The Ketamine Clue in the Cornell Seven Case and Female Mental Health in America | The Brief

What is happening to young girls in America? There is an increase in sexual violence that's being reported by young girls. The prevalence of use of ketamine jumped almost tripled. There's obviously another high-profile case that is made more complicated due to the presence of drugs. Clancy describes the psychosis. You can't really find it documented concretely in her history. You have Lindsay Clancy. You have the Great Wolf Lodge murders. Are mothers in America experiencing a mental health epidemic? Women who do commit these types of acts typically have a history of mental health issues. If a woman in the family is talking about harming a child, they need immediate help. Nick Reiner was under a new prescription regimen. It's very possible that Lindsay Clancy was under the exact same thing. Do you think that the health care industry in the United States is failing these alleged perpetrators? And welcome back to The Brief. We're joined today by Dr. Suzette Glasner. She's a clinical psychologist and she joins us here today. Dr. Glasner, appreciate you making the time. Thanks for having me. So if it's okay, I'd love to get just straight into the news of the day, and that, of course, is this really horrific case from Cornell University, and that's the Cornell 7. Jane Doe has made an allegation that she was sexually assaulted by seven male students at Cornell. One of the chief features of this allegation is the use of ketamine during this raucous party. I'm just curious, from a medical standpoint, what does ketamine actually do to the mind? And I don't know, do you see it as indicative of this growing concern pertaining to young people experimenting with a whole sort of drugs while sexually active? Great question. Great questions. Well, first of all, ketamine is a dissociative anesthetic, and it was developed in the 1960s as sort of an alternative to PCP. And when you take it at high doses, it does produce this sort of euphoria and somewhat of an out of body kind of experience. Like you feel like you're sort of disconnected from your body. You can't really feel pain as it was developed for that purpose. And it's difficult to form new memories. And some people describe when they're very high on ketamine, what they describe as sort of entering the K-hole, which is where they feel kind of confused, unable to move um and really kind of um like they're in sort of another dimension twilight zone like reality is not reality so if someone is confused and immobilized then clearly uh they're not able to make sound judgments about what's going on um as far as whether this is part of a broader problem of substance use, we are seeing that there is a pretty dramatic trend of increasing ketamine use, particularly in sort of party and club scenes. I think in Asia, it's become one of the biggest problems in terms of substance misuse. And in New York City in particular, there was a study recently that showed that the prevalence of use of ketamine had jumped about almost triple from over 5% to over 15%. So this is pretty significant, I would say. So you'd said something that I think is really important for our audience to understand. Just so we're clear, can someone under the influence of ketamine genuinely understand what they're consenting to, even if they voluntarily took the drug? I think it depends on how much ketamine they've taken. But if they get to that place with ketamine, where they are in the K-hole, as it's described by people who use it in sort of a party context where they feel confused, immobilized, and unable to understand what's happening around them or respond to it, then you would not be able to give consent to much of anything in that kind of state. But it's going to vary by user how tolerant they are to ketamine, how much ketamine they've taken, and importantly, what they've mixed it with. Because by and large, people who use ketamine aren't just using ketamine. Most people who are using ketamine in a party or a club scene are mixing it with alcohol, other sedatives, and that sort of compounding effect of substances interacting with one another is what determines how severe the level of impairment and cognitive impairment is in that state. Let me just ask one last question on the Cornell 7 case, because one of the criticisms that Jane Doe has received is that she's essentially doing a 180 on the initial police report that she had filed two years prior. But again, just from a medical perspective, it's entirely consistent with those who use ketamine, that they either forget things and remember it later, or they discover new memories that they otherwise suppressed or forgot. So just from a medical perspective, it's not out of the ordinary to say, actually, the original thing that I thought happened didn't actually happen. That's a really good point, because when you think about when, if you're undergoing a procedure, if you ever have, and you're under the influence of any kind of dissociative anesthesia, your memory starts getting fuzzy when they count down to a certain point. So your ability to form memories is directly impaired by the effects of the substance. And so, you know, that is an important consideration in the overall picture. Interesting. You know, there's obviously another high profile case of alleged, I should say, criminality that is made more complicated due to the presence of drugs. And that, of course, is the Lindsay Clancy case. She stands accused of murdering her three kids. And the only question is really whether she was mentally sound. So first and foremost can you just educate me and educate the viewers what is postpartum psychosis which is essentially the crux of her legal argument you know she was not mentally sound and how is postpartum psychosis actually different than what i think is more commonly known as postpartum depression postpartum depression is a somewhat common condition so that the most recent studies show that one in seven women will experience postpartum depression and yeah it's it's pretty high. And, and