I have always been a big fan of the documentary program The Passionate Eye on CBC, Canada’s public broadcaster. Until now. On January 6, 2018, they aired “A Prescription for Murder?“, which was originally shown on the BBC. The program focused on James Holmes, the young man who shot and killed 12 people and injured 70 in a movie theatre in the United States in 2012. The central argument is that the SSRI (selective serotonin reuptake inhibitor) class of antidepressants can, in rare cases, cause people to become psychotic, violent, and homicidal.
The lead-up to a mass shooting
According to the documentary, Holmes first started seeing a psychiatrist at his university’s student wellness centre 17 weeks before he committed the murders. He reported social anxiety and intrusive thoughts of killing people; these thoughts were not new, but it was the first that he had disclosed them. After the killings, he told a psychiatrist that he had experienced thoughts of killing people since his teens as a sort of social avoidance strategy. The psychiatrist at the wellness centre started him on the SSRI sertraline, at a dose of 50mg per day.
Not long after, he described a theory he referred to as “human capital” that involved intentions to kill people. The dose was increased over the next 4 weeks to 150mg per day, as his intrusive thoughts were increasing. A little under 3 months after starting sertraline, he had made the decision to drop out of school, and declined his psychiatrist’s offer to continue treatment and start him on an antipsychotic.
It’s not clear when he stopped taking the sertraline, but his last prescription would have run out 3 weeks before the shootings. The journalist argues that, because of the timing, it is likely that Holmes’ homicidal behaviour was triggered by the sertraline. Various psychiatrists are interviewed for the film, with several expressing the belief that the sertraline had triggered psychosis, which led to the killings. One went so far as to suggest that if Holmes hadn’t been put on sertraline, the murders might not have happened.
Do SSRIs cause mass murder?
The documentary bothered me on multiple levels. If someone wants to make a film arguing that SSRIs can trigger psychosis and people should be aware of that, so be it. But the choice of title is clearly intended to be sensational, as is the tagline “Is it possible that a pill prescribed by your doctor can turn you into a killer?“
On the Canadian broadcast that I viewed, on multiple occasions, a banner ran across the top of the screen warning that people should not stop taking their medication without first seeking medical advice. It seemed utterly absurd to be including this message for a film arguing that SSRIs turn people into mass murderers.
If one pays enough attention, the more nuanced argument being made is that SSRIs can cause psychosis and this can precipitate homicidal behaviour; however, what’s missing is the key piece of information that the probability of a psychotic person committing homicide is extremely low. That’s a very different can of worms than simply connecting SSRIs and homicide.
Temporal correlation does not prove causation
Another flaw in the argument that is never acknowledged is that temporal correlation, i.e. things being related in terms of timing, does not necessarily imply causation. I’ll talk more about this in an upcoming post about research literacy, but it is flawed logic to think that because Mr. Holmes took sertraline shortly before he committed a mass shooting, the only or even the best explanation is that the sertraline caused it.
The documentary does not even touch on alternate explanations, the most obvious (at least to me) being that he was started on the medication because he was getting sick, it didn’t work, he got sicker, and he became psychotic, which triggered him to act on thoughts he admitted he’d been having for years.
Potential consequences of this messaging
I worry that some poor person with mental illness is going to watch this and think oh, I don’t want to be on a medication that’s going to make me a killer. And maybe that person will stop the SSRI they are already taking, or avoid going to see a doctor to seek help for distressing psychiatric symptoms. Maybe that will mean they get sicker. And maybe, just maybe, that could have disastrous consequences like suicide.
I have no hesitation whatsoever in saying that the risk of suicide from a depressed person not taking an antidepressant is higher than the risk of someone taking an SSRI and committing mass murder. There’s no indication that the filmmaker has given any thought to these sorts of outcomes that could snowball in response to the messaging that antidepressants can turn people into murderers.
There also seems to be no consideration given as to how this documentary might affect public attitudes toward mental illness in general and psychiatric medication in particular. There’s already more than enough stigma around this, and I for one do not want some random idiot thinking that I might fly into a homicidal rage because of my antidepressants.
Someone who hasn’t lived with mental illness might think this concern is overblown, but the stigma around taking psychiatric medication is very real, as is the potential of this stigma to cause harm. By choosing to air this documentary, the BBC and CBC have chosen to move backwards in terms of stigma, exactly the opposite of where those of us blogging about mental health are trying to go.
I’m sickened by how irresponsible the BBC and CBC are for broadcasting this documentary. The same issue could potentially have been explored in a way that utilized much safer messaging. Being cynical, I’m guessing that this particular approach was chosen in order to generate buzz and viewership. I can only hope that it won’t do as much damage as I think it has the potential to.
My latest book, A Brief History of Stigma, looks at the nature of stigma, the contexts in which it occurs, and how to challenge it most effectively.
You can find it on Amazon and Google Play.
There’s more on stigma on Mental Health @ Home’s Stop the Stigma page.
