Someone tuning into the closing arguments in the Clancy case without having seen anything that went before, especially if they came to it thinking trials should hinge on facts rather than waffle or emotions, would likely have been left figuring the prosecution has to win. They dealt in details. Details about her illness, what she told her doctors, her drug levels, the timing of events in the final hours.
The defense did not focus on details and didn’t counter the prosecution details. It took an emotional broad picture approach.
The judge stressed keeping to the facts/details. He didn’t quite dismiss all the experts and their opinions about illnesses etc, other than to say they know no more about the details than you – the jurors do. Courts can be skeptical of expert witnesses and so it is not impossible that in between the lines he might have been hinting the experts know less about what counts than you the jurors do.
In response to the judge’s request for their comments on the instructions he had drawn up about what he should tell jurors their job was, the prosecution and defense input seemed to center on clarity in the case of the medicines on a question as to whether drug induced toxicity, if present, was debilitating. In the case of any mental disorder, if present, whether it removed Lindsay Clancy’s capacity to distinguish right from wrong or to conform her behavior accordingly,
Meanwhile, the Clancys had filed a parallel legal action on January 22 2026 claiming most of those who saw her, Dr Tufts et al along with the healthcare organizations they worked for, were negligent in failing to make the correct diagnosis which, the action claims, is a bipolar diagnosis. If that had been made, she would have been treated in a manner that would have saved the lives of her children and saved her from permanent disability.
The argument in this Negligence Lawsuit lists very similar points to the prosecution’s closing list of points but frames these points entirely differently.
Two points stand out. One centers on Command Hallucinations and the other on a Bipolar diagnosis
Command Hallucinations
The only people with command hallucinations I’ve seen, talked to or dealt with in any detail have been on psychotropic meds.
Command hallucinations are auditory. Auditory hallucinations are traditionally linked to schizophrenia and delusional psychoses in contrast to visual hallucinations which are more likely linked to drug toxicity. But I’ve never spoken to a person with schizophrenia or psychosis that I can recall who has been medication free and reporting command hallucinations.
It’s close to impossible for any clinician today to have ever seen such a person. Some patients who have been labelled as having schizophrenia, many of whom will not have it, may be drug free. But command hallucinations in my experience invariably start on meds and can persist long after the meds stop, so an interviewer may be misled into thinking these have no link to treatment.
Command hallucinations are also not known to be responsive to antipsychotics. This is not saying some might appear to respond – they can seem to clear up with or without treatment. It’s saying there is little or no guarantee they will respond. They can be one off phenomena or clear up with time on or off meds or can persist indefinitely while on meds.
Is it possible we have only recently developed Command Hallucinations. Are they described before the introduction of chlorpromazine in 1952 or anti-seizure meds like the barbiturates in 1912 or the bromides from around 1860?
The startling answer AI will offer you is the term Command Hallucinations came into use in the 1970s linked to Julian Jaynes ideas about Bicameral Minds – Left Brain, Right Brain ideas. Jaynes traced a lineage for Command Hallucinations back to the Ancient Greeks, claiming when they talked about communications from the Gods, they were having Command Hallucinations. Hearing voices like that is not madness – is certainly not psychosis.
Jaynes idea gave rise to the view that many normal people today can hear Voices and are like Greeks and no more mentally ill than the Ancients.
In 1987, Marius Romme, a Dutch psychiatrist, and Patsy Hage, a Voice Hearer, appeared on TV talking about her voices. She heard voices but apart from that appeared normal. This led to the creation of a Hearing Voices Network, where voice hearers meet in a non-mental health setting. This has been a very good outcome.
Many of us can hear voices without having a psychiatric disorder. We can hear them when falling asleep or when waking up and these voices can be very vivid and real. We can hear them under hypnosis. They can be helpful indicators of how we are thinking – voices that make us aware we may be actively considering more than one option at the same time. Lots of voices are benign and keep us company. Hearing voices groups are far better for many than antipsychotic or other drugs.
While it has had good outcomes, Jaynes’ and Romme’s links to the Ancient Greeks was fanciful. We don’t know that communications from the Gods are linked to what happens now. Did the guys just conveniently avail of a new phenomenon – Antidepressant, Anticonvulsant and Antipsychotic induced Command Hallucinations? All of these drugs can give rise to Command Hallucinations
Bipolar Boston
There is little doubt that Lindsay Clancy had what she called intrusive thoughts. She began mentioning them after taking Zoloft. Exactly what these ‘thoughts’ were or what their content was don’t seem to have been clarified in the murder trial. The negligence lawsuit seems to convert the intrusive thoughts into command hallucinations lock stock and barrel, whose content increasingly contained ideas that she should kill herself and, en route to doing so, should kill her children. All of this is/was supposedly evidence that she had/has a bipolar disorder.
There is a negligible amount of evidence, rather than opinion, that she does have a bipolar disorder. No admissions for mania, no convincing hypomanic episodes.
