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.