They tried that when the Columbine shootings happened in 1999 as well. One of the students involved, Eric Harris, had been put on SSRIs right before they shot up their school but they had been planning it forever. A lot of doctors tend to just throw meds at you without examining what’s really wrong. I was on anti-depressants for years & they never worked. Why? Because for me, it wasn’t depression, it was bipolar disorder.
& you’re right about the stigma. Especially with medication shaming I still have family members to this day that think I shouldn’t be on meds. That a walk or a “positive attitude” will fix it all. You’re not ashamed to take diabetic medication or heart medication but when it comes to anything with mental health, it’s looked down on.
You’re so right.
As a teenager, a few months after being put on Prozac I tried to end my life. They blamed it on the Prozac and how it increases suicidal thoughts for teenagers and young adults. This was when Prozac was the new drug. The reason I attempted suicide was because the Prozac gave me enough energy to actually act on my impulses. At least that’s my theory.
It’s very frustrating when the media portray mental health and medication this way. The stigma is still very alive and it’s scary how even highly educated people don’t get it.
That’s always my response when people make that antidepressant-suicide connection. It’s well known that energy starts to improve before mood does, and that’s a time when people are really high risk to follow through on suicidal thoughts. Unfortunately that kind of thinking demonizes treating mental illness. So frustrating.
Brilliant written! I need to watch this.
Thanks!
Mental illness always gets a bad rep once someone causes harm, or goes on a killing spree. Then the severity of the stigma stands out. Not everyone with mental illness is psychotic for God’s sake.
See. I would have watched this program and would have yelled at the TV. LOL! 🙂
It is so important for the mental health community to prove to the public, that we are all not insane. Breaking the stigma is how we go about that.
Fantastic post!
Thanks!
Obviously not an objective documentary. Seems like the show’s title and subtitle were created to increase ratings. I’m with you on how this is a step backward with regard to stigma.
Yeah, it seemed like they came to a conclusion first, and then investigated the issue afterwards
And maybe even presented information out of context
Same thing happened with Stephen Paddock and Las Vegas. He was quickly labeled as “mentally ill” with little to no information supporting that “theory”. I am currently working on a novel and I devote nearly a whole chapter to the similar points/arguments you make in your post. Awesome read. I love your posts!
Thanks! Yes, I remember hearing about that in the news. It always astonishes me how quick people are to jump to mental illness as a supposedly obvious explanation for deviant behaviour.
An interesting programme & interesting they brought up the same things as they did when it happened. It keeps happening that the media talk about SSRIs as bad but they save so many lives. Really interesting blog 🙂
Thanks! Yes, it seems to be something the media always latches onto with these kinds of crimes.
Great read, thanks for sharing! These sorts of sensationalist documentaries don’t help at all in terms of getting rid of mental illness stigma. Thanks for being a voice against this!
And thanks for reading 🙂
I use to love BBC but it has been letting me down a lot with some of its broadasting choices and continues to disappointment so I don’t bother with it much anymore, likewise with most television. I mainly just stick to netflix and I can just skim through for what I want to watch.
Maybe they should have had a better title like you said, I haven’t seen the document but if it said in rare cases, than they are not labeling all cases. I am for and not for anti-depressents as in I think it works for some as a band-aid into healing process hopefully, but it doesn’t work for everyone. I don’t trust or like the pharmaceutical industry and I hate that doctors/psychiatrists prescribe anti-depressents and other prescription drugs like candy. And how some still lack the knowledge that they don’t work for everyone. When it comes to mental illness, sometimes meds are not what the person needs or sometimes it can take a lot of time to find a combination of drugs to work for a certain person. We are all different. Another beef I have in general not with mental illness or medication is why is a lot of our population hooked on prescription drugs? The stats are literally disgusting. A man who worked high in the pharmaceutical industry came out and spoke about unheard of information to the public after retiring, he said if the American public knew how many of them were hooked to meds, how it all works they would be outraged. Which brings me to mental illness in general as well. Why are we not doing more for society and finding out why so many people have a mental illness and those numbers are raising in the generations? It is hardly actually discussed. Instead there is just more talk and commercials about more drugs to take.
Conclusion, rather it causes problems for some and works for others there needs to be more documentaries about why mental illness is rising, why society isn’t really doing anything about it, and yes the pharmaceutical industry itself. I am not anti meds, it works for some, not all but some. But if we dare take a look at society, and admitted we need a change a lot of mental illness could be removed without medication. Nobody is happy anymore really, that is my theory. So I don;t get why mental ilness still has such a stigma like people act like we are the only ones who have mental illness. But take time to really look around, I don’t believe anyone is truly happy anymore and if they say they are, they are probably lying and living some fake double life. And if you are truly happy then that’s sad in a way too. To be happy with the way our society is right now is a joke.
I agree with you, there are problems with medications and certainly with the pharmaceutical industry. I think it would actually be more effective for the media, etc., to raise those issues without over-sensationalizing them, as it could get more people engaged in a conversation rather than polarizing people.
Yes, exactly! 🙂 Thanks btw for the warning to not to watch this documentary. Great post! 🙂
Thanks!
Great post! They definitely used ignorance to increase the bottom line 🙄
Yeah, it’s unfortunate.