Treatment hampered by paranoia
Lionel Desmond suffered nightmares in which he killed his wife for cheating on him.
He told a psychiatrist at St. Anne's occupational stress injury clinic about the nightmares seven months before he killed his wife Shanna, daughter Aaliyah and mother Brenda.
That psychiatrist, Dr. Robert Ouellette, testified Tuesday at the Desmond Fatality Inquiry that the Afghan war veteran's paranoid personality traits prevented them from building the relationship of trust required to begin working on Desmond's complex problems.
It was Oullette's job to diagnose and work with veterans to stabilize them so that they could go on to the residential treatment portion of their stay at the clinic in Quebec.
Desmond checked into the clinic in May 2016 as his mental state was spiralling downward.
Ouellete diagnosed him with severe/chronic post traumatic stress disorder related to his front-line service in Afghanistan, major depressive disorder, alcoholism (in recent remission) and personality traits with mixed features.
That latter diagnosis is as much a characterization of personality traits that impede a patient's ability to function healthily. In Lionel Desmond's case, the particular trait causing problems was paranoia.
“In a normal person the personality helps him to adapt to stressors,” explained Ouellette.
“When you have a person with personality traits, it means they are more rigid, they adapt less well to stressors.”
Desmond would get “very angry” with Ouellette when the psychiatrist tried to convince him to take medication.
Ouellette considered the medication to be necessary if Desmond was to achieve the emotional stability to begin working on his complex underlying conditions.
Desmond's paranoia also extended to his wife, of whom he indulged delusions of infidelity.
He also attached anger to her in relation to money – he had cosigned for her student loan to attend nursing school and believed he would be stuck with the bill if they divorced.
Ouellete and Desmond would never get beyond these hurdles.
Without the aid of medication, Desmond did partially stabilize – his nightmares and depressive symptoms decreased, and he started talking with other residents, playing sports and music.
And so the decision was made to transfer him to the next stage of residential treatement with the hope that he could benefit from group therapy sessions.
At this stage, Ouellette's role in Desmond's care ended.
In the residential treatment program at St. Anne's, Desmond had access to peer support, psychologists, psychiatrists, occupational therapists, social workers and nursing staff.
Some of these staff members will testify in the coming days.
Desmond checked out three months early in August 2016, claiming to be feeling better, and he headed to Upper Big Tracadie to move in with his wife and daughter. Desmond hadn't lived with them for some time.
There, he had none of the same support lined up as he had experienced in St. Anne's.
Three months later, he would show up at the emergency room at St. Martha's Regional Hospital in Antigonish in crisis.
As the psychiatric staff there tried to get a handle on his condition, without the aid of his medical records from the military or St. Anne's, on Jan. 3, 2017, Desmond killed Shanna, Aaliyah, Brenda and then himself.