The Hidden Gorilla

David Healy, MD
66
167

Three weeks ago What would Batman do Now covered the issue of suicide in the military – an issue that had Batman missing in action, and the Joker suffering the adverse effects of psychotropic drugs. Then along came James Holmes to the premiere of Dark Knight Rises in Aurora.

Most drugs that can cause suicide, including the antidepressants, mood-stabilizers, antipsychotics, smoking cessation drugs and others, can also cause violence. The akathisia, psychotic decompensation, or emotional disinhibition these drugs trigger that lead some to suicide, lead others to violence (see Healy et al 2006).

There is some awareness that these drugs can cause suicide but considerable resistance to the idea. There is less awareness and even greater resistance to the idea that they can cause violence. Treatment induced violence lies in a medical blind spot – no doctor wants to contemplate the possibility that she may have had a role in the deaths of innocent third parties.

This may be the grim prospect facing Dr. Lynne Fenton. Dr Fenton we are now told had been seeing James Holmes, the killer at Dark Knight Rises in Aurora, and had seen him just a week before the killings. Given the current reliance of American medicine on medications it seems likely that medications are involved in the Aurora case.

For many the instinctive reaction to Holmes will be that he is either mentally ill, evil or a street drug addict. This makes sense. Violence is one of the associations we all make to the ideas of evil, mental illness and illicit drug use. In contrast most of us know people on antidepressants none of whom are violent. This makes it difficult to accept a link to prescription drugs. For many even raising the idea that Holmes may have been crazed by a prescription medicine is likely to sound deranged or the excuse of a bleeding heart liberal.

But in fact there is a great deal of publicly available clinical trial (Hammad 2004, p40-41) and other data highlighting the risks of violence from psychotropic drugs. There is far more hidden data. There is in fact no other area of medicine in which there is so much hidden data on a risk that has consequences for the lives of so many innocent third parties.

With each “outing” of suppressed data lately companies have been beating their breasts about the lack of transparency “in the past” and have committed themselves to greater transparency. Here’s a chance for our major companies to prove things have changed by making the data on hostility, aggression and violence on their drugs publicly available. These data might tell us something about who is at risk, and allow us to better manage these risks. If there were a conspiracy to keep the details of all plane crashes out of the public domain, would airlines or the authorities have any incentive to make travel safer?

Instead, we are likely to see a vigorous marketing of articles that deny the possibility of a link. It takes really great science to overcome our biases. But if an article fits in with our biases (our associations), almost anything can be published, and doctors can be depended on to treat it as respectable science.

While 9 + of us out of 10 find the idea that an antidepressant might have caused Holmes to behave the way he did unbelievable, those whose lives have been touched by these issues are in a completely different position. News of another mass shooting immediately raises the suspicion that an antidepressant or related drug will be involved. And as, Rosie Meysenburg has shown on SSRI Stories, the drugs are all too often involved.

The drugs have been involved so often in campus or mall shootings that for some the surprise is that the medication question is so slow to get asked, as Peter Hitchens who is not a bleeding heart liberal has pointed out. What political considerations keep the NRA out of the debate? When Batman tells America “no guns, no killing”, there must be a temptation to respond “no drugs, no killing”.

But if Holmes turns out to have been on a drug that can cause violence, it is a quite separate matter to establish that in his case the drug he was on did contribute to what happened. It may not have. Without details of the case it is difficult to offer a view.

But this will not stop the debate in the public domain about an easier question for drug companies to control – do psychotropic drugs cause violence. And here, even though in some jurisdictions companies are legally obliged to say their drug can cause violence, a recent article in Psychopharmacology by Paul Bouvy and Marieke Liem denying the possibility of a link is certain to be marketed heavily

Bouvy and Liem’s article has much in common with recent articles by Robert Gibbons in Archives of General Psychiatry (see Coincidence a fine thing & May Fool’s Day). These articles may have no links to or input from industry, but they fall on the fertile ground of a distribution system complete with public relations companies geared up to make sure that messages like this get picked up and equally that messages about problems that treatment may cause do not get heard.

When it comes to Adverse Drug Reactions (ADRs) on prescription drugs, there is no such thing as an academic debate with equal airtime for both sides, although Psychopharmacology have published a response to Bouvy and Liem’s article unlike Archives of General Psychiatry which has refused to publish responses critical of Gibbons’ articles.

Bouvy and Liem correlated data on lethal violence in Holland between 1994 and 2008 against sales of antidepressants. The drug sales went steadily up and the number of episodes of lethal violence fell, leading the authors to claim that “these data led no support for a role of antidepressant use in lethal violence”.

This is a marvelous example of what is called an ecological fallacy. An ecological fallacy is when someone claims that if an increase in the number of storks parallels an increase in the number of births that storks must be responsible for births.

The best known example of storkology in recent years were the graphs produced by tobacco companies showing rising life expectancies and even reduced deaths from respiratory illnesses in line with rising cigarette consumption. These were produced as part of a Doubt is our Product strategy to deny the risks of smoking.

Recent sightings of storks include claims that increased SSRI use is linked to falling national suicide rates. The articles making these claims offer data from the late 1980s but disingenuously omit some key facts. One is the fact that suicide rates in most Western countries were falling before the SSRIs were launched. Another is the fact that both suicide rates and antidepressant use rose during the 1960s and 1970s when antidepressants were being given to the most severely ill people at the greatest risk of suicide. This was when suicide rates should have fallen if antidepressants have any effects on national suicide rates (Reseland et al 2008).

Autopsy (post mortem) rates are also left out. The more autopsies done the more suicides and homicides are detected. Autopsy rates rose in the 1960s and 1970s and fell from 1980 before antidepressant consumption began to escalate dramatically. The rise and fall in autopsy rates perfectly mirrors the rise and fall in suicide rates.