the, the, the way that a woman will feel in a state of postpartum depression is they're obviously depressed by definition, but they can feel, you know, very overwhelmed, very anxious, and they have a difficult time bonding with the baby. And then they can often feel guilty about that. Like there's unfit to be a mother, you know, they can have, they can have some intrusive thoughts and even at times some unwanted thoughts around, harming their child but typically those thoughts are what we call ego dystonic so meaning it really frightens them that they have that thought it feels like not the person they are they would you know be inclined to seek help for those types of thoughts because they're very frightening and there are several risk factors for postpartum depression a history of mental health issues and depression preceding the pregnancy is one of them, for example, trauma. There are quite a few, but postpartum psychosis is a much rarer condition and so much so that it's not nearly as well studied as postpartum depression. It's also not formally a diagnostic category in our diagnostic system as of yet. And I believe the estimate is around one or two in a thousand moms will experience postpartum psychosis so it's much rarer and that's actually a medical emergency if somebody experiences postpartum psychosis because they have broken with reality so they may be hallucinating um they could be seeing things they could be hearing voices in some cases as was alluded to in the the Lindsey Clancy case they could have command hallucinations so that's where a voice is telling them to do something often something uh you know violent or, you know, unsafe. And so that is something that has very specific risk factors that include bipolar illness, severe sleep deprivation among them, both of which did play some role in the discussions around the Clancy case. The bipolar condition was not confirmed and it couldn't really be confirmed diagnostically, but it was suspected at one time. the sleep deprivation was a factor. But really, the differentiation is that you have a true break with reality when you have postpartum psychosis. And so your reasoning and judgment are, you know, pretty negatively impacted, though it is very difficult to prove that a person had experienced a symptom of psychosis at a specific moment in time when they were doing something like, you know, harming their child or children. I'm so glad you said that, because that's actually going to be my next question how do you prove this and not only how do you how do you prove it like medically this might be unfair because this is a legalistic question by nature but how exactly are you meant to adjudicate these cases when to your own point mental health concerns especially postpartum psychosis is so remarkably subjective like how how can you prove it yeah and i think that very question is the crux of why it was so difficult to reach a consensus in that case even though it was one juror i think you put any yeah dozen people in a room and it would be very difficult to arrive at a consensus, because first of all, there is no blood test for psychosis. You can't objectively prove that she was having a hallucination or she wasn't at the moment that she said she was. So what you have to actually rely upon is what the most typical kind of clinical patterns are in cases like this. If you go back to Andrea Yates' case from many years ago, there was a consistent documented pattern of psychosis in her case throughout her psychiatric history. And that's different from the Lindsay Clancy case in that when Clancy describes the psychosis, you can't really find it documented concretely in her history. It's really her self-report after the crimes were committed. And the report is that she experienced it at a particular moment in time, and then it was not re-experienced or had not been documented as having been re-experienced since that time. And that is less typical of a postpartum psychosis overall clinical picture but you only have these sort of general clinical pictures and the documentation and then of course the clinical opinions of what often can be dueling experts as we saw in her case regarding what the pattern points to whether it's consistent enough with psychosis to say yes we believe that was what was happening at the time or not and I think where jurors got stuck in this case was that it wasn't clear that there was a consistent enough pattern of historical psychosis or chronicity of the psychosis over time to say that that must have, without a doubt, been happening at the very moment when she was committing those acts or allegedly committing those acts. So I want to talk about one last case. Reports indicate that Nick Reiner, who, of course, stands accused of killing his parents, Rob and Michelle Reiner, had a history of substance abuse that includes methamphetamine and opioids. He was first exposed to heroin when he was 14. He was under psychiatric care for schizophrenia or schizoaffective disorder. So I guess my question to you is, could these acts perhaps be prevented or even become less prevalent if we know from the get-go that they're struggling with mental health? So the short answer is, I believe so, yes. And it's a tough one to answer because when these cases emerge, people do want to point the finger and blame someone. The family didn't do X or Y or Z directly, and that's why this happened. And I don't think that it can be explained or interpreted in such a black and white way because it's not so simple. But I guess if I were to boil it down into the simplest terms, I would say making sure that mental health conditions are treated effectively as they arise and making sure that substance use and addiction is treated effectively as it arises. and a third point that i think gets largely overlooked the gold standard for how you treat this these conditions when they co-occur in the same person is that you treat them simultaneously not just one and wait for the other to get better as has been historically done a person with addiction comes to a mental health setting and