2.Erin Bigler — Direct/Cross/Redirect/Recross
332 linesERIN BIGLER, being first duly sworn, testified as follows:
COURT CLERK: Have a seat up there, sir. Once you're seated, state your full name, spelling your last, please.
ERIN BIGLER: So my name is Erin, E-R-I-N, David Bigler, B-I-G-L-E-R.
DIRECT EXAMINATION BY MR. YOUNG:
BOYD YOUNG: Dr. Bigler, can you tell the jury a little bit about yourself? Where do you work, what do you do?
ERIN BIGLER: Sure. This last year, I retired from Brigham Young University where I was Professor of Psychology and Neuroscience and Director of the Magnetic Resonance Imaging research facility there. I still maintain my Adjunct appointments at the University of Utah in psychiatry and neurology. I am a clinical neuropsychologist, that is a psychologist who focuses on understanding brain and behavior relationships. And I have a particular background in looking at brain imaging methods and how to utilize those findings to relate to the behavior of the individual.
BOYD YOUNG: Have you published any articles in this area of looking at brain scans?
ERIN BIGLER: Yes. I was a professor for 43 years and directed a large research laboratory. And I also directed the Clinical Neuropsychology Training Subspecialty Program at the University and oversaw the neuropsychology clinical service there. And during that period of time, I was very involved in research and publishing. I've edited or written 13 textbooks and over 380 peer-reviewed articles in this area.
BOYD YOUNG: Have you testified as an expert in courts before?
ERIN BIGLER: Yes, I have.
BOYD YOUNG: Do you know about how many times?
ERIN BIGLER: Several hundred.
BOYD YOUNG: Your Honor, at this time, the Defense would offer Dr. Bigler as an expert in neuropsychology.
THE COURT: Any voir dire?
RICK HUBBARD: No, sir.
THE COURT: No voir dire. Dr. Bigler is offered as an expert in the field of neuropsychology and he may offer opinions in that field.
BOYD YOUNG: Dr. Bigler, I'm going to show you what's been marked for ID as Defense Exhibit number 136 and ask if you recognize that. (Whereupon, Defendant's Exhibit 136 was marked for identification only.)
ERIN BIGLER: Yes.
BOYD YOUNG: And what is that?
ERIN BIGLER: It's referred to as a curriculum vitae, a resume. It summarizes my professional background.
BOYD YOUNG: At this time, we would offer Dr. Bigler's CV as Defense 136 into evidence.
RICK HUBBARD: Your Honor, I think consistent with your prior ruling --
THE COURT: So y'all understand, the CV, the resume, all experts have that to show their work history, their education, their background, their publications. The witness here, he can be asked questions about anything he's done. That, to me, is the more appropriate way rather than seeing a copy of his resume. He's here, ask him. So he's qualified. I've reviewed that, so he's qualified to offer opinions for your consideration. So continue on, Mr. Young.
BOYD YOUNG: Dr. Bigler, are you being paid for your time here today?
ERIN BIGLER: Yes.
BOYD YOUNG: And how much are you being paid?
ERIN BIGLER: $275 an hour.
BOYD YOUNG: And do you know how much you've billed towards the Tim Jones case so far?
ERIN BIGLER: Around $5,000.00 dollars.
BOYD YOUNG: And how long have you been involved in the Tim Jones case?
ERIN BIGLER: Over the last year.
BOYD YOUNG: Does -- are you paid to render a certain opinion or are you paid for your time?
ERIN BIGLER: I'm paid for my time.
BOYD YOUNG: Does the fact that you are paid for your time affect your opinion?
ERIN BIGLER: No.
RICK HUBBARD: Objection, bolstering, Your Honor.
THE COURT: I don't think so. He can go -- to that extent, it's allowed.
BOYD YOUNG: So in, I think it was early 2018, late 2017, how did you become involved in the Tim Jones case?
ERIN BIGLER: So Dr. Agharkar contacted me and asked if I would review the brain imaging. As I indicated, as a clinical neuropsychologist and professor and director of MRI Research Center, we have developed a variety of techniques to analyze brain scans. And one of those techniques is what's called the volumetric analysis and the three-dimensional image analysis of the brain. The basic premise is that the brain is the master organ of behavior. And so if you're going to look at behavior and you want to know what is driving that behavior, you want to understand the brain as best you can. And we can do that with brain imaging now. And so Dr. Agharkar asked that we apply these imaging methods that we developed to analyze the scans. But the moment that I looked at Mr. Jones' scan, I could tell that there was a significant traumatic brain injury and that he had a skull defect. And that's when I called Dr. Agharkar and said we need to have a neuroradiologist involved in Mr. Jones' case as well to look at this because it appears that there's an old depressed skull fracture and there are these abnormalities that are clearly evident in the imaging. These are the type of abnormalities that I spent my career in analyzing and studying and showing objectively how these abnormalities occur in imaging and how they, in turn, relate to behavior of the individual.
BOYD YOUNG: I'm going to show you what's been marked as Defense Exhibit number 135 for identification.
ERIN BIGLER: Yes.
BOYD YOUNG: Do you recognize that?
ERIN BIGLER: I do.
BOYD YOUNG: And what is that?
ERIN BIGLER: This is what's the original magnetic resonance imaging files that we used for performing image analysis.
BOYD YOUNG: Your Honor, at this time, I'd offer Defense Exhibit number 135 into evidence.
RICK HUBBARD: I believe it may be some stuff I haven't seen, but I have no objection.
THE COURT: No objection. (WHEREUPON, Defendant's Exhibit number 135 was admitted into evidence.)
BOYD YOUNG: Now, that's the raw data, right?
ERIN BIGLER: That is the raw data, correct.
BOYD YOUNG: So when you got that and after Dr. Snyder had provided you with his findings from -- as a neuroradiologist, what did you do then?
