Unpacking the Insanity Plea: Looking at Suspected Murderer James Holmes' Not Guilty by Reason of Insanity Plea

http://www.nytimes.com/2013/06/05/us/suspect-in-colorado-movie-killings-enters-insanity-plea.html?_r=0


Not guilty by reason of insanity means you don't have to be punished for your crimes - right?

Definitely not.

Before we get to the issue of punishment though, let's make sure we have a firm grasp of what the Not Guilty by Reason of Insanity plea (NGRI) is.

The NGRI is a unique plea not only because it references mental illness, but because it is saying something seeming paradoxical - the individual has committed a guilty act without having a guilty mind.

What? We watch law and order and time and time again it's about proving that it was Joe that killed Mary. So if there's no question there, then what are they talking about? What's this "guilty mind" nonsense?

Well, lets talk about insanity. Insanity, despite the way we throw it around everyday, actually has a stringent legal definition. It is a "mental illness of such a severe nature that a person cannot distinguish fantasy from reality, cannot conduct her/his affairs due to psychosis, or is subject to uncontrollable impulsive behavior. Insanity is distinguished from low intelligence or mental deficiency due to age or injury." (http://legal-dictionary.thefreedictionary.com/insanity)

The crux of this definition is the severity of the mental illness. Even if a person is in the midst of a psychotic break it is extremely unusual for them to be so completely impaired that they they think they are holding a banana when they are actually holding a gun. Another example of a severe mental illness is if the individual was so out of touch with reality - so utterly in the throws of a delusion, for example, that they honestly believe that if they don't kill their son then he will be tortured in hell for all of eternity. So they kill their son.

The NGRI, then, is not a trial whose goal is to determine whether the individual committed a crime, rather it will be based on "the issue of the defendant's insanity (or sanity) at the time the crime was committed." (http://legal-dictionary.thefreedictionary.com/insanity)

 So let's skip to the end, let's say that an individual actually goes through a trial, and the verdict is Not Guilty by Reason of Insanity. (Which less than 10% of individuals who attempt this plea succeed in doing). Does the individual go free?

By no means. The individual goes to a state mental hospital until they can prove that they are no longer a threat to society due to their mental illness.

This means that the individual may actually spend more time locked away from society than they would have in jail.

A infamous example of this is John Hinckley, Jr. - the man that attempted to kill then-President Ronald Regan in order to win the love of teen actress Jodie Foster. His conviction was not guilty by reason of insanity.

He is still in St. Elizabeth's Hospital in Washington, DC. He has been there more than thirty years.

More Money for Drug Companies, You Say? The Disastrous Stigma Against Mental Illness

A rebuttal to Dr. Peter Lind's article in the Washington Times entitled, "More psychiatric illnesses means more money for drug companies." Link:  http://communities.washingtontimes.com/neighborhood/stress-and-health-dr-lind/2013/may/9/terrible-psychiatric-joke/#comments

 

More Money for Drug Companies, You Say? The Disastrous Stigma Against Mental Illness

I will start by saying Prozac is not an anti-psychotic drug as Dr. Lind suggests in his article. Yes, it's psychoactive. Yes, it's an antidepressant. No it is not an anti-psychotic.

While this may seem like a captious point, it exemplifies the author's understanding of the subject area. It is clear that Dr. Lind knows a thing or two about the human body, as his suggestion that mental illness may have its roots in advanced catabolic disintegration reflects a knowledge of human physiology. In addition, his request for physiological evidence for mental illness is a valid one - the knowledge of the biological basis for mental illness has been increasingly recognized in the mental health community over the past thirty years and this recognition has benefited those with mental illness.

But it is clear that Dr. Lind's understanding of the mental health field is elementary. If this ignorance were my only concern I'd go on my merry way and think little of this article.

Unfortunately, I sense a far more sinister motive at work in this article - that of the stigma against mental illness and mental health treatment.

