Dear Peter Hitchens: It does not follow

Peter Hitchens in an small aside in his Mail on Sunday column again linked rampage killings to antidepressants:

Tristan van der Vlis, the Dutch rampage killer who murdered six people last week, is said to have spent time in a psychiatric institution. Was he prescribed antidepressants?

The trouble with this suggested link is that it is not based on any real evidence and is compounded by lots of factors that need to be taken into account – it is not a topic that can be understood without forcing your mind to be as rational as possible. Firstly, a key study:

found an overall trend for any antidepressant treatment to reduce the risk of suicidality in people aged 25 years or above.

In the under 25s, however, there was a non-significant increased risk of suicidal thoughts or behaviour (preparatory actions for suicide or attempted or completed suicide) with antidepressant treatment. When limited to suicidal behaviour alone this increased risk became significant.

But it didn’t speculate about antidepressants leading to rampage killings. This speculation has only been made by the media and by Hitchens on several occasions, it is not based on any evidence and merely relies on the fact that some killers had been prescribed some form of antidepressant (or in this case had merely sought help from a psychiatrist).

Such links are caused by people putting to one side the most blindingly obvious variable that influences the behaviour of anyone prescribed antidepressants: they are depressed. When the media links antidepressants and suicide they seem to ignore the fact that the person was depressed and possibly suicidal before being issued with the medication. The medication may have failed to prevent that person committing suicide, but this is very different to blaming the medication for being the direct cause of suicide.

Likewise, a deeply troubled individual might be given a cocktail of drugs in order to attempt to control their behaviour, but these might fail and that person might end up killing someone or worse, killing many people in a seemingly random act of violence. Again, blaming the medication is to ignore the underlying mental illness that put them at risk of committing such an atrocity and led them to medication in the first place.

Objectively, any medication issued could be a contributing factor – we cannot know how any¬† individual will respond to any medication given and prescribing doctors might not be aware of other influencing factors not declared by the patient. Treating mental illness is far from an exact science because the patient is often an unreliable narrator of their own mental state and physical symptoms. It is complex, it is difficult and it is not helped by people like Hitchens believing that they’ve made some fabulously insightful link based on nothing more than their own ignorance of compounding factors – even when they are as obvious as they are here.

The truth is we will probably never uncover a satisfactory reason for why individuals commit such acts – and as the protagonists of suicide and rampage killings are usually dead at the end of the event we are reduced to speculation – but such speculation should be clearly labelled as such by all involved. However, the lack of a satisfactory reason for such behaviour should not lead to the vacuum being filled with commentators blaming medication when they have no evidence to make such a claim.

It seems to me that any act of random violence or the decision to commit suicide could be made with or without the differing influence of any medication – the medication is just one of many variables that could play a part in any action. Of course, we can’t ever know this because the protagonist is normally dead so we can’t experiment with the impacts of stopping medication to see whether they still want to commit suicide or not.

Blaming medication is lazy, simple-minded and above all ignores the myriad of complex reasons as to why people end up seeking medical help for a mental illness in the first place. Perhaps if as a society we focused more on well-being we wouldn’t need to write around 23 million prescriptions of antidepressants a year – but then I suppose that’s the kind of airy-fairy liberal wish-wash that Hitchens’ despises. After all, the Daily Mail is clear about what it thinks of depressed people:

Above all, columnists need to understand that we are not rational beings so we have to constantly force ourselves to think rationally. I am sure Mr Hitchens is aware of cum hoc and post hoc arguments as well as knowing what a non sequitur is. I can only appeal to him to re-read his columns with these arguments in his mind so he can clearly see where he is using them and why such arguments constantly undermine his writing.