ERIN BIGLER: Well, actually, the first thing that I did is I pulled -- this is what's called a DICOM, that's the digital imaging communication in medicine file. And I pulled up that file and there's what's called a 3D viewer. I actually generated a movie of that and you can clearly see the skull defect in that. And that's when I contacted Dr. Agharkar and actually sent him those images. So this is directly off of the MRI scan and you can see the skull defect in the left frontal area of his head. This is untouched. These are raw DICOM files put in 3D. And what the 3D means is that each individual slice, which is like a slab of the head, that is stacked on top of one another and now you're looking at the surface of the head. And this view right here, in particular, shows the defect in the left frontal skull region.
BOYD YOUNG: What did you do after that?
ERIN BIGLER: Well, after that, that's when Dr. Snyder was contacted. And he rendered his neuroradiological opinions and we also conducted our own three-dimensional image analysis. And I generated a Powerpoint to share with you what the straightforward defects abnormalities in Mr. Jones' brain were. So if you wanted to go to the Powerpoint, we could take a look at that and we could show the jury what we're looking at.
BOYD YOUNG: Dr. Bigler, I'm going to give you the --
ERIN BIGLER: The clicker.
BOYD YOUNG: -- clicker. And it also has a pointer on it, a laser pointer at the top --
ERIN BIGLER: The green?
BOYD YOUNG: Yes, sir.
ERIN BIGLER: So maybe at this point, it would be good -- I brought a skull, an actual human skull and a brain model and it would probably be appropriate to --
BOYD YOUNG: If that would help you in explaining it to the jury, please use those.
ERIN BIGLER: Yes.
BOYD YOUNG: If you need to come down here to show those to the jury, that's fine. Just keep your voice up --
ERIN BIGLER: Will do.
BOYD YOUNG: -- so the Court Reporter can hear.
ERIN BIGLER: With your permission, Your Honor?
THE COURT: Sure. Absolutely.
ERIN BIGLER: So this right here has been casted from an actual adult brain and this is pretty much what the brain looks like if you were to extract the brain at postmortem. A couple of things to point out here. We have two hemispheres, left hemisphere, right hemisphere. And there is what's called a interhemispheric fissure, this line that runs right down the middle. It's a fascinating aspect of the brain. It helps understands what happens when it's injured. I can remove that part of the hemisphere and notice it separates. The two sides of the brain are connected by this structure and we're going to talk about this in just a little bit. This is called the corpus callosum. The corpus callosum interconnects the two hemispheres. They are not -- when I put this like so, they are not connected here. You see I can pull that off. They are connected to one another by this structure called the corpus callosum.
I can pull this apart here and take out the corpus callosum and now we're looking at the internal structures of the brain. I'm going to turn it over here and I'm going to show you the base of the brain. This is the brain of the frontal lobe here and this is the base of the temporal lobe here. So frontal and temporal areas of the brain. They are particularly vulnerable to the affects of trauma because if I put this in this plastic see-through bottle here, this is like the base of the skull. And if you have a skull defect from trauma where that skull has indented into the brain, you can see where that defect is, it's going to injure the frontal lobe and the temporal lobe. But there's another very important aspect about trauma and injury.
And that is if you have an impact that's sufficient enough to produce skull fractures and damage the brain in the left frontal area, the mechanics of the movement of the brain -- and the brain is very jello-like, it is going to potentially injure the brain opposite of where the impact is. So the impact, we call the coup injury, the direct trauma, and the movement and distortion of the brain opposite of where the trauma occurs is called the contrecoup. So injury here and then, potentially, elsewhere in the brain. So now, if we look at the skull here, and this is an actual human skull. We take the skull cap off -- this is one of the examples that I use in the graduate classes that I teach. If you look inside the skull here, you can see that the skull bone is actually quite small and narrow. It's not a large bone. And the brain, especially in a child or adolescent, it comes right up against the inner surface of -- or what we call the inner cable of the skull.
So the brain is sitting right here. There's just an outer membrane that covers the brain. So if you have trauma that has affected the bone in this area and has depressed into the brain, it's going to affect the brain underneath it. And that is what we observed in Mr. Jones' case. The other point to make here is if you -- and I'm going to move a little bit closer so you can see. This is where the frontal lobe is housed and the temporal lobe is housed here. So this is frontal lobe here, temporary lobe in this region here. So frontal and temporal. Notice when you look inside internally in the skull -- and I'll just move back forward again. You'll see that the surface of the skull in this area here is not smooth. There are lots of ridges. And unlike the skull cap, if you look inside the skull cap up here, it's smooth. This is not down here. So this makes it vulnerable to the base of the frontal lobe and the temporal lobe and two structures that are inside the temporal lobe. One called the amygdala and the other called the hippocampus. And those are important brain structures that are involved in emotional control and regulation.
BOYD YOUNG: So you saw the areas where Tim's brain was damaged?
ERIN BIGLER: Yes. Maybe we should go to the actual images. May I leave this out because I'll come back --
BOYD YOUNG: Yes, sir.
ERIN BIGLER: So what we're looking at here, notice over here where that R is, that means right. So when you're looking at -- and these are the raw untouched data and I didn't manipulate this in any way. Because you can see this is what's called the header file. And when they obtained this in the original image, we edited this out when we did our analysis, but I left it in just to show the unedited version here. What you're looking at here is this slab of brain tissue, but it's as if you're looking at the individual. So when you're looking at me or if I'm looking at you, your right side is actually on my left side. So you have to keep that in mind. And this is where the left frontal defect is in Mr. Jones' brain. This is the right side. This is the left side. And what we're looking at here is this slab of tissue and it's at the level of what's called the lateral ventricle. See those internal cavities right there?
If I take this image here -- and this is the beauty of magnetic resonance imaging, see, if I hold that up right there, that is basically what you're looking at. So what we can do with the scans is we can look internally in the brain and we can see where these abnormalities are. And you can clearly see that the frontal area here has flattened out. And as Dr. Snyder has also indicated and testified to, there's old hemorrhagic, meaning there was hemorrhaging, bleeding that occurred in the brain, and it's left over in these areas of the frontal cortex where the injury occurred. And you can see again the difference, how the brain is flattened out here in the left frontal area versus the right frontal area. And what I want to point out now is, if I go back to the actual brain model here and we put it back together and you look at it on top, we have the four major lobes: The frontal lobe, the parietal lobe, the occipital lobe, the back of the head, and the temporal lobe here.
