December 6, 1984
SAUL NIEDORF, a witness, after having first been duly sworn, testified as follows:
DIRECT EXAMINATION
* * *
Q: Are you board certified in any specialty in the field of medicine?
A: Yes, I am, I'm certified as a Diplomate on the American Board of Psychiatry and Neurology, in psychiatry, and also in child psychiatry. Both of my examinations were completed in 1969.
* * *
Q: Do you do any teaching?
A: Yes, I'm on the faculty of the School of Medicine at U.C.L.A. It's called the Neuro-Psychiatric Institute. And prior to that, for seven years, I was on the faculty at Washington University School of Medicine at St. Louis. I've also lectured at Dartmouth and the University of Maine.
Q: Now, Dr. Niedorf, has Larry Flynt been a patient of yours?
A: Yes, he has.
Q: When did you first see Larry Flynt?
* * *
A: All right, I was asked to see him by his brother in November of 1983, and I saw him, I think, for a total of eight (8) or nine (9) hours in November, and the first day of December. And then, he went into prison as a result of the behaviors that I believed were a product of his mental illness, and he stayed in the mental hospital, or the medical center of the Springfield Institution, where he was confirmed and -- the same diagnosis that I had felt he had, bipolar illness, which is the current phrase used for manic depressive disorder.
And, they, they stated that he had this illness. And then he went into another institution, also a medical-psychiatric institution -- continued in Butner, North Carolina. When he finally got out in the summer of this year, later that summer I was contacted again. By this time, he had changed totally in his mental condition. He was no longer in the manic phase of his manic depressive disorder. He had entered into the depressive phase.
Q: All right, Dr. Niedorf, let's go back now to November of 1983, when you first -- when Larry Flynt first became your patient. Do you have that in mind?
A: Yes, I do.
Q: All right. Did you conduct an examination and an evaluation of him at that point?
A: Yes, I did.
Q: Could you tell us, just in summary fashion, what you did?
A: Well, ah, it was the first time in a long time that I had made a house call, because my office has thirty-eight (38) steep steps. And it's hard to get up there, and it's -- so I made a home visit. And Mr. Flynt, at that point, I guess, very typical behavior for him, had me conduct the interview for him in his bathroom. Him sitting on the comode.
And after two and a half hours I had come to the conclusion that he was a very ill man, and that his illness, as -- on the basis of my mental status examination, had a good many of the elements of mania -- of manic depressive or bipolar illness.
* * *
Q: Could you describe to the Court and jury what is manic depressive illness?
A: Well, it has two distinct phases, and those phases can last for hours or days or weeks, or months or even years. Generally, it's a matter of many weeks, or even many months. And the -- to a greater or a lesser degree, the individual is either in the manic episode or the manic phase, or the depressed or depressive phase.
I could describe the manic phase first, and that's a very clear, distinct period where there's a gradual, or sometimes sudden onset of a highly expansive and elevated mood. Or, it could be irritable, or both. Especially if a person is frustrated, that positive, optimistic, upbeat feeling suddenly becomes hostile, and nasty and mean. There's generally an active and hyperactive field to the person. They have pressured speech, and they have what is the classic symptom, a flight of ideas.
We saw that on the tape earlier this morning, where -- and yesterday -- they can't stop themselves. The brain suddenly gets going, and it just clicks off a whole series of names, or associations or places or ideas, that all seem to run on. And they're very difficult to interrupt. The -- attorneys or psychiatrists are the only other people you can't interrupt -- with difficulty.
* * *
A: The flight of ideas are the -- these sudden tirades or associated ideas where one thought after another may be connected by just a sylogal sound like "Henry George, Boy George," and then a whole bunch of words after. Or suddenly a bunch of names will appear. Or a bunch of dates will appear.
People with this illness -- Mr. Flynt in particular, have an inflated sense of themselves. They feel -- they feel supreme. They feel very powerful. They feel they know everything. They know everybody. They can do everything, and they try to. They need very little sleep. One of the things that was going on with him then was that he wasn't sleeping very much, and that greatly disturbed his brother, and that was one of the big fears that he had, that he would burn himself out.
He wasn't sleeping, there was a great deal of distractibility and suggestibility. Just about anything you say to him, he would pick up on, and agree with you, and go on. Or, if he were frustrated, he would disagree and become nasty.
Q: What do you -- what is manic depression? How would you characterize that? Is it a mental illness?
A: It's an illness. It has a biological basis to it. It's lifelong. It's a lot like -- well, it's not like -- one could analogize to diabetes, and say that you could control diabetes, we don't know what causes it. We know that it lacks -- there's lack of insulin, and we know if you replace the insulin that you can control the illness. But yet, many complications of that illness will occur in diabetes. The same is true for manic depression. What usually happens is that the complications set in for manic depression. The most serious complication for the depressive phase or manic depressive illness is suicide.