The event that supposedly should have caused the scales to drop from the eyes of those treating Lindsay was the activation of her thoughts on Zoloft.
This SSRI drugs reveal Bipolar Disorder notion was likely invented in Boston. It was picked up by Pharma around 2004 when the SSRIs ran into suicidality problems. SSRIs weren’t causing suicide (or homicide). These events were happening because the person had been misdiagnosed as depressed when they were really bipolar and should have been put on a mood-stabilizer.
This is total baloney but not surprising in a part of the world that was then well on the way to diagnosing bipolar disorder in utero – as the Bipolar Child unashamedly claims is feasible. See The Latest Mania.
Activation on an SSRI is a toxic effects of SSRIs that can be seen in healthy volunteers. That is all it is. It is not a diagnostic test for bipolar disorder.
The idea that it might be possible to make a bipolar diagnosis in utero was only one feature of Bipolar Mania that gripped Massachusetts and spread across the US. Another was the complete neglect of the data from company trials that show a statistically significant excess of suicidal events on anticonvulsants compared to placebo. The excess held whether the trials were done in epilepsy, migraine, pain, bipolar disorder or other conditions. See FDA, Anti-Seizure Meds and Suicidality.
The mania for bipolar disorders came at a wonderfully convenient time for pharma who were then bringing olanzapine, risperidone, and quetiapine onto the market. The door was opened to getting a license for bipolar disorder, which was then in the process of transitioning from Cis Manic-Depression, one tenth as common as schizophrenia, into Trans-Bipolar, a 5 times more common disorder than schizophrenia.
Manic-Depression had an established high rate of suicide. The bipolar 2, 3, 4, 5, 6, and in utero bipolar didn’t. Nor did schizophrenia. Schizophrenia had a very low rate of suicide and a patient with schizophrenia committing homicide was almost unheard of before the introduction of chlorpromazine – See Mortality in Schizophrenia.
The clinical trials of olanzapine and risperidone in schizophrenia had the highest rates of completed suicides and suicidal events in company trial history – higher than the suicidal event rates for SSRIs or anticonvulsants. So high that Eli Lilly have never divulged the true figures submitted to FDA, and FDA haven’t stepped up to the plate to force them to do so.
Why has no-one in Boston stepped up to this plate? What illness do the people who become suicidal on an anticonvulsant have – presumably not bipolar if they become suicidal? What should they really have been diagnosed with? What illness do the people who become suicidal on an antipsychotic mood stabilizer have – presumably not bipolar disorder? What should they really have been diagnosed with?
The idea that everything would have been just fine for Lindsay Clancy if she had been diagnosed as bipolar and put on a mood-stabilizer is deluded. Were most of the Boston (and American) psychiatric establishment responding to Command Hallucinations?
These antipsychotics and anticonvulsants are now called Mood Stabilizers. But FDA never licensed them as such. There is zero evidence these drugs stabilize moods. The companies applied to FDA for a license based on trials of these drugs in mania – where any remotely sedative drug cannot but produce a drop in scores on mania rating scales and will get a license – See The Latest Mania.
Throw in the fact that antipsychotics can be desperately difficult to stop and someone like Lindsay Clancy whipped off a highish dose of quetiapine risks having major difficulties. Antipsychotics are at least as difficult as SSRIs and perhaps more so to stop. There have been completed suicides in the withdrawal period of company trials of these antipsychotics submitted to FDA – who chose to turn a blind-eye to them
In addition to all that there is abundant evidence dating back 60 years that both antipsychotics and anticonvulsants can cause a range of delirious phenomena including hallucinations.
Negligent?
While it is difficult to see Jennifer Tufts, the nurse practitioners or other clinicians who saw Lindsay Clancy as having done a good job, it is even harder to see them as negligent.
One of the experts in the case, Avram Mack, has come in for a lot of vilification for not towing the bipolar line and offering a view that LC was depressed. On the basis of the limited details I have, I lean toward depression (and not especially major or severe) rather than any other disorder.
Lindsay Clancy did not have classic post-partum psychosis as described by Emil Kraepelin – who did not view post-partum psychosis as part of manic-depressive illness (bipolar disorder). Classic post-partum psychosis has all but vanished – See Post Partum Psychosis. It looked like a steroid psychosis. It happened in women who had no prior or subsequent mental health history. Lindsay Clancy did not look remotely like classic post-partum psychosis before being exposed to the series of medicines she was put on.
Why did Jennifer Tufts and others fail to badly? Because like Tom Kingston’s and Deirdre Morley’s doctors they were Pathway adherent doctors. They were conforming their behavior to the Rules rather than treating the person in front of them. To Rules that are based on ghost-written, often fraudulent trials. What kind of outcomes can we expect if we force doctors to adhere to Treatment Pathways based on junk? Are these treatment pathways not The Perfect Killing Machine?
