On Mental Illness, Medication and Guns: A Modest Proposal

Alleged school shooter Nikolaus Cruz posted this selfie on Instagram before carrying out his crimes.

It’s another week with another school shooting in America, but this time it feels different. The Republican strategy of offering thoughts and prayers, along with admonitions that now is not the time to talk about gun control, has been met with outrage from the community of Parkland, Fla., after yet another troubled teenager armed with an assault rifle gunned down 17 of his classmates in cold blood. There’s a sense in the air that now, finally, something will be done.

Having been through this ritual countless times since the Columbine High School Massacre in 1999, I have my doubts. Indeed, the responses to such incidents, from both proponents of gun rights and gun control advocates, have become a part of the ritual, with overly broad claims that purport to be solutions to the crisis—there’s no doubt this is a crisis—which have little if any chance of ever being enacted. Social media platforms have been burning up all week with such suggestions, with a sort of perverse glee.

In the wake of the bloodbath at Marjory Stoneman Douglas High School, gun proponents have un-ironically suggested the solution to the problem is more guns: Arming teachers will act as a deterrent to would-be school shooters emboldened by gun-free safe-zones in public schools. How exactly this is supposed to deter individuals who are often suicidal, or whether teachers would willingly go along with this plan, is not explained.

Gun opponents, besides calling for the predictable renewal of the ban on assault weapons such as the AR-15 used by Nikolaus Cruz to murder his former classmates at Stoneman, have gone as far to indict the entire white male patriarchy, observing that once again, the shooter was a white male. But banning assault weapons won’t stop deranged kids from using, say, a handgun to carry out their crimes, and condemning half the population, namely males, for perpetuating “gun culture” is not likely to yield positive results politically.

I, of course, plead guilty when it comes to offering my own overarching prescriptions for what ails society on social media and elsewhere. When it comes to school shootings—and many other mass shootings involving mainly young male perpetrators—the first question I always ask is: What kind of medication was that guy on?

That’s because one of the defining characteristics virtually all school shooters have in common is a history of taking psychiatric medications, specifically serotonin reuptake inhibitors, or SSRIs. These drugs, which are used to treat depression and other disorders, first became widely available in the late 1980s, when Prozac first came to market. There are many variations of SSRIs on the market today, and most of them now come with a “black box” warning, courtesy of the Food and Drug Administration, because they are known to cause suicidal ideation and bizarre, life-threatening behavior in some individuals, particularly young people, whose brains are still physically developing.

But in the early 1990s, before its relationship to suicidal and violent behavior became apparent, Prozac was being hailed as a miracle drug, because it helped millions of people recover from depression, a mental disorder that had been traditionally defined by an observable constellation of physical and mental symptoms delineated in the Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association, the DSM-5, now in its fifth edition.

Back then, the manufacturers of Prozac, pharmaceutical giant Eli Lilly, claimed depression was caused by a chemical imbalance in the body, namely a lack of serotonin in the brain. Serotonin is an organic chemical compound essential to neurotransmitters that is produced in the gut. Eli Lilly’s claim was based on patients’ positive reactions to Prozac, not on any actual measured chemical imbalance in clinical trials. Nearly three decades on, the chemical imbalance theory has come under heavy criticism, most notably from psychiatrist Dr. Peter Breggin and medical journalist Robert Whitaker.

I was one of those people suffering from depression in the 1990s who found relief in Prozac. In my case, I was diagnosed with dysthymia, chronic “mild” depression, a disorder I would much later discover was more related to the fact I had been living with undiagnosed Hepatitis C since the late 1970s than any supposed chemical imbalance. But at the time, Prozac was a godsend for me. It was like a cloud had lifted from my mind, and all my previously untapped potential was unleashed.

I quite specifically remember riding my motorcycle to work one day after the medication had taken effect, beneath a blazing azure sky, with a sense of well-being I hadn’t experienced since childhood. Suddenly the odd thought occurred to me that with a simple tweak of the handlebars, I could swerve into the oncoming traffic and end it all and that would be totally OK by me. For the first time in my adult life, I felt … free.

I have never been a suicidal person, so I rolled that idea around inside my head with some level of bemusement. I’ve always been possessed by an acute sense of my own mortality, and here I was riding down the divided highway, with a totally new mindset. I didn’t consider how the person I’d crash into might feel at being the harbinger of my end, or how my own family and loved ones might react. Nothing mattered, not even my own death.

It was the purest form of nihilism I’ve ever experienced, and while this feeling lessened over time, the Prozac-induced change in my head led to risk-taking behavior that caused me numerous personal problems, to say the least. As Breggin and Whitaker have documented, I am by no means unique when it comes to my reaction to these drugs. It wasn’t until I was cured of Hepatitis C several years ago that I finally got my mental health issues sorted out.

During this whole time period — the 1990s until the present — numerous school shootings began occurring, and it did not escape my notice that many, if not most, of the young perpetrators were on or had been on SSRI medications.

The first one I recall reading about was Kip Kinkel, the 15-year-old who first killed his parents then killed two students and wounded 25 others at Thurston High School in Springfield, Ore., in 1998. It turned out Kinkel had been treated with Prozac and was withdrawing from the drug when he committed his crimes.

The following year, heavily-armed teenagers Eric Harris and Dylan Kiebold killed 12 students and a teacher at Columbine High School in Colorado before committing suicide. Harris, it was later revealed, had been prescribed the SSRI antidepressant Luvox.

