Schizophrenia, James Holmes, and Hindsight

I think the psychiatry career of  Dr. Lynne Fenton may be over.

Worse than that, she must be questioning whether she could have done anything to prevent the “Batman shootings” in Aurora that killed 12, and wounded many others.

James Holmes: Schizophrenia?

So it leaks out that shooter James Holmes has been in “treatment” for schizophrenia. Big Duh. It was only a matter of time before that was revealed, sadly.

The question, though, is this: what kind of “treatment” was he getting?

According to this PBS Report, and interview withCAROL LEONNIG,  of The Washington Post

james-holmes-court-pictures
Holmes in court

“(New information) shows that James Holmes, the lead and only suspect in this shooting rampage in Aurora, Colo., was seeing a psychotherapist or psychiatrist in his university where he was a graduate student. She was a very senior psychotherapy director, basically the medical director for the outpatient clinic for mental health treatment for students.

And she was seeing him for some time before this tragic event…Lynne Fenton is the doctor in the case. Her specialty and what she has been mostly researching is schizophrenia.”

What has yet to be revealed is whether or not Holmes was taking medication for his schizophrenia, and whether he should have been committed to a hospital stay – whether he “wanted to” or not – if there were any signs of this possibility of violence.

Could Treatment Have Prevented the Tragedy?

This leads us to the issue of “Assisted Outpatient Treatment” well-covered by the Treatment Advocacy Center – so I will say no more about that in this post.

But there is also the issue of James Holmes’ family life.

aurora grief
Grief in Aurora

There are those who will point to his parents as the “cause” of his actions – yes, still. But I know all too well how the best parents can feel powerless in the face of schizophrenia – especially in the absence of support and education.

The Grief of Countless Families

Check out this Open letter  “To the parents of James Holmes: Our son has schizophrenia; we know how hard it can be” . In it, the family expresses first-hand empathy for the confusion and chaos that schizophrenia can bring to a family.

and this was my response (among many other comments)

Dear Margaret – and family – Thank you for this empathetic, beautifully written open letter. There will be those who do not believe your point of view; perhaps, before my own son Ben developed schizophrenia, I might have been one of them.

But no longer.

Ben is 30, and we have been through the same confusion, shock, grief, and anger as you. Eight hospitalizations later, a few of them as relapse during the recovery period that began when Ben’s meds began to restore his brain at last (not completely, of course, but enough to allow a slow thaw from his “frozen in time” state), we are grateful for every small step Ben takes to find a new normal for his life.

He has a job, goes to school and does well, and can – at last – take family trips with us with little fear that his behaviors will scare flight attendants.

It has been a long road, and we still monitor Ben’s medications – because in two days without them he will wind up back in relapse. I wish he didn’t need them – and perhaps, as he ages, this may change if he is carefully monitored – but right now he absolutely needs this treatment – medication, support, structure, community, purpose and love.

Perhaps if James Holmes had had treatment that works – involuntary, if necessary – this could have been prevented.

My heart goes out to you, and all affected by this senseless tragedy – including the Holmes family, and even James himself.

We are lucky, perhaps, to have Ben back in our lives in such a positive way – but I know that we were helped immeasurably by education (especially the Family-to-Family program at NAMI, and even the website communities like HealthyPlace that provide info and perspective) and by the stories of others – which is why we wrote our memoir, Ben Behind His Voices (which included some resources that saved our family) –
Thank you for sharing your story and perspective. Perhaps it, too, will make a difference.
best,
Randye

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11 thoughts on “Schizophrenia, James Holmes, and Hindsight

  1. Hello Randye

    There is so much tragedy and sadness building up around this incident.

    I think this case shows what happens when everyone who wants to help has limitations, and the person at the center retains the capacity to show up anywhere looking okay. None of our formal systems can reach everywhere or everyone. Holmes faked sociability, did not live in a community, and seems not to have had any visitors at all.

    Isolation is poison for people with mental illness. That’s why I always encourage people to connect with allies. I also promote strategies that keep families working together. Visiting family members and nosing around just a little keeps people safe.

    1. Hi Paul. You are so right. Let’s hope that, step by step, we can make changes that add up to restored – and saved – lives. Thanks for writing, and for all you are doing. Your book Defying Mental Illness is a great help.

  2. Hi Randye,
    I didn’t know you’ve had this challenge, but glad to hear things are getting better and that you’ve been sharing this important information. This is what gets me: one keeps seeing signs that say “If you see something, say something” referring to terrorist attacks – especially in the city (where I now reside). But mental illness is just as potentially dangerous as terrorist attacks. Why don’t behavioral scientists publish “signs to look for” regarding this kind of illness – and a place/number to report it? Schools, especially, should know these signs. Social workers can visit people at risk. All these type of killings always say “he was a loner” and other traits. Apparently that’s a marker. Add to that, the person “left their school program or job.” In addition, there’s the need for some record of internet sales of guns and ammunition – and investigation into that. If we can send rockets to the moon, we should be able to identify “at risk” behavior, teach everyone what to keep an eye out for (just like signs of choking or heart attack), and create social work teams to investigate before it is too late. Mental illness IS real and can be dangerous to others. Anyway, bravo to you for writing about it and dealing with it so successfully.

