The 'fine line' walked by medics treating troubled Elaine O'Hara
WHEN Professor Anthony Clare died of a heart attack in Paris in October 2007, the 'Guardian' newspaper said the psychiatrist and broadcaster "did more than anyone of his generation to improve the public understanding of psychiatry and to raise it from its former outcast status".
During his famous BBC series 'In the Psychiatrist's Chair', Prof Clare interviewed many high profile people including Bob Monkhouse, Esther Rantzen and Cecil Parkinson.
He also took a substantial interest in Elaine O'Hara who, in August 1992, presented as a 16-year-old with persistent, obsessional thoughts and fantasies.
And the Central Criminal Court has heard that at least two of her 14 psychiatric admissions may have been triggered by Prof Clare's death.
Yesterday the trial of architect Graham Dwyer, who denies murdering Ms O'Hara on August 22, 2012, heard that Elaine O'Hara began having disturbing thoughts and fantasies from the age of 12. Her obsession, the court heard, appeared to have been with being caught and tied up and was described as "a play in her head", a drama which concerned being restrained and imprisoned.
Prof Clare initially thought Elaine O'Hara was suffering from a gradually emerging psychosis, but later formed the view that she was suffering from borderline personality disorder and depression.
A year before his death, Prof Clare wrote to a consultant endocrinologist who had ruled out elevated testosterone levels as playing a role in what Prof Clare described as Elaine's "disturbing behaviour".
Read more: Trial day 16 in quotes
Prof Clare wrote in the November 2006 letter that his now 30-year-old patient's sexuality was "certainly disturbed, masculinised even" adding that the disturbance was a relatively subtle one. "She poses very real management problems," said Prof Clare. "It is not going to be diabetes, I'm afraid, or even a straightforward depressive illness that determines the fate of Elaine."
Dr Matt Murphy, a now retired consultant psychiatrist at St Edmundsburys and St Patrick's - two mental health hospitals in Dublin - became Elaine O'Hara's treating psychiatrist following Prof Clare's death.
Yesterday he told a jury of seven men and five women that when Elaine O'Hara was discharged from St Edmundsbury for a final time on August 22, 2012 - the day she went missing - that he was very hopeful about at least the immediate future for his patient.
Dr Murphy said that she was in better form than he had ever seen her on that day she disappeared. "She was planning forward in an 'immediate future' way, she had plans to get on with her life," he said.
While Dr Murphy was optimistic about Elaine's future, he spent a day - the longest any one witness has given evidence in the trial - explaining Elaine O'Hara's long and tragic psychiatric past. The consultant agreed with barrister Ronan Kennedy, for the defence, that Elaine O'Hara had been admitted to St Edmundsbury 14 times between 1992 and 2012, roughly once every 18 months. Dr Murphy said he believed that admissions after the death of Prof Clare - who had treated Elaine from the age of 16 years to 32 years - may have been related to her experience of losing him.
Elaine O'Hara told Dr Murphy in July 2011 that she had been pregnant, but had lost the baby at four to five weeks. A repeat self-harmer, she also reported masochistic behaviour, having pain inflicted upon her by others, something she had participated in. But she spoke about this behaviour only in an evasive way, he added. Elaine also disclosed, "years ago" to a clinical nurse manager at the hospital that she had solicited someone to harm and kill her and had arranged over the internet to take part in strange sexual practices with strangers as part of an S&M lifestyle she was involved in.
Dr Murphy confirmed that Elaine O'Hara was admitted to St Edmundsbury on July 14, 2012. Dr Murphy approved the admission after learning that Elaine O'Hara had called the psychiatric unit the previous day to say she was depressed and was either thinking of or constructing a noose to hang herself.
Dr Murphy said that he had told gardaí that the voluntary admission was something of an emergency, a quick decision, her extensive admission notes recording that she had made a noose.
Current or recent stressors were recorded by staff as a major leak in her apartment and exams coming up while a safety and risk assessment noted that she had suicidal thoughts "all the time" but denied any plan or intent.
The records noted that Elaine "denies CSA," shorthand for child sexual abuse, noting that she "refused to discuss any details from that time".
Ms O'Hara's notes also referred to a debt of €3,000 to €4,000 in a section entitled 'finances and debt'.
Elaine, who enjoyed weekend and day leave - and who could come and go as she pleased - gave her personal input into regular care plan reviews.
A case note from July 23, 2012 recorded that she was "constantly thinking about a noose and hanging". A day later, staff observed she had spent most of the morning sitting in a chair in a room in darkness. In one care plan review, Elaine spoke of how she was "losing a fighting battle," yet her risk status never rose beyond medium, said Dr Murphy.
Elaine O'Hara was anxious about leaving the hospital, said the consultant, who spoke passionately about "the fine line" he and his colleagues were walking between encouraging her independence and ensuring that she did not experience feelings of rejection by the hospital. Dr Murphy was adamant that Elaine was excited about her future plans the day she disappeared.
The trial continues.