The plaintiff was also referred to Dr Robert Black, who expressed the view that "the ( plaintiff's ) nightmares" would probably never leave him.
62 The principal contest in relation to the medical issued raised by the case was between Dr Holwill and Professor McFarlane on the one hand and Drs Roldan and Champion on the other. In large part the contest depended on the interpretation of the criteria for the diagnosis of PTSD that are included in the Diagnostic and Statistical Manual for Mental Disorders, fourth edition, that is generally known as DSM-IV and their application to the plaintiff's condition and history. The DSM-IV was published by the American Psychiatric Association and became effective on 1 October 1996. It included what is described as ICD-9-CM. The DSM-IV, as published in 1996, has been the subject of revision in 2000. The ICD-9-CM is an equivalent of DSM-IV published as part of the World Health Organisation's volume known as "The International Classification of Disease". It includes a specific section on psychiatric disorders. A revision of that document, ICD-10, has been published. However the criteria in ICD-9 and ICD-10 are not precisely the same as those in DSM-IV. It is unnecessary to detail the differences between the two sets of standards, suffice it to say that both standards are empirical, should not be regarded in the same way as a statute, but should be interpreted and applied reasonably flexibly. One matter that should be perhaps adverted to is that ICD-10 places more emphasis on the objective circumstances of the event and in this sense differs from criterion A2 in DSM-IV. PTSD involves the development of certain symptoms following exposure to an extreme traumatic stressor involving direct, personal experience. The highest rates of it, ranging from between one third and more than one half of those exposed, are to be found amongst people involved in, inter alia, military combat situations. Such situations would be apt to include the collision between Voyager and Melbourne on 10 February 1964. PTSD can occur at any age and there may be a delay of months or even years before symptoms appear.
63 DSM-IV sets out diagnostic criteria that are grouped under six headings or criteria (A to F). Each of the criteria has various subheadings and each looks to compliance with all or one or more of the indicators referred to in respect of each criterion.
64 Dr Holwill is a consulting psychiatrist. He had held staff positions at the Royal Melbourne Hospital, been senior lecturer in psychiatry at the University of Melbourne and was later responsible for the conduct of the Affective Disorders and Lithium Clinic. In the course of his career he was transferred to the Repatriation General Hospital, Heidelberg, where he was senior consultant. In 1992 he went into private practice and in that practice has been looking after a large number of veterans. He has published a number of learned papers and, together with another specialist, he undertook a study of morbidity rates (psychological illness) amongst veterans. He was clearly a psychiatrist of the highest qualifications and experience. He was of the firm opinion that the plaintiff was suffering from PTSD that was chronic and moderately severe. He expressed the view that:
"The development of Mr Stankowski's chronic psychiatric condition is directly attributable to his experiences aboard HMAS Melbourne at the time of the collision with HMAS Voyager and to no other significant factors. It would be a minor contribution to his overall level of Post Traumatic Stress Disorder by his experiences whilst serving in South Vietnam."
and
"Mr Stankowski's quality of life has been seriously, adversely affected by experiences at the time of the collision, as has the quality of life of his family. It is unlikely that there will be any further significant improvement in his condition with the passage of time or ongoing treatment."
65 In the course of his evidence Dr Holwill dealt with the phenomenon that people such as the plaintiff:
"… typically try and deny their symptoms to themselves. They often feel ashamed of having symptoms and are very reluctant to admit to others that they have symptoms, even to medical people."
66 He was then asked:
"Q. Doctor, is there any medical hypothesis or theory as to why it is that police officers or former police officers or members of the armed forces or ex members of the armed forces should engage in the sort of denial you've spoken of?
A. Well, I mean, first of all it is a clinically observed fact that they do. The explanation probably lies in the sort of people that they are and the sort of service that they have decided to undertake, whether in the armed services or in the police force, and they typically have a belief that they should be strong, that they should serve their community or their country, that they should be brave and they should be able to tolerate these things on the basis that they are trained for it. So when they develop symptoms they often try and hide it from their colleagues or comrades fearing that they will be perceived as weak and they feel shame about the symptoms and try and deny it to themselves and see themselves as a failure."
67 Dr Holwill was cross examined for almost a complete day. It was an appropriate, carefully constructed, well researched cross examination, but it did not cause Dr Holwill to recant or to deflect from the opinion that he had expressed. Much of the cross examination depended on taking parts of histories given at different times to different people or included in various documents that were brought into being in a range of circumstances. In adhering to his opinion Dr Holwill relied on a history taken by him that is supported by the specific findings of fact set out in paragraph 59 above as well as the more general evidence given by the plaintiff and his witnesses referred to in the text of this judgment. Furthermore, it should be remembered that s 72 of the Evidence Act 1995, provides that the hearsay rule of exclusion does not apply to evidence of a representation about a person's health, feelings, sensations or state of mind.
