Prima Facie – on the face of it – it is clear who the legally guilty party is – until (perhaps) it is proven otherwise.
Prima Facie is a play by Suzie Miller. She tells the story behind it and the changes to the law around sexual assault it has brought about, along with her Australian and legal background in this Women’s Podcast.
Prima has won multiple awards – as has Jodie Comer, who features in one of its one-woman iterations. Tickets to a live performance are impossible to get. Every so often a video version is available to rent from the National Theatre. In the meantime here is the Prima Facie Transcript.
Prima Facie sets a legal stage very like the stage on which drug induced injuries and assaults play out – see Are Healthcare and Science Compatible.
On the courtroom floor a process, its participants believe to be rational and fair, plays out. Tessa Ensler, a good lawyer knows the process is not always rational or fair but goes along with a system, which may have its failings but every system has blind spots. She is good at using the process, the system, to get sexual assaulters off the hook.
Despite the problems, 99% of us agree anarchy would be worse. As a defense against anarchy, we turn to systems (a greek word), which all too easily (can) become system-archy.
When drawing up the The Healthcare Lecture, I knew (intellectually) and I imagine lots do, that we have an increasingly rigid health system that has got to the point of being all too willing to mandate treatments despite the evident harm they can cause. We saw visible hard mandates with Covid but mostly miss the host of soft mandates, especially linked to what can be branded as mental health, which slide in beneath our radars.
Pointing out the mismatch between our reality and the semi-religious healthcare formulae that give a pleasing look of truth by virtue of repetition and solemn intoning to the truths of the system is a recipe for rejection. The good thing about the Midlands lecture was the questioners didn’t reject. They articulated the difficulties the mismatch poses for them.
This openness was quite unlike Canadian and British responses to the same messages some years ago – see Health a Privilege of Wealth.
A Witness in Court
Tessa Ensler comes up against this rigidity when she herself is sexually assaulted. In sexual assault cases, the woman, the victim, becomes the guilty party. She is up against an – archy – patri-archy.
The process asks juries to decide between the answers of two people. He just has to say he didn’t know she wasn’t consenting. She had consented a short time before. She can be quizzed about minor details it may be hard to get right when you are being assaulted.
Consistency and body language are key to the verdict. The process has been set up by men who have never been sexually assaulted and can’t understand why asking a woman for details of the assault which she may not be able to recall clearly is not the way to go. Putting a woman who is the victim in the witness box and interrogating her as though she were trying to get an innocent man convicted for some perverse female reason, and then not convicting him on the basis that her testimony has more holes in it, brings out the bias.
A Witness in Clinic
In the Clinic Witness Box there is often no way to tell your interrogator what is, or might be, or you hope is not going on.
You might get as far as James Holmes, the Aurora Batman Rises gunman, who told Dr Feinstein if she knew the thoughts going through his head she’d lock him up. As part of standard clinical process, she told him he was responsible for the thoughts going through his head. Holmes’ lawyers chose not to mention sertraline even though they had a report saying his sertraline did it. See Prescription for Murder.
A husband like Woody Witczak on sertraline might tell his wife Kim that she would not believe the thoughts going through his head but will likely be unable to tell her that these include killing her – see Healthcare and Science. See also The Man Who Thought He Was a Monster,
Within days on an SSRI, David Rule confided thoughts he was going mad and was scared of what he might do – to his diary. But not to anyone else. He battered his wife to death a few days later. No one who knew her and him thought he was guilty. In jail, off meds, he came back to normal and couldn’t remember much of the week on meds. Despite a complete not-guilty defense, his lawyers bottled it, advised a plea deal that transformed him into a monster – see Odysseus Come Home.
Many a woman, hypnotized by sertraline or another SSRI, has finally seemed to her doctor to be calmer, leaving him thinking her pills are working and there’s no need to ask questions – a few days before she killed her children – See Marilyn Lemak.
Many a person made delirious at night by their meds has been jailed because their lawyer, rather than seeing someone with a perfect not-guilty case because of his poor memory for the key event, sees an unreliable historian (witness), who the lawyer views as standing no chance with the legal process as is.
