Professional suicide – the Clancy case

Shane Clancy, a 22-year-old going to University in Dublin, broke up with his girlfriend, Jennifer Hannigan, in April 2009. Despite his having broken the relationship off, he found it difficult without her. She, meanwhile, had found someone new: Sebastian Creane.

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. Sebastian Creane was also there with friends. Shane gave them a lift home, leaving Sebastian to his house last. He came in and spent time chatting before leaving. Jennifer Hannigan came round to Sebastian’s house later, where she had a phone call from Shane who was outside. He asked her to send Sebastian out saying he was hurt and needed help. Sebastian went out and was attacked and stabbed fatally. Jennifer was also stabbed, as was Sebastian’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 Sebastian (fatally), Jennifer, and Sebastian’s brother. He was later found dead having stabbed himself 23 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 Sebastian Creane and Jennifer Hannigan, 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 Sebastian’s friends at the public house on the night of August 15, 2009, from Jennifer Hannigan and Sebastian’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 Sebastian Creane’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 (see article on Antidepressants & Violence). 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.


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Comments

  1. And psychiatrists remain silent.

  2. My two-penneth as the debate goes on.
    Do anti-depressants cause violence and suicide?
    Yes, they do and Shane Clancy underwent the ultimate surge of adrenalin which occurs when the brain is subjected to these dangerous drugs.
    I was off Seroxat for eight weeks and if I had gritted my teeth, I think I would have been alright. But I caved in because I could not stand acute akathasia, agitation, confusion, nightmares, brain zaps, exhaustion, hysteria and crying, etc. etc. I started to take them again and within seven days I had the ‘adrenalin’ rush, just like Shane did. My theory is because I was fifty and not an adolescent, I did not violate anyone else, but I did violate myself severely. It comes out of nowhere, one minute you are a normal, rational human being, the next minute comes this surge so great, that it takes over your mind and body and nothing could ever stop it. It is an urgency, Roger Whittaker calls it a Serotonin rush, it is overpowering and nothing can halt it. I experienced this and I can relive every single moment even though it was ten years ago. This extraordinary and monumental surge of energy, there are no rational thoughts whatsever, it is like you have been taken over and all common sense is obliterated and only violence and suicide will stop it.
    I am a mild, calm individual and this drug-induced explosion of the mind is something so unbelievably grotesque that it is an extremely difficult and frustrating nightmare to explain. This is why nobody believes you when you try and tell them what actually happened.
    As I said, it comes out of nowhere and I can recall rushing around like a headless chicken doing everything in my power to obliterate myself. I suppose it was like a blast of the most powerful street drug you could imagine, people throwing themselves out of windows and all that, but it was an anti-depressant.
    As to it being a placebo. I felt no different on Seroxat, but I can say that when I carried on with my life, back on Seroxat, I had almost no recall of my near fatality and in such a shocking way.
    So, to me that suggests Seroxat has a deep seated sedative affect which perhaps is not noticeable when you are taking it, but after a profound shock, it definitely drew a veil because I just carried on as if nothing had happened.
    It is worse now, because my mind after all these years of being sedated is now waking up and more and more I relive the horror of that time.
    Regarding brain zaps, I still get them which to me means that I am still not out of the woods and am still not quite one hundred percent adjusted to life without Seroxat.
    One more thing, an intellectual I am not, but my brain told me through Seroxat that I should be dead, and I have to pinch myself sometimes to tell myself that I am still here.
    Hope that helps a little bit with what you are trying to do here.
    The experiences are the answer, but, of course, most of them aren’t with us anymore.

  3. Dr Healy,

    I have been following your work for years now.
    Just wanted to say great blog.
    And great to see you in the blogosphere!
    Keep up the fantastic work you do.
    It is appreciated more than you will ever know :)

    Thank You

  4. Neil Carlin says:

    “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.”

    Ten days before her death on 6 May 2007, our daughter Sara visited a walk-in clinic complaining of severe fatigue – diagnosis – exhaustion due to “post-mono fatigue” She had been diagnosed with mononucleosis eight months previously. She called me on 3 May saying she had lost her Paxil pill bottle.

    I picked up a refill from the pharmacist next day on the evening of 4 May and handed it to her. I found her hanging dead sometime around 4 pm on the sixth.

    We believe she killed herself sometime in the morning of that day. There were six 20 mg Paxil tablets (6 x 20 = 120 mg) missing from the bottle, we believe she consumed after I handed her the Paxil pills – 40 hours or so prior to her violent suicide.

