The headlines seemed to say it all. A top student recently stopped taking his medication, became irritable and killed five other students. Another tragedy caused by non-compliance with highly effective mental health treatment. On further investigation a more complex picture emerges. Steven Kazmierczak had serious emotional difficulties since high school, and was treated at both a residential school and a mental health facility for issues related to “unruly behavior” and self-injury. It appears that he had been on anti-depressant medication since that time. What is unclear is whether he had received any other form of treatment over the past years. The use of anti-depressant medication has tripled over the past ten years, often for off-label indications. Recent investigations have shown that the effectiveness claimed for these medications even in clear severe depression may be suspect. As mental health problems seem to rise, the tendency to treat complex emotional problems primarily with medication has increased. Research indicates that anti-depressant medication has limited effectiveness in people with personality disorders or problems related to trauma or neglect. There are no long term studies on the effectiveness of SSRI’s in these complex problems. The picture that is appearing of Steven Kazmierczak of having problems with anger, relationships and impulsivity, combined with self-injury, fascination with violent images, and inconsistent work history is likely indicative of a severe personality disorder. This does not mean that drugs like Prozac are not useful in the treatment of personality disorders when used as an adjunct to therapy. At least in the short term, medication may decrease angst, anxiety, impulsivity and self-injury in some people. From a clinical perspective in many individuals, SSRIs appear to primarily have a non-specific mood dampening effect. It is possible that it is largely this effect that results in the marginal difference between placebo and medication in drug studies. Patients frequently comment on this effect in describing SSRIs as being containing or numbing of emotion. For some people this effect is productive, as taking the edge of extreme anxiety or angst can help a person function better both in life and in therapy. Other people feel uncomfortable with having their emotions numbed, and describe feeling a sense of inner pain that is denied an outlet. People who self-injure often describe either a sense of intense angst that is relieved by the cutting, or a sense of feeling dead inside and needing to feel pain and see blood in order to feel alive. SSRI’s may control the need to cut in some people, though in those who are already feel a sense of deadness, medication may actually increase self-injury. Steven Kazmierczak is reported to have felt that the medication he was taking left him feeling like a zombie. The numbing of emotional pain can have negative effects on a person’s emotional growth as it can remove, both from the patient and the treating physician, the incentive to deal with underlying issues. In Steven Kazmierczak, his underlying problems with anger, relationships and self-injury clearly just went underground for some years. Perhaps he was able to sublimate these issues into concern about social justice and his work on self-injury in inmates. His issues were bound to resurface, as these deep traumas do not disappear easily. His tattooing his arms with horrific images was evidence of a return of self-injury and anger, as was the increasing trouble he had in being able to sustain stability in a working environment. His actions of February 14th appear to have been well planned, and probably evolved well before he stopped taking his medication. It is more likely that he wanted to go out of this world not feeling like a zombie than it is that being off his medication precipitated his actions. As a society, if we continue to focus on just treating superficial symptoms with marginally effective medication, then it is likely that we will be faced with the consequences of troubled minds left to their own resources to deal with complex problems.