The most serious complication of the manic phase is legal difficulties, and then the next most serious is substance abuse.
Q: What was his physical condition at the time you evaluated him?
* * *
Because of his paralysis, he has to compensate with a sense of potency. And, here he is impotent in a sense, in every respect, and he has to act in a denying way to any inferiority or any disability. So he will deny any disability. He would, he would experience anything that limits or controls him in a very harsh or threatening sense, and try to compensate for it. Therefore, he would try to deny any incapacity, including a mental incapacity.
He was convinced that he was normal and I was crazy.
* * *
Q: All right. Now, I want to direct your attention to a video-tape that was played here in the courtroom.
A: Yes.
Q: Were you present during the playing of the video-tape?
A: Yes, I was.
Q: And, have you seen the video-tape, or a transcript of it, at any time prior to that?
A: Yes, I had.
Q: What had you seen?
A: I had seen the video-tape prior to that time, approximately one week ago. A little less than a week ago.
Q: Now, based on your observation of the video-tape, do you have an opinion as to Mr. Flynt's mental condition at the time that he gave that deposition?
A: Yes.
Q: What is your opinion?
* * *
A: My opinion is that the behavior, the utterances, the emotional state, the kinds of episodic flight of ideas, especially the inflated sense of himself, and especially the delusional beliefs that he held, the false beliefs that he tenaciously held against all reality, against the intrusion and against the reflection of all reality, is a classic example of manic depressive disease.
The individual can look and act as obnoxious and irritable and cranky -- they can look as faking as -- as malingering as possible. But you cannot sustain that kind of behavior unless you truly are a genuine manic depressive. He has the history for it, he had the, the presentation of manic disorder when I saw him originally. He continued to have it in its typical waxing and waning course. Classically, the mania rises and falls. One day, the person is more generous than the next, and gives away money, or gives away candy on the street. The next day, they can be cranky and irritable, and suspicious and paranoid. The next day, they can be euphoric and exalted.
They have a tendency to dress bizarrely, or doll themselves up. If they're women, they often make up in a bizarre way, in excessive ways. They do also become hostile whenever they're thwarted. And most of all, they have a tendency to involve themselves in activities or in statements that have painful consequences, but they don't recognize the pain that they are going to receive. They put themselves into enormous hot water, and for that reason, as I say, the most typical complication of manic disorder is legal difficulties.
Q: Did you see those things exhibited on tape?
A: Oh, very much so. I think that you don't have to be a psychiatrist to, to see that --
THE COURT: Are you telling us that he was totally incapacitated to testify, or that his ability to testify was limited at that time?
WITNESS: Well, Your Honor, no one is totally incapacitated --
THE COURT: Right.
WITNESS: -- unless you're in a coma. But, what I'm suggesting is --
THE COURT: His capacity to give testimony was limited.
WITNESS: Limited by the intrusion, periodically, repetitively, relentlessly, of his false beliefs.
* * *
Q: Did you form the opinion as to whether or not he was competent or had the ability to accurately perceive events?
A: I think that his thinking for many years, and especially during the hours of that deposition, has -- his consciousness has been subject to the intrusion of false beliefs, which he tenaciously holds, regardless of the facts or regardless of how things are presented to him.
He may or may not be under the emotional pressure to express them. A lot depends on the type of genetic makeup which you're born with, in a sense -- as to how this disorder manifests itself.
Q: You believe he had the ability, the capacity, to accurately perceive events at the time that deposition was taken?
A: No. He would have the intrusion of false beliefs, and it would not be accurate. They would be tinged and colored in a sense, not only factually but emotionally altered.
Q: You believe he had the ability or the capacity to accurately recall events at the time of his deposition?
A: No, again, he would have "clang association," so that one element of recall would elicit a connection with another that was highly irrelevant, but only associated perhaps with the sound of the word, but not in terms of a rational connection of time or place or person. There are too many irrationalities in a manic's thinking to make them a good witness to remember things.
Q: In your opinion, at the time of his deposition, did he have the competency to accurately recount and describe past events?
A: Sometimes excellent. His memory, by the way, is incredibly good. In testing his memory, he has extraordinary abilities, and he uses them to great advantage. But at other times, his memory was totally involved in the "clang association," in the irrational associations, and therefore, those memories were inaccurate.
Q: So in answering my -- what is the answer to my question, as far as his ability to accurately recount past events?
A: He did not have that capacity. Consistently.
Q: Now, did you notice any physical symptoms manifest -- manifestations, characteristics, so forth, on that tape, that were of any significance to you as a psychiatrist?
