David Spiegel — Direct/Cross/Redirect/Voir Dire
1,522 linesTHE COURT: Your next witness.
MS. BREDEHOFT: Your Honor, we would like to call Dr. David Spiegel.
THE COURT: Dr. Spiegel.
MR. DENNISON: Your Honor, may we approach before the witness is sworn?
THE COURT: That's fine, yes, sir.
MR. DENNISON: This witness in this deposition testified that he is go to opine to a degree of medical certainty that Mr. Depp in fact committed intimate partner violence. I think that's an ultimate-issue issue and also is not reflected in his disclosure. Beyond that, he's going to -- he indicates he is going to opine, at least in his deposition, as to the credibility of Ms. Heard, which I believe is an improper inquiry for an expert under the Virginia rules.
THE COURT: I think this was a Motion in Limine.
MS. BREDEHOFT: It was, Your Honor. You denied it. Your Honor denied the Motion in y Limine intimate issue.
THE COURT: Oh.
MS. BREDEHOFT: Yeah. What's he's going to testify to, Your Honor, is that Mr. Depp's conduct is consistent with the risk factors that are part of intimate partner p violence. That's what he's going to say.
THE COURT: The risk factors?
MS. BREDEHOFT: The risk factors. That O it is consistent with -- correct, that the evidence indicates that it's consistent with.
THE COURT: Let me see what Motion in Limine, it was ...
MR. DENNISON: The testimony --
MS. BREDEHOFT: I don't.
MR. DENNISON: That testimony is I consistent with his disclosure.
THE COURT: As long as he stays with I that.
MR. DENNISON: Right. But they cannot say, and I think you said, improper for him to say is that Mr. Depp committed --
THE COURT: Well, he's not going to h say -- risk factors.
MS. BREDEHOFT: He's going to say that it's consistent, but we're going to go through all of the evidence of that.
THE COURT: Correct.
MS. BREDEHOFT: But even if he did, and he did say it any time deposition and he did incorporate and supplement all of our depositions of our experts, but what he's going to say is that it's consistent with it. But the rules would 112 allow him to testify to an ultimate issue if --
THE COURT: That's what we're making sure that is not being testified.
MS. BREDEHOFT: But I believe that he is going to testify that he has all the evidence of the risk factors, and the risk factors consistent [ with risk factors consistent.]
MR. DENNISON: I don't have a problem with that. I also do have a problem, however. He met with Ms. Heard over Zoom for one hour and has testified, at least in deposition, that he find her the more credible witness.
THE COURT: He's not going to testify to credibility.
MS. BREDEHOFT: That's not what he said in his deposition. He said based on Dr. Curry's testing, the issues that, in fact, one of the findings in there is that they're being truth in their responses, and he has been consistent on that. That's absolutely one of the things that he said.
THE COURT: He can't testify to credibility. That's up to the jury to decide, credibility.
MS. BREDEHOFT: He's going to testify that that testing result reflected that she was giving truthful responses to Dr. Curry's test, which he can do. That's one of the factors.
MR. DENNISON: Again, not in the disclosure.
MS. BREDEHOFT: Actually, it was.
THE COURT: I'm going to allow that testimony, and you can cross-examine on that.
MR. DENNISON: Okay.
THE COURT: Just on Dr. Curry's tests, though.
MS. BREDEHOFT: Correct.
THE COURT: Not on credibility as a witness, okay?
MR. DENNISON: Right. And remember -- I don't have to tell you to remember; you remember. Both Dr. Curry and Dr. Hughes talked about this in terms of professional opinions around evidence of feigning. This wasn't who's telling the truth.
THE COURT: Right. But it was just a factor in that particular test.
MS. BREDEHOFT: A factor in that particular test.
THE COURT: So that's fine. you can cross-examine on it, okay?
MR. DENNISON: Okay. Thank you, Your Honor.
MS. BREDEHOFT: May I just tell the witness briefly?
THE COURT: To remind him?
MS. BREDEHOFT: To remind him --
THE COURT: Yeah. Remind him before he's sworn in. That's perfect.
MS. BREDEHOFT: Thank you, Your Honor.
THE COURT: Yeah. Thank you.
MR. DENNISON: Thank you.
MS. BREDEHOFT: Thank you, Your Honor.
THE COURT: All right. The doctor can be sworn.
THE COURT: DAVID R. SPIEGEL, MD, a witness called on behalf of the DEFENDANT AND COUNTERCLAIM PLAINTIFF, having been duly sworn by the as follows: 116
THE COURT: Okay.
MS. BREDEHOFT: Thank you, Your Honor.
MS. BREDEHOFT: Will you please tell the jury your full I name and business address.
DR. SPIEGEL: David R. Spiegel. I'm a physician. I work at 825 Fairfax Avenue in Norfolk, Virginia, as part of the Eastern Virginia Medical School.
MS. BREDEHOFT: And what is your occupation?
DR. SPIEGEL: I'm a physician/psychiatrist.
MS. BREDEHOFT: Okay. And where do you work? Do you work at --
DR. SPIEGEL: I work at Eastern Virginia -- I'm employed by Eastern Virginia Medical School, but I also work at Norfolk General Hospital, which is a teaching hospital in Norfolk.
MS. BREDEHOFT: How many years have you been practicing I as a psychiatrist? Its
DR. SPIEGEL: I entered residency in 1989. I graduated residency in 1993. So from 1993 to today, I've been a physician, practicing.
MS. BREDEHOFT: That's almost 30 years?
DR. SPIEGEL: That's 30 years, yeah.
MS. BREDEHOFT: Okay. Thank you. Please describe for the jury the nature of your clinical practice.
DR. SPIEGEL: So my clinical practice is comprised of both inpatient care at Norfolk General Hospital as well as my outpatient practice at Eastern Virginia Medical School. About 85 to 90 percent of my day is clinical between the two components.
MS. BREDEHOFT: And what is :involved in a comprehensive evaluation?
DR. SPIEGEL: So in a comprehensive evaluation, in addition to reviewing the historical information that you receive from collateral other sources, you undertake a history from the patient, you get - whether it's the history of current illness, the past psychiatric history, family history, social history, legal, substance history.
DR. SPIEGEL: Then you do what's called a mental status exam, which is the psychiatric version of a physical exam where you're actually giving a description of what you see in front of you. Then you can do cognitive testing, which tests the patient memory, attention, concentration, et cetera. Then you come up with a working and a differential diagnosis, derive any additional g y testing that you may need or not need, and then you up come up with a treatment plan.
MS. BREDEHOFT: How many patients have you treated over the 30 years?
DR. SPIEGEL: A lot. Probably in the tens of thousands.
MS. BREDEHOFT: And how many patients do you regularly see?
DR. SPIEGEL: So inpatient is generally about five to eight, sometimes more. Outpatients, probably five to six, sometimes more. I should point out that my inpatient work is divided between consultation, psychiatry, but we're going to talk about that, as well as working on the inpatient service, but we will talk about that.
MS. BREDEHOFT: What, if any, differences are there in how many patients you sigh on weekends as opposed to weekdays?
DR. SPIEGEL: So when I'm on call, which is either a Saturday or Sunday, meaning I have to be in the hospital and around, that's probably additional 35-plus patients.
MS. BREDEHOFT: How frequently do you treat patients /2 who abuse drugs and alcohol?
DR. SPIEGEL: Unfortunately, drugs and alcohol are part of psychiatric practice, and so probably three-fourths of my patients have substance abuse problems.
MS. BREDEHOFT: Does this include both legal and illegal drugs?
DR. SPIEGEL: Yes. Put them both together, probably 75 percent.
MS. BREDEHOFT: And how frequently do you treat patients who have suffered from someone in their lives who abuses alcohol and drugs?
DR. SPIEGEL: On a regular basis, like I said, on a daily basis. This is part of what psychiatry is.
MS. BREDEHOFT: Okay. As part of that treatment of patients who abuse drugs and alcohol, do you evaluate the impact of the abuse on their brains and personal interactions with others?
DR. SPIEGEL: Yes. Substance of abuse, both in their short term and the long term, can affect the brain in terms of mood; behavior; cognition, meaning attention, concentration, memory, ability to control your behavior; as well as your overall level of functioning. It can affect it in the short term, such as alcohol with blackouts. It can affect it by causing stroke, such as stimulants can. And so at the end of the day, it's a rather lengthy list of what substance abuse can do to the human brain.
MS. BREDEHOFT: Dr. Spiegel how frequently have you treated patients who have suffered intimate partner violence?
DR. SPIEGEL: Again, it's very unfortunate. Probably 50 percent of my patients suffer from trauma. If I had to guess, of those 50 percent, probably 25 percent of my practice is people who have suffered intimate partner violence.
MS. BREDEHOFT: And how consistent is that with the I national average?
DR. SPIEGEL: In America, unfortunately, it's about 20 to 25 percent, depending on the study, women have complained or reported intimate partner violence.
MS. BREDEHOFT: And how frequently have you treated patients who have perpetrated the intimate partner violence?
DR. SPIEGEL: So, again, in the outpatient setting, I don't see it quite as much, but in the inpatient setting, again, it's a really relative common phenomenon. I will see perpetrators of intimate partner violence, and, you know, they're patients who need treatment to.
MS. BREDEHOFT: And over all, how many patients have you treated who have been perpetrators of intimate partner violence?
DR. SPIEGEL: Perpetrators?
MS. BREDEHOFT: Yes.
DR. SPIEGEL: Probably five to ten percent of the patients I do is perpetrators.
MS. BREDEHOFT: And would you say tens of thousands over the 30 years?
DR. SPIEGEL: Yes.
MR. DENNISON: Objection to leading.
THE COURT: Overruled.
MS. BREDEHOFT: Thank you.
MS. BREDEHOFT: As part of treating patients relating to intimate partner violence, do you regularly evaluate these patients?
DR. SPIEGEL: Do I regularly evaluate the patients?
MS. BREDEHOFT: Evaluate the patient, yes.
DR. SPIEGEL: Oh, yes. Yes, regularly. I mean, they get the same comprehensive evaluation that I've described before.
MS. BREDEHOFT: Are you licensed in Virginia?
DR. SPIEGEL: Yes, I am
MS. BREDEHOFT: And when did you first become licensed in Virginia?
MS. BREDEHOFT: Have you been qualified by courts as an expert witness?
DR. SPIEGEL: Yes, I have.
MS. BREDEHOFT: In how many states have you been qualified as an expert?
DR. SPIEGEL: Three, which would be Virginia, Maryland, and South Carolina.
MS. BREDEHOFT: Dr. Spiegel can you please review for the jury your educational background beginning I with your undergraduate studies?
DR. SPIEGEL: So I went to Duke University undergrad. I went to medical school at the State University of New York Health Science Center in Brooklyn, formerly known as Downstate Medical Center. I did my internship and residency between Dartmouth Hitchcock Medical Center and Penn State Hershey Medical Center.
MS. BREDEHOFT: And -- I
DR. SPIEGEL: And I'm also fellowship board certified in consultation liaison psychiatry.
MS. BREDEHOFT: Okay. And did you -- so where did you do your residency and your internships? I'm sorry.
DR. SPIEGEL: So I did my residency for Penn State and internship at Dartmouth.
MS. BREDEHOFT: Okay. And what is your current title and position?
DR. SPIEGEL: So I am in the acting chair, endowed chair, professor in the department of psychiatry and behavioral sciences at Eastern Virginia Medical School.
DR. SPIEGEL: I Are you board certified?
DR. SPIEGEL: Yes, I am
MS. BREDEHOFT: And what are you board certified in?
DR. SPIEGEL: Generally adult psychiatry and consultation liaison psychiatry as a subspecialty.
MS. BREDEHOFT: Okay. So you have two board certifications?
DR. SPIEGEL: Yes.
MS. BREDEHOFT: Okay. Can you explain to the jury what's involved in board certifications in those ! 11 two fields?
DR. SPIEGEL: So board certification is the standard we strive to in being a physician or any other mental health practitioner. It involves taking a very comprehensive test at the beginning of your career to initiate board certification. Then you get tested again every ten years. Then you have to go through continual medical education throughout the entire period. You have to do performance in practice, which is basically ways to approve things in your practice, and, again, these is - throughout - this occurs always throughout the years.
MS. BREDEHOFT: Okay. Now, are you a member of any professional organizations?
DR. SPIEGEL: Yes, I am
MS. BREDEHOFT: Could you please tell the jury --
DR. SPIEGEL: I'm member of the American psychiatric Association as well as the fellow of the American Psychiatric Association. I'm a member of the Medical Society of Virginia. I'm a member of the Psychiatric Society of Virginia. I'm member of the Tidewater Academy of Psychiatry, and I'm a member of the Academy of Consultation Liaison Psychiatry.
MS. BREDEHOFT: Do you have any teaching responsibilities?
DR. SPIEGEL: Teaching responsibilities? Oh, yeah.
MS. BREDEHOFT: Teaching, yes.
DR. SPIEGEL: Yeah. So teaching is a daily occurrence. That's part of my job. When I do my inpatient rounds, residents, medical students, physician assistant students are assigned, so we round together and there's teaching with every single encounter. In addition to that, I teach lectures to the residents, to the third-, second-, and first-year medical students, as well as a fourth-year medical student lecture as well. So I'm constantly teaching.
MS. BREDEHOFT: Are you engaged in any hands-on training of psychiatrists practicing in Virginia?
DR. SPIEGEL: Hands-on training with the residents?
MS. BREDEHOFT: With psychiatrists.
DR. SPIEGEL: Oh, yeah. So, again, I'm teaching at bedside. I mean, we don't speak in front of the patient, obviously, but I'm teaching at bedside, meaning after we see a patient, we discuss important points to learn. And, again, that includes residents at every level. That includes medical students, third-, second-, and first-year, physicians assistant students, so every day is a teaching/explanation session to the students and residents.
MS. BREDEHOFT: What is your role at Eastern Virginia Medical School as the acting chair? Please tell the jury what that means.
DR. SPIEGEL: So as the acting chair, you are not only accountable for your own practice, but you are accountable for your faculty members' practices. So I have to make sure that everyone is treating, seeing, evaluating a certain number of patients. I am responsible for their academic requirements, so in terms of publishing, et cetera. I'm responsible for their teaching assignments to other residents, to other students. I'm responsible for fiscally that they are accountable to their fiscal productivity. So I have a heck of a lot of other administrative meetings that I go to.
MS. BREDEHOFT: Have you published in your field?
DR. SPIEGEL: To a tune of about 80 manuscripts. And I have my own book on catatonia in a consultation liaison setting. I have a book chapter on the current and -- current and contemporary approaches to temporomandibular disease, at least the psychiatric portion. I've written a dissociative identity disorders chapter on a Wikibook.
MS. BREDEHOFT: And have you peer reviewed literature?
DR. SPIEGEL: Yes. So I'm a reviewer on- I've served as reviewer on Lancet. I've served as reviewer as Innovations in Clinical Neuroscience. I've served on reviewer for Clinical Neuropharmacology, and I'm actually editor-in-chief of - at this point - of Clinical Neuropharmacology.
MS. BREDEHOFT: Have you lectured on the effects of drugs and alcohol on the human brain?
DR. SPIEGEL: Yes. I teach to the residents. I teach lecture to the second-year medical students, third-year medical students. So I'm fully aware of not only what I teach, but what I see in the emergency room and the consultation and inpatient settings.
MS. BREDEHOFT: Have you published and lectured on the causes and effects of intimate partner abuse?
DR. SPIEGEL: Yes. I've punctured [sic], I believe, 1191:wo articles on the effects of trauma, and in that trauma was intimate partner violence.
MS. BREDEHOFT: Are you familiar with the hallmarks of intimate partner violence?
DR. SPIEGEL: Yes.
MS. BREDEHOFT: Are you familiar with what causes intimate partner violence?
DR. SPIEGEL: Excuse me?
MS. BREDEHOFT: What causes intimate partner violence?
DR. SPIEGEL: Yes. There's multiple explanations that cause intimate partner violence. I kind of mention at this point, too, that when we are discussing intimate partner violence, I think it's imperative for the jury to know we are talking about repetitive behavior over periods of time, and the type of abuse can be any physical, psychological, sexual. But just as important is for somebody- one of the partners to maintain some uneven element of control or to maintain power, control, or authority.
DR. SPIEGEL: So there are a lot of facets to intimate partner violence. I know people tend to think of it as just the actual abuse act, but there's more to it than just the actual abuse accident. The abuse act's important but it's not the sole finding.
MS. BREDEHOFT: Your Honor, I move to qualify Dr. Spiegel as an expert in the field of psychiatry and behavioral sciences with specific emphasis on drug and alcohol abuse, intimate partner violence, and the effect of these as they pertain to the issues in this case.
THE COURT: All right. Any objection?
MR. DENNISON: Yes, Your Honor.
THE COURT: Do you wish to voir dire?
MR. DENNISON: I do.
THE COURT: To his qualifications.
MR. DENNISON: His qualifications.
THE COURT: Okay. Thank you
MR. DENNISON: Sir, you talked about two board certifications: General adult psychiatry?
DR. SPIEGEL: Yes.
MR. DENNISON: And liaison consultation psychiatry?
DR. SPIEGEL: Other way around, consultation -
MR. DENNISON: Consultation liaison psychiatry? Subtle point. Right. Now, that is not intimate partner violence. That deals with the issue of comorbidity between people who have medical problems and health problems.
DR. SPIEGEL: So you're saying subspecialty?
MR. DENNISON: Yes.
DR. SPIEGEL: So consultation liaison psychiatry does have that, but you're also treating patients who have medical illness who have comorbid psychiatric illness or people who have psychiatric illness that have comorbid medical illness. And many of the patients that I see on the trauma service have tried to take their own life, and unfortunately as part of that, intimate partner violence and trauma in general is part and parcel of that. So it's very, very narrow to say it's just the medical/psychiatric interface.
DR. SPIEGEL: It's much more of psychiatric patients who need medical help, medical patients develop psychiatric problems, or also that interface.
MR. DENNISON: So as a subset of your trauma patients, which you say are about 50 percent of your practice, as a subset of that practice, some people have been involved with intimate partner violence?
DR. SPIEGEL: So as a subset of my overall practice, 50 percent have suffered from trauma. About half of that number have suffered from -- I'm sorry, about 20, so 20 of that, 20 percent suffered from IPV, intimate partner violence.
MR. DENNISON: All right. You've never conducted any empirical research on individuals who experience intimate partner violence, have you, sir?
DR. SPIEGEL: If your definition is trials, is that what you're saying?
MR. DENNISON: Yes.
DR. SPIEGEL: Like pharmaceutical trials, or what are you saying? Is that what you're saying? Because I've done review articles on patients who suffered from trauma. So the answer is "Oh, I haven't done any studies, like, where you give them medication for treatment or try one treatment versus another. I reviewed the body of literature on intimate partner violence to get two review articles, yes.
MR. DENNISON: So you've read about it is what you just testified to?
DR. SPIEGEL: I would have to disagree with you on that, sir. Reading about it and writing a review article are completely two different things, sir.
MR. DENNISON: You haven't authored any articles specifically on IPV, have you, sir?
DR. SPIEGEL: As a subset of trauma, the answer is yes. In terms of in the name of the title of the article, the answer is no.
MR. DENNISON: You've never written any books specifically on IPV?
DR. SPIEGEL: I've never written any books on IPV. Although, although temporomandibular disease, okay, in terms of psychiatric issues, does have a higher frequency in those patients who have suffered from trauma, including intimate partner violence.
MR. DENNISON: You've never --
DR. SPIEGEL: And I am part of that book.
MR. DENNISON: Okay. Temporomandibular disease deals with problems with the jaw?
DR. SPIEGEL: Say your question again.
MR. DENNISON: What is temporomandibular --
DR. SPIEGEL: Temporomandibular disease is a problem with oral issues, yeah. But there are many patients who complain of the oral issues where the oral surgeon cannot find a reason for it, and the reason why they can't is because people who have suffered from trauma, intimate partner violence, are prone to increased sensitivity of somatic sensations which can manifest in temporomandibular disease. Thank you, I appreciate that. Nice plug for my book, too, thank you.
MR. DENNISON: Didn't hear it, but there you go.
MR. DENNISON: So you haven't written any chapters of any books specifically about IPV?
