Propose for a moment you are about to say something that you know people don’t want to hear and will argue with you angrily, saying that your motives are devious and self aggrandizing. They might quote books you’ve already read yourself or mount arguments you’ve heard endlessly before. Perhaps they’ll end up saying that your profession isn’t actually even a profession, but rather chicanery, that you’re on some kind of power trip. Would you say it?
A Rhode Island police sergeant reported Alexis to naval station police last month after the suspect told cops he was “hearing voices” through his hotel room wall and that three people were following him and sending vibrations into his body, according to a police report… According to the document, the officer said he was sent to a local hotel on Aug. 7 to check out a suspicious person report involving Alexis, who told him he was a naval contractor and traveled often. Alexis told the officer that while flying from Virginia to Rhode Island, he got into an argument with someone else at the airport who he believed had sent three people to follow him and keep him awake by talking to him and sending vibrations into his body, the report stated. Alexis also said he thought he heard these three people speaking to him through a wall of his hotel room and through the walls, floors and ceiling of a hotel on the Navy base. Alexis told the officer the trio was using “some sort of microwave machine” to keep him awake.
On Aug. 23, he went to a VA hospital in Providence. Five days later, he went to another one in Washington, seeking a refill of the medication he had been prescribed in Rhode Island, according to the officials, who spoke on the condition of anonymity because the investigation is ongoing. In both cases, doctors sent Alexis home with the medication, identified by law enforcement officials as Trazodone, a generic antidepressant that is widely prescribed for insomnia. The VA doctors told him to follow up with a primary-care doctor. It is unclear whether he did. “Mr. Alexis was alert and oriented, and was asked by VA doctors if he was struggling with anxiety or depression, or had thoughts about harming himself or others, which he denied,” the Department of Veterans Affairs said in a memo sent to Congress on Wednesday.
Are there people around who would’ve suspected what was coming? A better question is are there people around who would’ve seen what was coming as a possibility? The answer to the second question is "yes." The person reporting him at the hotel knew it. The policemen knew it. They called to tell the Naval Yard. The people in the Emergency Room knew enough to ask him if he was thinking about harming someone or himself. Someone who had spent some time in grade would have noted that Aaron was actively afraid of a Pseudocommunity coming after him using Tausk’s Influencing Machine, and that he was acting on those beliefs. He had lost his sense of agency and intentionality [welcome relief…]. They would have surmised that he was having ominous auditory hallucinations from his history. They might have experienced Rümke’s praecox feeling. These are all danger signs so they would have then been in a position of saying something he would likely not want to hear, "We need to put you in the hospital," and possibly gotten the reaction I started with in the first paragraph or something similar – not as a rhetorical discussion about psychiatry vis-à-vis science in general, but because the psychiatrist would quickly have been moved into the Pseudocommunity of a paranoid experience.
In the 1940s, he would have been sent to a State Hospital which he may have never left. In the 1970s, he might have been admitted and heavily medicated but released when no longer psychotic. Nowadays, it’s unclear what would’ve happened had his illness been properly diagnosed. Hopefully he would’ve been hospitalized, but many such patients end up in jail where they are treated. I once heard that America’s largest mental facility is the L.A. County Jail. Unfortunately, in our modern world, there’s not always a clear path for officers, doctors, psychiatrists, other mental health personnel, or ordinary citizens to know what to do. Even worse, the patients undergoing the terrifying experiences don’t know what to do or where to go either. Sometimes they do what Aaron did. Sometimes, they commit suicide. Sometimes they get treated. Many options.
