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  • Writer's pictureJames W

Sitting behind a Mass Murderer in school.


Yup. You read that correctly. I reflect on my collegiate years and discuss the butterfly effect of our choices, decisions and habits - whether intentional or unintentional. I end my discussion with treatment modalities in Schizophrenia.

 

I wanna go to college for the rest of my life.


Chauncey and James, Day 1 of College, 2007


My mom took the long trek with me from the Bay Area down to Los Angeles - which is roughly a six hour drive with endless view of unexciting dry land, farm and cattle. After unloading my bags, I hugged my mom and decided to begin unwinding. My roommate happened to be Chauncey, a friend from high school.


(Funny story on how Chauncey and I met: I just moved to San Jose and my mom took me to the library. My mom went up to Chauncey and said I needed a friend. Both of us were chatting in the comic section of the public library!)


I felt relieved and comfortable knowing a familiar face in a foreign environment. Naturally, my extroverted-ness took over and I met a ton of cool people! We would be roommates in our cramped and cold brick looking dorm room together. I will cherish the many memories of popping out the screen window and sitting out on the patio ledge. I am glad the Residential Advisor never caught us! Chauncey and I went out later that night and went to our first college party. To summarize it: Insane!


There were at least 1000+ people packed into a two-story house that overcrowded onto the main street of campus. You could be outside, look up and see two police helicopters shining their spotlights on the backyard. The police would use a loud microphone to ask people to leave and disperse; the attempt was unfruitful as the night passed. Jungle Juice seemed to be the popular beverage of choice for everyone that night. It felt like a scene out of the movie 'Project X' or Asher Roth's music video 'I Love College'. Asher Roth's song was very popular during my freshman and sophomore year. Only second to "Superman" by Soulja Boy.



 

I chose my major by throwing a dart on the wall


I felt clueless in picking a major to study, when I arrived in college. It seemed that everyone had an interest in something but I decided to gravitate towards science. I perused the semester catalog and couldn't decide what to pick. As ridiculous as it sounds, I had a push pin board on my wall. I decided to hang the class catalog on the wall and my dart landed on Neuroscience. I thought to myself Neuroscience sounds cool and somewhat sexy. How cool is it to say you studied Neuroscience! Well it sounds cooler than saying you studied boring ol' biology! (At least this is what I thought in my head). I still to this day, do not know how to apply my Neuroscience degree to my career.

I shaved my head freshman year.


A funny story I must mention about the pin board in my dorm room. My roommate would have Playboy magazines and hang pictures on the push pin board. While I was away from campus, a student tour group visited the dorm rooms to prospective students and decided to tour our dorm room. My roommate Chauncey was in the room, playing Counter-Strike (A first person shooter game) with his headphones on. Unbeknownst to the controversy, he could hear snickering and jeering from the prospective students and their parents. Chauncey and I laugh at this story.


 

Studying makes your brain wrinklier



Philosophers in the 1800s theorized that intelligence could be measured by the size of your brain, or what would call 'Brain Mass'. The way this was measured was done by pebbles being placed in a skull. If a skull could fill more pebbles, it would be extrapolated that this person was much smarter than other individuals. This practice was applied between many ethnical, social-economic and religious backgrounds as a deterministic practice of hierarchy. Given the patriarchal nature of society during this era, the question arose if women were smarter than men. The great debate alas! The pebble brain study was applied. Here's what happened. Hundreds of female skulls were compared to male skulls. Pebble for pebble. Rock for rock. The practice of measuring brain mass with pebbles to correlate intelligence quickly disappeared overnight. How ironic!


As the years passed, the classes for Neuroscience gradually became more difficult. I definitely wrinkled my brain more than necessary with the late night projects and lab experiments we had to undertake. Specifically - we had to place a canula on a live rat and administer various neurotransmitters like dopamine, acetylcholine, gaba and serotonin to observe how our rat would react. A canula can be viewed as a hollow tube. You would have to remove a section of the rat's top skull and insert the canula gently. To prevent the canula from falling out, you would need to bond the canula to the skull/skin. We crudely used superglue, if memory serves correctly. The syringe would have a liquid variation of a neurotransmitter, chemical or drug. You would place the tip of the syringe trough the tube and press down on the plunger to administer said neurotransmitters. The effects were almost immediate. On the other side of the laboratory room, I remember a girl fainted in the middle of the class experiment! The rat would be placed to sleep at the end of the experiment. It felt cruel but it was a right of passage to major in Neuroscience. It was a difficult experiment to stomach and, I quickly realized animal experimentation might not be an avenue for me to pursue in my future endeavors.

does anyone else remember these clickers?

