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Blood-Injury Phobia: A “Reasonable Excuse” for Failing to Give a Specimen in a Case of Suspected Drunken Driving
J.F.S.S. COMMENTARY
Blood-Injury Phobia: A "Reasonable Excuse" for Failing to Give a Specimen in a Case of Suspected Drunken Driving G. H. GUDJONSSON and G. SARTORY Department of Psychology, Institute of Psychiatry, De Crespigny Park, Denmark Hill, London, United Kingdom SE.5 8AF Abstract This paper illustrates the application of an experimental procedure to blood-injury phobia in a case of suspected drunken driving. Cardiac reactions have been shown to discriminate between blood-injury phobia and other phobias. Whereas the latter are accompanied by an increase in heart-rate, bloodinjury phobics react with a decrease in heart-rate when confronted with relevant material. A defendant was tested and exhibited a heart-rate pattern characteristic of blood-injury phobics. The finding was presented in a Crown Court of Appeal. On the basis of the totality of evidence the defendant was acquitted and was considered to have a "reasonaue excuse" to refuse to give a specimen. Key Words: Alcohol; Urine; Psychology; Traumatic events. Journal of the Forensic Science Society 1983; 23: 197-201 Received 13 July 1982 Introduction The purpose of this paper is to report a recent court case where a defendant was acquitted by a Court of Appeal for failing to give a blood and urine specimen to the police after having been arrested on the suspicion of drunken driving. The defendant had three months previously been found guilty in a Magistrates Court for failing to give a specimen of blood or urine for a laboratory test. A Notice of Appeal was immediately filed against the conviction on the grounds that the defendant was not guilty of the offence as he could not stand the sight of blood. The case was referred to the Institute of Psychiatry and a psychophysiological experiment was carried out in order to investigate whether or not the defendant had a genuine fear of the sight of blood. This paper reports how the findings were presented in Court and evaluated. The psychophysiological evidence helped to convince the Court that the defendant was sufficiently disturbed by the sight of blood as to provide a reasonable excuse for his refusing to give a blood specimen to the police at the time of his arrest. Legal Requirements The maximum level of alcohol permitted by law in a motorist who is in charge of a vehicle is 80mg per lOOmls of blood or 107mg of urine. Before 1967 if a motorist was suspected of drunken driving he was asked to offer a blood or urine specimen voluntarily, but he could not be compelled to do so. A breathalyser test is now used to estimate approximately whether or not the alcohol in the body is likely to exceed the legal requirement. If the test indicates a level exceeding the legal limit the driver can be arrested and taken to the police station where he is required to provide a specimen of blood. If the accused refuses he will be asked to provide two specimens of urine within an hour. If he
fails or refuses he must be asked again to supply a specimen of blood. If this fails without a reasonable excuse the suspect will be found guilty of the offence, even though the alcohol in his body may well be below the legal requirement. What constitutes a reasonable excuse is debatable since there are no general principles and guidance can only be obtained from decided cases. In R. v. Lennard [l] it was argued by the defence that the suspect was physically unable to give urine and mentally unable to give blood. The Court of Appeal held that no excuse can be adjudged a reasonable one unless the person from whom the specimen is required is physically or mentally unable to provide it or the provision of the specimen would entail a substantial risk to health. I n such cases medical evidence is invariably required. I n cases of severe blood-injury phobia, people may be sufficiently disturbed by the thought or act of giving blood to be considered mentally unable to provide a specimen. Whether such a condition is sufficient to provide a "reasonable excuse" for failing to give a specimen is for the Court to decide. I t could not be generally argued that phobics are physically unable to provide a specimen or that it might entail a substantial risk to their health.
