My central argument of paranoid schizophrenia and diabetes

Ranjit S.J.B. Rana


Unit 1/25 Hackney Road

Hackney SA 5069



Sunday, October 19, 2008



Registrar

Administrative Appeals Tribunal

Grenfell Street

Adelaide SA 5000



Re: The basis of my appeal claim in this matter



Dear Madam,



Dr. Robert Goldney and Dr. Tony Davis have told me for the respondents my claim has failed based on theirs’ assessment of my entire case history. They have provided a bizarre result saying the diagnosis of paranoid and/or any other psychosis in not the result of what may have occurred to me in the Australian Army between 1980 and 1982. It is related to other causes and such they are significant and major contributors of the disease being aggravated. Likewise, concerning my diabetes Dr. Stevenson has the opinion that schizophrenia sufferers are probably more likely than not getting diabetes type 2 and there is no link with Army matters after so long. I do not agree with theirs’ assessment about my case after consulting with my doctors.



Firstly, I will do a collateral attack on the epistemology, ontology and methodology used by them to prove that fatal errors of assessment of my psychiatric case. They have claimed that there is just not sufficient and/or no symptoms history of paranoid schizophrenia with Army abuses that transpired so long ago. It is unreasonable of them to say that all the psychiatrists and hospitals I have been has not recorded of my history of presenting complaint (detailed patient’s central problem and related symptoms in a chronological order). So most of the clinicians have identified my common psychiatric symptoms like depressive, psychotic, anxiety etc. However, the respondent’s doctors claim there were no logical sequences from those data for them to comment on relevant negative as well as positive symptoms. I argue this is an absurd and unreasonable hypothesis. In other words, they failed to identify common psychiatric symptoms. They did not properly read all the three volumes of the data before the AAT as evidence. They only read the brief of selected briefs and summary provided by the respondent that was highly selective and inferred from them opinions that was normative, descriptive, and subjective. The analysis lacked proper rigor. They have even failed to provide differential diagnosis.



They have failed to comment on impact of illness on my life, there is no consideration about work, social relations and self-care. Further, they failed to record information on who administered my treatment when and where previously, what the treatment was (and preferably the dose and duration of treatment and my response to such treatments. Again, they did not consider the relationship between my psychiatric state and concurrent medical conditions properly from 1981 as of current. I have done this deconstruction of my history of presenting complaints that encompasses the three volumes and more.



They have not organized the notes that are the three volumes, in terms of my general appearance and behaviour, speech, affect and mood, quality, range, appropriateness, depersonalization and derealization, thought (stream, form and content), perception, cognition, judgment, insight and rapport. Thus, no proper analysis has taken place for this tribunal to be so satisfied via their reports in terms of fairness to me and being reasonable.



They also have failed to examine me physically and emphasize signs to my presenting and chronic problems, and there are no signs of long-term psychotropic drug use. There is further no identification sign of presence/absence of conditions that may present to me with psychiatric complications like endocrine disorders and so on.



In the summary and diagnosis, there is no synthesis of signs and symptoms containing the three volumes to identify the core problems (of cause and effect). Thus, there is no explication in theirs’ reasoning for drawing the links between sign and symptoms and diagnostic decision-making like done by Dr. Jha. In other words, what important aspects in the history, mental state examination and physical examination led them to making provisional diagnosis. They failed to pick out relevant pieces of these sections and make links with the final diagnosis (and differential diagnoses). There is no brief indication of why the problems arose (precipitating factors), how the problems arose (predisposing factors) and factors influencing progression/the course of the problems (perpetuating and protective factors).