The lawyer above gets the person to plead guilty even though, as far back as 2001 the prosecutor and judge looking at David Hawkins case who had pleaded guilty figured that but for the sertraline he took, Hawkins would not have murdered his wife. They could do so because Hawkins Australian lawyer, whose initials curiously were T.E. made is possible for them. She had a medical expert report saying he had a mitigating mental illness but T.E. figured prima face this was wrong. He was no more mentally ill than she was – there must be something else involved. She got a report on the effects of his medication and the prosecutor and judge agreed.
Healthy medical and nursing staff participated in a 1999 study run in the unit pictured here. It aimed at exploring what sertraline does. Two became suicidal and hostile (code for homicidal). Thinking as James Holmes did, one later said if she’d told us what she was thinking when on the drug we’d have locked her up – even though ordinarily we gossiped and shared coffee on a daily basis.
Sexual and Drug Assault cases share a common difficulty – putting in words what has happened in a way that a jury can get to grips with. There are still vanishingly few sexual assault convictions or, to put it the other way around, cases where the woman walks out of court exonerated (not guilty).
But the number of sexual assault successes swamp the number of successful not-guilty verdicts in drug assault cases, which can be counted on the fingers of a hand or two.
Changing Legal Systems
We say women who are sexually or otherwise assaulted but end up seen as guilty just by virtue of being a woman illustrate a deep-seated misogyny.
Telling good stories is central to Suzie M’s view on changing systems. Staging Prima Facie did more to bring about change than the discussions she had with colleagues and others over years.
A few days into Prima Facie’s run in London, she had a call from a British Judge who had been at the play the previous night and wanted to talk to her. S’s initial reaction was the play was about to be pulled but the Judge, a woman, was responsible for writing the Rules for Juries in cases and wanted to liaise about changing the Rules. A good example of the need to get women into positions where they can make a difference.
Things are changing but the legal system is still a problem for women in assault cases. Women however are taking things into their own hands and rather than be ashamed into staying quiet, they are speaking out and naming the man.
Changing Clinical Systems
Does Prima Facie offer leads for those injured by a prescription medicine, who are guilty by virtue of their infirmity. Mis-infirmity is too mild a word. The Damned is closer to the mark.
Few likely figure that someone injured by a prescription medicine is more disadvantaged than a woman or someone with the wrong skin color. See I can’t Breathe, along with I can’t Breathe II and I can’t Breathe III, and Being Black.
The bias is profound and hidden from view. As one woman in To The Last Breath put it.
The perpetrator of our distress is at home in a blister pack on the bedside table.
A perpetrator who is commonly white – definitely not black. A perpetrator who must be male as everyone is obsessed with his potency, which is viewed with awe and is allowed to sweep aside all other considerations
As many women can tell you, mentioning you take an SSRI can help a social group relax the way telling them you have epilepsy but are taking anticonvulsants or have had all your vaccines, can.
The sigh of relief on hearing you are not just taking SSRIs but doing what a doctor tells you reflects two deep-seated fears. One is the fear we only get a disease like epilepsy if we, or perhaps a parent, has sinned. We may have moved on from sin to bad luck, today, but essentially the diseased are not part of the Chosen People, the lucky ones, the Saved.
The other is the patriarchal fear of emotional women, who are all too liable to invent stories designed to harm innocent men.
Treatment that’s working shrinks our fears to a manageable size. Bad reactions – disinhibition, agitation, homicidality or asexuality on an SSRI – rattles the Chosen People. Will these wounds, like those of the dead Caesar, cry Havoc and let slip the dogs of war?
See the papers on Consent, Pharmacological Abuse and Liability. These have been on the RxISK site for 15 years and in Psychiatric Drugs Explained for 30 years. To no effect.
There is a series of 7 posts from 2015 to 2016 by Laurie Oakley starting with Pharmaceutical Rape and ending with Ending our Tolerance. But we are still being raped – maybe even more so.
As regards stories making a difference, contributors to RxISK have told and tell dramatic stories. But so far, these have had more effect compiled into publications quantitatively linking treatments to hazards rather than in accounts that make the assault live.
