B (2:58)

It is and I think it's so complicated in terms of not only trying to understand what mental illness is like in general, but then when you have a family member and you have those relationships and their personalities and then you have perhaps substance abuse and then you have mental illness, I think it can be so confusing even for family members to try to figure out what is this, is this a conflict we're having like a regular family conflict? Is this, is this person high or, you know, or is this person experiencing a mental health symptom? Is this person psychotic? And I think that can be so confusing and I think that's certainly at play here for the rest of us who were, have been following this story since it happened, is trying to figure out, you know, what happened and what, what caused it.

A (3:45)

Well, and you know, I want to kind of jump off with like this. We hear from Jake Reiner, the brother of Nick Reine Robin Michelle's son. Jake writes this unbelievably beautiful piece on Substack talking about his parents murder. When you read something like that, is this something that you would suggest, is this particularly helpful for, for a son of a, such a celebrity to be able to get his feelings out?

B (4:16)

If this was somebody I had in therapy, you know, we, we would certainly talk through, you know, where, where, where that desire was coming from. You know, what was the inspiration for that, what was the goal for that, you know, kind of the pros and cons and that kind of thing. But ultimately I think, you know, we perhaps don't give each other enough space to navigate grief in the way that we need, that other person needs to, even if it's not the way we might want to do that.

A (4:44)

I did notice like when, when you're reading through it, that he does not name his brother Nick, who is, who's the suspect in these murders or even address him as being a suspect. What do you, what do you think about that?

B (5:03)

You know, probably, I'm sure reflects, I'm sure I, I'm absolutely sure it was an intentional, you know, act on his, on his own part. And I think, you know, I have worked quite a bit with families who've had murder suicides in their families and obviously this is not an example of that. But I think the parallel is when you have victims and perpetrators in the same family. And I think that just, it's just mind boggling even to begin to put our heads around how you navigate that not Only in terms of those relationships as siblings, but also just in terms of what the sibling has taken away from you. And yet the memories you have with the sibling, it's gotta be so complicated. So it. It's not surprising to me, in a way, but he's wanting to focus on his parents and the love he had for them, the legacy they left him, how wonderful they were as parents, the loss that he's feeling, as opposed to focusing on, you know, his brother and naming his brother and, you know, that may come in time.

A (6:06)

Yeah. So it's kind of like he can just separate out right now. Like, he. He made it very clear at the top. He said, my goal in writing this piece is to offer some insight not only to what I lost, but also to celebrate my parents and what they meant to me. And I thought that kind. He did that. That was his goal in the writing. And. And that's exactly what came across. It's just. He's not negating the fact that he has a brother. Maybe that's just. That part of it is just. That's not part of this story.

B (6:36)

Well, and I also think, you know, one of the things, whenever there's. When somebody is murdered, I think for. For family members, oftentimes there is this pushback on. I don't want my loved one to be remembered for how they died. And that is such a focus. Obvious, understandably, in a way, at the time, because it's shocking and it's horrific and it's upsetting, and people are trying to figure out why. And so the headlines become, for, you know, a long period of time, oh, this person was murdered, and it's a violent murder. And here's the, you know, the autopsy report or whatever. And so I think there was a pushback from him on that, which I think is great, which is, look, this is a legacy my parents have left us. How wonderful they were. Let me make sure that, you know, what all I've lost from both of my parents and what I got from them, what they left behind for me. I thought that was very touching.

A (7:28)

One thing that we were looking at, you know, is when he. When Jake talked about his parents, he talked about the unconditional love. And I think that is something for. For just folks to understand, like when. When. When the viewers are listening and we're, you know, reading this. These parts of the letters, of how he. He believed they had unconditional love. How is it that a son can end up murdering allegedly his parents, who have, by all accounts, given everything they possibly can in this scenario, is there a way for us to wrap our

