Psychologist for veteran who killed family tells N.S. inquiry she 'would never have predicted it'
Lionel Desmond responded to prolonged exposure therapy for his PTSD, but then he relapsed
The psychologist who treated Lionel Desmond for complex post-traumatic stress disorder at Canadian Forces Base Gagetown says she never saw any sign that the Afghanistan veteran would harm himself or his family.
Dr. Wendy Rogers testified that an abusive husband who is "prone to violence" would typically speak about his spouse in derogatory terms. But in her patient's case, whether due to his depression or the fact that he and his wife were living in different provinces, he seemed "distant" from his wife, at times almost showing "indifference."
When asked about her reaction when she learned that on Jan. 3, 2017, her former patient had fatally shot his wife, Shanna, his mother, Brenda, his daughter, Aaliyah, and then himself with a rifle he'd bought that afternoon, the psychologist said she would "never have predicted it."
"I was deeply, deeply shocked, particularly that he killed his daughter, because he, he, loved that little girl," she said. "There was just nothing that raised red flags for me."
Slow but steady progress
What he focused on instead, she testified, was making slow but steady progress in his treatment.
The pair began meeting in 2011, beginning weekly visits for a type of trauma-informed therapy known as prolonged exposure therapy.
In it, the patient retells the stories of the trauma they've experienced, with a therapist helping to keep their distress under control during the retelling.
Then, the patient will record that story and continue listening to it until it's no longer a source of anxiety.
CBC reporter Laura Fraser was live blogging the hearing:
"As the distress goes down, the person is better able to think straight," Rogers testified. They can process the event differently and, listening, to "the recording of your own voice, it gives you a bit of distance from the situation and ... you have more empathy for yourself."
After their sessions, Rogers reported that Desmond's depression went from moderate to mild — dropping to a 27 from a 60 on the clinical assessment scale — and that his PTSD symptoms were under control.
Daughter was a source of joy
His daughter was living with him and that also made him happy, she said.
Rogers testified earlier about Aaliyah being a calming presence in her father's life. She said that Desmond had wanted to return to working on the range, but turned down the opportunity in November 2012 because he wanted regular hours so he could be present as a father.
Rogers said Desmond described caring for his daughter as a joy, never as "a burden."
When it comes to domestic violence, Rogers noted that research has found that military families are at slightly higher risk. But she said that it's still relatively rare for it to be a result of PTSD.
She said that in her practice, it's more often that she sees patients who have violent outbursts toward "an object" — and that their families' reaction to this aggression can be what prompts soldiers to seek help.
When asked whether PTSD increases the risk for homicidal behaviour, she testified that it's still extremely rare.
"It's a rare event," she said, noting that Desmond is the only client she's ever had who has killed someone else.
Triggered by racist comments
Desmond finished therapy with Rogers in February 2013. At that point, his medical officer was considering whether the corporal could soon return to full duty.
He had begun a new posting managing a warehouse on the base and showed interest in taking military courses, all of which Rogers said were healthy developments.
But then in September, Desmond made an appointment with her office, saying he was unable to stop reliving an incident from the spring when a colleague made a racist comment about him.
Rogers testified that she would not necessarily have called it a relapse of his PTSD, given that the event he was focused on was not connected to his combat.
But she acknowledged that it was clearly an unhealthy response to a stressor.
After that, the rest of Desmond's clinical team began to prepare him for the possibility that he might have to seek a medical discharge.
Recommendation to prevent PTSD, future deaths
The inquiry's mandate is to see whether changes to policy — in health-care and domestic violence intervention — can prevent future deaths.
Both Rogers and Dr. Vinod Joshi, the psychiatrist who treated Desmond at CFB Gagetown, offered the inquiry a closer look at the breadth of services already available for soldiers while still in the military.
Those include the Operational Trauma and Stress Support Clinic at the base, which now has five psychologists, three psychiatrists, clinical social workers, addictions counsellors and mental health nurses. Together, the team provides both medication and talk therapy for the soldier, which may or may not include a soldier's spouse."
The clinic holds group therapy sessions for spouses of members with PTSD, but due to doctor-patient confidentiality, it must be the patient who passes that information on to their family. Shanna Borden did not attend these sessions.
When asked whether Rogers had any recommendations about preventing PTSD in soldiers who saw combat, she said that there's only so much you can prepare somebody for.
She referenced one incident in particular in which Desmond told her he'd found the body of an enemy soldier.
"But I don't know that anything can ever prepare someone for seeing a dismembered body covered in flies," she said. "It's hardwired into us to feel disgust and horror.
"Emotionally, existentially, you can read about it in a novel, you can see a video about it, but it's pretty difficult when you're faced with it."