Shamed by Post-SSRI Sexual Dysfunction (PSSD), most sufferers spent decades, some over 3 decades, concealing their identities in the way folk with AIDs once did. In 2022, a group of them magnificently came out, publicly sharing their photos with names – I am Joseph, I am Mary etc and I have PSSD. See PSSD Podcast Episode 2. Despite this, sufferers are still dismissed in clinics – and can even be detained for Prima Facie madness. See Patient Experiences.
Thirty-five years ago, Eli Lilly, facilitated by FDA, leading medical journals (BMJ, NEJM) and presidents of psychiatric associations (APA, RCP etc), branded compelling stories of Prozac induced suicides and homicides as Anecdotes. The system lined up behind Lilly’s mantra that randomized controlled trials (RCTs) offer the Science of Cause and Effect. The only way we can, supposedly, know what a drug does is by doing an RCT.
Whatever about the failings of legal systems, legal processes created a middle ground between Church and State that prioritized us. The Rule of Law and an independent judiciary created a degree of freedom – ultimately capable of tackling misogyny.
Legal processes were also adopted by and created what we call science and these processes are central to the science of clinical medicine born in Paris in 1800. Few lawyers are aware of this. When it comes to clinical issues, many lawyers have swallowed the mantra that scientific proofs, as in RCT evidence, are more objective than the verdicts legal processes deliver – See Are Healthcare and Science Compatible.
RCTs are cryptonite to the super-powers legal systems at their best can deliver. On average (in RCTs) men don’t murder (or kill) their wives but what this case and this jury have to decide is did this man murder his wife. Saying men don’t murder wives (on average) is different to deciding if men have the capacity to murder their wives (or wives their husband). Legal trials (Cases) not clinical trials establish this.
To return to story mode – these points came to a head some years ago in Chile, where Jorge Bergoglio, the Pope, told people who had been sexually abused by priests that in order to believe them he had to have evidence but they had to believe in him and the Church.
Jorge here was going along with Eli Lilly’s strategy in 1990 and both ironically were using a defense deployed by the Pedophile Liberation Front in the 1970s – show us the evidence that pedophilia harms. Jorge apparently later recanted. Lilly and pharma haven’t.
Jorge was the first head of state to hard mandate Covid vaccines despite knowing pharma sequester study evidence, ghostwrite negative studies into positive publications, and personally knowing people badly damaged by the vaccine. The story of this man, who seemed decent in many ways, appears to have ended ironically. An RSV vaccine looks like it may have done for him.
We haven’t had Suzie Miller’s access to the Judge who writes the Jury Rules, but Brenda Hale, Spiderwoman, the recent Chair of the British Supreme Court has known about these issues for 24 years or so. I wrote to her in the wake Stephen O’Neill’s death – see The Death of Stephen O’Neill and The Perfect Killing Machine. There was no response.
I also wrote to the then CEO of the Nice Guideline committee – The NICE before Christmas – who accepted their guidelines were based on fake literature but asked what else could NICE do?
Stephen was related to Northern Ireland’s First Minister who has done nothing despite being handed a bunch of vote winning cards. If the literature on these drugs is all ghostwritten and fraudulently writes hazards out of the scripts, its no surprise that people cannot get justice when this literature is portrayed in court and the stellar science. It is also no surprise that health service costs spiral out of control and life expectancy starts falling.
After Tom Kingston, the husband of Lady Gabrielle Windsor, a member of the extended Royal Family, died by his own hand following a malignant reaction to sertraline, she said: “if this can happen Tom, it can happen anyone”.
The coroner’s verdict at his inquest clearly implicated the drug. Coroners can finger a drug at inquests and juries can in familicide cases. Doing is easy it seems when everyone in the final act is dead. But it makes no difference. It doesn’t reduce the death rate linked to these medicines.
Another option Suzie mentioned was to reject the stigma and transfer it to the assaulter. Who in this case does that mean? You might figure it must be the prescribing doctor but the prescriber is in a similar position to the assaulter’s defense lawyer whose job is to defend him.
The legal system might indeed wake up if defense lawyers got pilloried as adjuncts to sexual assaults but instead they get clapped on the back. The trouble is we still need defense lawyers. Should prescribers be pilloried as adjuncts to drug assaults?
