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Will Quoted in NYT on Forced Drugging
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Will Hall
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Sep 19, 2006 05:24 PDT
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http://www.nytimes.com/2006/09/19/health/psychology/19slay.html?_r=1&adxnnl=1&oref=slogin&adxnnlx=1158668152-fheNFoKTChsEiwl6ReD/HA
Essay
A Psychiatrist Is Slain, and a Sad Debate Deepens
By BENEDICT CAREY
Published: September 19, 2006
New York Times
In the hour before he was killed, on Sunday, Sept. 3, Dr. Wayne S.
Fenton, a prominent schizophrenia specialist, was helping his wife clear
the gutters of their suburban Washington house. He was steadying the
ladder, asking her to please stop showering debris on his clean shirt;
he had just made an appointment to see a patient and wanted to look
presentable. She said she would be happy to go along, to help control
the patient.
THE VICTIM Dr. Wayne S. Fenton was killed this month by a 19-year-old
patient suffering from severe psychosis.
It was a running joke between them. For in this part of the country, Dr.
Fenton was the therapist of last resort, the one who could settle down
and get through to the most severely psychotic, resistant patients,
seemingly by sheer force of sympathy and good will. An associate
director at the National Institute of Mental Health, he met with
patients on weekends, sometimes late at night, at all hours.
“Absolutely the most nonthreatening person you ever, ever met,” his
wife, Nancy Fenton, said in an interview last week.
At 4:52 p.m. that Sunday, the Montgomery County police found the
53-year-old psychiatrist dead in his small office, a few minutes’ drive
from his house. They soon tracked down the patient he had agreed to meet
that afternoon, Vitali A. Davydov, 19, of North Potomac, who admitted he
had beaten the doctor with his fists, according to charging documents.
When the young man left the office, “Dr. Fenton was on the ground,
bleeding from the face,” the documents said.
Dr. Fenton had known that the patient presented some risk: he was young,
male, severely psychotic and struggling with a mental state that was
frightening and unfamiliar. The psychiatrist was trying to persuade his
patient to continue taking medication, Mrs. Fenton said.
The killing, besides devastating the two families involved, has deeply
shaken mental health workers around the country. In the days since, many
have wondered about their own safety and about the dangers of allowing
patients with severe psychosis to go without medication.
Dr. Fenton’s death is not likely to change psychiatric practice, experts
said, but it may become a touchstone for one of the most contentious
debates in psychiatry: whether people suffering from psychosis should be
compelled to accept treatment to reduce the risk of violent outbursts.
“We have been thinking about all these things in the past week, that’s
for sure,” said Dr. Thomas H. McGlashan, a psychiatrist at Yale and a
close friend of Dr. Fenton’s, who worked with him decades ago at
Chestnut Lodge, a renowned psychiatric hospital that closed in 2001.
“Yes, there is a risk of violence with some patients, and no, it’s not
black-and-white, like some would want you to see it. It’s not just that
Wayne is dead, but that the kid’s life is ruined too.”
Violence is less common among those with mental illnesses than is
sometimes assumed. Many people with schizophrenia are withdrawn, more
likely to be targets of an assault than to commit one, said Bruce Link,
a professor of epidemiology at Columbia.
But studies suggest that those with untreated psychosis — often
characterized by intense paranoia and imaginary voices issuing commands
— are at least two to three times as likely as people without mental
disorders to get into physical altercations, including fights using
weapons, Dr. Link said.
An analysis published last month in The American Journal of Psychiatry
found that people with severe mental illness committed about 5 percent
of the violent crimes in Sweden, though they made up a small fraction of
the population. The United States, which has higher crime rates, has a
much smaller proportion of crime attributable to the mentally ill than
Sweden, experts said.
Yet the risk is real, if remote, for those who meet one on one with
severely psychotic patients and try to negotiate difficult issues like
medication. So-called antipsychotic drugs effectively blunt symptoms of
psychosis and tend to reduce the risk of violent outbursts,
psychiatrists say. But the medications are mentally dulling and often
cause weight gain, among other side effects, and many patients either
stop taking them or refuse them altogether.
In part to forestall violent episodes, several states, including New
York and California, have tightened their treatment laws to compel some
mental health patients to accept treatment, even if they have not
committed a crime. The issue is divisive among former psychiatric
patients, researchers and practicing psychiatrists.
“This is an extremely important issue for psychiatry, and there are two
sides of this story,” said Dr. William T. Carpenter Jr., the director of
the Psychiatric Research Center at the University of Maryland and the
editor of the journal Schizophrenia Bulletin. “As doctors, we think
patients ought to do what we think they should do, and if someone needs
to be on medication it’s difficult not to wish there was some way to do
that.”
On the other side, Dr. Carpenter said, “you have a significant civil
rights argument.”
In the wake of Dr. Fenton’s killing, some patient advocates cautioned
against exploiting the tragedy to promote forced treatment.
“The main concern is that we not let fear and stereotypes based on this
case drive public policy” in support of forced commitment and drug
treatment, said Will Hall, a mental health advocate in Northampton,
Mass., who was hospitalized as a young man and treated with
antipsychotic drugs for about four months after a suicide attempt. A
better way to prevent violence, Mr. Hall said, “is to offer patients who
refuse medication on any ground a much wider range of options, including
psychosocial treatments.”
Yet alternatives to drug treatment are not yet widely available. And
with the news of Dr. Fenton’s killing in their thoughts, some
psychiatrists said they were thinking carefully about the precautions
they take every day.
“When a patient is revving up and paranoid,” Dr. McGlashan said,
“instead of becoming imperious or dogmatic or rigid I might admit that
I’m kind of nervous too. If you’re scared, you let the patient know
that. Because a lot of their behavior is coming from their perception of
being threatened. If you let them know that you are feeling threatened,
vulnerable and not interested in controlling them, that can help defuse
the situation.”
All of which, of course, Dr. Fenton understood.
But the need was urgent, Mrs. Fenton said. The need was urgent, the
family was desperate, and that was enough for her husband, as long as
she had known him. Someone wanted his help, so Wayne would go.
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