When I arrived to psychiatry in the 1970s, this business of involuntary hospitalization was all new to me – a major unknown. And in training, the first year was spent mainly seeing psychotic people where that came up throughout most days. I didn’t like anything about it. As I’ve said and many critics have said, it didn’t feel like "doctoring." Those were the days when Dr. Szasz was in full form and antipsychiatry was a stated position for many. After a time, I realized that nobody wanted to do it – make an assessment of dangerousness which is an essential part of the decision. And the stakes were pretty high. I finally decided that whether I liked it or not, it was right for psychiatrists to at least make the initial assessments. I was spending every day among psychotic people, or reading about psychotic people. I had patients who had killed people, hurt themselves, been abused by one system or another, been overmedicated, been undermedicated, been misdiagnosed, wrongly hospitalized, wrongly released, etc. If only by experience, I ought to be able to make accurate assessments. And the best teachers weren’t the faculty, they were the staff who had worked in psychiatric facilities forever and had a sixth sense about what to do and when to act. I made my mistakes in all directions. That’s part of the job – it’s so subjective.
I feel sorry for not just Aaron Alexis’ victims. I feel sorry for him too. From his perspective, he was under attack on all fronts and he could find no safety. Unlike Eleanor Longden [voices…], he didn’t understand his torment as split off wounded parts of himself, but rather as an ever-present enemy. I hope that if I had met him along the way, I’d still have my assessment skills and a proper level of suspicion to pick up on his internal state. I hope I would still have the will to tell him what he might not want to hear, and follow the procedure to get him some place safe. I hope that he would’ve been someone who was not overmedicated but rather appropriately medicated and followed by someone who knows the ins and outs of this disease.
Mickey,
You said it best,
“I made my mistakes in all directions. That’s part of the job – it’s so subjective.”
To which I will add: we, individuals, have free will. I repeat FREE WILL. Something that psychiatrist seek to deny with their labels but that exits. The problem with psychiatrist is that you want to have it both ways. For every Aaron Alexis who hears voices telling him to do horrible stuff, there are thousands who hear the same voices and do nothing. And the reason is simple. We, human beings, have free will. The opinion of 1 million people with respect to whether that million people think that rape is moral and justified is irrelevant to my own conviction that rape is immoral. Same with murder. I could hear one million voices asking me to murder somebody, I wouldn’t do it. So, coming to the “having it both ways”. Psychiatrists estimate the prevalence of psychotic behavior as 1 in every 100. That is 3 million Americas that would qualify for a label “potentially dangerous”. Even if 1% of those were really, really, dangerous, that would be still be 30000 people that would be truly evil in circulation, killing people. We don’t have that many.
So, just as it happened with Virginia Tech, Aurora or Newtown, we have again psychiatrists reasoning by “anecdote/extreme” to ask for ever increasing powers to lock people against their will “just in case”. Well, “just in case”, please ask for ever increasing powers to lock in all black males in the inner cities of ages between 10 and 30. I can assure you that most violent crime in the US would go away.
https://en.wikipedia.org/wiki/O%27Connor_v._Donaldson was a victory for human rights. It has to be celebrated, especially in times like these when the enemies of personal freedom waste no time to take that freedom away.
Glad you posted on this. My take is different, as I see the role of medication authorizations, especially on antipsychotic meds, increasing the risk of future incidents after patients get denied meds at times they were already on when the insurer intruded.
God forbid a future incident involves care that was disrupted solely because of cost containment. Tell that to victims’ families?!
And to elaborate more. When I was civilly committed, under a European standard that allows for that in case of so called “need for treatment”, I was literally told by a psychiatrist that I was destined to become homeless, probably in less than one year. That my free will alone would not be enough to keep me alive. That I needed meds. I am not joking, this is the type of nonsense one is forced to accept as the “truth of God” when psychiatrists are given “God powers”. Several years later, I enjoy the highest standard of living ever. Only, my forced contact with psychiatry brought me the destruction of the relationship with my parents, and ex-wife, as well as a social life that has become very toxic because very people know about what happened to me.
Psychiatry is evil. That you guys profit from tragedies like this to defend the indefensible is only another piece of evidence for that.