Moving Forward
The jurors in the Clancy trial have a dearth of detail that might form a basis for an acquittal. This was in part because the medicines Lindsay Clancy was taking were not center-stage. Even if they were front and center, however, there are almost no psychiatrists who could have interviewed her and brought details to light that might help jurors understand what happened.
There are thousands of people who have been harmed on the meds Lindsay Clancy was on who will shout about akathisia but shouting about akathisia is almost irrelevant – except in very severe cases of akathisia. Even if she showed some signs of akathisia, which it isn’t clear that Lindsay Clancy did, jurors have to be able to understand how they can get from whatever it is the drug is causing to an understanding as to how someone loses the capacity to tell right from wrong and conform their behavior accordingly. There is a gap there to be bridged that megaphoning akathisia is not going to bridge.
We desperately need detailed reports from people who have had the intrusive thoughts and command hallucinations and other phenomena that these drugs can cause that might help jurors understand how the ability to tell right from wrong or the ability to conform out behavior may be lost.
There are two posts on RxISK linked to this. The Troubled Dream of Life tries to explain what SSRIs do and how this might lead to a Loss of Capacity to tell Right from Wrong and how to conform our actions to these standards.
Drug Induced Loss of Capacity features a series of cases that might give some of you an idea about the kinds of details jurors, the media and doctors need if they are going to bring the drugs into the frame in any of these cases. Many readers will have had the experience of effects like these or know someone who has. This post is based on what you have told me and others of us linked to RxISK – there is very little in it that comes from books.
We now collectively desperately need more input from you. If you can, respond to the posts in the comments or by email and/or by filing RxISK reports.
Spoiler:
I have no idea what the outcome in the Clancy case will be and no views on what it should be. Unless I got a chance to talk at length to her in my opinion it’s not possible to have a view. The jurors will have a view on what has been presented to them, which does not appear to include anything about the effects of her drugs on her.
Postscript
There are many articles covering this case. In the US some also cover Marilyn Lemak’s case.
Marilyn Lemak and Lindsay Clancy
In the UK and Ireland – there are articles covering Deirdre Morley’s case
Many BC cases have been collected by Dr. Anna Kindy
Dr Anna here does not appear to be Dr Anna Kindy who is a doctor, and a British Columbia politician with an interest in the effects of these drugs.
D
We desperately need detailed reports from people who have had the intrusive thoughts and command hallucinations and other phenomena that these drugs can cause that might help jurors understand how the ability to tell right from wrong or the ability to conform out behavior may be lost.
100%
But how?
Still, fabulous, thanks David
Today the Jury told the Judge, they are unable to come to a unanimous verdict. Judge tells them to go back in.
Under Massachusetts law, apparently, they can only do this twice, and then a hung-jury. A retrial?
Three children have been strangled and the jury, hardly surprisingly, are split, to get recourse for the victims, the children, and she didn’t intend to do it, not knowing right from wrong by the others.
Lindsay pleaded Not Guilty.
I think it’s great the David has put together these three posts, endeavouring to ferret out reason and causality. Let’s hope the vignettes David has put together increase over on Rxisk.
It was definitely worth watching today’s trial proceedings.
Judge Sullivan declared a mistrial. 11 – 1.
One juror yesterday was accused of not obeying the law regarding ‘beyond reasonable doubt’. Kevin Reddington, defense, wanted the juror removed, this was not granted. KR was granted leave to approach the Superior Court Justice for an emergency Stay. Choice phrases batted back and forth between the Judge and Attorney.
A Supreme Court Justice interviewed both prosecution and defence by zoom and denied.
KR read a statement to the Judge and Court to apply the law to remove the lone juror.
Judge denied.
Judge declared a mistrial.
A hearing was agreed for 29 September, 2026.
Addressing the Jury to thank them, Judge Sullivan quoted Churchill, ‘Brace ourselves to our duties’
DA Timothy Cruz gave a press conference, and gave an impassioned speech.
‘This is not about healthcare, this is about first degree murder’ …
And she’ll have to suffer it all over again.
Thank you for this week’s compelling, powerful and valuable trilogy of linked posts.
The summing up in the Clancy Case was distressing to watch.
This further detailed insight into adverse psychotropic drug reactions, their subtlety and complexity
is greatly valued.
The misinterpretation of SSRI – ADRs as ‘Bipolar Disorder’, and the fantasy of ‘Mood Stabilisers’ must become more widely known and understood by those who prescribe antidepressants (SSRIs/SNRIs et al) with almost religious belief in: – “Safe and Effective”.
If only our loved one had experienced a serene response to her inappropriate SSRI prescriptions, our entire family would have been able to continue our fulfilling and rewarding lives/retirement.
Fortunately the extended support from RxISK at least enabled us to understand what had happened.
I was not aware of the failure of pupil constriction in response to light caused by SSRIs.