For the purposes of this argument, let’s assume the data on episodes of violence in Holland that Bouvy and Liem use is correct. This may not be the case – British national suicide rates are no longer dependable. The national figure is in essence set by a bureaucrat in London, who has scope to make the rate rise or fall as needed. Let us also assume declining autopsy rates play no part.

Before considering what else could be involved, let’s look at the shape of the argument and ask why Psychopharmacology would take an article like this. First alcohol use has increased in Holland during this period but no-one is making the argument that increased alcohol use has led to a decline in acts of lethal violence or the further Bouvy and Liem argument that this means alcohol cannot cause violence. Why not? Because, we associate alcohol with violence.

SSRIs cause growth retardation in growing children. The clinical trial data show this retardation and the labels for the drugs mention it. During this period SSRI consumption among children has increased in Holland but the Dutch have become the tallest people in the world and are getting taller. Where is the article saying that the increasing height of the Dutch proves that SSRIs don’t retard growth?

In the case of violence, the published trials show antidepressants cause it, probably at a greater rate than alcohol, cannabis, cocaine or speed would be linked to violence if put through the same trial protocols that brought the antidepressants on the market. The labels for the drugs in a number of countries say the drugs cause violence. And there is at least one clear and well-known factor, just like autopsy rates, that can account for the findings – young men. Violence is linked to young men, and episodes of lethal violence are falling in all countries where the numbers of young men are declining.

Whatever Psychopharmacology were doing taking an article like Bouvy and Liem’s making claims that run counter to the warnings that are already on the drugs, without warning their readers that this was the case, from here on the game for industry is about managing associations. From conmen to hypnotists to Batman, the trick is to hold the audience’s focus so they miss something much more important in their peripheral vision field. This is what public relations companies excel at.

One of the best examples of how we can be tricked can be seen in the Hidden Gorilla video where selective attention can lead to us missing a Gorilla walking right across screen in front of us. But the very best trick must be the one that leaves us certain that serotonin reuptake inhibitors or amphetamines available on the street cause violence while in complete denial that almost identical  prescription-only drugs could do so.

In the case of prescription drugs, the key people are doctors, the Watsons. Always one step behind the smarter Holmes. While it would be nice to see Watson turn the tables for once, in this mystery Sherlock Holmes has the last line once again. It’s elementary My Dear Watson. For an ADR you need A Dr.

66 COMMENTS

  1. I think psychiatric drugs affect the human brain, after all that is what the drugs are designed to do.
    You can do good things, and you can do bad things under the influence of drugs.
    Everyone taking psychiatric drugs has to be in a preventive pre-crime hospital-prison to prevent them from making a wrong choice with their freedom (and altered brain), but that would be too expensive.

  2. More fantasist nonsense from Healy.

    I suppose SSRIs made James Holmes plan his attack for months. Four months prior he made his first purchases of ammunition, purchases that were to be among many, many deliberate and calculated purchases made both online and in stores.

    I suppose SSRIs made James Holmes diligently research and purchase up to 20 separate pieces of equipment, weapons, body armor, and bomb making equipment.

    I suppose SSRIs told James Holmes to pick the opening night of a big movie for maximum press exposure.

    I suppose SSRIs have everything to do with the fact that James Holmes had dropped out of college and that he was facing eviction from his apartment.

    I suppose SSRIs caused him to mail a package stating his intentions to kill to his psychiatrist.

    I suppose SSRIs caused him to practice shooting in the remote mountains northwest of Denver.

    I suppose SSRIs caused Holmes to carefully research and teach himself how to construct elaborate home made bombs and grenades that tested the skills of bomb squad members charged with clearing them.

    Healy is shameless in his desire to latch on to any suicide, ANY violent event, and tie it to his livelihood, blaming drugs for complex human actions.

    Healy is very similar to the E Fuller Torrey crowd, in that they too, monitor the press for violent crimes and use them to advance their agenda, in their case for forced treatment, in Healy’s case, he can be counted on draw his long bow at any opportunity. It is embarrassing and deeply offensive to the victims families who have been the victims of the man who is charged with murder with DELIBERATION among many other charges.

        • I must agree with Anonymous. His/Her anonymity doesn’t affect the validity of the points and questions raised. I find it far-fetched that SSRIs could have explained Holms’ actions. The complexity of the attack and the sustained momentum leading up to it defy such a pat conclusion.

      • Ok anonymous I’ll bite. I don’t see anything in conflict between what Healy wrote and the longer-term strategizing done by Holmes. Why should they be incompatible? Healy isn’t saying that he “snapped” suddenly and committed violence. He is just pointing out how psychiatric drugs can cloud a mind, induce an unsettled outlook and produce a proclivity for violence. It’s not that SSRIs have a one-to-one relationship to violent behavior. Indeed, as the drugs build up in a brain they could induce the kind of final action taken in Aurora. And I must ask, why do you feel the need to be anonymous? I’m sure your thoughts are very common in the general public and the psychiatric community.

        • “Indeed, as the drugs build up in a brain they could induce the kind of final action taken in Aurora.”

          What a load of rubbish. A just so story.

          I’m anonymous because I choose to be and this is the internet it’s quite common and not unusual. I’d further point out that you could be operating under a fake name, or I could have just as easily chosen a fake name, and you wouldn’t be haranguing me about anonymity because you apparently truth the veracity of whatever name someone chooses to use. Or that anyone tomorrow could just as easily leave a comment and label it Rob Levine. Your faith in the objective reality of internet identification is utterly misplaced, I suggest you jettison it and stop bringing up irrelevancies about internet commenting.

          My thoughts are very uncommon in the general public and the psychiatric community. I don’t believe psychiatry is a real medical profession, and I don’t believe in ‘just so’ stories to explain human actions, whether they involve claims resting on unproven “disease” mechanisms (schizophrenia made me shoot up the theater), or unproven drug mechanisms (drugs made me shoot up the theater).

