"PINOCHET UNFIT TO STAND TRIAL" : THE HASTY CONCLUSIONS OF THE MEDICAL REPORT
By Martial Van der Linden
· Professor of Adult Clinical Psychology in the Psychology and Educational Sciences Faculty of the University of Geneva
· Professor of Neuropsychology in the Psychology and Educational Sciences Faculty of the University of Liege
· President of French-speaking Neuropsychological Society
· Research: Memory problems associated with cerebral lesions (in particular, in the context of dementia).
· Publications: Several books and scientific articles pertaining to the neurological evaluation of cognitive functions
I have had the opportunity to read the medical and neuropsychological reports on Mr. Pinochet, which have been published by the Guardian of London and the Spanish newspapers El Mundo and ABC. Since this report has now been placed in the public domain, as have the critical comments of various experts, it seemed to me important and legitimate to put forward a technical analysis, focusing particularly on issues that fall within my area of expertise, namely the analysis of cognitive functions. Obviously, this analysis can only be considered pertinent on the understanding that the medical report published includes the totality of the original report and has not been modified in any way.
The report in question concludes that this Mr. Pinochet exhibits, among other things, progressive cerebral damage of vascular origin along with disturbances of memory (for recent and past events), difficulties in understanding complex sentences and questions (relative to the disturbances in memory which prevent Mr. Pinochet to appropriately process verbal information), difficulty in expressing himself understandably, succinctly and relevantly as well as problems related to fatigue. According to the experts, these disturbances would make it impossible for Mr Pinochet from being able to stand trial: specifically, he would have difficulties to make himself understood, to ensure his defence, to understand the content and implications of the questions he might be asked, and, additionally, he would not even be completely conscious of these difficulties. The experts also conclude that a further deterioration of the mental and physical health of Mr Pinochet is probable, and that the situation of stress generated by the trial could theoretically contribute to accelerate the progression of the vascular disease. However, the experts state that they cannot give an opinion on the possible impact of the trial on Mr. Pinochet's state of health (citing particularly his previous ability to manage stressful situations).
On the basis of the data contained in the report, it appears that Mr Pinochet's health has, without doubt, deteriorated and that he has suffered from progressive vascular problems, which have led to a diminution of his cognitive abilities.
However, the conclusions relating to the impact that these cognitive difficulties may have on his fitness to stand trial appear to us to, at best, to be only weakly supported by the data provided in the medical report.
In the first place, the neuropsychological examination carried out on Mr. Pinochet is incomplete and does not meet the standards which one would expect of a current examination of cognitive abilities. In particular, given the small number of psychometric tests carried out, it is impossible to obtain any precise conclusions about his cognitive state. Thus, in the general conclusions of the report, reference is made to his difficulties in remembering past events, although no systematic test was carried out to evaluate these abilities. By the same token, no formal test was carried out to explore systematically his attentional and language (production and comprehension) abilities. Further, the expert indicates that there exists no indication that Mr Pinochet has simulated such difficulties, but in the report there is no mention of the methods customarily used to exclude such a simulation or any exaggeration.
On the other hand, the conclusions reached by the experts do not seem to correspond to the data taken from the brief neuropsychological examination carried out. In effect, the neuropsychological report shows the existence of a deterioration described as moderate to severe. In fact, the quantitative data presented (Mini Mental Examination Status: 23/30; Intellectual co-efficient of 100 in the Raven Progressive Matrix test) are indicative at paste of the presence of a small cognitive deterioration. On the other hand, and contrary to what is stated in the general conclusions, the report specifies that Mr. Pinochet's level of verbal comprehension is good, that his verbal production is fluid, with no disturbance to rhythm, prosody or construction of sentences. The neuropsychological report also indicates that Mr. Pinochet makes the impression of being perfectly able to say what he wants to say. The report also underlines that the occasional difficulties in comprehension that he displays are mainly linked to a memory problem and not to any difficulties with actual verbal comprehension (it should be noted that these types of difficulties is often found in elderly people, who don't necessarily show any evidence of brain damage).
Contrary to what can be read in the general conclusions, the neuropsychological report does not mention any significant difficulties in recalling past events: Mr. Pinochet has been able to give information about the history of Chile and his own personal history. With regard to the conclusions relating to disturbances in memorising new information, these are based on results of memory tests for which no benchmark data is provided for subjects of an age comparable to Mr. Pinochet, which makes it very difficult to appreciate correctly the range of his difficulties. On the other hand, it is important to underline that the results obtained by Mr. Pinochet in the logical reasoning tests (Raven's test and Wechsler Adult Intelligence Scale) are at a good level, which suggests that his capacity for abstraction and reasoning is not seriously impaired. Similarly, it should be specified that the changes observed in a visuo-spatial test (the block design sub-test of the Wechsler Adult Intelligence Scale from which the expert infers an IQ - intelligence level - of 75) cannot be easily interpreted in isolation, given that this result can be due to slowness in carrying out the task or motor difficulties (mentioned by the experts). Finally, it is necessary to say that Mr. Pinochet cognitive functions were evaluated during an afternoon, after he had endured several medical examinations in the morning, which represents significant cognitive overload for a person of his age. It is very probable that this factor has influenced the cognitive results.
In conclusion, according to the data contained in the published medical and neuropsychological report, it is evident that Mr. Pinochet has health problems (and specifically apparent brain damage of vascular origin). These problems are accompanied by some cognitive disturbances. However, the examinations which have been carried out on Mr. Pinochet (the neuropsychological examination in particular) seem to be too incomplete to allow any characterisation of his memory, attentional and language deficits with precision and to conclude unequivocally that he is incapable of following a trial. The succinct information described in the neuropsychological tests suggest, on the contrary, that Mr. Pinochet has sufficient memory capacities and abilities to express himself, to comprehend, to reason in a sufficiently abstract manner, in order to understand the questions he would be asked, the charges against him, and to respond and make himself understood (without prejudice to the fact that his cognitive difficulties, due to his age and health problems, would require that the trial presentation should be adapted to his difficulties).
Martial Van der Linden, Geneva, 18th February 2000.