In 2007, Seung-Hui Cho, a Korean student at Virginia Polytechnic Institute and State University with a history of mental issues, killed 32 people and wounded 17 others on campus. Cho was prescribed Prozac prior to his rampage.

In 2012, 20-year-old Adam Lanza, armed with an assault rifle, first killed his mother and then 20 children between the ages of 6 and 7 at the Sandy Hook Elementary School in Newton, Conn. Two years later, it was revealed that Lanza, who had a long history of emotional disturbances despite his young age, was treated with the SSRI medications Lexapro and Celexa.

After each of these mass shootings, and many, many others—not always at schools, but often involving young men who had previously been on SSRIs or some other psychiatric medication—the inevitable cry of “Why?” rang out. When I’d later learn that SSRIs were involved, having experienced personally how these drugs can shape what we might call our conscience, our concept of right and wrong, our sense of self-preservation, that was answer enough for me.

While my viewpoint is biased because of my own experience with these medications, it is validated by ongoing scientific research, not to mention the FDA black box warning that now comes with virtually all SSRI medications. A 2010 peer-reviewed study using the FDA’s Adverse Event Reporting System found a correlation between 31 commonly prescribed psychiatric drugs and violent behavior toward others, with three of the most widely used SSRIs topping the list, followed by amphetamines, which are used to treat conditions such as ADHD.

Interestingly, Charles Whitman, the Texas Tower sniper who killed 17 people in Austin, Texas in 1966, was later determined to be on amphetamines prior to and during the shooting. Stephen Paddock, the 64-year-old Las Vegas shooter who killed 58 people and injured 851 others after he opened fire from his hotel room window on a crowd of concert-goers below last November, was later determined to be on the sedative Valium, which also made the list of 31 prescription drugs linked to violent behavior.

However, as the statisticians say, correlation is not necessarily causation. Millions of people take SSRIs and are satisfied with their medications, which enable them to lead happier, more productive lives. While many patients experience the same side effects as I did and discontinue SSRIs, the vast majority who remain on medication don’t commit suicide or perpetrate mass shootings.

Similarly, the millions of legal gun owners in the United States are by and large responsible gun owners, although it’s worth noting that the Centers for Disease Control and Prevention estimates that two-thirds of the 38,000 firearm deaths recorded in the United States in 2016 were suicides, mainly by men.

It’s also worth mentioning that the pharmaceutical industry maintains one of the strongest lobbies in Congress, financially more powerful than the highly vaunted National Rifle Association. Any attempt to restrict or otherwise regulate the use of incredibly lucrative antidepressant medications is certain to meet heavy resistance, just as the NRA will surely oppose any attempt to curb its view of Second Amendment rights.

All of this goes to show school shootings are a complex social phenomenon that defy an easy political solution. Last year, gun control proponents roundly criticized President Donald Trump when he rescinded an Obama era initiative requiring severely mentally ill people to register for the FBI’s National Instant Criminal Background Check System. Trump’s move was applauded by the NRA—and the American Civil Liberties Union, which complained the policy, put in place after Sandy Hook, perpetuated the stereotype that all mentally ill people are potentially violent, when clinical evidence suggests the opposite.

In the wake of the latest school shooting in Florida, Trump has attempted to shift the conversation away from guns and toward mental health treatment. While this may indeed be a deflection designed to please his gun-supporting base, as Trump’s detractors claim, it could turn out to be a move in the right direction.

That’s because the evidence is mounting that mental health treatment may have played a roll in Nikolaus Cruz’s decision to mow down 17 people, students and adults, with an assault rifle. As with past school shooters, Cruz appears to be a troubled young man with a history of severe emotional and behavioral problems. His adopted mother reportedly sought treatment for him, and according to acquaintances, he was known to be on medication.

What exact medication Cruz took, if any, remains a mystery at present. Due to patient privacy concerns, such information is guarded closely by treating psychiatrists and often doesn’t come to light until years after the incident, as in the case of Lanza. But I will not be surprised in the slightest if it turns out Cruz was at some point on an SSRI medication, like many of his predecessors.

What can we do about this, presuming SSRIs are a contributing factor to school shootings? Considering that millions of young people and adults are helped by these medications and don’t commit acts of violence, an outright ban on SSRIs would be both unwarranted and unfair to those who are helped by these drugs. It would also be vigorously opposed by the formidable pharmaceutical lobby, which has billions of dollars at stake.

But we could modify our treatment approach to young men like Kinkle, Harris, Cho, Lanza and Cruz. As Dr. Breggin has repeatedly pointed out, as a society, we’ve come to rely more on the quick fixes offered by modern pharmaceuticals, rather than more traditional talk therapies that in many cases prove safer and more effective in the long run.

Perhaps when we place such young men on these powerful medications, we could establish a mandatory waiting period, during which the patient would voluntarily forfeit any weapons in his possession and be prevented from purchasing any new ones, until it can be determined that he’s responding normally to the medication.

This, to me, seems like a productive avenue to explore. We don’t have to ban all guns, we don’t have to prohibit certain medications. Somewhere along the way, perhaps by actually talking to them, we might discover why so many young men have become so alienated from society, and why a small number of them strike back with extreme, incomprehensible violence.

Unfortunately, until we find those answers, this will almost undoubtedly happen again, and the ritual will repeat itself.

R.V. Scheide

R.V. Scheide has been a northern California journalist for more than 20 years. He appreciates your comments and story ideas. He can be emailed at RVScheide@anewscafe.com.

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