          • Not sure what a “just so” story is. Drugs don’t “make” anyone do anything in particular. But it is, IMHO, extremely dangerous to mess with brain chemistry, especially when the effects and mechanisms are not well understood. No one is trying to blame SSRIs for anything – we’re trying to understand how people who otherwise seemed “normal” can experience sudden personality change and do such unimaginable harm.

          • “Not sure what a “just so” story is. ”

            Then google it!

            This sudden personality change is a dead end. Look at the changes in his life. He was under a lot of pressure, and he was young, people grow into different people with each period in their life.

            Massacres, rapes, murders, wars, ARE normal. Imagine a year without them, it would be a very abnormal year.

            You see unusual human behavior, and your first instinct is to blame the brain. Look at the human world.

    • I agree with Anonymous that SSRIs are irrelevant in determining responsibility for a case like James Holmes. But I don’t think the goal of Dr. Healy was to minimize individual legal responsibility.

      When a camel’s back breaks after adding a straw, only fools will mostly focus on the straw while being completely blind to the 800 pounds of metal the camel was already carrying.

      That does not mean that as a matter of public policy, SSRIs role in violence is not a legitimate topic (like spreading straws on a overloaded camel caravan).

      SSRIs don’t cause individual violent acts, but David Healy is asking a legitimate question: do they load the dice (or the camel)? Could they have a real statistical effect on society’s violence.

      David Healy might be provocative in suggesting that spreading SSRIs might increase violence in society. But his stance is helping restoring balance against the common psychiatry bias: when somebody gets better, psychiatrists thank the drug and congratulate themselves on saving the world, when somebody gets worse, they express their sorrow at the worsening of the natural course of the mental illness and congratulate themselves on the fact it would have been even worse without drugs.

      To oppose that predominant bias, and force people to think twice, you sometimes have to be provocative, and make suggestive (rather than scientific) associations. The context is what make the provocative discourse legitimate.

      Individual responsibility is tantamount to the world health. Good public policies, and collective thinking/discourse are equally important.

      • Healy drew an incredibly, non-credibly long bow with this one, by exploiting this tragedy to further his agenda.

        He called this “treatment induced violence”. Sounds pretty definitive to me, combined with the repeated use of “caused by”, that he really believes in a direct causal relationship between molecules in drugs, and complex human actions. He comes bearing nothing but statistics, ever, and his supporters attempt to water down how unsavory this article actually is, but far from being some “loading the dice” final straw argument that you water it down to, you never hear him talking like you have just done in your comment.

        Every “bad” action someone with a drug in their body ever took, is an “adverse event” in Healy’s worldview.

      • I Love this: “when somebody gets better, psychiatrists thank the drug and congratulate themselves on saving the world, when somebody gets worse, they express their sorrow at the worsening of the natural course of the mental illness and congratulate themselves on the fact it would have been even worse without drugs.”

        You are so right! What will it take to get these psychiatrists to reality test their own assumptions? How do we cut through the self satisfied, demeaning, dehumanizing bullshit the doctors throw our way?

        It reminds me of a saying that my best friend favors. She worked for around 20 years around doctors before changing careers. Her saying was: “what is the difference between a doctor and God? God knows he is not a doctor”.

    • SSRI’s can most certainly cause those behaviors, especially over long periods of time. All psychotropic drugs can cause both spontaneous “freak-outs” AS WELL AS long-term personality and behavioral dysfunctions. These are in fact MIND BENDING drugs. It’s not just that a psychotropic drug can cause you to freak out and go on a out-of-nowhere rampage. The drugs alter your perception and thinking and can cause drastic changes to your personality and the way you view and interact with the world. This can go on for years, even decades. The adverse effects on behavior caused by psychotropic drugs does not need to be immediate or sporadic.

      I really believe that he became dissociated on drugs and felt his mind slip into a fictional movie world. This could definitely go on for months. I cant understand why you, like most people, seem to think that his ability to function and plan must mean that he could not be impaired by drugs in a way that could have caused the shooting. I really cant understand it. What part of the term mind-bending do you not understand? Seriously. What do you think it means to have a bent mind?

      • A driver who can competently drive his car, is not impaired, and won’t be wearing a DUI.

        A carefully planning, skills-learning, armaments and armor acquiring, bomb building, venue choosing, premeditated spree killer, is not an impaired spree killer.

        But you’ve got a couple of “statistics from David Healy” so you’re “right”.

        Bizarre.

        “I really believe that he became dissociated on drugs and felt his mind slip into a fictional movie world. ”

        Yeah right. A fictional movie world where you elaborately plan a massacre. Whatever.

          • First of all, alcohol is not a psychotropic drug. It is a central nervous system depressant. The two can not be compared. The impairment judgment and motor skills associated with being drunk are more comparable to being physically ill or very tired. Psychotropic drugs on the other hand will change the way you think and perceive the world. They will change your very personality and that will change the sort of things you would and wouldn’t do. If a person experiences a personality change on a psychotropic drug, and it was this new personality that lead to violence, then it’s hard not to blame the drug since the new personality would not have been there without it.

          • That’s pretty wrong. Actually. Psychotropic is just a synonym in practice for psychoactive. Alcohol is psychoactive. People don’t get drunk to “feel ill and tired” or whatever you said.

            http://www.wisegeek.com/what-are-psychotropic-drugs.htm

            Violence isn’t “caused by personalities”, in fact, I’m not even sure what you think a personality is. Violence can be the response to many different things, and people with lovely personalities commit violence under pressure all the time.

            You can blame the person for putting the drug in their body, too.

          • The choice of psychiatrist is up to the person.

            Unless it is forced, and you know I’m opposed to that. But Healy RARELY ever strays from your garden variety consumer antidepressant type “primary care” physician for “depression” type story.

            And people should know putting drugs in their brain is risky. I mean why would you even do it when the doctor can’t prove jack is even wrong with your brain?