says uh can you treat my addiction and they say oh you have to go get that depression fixed first or otherwise the addiction treatment will never work and vice versa but people with overlapping conditions like in Nick Reiner's case really need a dedicated treatment for both conditions simultaneously. And now that treatment has to be not only for the individual, but also for the family. Because as opposed to pointing fingers and saying people are doing things wrong, people don't know what to do. When someone in their family is potentially violent, potentially psychotic and hearing and seeing things that aren't really there, when they're in and out of crisis constantly based on the behavior of that person when they're relapsing over and over again to using a substance that magnifies those symptoms families often don't know what to do and they may inadvertently do things that do result in the illness worsening um or in it not getting treated in time before something something like this potentially happens so you know the concept of enabling you know it may be a little bit oversimplified that when you love somebody who has an addiction or a mental health condition, you want to insulate them from negative consequences and bad things happening to them and becoming homeless. And I mean, all these things is for anyone who's listening as a parent, they don't want to turn their children out to the street. It's not that simple. But there are ways that parents and family members sometimes insulate individuals who are violent. The violence from an adult child towards a parent is something that is very underreported because of that parental bond. And parents often don't want to report it to authorities and end up having their child jailed, etc. So it can escalate in that manner. And then the specific substances that we understand that Nick Reiner was involved with, like methamphetamine, have a unique association with violence. Methamphetamine more than doubles the risk of violent behavior. So the bottom line is getting a person effective treatment for that methamphetamine addiction. We actually have very effective treatments can prevent a tragedy from occurring because when they're not using substances, they're often a very different kind of person. Can I ask what would those treatments look like? Is this just a medical detox? No. So with methamphetamine addiction in particular and stimulant addiction in particular, that that's one of the classes of substances for which we don't have any FDA approved medications for its treatment. So yes, if somebody becomes acutely agitated, potentially violent when they're using methamphetamine, getting them hospitalized and stabilized psychiatrically could be one component of the treatment. But actually the most effective treatment that we know of for stimulant addiction, and that could be cocaine, other amphetamines, methamphetamine, even addiction to prescription stimulants like Adderall, the most effective treatments that we have, and they're actually highly effective, are behavioral therapy treatments. So teaching somebody what are the triggers for their substance use, what can they do instead of using substances in the face of those triggers, getting them properly diagnosed with any kind of psychiatric illness that they might have overlapping and making sure that gets treated, to my earlier point around treating those conditions simultaneously, as well as helping them sort of reconstruct their life and recovery. as one that removes them from environments where they're tempted or they're triggered and redefining their jobs or careers or you know what they do for fun rebuilding their family relationships all of these things are very effective for stimulant addiction people think that oh you see someone addicted to meth they're losing their teeth they look horrible they're you know they probably never get well but i've seen firsthand that they actually do so i know you don't want to blame one particular person or thing or institution. You don't want to, you know, point fingers here. But it is true, and you mentioned this, that reports indicate that Nick Reiner was under a new prescription regimen. It's very possible that Lindsay Clancy was under the exact same thing. Do you think that the healthcare industry in the United States is failing these alleged perpetrators? And if so, do we need to reevaluate our healthcare system vis-a-vis its treatment of those who are facing mental health challenges? I do think that the mental health care system is a really important place to look because in the case of Lindsay Clancy, for example, I think because postpartum psychosis is not something that treating clinicians see every day, it may not be something that they are really adequately screening and evaluating for. And just because something is a low base rate phenomenon, it doesn't happen to that many people doesn't mean that it's not something that we should be taking our time to assess and evaluate and that people in the treatment system shouldn't be trained to look for that. Because my understanding is that she was talking about some of those thoughts that she was having to Patrick Clancy, but she wasn't necessarily speaking to the treatment system about it. Now, whether or not they asked and she denied it, that wasn't something that was clearer that emerged that I heard about in the case, but if they had been asking proactively those questions, and if these were asked to all moms who are experiencing any signs or symptoms of postpartum depression, then we have at least a chance to capture or detect these things as they're happening and prevent tragedy. So I do think that on the screening and prevention side, that's important. And then also educating people who are pregnant or educating families of individuals with addiction like Nick Reiner about what exactly are the signs of symptoms that you should be concerned enough about that you actually bring someone like Nick in to be psychiatrically hospitalized because families often have a way higher threshold for hospitalizing uh their children or their family