Dr. Lind argues that the increase in diagnoses in as reflected in the DSM-V (and seems to insinuate that most if not all diagnoses in the various DSM editions) are "bullshit." And yet in a country whose health care is almost entirely dependent on insurance a diagnosis is the difference between affordable treatment and astronomical out-of-pocket expense. 

Treatment of depression includes medication, it's true. But Dr. Lind claims that there "is no money in non-drug treatment" - is he unaware of  "counselors," "therapists," and "psychologists?" Last I checked there were no drugs administered in a session with a Marriage and Family Therapist. Were Dr. Lind's intent to encourage his readers to seek treatment using what non-drug methods are available, therapy would be an excellent suggestion.

Instead Dr. Lind argues that the increase in diagnoses in as reflected in the DSM-V (and seems to insinuate that most if not all diagnoses in the various DSM editions) are "bullshit." And yet in a country whose health care is almost entirely dependent on insurance a diagnosis is the difference between affordable treatment and astronomical out-of-pocket expense.
 
And why might an individual want treatment? 

Because untreated depression is the number one cause for suicide, according to Suicide.org.

Dr. Lind seems to be suggesting that Prozac itself is dangerous. His focus on Prozac is entirely on how it causes suicidal thoughts. Well, let's take another look at that, shall we?

According to the drugs.com report of the side-effects of Prozac (otherwise known as fluoxetine), "The 1991 meta-analysis of controlled trials (which was sponsored by the manufacturer of fluoxetine) reported six suicidal acts occurring in a total of 1763 patients treated with fluoxetine. The frequency of suicidal acts was 0.3% and was similar to the frequency reported for placebo (0.2%) and tricyclic antidepressant therapy (0.4%)."

For those in the world that did not love statistics class, this means that when researchers looked at several well-designed studies and averaged them out, there was 1 more case of a suicide attempt (which are far more common than completed suicides) in 1000 for those who took Prozac than for those who took no drugs at all.

(If you are thinking that the drug companies have a reason to report so low a percentage reflect that the same page reports that 12% of participants experienced diarrhea. What benefit could possibly come from that?)

Dr. Lind spends three of fifteen paragraphs in his article describing the increased risk of suicidal behavior in those taking antidepressants when the difference is 0.1%. 1 in 1000. 

My question - why are we ignoring the 999 in 1000 over that 1?

Does Prozac work for every person that tries it? No. But if an individual with diagnosable Major Depressive Disorder keeps at it and tries more than one medication, he or she is more than likely going to find one that works.

Also, the more severe the case, the more effective antidepressants are. Why is this important?

Suicide is the tenth leading cause of death among Americans in 2012 according to the Center for Disease Control and Prevention.

The treatment of depression is effective 60 to 80% of the time, according to the American Association of Suicidology. 

What this means is that, literally, by encouraging individuals not to take antidepressants when they have diagnosable depression he is encouraging them not to take actions that could save their lives.  

He may not have to deal directly with the consequences of reinforcing the stigma against seeking help for mental illness, but I do. I volunteer at the Suicide Prevention Center in Los Angeles and take calls every week from people that suffer from major depression. I can't tell you how many people I've spoken to who think antidepressants are a hoax and are at the same time taking steps toward their own suicide. I've been on the phone with individuals in the last moments before their self-delivered death and had to live with the thought that if this person had had treatment for their severe depression, they might still be here today.  

So here is the question I pose: Is Dr. Lind's quarrel with drug companies worth tens of thousands of lives? 



Bibliography:
http://www.mayoclinic.com/health/mental-health/MH00076
http://www.suicidology.org/c/document_library/get_file?folderId=232&name=DLFE-157.pdf
http://www.suicide.org/suicide-causes.html
http://www.drugs.com/prozac.html
http://articles.washingtonpost.com/2013-05-02/national/38974326_1_suicide-rate-12-suicides-prevention
http://www.cdc.gov/nchs/fastats/lcod.htm
http://www.webmd.com/depression/features/are-antidepressants-effective

Honoring an Honors Student: Why Would He Kill Himself?