DR. SPIEGEL: Again, I think I've gone over that. I've written two articles on that, and I've written parts of chapters, and disassociative identity disorders, a subject where I did write a chapter on, is completely based on trauma and intimate partner violence.
MR. DENNISON: Right. I'm not asking you about trauma l,2 because you want to talk about trauma. I'm asking you about IPV specifically.
DR. SPIEGEL: I will reiterate again, you cannot separate intimate partner violence and say that is a separate rubric aside from trauma. Trauma is, over all. Intimate partner violence is part of trauma, and the answer to the question is any individual who suffers from a dissociative disorder, which I am the author of chapter of, suffers from trauma, whether be at the hands in childhood or it be the hands of an intimate partner.
MR. DENNISON: Right. But you've already testified that half your practice is trauma, and a subset of that practice is IPV, correct?
DR. SPIEGEL: Which is, actually, I treat the national average of patients. About 25 percent of patients suffer from it, and that's about my practice number.
MR. DENNISON: Except you're discounting the fact that half your practice is not trauma at all So IO percent of your practice is IPV.
DR. SPIEGEL: I don't know if the numbers add up exactly like that.
MR. DENNISON: I'm just using yours.
DR. SPIEGEL: I don't know if I'm doing - I don't know if those numbers add up like that. Because I'm not sure if that's the case. Could be 25 percent, maybe 12.5 percent, of my practice. That's being rather specific. So, again, a significant number of my patients have suffered from intimate partner violence. I see it on a daily basis, and I'm not sure exactly why I'm getting asked the same question again.
MR. DENNISON: Okay. Its
DR. SPIEGEL: Thank you, sir.
MR. DENNISON: You listed 60 references to articles. I guess you said 80, now, and publications.
DR. SPIEGEL: I said "around," sir, I said around 80. I said around 80.
MR. DENNISON: 60, 80, whatever it is, right?
DR. SPIEGEL: No, 60, 80, not - if you go to the PubMed app - you go to PubMed right now and Google -- not Google. Go to PubMed, it's Spiegel DR, and you will find that number is 72, with two waived to be impressed. One submitted -- so that would be 75, so around 80. So again, what's on my CV is not necessarily the most updated version because I still published since the CV's been given to you, sir.
MR. DENNISON: Right. And not one of the 72, 80 articles has IPV in the title, right?
DR. SPIEGEL: Correct. Not one of them have IPV. It does have trauma, but not IPV.
MR. DENNISON: Right. And you've never presented on the topic of IPV specifically?
DR. SPIEGEL: As a function of trauma, as function of somatic illness, again, I would say to you that it's part and parcel of these illnesses. So the answer is yes, I have. The answer is yes, I have.
MR. DENNISON: And IPV doesn't appear in your CV at all?
DR. SPIEGEL: If you say it's not in my CV, I will believe you. There's a lot of things not in my CV that I do, so ...
MR. DENNISON: And you're not associated with any professional literature on IPV?
DR. SPIEGEL: I'm sorry. Repeat the question, sir.
MR. DENNISON: Is there any professional literature that you've contributed to relative to IPV specifically, as opposed to trauma generally?
DR. SPIEGEL: The answer to your question, again, sir, is that you cannot separate this artificial separation you're trying to do between trauma and intimate partner violence. It is part and parcel of trauma. We don't thread it like that.
MR. DENNISON: Your Honor, plaintiff would accept this witness as an expert on general psychiatry, but -- and with respect to the drug usage issues that Ms. Bredehoft referenced, but not with respect to IPV. I 7
THE COURT: All right. Over objection, he's entered as an expert as stated on the record. All right. You may continue. Thank you.
MS. BREDEHOFT: Thank you very much, Your Honor.
MS. BREDEHOFT: COUNTERCLAIM PLAINTIFF
MS. BREDEHOFT: Dr. Spiegel at our request, what have give me --
DR. SPIEGEL: So it's a lengthy review, but court filings; psychological testing that was done on Ms. Heard by both Dr. Hughes and Dr. Curry; other physicians' medical records, just you so know, Dr. Kipper; counsel; counselors and therapists that both parties -- and psychiatrists they went to; text messages; depositions; snippets on the U.K. trial; and I'm sure pictures of physical injuries. So I've seen a lot.
MS. BREDEHOFT: What, if anything, have you seen in terms of emails, audios, videos?
DR. SPIEGEL: Yes. So I've seen videos of Mr. Depp -- I think a video was shown, right, of Mr. Depp destroying and slamming cupboards and breaking glass and yelling at Ms. Heard while having a wine glass in his -- with wine in his hands. I've seen videos of destruction of property in the house.
MS. BREDEHOFT: Okay. And what, if any, review have . you conducted of the deposition and testimony of Mr. Depp's hired witness, Dr. Cuny?
MR. DENNISON: Objection, Your Honor.
MR. DENNISON: May we approach?
THE COURT: Sure. j I 8
THE COURT: All right.
MR. DENNISON: Your Honor, when we were up here last time, Ms. Bredehoft represented to you that there's reference in this disclosure or in the rebuttal to disclosure to Dr. Curry. Her name does not appear. There's no reference at all to any evaluation of Amber Heard.
THE COURT: Is there it opinion about I the credibility?
MS. BREDEHOFT: He testified in his deposition. Then we supplemented and incorporated his deposition.
THE COURT: Do you have that for me?
MS. BREDEHOFT: I do.
THE COURT: This is the deposition taken on the 14th.
MS. BREDEHOFT: Specifically--
THE COURT: So where in here does it talk about --
MS. BREDEHOFT: It specifically incorporates his deposition testimony.
THE COURT: Well ...
MR. DENNISON: Well, the contention is the last line says, "I can talk about anything anybody else talks about that." That's not an appropriate disclosure.
MS. BREDEHOFT: No, Your Honor. We did incorporate ...
THE COURT: Well, you just can't incorporate?
MS. CALNAN: Yeah. That's --
THE COURT: You can't incorporate it without the deposition. Expert depositions you can't have him testify.
MS. BREDEHOFT: What we did was incorporate what he said. We did incorporate his deposition.
THE COURT: But is this specifically put in his supplemental disclosure?
MS. BREDEHOFT: You know, I don't think that we went and put everything he said in the deposition in.
THE COURT: You have to put his deposition in. You have to supplement what his opinions are going to be.
MS. BREDEHOFT: Right. Right. But that's just a commentary on a particular -- I mean, he's just saying that evidence supports. That's an evidence that supports.
THE COURT: Right.
MS. BREDEHOFT: It's not a major opinion.
THE COURT: I understand that. But what Mr. Dennison is talking about, if he's going to opine an opinion that she was credible in her answers to place it --
MS. BREDEHOFT: That's not a major opinion. That is part of-- the major opinions, Your Honor, are very specific to drugs and alcohol, but he gives all the evidence that supports that.
THE COURT: I understand. The opinion that she was truthful in her answers, where is that? Is That's :! s::i!!:: !!: ;s\::s i:on. she scored this in that particular test result of Dr. Curry, and that means that she was incredibly answering those tests.
THE COURT: That's an opinion. I'll sustain the objection.
MR. DENNISON: No references to Dr. Curry, right?
MS. BREDEHOFT: I don't think you can say he can't make any reference.
THE COURT: If he referred to hers in his opinions, that's fine. He can't opine about the results. Right. , that's the issue. There's no reference in this instance to any MMPI. I suspect he's going to talk about Dr. Curry's MMPI.
MS. BREDEHOFT: Your Honor, it's not a major part of his opinion.
THE COURT: I'm going to sustain that objection.
MS. BREDEHOFT: All right. Thank you.
MR. DENNISON: Thank you, Your Honor.
THE COURT: Uh-huh.
THE COURT: BY MS. BREDEHOFT:
MS. BREDEHOFT: Do you remember my question? Did you review the deposition and testimony of Dr. Curry?
DR. SPIEGEL: Doctor?
MS. BREDEHOFT: Curry. Curry.
DR. SPIEGEL: Yeah. Dr. Curry, yeah, I reviewed the testimony of Dr. Curry. I reviewed Dr. Curry's I reports. I reviewed Dr. Curry's testimony.
MS. BREDEHOFT: What if -- did you review the deposition of trial testimony of Dr. Hughes?
DR. SPIEGEL: Yes.
MR. DENNISON: Objection, Your Honor. Beyond the scope the disclosure.
THE COURT: I'll allow that.
MS. BREDEHOFT: Thank you, Your Honor.
THE COURT: Overruled.
MS. BREDEHOFT: Did you interview Mr. Depp?
DR. SPIEGEL: No, I did not.
MS. BREDEHOFT: Did you request to interview?
DR. SPIEGEL: I requested to interview Mr. Depp twice, and both times, Mr. Depp and his lawyers refused.
MS. BREDEHOFT: Dr. Spiegel, I'm going to ask you some questions in this case respecting your opinions and the opinions you have fanned and the bases for them. And I'm going to ask you to provide me within a reasonable degree of medical probability or certainty.
MS. BREDEHOFT: Can you do that?
DR. SPIEGEL: Yes.
MS. BREDEHOFT: Okay. On what were you requested to analyze and opine in this case?
DR. SPIEGEL: So it's fourfold: One, I was asked to opine about the risk factors that are associated with intimate partner violence and behaviors that are shown, risk factors that are shown, in intimate partner violence to be consistent with behaviors that Mr. Depp has demonstrated.
DR. SPIEGEL: Two, I've been asked to opine about the acute effects on alcohol and substance use, and I mentioned that including mood, behavior, cognition, functional impairment.
DR. SPIEGEL: Three, talking about the psychological profile, if you would, of - is there a question? I'm sorry.
MS. BREDEHOFT: No.
DR. SPIEGEL: Oh, okay. - of psychological and medical sequelae of patients who have suffered intimate partner violence and perpetrated intimate partner violence and whether or not Mr. Depp's behavior is consistent with that.
DR. SPIEGEL: And, lastly, about alcohol and other substance use disorders, the diagnostic criteria, their medical and psychological effects, psychiatric effects, their cognitive effects, and I their functional effects.
DR. SPIEGEL: And I think I would like to just go through one other thing. When we talk about - when psychiatry talks about substance use disorders, it's imperative to understand we're not talking about someone who rarely use and happens to have a bad night. We're not talking about someone who uses on a weekly basis and has a bad night. We're talking about repetitive patterns of behavior that meet a list of 11 criteria that can be deemed mild, moderate, or severe.
DR. SPIEGEL: Because I think people get confused when they hear the word "substance abuse," that they think of "Oh, I may abuse this because I used it twice." There is a whole criteria of behavior and sequelae and consequences that go with a substance use disorder. I'm not just talking about someone who will occasionally smoke a joint or smokes a joints or snorts occasionally coke, okay, or alcohol on the weekends. So really I need to reiterate that because I think when you look at psychiatric behavior, we tend to look - people look online and say, "My gosh, I have all seven of these," right? And they're reading it not quite the way the psychiatric literature is supposed to go. So, please, when I'm talking about this, I need you to understand, one, that that's what's going on as I told you about intimate partner violence. It's horrible and it will strike anyone. Okay? But again, we're talking about repetitive behaviors for means of control. All right? So that's really important to understand when you're moving forward.
DR. SPIEGEL: I may say occasionally substance abuse, but what I'm referring to is substance abuse --
MR. DENNISON: Objection. Beyond the scope of the question.
THE COURT: Sustained. Next question.
MS. BREDEHOFT: Okay.
MS. BREDEHOFT: Dr. Spiegel, could you please just summarize for the jury the conclusions you came to ,22 with your opinions, and then we'll take you through the specifics?
DR. SPIEGEL: So in my opinion, based on my -- a review of the evidence, based on my clinical experience, based on my publishing experience, based on my teaching experience, that Mr. Depp has behaviors that are consistent with both someone who has a substance use disorder as well as consistent behaviors for someone who is a perpetrator of intimate partner violence.
MS. BREDEHOFT: Thank you.
MS. BREDEHOFT: I'm going to start with the impact of drug and alcohol abuse over time.
MS. BREDEHOFT: First of all, based upon your review of the record evidence, what type of drugs has Mr. Depp used?
DR. SPIEGEL: So Mr. Depp -- and I will get -- I'm told -- usually talking about a substance use disorder here. We're not just talking about use, okay, so we're talking about alcohol. We're talking about amphetamines. We're talking about marijuana. We're talking about cocaine. We're talking about LSD. We are talking about ecstasy. We are talking about opiates. We are talking about prescription benzodiazepines. And we'll get into a separate thing about the abusability of Seroquel and/or gabapentin, Neurontin. And we're talking about, much of the time, concurrent use, meaning simultaneously.
MS. BREDEHOFT: In your practice, do some patients suggest to you that drugs and alcohol actually help them?
DR. SPIEGEL: So I think it's -- patients who lack insight or are in the very early stages of recognizing they have a "problem" "ill sometimes actually say that they have -- "This medication actually calms me down. This medication makes me feel better." And, in actuality, they may not acutely feel anything, but chronic and continual use will take toll on the brain.
DR. SPIEGEL: So the answer is yes. But, again, people who have substance use disorders have a very -- have lack of insight and a lack of judgment about what's going on and very poor moderation of their own behavior.
MS. BREDEHOFT: Has Mr. Depp suggested, based on your I review of the record evidence, that alcohol and drugs actually help him?
DR. SPIEGEL: I've interviewed the evidence. He has suggested that alcohol, Xanax - I mean, the list of medications do help. Although I will also tell you, on review of the evidence, that there were at least two times I can remember that Mr. Depp was referring to at least short-lived periods of sobriety, and I cannot tell you exactly what that included. That both times he said that he functioned better and that he recognized that I. alcohol and drugs was at the root of his problems.
MS. BREDEHOFT: Now, there has been testimony that Mr. Depp is quite charming, both off and on the drugs and the alcohol What is your answer to that?
DR. SPIEGEL: So, again, let me make one thing clear here: I am not here to impeach Mr. Depp's acting I skills or his persona. He has way greater skills than I do in that. What I'm here to say is talk about how drugs and alcohol affect what we all have in common. We're all human beings. We can I all only get so much, take so much, when something is going to happen, and that's what I see every day in the emergency room, on the consult service, and inpatient psychiatry: Bad things happen, not because of anything special except we're all human beings and our brains -- substances of abuse are not titrated, they are not regulated by the FDA. We don't know what we're getting. We don't know how much we're getting. There's no control over what makes it to our brain. So it is not the actor. It is not the persona, okay?
DR. SPIEGEL: It is a person just like the rest of us, who are human beings, who will have these effect, and that's what we all share in common. Every one in this courtroom shares that in common.
MS. BREDEHOFT: When Mr. Depp was in his relationship with Amber Heard, was he a polysubstance abuser?
DR. SPIEGEL: Was he a what abuser?
MS. BREDEHOFT: Polysubstance abuser.
DR. SPIEGEL: Yes.
MS. BREDEHOFT: So can you explain --
MR. DENNISON: Objection. Leading, Your Honor.
MS. BREDEHOFT: What that is?
THE COURT: Overruled. I'm sorry. Go ahead. So polysubstance abuse is the use of three or more substances, and like I said, concurrently, he was. Even while he was getting ready for rehab on the island, he was. So, yes, he did engage in that.
MS. BREDEHOFT: Did Mr. Depp's drug and alcohol abuse affect his cognitively?
DR. SPIEGEL: Yes. So if nothing else to look at, Dr. Blaustein, a psychiatrist that evaluated Mr. Depp, did a Mini-Mental State Exam on him. And as part of that Mini-Mental State Examination, being tested too.
DR. SPIEGEL: Mr. Depp was unable to recall any of them, and that is very unusual for a 50ish-year-old male. I don't remember how old he was when he took that. Generally speaking, that age group should be remembering two or all three of those words.
DR. SPIEGEL: One, I do know that his lines were also fed to him by earpiece, again, affecting memory. I did see in deposition - I'm sorry, video deposition about having to have questions - I don't want to say repeated as much as completely forgotten. So the answer is yes.
DR. SPIEGEL: And, you know, again, any one of us who use alcohol and cocaine to that level of degree, and I'm talking about a severe level of substance use disorder, are going to have effects. It is inescapable because we all have brains that are malaffected by extensive substance use. And potentially sometimes less, but certainly what we're talking about here is extensive.
MS. BREDEHOFT: What, if anything, did you observe from the record evidence about Mr. Depp having difficulty focusing, his attention span processing, whether he could function as an actor?
DR. SPIEGEL: So-
MR. DENNISON: Objection. Compound.
MS. BREDEHOFT: Compound is only if it's -- ,8
THE COURT: Overruled.
MS. BREDEHOFT: Thank you.
DR. SPIEGEL: So, again, in terms of the acting part, we do know that he needed his lines fed to him for movies. Part of that could have been also due to - and I don't know which movie, and please forgive me about that - that he actually contested that he did a movie entirely wasted. So I imagine it would be harder to do that Additionally, like I said, when I looked at the processing speed was down; his thinking rate was down. If your thinking rate is down, and I'm not talking about, again, I'm getting older. I'm probably not as sharp as I was at 25, okay? But I'm talking about so slow that when we're trying to move on to other questions, we're still trying to answer the original data that's presented to us. So attention span is very much impaired, and if your attention span is impaired, your memory is going to be impaired. It is inescapable that that's going to happen. So all of that comes into play. And that's what I witnessed in the video deposition. Fortunately for Mr. Depp, I do see that during this trial that his cognition has improved, some of which will happen if you are sober, so I commend him on that.
DR. SPIEGEL: But, again, I'm specifically referencing the time with Ms. Heard and Mr. Depp's relationship, so we're talking about that.
MS. BREDEHOFT: What, if any, observations from the record evidence did you have about Mr. Depp having alcoholic blackouts or foggy mind?
DR. SPIEGEL: Again, there are reported times where he would be essentially "passed out drunk." You saw pictures of him passed out drunk and not being able to remember what he did. Which is, again, if you look at the record evidence, you will see that - and this is linking intimate partner violence and substance usage together; I know we're going to get to that - which is basically if you have blackouts and you're using alcohol or using cocaine, it's going to be near impossible to remember what happened the night before.
DR. SPIEGEL: I don't think I'm the first person that's ever told you that alcohol can cause blackouts, and basically alcohol decreases a brain chemical, glutamate, which is involved in memory formation. If it blocks that to an extensive degree, the individual cannot remember what happened because they didn't have enough time for their brain to process the memory and use this brain chemical.
DR. SPIEGEL: So do alcohol blackouts happen every time? No, of course not. But are they a complication of a use disorder? Absolutely, yes. And there was record evidence of that.
MS. BREDEHOFT: Dr. Spiegel you said at one point "alcohol and cocaine." Is it possible to have blackouts with alcohol and different types of substances?
DR. SPIEGEL: Yes. So my clinical experience - and I'll be - I'll date it back within the last month - we had a patient who was using both, especially cocaine, and she had these kind of stroke-like lesions around the brain center known as hippocampus, which is involved in memory formation. So -
MR. DENNISON: Objection. Relevance.
MS. BREDEHOFT: Just giving an example.
THE COURT: Overruled.
DR. SPIEGEL: Combining the two substances together increases the likelihood, even if you don't get what is a major stroke - and again, we think of major stroke as someone who has speech difficulties and moving difficulties. There's a lot of different types of stroke that can just affect cognition. They don't necessarily have to have severe movement deficits or severe language deficits; they can solely affect you in terms of your cognitive symptoms, and they're actually that is part of the psychiatric diagnosis. known as a vascular neurocognitive disorder, and you need to understand that you can have these insults, these lesions, and these strokes without demonstrating physical features, and at a minimal, we know that he was using both substances concurrently. And at minimal, we know we have cognitive issues that we talked about, or at least had some of them.
MS. BREDEHOFT: Thank you, Dr. Spiegel. What, if any, con-elation is there between domestic abuse, heavy alcohol abuse, and cognitive disorders?
DR. SPIEGEL: So the risk factors, if you would, for intimate partner violence, okay -- and there are probably many of them; I don't have time to go over all of them -- but the ones in particular, characteristic in particular, are, one, having someone in the relationship who is jealous or suspicious; two, having someone who has a higher-than-average acceptance of violence ideations; three, someone who has rapid and extreme mood shifts; four, someone who has limited self-control.