This posts links to Health a Privilege of Wealth on DH
Continued Next Week
Anon says
Prima Facie – what an amazing piece of theatre, in the transcript, I felt I was there. All the emotion, all the tremors, all the male domination, all the stricken, that she had lost. Lost but not bowed. What a sensational piece of theatre, so very clever and so dear to our hearts.
No-one can imagine the horror of a self-induced, drug adverse affect, that suspends a life with all the fall-out that goes with it. You are not only a victim of an assault from a drug, you then have to navigate public shame and pharmaceutical companies denying any impact. You are guilty, and can never prove innocence.
This is probably by-the-by but I was at a business conference in Miami. I had an important contact, who I liked, and could have been a really good client for me as a lone woman sent to the US to introduce my company to the US market for our product. It was such a fun evening, dancing in to the night and my contact plied me with gin which I gulped as I was so thirsty from all the dancing. He gave me a lift back to my hotel and lay me on the bed. He then raped me. I knew what was happening through the haze of the gin, he got up and left. This utter creep from South Carolina. My boss would have gone berserk if I had told him. Don’t mix business and pleasure. But it was the conference ball. I was only 27, and I learnt the biggest lesson in life. I just carried on with my career, my fault, and it never occurred to me to seek redress.
The other molester
‘The perpetrator of our distress is at home in a blister pack on the bedside table’.
I had not thought about Miami for several years, until I read Laurie Oakley’s book, Crazy And It Was, and came to the same dramatic question myself.
Should prescribers be pilloried as adjuncts to drug assaults?
Not leaving it hanging there, if we didn’t have RxISK and all who sail on her fighting the corner of accused, what in the world would we do not to become just another anecdote as clearly from Prima Facie, and what the word ‘assault’ actually means when doctors clearly assaulted us, leaving us at the mercy of so much unwillingness to confront the paradoxical in which we became enveloped.
This post assimilates such a lot..
Harriet Vogt says
The words that have stayed with me from Suzie Miller’s play – ‘Violated’ –‘trapped’ – and ‘snicker’ (snigger) – fit equally well into Laurie Oakley’s piece, ‘Pharmaceutical rape’.
The same old-fashioned – well you’d hope so anyway – ‘masculine’ cultural values enable both:
POWER
Control
RATIONALITY
Achievement
Competitiveness
Anyone involved in this prescribedharm space has an acute sense that the system – and the doctors constrained by it –is programmed by industry’s need to deliver return on investment, rather than safe care for the individual human being. It’s the tangled web you often talk about.
You’ve spent years cutting the heads off the Industry Hydra – and patient survivors decades campaigning. But I think you’re right – the group who could make a tipping point difference is doctors themselves, especially those harmed and relying on peer support – the professionals who enact the commerical guidance and could disconnect it from a closed system.
It’s not an easy road. Just thinking of three harmed professionals who have endeavoured to do this – Peter G, Cathy W, Mark H. They’ve had to endure variations on the Tessa Ensler treatment. I’ve witnessed some outrageous ‘old fashioned’ oppressive masculine moves on X nee Twitter. Unscrupulous peers trying – unsuccessfully – to silence Peter with faux pity and a anosognosia ‘diagnosis’. Mark being slurred with status nonsense, ‘he’s only in training’. Cathy comes in for similar diminishment and a slight misogynistic sneer – ofc she never made consultant – how could she when she was medicated insensible for 7 years by the system? But these guys will not be deterred.
Cathy has launched the New Year with an open letter to the UK’s, albeit ludicrous, Prime Minister :
‘The fundamental problem Sir Keir, is that drugs cannot fix people’s lives. This may seem obvious when we talk about street drugs or alcohol, but are you aware of the similarities they have with prescribed psychiatric medication? It makes no sense to give people near chemical equivalents with virtually the same effects, packaged as a branded pharmaceutical and expect them to ‘cure’ non-existent physical disease! While some psychiatric drugs may temporarily alleviate the worst feelings of distress by causing sedation or numbing of the emotions, (in a similar way to the effects of self-medication with alcohol or street drugs), the truth is that these drugs cannot change the root causes of people’s problems.’
https://www.madintheuk.com/2026/01/new-year-open-letter-to-the-prime-minister/
As not being deterred you offer some great advice for those brave and principled doctors prepared to step up and take the ‘Scaremongers of the world- Unite! ‘ Challenge.
