Wednesday, September 18, 2013

Speaking Ill of the Dead

I'm moving this discussion to its own post since it has little to do with mandatory employee health screening and I think it deserves its own section.

Jesse put up a link to a PBS news interview with Drs. E. Fuller Torrey and Elspeth Ritchie regarding Aaron Alexis, the alleged Navy yard shooter. This has spurred discussion about what, if anything, psychiatrists should be saying in the media about specific individuals with rumored mental illness.

I've gotten on a soapbox about this a number of times before and I don't want to be repetitive, so if you feel inclined you can search the blog for the labels "shooter psychology" and "spree killing." You can also read my Clinical Psychiatry News column about a similar situation, "Use of Psychological Profile to Infer Ivins' Guilt is Prolematic". (Titles are not my strong suit.) I wrote a followup column about this just last month when the president of the APA tweeted out a statement regarding the legal sanity of the Fort Hood shooter.

Honestly, at this point I feel like a broken record. (Oh dear, some of our readers have probably never played a record!)

In my opinion, no mental health professional should be making public statements about the legal sanity or mental state of a living criminal defendant prior to trial. Presently our APA ethical guidelines do not expressly forbid this, unfortunately. The guidelines make a generic caution against public statements regarding people we haven't personally examined in a principle known as the Goldwater rule. This has been interpreted to mean that public statements are OK as long as the professional makes an initial disclaimer that they have not personally examined the individual they're talking about.

This guideline was written and adopted before the Internet was invented, even before there were personal computers (back when people knew what 'records' were and what happened when they cracked).

I felt the time was ripe to bring this so-called Goldwater rule into the modern age, and I also felt strongly that we should include a specific caution or prohibition against public statements regarding criminal defendants. I drafted proposed language in an action paper which was later adopted by the APA. To my knowledge, the Goldwater rule is being revisited (and hopefully revised) right now.

But back to Aaron Alexis and the PBS interview. This is where it gets tricky. In contrast to the Fort Hood shooter, Jared Loughner and the Aurora theater shooter, this is a situation where people are making statements about a dead suspect rather than a living defendant. The impact on a dead person is, well, moot.

Nevertheless, there are ramifications to consider. Media statements may reinforce the notion of guilt in the public mind when the deceased was never actually tried or convicted, or any of the evidence put to the test. This was the case in the situation of the late Bruce Ivins, the anthrax mailing suspect. In that case the only physical evidence linking him to the crime was the genotype of the anthrax bacillus. This evidence was weak enough that FBI investigators were concerned it might not be admissible. He might have been innocent. The situation is slightly different for Aaron Alexis given that he was definitely at the scene of the crime and presumably the evidence of guilt might be stronger than in the Ivins case. But does that change our professional obligation to maintain respect for persons? At what point do we need to balance the real need for public education about mental illness, violence risk assessment and the pro's and con's of involuntary treatment against the distress of a surviving loved one? While public opinions about won't impact a dead suspect, they will impact the suspect's wife, children and siblings. Just ask the mother of the Columbine shooter.

This post is getting a bit long and I have other things to do, but I thought I'd spew out an initial reaction. There are also state laws about medical confidentiality which address the maintenance of confidentiality after death, but that's a topic for another post. Some confidential information might have become available to investigators when the suspect was still alive, in the heat of the incident when danger was imminent. Given that there will be no trial, we likely will never know. But these situations are bound to come up again so we should be prepared for these discussions.


10 comments:

Dinah said...

Thanks Clink. So Goldwater does not apply if the person spoken about is dead?

I thought the interview was offensive because of the assumptions the two psychiatrists made about diagnosis, motivations and treatment that they seemed to think was probably offered and probably refused, with no factual basis.

Torrey ends the interview by saying that these shootings keep happening because of the lack of state beds, and I don't see how that's relative to this case. Maybe they keep happening because they get so much publicity.

Anonymous said...

""Honestly, at this point I feel like a broken record. (Oh dear, some of our readers have probably never played a record!)""

Gosh Clink, you're making me feel old with the statement:)

On a more serious note, to add to Dinah's excellent post, Torey has a record of making assumptions following mass shootings and is never called out on it by the press. It is very upsetting.

