Alienation and brutality

Alien Boy documentary

Alien Boy: The Life and Death of James Chasse is a documentary, available on Amazon Prime, about a man with schizophrenia who was killed by police in Portland, Oregon.  This film was funded by The Mental Health Association of Portland and over 1500 individual supporters, which I thought was pretty impressive.  It’s an extremely disturbing example of policy brutality against a man who had done nothing wrong except be mentally ill.  This wasn’t just an isolated incidence of brutality by two officers who had previously been named in police brutality lawsuits, but rather an indication of much broader problems with use of force and police attitudes in general when it comes to people with mental illness.

James, or Jim Jim as he was known by family and close friends, began having psychotic symptoms in his mid to late teens.  He lived in a series of group homes in her early adulthood, but got stabilized on medications and was able to live independently.  He was a regular at the public library, and he enjoyed drawing comic books.

In the couple of months leading up to his death, he had stopped taking his medications.  His mental state deteriorated, and his hygiene and self-care were very poor.  He had lost a significant amount of weight.

On the day of his death, police approached James in a public area.  They noticed that he was stiff legged and rocking side to side.  One of the officers later said that he was “hunched over, and his hands are towards his waistband like somebody either urinating or just starting to finish and do the shake”.  When addressed he looked at the police with “sheer terror” in his eyes and the cops  suspected he was going to run.  James had good reason to want to run; he had been beaten up by police in the past.

He did run, and police gave chase, with one of the officers tackling him.  The officer (250ish pounds) later said in an inquiry that he pushed James down but denied that he landed on top of him.  Witnesses commented that “it literally looked like 2 people shaking out a rug”, with knees to  his chest, punched in the face, and kicked.  He was then tasered and he passed out, lying in a pool of his own blood,

Photos taken by witnesses show James on the ground, handcuffed and with leg restraints.  Fire and ambulance personnel were standing around with police, two of whom were holding cups of coffee.  Meanwhile the police were heard by witnesses making false statements about James having drugs.  Paramedics were not informed of the force used or the tasering.  They found his vital signs were normal, and left it up to police to decide if he should be transported to hospital or taken to jail.  They chose to take him to jail.  As the paramedics were packing up to go, James cried “don’t leave me, don’t leave me” according to witnesses, although the police denied this in the inquiry.

Video from the jail shows the cops carrying him in, arms and legs restrained, like you might carry a duffel bag, with a spit hood over his head.  Once they had him in a cell he started breathing and started seizing.  They called the jail nurse, but didn’t take the spit hood off.  When she showed up, she decided that she couldn’t take responsibility for him, so the cops decided to drive him to the hospital, which was 15-20 minutes away, still restrained and with the spit hood on.  They stopped to talk to a sergeant on the way out, and did not have lights and sirens on for the drive to the hospital.  Along the way, James died.

The state medical examiner found that the cause of death was blunt force chest trauma.  He had 26 breaks to 16 ribs, including in areas that aren’t necessarily that easy to get at.  She suspected he likely would have survived had paramedics transported him to hospital rather than police taking him to jail.  The toxicology report showed no drugs of any kind, including medications.

A grand jury review of the in custody death resulted in no criminal charges.  After an internal review by the police bureau, the city requested a Department of Justice investigation into bias in how the local police dealt with mental illness.  That investigation concluded that the Portland police did use force excessively, including tasers, and this force was often used in dealing with minor offenses committed by people with mental illness.

Oh, and the officer who tackled James?  He later ran for county sheriff and was elected.

Police have a hard job to do.  But this kind of thing should never happen.  I can understand that on the rare occasion someone who’s highly psychotic and brandishing a weapon may not be able to be safely contained without legal force.  I can accept that.  But James Chasse?  He did absolutely nothing except be mentally ill.  I suspect that an animal would have gotten better treatment than did Mr. Chasse, a man who was ill and needed to go to hospital.

I think prosecutors and governments need to really reflect on how they make decisions about pursuing prosecution when it comes to in custody deaths, particularly when it comes to marginalized communities, like people with mental illness, like racial minorities.  The police should be there to protect the most vulnerable, not to take their lives.  Change can’t happen soon enough.

 

Have you checked out my book Psych Meds Made Simple?  It’s available on Amazon as an ebook or paperback.

God Knows Where I Am: Death by mental illness

God Knows Where I Am film

This disturbing documentary tells the story of Linda Bishop, and her death after being released from a state psychiatric hospital. The film includes readings from Linda’s journal, and commentary from people who knew her, including her sister and her daughter.  Their words powerfully captured the pain and frustration of a family seeing their loved one deteriorating without having any power to stop it.  The sweeping visuals and music that accompanied slow, dramatic readings from the journal were effective in the later part of the movie, although to me they seemed overly drawn out in the first half.

After Linda was first diagnosed with bipolar disorder with psychosis, she was put on medication, although she didn’t stay on it for long.  Subsequent attempts at getting her treatment also eventually resulted in her discontinuing medication.  Over the years she became increasingly delusional and her behaviour grew more and more erratic, and as a result a court in New Hampshire committed her to the state psychiatric hospital for a period of up to 3 years.

In hospital she refused to take medications, and in New Hampshire medications can’t be forced upon someone without a guardianship order.  Linda appeared in front of a judge and managed to keep her delusions contained during her testimony, and the judge decided she didn’t meet the criteria for guardianship.  After some more time in hospital without any medication, she was deemed “clinically suitable for absolute discharge”, although her psychiatrist described her as having very poor judgment and insight.  Linda had refused all along to give consent for the hospital to speak to her family, so they were not informed of her release.

She was discharged in early October, and when she left the hospital she didn’t even have clothes suitable for the weather.  After some roaming about she found an empty farmhouse for shelter.  Winter soon set in, and it was unusually cold and snowy. For two months she lived off of apples from a tree outside the house, until she ran out of food on December 6, 2007.  She had a supply of water from the snow outside.  Although the farmhouse was within sight of another house and a major highway, Linda’s presence was never noticed, and her delusions prevented here from seeking help.

Throughout this time, she kept a journal.  It was eloquently written, but clearly showed the she was unwell.  She had the insight to recognize that she was starving to death. On December 14th, she wrote a note that began “To whomever finds my body: My death is the result of domestic violence/abuse”, although this was not based in reality.  She continued daily journal entries as she grew progressively weaker.  She wrote that she would keep praying since “God knows where I am.”  January 13, 2008 was the last entry, with only the date written.

I was left feeling ill at the end of the movie.  This poor woman died a torturous death, drawn out over more than month without food in an already weakened state.  Her mental illness killed her after the mental health system utterly let her down.  While it was a perfect storm of circumstances, this is something that could happen again.  It could happen to one of us.  I’m aware that my illness could take my life via suicide, but the thought of undergoing this sort of ordeal is bone-chilling.  We as a society should not be allowing this to happen to the most vulnerable among us.  And yet where do we find a balance between allowing autonomy and enforcing desperately needed treatment?  I’m a bit too shaken right now to have any sort of articulate idea.

 

You can watch the film on Netflix.  The official film site is here.  There’s also a good article in the New Yorker from 2011 with the same title.

A Prescription For Murder?

Prescriptionformurder

 

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.

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 is 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.

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, okay, 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 is a very different can of worms than simply connecting SSRIs and homicide.

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 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.

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 is 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 is 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.