The Troubled Dream of Life

This is the first time RxISK has run 2 posts on the same topic on the same day.  Not only that but in addition to the Troubled Dream of Life linking to Drug Induced Loss of Capacity that follows on from this post, Troubled also links to Damnation and Salvation posted on dh.org today.

Finally all 3 also link to both The Eclipse of Science and of Us, Entranced, Spellbound and Mesmerized on DH and to Consent to Waltz, Capacity to Tango on RxISK.

In a case where, shortly after starting an SSRI and developing severe akathisia, a man like Don Schell wipes out his entire family and himself, it can be very clear to a jury that the drug, causing a serious problem, abolished his responsibility for the event. They don’t need to think too hard about the steps from akathisia to Right and Wrong or Responsibility for deaths.

In Minneapolis 6 years ago, Brian Short developed very obvious akathisia on SSRIs, killed his 3 children, his wife and himself. The case was very similar to the Schell case. When it came to accepting responsibility, the clinic where he had been treated, arguing very creatively, initially stalled. The clinic, in effect, accepted they would have been responsible if he had slipped on a banana skin in their building, but were not responsible for something that happened in his own home.  Extraordinarily, the clinic had a slate-full of professional medical bodies on their side but, despite this, the argument failed and the clinic settled the case with the extended Short family.

In these cases, a jury doesn’t have to let someone who has killed others walk out of court, or potentially later walk out of hospital, free. If as a juror, in contrast, you have someone who has killed others sitting in court across from you, there are two possibilities.

You may have someone who was delirious at the time and will have no clear memory of the events, in which case the person should walk free from court. Like sleep-walking, but unlike akathisia, delirium is an absolute defense against homicide or other felonies.  Unfortunately for us, medical ‘experts’ and lawyers get confused trying to distinguish delirium and psychosis, and can mess up a straightforward Not Guilty by Reason of Toxicity case.

Katinka Newman gives a gripping example of SSRI induced delirium in The Pill That Steals Lives, but grappling with what was happening to her at the time she couldn’t work it out quickly enough to prevent herself being sucked into a medical web and injected by the spiders there.  She got trapped and it was only a year later after being tanked up on drugs, when the drugs got stopped in a different hospital that she could finally slot the jigsaw pieces together and both see and explain what had happened.  See Katinka and Lindsay here.

More likely, we as jurors will be faced with someone like Lindsay Clancy, who was not delirious and will not have had obvious akathisia, whom the prosecution can plausibly suggest was deliberately or semi-deliberately planning killings. Even if akathisia was present, we will be asked to decide on the defendant’s capacity to know right from wrong as jurors were in the Pittman case – Drug Induced Loss of Capacity.  In this case, the jury agreed 12 year old Chris Pittman had akathisia but after the prosecutor pointed the gun he shot his grandparents with at them and asked jurors had this 12 year old lost the ability to tell right from wrong, they could not agree that he had.

Akathisia is one thing.  Telling Right from Wrong is another.  As a juror we need someone to show us exactly how SSRIs can abolish the Capacity to distinguish Right from Wrong

What SSRIs Do

Akathisia is not what SSRIs do.  They can cause akathisia but do not cause it in most people.  Akathisia is likely something that develops in part because of the carbonic anhydrase activating effect of these drugs – See Homicide. This leads to a build-up of fluid in places it should not build up in, as in our eyeballs making them feel gritty and uncomfortable and causing glaucoma.  Or to build up beneath the periosteum, the skin on our bones, leaving Bruce Springsteen tellingly describing it as a feeling in his bones that left him understanding why people might want to kill themselves –  Homicide

SSRIs primarily mute sensory receptors. This action closes the Gates to Perception. LSD acts on the same system and opens the Gates to Perception.  Opening the Gates sounds good and closing them sounds less good, but in fact, like Goldilocks, we need the Gates to be just right rather than too open or closed.  Too open might be welcomely ‘mind-blowing’, but even if later described as a Good Trip we risk ‘seeing’ what we figure is the Afterlife, God or Traumatic Events in past lives and this can damage us.

Closing the Gates, especially when we are under stress, can be Serenic.  We put ourselves into Sensory Deprivation Tanks to achieve effects like this – See Good Trips on SSRIs.  Nearly as quick as LSD, SSRIs can produce this Serenic effect within an hour. We got SSRIs because doctors could once spot this effect in us and aimed at making more precise Serenics.  Without knowing their doctor is on an SSRI, patients can now spot this effect almost immediately in him or her while doctors on the other hand are now blind to what is there to be seen in us right in front of them and whether the treatment is having the right effect – making us Serene.

The Troubled Dream of Life

An important part of our Capacity to tell Right from Wrong hinges on the gates of perception being open to just the right extent and able to adjust flexibly within the normal range.

From time to time, we all get fleeting images of weird or horrific things but these get nudged to one side by a constant flow of sensory inputs from both outside us but even more so from within. Images of assaulting someone will trigger images of consequences along with bladder and bowel sensations, a galloping heart or catch of breath. The assault doesn’t happen. Our bodies know how to conform us to the Rules. We don’t have to consult a manual or ask the Ghost in our Machine to help sort out what Right is and Wrong is.

If we are deprived of a chunk of sensory input from outside, when in a sensory deprivation tank, one of these weird or horrific images can come to dominate in a way that would not normally happen.  People in sensory deprivation tanks have Command Hallucinations.

MRI scanners can semi-resemble a Deprivation Tank and can reduce some of us to gibbering wreck status.

When we dream our attention to the outside is muted and our imagery can go careening all over the place out of our control, stimulated mostly by sensations from within. We can get trapped in troubled dreams or nightmares.