Blood-injury phobia A considerable number of people, namely 3 1 in 1000 according to Agras [2], are phobic of the sight of blood and stimuli associated with the extraction of blood samples. Blood-injury phobia may develop after having fainted when giving blood or after injuries. Phobics will typically avoid contact with medical establishments and any other settings in which blood relevant stimuli can be seen. During the past two decades blood-injury stimuli have been shown to elicit different heart-rate responses compared with those observed in other phobic situations [3-61, namely, blood-injury phobia is associated with lowered heart rate (bradycardia) unlike the usual cardiac acceleration to other phobic stimuli [7]. In a threatening situation, that is, when a request for a blood sample is made, blood-injury phobics will typically show increased heart-rate followed by a marked decrease which may precede fainting [6]. Bradycardia has also been observed in some non-blood phobic subjects during venepuncture and whilst giving a blood specimen [3]. However, without the threat of venepuncture no bradycardia to blood-injury stimuli was observed in "normal" subjects when stimuli were presented for fairly short periods of time [8]. There is some evidence that substantial bradycardia can be produced voluntarily by such means as breath holding, but such reactions typically emerge gradually over long periods of time [9]. Circumstances of the ofence C.B., the defendant, was stopped by the police late at night for a speeding offence and given a breath test. C.B. claimed to have drunk three pints of beer between 8 and 11 p.m. in three separate public houses. As the test proved positive he was taken to the police station, given another breath test, and subsequently asked to give a blood specimen. Having explained to the police officers that he was terrified of the sight of blood, C.B. was permitted to give a urine specimen which he successfully did. However, in spite'of several attempts, C.B. was unable to give a second urine specimen within the hour as required by law. He was again asked to give blood but refused. Shortly afterwards he offered to try to urinate again but the police officers told him it was too late. C.B. was subsequently charged and convicted of failing to give a specimen of blood and urine for a laboratory test without a reasonable excuse. A Notice of Appeal was filed and the defendant was referred for expert evidence by the defence lawyer.
Methods and Results I n the interview with C.B., as well as his elder sister and wife, it emerged that
the defendant had been frightened of the sight of blood since an accident in childhood and had previously refused to give blood when requested by his doctor. He avoided any setting associated with blood (e.g. violent films, hospitals, fights, going into butchers' shops) and was helped in doing so by his family. He was able to visit the dentist although he found it stressful. The defendant had never actually fainted because he always left the threatening situation before reaching a "point of no return". Feelings of anxiety were accompanied by light-headedness, cold sweat and impending loss of balance which are commonly associated with panic states. During the interview the defendant stated that he was not prepared to give a blood sample during testing. Consequently, it was decided to record heart-rate during presentations of stimuli only. The stimuli consisted of three bloodrelated items (a little bottle containing blood, and two syringes that differed in size) and four control items that were of a similar size and shape to the critical items (small bottles containing water, glue, and TippEx fluid). The stimuli were presented for 15 seconds each and there was an inter-stimulus interval of 30 seconds. The stimuli were presented four times in random order from a distance of approximately three yards. Before each trial the subject was informed about the nature of the item to be presented. Testing was carried out in a relaxed atmosphere due to assurances that the defendant would not be required to give a blood specimen. Respiration was also monitored throughout the experiment in order to detect any irregularities in breathing. The pulse was recorded by means of an ear-lobe photoplethysmograph and the amplified signal was converted into beats per minute (bpm) by a rate meter. Respiration was recorded by means of a thermistor attached to the right nostril. A marker operated by the experimenter, signalled onset of presentations to allow location of the responses on the record. Heart-rate and the marker were recorded on a magnetic tape to be subsequently analysed on a laboratory computer (LING-8). Response magnitude to test and control trials, as well as the basal level of heart-rate and range of sinus arrhythmia (the ongoing variations in heart-rate), were assessed. The defendant's basal heart-rate was 75bpm with average fluctuations of 3bpm which is a normal resting rate and supports the notion that the subject was relaxed during the testing procedure. Heart-rate changes to the "neutral" objects were scored at the same latency as those to the relevant items. Response deflection varied from 72.0 to 78.2bpm and were well within the range of normal sinus-arrhythmia. There was no evidence of bradycardia upon the presentation of the "neutral" objects. Upon presentation of the small syringe which had a needle attached, heartrate was lowered by 8 beats to 66-3bpm. The longer syringe without a needle prompted a deceleration of 7bpm to 67.1bpm. Presentation of the blood sample was accompanied by a deceleration of lObpm (64.8). Response amplitudes decreased over repeated presentations whilst the subject also reported less fear of them. However, the last presentation of the blood sample still evoked a heart-rate deceleration of 7bpm (67.2). The onset of the heart-rate deceleration was noted immediately after the visual presentation of the critical stimulus. The heart-rate remained decelerated until the stimulus disappeared from view, after which the heart-rate rapidly returned to baseline. Considering that the test stimuli constituted no threat of impending venepuncture, the marked heart-rate responses to the blood container and syringes lended support to the diagnosis of blood-injury phobia. There was no change in the rate of respiration to any of the stimuli. This suggests that the defendant was not deliberately attempting to alter his heart-rate responses by means of breath holding.