One of the first lessons I learned while training at the suicide prevention hotline is to never say, "But how could you want to kill yourself? Don't you see how much you have to live for?"
 
In Cincinnati, Ohio a student the La Salle High School shot himself in his first period classroom.

The controversial gun legislation in the wake of the Sandy Hook shooting has assured that the coverage on the incident has focused on issues around how the gun came into the student's possession and how he was able to bring it, loaded, to school. I will, therefore, leave that important question for others to decide.

Instead, I will ask who was he? Who was this unnamed student?

According to Cincinati.com, he was an honors student with more than 80 hours of community service under his belt at a private school.

Read: Likely to get into college. Has future.

So, instead of asking how did this student manage to shoot a gun in a classroom, I will ask why would an honors student with a conceivably bright future attempt suicide? 

This question resonates more deeply with me because I feel like I have spoken with him dozens of times when taking calls on the suicide prevention hotline.

So often I speak with individuals for whom it is common to hear: "You have no idea how much others would give to have what you have." or "You have nothing to complain about." or "You don't know how good you have it."

The most frequent reaction I hear from people who take this to heart is, "You know what, it was a mistake calling. You have someone else who needs your help more."

These are people who go to Ivy League schools or who have been accepted to graduate school or who have amazing jobs or are beautiful or have the perfect husband or children.

Then I tell them the truth - that I want to talk with them. I'm here to help those who reach out for help, not to judge within minutes if they are close enough to Holocaust victims to deserve my time.

If they choose to tell me their story, I hear the same beginning to the story again and again. How the individual is tired of the mask they have to wear every day. They have to be the happy like the intelligent, successful person they are. And pretending all day makes them exhausted. 

But no matter what they have to face, the fact is that every one of them has something they are dealing with that legitimately grieves and/or tortures them. But they don't feel their pain is legitimate because there is this competition with some unknown horror.

And every time these end up being people who have been sexually abused over long periods of time, who have gone to treatment for their mental illness and have tried half a dozen medications with little relief, who have lost close family members, or struggle with horrific health conditions. These are people for whom, when I hear their stories, I want to get up and scream at the government for mismanaging their case or cry for how much difficulty they have had to endure or jump across the phone and protect from the bullies they have to face the next day. Or I wish that someone in their life would just stand up and show them that they are worthy to be loved.

But instead I have to hear their heartrending stories from a thousand miles away. I thank God if the individual has a friend or family member with whom they are allowed to be in pain. With whom they can talk about the very real issues they have had to face.

For those who have no one I feel like I a rope dangling to save someone who is falling fast, who may manage to cling to me or may not. 
 
So who was this boy? Honors student who couldn't see that he had the world underneath his feet? Or individual who was so haunted by something he couldn't even begin to consider that there was a future beyond it, nonetheless one that would offer him all his wildest dreams.




For more information on the La Salle High School suicide attempt see:
http://news.cincinnati.com/article/20130429/NEWS0107/304290050/Police-Student-shot-himself-class-La-Salle-HS?odyssey=mod|breaking|text|FRONTPAGE&nclick_check=1

http://www.latimes.com/news/nation/nationnow/la-na-nn-student-shoots-himself-in-catholic-school-in-cincinnati-20130429,0,1933386.story

http://www.nydailynews.com/news/national/1-injured-cincinnati-high-school-shooting-article-1.1330056

On the Fourteen Anniversary of the Columbine Shooting

Forget, Remember. Too Early

The retrospective gaze of a twenty-one year old. A certain third-party apathy mixes with the desire to drown memory in wine. A 2006 cabernet sauvignon - allowing the tannins, the body to wallow on the tongue with hints of black cherry, plum, vanilla. Glass after glass, making chic the art of forgetting. 

    Wine is the choice intoxicator. Celebrate wine in all its splendor on April 20th. Not those grassier choices. Not the inhalation of hallucinogenic humor, stimulation of contemplation. This is not a day to dwell on. 

    But of course, you forget. All the better perhaps, when there's no humor in remembering. Though maybe you were hundreds and hundreds, no thousands of miles deep in safety. Or perhaps like me, you want to forget. 