DR. SPIEGEL: One of the roles of cognition, one of I the roles of our brain, is to prevent inappropriate behaviors and acting out on Is thoughts. We all get angry at people. That's human. We all get angry at people. We all think things about people. The difference is when our brains are intact and working well, most of us don't act them out, okay? Most of us do not act them out.
DR. SPIEGEL: So that's - that's because your frontal lo be and other parts of the brain are involved in making sure these negative thoughts don't get acted on, okay?
DR. SPIEGEL: So when you have the effects of alcohol acutely, that causes disinhibition, which means you are, by definition, losing control and having rapid mood swings; two, you are affecting parts of the brain that are involved in what we call "social processing cues," so you no longer can interpret what's in front of you that is, let's say, right or wrong or what I should act on and what I shouldn't act on.
DR. SPIEGEL: So we act on them, even though sober -- and I've seen it with Mr. Depp's record evidence; I've seen it clinically. Sober, we can contain that. We can contain that. But when you have these mixtures together -- known, by the way, that about 30, up to 60 percent of intimate partner violence is done under the influence of alcohol and/or substance use disorders, okay, knowing that treating it gets it better and improves -- I'm not saying removes it, but improves it -- hearing from Mr. Depp's own text to Dr.
DR. SPIEGEL: Kipper that he was better, that things are going better, I'll show you that, given this confluence of factors, given them all lining up, the risk factors combined with something that any of us, any of us used to a certain amount -- if we're a novice at it, it would be a lot less; if we're more experienced, you have more tolerance and dependence, it's going to take a lot more, but inevitably will make us disinhibited and will make us act out, and acting out can be done in a lot of different ways in out can be done in a lot of different ways in intimate partner violence, okay, with also remembering control is the endgame of intimate partner violence.
DR. SPIEGEL: So that's how they basically interact in a nutshell.
THE COURT: Ms. Bredehoft, I assume you have --
MS. BREDEHOFT: I have quite a bit more.
THE COURT: Let's go ahead and take our morning recess, ladies and gentlemen. Just do not discuss the case, and don't do any outside research. We'll be back with you in 15 minutes.
DR. SPIEGEL: I'm sorry.
THE COURT: No, no. We're just taking a break.
THE COURT: All right. Let's just take a break until 11, then. We'll come back at 11, then, okay? May 23, 2022 !
COURT BAILIFF: All rise.
COURT BAILIFF: All rise. Please be seated and come to order.
COURT BAILIFF: Ls jury?
MR. DENNISON: Your Honor, can we
THE COURT: All right. Ready for the approach before the jury gets in?
THE COURT: Okay sure.
MR. DENNISON: Your Honor, I want to be totally mindful of your prior orders. This witness testified that he invited, twice, Mr. Depp to be examined. Those two invitations were motions to this court to order a medical exam, and both of those were denied.
MS. BREDEHOFT: Actually, we did request it, and they said no, and then we moved for it and you said no.
THE COURT: You can address that on You can address that on !
MR. DENNISON: But I can mention your order?
MS. BREDEHOFT: We didn't ask whether I they will. We did make a request. We requested of them independent of the order.
THE COURT: Right. But you did an is order. Afterwards you asked for an order?
MS. BREDEHOFT: That's correct.
THE COURT: You can redirect on that too. That's fine. That's fair game.
MR. DENNISON: Okay. Thank you, Your Honor.
THE COURT: All right. Thank you. You may be seated. Your next question. Thank you, ma'am.
MS. BREDEHOFT: Thank you, Your Honor.
MS. BREDEHOFT: Dr. Spiegel before we took the break, you were talking about the correlation between domestic abuse, heavy alcohol abuse, and cognitive disorders. Does the literature support your testimony on this?
DR. SPIEGEL: Yes, the literature fully supports everything I just said -
MS. BREDEHOFT: Okay.
DR. SPIEGEL: Through that interaction.
MS. BREDEHOFT: Thank you. Now, you indicated that you reviewed Mr. Depp's video depositions; is that correct?
DR. SPIEGEL: Yes.
MS. BREDEHOFT: The ones from November 10 through 12 of 2020 and December 14 of 2021; is that correct?
DR. SPIEGEL: Yes.
MS. BREDEHOFT: Okay. Did you reach any conclusions about his cognitive symptoms, insight, and judgment in watching those?
DR. SPIEGEL: So during the video deposition, what was readily apparent was a gentleman who had a significant delay in processing speed. And like I said, when you have a delay in processing speed, many other cognitive functions are going to follow. You're going to be impaired in attention, concentration, memory. All that's going to happen.
DR. SPIEGEL: In terms of having to -- the speech part, if you heard the deposition, the way the thoughts were conveyed were much more in the way kind of disconnected, disjointed statements. It wasn't that they were not necessarily understandable, but they didn't have any coherent pattern until he was more structured by Ms. Bredehoft to kind of get to the point of the question, which happened throughout most of the deposition.
DR. SPIEGEL: And so you could see there that there was obviously some form of cognitive issue that should not be happening in someone in their mid-SOs, and probably due to the alcohol and substances.
MS. BREDEHOFT: What, if any, observations did you make about impulse control?
DR. SPIEGEL: So during the deposition, or ...
MS. BREDEHOFT: Yes.
DR. SPIEGEL: Or anything other -
MS. BREDEHOFT: And of the record evidence either?
DR. SPIEGEL: In either? So, again, I think that under the guise of not being acutely intoxicated, I think Mr. Depp is able to control much of his behavior, much of his thinking. Even if it was aberrant or negative, he's able to control that. I think that once you start getting to the point of adding substances to that, that will set it over.
DR. SPIEGEL: If you saw the video, I think you all did, about the - in the kitchen where there was smashing of glasses, slamming of cupboards, and yelling at Ms. Heard that you don't exist, and throughout the deposition of Dr. Kipper, Mr. Depp is firing him and rehiring him and yelling and screaming. And I do believe that a lot of it had to do with the interaction of, "Hey, we're trying to help you get sober, okay? And it is obviously something you are resisting, not ready for, not wanting," and so you saw a lot of yelling, a lot of acting out, if you would, which puts you on the state of "Hey, this is a gentleman who has really significant trouble with delay in gratification, okay, delay in reward." And certainly one way to - one way to make that significantly worse is with substances. There's no question about that.
MS. BREDEHOFT: And you may have subsumed this in, but what, if anything, did you observe relating to erratic behavior based on the record evidence?
DR. SPIEGEL: Yeah. I mean, I think, again, when you talk about erratic behavior, Dr. Kipper's deposition, I believe it was, where - I think I made particular notice only because I'm a psychiatrist myself- there was a very large ranting about Dr. Cowan, who was Ms. Heard's psychologist/therapist, and the language -you can be dissatisfied with your provider; I have no problem with that. You can be dissatisfied, and you have a right to go to wherever you want to go to. But the texting that were involved in this, in terms of erratic behavior, was disturbing in terms of the verbiage used, the phrases used.
DR. SPIEGEL: Am I free to use some of the language? Or should I reserve that, Your Honor?
MS. BREDEHOFT: Go ahead. Believe me, the jury's been hearing it.
DR. SPIEGEL: Okay. Sorry. I wanted to make sure. I wanted to make sure. So it was something along the line that Dr. Kipper is an "effin' charlatan."
MR. DENNISON: Objection. Hearsay.
MS. BREDEHOFT: He's entitled to rely on it and to give his examples.
MR. DENNISON: He can talk about what he developed from the hearsay, but not repeat it himself.
MS. BREDEHOFT: He's entitled to give examples of it.
THE COURT: I'll sustain the objection.
MS. BREDEHOFT: Without giving the exact words that you recall --
DR. SPIEGEL: Oh, without the exact words?
MS. BREDEHOFT: Yeah.
DR. SPIEGEL: Okay. So, I mean, without giving the exact words it was basically vulgar language directed towards Dr. Cowan throughout multiple texts, multiple things that Dr. Cowan were doing in therapy. It was -- like I said, it was without relaying the exact thing, I'm trying to be as accurate as I can. I think at the end of it, I think he was also talking about that Dr. Cowan was filling Amber with positive thoughts or therapeutic psychiatric --
MR. DENNISON: Objection. Hearsay.
MS. BREDEHOFT: I think he's keeping it more general. He's entitled to rely on it.
THE COURT: Overruled.
MS. BREDEHOFT: Thank you.
DR. SPIEGEL: So more along the line of giving Amber psychiatric jargon to put on him. And actually what I read and interpreted with Dr. Cowan's -- was getting blasted for was he was, you know, kind of teaching Amber how to -- Ms. Heard how to use conflict resolution in a more appropriate manner and learning to express things y more rationally rather than express things as irrational as they had been expressed. And for that, there was a lot of negativity, being sworn at.
DR. SPIEGEL: So, again, erratic behavior in terms of writing a text, but I have no problem with people being angry, okay, none whatsoever. It's just the expressing of it and the continual ranting of it was very uncomfortable for me to read. But regardless, I think we have seen in terms of erratic behavior much of the psychological and the physical maltreatment we talked about -
MR. DENNISON: Objection. Beyond the scope of the question.
MS. BREDEHOFT: I don't agree.
THE COURT: I'll sustain. Next question.
MS. BREDEHOFT: Okay.
MS. BREDEHOFT: Mr. Depp is 58 years old. Are the behaviors that you have been describing for the
DR. SPIEGEL: No. So, well, I don't consider 58 years old - I'm 59, okay? I will tell you that the age-related changes that occur in humans are very- they're very erratic, hit and miss, meaning they'll occasionally bear, disappear. You may need a little bit more time to answer a question or pull things out of memory because you're just a little bit slow and a lot more inconsistently slow. You wouldn't ascribe what Dr. Blaustein's changes were or what I saw in the deposition attributed to age.
MS. BREDEHOFT: Dr. Spiegel what is Seroquel?
DR. SPIEGEL: Seroquel, or quetiapine, is actually an atypical antipsychotic which is indicated for many things including schizophrenia, bipolar disorder, adjunctive treatment for major depression, so it's indicated for a lot of things.
MS. BREDEHOFT: But what effects may it have? This is 118 one of the drugs that Mr. Depp was taking, correct?
DR. SPIEGEL: Yes.
MS. BREDEHOFT: It was a prescribed drug?
DR. SPIEGEL: Yes.
MS. BREDEHOFT: Okay. What--
DR. SPIEGEL: So.
MS. BREDEHOFT: Yeah. Please explain.
DR. SPIEGEL: So the effects of Seroquel is - it's very often used as a sleeping agent because it doesn't have a lot of the side effects that are associated with conventional antipsychotics, movement disorders, tardive dyskinesia, et cetera, or at least it's a very low risk for that.
DR. SPIEGEL: So people have used it off-label, physicians have used it off-label, to help them sleep. The problem is the effect is very barbiturate-like, and it really knocks people out, or certainly if you use it at high enough doses, it can, okay?
DR. SPIEGEL: And the problem is, the problem is it also has street value. So it's absolutely used on the street for that down-like effect, and obviously a little bit more readily available because it's prescribed. So it does have that street value portion of it.
MS. BREDEHOFT: And, Dr. Spiegel what effect would , this have on Mr. Depp, based on the dosages he was taking?
DR. SPIEGEL: So I think what you're looking at is -
MR. DENNISON: Objection. Speculation.
THE COURT: Overruled. Please continue.
DR. SPIEGEL: What you will see in patients who have substance use disorders are people who, unfortunately, kind of wake up and fall asleep only through pharmacological assistance, meaning that their own circadian rhythms are no longer in control of that behavior. So you will take stimulants to "get you up" in the morning, and then you will take things like quetiapine/Seroquel to knock you out.
DR. SPIEGEL: So basically what these are being used for is "I'm going to get up, and I'm going to get knocked out," and that's very characteristic of what would be, actually, legal prescribed substances. That's not illegal at all. That's very legal, and that's seemingly what these medicines' effect are on patients of substance use I disorder.
MS. BREDEHOFT: Dr. Spiegel what is Neurontin?
DR. SPIEGEL: So Neurontin/gabapentin is actually an anti-seizure medicine which is, I think, is - it's indicated for seizures, and it might be indicated for one chronic pain condition, although I can't swear that to you. That's, again, in a substance use disorder population, it has significant street value, and people who misuse opiates often supplement that with Neurontin because it has this anti-pain calming effect. So unfortunately, it also can cause respiratory suppression. And so when you use it with opiates, they're very- there are people 115 that are unlucky enough to succumb to respiratory suppression as a result, but it has a very I additive calming effect that people use it for.
MS. BREDEHOFT: And what effect would that have on Mr. Depp in the dosages he was taking?
DR. SPIEGEL: Again - I'm still waiting for that objection. Okay. Again, what we do is have the street value of using it with the opiates, the advantages of using it with opiates, and it'll make - because opiates in general, despite everything else it does, are calming, and you use it with it, it offers further calming, which is why doctors have been warned not to prescribe medications like gabapentin and opiates together unless under significant, strict following because it can cause serious problems such as death, respiratory suppression.
MS. BREDEHOFT: And Mr. Depp is also taking Adderall correct?
DR. SPIEGEL: Yes.
MS. BREDEHOFT: Can you please describe to the jury what that impact would have and particularly in connection with the dosages?
DR. SPIEGEL: So Adderall is a psychostimulant which is prescribed relatively regularly for ADHD. The problem comes, again, when you shouldn't be prescribing or receiving Adderall when you're already using/misusing cocaine, okay? You're now doubling your stimulant dosage here. And basically what you are talking about, again, it comes down to in the substance use disorder population, you are using it to stay awake, have energy, keep yourself going, getting high, getting energetic, and then the only way to kind of combat that, because you have this effect, is to kind of take downers during the day, and downers being anything that's calming, so anywhere from opiates prescription, anywhere from Neurontin, anywhere from Seroquel, all medications that are potentially - not potentially, which are abusable.
DR. SPIEGEL: And so that's what this is going on. That's what the substance abuse patient has, and, you know, it can't be given with someone using cocaine because that's an extreme risk for death. You can't be doing them together.
MS. BREDEHOFT: And what, if any, effect would these drugs have if they were mixed with MDMA or cocaine?
DR. SPIEGEL: So when you combine the two together like I talked about before, there are effects where you are looking at, right, the predisposing y g g p p g traits of intimate partner violence, so jealousy; rapid mood changes; poor self-control; and to some degree -- and to some degree, condoning violence to a certain degree.
DR. SPIEGEL: When you combine them all together, you get this disinhibiting forward effect from cocaine and Adderall. Then when you combine the two together, what happens? You get too much, and then you start getting irritable, you start getting agitated, okay? You start becoming suspicious, jealous, potentially disinhibited, psychotic, and these are the risks. And again, we're not talking about your average, everyday use of these substances. We're talking about chronic use together.
DR. SPIEGEL: And we also know that alcohol and cocaine use independently increase significantly the risk of intimate partner violence. These aren't statistics I'm coming up with. They all depend -- anywhere from -- reports up to 7 to 27-fold. So you are, let's say, "playing with fire," when you're talking about substances and intimate partner violence. You are playing with fire. And that's all of us.
MS. BREDEHOFT: And the substances that Mr. Depp was taking and the record evidence relating to those, did you draw any conclusions concerning whether he met these -- this criteria or these risk factors?
DR. SPIEGEL: So in terms of substance abuse disorder when you look at it, so major role obligations not being fulfilled, don't have any evidence about operating under the influence or not Social issues, especially disagreements and arguments with your spouse or family, obviously there was tolerance and dependence for the amount he was using because if anyone is naive to these medications, most of us would be dead. Unsuccessful efforts, difficulty cutting back, using more than intended, giving up social/occupational obligations because, this I know, there was part- right after the rehab on the island and in Australia, when he stood there partying with Marilyn Manson and they used -
MR. DENNISON: Objection. Beyond the scope of the question.
MS. BREDEHOFT: Actually, that's asking for the record evidence for this.
THE COURT: I'll sustain the objection. Next question.
DR. SPIEGEL: Okay.
MS. BREDEHOFT: What other record evidence did you have supporting this?
DR. SPIEGEL: Okay. So psychological, using despite the fact you know it causes known psychological, psychiatric, or medical effects. And I think that's pretty well documented. So in this case, you're talking about someone who has a severe substance use disorder. Again, I do want to emphasize, ladies and gentlemen of the jury, that intimate partner violence and substance use disorders are two scourges in this country. They are two plagues. This is very serious stuff we're playing with, and when you are just getting someone closer and closer to threshold -
MR. DENNISON: Objection, Your Honor. Relevance. relevant, Your Honor.
MS. BREDEHOFT: This is highly
THE COURT: I'll overrule as to relevance.
MR. DENNISON: Beyond the scope.
THE COURT: Beyond the scope of the question?
MR. DENNISON: Yes.
THE COURT: Okay. I'll sustain that objection.
MS. BREDEHOFT: All right.
MS. BREDEHOFT: Tell me more about the relationships between substance abuse and IPV, please.
DR. SPIEGEL: Yeah. So again, that - you're talking about this, and you are -you may be able to control the risk factors for - any of us may be able to control the risk factors for IPV; any of us might be able to, okay, when we're thinking and we're not disinhibited, not having these hyperintense emotions from substances.
DR. SPIEGEL: Once you add that to this mix, your brain can no longer do what it's supposed to do, and it's supposed to prevent you from doing this, quite frankly, because it's wrong.
MS. BREDEHOFT: Did you arrive at any conclusions concerning substance abuse and potential self-harm that may have led to Mr. Depp injuring his finger?
DR. SPIEGEL: So I think the physician before me explained that pretty well. But I'll tell you IO that Mr. Depp has a history of self-injurious behavior, meaning cutting himself. Mr. Depp has a history of burning himself. I know when the actual event happened, there was texting to Dr. Kipper -- paraphrasing, not saying exactly -- that Amber and him got into a disagreement related to her wanting him to be sober and that as a result of that, he said he got so angry he cut the tip of his finger off.
DR. SPIEGEL: So if you're asking me can someone who has -- or have I seen and can someone who cuts themselves, bums themselves, can cut a tip of their finger off with or without alcohol or cocaine? More or less, the answer is
MR. DENNISON: Objection, Your Honor. Beyond the scope of the question.
MS. BREDEHOFT: That's exactly what ls he --
MS. BREDEHOFT: It was overruled.
MS. BREDEHOFT: Go ahead.
THE COURT: Overruled.
MS. BREDEHOFT: Thank you.
MS. BREDEHOFT: Please continue.
MR. DENNISON: Was it overruled?
DR. SPIEGEL: So that is not a very far jump. I've certainly seen patients do a lot worse than that who started out with similar risk factors of, you know, burning self and cutting self. I'm not going to get into the descriptions, but I've seen people do a lot worse than that.
MS. BREDEHOFT: Okay.
DR. SPIEGEL: So the answer's yes.
MS. BREDEHOFT: Okay. I'm going to turn, now, specifically to intimate partner violence, and I know you've talked, certainly, about it.
MS. BREDEHOFT: But can you tell the jury, please, a little bit more about intimate partner violence and what is included in that?
DR. SPIEGEL: So the APA task force on violence in the family defined, more or less, this topic of domestic abuse and intimate partner violence as recurrent abusive behavior by means of psychological, sexual, or physical maltreatment for the purpose of achieving control or maintaining power, authority, and control.
MS. BREDEHOFT: Can it include threats and intimidation?
DR. SPIEGEL: It includes - so in the part of psychological abuse, which is done essentially as it's a means of emotionally and mentally hurting someone - but with the same end goal to achieve control - it can be destroying property, it can be financial which is part of that, verbal out abuse - verbal outbursts, I'm sorry - threats, intimidation, body language, all of that goes under the concept of psychological abuse. And you may be able to divide it verbal, nonverbal, what's actually emotional versus verbal. But they're all under that rubric, and they're all under the guise of maintaining control.
MS. BREDEHOFT: Do survivors of intimate partner violence experience mental health issues?
DR. SPIEGEL: Can you repeat the question?
MS. BREDEHOFT: Do survivors of intimate partner violence experience mental health issues?
DR. SPIEGEL: Oh, yes. Oh, yes. So survivors of O intimate partner violence - and by the way, I should start out by saying we don't expect - in psychiatry, we don't expect our victims to be perfect We don't expect our victims to be unscathed by what they've received. So starting with that, okay, it is not unusual, as survivors, to see substance use - substance abuse, substance abuse - substance-induced symptoms: Chronic depression, post-traumatic stress disorder or subsyndromal post-traumatic stress disorder along the lines of battered wives syndrome, and some emotional unpredictability.