Discussion During the court appearance the prosecution alleged that the defendant had
refused to give a blood sample in order to avoid conviction. Countering the plea of blood-injury phobia the prosecution argued that the defendant did not avoid dental visits and had once had a tooth extracted. Furthermore, the defendant had never actually fainted. However, the expert witness (the first author) pointed out for the defence that, although the populations of dental phobics and blood-injury phobics overlapped, the two phobias did not always coincide: the absence of fainting in the defendant was due to his recognition of symptoms preceding a faint and rapid escape from the setting which elicited them. The evidence from the interview and the laboratory test were presented when it was also pointed out that these kinds of heart-rate decelerations were unlikely to be caused by deception for the following reasons. Firstly, since bradycardia is paradoxical to the usual cardiovascular responses to phobic stimuli and the phenomenon is not widely known, a person attempting to fake the results would probably try to increase cardiovascular output rather than the reverse as to lay people this would be the expected pattern. Secondly, the onset of the bradycardia was noted immediately after the onset of the critical stimuli and was maintained until the stimuli were withdrawn. This pattern was considered more consistent with genuine phobia than voluntary manipulation. During the case the arresting police officers gave evidence to the effect that the defendant had shown no physical signs of alcoholic intoxication a t the time of his arrest and appeared to become very apprehensive when failing to give a second urine specimen. The defendant was acquitted with the following conclusions: a) C.B. was at the time of his arrest considered to have been physically unable to provide a second specimen of urine as required by law, due to mental condition precipitated by severe anxiety. b) I t was considered that the sight of blood was so repellent to C.B. that a t the time of his arrest he was mentally incapable of providing a blood sample. Haward identifies four distinct roles that are relevant to psychological evidence presented in English Courts [lo]. These he labels the "clinical", actuarial", "advisory" and "experimental" roles. Although not the most common role, establishing the probity of testimony by experimental procedures is one of the most unique and valuable contributions that psychologists can make to court cases. The experimental role is the oldest of the four roles and developed from the Leipzig school of Wundt in the early part of this century. Originally psychologists merely reported the results of general psychological experiments that appeared relevant to the legal arguments. Although psychologists still quote general findings they are now more inclined to carry out field studies and laboratory experiments that are of direct relevance to the particular case [lo, 111. In the present case psychophysiological methods were applied to a problem whose manifestations have been well documented recently. The laboratory evidence of heart-rate deceleration to blood-related stimuli thus lent objective support to the notion of the presence of blood-injury phobia, and the Court considered the presence of the phobia to be sufficient for the defendant to have a "reasonable excuse" for failing to give a blood specimen. However, the Court was aware of the case's legal implications, showing concern about opening the "flood gate" to people exhibiting phobic symptoms. The judges accepted that each case had to be considered according to its merit and the outcome of the trial would only give precedence to people who were proven to be genuinely phobic. 6'
References 1. R. v Lennard. All England Law Reports 1973: 831-832. 2. Agras S, Sylvester D and Oliveau D. The epidemiology of common fears and phobia. Comprehensive Psychiatry 1969; 10: 151-156. 3. Graham DT, Kabler JD and Lunsford L. Prediction of fainting in blood donors. Circulation 1961 ; 23: 901-906.
4. Cohn CH, Kron RE and Brady JP. A case of blood-injury illness phobia treated behaviourally. Journal of Nervous and Mental Disease 1976; 162: 65-68. 5. Marks I. Cure and Case of Neuroses. Theory and practice of behavioural psychotherapy. Chichester: John Wiley & Sons, 1981. 6. Wardle J and Jarvis M. The paradoxical fear response to blood, injury and illness-A treatment report. Behavioural Psychotherapy 1981; 9: 13-24. 7. Sartory G, Rachman S and Grey SJ. An investigation of the relation between reported fear and heart-rate. Behaviour Research and Therapy 1977; 15: 435-438. 8. Prigatano GP and Johnson HJ. Autonomic nervous system changes associated with a spider phobic reaction. Journal of Abnormal Psychology 1974; 83: 169-177. 9. Ross A and Steptoe A. Attenuations of the diving reflex in man by mental stimulation. Journal of Physiology 1980; 302: 387-393. 10. Haward LRC. Forensic Psychology. London: Batsford Academic Press, 1981. 11. Gudjonsson G H and Gunn J. The competence and reliability of a witness in a criminal court: A case report. British Journal of Psychiatry. 1982; 141: 624-627.
