(For everyone but you, Deborah, because you seem like a nice enough lady, but we're just never going to agree on anything remotely related to modern psychiatry.)
This tragedy was caused by:
Malpractice by the pshrink, or negligence bythe patient *before* she became manic, or negligence by the spouse.
Anyone taking any antidepressant should be warned of what the symptoms of mania are and should be told to call their doctor *immediately* if they notice any.
This woman had *multiple* nights of sleeping through the day and cleaning the house in manic bursts at night?
*ONE* manic night should have triggered immediate action by her pshrink to do absolutely whatever was necessary control the mania, to assess her for immediate risks to self and others, etc.
It also should have triggered her shrink evaluating her for bipolar disorder.
Either the doctor didn't address the potential side effects with the patient and ensure she had someone watching her who knew what to watch for and who to call in case of problems, or the patient didn't take the information at the beginning to her spouse, or the spouse ignored it, or the doctor did not respond correctly when told the patient was having side effects.
Chainsaws can be incredibly useful for doing things like removing fallen trees safely from downed power lines--by qualified personnel only, of course.
If you cut off your leg with a chainsaw, the problem is not that chainsaws are bad and evil, the problem is that you or someone else didn't follow the appropriate safety rules for using a chainsaw (which include knowing what you're doing before using one at all).
Psychiatric drugs are not bad and evil.
When the safety rules for using them are followed, they are powerful, useful, necessary, and safe.
When the safety rules for using them are not followed, they're every bit as dangerous as a chainsaw in the hands of a 25 year old man with the mind of a six year old.
The problem is not that the drug is bad, any more than the problem in chainsaw accidents is that chainsaws are bad.
The problem is that the *sane* people did not follow the appropriate safety rules for handling a powerful, necessary, but potentially very dangerous tool.
The doctor *should* have provided the patient with a handout on the warning signs for all of the serious possible side effects, including mania. The doctor should have carefully explained everything on the handout and made sure the patient knew when to call the doctor immediately and when to call 911. The doctor should have required the patient to provide the handout to a friend or responsible third party--usually but not necessarily the spouse--with the offer to have his nurse explain anything on the sheet that the friend didn't understand. The doctor should have followed up with the patient to ensure this had been done and gotten a signed acknowledgement of informed consent for the patient's files.
When you go in for surgery and they drug you so you mustn't drive for a certain length of time, they *make* you bring a friend to drive you home. If you're going to take psychiatric medications, they should make you have a friend to keep an eye on you *at least* whenever you're making a major change.
Most pshrinks that I've encountered *do* carefully explain possible side effects, but they aren't as careful as I've recommended above at *documenting* that they have done so. I think they should document it. That's a procedural change I'd like to see made.
If this woman had had her dose(s) lowered, and specific problem drugs (problems *for her personally*) removed, and had had a mood stabilizer added if necessary to bring the mania under control, the violence would have never happened.
Just like if you learn what you're doing first and follow the safety rules for using a chainsaw properly you're going to cut off the log, not your leg.
Does malpractice happen? Yes, it sometimes does.
Does criminal negligence happen even when malpractice does not? Yes, it sometimes does.
So do serious chainsaw accidents, or other serious or fatal accidents among people operating power tools or heavy equipment.
Psychiatric drugs are powerful, dangerous, necessary tools.
Someone not careful and conscientious enough to be a heart surgeon or a brain surgeon shouldn't be a psychiatrist, either. Practice of any branch of medicine is one of the most serious responsibilities there is.
We have procedures to screen out poor candidates before they become doctors. We have medical licensing boards to yank the licenses of bad doctors who slip through the cracks.
We have criminal negligence laws for when people are told how to handle something dangerous and they don't pay attention.
The doctor should have explained about mania and psychosis risks. Her husband had noticed what he should have known was mania. He should have reported it to the doctor. The doctor should have immediately acted to control the mania or hospitalized the woman until they could get it controlled.
Somebody along that whole chain of events failed in a major responsibility. The first person in that chain of failure needs to go to jail for it.
If it was the pshrink's fault, his license needs to be yanked.
If the woman told the pshrink, when she was in a responsible state of mind, that she had told her husband what to watch for and she lied, then it wasn't "involuntary"---it was negligent, and she's responsible for it.
If I was the pshrink, I would have insisted on the husband knowing since they were both in the house with kids and he was the other custodial parent.
If the husband had been told and just blew it off, he was criminally negligent.
Somebody belongs in jail, and the pshrink *probably*, looking at the whole chain of events, was negligent and needs to lose his license. But it's not the drug company, or the drug, or the drug rep that belongs in jail.
This comes down to the pshrink, the woman, and her husband. One or all of them didn't do something vital that they absolutely had a responsibility to do and people died from the negligence.
It's nice and comfortable to blame the drug and say, "Oh, it's nobody's fault, it was just that big bad old evil nasty mean chemical."
The problem is, it's letting someone off the hoook whose *personal* criminal negligence caused deaths.
I don't know if it's the woman, the husband, or the doctor who's the guilty party here, or some combination of the three, but I know *at least* one of them is.
We don't like to call other people stupid, or socially obnoxious, or ignorant, or criminally negligent. It's embarrassing. It's "not nice."
It's "rude."
And it's a lot less socially unpleasant to blame an inanimate object or a big corporation when someone does something bad or a horrible accident happens.
Even when you have three people where at least one of them was clearly horribly criminally negligent and whose horrible criminal negligence *is* what caused the bad thing to happen.
"Nice" and "polite"---but wrong.
It's a terrible thing that the woman did.
A terrible thing that was the direct, personal, criminal fault of the doctor, the woman, and/or her husband.
Bad ol' me for saying so, but hell yes it was that person(s)' personal fault and not the fault of an inanimate chemical, or the company that makes and sells it, or the FDA.
Individuals personally close to the events failed to follow vital safety rules and people died.
Some people hate corporations so much they like to blame them for anything they can. Some people hate "chemicals" or things that are "unnatural" so much they like to blame them for anything they can. Some people just think it's "mean" or "rude" to blame anyone who's "suffered a loss" for things they screwed up that caused it to happen.
I guess people can have a lot of motivations to let someone off the hook for something they did.
But, hey, look, the emperor over there ain't got no clothes on!
It was their fault.
Timoclea
The mystery of the beginning of all things is insoluble by us, and I for one must be content to remain an agnostic.
--Charles Robert Darwin, English naturalist