DR. SPIEGEL: That's - and again, you are a victim here. You are a victim. y treatment or counseling?
DR. SPIEGEL: No. Perpetrators are not receiving counseling treatment. One, because they're going to be probably having to tell someone that they actually struck someone, which is what their thought is about the big problem, that intimate
MS. BREDEHOFT: Do perpetrators typically seek partner violence is just the hitting. Again, important but not the sole part of it. So perpetrators very rarely will go into any type of formal counseling.
MS. BREDEHOFT: Victims go into counseling. Victims are seeking, actually, couples counseling. Victims are seeking couples advice to try to repair what's happening, okay? But in terms of actually perpetrators? No, they don't do that.
MS. BREDEHOFT: In your view of this case, is there record evidence of physical violence by Mr. Depp?
DR. SPIEGEL: So -
MR. DENNISON: Objection, Your Honor. Foundation.
THE COURT: Do you want to approach on I that?
THE COURT: Yes, sir?
MR. DENNISON: We're getting to this.
THE COURT: Can you say that question , again?
MS. BREDEHOFT: It's "Is there record evidence of physical violence by Mr. Depp?" which is one of the risk factors, and it's in the O designations, page 84, paragraph 2.
THE COURT: Wait, wait, wait.
MS. BREDEHOFT: "Is there record evidence of physical violence by Mr. Depp?" I'm 1114 not asking if he was a perpetrator. This is physical violence.
THE COURT: You're saying -- you're I saying if there's physical violence?
MS. BREDEHOFT: Yes, that he's engaged in physical violence, but this is at -- I mean, very much -- it's at page 84, paragraph --
THE COURT: I understand that. You're just going to state that he has the risk factors. I You're not getting into why he's thinks --
MS. BREDEHOFT: Yes. He's going to -- he's going through the risk -- what are the factors. And he actually says --
THE COURT: You can ask that question, . 6 what the factors are.
MS. BREDEHOFT: But then he also said -- and this is part of his opinion -- that there's physical -- there's actually record evidence of him committing physical violence, sexual violence, psychological regression, which he can testify to that and that's in his opinion.
MR. DENNISON: That's exactly the issue ! 14 that we raised previously. It's making judgments I as to all --
THE COURT: Right. He's making judgments as to the evidence. He can't say that there is known physical acts of Mr. Depp because it isn't -- that's what the jury is here to decide.
MS. BREDEHOFT: He can testify that there's -- I mean, he's read the record --
THE COURT: It doesn't come into evidence. I mean, you want to testify that he has read reports in evidence, I mean, that's what he based his opinions on. That's fine. But he can't say, "Yes. There's reported times of this." Because he doesn't know that, and that's what the jury has to figure out.
MS. BREDEHOFT: So I can ask him if there's record evidence of physical violence, O sexual abuse, and physical aggression, but that he can't say any specifics?
THE COURT: What was your question again?
MS. BREDEHOFT: It was "In your review of the case, is there evidence of physical violence by Mr. Depp?"
MR. DENNISON: Your Honor, I think it literally continues to invade the province of the jury here. That's specifically one of the issues the jury is going to ultimately decide, and she's asking him to sum it all up for them and --
MS. BREDEHOFT: Your Honor, we disclosed this --
THE COURT: I know you disclosed it. We're past disclosure.
MS. BREDEHOFT: And experts are able to testify to ultimate issues as well, but he's going through the three different types of the IPV here in talking about it.
MS. BREDEHOFT: But he's seen recorded evidence that we -- IO Record evidence. I'm sorry.
THE COURT: Record evidence. I don't want him commenting on the evidence that's before the jury. He can't comment on, "Yes, he assaulted Ms. Heard," because he doesn't know that. It's in evidence for the jury.
MS. BREDEHOFT: And what he said in his report is he said, "There are numerous witnesses who report seeing cuts, bruises, and injuries." And it was reported that --
THE COURT: Okay. So that -- why don't you ask, "What have you reviewed that shows PIANE that" -- I'm not sure how you want to do it, but I just don't want him to give any kind of conclusion with respect to the evidence. Make sense?
THE COURT: All right.
MR. DENNISON: I mean, fundamentally --
THE COURT: He's not going to give -- his only conclusion is going to be that he meets the risk factors, not that he's done it, correct?
MS. BREDEHOFT: So I'm going to ask -- I just want to make sure --
MR. DENNISON: I mean, it makes sense to me.
THE COURT: Well, okay.
MS. BREDEHOFT: "What have you reviewed that reflects Mr. Depp engaging in physical violence?"
THE COURT: No, no.
MR. DENNISON: Objection.
THE COURT: You just say "the risk factors." Risk factors.
MS. BREDEHOFT: Risk factor relating to physical violence? I mean, that's just one of
THE COURT: I understand. But what we were discussing earlier is he wasn't going to --
MS. BREDEHOFT: He's engaged in -- there's evidence of him engaging in each of the I risk factors.
THE COURT: Right. Just in risk factors, not engaging in physical violence. Maybe just explaining what the risk factors are first, and then "What have you reviewed? Give us your information that he knew that he was" --
MS. BREDEHOFT: So if I'm understanding Your Honor's ruling here, I can't ask him what the record evidence is of Mr. Depp engaging in physical violence, sexual abuse, and instead I just have to have him explain what that is and the significance of it to IPV.
THE COURT: What the risks -- right, "What are the risk factors," right. And what he reviewed that makes you believe that he correlates with those risk factors?" Does that sound all right?
MR. DENNISON: Yeah. He can identify what the risk factors are for IPV.
THE COURT: Right. And what he reviewed that would put that on that course. But I just don't want him commenting on the evidence itself.
MS. BREDEHOFT: Okay. What it correlates, okay.
THE COURT: Okay.
MS. BREDEHOFT: I think so. Thanks, Your Honor. We'll give it a whirl.
MR. DENNISON: Okay.
MS. BREDEHOFT: So what have you reviewed that correlates with the risk factors for IPV that Mr. Depp -- related to Mr. Depp?
DR. SPIEGEL: So risk factors I reviewed that correlate, so starting with the - I guess we'll start with the physical because that was the question that was put out there. What I have reviewed has demonstrated pushing, shoving - l-------------------6--3-54---,
MR. DENNISON: Objection, Your Honor.
MS. BREDEHOFT: Let me see if I can direct this a little differently, Dr. Spiegel.
MS. BREDEHOFT: Rather than giving the summary of what that was, what did you review that correlates? In other words, did you review witness statements? Did you review --
DR. SPIEGEL: Oh, okay.
MS. BREDEHOFT: Depositions, photos?
DR. SPIEGEL: So what I reviewed was in terms of witness statements, Dr. Kipper's notes. Very, very interestingly, actually, early on, in I think it was 2012 or around that time, circa 2012, 2014, Ms. Heard was -
MR. DENNISON: Objection. Beyond the scope of the question.
THE COURT: What he reviewed is the question.
MS. BREDEHOFT: All right.
DR. SPIEGEL: So I reviewed - so Ms. Heard's -
MR. DENNISON: Objection. There's no question pending.
MS. BREDEHOFT: He's answering -- I Please continue with what you reviewed.
THE COURT: Okay.
MS. BREDEHOFT: Go ahead and answer what you reviewed.
DR. SPIEGEL: Therapists' notes, counselors' notes, te}.i messages, depositions, video, pictures, psychologists' notes and evaluations, and I said Is physicians' notes; that's what I reviewed.
MS. BREDEHOFT: Okay. Now, you've indicated that intimate partner violence includes physical violence, sexual abuse, and psychological aggression. Can you please describe for the jury what "psychological aggression" is and what it entails?
DR. SPIEGEL: So psychological aggression would be the engaging in behavior for the sole purpose of emotionally and/or mentally harming someone with the main purpose of, again, to maintaining control. So behaviors that can occur with psychological aggression include insults, intimidation, holding things financially against someone, jealousy rants, property destruction. So all that is involved -- nonverbal communication, so threatening looks, glances, things like that, all of that is involved in psychological maltreatment and intimate partner violence.
MS. BREDEHOFT: What, if any -- what, if anything, would be psychological aggression if it was trying to control somebody's career? Would that be a factor?
DR. SPIEGEL: Yeah. So --
MR. DENNISON: Objection. Leading.
THE COURT: Overruled.
DR. SPIEGEL: So, yeah. Trying to control someone's career, that would be under financially trying to mistreat someone, especially, you know, if someone wants to succeed and try and have a career and you're preventing them from doing so by maltreatment, that's another example.
MS. BREDEHOFT: Okay. So I'm going to ask specifically about the risk factors for intimate partner violence. Is substance abuse a risk factor for IPV?
DR. SPIEGEL: Yes, it is a risk factor, as well as a precipitating cause.
MS. BREDEHOFT: Okay. And what record evidence did you review that correlates to Mr. Depp engaging in substance abuse?
DR. SPIEGEL: So the record evidence of - I'll just start with Dr. Kipper and the substances that Mr. Depp was using and misusing, both in terms of prescribed and on urine drug screen, were brought out through that.
MS. BREDEHOFT: Is lack of behavioral control and impulsiveness risk factors for intimate partner violence?
DR. SPIEGEL: Yes, they are.
MS. BREDEHOFT: Okay. And what, if any, record evidence were you aware of that Mr. Depp had lacked -- exhibited lack of behavioral control and impulsiveness?
DR. SPIEGEL: Again, threatening -
MR. DENNISON: Objection. Record evidence.
MS. BREDEHOFT: That correlates with -- and I'm on the risk factors at this point.
THE COURT: Overruled.
DR. SPIEGEL: Threatening; destroying furniture,
MS. BREDEHOFT: Thank you, Your Honor. property, breaking things; writings on walls, mirrors, writing in blood on furniture, all that would be - go with that.
MS. BREDEHOFT: Okay. All right. And what, if any, risk factor is narcissism for intimate partner violence?
DR. SPIEGEL: So a patient - before we get into narcissistic personality traits or disorder, the overall - it's categorized under what's called cluster B personality disorder.
MR. DENNISON: Objection, Your Honor. Beyond the scope of the question.
MS. BREDEHOFT: He's explaining the narcissism.
THE COURT: I'll sustain the objection to the last question.
MS. BREDEHOFT: Okay.
MS. BREDEHOFT: Can you explain to the jury what's involved with narcissism as it relates to the risk factors of intimate partner violence and what that realm is?
DR. SPIEGEL: So narcissism patients have, again, poor self-control, okay, rapid mood shifts, okay? As a result, they have an undue sense of admiration. They worship power or worship control. They are - they have lack of empathy, and people are generally kept around as long as they're useful to them A large sense of entitlement. Anything else? Need for praise, so that would go under narcissistic personality and IPV.
MS. BREDEHOFT: What, if any--what, if any, traits would be requiring admiration? Would that fit into it?
DR. SPIEGEL: Yeah. Oh, yes. Requiring admiration, need to be admired is part and parcel of narcissistic personality disorder, yes.
MS. BREDEHOFT: And would being envious fit within I that?
DR. SPIEGEL: Yes.
MS. BREDEHOFT: Fragile self-esteem?
DR. SPIEGEL: Yes.
MS. BREDEHOFT: And what, if any, record evidence do you have that correlates with Mr. Depp being narcissistic?
DR. SPIEGEL: Right. I do think that fact that he felt that Amber owed him, Ms. Heard owed him - s
MR. DENNISON: Objection, Your Honor.
THE COURT: Overruled. I po
MS. BREDEHOFT: Thank you.
MS. BREDEHOFT: Go ahead.
DR. SPIEGEL: The fact that Ms. Heard owed him and only wanted to be together with him because of his fame is an example of that. I do think the jealousy aspects are an example of that. I do think, you know, as I think Mr. Tillett had testified that, you know, being admired is one thing, but behind your back saying something else about people is another thing. And I can probably say with reasonable certainty that to some degree, this whole trial is that -
MR. DENNISON: Objection, Your Honor.
THE COURT: What's the objection?
MR. DENNISON: That's not record evidence. Speculation.
THE COURT: Overruled. Overruled.
MS. BREDEHOFT: Please continue.
DR. SPIEGEL: That this whole trial, in terms of narcissism - narcissistic insult, is what's going on. I believe that Mr. Depp was very much a mainstay, appropriately, in Hollywood, and then this was - pulled the rug without -
MR. DENNISON: Objection, Your Honor.
MS. BREDEHOFT: He's simply explaining --
THE COURT: I'll sustain that objection.
MS. BREDEHOFT: Can you explain what you mean by "this whole trial"?
MR. DENNISON: Your Honor, may we approach?
THE COURT: Yes.
DR. SPIEGEL: This court case we're going through.
THE COURT: There's an objection, sir.
MR. DENNISON: May we approach?
THE COURT: You May.
THE COURT: You want to talk about the court case? I'm not sure.
MS. BREDEHOFT: Well, I think he's just saying as an example that -- the fact that we've got this trial.
THE COURT: I th.ink it's beyond. Get IO back to what he reviewed.
MS. BREDEHOFT: All right. I'll try.
THE COURT: Sustained.
MS. BREDEHOFT: All right. Thank you.
MS. BREDEHOFT: What other conduct is in the record evidence that correlates with Mr. Depp being narcissistic, having those traits?
DR. SPIEGEL: Was the thing about the trial ruled? I can't say --
MS. BREDEHOFT: Yeah. You're not allowed to say that.
DR. SPIEGEL: Not say that? Okay. The only other thing about narcissism, I think, in terms of the trial would be in order to maintain any sense of control, a narcissistic person really has to have lack of empathy. Because in order to engage in behaviors that "are used to keep individuals in control," you don't really think about the other person. You're not Is really caring what happens to that other person.
DR. SPIEGEL: So I think that's another facet.
MS. BREDEHOFT: So are attitudes accepting or ! 11 justifying intimate partner violence a risk factor ! for intimate partner violence?
DR. SPIEGEL: Yes.
MS. BREDEHOFT: Do some perpetrators in intimate I partner violence try to minimize the IPV?
DR. SPIEGEL: Yes. So it is unfortunately not uncommon, especially during - especially during the calm phases of the abuse cycle where there's no increased tension, there's no acting out, okay, you are talking about more of the honeymoon/apologetic phase, begging for forgiveness, telling them how you're going to change, maybe giving them gifts.
DR. SPIEGEL: And then when the dust settles later in the day, a day or two later, it is not uncommon for the perpetrator to kind of switch the blame over to the victim, saying that, "Hey," you know, this either denial, "this never actually happened, trying to make me look bad," or allopathic defense where "You instigated it," or an altruistic effect, where "I'm doing it for you," , transformative effect that society kind of accepts this. So it is very uncommon for, all of a sudden, for that to start shifting.
DR. SPIEGEL: During that time, because it is during the calm phase and everything is relatively calm - this, of course, is when the victim wants to engage in treatment. But beyond that, the ability to kind of, quote/unquote, for lack of a better phrase, "win people over," family, friends, the law, the very ability to do that is part and parcel of that calm, charming phase where it looks like the victim is, you know, just fabricating this.
MS. BREDEHOFT: Okay. And is victim blaming a characteristic?
DR. SPIEGEL: Yes. Like I said, I mean, it's you blame the victim, that one of the defenses, or the allopathic defense, comes along with victim blaming. That's what essentially you're doing, "I'm blaming you for what you made me do."
MS. BREDEHOFT: And is there record evidence that you reviewed that correlates with Mr. Depp engaging in this type of behavior?
DR. SPIEGEL: So I think for a lot of the issues seen, the big precipitant was going to be the need for sobriety. Again, coming back to that severe -
MR. DENNISON: Objection, Your Honor. nonresponsive.
MS. BREDEHOFT: I think he's trying to explain it.
THE COURT: Overruled.
MS. BREDEHOFT: Thank you.
MS. BREDEHOFT: Please continue.
DR. SPIEGEL: Severe substance abuse disorder, and 3 66 + ------- ----------------6-3-66-+ many of the arguments, from what I viewed in the record, stemmed around Ms. Heard's desire for Mr. Depp to maintain sobriety, and that wasn't happening. So as a result, she was blamed for, you know, bothering him in a way he didn't want to be bothered, and that triggered what was going on.
MS. BREDEHOFT: Are you familiar with the term "gaslighting"?
DR. SPIEGEL: I'm familiar with the term "gaslighting."
MS. BREDEHOFT: Okay. What, if any, gas lighting is consistent with intimate partner violence and the risk factors?
DR. SPIEGEL: So, again, when you start being able to be - when a person starts to be able to be manipulative and charming, you start to be able to win people over, and especially when you see someone who's a victim who is essentially vulnerable, emotionally labile, okay, you see that person, and then you see this calm demeanor in front of you who is very charming, very engaging, very personable. And then, all of a sudden, it starts looking like the victim is just a - or essentially losing it, and, i.e., they make - they're being gaslighted
MS. BREDEHOFT: Is there an examples where an intimate partner violent perpetrator claims that the victim is the person who's actually committing the abuse?
DR. SPIEGEL: Yeah. Oh, yes. Oh, yes.
MS. BREDEHOFT: How common is that?
DR. SPIEGEL: Oh, very common. Again, that's part of I the - that is very common in the occurrence of I the, like, the honeymoon phase and the calm period I of the abuse cycle, very common during that time I where the victim, where they're shifting the blame or anything along that line, that's very common for that to happen.
MS. BREDEHOFT: And you indicated that you reviewed some audio tapes in this case, correct?
DR. SPIEGEL: Yes.
MS. BREDEHOFT: And what, if any, evidence did you review there that correlates with Mr. Depp attempting to claim that Amber was the one?
DR. SPIEGEL: Well, I think that was what was said, that Amber was the abuser.
MR. DENNISON: Objection, Your Honor.
MS. BREDEHOFT: I don't understand the objection.
MR. DENNISON: What record evidence?
THE COURT: Overruled.
MS. BREDEHOFT: Thank you. Please continue.
DR. SPIEGEL: So that claiming that Amber was the abuser in this particular scenario, and what I would reiterate, again, is that, one, victims aren't perfect. And, two, it is not uncommon in the context of being a victim, when you know that person is about to proceed or relapse into a substance or go into a substance and anticipating what's going to happen, that you anticipate the next mood and start initiating self-defense. But by and large, that's not what's going on here. By and large, Mr. Depp's behavior -
MR. DENNISON: Objection, Your Honor.
DR. SPIEGEL: Behavior was consistent -
THE COURT: There's an objection, sir.
DR. SPIEGEL: I'm sorry.
THE COURT: I'll sustain the objection.
MS. BREDEHOFT: Okay. All right.
MS. BREDEHOFT: We can move on to the next one. Is prior victimhood of abuse a risk factor for intimate partner violence?
DR. SPIEGEL: Yes. So- And what -- go ahead.
DR. SPIEGEL: So there was something that was
MS. BREDEHOFT: Intergenerational theory of violence, which is basically along the line of observation, imitation, reinforcement. So you observe a behavior that occurred in childhood. You imitate it when you see that there's no significant negative consequences, but you do get the positive consequence of maintaining control of a situation, solving the conflict in your way, if you would.
MS. BREDEHOFT: So that theory is - interestingly, it's - it applies to not only the the victims - I'm sorry - not only the perpetrators, but also the victims. Because there are many victims who - - grow up in a house of abuse that are not abused, but they're the victims of abuse.
MS. BREDEHOFT: What are the warning signs of intimate partner violence?
DR. SPIEGEL: So warning signs would be increasing the tension, escalation of tensions. So that's when you start seeing, hey, partners getting angry, okay, starting to -- starting to break down the communication, starting to engage in verbal/nonverbal threats. Victim concedes due to this tension, and that leads you to the actual acts. So these acts progressively build, and then they occur.
MS. BREDEHOFT: What, if anything, have you seen in intimate partner violence about apologies and promises?
DR. SPIEGEL: Again, the apology is part and parcel of the honeymoon phase, and promises are part and parcel of the honeymoon phase. And, you know, the victim wants to believe it's going to work. They want to believe their spouse is going to be faithful to this, and as part of this abuse cycle, it ends up - I should say in the calming cycle, like I said, the victim tries to get some help to try to resolve this until the tension buildup phase where something bothers them.
