A Prescription for Murder, or Sensationalist Anti-Mental Health Propaganda?

James Holmes, BBC Panorama 'A Prescription for Muder'

Trigger Warning: This article contains talk of mental illness, medication, violence, and guns.

Earlier this week, the BBC announced a new Panorama documentary titled ‘A Prescription for Murder?’. In it, they aim to explore the possibility that selective serotonin reuptake inhibitor (SSRI) medication commonly prescribed for anxiety and depression could be linked to psychosis, violence and possibly murder. They ask if “doctors are unwittingly prescribing what could be a prescription for murder.”

Straight away, this raised red flags with people who experience mental health issues and, as a result, take prescribed medication to control it. The language used to promote the show echoes many of the prejudices an already vulnerable community experience, and makes an extremist and sensationalist claim to draw people to the programme.  Many believed that it would be incredibly off-putting for those seeking mental health care, and who may be prescribed medication to help ease their suffering.

But this could have just been a case of poorly planned promotion–perhaps the documentary itself would be much more balanced, and much more mindful of the impact such claims about SSRIs could have on those suffering from mental illness. Last night, I sat down to watch the programme to find out.

“Holmes was taken alive, giving us a ‘unique opportunity to ask why.'”

The bulk of the documentary focusses on the case of James Holmes, a twenty-four-year-old man from Aurora, Colorado, responsible for the mass killings at the 2012 midnight premiere of a Batman film. Because Holmes was taken alive, the BBC states that this gives us a “unique opportunity to ask why”.

We are taken through a harrowing report of the Aurora shooting by George Brauchler, District Attorney, Colorado 18th Judicial District , and survivors of the attack. We are walked through Holmes’ actions as he enters the movie theatre, deploys a smoke bomb, and proceeds to shoot 12 people dead, and injure 70 more. Brauchler says of the case: “I knew when I heard that the shooter had been taken alive behind the theatre, I knew this would very likely turn into a trial, and that this trial would very likely turn on the issue of mental health.”

A Prescription for Murder: James Holmes is sentenced in court.

A Prescription for Murder: James Holmes is sentenced in court.

The case took three years to come to trial, where Holmes plead innocent by reason of insanity. The jury rejected his plea and found him guilty on all counts, handing down one of the longest sentences in US history. Holmes narrowly escaped the death penalty. As he was escorted from the courtroom, witnesses cheered.

“The main focus is squarely on Holmes, one out of an estimated 54 million Americans who are prescribed anti-depressants.”

The documentary bases a great deal of its ‘evidence’ on the case of James Holmes. While they do interview one other perpetrator of violence crime–David Carmichael of Toronto, Canada, who strangled his son to death in a hotel room shortly after beginning a course of SSRIs–the main focus is squarely on Holmes, one out of an estimated 54 million Americans who are prescribed anti-depressants (one-in-six out of 325 million).

The cross section of people they interview, including Holmes, his parents and friends, another perpetrator of violence and the families of others, are all white Americans. Somehow it wasn’t surprising that the rhetoric of ‘he was a good kid’ and ‘this was so out of character’ ran throughout this programme, accompanied by accounts of his ‘friendly banter’ with classmates and adorkable nervousness at speaking in public. It’s important to note that no people of colour were investigated to see if the medication they were taking had an impact on committed acts of violence–similarly, no people of colour were interviewed as experts to gain their take on the situation.

Another thing the BBC does not do is quote any statistics on the number of people on SSRIs versus the number cases where violence has been linked to the drugs (they go so far as to say that “millions of us” are taking anti-depressants, but doesn’t quote any estimated total figures). No mention of the millions of people worldwide that rely on this medication to keep them stable, to ease the strain of anxiety or depression, and in many cases, to keep them alive.

“Not only is the correlation between the drug and the violence flimsy to begin with, there is also the possibility that he wasn’t even under the influence of the medication at the time.”

It’s interesting to note that Holmes was not in fact taking his SSRI medication when the shooting occurred–his last filled prescription would have taken him up to three weeks before the attack occurred. Experts speculate that the drugs could still have been in Homes’ system for up to six or seven weeks, however others say it’s very possible he was no longer under the influence at the time of the attack. So not only is the correlation between the drug and the violence flimsy to begin with, there is also the possibility that he wasn’t even under the influence of the medication at the time.

A Prescription for Murder: The BBC equates correlation with causation.

A Prescription for Murder: The BBC equates correlation with causation.

The interviewed psychiatrists also talk about how Holmes was not having these violent urges before taking the medication–which contradicts evidence given by Holmes’ psychiatrist, who says he revealed to her that he often had “intrusive thoughts of killing people”. Whilst the experts go on to discuss that these fantasies are common coping mechanisms for people with intense social anxiety, it still indicates a predisposition to violent actions before the medication was prescribed. A predisposition that was left to manifest itself in the violent and fatal way that it did.

“Is this a man who was driven to murder by the effects of anti-depressants, or who has been criminally failed by the mental health support he was given?”

When asked directly if the SSRI medication he had been taking had caused the shooting, Holmes says, “It’s a possibility”, and that he “regrets that she [his therapist] didn’t lock him up, so this could have been avoided”. Is this a man who was driven to murder by the effects of anti-depressants? Or a man who has been criminally failed by the mental health support he was given, and the systems in place to prevent this kind of psychotic violence?

This documentary could have just as easily (and more responsibly) been on the availability of weapons to mentally unstable people in America, and could have used the exact same case study of James Holmes. Despite having disclosed his intrusive, violent thoughts of killing to his therapist, Holmes was still able to walk into a shop and buy a 40-calibre hand gun, later going on to purchase a shotgun and a rifle. His therapist even had a security and gun permit carried out on him, and found “insufficient grounds” to lock him up for his own and others’ safety. An investigation into the gun laws that fail an estimated 33,880 people a year who die from gun violence would have been much more appropriate. It’s very telling that no UK residents are interviewed or featured in this documentary, where gun laws are much more restrictive.

A Prescription for Murder: James Holmes' diary, indicating violent and murderous thoughts.

A Prescription for Murder: James Holmes’ diary, indicating violent and murderous thoughts.

The programme ends with the inconclusive statement, “We will never know what caused James Holmes to commit these murders.” After setting up the whole programme to make a link between anti-depression medication and violence, this conclusion is significantly poor.

“The BBC never offers any real reason why a link can be made between anti-depressants and murder.”

The BBC, and the experts in psychiatry they interview, offer no factual evidence to support the theory that SSRIs had anything to do with the violence perpetrated by Holmes and his like. It is mere speculation and theory, but coming from the mouths of those with ‘Psychology Expert’ stamped under their face, this can so easily be taken at face value. It is so important to remember that correlation does not equal causation, and that drawing out a timeline on a whiteboard does not constitute concrete evidence that medication causes people to commit violent crimes.

The documentary as a whole focuses much more on the individual events in the case of James Holmes, and a lot less on the scientific connection between SSRIs and violence. Conflicting opinions from experts simply muddy the water on this issue, and distracts from the fact that the BBC never offers any real reason why a link can be made between anti-depressants and murder. One interviewee seemingly concludes that, if they knew someone who was prescribed an SSRI medication, they would “ask the doctor to pay close attention to the patient”–but surely this should be the case anyway?

A scrolling banner across the bottom of the screen at one point advises the audience not to change their medication without first consulting their doctor. But after an hour of pushing the at best inconclusive, and at worst incredibly dangerous, propaganda against mental health medication, it’s a case of too little too late.

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