Graham Dwyer Trial: Elaine O'Hara had been suffering from 'obsessional' fantasy about being restrained since age of 12 - psychiatrist
First spoke to doctors about 'play in head' while in her teens, court told
ELAINE O’Hara had been suffering from an “obsessional” fantasy about being restrained or imprisoned since the age of around 12, the Central Criminal Court has heard.
One of her treating psychiatrists, Dr Matt Murphy said notes on her treatment showed she first spoke to doctors about a “play in her head” in her teens in 1992 but the obsession went back much earlier.
Dr Murphy was giving evidence in the trial of architect Graham Dwyer today.
Mr Dwyer (42), of Kerrymount Close, Foxrock, is pleading not guilty to the murder of Ms O’Hara (36) at Killakee, Rathfarnham on August 22, 2012.
Read more here: Elaine 'playing dangerous game' with architect, warned friend
Ms O’Hara, a childcare assistant from Killiney, was last seen alive near Shanganagh Cemetery in Shankill that day.
Her remains were found by a dog walker in undergrowth in the Dublin mountains on September 13, 2013.
The prosecution maintains Mr Dwyer killed her for his own sexual gratification.
Dr Murphy said he took over Ms O’Hara’s care after the death of her previous psychiatrist, Professor Anthony Clare in 2007.
He referred to Dr Clare’s notes on her earlier care while giving evidence to the jury.
Dr Murphy said Ms O’Hara was first seen at St Edmundsbury Hospital by Dr Clare on August 5, 1992.
She presented with persistent obsessional thoughts or fantasies but it was a little unclear exactly what she meant.
She talked a good deal about a play in her head and there was “some uncertainty about how to interpret that” in psychiatric terms.
She had been experiencing this from the age of about 12, the notes stated.
Sean Guerin SC, prosecuting, asked Dr Murphy what the details of the thoughts or play were.
“I think it concerned being restrained or being imprisoned, she had acted out those thoughts to some degree herself,” he said.
She received regular outpatient care for a time after that for a number of years and had therapy.
Her second admission was some years later, in 2000. She had had cognitive behavioural therapy, but more so in recent years.
She had been on a combination of anti-depressant medication and major tranquilisers.
Dr Murphy explained that this was because there was initial uncertainty about her diagnosis and it had been thought there had been a possibility that there was an emerging psychotic illness.
He explained that psychosis was where someone might lose touch with reality and have delusions and hallucinations.
This sometimes emerged in the late teen years, Dr Murphy said. Professor Clare had kept a watching brief on whether the process of psychosis was actually happening.
As time progressed, however, the feeling was that what she was suffering from was nearer to a personality problem.
He told Mr Guerin there was never a diagnosis of psychosis and the tranquilisers were used because of her state of extreme agitation.
“I think the diagnosis that we all would have concurred with, certainly in the latter part of our acquaintance with Elaine was borderline personality disorder,” he said.
He explained this was where someone registered emotions very acutely and strongly, and might have low self esteem and think themselves to be worthless and valueless.
Self harm might be a feature of this and it could overlap with depression, Dr Murphy said.
Dr Murphy told the court that while Ms O’Hara was admitted in to the hospital in July 2012 with suicidal ideation, she was not suicidal when discharged the day before she vanished.
She had indicated she was a little anxious, but added that was normal, he said.
He said there was no signs of suicidality on discharge.
“What I mean was she was talking in different terms about life, talking about going forward, doing things, and engaging with life again and no further talk at that time of self harm,” he said.
Dr Murphy said he admitted Ms O’Hara as an emergency after she called the hospital and told staff she had constructed a noose and planned to hang herself.
However, she was in much better form leading up to her discharge, he said,
“She was probably as good as I’ve ever seen her. Bright, cheerful and optimistic and was planning forward in an immediate future way,” he said.
“She had plans to do things and get on with her life.
“She was planning to continue work and increase her attempts at socialisation.”
Dr Murphy said over the previous years Ms O’Hara had seemed to progress in terms of employment, gaining a number of different jobs, working in a bank at one stage before eventually working in child care and a news agents.
However it remained difficult for her to connect with people socially in the usual manner, he said.
Anxiety, some self harm and suicidal ideation were a feature of admissions to St Edmundsbury in 2005 and 2006.
The psychiatrist explained suicidal ideation is when someone becomes preoccupied with the idea they should end their lives and tempted to act on that.
"On the last admission to hospital she had the idea and urge to hang herself, and instead of that she rang the hospital and things settled down, but prior to admission she had urges to act on the idea she should be dead,” Dr Murphy said.
Ms O’Hara’s preoccupation was chronic and based on her personality, low mood, low self-esteem and self-harm.
Mr Guerin read from notes the doctor had previously made on Ms O’Hara, which indicated self harmed and harm being inflicted with others, but context that she was participating.
He agreed these showed masochistic behaviour.