‘The only risks of an on-patent drug that can be mongered are ones that are real.’
https://davidhealy.org/scaremongerers-of-the-world-unite/
Dr. David Healy says
People will have to read your link to work out what you’re saying. This was a talk 15 years ago. Since then, the snag is the Scaremongerers haven’t united and don’t show any signs of being able to unite.
Another of my talks has a slide of a Big Fish being pursued by a shoal of little fish emblazoned with the strapline We are the 99% – suggesting we have the power and can even take sort out a Big Fish. This though is wrong. The 99% are the little fish who all want what the Big Fish has to offer – the pills, the magic.
Nobody really wants to think that the only magic there might be lies within them. This is where an ordinary girl a Dorothy comes into the frame – able to tell a scarecrow he has a brain and a lion he is courageous and a tin man he has a heart
D
mary H. says
This :- ‘Nobody really wants to think that the only magic there might be lies within them.’ really is the hardest truth to get across to people who are suffering!
Mention the use of certain supplements and some are willing to take them; mention the use of a Flow headset ( which one person has used with positive outcomes) and you have others looking into the use of such. Explain that the changes will only come from themselves and your words are like water off a duck’s back.! The greatest problem – in a group such as ours – is that many have been left suffering for so long. They have searched high and low for diagnoses, their doctors have changed their minds, and the prescriptions, umpteen times. If they are still on the drugs, as most are, their prescriptions keep on coming month by month without any connection with a doctor. Some do see a nurse every now and again. With all of this going on, the only confident piece of the puzzle being that ” at least they haven’t stopped my prescription” – how can our message of ” the magic maybe lies within” the individual hit the right spot?
We encourage people to use the proforma from rxisk Tools – the idea being that THEY decide where they’re at rather than a GP making that presumption of knowing better than a mere patient. How successful are we in getting the proforma used? Not very! One of the main reasons being FEAR. Fear that, if they stand up for themselves, the GP will either class them as being quite seriously deluded or their regular prescription will be discontinued. Overcoming that fear is so very difficult – but, actually, quite understandable when taking into consideration everything that has happened in their GP meetings’ history. We know that doctors, in the main, do their best for all patients ( we hope!) BUT with all knowledge now available to us, the public, isn’t it high time that doctors become fully aware of it too?
Trust has been lost – not only our trust in doctors but, also, our trust in OURSELVES.
Dr. David Healy says
Mary
You’re describing not very loving relationships, transactional at best, assault at times. It must leave most people with a degree of Imposter Syndrome.
You’re also describing what we found in the early days of RxISK. Figuring that having a RxISK report would somewhat level the playing field, we made them available for people to take to doctors. Now people have made good use of them and helped do good with them but they close to universally backed out of taking them to doctors figuring that the response would be aggressive and hostile.
We are in the middle of the Wizard of Oz story. We need someone who can see the courage and brains and passion in people injured by meds and get them acting on that – helping to pull back the curtain which reveals —
— someone who has been cleaned up and maybe put in smart clothes and has a bit of medical jargon – biobabble – that they spout but who when it comes to meds knows less about them that the folk who have had to learn by bitter experience.
The only time this changes is when some of these ordinary people who feel they are imposters – almost always women – have a child who is harmed. At times like that the dude behind the curtain does as s/he is told if s/he has any sense
David
mary H. says
With reference to this paragraph:-
‘The only time this changes is when some of these ordinary people who feel they are imposters – almost always women – have a child who is harmed. At times like that the dude behind the curtain does as s/he is told if s/he has any sense.’
As long as the woman with a harmed child is not, herself, also harmed, I guess that ,yes, that is true – true that the woman will do whatever is possible to fight for the rights of the child. I’m not sure that all ‘dudes behind the curtain’ do as they are told though!
