Competence and Compassion in the Reiner Family Tragedy

PSYCHIATRIC VIEWS ON THE DAILY NEWS

“It’s inconceivable.”

—The Princess Bride

I have written scores of eulogies for Psychiatric Times about psychiatrists and, on rare occasions, individuals outside of our field. I’ve been wondering for days: Should Rob and Michele Reiner be such an exception? On the one hand, such coverage seemed unnecessary given all the media coverage of their lives. On the other hand, they had quite an impact.

Live many others, The Princess Bride was my favorite movie of his. I cheered the scene where actor Mandy Patinkin, after being stabbed by the villain, repeatedly says, “My name is Inigo Montoya. You killed my father, prepare to die,” until Patinkin’s Montoya finally kills the villain. That scene feels twisted now, almost inconceivable because Rob Reiner, the father, died at the hands of one of his sons.

Patricide, though, is all too conceivable. The psychodynamic Oedipal point of view would say that there is a universal desire for patricide, the deliberate killing of the competition for the mother, which being the father. There’s also parricide, which includes the killing of either or both parents. Grandparents are not immune, either, to such violence. Although the commandment to “Honor Thy Parents” may help keep the fantasy in check, unfortunately, it seems to turn into action more than most of us imagine, and generally by a son. Parricide accounts for about 1% to 2% of all homicides. The 3 most common causes are revenge for childhood abuse; severe mental illness with command hallucinations; and sociopathy.¹

Parricide accounts for about 1% to 2% of all homicides. The 3 most common causes are revenge for childhood abuse; severe mental illness with command hallucinations; and sociopathy.¹

Even if parricide is conceivable, how can we discuss it publicly in and beyond this case? There is our ethical “Goldwater Rule” to consider, which basically tries to prohibit using any of our psychiatric knowledge to publicly comment on any living public figure. Although the Goldwater Rule is usually thought of in regard to politicians, it is also pertinent to entertainers in the public sphere like Rob Reiner. Similarly, it does not apply to the deceased, but respectfully, some of the nuclear family are still alive and in the news as a result of this recent tragedy. This raw news needs some distance for objective analysis.

Much has been said about the ongoing substance abuse treatment of the son and considered perpetrator, Nick Reiner. Nick was the middle child of Rob and Michele, and it appears that the substance abuse turned the common helping role of the middle child upside down. Yet, having multiple residential treatments is not rare. What about the possibility that he took something unusual that precipitated such an attack? Could there be a separate major psychiatric disorder, possibly hearing a command hallucination? What were the parents thinking and doing as the crisis erupted? Were the parents warned of the risks? Will we ever truly know what happened in that house during the time of the murders?

In reading so much about the family history involving Nick, it seemed notable that Rob said that he and Michele stopped listening to the clinicians and more to Nick, as all felt that the clinicians didn’t seem to be helping enough. That was part of the discussion about the 2015 movie Being Charlie, a collaboration of Nick and Rob Reiner based on the life of Nick up to that time. Ah, that grabbed me as it usually does, the question of competent care in all of its considerations. That should be what I should focus on, I finally thought as I deliberated this piece.

We haven’t yet heard any of the details about the treatment of Nick and his parents. We don’t even know if he was in treatment recently. Can you imagine what any of the therapists involved over so many years must now feel? The shame? The guilt?

I knew the psychiatrist in Milwaukee who treated the serial killer Jeffrey Dahmer before his arrest. He was devastated to find out what Dahmer did, and he seemed to disappear from clinical work thereafter.

I felt ashamed and guilty after my first and only patient who died by suicide. It happened during my psychiatric residency. I thought that perhaps I wasn’t cut out to be a psychiatrist, but compassionate faculty took some of the blame and I was able to move on with some post traumatic growth.

Certainly, we fall short in terms of treatment, not infrequently, and quality improvement has to be an ongoing process. Although some of such failures are inevitable, they provide a controversial opening for for-profit managed care to control and manage psychiatric care.²

Perhaps someday a psychological autopsy will help us understand this tragedy, but it is doubtful it will occur. It may be too impractical with such a public case. Even so, there should come another opportunity for public education, sort of carrying on what Rob Reiner was doing himself, about risks and relationships relating to substance abuse problems.

As is usual when looking for blame and a scapegoat in such tragedies, loved ones may well be considered. Certainly, Hanukkah this year for the living loved ones will be full of darkness as the darkest day of the year arrives. May the increasing light starting on the Winter Solstice herald some beginning of healing.

The clinicians involved over the years are also a likely target, wrongly or rightly. If so, they will need all the empathy and compassion we colleagues can give them. After patient needs, colleagues and ourselves are among our secondary ethical priorities. As the saying goes:

“There but for the grace of God go I.”

Dr Moffic is an award-winning psychiatrist who specialized in the cultural and ethical aspects of psychiatry and is now in retirement and retirement as a private pro bono community psychiatrist. A prolific writer and speaker, he has done a weekday column titled “Psychiatric Views on the Daily News” and a weekly video, “Psychiatry & Society,” since the COVID-19 pandemic emerged. He was chosen to receive the 2024 Abraham Halpern Humanitarian Award from the American Association for Social Psychiatry. Previously, he received the Administrative Award in 2016 from the American Psychiatric Association, the one-time designation of being a Hero of Public Psychiatry from the Speaker of the Assembly of the APA in 2002, and the Exemplary Psychiatrist Award from the National Alliance for the Mentally Ill in 1991. He presented the third Rabbi Jeffrey B. Stiffman lecture at Congregation Shaare Emeth in St. Louis on Sunday, May 19, 2024. He is an advocate and activist for mental health issues related to climate instability, physician burnout, and xenophobia. He is now editing the final book in a 4-volume series on religions and psychiatry for Springer: Islamophobia, anti-Semitism, Christianity, and now The Eastern Religions, and Spirituality. He serves on the Editorial Board of Psychiatric Times.

References

1. Heide KM. Understanding Parricide: When Sons and Daughters Kill Parents. Oxford University Press, 2012.

2. Moffic HS. The Ethical Way: Challenges and Solutions for Managed Behavioral Healthcare. Jossey-Bass, 1997.