In the formulation structure, they did not explore in more depth the aetiology of my illness like Dr. Jha. Dr. Goldney just says in normative statement that paranoid schizophrenia has no known aetiology and it is obvious that he has not read the three volumes before the AAT and the set of documents given to him in another matter. It applies to Dr. Davis and others. Thus, they have failed to draw on the precipitating, predisposing and perpetuating factors identified earlier in theirs’ summary to define, the biological, psychological and social forces that have contributed towards (i) the development of my paranoid schizophrenia and diabetes, and (ii) their response to my illness and/or disease. A major difference between a summary and a formulation is that the latter seeks to link the pieces of information as opposed to listing them. Thus, it was inevitable that they erred to draw on relevant pieces of information from earlier parts of reports on the three volumes; that contains my presenting problems in the context of my history of chronic illness. They have not integrated evidence and concepts from the wider literature; however, theirs statements lacks an understanding of me, and more focus is on the literature-based theories if any.



They have not based on the formulations have outlined appropriate management plans including investigations, short-term goals and long-term goals. In other words, they lacked management structure of my illness.



Second part will explore the three volumes and the Military Police Report that was before the AAT of 2004 for specific findings that this tribunal has to make in terms of sexual and physical abuses and others in proper definitions and the gravity of the cumulative impacts on me after so many years.



All of the respondent’s psychiatrists have claimed that psychosis cannot be a traumatic event. There are similarities between the reaction to psychosis and PTSD: I got Army abuses image or feelings of what happened there in 1980s. I often get distracted by and go quiet in the middle of a conversation…it drew me like the voices did, wanting me to listen harder and closer. I find and in literatures in first episode suffer found similar levels of PTSD symptomatology (intrusion and avoidance) in survivors like me. See Shaw, K., McFarlane, A., Bookless, C and Air, T. (2002). ‘The aietology of post psychotic posttraumatic stress disorder following a psychotic episode.’ Journal of Traumatic Stress, 15, 39-47. Professor McFarlane destroys the hypothesis if Dr. Goldney in all respect of his reports so far. I can lay claim that after seeing many respondent’s doctors I was suffering PTSD arising stress due by theirs’ rejection of my trauma.



I do not understand how the respondent’s psychiatrists claim my abuse in Army cannot be defines as a trauma and such psychosis emerged as a reaction to it after so many years. I have been telling about being sexually abuse in my childhood, and this has caused me to be hypersensitive. The proof is that there is only one person Dr. Deepak Pant, who is currently President of Nepalese Association of Victoria. I might have to call him as a witness about my sexual abuse in Nepal via phone hookup. I have been hearing voices while in the Army for physical and interpersonal violence and did not tell others. The auditory hallucinations also occurred to me in the Army after any trauma and Army doctors did not accept it.



Read, J. (1997) states “…it seems reasonable to conclude that there may indeed be relationships between childhood abuse and adult psychosis, and, more specifically, between childhood abuse and schizophrenia.” See at p. 450 in ‘Child abuse and psychosis: A literature review and implications for professional practice.’ Professional Psychology: Research and Practice, 28, 448-456.



Psychotic symptoms have long been observed in the aftermath of a range of traumatic life events: for example, lifetime exposure to interpersonal violence just like in my case and for people with severe mental illness varies between 48 and 81% (Jacobson, A., and Richardson, B. (1987). ‘Assault experience of 100 psychiatric inpatients: Evidence of the need for routine enquiry.’ American Journal of Psychiatry, 144, 908-913).



Further evidence that trauma can lead to psychotic states can be found by examining studies of concentration-camp survivors. Eitenger (1964, 1967) studied survivors in Norway and Israel and found that a core group of patients, particularly those in Israel, clearly met the schizophrenia criteria for that time, and he attributed this to the trauma they had experienced in the concentration camps. Klein, Zellermayer, and Shanan (1963) and von Baeyer (1977) described psychosis among some Nazi-concentration camp victims. Beebe (1975), describing a long-term follow-up of Pacific Theater prisoners of World War II, found a marked increase in schizophrenia in those prisoners who had experienced the most severe traumas. Most recently, Kinzie and Boehnlein (1989), in a study of Cambodian refugees who suffered trauma as a consequences\ of the Pol Pot regime, concluded that the symptoms of PTSD and psychosis coexist in this population. Whilst there is some support for the view that traumatic events such as combat may be associated with the development of psychosis. See at page 336 of Anthony P. Morrison, Lucy Frame and warren Larkin (2003). ‘Relationships between trauma and psychosis: A review and integration’. British Journal of Clinical Psychology, 43, 331-353.