If deprived of sensory input from both within and without, if for instance we are on an SSRI in too high a dose for us …… is it any surprise that SSRIs are the number one drug reported to trigger nightmares.  They also badly disrupt sleep and this may endure for years after we stop – Forty Winks,

SSRIs can do all this by day as well as at night.  They do it by muting input from both without and within. This removes the distractions that can break a hypnotic trance, increasing the risk that a horrific visual image or commanding auditory experience is going to hypnotize us – See Drug Induced Loss of Capacity.

Just as no more than Canute knew he couldn’t stop the tide coming in, there is not a great deal we can do in a boat to stop Tidal Waves but boats have stabilizers to help ride out big waves or storms.  Our sensory systems stabilize us. SSRIs risk destabilizing us.  The compromise our capacity to ride out events like these – events we are not used to.  Without them we lose our balance – both physically and mentally. They are among the commonest causes of loss of balance – see Lonesome Heroes.

How come?

Even taking an SSRI, we can with time develop the capacity to manage Command Hallucinations or Violent Imagery, just as we develop the capacity to ride a bike or ski, or as children we develop the capacity to stand upright and walk.  This takes trial and error and time – possibly a few weeks, or sometimes decades – see Drug Induced Loss of Capacity.  It happens a lot quicker if there has been a prior exposure.  Googling it is no substitute.

Until you are in the boat and facing the wave, you as a juror watching from the bank who has never sailed, cannot tell if you’d have managed the situation.  It is possible you’ve sailed before and managed or managed certain problems but not this one and have little sympathy for the current sailor who does not appear to have gotten a grip on things.  In either case, the justice system needs to work out what to do about jurors who’ve developed a capacity to manage drug induced problems and those who haven’t.  This is not a great mix.

Tangled Web

The prosecutor in the Clancy murder trial told the jurors this case is about Lindsay Clancy’s details – See Damnation or Salvation.  It is not about US healthcare in general or healthcare for women.  This point has to be correct.

Its a problem as old as time – or at least Job. If God (the system) is unjust our options are to either dis-invent a vengeful God or punish the unlucky innocents who fall foul of the system.  Those who are not part of the elect.

When the Common Law system under which Lindsay Clancy is being tried came into being, it’s proudest boast was that it was better that 10 Guilty men walk free than 1 Innocent man be found Guilty.

Notice the word men. When it came to non-consensual sex in marriage, sexual assault or rape, in practice 10 innocent women would be found guilty (be humiliated) rather than one man be impugned.  See Prima Facie.

Anyone who is Irish knows there is a system factor here.  Innocent people should be let rot in jail rather than have the System be impugned.  As a Lord Chief Justice, Thomas Denning, said in the case of the Guildford Four – See In The Name of the BMJ  and In the Name of the BBC: .

While the Guildford 4 were released 37 years ago, as the references to the BMJ and BBC above show you things have got worse.  It is almost impossible for me or anyone else to make a case that a person who has been intoxicated by a prescription drug is innocent and should be let walk out of court free – because it would make the system look bad.

But more than the legal system is involved. The media have bought into this.  The media now operate under a Command to avoid False Balance. They are not allowed to let anecdotes blaming a drug, which is all an individual case can supposedly be, weigh in the scales against the marvelous benefits these drugs can bring.

You can maybe see the problem here in the court room but what about in the jury room. When the media want to cover the antidepressants, as sure as eggs are eggs they will want to get some people who have done well on the drugs. These believers are just as likely as the media in a religious country are to say it would be irresponsible to run a story about these wonderful drugs making someone homicidal as it would be to say members of the clergy abuse children.

We can talk openly about sex abuse by the clergy now because the Church no longer scares anyone.  That’s not the same on the pharma front, where it’s a mortal sin to create treatment hesitancy.  The sin of fostering treatment hesitancy began with the SSRIs not with vaccines.  – See Where Does the Misinformation Come From.

A lot of nasty Violence, especially on social media but even in the comments after an article like Katinka Newman’s, gets directed at misinforming non-believers.  Often painted as coming from the bottom up, this violence more usually starts at the top with trolls knowing they are protected.

What happens if you are sitting in a jury room with people who will not find against a drug (a sacrament) some of whom regardless of the details may figure they are doing to right thing to refuse to find the drug guilty?  An inability to find the defendant guilty is the other side of the same coin.

It’s almost impossible to see how a jury composed of a cross section of those commenting on any aspect of the Clancy case in any media features could come to a verdict in this or any case involving a medicine.

One of the more interesting comments following Katinka’s article is that antidepressants are a consumer answer for a consumerist society.  They aren’t.  They aren’t a consumer good.  They are available on prescription only.  The real consumers have their professional experience – their experience of these Obscure Objects of Desire – dictated to them. They learn that whatever they might think looks black is in fact white and they and their professional bodies and medical media go along with this.

If its a sign of a sophisticated mind to be able to believe two things at the same time and still function, we may be losing or may even have lost the ability to function.

It’s not enough for anyone to ‘believe’ the drugs can cause a problem. Someone needs to be able to provide the scenarios drawn from real experiences that will help a juror see not just that things like this can happen but how these meds can potentially cause many of us to lose the Capacity to tell Right from Wrong – and whether the mechanism proposed helps explain the Clancy case.

This will take a collective effort.  So if you get around to reading Drug-Induced Loss of Capacity, please contribute any vignettes that speak to the scenarios outlined there or others you think of that can land us in the situation Lindsay Clancy is now in.  That speak to the issues we all have to grapple with as patients and might have to grapple with as defendants or jurors.

Getting to grips with the legal issues, rather just putting on a legal show, is one way to get to grips with what happens in clinics – the two go hand in hand.

Spoiler:

I do not know what the outcome of the Clancy case will be or should be. Unless I had a chance to listen to her at length I do not think it would be appropriate to have a view.