    1. Hi Laurie – You are so right, and thanks for writing. Early detection is a hot issue right now – the DSM IV (Diagnostic Manual) requires an incident of psychosis before a definitive diagnosis can be made. This is partly because there are no other clear tests (like brain scans etc.) for mental illness – research is in early stages and unfortunately underfunded – kind of where cancer and heart disease detection processes were a couple of decades ago, when no clear diagnosis could be made until about what we now refer to at Stage 3 cancer, or an actual heart attack.

      As you can see, the results of waiting too long to insist upon treatment can be tragic. Early detection can save lives, both directly (the patient) and indirectly (extreme cases like Aurora, or simply the emotional lives of family and friends).

      All we have to go on are early symptoms, and one of the reasons I wrote my book is to advocate for early detection, a watchful eye, and earlier treatment. Ben’s path might have been very different, if his illness had been diagnosed earlier.

      There are several lists of signs – but symptoms can also look like drug use, another mental illness, psychological problems, or even just plain old teen hormones. One such list is supplied by the author of Defying Mental Illness, Paul Komarek, in this post .

      It includes:

      CHANGES IN THINKING OR PERCEIVING
      — Hallucinations
      — Delusions
      — Excessive fears or suspiciousness
      — Inability to concentrate
      CHANGES IN MOOD
      — Sadness coming out of nowhere, unrelated to events or circumstances
      — Extreme excitement or euphoria
      — Pessimism, perceiving the world as gray and lifeless
      — Expressions of hopelessness
      — Loss of interest in once pleasurable activities
      — Thinking or talking about suicide
      CHANGES IN BEHAVIOR
      — Sitting and doing nothing
      — Friendlessness
      — Abnormal self-involvement
      — Dropping out of activities
      — Decline in academic or athletic performance
      — Hostility, from one formerly pleasant and friendly

      and continues, along with possible steps to take.

      One problem with issuing such a diagnosis is stigma – and sometimes families, especially if not yet educated about mental illness, will resist the idea. So, I might add, will the people who are exhibiting the signs of mental illness – partly because the logic centers of their brain are impaired (anosognosia), and partly because of the shame and stigma we still associate with mental illness.

      Your comments are right on. Wanna run for congress? 🙂
      Thanks,
      Randye

  3. It doesn’t help to see the signs or report the signs or even to drag an obviously “off” person to the hospital as long as all they have to do is sign a piece of paper stating that they won’t kill anyone–which covers the hospital’s liability but do they seriously believe it stops a person from acting on one of those horrific impulses? And a child of 17 can sign that paper and be released–my son did. He didn’t go out and kill anyone, but I was terrified that he might. I feel for those parents–there is nowhere to get help. I get the whole civil rights thing, but when a person is obviously psychotic there should be someone who can help.

    1. Hi Bonnie – I agree, this is indeed a very complicated issue, with more than one facet and more than one answer. Still, it’s clear that many who need services and treatment often are either ignored, or told that they don’t “have to” be treated if they don’t want to be. Until the issues of mandated treatment and assisted outpatient treatment are clarified – not simple, but necessary – those with mental illness, and those that love them , will continue to feel the frustration and pain of a mental health system gone awry.
      thanks for writing – increasing awareness is a first step, as we share our experiences.
      Randye

    2. AMEN! The alternative to simply endorsing what was just said is to go into a long rant. The notion of sending seriously mentally ill “into the community” is seriously naive. Adding to the complication of obtaining correct information is that assessment centers do not interview family members separately and leave paranoid patients alone in the intake area for long periods of time. The public wants to blame families, but when it comes to funding appropriate services for the mentally ill . . . We are encountering similar problems in public schools: Some students with autism are left to cope in OVER-stimulating classrooms in the name of “least restrictive environment” when a more restrictive environment would be more merciful. Some of our “reforms” have back-fired.

  4. My son is an “intractible”. No meds worked for him until they put him on clozapine, which will kill him in a heartbeat unless I make sure that his white cell count is monitored. A few years ago he decided to stop his meds, decompensated, and there was nothing I could do unless he committed or tried to commit an act of violence. So this young man, my son, who had a record of at least twelve psychiatric hospitalizations, was allowed to simply run amok. I was finally able to get him into the hospital by precipitating a violent outburst in front of a policeman. There has to be a solution for this that will not increase the stigma against schizophrenia and yet protect the victims of this terrible illness.

    1. Hi Patrice – I am so sorry for the pain your son – your entire family – is going through. The lack of services to support recovery is staggering and shameful, I agree. One of the reasons I advocate (and the book is a big part of that) is to put that human face on mental illness – and I know we are so lucky that, at last, my son agrees to the “rules” of monitoring his health and supervision of medication. We live with the fear that tomorrow will not go as smoothly as today, and though Ben has “support services” in place, I honestly don’t know where he’d be if we hadn’t stepped in. There is, indeed, so much work to be done. I hope your son can eventually get the help – and hope – that he needs. You too. Hang in there, and know you are not alone. best, Randye

  5. James Holmes is a victim of his illness. He was alone and nobody see this illness before tragedy happened. Our health system dosent open any help to person with mental illness unless he become violent. The health system is not smart enough to diagnosed the problem in advanced. I absolutly sure, that James did not understand what he did because of nature of his illness. He will get back and it will be huge tragedy for this young person, who is a victim of his illness.

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