Wednesday, February 27, 2008

Another Mental Illness Tragedy

I blogged about this on the Civilian Gun Self-Defense Blog last month. The first news accounts only described Marshall Fink as "mentally ill." There's a bit more about the tragedy in this February 26, 2008 St. Louis Post-Dispatch article:
WELDON SPRING — The veins in Marshall Fink's neck bulged with fury as he pumped his fist, telling his parents they should stick a shotgun in their mouths and pull the trigger.

His mother and stepfather begged Fink, 26, to take his medication and calm down.

That set him off.

Fink put his fingers to his head, pretending to have a gun, then pointed at his parents. He chest-bumped his mother into the garage, snarling and telling her she should die.

Shirlee and John Gentles called 911 several times the night of Jan. 11.

The police were on their way, but by the time they arrived John Gentles had fatally shot his stepson.

...

Fifteen months after graduating from Francis Howell High School, Fink enlisted in the Navy, inspired by the Sept. 11 attacks to serve his country.

ILLNESS TAKES HOLD

Fink was stationed at the Naval base in San Diego as a mechanic aboard the Peleliu assault ship.

"It was a natural fit that he would go and work on engines," Shirlee Gentles said.

For more than two years, his service record was clean; his superiors even wrote him several letters of commendation. Fink wanted a career in the Navy, but a conflict of highs and lows was escalating inside his head.

"Something happened to him in the Navy," Heather Gentles said. "He just was never going to be the same."

Fink's illness developed quickly and was brought on in part by stress and lack of sleep, said his psychiatrist in St. Charles, Dr. Greg Mattingly. Fink's condition emerged about the same age as most bipolar patients, Mattingly said, and was not spurred by any specific traumatic incident.

"With bipolar, you can go from pretty much normal one day, to the next day being very, very, very sick," Mattingly said.

Fink mouthed off to his commanders, stopped eating regularly and lost 20 pounds. He grew increasingly paranoid, and in September 2005, doctors at the Naval Medical Center in San Diego diagnosed his condition as bipolar disorder, which often results in episodes of severe depression and mania. It affects more than 5 million Americans.

Most people who develop the disorder are genetically predisposed to it, Mattingly said. Along with stress and sleep deprivation, he said, substance abuse is another common trigger. Fink had begun taking legal stimulants as part of a body-building regimen.

Because of Fink's diagnosis, the Navy started discharge proceedings.

Fink challenged the diagnosis. He wanted the chance to return to active duty, but the Navy considered him unfit to serve.
About 2.6% of the adult population suffers from bipolar disorder. Not everyone with bipolar disorder ends up as out of control as Marshall Fink. A lot of people with bipolar disorder manage to lead productive lives--using the energy in the mania stage to get a lot accomplished, and sleeping or sulking during the depressive stages. I've read that CEOs are disproportionately bipolar, and there are some astonishingly creative characters out there, such as Sir Isaac Newton and Howard Hughes, who are believed to have been bipolars whose condition was not severe enough to disable them. (Although Newton, in his later years, seems to have collapsed into a pretty severe depressive state.)

From my reading, it appears that alcohol can pitch people with mild bipolar disorder over into acute bipolar disorder. I have watched several relatives whose acute bipolar disorder appeared shortly after they started smoking marijuana--and one of them has not recovered. Since marijuana appears to increase the risk of a psychotic breakdown by about 40%, I do not find it difficult to believe that it might play a part in aggravating bipolar disorder. This is part of the reason that I no longer regard legalization of marijuana as a great idea. Yes, most people who start smoking marijuana aren't going to suffer a psychotic break, or find their unrecognized bipolar disorder aggravated. But for those who do, it's tremendously bad news.

Another interesting problem is that SSRI antidepressants, if prescribed without a mood stabilizer, can aggravate the mood swings of someone with bipolar disorder. One of the advantages of Prozac, when it was first released, was that it was relatively low risk for side effects, and so a lot of GPs were encouraged to prescribe it. Unfortunately, people suffering from bipolar disorder would show up at their doctor when they were depressed--not when they were feeling energetic and powerful. Not surprisingly, GPs assumed that they were treating depression--not the depressive phase of bipolar. And the mood swings would just get worse.

If you have a really smart child who is also defiant and is rapidly getting out of control--you should at least consider the possibility that the problem is bipolar disorder. Until quite recently, psychiatry would not acknowledge that minors can suffer from bipolar disorder--partly because it is so difficult to easily distinguish from normal adolescent behavior. Demitri Papolos, M.D. and Janice Papolos's The Bipolar Child: The Definitive and Reassuring Guide to Childhood's Most Misunderstood Disorder is a good place to start. You may decide, after reading the Papalos's book, that you just have a strong-willed child. You may decide that it is time for psychiatric evaluation.

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