    Forget April 20th, 1999. Forget Littleton, Colorado. Forget thirteen dead, scores wounded. Forget the day that made suburban a high school a guerilla war zone. Forget the state flower dashed in dark red, no longer the Blue Columbine. 

    Forget with me.

    We'll start five miles away. Children are running through the stones in the playground, back toward classrooms though isn't over yet. Yes, run, run children don't walk, don't line up. Get inside! Leave the soccer ball, leave it!

    Inside the classroom - the dark classroom, no, don't turn the light on! The frazzled substitute searches the desk for a video, something - ah! Valley Forge. Then pops it in the VCR. Then sits. Then rises. Don't leave! I'm just going to go ask the front office something. And she's out, in the hall and away.

    And we are quiet. No one says, sh! But we mingle in whispers, ten-year-old theorists passing their privileged information. Some crazy guy is over at Powell Middle School, says one keeper of knowledge, waving a gun around. He might walk the mile down here and wave a gun at us. 

    And she's back. And she's quiet and we're quiet. And the air is palpitating with anything but quiet. 

    And we're in the passenger seat too early with a father that's cutting corners too tightly and a radio broadcasting too clearly. Too clearly telling us too many journalistic theories of a neighborhood that's too dangerous with too many, who knows how many, too many crazy men waving guns around, opening fire on the neighborhood. No wasted bullets. It seems no wasted bullets. Where are they, who are they... stay away. 

    Stay away, we think in bed, staring at the chair mere feet from our feet. Stay away to the man in the chair who will shoot me if I say to him, stay away. Who will kill me indiscriminately if I move indiscriminately. So we barely breathe, don't breathe. he may be a shadow of the light, but only may be. No, no, no. Shouldn't move. We won't move, don't move. 

    We don't move from the living room we watch the news, glues we watch the news. We watch scenes no R rating could could hide. No fiction, nonfiction. No, fiction can lie. Lie about the bloody body falling from the second-story library, half-conscious body, glass ridden body, dying body. Out that window we've driven by so many times, too many times, so many times. With the girl in the voiceover in utter disbelief drench in shock. How could it happen here? How this quiet, unassuming school? How here? How did it happen here? 

    And we're in church and we listen as Pastor Barry finally explains but what he explains no one will explain. They just bring us forward, here, yes here sign your name. For Rachel Scott? Yes, for Rachel Scott. Why only Rachel Scott? There were others, yes twelve others that died. 

    The girl who couldn't, who didn't, who couldn't finish out the year. The girl and her friends and their friends and their not so friends and their wounded and their dying, not dying, am I dying? friends. No one could. No one did finish the year. No one to the shattered halls and windows and adolescent memories. Many never returned, even when shattered halls were reformed and changed, never the same as each friend was never the same it was never the same.

    With thirteen dead. Yes, thirteen - not fifteen - thirteen. We don't count the killers, they are not victims, they took with their own lives thirteen others. No, not the friend in the parking lot - they told him he should get out of there. Not anther who drove away but moments before. Not the seniors exploring grasses to simulate hallucinogenic contemplation nor the seniors skipping out, missing out.

    Still, thirteen. Not soldiers, not workers, not lawyers, not patients. Twelve students, twelve teenagers, twelve children growing out of childhood, twelve leaders of our future, not the future, not our future, anymore. Twelve students and a teacher. A teacher who risked, who worried, who sacrificed to get his students out first, students first - get them out first, get them out. Got them out. A teacher, not the SWAT team outside, waiting unsure, too unsure, yes unsure who is killing, who is shooting who to shoot. So many killed but we don't know we must wait until we know, until we know we know we must wait.

    And wait and wait and thirteen killed, dozens wounded.