It should be noted that the briefs provided to Drs. Goldney, Davis and others are not precisely matching the summaries of my psychiatric episodes. The brief has been constructed to suit the needs of the respondent, and data has been highly selective for the doctors to interpret it to the benefit of the respondent. It is not objective and scientific methodology is lacking. They claim yet it is critical and based on symptoms based analysis for them to conclude my paranoid schizophrenia lacks symptoms to link the events of so long ago in my Army service. They claim the analysis of Dr. Jha is based on lack of symptoms and that is patently false. He has used all symptoms from various mental state analysis I had to under go from 1981 until now. He has used a problem solving approach and they do not agree with it. None of the respondent’s psychiatrists has done so far differential diagnosis like Professor Bal Jha in a very rigorous, objective, and integrated perspective. The tribunal should give no weight to the respondent’s psychiatrists.



Manfred Bleuler in ‘Die spatschizoprenen krankheits-bilder. Fortschr Neurol Psychiatr 1943; 15: 259-90’ had indicated about the systematic examination of late onset patients and defined late schizophrenia as follows:



1. Onset after the age 40.

2. Symptomatology that does not differ from that of schizophrenia occurring early in life (or if it does differ, it should not do so in a clear or radical way).

3. It should not be possible to attribute the illness to a neuropathological disorder because of the presence of an amenesic syndrome or associated signs of organic brain disease.



He later confirmed that while onset of schizophrenia after the age of 40 was unusual, onset after 60 should be considered even rarer.



An association between the presence of extremely life-threatening experience needs to be present like in my case (Dr. Hoff indicated that personality disorder sufferers like me are more prone to stressors than the normal cohorts of the population). This Army abuse experience has caused a paranoid and delusional pathology to develop in me later in life. The risk of developing paranoid psychosis to be doubled in immigrants who were escaping war or political unrest, compared with those who had moved for economic reasons. This type of analogy can also be made out in my case. Thus, the period during which a personality may be rendered sensitive to the later development of paranoid psychosis by exposure to trauma is presumably not limited to early childhood. See Cervantes, RC., Salgado-Snyder VN and Padilla AM. (1989). ‘Post-traumatic stress in immigrants from Central America and Mexico.’ Hosp Community Psychiatry; 40: 615-18.



Exactly how important abnormalities in personality functioning are in aetiology and onset of late-life paranoid psychosis is unclear. Whilst there is evidence linking social or early adult life to the later development of psychosis, it is perhaps more plausible to view the abnormal premorbid personality as an early marker of impending psychosis rather than to regard the psychosis as an indication of earlier personality dysfunction. See in page 346 by Robert Howard (2001). ‘Late-onset schizophrenia and very late-onset schizophrenia-like psychosis.’ Reviews in Clinical Gerontology. 11; 337-352.



I now turn in to the report of Dr. Stevenson about my diabetes. Gaston, R L., George, M and Azhahan, N. (2008). ‘Diabetic control and atypical antipsychotic a case report.’ Journal of Medical case Reports. 2. 155 (May 14, 2008) has reported that introduction people with schizophrenia are at increased risk of developing metabolic disturbances. This risk may be further exacerbated by the use of antipsychotic agents. Research is still ongoing to determine the metabolic impact of antipsychotic medication on glucose regulation. This article deals with a 50-year-old man diagnosed with paranoid schizophrenia that developed type 2 diabetes mellitus whilst on treatment with second-generation antipsychotic drug.



