March 5, 2012 Leave a Comment (On Prof. Healy’s Blog)
Shane Clancy, a 22-year-old going to University in Dublin, broke up with his girlfriend, Mary Jones, in April 2009. Despite his having broken the relationship off, he found it difficult without her. She, meanwhile, had found someone new: John Kelly.
Shane took a trip to Thailand and Australia, but aborted his travel and came home unhappy. His mother took him to his doctor on July 18. The doctor told him to go away and exercise and eat properly for a week to see if that would make him feel any better. A week later, his mother took him back to the clinic, and on July 27, he was prescribed a month’s supply of citalopram 20mg. He took them as prescribed but after the first few days began to get agitated. He rang the doctor on July 31 to say his tongue felt very swollen (a recognized side effect of citalopram). He left a message but got no response.
On August 5, feeling increasingly unwell, Shane took the remainder of his month’s supply of tablets in an attempted suicide.
On August 3 he wrote on Facebook that he felt unwell and thought he had the flu (this is consistent with the effects of the drug). On August 5, feeling increasingly unwell, Shane took the remainder of his month’s supply of tablets in an attempted suicide. He slept for 24 hours and only then told a friend what he had done. His mother brought him back to the clinic where he saw a different doctor who continued the prescription for citalopram.
On August 15, Shane was with friends at The Eagle House. John Kelly was also there with friends. Shane gave them a lift home, leaving John to his house last. He came in and spent time chatting before leaving. Mary Jones came round to John’s house later, where she had a phone call from Shane who was outside. He asked her to send John out saying he was hurt and needed help. John went out and was attacked and stabbed fatally. Mary was also stabbed, as was John’s brother who emerged from bed to find out what was going on. Shane was later found dead in the garden having stabbed himself 19 times.
Shane stabbed John (fatally), Mary, and John’s brother. He was later found dead having stabbed himself 19 times.
Ireland was shocked. The case was all over the media for several days. Everyone’s sympathies were and continue to be with the families of John Kelly and Mary Jones, who bore themselves with remarkable dignity throughout.
Based on media reporting, that at times approached the horrors of Heinrich Boll’s masterpiece The Lost Honor of Katherina Blum, pretty well everyone thought Shane Clancy guilty. Every scrap of evidence that pointed to pre-meditation was a nail in his coffin. It almost has to be this way, given how many Irish youngsters are on SSRIs.
But, as Rosie Meysenburg brings out (see The story of SSRI Stories), once you are exposed to more and more of these cases, those put on antidepressants appear as much the victims as anyone else. At first there was no mention of antidepressants, but Leonie Fennell, Shane’s mother, feeling guilty for having engineered her son onto citalopram, raised the issue. The Irish College of Psychiatrists responded that there was no absolutely no evidence that antidepressants could cause problems and to say so was dangerous and irresponsible.
Before the hearing there was an extraordinary letter to the national newspapers from all professors of psychiatry in Ireland stating that there was no evidence that antidepressants could cause harm.
An inquest was scheduled for April 2010 in Wicklow, a town south of Dublin. Before this hearing there was an extraordinary letter to the national newspapers from all professors of psychiatry in Ireland, stating that there was no evidence that antidepressants could cause harm. One of these professors, Patricia Casey, sought leave to testify at the inquest but was denied by the coroner.
The seven jurors, men and women, who appeared to be shop owners or farmers, with an average age close to 60, heard witness statements from John’s friends at the public house on the night of August 15, 2009, from Mary Jones and John’s brother, as well as from the Clancy family, in addition to hearing from the pathologist and from me.
The facts were not in question – no one disputed that Shane Clancy’s actions had led to John Kelly’s death and that he took his own life. The jurors, however, were asked to recommend whether the verdict should be suicide or an open verdict.
With a verdict of murder, a jury has to agree that the person intended to kill their victim. So also to return a verdict of suicide, the jury has to be satisfied that the subject intended to take his own life.
In this case, an open verdict would be more appropriate than a suicide verdict.