DR. SPIEGEL: Is l So, again, it can be bothering someone about substance abuse. It can be bothering someone about financing. It could be bothering someone about your career. Anything is liable to build up tension when you have this framework of limited self-control and erratic, intense mood l • I'll shifts.
MS. BREDEHOFT: So what, if any, record evidence did you review that reflected Mr. Depp engaging in these warning signs, including the apologies and the promises?
DR. SPIEGEL: I think it's - that was almost routine, that after it was all said and done, that he would apologize for letting this monster out, letting this anger out, almost routinely. And there's very well record evidence of that starting as early - early on in the marriage in therapy for Ms. Heard.
DR. SPIEGEL: I 15 i So that's very common and very much occurred - recognizing what happened. And the other part of this is, again, when you can recognize that when you're sober, even short-lived sobriety, when you can recognize that, that things are better, things are happening, but a life is better, then even that should show you that, hey, is there's an issue here. There are issues here that when I don't use could be resolved.
MS. BREDEHOFT: Thank you, Dr. Spiegel. I'm going to now move to the Goldwater
MS. BREDEHOFT: Rule. Can you explain the Goldwater Rule, please?
DR. SPIEGEL: So the Goldwater Rule is when Senator Goldwater was running for presidency, and I'm going to be honest with you; I think it was in the late '60s when he was, early '70s, because I was too young to even follow politics then, so please don't quote me on exactly when it was. But basically what was happening is clinicians, psychiatrists were making these "armchair diagnosis" from their homes or offices because they saw this person on TV, the way they acted, and were asked to comment about that they think their diagnoses are, and, therefore, it was felt that that should not be done by professionals in these public settings.
MS. BREDEHOFT: Does it have any applicability here?
DR. SPIEGEL: No.
MR. DENNISON: Objection.
DR. SPIEGEL: It does not.
MS. BREDEHOFT: Why not?
MR. DENNISON: No foundation.
THE COURT: All right.
MS. BREDEHOFT: He was explaining what the Goldwater Rule --
THE COURT: You can approach for a minute.
MR. DENNISON: If he wants to testify that there are exceptions to the Goldwater Rule, go ahead. But the question was "Does it have any applicability here?"
MS. BREDEHOFT: It's in my designation at page 94, paragraph 1.
MR. DENNISON: Clearly it's in her designations.
THE COURT: What's the foundation?
MS. BREDEHOFT: It's a psychiatric: It's American Psychiatric Association, and the reason I'm asking him this is Dr. Shaw is one of their experts. He claims that it's unethical for him to be giving these opinions here because he hasn't examined Mr. Depp and --
THE COURT: Which is the Goldwater Rule?
MS. BREDEHOFT: Excuse me?
THE COURT: Which is the Goldwater Rule?
MS. BREDEHOFT: Right, right. And so he's --
THE COURT: There was a Motion in Limine against this at one point. Was it your Motion in Limine that it mentioned the Goldwater Rule? Am I out of bounds here?
MS. BREDEHOFT: I think we had a Motion in Limine to exclude some of Dr. Shaw's testimony, I b and Your Honor granted that.
THE COURT: To include Goldwater?
MS. BREDEHOFT: I don't think it ! included the full Goldwater Rule. That's why I'm asking him
THE COURT: So is that something your expert is going to be testifying to? IS
MR. DENNISON: Yes.
THE COURT: Okay. I'll allow it.
MR. DENNISON: In that form? Does it ! 11 have any applicability here?
MS. BREDEHOFT: I can ask him that.
THE COURT: I'll allow it.
MS. BREDEHOFT: Thank you.
MR. DENNISON: Okay. Thank you.
MS. BREDEHOFT: BY MS. BREDEHOFT:
MS. BREDEHOFT: Dr. Spiegel, do you remember the question?
DR. SPIEGEL: I think--
MS. BREDEHOFT: Does the Goldwater Rule have any applicability here to your testimony and your conclusions and opinions?
DR. SPIEGEL: No, it does not.
MS. BREDEHOFT: And why?
DR. SPIEGEL: For multiple reasons.
DR. SPIEGEL: One, the basics of expert witness testimony would almost be thrown away if you were not allowed to base things on what you evaluated of an individual, what you've read about an individual. So if I'm not allowed to comment on records or charts or information that I had looked at, expert witness testimony can't be done. But more specifically for this case, in the Goldwater Rule, the pure version of it was the armchair diagnosis of watching someone on TV. Just you don't make a diagnosis. More recently, I think there's more recent examples of that.
DR. SPIEGEL: So you don't make diagnoses like that. This is not the case here because as I said to you at the beginning, I have reviewed a lot of professional, a lot of professionals and their evaluations and their treatment course, video deposition, picture deposition, court filings, emails. I mean, I reviewed a whole lot of things that directly describe Mr. Depp and his behavior. So I'm not commenting on a public opinion, and I have absolutely no knowledge of what's in Mr. Depp's history.
DR. SPIEGEL: If I was just doing that, it would be like watching a movie. That's not relevant here.
MS. BREDEHOFT: And, in fact, I think you testified earlier you invited Mr. Depp to --
DR. SPIEGEL: Oh, yes. -- give an examination --
MR. DENNISON: Objection. Leading.
THE COURT: Overruled.
MS. BREDEHOFT: Thank you.
DR. SPIEGEL: So to be fair, for an evaluation -- for my own direct evaluation, and again, I -- it was offered twice that I could do an evaluation of Mr. Depp directly, and both times, Mr. Depp and/or his lawyers decided that that wasn't going to happen.
MS. BREDEHOFT: Okay. And, in fact, the Court did not require Mr. Depp to --
DR. SPIEGEL: No. And the Court did not require Mr. Depp to undergo this evaluation.
MS. BREDEHOFT: Okay. Dr. Spiegel, these opinions that you have offered here, do you hold them to within a reasonable degree of medical psychiatric probability or certainty?
DR. SPIEGEL: Absolutely.
MS. BREDEHOFT: Thank you
THE COURT: All right. Cross-examination.
MR. DENNISON: Sir, I'm Wayne Dennison. We haven't met.
MR. DENNISON: But let me ask you, let's start with what you finished with.
DR. SPIEGEL: I'm sorry, what?
MR. DENNISON: Let's start with what you finished with. You understand that the Court was twice asked by Ms. Heard's counsel to order a medical exam of Mr. Depp, and those motions were denied?
DR. SPIEGEL: I think the - your team told the Court you didn't want to have them, and the Court ruled on them I don't think the Court proactively did it. You had a motion to them, right?
MR. DENNISON: No. Ms. Heard's lawyers moved for them and asked for them and did not get them. Isn't that right, sir?
DR. SPIEGEL: If you're saying that's what happened, my understanding of it was that you-all did not want him to undergo one. They petitioned for it, the Court said no. Yes, that's what my understanding of it was.
MR. DENNISON: The Court said no to ordering Mr. Depp I to do the medical exam.
DR. SPIEGEL: That's what I said. The Court did not !ts require it, right.
MR. DENNISON: And it was ordered, in fact, right?
DR. SPIEGEL: It was -
MS. BREDEHOFT: Your Honor, may we approach?
THE COURT: All right.
THE COURT: We're not going into this.
MR. DENNISON: There you go.
MS. BREDEHOFT: Thank you.
MR. DENNISON: All right. So the last thing you talked about was the Goldwater Rule.
DR. SPIEGEL: Yes, sir.
MR. DENNISON: Been around for almost 50 years, right?
DR. SPIEGEL: I'm 59. That sounds about right.
MR. DENNISON: Yeah. And it's been around as a result I of a presidential election that you referenced? Its
DR. SPIEGEL: Yes.
MR. DENNISON: And who has that rule? What organization maintains that rule?
DR. SPIEGEL: The American Psychiatric Association.
MR. DENNISON: An association you're a member of?
DR. SPIEGEL: Association I'm a member of, yes.
MR. DENNISON: Aren't you a fellow or something?
DR. SPIEGEL: Yes, I am
MR. DENNISON: Okay. So and this is an ethical rule, right?
DR. SPIEGEL: It is an ethical rule, yes. It's ethical, I say "rule." It's an ethical guideline, yes. They're guidelines.
MR. DENNISON: And you've known that over time, the American Psychiatric Association has amended the rule so it's not just about diagnoses, but it's also about professional opinions?
DR. SPIEGEL: Could you be more specific? Say about professional opinion in regard to what?
MR. DENNISON: Well, let me read this and see if you're familiar with it: "It is unethical for psychiatrists to offer a professional opinion about an individual based on publicly available information without conducting an examination."
DR. SPIEGEL: If you're reading it directly, I would believe you.
MR. DENNISON: Okay. However, a diagnosis is not required for an opinion to be professional. So my question is, it's not just diagnosis that this Goldwater Rule applies to; it's professional opinions?
DR. SPIEGEL: So, again, I will reiterate that that would come down to essentially nullifying witness testimony, expert witness testimony, without direct evaluation. And as we know, it didn't happen, but regardless of that, the whole expert witness testimony thing would be basically rendered null and void.
MR. DENNISON: The rule in fact contemplates that issue, doesn't it, sir?
DR. SPIEGEL: Again, I'm just telling you the answer to the question. 'When you were reading me those statements, I'm telling you the response by the other side, who this publishes also, is that if that was the case, there could be no expert witness testimony in the courtroom.
MR. DENNISON: "Psychiatrists are ethically prohibited from evaluating individuals without permission or other authorization such as a court order."
MR. DENNISON: That's the rule, right?
DR. SPIEGEL: Again, if you're reading that, then I'd have to believe you're not misrepresenting it. And I would come back to, again, then this whole thing - we might as well get rid of all the expert witnesses we've had throughout all of time for court proceedings. Because what you're saying that unless a court orders it, and that's what you just said, or the APA said, then, therefore, expert witness could not do an evaluation based on an observation of the medical records. Insurance companies cannot do evaluations solely based on medical records where there are doctors rendering professional opinions.
DR. SPIEGEL: So at the end of the day, you are essentially saying that unless someone has directly evaluated it, this whole medical system we have, this whole legal system we have, is null and void.
MR. DENNISON: I'm not saying --
DR. SPIEGEL: Oh, yes you are, sir.
MR. DENNISON: Well, give me a second.
DR. SPIEGEL: Yeah, you are.
MR. DENNISON: I gave you more than a second. What I'm saying and what I was reading to you is a rule by your organization that takes into account that there could be court orders that will permit the exact kind of evaluation that you say I'm eliminating.
DR. SPIEGEL: And I think we're going in circles because I think I just said that means expert witness testimony would not be allowed and the branch of forensic psychiatry would be especially hindered, and we know the branch of forensic psychiatry does not prohibit that. So I am a member of the APA. That doesn't necessarily mean every single thing they put in there everybody has to uncategorically agree with, because clearly that's not the case.
MR. DENNISON: Did you agree in your deposition that the professional opinions you rendered were inconsistent with the Goldwater Rule?
DR. SPIEGEL: Yeah. My first was -- if we're saying that I -- if the Goldwater Rule says -- and I very much said that during the deposition -- that the Goldwater Rule was made for presidents and public figures such as that. But regardless of that, because that's what it was made for; it's not made for Hollywood. But I'll even take that Mr. Depp's a public figure. What I'm saying to you is that the Goldwater Rule is saying we cannot do any expert witness testimony in our field. That is exactly what the Goldwater Rule is saying, based on exactly what you read. And I'm just telling you what you are saying that rule encompasses.
MR. DENNISON: What I'm asking you, sir, is did you comply with the ethical requirements of the AP A when rendering the professional opinions that you've rendered today?
DR. SPIEGEL: It is a -- it is a requirement of the AP A, it was not the requirement of the AP A. Secondarily --
MR. DENNISON: So the answer is no?
DR. SPIEGEL: Secondarily, secondarily, secondarily, again, in order to not -- we wasted our whole morning because of an expert witness before me, as in expert witnesses everyone brought in. So all I'm saying to you, that means the whole field of medicolegal law is corrupt and unethical for engaging in an act that the AP A clearly says we should not do. So if you're saying that, then the answer is "Yes, I'm agreeing with that statement".
MR. DENNISON: You're agreeing that the AP A would deem your testimony and your professional opinions rendered unethical?
DR. SPIEGEL: Again, I'm saying you are saying that the whole -- I'm an expert witness. I'm saying as an expert witness, and solely as an expert witness, that guideline is permitting [sic] that from occurring. I would say, then, that the whole field of expert witness testimony, again, would be disavowed by what you are quoting in the Goldwater Rule, and we know that's not the case because if it was, we would not be allowed to do it.
MR. DENNISON: And you said the rule was for presidents, right?
DR. SPIEGEL: That was initially what it was, yes.
MR. DENNISON: And the name of the rule came from that. But the rule says, "It is unethical for a psychiatrist to offer a professional opinion about an individual"; that's right, sir. It's not just presidents, not public figures, it's individuals.
DR. SPIEGEL: Funny, it was named after the - according to your logic, if you don't put something in the title, it's not true. That's what you told me this morning, I believe, about my intimate partner violence. So what I would say to you, then, sir, is that if you say this about an individual, again, any court would have to render expert witness testimony invalid. Any doctor that reviews charts would have to render it invalid. I could go on the list of docs that do not see any patients directly, and that's a violation.
DR. SPIEGEL: So basically you are saying that unless you deal with direct clinical evaluation, then all the field of forensic psychiatry and all of managed care is doing an unethical violation because we are not seeing the presence. We deny patients medications all the time without seeing them. We deny patients treatments, unfortunately, without seeing them, and I'm on the receiving end of that.
DR. SPIEGEL: So the answer to your question, again, unless you are saying to me that all of this is unethical, which is what you are saying, this is what you are - this is how I'm interpreting what you are saying to me, that unless you do the evaluation directly yourself, therefore, it could not be considered ethical. Is And I'm telling you how that's applicable to not just expert law, but also managed care. It's applicable to multiple branches of medicine, hospital - duration of hospitalizations stay, they get evaluated. So ! tell me where you want me to end this.
MR. DENNISON: When you talk about what you just testified to, because I didn't ask you anything about that; I asked you whether under this rubric, under this principle of medical ethics, have you acted unethically, yes or no?
DR. SPIEGEL: No. As an expert witness, I have not acted unethically. And if you want the jury to believe that expert witnesses are unethical, then I guess that's for them to decide.
MR. DENNISON: Yes or no, so you said no.
DR. SPIEGEL: And that's for them to decide.
MR. DENNISON: Let's go to the next question, right?
DR. SPIEGEL: Okay.
MR. DENNISON: "Psychiatric diagnosis occurs in the context of an evaluation based on thorough history-taking; examination; and where
DR. SPIEGEL: I believe I said that earlier, yes.
MR. DENNISON: "And it's a departure from the methods of the profession to render an opinion without an
DR. SPIEGEL: Well, again, it's public, for the record. But intimate partner violence is not a psychiatric diagnosis; I'll start with that. Substance usage by themselves is not a psychiatric diagnosis - if you want to cut to the chase. So it's not a diagnosis of that. -------- -------------6-39-o - Narcissistic personality traits is not a diagnosis. Ergo, I am basically commenting on the things that were brought to me which are not diagnoses. But an evaluation, if I was going to treat a patient or anyone here, those are the steps I would take.
MR. DENNISON: We, I think, started with a notion that this rule applies broader than diagnoses; it applies to professional opinions.
DR. SPIEGEL: I believe you -
MR. DENNISON: And you've given professional opinions relative to narcissistic personality traits, haven't you, sir, relative to Mr. Depp?
DR. SPIEGEL: Again, I believe you just commented on what it takes to do a psychiatric evaluation to establish a diagnosis. I'm almost certain that's what you said, and maybe I'm wrong; maybe you didn't say that, but I'm sure you did. And therefore, what I'm saying is neither IPV nor substance usage nor narcissistic personality traits are psychiatric diagnoses. And then under the rubric of expert witness testimony, you're I i saying I acted unethically under the rubric of expert witness testimony. So if you, sir, would like to perceive that expert witnesses are unethical based on that, I'm not going to sit here and disagree with you and waste everyone's time. I think it's fairly obvious. But thank you. Go ahead. These were your words. I'm just saying back how they're interpreted!
MR. DENNISON: Okay. Let's start with the easy question, then. Maybe we can --
DR. SPIEGEL: That was pretty easy.
THE COURT: Doctor, you're going to have to just answer the questions, okay?
DR. SPIEGEL: Okay. Sorry about that. Getting into it some.
THE COURT: You need to just answer the questions, Dr. Spiegel.
DR. SPIEGEL: Okay.
MR. DENNISON: You are not rendering any diagnosis whatsoever of Mr. Depp today or ever? 6 392
DR. SPIEGEL: No. I probably would say to you that - certainly I would not say "narcissistic personality disorder"; I would say "traits." Certainly, from what I have read - intimate partner violence is not a diagnosis, so the answer is no for that. Narcissistic personality traits is not a diagnosis; the answer is no. But if you want to tell me that substance use disorder is a psychiatric diagnosis, the answer is, yes, and I -
MR. DENNISON: But that wasn't an issue, was it? Whether Mr. Depp used substances? When you say you've gone through the record, that wasn't really an issue with this trial; he's said it from day one.
DR. SPIEGEL: Oh, so you're saying he's already Its admitted to the diagnosis?
MR. DENNISON: He's already admitted to the use of the substances.
DR. SPIEGEL: Well, again, there's a difference between admitted to substance use and substance use disorder.
MR. DENNISON: Let's go back to what you just said about narcissistic personality traits.
DR. SPIEGEL: Yes.
MR. DENNISON: Narcissistic personality disorder is a DSM-5 diagnosis, correct?
DR. SPIEGEL: Correct.
MR. DENNISON: Diagnostic personality -- and you haven't testified that Mr. Depp has narcissistic personality disorder, have you?
DR. SPIEGEL: I would certainly - if I didn't, I'm certainly thinking that, but at least I'm going to say he has traits which are characteristics of provisional diagnosis of - it's a provisional diagnosis, probably of narcissistic personality, but yeah, I do believe that.
MR. DENNISON: When you say "provisional diagnosis," you know the DMS-5 requires, in order to find that diagnosis, five of the nine factors?
DR. SPIEGEL: Uh-huh.
MR. DENNISON: And you haven't done that analysis, you've never made that diagnosis, you've just identified certain factors?
DR. SPIEGEL: That are criteria for the diagnosis.
MR. DENNISON: Right. But you need five of nine to get to the diagnosis. You've already told us that you didn't make a diagnosis. You're just identifying traits, correct?
DR. SPIEGEL: I'm identifying traits that are consistent with the diagnosis, yes.
MR. DENNISON: Right. And did you testify in deposition that the existence of traits, as opposed to the disorder, doesn't have a correlation with IPV?
DR. SPIEGEL: If I said, "Traits do not have a correlation," if that's what I said, I don't remember saying that, but that wouldn't be a correct statement. Narcissism has a correlation with the diagnosis, yes. That part's true.
MR. DENNISON: How far are we going to back this up? Because there's a diagnosis of narcissistic personality disorder, right?
DR. SPIEGEL: Yes, sir.
MR. DENNISON: And that one is tied -- has some correlation with IPV, right?
DR. SPIEGEL: Narcissism has correlation with - I again, sir, you're not allowing me to answer. You're splitting hairs. You're splitting hairs between the traits that are consistent - which all I'm officially commenting on is behaviors and traits that are consistent with the diagnosis in Mr. Depp. Narcissism absolutely has risk factors associated with IPV.
MR. DENNISON: Let's go back again, and maybe we can focus on the question I ask you and we can get an answer to that question.
MR. DENNISON: Narcissistic personality disorder is a risk factor for IPV, yes or no?
DR. SPIEGEL: Yes.
MR. DENNISON: And you previously testified that there is no literature of which you are currently aware that the mere presence of narcissistic traits is a risk factor for IPV?
DR. SPIEGEL: May I answer the question?
MR. DENNISON: Yes.
DR. SPIEGEL: That's incorrect. Cluster -
MR. DENNISON: You didn't testify to that.
DR. SPIEGEL: Cluster B traits, which narcissistic personality disorder is part of, is a huge risk factor for intimate partner violence, which include - cluster B traits include narcissistic personality disorder, antisocial personality disorder, amongst others. So the answer to the question is every, to every resource on intimate partner violence will support that cluster B traits, where narcissistic personality falls under, is a risk factor for intimate partner violence.
