, but these did not change her diagnosis because he was “very frightened of the threat.” She even stated, “He could just be lying – it’s another explanation.” It is now up to Judge Masipa to decide whether Oscar Pistorius needs psychiatric evaluation or not.

By Penny Swift




Times Live

Criminal Procedure Act


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