Thanks for this very thoughtful post, Mickey. I find the Alexis case poignant for a many reasons. I became a social worker/therapist in my 50s. While in school, I traveled to DC for a conference and returned to NYC by the local bus. On my bus was a woman who underwent a psychotic episode en route and I was forced to have her transported to the psychiatric emergency room during the trip. Standing in the cold by the side of the NJ Turnpike with an ambulance crew and some (pretty sensitive) state troopers, she told me she had been spent time around Newport News naval station, where someone gave her the money to travel to New York City to see her uncle. I was glad to put her on the ambulance to connect with mental health specialists who could contain, assess and aid this woman. In the 20 minutes I met with her, I became fond of her and hopeful she could return from this struggle.
Since then, as a mental health clinician, I have sent many people to hospital. And sad as I am when a treatment interaction ends this way, I have never lost a night’s sleep when I know the person is being cared for, observed, and treated. The lost sleep is when the patient is wandering out there, unobserved and expressing their “free will.”
I don’t think many “lay” persons understand the struggles we clinicians go through when we deal with florid psychosis. But I always feel the need to sit with the person, try to reach through the symptoms to reach the person trapped inside.
According to the CDC, 20 to 25% of all homosexuals living in large metropolitan areas are HIV positive. Should be quarantine all homosexuals living in those areas to contain the HIV epidemic in the US, given that Cuba proved the world that quarantine is an effective way of containing the HIV epidemic http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2688320/ ?
The analogy with HIV, or other infectious diseases is pertinent because in both cases we are talking about “allegedly” protecting the individual and society from harm. 15000 people die of avoidable AIDS every year in the US. Why is that you guys defend civilly committing so called “mentally ill” but I am sure it doesn’t cross your mind to civilly committing all newly diagnosed HIV patients, even though the toll in terms of victims of AIDS , and money, in the US is much higher than all the murders perpetrated by so called “mentally ill”?
It has been speculated that Alexis was on various antidepressants. He was on Trazadone at the time of the shootings for sleep problems, had PTSD, had encountered the mental health profession several times and had anger management and other issues typical of SSRI’s and other psych drugs.
http://www.drugawareness.org/antidepressant-evidence-13-dead-in-washington-dc-naval-yard-shooting/
Mickey,
With all due respect, I have to agree with CannotSay2013. Exhibiting strange behavior is not a crime and putting someone away for what they might do sets a horrible precedent.
You’re also forgetting that if any of the security lapses had been dealt that caused this guy to have a security clearance when he shouldn’t have had one, those shootings most likely would not have taken place. Please, let’s focus on the relevant issues instead of unintentionally stigmitizing a group of people which will discourage instead of encourage people to seek treatment who need it.
Many decades ago I was taught that I would never be in a position to diagnose a mental illness, but I could recognize someone who was having a problem, much like the examples given. People do have a sense of impending danger.
Today we live in a very passive/aggressive world where people are allowed to exhibit almost any behavior and for a number of reasons nothing is done. We do walk away from that person who is exhibiting antisocial behavior even though we know they may be of danger to themselves or others.
In 1998 my brother was shot and killed by a man who had a long history of alcohol, drug, and spousal abuse. He should not have had a weapon but was able to acquire one. Delusional, he felt that if he killed all of the managers at his company the employees would make him President and he would run it for all of their combined benefit.
Today my brother’s family and friends are one again reliving this tragedy as this person is up for parole. An eight year cycle that will never allow this tragedy to be forgotten.
There were and are excesses in the system, our feeling that a person is not a threat to me, and our willingness to move along and not deal with the problem, will only allow these tragedies to continue.
We have a broken system that allows those who most need it to not take their medication. Add to this returning vets, the massive jobs losses and underemployment in the country and a society that has become more and more isolated and we have all of the behavioral underpinnings to create more and more people in need of mental health professionals.
I am not one to believe that everyone with a problem needs counseling, and certainly not everyone needs medication, but we do need to return to a place where those who show real agitation need to receive help.
Steve Lucas
It appears that Alexis had all too many encounters with the so called mental health system like most of the school/public shooters and it appears more and more that that is the greatest danger to society: the mental health death system in bed with Big Pharma pushing useless, toxic, dangerous drugs and life destroying stigmas that just make things far worse. The fact that they demonize, scapegoat, blame and bully their victims in the so called mental health system just makes them more angry and determined to seek revenge on their persecutors.
