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On two
previous occasions the doctors who endorse this document responded
to reports on the health of Augusto Pinochet: in January 2000
in London, and on January 10, 11, 12 and 13, 2001 as part
of a group appointed by Judge Juan Guzman.
First
Report:
On the basis of the detailed analysis of the tests conducted
by British doctors and supported by a broad bibliography,
after noting the World Health Organization definition of dementia
or mental derangement, we reached the following conclusions:
1) The
medical examinations upon which Home Secretary Jack Straw
founded his decision to release Pinochet fail to sufficiently
prove that a state of dementia or mental derangement incapacitates
him for facing trial in court.
2) That these tests have not been conducted under conditions
recommended and required by the international medical community
to found a thorough and rigorous diagnosis.
3) The commentaries the British doctors include in relation
to many of the tests they performed on Pinochet fail to
concur in an objective and informed interpretation, which
lead us to question their conclusions.
Therefore,
we conclude that on the basis of the information available,
it is not possible to seriously and scientifically deduce
that the Lifetime Senator is "impeded from attending
a normal judicial proceeding."
This report was issued and made public April 17, 2000
Second
Report:
As in the previous report a clinical analysis was made of
each of the affirmations made by Chilean doctors, supported
by an important bibliography. These are the conclusions reached:
A.- Observations on the final conclusion reached by the Chilean
doctors.
The expert examinations the Medical Legal Institute practiced
on Mr. Augusto Pinochet Ugarte detected signs of psychological
and organic deterioration of probable vascular origin, estimated
greater than normal for his age. Our analysis of the report
explains why this determination is questionable. The brain
damage detected by the tests, in our opinion, does not affect
the subject's competency; nor does it comprise a dementia
of a severity that should warrant exempting him from penal
responsibility. Finally, we contend that, from a psychiatric
standpoint, Mr. Pinochet is fully capable of participating
in a judicial proceeding with the appropriate consideration
for his age and problems of mobility.
B.- Observations on the final conclusion reached by Medical
Expert Report regarding Augusto Pinochet Ugarte, Case Rol
N�2.182 - A.
As
a principal observation, the Medical Expert Report's clinical
diagnosis limits its conclusion strictly to what the Judge
literally and explicitly requests. In fact, the judge ordered
a "report on the mental faculties and neurological condition
of the individual previously identified so as to determine
whether he is affected by psychosis or dementia, and, in the
event these conditions exist, to what degree." The response
to this request was: "the neurological, psychiatric and
neuropsychological appraisal confirms the existence of a moderate
subcortical dementia of vascular origin, according to existing
international classifications of, DSM-IV, ICD-10, NINDS-AIREN."
This diagnosis
is accompanied by two details, with no legal medical explanation:
1. That the diagnosis is based on three elements (multifocal
neurological damage; tomographic study with multiple subcortical
and basal strokes, and neuropsychological studies that indicate
reduced attention span, concentration and memory, particularly
short-term memory, learning, executive function, and intellectual
processes)
2. That the result of the tests conducted does not suggest
presence of drugs (certified by chemical-toxicological tests).
The report
lacks any statement or interpretation as to the implications
of the diagnosis for the capacity to stand trial, prognosis,
risk, or recommended therapy. On the last point, it is important
to bear in mind that the legal medical report is a written
declaration concerning a legal situation related to a biological
or medical condition, which must present causes, circumstances,
and consequences.)
The "purist" perspective of strict literal adherence
to a judicial request fails to provide information that permits
forming a full and adequate opinion on the facts. In our opinion,
Forensic Psychiatry requires not only determining the existence
and origin of a mental illness , but it must also determine
categorically and with well-founded reasoning indicate the
existence of a mental illness and the degree of that illness.
It is necessary to formally determine and state that the characteristics
of the illness may be considered a cause compatible with extenuating
circumstances that warrant discontinuing with a trial.
This task and determination pertains to Forensic Psychiatry
and is the purpose of a medical expert report, which serve
to validate such affirmations. (This entails illustrating
to the judge aspects of the mental health of the defendant
in relation to the crime charged, contributing scientific
basis for judicial consideration of the mentally ill defendant,
and determining the mental capacity of a person in the civil
arena.) The process implies reviewing two fundamental concepts:
penal responsibility and civil capacity."
