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Tuesday, July 31, 2012

Every Therapist's Worst Nightmare: The Colorado Massacre

After the recent shootings in Colorado, it's now come to light that the shooter, James Holmes, was under the care of psychiatrist Dr. Lynne Fenton. Latest news reports don't indicate what, exactly, he was being seen for, but they are clearly pointing toward a serious disorder, such a schizophrenia, because Dr. Fenton specializes in it. (Perhaps the fact that he died his hair bright orange and called himself "The Joker" might have also given his mental state away.)

James "The Joker" Holmes
A similar thing happened in the Virginia Tech shootings. When Seung-Hui Cho's records were released back in 2009, it was apparent that he had suffered from some serious mental disorders and had ongoing suicidal ideation. Triage counselors at the psych ward where Cho was seen must have been shaking in their shoes as their exact case notes regarding Cho came to light.

I imagine the same thing will happen with court-ordered subpoenas for Fenton's notes. 

All that is known right now is that Holmes sent Dr. Fenton a package containing a notebook of some sort, and while communications between therapists and clients are privileged, if there was something in the notebook that could have indicated his plans to open fire on a group of midnight movie-goers, she would have had a duty to warn (also called a duty to protect). By the way, according to ABC, she never received the notebook.

I realize the public is clamoring for a "fall guy," a scapegoat on which to blame the tragedy. Her entire background is now circumspect, with information coming out about her being disciplined by the medical board of Colorado about poor documentation and prescribing pills to herself and family members. So she's done some wrong--who hasn't?--but it's not fair to lay everything at Fenton's feet. Lay the blame where it deserves to be lain: JAMES HOLMES. He alone made the choice to open fire.
Dr. Lynne Fenton

I've been in a couple of situations where I had serious concern about a client's mental state enough to call the police and have them escorted (voluntarily or involuntarily) to the emergency psychiatric services unit.

A client says something in my office that reeks of instability, makes my heart pound, and my gut squeeze. So I do what the law requires, and when they reach the psych ward....they sometimes are released a few hours later, b/c the client knew exactly what to say to get out of Dodge.

"I was just joking. I'd never hurt myself."

"I just said that to get attention. I'd never kill anyone."

This is NO JOKE. Mentally unstable clients know the buzz words to use. I would not be liable if a client I had concerns about was released, and then later went to kill themselves or someone else. The psych ward people would be, though. I would have documented my treatment approach, my referral (whether voluntary or involuntary) to psychiatric services, and then it's quite literally out of my hands. 

Now if a client gave me a name of someone he'd want to kill, I'd have a legal (and moral/ethical) obligation to contact that person and warn them. I'd also need to contact the police. But I'm going to assume (b/c I have the need to trust in Fenton's treatment of Holmes) that she knew nothing of his homicidal urges. And since she didn't see this alleged notebook, she shouldn't be held liable if there is something in there indicating what Holmes was planning to do.

This truly is a therapist's worst nightmare. Having your treatment decisions called into question at all--much less by the national media--is enough to ruin a career forever...even if the therapist is exonerated. There is still a taint now associated with her name. Do you think the University of Colorado is happy? Do you think she'll keep that job very long?

I just urge my readers to keep an open mind (as I'm going to) and reserve judgment until more is known about Dr. Fenton's treatment of the Holmes. 

Let's Analyze: How many public tragedies can you recall that have been pinned to a mental health professional besides the Virginia Tech shooting?

I'm going to be out the rest of the week until Friday's Free Association Chain. My parents are visiting, and I need a break! See you Friday.