And again, I would like to know why male batterers who torture the women and children in their lives and often kill them are not regularly rounded up, put in a chemical straight jacket of deadly neuroleptics and other poison, useless drugs and locked away for the protection of women and children. Obviously, most if not all of what mainstream psychiatry does is just political and only serves those in power.
Saying that someone “should be forced to take their meds” once given a life destroying bogus DSM stigma amounts to murder of that person, so public safety is in the eyes of the beholder.
http://www.drugawareness.org/antidepressant-evidence-13-dead-in-washington-dc-naval-yard-shooting/
AA,
We are on the same page.
Steve Lucas,
I am sorry about what happened to your brother. However, I can assure you that many brothers, sisters and parents have been killed by black youth in inner cities. In fact, there is probably a higher degree of correlation between being a black male in an inner city than with a DSM label alone. . According to this Oxford study, the largest of its kind when it was published, http://www.ox.ac.uk/media/news_releases_for_journalists/090520.html “There is an association between schizophrenia and violent crime, but it is minimal unless there are also drug or alcohol problems, a large-scale study led by Oxford University has shown. “. The relationship between being a black male in an inner city and violence is huge.
It’s no other than Allan Frances who says,
http://www.huffingtonpost.com/allen-frances/gun-control-cant-work-if-_b_2359049.html
“It is impossible to predict in advance who is likely to become violent and when”
That is why we don’t trust anybody’s sixth sense when it comes to enforcing criminal laws. Mickey, no offense implied but I think that if your true goal is to reduce criminal conduct, I think you’d get better results if instead of using as screening criteria a DSM label, the fact that a person is a black male living in an inner city. Now, try to convince the NAACP or the ACLU of such idea!
Again, we are back to basics. When people refuse to accept the obvious, ie, that psychiatry is a non scientific endeavor, people come up with all kind of nonsensical ideas to avoid the obvious conclusion. In this shooting, just as in Aurora or Virginia Tech, psychiatric drugs were involved. A few years ago, somebody did this documentary titled “The Drugging of Our Children” https://www.youtube.com/watch?v=26e5PqrCePk in which both left (Michael Moore) and right (George W Bush’s brother Neil) make the case the increase in use of psychiatric drugs, and nothing else, offers the highest degree of correlation with the increase of mass shootings. In fact, I think it was Neil Bush’s activism that resulted in a federal law that prohibits schools from asking children to be put on Ritalin as a condition to attend school.
I see it as a moral duty, in my condition of survivor of psychiatric abuse, to stand up to the quacks when they use tragedies like these to advance their anti freedom agendas.
http://blogs.scientificamerican.com/cross-check/2013/09/20/did-antidepressant-play-a-role-in-navy-yard-massacre/?utm_source=September+2013+News&utm_campaign=September+News&utm_medium=email
More on role of antidepressants in increasingly bizarre public violence.
http://wp.rxisk.org/shooters-on-prescription-drugs/?utm_source=September+2013+News&utm_campaign=September+News&utm_medium=email
Dr. David Healy’s web site risk.org on the latest association of antidepressants and violence in navy yard massacre
Another take:
http://www.nytimes.com/2013/09/20/opinion/luhrmann-the-violence-in-our-heads.html?_r=0
Florence,
I’ve been reading your references and others raising the possibility of Aaron Alexis’s rampage being a reaction to Trazodone. I’ve not personally seen it on TCAs, but I don’t question they can happen. My opinion that this was a schizophrenic illness with decompensation was based on the plethora of first order and classic symptoms. I’ve not seen that constellation from ADs, but that’s the big problem. No clinician’s personal experience is big enough to encompass the gamut. That’s why I think David’s RxISK is such a good idea. I hope that databank continues to grow. So I take your point questioning my diagnosis and hope we can get some medication timelines and previous history that clarify the point. Thanks for the references…
Mickey,
Although you didn’t reply to me directly, I feel you have attempted to address my concerns with your reference to “others”.