    Hundreds and hundreds, maybe thousands and thousands and millions watch in memory of a memorial to remember, somehow remember tragedy with tranquility. Thousands, maybe millions, not just in Littleton, not just in Colorado or the United States, all over the world we listen to Pastor Barry, our pastor speak, yet again. But not just for Rachel Scott, for eleven other students, a teacher, and dozens upon dozens wounded still in hospitals. Thousands and millions watch the rainbow stretch across the stormy sky behind the stage behind the podium set up to remember. Thousands and millions watch the thirteen doves escape and fly and fly toward the rainbow, disappear in the sky like the souls of the thirteen now white, no more red no more blood, pure white. 

    And we disperse, walking through posters and banners and flyers and photographs of those who remember those lost to memory. Of those whose hearts bleed for those no longer bleeding. Our church's poster, friends' posters, families' posters, schools' posters, communities' posters, communities in Littleton in Colorado in the United States, all over the world. 

    Then years pass. And still, still we are silent. Grades pass by and still. And we grow inches then feet and we grow smarter then more stubborn and still, still we are silent. Littleton? but isn't that where - yes. And we're silent. Shifting eyes and shuffling feet and stammering hands. We are silent. Conversations of friends fade as we drive by Bowles St. and Pierce Ave., the silence piercing the conversation with memories that wish they were never memories. 

    And years lead us to high school. To youth group at the church whose pastor was Pastor Barry, whose pastor memorialized a disquieting memory. A youth group that changed our lives and saved our lives and gave us life in a life with so little life left. And we pick up a book we've heard of all these years and we read. She Said Yes. And you read Chatfield and Simms and Wadsworth and Kipling and you know these streets you been on these streets thousands of times. These are you streets. And you learn what she believes and you know what she believes because she believes what you believe. And they asked her what she believed, what you believe. And they ask her if she wants to live. And, no I don't believe says yes, let me live. And yes I do believe says do what will. She said yes. 

    And we read Rachel's Tears and her Bowles is our Bowles and her Wadsworth is our Wadsworth, as is our Santa Fe and her I-70. The schools are so near and the church...the church is our church. Her youth group is our youth group. The passion for her God is our passion is her passion is our passion. And they know her passion. And they find that day. And they ask her, do you believe? Yes. They shot her in the leg. Do you believe now? Yes. They shot her in the arm. They took aim for her head and asked, do you believe? She said yes. 

   

    The retrospective gaze of a twenty-one year old, setting down the Cabernet. In memory of a memory no longer remembered. Remember eleven years thirteen can't remember, won't remember, can't remember. Remember when thirteen was overshadowed by a shadow no one wished would descend. Thirteen overshadowed by thirty-three where invention, creation, intelligence were stained black by the black shadow of black memory. Eight years almost to the day after the day we tried to forget, we could no longer forget. Memory donned the black to memorialize those taken in Blacksburg.

    Remind those gone at Columbine, remember those gone at Virginia Tech. Not schools, numbers again. Thirteen, thirty-three, thirteen, thirty-three. Spiraling to forty-six, forty-six. But now, remember the killer, the schizophrenic killer the dead killer the victim killer. Yes, thirty-three, not thirty-two. Thirty-three. Halls close, memorials...You went where? Virginia Tech. Isn't that where - yes. Shifting eyes, shuffling feet, stammering hands. Thirty-three and dozens wounded.

    Blacksburg, remember with me. In eleven years, only seven more, most will have forgotten April 16th, 2007. you won't have forgotten, can't have forgotten, won't have forgotten. but they won't remember as you remember. No more will your eyes shift, your feet shuffle, your hands stammer as now at each inquiry. As now you try to forget you nearly forget will forget almost forget. Raise your glass to forgetting. 

    We all want to forget. Raise our glasses of Cabernet to memory, that memory that is merely memory and a long off memory at that. And take only a sip of the Cabernet, to forget what we almost forget but somehow can't forget. 

    Because of the lingering fear that again memory will be reality will be currently will be surrounding me again after all these years of forgetting. When not just thirteen, not just thirty-three - the forty-six but how many more will leave their bleeding arms and legs and chests behind, their yes's behind and rise to the sky as a white dove, too early. Too early.