 

Meeting the Joker, face to face


There were very few students in the upper division class for Neuroscience. In fact there were only thirty students. Most upper division classes have 200 to 300 students. The neuro classes became much more intimate in nature. Everyone was memorable and had their own quirks. There as clearly an out of place male in our class that seemed to be in his 50s. He had a wealth of information on relationships and the construction business. My guess was he was going through a career change. There was a bulkier black male in our class as well that struggled to walk to lecture if there were stairs involved. He would sit up in the front, two rows in front of me. When he spoke, it was the most eloquent dialog you could hear. He was very well versed and articulate with the functions of the brain and dopamine pathways.


Everyone in Neuroscience seemed to be pretty normal for the most part. I would have general discussions like, "Hey the weather is nice!" or "How did you feel about the HEAT concert last weekend?"


To give you a sense how students were closely acquainted in these upper division neuroscience classes, we would be crammed in a small room with not enough chairs; it was difficult to have a side conversation without someone on the opposite end of the room being able to hear it. Some of us had to stand or possibly listen from outside the room door. In fact, one professor actually threw a students laptop out of the second story window because he got pissed off from being interrupted by a side conversation! The look on the students face was hilarious, in retrospect.


There was a fellow colleague who I sat in front of me during our neuro lectures. My leg would sometimes shake and rattle the back of his chair. I am sure it annoyed him. I couldn't help my habit! I don't shake my leg anymore while I sit. (There is a superstition that shaking your leg is equivalent to losing money). Naturally we spoke and discussed about life. It was funny too, he had the same name as me - James! He had short curly black hair. I knew him as a quiet individual but understood his brilliance. He was the one that always got perfect marks on the exams while the rest of us prayed for a beautiful bell curve grading system. Holmes and I would make small talk here and there throughout class. I never bumped into him in passing or the cafeteria commons.


James rented a house with a few of my other friends across the Chancellor's house. I lived the next door over from James. Both houses (mine and James's roommates) would throw massive parties every Friday, but James seemed to never wanted to participate and stayed in. Thankfully the Chancellor did not care about the partying shenanigans! I figured James might just be introverted and wanted to spend time by himself. Nothing wrong with being introverted! James Holmes would graduate a year before me, magnum cum laude. This is one of the highest academic honors you can graduate with. James Holmes and I did not keep in touch after school. For me, the semesters went by and suddenly I found myself walking across the auditorium stage with a diploma in hand. Time sure flies when you're having fun in college! Queue the fallout of knowing James Holmes.


James Holmes sat in front of me in upperdiv neuroscience classes


 

The FBI called me. I freaked out.


Hungover in Las Vegas, sometime in 2010

I was nursing a wicked hangover laying in bed. It was probably 11, 12 or 1 in the afternoon. Who knows, it might have been 3pm. My buddies and I were in agonizing pain from the debauchery of last night in Las Vegas. There was UFC fight that my friends wanted to watch and gamble on. in the afternoon. We decided to stay in and relax.


My cell phone rang loudly. The tinnitus from last night's club music didn't help. My ring tone is an excerpt from Common's song - "The Light." It went something like this: "There are times when you'll need someone. I will be by your side. there is a light that shinessssss (extra emphasis here), special for you and me." (Sorry Chauncey, I know you hate this song now! Haha!)


I normally do not pick up calls from numbers I do not know, but some gut feeling told me to pick up. Maybe it was someone you met last night that needed help? Or maybe it was mom and dad calling to check up? Nah. If it's important then they'll leave a voicemail or message. I screened the call and shortly after received this text message.


Holy Shit!


Me: "Hello?"