You also say ” so I take your point questioning my diagnosis”. EXACTLY! In your other post you criticize the psychiatrists that removed the BE for depression from the DSM as “elevating opinion to the level of fact”. Yet, on this particular area “your sixth sense to detect people in immediate risk of becoming violent” you claim for you the same that you deny those psychiatrists: having your opinions (in this case your ability to predict violent behavior) elevated to the level of fact.
It is very clear why this problem of “elevating opinion to the level of fact” affects primarily psychiatrists and no other medical doctors. It also explains why when data from clinical trials is aggregated and averaged no drug beats placebo or psychotherapy consistently according to valid criteria of clinical practice or why the DSM-IV field tests flunked the already low kappas of DSM-IV.
Science requires an “objective reality” that the scientific methods uncovers. Then one makes a carefully designed falsifiable experiment to test hypotheses.
A cancer diagnosis requires cancerous cells. An HIV diagnosis requires infection by HIV test.
When there is nothing objective to begin with, as it is the case of “mental illness”, there is no question that the predictive value of psychiatric value judgement, on average, is zero. In a situation like this, he or she with the loudest megaphone (or pockets) ends up winning. The result of this “the guy who screams loudest wins” is the DSM, whose latest iteration was released in May. I see the DSM more a reflection of the struggles for power within psychiatry than a description of anything real.
Mickey-
I admire you tremendously but when you get onto this topic of psychosis, something happens that is hard for me to articulate. You seem to acccept some notions of essentialism with regard to diagnosis that I just do not think are valid. Maybe that is not the most important problem with this tragedy but it is important, nonetheless. Schizophrenia is no more a “thing” than is MDD, at least from the trench where I spend much of my time.
Sandy
Sandra,
I think I take your point when I say, “I won’t live to see the ’cause’ of Aaron’s disorder discovered or even know if it is a disorder or many.” I’m so far from the hands-on on contact [trenches] that I’ll never be in a position to parse the condition [or conditions] in a 21st century way. If you’d like to enlighten me [or us] on this point, I’d be pleased to publish it as a guest post. In fact, I hope you take me up on that.
Also possibly of interest:
http://www.scientificamerican.com/article.cfm?id=how-to-live-with-voice-hearing
Dr. Steingard, for whatever it is worth I hope also hope you contribute a guest post on this. I would find it particularly enlightening if it were structured with having someone like Dr. Carroll engaging in discussion with you around this. I suspect that the two of you could sustain a respectful yet energetic dialogue. This post from Dr. Carroll comes to mind, though I note that there he chose to list “psychosis” rather than schizophrenia:
http://www.garygreenbergonline.com/w/?p=330&cpage=1#comment-5080
I am also reminded of these comments from Dr. Noll:
http://1boringoldman.com/index.php/2013/03/16/coverage-this-issue-deserves/#comment-238638
http://1boringoldman.com/index.php/2013/05/14/a-long-and-winding-road/#comment-244739
http://1boringoldman.com/index.php/2013/05/29/psychiatric-diseases/#comment-245339
Particularly given this from Dr. Noll in one of the comments referenced above:
“Over time it was clear that the classic Kraepelinian subtypes were fundamentally useless, so most persons with schizophrenia were marked as “undifferentiated” types. As for understanding the disorders we were seeing, Arieti, Bateson and Lidz were no help, so we passed around an old 1950 copy of the translation of Bleuler’s 1911 monograph on the schizophrenias. At least there were descriptions in Bleuler that matched what we were seeing, but still no understanding. What finally helped was E. Fuller Torrey’s 1985 edition of Surviving Schizophrenia, which made everthing much clearer.” – emphasis mine.
It seems there would be some value in collaborative engagement around the tension between this:
https://www.madinamerica.com/2013/01/vermont-turns-to-open-dialogue-less-meds-for-psychosis/
&
http://www.treatmentadvocacycenter.org/problem/anosognosia/2178
http://www.madinamerica.com/2012/10/response-to-fuller-torrey/
There appears to be a fair degree of agreement here about, and common cause around, the conceptualization of, and intervention for, mental symptoms that are not psychiatric diseases.