MR. DENNISON: Any single trait under -- is a risk I factor for IPV?
DR. SPIEGEL: Again, I will repeat. Cluster B traits - I didn't say any trait; I said cluster -
MR. DENNISON: No, let me be more precise, then.
DR. SPIEGEL: Okay.
MR. DENNISON: Any narcissistic trait, in and of itself, is a risk factor for IPV?
DR. SPIEGEL: But you are mischaracterizing what I said. What I said, I'm pretty sure I said, cluster - if you look at all the intimate partner violence literature, and would behoove you to do so, you will see that cluster B traits, specifically- I didn't say narcissistic per se - cluster B traits, where narcissistic personality is part of, are risk factors for intimate partner violence, part and parcel uniformly true. And I'm not sure - the thing I don't understand is I'm not sure why we're arguing psychiatry because I'm telling you what it is.
THE COURT: Dr. Spiegel, you just need to answer the questions.
DR. SPIEGEL: Okay.
MR. DENNISON: Sir, you want to talk about cluster B, sci let's do that for a minute.
MR. DENNISON: Borderline personality disorder is a risk factor for IPV?
DR. SPIEGEL: As part of cluster B traits, yes.
MR. DENNISON: All right. Histrionic personality disorder is a risk factor for IPV?
DR. SPIEGEL: Less so.
MR. DENNISON: But it --
DR. SPIEGEL: Less so.
MR. DENNISON: But--
DR. SPIEGEL: Less so. It's a risk factor, but less so, yes. Less so. Significantly less so.
MR. DENNISON: All right. So which trait under narcissistic -- before I move on there, there's only been one diagnosis in court of personality disorders, correct?
DR. SPIEGEL: I'm not certain who are you referring to. Are you referring to Mr. Depp? Ms. Heard? I'm not sure what you're talking about.
MR. DENNISON: Do you understand that there was a medical examination done of Ms. Heard?
DR. SPIEGEL: Yes, I did.
MR. DENNISON: Do you understand that the testimony was ultimately that Ms. Heard suffers from two personality disorders?
DR. SPIEGEL: Okay. So I'm just being specific. I just wanted to know if you're talking about Ms. Heard or Mr. Depp. That's all I was asking
MR. DENNISON: Yes or no to my question?
DR. SPIEGEL: Which was there is only one diagnosis of - Ms. Heard was diagnosed with that, yeah.
MR. DENNISON: And both of the diagnoses are in cluster B, and both of them are risk factors for IPV?
DR. SPIEGEL: Both those cluster B things are - I'm not allowed to comment on the testing, so, therefore, all I can say is that cluster B traits, and tell you what they are - and by the way, I testified to this before, which was that, one, I don't expect perfection from my victims; two -
MR. DENNISON: Dr. Spiegel--
DR. SPIEGEL: And absolutely-
MR. DENNISON: Given that you testified to it before,
MR. DENNISON: 117 let's move on to a new question.
DR. SPIEGEL: Okay. Ir 9
MR. DENNISON: All right? You indicated in your opinion that you thought -- well, why don't we move a little different? Are you a member of the American Medical Association?
DR. SPIEGEL: No.
MR. DENNISON: Okay. So you don't know what the s ethical rule of the American Medical Association I is relative to doing clinical diagnoses about individuals you've never talked to?
DR. SPIEGEL: So you're saying in terms of doing expert witness evaluations, under that rubric, right?
MR. DENNISON: I'm just asking you do you know the AMA's rule?
DR. SPIEGEL: Under - you're saying the AMA's ruling under the rubric of not to evaluate someone you did not see. I'm questioning, I'm asking. So you are talking about expert witness testimony?
MR. DENNISON: No. I'm talking about do you know the I rule.
DR. SPIEGEL: I'm not a member of the AMA, so I don't read their rules.
MR. DENNISON: All right. Move on. You don't know the rule. All right. You rendered an opinion about Mr. Depp's purported cognitive impairment.
DR. SPIEGEL: Yes.
MR. DENNISON: What did you use as a baseline?
DR. SPIEGEL: Baseline for processing speed?
MR. DENNISON: Yeah, for analyzing Mr. Depp before you watched his deposition.
DR. SPIEGEL: What is the baseline for that?
MR. DENNISON: Yes.
DR. SPIEGEL: I mean, I guess my baseline would probably be how I've seen him impact in public, how I've seen him interact with others. I've seen him interact in media. I've seen him interact while -- and his processing speed is certainly not slow. I've seen him do commercials. His process speed was not slow.
MR. DENNISON: In deposition, didn't you say that what you did was compare Mr. Depp's performance in lots of Pirate movies against his deposition testimony?
DR. SPIEGEL: What I said was I've seen Mr. Depp do apology ads. I remember he did an apology ad with (indiscernible). No delay in process speed. I've --- seen him interact with the media regarding to that. I saw no delay in processing speed. All I'm saying --
MR. DENNISON: Let me ask you about Pirates, though. You compared Pirates to the -- to the depositions given in this case.
DR. SPIEGEL: And I apologize for what I said. Then I misspoke.
MR. DENNISON: You misspoke? You didn't make the comparison?
DR. SPIEGEL: Right now, just a second ago? Just a second ago, I may have said that. I misspoke. I apologize. I misspoke.
MR. DENNISON: Okay. Because you know you can't compare Pirates to sworn testimony, right?
DR. SPIEGEL: Yes.
MR. DENNISON: Okay.
DR. SPIEGEL: But you can -- as an aside, you can judge someone's processing speed at any time. Like, I'm judging yours right new. You're judging mine, we all judge processing speed as a baseline because of what we know about each other. I would ! say your process speed right now is not slow. So, I mean, we're judging processing speed, I'm just saying to you. It
MR. DENNISON: Yeah. So any of Mr. Depp's other portrayals in movies, did that affect your analysis of processing speed?
DR. SPIEGEL: Only I've seen him interact on interviews, and that was it. When he wasn't in the movies.
MR. DENNISON: Right. But Willy Wonka doesn't matter to you? You've seen that movie? Charlie and the Chocolate Factory? Did you look at that when you were comparing his processing speed?
DR. SPIEGEL: Do I have to answer that question, Your Honor?
THE COURT: You have to answer questions, yes, sir.
DR. SPIEGEL: No. You would be happy to know I didn't see Willy Wonka. I didn't see 21 Jump Street when it happened. No, I did not.
MR. DENNISON: All right. You made a very kind admission, I think, early on in your deposition that you're not claiming to be a better actor than Mr. Depp; that's correct, isn't it?
DR. SPIEGEL: 100 percent.
MR. DENNISON: All right. But with respect to acting, you know that actors actually rehearse for their parts and work on the language, diction, timing of their dialogue as part of that rehearsal?
DR. SPIEGEL: If you say that - I'm not an actor, so I don't know what goes on; I can't tell you. I h O have no idea what goes on in acting.
MR. DENNISON: Okay. But you don't know enough about acting to know whether actors rehearse?
DR. SPIEGEL: Sir, I am not an expert in acting. I have no idea what an actor does.
MR. DENNISON: Okay. During your deposition, what were the circumstances under which you decided to ! call Mr. Depp an idiot?
DR. SPIEGEL: I'm sorry. I called Mr. Depp an idiot?
MR. DENNISON: Yeah. You called Mr. Depp an idiot in your deposition.
DR. SPIEGEL: Well, I think - oh, okay. So I think it was in the context, I think it was - probably should read the context of it because I think the context was, and I'm trying to think back, and I'm trying to think back. Okay? And what I thought it was related to is if you're coming to some deposition, okay, again, I'm thinking back, so you have it in front of you; I don't So I'm thinking back where he was coming in from Europe for a deposition, video deposition that he gave, and he took an overnight the night before. And what I think I said was that if you're going to take a - if you're going to do a major thing for a trial that you're involved with, I would think you would be idiot to come in the night before.
DR. SPIEGEL: So I didn't call Mr. Depp an idiot. I certainly called that planning idiot. I didn't call him an idiot.
MR. DENNISON: So the words "So, I mean, he's an idiot" are mistranscribed?
DR. SPIEGEL: No. I'm trying - yeah. If I said it in that context, if you're just reading one line, one snippet, I'm sure it was in the context I just said. But yeah, you have it in front of you; I don't.
MR. DENNISON: Is "idiot" a professional opinion?
DR. SPIEGEL: I wasn't rendering a professional opinion.
MR. DENNISON: Is it a psychiatric opinion?
DR. SPIEGEL: That follows the Goldwater Rule.
MR. DENNISON: How does it follow the rule?
DR. SPIEGEL: I just said that I did not render a professional opinion. I just said "idiot." That's not a -
MR. DENNISON: So "idiot" is not a professional opinion?
DR. SPIEGEL: Uh-huh.
MR. DENNISON: Is it your practice to describe people as idiots?
DR. SPIEGEL: My practice to describe people - in my practice? No, I don't describe people - clinical - my clinical cases as idiots or patients as idiots or of victims as idiots, no, sir.
MR. DENNISON: But you sat for a deposition in this I case and described the plaintiff as an idiot correct?
DR. SPIEGEL: You gave me nine hours of deposition, and if I said the word "idiot," it was an idiot in planning; it wasn't making him an idiot. I don't know Mr. Depp's IQ. I don't know his overall functioning, so, therefore, if I said it, it was an idiot in planning which is what I meant to come across as.
MR. DENNISON: You did say you don't know his overall functioning, but you made some testimony today as to some evaluations you made relative to his functioning. You would agree with me that it's probably a good idea to think about the questions that are asked you in a court proceeding before answering them?
DR. SPIEGEL: Am I allowed to answer that question?
MR. DENNISON: Yes.
DR. SPIEGEL: Okay. So what I meant by "function" -- what I said by function, I believe his agent reported how late he was showing up to every movie while the cast was waiting for him. I believe that would be an impairment. If I showed up for that, I would not be here right now. I wouldn't have a job. I believe the thing was in terms of barking out of treatment for substance rehab that his doctor is prescribing for him. So if you're asking me if that's an impairment of functioning, I would say I'm very much substantiated in that.
MR. DENNISON: I'm trying to understand how you got to this notion of cognitive decline. And I thought it was based, at least in part, on the manner in which he testified.
DR. SPIEGEL: I'm sorry. What?
MR. DENNISON: On the manner in which he testified.
DR. SPIEGEL: On the manner - I'm sorry. I'm not being difficult. I can't hear. I'm sorry. What?
MR. DENNISON: I was asking you about the cognitive I decline --
DR. SPIEGEL: Yes.
MR. DENNISON: Testimony that you made.
DR. SPIEGEL: Yes.
MR. DENNISON: And it was my understanding that at least a portion of that testimony that you rendered was that you derived some evidence of cognitive decline from the way Mr. Depp testified.
DR. SPIEGEL: Yes.
MR. DENNISON: Okay.
DR. SPIEGEL: And that's what I said, yes.
MR. DENNISON: Right. And so, all I'm asking is don't you think it's a good idea, when you're in the middle of a court proceeding, to answer questions IO carefully?
DR. SPIEGEL: Again, professionally we diagnose patients with a neurocognitive disorder by gross evaluation all the time with cognitive - on the thought that, again, age-normative controls, I'm just saying again, age-normative controls does not put a 58-year-old gentleman at that processing. That's all I'm saying.
MR. DENNISON: Right.
DR. SPIEGEL: That's all I said.
MR. DENNISON: And you derived this without ever once talking to the man?
DR. SPIEGEL: Me directly talking to him? Because I y g heard - because we know how I derived it. So you're talking about me directly talking to him.
MR. DENNISON: Yeah. You never talked to him?
DR. SPIEGEL: No, I've never talked to him.
MR. DENNISON: Right. And this exam you gave -- well, you did talk about Dr. Blaustein, right?
DR. SPIEGEL: Yes, sir.
MR. DENNISON: And you understand that the entirety of Dr. Blaustein's medical records are 12 pages of handwritten notes?
DR. SPIEGEL: The important part was what I said. For me, as an example of cognition, which I'm trying to prove, which is what you asked me, the important part was what I said. And that was irrefutable.
MR. DENNISON: The important part is that he give -- he gave the Mini-Mental Status Exam?
DR. SPIEGEL: Yes, sir.
MR. DENNISON: All right. Let's talk about the Mini-Mental Status Exam. Scored on a 30-point scale, right?
DR. SPIEGEL: Yes.
MR. DENNISON: All right. It's an exam that basically is most often used for what? Alzheimer's, dementia, those kind of testing?
DR. SPIEGEL: It's an exam that tests cognition in all psychiatric illnesses, not just Alzheimer's. It was made for dementia and Alzheimer's but is the standard - has been the standard for testing ! IS cognition in all psychiatric illness, substance abuse disorders included.
MR. DENNISON: Okay. Now, there's an element of that I exam that requires drawing, correct?
DR. SPIEGEL: Yes.
MR. DENNISON: So you don't know what drawing Mr. Depp did or whether the drawing should have been fully scored?
DR. SPIEGEL: I wasn't questioning his visuospatial perceptual skills, which is what that does.
MR. DENNISON: Right. And you don't know what score ! Mr. Depp received on the exam?
DR. SPIEGEL: I was very specific. I know three words, not remembering at five minutes. That's all I said.
MR. DENNISON: Three words, not remembering in five minutes, and he remembered the other one, right?
DR. SPIEGEL: From my understanding, he didn't remember any of them.
MR. DENNISON: All right. Memory on the exam, out of the 30 points, what's it worth?
DR. SPIEGEL: Three.
MR. DENNISON: Three, right? Memory is three out of those 30?
DR. SPIEGEL: Yeah, memory's three. Again, the memory section in and of itself tests memory. That's the only question that tests memory, only section that actually tests memory.
MR. DENNISON: So the memory section tests memory. It's the only section you testified about, and for all you know, that with respect to the exam that I you're relying on, Mr. Depp scored 27 out of 30?
DR. SPIEGEL: And that would be telling, though. Cognitive, you score 27 out of 30, and you miss three points on memory, that would be very telling.
MR. DENNISON: You don't know if Mr. Depp had been up all night the night before?
DR. SPIEGEL: Again, you wouldn't expect to not recall any words at three minutes unless there's a cognitive issue.
MR. DENNISON: You don't know if Mr. Depp was high?
DR. SPIEGEL: And again- now, that's - again, now that could affect memory; I'm not refuting that. I'm not refighting that at all. He could have been high. Could have been drunk. He could have been using cocaine, and that would absolutely affect his memory, which is what I said. Yes, you're right.
MR. DENNISON: So ultimately, you have no idea what state Mr. Depp was in at the time he took the exam that you're relying on?
DR. SPIEGEL: Short of what you just said about drugs and alcohol, okay, there shouldn't be a reason why a 58-year-old - also with strokes and other neurocog conditions - but short of that, there shouldn't be a really good reason why someone at that age shouldn't come up with at least one.
DR. SPIEGEL: But in answer -
MR. DENNISON: Wait a minute. You started that question with "short of drugs and alcohol," and spent 35 minutes talking about his use of drugs and alcohol. Isn't that right?
DR. SPIEGEL: Oh, I'm agreeing, but - I thought I agreed with you. I think I agreed. I said that drugs and alcohol can absolutely affect cognition. I'm not - so, yeah, I agree. But I'm not sure if that's the problem I agree with you on that.
MR. DENNISON: Right. So you didn't know one way or the other how he scored on the exam? You don't know whether he was, at the time, on drugs and alcohol, but you're going to rely on it in your testimony to say that he's cognitively impaired?
DR. SPIEGEL: Which is what we do in clinical medicine, sir.
MR. DENNISON: Okay. You rely on a test that you don't know the way it was administered, you don't know the score of the test, and you don't know the state of the person being tested, but you rely on it anyway?
DR. SPIEGEL: Again, if we had to know every test - I when people get the Mini-Mental State Exam, we have no idea, clinically, if they are high, wasted, stoned, stroke. We have no idea. So if you're going to say that, that means everybody needs a drug test before they do a mini-mental study, and that's not the standard of care. And I think you know that, so ...
MR. DENNISON: Let's talk a little bit about this word you kept using, "correlation." You know the word, right? •11
DR. SPIEGEL: Yes.
MR. DENNISON: Correlation and causation aren't the same thing, are they, sir?
DR. SPIEGEL: No, they're not the same thing.
MR. DENNISON: How are they different?
DR. SPIEGEL: Correlation is "consistent with." Causation means "direct link."
MR. DENNISON: Can you say that again? It was so I fast, I didn't hear it.
DR. SPIEGEL: I'm sorry about that. Correlation is a risk for something happening; causation is a direct link.
MR. DENNISON: Right. So just because something's correlated doesn't mean it's going to happen?
DR. SPIEGEL: Hundred percent.
MR. DENNISON: Right.
DR. SPIEGEL: Hundred percent.
MR. DENNISON: Lung cancer, for instance. Smoking is ! 7 very highly correlated with lung cancer, right?
DR. SPIEGEL: Yeah, certainly. And there's certainly a link to lung cancer and smoking.
MR. DENNISON: But not all smokers get lung cancer? :11
DR. SPIEGEL: No, not all smokers do. No one - like I • I said, no one fits the curve perfectly.
MR. DENNISON: Right. And you made repeated testimony to all of us, all of us do this, all of us do ! 15 that.
DR. SPIEGEL: Uh-huh.
MR. DENNISON: Your suggestion about "all of us," is you're just looking at the world as an example and not at any particular individual, correct?
DR. SPIEGEL: What I'm looking at is that I'm not talking about an individual, how they can or cannot be resistant. What I'm saying is invariably when used substances, this is going to happen. Is there a percent chance that someone who does? Absolutely there is. But is that medical degree of certainty? Absolutely not.
DR. SPIEGEL: 05 percent chance of what, sir?
DR. SPIEGEL: Of developing - eventually developing symptoms - if you're using excessively, eventually you're going to develop symptoms.
MR. DENNISON: Right. But risk factors tell us nothing about any one particular individual do they, sir?
DR. SPIEGEL: No. No. Again, risk factors tell us nothing except if they have it, they're at a higher likelihood of developing it. That's what it tells us.
MR. DENNISON: Right. But you did a whole litany of risk factors relative to IPV.
DR. SPIEGEL: Yes.
MR. DENNISON: And none of those risk factors tell us anything specifically about an individual --
DR. SPIEGEL: Right.
MR. DENNISON: Other than they're at higher risk?
DR. SPIEGEL: Right.
MR. DENNISON: So someone could have every single risk factor for IPV and never commit IPV, right?
DR. SPIEGEL: It would be, again, if you're going to say medical degree of probability, the answer is "They will." But if you're saying uniformly, the answer is no.
MR. DENNISON: Right. IPV can occur without substance abuse?
DR. SPIEGEL: Oh, sure.
MR. DENNISON: Someone can abuse substances without ever perpetrating IPV?
DR. SPIEGEL: Again, absolutely. But, again, you are saying different than what I said. I did not say "abusing substance"; I said "substance use disorder." You are - those are two different things. Because there are surely people who use substance that do not engage in any violence, do not become psychotic, nothing at all.
MR. DENNISON: Absolutely true of people who have substance abuse disorder? There are certainly people who have substance abuse disorder who don't commit IPV, correct?
DR. SPIEGEL: They are saying people who have substance use disorders, the majority of them, over 50 percent do. So over 50 percent do. That's -
MR. DENNISON: So the answer is, yes?
DR. SPIEGEL: As you said, not everyone who smokes gets lung cancer.
MR. DENNISON: So there are significant numbers of ho people -- you said it was over 50, so you'd say 40 percent of the people who have substance abuse disorder don't commit IPV?
DR. SPIEGEL: Those are the ones that do not have IPV risk factors, though, right? So we're talking about people -
MR. DENNISON: Wait a minute. Isn't substance abuse disorder an IPV risk factor?
DR. SPIEGEL: Oh, yeah. You know, other people that have don't have other risk factors, right.
MR. DENNISON: Right. But, again, we're talking about 1121 people in general. You don't know anything about any particular individual as to whether anybody's ! 1 going to commit IPV?
DR. SPIEGEL: If statistics follow through, all we can say is more than 50 percent, 70 percent will. If you combine more risk factors you have, the Is more likely you're going to develop (indiscernible). Smoke cigarettes once, that I might not correlate to lung cancer. If you smoke it chronically, that might.