    We now believe Sara’s complaint (Apr 26) to the doctor of severe fatigue & the flu-like symptoms she mentioned to me two days before her death were symptoms of Paxil withdrawal. And the abrupt cessation and restarting of Paxil at a higher dose caused severe agitation (akathisia) resulting in her irrational act. As Dr. Joseph Glenmullen has described “suicide being a welcome relief from akathisia”.

    Like the Fennells we did not make these connections until some months after her death.

    We had no idea of the existence of the 2004 Health Canada warnings re Paxil & other SSRIs (a good reason to support David Healy’s RxISK.org).

    These are the facts although we cannot ever conclusively prove causation.

    It is a sad state of affairs when we victim families, as the Fennells, are the ones left to the heavy lifting in raising awareness to the dangers of these drugs through anecdotal stories and not properly conducted clinical trials with unbiased & unhidden data.

    So, my heart is with Shane’s mom with her feelings of guilt. I live with this same guilt every day.

    Neil Carlin
    Oakville, ON
    Canada

  5. I think what is interesting here is that the mother of Shane, Leonie, has created a blog and is posing questions that seem uncomfortable for many of the pro-pill pushers out there.

    It was interesting to see the reaction of Patricia Casey [a psychiatrist] when Leonie wrote about her on her blog.

    Setting lawyers on a blogger for having an opinion was a bad move by Casey. Despite what Casey may feel about her own credentials everyone, especially a grieving mover, has a right to question whether or not these drugs actually work and whether or not those that prescribe them are doing so with misguided judgement.

  6. David Healy says:
  7. Thank you so much for speaking up for Shane. He would have found the fuss you have caused over here by speaking at his inquest hilarious.
    Shane was funny, smart and the kindest person I have ever met. He could never have hurt himself, let alone another person; yet 17 days on Citalopram, he committed murder/suicide?

    Your blog seems to have ruffled a few feathers here in Ireland. Yesterday Jim Lucey, one of the 8 professors who wrote the multi-professorial letter you refer to, came on RTE Radio and again denied that SSRI’s can cause suicide. He is of course a member of the ‘Irish College of Psychiatry’. They do protest a lot, don’t they?

    As for Patricia Casey, she can send me as many Solicitor letters as she wants to; what’s the worst she can do, take my son away from me again? The idea that these psychiatrists who make money from pharmaceutical companies, and then attend Inquests to deny that a drug from the same company can cause death, and not expect a parent to take issue is ridiculous. This practice has gone on long enough in Ireland and it’s about time it was stopped.
    Thank you again from the bottom of my heart,
    Leonie Fennell (Shane’s Mum)

  8. Ana,

    Your description of what these drugs can do and what feels like “from the inside” is extremely powerful and relevant. I hope that skeptical people (like Patricia Casey?) see it. This is what happened to Sara (see Neil Carlin’s post) and Shane and so many others. First hand reports of this phenom are rare, for obvious reasons but difficult to dismiss. So, your description is very important to anyone who wants to understand.

  9. There is no way that mainstream Irish psychiatry is ignorant of the effects of these drugs. They are quite aware of these happenings. This is not about them being skeptical or mis-informed. But, I suspect that in order to clear their consciences, they convince themselves that the good outweighs the bad overall. Most of them really believe that their methods and treatments are in our best interest and society’s as a whole. They might be highly deluded in their thinking, but they are also very well paid for it… Nobody likes to see their ‘bread and butter’ under threat… That’s the bottom line.

Trackbacks

  1. [...] Another inquest may bring out the risks to doctors from their professional associations behaving as the American Psychiatric Association (APA) or the Irish College of Psychiatry has done (see Professional suicide – the Clancy case). [...]

  2. […] Predictably, following Dr Corry’s statement and the news that Prof David Healy was to give evidence at Shane’s inquest, the Irish College of Psychiatry went into a frenzy, publishing letters to the editor, seeking (and being refused permission) to testify at the inquest, giving television interviews and issuing statements. Frantically refuting the evidence that SSRIs are associated with suicide and homicide and seeking to shut down discussion on the grounds it may result in people refusing to take their antidepressants or failing to seek treatment. (Additional information on the events surrounding Shane’s death and the response of Irish Psychiatrists can be found on the blog of Prof David Healy). […]

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