            Not that I agree the drugs themselves are directly responsible for any particular human action, whether it be killing yourself or purchasing a meal.

    • All of this is conjecture, of course, because as far as we know, Holmes was seeing a psychiatrist and that’s about all we know. Psychosis, treated or untreated, can last a very long time. While it is happening, people can plan and carry out lots of methodical, but unpopular plans. SSRIs and other medications used to treat the psychosis are known to increase suicidal thoughts and violence in certain individuals. What’s so hard to believe about that?
      You seem to object to being called a coward. As a service to other readers of this blog, why don’t you, at the very least, invent a user name for yourself that is not anonymous? Readers can then keep your anonymous position straight from the other people who post anonymously. You can be held accountable, but still retain your anonymity.

      • I’m not going to be entering into any debates about the merits of anonymous commenting. I already covered that yesterday. I will point out you just told me other people are allowed to post anonymously, but not me, and that you’d be more than happy if I just picked a fake name. A very interesting position.

        “Psychosis, treated or untreated, can last a very long time.”

        THAT, is if you think the act of slapping the label “psychosis” onto unusual fixations, thoughts and behaviors suddenly makes them a “thing” that “is” something “medical” and worth wrapping in one catch-all label like “psychosis”. That, is if, you believe, by calling these sets of thoughts and behaviors a name, you suddenly proven that they are thing wholly separate from other people’s usual thoughts and behaviors, which is not something I agree with.

        You act as if this amorphous blob of thoughts and behaviors is legitimately a “thing” that one can “get”, like AIDS.

        In other words, the Nazis believed very unusual things, and for a very long time, do we get to label them as having a “long lasting psychosis”?

        I don’t think so. And I don’t even consider that concept to be a legitimate “medical” concept.

    • There is no contradiction in the fact that Holmes planned his attack for a long time. If a drug causes a homicidal mania, it isn’t necessarily going to be something that appears and then disappears within a few hours.. Obviously Holmes’ mental state lasted for a long time. So what? I don’t see the logic of this.

      I am also surprised to read a comment on this website from someone who clearly defends the use of psychiatric drugs. Where did this come from?

      • Your comment would make sense, if there was such a “medical condition” as “homicidal mania”. Unfortunately that’s just a psychiatric label that you, or some shrink will just slap on somebody’s months long massacre planning with absolutely nothing behind it but the label itself.

        I’m not in favor of psychiatric drugs. I’m also not in favor of mindless just so stories where we blame drugs for highly complex and deliberated spree killings.

        And if I ask, why this alleged condition of so called “homicidal mania” was executed with such precision and mastery on the high profile movie premier night that it was? I suppose you’ll tell me that’s “what this condition caused”.

        Whereas if someone sets their brilliant mind to planning and executing something beautiful, for months, instead of a massacre, perhaps a wonderful piece of art, you’re not going to label that diseased or the product of some “condition”?

        I think the selective tendency for people to look for psychiatric explanations for bad events, but allow that all the rest of human nature is not a “condition” just shows how deeply ingrained psychiatric beliefs are, even in the most surprising people.

  3. This is not an issue of whether or not Holmes’ actions were caused or accelerated by antidepressants. (He says in the article that he doesn’t know if it was a factor or not.) It’s about whether or not antidepressants can cause violence, and whether an investigation of violent acts should include this possibility as a factor. People are sometimes violent, whether on antidepressants or not. But there is plenty of evidence supporting the idea that people can become violent or more violent when taking antidepressants, and also plenty of evidence that these facts are being suppressed. That is true no matter whether the Holmes shooting was antidepressant-involved or not.

    And I will point out that it is POSSIBLE that Holmes may have been taking antidepressants the whole time he was plotting. The point is, the question needs to be asked.

    —- Steve

      • You are seemingly the sort of person who refuses to believe that peoples personalities are the result of biological functions. You don’t seem willing to consider the fact that perception, thoughts and behavior are products of the brain. Psychotropic drugs can change behavior not by controlling people like puppets but by changing their very thinking, personality and world view entirely. A person who has never had violent thoughts in their entire life can become obsessed with killing while experiencing the mind bending effects of psychotropic drugs. I recommend that you read Peter Breggin’s book titled Medication Madness.

        • “Psychotropic drugs can change behavior not by controlling people like puppets but by changing their very thinking, personality and world view entirely.”

          Hahaa “worldview”, yeah right. There’s a drug to make someone change their politics? You’re a biological determinist, there’s no point arguing with you.

          I will say that who I am, what I think about things, how I view things, is a result far more of what I’ve seen and done in my life, than the small biological influences on my temperament, which are not even understood in the slightest.

          If you really think some drug turned Holmes into a carefully planning, gun training in the desert, internet store body armor purchasing, bomb making manchurian candidate, good for you. Just understand I don’t buy it, and agree to disagree. No further comments.

          • “I will say that who I am, what I think about things, how I view things, is a result far more of what I’ve seen and done in my life, than the small biological influences on my temperament, which are not even understood in the slightest.”

            But that’s just what you think, which is ironically not even in your control. Objective scientific tests have determined that awareness of a thought occurs only after the brain activity which produced it.

          • Also, psychotropic drugs can most certainly change a persons worldview. LSD is a drug famous for doing this. it created an entire generation of liberal hippies. MKUltra experiments demonstrated the drug useful for “brain washing” and mind control and Timothy Leary was well aware of those studies before he promoted the drug in his “turn on, tune in, drop out” campaign.

          • I’m supposed to believe a chemical created “a whole generation of hippies”. I don’t think so.

            Sure, these people have an unusual experience on drugs loosened them up to the possibility they already had inside themselves that they wanted to expand their worldview, but you can’t blame the chemical itself.

            Taking a trip to India, drug-free, did the same for many people.

            First person to mention MK Ultra wins a trip to Alex Jones’ website.