In ‘Association between antipsychotic drugs and diabetes’ from Diabetes, Obesity and Metabolism. 8. 2006, 125-135. Richard, I. G. Hold and Robert C. Peveler provide the abstract that, the link between atypical antipsychotic drugs and development of diabetes has been hotly debated in the literature. In this review, they have attempted to classify the various types of data published and presented in a hierarchical basis. Case reports and retrospective studies suggest that both conventional and atypical antipsychotic medications are associated with an increased risk of glucose abnormalities or diabetes. They do not agree with this approach. One wonders if they are in the payroll of the drug companies.



Lambert, BL., Cunningham, FE., Miller, DR, Dalack, GW and Hur. K. (2006). ‘Diabetes Risk Associated with Use of Olanzapine, Quetiapine, and Risperidone in Veterans Health Administration patients with Schozophrenia.’ American Journal of Epidemiology. Vol 164. No. 7: 672-681. The authors studied 15,767 patients who initiated use of olanzapine, risperidone, quetiapine, or haloperidol in 1999-2001 after at least 3 months with no antipsychotic prescriptions. Assuming that the observed associations are casual, approximately one third new cases of diabetes may be attributed to use of olanzapine, risperidone and quetiapine in patients taking these medicines.



I agree with Dr. Stevenson that people who suffer from paranoid schizophrenia have higher chances of probability getting diabetes type 2. The issue of antipsychotic drugs and worsening of my diabetes we may need to argue for a long time.



Doctor Goldney has explained that I do not have problems with concentration and memory, and has alleged that I have faked all the symptoms of psychosis from day one. However, I am going to persuade the tribunal from my childhood days I had problem controlling my impulses and had poor memory and concentration. Thus, I have failed to accomplish many things I started and remain my unfinished business in life. I finished my universities arising reasonable accommodation under the Federal Disability Discrimination Act. I will lead the evidence at the hearing by tendering such materials in a relevant and timely manner.



I will again tender Military Police report that was A26 exhibit material in AAT of 2004. I will deal with them in specific terms as DP Forgie had said no specific findings were made from it. I will explain how Private Jenkins sexually and indecently assaulted me in regular basis. How he regularly sexually harassed me, physically assaulted me and racially abused much more and me. Definition is required to understand the impacts it had cumulatively and remains an obsession with me for a closure.



I like the tribunal to note pages 16, 19, 24, 28 (see paragraphs 6, 8, 9 and 10), 30 32, 35, 37, 39, 41, 43, 45, 49, 53 and 197 of the Military Police report which was given to me only in 2004.



Concerning the three volumes provided by the respondent to the tribunal. I ask the tribunal to note pages 8, 11, 12, 14, 15, 16, 18, 23, 24, 25, 33, 54, 56, 60, 62, 69, 70, 80, 76, 88, 89-90, 91, 95 to 103, 104, 107, 108, 111, 131, 155, 180, 181, 183, 184, 189, 204, 211, 221, 223, 224, 225, 230, 231, 232, 246, 249, 256, 290, 296, 310, 316, 320, 322, 324, 338, 346, 348, 374, 393, 407, 438, 450, 451, 457, 459, 461, 464, 466, 467, 468, 469, 470, 480, 490, 496, 511, 518, 524 527, 541, 542, 557, 558, 570, 612, 622, 644, 672, 720, 724, 784, 890, 918, 937, 940, 954, 973, 975, 985, 990, 1003, 1004, 1013, 1016, 1052, 1084, 1086, 1087, 1088, 1100, 1108, 1117, 1120, 1121, 1123, 1173, 1201, 1214, 1237, 1242, 1246, 1250, 1259, 1266, 1276, 1332, 1358, 1363, 1365, 1378.



I vigorously oppose the reports of Drs Goldney and Davis. They have not seen me in person for the recent reports. I saw Dr. Goldney in December 2007 and January 2008. I saw Dr. Davis in 2003. The tribunal should note this and give them no weight. Further, all the documents given to them are not the same as of 2003 and in Repatriation Commission matter.