68 The evidence of Dr Holwill was convincing and I accept it.
69 Professor McFarlane was a mainstay in the plaintiff's case. He is a person who possesses formidable qualifications and experience. His knowledge of PTSD is encyclopaedic. His association with the formulation of the DSM-IV was intimate. He is Professor and Head of the Department of Psychiatry at the University of Adelaide and has been so for some 13 years. He holds a doctorate in medicine and is a Fellow of the Royal Australian and New Zealand College of Psychiatrists. He holds a Diploma of Psychotherapy. He is the senior advisor to the Director General Health Service Branch on Mental Health and senior psychiatric advisor to the Australian Centre for Post Traumatic Mental Health. His various appointments and positions over the years from 1976 to the present, extend over three pages of his curriculum vitae. He has won numerous prizes, scholarships and awards and has written and had published some 150 learned papers. He is the co-author of a recent book on Treatment Planning for Trauma Survivors with PTSD (2000). In addition, he has published three other books on traumatic stress and PTSD and was a member of the DSM-IV sub-committee for the editing and compilation of that manual. He has studied a range of different traumas and their effects. One was an earthquake in China that killed 800 people. He also acted as an advisor in relation to the Kobe earthquake that killed 30,000 people. In the field of military trauma he wrote a report for the United Nations Compensation Commission about the Iraq occupation of Kuwait. Subsequently he acted as an advisor to the government of Kuwait and in the months preceding the most recent war in Iraq he wrote a report for the government about how to deal with chemical and biological attacks, because of the importance of psychological elements in such matters. Closer to home is a Group Captain in the Royal Australian Air Force in the Medical Specialist Reserve. He has also been involved as the scientific advisor in relation to the study of veterans of the Gulf War.
70 In addition, Professor McFarlane sees and treats patients, particularly in the field of trauma related psychological disabilities. He sees and has seen many patients suffering from PTSD. He is a medical professional with outstanding qualifications and experience both national and international. He was a most impressive witness. It is no exaggeration to say that he was, in my experience, one of the best equipped and impressive medical witnesses that I have seen.
71 In the course of his evidence Professor McFarlane analysed each of the criteria included in DSM-IV for the diagnosis of PTSD, insofar as they related to the plaintiff. He said that certain of the criteria were self evident, some were critical and some involved clinical judgment. He expressed the opinion that criteria A1 and 2 had been met. Both of these were specified as requirements for meeting DSM-IV criteria for PTSD. He further expressed the opinion that criteria B1, 2, and 5 had also been met. Dr Roldan, for the defendant accepted that there was evidence establishing criteria B1, 2, 4 and 5. The DSM-IV requirements are that for only one of these matters needed to be met. He said that in respect of criterion C, factors 1, 2 and 5 had been met. DSM-IV required at least three of the factors under this heading to be present. In addition there was strong evidence of criterion C4. Dr Roldan agreed that criteria C2 and 4 had been established and that the history he obtained went a long way to satisfying criterion C5. Professor McFarlane testified that the plaintiff satisfied criteria D1, 2, 3 and 4. The defendant's Dr Roldan agreed that there was evidence to satisfy criteria D2, 3 and 4. DSM-IV required the presence of only two (or more) of the factors listed under this heading. It was accepted that if the plaintiff's symptoms commenced soon after the accident and have continued since, criterion E was met. Similarly it was not gainsaid that if the disturbance produced clinically significant distress or impairment of the kind that I have found, criterion F was met.
72 Professor McFarlane was of the opinion that:
"Mr Stankowski has a post traumatic stress disorder that is in partial remission, following his involvement in the Repatriation Hospital program and the prescription of anti-depressant medication. In particular his avoidance symptoms, interpersonal withdrawal, irritability and mood have improved. Furthermore his alcohol abuse has very significantly decreased in recent times."
73 Professor McFarlane was cross-examined by senior counsel of long experience and acknowledged skill in the art of cross-examination. His cross-examination extended over the course of two full days. Various possible scenarios were put to him arising out of parts of histories given by the plaintiff either to medical practitioners or taken from various documents. The delay in the emergence of nightmares was also dealt with. The plaintiff's drinking problems and possible alternative explanations for them were put to the Professor. The plaintiff's ability to perform his naval duties, achieve promotion and hold down a responsible job at Moomba for any years were adverted to, as were many other matters too numerous to detail in these reasons. Reference was also made to various learned papers, of which Professor McFarlane demonstrated a knowledge, even without having the papers put before him. He further demonstrated his encyclopaedic knowledge of the subject and the literature relating to it. It is fair to say that virtually nothing that could have been put to Professor McFarlane was not put to him. It was a very searching, thorough cross-examination conducted with real skill. Various matters that were the subject of the cross-examination were suggested to be inconsistent with the diagnosis arrived at by Professor McFarlane. Professor McFarlane did not agree. He adhered to his opinion and, in the course of dealing with the various matters raised he not only dealt with them convincingly but further demonstrated the depth of his knowledge and experience of PTSD and associated mental disorders.