Blood-Injury Phobia: A "Reasonable Excuse" for Failing to Give a Specimen in a Case of Suspected Drunken Driving G. H. GUDJONSSON and G. SARTORY Department of Psychology, Institute of Psychiatry, De Crespigny Park, Denmark Hill, London, United Kingdom SE.5 8AF Abstract This paper illustrates the application of an experimental procedure to blood-injury phobia in a case of suspected drunken driving. Cardiac reactions have been shown to discriminate between blood-injury phobia and other phobias. Whereas the latter are accompanied by an increase in heart-rate, bloodinjury phobics react with a decrease in heart-rate when confronted with relevant material. A defendant was tested and exhibited a heart-rate pattern characteristic of blood-injury phobics. The finding was presented in a Crown Court of Appeal. On the basis of the totality of evidence the defendant was acquitted and was considered to have a "reasonaue excuse" to refuse to give a specimen. Key Words: Alcohol; Urine; Psychology; Traumatic events. Journal of the Forensic Science Society 1983; 23: 197-201 Received 13 July 1982 Introduction The purpose of this paper is to report a recent court case where a defendant was acquitted by a Court of Appeal for failing to give a blood and urine specimen to the police after having been arrested on the suspicion of drunken driving. The defendant had three months previously been found guilty in a Magistrates Court for failing to give a specimen of blood or urine for a laboratory test. A Notice of Appeal was immediately filed against the conviction on the grounds that the defendant was not guilty of the offence as he could not stand the sight of blood. The case was referred to the Institute of Psychiatry and a psychophysiological experiment was carried out in order to investigate whether or not the defendant had a genuine fear of the sight of blood. This paper reports how the findings were presented in Court and evaluated. The psychophysiological evidence helped to convince the Court that the defendant was sufficiently disturbed by the sight of blood as to provide a reasonable excuse for his refusing to give a blood specimen to the police at the time of his arrest. Legal Requirements The maximum level of alcohol permitted by law in a motorist who is in charge of a vehicle is 80mg per lOOmls of blood or 107mg of urine. Before 1967 if a motorist was suspected of drunken driving he was asked to offer a blood or urine specimen voluntarily, but he could not be compelled to do so. A breathalyser test is now used to estimate approximately whether or not the alcohol in the body is likely to exceed the legal requirement. If the test indicates a level exceeding the legal limit the driver can be arrested and taken to the police station where he is required to provide a specimen of blood. If the accused refuses he will be asked to provide two specimens of urine within an hour. If he
fails or refuses he must be asked again to supply a specimen of blood. If this fails without a reasonable excuse the suspect will be found guilty of the offence, even though the alcohol in his body may well be below the legal requirement. What constitutes a reasonable excuse is debatable since there are no general principles and guidance can only be obtained from decided cases. In R. v. Lennard [l] it was argued by the defence that the suspect was physically unable to give urine and mentally unable to give blood. The Court of Appeal held that no excuse can be adjudged a reasonable one unless the person from whom the specimen is required is physically or mentally unable to provide it or the provision of the specimen would entail a substantial risk to health. I n such cases medical evidence is invariably required. I n cases of severe blood-injury phobia, people may be sufficiently disturbed by the thought or act of giving blood to be considered mentally unable to provide a specimen. Whether such a condition is sufficient to provide a "reasonable excuse" for failing to give a specimen is for the Court to decide. I t could not be generally argued that phobics are physically unable to provide a specimen or that it might entail a substantial risk to their health.