A: Yes. The -- his facial expression did not change very much at all. He was in a state of high excitement and agitation. There wasn't the kind of variation that one would have hoped for in a more normal person. Once in a while, he moved his nose. I think that he was either trying to fix the glasses that were falling down on his nose, or he was actually having what psychiatrists call a "schnoutzkapf," which is an old German word that means your nose crinkles.
These are involuntary grimaces that people with a lot of emotional pressure can make. The depressed person can frown, so that the creases in their -- between their eyes is very deep and very tight, and the corners of their mouth go down. The manic often has an excited and tense kind of air to them. But, the physical qualities aren't as important to a psychiatrist as the mental qualities. The communication of the patient, the way that they talk, the kind of thoughts, the kind of emotions they express are what we use. Just as cardiologists listen to the heart, we listen to the content of what a person says.
Q: All right. What did you determine from the content -- what he said, to support your opinion that at that time he was not competent and couldn't accurately testify?
A: He lacked judgment. He had unwarranted grandiosity. He was reckless in his talk, he had the typical talk of the manic, which involves sexual, political, and religious and sometimes occupational preoccupations. But they're, they're generally overinvolved with everything and everybody that is at all significant in their own or in public life. They're colorful, they're flamboyant in the way they present themselves -- and he certainly did. There was a lot of theatricality to, to some manics.
The most important thing, though, was the flight of ideas. The way in which he would have this accelerated, nearly continuous kind of monologue, with these abrupt changes from topic to topic, -- you might find some association to them, but sometimes it was based on some distracting stimuli. Somebody who might be in the room could be incorporated into their ideas or their responses suddenly. Or they might make a play on words. He did that on a number of occasions.
Sometimes the flight of ideas can be so disorganized that it makes no sense at all. They're incoherent, and they are very distractible. That means that they have very rapid changes in the subject that they're talking about. They might respond to, as I say, the external stimuli are irrelevant, and yet they throw them in.
* * *
Q: Is, is that a symptom of mania?
A: The symptom of self-destruction is present in mania, but it is not clear, as it was with Mr. Flynt in his depressive phase he wanted to die, he had no purpose to live, he was --
Q: What about the manic phase?
A: In the manic phase, it's defended against, and it's expressed often in a hidden way. In other words, they do something that's reckless. They drive recklessly, they, they believe that they have powers to survive anything. And they often get hurt, so that the unconscious element of self-destruction leading to behaviors that are self-destructive, but not recognized as such -- the painful consequences of their actions is not apparent to most manics.
Q: What about any kind of gross, vulgar behavior? Is that any kind of a symptom of manics?
A: Well, it depends. Some manics are mild and mellow, and they just go on and make you laugh, and the average manic entertains, and it's infectious. It catches people up, and they start to talk and act like the manic. They make some of the same associations.
And I noticed on the tape that oftentimes people present with him -- not often, but on a few occasions -- actually got involved in making the same kind of irrelevancies that he did.
Q: What about vulgarity?
A: That's more typical of the older manics -- it's unusual to see somebody who's younger to do that. But older manics often have a sudden change in their demeanor, so that you see somebody that's not at all expected to be that way, suddenly the vulgar course of abominable language comes out, and it's disgusting and foul. And part of it --
Q: Was that then --
A: Yes.
Q: Was that typical for him?
A: Yes. It's --
Q: Was that of any significance?
A: For him, it's typical. He's much more likely in his manic phases to use a stream of invectives in that way. Especially when he's thwarted, when he's frustrated, when he's insecure, if he's in pain, if he's been injured, or if he's threatened, if he's made to feel powerless or helpless. He'll reaffirm himself with the foul language.
The foul language basically is a defense against the sense of helplessness and vulnerability and weakness.
Q: What about the, the illusional type of testimony? Things that were obviously --
A: I --
Q: -- in the sense of the reference to Kennedy, and that kind of language.
A: Yeah. That's classical. There is a, a very clear statement made, which has been approved of by all psychiatry -- I shouldn't say all -- about 25,000 psychiatrists in the United States and Canada have approved a description of manic depressive disorder in the Diagnostic and Statistical Manual, Number 3. That was in 1980. And that specifically says that the manic often talks about delusions of special relationship -- either to God or to the President. That's very common. But to any famous person.
It's -- and oftentimes the delusion is to a dead person. I mean, you could be speaking to Marilyn Monroe, for example, as Mr. Flynt often did on the telephone. Long after her death.
* * *
Q: Is what -- the symptoms that you saw after viewing the tape, were they consistent with the symptoms of the condition of mania, as described by this in court, that you referred to?
A: Yes. Very, very typical. He is a classic textbook case in the way he presents himself. The, ah, the previous examiners felt that he was less severely ill. And it depends on when you catch him. Oftentimes he will have most of the symptoms, but many times he can have them all. He is, over the long run, if you listen to him for a few hours, let's say three or four hours, you'll catch every symptom of mania.