Shouldn’t the risks of RTA, whilst driving at night on these drugs, also be included in full, fair and informed consent? (Road Traffic Accident)
You act on a very over powering compulsive urge/impulse that you cannot stop or control in those seconds or minutes it happens very quickly. You are only focused and thinking on the thing you are going to do. There is not right or wrong thinking at all.
That’s what I felt on ssris and alcohol. There are lots of other side effects too like emotional numbness, detachment e.t.c e.t.c
This is very helpful and I’m sure it’s true. But we have to explain how it happens rather than just say it does happen. The explanation that works for me at the moment is in The Troubled Dream of Life Post.
There has been a lot of debate as to why SSRIs cause Alcohol Use Disorder – is it because alcohol relieves akathisia, or the SSRIs mute the sensations of getting drunk or it something more like the 2D experience you outline here and is mentioned below. Perhaps its separate things from person to person or some combination
Your comment echoes comments from someone else I saw who had changes to his visual reflexes. My question is how much could changes to visual reflexes give rise to experiences like the ones described here.
There was a loss of depth to my vision. It was more like a two-dimensional video-game. There was a similar loss of depth to my thinking. I was reacting to things on the surface rather than able to see through to the consequences.
If I had an impulse to drive, I would go rather than consider the time or whether I had work the next day. If I had an impulse to go out for a walk, I might go without my phone – or shoes
This man also had altered balance reflexes. How much does out ability to balance physically link to an ability to balance mentally?
SSRIs are among the drugs most commonly reported to FDA as leading to Vision and Balance problems.
D
I think SSRI drugs can cause ‘Command obsessions’ aside from command hallucinations. These obsessions present as ‘Do it’ intrusive thoughts which feel like commands and tend to get diagnosed under OCD specifically Harm OCD although people with OCD are unlikely to act on them.
I’m wondering if people acting on commands is not necessarily about a loss of capacity rather than them being worn down by the attrition of persistent commands and feeling that acting on them is the only way to obtain relief.
In regards to alcohol, one can have an increased appetite for alcohol on SSRIs as one can have an increased appetite for sex and not just for one’s normal sexual orientation. In this respect there may be, even a mild, mania of which common symptoms are increased interest in sex and increased alcohol intake. Or simply the SSRI sustains one in an elevated mood where one feels like drinking and isn’t ruminating on one’s problems
R
Thanks for the comment. I agree totally about Command Obsessions (Intrusive Thoughts). And that there is a real risk that these will be seen as OCD. This is not OCD but it is easy to see how some clinicians particularly might think it is – and double the dose of treatment
I think the persistent commands is not a wearing down effect. Almost by definition when they first start we don’t have the capacity to manage them Over time we develop a capacity – they may still happen but we know they are not us. But before that happens, things may go badly wrong.
I don’t think there is an increased appetite for alcohol. People do develop Alcohol Us Disorder but most of these cases don’t report an increased appetite per se – the problem is gone once the SSRI stops – except when it isn’t. There may be a group in whom an appetite is established that doesn’t go away on stopping treatment.
I don’t see an increased appetite for sex. I see Persistent Genital Arousal Disorder but this is not an increased appetite. And there are people who are numbed and engage in high risk sex etc in order to try and feel something.
I think it would be a mistake to call any of this mania, or hypomanic. Stopping the provoking agent is the best idea
D
Stopping the ‘Provoking agent’ doesn’t lead to a cessation of the intrusive thoughts which can persist for years. I’m curious to know how this can be treated as mainstream clinicians treat this as OCD with ERP and a recommended return to the SSRI.
In some cases stopping the drug does clear the intrusive thought or command hallucination – in other cases it doesn’t. In the cases that persist – See Drug Induced Loss of Capacity on RxISK – in one case a Hearing Voices left voices there but made a difference, in another case the intrusions coincided with PSSD and as a treatment for it helped the intrusions also eased.
D
‘See Drug Induced Loss of Capacity on RxISK – in one case a Hearing Voices left voices there but made a difference…..’
When Shane first started attending the Hearing Voices group I was lucky enough to be invited to join one of their sessions ( with a view to run our withdrawal group along similar lines in fact). Whereas I had suspected that taking the “patient” away from the voices by steering a conversation in other directions was acceptable I was amazed at how wrong I was. Here, the facilitators spoke of the actual person AND of the voices as if they were two separate individuals. When the patient described what the voices were saying in an obvious negative way which scared them, the facilitator would share ways in which the same voice message could be seen positively. The whole atmosphere was so calming and accepting. I found it really therapeutic.
Prior to attending this group, how had Shane been treated when mentioning his voices and their commands? In the case of the Community Mental Health Team, especially the psychiatrist, by an absolute state of panic and a rush to find a bed at the psychiatric unit. – all of which increased rather than subsided the fear.
Yes, Shane’s voices are still present 24/7 but he now understands their presence.