          • Jeffrey C, how can something that isn’t locatable in space, such as awareness of a ‘thought’, be shown to come after, through objective scientific tests, brain activity? You talk of ‘thoughts’ (a metaphor for talking to yourself inaudibly) as if they were entites.

            You talk as if also that there are such things as thoughts existing before our conscious awareness when you say ‘awareness of a thought’, as if it was ‘there’ before our awareness.

            As for the materialistic and neuro-deterministic view of human behaviour, you seem to me to be disjoining human behaviour from its many different contexts, making it into a monocausal phenomenon, as if we were robots.

            Human behaviour is irreducible to a single material substrate of a person. This only impedes our capacity to understand a complex interplay of forces underlying human behaviour the nature of which are beyond my powers of comprehension (though I do have more of an idea than just that), no matter how much it satisfies the all to human need for complete control over our environment.

            It is reductionistic, and reflects the complete want of intellectual humility amongst these neurophilosophers.

          • Cledwyn Bulbs you are a person after my own heart. Thankful to have someone circle the wagon.

            We need to concentrate on the human world, the human reasons, for why James Holmes thought the future was hopeless and that he hated the world so much to destroy lives. Rather than this ridiculous conjecture and the just-so stories from drug blamers AND brain blamers.

          • OK then anonymous. He did it because he was a social reject who couldn’t get laid. That is the obvious reason. He had everything else going for him in life, including a successful career. But he couldn’t get laid. Since you only wish to acknowledge “life-based” reasons for behavior then the burden of proof is now on you to show that his social issues can cause people to kill. The fact that a great majority of social rejects do not is going to make this difficult for you, but I don’t think that you care since you don’t seem to have any appreciation for science anyway. You will believe what you want to believe and it will be nothing more than that; a belief.

          • @bulbs: It is impossible to respond to something unless you are aware of it. Awareness of a thought is most definitely measurable, especially since eye movements are correlated to them.

  4. I don’t know about SSRIs but in my experience Clozapine can turn a nice intelligent young woman into a violent person. When put on this drug my niece attacked her mother with a knife. She was so shocked by it herself that she tried to kill herself. Since she has been taken off that drug, her urges to hurt her mother have gone too and she is back to her old self. Just check out the “Diary of a father”. The same happened to his son when the psychiatrists put him on Clozapine: he turned violent.

  5. Twelve hours after taking my first and only Zoloft capsule (1990) I felt intensely afraid of my friends and family. The only other time in my life I experienced this feeling was within an hour after the first and only time I smoked marijuana(1975). Paranoia is a frightening feeling that I’m fortunate to have only experienced due to mind altering drugs. I am sure that my behavior and life would have been different if I would have had to live with those feelings.

    When I shared with a close friend the effect I believe the “antidepressant” had had on me, she shared that her husband had also been prescribed an “antidepressant”. He, a soft spoken gentleman, stopped taking it after a few days as he believed it was taking the drug that made him feel the urge to murder his customers when they entered his shop.

    For both of us, the feelings left as the drug left our bodies. Neither of us acted on our feelings nor struggle seriously with impulse control.

    We are encouraged to dismiss anecdotal information as exceptional, but having a family member who attempted suicide and became paranoid only after taking prescribed “antipsychotics” (2001), and being exposed to the literature on this website, I wish further research would be done to investigate the very possible influence psy drugs have on violent behavior.

    • ” drug that made him feel the urge to murder his customers when they entered his shop.”

      I suppose he didn’t spend over four months planning and buying body armor and building bombs? This comments section, is allegedly supposed to be about THIS ARTICLE, about Healy feeling the Aurora massacre was relevant enough to his schtick to write an article inspired by this massacre. I’ve labeled it exploiting a tragedy to further his own agenda. I stand by that.

      Google ‘set and setting’. http://en.wikipedia.org/wiki/Set_and_setting

      People bring all sorts of preconceived expectations and things into the drug taking experience.

      People who have been told all their lives that the first time anyone ever touches heroin, they’ll become a junkie, are much more likely to blame the drug when they develop a bad habit.

      I agree, drugging your brain is rarely a good idea, but this article right here above, is about Healy drawing a long bow calling a long term planned, well executed spree killing, “treatment induced violence”.

      • What was Holmes motivation to perform the violence? He felt angry or wronged I presume. These feelings motivated him to prepare for violence, get skilled . You or I know the reasonable/appropriate level of violence to perform when wronged or feeling angry, Why did Holmes not have this ability?

        • You or I “know the reasonable/appropriate level of violence”?

          When someone is prepared to cross the line, they are prepared to cross the line. Some just get desperate enough to cross that line.

          Every person has it within to cross lines. Why some do and some don’t, is not a matter of anything mechanistic or scientific. It just depends on the choices one makes. The line-crosser has to live or die with the consequences.

          Read my comments on the other recent article, the one about gun control.

          • I agree that the drugs by themselves are not likely to cause a person to plot such detailed violence. What I believe these drugs do, based on reading research and also on many personal anecdotes that others who did not kill people have shared with me, is to reduce social inhibition against doing things like killing oneself or others. We all have impulses to do destructive things from time to time, which we almost always are able to redirect, because we have an internal sense of ethics, or we’re afraid of being embarrassed, or we fear social consequences like arrest and jail time. What I believe these things do, based on observation and research, is create a situation where the person is no longer concerned about these consequences and is willing to act on what they’re thinking about.

            There are many stories of these drugs also inducing destructive impulses in those who didn’t experience them before, but again, most people are able to say, “OK, suicide is not the answer” or “I didn’t start feeling this hostile until I took the drugs – maybe I should stop.” But a person who is already kind of unstable appears to be able to do things that they might previously only have thought of – to “Cross the line,” as you put it.

            It sounds like you have an axe to grind with Healy, which I do, too, based on his historical support for ECT, which I consider barbaric and incredibly destructive. However, this issue goes far beyond Healy’s opinions. There is good evidence in many places that this phenomenon is very real, and that people die as a result of this information being suppressed.