Agent: "Hi this is agent XXXXX from the Federal Bureau of Investigation"

Me: "Uhh.... (long pause) ........... What?"


Right about this time, my head was spinning. I wanted to throw up. The AMF from last night was not sitting well in my stomach. My mind circled. Anxiety was creeping in. What was this about? Mind you, my friends and I just took a shot of vodka right before this call happened. Because, it's Vegas and we're in our early twenties here.


Agent: "We were going through the class roster and noticed you were roommates with James Holmes"

Me: "Yes that's right. I haven't talked to him in a while. Did he do something? What's up?"

Agent: "Mr Holmes is the primary suspect of a Mass Shooting incident in Aurora, Colorado. What can you tell me about him?"


I didn't have anything memorable or negative to say about James other than the story above. The conversation was short. My words were not slurred thankfully. Following my discussion with the FBI, I would receive a call from NBC and ABC asking similar questions. It turns out someone leaked the class roster. "Oof!" I turned on the tv and searched the news on my phone to find out a lot of people went to see the Batman movie premier in Aurora, Colorado. The alcohol from the shot was starting to settle in. I turned on the TV and saw James, who dressed up as the Joker and did the unspeakable. It is pretty nuts to see that he dyed his hair orange. I tried to research a little bit more about James and discovered he was attending a prestigious graduate program at the University of Colorado. It was such a shame to see such brilliance turn into something destructive. This was a huge buzz kill of my trip.


What was crazy to me was the pictures they took inside James Holmes apartment. He tried to booby trap his apartment with the intention to harm someone who would enter. It seemed so chaotic in placement considering he presented himself as normal for the most part in College. I do not recall him having a messy room either.


Holmes left behind a manifesto; I took the time to read it and wanted to understand his thought process and why he did, what he did. To be clear, I am not praising him; I think his actions are terrible. My heart hurts knowing the family and friends he affected by taking many lives away. I won't link the manifesto but you can search it on Google. I do cut out a few excerpts for a discussion on Pharmaceutical Modalities in the treatment of Schizophrenia down below. His manifesto can be characterized as methodical, delusional and paranoid. He goes to the extent of self diagnosing himself by writing out personal symptoms he is dealing with, his treatment progress and ends with a disturbing planned attack layout of the theater.


Victims of July 10, 2019, a few pictures of James Holmes apartment, selected pages of Holmes Manifesto



 

Throw a ball to the moon. The slightest touch will set it off course.


For imagination purposes, let's say the Earth has no gravity. Imagine taking a tennis ball and throwing it towards the moon. This tennis ball can represent an idea, an action, or an emotion. As you wind your arm up, extend your arm and release the tennis ball from your hand, your fingers will have a slightly push or pressure applied to it. This ever so slight touch may alter the course so slightly and affect the intended

trajectory towards the moon. (Remember this example does not take into account gravity!)


Michael and James, somewhere in Las Vegas 2010

Chaos theory states that a non-linear dynamical system that are seemingly random are actually deterministic from much simpler equations. In chaos theory, the butterfly effect is the sensitive dependence on initial conditions in which a small change in one state of a deterministic non linear system and result in a large difference in a later state. What does this mean? A slight change to your choices, behavior or options can place you in a different environment or alternate reality. Well I contemplate below.



I often wonder, what would have happened if this mass shooting occurred on campus? What if I treated others different, like an asshole? How different would my life be if Holmes had a break at school? Perhaps in the classes we attended together? Or what if I was in Colorado visiting a friend and we decided on a movie night? Would I have met the people who have influenced my decisions today if I didn't join school social clubs?


I further speculate what would life be like if I went to a different college instead of UC Riverside. Would I have met the wonderful people I know today? Would I have met the love of my life? Would I have chose an entirely different career? What if I purchased bitcoin and HODL'd in 2011 (haha! wishful thinking!)


I realized the importance of compassion and empathy. We don't know what people are going through in life. It's hard to tell! This helped me formulate my principals of Quality Time and Seeking Inner Harmony.


Holmes would be evaluated by multiple psychiatrists who would later diagnose Holmes with schizoaffective disorder and schizotypal personality. We discuss this below.