My brother was diagnosed with Schizophrenia at around 30 or 31 years old. He, at first, refused any treatment or medication. Eventually my aunt helped him and got him on Medicaid, SSI and medication with a doctor. So, he took one medication for 10 years (an antipsychotic – I won’t mention the name here). Eventually, he experienced Homicidal Ideations on it. It was so horrible he locked himself in his room and chained himself to his bad with handcuffs. It was terrifying to him and horrible. He is a sweet man with no intention to hurt even a bug. So, it was horrible. It did occur.
So, the new antipsychotic he took for 7 years and again, 7 years later Homicidal ideations again. He’d never had that before he took the medications. He’s now59 I believe. The doctor said what he needed was an INCREASE in dosage of the last meds. He asked me to go with him to stop the doctor from wanting him to take that high of a dose. Indeed, AI told me that what the doctor did was wrong. If someone is experiencing Homicidal Ideations, you don’t increase the dose, you stop it. So, this doctor – my other brother and I went with him – and we got him to stop wanting to give him any higher of a dose. The doctor basically told us not to come back if we didn’t want any more medicine. So we made no more appointments.
Also, the older you get, the more dangerous these medicines are. They’ve got BLACK BOX labels for a reason. So, he felt better WITHOUT the medicine because it’s better not to experience homicidal ideations. It was horrible to watch him hide in his room. He is now WITHOUT any medications for the past 2 years. He IS better without it because – well, no homicidal ideations. The voices are still no good and he has left over side effects that are not good, but no more homicidal ideations. I just wish I could help him stop the voices. He is still not happy with them and would rather not have to live life with them. Who would blame him, right? I love my big brother. I wish I could fix him.
Thanks. Oh, he doesn’t drink alcohol, he never did drugs (he did try MJ like last year after stopping all of the meds in hope to try to stop the voices, but he eventually stopped that experiment). You try anything when you’re sick. We tried Ketones – the drink. That helpd for a few days but then didn’t. So, you know. Thanks.
Thanks for this. Reactions like this are not uncommon and too often interpreted as psychosis with more drugs given that make the problem worse.
Chances are he might have done well on much lower doses of the first drug from the start and maybe even stopping it when well and only taking it when stressed.
Either way, these drugs are not anti-voice drugs. Not even anti-psychotic. They can reduced tension and preoccupation and often are only needed for a period while the person adapts to a stress.
In terms of voices – there is a post on RxISK – Gripped and Discarded by GSK in March 2021 that outlines a case like your brothers who had malignant drug induced voices that no antipsychotics helped. This man was helped by a Hearing Voices group. A lot of us hear voices. Finding others who do too can help a lot. This man has now no mental illness labels and is going from strength to strength decades later
D
“This man was helped by a Hearing Voices group” – I would add that his life was TRANSFORMED by the Hearing Voices group. To Rocky, I would say that I have no idea of the HV Network Groups’ success rate in general but I would fully recommend trying to locate one close to you .I do believe that they actually hold meetings by zoom now too. Here is a link to their website – https://www.hearing-voices.org/#content
“help jurors understand how the ability to tell right from wrong or the ability to conform out behavior may be lost.”
Please, watch this video where the craziness of the legal American system is explained.
https://youtu.be/-pf4DfLyjQc?is=j2wnzgmmRywmCkBy
Unfortunately Keal L. Shah believes Lindsay Clancy is bipolar.
But the part of the American legal system is good.
This is a comment from a colleague – Jack Noble
Finally (maybe), the Lindsay Clancy case has ended in a mistrial, leaving the door open for the prosecution to pursue a new trial.
There is much to be learned from the proceedings. The majority of the jurors embraced the theory that Ms. Clancy was not criminally responsible for strangling her 3 children because she was suffering delayed postpartum psychosis.
I was intrigued by the behavior of the TV media—most notably CNN news. By dragging out every actual and speculative angle, they made millions each news break from advertisers pitching their product—many, if not most, by pharmaceutical companies asking potential consumers to „ask your doctor“ about trying their product.
Clearly you have command of the literature and have debunked the notion of postpartum psychosis as something that exists per se. If I follow your argument correctly, it comes about as the result of receiving other psychotropic drugs—something that neither the prosecution nor the defense made mention in their arguments. Instead they perseverated in arguing for or against postpartum psychosis per se.
My take away IF Ms. Clancy is retried is that the prosecution should bring you in as their expert witness. But I don‘t think the politics and overarching pubic support of Ms. Clancy will allow it. Selected jurors are selected with few exceptions because they laymen. The voir dire process is designed to weed out folks with expertise that would allow them too much influence in determining the verdict of the jurors.
As one who has erroneously subscribed to the notion of postpartum psychosis, I am a member of the unwashed laity who will oppose retrying Ms. Clancy. She is s a pitiful victim of whatever demons possessed her—ever mindful or reminded by others of what she did to her three children. Her life in a wheel chair with spinal cord injuries will almost inevitably be abbreviated—usually due to respiratory complications and cardiovascular disease.