            I hope you can get by the specifics of this particular case, where this SSRI phenomenon may or may not be involved, and look at the bigger picture.

            —- Steve

          • Of course drugs can be a tactic to decrease inhibitions. But saying they specifically allow someone to cross the line and that something about the drugs specifically overrides their previous feelings that prison was a deterrent is not something I can accept. It can be a factor, but never the whole story.

            Anders Brievik in Norway took steroids in the belief, as a tactic that it would help him be more aggressive on the day of the killings. But he had years to carefully consider if he was willing to cross the line.

            Child soldiers are given cocaine by warlords to make them less inhibited when they kill people. Sure, I agree to some extent, but there are always other factors at play, like the warlords will kill the kids, the kids know this, the general coercion of the situation etc..

            Alcohol leads to dis-inhibited sex, but there must still be personal responsibility for rapes occurring while drunk. Slap a warning label on all the psych drugs, whatever, and let people take personal responsibility.

            Healy is someone I’m not a fan of. I’m actually glad he wrote this article, because I believe his premature and ill-informed (he clearly has barely even read any of the facts that are available about the case, he refers to Holmes’ woman psychiatrist as a ‘he’, he demonstrates he isn’t even aware of the many points about the complex planning that I have mentioned), I’m glad Healy wrote this article. It’s a prime example of Healy drawing a long bow. He went too far this time, and went into the territory of exploiting a tragedy, in a far too premature way, to further his own ends, that is, making everyone believe in his simplistic stories.

            Anyone who is willing to put electroshock machine electrodes up to someone’s head and flip the switch, is not a very deep thinker about the human world and the reasons humans feel troubling feelings/thoughts and perform troubling actions.

          • – When we force ourselves to smile, we feel a little better.
            – When we stand straight up rather than slouch, we feel a little better.
            – When we sip tea, get a massage, or hum a tune we tend to relax a little.
            – When we are ill, we might feel a little more hopeless or defeated.
            – When we breathe air that has a higher percentage of carbon dioxide, we tend to panic sooner, attributing the sensations of panic to anything from heart trouble to unidentified malevolent forces.
            – There are many pathogens which specifically cause behavior change in order to increase their efficient spread via host organisms, from fungi that cause ants to crawl to the top of grass leaves, clamp on with their jaws and die so the fungus can sprout a fruiting body from the ant’s head, to rabies which spreads by getting mammals to go on ferocious attacks at the same time that the virus is propagating in the animal’s saliva.
            – So it’s perfectly plausible that physical causes and conditions influence states of being and consequential or concomitant cognitive structures, schemata, etc. I don’t think there is any question that this is the case. It’s a question of what conclusions can be drawn from this. And the evidence seems to suggest that SSRIs influence a state of being that may lead to many things, perhaps depending on states of being or foundational beliefs of the person taking them. Perhaps, for some, an increased sense of motivation for momentum leads to something that is experienced as “less depressed.” This is not necessarily exclusive of the possibility that for others this augmentation results in aggression toward self or others. The question is: if we assume this is true, is it worth it?

          • I went back and read that again, Healy didn’t get the psychiatrist’s gender wrong, but so what, it is still patently obvious that Healy hasn’t read widely on the case. He fails to mention numerous factors that I outlined in my first comment on this article.

          • Yes Kermit, but we are not in any position to be having psychiatrists stand up in court and absolve carefully planning and precise deliberative spree killers of responsibility for their actions.

            And Healy has outdone himself with this one in terms of prematurity and reaching.

          • I don’t think any of this is necessarily about absolving anyone of anything. But if it is true that these meds cause SOMETHING to happen, then even if it is true that for most people that SOMETHING turns out well (even if it is only for a short time, which is another matter entirely), and it is also possible that that SOMETHING could statistically be expected to lead to SOME people having a different reaction that turns out badly for themselves or others, then it seems at least a worthwhile conversation to have. Is it worth the “benefit,” knowing that some occasional shooting sprees might occur? If so, who chooses? Because “informed consent” is perhaps an insufficient model if I’m told that, while I might briefly benefit, it could be at the cost of someone else suffering. That’s what we call a “moral hazard.”
            At the very least, the effects of these medications need to be considered in a broader context. Either they have no effect, which is one thing, or they have some effect, which is another. Psychiatry has slipped by with the easy “chemical imbalance” rubric. Even if it’s true that the meds can be helpful, I believe, they could only be helpful with a consummate mindfulness as to their effects; not a hammer-and-nail situation. Perhaps if that were they way there were used, more benefit would be derived and more “adverse events” would be avoided.
            I am not arguing anything, here, for or against the use of meds. All I’m saying that there is more to talk about, and it’s much more interesting, than merely a to-and-fro about whether psych meds can or cannot induce specific behaviors. This is a specious, simplistic, and unsatisfying conversation. As with everything; it’s more complicated than that. My motto: isn’t this interesting?

          • Comparing rabies, a real disease with a definite course and demonstrated disease mechanism, to Healy’s long bow attempt, that he wrote before even a single news story has been published detailing James Holmes’ psychiatric drug treatment if any, is ridiculous.

            This stage often known as “furious rabies” for the tendency of the affected animal to be hyper-reactive to external stimuli and bite at anything near, is a completely different kettle of fish to Healy saying James Holmes’ four month planned massacre was “treatment induced violence”.

          • We do not know whether Holmes was on psychiatric meds. Which is why I’ve more or less ignored putting up any news on the matter, other than the fact that he was under a psychiatrist’s care. It would be difficult to imagine that he would not be medicated, as most psychiatrists consider it to be an exposure to liability NOT to medicate someone under their care, but even so it is rash to assume this was the case.
            Nevertheless, given that the overwhelming preponderance of such events have in fact involved people on psych meds (in fact every one for which I have been able to find any information on the matter, which I have spent time doing), it seems it’s hard not to consider that at the very least the meds don’t seem to have helped much.