- Our opinions were not taken into account and on July 1,
2002 in the Thirty-fifth whereas the judges of the Supreme
Court's Penal Chamber concluded: "The participation of
Augusto Pinochet Ugarte in the proceeding is partially and
definitively dismissed".
Whereas Thirty-two concluded categorically: "That the
defendant Augusto Pinochet Ugarte suffers from a mental derangement
condition known as vascular dementia. … This condition
produces symptoms that make the patient suffer a cognitive
deficit manifested in memory loss, as described in reflection
nineteen. This has caused him significant deterioration in
his manner of acting, prevents him from organizing relatively
complex actions needed to carry out a (such as touching fingers
together, described in clause twenty-two.) It has also produced
an alteration in his executive ability, that is, his ability
to plan, organize, carry out sequential actions and abstractions,
as described in paragraphs twenty and twenty-three. In effect,
he fails to carry out commands and responds inadequately to
problems posed to test his judgment. He is unable to function
independently in work activities in his community and has
abandoned more complex tasks such as reading."
In contrast with out previous comments that are founded upon
the exams practiced by British and Chilean doctors, the medical
psychiatric observations we pose below are based on analysis
of the communications media - press and television - that
reflect the behavior and statements made by Pinochet himself,
his family or others close to him. We shall analyze his habits,
his emotional expressions and his recent and long -term memory,
as well as his ability to make decisions, plan, organize and
carry out his own wishes and interests. Our analysis will
demonstrate that the judges' statement in Article Thirty-five
clearly is at odds with what may be discerned from his conduct
and statements.
We must note that Pinochet's wife Lucia Hiriat informed medical
experts in Santiago that her husband confused dates, filled
in his mental lapses with confabulations, failed to recognize
people who visited him, forgot important events; frequently
forgot words, tended to lose the train of thought in conversation
and that he had become inward and hardly expressive. Regarding
general orientation, his wife stated that he had lost interest
in hobbies that he no longer reads or writes, and rarely participates
in social activities. According to Lucia Hiriart, his ability
to reason and his problem-solving capacity were also affected.
However, it is well known that as senator Pinochet devoted
an hour each day to sign autographs and allow people to take
photographs with him, although he privately admitted that
this bored him.(La Segunda, 7.05.02).
We must state first of all, that Pinochet shows no sign of
suffering from any loss of his higher mental faculties, as
diagnosed by the doctors and judges: he has no speech alterations
(aphasia), does not show failure to integrate perceptive functions
characterized by an inability to identify certain objects
and forms (agnosia), nor does he show any indication of apraxia,
as we have seen him with full ability to carry out voluntary
actions, as observed in public activities carried by television
broadcaster. He shows no sign of suffering from Parkinson's
disease, which was diagnosed more than two years ago by the
British doctors in their Final Report. Up to the present time,
he has not been observed to be affected by the characteristic
signs of the disease such as trembling and rigidity as we
see in the Pope.
Secondly, we shall analyze the state of his memory, mental
ability disturbed by dementia, whether light, mild or serious,
in short-term and long-term memory. On January 23, 2001, after
interviewing Pinochet, Judge Juan Guzman stated: "I confirm
that Pinochet has a clear mental health" and added that
he found him "extraordinarily normal." Earlier,
on March 17, 2000, his son Augusto stated: "He remembers
everything." On September 1, 2000 his daughter Jacqueline
said his "memory is perfect".(Revista Caras).