 

Pharmaceutical Treatment Modalities in Schizophrenia Disorders

I know those are big words. Pharmaceutical is drugs. Modalities is doctor speak for different treatment options. Schizophrenia is a mental disorder that has many classifications. Here are some of the many related disorders as it relates to Schizophrenia:


  • Schizotypal personality disorder. A person with schizotypal personality disorder has a difficult time developing close relationships with other people and may hold beliefs not shared by other people in his or her same culture. The person may also have unusual behaviors and learning difficulties.

  • Schizoid personality disorder. A person with schizoid personality disorder is aloof from other people and does not show many emotions.

  • Delusional disorder. People with delusional disorder believe things that could happen but are unlikely to happen. For example, a person with delusional disorder may believe he or she has cancer despite several negative test results. The person has no other psychotic symptoms, except those related to the delusion. But he or she is able to function in daily life.

  • Schizoaffective disorder. People with schizoaffective disorder have the same symptoms as people with schizophrenia. But they also have episodes of depression and times when they feel extremely happy or have lots of energy (mania). For more information, see the topics Depression and Bipolar Disorder.

  • Schizophreniform disorder. People with schizophreniform disorder have the same symptoms as people with schizophrenia. But their illness episodes do not last as long (from 1 to 6 months), and they may not have as many problems getting along with other people.


CREDIT E. Onwordi at MRC London Institute of Medical Sciences (LMS)
PET brain scans showing that 18 healthy volunteers (right) have on average higher levels (shown by yellow-red) of synapse marker protein SV2A than 18 participants with schizophrenia (left). CREDIT goes to E. Onwordi at MRC London Institute of Medical Sciences (LMS)

It is estimated that schizophrenia affects 1% of the American Population which is roughly 2.6 million people. It is theorized that dopamine fluctuations and imbalances cause Schizophrenia. There are theories of why people develop schizophrenia ranging from genetics to fluctuating cortisol levels during pregnancy to physical environmental factors. It [Schizophrenia] typically occurs in the early 20s for men and late 20s to early 30s in women. It is rare to see schizophrenia develop earlier or later with respect to the age range listed in the prior sentence. For those do develop schizophrenia later in life, it is considered "Late-Onset Schizophrenia" and it is believed environmental triggers have played a larger role. To note, there are many high functioning individuals who live well with schizophrenia. I had a few patients that worked in tech, banking and sales, to name a few.


Schizophrenia typically presents POSITIVE or NEGATIVE symptoms.


Positive Symptoms are typically hallucinations (can be auditory, visual, olfactory meaning smell or taste, or tactile meaning sense of physical touch) delusions (possessed by demon, they are world famous athlete, or someone's out to get them), confused thoughts and disorganization speech, trouble concentrating and movement disorders.


Negative symptoms present differently from positive symptoms which can be characterized by lack of pleasure, trouble with speech (alogia, meaning not wanting to talk or show feelings), withdrawal, struggling to perform daily tasks like showering, brushing teeth, and lacking follow-through (sticking to a routine, schedule or life cycle).


The media (shows and movies) typically misrepresents those with schizophrenia. This can affect how people see those with Mental Health issues in a negative way. Schizophrenics are often stereotyped as a homicidal maniacs, possibly extraordinary genius or creativity, that experience visual hallucinations arising from dysfunctional parenting. These stereotyped characters, in movies, may undergo a grossly archaic treatments such as electroconvulsive therapy, catharsis. These could not be further from the truth. (On a side note, I will do a write up in the future on the history of psychiatric treatments modalities because there was a period of time when ECT, catharsis and lobotomies were popular) Back to the discussion on hand regarding stereotypes, most diagnosed with Schizophrenia are not violent. Auditory hallucinations is the most common Positive Symptom. Visual hallucinations are much more rare, but they do happen. Most with schizophrenia have diminished cognitive abilities so it is difficult to say it is linked with extraordinary genius or creativity. Dysfunctional families does not equate to having a child develop schizophrenia. The use of oral antipsychotics is the first line treatment of Schizophrenia, not lobotomies or ECT. In short, negative information and misrepresentation portrayals of schizophrenia underscores how viewers create beliefs around people with schizophrenia.


