M ental I llness C oncerns A ll	Dr. S holds a doctorate in History, gained as a mature student, after leaving school at fifteen and working until aged thirty-five,when he was made redundant. He subsequently was a part time teacher in history forhe Open University A first marriage with no children ended when he was aged thirty five, the first wife leaving him. The next year he saw a psychiarist, treated for depression over several months, including a biref admission. He married again to someone who had two children, which had been followed by manic/depressive illness, treated with lithium. is described as apprehensive when her husband might disapprove. Her last prominent illness was five years before the last tragedy. Otherwise, generally up to ordinary living. Subsequently he attended his GP regularly, over ten years, continuing on what is called anti-depressant medication, being assessed as obsessional, ruminative, contr olling in his marriages, angrily exclaiming at times, infrequently into aggressive behaviour. It is described that he needed to be confident he could depend upon the support from his companion. The year before the tragedy she complained of low back pain and in her legs. At an urgent visit to an A&E department the complaint was put down to overanxious reaction, a hysterical response to mechanical back pain. On learning that his wife was to be returned home Dr S pressed successfully that he would not cope and he persuaded the Consultant psychiatrist who knew them both, to have the wife inthe psychiatric Unit until Dr S would work out some better arrangemnt with which he would cope. By chance an orthopoedic consultant on detachment saw the wife, at the same time as witnessing the distress of Dr S, and therefore an admission for orthopoedic survey was arranged for the wife. There, a physical abnormality was discovered for the back and leg pain, and some urinary symptoms. No radical treatment was proposed so that there was going to be some kind of invalidism when the wife went home. Dr.S visited most days. On the last day, he and his wife went for a walk, found an empty building, where Dr S claimed his wife sat down on a chair and wanted, and allowed, him to strangle her. He had carried a cord around for a few days, even when consulting his family doctor giving no pointer to any sort of suicidal depression. He and his wife had made some kind of preparation inthe past - that if it cameto a head, they would die together. Dr, S went from Court to the Unit which had harboured his wife, and back to the care of his consultant psychiatrist. Even when it seemed clear that Dr. S was no longer depressed, he still claimed that he had done the right thing -by his wife. A curious parallel which may have had some influence on the outcome was that his brother, who had been only for a short time in prison after killing his wife, was due to be released and was coming into the district. Dr.S had taken the letter indicating this to show his psychiatrist Although some of the description of the tearfulness and depression in Dr S. fits with an endogenous type of illness - diurnal variation, mid night waking. not knowing why he felt so helpless, his current psychiatrist felt his state and behaviour was down to his personality, and a realisation that his wife would require more care from him, more care than he could cope with, , and that she could not now be his support in dealing with the household worries, and her own requirements. Never the less an ssri drug paroxetine ( fluoxetine ) was recommended. The Inquiry report makes no attempt to discover whethter or not it was taken. The three Court psychiatric reports, supporting diminished responsibilty and a hospital placement, were more like each other and consistently described a serious psychiatric illness, but superimposed upon an obsessional personality, yet one which would cope without the depression illness. They also - the treating psychiatrist did not - although this is not clear in the Inquiry report, had information that Dr S showed auditory hallucinations. More usual in schizophrenia, in depression they usually have a pessimistic content and quality, and would indicate depressive illness rather than depression from personality upset. Comment back to Inquiry List back to Home page.   back to Inquiry Link page       E-mail reaction is welcome mica@didgy.freeserve.co.uk