But if you look down on this, you can see the symmetry of the brain. One side of the brain looks like the other side of the brain. When I'm teaching this in the classroom, I do one little example here. I hide my left hand, then I hold my right hand up. If I show you my right hand, you know what my left hand is going to look like. So now, I bring my left hand up and put it side by side and you can see one is the mirror of the other. If we go back to the brain model and we look at this brain model, we see that one side predicts the other side. So what we're looking for on the imaging standpoint i the brain to appear symmetrical. And just with the naked eye, you can see this is what a more healthy-appearing frontal lobe looks like. This is the right frontal lobe compared to the left frontal lobe. It's misshaped, it's different in size and shape. And these are the things that Dr. Snyder has already testified to.
BOYD YOUNG: So what's the next slide?
ERIN BIGLER: Okay. Onto the next slide. Now, we're going to go to the temporal lobe. The temporal lobe here shows -- where that arrow is pointing, this area right here is called the temporal horn. So we're going to dissect this brain model just a little bit further up here. So I'm going to pull off the cerebral hemispheres and I'm going to drop down the -- this is called the orbital frontal part of the cerebral cortex. The cerebellum, or the little brain, I'm going to pull that apart. And now, I'm going to take out these areas. These are what are called subcortical areas of the brain. To show you this ventricular system. So this is the internal cavity of the brain, it's called the ventricle. It's a cavity. It's filled with cerebral spinal fluid. The reason why it's filled with cerebral spinal fluid is to pressurize the internal cavity of the brain.
Because if the brain is jello-like, it would collapse in on itself, so you have to have an internal pressure gradient that pushes out and maintains the pressure inside the skull. What happens then is if there's a loss of brain tissue or abnormalities in brain tissue, the size of the ventricle may increase. Now, we're back to this symmetry ventricle. Look at -- if I hold this up like this, you can see the beautiful symmetry of the ventricular system. So it's symmetric. If I hold it like this, this is what's called the temporal horn of the lateral ventricle. So this is the left temporal horn, this is the right temporal horn. Notice they're the same size, they're symmetric, evenly distributed and in the same plane and position. If we go to this image right here, what we see here is this is -- remember the right and left on the imaging. So it's as if you're looking at Mr. Jones. This is the left side.
This is the hippocampal area of the temporal lobe and there is this temporal horn of the lateral ventricle. This is the appearance of it on the right-hand side and you can see that it -- that the ventricle is substantially larger there. And you can also see that there's a wavy appearance -- oh, I'm sorry, I'm standing in front of you. So I'll stand in front of you guys. So there is the temporal horn. With your own eye, you can take a look at this and see that that temporal horn is larger than over here and the shape of the hippocampus is different on the right side than on the left side. And this is what Dr. Snyder was referring to as hippocampal atrophy and a change in this part of the brain. What's also very important about this part of the brain is that the temporal lobe is a critical brain structure for emotional control and regulation. And there's a very interesting issue with how information gets in and out of the temporal lobe. This structure right here is called the temporal stem. These are the cortical sulci. So the cortical sulci move all the way around here. And the only way to get in and out of the temporal lobe is to go in and out this way. So if you have a change in the size of the hippocampus and enlargement of the temporal horn, there is typically degradation in the white matter that surrounds it. And that means that there's a disruption in the ability of this part of the brain to link and connect with other parts of the brain.
BOYD YOUNG: You call this a schizo-form brain?
ERIN BIGLER: Okay. So the issue of schizophrenia, if we actually look at the brain in individuals who have a diagnosis of schizophrenia, what we can see are changes in the frontal areas, the temporal lobe areas, the corpus callosum, the amygdala and the hippocampus. Let me point that out, I haven't done that yet. If I hold this structure up like this, you see this sort of pea green structure here, that is the hippocampus. Just in front of the hippocampus, it's actually removed in the model here, where these red lines are coming down. If you look at those red lines, those are the structures that relate to the amygdala. And those areas of the brain are connected and they're very important in terms of emotional control, regulation and cognition. And so when we look at schizophrenia, which is a brain disorder. Schizophrenia is a brain disorder. It is not some ethereal mental illness that happens independent of the brain. It is a brain disorder. So when we look at schizophrenia, we see that there are differences in the frontal area, the temporal lobe area and those structures, amygdala and hippocampus. And so this is the connection between having a traumatic brain injury and the development of schizophrenia.
BOYD YOUNG: Anything else with regard to Tim's brain?
ERIN BIGLER: Well, there are a couple of other -- this is just another slide again showing these differences in the frontal area and this is just what's called another imaging sequence. This one here, the cerebral spinal fluid, instead of being dark is actually light and it actually helps you see the normal appearance of the slit-like view that the ventricle should be in this part of the temporal lobe on the left and dilation that's on the right. And then you can see this curly-Q appearance of the hippocampus, which is an indication of the atrophy or shrinkage of that particular brain structure. And this is just another image sequences again showing that change and difference. Now, I also put this into a -- what's called a 3D PDF that allows you to actually look at the surface of the brain and see those differences.
BOYD YOUNG: Do you want to come show the jury that?
ERIN BIGLER: Yes. That one I will have to manipulate with the mouse over there, though. Yes, that's it. So you saw that raw imaging file that we started off with, that is untouched. That's straight off of the computer. This one, we've actually edited it some to smooth out and just to isolate the head, but it's the same image. So, you know what, there may be a problem here. No, there we go. So I can control this with the mouse here as you see. And this is Mr. Jones and I can make this big or small. And what we can now do is we can actually look at his brain. And I'm going to move it down so I can enlarge it here and I'm going to move it up just a little bit. And I'm going to spin it around here so we look down on the surface of the brain here. And so back to the model, I won't put it back together right now, but remember when I was holding the model up and one side was mirroring the other side, well, now, you can look at this -- what did I do with the clicker? Just to show that -- there we go.