          • There is simply no way, that all or even most spree killers are on psych drugs. Did you look all over the world? What about the machete killings in China that happen with regularity? Spree killings predating wide saturation of biopsychiatry in history… etc.

            Merely focusing on America post late 1990s, you’re going to inevitably have a heap of kids on psych drugs.

            And this faith in statistics really, really, is not that compelling to me.

            Statistical analysis of a set of traits, when that set of traits is as infinite as something like human thought, decisions and action, is really overstretching the capabilities of so called RCTs to tell us much.

      • This response seems to miss and dismiss both my points – 1) that there can be a cause and effect when taking antidepressants and feeling violent or paranoid and 2) that it is reasonable to expect that those feelings, especially if prolonged, could contribute to a person acting on those feelings.

        You are presuming too much in the psychoanalysis of either person’s “setting”.

        • It is the drug blamers that presume too much.

          I take into account the vastly important human factors and life factors in these young men’s lives. Factors that can be easily understood, the context of their lives in the lead-up to bad crimes.

          You, just assume a “violent feeling” caused (you can’t tell me exactly how) by drugs, but you never assume a “generous” or a “lazy” or a “hardworking” feeling. It’s always the drugs nicely and neatly seem to cause the undesired behaviors and never the good behaviors.

          Next Healy article, watch me ignore it, and leave no comment, and we’ll see how it gets like 5 comments total. I should not even be giving Healy oxygen, and making his article look like it is the focus of the most lively debate.

          A stealth electroshock psychiatrist isn’t worth a second of my finite lifespan.

          • Trying to whitewash the possible role of psychiatric drugs in violence is not particularly lively. The FDA and numerous regulators around the world have acknowledged that SSRIs can sometimes cause increases in self-harm or aggression/disinhibition, especially in youth.

            And they are often casually prescribed without any real psychological-social support or guidance.

            Having said that I don’t agree with Healy’s views on ECT (or for that matter his speculation about insulin coma ‘therapy’).

          • An argument from authority using the FDA! as something that is supposed to impress me? The FDA is worthless. The other worldwide regulators just copy what the FDA says.

            I’m just sick of everyone whitewashing psychiatric drugs’ role in the increase of Ipad sales. After all, we can use statistics to blame these drugs for any action we choose to ‘prove’ a direct causal link to.

            I don’t know about you, but I blame Afghan warlords for growing poppies when heroin addicts break into my house a world away.

  6. I side with Dr Healy’s analysis. Anonymous is just offering a caricature of Dr Healy’s argument. All Dr Healy is saying is that there is more than anecdotal evidence that antidepressants make people more prone to violence. I explore the topic here http://endpsychiatry.blogspot.com/2012/07/should-all-gays-be-civilly-committed.html and I mention this data http://www.psychologytoday.com/blog/mad-in-america/201101/psychiatric-drugs-and-violence-review-fda-data-finds-link . Does this mean that there is cause-effect 1-1 relationship between prescription of psychotropic drugs and suicide/violence? No, and I didn’t read that Dr Healy was making that point either. After all, there is free will. And there is also the fact that there might be also other factors involved as well. As in all things about human behavior, trying to find a single indicator that has 100% predictive power is a mistake. That said, psychiatry is all too willing to give drugs credit when it gets positive results, even though those results are no better than those obtained by placebos or homeopathy for that matter, but it ignores the very real fact that those drugs not only don’t work but they might play a role in pushing people to do horrible things. Psychiatry is an evil endeavor, period.

  7. After many years of frontline experience and just a few spent investigating incidences of “out of character” acts of violence towards self and others amongst adolescents and young adults, I trust in my visceral responses. Not only do I feel certain J. Holmes was taking prescribed psychotropic drugs, I believe, with equal conviction that most likely: 1) The statements and or presentation of behavior by Holmes that prompted Dr. Fenton to disclose her concerns to the threat response team (not going to look back for the *official* name of it), were her *patient’s* response to her prescriptions for *treatment*; 2) that Dr. Fenton is in the dark regarding: a) contraindications for administering CNS stimulant and SSRI’s and/or indications that these drugs are producing a potentially fatal ADR.

    I am hoping this will become the main topic for public discussion. AS American society awakens to the heinous incompetence of mainstream psychiatrists; the futility of seeking psychiatric help as an uneducated *service users*; we can seriously and passionately engage in pursuit of self exploration and deepen our understanding of each other as human beings.

    David Healy continually urges his readers to recognize the danger of … asking your doctor if ________ will work for you. I appreciate how he is demonstrating both respect for and faith in *the people* over and beyond the expertise of his colleagues. After many years on the front lines, I can attest to the rarity of Dr. Healy’s tireless efforts to empower people and frame the thesis statement of the most direly needed public debate of my lifetime.

    It is Not so important that ALL perpetrators of mass murder were taking prescribed psychotropic drugs . What IS important is that we thoroughly examine, investigate and disclose the details of any single episode where the perpetrators were under the care of a MD, taking prescribed psychotropic drugs.

    Once is NOT never…. There has got to be a way to provide a clear warning to the public of the horrifying risks of taking these *prescribed drugs*.

    Even if my gut feelings are not validated by forthcoming media coverage of this case, I am hopeful that what is now known; that Homes sought psychiatric help, will be thoroughly absorbed and digested… THINK about it… this bright, non-violent young man, who had invested most of his young life developing self discipline and acquiring knowledge— sought our current, culturally sanctioned path to obtaining HELP for a deeply disturbing personal crisis. Beyond interesting… this is a pivotal point— a golden opportunity !

    ..