During the year 2001, his activities showed no appreciable
change: he went to mass every Sunday, had no trouble following
the service, went out to stores to purchase things, such as
clothing for his grandchildren. (La Segunda, 4-06.01)
On October 5 , 2001 he sent a letter to his grandson Rodrigo
in which he showed a very good abstraction ability, an indication
that his intelligence and thought processes are unaffected:
"I cannot attend [his grandson's birthday celebration]…
but my thoughts and my heart are with you ".(La Segunda,
10. 5.01).\
Now we shall analyze his condition during the year 2002. On
his wedding anniversary celebrated January 30, 2002: "He
appeared relaxed and gave his wife a kiss, spoke in a strong
voice, and took time to chat with guests." In other words,
he recognized, acted and spoke in a normal fashion. Moreover,
during those days he demonstrated the ability to analyze and
make decisions, actions impossible for one whose memory fails:
"He sent a letter to Margaret Thatcher, expressing his
deep concern for her health. " (La Segunda 1.31.02)
He gives himself certain pleasures as last February when,
"Together with his escorts Pinochet went to the Lomiton
restaurant of Casablanca, surprising customers who were having
lunch..". He was observed to be relaxed, smiling, with
no motor difficulty, nor inappropriate words, associated with
dementia. He was able to fulfill a whim, and returned to his
old habits, in this case, eating in Lomiton restaurant.
He clearly
selects the places he wants to go, as well as the clothes
he wears, including his ties. He states that he has kept up
a daily routine with no change except that now he gets up
as 9AM not at 6 AM as he did when he was more active. Then
he takes a walk and reads the daily newspapers in his private
office. He takes a nap and asks to be brought La Dehesa mall
to buy books and gifts for his grandchildren and says that
he longs to visit the Foundation that bears his name. He constantly
asks to go to his office on Malaga Street, and is a fanatic
of the History Channel, which he says "he loves."
(Revista Caras, 5.24.02, p.39).
On April 3, 2002 Cardinal Jorge Medina dined at Pinochet's
house. "I found him like any person of his age, with
the health of anyone of this age, trying to live a normal
life. We talked about Valparaiso and many pleasant things.
He is lucid and his memory is fine." (Revista Caras,
4.12.02, p.16)
On April 19, 2002 he ate at the Lo Curro Military Club, and
exclaimed, "This place brings back so many memories!"
A phrase impossible for a person who suffers from dementia
or moderate mental derangement , revealing that his long-term
memory is intact and that he continues to have the ability
to evoke events and places he knew in previous years. He shows
no alterations in judgment, as he is able to appropriately
handle interpersonal situations. A close collaborator says
he is obsessed with the idea of returning to Iquique. "He
most recurrent topic of conversation is going to Mamiña
and touring the north... He appears to be set upon the idea."
But, his family and lawyers put limits on the lifetime senator,
even when he has his bags packed and ready to travel. "On
other occasions attorney Pablo Rodriguez, who heads his defense
staff has refused to allow Pinochet to move at all. In fact,
some observers fear that if the former general makes another
unnecessary visit, Rodriguez will abandon the case."
(Revista Caras,5. 24.02, p. 36-37)
Again, on June 1, 2002 he attended Lo Curro Military Club.
"He was in good spirits during the two hours he attended
an event there." (La Hora. 3.06.02)
As of July 1, 2002, date on which the Supreme Court definitively
dismisses proceedings against him due "incurable subcortical
vascular dementia" that people who visit him repeat,
"that he is a sick man with the appearance of a healthy
person. "(Caras, 5. 24.02, p.37).
In our opinion more in keeping with reality are the remarks
by Alfonso Marquez de la Plata , who visited Pinochet June
7, 2002 [ less than a month before the ruling]. Marquez de
la Plata told the La Tercera newspaper that he had been with
Pinochet who remembered an old acquaintance, the former CIA
Assistant Director Vernon Walters, who died last February.
Marquez de La Plata added, "He is not crazy as they try
to make him out to be. He has a number of physical problems
but his head is normal and his memory is perfect." (La
Tercera, 7.5.02, p.5).