American Psycho featuring Christian Bale

So now that we have a general understanding of what schizophrenia is, what are the proper treatment options in America?


Notice I stated America. Every country has different approaches. Ultimately, we would prescribe an Antipsychotic medication. The name of the drug is pejorative and sucks and I would prefer to describe them in doctor-speak as "Dopamine 2 Antagonists" In reality, these pills touch more than the Dopamine 2 receptors but for the layman reading this article, just know that medications affect a lot more than just one specific cellular receptor at times.


Drug Treatments


These Dopamine 2 (D2) Antagonists are broken down between 1st Generation ( also known as Typical) and 2nd Generation ( also known as Atypical). No surprise here, its based on the era of when these medications were released and came to market.


There's so many drugs to choose from!

While each medication has slightly different nuances, I point to five antipsychotics that are noteworthy champions in treating schizophrenia. Don't worry, I will explain these in layman terms and you will be able to go back and understand drugs are incredibly nuanced and specific.


Chlorpromazine (Thorazine) - This drug was one of the first antipsychotics that was released onto the market. They come in tablet form and can not be cut. This is also used to treat nausea and vomiting due to surgery or possibly chemotherapy.

Haloperidol (Haldol) - Probably the first line drug if you are admitted into the hospital. It is heavily sedating. The maximum dose is 100mg/day however that is never ever used in practice. We see doses around 1 to 5mg daily. Anything higher and our patient may experience eps/tardive dyskensia. I have seen this used for "Bat Shit Crazy" patients.

Clozapine (Clozaril) - Very effective medication. Probably the best. Only issue is that it requires blood draws which begin weekly. Can be sedating and cause weight gain.

Risperidone (Risperdal) - One of the first atypical antipsychotics to be released in injectable form. This was a game changer in pharmaceutical treatment modalities since it eliminated the need to take oral mediations daily. A lot of our schizophrenic patients are "non compliant" and sometimes miss oral doses.

Quetiapine (Seroquel) - We see this used for a myriad of reasons. Including sleep. It's the preferred antipsychotic to use when someone has dementia or parkinson's.

Aripiprazole (Abilify) - This actually is a partial agonist at the Dopamine 2 receptor. One of the first. Also used to treat Bipolar Disorder. Not for everyone and can exacerbate risky behavior like gambling or unprotected sex.


The discussions and nuances can get much deeper but I would rather discuss the merits of each medication in a one-on-one session. Everyone is different. Pharmaceutical treatments need to be tailored to the individual.



 

Why should you care about Mental Health?


It's estimated that 13% of the world has mental health or substance use disorders. It is very likely you will know someone with unmet mental health needs. Most people do not receive treatment. Every year close to three million people die due to substance abuse. Mental Health is blind to a socio-economic, racial, or religious status. Depression is more common than ever. In fact, Rhode Island has the highest rate of depression while Hawaii has the lowest.


More related to business, as a business owner you are asking someone to spend one-third (1/3) of their life to work. The two-thirds is sleep (1/3) and personal time (1/3). As an entrepreneur, your work life is probably even more than one-third! It is important we strive to offer the best working environment with the proper mental health support to keep our staff, employees and contractors happy. How shitty does it feel to come home after a long exhausting day of work and to mentally prepare yourself for another day?


 

Here's How I Can Help You


I understand the importance of compassion and empathy. People problems are the most difficult things to solve. Different motivations require customized solutions. My experience as a Pharmacist working in Psychiatry/Mental Health provides valuable insight and comfort to Entrepreneurs during any business phase when things get difficult. I listen and I understand what you are going through. If you are interested in doing a depression and anxiety questionnaire (PHQ-4 or GAD-2), we could walk through it together.


the pharmacy club at ucr, 2010

 

Takeaways and the tldr


I went to college with James Holmes, the mass murderer who dressed up as the Joker and killed innocent people in a movie theater in Aurora, Colorado. Schizophrenia is one of the many mental health disorders that needs careful medical attention and support. Not everyone with schizophrenia is violent. The bigger picture here is to note that everyone is going through personal challenges and it is okay to reach out for help. We all seek inner harmony in our path through life.








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