I think the one thing we can take away from this case is that a lot of people in America are going to be wondering what the hell did happen and regardless of the view they form, I think a lot of people in America are going to be having a little doubt niggling at them about some of these drugs.
I hope it’s happening in a wider world, Peter, and not just in America. Only this morning I found that speaking to a couple of ‘doubters’ I found that they were well aware of the LC case and both threw a light on the prescribed drugs (knowing no doubt that that is where my thoughts would lie!). I feel it’s time to “strike while the iron is hot” – to bring this topic up in as many conversations as we can, with an open mind but making sure that the prescribed drugs issue is always uppermost in our minds. The trial made it to our UK TV screens recently so many will have seen it and been troubled by the death of 3 children. It is, I feel, up to us to ensure that the prescription details are also shared.
A little more thinking got me questioning the assumption that planning was involved. We’re essentially accepting the prosecution’s account, along with the rather shaky inference that mobile phone data can tell us whether someone was going up and down a flight of basement stairs. The defence’s narrative is that the attack occurred suddenly, virtually upon hanging up the call. If that timeline is right, it brings the possibility of a paroxysmal attack back into the realm of possibility. Lindsay’s planning around the meal and the trip to and from the pharmacy seems entirely consistent with her premorbid personality.
Let’s say we accept the defence’s timeline. The call from Patrick irritates Lindsay, she becomes furious, the attack unfolds, and she is subsequently found dazed and confused at the bottom of the window. It sounds pretty wild, but it is much more consistent with my own experiences.
Is there any point speculating about being irritated by a phone call from Patrick. That’s very Deus ex Machina. We need someone to sit down and listen to Lindsay.
It doesn’t need an irritating phone call to have a sudden onset attack. Shane Cooke who features in a lot of the comments here and in many posts here and on RxISK had rage attacks that came on in waves. Relatively calm and even optimistic at one point and soon after getting antsy – all without a phone call. But he had intermittent command hallucinations.
D
I would like to add, regarding Shane’s rage attacks, that I have often described them, as an onlooker, as being like watching a person going into an epileptic fit – seemingly aware of what was coming but having no control whatsoever of his actions and definitely no means of stopping it. He would urge us to get help to keep us safe, keep the dog out of his way and then he would totally lose control. The strength in him during those attacks was incredible and came with an urge to destroy anything that happened to be near him.. Once the wave cleared, he would be unnaturally calm and passive. It was as if the one person was splitting into two totally different people within a few minutes. It was horrific to watch – I just cannot imagine what it must have been like to be in his shoes. Although these cleared once the Seroxat was taken away, it took a long time for Shane to accept that those intense urges had disappeared with the offending drug.
Mary
This is a compelling description of what happens. Anyone reading it might wonder about Shane normally – I need to add that he is among the most mild mannered of people normally. Someone who believes in getting on with life and helping others rather than bemoaning his past. He is like Katinka Newman who has used what happened her in every way she can to alert people to what can happen on these meds.
The Boston group who first described the Prozac induced problems and initially said akathisia was the cause – soon after developed a number of other explanations one of which was epileptiform outbursts. This does not mean epilepsy but it does seem to described something like what happened Shane
David
Yes, and the way I wrote it, it almost sounds like *Gaslight* or *Rebecca*!
It wasn’t what I had in mind, though. By “irritating” I meant something more benign, like an irritant or stimulus.
But there are better reasons to think my suggestion is silly.
I suppose it’s partly that the tail end, the knife and then barrelling headfirst through the window, those last acts do look a bit similar to some of the steroid psychosis cases, but it makes little sense with everything that comes before.
I think in some respects Lindsay would be one of the most interesting cases to talk to, partly because some of what we usually associate with these kinds of problems seems to be missing and also because what remains seems to be the gravest parts.
Can I help..
Some people are not very good at killing themselves and some people are. In the grip of a toxic drug state we have seen hangings, jumping in front of moving trains, and the use of guns.
We have discussed before how very rapidly this can happen. One minute you are seemingly functioning, the next minute an overpowering urge unleashes itself.
In the grip of a toxic drug state it seems that the person although seemingly not knowing what they are doing, does know what they are doing, as they grasp at what seems available to them at the time. Is there a handy train, a handy rope or a handy gun. Not in a planned sense, in an intoxicated sense.
It will seem implausible to most. That presence of mind, finding something, anything, when the end of life absolutely has to come. I was terrible at it, rushing around like a headless chicken. I didn’t know how to gas myself, or how to cut my wrists, or use a car exhaust, when I tried. I was standing on a chair with a rope chafing my neck. Relentless bodily actions stopped me from doing that and I ran from the garage to the kitchen and grabbed the box of pills. A racing mind, a racing body, a racing toxicity.
If this was the scenario that happened to me, then I can quite see how Lindsay grabbed a knife to cut her neck and wrists and as fast as that thought occurred to her, like me, she needed something else in this jumble of speed, and at all costs, and the handy window beckoned.