So here we are looking at Mr. Jones' brain on top. This is the three-dimensional rendering of his imaging, so now we're not looking at a single slice, but multiple slices that have been stacked upon one another. And you can see that there's a difference in his left frontal lobe versus his right frontal lobe and the anatomical appearance of that. I have one other image here that I want to show just for the purposes of -- so if you look here, you can see the outline of the brain, but what I'm going to show here now are the internal structures of the brain. The yellow here is the hippocampus. The orange color is the amygdala. And you can see that they butt up right next to each other. They are adjacent to one another and there are important pathways that go between those two structures and one another. And then there are important pathways that go from these regions of the brain that go especially into the orbital frontal cortex and that go off the back of the hippocampus here to the rest of the brain. And that's --
BOYD YOUNG: Okay.
ERIN BIGLER: -- what needs to be shown.
BOYD YOUNG: All right. So -- and I'll let you get back on the stand.
ERIN BIGLER: Okay.
BOYD YOUNG: Does Mr. Jones have a brain defect?
ERIN BIGLER: Clearly.
BOYD YOUNG: There's no question about that?
ERIN BIGLER: There's no question about that.
BOYD YOUNG: Okay. Let's talk about -- can we back up a little bit? Before he got this brain defect, how does -- how do brains develop? What's important in brain development? And can you walk us through a little bit about how the process happens and how it's supposed to occur?
ERIN BIGLER: Sure. So the developing nervous system is just a unbelievably fascinating story to think about. Because you start off with a single cell that becomes fertilized and nine months later, you have 300 billion cells. And that's just the brain, that's not the rest of the body. Those cells have to develop and they have to migrate to areas of the brain and then they have to connect one with another, all over nine months timeframe. So in neuroscience, we like to talk about brain development as being experience dependent. Your brain develops as an experienced dependent organ in response to its environment, in response to its nutrients, in response to a host of genetic factors. As soon as the baby is in the outside world, now, this experience dependence becomes even more and more important as this infant interacts with the environment. And that's the brain growth and stimulation that occurs. So at the time that you are born, brain volume is approximately 25 percent of adult volume. But by the time you are three or four years of age, it's now 80 to 90 percent of adult volume. And pretty much by the time you're eight years of age, at least, in terms of overall of the brain, it's pretty close to adult. We've all seen the little toddler that the bobble head. Well, there's a perfect explanation for that, that is head growth is critical in those first few years of life. And that's dependent again on nutrition, environment and all of the factors that go into good brain health.
BOYD YOUNG: If you have negative health issues or if you have additional stress or a poor diet or any sort of environmental deprivation, how does that affect that developing brain?
ERIN BIGLER: There are periods of time where you're laying down thousands to tens of thousands of new synapses every minute. And so if you have an adverse environment or if you have an adverse metabolic situation or if you have an adverse genetic situation, this occurring at a critical time period can affect brain development.
BOYD YOUNG: What about a brain injury at the age of 15?
ERIN BIGLER: A brain injury at the age of 15 is going to disrupt the final maturation aspects that occur as one transitions from adulthood -- I mean, from adolescence to adulthood. My undergraduate students don't like me to point this out, but you really don't have an adult brain until you've about 25 or maybe a little older. There are dynamic changes that happen in the brain that are ongoing throughout adolescence and into young adulthood. And there's a very fascinating process. I like to use the analogy of a -- I love to garden, so pruning a plant back may actually make it healthier. The cerebral cortex is somewhat similar that there's a pruning process where the gray matter is actually pruned back a little back as pathways get honed in and there's a major process that happens in adolescence and young adulthood where there's an expansion of white matter in the brain, but a reduction of gray matter in this dynamic development stage that is going on. An injury at age 15 is going to disrupt those mechanisms that allow that brain to develop normally.
BOYD YOUNG: Does schizophrenia also affect that sort of brain pruning process?
ERIN BIGLER: Yes.
BOYD YOUNG: And can you tell us how?
ERIN BIGLER: In the same way. Synapses don't form properly. There may be a thinning that's more dramatic than what it should be for a particular age in the cerebral cortex, the outer part of the brain.
BOYD YOUNG: And does the brain have any mechanisms to sort of compensate for a traumatic injury or other issues that may come up?
ERIN BIGLER: Yes. So the brain is no different than any other organ system in the body. It's designed to attempt to heal itself and to adapt. And there is a really fascinating aspect of certain aspects of certain regions and certain brain cells. And we refer to it as equipotentiality. In other words, in that developing brain, many cells are equal in what their potential is to become and the pathways that they lay down. I like to use road analogies when describing this. If a particular road is closed for repair or is damaged in some way, there's usually a way to work around it. Now, that work around may not be as fast and as efficient, but there's still a work around, so the brain has all of these parallel systems. And often, it's a rerouting and the adaptation when injured is a combination that occurs in the brain because it has all of these redundancies built into it anticipating that there likely is going to be some kind of injury or change or pathology that's going to happen.
BOYD YOUNG: Now, I know you talked about the areas of injury and brain changes that you've seen in Tim's scans. What are those areas for in the brain? What does the brain use those areas for?
ERIN BIGLER: So we go back to the brain model which I have left laid out there. The frontal lobe is very important for what we call executive function, complex reasoning, decision making, problem solving, emotional regulation. The temporal lobe is very important also for emotional regulation and certain aspects of cognition. None of these areas are dedicated areas to motor problems or particular sensory problems. So there may not be any outward manifestation in the individual that they, in quotes, have brain damage because there's nothing visible that shows up outwardly. But damage to the frontal lobe is going to disrupt these executive functions and these emotional control abilities.
BOYD YOUNG: Like, what kind of behaviors do you expect to see in somebody that has those sort of frontal lobe impairments?
ERIN BIGLER: So there's a wide spectrum of changes that may occur when there's frontal injury. It may affect social emotional functioning. It may affect their ability to regulate mood. There may be highs and lows that occur in mood regulation. Their behavior may be inappropriate in certain social situations. Some individuals who have frontal damage, because of it being easier if you follow a routine, like to follow a routine rather than having to be adaptive, which requires greater executive control function. So there's a broad spectrum of changes that may occur. Disinterest may occur, lack of motivation, lack of drive, a host of factors can evolve in those that have frontal damage in personality change.
BOYD YOUNG: Does it affect the person's intelligence?