In truth, Pinochet is a healthy man who tries to appear or
simulates as someone who is mentally ill. All actions chronicled
in the press to obtain his resignation from the Senate also
show that he is a person capable of making decisions and determining
a course of action. He has a sequence of clear, independent
actions that reveal purpose and evaluation of meaning and
understanding of the importance of his role . He decides for
himself the text of his letter of resignation, and decides
who will read it for him in the Senate. Some of the basic
ideas Pinochet gave for the content of the letter was: explain
the reasons he remained in power 17 years and indicate the
reason that justifies his retirement. On the basis of the
ideas he gave, the lawyers, mainly Pablo Rodriguez composed
the letter. Is it possible to consider a person judicially
and procedurally dismissed when he has perfect recollection
of the most important moments of the 17 years of his government
as well as reasons for retiring? (La Tercera, 7.5.02, p.3)
Cardinal Errazuriz is asked to read the letter of resignation
and pick it up at Pinochet's home. There, on July 4, 2002,
as reported in the newspaper, Pinochet: "Aware of the
importance of the day, rose early, appears nervous, dressed
in a somber, but elegant dark suit, to await the Cardinal's
visit." The Cardinal gives Pinochet the rosary that his
mother used throughout her life. Earlier, Pinochet remarked
to the Senate President Adolfo Zaldivar: "I am not crazy,
although I do have a health problem. My age does not allow
me full use of my faculties." (La Tercera, 7.7.02,Reportajes-
p. 11 and 10).
Later the Cardinal stated on Radio Chilena: "I found
that he felt relief at having taken the decision, smiling
and moved, because of the significance of the action he was
about to take... that is, sign his letter of resignation…
He revealed wish to have witnesses present when he signed
the letter. He wanted witnessed that he freely signed the
letter. He signed it with a firm hand." (La Nacion, 1.7.02).
Errazuriz exclaimed: "That's how presidents sign!"
(La Tercera 7.7.02, Reportajes, p.11)
Pinochet's hand did not tremor; he did not hesitate or show
any neurological weakness. In this act in which he demonstrates
his will, as in all previous intentional actions accompanied
by powerful feeling, Pinochet showed that he is no way affected
by apathy. How can a signature from a person declared demented
be legally valid?
Earlier, Zaldivar, who orchestrated this resignation, spoke
about his meeting with Pinochet: "His position was coherent,
which means he was in sound judgment. " And he adds,
"As a notary public would say." (El Mercurio, 07.6.02,
C 5) As if to offer an explanation, Zaldivar went on to say,
"In these diseases, there are periods of higher and lower
lucidity." (La Segunda, 7-5-02, p.13).
After signing his resignation, Pinochet immediately took the
telephone and called Army Commander-in Chief Cheyre. "It
is the first time they speak directly, without intermediaries.
Pinochet asks the Army chief to inform the institution that
compelling reasons motivated his resignation." .(La Tercera,
7.7.02, Reportajes, p.11).
Unlike what the judiciary says about him, Pinochet is clearly
capable of organizing relatively complex actions to carry
out a task. He retains his executive ability, that is, the
ability to plan, organize, abstract, belying through his actions
the statement of whereas Thirty-two of the Supreme Court's
resolution dismissing proceedings against him.
As we read in the La Segunda newspaper, it is the opinion
of a person close to Pinochet that: "General Pinochet
has plenty of things to do yet." And, "…despite
his retirement from political life, he will continue to provide
reason for talking about him." (La Segunda, 7.5.02, p.17).
This opinion clearly refers to an individual whose thinking
and acting abilities are intact.
People close to Pinochet informed the press of his reaction
upon learning of the Supreme Court dismissal of proceedings
against him: "It lifted a weight that was pressing down
on him." (La Segunda, idem). This indicates that he was
aware of the situation, the serious nature of the ruling,
and that he expressed relief at the favorable outcome.
The day after his resignation, July 5, 2002, Pinochet asked
Senator Romero to his Malaga Street office. This time he wore
a light-colored suit with a pearl in his tie.. Romero described
him as :"He is in good spirits and he looks great. "
He added that Pinochet feels "free after the pressure
of the long trial and tells me that he had been thinking about
retiring for quite some time." Also, Pinochet informed
Romero that "He wants to travel and… He told me
wants to come to see me at the Senate… I got the impression
that he is like any person who wants to visit his former classmates."
(El Mostrador, 7.5.02)
That same day, Pinochet invited Providencia Mayor Cristian
Labbe to lunch. The two friends, who know each other 30 years,
laugh and joke together. During the lunch that lasts from
13:30 to 15:00, Pinochet begins to plan his trip to Iquique.
He commented to Labbe about a book he read "some months
ago" called "Medico de cuerpo y alma" [Doctor
of body and soul], an indication of an excellent memory.(La
Segunda, 5.07.02, p.17).