MR. DENNISON: Yeah. But we're talking about I individuals here. You either have lung cancer or ! 11 you don't, right?
DR. SPIEGEL: If you're smoking.
MR. DENNISON: Right?
DR. SPIEGEL: Right.
MR. DENNISON: You either commit IPV, or you didn't?
DR. SPIEGEL: I mean, yeah, you either did or you didn't, yes.
MR. DENNISON: Right. So you took the issue with me because I was asking about substance abuse generally, and you wanted me to talk about the disorder. I asked you earlier about narcissistic personality disorder.
DR. SPIEGEL: Uh-huh.
MR. DENNISON: And you haven't made that diagnosis; you've just talked about the traits, right?
DR. SPIEGEL: Yes.
MR. DENNISON: And anybody -- if somebody had these narcissistic personality traits and substance abuse disorder and never commit an IPV, right?
DR. SPIEGEL: So along that line --
MR. DENNISON: Right.
DR. SPIEGEL: About, about 80, 90 percent of people who commit IPV have a personality disorder. So the answer's less than about 10 percent, obviously, do not.
MR. DENNISON: Right. There are more close links with IPV for borderline personality disorder than narcissistic personality disorder, correct, sir?
DR. SPIEGEL: I'm not going to agree with that.
MR. DENNISON: No?
DR. SPIEGEL: I'm not saying there are more. I would say there are absolute -- if you're asking me if there are links, the answer is absolutely. If you're saying to me more, I can show studies that say yes, show studies saying no. That has not been absolutely, definitively correlated, no.
MR. DENNISON: No?
DR. SPIEGEL: Absolutely not.
MR. DENNISON: MDMA, what is it?
DR. SPIEGEL: Ecstasy.
MR. DENNISON: Yeah. And what's the normal dosage of ecstasy for people who use ecstasy?
DR. SPIEGEL: Again, I couldn't tell you the "normal" dose because, obviously, speaking -- no one knows what they're getting when they're using it, right? It's not regulated, so ...
MR. DENNISON: But the effects of ecstasy enhance sense of well-being?
DR. SPIEGEL: At low doses, the answer is yes. I'm going to gather, when you're using it at higher doses and develop tolerance, you develop the sympathomimetic effects which are not-so-enhanced well-being.
MR. DENNISON: Increased extroversion, that's a symptom?
DR. SPIEGEL: Again, at low dose, you are a hundred I percent right. At low amounts, you're a hundred percent right. It is an entactogen. We feel closer to people. That's why people use it say they feel close to people, warmth to people, 100 percent. But with continual use and higher doses, it could be fatal.
MR. DENNISON: Right.
DR. SPIEGEL: So that's not well-being. I don't know if I'd call that well-being.
MR. DENNISON: So continued use at higher doses, MDMA can be fatal, correct?
DR. SPIEGEL: Correct.
MR. DENNISON: What if you took eight to ten tablets of MDMA?
DR. SPIEGEL: What if you took? Again, you don't know what on - it's very hard to say that. You don't know what it's -what's the word I'm looking for? - contaminated with. You can't just say, "Hey, let me just take 8 to 10 pure ecstasy and see what happens." That's not going to happen. So what I would say to you, again, because substances of abuse are unpredictable, they are unregulated, no one knows what they're going to. No one actually has any idea whether it's going to cause this empathic entactogen effect at very low doses or is it going to cause the sympathomimetic - I'm sorry- increase - like a stimulant, cocaine, something we talked about like that. No one knows what's going to I happen. It's not regulated, and no one knows if you're using with other substances either, like other stimulants.
MR. DENNISON: Or if you mix it with the alcohol?
DR. SPIEGEL: Or if you mix it with alcohol. No one knows if it's going to be potentially worse.
MR. DENNISON: Right. But this is a potentially lethal combination, eight to ten MDMAs with alcohol?
DR. SPIEGEL: This is a potentially toxic ; combination.
MR. DENNISON: Right.
DR. SPIEGEL: Can it kill you? Yeah. I mean, it's a potentially toxic combination, that's true.
MR. DENNISON: Ever heard of someone cutting off their own finger on MDMA?
DR. SPIEGEL: Have I ever heard of it?
MR. DENNISON: Yeah.
DR. SPIEGEL: No. I can only give you one example. I haven't had that one before.
MR. DENNISON: So SeroqueL that one puts you to sleep, right?
DR. SPIEGEL: If you want to phrase a barbiturate putting you to sleep, then the answer is yes.
MR. DENNISON: Yeah. You heard Mr. Depp talking about sometimes being on the nod, right?
DR. SPIEGEL: And, again, I think I explained Seroquel very well this morning.
MR. DENNISON: Right. I'm going to ask a few more questions.
DR. SPIEGEL: Oh, okay. Okay.
MR. DENNISON: All right. You kept making references to street value. Why were you doing that?
DR. SPIEGEL: Because that's why people with substance use disorder use quetiapine and Seroquel.
MR. DENNISON: Say it again. I'm sorry.
DR. SPIEGEL: That's why people use quetiapine or/Seroquel. It sells on the street because it's so barbiturate-like in effect.
MR. DENNISON: Right. But you said that Mr. Depp had a prescription.
DR. SPIEGEL: There are many substance use disorder patients who have prescription for Adderall and quetiapine from their doctor, and that doesn't mean they're not getting high out of it. That doesn't take much - doctors like to believe what patients have to say. They're not going in there to give e'])ert witness.
DR. SPIEGEL: AU I'm telling you is that in people with substance use disorder, it is not uncommon - and the thought was initially that because quetiapine was not addicting, that it's safe to give in people with substance use disorders, when, in fact, we absolutely know it has street value, absolutely know that for a fact.
MR. DENNISON: Right. But my point about this is you knew it -- bunch of testimony about street value, but you know at the time you made the testimony that Mr. Depp, in fact, had a prescription?
DR. SPIEGEL: He also had a prescription for oxycodone. Or oxycodone, is that - does that count? Because that's also probably not a good thing. Just because you have a prescription, I !s doesn't mean -
MR. DENNISON: But we would agree that it wasn't a good thing.
DR. SPIEGEL: Just because you have a prescription doesn't mean you can't abuse it.
MR. DENNISON: No. I'm not suggesting you couldn't -- you're abusing it. I'm just wondering why your testimony was in any way tied to street value when every single drug you referenced Mr. Depp had legally.
DR. SPIEGEL: Again, you can have prescription substance abuse, and we know that. Correct? No, shouldn't be asking you that We can have prescription substance use disorders, and that's not uncommon if you look at the opiate epidemic that we're living in right now. We can have that. That's not an uncommon thing. Unfortunate, not uncommon - not uncommon.
MR. DENNISON: So SeroqueL I think you described as a sleeping agent when used off-label?
DR. SPIEGEL: When I said what?
MR. DENNISON: Sleeping agent, SeroqueL when used off-label.
DR. SPIEGEL: When used off-label, it's used - it can be used as sleeping agent, yes, right
MR. DENNISON: So Mr. Depp's use of Seroquel could account for some of the photos we saw in this trial where he was asleep in a chair?
DR. SPIEGEL: Again, what I would say to you is that if you have a substance use disorder, you are using it to be knocked out. Yes, I agree. But I'm not sure, at the end of the day, if you have its vomitus over you either because I've never seen Seroquel do that. So when he was passed out in the chair, he also had vomitus over him I've never seen Seroquel do that, ever.
MR. DENNISON: Neurontin is another one of the drugs you testified about. That one's also prescribed, right?
DR. SPIEGEL: Yes, it is.
MR. DENNISON: And what's the prescription for that?
DR. SPIEGEL: What's it used for? What's its indication or what's it used for?
MR. DENNISON: Yeah. What's its indication?
DR. SPIEGEL: I mean, its indication is for seizures. It may have one pain indication, and again, I'm not a neurologist, so I can't tell you exactly if it does. But it's chronically used off-label for pain. It's used off-label for anxiety.
MR. DENNISON: All right. And what's its effect? That's another one that puts you to sleep, right?
DR. SPIEGEL: Well, yeah. I mean, sure. A hundred percent.
MR. DENNISON: Right. And you made reference to a picture. There's been testimony around the -- around that picture that Mr. Depp fell asleep with ice cream in his hand. That's not vomitus, right?
DR. SPIEGEL: I was told it was vomitus.
MR. DENNISON: Okay. You talked about the fact that Mr. Depp indicates that from time to time, he uses an earpiece?
DR. SPIEGEL: Yeah. I mean, I read that, yes.
MR. DENNISON: Okay. Did you read the testimony of Mr. Wyatt, who told you what was being pumped into that earpiece?
DR. SPIEGEL: Yeah. I mean if I remember right, I mean, it was - I think it was lines, right?
MR. DENNISON: No. It was music.
DR. SPIEGEL: Oh, it was music, not his lines?
MR. DENNISON: Yeah.
DR. SPIEGEL: Okay.
MR. DENNISON: So if Mr. Depp was listening to music rather than being fed his lines, does that change your opinion as to his cognitive function?
DR. SPIEGEL: If he was never fed his lines through the earpiece, which I know he was, but when he was - and that may be that example. Mr. Wyatt may have said that it was music. I guess the question was were you having the music during the - during the actual talking of your lines? Is that what you're saying to me?
MR. DENNISON: You know, if you can do two things at once, that's a pretty high cognitive function, isn't it, sir?
DR. SPIEGEL: You know, it's a very good point, actually. Divided attention is something humans have a lot of trouble in. For instance, we have I!
DR. SPIEGEL: Trouble driving and putting on the -you know, using our cell phones and direct - so divided attention, humans actually are not very good at, I'm going to put that out there. In general, not just Mr. Depp, in general.
MR. DENNISON: But Mr. Depp is good at acting? You both acknowledged that early on. In
DR. SPIEGEL: Absolutely. Well, better than me, so I know that
MR. DENNISON: Because you don't act. In fact, you don't know about acting?
DR. SPIEGEL: You're right. I have no idea about acting.
MR. DENNISON: And you don't know how prevalent the use of earpieces are in acting?
DR. SPIEGEL: Again, I know nothing about acting.
MR. DENNISON: Irrespective of the fact you know nothing about acting, you've testified that Mr. Depp's use of an earpiece is somehow cognitive, I deficit?
DR. SPIEGEL: So if I was giving a lecture and I was fed my lines I would think there's a cognitive deficit, so I'm - and maybe I'm wrong. Like I said, maybe I could be wrong. Maybe Hollywood stars get lines fed to them through earpieces all the time. I don't know. That could be - sounded to me to be unusual, if you're doing a movie and you don't know the lines. But like you said, I'm just judging on what I do with lectures, and that would never happen.
MR. DENNISON: If you gave lectures, you wouldn't use l I! :::a:i::; but you're not going to tell anybody
DR. SPIEGEL: I'm sorry. What was the question?
MR. DENNISON: I said if you gave lectures, you I wouldn't use an earpiece, but you're not telling I ! 18 anybody how to act?
DR. SPIEGEL: Right. I would not use an earpiece during lectures.
MR. DENNISON: Right.
DR. SPIEGEL: But, again, I don't know what the standard for Hollywood is for that, I have no idea.
MR. DENNISON: Your testimony about the use of an earpiece as maybe you're wrong. You're comfortable with the fact that you may have made a mistake there?
DR. SPIEGEL: No. Because I think in the basis of what I've read about it, I'm comfortable that - I don't believe that actors are routinely given their entire script through earpieces. I find that hard to believe.
MR. DENNISON: But not one bit of evidence that this ever happened here?
DR. SPIEGEL: That's what I said. I just said I find it hard to believe. I didn't say it happened. I said I find it hard to believe. That's all I said.
MR. DENNISON: But what you found hard to believe, sir, is that every line of the script was pumped through an earpiece. Where did you ever get the idea that that occurred?
DR. SPIEGEL: That's what I have - that's what I read in the court review, the court evidence. That's where I got it from.
MR. DENNISON: And do you know whether Marlon Brando used an earpiece?
DR. SPIEGEL: Well, isn't he dead?
MR. DENNISON: Yeah.
DR. SPIEGEL: So the answer is no, he does not use one now.
MR. DENNISON: I used the past tense.
DR. SPIEGEL: I'm sorry. Again, I know nothing - I will concede to you I know nothing about acting. I will concede to you a hundred percent if that is the standard and people have done that with acting, then I apologize and that was wrong on my part. If that's the standard, I'm wrong. I don't know.
MR. DENNISON: Okay. Let's go with that.
MR. DENNISON: No further questions.
THE COURT: All right. How long is your redirect?
MS. BREDEHOFT: A bit. You may want to take a break.
THE COURT: All right. Let's go ahead and break for lunch, then, ladies and gentlemen. Again, do not do any outside research. Do not discuss your testimony with anybody, okay?
THE COURT: (Whereupon, the jury exited the courtroom and the following proceedings took place.) Is All right. So let's come back at 1 :55, then. All right? Is that fine?
THE COURT: All right. 1:55.
COURT BAILIFF: All rise.
COURT BAILIFF: All rise.
COURT BAILIFF: Please be seated.
THE COURT: All right. Are we ready for the jury?
MS. BREDEHOFT: Yes, Your Honor.
THE COURT: Okay.
THE COURT: (Whereupon, the jury entered the courtroom and the following proceedings took g p g place.) seated.
THE COURT: Your next question -- or redirect.
THE COURT: All right. You may be s
MS. BREDEHOFT: Thank you, Your Honor. I 6
MS. BREDEHOFT: Dr. Spiegel you were asked about I whether you were able to examine Mr. Depp. Do you recall those questions back and ! 12 forth?
DR. SPIEGEL: Yes.
MS. BREDEHOFT: And so, if I understand the testimony, you asked twice, for Mr. Depp to be interviewed by you, correct?
DR. SPIEGEL: Yes.
MR. DENNISON: Objection. Leading. I.
THE COURT: Overruled.
MS. BREDEHOFT: And then in addition to that, Ms. Heard requested twice of the court for Mr. Depp to be submitting to an examination of you, correct?
DR. SPIEGEL: Yes.
MS. BREDEHOFT: And those were denied, correct?
DR. SPIEGEL: Yes.
MS. BREDEHOFT: And now, Mr. Depp is contending that it's unethical for you to provide an opinion in this case because you didn't get an opportunity to interview him.
MS. BREDEHOFT: Do you think that makes sense?
MR. DENNISON: Objection, Your Honor.
THE COURT: I'll sustain the objection.
MS. BREDEHOFT: All right. Is that your understanding?
DR. SPIEGEL: That is my understanding of it, yes.
MS. BREDEHOFT: Okay. Now, when counsel for Mr. Depp was reading to you the Goldwater Rule, there were two words that he kind of went over pretty quickly and I'm going to go over them again with you, a little bit slower. And that was that the Goldwater Rule was that you cannot make an armchair diagnosis, right?
THE COURT: Objection.
MS. BREDEHOFT: Based on publicly available records. Do you recall that?
DR. SPIEGEL: Yes.
MS. BREDEHOFT: Okay. Now, the records that you reviewed in this case were private; were they not?
DR. SPIEGEL: Yes.
MS. BREDEHOFT: And, in fact, Dr. Blaustein's records were marked confidentiaL correct?
DR. SPIEGEL: Yes.
MS. BREDEHOFT: And his deposition was marked confidential?
DR. SPIEGEL: Yes.
MS. BREDEHOFT: Okay. And Dr. Kipper's records were all marked confidential?
DR. SPIEGEL: Yes.
MR. DENNISON: Objection. Leading.
THE COURT: I'll sustain.
MS. BREDEHOFT: Okay.
MS. BREDEHOFT: What, if any, labeling was there on Dr. Kipper's deposition?
DR. SPIEGEL: All the documents I reviewed were confidential, and I also signed a confidentiality agreement, so everything that I read was Is . ,167 confidential.
MS. BREDEHOFT: Okay. So that, in fact, does not even comport, that doesn't meet the restrictions of Goldwater?
MR. DENNISON: Objection. Leading
MS. BREDEHOFT: So would it be fair to say that you have not -- have you rendered any opinions in this Is case, as an expert witness, based on publicly I available records?
DR. SPIEGEL: I have not rendered any opinion based on publicly available records.
MS. BREDEHOFT: Thank you. Now, you were asked a number of questions about narcissistic traits and your diagnosis or findings that Mr. Depp exhibited narcissistic traits or had that disorder. Do you recall that testimony?
DR. SPIEGEL: Yes.
MS. BREDEHOFT: And the question was asked of you whether if you have five of nine narcissistic traits; do you remember that testimony?
DR. SPIEGEL: Yes.
MS. BREDEHOFT: Okay. Now, one of the ones you testified before, for narcissism, it requires admiration, correct?
DR. SPIEGEL: Yes.
MS. BREDEHOFT: What, if any, record evidence was there that Mr. Depp requires admiration?
DR. SPIEGEL: The very people that surround him need to admire him or they're no longer in his !S employment or his working circle.
MS. BREDEHOFT: Okay. The second one that you discussed was sense of entitlement.
MS. BREDEHOFT: Do you recall that testimony?
DR. SPIEGEL: Yes.
MS. BREDEHOFT: All right. What record evidence is I there that Mr. Depp exhibited -- exhibits behavior I of needing sense of entitlement?
DR. SPIEGEL: So, again, thinking that Ms. Heard was marrying him solely for his money and his influence and that that was the case was, in my opinion, very entitled.
MS. BREDEHOFT: All right. And the third one you discussed was exploitative. Do you recall that?
DR. SPIEGEL: Yes.
MS. BREDEHOFT: And what is the record evidence that Mr. Depp exhibits behavior of -- that are exploitive?
DR. SPIEGEL: Again, I think the whole concept of abuse is exploitative.
MS. BREDEHOFT: Okay. The fourth one was lacks empathy.
MS. BREDEHOFT: Do you recall that?
DR. SPIEGEL: Yes.
MS. BREDEHOFT: What is the record evidence that Mr. Depp exhibits lacking empathy?
DR. SPIEGEL: To be able to commit intimate partner violence and the control you have over someone -
MR. DENNISON: Objection.
THE COURT: I'm sorry.
MR. DENNISON: Objection. Can I be heard?
THE COURT: Okay.
MR. DENNISON: He started his response with "to be able to commit intimate partner" violence.
MS. BREDEHOFT: All right. I'll redirect him.
THE COURT: All right.
MS. BREDEHOFT: I'm just going to ask you to give the record evidence of Mr. Depp's lacking empathy, that you know of.
DR. SPIEGEL: Yes. Am I allowed to elaborate?
MS. BREDEHOFT: Yes, just a little different than what you said before.
DR. SPIEGEL: Okay. So, if one - so, let me redirect. So if you're not agreeing with what Mr. Depp has to say, you are no longer useful, okay, therefore, you don't really care about others for others, you care about others for your benefit.
DR. SPIEGEL: So, off and on dismissing Dr. Kipper, for Dr. Kipper setting some boundaries on substance use protocol, substance detox, is an example of lacking empathy and not really caring I what other people have to say.
MS. BREDEHOFT: All right. Another one of the characteristics that you cited was envious.
MS. BREDEHOFT: Do you recall that testimony?
DR. SPIEGEL: Yes.
MS. BREDEHOFT: What is the record evidence that Mr. Depp exhibits envy?s
DR. SPIEGEL: I think jealousy is a good start for that. I think that Ms. Heard wanted to have a career, start with that, beyond what she has, and the jealousy parts of - with Mr. Franco and I think others comment, this week Ms. Berstein - sorry, last week, Ms. Berstein [sic] commented about things about jealousy, so I think it's pretty apparent.
MS. BREDEHOFT: The next one you listed was fragile ! 17 self-esteem. Do you recall that? •19
DR. SPIEGEL: Yes.
MS. BREDEHOFT: What's the record evidence of Mr. Depp exhibiting that?
DR. SPIEGEL: So, fragile self-esteem can be more along the line of a cluster B trait, I should put that in. It's not necessarily the criteria for narcissism, so it's a trait. And, basically, what that means would be that the combination of poor self-control and rapid mood states is fragile self-esteem, fragile personality traits. So, goes in line with cluster B rather than, per se, narcissism.
MS. BREDEHOFT: Now we've seen Mr. Depp, during this trial doodling and eating candy, what, if any, evidence would that suggest that he has narcissistic traits?