Blood-injury phobia A considerable number of people, namely 3 1 in 1000 according to Agras [2], are phobic of the sight of blood and stimuli associated with the extraction of blood samples. Blood-injury phobia may develop after having fainted when giving blood or after injuries. Phobics will typically avoid contact with medical establishments and any other settings in which blood relevant stimuli can be seen. During the past two decades blood-injury stimuli have been shown to elicit different heart-rate responses compared with those observed in other phobic situations [3-61, namely, blood-injury phobia is associated with lowered heart rate (bradycardia) unlike the usual cardiac acceleration to other phobic stimuli [7]. In a threatening situation, that is, when a request for a blood sample is made, blood-injury phobics will typically show increased heart-rate followed by a marked decrease which may precede fainting [6]. Bradycardia has also been observed in some non-blood phobic subjects during venepuncture and whilst giving a blood specimen [3]. However, without the threat of venepuncture no bradycardia to blood-injury stimuli was observed in "normal" subjects when stimuli were presented for fairly short periods of time [8]. There is some evidence that substantial bradycardia can be produced voluntarily by such means as breath holding, but such reactions typically emerge gradually over long periods of time [9]. Circumstances of the ofence C.B., the defendant, was stopped by the police late at night for a speeding offence and given a breath test. C.B. claimed to have drunk three pints of beer between 8 and 11 p.m. in three separate public houses. As the test proved positive he was taken to the police station, given another breath test, and subsequently asked to give a blood specimen. Having explained to the police officers that he was terrified of the sight of blood, C.B. was permitted to give a urine specimen which he successfully did. However, in spite'of several attempts, C.B. was unable to give a second urine specimen within the hour as required by law. He was again asked to give blood but refused. Shortly afterwards he offered to try to urinate again but the police officers told him it was too late. C.B. was subsequently charged and convicted of failing to give a specimen of blood and urine for a laboratory test without a reasonable excuse. A Notice of Appeal was filed and the defendant was referred for expert evidence by the defence lawyer.
Methods and Results I n the interview with C.B., as well as his elder sister and wife, it emerged that
the defendant had been frightened of the sight of blood since an accident in childhood and had previously refused to give blood when requested by his doctor. He avoided any setting associated with blood (e.g. violent films, hospitals, fights, going into butchers' shops) and was helped in doing so by his family. He was able to visit the dentist although he found it stressful. The defendant had never actually fainted because he always left the threatening situation before reaching a "point of no return". Feelings of anxiety were accompanied by light-headedness, cold sweat and impending loss of balance which are commonly associated with panic states. During the interview the defendant stated that he was not prepared to give a blood sample during testing. Consequently, it was decided to record heart-rate during presentations of stimuli only. The stimuli consisted of three bloodrelated items (a little bottle containing blood, and two syringes that differed in size) and four control items that were of a similar size and shape to the critical items (small bottles containing water, glue, and TippEx fluid). The stimuli were presented for 15 seconds each and there was an inter-stimulus interval of 30 seconds. The stimuli were presented four times in random order from a distance of approximately three yards. Before each trial the subject was informed about the nature of the item to be presented. Testing was carried out in a relaxed atmosphere due to assurances that the defendant would not be required to give a blood specimen. Respiration was also monitored throughout the experiment in order to detect any irregularities in breathing. The pulse was recorded by means of an ear-lobe photoplethysmograph and the amplified signal was converted into beats per minute (bpm) by a rate meter. Respiration was recorded by means of a thermistor attached to the right nostril. A marker operated by the experimenter, signalled onset of presentations to allow location of the responses on the record. Heart-rate and the marker were recorded on a magnetic tape to be subsequently analysed on a laboratory computer (LING-8). Response magnitude to test and control trials, as well as the basal level of heart-rate and range of sinus arrhythmia (the ongoing variations in heart-rate), were assessed. The defendant's basal heart-rate was 75bpm with average fluctuations of 3bpm which is a normal resting rate and supports the notion that the subject was relaxed during the testing procedure. Heart-rate changes to the "neutral" objects were scored at the same latency as those to the relevant items. Response deflection varied from 72.0 to 78.2bpm and were well within the range of normal sinus-arrhythmia. There was no evidence of bradycardia upon the presentation of the "neutral" objects. Upon presentation of the small syringe which had a needle attached, heartrate was lowered by 8 beats to 66-3bpm. The longer syringe without a needle prompted a deceleration of 7bpm to 67.1bpm. Presentation of the blood sample was accompanied by a deceleration of lObpm (64.8). Response amplitudes decreased over repeated presentations whilst the subject also reported less fear of them. However, the last presentation of the blood sample still evoked a heart-rate deceleration of 7bpm (67.2). The onset of the heart-rate deceleration was noted immediately after the visual presentation of the critical stimulus. The heart-rate remained decelerated until the stimulus disappeared from view, after which the heart-rate rapidly returned to baseline. Considering that the test stimuli constituted no threat of impending venepuncture, the marked heart-rate responses to the blood container and syringes lended support to the diagnosis of blood-injury phobia. There was no change in the rate of respiration to any of the stimuli. This suggests that the defendant was not deliberately attempting to alter his heart-rate responses by means of breath holding.