I would be very interested in hearing more about Dr. Steingard’s take on the nature of “psychiatric diseases”
http://1boringoldman.com/index.php/2013/05/29/psychiatric-diseases/
and then also on the nature of how individuals are best aided in coping with, in living fulfilling and safe lives with, what is called psychosis.
Dr. Nardo,
Thank you for your comment about the references I cited about the connection between antidepressants and public/school shootings that seems to apply somewhat in the latest navy yard massacre. I appreciate your having an open mind. I’ve been following these types of shootings for a long time and like others who have done so, whenever I hear of them, I immediately think of the psychiatric drug connection like all too many others as you saw with the author of the Scientific American article and Dr. Healy’s RISK.org web site along with the ssristories site Dr. Healy and its creator discuss on RISK.org.
I don’t know a great deal about schizophrenia except that Dr. Loren Mosher’s Soteria program and the latest Open Dialogue program with the least amount of toxic drugs used seem to be the most successful for treating this type of meltdown that seems to happen with young adults. Dr. Mosher’s web site detailing his program and many articles about what is called schizophrenia is still available and run by his daughter since he died.
If I come off as upset with biopsychiatry’s approach today of slapping on a fad bipolar stigma to push the latest lethal drugs on patent (per Dr. Healy in his book, MANIA) in the least amount of time, it’s because from what you say and reading those like Dr. Peter Breggin, I lament the fact that the whole DSM biomedical approach to so called mental illness refuses to consider typical life problems that I think psychiatrists like you and Dr. Breggin would be more inclined to help by listening to the person and using the type of eclectic approach you’ve discussed. That is not happening for the most part today with the bio-bio-bio paradigm of psychiatry that I think is starting to backfire greatly or at least I hope so. It would be nice to see common sense prevail again which is not so common.
Finally, I believe that I have heard or read that too much lack of sleep can even lead to psychosis. Is that true? If so, the latest navy shooter was having very bad sleep problems related to PTSD and other problems that seemed to be driving him “crazy” so to speak and most likely contributed to his irritability, anger and weird behavior. You may be right about his symptoms being a more typical psychosis, but such constant mass shootings only seemed to appear on the scene in such vast numbers with the advent of today’s very dangerous psychiatric drugs.
Anyway, as I’ve said before, I greatly appreciate your blog and your patience and willingness to keep an open mind. However, I think you still have much to offer from good old fashioned psychiatry before the Big Pharma sellout and I’d like to hear more about that too.
The ability to express ideas eloquently does not give you, or anyone else, clairvoyant powers. Psychiatry is a branch of medicine, not the humanities.
Aaron Alexis’ symptoms were certainly worrisome and warranted further medical evaluation. However, to suggest, that they, in and of themselves, clearly indicated that he would act violently suggests that you are better able to predict risk than the rest of us.
Even the assumption that he suffered from a “decompensating paranoid schizophrenia” is, just that, an assumption. Punishments will be meted out to anyone who had contact with him in the past who lacked the magic of your “praecox feeling(s),” and wizards, such as you, will remain in your towers and point crooked fingers at us mortal ER physicians, police, nurses etc. who should have known better.
http://ssristories.com/
Web site on thousands of SSRI tragedies. Dr. David Healy interviewed the creator of this web site on his web site, RISK.org.
Thomas,
I appreciate your point. In a former career as an Internist, I did my ER time and I had no clue how to deal with psychiatric patients other than to scream “help.” In later years, I taught the “behavioral science” course in the medical school and I cheated. I covered the psychiatry didactics in as little time as possible, and spent my time talking about what I didn’t know as an Internist and telling stories from those days, hoping to give the students some of what I never got. No clairvoyance claimed either, but experience counts. In the ER, having seen a jillion heart attacks helps to know when to jump into action. Psychiatrists aren’t clairvoyant, but I sometimes thought the chronic staff was. At an another time, I ran a Psych ER, and my best evaluator by far was a physically handicapped audiovisual tech who worked the ER for extra cash in his spare time. He was the kind of guy that you’d pick for a forward scout in combat.