ERIN BIGLER: It can. It depends on when the injury occurs and how extensive the damage is. An injury at age 15, basic intellectual and cognitive functions are pretty well established at that point in time. And again, the work-around circumstances that I described earlier are still going to be in play in someone that age. The -- we call it plasticity. There are different issues of plasticity in how the brain may adapt before it's fully matured. But basic intellectual cognitive functions are pretty well established at age 15.
BOYD YOUNG: So could somebody with the brain impairments that you've seen on these scans go to college?
ERIN BIGLER: Sure.
BOYD YOUNG: Could they get a job?
ERIN BIGLER: Sure.
BOYD YOUNG: And be a computer engineer?
ERIN BIGLER: Sure.
BOYD YOUNG: Are you saying that you would expect to find no issues with a person with this type of brain pathology?
ERIN BIGLER: No, I would expect you would find issues. But what's important is to understand that brain injury really needs to be viewed in three compartments. One is a physical compartment where it may produce motor and sensory deficits. It may also produce particular symptoms like headaches, dizziness, epilepsy, et cetera. So that's the physical side. Then there's a cognitive side, so the injury may affect cognition, and then there's an emotional side. So you have these three compartments, physical, emotional and cognitive. The brain injury such as we see here is going to effect behavior, behaviors that global, umbrella overall aspect that I'm talking about. Is it going to be in the motor compartment? Is it going to be in the emotional compartment? Is it going to be in the cognitive compartment? Is it going to be some of all, parts? What is it that's related in part to the individual differences that occur when someone is injured? But an injury such as this is going to have an effect. You don't have this kind of injury and it not alter behavior in some fashion.
BOYD YOUNG: Well, what is emotional control? You say somebody has impaired emotional control, what does that mean?
ERIN BIGLER: Well, emotional control is, to a certain part, dictated by the social circumstances that you are in. We're in a courtroom right now. There are certain behaviors that are expected and the ability to conform to those behaviors specify the social aspects of what would be normal. If one is not able to regulate emotion to that social situation, then there's a change in their ability to regulate emotions. Mood can escalate, it can become depressed. We have what's called psychomotor retardation. There are all kinds of fluctuations that can happen with emotional regulation that are more likely to occur when there's been damage to the frontal or temporal areas of the brain.
BOYD YOUNG: Are those also things that are associated with positive symptoms of schizophrenia?
ERIN BIGLER: So having problems with hearing voices and delusions and things along those lines, if we go into the schizophrenia literature, those are changes that occur in the front and temporal lobe regulatory systems that not only relate to emotion, but also relate to cognition. Auditory processing a temporal lobe function. The auditory hallucinations that someone with schizophrenia has, there are corollaries of abnormalities that are occurring in these areas of the brain.
BOYD YOUNG: And can those functions or dysfunctions be controlled through medication?
ERIN BIGLER: Yes. That is, in fact, the goal of medication is -- because part of schizophrenia is a neurotransmitter imbalance within these areas. And what the medication is going is it's bringing that into balance.
BOYD YOUNG: And is that the same with regard to the other areas of impairment you talked about with executive functioning and regulation of behavior and decision making?
ERIN BIGLER: Yes. And one of the fascinating aspects of this is in a relatively controlled setting that has a lot of predictability to it and maybe even some rigidity to it, the person with a frontal lobe injury may appear to function just fine.
BOYD YOUNG: Couple of final questions. The areas that you've talked about, are those also the areas that are responsible for what we call a person's personality?
ERIN BIGLER: Sure.
BOYD YOUNG: And if you have damage in those areas versus -- can you explain to the jury a little bit about damage in those areas versus a personality disorder and what the differences are on those?
ERIN BIGLER: So from my perspective, if one is going to be diagnosed with a personality disorder, one needs to rule out obvious, what we call, organic causes because there's this condition called organic personality disorder. And organic personality disorder is this change in personality, temperament, mood, emotional control and regulation that comes from having a brain injury. So it's not a, in quotes, personality disorder in the traditional sense because those individuals do not have a history compatible with this type of brain injury or brain disorder.
BOYD YOUNG: I believe you told me one time every behavior has an anatomy. Can you tell me what that means?
ERIN BIGLER: Yes. So that's actually a statement that's in my research laboratory. And that was a statement by a behavioral neurologist by the name of Norman Geschwind back in the early 1970s as we were developing these imaging tools where we could look at the scan and we could see internally what was happening in the brain in someone who was alive and want to know what is driving that behavior. So every behavior has an anatomy. All of our actions, all of our thoughts, all of our behavior goes back to a basic functioning of the brain. So as we understand the brain better, we will understand behavior better.
BOYD YOUNG: And if you have a broken brain, what happens?
ERIN BIGLER: Behavior is altered and it is no longer normal.
BOYD YOUNG: Thank you, Dr. Bigler. Please answer any questions that the State has.
THE COURT: Y'all go a little bit longer?
(Affirmative response from the jury.)
THE COURT: Go ahead.
CROSS-EXAMINATION BY MR. HUBBARD:
RICK HUBBARD: Doctor, let's talk about a few things just to clear up what you can and can't say as an expert. You're not here to tell this jury to a reasonable degree of medical certainty that the Defendant's traumatic brain injury caused him to kill his kids?
ERIN BIGLER: No.
RICK HUBBARD: You can't say that?
ERIN BIGLER: I'm not here to say that. I'm here to explain that he had a traumatic brain injury and you can see these abnormalities and then it's all objective.
RICK HUBBARD: And all these slides, as impressive as they are, none of them would be able to show you scientifically, all right, here's the brain of a man who kills?
ERIN BIGLER: We cannot do that.
RICK HUBBARD: Right. So when we talk about anatomy of behavior, there is no anatomy for the behavior of a man who kills his kids?
ERIN BIGLER: We can show anatomical areas that are likely to relate to emotional discontrol, cognitive discontrol and we can do that straightforwardly. I cannot specifically answer the question you're raising, though.
RICK HUBBARD: Right. In fact, you can take two brains that almost look identical with similar injuries and one person might do fine in life and another might end up in prison for doing horrible things?