I don’t think people realise the speed at which this all happens. There is nothing there to stop it and this is the terrible thing about suicide, homicide and violence that happens in these drug-induced toxic states.
I have the battle scars to compare. There is no one size fits all.
Annie
This is very helpful for me anyway. It fits with what Mary describes of Shane’s attacks. And what Kim Witczak describes about Woody. He could seem fine and then an attack came over him and the thoughts in his head were unbearable. During these attacks he seems to have clearly thought about killing Kim
So a prosecutor could say to a witness on the stand – well you’re saying these attacks come on but I and the jury want to know whether they eliminate the ability to choose for instance between killing yourself or killing Kim. I have often thought faced with horrific thoughts about killing Kim that Woody decided he’d better kill himself first in order to avoid doing worse than killing himself. But what you and perhaps Peter’s and Mary’s comments opens up is that perhaps when an attack comes on you ending up killing whoever is around to be killed. With Brian Short and Don Schell it was the entire family.
David Hawkins and David Rule killed their wives and figured on killing themselves but when the attack worse off they turned themselves in.
David
Annie – what a fantastic comment and so, so true. The speed – of thoughts and actions is quite remarkable at that point isn’t it.
David –
I’m learning so much about Shane’s case from your present posts. Your latest comment sent me Googling and found this which I guess explains the reasons for a number of EEG appointments for Shane around that time :-
‘Yes
Yes, certain medications can cause epileptiform outbursts as a side effect. These outbursts are characterized by abnormal electrical discharges in the brain and can occur in patients with epilepsy or those who are susceptible to seizures due to other medical conditions.
Medications that may lead to these outbursts include antipsychotics, antiemetics, and SSRIs. It is important to note that not all medications will cause these outbursts, and the occurrence can vary based on the individual patient and the specific medication used.
If you suspect that a medication is causing an epileptiform outburst, it is crucial to consult with a healthcare professional for proper diagnosis and management’.
Thanks so much for all your comments. I wish Lindsay Clancy was as fortunate as we have been in getting your expert knowledge – both for her own wellbeing and to be shared with her legal team.
Mary
It looks like awareness of these outbursts go back to 1993 when Martin Teicher and colleagues reported a possible link to epilepsy. And in this case you have always insisted Shane’s outbursts seem almost epileptic to you – with something like an aura before them – he knew they were coming on. He switched from being fine to becoming aware that something was coming on that was going to put both you and him at risk.
Epileptiform does not actually mean epileptic. It’s not a case of adding an anticonvulsant – it’s a case of stopping the drug. I imagine that in most cases, off drug the person will not look epileptic on an EEG and the person may be told something like they have a low seizure threshold but that they can for instance drive a car because technically they are not epileptic.
These are things you’d imagine that after 30 years and so many people being put on these meds that we’d have worked out what is going on but there is so much discouragement to even thinking about asking Shane and others the questions that would help us understand and perhaps prevent things going wrong – that we know little more than we knew 30 years ago.
One thing I’m left wondering about is this. In the cases of mothers killing children, there is a lot of talk about altruistic filicide (killing a family). No one says this about men like Don Schell or Brian Short. But the cases of mothers linked to the meds don’t look any more altruistic than an epileptic fit looks. It looks far more like they are doing something ego-alien.
D
It’s only ever women who are seen as altruistic killers. Its a neat explanation but also a plausible confabulation and a seductive one.
What is a bit like the old epileptic insanity, yet not automatic, but also not fully alert? Not self-possessed but possessed by something that cannot quite be put into words? Like a trance.
It’s a bit like that old RKO movie, “I Walked With a Zombie”. And yet these Zombies can use Apple maps.. Or can they, in actuality, in the 35 minutes during which we are unable to assess their volition?
It might be neurobabble but in my ignorance I would describe my own experiences as a “limbic” trance in which the limbic system perhaps guided “from below” appears to guide behaviour. But that is just an overcooked way of describing precisely the sort of emotionally driven behaviour that usually gets someone convicted rather than acquitted
The neurobabble is confabulatory but will be seductive to some. But if you are going to persuade jurors – told by a judge not to be swayed by expert babble – and if at least one hard headed juror sticks to that line you’re in trouble.
Besides you don’t want to open – or shouldn’t want to open – or aren’t going to be let open a door to emotionally driven behavior. I was angry your honor, sorry.
D
That lone juror wrecked the case for KR despite KR’s case being on extremely shaky ground with ‘postpartum depression’. Most of the Experts were talking twaddle. Lindsay was put through several hours of interviews with Experts, whose qualifications were doubtful. She even had two at one time. None of them actually drew out from Lindsay the effects the drugs had on her. She was faced with Experts who buffed up situational circumstances which had nothing to do with the person who is Lindsay.
The whole thing seems like a medical set-up. All these Experts bandying around their medical prowess and buffing up some sort of medical competition as to who is the most Expert.