MR. DENNISON: Objection, Your Honor. No foundation.
THE COURT: I'll sustain the objection.
MS. BREDEHOFT: All right.
MS. BREDEHOFT: Now, you were asked about the cluster B and counsel for Mr. Depp came back and said, are you aware Ms. Heard has been diagnosed with borderline personality disorder or histrionic personality disorder. Now, you reviewed, I think you testified at the beginning, you viewed the therapy and counseling and medical records for Ms. Heard, correct?
DR. SPIEGEL: Correct.
MS. BREDEHOFT: What, if any, evidence was there that Bonnie Jacobs diagnosed Amber Heard with either borderline personality or histrionic personality disorder?
MS. BREDEHOFT: That's fair. He asked the question. That's fair redirect.
MR. DENNISON: Beyond the scope.
THE COURT: Overruled.
DR. SPIEGEL: In fact, so Ms. Jacobs demonstrated no type of personality disorder, borderline or otherwise. And on review of Dr. Curry's records -
MR. DENNISON: Objection. Beyond the scope of the question.
MS. BREDEHOFT: I'll ask each of them separately.
MS. BREDEHOFT: And you also reviewed the medical -- the therapy records for Ms. Heard for Connell Cowan, correct?
DR. SPIEGEL: Yes.
MS. BREDEHOFT: What, if any, evidence was there, at any tune, that he diagnosed Amber Heard with borderline personality disorder or histrionic personality disorder?
DR. SPIEGEL: Not only did he not, he referred to Mr. Depp as a narcissist too.
MS. BREDEHOFT: You also reviewed all of Dawn Hughes' records and her testing, correct?
DR. SPIEGEL: Yes.
MS. BREDEHOFT: And what, if any, evidence did you find in any of that extensive testing and note taking that she had found that Amber Heard had borderline personality disorder or histrionic personality disorder?
MR. DENNISON: Objection. Leading.
MS. BREDEHOFT: What, if any.
THE COURT: Overruled.
DR. SPIEGEL: None.
MS. BREDEHOFT: You also reviewed Dr. Curry's notes and . her testing, correct?
DR. SPIEGEL: Yes.
MS. BREDEHOFT: All right. And what, if any, evidence did you find in any of Dr. Curry's testing that Amber Heard had either borderline personality disorder or histrionic personality disorder?
DR. SPIEGEL: She had traits. She did not meet In the - her own evaluation, she did not have the full - endorse enough criteria to meet the criteria for borderline personality disorder and/or histrionic personality disorder. She definitely had traits; she did not have the disorder by going by the strict number of criteria.
MS. BREDEHOFT: All right. Now, you mentioned, in response to Mr. Depp's counsel's questions, you started to talk about battered wife syndrome. What is your experience with battered wife syndrome sometimes being mistaken with borderline personality disorder or histrionic personality disorder?
MR. DENNISON: Objection. Compound and ! leading. ,22
THE COURT: Overruled.
DR. SPIEGEL: So, battered wife syndrome, which is -- were a subsyndrome, or not quite PTSD, has so many symptoms of PTSD. And if you hear some of them, you'll see why someone might think that. They do have reliving experiences feeling as if the abuse is happening even if it's not, as part of reminders of -- upon reminder of abuse, such as getting ready to use something, getting ready to use a substance or something along that line. They do have hyperarousal, they do have hypervigilance, which is very easily mistaken for the emotional reactivity of borderline personality disorder.
DR. SPIEGEL: They do have avoiding symptoms, so they avoid emotions, activities, people, and if that can't be happening, they start becoming much more anxious, much more hyperaroused. They have disturbances in relationships, which clearly can be an issue, intimacy problems, again, which could also resemble borderline personality disorder. So the descriptions and traits that were there, A, did not meet the full criteria for borderline, and, B, could have very easily been explained by battered wife syndrome, a form of PTSD.
MS. BREDEHOFT: Thank you. Now, you also :indicated earlier that you reviewed the deposition of Amy Banks, correct?
DR. SPIEGEL: Yes.
MS. BREDEHOFT: And what, if any, determinations did you make based on her deposition, from her meetings with Mr. Depp and Ms. Heard?
DR. SPIEGEL: So, Dr. Banks is a professor at Harvard, a leading institution in America for medical schools, who is an expert on intimate partner violence. She had a chance to meet them in relationship counseling.
MR. DENNISON: Objection, Your Honor. Nonresponsive.
MS. BREDEHOFT: That's not nonresponsive. I said what, if anything --
THE COURT: Sustained.
MS. BREDEHOFT: Tell the jury about Amy Banks, the significance of Amy Banks.
DR. SPIEGEL: Dr. Banks found that she fully believed Ms. Heard's version of what was going on.
MR. DENNISON: Objection. Hearsay.
MS. BREDEHOFT: I reversed. Let me try it again.
THE COURT: Sustain the objection.
MS. BREDEHOFT: Please let me -- please tell the jury about the qualifications of Dr. Amy Banks. This is the one that saw both Ms. Heard and Mr. Depp.
DR. SPIEGEL: Dr. Banks is a professor at, I don't know whether assistant associate professor, at Harvard University Medical School, one, if not one of the two top medical schools in the world, who specializes in intimate partner violence. She's above all people to understand if someone is a victim or perpetrator because she does this, researches this for a living every day. And that's her qualifications.
DR. SPIEGEL: Can I say what she reported?
MS. BREDEHOFT: No, I'm going to ask you what, if anything, did Dr. Banks indicate relating to histrionic personality disorder or borderline personality disorder for Ms. Heard?
DR. SPIEGEL: Dr. Banks didn't mention anything about personality disorder at all. What she did mention was who she felt gave a more accurate version Is of -
MR. DENNISON: Objection, Your Honor.
THE COURT: What's the objection?
MR. DENNISON: That's a credibility testimony.
MS. BREDEHOFT: I think he can testify l to that.
THE COURT: I'll sustain the objection. Next question.
MS. BREDEHOFT: What, if anything, did Dr. Banks I s report, not saying what the ultimate conclusion p6 was, what, if anything, did Dr. Banks say about what was reported to her by Ms. Heard and Mr. Depp and how they responded?
DR. SPIEGEL: So, Ms. Heard discussed the - in trying to, again, as a victim, trying to save the relationship, discuss with Dr. Banks these accusations, these acts of intimate partner violence. Mr. Depp --
MR. DENNISON: Objection. Hearsay.
MS. BREDEHOFT: He's entitled to rely on hearsay. He's not giving what, ultimately -- ! he's entitled to it.
THE COURT: You can rely on hearsay but you just can't state the hearsay. So, he can rely on it.
MS. BREDEHOFT: All right.
MS. BREDEHOFT: What, if anything, did Mr. Depp do in response? e 112
DR. SPIEGEL: Mr. Depp said nothing. When Ms. Heard accused him of intimate partner violence, Mr. Depp said nothing.
MR. DENNISON: Objection. Hearsay.
THE COURT: I'll sustain the objection.
MS. BREDEHOFT: And what is the significance of that?is
DR. SPIEGEL: Significance of that is with -- 1
MR. DENNISON: Objection. No foundation.
THE COURT: Sustained.
MS. BREDEHOFT: All right. We'll move
MS. BREDEHOFT: You were asked about :MDMA and what the impact could potentially be of taking eight to ten of these pills.
MS. BREDEHOFT: Do you recall?
DR. SPIEGEL: Yes.
MS. BREDEHOFT: Okay. And, now, I'm going to take you to Australia 2015. You've reviewed testimony over that, right, from Mr. Depp, Ms. Heard --
DR. SPIEGEL: Yes.
MS. BREDEHOFT: And a number -- okay.
MS. BREDEHOFT: Were you -- do you recall that Ms. Heard also said that she found dime bags of cocaine in drawers at the end of that three days?
DR. SPIEGEL: Yes.
MS. BREDEHOFT: Okay. I'm going to ask you --
MS. BREDEHOFT: Michelle, can you bring up 1828. It's already in evidence.
MS. BREDEHOFT: And if we can publish that. Okay. We can. Thank you.
MS. BREDEHOFT: I'm going to -- this is one of the pictures that was taken in Australia, and the testimony's been that these two canvases of Ms. Heard were painted completely over.
MS. BREDEHOFT: Is that something that could be the impact of having eight to ten tablets of MDMA and combining that with cocaine and alcohol?
MR. DENNISON: Objection. No foundation. Speculation.
MS. BREDEHOFT: The foundation's already been laid, Your Honor.
THE COURT: I'll sustain the objection.
THE COURT: Next question.
MS. BREDEHOFT: Okay. What, if anything -- if you look at the painted canvases on this one, what, if any, evidence is that reflecting behaviors indicative of taking a lot of MDMA, cocaine, and alcohol?
MR. DENNISON: Objection. Speculation. No foundation.
THE COURT: That's the same question. Sustained.
MS. BREDEHOFT: You testified earlier about property, destruction of property.
MS. BREDEHOFT: Do you recall that?
DR. SPIEGEL: Yes.
MS. BREDEHOFT: Okay. Could you tell the jury what -- how that relates to the correlating factors of -- risks factors for IPV?
DR. SPIEGEL: Again, destruction of property is a 1 1; form of psychological abuse, psychological mistreatment. So, destruction of property is used as intimidation and as means of control.
MS. BREDEHOFT: Okay.
MS. BREDEHOFT: Michelle, can you bring up 1829. And this has already been admitted. Yes, thank you, Your Honor.
MS. BREDEHOFT: What, if any, evidence does this reflect as correlating behavior to risk factors of IPV?
DR. SPIEGEL: I would say that, one, that demonstrates a good deal of violence and psychological abuse. I think it's pretty clear that just trying to be intimidating -
MR. DENNISON: Objection, Your Honor.
THE COURT: Overruled.
MS. BREDEHOFT: Thank you.
MS. BREDEHOFT: Please continue.
DR. SPIEGEL: It would be - people who misuse ecstasy without coke, the cocaine, are prone to agitation, suspicion, jealousy, violence. What we're seeing there would be very consistent with : 7 that presentation.
MS. BREDEHOFT: Okay. Thank you.
MS. BREDEHOFT: Michelle, can you now bring up 1830, I guess. And that's already been admitted into evidence as well. Your Honor, I'd ask that it be published.
MS. BREDEHOFT: What, if any, evidence does this correlate with behavior indicative of IPV perpetration?
DR. SPIEGEL: Again, this is intimidation, psychological abuse, where you're solely trying to emotionally -
MR. DENNISON: Objection, Your Honor. Can we be heard?
THE COURT: Okay. If you want to.
MR. DENNISON: It's a form of him saying that this is psychological abuse. This is the exact thing we're going to preclude him from talking about.
MS. BREDEHOFT: I don't agree, Your Honor. He testified to the risk factors, one of the risk factors --
THE COURT: I'm sorry, risk factors. O This is not about risk factors.
MR. DENNISON: That question, I like. I think it's responsive, but the answer after --
THE COURT: If you can just get him there with the risk factors, you'll be fine.
MS. BREDEHOFT: Thank you.
MS. BREDEHOFT: Dr. Spiegel, if you can answer the question what, if any, evidence is this correlating to the risk factors for IPV perpetrator?
DR. SPIEGEL: Again, I think the violence comes through-
MR. DENNISON: Objection, Your Honor. Move to strike.
MS. BREDEHOFT: Just the evidence of risk factors, if you can.
THE COURT: All right.
DR. SPIEGEL: The evidence of risk factor would be accepting a more than average degree of violence, as well as psychological abuse.
MS. BREDEHOFT: Okay. Are you aware of any record evidence of Ms. Heard writing on walls, mirrors, countertops, or painting canvases?
DR. SPIEGEL: No.
MS. BREDEHOFT: Okay.
MS. BREDEHOFT: Thank you, Michelle. You can take that down now.
MS. BREDEHOFT: Now, you were also asked about Seroquel and some of the other prescription medications.
MS. BREDEHOFT: Did you, during the course of your review of evidence, see the list of medications that Mr. Depp was on at one point?
DR. SPIEGEL: Yes, I read that list.
MS. BREDEHOFT: Michelle, I'm going to ask you to bring up Defendant's Exhibit 301.
MS. BREDEHOFT: And, Dr. Spiegel, it's not into evidence yet. I'm going to ask you to take a look at this. Is this one of the documents that you had that reflected the amount of medication that Mr. Depp was on as of October 26th, 2014?
DR. SPIEGEL: Yes.
MS. BREDEHOFT: Okay. And this was an email from O Debbie Lloyd to Dr. Blaustein, his treating psychiatrist, correct?
DR. SPIEGEL: Yes.
MS. BREDEHOFT: Okay. Now, can you tell the jury, we've got Seroquel 50MG --
MR. DENNISON: Objection. Hearsay.
MS. BREDEHOFT: I haven't finished asking the question yet.
THE COURT: Let's approach.
MS. BREDEHOFT: Okay.
THE COURT: The hearsay is going to take over, and so that's why -- '1'"'
MS. BREDEHOFT: Right. I'm going to ask him how much Seroquel he was taking per day and what the significance of that was. I'm going to do the same with the Adderall, going to do the same with newer -- whatever the newer -- the ones that we asked about.
MR. DENNISON: The document did not get in evidence. There's no foundation for this I document, other than the question -- I
MS. BREDEHOFT: He's entitled to rely on hearsay, Your Honor.
THE COURT: He can rely, but you can't get the hearsay in.
MS. BREDEHOFT: Well, he can say how I much he was taking and then what the impact of that was.
THE COURT: He isn't saying how much. He can do a hypothetical, if somebody takes him around. Do you agree with that?
MR. DENNISON: Yeah, he can do a hypothetical.
THE COURT: He can do a hypothetical.
MS. BREDEHOFT: All right. I'll ask him that way. Thank you.
MR. DENNISON: Thank you.
MS. BREDEHOFT: Michelle, can you scroll up, just so I can see all of them at the same time. Thank you.
MS. BREDEHOFT: So, Dr. Spiegel if someone was taking 50 meg -- is that milligrams?
DR. SPIEGEL: Milligrams.
MS. BREDEHOFT: Milligrams of Seroquel 25 milligrams of Seroquel and 50 milligrams of Seroquel and 50 all in one day, how would that impact them?
DR. SPIEGEL: So, obviously, this is not for sleep because I'm presuming you're not wanting to sleep in the morning, noon, and from four to six, although you are sleeping at night. What I would say is he's using it for one purpose, as I said with substance abuse disorder, they're using it to calm down, they're using it just as a downer and to relax. Given that you're taking 45 milligrams of Adderall a day to stay awake, that's more than the prescribed for adults and children, for that matter, the combination makes very little sense, at all, to me.
MS. BREDEHOFT: All right. And if a person was taking 300 milligrams of Neurontin, I'm going to pronounce that wrong again --
DR. SPIEGEL: Neurontin.
MS. BREDEHOFT: Four times a day, 600 later in the day, how would that impact a person?
DR. SPIEGEL: Again, you're looking at medications that are there solely for a substance use disorder patient to get them up and to calm them down. That's all this is - this regimen is about.
DR. SPIEGEL: Gabapentin doesn't have a psychiatric indication other than - actually, it doesn't have a psychiatric indication, although it calms you down. As I said before, similar to Adderall, gabapentin is also abusable; similar to quetiapine, Seroquel is also abusable. So, you're getting these calming effects from these medicines while, at the same time, getting what's called the super-therapeutic dose, or an excessive amount of I Adderall.
DR. SPIEGEL: For the record, adults are only indicated with Adderall for the extended release, not the immediate release preparation. Why that's relevant is that immediate release preparation is abusable; you get more high quicker. The extended release goes out throughout the day. The immediate release gets you up right away and then down.
DR. SPIEGEL: Now, in ADHD, this medicine is very effective. But from what this is being used for, clearly, based on the combination, no.
MS. BREDEHOFT: All right. Do addicts lie?
DR. SPIEGEL: Yes.
MR. DENNISON: Objection.
MS. BREDEHOFT: All right. Now, you were asked about Mr. Depp passing out. Do you recall reading testimony of Mr. Depp passing out in the bathroom in his vomit?
DR. SPIEGEL: Yes.
MS. BREDEHOFT: Okay. Was that -- does that help refresh your recollection --
DR. SPIEGEL: Yes.
MS. BREDEHOFT: Of what you recall?
DR. SPIEGEL: For the record book, I don't think that falling asleep with ice cream on you is a -
MR. DENNISON: Objection. Beyond the scope of the question.
THE COURT: Overruled.
MS. BREDEHOFT: Keep going. In
DR. SPIEGEL: So I don't think taking Seroquel at night and falling asleep with ice cream on you is not what Seroquel's indicated for. It's not meant to put you out in a state where you don't even be able to stay awake to put ice cream away.
MS. BREDEHOFT: Okay.
MS. BREDEHOFT: Michelle, if you can put up Defendant's 1090. It's already into evidence. If we could publish that to the jury, Your Honor.
MS. BREDEHOFT: Dr. Spiegel, does this look like -- I mean, would this be evidence correlating with behaviors consistent with IPV perpetrator risk factors?
DR. SPIEGEL: This would be called a person who is completely knocked out, and there's usually only one way someone gets knocked out that badly, and that's with pharmacological assistance, whether it be legal or illegal. They make it to the bed. They don't sleep with their head on a GameBox in a furniture. That doesn't happen to people who sleep. No matter how tired you are. No matter how tired. I've been a resident in the past, and I was up for 40, 45 hours --
MR. DENNISON: Objection. Beyond the scope.
MS. BREDEHOFT: Just explaining, Your Honor.
THE COURT: Sustained.
MS. BREDEHOFT: All right.
MS. BREDEHOFT: Michelle, can you pull up 1095, please.
MS. BREDEHOFT: And this has been --
MS. BREDEHOFT: I'm going to ask you the same question, Dr. Spiegel. What, if anything, does this indicate relating to risk factors for IPV perpetrators?
DR. SPIEGEL: Again, you know, colloquially passed out, and there's very few ways to get like that without pharmacological assistance, legal or illegal - and/or illegal.
MS. BREDEHOFT: Let's pull up 1094, please, Michelle. Defense.
MS. BREDEHOFT: And that's also been admitted.
MS. BREDEHOFT: Have? And now, we have the ice cream picture. And what, if any, indication does this
DR. SPIEGEL: Probably could see how I could -
MR. DENNISON: Objection. Speculation. No foundation.
MS. BREDEHOFT: What, if any, correlation -- what, if any, evidence does this indicate correlative with the risk factors for IPV?
DR. SPIEGEL: Again, this proves one of the major risk factors and precipitating factors for I intimate partner violence.
MR. DENNISON: Objection. Move to strike.
THE COURT: All light. Sustained. Is I'll strike it from the record.
THE COURT: Next question.
MS. BREDEHOFT: We'll just move on.
THE COURT: Okay.
MS. BREDEHOFT: You were asked about earpieces. Did you -- do you recall reviewing ' Tracey Jacobs and Joel Mandel's deposition?
DR. SPIEGEL: Yes.
MS. BREDEHOFT: Do you recall them both testifying that I Mr. Depp had someone on salary to feed him his !is lines?
DR. SPIEGEL: Yes.
MS. BREDEHOFT: Now, you've testified that you've reviewed a substantial amount of evidence in this case. Did you find any evidence that Amber Heard exhibited conduct or behaviors indicative or consistent with any of the risk factors for perpetrators of IPV?
MR. DENNISON: Objection. Beyond the scope.
THE COURT: Sustained.
MS. BREDEHOFT: Well, it was suggested with the borderline personality.
THE COURT: Sustained.
MS. BREDEHOFT: Okay. But we did find that for Mr. Depp, correct?
DR. SPIEGEL: Yes.
MS. BREDEHOFT: And did you find record evidence that Mr. Depp had a substance abuse disorder?
DR. SPIEGEL: Severe substance use disorder.
MS. BREDEHOFT: All right. Did any of the questions asked by Mr. Depp's counsel change any of your opinions in this case?
DR. SPIEGEL: Did it - nothing - no, my opinion has not swayed an iota.
MS. BREDEHOFT: Do you hold them all still within a reasonable degree of medical and psychiatric probability or certainty?
DR. SPIEGEL: Absolutely, yes.
MS. BREDEHOFT: Thank you very much, Dr. Spiegel
THE COURT: So you can have a seat in the courtroom or you're free to go.