Q: All right. Do you think you now have summarized the points that are the basis of your opinion?
* * *
A: Yes, I'd like to just say, that one of the tests of an illness is that, if you treat it, it gets better. In other words, if you, if you use what is typically the correct treatment for an illness and it gets better, you're sure that you have the right illness.
For instance, if you think it's pneumonia, and you give penicillin, and the person gets better, they have pneumonia. You assume that. Especially if it's causally related in time and dose.
Well, when we use the correct medicine for him, he does improve. In other words --
Q: That, that -- is that then what has occurred? You did treat him --
A: Yes.
Q: -- after he was returned to California?
A: Right.
Q: And was under your care. What drugs did you administer?
A: He is presently taking lithium, which is the standard treatment for manic depression throughout the world. He's taking lithium carbonate, 300 milligrams, 2 or 3 times a day. On occasion, if the blood level drop -- we monitor that by blood levels on a weekly basis. If the level of lithium drops, we increase the dose. If it is too high, and could give him toxic symptoms, we decrease it in a regular basis.
He's also given an anti-depressant at this time. The original medicine was called Desyrel, D-e-s-y-r-e-l. Now it's Norpramin, N-o-r-p-r-a-m-i-n. And he's given it in the, ah, recommended high level dosage.
He's also receiving a medicine called P-3. It's official name is El Triota Thiamine. That's an active form of thyroid, but it's given in micrograms. Not even in milligrams. Because it's extremely potent. Most people with thyroid trouble get ordinary thyroid, -- but this particular kind seems to enhance the functioning of the other two. So he's getting --
Q: Is that then all the drugs that you --
A: We did give him at one time El Triptophane, which would help him sleeping. He had severe sleep disturbance, and that seems to be improving now.
Q: What, in your opinion, is his condition psychiatrically at the present time?
MR. GRUTMAN: That's objected to as irrelevant. The only thing that's relevant to the issue --
THE COURT: Well, it, it might go to the credibility of his testimony today. I'll let him answer it. All right. Go ahead.
DIRECT EXAMINATION CONTINUED
BY MR. DALTON
A: He improved dramatically about two (2) weeks ago. He started -- which is very typical of people with this disorder. They can suddenly, -- it's like a light comes on, either from manic depression, or from depression up towards mania. And many of the old qualities of their behavior return. It's not apparent to the lay person or to the stranger, but it is to the family. People who really know them see the difference. Otherwise, it may not be that clear.
But the person subjectively feels better. Mr. Flynt for the past two (2) weeks has improved.
* * *
Q: All right. What about the behavior or dissipating assets, giving --
MR. GRUTMAN: Now, Judge.
Q: Giving away those assets and his irresponsibility. Is that a symptom of mania?
A: Very --
MR. GRUTMAN: I object to that, Your Honor.
THE COURT: Well, I'll let him answer that. All right.
DIRECT EXAMINATION CONTINUED
BY MR. DALTON
A: It's extremely common. The, the classic manic gives away candy in the street, or gives away money in the street, sometimes it's giving away their car or buying, going on buying sprees, and then giving away the things as gifts. Of just amassing them. It's not at all uncommon to see frivolous behavior, and outrageous behavior vis a vis money, power, prestige. Sometimes reputations can be blown, depending on the, the kind of outrageous behavior in moments.
* * *
CROSS-EXAMINATION
Q: . . . Doctor, you say that Mr. Flynt is a psychotic?
A: Well, if you, if you leave the word "A" out of that statement, I would say he has, he is psychotic, in the sense that he is not always totally rational. He knows some of the realities of time, place, and person. But he does have some false beliefs. If they interfere with his functioning, I would call him psychotic.
* * *
Q: Did you not, and you therefore, from that answer knew, that besides Judge Marshall, a finding had been made by Judge Dwyer that Mr. Flynt was competent to stand trial. Correct?
A: Judges often do that to get somebody out of a prison, where they would sit until they become competent. That could be months or even years.
Q: I just asked for --
A: So they often say "Yes, they're competent. Go ahead with the trial." I believe everyone should have the right to a trial, and the sooner the better.
* * *
Q: He was competent, wasn't he?
A: When?
Q: In June of 1984, when he gave that deposition.
A: I think that he was highly disturbed, that he was delusional, and that he had false beliefs and that these intruded consistently and repetitively, and they were very frustrating to all concerned. You don't have to be a psychiatrist to see that.
Q: But he was --
A: He had --
Q: -- Competent.
A: -- Flights of ideas. If you're talking about his competence as a witness, I say no, he's not competent. If your talking about his competence to stand trial, yes.