I feel like the focus on this man's diagnosis and even his meds is a bit off. Clearly, anyone who kills 15 people is going to be having a lot of emotional and psychological trouble. The more important question is, how did he end up at this point?

My guess is that he probably has heavy trauma and/or abuse in his past, as so many people who "hear voices" do. Why don't we ever focus on this? Wouldn't talking about childhood violence - if that is what he experienced - actually address the culprit, therefore at least offering a space for constructive dialogue as to how to address the actual problem?

So little progress is made in curbing any violence because we so often overlook the source and context and instead obsess about the individual.

It's pretty hard to determine if he was hearing voices let alone why he did or could have been. There is also a thing called "drug induced psychosis" and "withdrawal psychosis".

Why doesn't any one ever talk about THAT??!!!

Technically, a true diagnosis of bipolar disorder must include psychosis. All the dx really means in a true clinical situation is moody schizophrenia that sometimes abates. The dilution of the dx to include a spouse who goes on a shopping spree the other spouse finds unreasonable is dangerous business, but it's this sort of behavior Torrey is talking about when he makes his dire recommendations for people who are bipolar. In legal terms, any murderer who is caught and is not obviously delusional or a good enough actor to fake it to avoid the death penalty can use bipolar as a fall back because, unlike schizophrenia, bipolar is a dx for people who are extremely dangerous but sometimes appear to be normal. With a record of a bipolar diagnosis, that's why folks face so much discrimination. If more people understood what the label meant, less people would be willing to accept it.

As for Kaz... it sounds like he was a troubled kid who was tortured by the educational and psych systems until driven "mad," probably on and off various different psych drugs suffering from various different humiliating and invasive psych treatments, a monster created by the system and then used by the system to justify itself.

It's tragic, but to use his story to lend credence to the idea that forced imprisonment of people who have the word bipolar written in their medical charts is horrible. All mass murders are insane acts, that doesn't mean that all people labeled as insane are mass murderers.

In the end, though it's being sold to prove us bipolars must have our civil rights revoked, especially if we appear normal, the article is really further proof that there's no such thing as bipolar as it doesn't mention structural differences in his brain or genetic markers in his blood which means they weren't there. Medically the dude didn't pass whatever bs test there is to supposedly diagnosis this "medical" condition.

If he was truly bipolar, then someone wasn't offering him anything close to appropriate treatment.

What, I pray tell, is appropriate treatment in your book. Having him on a ton of psych meds wouldn't have made him any safer as far as I'm concerned.

There are just as many examples of people doing heinous things on meds, contrary to what Fuller Torrey would have us believe. Meds don't make people less violent and often make them more violent.

"Hearing voices and having hallucinations is pretty extreme for bipolar disorder, unless they are very infrequent, and this makes me wonder what his true diagnosis was. I'm not dismissing the bipolar dx here, just saying it strikes me as suspect"

Just think Dual Dx Philip. It doesn't invalidate the manic depression mood swings. I am thinking schizophrenia, comorbid with Bipolar without negative symptoms it's schizo affective disorder.

Bipolar Schizoaffective was my Dx as a teen and I had mania, suicidality, delusions and inner voices.

But no one will ever know his *true* Dx, since he needs to be a participant in his Dx in order to come to a complete consensus. We need to know how he thought and felt in order to pick out the proper DSM label for him.

You think these biomarker tests for SZ and BiPD are going to tell us without a doubt one way or another?

I highly doubt it.

Steph has a point, maybe is was psych med induced psychosis,

Steve has a point, maybe the Bipolar and SZ morphed out of pre-existing PTSD.

No one will ever know for sure but we will have fun speculating for some time.

Philip:

2 comments to you about this posting

1. Diagnosis takes time and one thing that is minimally done by too many psychiatrist (even if just one doc is too many) is getting collateral info to clarify, collaborate, or refute what the patient tells you alone. In adult care, when a patient does not want you to get more info, you should be suspicious there is an agenda that will not help the patient in the long run. With the age group this young man was in, a provider should always suspect concurrent substance abuse, even if there is a true axis 1 mood/thought disorder independent of substance abuse/dependence.

2. You should know that there was a list of the top ten psychotropic medications (for 07 I think) being prescribed in the US off the June issue of Clinical Psychiatry News (I don't have the link but I'm sure it is clinicalpsychiatrynews) and benzodiazepines xanax and klonopin were 1 and 4 respectively, so the use of benzo's continues to be too much. I personally hate the benzo's as they are frequently abused or misused, and they feed into the quick fix mentality that I have spoken about previously that does not do service for healthy mental health care interventions.

As I have signed off previously and will do forever hereon at this site, that's just my opinion. This posting is for you, Philip, and I will not be coming back to read further comments, so whoever else is interested to address these comments, I leave it to the masses to use for benefit or rage.

Again, have a nice weekend, I'll be reading as of Monday. Thanks for the info.

I agree with Steven about the childhood trauma.

This article does increase my fear of going back on meds, even though I am having a hard time, because of severe complications from being on-again, off-again.

I would be curious to know how the writer of the article knew that Kazmierczak was listening to Marilyn Manson before he shot 20 people. It seems to be dramatic embellishment. I personally can't stand that kind of music, but creating a direct correllation between listening to a stupid song that kids find a kind of cathartic release and committing heinous acts seems far-fetched and ultimately repressive. People need to release their emotions in a way that isn't destructive, even if it's music I can't stand.

Since the UNI shooter was only taking Prozac and two benzo's, then his diagnosis should have been unipolar depression. This article doesn't even mention this diagnosis or come close.

Why give Prozac to someone who has already had a psychosis?

Now I am convinced that the withdrawal from the Prozac is what caused the shooting.

Prozac can cause a shooting by someone who truly is only unipolar so--------------------------

Not sure if anyone is "truly bipolar" or what that really means. Everyone who is manic or psychotic has a story that got them to that point. The important thing really is the story -- not the mania or psychosis -- and what people -- friends or professionals -- can do to help reframe the story for the suffering individual. In any case this guy surely had a bad story as well as some really bad treatment that made the story worse -- the end result was the rampage. It's tragic.

i have seen a lot of patients where the term 'psychotic' or 'delusions/delusional' in one chart note or intake exam or one eval got morphed, in later records, into 'auditory hallucinations.'

i have done assessments myself where i have had to dig through medical charts stacked up to 2 ft high tryingto find the original report justifying a dx of schizophrenia or mania.

it would not surprise me at all if this peson did truly meet criteria for having 'psychosis' and/or 'delusions' but with nevre ever 'auditory hallucinations', yet having 'auditory halllucinations' or 'hearing voices' crop up in some later report, note or assessment.

similarly, i have seen 'visual hallucinations' creep in to a chart based on 'auditory hallucinations' actually being well-documented, when reports have depended upon previous reports, and been done carelessly or naively.

psychosis does not mean that AH were involved.
AH does not mean VH are involved, and VH are actually quite rare compared to AH. It is just poorly trained, or naive, or unconcerned, mental health staff that let these phenomenological descriptors appear as a medical record grows.

Row1- great point re: the charts and how often they are incorrect. I took a look at one of my daughter's binders with a social worker, and she was disgusted with the inaccuracies. It also appeared that some ppl had agenda's when writing their own report(such as giving cause to send her to an institution by making up symptoms!)