Ganser syndrome amongst patients on remand in prison

I want to say a bit more about Julian Assange’s confusional illness (see previous post), from which I'm not sure he has recovered. In 1897, Sigbert Ganser delivered a paper entitled ‘A peculiar hysterical state’ in which he described four criminals (for three of which he gave clinical details) who developed transitory symptoms of mental illness and were brought to hospital, three of them from prison (see article). Ganser did not doubt his patients were "truly sick people". He didn’t really look into how they were being treated in prison. Scott (1965) in a commentary on Ganser's paper says Aubrey Lewis noted that Ganser syndrome is found typically in patients awaiting trial. This has led to the idea that Ganser symptoms are a dissociative reaction caused by an unconscious attempt by the patient to escape from an intolerable mental situation of potential prolonged imprisonment. All of Ganser's patients improved dramatically on being admitted to hospital and had no recollection of what had happened for a rather extensive period of time preceding. This state of clarity did not generally last and was interrupted by a deep depression and return of some symptoms.

The most striking aspect of the Ganser syndrome is ‘Vorbeireden’ or ‘approximate answers’ or ‘talking past the point’. Ganser actually used the term ‘vorbeigehen’ (‘to pass by’) by which he meant that interspersed with correct answers there are (a) approximate answers to the simplest questions which are incorrect but which show that the sense of the question has been approximately understood (like answers sometimes given by children), and (b) ridiculous answers showing an astonishing ignorance and deficit of knowledge which must definitely have been or still be in the patient's possession. He gave several examples such as:-

a conversation which was held with one of these patients : —Are you able to count to ten ? Yes. (But he does not, and is silent.) Well, then, count. (But he does not, and only counts on being prompted.) 1, 2, 3, 4. (Then he is quiet again.) What follows one? Two. Then? Twelve, 93 and . . . and after 93? (He continues in that fashion.)

Additional symptoms include hallucinations, disorientation and hyperaesthesia. Ganser characterised the syndrome as a “hysterical twilight state”.

I have no knowledge of Assange's current mental state or whether he still appears confused. I am unsure whether there are still elements of the Ganser mental state he demonstrated when he appeared in court last October (see description by Craig Murray). The extradition hearing to decide whether Assange should be sent to the United States is split into two parts, with the second half delayed until 18 May 2020, although Assange’s lawyers have said it is impossible to prepare his case for the second part because of Belmarsh being on lockdown because of the coronavirus crisis.

Reuters reported he was cleanly shaven and acknowledged supporters in the public gallery in court on Monday 24th February 2020. This was after his spokesperson said his health had improved after he was taken out of solitary confinement to the medical wing of the prison (Reuters). As in the Ganser cases, moving a patient to a medical setting can produce dramatic improvement, but this does not necessarily last completely. On 26th February 2020, Assange complained he was struggling to follow his extradition hearing. In particular he said he was as much a "participant in these proceedings as I am at Wimbledon (tennis)” because he was unable to communicate with his lawyers or ask them for clarifications. He said he was unable to communicate privately with his lawyers because of microphones in the dock and U.S. embassy officials in the courtroom. He said his legal team has been spied on and therefore he could not give comments to them in confidence. At one point, the judge asked whether his lawyers needed to check on him because his eyes were closed. On 27th February 2020 in the fourth day of the hearing the judge commented that it was quite apparent that Assange had had no difficulty communicating with his legal team despite him continuing to complain he was struggling to follow proceedings. He was given a pair of headphones to allow him to see if they would help him hear, but he took them off after about 30 minutes.

Chelsea Manning was released from prison on 19th March 2020 (see Reuters). Assange is of course wanted in the United States on charges of conspiring with Manning to hack into a Pentagon computer system containing classified materials, which led to the publication of the Iraq War logs, the Afghanistan war logs and the State Department cables.

I am unsure how much care has been taken to protect the health and safety of Assange in prison. I am also unsure whether the court wrongly thinks he is malingering. Before he went to the Ecuadorian Embassy, he took refuge at Ellingham Hall (see Beccles and Bungay Journal article). With the coronavirus crisis, why can't he go back there, even with a condition of psychiatric treatment?