I have been opposing theirs’ report, as they have not asked permission from me to write about me and pass on my confidential and private information to others. In lieu of that, I have a court action against Dr. Goldney and Australian Government Solicitors and others in the federal court in civil wrongs done against me. I will explain the implication of that to the tribunal in the hearing.



I have now outlined the thrust of my central argument that my symptoms history of pre paranoid schizophrenia and late onset of it was there from August 1981 and up to now. This was via various people investigating my mental history and state of the mind from neurosis, personality disorder to psychosis now. The most important symptom that has been with me from my childhood days are impulsiveness, poor concentration and memory that has impaired my Army and other employments opportunities. Most of the other factors have faded but Army related matters remain my obsession and has negatively affected my inability to find employment.



The counter argument that is headed by the hanging psychiatrist and an evil narcissistic one who has violated the terms of my agreement to see him says: (i) Army abuses has never been a significant factor about my suffering if any psychiatric and/or diabetes condition. (ii) He puts my case in the worse Baron Munchausen Syndrome by proxy he has ever seen. He says that all the brief materials that is on me and scientifically he has examined makes him feel that there are several multifactor stressors at play and the Army related issues had faded away as Dr. Kutlaca indicated in 1985 (time based). All that is occurring now is just what Dr. Kutlaca predicted that I was the man going to be from my birth until I die manipulating and being a vexatious litigant at great cost to the society. (iii) I was tried to be made into a space goat in the Army in my last days, as higher officers were involved in fraud and theft at the stores of electronic parts. See page 181 of the Military Police report on Major Blackwell having fraud conviction and much more. I was asked by others to steal missile guidance part and so on that put me under tremendous stress and my drinking escalated. I just wanted to quit the Army, as it did not make me happy. It reminded me when my father in Nepal was Master General of Ordinance, that erupted into a bribery scandal involving the Royal family, and my father lost his job. I argue that my Army life is still appearing to me and I have become obsessed with it for a closure. Drs. Miller and Jha are spot on about me.



What about the past two tribunals? Well, I was not experienced in litigation and the respondent did not provide me with Military Police files until 2004. Without specific finding from it, no one really can understand the impacts that I suffer. I am grateful to DP Forgie for being the most fairest legal mind I have ever come across. In the first tribunal, I just could not articulate the volumes of documents, and the Military Police files were not given to me. In 2004 hearing, all came together and I just did not have time to digest and synthesize them in a holistic way. This time I have everything together and I am not interested winning or losing. I just want to have a damn closure in my life as to why my journey in life has been the man I have come to become. I was obsessed with finding the truth, and now I have come to accept the reality as there is no such thing as truth ultimately. What I have come to understand in this journey is just perspectives of me seen from my own filters, beacons and lenses. I guess all do the same in this life. Thus, there are theories for someone and for some purpose. These theories are as good as it is based on assumptions. They are bad as it tumbles if those assumptions are bad. This is what computer age is all about “garbage in garbage out.”



Yours sincerely







Ranjit Rana



PS: I have not worked full time from 1982 and part time from 1987.



PPS: The assessment of Dr. Jagermann dated 15/4/1985 for Commonwealth Rehabilitation Centre (CRC). Accounted of my past and factored in the psychosis in Queensland (I had just returned in from there in early 1985). He refers to my ongoing Army related litigation related depression and stress too. He also indicated how another psychotic disturbance could not be ruled out and so it tarnished the prognosis. Thus, I was not deemed worthy for sponsorship by CRC. Dr. Kutlaca saw me last on 15/4/1985 and noted I was fit to work on part time basis. Department of Defence gave me compensation from the day I was discharged from the Army to this date Dr. Kutlaca saw me. Thus, there is significant doubt about the integrity of Dr. Kutlaca’s report in terms of conflict with Dr. Jagermann. My compensation was cut off arbitrarily because Army related factors were not operational. See pages 404-406 and pages 330 and 374, 371 and 377 in volume one before the tribunal requires further analysis about the inconsistencies between Drs. Kutlaca and Jagermann.