I wonder how matters would play out if the mother, herself, was also being treated for mental health matters? I know how often I was referred to as the “fussing mother” – told to “let him go and live his life” etc. How much worse would it have been if I was a sufferer also – would accusations of Munchausen Syndrome or some such label appear in my medical records?
I do feel that the only way forward is to be aware that a doctor is there to help, not hinder our health. What I would like to see, from their side, is doctors owning up when they are baffled by a patient’s condition – asking for a second opinion to make sure that their diagnosis is as it should be and taking into consideration the words of those who see the patient 24/7 rather than judge by the 10 minutes that they have to sum it all up.
As of this week, I understand that all GPs in England must obey a new “three strikes rule” :-
“The new three strikes rule in England, known as Jess’s Rule, aims to enhance patient safety by encouraging GPs to re-evaluate diagnoses if a patient presents with the same symptoms three times.
Named after Jessica Brady, who tragically died of cancer after being misdiagnosed, the rule emphasizes the importance of listening to patients’ concerns and recognizing their expertise in their own bodies.
GPs are encouraged to conduct thorough examinations, order additional tests, and seek second opinions if they have not been able to provide a substantiated diagnosis after three appointments.
This initiative is part of a broader effort to ensure earlier detection of serious illnesses, particularly in younger patients and those from ethnic minority backgrounds.
The rule is being rolled out across all GP surgeries in England, with posters displayed in consultation rooms to remind healthcare professionals of the importance of this safety measure. ”
Will this make a difference in the field of mental health I wonder?
Dr. David Healy says
You are absolutely right not to swallow my simple happy ever after tale too readily or completely. The dude behind the curtain can often remain nasty even in the face of a Tiger mother and is quite capable of creating a Munchausen Syndrome by Proxy label and calling in social services.
The situation is violent. And partly of our own making. Tiger Moms are more likely to have dragged their children along for a treatment that results in them being injured – sometimes because the mother herself is on the same treatment. I didn’t mean to oversimplify.
But the fact that Dorothy goes into the Wizard’s lair with a gang points to something. Our situation is rather like tenant farmers (or perhaps apartment renters now) who had to cope with abusive landlords. They got together and developed weapons like the boycott and ultimately co-operative movements. We ideally need something like health co-operatives, where the doctor is either one of us or knows he is going to be faced with a gang unless he behaves like one of us.
I’ve never seen any of these laws make much difference. Have you?
D
annie says
Take a Big Note of Millie
Daughter’s death leads to Fringe debut at 79 – The Times
A 79-year-old woman will make her debut as a playwright on Monday with a play about the potentially devastating impact of prescription drugs. Millie Kieve’s production, Cruise to Hell, is …
Millie and the Tsar
Meanwhile, at the age of 79, the indomitable Millie Kieve made her debut at the Edinburgh Festival Fringe in August this year, telling the story of the Cruise to Hell (below), in which she relived the tragedy of her daughter’s medication-induced death in 1995.
http://antidepaware.co.uk/millie-and-the-tsar/
Cruise to Hell – True story at EdFringe 2019
https://vimeo.com/415328274
Deeply moving, desperately sad, Millie puts her daughter on the Rxisk map
annie says
The Marilyn Lemak Case
https://www.youtube.com/watch?v=PiC4T5zsE48
Be interesting to see how this case unfolds, the ‘Seven’ dwarfs they will not read to their kids – Doc…
Husband of woman accused of killing their 3 kids in ‘postpartum madness’ SUES doctors for overmedicating her
https://archive.ph/XCo7t
From September 2022 to January 2023, Lindsay suffered from depression and was prescribed multiple psychiatric drugs including antidepressants, mood stabilizers, and benzodiazepines, per the suit.
Her attorneys claim the meds caused paranoia, suicidal thoughts, and fear of being alone, with no lab work conducted after they were prescribed.
The suit also claims she checked into Women & Infants Hospital for postpartum depression, where staff suspected her deteriorating mental health were caused by overmedication and misdiagnosis.
Prosecutors have argued that Lindsay knew what she was doing the night her children died and that the seven medications in her system would not have suddenly driven her to kill them.
Snow White and the ‘seven’ dwarfs – Doc, Grumpy, Happy, Sleepy, Bashful, Sneezy, and Dopey