ERIN BIGLER: That's correct.
RICK HUBBARD: And just so the jury knows, you're not here to say as an expert, even though you're a psychologist, that you know to a reasonable degree of medical certainty whether Mr. Jones on the night of August 28th, 2014, whether he knew legal and moral right from wrong? You can't say that?
ERIN BIGLER: I'm not here to address that question.
RICK HUBBARD: Now, psychologists -- you're a psychologist?
ERIN BIGLER: That's correct.
RICK HUBBARD: In your field, you have many colleagues and people in your profession, they can actually do scientific testing to determine not just cognitive functioning, but if there is psychosis as well, is that correct?
ERIN BIGLER: Well, there are tests that can be administered. The issue of psychosis, part of the problem there is being able to evaluate the patient when they're in the midst of the psychosis versus being sometime after being treated.
RICK HUBBARD: Let me ask you this, you've referenced in your report two psychologists -- I mean, two psychiatrists hired by the Defense?
ERIN BIGLER: Yes.
RICK HUBBARD: And then a psychologist by the name of Tora Brawley, who was also hired by the Defense?
ERIN BIGLER: Yes.
RICK HUBBARD: And you saw all their reports, all the things they did?
ERIN BIGLER: I did.
RICK HUBBARD: And, of course, the psychologist, Tora Brawley, only did cognitive testing. She did not do any kind of testing for psychosis?
ERIN BIGLER: She did not do a personality emotional evaluation.
RICK HUBBARD: Well, not just personality emotional, but like SIRS and some of those other tests that would test if somebody's got, say, schizophrenia?
ERIN BIGLER: Well, those are standardized measures where a --
RICK HUBBARD: They're empirical?
ERIN BIGLER: They're empirical. There's a score that suggest schizophrenia. It doesn't necessarily mean that the person has it because it's a clinical correlation of all of that information.
RICK HUBBARD: Psychologists and psychiatrists can work really well together coupling their skills to diagnose schizophrenia, correct?
ERIN BIGLER: Sure.
RICK HUBBARD: I didn't see in your report where you considered any expert other than the ones the Defense hired, is that correct?
ERIN BIGLER: Yes. I mean, at the time that report was generated, those were the individuals I had spoken to and gotten information from.
RICK HUBBARD: Were you not aware that Dr. Kimberly Kruse, who is a psychologist, not hired by me, not hired by the Defense, but appointed by the Court did actual testing to see --
BOYD YOUNG: Objection as to characterization. He's mischaracterizing the facts.
RICK HUBBARD: Court appointed.
THE COURT: Go ahead. Rephrase your question.
RICK HUBBARD: Were you aware that Dr. Kimberly Kruse, who was Court appointed, not hired by the State or the Defense, did testing, just that very kind of testing to see if there was any kind of underlying psychosis that could be identified?
ERIN BIGLER: So I'm aware that other things were being done. My role here was just to address the traumatic brain injury.
RICK HUBBARD: But, Doctor, you also talked about schizophrenia, so what I'm asking you is there were some other doctors looking to see is there schizophrenia and they were doctors not hired by the Defense.
ERIN BIGLER: I understand.
RICK HUBBARD: Okay. Were you aware that Dr. Kimberly Kruse found nothing that would indicate schizophrenia?
BOYD YOUNG: I'm going to object.
THE COURT: He's an expert. He can give opinions. You can continue to object.
BOYD YOUNG: If he wants to give him a copy of Dr. Kruse's report, which the State --
THE COURT: All right. All right. All right. I agree with everything. I don't need a full argument, okay. If you want to be heard, come on up here.
RICK HUBBARD: It's part of my cross because he wasn't. That's part of my cross.
THE COURT: All right.
RICK HUBBARD: Were you also aware Dr. Richard Frierson, again, not hired by the State, not hired by the Defense, but Court appointed did a psychiatric examination and concluded no schizophrenia? Were you aware of that?
ERIN BIGLER: Yes.
RICK HUBBARD: You were aware of that?
ERIN BIGLER: Yes.
RICK HUBBARD: So all this talk about schizophrenia, the only experts saying that come from the other side of this courtroom?
ERIN BIGLER: That's correct.
RICK HUBBARD: Now, you've talked about a very clear injury to Mr. Jones' head, the TBI, correct?
ERIN BIGLER: That is correct.
RICK HUBBARD: And that you would expect, based on your background, certain deficits, certain issues because of that, correct?
ERIN BIGLER: Yes.
RICK HUBBARD: But, again, if you took that same slide, if you never knew anything about Tim Jones, you took that slide and you took an almost identical slide of someone else, you could not tell where they would go in life or what they would do in life, correct?
ERIN BIGLER: You would need additional information.
RICK HUBBARD: Right. And that would be beyond what you were given?
ERIN BIGLER: Well, I was given some information, of course.
RICK HUBBARD: Okay. We're going to go through that in just a minute. But before we do, you would agree that not everyone who has traumatic brain injury gets schizophrenia?
ERIN BIGLER: That is correct.
RICK HUBBARD: In fact, there's studies, but it's showing some linkage?
ERIN BIGLER: That is correct, an increased risk for the development of schizophrenia.
RICK HUBBARD: You would agree, the profession right now, we're still in the infancy phase of knowing what damage leads to what effects, wouldn't you agree with that?
ERIN BIGLER: I would basically agree with that. The issue here, though, is if you look at the literature, there's a term called schizo-phreniform, meaning features of --
RICK HUBBARD: Sure.
ERIN BIGLER: -- so there are a lot of overlap. And as I testified to earlier, these regions of the brain are the regions of the brain -- the whole reason for exploring the TBI linkage is because of commonality between the areas that are damaged in trauma and the areas that show up in the neuro-imaging aspects of schizophrenia.
RICK HUBBARD: But the bottom line is right now, we just don't know what that real linkage right now, it's still -- we see similarities. But a doctor, whether it's you or anybody else, can't look at a scan and say I can diagnose schizophrenia?
ERIN BIGLER: No, you're not looking at the scan to diagnose schizophrenia.
RICK HUBBARD: You can't?