members than we as mental health professionals would if we heard about certain things that an individual was saying or doing or ways that they were acting we might recommend to a family that they bring them into emergency care or for evaluation for an inpatient hospitalization. But they have to be educated as part of the process of treating an individual with an addiction. And I think a lot of the time, individual treatment and family treatment are a little bit disjointed. Not enough people are getting both. And addiction is a family illness. It affects the family in every way imaginable. And the way that they respond to addiction in the family is equally important. So doctor, in the couple of minutes I've left with you, I want to zoom out just for a second and talk about an issue that we've spoken about here at PragerU and an issue that you care about as well. And that's this almost unprecedented mental health crisis facing young women and teen girls in the United States. It's marked by the sharp increase in depression, anxiety, self-harm, suicidal ideation. You know, there was a report by the CDC that showed more than 50% of U.S. high school girls reported persistent feelings of sadness or hopelessness, which is a dramatic jump from previous decades. We know that about 30% of teen girls have seriously contemplated suicide. So my question is kind of twofold, and I know it's unfair of me to do this with such short time, but what is happening to young girls in America? And when I was discussing this, doctor, a colleague of mine at PragerU said that he brought this up to his wife and his wife said, well, I think this is just, you know, young girls being young girls. So is that true? Is it just young girls being young girls, or is there something different here? Anyone who understands teen psychology knows that there are a lot of emotional ups and downs that are expected in teenage years. But when you're talking about clinical or clinically significant symptoms of depression, anxiety, and potentially as part of that thoughts of self-harm or suicidality, then it's important to take a deeper look and try to understand what's beneath it and what we can do about it. I think we have to look at how young girls are being raised and what they're being exposed to now that might have been different from when these estimates were lower. And I mean, you can point to a few things. The one probably most obvious one is social media. And kids are being raised very differently nowadays on screens and and the extent of social comparison that happens on screens some of the ways that young people can bully one another have really changed but the stakes are a lot higher so when you think about um you know exploitation around sexual themes where kids are sending nude photos of sometimes they're ai generated you know of other young people around and the way that that affects um a young person i mean any parent out there who has teens knows that as adults often we can brush something off and say put it into broader context and it's not the end of the world and we can get through it but for for young girls a lot of things feel like they are the end of the world and if you feel that way and you don't have the resources to cope with it or to consult a trusted adult um well to explain how you're feeling and seek some solutions to it you could become very isolated and very stuck and we do hear about cases where young people get suicidal become suicidal or even complete a suicide and they indicated it somewhere online, but nobody saw it. And then the suicide occurs or the suicide attempt occurs. This is something that's very different for this generation. So, I mean, I would definitely look to the social media exposure and the way that it's impacting mental health for many different reasons, not even just the content of what's online, but the way that it's impacting young people's sleep and some of the just general kind of indicators of mental well-being. And then And that coupled with the fact that the CDC is reporting, and it's really difficult to source what's going on and what explains this, but the CDC is reporting that there is an increase in sexual violence that's being reported by young girls. Now, that may be that people are more willing to report this now than they used to be, but it could also be that they are being more exposed to violent sexual images and themes via social media and technology. So, I mean, those are a couple of places that I would look to try to better understand what's happening and why mental health is declining in young girls. So, doctor, thanks again for joining us. Since the recording of our episode, we just learned of really these horrific events out of Pennsylvania. And I just wanted to reconnect, even though we're out of the studio. Specifically, we're learning about a case involving a mother, a 27-year-old, Metallica Harrison. She's been charged with killing her husband and her three-year-old son at a Great Wolf Lodge in Pennsylvania. Now, according to the authorities, she then called 911 expressing suicidal thoughts. So we don't yet know her mental health history or what led to this specific tragedy. But almost coming off of the heels of the Lindsay Clancy case, I just have to ask, are we failing to recognize serious mental health warning signs in women, particularly mothers, before they reach a point of crisis? And then fundamentally, what should families be looking for in these cases? Yeah, both great questions. I think, first of all, yes, we are failing to recognize these signs and symptoms. There is research on this very sad phenomenon of familicide, where someone kills members of their family. And what that shows predominantly is that these are usually tied to suicide. So in nearly 60% of cases that have been studied, the perpetrator commits suicide. And if you look at those who attempted and committed suicide together, that number is even higher, just like we're seeing in this case with this woman from the Great Wolf Lodge story. So she was one of those attempters. We also know that some of the risk factors and