The combined testimony of the mental health clinicians who saw Lionel Desmond reveals the fluctuating nature of mental illness — how the veteran who killed his family and himself changed over the years from a patient reportedly willing to take medication and engage in processing the trauma he witnessed in Afghanistan.
Dr. Isabelle Gagnon, a psychologist at Ste. Anne's Hospital in Quebec, first saw Desmond at an in-patient program for veterans with post-traumatic stress disorder (PTSD) in May 2016. She described him as a patient with borderline personality traits, including paranoia and a poor ability to trust others, who made only minor progress in his therapy.
She agreed with Desmond's previous clinicians, however, in saying that she saw no warning signs of the violence to come.
Gagnon testified that even after learning that Desmond had killed his wife, Shanna, his daughter, Aaliyah, his mother, Brenda, and then himself at a home in Guysborough County, N.S., on Jan. 3, 2017, it didn't change the way she does safety assessments.
Instead, she testified Wednesday that Desmond seemed focused on the stress in his everyday life: having to sell his home, finding a job after leaving the military and becoming a "good husband and father."
The CBC's Laura Fraser liveblogged the inquiry:
She noted that while he kept repeating these goals, he would sometimes struggle to explain what they would look like in practical terms.
He was rarely willing to discuss the traumatic events that had affected him, she said, nor was he willing to consider how they might be affecting his reaction to every day stress.
"He would say that he had to focus on the future, not on the past," Gagnon said.
Resistance to medication
Testimony on Tuesday from Dr. Robert Ouellette, a psychiatrist at Ste. Anne's Hospital, also revealed Desmond's resistance to taking or changing medication. Ouellette testified that he felt the veteran's progress might stagnate without the right doses.
Gagnon and Ouellette's testimony sounded very different than that of Dr. Vinod Joshi and Dr. Wendy Rogers, both of whom worked with Desmond from 2011 to 2015 at Canadian Forces Base Gagetown in New Brunswick.
It was there that Desmond first sought treatment for symptoms that Joshi would diagnose as complex PTSD and major depression, roughly four years after he returned from Afghanistan in 2007.
Both Joshi and Rogers testified that their patient was someone who complied with the goals of treatment; he successfully completely prolonged exposure therapy with Rogers, retelling the trauma he'd witnessed until he could manage the distress it provoked, she testified.
Desmond struggled to trust
It's unclear what changed in terms of compliance with medication or Desmond's willingness to retell that trauma, though Gagnon noted it can also take time to develop a therapeutic relationship.
She said that Desmond struggled to trust people, often believing that if others were laughing, it was directed at him.
Desmond chose to leave Ste. Anne's in-patient program early, on Aug. 15, 2016. He reportedly left because he wanted to spend time with his 10-year-old daughter, Aaliyah, before she began school in Nova Scotia.
In his release report, the clinicians at Ste. Anne's noted Desmond had made only "minor progress" during his time there, and that he needed ongoing therapy within the community. They also recommended that he undergo neurological testing to see if he had a brain injury from the head injuries he'd reportedly sustained during his military service.
Instead, he went months without seeing a therapist.
It wasn't until he was in crisis and went to the emergency room in Antigonish, N.S., that he would meet with a psychiatrist in late October 2016. In late November, his Veterans Affairs case manager connected him with a community therapist, according to evidence already presented at the inquiry.
The inquiry is charged with making recommendations to prevent future deaths.
It is also charged with examining whether Desmond had access to the necessary mental health care, and whether his family had access to domestic violence intervention.