74 I accept the opinion of Professor McFarlane.
75 Dr Fernando Roldan is a consulting clinical psychologist and neuro psychologist, the latter being a further specialisation within clinical psychology. At the time of giving his evidence he was a consultant in clinical psychology and neuropsychology at Cumberland Hospital, Parramatta, and had been since mid 1993. Between 1996 and 2002 he was a consultant in clinical psychology and neuropsychology at the Commonwealth Rehabilitation services at Parramatta. His experience prior to 1996 had been as a clinical psychologist in the Community Mental Health Division at St George Hospital and in private practice or lecturing at the ACT Health Commission in Canberra. Between August and November 1987 he was a locum clinical psychologist at the Vietnam Counselling Veterans service, Canberra, prior to which he spent some time with the CSIRO.
76 Dr Roldan saw the plaintiff in March and June 2002. He subsequently prepared a report dated 25 April 2003 in which he detailed the history taken from the plaintiff and the tests that he conducted. He made a functional and clinical assessment of the plaintiff and, under the heading "Document Review", included extracts from the plaintiff's naval records and a report from the late Dr Wu. In the final analysis he said:
"In my opinion the objective evidence available to me indicates that it is unlikely that Mr Stankowski developed a formal psychological disorder as a consequence of the accident in question. That is not to say that Mr Stankowski may not have been distressed by the events of 10.02.64.
…
In my opinion, the available objective evidence indicates that any psychological distress that Mr Stankowski may have experienced in relation to the accident did not result in the level, range and duration of psychological and behavioural disruption that is now claimed and if there was any such disruption that it is likely to have been very short lived. In my opinion, the evidence available to me suggests that Mr Stankowski is now engaging in a distorted and self-serving report of his history due to the potential for monetary compensation that such report carries with it."
77 From the foregoing it can be seen that Dr Roldan characterised the plaintiff as untruthful and as having embarked on a deliberate course of deception for the purposes of obtaining monetary compensation. That conclusion in part depended on the assessment of the plaintiff and his history by Dr Roldan. It is an assessment of the plaintiff and his truthfulness with which I have already disagreed. Moreover his conclusion does not in terms negate the existence of a psychological disturbance or its causal connection with the collision. In the very passages referred to in paragraph 76 above, Dr Roldan accepts:
(i) that the plaintiff may have been distressed or upset by the events of 10 February 1964;
(ii) that the plaintiff may have experienced psychological and behavioural disruption as a result of the collision;
(iii) that such psychological and behavioural disruption as a result of the collision was not of the level, range and duration claimed but " is likely to have been very short lived " (italics added).
78 The cross examination of Dr Roldan took him through each of the criteria in DSM-IV and related them to various paragraphs of the witnesses report in which he recorded various information given to him by the plaintiff. He accepted that criteria A1 and 2 had been met. Initially he did not agree that criterion A2 had been met, but a little later conceded that, if what the plaintiff had told him in answer to specific questions directed towards such criterion were to be accepted, then criterion A2 had been met. His problem with the meeting of the criterion was that he did not accept what the plaintiff said. In this regard it should be said that the factual findings are matters for the Court, not the expert witness. In rejecting parts of the history given by the plaintiff that were not obviously absurd, I am concerned that Dr Roldan may have strayed beyond his field of expertise. The same methodology was applied to the various other criteria in cross-examination, as a result of which Dr Roldan conceded that if the history given to him by the plaintiff were correct, then each of criteria B1, B2, B4, B5, C1, C2, C4, C5, C7, D2, D3, D4, E and F were met. The difference therefore between Dr Roldan on the one hand and Dr Holwill and Professor McFarlane on the other, was that the two last mentioned specialists formed their opinions on the basis of the history they were given, whereas Dr Roldan formed his opinion largely on the basis of the rejection of such history. The essence of the histories on which Dr Holwill and Professor McFarlane formed their opinions are in accordance with the essential facts that I have found; Dr Roldan's relevant rejections are not.
79 The second medical witness called by the defendant was Dr JR Champion who was a member of the Royal Australian and New Zealand College of Psychiatrists (1976). In 1972-1973 Dr Champion was the Registrar at the Neuropsychiatric Institute and between 1976 and 1978 was the visiting psychiatrist to the Renal Unit at Sydney Hospital. He had extensive experience in general psychiatry and deposed to a special interest in the area of post traumatic stress disorder and other manifestations of stress related psychopathology.
80 Dr Champion reported that he had seen the plaintiff at his Mosman rooms on 7 March 2002. Although Dr Champion prepared six reports for the Australian Government Solicitor concerning the plaintiff, this was the only occasion that he saw the plaintiff. Dr Champion took a history from the plaintiff as to his personality and background. He noted his mien, reviewed a number of documents, referred to a number of older learned papers and expressed the view:
"On the basis of the history he now gives as set out in his written statement it would seem likely that he may have suffered with a mild PTSD."