On Monday night, Irish television screened a documentary covering the events leading to the deaths of Shane Clancy and Sebastian Creane. I have previously written about Shane who, under the influence of Citalopram, killed Sebastian and then himself. In both an interview with the Irish Sunday Times and the documentary, psychiatrist Professor Patricia Casey, speaking on behalf of the Irish College of Psychiatry is quoted as saying that she does not believe the drug played any role in Shane’s actions and that in her opinion he suffered from a psychiatric illness which led him to kill himself and another.
According to New York University Psychiatry Department’s Director of Medical Student Education, psychiatric evaluation comprises taking a comprehensive patient history and conducting a thorough mental status examination.
Clearly Professor Casey has not made her assessment of Shane Clancy’s mental state based on any professional standards for diagnosis developed by her profession. Shane is dead and she did not ever meet him when he was alive. She has never spoken to his family, does not have access to his medical records or family history and has not spoken to his doctor.
Most people would consider it impossible for a psychiatric assessment to be conducted on a dead person. As I’ve discussed in a previous blog however, psychiatrists don’t let the fact their patients are dead stand in the way of assessing their mental health and labelling them mentally ill. In a process known as a psychological autopsy, psychiatrists interview family and friends of the deceased and arrive at a psychiatric diagnosis. Researchers have noted that the diagnostic interviews conducted have not been validated for proxy informants. If what Professor Casey conducted was a psychological autopsy, she again failed to follow accepted practice for doing so given psychological autopsies involve asking those closest to the deceased a series of standardised questions within a structured interview.
On what basis does Professor Casey claim to have formulated an expert opinion that Shane Clancy was psychiatrically ill? In the documentary she tells us she has access to what she refers to as a journal of Shane’s which in fact is, according to Shane’s mother, not a journal but a collection of letters he wrote to his former girlfriend, and his emails and text messages to her. Despite the DSM-V lowering the diagnostic threshold for psychiatric disorders, even it does not allow for a diagnosis to be made solely on a small number of letters, emails and texts sent to an ex-partner while ignoring letters, emails and texts sent to others. It does not suggest that evidence of those closest to the patient and a medical file which records his experiencing adverse effects from the drug Citalopram and that the dose of that drug was changed shortly before his death, be discounted. It does not suggest that recent mental health assessments by other physicians which found no mental disorder, be ignored.
Shane’s medical file records no psychiatric diagnosis at any time during his life including the 17 days leading up to his death during which time he was taking Citalopram. This file is of course the record of the information gathered by three separate doctors who unlike Professor Casey sat in the same room as Shane and conducted a mental state examination. It is Professor Casey’s contention that these three doctors, failed to identify a mental disorder of such severity it resulted in the killing of a young man? If so, it is surprising questions have not been raised about the competence of these doctors who were unable to reach a diagnosis that five years after his death, Professor Casey was able to reach merely by reading a few letters.
Professor Casey tells us on the documentary that she was appointed by the Irish College of Psychiatry to represent them at Shane’s inquest. This is extraordinary given neither the College nor any of its members were a party to the inquest. Shane did not ever consult a psychiatrist, he did not ever receive psychiatric treatment, he was not prescribed Citalopram by a psychiatrist. It is hardly surprising therefore that Professor Casey’s offer on behalf of the College, to provide expert evidence at Shane’s inquest was declined by the Coroner. Professor Casey’s role as a paid consultant for Lundbeck Pharmaceuticals, who manufacture Citalopram, may have further removed her from being the independent expert the Coroner was seeking.
Instead, the Coroner Louth decided the jury would hear expert testimony from a world renowned psychopharmacologist and expert in pharmacovigilance – an expert in the action of these drugs and their potential for adverse reaction and in assessing the causal relationship between them, self-harm and harm to others.
Professor David Healy, who provided expert testimony at Shane’s inquest is both a psychiatrist and a psychopharmacologist. He is an acknowledged expert in the area of psychiatric drug induced suicide and homicide having conducted research on these issues and provided expert testimony in numerous homicide trials. He is the founder and CEO of a global pharmacovigilance organisation specializing in assessing causal relationships between drugs and adverse reactions. For these reasons, he was selected to provide evidence at the inquest over Professor Casey who is a clinician providing a service in which Shane Clancy never engaged. The Coroner’s decision in this respect should not be difficult to understand.
The documentary leaves us wondering whether the Irish College of Psychiatry seeks to involve itself in other legal proceedings to which it is not a party. Does the College conduct a psychiatric assessment on all those charged with homicide or who are suspected of dying by suicide and offer to provide expert testimony? Or does it do so only in cases where it considers that information about the risks of psychiatric drugs may get media attention?
Despite having far more information than Professor Casey, Professor Healy did not presume to conduct a psychological autopsy on Shane and to diagnose him posthumously. Rather he provided an expert opinion, using robust science, on the causal link between Citalopram and Shane’s self-harm and violence.
Psychiatry is the one field of ‘medicine’ that has spawned a huge international survivors movement peopled by those who have suffered psychiatric abuse. The practice of conducting psychological autopsies is in my view another form of psychiatric abuse. Those of us whose children have died as a result of an acknowledged adverse reaction to psychiatric drugs are standing up for our rights – and theirs – not to be stigmatized with psychiatric labels following their deaths. We believe that psychological autopsies are unscientific and unethical. We know they are disrespectful and cause pain to families.
We demand that psychiatrists like Professor Casey and bodies like the Irish College of Psychiatry cease and desist from this practice forthwith and we ask that the psychiatric survivors movement support the right of those who did not survive to cease being hounded and abused by psychiatry as they lie in their graves.