Elaine O’Hara’s psychiatrist has said he would have been “very surprised” if his patient’s mood had “slipped back suddenly” when she was discharged from hospital on the day she disappeared.
Dr Matt Murphy told a jury at the Graham Dwyer murder trial he would have been “very hopeful at least about the immediate future” for Ms O’Hara when she was discharged from St Edmundsbury Hospital, Lucan, on August 22nd, 2012.
He said if her mood had slipped back, he would have been surprised and disappointed “if she hadn’t turned back to us for help”.
Under cross-examination, Dr Murphy said he acknowledged the immediate aftermath of discharge from hospital was “a high risk period”. “I think it is generally accepted that post discharge phase is a risky time,” he said.
Graham Dwyer (42), an architect from Kerrymount Close in Foxrock, is charged with murdering childcare worker Ms O’Hara (36), on August 22nd, 2012. He has pleaded not guilty.
Ms O’ Hara’s remains were found in forestry on Kilakee Mountain, Rathfarnham, on September 13th, 2013.
Dr Murphy said Ms O’Hara was in better form than he had ever seen her on the day she was discharged. She was bright, cheerful and optimistic.
Dr Murphy said he treated Ms O’Hara from 2007 on after the sudden death of her psychiatrist, Prof Anthony Clare.
He said he reviewed her notes beginning with the first time she saw Prof Clare on August 5th, 1992, when she was 16. He said from the age of 12 she had fantasies and talked a good deal about “a play in her head”. This involved “a sort of imaginary situation” where she was engaged with others “in restraint situations and the like”. But, he said, the preoccupation seems to have “petered out to a large extent” by the time he began treating her.
He said when Prof Clare saw her, he thought she might have had an emerging psychotic illness, but she was ultimately diagnosed with a borderline personality disorder and depression.
Dr Murphy said a person with a personality disorder registers emotions “very acutely and strongly”, and has extremely low self-esteem. He said Ms O’Hara was admitted to hospital 14 times over her lifetime. There had been suicide attempts, including self-harm and overdoses.
Dr Murphy also said she told him in February 2009 that she had been pregnant, but lost the baby at four or five weeks.
She had also reported masochistic behaviour, about having pain inflicted on her, he said. She spoke about this in “an evasive way”.
Dr Murphy said her last admission, on July 14th, 2012, was triggered when she called the hospital and told them she was depressed and either thinking of or constructing a noose to hang herself.
“I felt it was the right thing to do, to bring her in and see how the situation went,” he said.
He said he felt that, during her last admission to hospital, she was dealing with her emotions better and in a more mature way.
“We all felt there was a distinct improvement,” he said.
Under cross-examination from Ronan Kennedy BL, for Mr Dwyer, notes taken when Ms O’Hara was admitted to hospital, on July 14th, were read to the jury.
A note from a registrar said Ms O’Hara “denies child sexual abuse” and “refuses to discuss details from that time”, but acknowledged she had been bullied at school.
Mr Kennedy also opened a letter to the court written by Prof Clare in November 2006 to Dr Margaret Griffin, an endocrinologist.
It noted Ms O’Hara’s elevated testosterone levels did not play a role in her “disturbing behaviour”.
“Her sexuality is certainly disturbed, masculinised even, and yet her disturbance is a relatively subtle one,” the letter said.
Ms O’Hara had told Prof Clare “I’d rather be a boy” and “I don’t like being a girl”. Her dress sense was assessed as “not especially feminine”.
It was not going to be diabetes that determined the fate of Ms O’Hara, Prof Clare had said.
During her stay in hospital in 2012, Ms O’Hara’s mood was monitored by staff and she admitted to having suicidal thoughts on some occasions, her medical notes show. She also scratched her arm on one occasion after spending a couple of hours at the newsagent’s she worked in. Her notes said she did it “to relieve the tension”. She had also burnt her arm with an iron.
Dr Murphy said he viewed this as “a minor setback in her attempts to deal with her stresses, strains and frustrations without self-harming”.
By the time she was discharged, Ms O’Hara’s notes said she was calm and relaxed and had “suicidal thoughts all the time” but “denies any plan or intent”.
Mr Justice Tony Hunt told the jury they would be required again on Monday.