    • “I trust in my visceral responses. Not only do I feel certain J. Holmes was taking prescribed psychotropic drugs, I believe, with equal conviction that most likely: 1) The statements and or presentation of behavior by Holmes that prompted Dr. Fenton to disclose her concerns to the threat response team (not going to look back for the *official* name of it), were her *patient’s* response to her prescriptions for *treatment*;”

      – Just read that everybody and let it be known the blind faith Healy’s acolytes work on the basis of.

      ‘Healy’s book states, “the charge of brain damage from ECT is an urban myth” (p. 3) and “Therapeutic convulsions induced by electricity, by contrast [to epilepsy], do not harm the brain and can save lives” (p. 9). His statement, “ECT really does work in illnesses where drugs fail” (p. 7), directly connects to his work in criticizing drugs. ‘

      • Getting just a tad grandiose in your pronouncements there, Anonymous— and leaning toward personal attack via your feeling based judgments of a person you have never met, me.

        I am no one;s acolyte, and you are certainly no one’s expert on any aspect of the topic of this blog. Your opinions are as respect worthy as anyone’s, but your reply to my comment here is repugnant, insulting and way off topic.

        • ““I trust in my visceral responses. Not only do I feel certain J. Holmes was taking prescribed psychotropic drugs, I believe, with equal conviction that most likely: 1) The statements and or presentation of behavior by Holmes that prompted Dr. Fenton to disclose her concerns to the threat response team (not going to look back for the *official* name of it), were her *patient’s* response to her prescriptions for *treatment*;””

          I was judging that statement, which is a ridiculous statement filled with blind faith. Not you, the person.

          • Yo! Anonymous!

            Visceral responses are uniquely human and universally experienced. One might say they have played a big part in our ability to survive the ever changing perils of existing on this planet. I attributed my visceral responses to my own experience. which, as I stated, has developed over *many years*. If you want to challenge the validity of my experience, you will not likely put a dent in it, because the research I have done and the comments right here on this site are validating MY experience and MY visceral responses.

            WHO are YOU to say that the perceptions and conclusions of anyone else are ridiculous? And how do you get from “ridiculous statement” to “proponent for ECT”?

            “Blind faith” is YOUR term, and it does not apply to what I have written or any of the testimony on this blog that supports a link between psychotropic drugs and violence. In other words, YOUR judgment is impaired, by your own attachment to your feeling-based belief system. You cannot simply agree with those who share your beliefs, you have to negatively JUDGE those who don’t, by assigning them various labels to indicate the way in which you have JUDGED their perceptions to be “ridiculous”…

            You really do not KNOW the mind of a mass murderer, another angry young man, or anyone posting their comments here. YOU have perceptions and opinions— as we all do. YOUR claim to superiority here is the only “ridiculous” aspect of the comment flow I perceive!

          • You see this?

            “What’s Hot This Week

            Most Commented

            The Hidden Gorilla (58)”

            The Healy articles that I don’t comment on, get like 5 comments total. That’s where Healy’s articles will be going from now on, into the memory hole where they belong. Because I’ve given up arguing with his acolytes.

  8. Hi, I am from Australia and I logged onto the web tonight for the sole purpose of finding out whether The Dark Knight Rises Killer was on prescription drugs or not. I don’t care what any guru has to say about these drugs anymore they are dangerous and there needs to be more regulation placed on them as they are life destroyers and killers. I suffered a physical injury and went from painkillers to antideps onto anti-psychotics in the end as I was losing the plot along with anything resembling my personality.

    They caused me physical harm and a whole range of problems from crashing cars to spending my life savings like there was no end to it. After a few years of this subscribed torture and reaching a point where I was feeling like I was going spontaneously combust. I took myself off the lot as the answer to regaining something like a normal life didn’t actually lie in being a human petri dish for the doctors who in the defence of many were just trying to help lol but in dealing with what was going on in my life on life’s terms and free of personality and reality altering drugs.

    I now have ongoing problems with my liver as a result of being on the meds and my once couldn’t get fat metabolism will never ever be the same again. On the upside the space between my ears is back on track apart from the fact I feel like I have been to war as the experience was just so damaging in so many ways. I would have put what little of my life savings is left on the fact that this bloke was taking some sort of medication, not illicit drugs but medication.

    I would like to know how many people not only kill others or themselves as a result of this family of drugs but how many lives are ruined as a result in total. How many end up in jail who would have otherwise never done so, how many end up in psych wards who otherwise never done so, how many families break up that otherwise never would have done so and so on and so on? The drug companies are seemingly free of any responsibility from any damage caused by their drugs which are destroying so many lives in so many ways its not funny.

    What percentage of people in the psych places are there now who until they went on their drugs weren’t candidates to do so? It has gotten out of hand and other than to blame the bugger taking the meds as prescribed by the professional whom they have trusted in when it all goes pear shaped. Surely the amount of people on this family of drugs is in itself an indication that the people are being misdiagnosed at an alarming rate and that something in the process needs to be addressed.

    I would hate to see numbers lost in a field that is short of people now and whom society desperately needs more of but I think that MDs and mental health professionals need to made much more accountable. Legislation whereby which the subscribing professional is required to actually pay for people losing their jobs, families, savings, lives, sanity, damaging otherwise healthy organs and everything else that consuming these drugs results in because the laws that both of our countries are currently operating under aren’t actually doing the job of protecting the people.

    If legislation was passed and that was the case then less and less of these drugs would be administered as easily as they are and news headlines like the subject of this article would be in rapid decline.

    Thank you and hooroo – John

    • You said it, John. If a mechanic ruined my car, he’d have to pay to have it replaced. If he knowingly did something to ruin my car, he’d be committing a crime and susceptible to criminal penalties. How much more should a person be accountable for ruining a life? Why do these guys get off without even a bad news story? The best way to end biological psychiatry is to make sure that this particular crime no longer pays. Fines in excess of profits made, and jail time for knowing perpetrators, those are the tools to drive the drug dealers out of business.