There wasn’t anything I liked about those ER days except trying to keep from burning out and doing my best with an impossible task. You have my respect for sticking with the ER. There’s little comment if you get it right and lots of fingers pointing when you get it wrong. In my experience, psychiatry has been similar as you can see from the comments on this blog.
There’s a saying, “the past is history, the future’s a mystery, all we have is the present.” Until someone comes up with a serum dangerous level, I don’t know any way to approach the problem other than the very criticizable way that has evolved, primarily in the legal system. And they don’t know what to do either. It’s a true “hot potato”…
Mickey,
I’ll let Thomas reply, but I think you are missing his point completely and making again true your own critique of elevating opinion to the level of fact. I encourage you to watch the movie https://en.wikipedia.org/wiki/Minority_Report_%28film%29 .
You say,
“No clairvoyance claimed either, but experience counts.”
Experience in what? You have to deny free will to claim that the ability to predict who among 1000 people is likely to become violent counts in any way gives you information to predict when I, a free will endowed person, will become violent, or will become homeless (as it was claimed when I was civilly committed).
And besides, I put into question the notion that that experience is even a good on. Unless you randomized 1000 people, predicted who’s likely to become violent and who isn’t then wait for results, your experience is even irrelevant. But as I said, your whole comment misses the point of free will.
I re-read your post and noticed that you predicted my reaction quite accurately in it’s preface – clairvoyant indeed! You also call for an improved system for evaluating and treating patients with mental illness. No argument there.
I was rankled by what felt like an accusatory tone… probably the result of drinking too much coffee while reading your post.
On a more positive note, I appreciate your thoughtful blog and once my feathers are fully unruffled, I plan to read “welcome relief…” Whatever ‘cheating’ you engaged in when you taught psychiatry in medical school, you’re making up for it now.
My takeaway from the Aaron Alexis case and all the other mass shooters with psychiatric medication histories is that 1) the prescriptions thrown at them didn’t help; 2) the “care” they received, which was the normal sloppy attention anyone would get in the US, was misguided and inadequate; and 3) potential adverse effects from the psych drugs or from taking them inconsistently probably made matters worse.
As for predicting who would become a mass murderer — those are black swans that, by definition, cannot be predicted.
It was great to see Scientific American post John Horgan’s interview with David Healy on this usually taboo subject (and by not pretending to have an oracle handy, Healy was all the more persuasive). Well worth reading & passing around!
I was struck with the fact that Aaron Alexis confided to the COPS his strange tale of people persecuting him with a microwave machine … but not to the “helping professionals” at the VA. And that they had absolutely no ability to go beyond a simple rote questionnaire (“Are you depressed? Are you thinking of harming self or others?) to draw him out as to what was really wrong. A fraternity of tin ears.
I’m also struck by the fact that they apparently see Trazodone and other TCA’s as simple, general-purpose “sleeping pills” that can be handed out willy-nilly without knowing anything about a person’s history or current life problems. These are POWERFUL, COMPLEX drugs that affect each individual differently. Back in the 80’s, people were often hospitalized in order to start or adjust these drugs so they could be closely observed. I never thought I’d look back on my own psych hospitalization thirty years ago as representing some sort of lost golden age of psychiatry — but gold is relative I guess.
I don’t presume to know the pharmacology, and as for personal experience, the TCA drugs did nothing more than make me feel groggy and dissociated. But I know they make some people energized, even agitated. It’s possible that for someone who was not “depressed” but definitely agitated and paranoid, they were the worst of all possible choices.
Johanna,
As an FYI, a former doctor wanted to prescribe Trazadone without any review of my past medical history which I rejected as I had had horrible experiences with it previously. She didn’t take too kindly to that.
You nailed the issue precisely with these rote questionnaires. But of course, we can’t ask medical professionals to treat patients as individuals now, can we?