Someone needs to sit down with Lindsay and draw out from her the effects the drugs had on her. Without this, we reach an impasse. Nobody knows the effects of the drugs like the person who is taking them. This is what has turned this trial in to a circus.
Thank you Annie.
Your last two paragraphs perfectly document what causes me so much anguish and distress with the television coverage of this alleged ‘expertise’.
Surely a highly specialist, respected and widely published EXPERT in ADVERSE PSYCHOTROPIC DRUG REACTIONS is needed in order to facilitate a comprehensive understanding of the most important issues in this heart breaking situation?
Yesterday on X, an apparent breakthrough in suicide (but not homicide) prediction was heralded from Harvard. The paper itself is due to appear in the October issue of the Journal of Psychopathology and Clinical Science.
https://current.fas.harvard.edu/stories/harvard-study-predicts-most-suicide-attempts-week-advance
The suicide stats quoted are shocking – if less surprising to some of us.
‘Suicide is the second-leading cause of death for Americans aged 10 to 34, trailing only accidents. It claims more lives around the world each year than war, genocide, homicide, and all other violence combined’
50% of those who take their own lives had seen a doctor in the last month.
Prof Matthew K. Nock’s (yes, that’s his name) Lab, had developed quite a complex survey app that monitored a whole raft of affective states. 20 questions, sliders 1-10 etc. Research participants were recruited from two groups: adults who had received emergency room-based psychiatric treatment, and young people aged 12 to 19 treated at an inpatient clinic for suicidal thoughts or behaviour. They were tasked with completing the surveys on the app when they were first released from the hospital/clinic – 6 optional surveys a day for the first 2 months, one a day for the next three.
And guess what they found out?
‘Among the affective states, AGITATION was a far greater indicator of suicide risk than depression, with an 11 percent increase in the likelihood of a suicide attempt for every additional point of agitation a person indicated on the sliding scale. That’s consistent with other recent research from Nock’s lab, which found that 90 percent of people who survived a suicide attempt reported that they had been feeling an urge to alleviate psychological agitation and pain that turned out to be temporal — like “being in a burning room” or wanting to “shut everything off for a couple of days,” Nock said.’
I’m not denying that any progress in the understanding and prevention of suicide is a good thing. And likely some sort of personal app based emergency button could save some human beings (we’ve talked about this). But – I thought, really? Isn’t this rather like discovering that in order to walk, people first need to stand up? And – hang on a minute – why has nobody even mentioned the whacking great pachyderm in the room – all these research subjects had just been given psychiatric ‘treatment’ – which means drugs. Why is this – as in the UK Suicide Prevention Framework- not even given a nod of recognition? Let’s wait and see what other details the paper reveals,
Don’t we already understand more about the meaning of drug-induced ‘agitation’ from listening to Anne-Marie (‘over-powering compulsion’, ‘mental tunnel vision) and Chris – Mary and Shane (‘rage like an epileptic fit’ – your ‘epileptiform’ – that’s really interesting) ,Annie (‘a racing mind, a racing body, a racing toxicity’) ,Richard (‘command obsessions’), Katinka’s perfectly lucid interview, ‘I could have been Lindsay’ https://whyy.org/episodes/i-could-have-been-lindsay-one-womans-take-on-the-clancy-murder-trial And so many more survivor stories. Aren’t these Bill’s ‘frenzies’?
What this raises once again – is the system’s obsession with developing mechanistic methods for understanding human beings in extreme states of distress. And, as far as I can see, the danger is putting a conceptual and emotional distance – like a glass wall – between the doctor and the human being at risk. How much of this is paternalism, how much covering the medical bottom?
The fascinating and critical element in all this – the direction you are working through right now –is we can describe the reactions – suicidal or homicidal – but how can you explain them scientifically and convincingly for a jury?
‘I don’t have a slide for the voice of God – to represent the fact that drugs can cause you to hear a voice or become delusional and lead to violence this way. This is strictly speaking delirium rather than psychosis.’
This might put the willies up the Jurors and Judge Sullivan has decided against ‘religion’.
Drug induced frenzy or delirium – The original insanity defence
Courts have struggled ever since with the issue of when to excuse people who are deluded. This is a different issue to excusing people who are delirious.
There is one final barrier to the recognition of violence on psychotropic drugs – the families of the injured and bereaved have to in some cases be prepared to let the apparent perpetrator walk free.
https://davidhealy.org/prescription-only-homicide-and-violence/
Prescription-only Homicide and Violence
February 18, 2013 10 Comments
The jurors spilling the beans did reveal one thing: they were fixated on the toxicology report. It was the salient evidence. Maybe, to persuade a jury, all you really need to do is show that the drug caused it after all. It may be that, as humans, we have a particular sensitivity to the injustice of being “drugged” or “doped” against your knowledge: Sir Matthew Hale included a crime committed due to “the unskilfulness of his physician” in one of the earliest attempts to formulate an insanity defence, predating M’Naghten.