AA

Joel Hassman, MD said...

So many error in judgment have seemed to occur with this incident, there is no one finger to point.

As I blogged about it last night, one of our more "celebrity" colleagues wrote a column that made just absurd conclusions and expectations, it was more important to protect the need for gun access than responsible boundaries with others.

By the way, what defines a broken record, a scratch that just repeats, or a fracture in the vinyl that makes it unplayable?

Sarebear said...

Maybe I'll get lambasted for this I dunno, but I thought PERHAPS the generational differences between the two shrink "experts" struck me a bit as to how they were handling themselves and handling discussing a hypothetical non patient, as it were, publicly. The older shrink, seemed very very eager to "diagnose", with obligatory but let's get it out of the way so I can fake diagnose but show you how much I know about what I'm doing here . . . . . he just seemed to want to show off . . .

At FIRST, Ms or Mrs. or whatever Ritchie seemed to be more restrained in that regard, but then she seemed less restrained in other areas with other agendas to push, and it just seemed to me, especially when the older shrink pulled out his book, that "Aha! This isn't just some no agenda shrink they have on here, he's pushing one or more agendas . . . . ". Forgive my sloppy punctuation I'm just typing too fast oops I gotta go to therapy. Lol be back later.

Anyway. I thought PBS should screen their experts better than that.

cassara cook said...

It's okay, Clink. If some of us haven't played a broken record, we've probably scratched a CD, or at the very least had our iPod break!

Anonymous said...

I appreciate reading the comments here. I fully support you being a broken record on this topic, in fact, I'm grateful. I think it's important that we hear from psychiatrists like you guys who are more thoughtful and less reactionary.

The rhetoric espoused by folks like Torrey only increase the potential that people who are struggling won't tell anyone. I wonder how many folks who hear voices and are struggling with severe mental illness listened to this interview and think I am not going to tell because they will think I am a murderer and forcibly treat me. Who is going to even admit to hearing voices when it's automatically linked with murder?

The psychiatrists in the interview didn't bother to find out the facts before they spouted off. They don't know if the person involved knew right from wrong or if he was capable of choosing. That's a critical thing to know. They don't know if he even had schizophrenia. They are just making wild speculations that end up further stigmatizing a group of people who had nothing to do with this. That makes me really sad.

Oh dear, more mental health professionals on CNN now. It's all about tracking people with mental illness. Ugh.

Pseudo-Kristen

Dinah said...

Pseudo-Kristen,

Obviously, I agree that it doesn't help to have psychiatrists talking without facts to push their own agendas. But it's a stretch to say that people will listen to the interview and decide not to tell anyone they are having psychiatric symptoms because people will think they are a murderer. The shooter had two recent visits to the ER for insomnia -- are all insomniacs murderers? He had a security clearance. Maybe everyone will think that if they have a security clearance, they are a murderer (or destined to move to Russia).

Or maybe someone will hear the radio and say "I hear voices, maybe they will tell me to do something heinous so I should go get help so the voices stop before they tell me to do horrible things to innocent people."


Anonymous said...

Dinah,

I think when there are psychiatrists who appear on t.v. every single time a mass murder occurs (before they know any facts) and say it's due to untreated schizophrenia, then they are sending a message that schizophrenia = murderer.

I don't think it's a stretch to be concerned that this kind of rhetoric can lead to people avoiding care and/or afraid to admit certain symptoms. I hope I'm wrong, but I don't think I am.

P-K

Anonymous said...

I agree with Anonymous- as a matter of fact, because of this site alone, I have learned to not admit my depression or symptoms openly anymore- especially to doctors other than my shrink.

Anonymous said...

Yeah, I don't think pseudo-kristen is reaching at all. This site has let me know just how much stigma there is, and I am very careful in not discussing mental health issues with my GP.

Insomnia is not as stigmatizing as schizophrenia. Most people will experience at least temporary insomnia, so it is not as damning a diagnosis as schizophrenia--which almost no one will ever have unless they are in that really unfortunate one percent of the population. Probably everyone who has taken care of a baby, gotten sick, overly excited, etc has experienced insomnia.