The Power to Harm: Mind, Medicine, and Murder on Trial.

Robert Coles 

We are intent, these days, on exploring the physical basis of the mind, the hitherto impenetrable mysteries of the brain. The organ of our body that has learned so very much about all the other organs which, in their sum, make life possible for us, has at last begun to know a good deal about itself. To be sure, our inquiry into the mind has a long way to go, and even at the end of this next millennium may well fall far short of its goal. For some of us who trained in a psychoanalytic psychiatry, the shift in interest from what Freud (ever the prophet) called his "metapsychological" constructs to a biological way of regarding human behavior has been surprising, unnerving - even as we have witnessed (experienced with our patients) the increasing therapeutic capability that a considered psychopharmacology can offer. Lithium, for instance, has a dramatically constraining or tempering influence on manic-depressive psychosis. With each year the list of drugs available to a psychiatrist grows longer - though many of them prove to be far less useful, over time, than early reports of their action and the consequences of their use had suggested. Some medications, alas, have turned out to be duds or worse (distinctly dangerous for certain patients).

None of those drugs has quite achieved the prominence, demonstrated the promise, or commanded the clinical prevalence of Prozac. Prozac has become a cultural symbol of our neediness, our hopes - meant to banish all the anxieties and worries and fears that prompt millions of us to take a host of antacids, pain-killers, tranquilizers. It can also be seen as a symbol of our meliorist expectations, fantasies that inform the late twentieth-century life of the world's richest, most powerful nation. But there is another side to all of this: a particular drug's limitations and its side-effects - indeed, the contra-indications to its use that psychiatrists must consider as they try to figure out who should take what medicine for which kind of psychological distress. As the English essayist and investigatory journalist John Cornwell lets us know in the very title of his book, a drug that alters the way the brain functions can potentially have "the power to harm" - can undo the fragile ways that troubled people have learned to deal with the urges that beset them from within, never mind the rages the outside world stirs in all of us as it presents its frustrations and disappointments, its social and economic challenges and obstacles.

In mid-September of 1989 Joseph Wesbecker went on a murderous rampage. Armed with several automatic guns, he entered his longtime place of employment, the Standard Gravure printing company, located next door to the Louisville Courier Journal, sprayed bullets everywhere, killed eight people, injured others, and shot himself dead. Soon enough, his life would be examined by reporters and public officials, by physicians and lawyers. The families of those hurt or murdered initiated a liability lawsuit against the Eli Lilly Company of Indianapolis, because Wesbecker had been taking Prozac before he ran amok. The trial that took place did not attract much national attention, but John Cornwell, an Englishman, came to witness it, and what he saw and heard and learned through the interviews he conducted, the reading he did, the reflection prompted by this melancholy, gruesome event and the court proceedings it set in motion, informs this clearly written, exceptionally instructive book.

Before we are taken by the author to the trial (whose proceedings provide their own compelling story), we are introduced to Wesbecker and to the company where he worked so long and so hard. His was, unsurprisingly, an extremely vulnerable life from the very beginning - abandonment and abuse, a childhood of loneliness, sadness, fear, pain, confusion. As I read this account, sensitively rendered, I was reminded of the "juvenile delinquents" with whom I used to work when I was training to be a child psychiatrist - and of the words of my ever-so-wise supervisor, Abe Fineman. He once told a group of us hospital residents: "The big miracle often is how well some of these kids eventually do, given the horror of their lives. The big mystery is why more of them aren't more of a danger to themselves and the rest of us." He was, of course, reminding us of the resiliency to be found in many individuals who have endured great pain. Still, as he also insisted again and again, each of us has that proverbial snapping point, and it is the purpose of this book (as it was the Louisville trial) to explore the possible reasons for Joseph Wesbecker's sudden, savage spree.

The lawyers for the plaintiffs (the families of those maimed or murdered) argued that Prozac had substantially undone a man who had admittedly been severely troubled for many years, but who had somehow kept up a semblance of normality. In contrast, the Lilly Company, as a defendant, through its lawyers, insisted that Wesbecker had long been an agitated, moody, sullen person, had been diagnosed as a manic-depressive, had been treated by a succession of psychiatrists, and so ought not be regarded as a victim, somehow, of Prozac's impact on his psychology. In that regard, we get a detailed account of Wesbecker's personal life, with an emphasis on his complicated psychiatric history. We also learn how demanding, stressful, and at times scary his work was - he often put in double shifts in a job whose circumstances many of us would find hard to imagine, let alone endure.

Moreover, we are brought to the courtroom as witnesses, courtesy of a writer's narrative skill and energy. Cornwell attended the trial daily for many weeks, and this longest part of the book becomes, finally, a moral fable - scenes pile upon one another, interviews fill in intervals of delay, adjournment. Eventually we reach a climax, or really, anticlimax: the hugely rich Eli Lilly Company, afraid that it might lose not only a trial but tons of money (the reputation of its popular Prozac tarnished, and consequently, a plunge in its sales), fights not only in open court with high-priced, fancy lawyers, but behind the scenes. A settlement is reached, but without the knowledge of the judge, and in such a way that there is reason to wonder whether the lawyers for the bereaved families have themselves been paid large sums, so that they end up arguing less forcefully than might have been expected, hence a jury's unwillingness to call Prozac and its manufacturer guilty. The judge concluded that justice had been circumvented by a brazenly manipulative maneuver. There are, as Strindberg reminded us, "crimes and crimes." Wesbecker's terrible descent into gun-wielding carnage is one sort of crime, but Lilly's apparent decision to take no chances that it might lose a case, and thereby a hunk of its profits, is certainly another.

The rest of us should also struggle with the other questions this book brings to mind: what does cause our Wesbeckers to crack, and why do others, no less victims of fate, chance, circumstance, of hurt and suffering at home, of callousness and cruelty at work, nevertheless stay the course, live decent lives, unblemished by wrongdoing, never mind an outburst of homicidal abandon?

At the end of his book, John Cornwell tells us of a journey he took, while in Louisville, to nearby Gethsemani, where Thomas Merton once lived in monastic isolation. He reads Merton's Conjectures of a Guilty Bystander in the monastery's library, and Merton's words, his expressed willingness to connect himself to other worlds, no matter their remove morally and spiritually from his own, have a telling impact upon this talented, ethically introspective observer and writer, who has tried hard and most successfully to make the rest of us think about why people do harm (with guns, or sometimes with the money and power they have to do an end-run around our judicial system).

Robert Coles's most recent book is The Moral Life of Children (Random House).