predictors of familicide, which, by the way, is a low base rate phenomenon. I mean, we do hear about it, you know, because it's so rare and so horrific that it's not it's not particularly common. And women as perpetrators are not the most common scenario either. um however what what we do know is that women who do commit these types of acts typically have a history of mental health issues what's most common is either psychosis or depression and you could think about Lindsay Clancy as well in terms of both of those types of diagnoses coming up in her trial and being debated um and then they're often planning suicide and they have these very distorted ideas in mind and very, you know, clearly irrational ideas that their children would be better off if they were not to be raised without a mother. So then the children become part of the plan. Now, we don't know anything about Metallica and her mental health and what her motives were specifically. I did review some of what has been disclosed around things that she said, but about wanting to go with them and things like that. But, you know, there's very, very little that's known. But coming back to your question around, are we missing something around mental health and how to help people like this? I think we really are. And part of the reason for that, I think, is because we tend to focus on the postpartum period, which is a relatively brief window. But in reality, parents can struggle, you know, and mothers in particular, at any time. And If you look at some of these crimes like Lindsay Clancy and this most recent crime of the Great Wolf Lodge, these aren't infants or one-year-olds who are being harmed. They're a little bit older, which is actually consistent with what the literature on familicide shows, is that they tend to be a little bit older. Right. And certainly, you know, from my vantage point as an outsider, it seems like between Lindsay Clancy and the Great Wolf Lodge murders, you know, mothers seem to be experiencing a mental health epidemic. I do want to ask you one last question. You know, you've discussed how difficult it is to treat overlapping psychiatric conditions and how medications can very much complicate those cases. So how can doctors distinguish between worsening mental illness, adverse reactions to psychiatric medications, and a patient who may be entering a dangerous psychiatric crisis? I mean, are there safeguards that our mental health system should be using to recognize these situations sooner? Yes. I mean, I think I'd like to answer both that question and your question about what families can do, because you did ask me that as well. And I didn't quite get to that in the last question. And I think they are related. So first of all, screening women during routine visits to OBGYNs or primary care where they're seen more frequently is one thing that can be done that doesn't really happen routinely enough for psychiatric symptoms and mental health struggles and asking them directly about suicide so this is one thing that people tend both i think lay people and maybe even in the medical profession as well people tend to skirt around and avoid questions around uh suicidal thoughts because they're worried about planting a seed especially people who are not in the mental health profession and there have been a lot of studies on this that show that you that the risk of suicide is only reduced by asking about it is not increased so if people can kind of cast those worries aside if they have any concerns around uh around someone close to them and particularly a mom being suicidal and and then sort of blending in they should ask about it and then blending into um you know what families and what doctors can do so screening for for these problems but then also some of the the barriers to women seeking help for these problems is they're afraid they're going to lose custody of their children. And though you can't promise someone as a mental health care professional or a health care professional that that's not going to happen, the ultimate goal of these types of screenings and asking these questions is to keep everybody safe. So more often than not, someone who discloses that they're having thoughts of self-harm or even having intrusive thoughts about harming someone else in their family will not have a direct consequence of losing their entire family. They will just get treatment and help and then of course if part of the safeguard against you know any harm coming to their family is separating them that will happen but that's all in the spirit of safety that the goal of you know child protective services is not to separate families it's to unify them and do that in a safe manner the other thing for families to know is that if a woman in the family is talking about you're better off without me or if they're talking directly about harming a child or having thoughts about that, A, they need immediate help and that's an emergency, but B, you can do things to remove lethal means from, remove their access to lethal means, remove medications or firearms or things like that. I mean, it is morbid to think about, but this is the way that we need to be thinking about people who are potentially a risk to themselves or to other people. Well said. And as our audience can see, we're out of the studio. This is not how a typical episode looks like, but we thought that the news coming from Pennsylvania was so important and that it really underscores the message of what you're saying, that we felt that it was critical that we continue that conversation. So I want to thank you for making the time and really your medical clarity as we continue to grapple with these cases. So thank you, doctor. Appreciate it. Thanks for having me. Well, thank you so much for watching this week's episode of The Brief. Feel free to keep the conversation going by leaving a comment below. You can also offer an idea for a topic you would like to see covered, also ensuring you're liking, subscribing, following, so you do not miss any new episode of The Brief. And we'll see you next week. Thanks for watching!