It is worth noting that a person with such a busy calendar
of activities, slightly hard of hearing, worried about legal
cases and takes 12 medications each day (La Segunda, idem),
has a right to rest. This in no way would deteriorate his
ability to judge situations, to plan, and take actions, and
in no way brings about symptoms of apathy. Apathy is a classic
indication of brain damage, as previous reports have established,
and there is no indication that Pinochet suffers apathy.
On July 12, 2002, Pinochet traveled to Iquique, in northern
Chile. He did not postpone his arrival in the city of Iquique,
despite injuries two bodyguards sustained in a serious traffic
accident. (La Tercera, 7.12.02). El Mercurio, July 13, 2002
reports: "Pinochet will spend the winter in Iquique.
He was observed to be in good spirits and responded to greetings
by waving his hand high… He arrived very happy, opened
the car window and began to greet the people." Then he
got out of the car, acknowledged people greeting him, hugged
them and gave the ladies a kiss. And that same afternoon he
visited the Iquique duty-free zone. (El Mercurio, 7.13.02,C6)
Once again, he repeated his actions on the return from England:
the sick person walked, waved, smiled, and felt happy. There
is no evidence of the apathy that allegedly afflicts him in
any of his public appearances.
"Is the idea to change the image of a demented person
who was dismissed due to mental illness and who never proved
his innocence?", asked "La Tercera" on July
13, 2002, and added, "the idea is not to hide him anymore.
"
On July 14, 2002 "He attends mass, receives communion
and during the Eucharist greeting stretched his hand to the
faithful who he greets with a smile and wishes for peace.
"(El Mercurio, 7.15.02).
The newspaper El Diario Estrella de Iquique describes his
visit to the walled duty-free zone and the La Segunda newspaper
of July 16 quotes him: "I have come to see my friends."
It also describes that he greeted all the people who approached
him and even had his picture taken with workers and his friend,
the business executive Lombardi, who he gives a hearty hug.
La Segunda adds that Pinochet remarked on " the progress
Iquique has made and that he really liked the remodeled Costanera
Avenue, the park and the beach; also that he could remembers
every detail of the downtown area."
After the unfortunate episode in which his bodyguards threatened
three teenagers who were off to catch crabs, beating them
up with their rifles, La Tercera reports (July 17, 2002):
"La Moneda is annoyed with the frequent outings of Pinochet.
The government wants him to lower his profile."
Why should La Moneda be annoyed when it never attempted to
expose the orchestration it mounted even in England in order
to free him?
Before returning to Santiago, Diario El Nortino, carries an
interview with Pinochet's wife Lucia Hiriart. When asked:
"Has the general traveled to Iquique for personal reasons
or for other reasons?," she replied, "Of course,
dear, why shouldn't the trip be a personal decision? After
all he is boss and master of his decisions. I hope you don't
believe that stupid thing about him being crazy or demented?"
(Quoted in Spain's daily El Pais, de 7.3.02).
Comparing his behavior in public and the Supreme Court's ruling,
we observe a surprising and clear contradiction, which is
notorious when comparing his wife's statement to the doctors
and her response to the journalist in Iquique. This leads
us to one of two conclusions: either the information handled
by the medical experts was falsified or Mr. Pinochet has completely
recovered from an illness that even the Supreme Court had
considered incurable.
El Mercurio of July 23, 2002 writes: "On recommendation
from his doctors, Pinochet suspended his trip to Arica and
returned to Santiago. …He had spent 10 days in Iquique.
During his stay, he attended mass, visited the Zofri duty-free
zone, visited downtown Iquique, visited Alto Hospicio [scene
of a serial murder uncovered earlier in the year], and had
lunch in Pica and Playa Yape. He received visitors every day."
The courts and the government of Chile owe the Chilean people
an explanation about this farce,
especially the doctors who attended him, relatives of victims
of the Caravan of Death, and all family members of persons
made to disappear, executed and tortured during the 17 years
Pinochet ruled this country. The judiciary must act coherently
and deprive him of immunity derived from his condition as
"former president" which this very government enacted
to free him once and for all.
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