Thursday, December 11, 2008

A Mental Health Tragedy

At 8:00 PM on Friday January 11, 2008, Marci Thibault came to her twin sister's home to pick up her 4 year old nephew Shane and 5 year old niece Kaleigh for a sleepover at her own home in Bellingham MA. On the way home she pulled her car into the median of the highway, undressed herself and the children, and carried the children into the oncoming traffic. All three were killed.

Four months earlier Thibault had been treated at McLean Hospital for a psychotic episode. She was discharged after six days with medication and a referral for outpatient treatment. Between her discharge and her death she was said to be "95 percent back to her old self."

On her way to her sister's home Marci Thibault came to the attention of the state police. She apparently drove into the median area at full speed. When a motorist stopped to offer help she began to punch him. State police came to the site and questioned her. She told them she was having "a debate between good and evil." The troopers considered committing her to a psychiatric hospital, but she calmed down, and they concluded they did not have enough evidence to do so.

By the time Marci arrived at her sister and brother in law's home, however, "she was acting like the normal Marci I knew all my life," her twin sister Danielle Lambert, a pediatric nurse practitioner, reported.

In the aftermath of the tragic event, Danielle and Ken Lambert, Kaleigh and Shane's parents, have started a nonprofit group "to improve the mental health system by educating the public and promoting practical solutions."

I'm writing about this story on a blog devoted to health system ethics for two reasons.

First, the way Danielle and Ken Lambert have channeled their grief is ethically admirable. By devoting themselves to "prevent[ing]similar incidents from occurring by improving society's understanding and management of mental health issues" they are transforming private tragedy into public benevolence. And, the fact that they portray Marci Thibault, the agent of their childrens' death, as a victim of mental illness and not as a perpetrator, shows an admirable capacity for not blunting grief through blame.

Second, the excellent Boston Globe article from which I learned about this tragic event, is unusually clear about the ethical trade off between public protection and civil liberties:
Dr. Alberto M. Goldwaser, a forensic psychiatrist who teaches at New York University's medical school, said it is understandable that the Lamberts are second-guessing the State Police and McLean. But he said the couple's criticisms are probably unrealistic.

"Right now, we know the police should have taken her to a hospital, and then this tragic event wouldn't have happened. But that's in hindsight," said Goldwaser, who is not involved in the case. "So, yeah, [Thibault] was peculiar. We're talking about taking her liberties, taking her freedom"...

Thibault's husband, Michael, an EMC Corp. employee who met his wife at Bellingham High School, said it might be a good idea for police to have access to a database of individuals who had been committed to psychiatric hospitals, despite the inherent privacy concerns. He said the State Police "had Marci in their hands on the way up" to New Hampshire.

But Dr. Mark Goldblatt, a Cambridge psychiatrist and president of the New England chapter of the American Foundation for Suicide Prevention, said Americans are ambivalent about how to respond to people with mental illness.

"Society wants it both ways," he said. "We want to have complete freedom and liberty and not be restrained by government, not have people's names in databases. And at the same time, we want to control people who live a certain way with mental illness. It's hard to have both."
The Boston Globe deserves gratitude for the kind of journalism that contributes to public understanding of complex ethical issues. And, most notably, Danielle and Ken Lambert deserve admiration and respect for their efforts to transform private grief into public altruism.


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Jim Sabin said...

Dear Women's Health -

Thank you for visiting this blog and for making a link to it. I appreciate having as wide a range of readers as possible.

I visited the Women's Health blog and appreciated seeing the wide variety of topics you've developed. Given the limited number of links I keep on my blog I've limited those to blogs that concentrate on ethics and policy, so with apologies I haven't added a new link.

Again, thank you for the visit!



eric said...

Reasonable criteria can be developed for police to follow. "Zero tolerance" is often reasonable. Each individual doctor, nurse, policeman, can't wait till they've been burned once to realize that behavior that's over the line can't be ignored. It's one thing to do racial profiling and stop people just because they look suspicious. It's quite another to stop a person who was speeding and driving to endanger and unable to control themself.

Jim Sabin said...

Hi Eric -

You make an excellent point. Apparently when the police examined Marci she ultimately calmed down, and we know from the story that when she got to her sister's home she seemed to be her normal self. But you are emphasizing the "driving to endanger" aspect, not the often difficult assessment of mental health status.

With hindsight it's obvious what should have been done. The fact that Marci gave a plausible explanation for what happened (that she'd fallen asleep), however, must have added to the difficulty of the judgment the police had to make.

I suspect that if the situation the police confronted when they examined Marci on the highway were presented to experienced state troopers some would recommend mental health committment and some would say "I've seen too many 'normal' people get locked up to let me commit someone like this person."

It's always good to hear from you!



eric said...

Jim--Who works with the police on their institutional ethics? Who met with the police involved in this case, to allow them to vent their feelings and moral dilemmas? Police must make life and death decisions with less training and less pay and less respect than doctors receive. Just as the ethics of distribution of resources for health care requires precision of thought and clear definition of the issues, so too do the daily decisions of police and health care workers. People need the vocabulary to talk about these issues, the training in pattern recognition, and the empowerment to act on their observations.
To a healthy 2009!

Jim Sabin said...

Hi Eric -

Your question is important & I don't know the answer. Police & fire departments are local, and departments vary in the resources they can provide. I know that Boston has a "stress management" program for its police. Years ago in my practice I saw a police officer who had been used by a mentally disturbed person for what is called "suicide by cop" (provoking the police to use deadly force). The officer had a severe PTSD reaction.

Best wishes to you and your family for a happy & healthy 2009!


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Anonymous said...

I think the parents need to second guess themselves.

What prudent person would allow someone that had had a psychotic break to be responsible for their children?

Jim Sabin said...

Dear Anonymous -

I'm sure that after the tragic events Danielle and Ken "second guessed" themselves. But as Danielle said in the quote - her sister seemed to be her normal self.

I can't agree with your view about the way a prudent person should have responded. The fact of having had a psychotic episode does not in itself make someone unfit for taking responsibility for others. I first learned this during my residency in psychiatry, where I saw patients with significant ailments showing good capacity to act responsibly in other areas of their lives.

I suggest that you read a post I wrote a couple of weeks after this one to get a fuller sense of what thoughtful and responsible people Danielle and Ken are. It's at