This post continues the Spotlight on the Suicides series.
There were 8 named people in Stephen O’Neill’s medical record, or who made entries in the record between the time of first admission and his death. He appears to have told most of them that in his view the sertraline he had been put on and took two doses of had had a disastrous effect on him. There were likely up to 20 others or more whom he had contact with and probably said much the same thing to.
No-one heeded him. There was an obvious course of action had they listened – stop all meds, agree with his diagnosis and tell him this would settle. It would have settled, perhaps facilitated by diazepam or the lorazepam he was briefly given, but even without this it would have settled.
The pharmacist who filled his original prescription was the first person he turned to when things began to go wrong – before going to hospital. She was the only person who appears to have listened.
At various points over the following 6 weeks Stephen told visiting secondary care staff and others in the day hospital or outpatient settings that he was thinking of suicide following changes in his drugs. This led to the addition of further drugs and finally Buspirone.
Buspirone is a failed predecessor of the SSRIs and is closely related to them. One of the surprises in Stephen’s case was that anyone thought to give it to him – it is rarely prescribed now. Anyone who had reacted with agitation and suicidality to an SSRI was on the face of it more likely to react in a similar way to buspirone than to the mirtazapine or quetiapine he was also tried on. A few days after being put on buspirone Stephen was dead.
When they came to review what had happened the secondary care services patted themselves on the back. Every thing they had prescribed was, they said, recommended by NICE Guidelines. Everyone who had been supposed to liaise with anyone else had all liaised with all the people they should have liaised with. All boxes had been ticked. The service had done a wonderful job. No one seems to have passed on the message they were given by Stephen.
In the 1980s, a concern about abusive clergy emerged in Ireland. It led to the fall of the Irish Government and triggered a crisis that engulfed the Catholic Church worldwide.
Decades later Hollywood in the movie Spotlight twisted the events out of shape – clerical abuse had been discovered by brave journalists in Boston who had gone where no-one else dared go. The truth was the United States was very late in facing up to what was happening, and has been behind the curve ever since. Ireland, who might have been thought to be the least likely to face up to the issue, had grappled with it long before Boston.
The crisis came to a head during a visit by Jose Mario Bergoglio to Chile in 2018. Facing anger about the Church’s failure to confront child abuse, Bergoglio responded – if you have faith you believe in us [the clergy] but for us to believe in you [the abused] we need proof. The powerful are innocent until proven guilty. The powerless have anecdotes but not evidence.
If you have faith you believe in doctors but for us to believe in your claim a drug has wrecked you we need proof.
Unlike the participants in Stephen O’Neill’s inquest, and thousands of other inquests that have unfolded the same way, Bergoglio appears to some extent to have recognised how his response has added to the original damage.
In the case of the Church, the tacit understanding seems to be that the authorities figured their personnel, the clergy, were bound by canon law rather than civil law. Loosely, if the person responsible confessed their sins, God would forgive them and cure them. It was not the place of the authorities to punish them. Even when the trespassing continued, who gave a bishop, archbishop, cardinal or even pope the right to take the place of God and condemn the trespasser.
For physicians today, Guidelines operate the same way. They transcend common sense. If you have adhered to them, you can do no wrong, or no earthly authority is going to find you at fault – “there but for the grace of God go I” as was once commonly said.
Unlike his people beforehand and his church since, God finally figured Guidelines were not the right approach. But the right approach, as became clear, was likely to be painful. This perception that grappling with the issues might be painful underpins the appeal commandments and guidelines have for good and decent people – and why the greatest problem for Christianity has always been good and decent people.
At the inquest, to give them their due, the secondary services appear to have accepted that some of the medicines Stephen was put on could cause akathisia – agitation.
I can’t be certain how this was put because apparently I am not a person entitled to a transcript of the inquest. The coroners conclusion suggests that what he picked up is that there was an acceptance the drug might have caused a relatively minor problem – a dissociative problem – which fed into the longstanding mental difficulties Stephen had from bullying at school (which was minor and of no obvious consequence), through loss of a parent, onwards – the memories of which triggered by agitation linked to the drug caused him to commit suicide.
Now we know why healthy volunteers commit suicide on these drugs. Even healthy volunteers who didn’t know they’d ever been bullied and both of whose parents are still alive. There’s always going to be something a drug can activate – which is the true cause of the suicide.
What’s a coroner to do when caught between warring factions?
One side saying we have kept to all the commandments. This man clearly had an enduring mental illness. And the folk on that side are all pillars of the Establishment.
On the other side, the main offering being the word of a man who is now dead.
Sticking with the Establishment also meant not having to get involved in someone else’s politics. How can he be expected to understand ghost-writing, zero access to trial data – it sounds unbelievable that physicians and their professional bodies would let something like this happen. Better let the Judaeans sort this out for themselves.
What would you do?
Next week Spotlight on the Politicians