When someone else is killed, if there is no clear intention to kill them, the appropriate verdict is homicide. If someone jumps to their death from a 10th floor balcony under the influence of LSD, unless there is clear evidence beforehand that this was what was planned, an open verdict would be more appropriate than a suicide verdict.
In cases like the SSRI suicides and homicides, families who are convinced that their husband, wife, parent, or child did not intend to kill themselves (or others) but was acting under the influence of a drug-induced state are keen to get an open verdict. In European countries this is not an initial step to suing a pharmaceutical company, as it is almost impossible to sue a pharmaceutical company in Europe.
When it comes to cocaine, crystal meth, or LSD, we have no difficulty thinking a drug might contribute – the drug is guilty and the person innocent. But in the case of prescription drugs, the drug is always innocent and the person guilty.
In fact, citalopram and other SSRIs can cause a delirium and lead to homicide this way, but this is not ordinarily what happens. They can also cause entirely normal volunteers to start thinking aggressive and violent thoughts they had never had before, as they did to some volunteers in Leeds (see Mystery in Leeds). And they can switch off anxiety so that someone coldly starts to plan something they would be too scared to do ordinarily – so there can be pre-meditation. The problems can happen within 48 hours, as in the Tobin case (discussed at greater length in Let Them Eat Prozac), or build up over 2-3 weeks, as in Shane Clancy’s case.
Pharmaceutical companies will send academics and high-powered lawyers to a humble inquest in a small town to ensure the coroner or the jury returns a suicide verdict.
Returning an open verdict in England or Ireland does not blame the drug. It simply means in this case that the jurors have decided that the killings and the events did not permit a straightforward answer. But even so, pharmaceutical companies will send academics such as Professor Guy Goodwin from Oxford, along with several high-powered lawyers to a humble inquest in a small town to ensure the coroner or the jury returns a suicide verdict.
The Irish College of Psychiatrists went into overdrive issuing statements left, right, and center that there was no evidence that citalopram could cause suicide or violence.
In the Clancy case, the jury returned an open verdict. Just like the American Psychiatric Association (APA) before and since, The Irish College of Psychiatrists went into overdrive issuing statements left, right, and center to anyone who would listen that there was no evidence that citalopram could cause suicide or violence. Here is one example: Experts clash over anti-depressant link to homicides.
Drinking the Kool-Aid?
This led to a letter to the Irish College by a retired professor of psychiatry, Tom Fahy:‘I am afraid the College is plain wrong. There is no such thing as a college statement which is circulated to the membership simultaneous with its publication, without opportunity for comment or vote and “in unison” with a body 100% financed by drug companies, and with personal hostile references to expert testimony at an inquest with families still in grief. And this on the heels of a dreadful multiprofessorial letter even before the inquest began. Extraordinary and outside my experience. If I were not retired I’d dissociate and publicly resign.’
Both the Irish College and Lundbeck, the makers of citalopram, issued statements about the matter. Reminiscent of debates in Ireland on matters of Catholic ethics, where the College of Obstetricians could always be depended on to be somewhere to the right of the Catholic Church, the Irish College of Psychiatry’s position was far more extreme than Lundbeck’s, as we shall see in the next blog post, Model doctors.
Is this professional suicide on the part of the Irish College, like that of the APA in Professional suicide, or should we return an open verdict?
Unfortunately when it comes to murder or suicide, the fact that the College is laboring under a delusion is not grounds for returning a not guilty verdict. It is only if they are laboring under the influence of a biological disorder, drug-induced or not, that they have a chance of being declared not guilty by virtue of insanity.
Drinking the Kool-Aid is no defense.
Suicide, or open verdict? There is another intriguing option that will be outlined in an upcoming post: Notes on a Scandal.
07/03/2012 Follow-up to this post…
AC: Do you believe that citalopram can cause somebody who would not otherwise take their own life to do so?
CM (Lundbeck Doctor): Yes. http://davidhealy.org/model-doctors