ERIN BIGLER: You can't. But in the clinic, if you put your clinician hat on and you look at these things, the feedback that you would give to a family is that there -- if there was a history of schizophrenia and the person had a TBI like this, you would give them feedback that they're at increased risk.
RICK HUBBARD: Sure, increased risk, but no guarantee it's going to happen?
ERIN BIGLER: Yes, that's an accurate statement.
RICK HUBBARD: And you're not aware of any expert that's been provided to you by the Defense that's a psychologist that did any testing to see if there was, in fact, schizophrenia?
ERIN BIGLER: No, I don't have anything.
RICK HUBBARD: Okay. You would agree with me, too, that not everyone who has a traumatic brain injury is going to go on to kill people?
ERIN BIGLER: That is true.
RICK HUBBARD: And you've written extensively, Doctor, and honestly, I've only just tapped your work, you've been in the business 40 plus years?
ERIN BIGLER: Yes.
RICK HUBBARD: But isn't it important when you have somebody who has a head injury like this to look at their daily activities, how they function and how they've gone through the years to see if there's evidence of that brain injury affecting their lives?
ERIN BIGLER: Sure, that's an appropriate thing to consider.
RICK HUBBARD: And that's not what you were asked to do?
ERIN BIGLER: That's correct.
RICK HUBBARD: But because of what you found, it would be important to know that right after this incident, the Defendant was still in high school, he was still -- both before and after this incident, he was outperforming his fellow students at his school, outperforming the students in his district, he was outperforming students in his state. That would be something you would want to know if you're taking a whole view to look at how's he functioning, right?
ERIN BIGLER: So I anticipated that those things actually were occurring because of how well he did with his brain injury and the fact that he was able to go on and get a degree in engineering. There's a concept of what's called cognitive reserve and brain reserve. And so the higher that you are before you're injured, that has an influence on how you recover. So my assumption was that Mr. Jones had significant cognitive and brain reserve when this injury occurred at age 15.
RICK HUBBARD: He has a resilient brain?
ERIN BIGLER: I think you would have to conclude that in one sense because of his being able to go on to college.
RICK HUBBARD: And when we talk about college, obviously, initially, he put himself back by some of his activities, but then he went to Itawamba, I believe it is, Community School, made a 4.0?
ERIN BIGLER: Uh-huh.
RICK HUBBARD: You were aware of that?
ERIN BIGLER: Yes.
RICK HUBBARD: Transferred to Mississippi State in Computer Engineering, very complicated field?
ERIN BIGLER: Yes.
RICK HUBBARD: Graduated Summa Cum Laude?
ERIN BIGLER: Yes.
RICK HUBBARD: But not just looking at -- you understand all of that. But not just looking at his academic abilities, did you know that while he was attending, he was married and had multiple children and had to work multiple jobs while attending school, while outperforming all his other students? Were you aware of all of that?
ERIN BIGLER: I was assuming that those things were occurring and some of that is in the reports that I had.
RICK HUBBARD: That's pretty impressive for anyone to be able to do that, is it not?
ERIN BIGLER: It is an indication -- if we go back to those three compartments that I talked about, the physical, the emotional and the cognitive. That from a cognitive standpoint, even in the face of this significant brain injury, there were these adaptations that occurred.
RICK HUBBARD: And you were aware that he got a job at Intel, very competitive environment. Just four months before this incident, he was rated as exceeding expectations compared to his peers and got a raise. You were aware of that?
ERIN BIGLER: Some of that is in the records that I had.
RICK HUBBARD: But were you also aware that his manager, Jim McConnell, said he was not only a bright guy working hard, but that he was someone that was fun to work with? Were you aware of that?
ERIN BIGLER: No, I didn't have that information.
RICK HUBBARD: That one of the things that was absolutely necessary for that job is that you had to work well with others. Did you know that?
ERIN BIGLER: I did not have that information.
RICK HUBBARD: And that he excelled in that environment working with others. You did not know that?
ERIN BIGLER: Correct.
RICK HUBBARD: And that at no time while he was working at Intel in this competitive environment, not one time did he have one complaint from any coworker that he was hard to work with. Did you know that?
ERIN BIGLER: I did not have any of that work information.
RICK HUBBARD: I'm just going through my notes, Doctor.
ERIN BIGLER: That's fine.
RICK HUBBARD: Just a moment. I may be about done. Basically, everything you know about Tim Jones has been provided by the people who hired you?
ERIN BIGLER: That is correct.
RICK HUBBARD: And again, nothing in your slides, which are very informative, but nothing in your slides answers the question that these jurors are going to have to answer at the end of this trial as far as whether the Defendant knew right and wrong. Nothing in the slides will be able to show them whether he appreciated on the night of this incident, whether this man, Tim Jones, knew the difference between legal and moral right from wrong?
ERIN BIGLER: As Mr. Young asked me at the end, he has a broken brain, that's what I can show.
RICK HUBBARD: And that's all you can show?
ERIN BIGLER: That's all that I can show at this point.
RICK HUBBARD: And you can just show that from a slide from something that happened when he was 15?
ERIN BIGLER: That's correct.
RICK HUBBARD: But you can't show anything that would answer the ultimate issue in this case about what happened August the 28th of 2014?
ERIN BIGLER: I can only show that he has a broken brain.
RICK HUBBARD: Beg the Court's indulgence. Doctor, thank you so much for answering my questions.
ERIN BIGLER: Thank you.
BOYD YOUNG: Briefly.
REDIRECT EXAMINATION BY MR. YOUNG:
BOYD YOUNG: Dr. Bigler, were you aware that Dr. Wood, a State psychiatrist who has treated Mr. Jones for over four and a half years has diagnosed him with schizo-affective disorder?
ERIN BIGLER: Yes.
BOYD YOUNG: And can you tell the ladies and gentlemen of the jury what schizo-affective disorder is?
ERIN BIGLER: It's on the spectrum of schizophrenia, but it's more the emotional lability, the up and down, more akin to bipolar-type problems.
BOYD YOUNG: When -- do you recall what the date of your final report was?
ERIN BIGLER: Yes, I have it right here in my chart. It was
February 28th, 2019.