Discussion During the court appearance the prosecution alleged that the defendant had
refused to give a blood sample in order to avoid conviction. Countering the plea of blood-injury phobia the prosecution argued that the defendant did not avoid dental visits and had once had a tooth extracted. Furthermore, the defendant had never actually fainted. However, the expert witness (the first author) pointed out for the defence that, although the populations of dental phobics and blood-injury phobics overlapped, the two phobias did not always coincide: the absence of fainting in the defendant was due to his recognition of symptoms preceding a faint and rapid escape from the setting which elicited them. The evidence from the interview and the laboratory test were presented when it was also pointed out that these kinds of heart-rate decelerations were unlikely to be caused by deception for the following reasons. Firstly, since bradycardia is paradoxical to the usual cardiovascular responses to phobic stimuli and the phenomenon is not widely known, a person attempting to fake the results would probably try to increase cardiovascular output rather than the reverse as to lay people this would be the expected pattern. Secondly, the onset of the bradycardia was noted immediately after the onset of the critical stimuli and was maintained until the stimuli were withdrawn. This pattern was considered more consistent with genuine phobia than voluntary manipulation. During the case the arresting police officers gave evidence to the effect that the defendant had shown no physical signs of alcoholic intoxication a t the time of his arrest and appeared to become very apprehensive when failing to give a second urine specimen. The defendant was acquitted with the following conclusions: a) C.B. was at the time of his arrest considered to have been physically unable to provide a second specimen of urine as required by law, due to mental condition precipitated by severe anxiety. b) I t was considered that the sight of blood was so repellent to C.B. that a t the time of his arrest he was mentally incapable of providing a blood sample. Haward identifies four distinct roles that are relevant to psychological evidence presented in English Courts [lo]. These he labels the "clinical", actuarial", "advisory" and "experimental" roles. Although not the most common role, establishing the probity of testimony by experimental procedures is one of the most unique and valuable contributions that psychologists can make to court cases. The experimental role is the oldest of the four roles and developed from the Leipzig school of Wundt in the early part of this century. Originally psychologists merely reported the results of general psychological experiments that appeared relevant to the legal arguments. Although psychologists still quote general findings they are now more inclined to carry out field studies and laboratory experiments that are of direct relevance to the particular case [lo, 111. In the present case psychophysiological methods were applied to a problem whose manifestations have been well documented recently. The laboratory evidence of heart-rate deceleration to blood-related stimuli thus lent objective support to the notion of the presence of blood-injury phobia, and the Court considered the presence of the phobia to be sufficient for the defendant to have a "reasonable excuse" for failing to give a blood specimen. However, the Court was aware of the case's legal implications, showing concern about opening the "flood gate" to people exhibiting phobic symptoms. The judges accepted that each case had to be considered according to its merit and the outcome of the trial would only give precedence to people who were proven to be genuinely phobic. 6'
References 1. R. v Lennard. All England Law Reports 1973: 831-832. 2. Agras S, Sylvester D and Oliveau D. The epidemiology of common fears and phobia. Comprehensive Psychiatry 1969; 10: 151-156. 3. Graham DT, Kabler JD and Lunsford L. Prediction of fainting in blood donors. Circulation 1961 ; 23: 901-906.
4. Cohn CH, Kron RE and Brady JP. A case of blood-injury illness phobia treated behaviourally. Journal of Nervous and Mental Disease 1976; 162: 65-68. 5. Marks I. Cure and Case of Neuroses. Theory and practice of behavioural psychotherapy. Chichester: John Wiley & Sons, 1981. 6. Wardle J and Jarvis M. The paradoxical fear response to blood, injury and illness-A treatment report. Behavioural Psychotherapy 1981; 9: 13-24. 7. Sartory G, Rachman S and Grey SJ. An investigation of the relation between reported fear and heart-rate. Behaviour Research and Therapy 1977; 15: 435-438. 8. Prigatano GP and Johnson HJ. Autonomic nervous system changes associated with a spider phobic reaction. Journal of Abnormal Psychology 1974; 83: 169-177. 9. Ross A and Steptoe A. Attenuations of the diving reflex in man by mental stimulation. Journal of Physiology 1980; 302: 387-393. 10. Haward LRC. Forensic Psychology. London: Batsford Academic Press, 1981. 11. Gudjonsson G H and Gunn J. The competence and reliability of a witness in a criminal court: A case report. British Journal of Psychiatry. 1982; 141: 624-627.