“Alastair Hay is an environmental toxicologist. He is a chemical weapons expert who is much quoted in newspapers. He advises select committees, lectures, writes papers and travels to conflict zones such as Bosnia to find out which deadly toxins have been released in the name of peace and freedom, or gives evidence in US courtrooms in high-profile proceedings involving the food biotechnology company Monsanto or Vietnam veterans.
He never supposed that at the height of his career he would find himself using his specialised skills and knowledge to investigate the death of his wife.” Guardian/UK
Another in a series of irresponsible attacks on the medication rather than the way it was used and supervised. Forgive me if you’ve read it here before; I go off on this type of tirade periodically here at FmH whenever this topic comes up. I am no fan of big pharma’s marketing of these medications, or their apparent ongoing efforts to sweep complications of SSRI therapy under the rug, but all medications have risks and benefits and require an experienced and quality-controlled prescriber. Regarding Prozac, Hay — perhaps abit ghoulishly? — reports he did toxicological studies of his wife’s tissues after her suicide and found evidence that fluoxetine (Prozac) and its metabolites had built up to exceedingly high levels in her system. He is right, ‘one size does not fit all’ with this medication, and there is good evidence that excessive levels of this or other similar antidepressants in a person’s system can induce irritability, agitation, ragefulness, etc. sometimes sufficient to induce a person to take their life. This probably accounts for a subset of people who begin to improve on the medication and then, as it continues to build up in their system, plummet again. Hay’s reaction? To wonder why blood level monitoring is not part of treating people with these drugs, as it is with other medications — he mentions warfarin, but I would add anticonvulsants, some antibiotics, some antiarrhythmics, lithium carbonate, theophylline, even some other classes of antidepressants. Surely the toxicologist’s solution, but there are several reasons why it is not possible with SSRIs. First, serum levels (that can be measured in the living, as opposed to post-mortem tissue levels) are so miniscule that the margin of error is quite high. Second, studies have shown that there is little correlation between levels and physiological effects or responses.
But, at least from the Guardian article, it is not clear that is what we are dealing with here, in other words not clear that his wife was not suicidal on the basis of her progressing psychiatric disease, as Eli Lilly will claim at the inquest in response to Hay’s imputations about the medication. If the only tool you have is a hammer, you start to see everything as a nail; the grieving husband who is a toxicologist — and, let us add, an environmental toxicologist rather than a clinical one, at that — may be forgiven if only on that grounds for focusing on a real or imagined toxicological problem to the exclusion of other factors. As I usually point out, the fact that his wife’s prescribing was conducted by a GP rather than a psychiatric specialist better trained to evaluate and manage treatment response and complications in the medication treatment of depression was almost surely the greater problem.
The added twist in this case is that Hay himself seems to have tried to control her treatment at times in a manner which is shockingly inappropriate, so much so that if the journalist who wrote this piece wasn’t so obviously in Hay’s thrall, she might have realized how unflattering some aspects of her portrayal of Hay are. His motivations may have been admirable; I am not sure, but in any case the picture is pretty damning. I’ve already mentioned that he did the toxicology on her remains. Then there’s the issue, which the author of the article finds admirable but I find shocking, of his claiming to have taught himself cognitive behavioral therapy from some books and conducted it on his wife himself to circumvent the long wait for services she encountered. Let us start with the hubris of thinking he can become a competent therapist in this manner and add to that the fact that no competent therapist treats a family member.
In what other ways might he have been interfering, overbearing, controlling (which, it is even tempting to speculate, may have contributed to his wife’s depression and suicidality)? I doubt Hay has either the insightfulness or the candor to self-assess these factors, although I noted that the writer does indicate Hay’s ‘beating himself up’ for not recognizing warning signs of his wife’s impending suicide. It is not clear he is so much remorseful as merely regretful, however — too bad it happened, but no way his responsibility. He pleads ignorance, which is precisely my point. A trained mental health practitioner, rather than someone who is not a clinician and thinks he can learn to care for a major mental illness from a book, would not have missed them. And I won’t even deign to comment on the lack of empathy for his wife’s suffering that runs through his reminiscences — what seems to bother him most about her suicide is how painful it is for him to go on afterward.