BOYD YOUNG: So if the State had requested additional testing be done in March of 2019, would that be after your report?
ERIN BIGLER: That is correct.
RICK HUBBARD: Your Honor, this was Court appointed. Talking about me hiring somebody, I didn't hire anybody.
THE COURT: That's true.
BOYD YOUNG: The State being the state psychiatrist of South Carolina as appointed by the Court, if they did additional testing --
RICK HUBBARD: Your Honor, I object to the misleading there.
THE COURT: I think he characterized it. There's been multiple evaluations, most of which have been paid for with State money, Court-appointed evaluations.
BOYD YOUNG: Those were done after your final report, right?
ERIN BIGLER: Correct.
BOYD YOUNG: As a clinician, putting on your clinician hat and taking out the actions that brought us to court today, knowing what you know about Mr. Jones' history and his complaints, how long would it take you to come to a conclusion that this guy is schizophrenic?
RICK HUBBARD: Objection to the form of the question, also, beyond his scope of expertise. He's already clarified that of what he's done -- well, not -- what he was asked to do.
THE COURT: All right. I'm going to ask you to rephrase that question. It seemed lengthy to me. Make it clearer for the Court's benefit.
BOYD YOUNG: Hypothetically, you as an expert --
ERIN BIGLER: Yes.
BOYD YOUNG: -- and as a clinician, somebody presents to you with a family history like Mr. Jones, mother is diagnosed schizophrenic, I have family members on both sides of my family that are schizophrenic, and presents complaints of hearing voices, auditory hallucinations and you get some brain scans and you look at them and they have hippocampal atrophy and enlarged --
THE COURT: That's way too long. I lost you about three sentences ago. Break it down. I mean, that's -- Mr. Young, that's horribly unfair to him as an expert, much less the jurors and the Court. It's just too long. I mean, it's just way too long.
BOYD YOUNG: Dr. Bigler, putting on your clinical hat as an expert in a hypothetical case, somebody has a family history of schizophrenia. You with me on that?
ERIN BIGLER: Yes.
BOYD YOUNG: And then in addition to a family history of schizophrenia, you get brain scans that show an atrophy, hippocampus?
ERIN BIGLER: Yes.
BOYD YOUNG: You with me on that.
ERIN BIGLER: Yes.
BOYD YOUNG: And an enlarged temporal horn.
ERIN BIGLER: And there's no history of trauma or anything else? This is just --
BOYD YOUNG: Right.
ERIN BIGLER: -- straightforward issue looking at it from the standpoint of schizophrenia.
BOYD YOUNG: Right. And they have a deformed corpus callosum.
ERIN BIGLER: Yes.
BOYD YOUNG: And they're complaining about auditory hallucinations, you with me?
ERIN BIGLER: Yes.
BOYD YOUNG: How long would it take for you to come up with a diagnosis and what would it be?
RICK HUBBARD: Objection --
THE COURT: It's hypothetical. I'm going to let him answer it.
RICK HUBBARD: All right.
ERIN BIGLER: All of that is certainly consistent with it being schizophrenia. Schizophrenia usually is then diagnosed as more of a team approach where a psychologist and a psychiatrist work together in making that diagnosis. And if there are differences on the -- maybe involving other clinicians as well. But, certainly, that would be a straightforward initial conclusion.
BOYD YOUNG: Please answer any questions the State would have.
RECROSS-EXAMINATION BY MR. HUBBARD:
RICK HUBBARD: Psychologists do testing. You don't just do clinical interviews and take a history from one side in order to reach an opinion? You would never do that, would you, Doctor?
ERIN BIGLER: I would want all the history and all the information that I could, yes.
RICK HUBBARD: Not just from one side?
ERIN BIGLER: I would take information from all sides, yes.
RICK HUBBARD: And you would also want to know he's presented this information, but is there anything that might also be there that we call malingering or exaggerating your symptoms during testing and presentation, correct? You would also want to know that?
ERIN BIGLER: You would want to know that. The straightforwardness of brain imaging, though, is that can't be malingered. Those abnormalities that we looked at are straightforward.
RICK HUBBARD: I'm talking about schizophrenia, whether there's any indication of malingering as to a diagnosis on schizophrenia. You would want other professionals, because you wouldn't be able to do that just from a brain scan, right?
ERIN BIGLER: Not just from a brain scan, but I believe that Mr. Young's question was that if you had a scan that had this hippocampal findings and you have his history that you're looking at from a perspective of schizophrenia, those -- the imaging is objective. Hearing the symptoms raises the question this is schizophrenia.
RICK HUBBARD: Right. And if those are self-reported, you're going to want to dig deeper, correct?
ERIN BIGLER: Sure.
RICK HUBBARD: That's where a psychologist can do testing, right?
ERIN BIGLER: Sure.
RICK HUBBARD: And where a psychiatrist would spend, if he's doing his job, hours and hours and hours talking and investigating, correct?
ERIN BIGLER: All of that requires clinical correlation and clinical interview and what is referred to as a mental status examination.
RICK HUBBARD: Correct.
RICK HUBBARD: Thank you, Doctor.
THE COURT: Thank you, Doctor. You may step down.
ERIN BIGLER: Okay. I've got to put my brain back together.
THE COURT: Me, too. All right. We've been going an hour and a half and that's a very lengthy presentation. I'm certain we all need a break now, all of us in the courtroom. That was for the benefit of all the streamers that say we take too many breaks. Don't talk about the case. (WHEREUPON, the jury was excused from the courtroom for a break.)
BOYD YOUNG: Your Honor, we attempted to move in Defendant's Exhibit number 137, which was a copy of the Powerpoint and the head movie and the head thing.
THE COURT: Okay. (Whereupon, Defendant's Exhibit 137 was admitted into evidence.)
(Whereupon, a bench conference was held.)
THE COURT: I will tell you what we are going to do. We are going to proffer this right now. Fair enough. I would like the proffer made and I want your questions to be where you can repeat them verbatim.
CASEY SECOR: Yes, sir.
THE COURT: Okay.
CASEY SECOR: The Defense calls Roberta Thornsberry.