“Yes, it means having pain inflicted on you,” he added.
However Ms O’Hara was talking about that aspect indirectly and would be evasive and “liked to control how much she said and to whom,” he added.
Records showed Ms O’Hara first mentioned this type of behaviour with Professor Clare in late 2006 and it had come up for discussion a number of times.
“But if you measure it against the number of times she talked about self-harm it was of a lesser degree,” he said.
One note, from April 2008, indicated she told a man in email wanted to desist the practice, but by February 2009 the practice had stopped but she felt like contacting him again, the court heard.
In July 2011, she reported she had been pregnant but had lost the baby at four to five 5 weeks, the court heard.
In her latter years her medication was reduced and she was receiving cognitive behavioural therapy.
“I would have thought she was doing pretty well, especially in the last year of her life,” Dr Murphy continued.
“I would have seen distinct improvement in her overall attitude and manage of mood and feeling.
“The last admission was a set back but was characterised by a greater ability to control and manage moods and feelings than before."
In cross-examination, Defence Barrister Ronan Kennedy asked Dr Murphy to comment on a number of medical records from Ms O’Hara’s final admission to St Edumdsbury.
Her July 14, 2012 admission record noted a history of suicide attempts and self harm by cutting.
She presented with very low mood and increased anxiety and irritability. She also showed signs of anhedonism, which Dr Murphy explained was an inability to enjoy anything.
It was noted that she found it very difficult to cope and reported that she “made a noose yesterday to hang herself with but did not act.”
Dr Murphy agreed that one of the concerns early on was that she was in college and had upcoming exams. Very shortly after her admission, he wrote a letter so she could be excused from college for a month.
On August 8, he wrote another letter stating that she was unfit to sit exams or submit essays and asked for these to be deferred for a year.
The court heard Dr Murphy sent a letter to Garda Brian Jennings on September 4, after he was contacted when Ms O’Hara went missing.
The letter confirmed that Dr Murphy was treating her and she had been admitted between July 14 and August 22 that year.
“This admission was something of an emergency in that Elaine was having suicidal thoughts in the period immediately prior to her admission,” the letter to Garda Jennings stated.
Dr Murphy confirmed to Mr Kennedy that it had been an emergency and said Ms O’Hara rang the hospital before she was admitted, saying she felt quite suicidal.
“I think I had to make a quick decision on the matter...I said I think I had better arrange for her admission,” Dr Murphy told Mr Kennedy.
Returning to the letter, Mr Kennedy said it stated that Ms O’Hara had said “she had a noose to hang herself if it didn’t proceed.”
The letter continued to state that Ms O’Hara had been discharged in good form, looking forward to the Tall Ships festival, with a prescription for medication and a follow-up appointment with her therapist.
In the admission assessment form, it was recorded by nurses that she was affected by a major leak in her apartment and her exams coming up.
Dr Murphy told the court these factors “certainly wouldn’t have helped” her but he could not be certain that he mood would not have been low without these stressors.
In relation to suicidal thoughts, the form noted: “denies any plan or intent”.
A section on whether the person was thinking of a method or whether one was available to her was marked “not applicable.”
Later, the record noted that she had a long-standing problem with low mood and anxiety since 16, and “denies CSA but refused to discuss any details from that time.”
Dr Murphy explained that CSA meant child sexual abuse.
The record stated that Ms O’Hara had acknowledged being bullied a lot in school and felt she could not trust people. Self harm was noted, along with suicidal ideation and “tired of feeling this way.”
On specific triggers for self-harm, it was noted: “doesn’t know, just want to mark mental pain becoming physical.”
Dr Murphy explained that often people sought relief or distraction from mental anguish by replacing it with physical pain.
The court heard she told told doctors she did not know what the triggers for her relapse were, although the nurses’ notes marked two triggers - her exams and the flood in her apartment.
It was noted that she had debts of €3,000 to €4,000.
Mr Farrell referred to a letter from Prof Clare to Dr Margaret Griffin on in November 2006, a consultant endocrinologist who specialised in the treatment of gland trouble.
It remarked how physical tests, particularly on testosterone levels, did not play a role in her disturbed behaviour, which Prof Clare stated he wanted to get to the root of. The letter also referred to her “sexuality being disturbed, masculine even”.
Dr Murphy said there were a number of references in charts to Elaine saying she thinks “I’d rather be a boy” or “I don’t like being a girl”.
“There probably would have been a sense her dress sense was not especially feminine,” he added.
Prof Clare had also stated Ms O'Hara poses real management problems, but that it was not going to be diabetes "that determines the fate of Elaine", hence his desire "to get to the root of such disturbed behaviour ".
The trial continues before Mr Justice Tony Hunt and a jury of seven men and five women.
If you are affected by any of the above issues, call Samaritans on 116 123 from ROI or 08457 90 90 90 from the UK