B (8:05)

heads around that, you know, on an emotional level? Perhaps not, because it's just so horrible and so heartbreaking. I think, kind of stepping back from it, obviously I've never met Nick Reiner, and I'm not diagnosing him. I do know that he seems to carry a diagnosis of schizophrenia. He was put under conservatorship, I believe, in 2020. And I think what that tells me is this is not just about drug use. I mean, in California, conservatorship is a pretty high bar. I mean, it's basically saying this person is what we call kind of gravely disabled. They're not able to really even take care of themselves. And that almost always happens when somebody either has a severe intellectual disability and they're not able to do that, or they have a severe mental health disorder. So it sounds like I know from some of the information that's been released that he was, I think, had a dual diagnosis. And that makes sense to me. And about 50% of people with schizophrenia will also develop a substance abuse problem in their lifetime. It's oftentimes a child, an attempt to self medicate. And so I'm saying all that because it has nothing to do with his parents in terms of their relationship necessarily. You know, if, you know, if these diagnoses are accurate. And, you know, watching some of the body language that we've seen, not just in terms of since this has happened, but historically, it very much is consistent with many individuals I've worked with who have schizophrenia. There are certain signs that you often see in terms of their body language and lack of emotional expression and kind of appear. There's some of those things, again, I'm not diagnosing, but it. When I first saw his picture afterwards, not again related to this crime, but pictures of the family, he definitely stands out and looks different from his siblings, for example. So with this history, we also know, of course, that there are certain drugs that will exacerbate psychotic symptoms. So methamphetamines, for example, is the hallmark. I cannot tell you the hundreds of people I've seen in prison who have been doing meth. It does not cause violence, but it can certainly amp it up. I mean, it's a disinhibitor. So if you have somebody who has a severe mental illness and they're doing other drugs, and I'm not saying he was doing it at the time, but when you have this dual diagnosis, that in and of itself is like a. A recipe for disaster, Particularly if it's untreated and a person is not responsive. The other part of it, I think that's important to talk about is just how challenging it is for parents who have an adult child who has a severe mental health disorder. There are some characteristics of schizophrenia, for example, that make it so difficult to treat. One of them oftentimes being that people don't think they have it and. Or they start feeling better and they convince themselves over and over again, well, I'm feeling better. I don't need the medication anymore because I'm feeling better, as opposed to this is making me feel better. It's like there's so there's some certain parts of that illness that make it so challenging for families. And then, of course, there are all the legal hurdles that families have to go through. You can't just say, you need to be in the hospital. I'm putting you in the hospital. So it's just such a difficult journey for families to try to navigate.

A (11:19)

Well, and doesn't it all. I mean, from what I've read about it too, and once again, I'm not diagnosing Nick Reiner. But didn't schizophrenia isn't this commonly coming out in those early formative twenties?

B (11:32)

Yeah, we typically see the earliest signs of schizophrenia starting the, you know, late teens, early 20s. That's definitely the most common side. And it can be very challenging for families because, of course, we know that adolescence can be a very difficult and challenging time anyway. And so you'll oftentimes see this gradual kind of change in the person where they become less social, for example, and start exhibiting somewhat odd behavior. And then they'll have a. What we call a break when they'll lose touch with reality. They may start hearing voices, they may start having unusual beliefs. They may start pacing around or do all kinds of rituals. There's all kinds of things that go along with that. But yeah, that was. That is most likely when we are to see it, is in the late teens and early 20s.

A (12:17)

Well, and so, Dr. Johnson, when you're looking at a patient that has, you know, what we've learned about it, like you said, we're learning about Nick Reiner as he's going through these hearings. One of the things is that I'm, I'm curious about is, can these drugs alter the brain chemistry, causing some level of schizophrenia? Or does schizophrenia come first and then like, you're layering on this sort of fuel to the fire, which is a possible drug interaction?

B (12:49)

That's such a good question. And so there's two different parts of that that I think that I heard you say questions maybe one being, is it the chicken or the egg? What starts first? And you know, that can depend. Typically we'll see they're almost independent of each other to some extent. They can be. So you can start having a person can start having some unusual beliefs, or they can already be experimenting with drugs. And drugs aren't going to cause you to have schizophrenia, just like schizophrenia doesn't cause somebody to do drugs, although there's somebody's self medication part of it. So you have to kind of really look at that person's history to start teasing out which came first. And was the person exhibiting maybe bizarre behavior or thoughts or actions independently of any substance use. So you have to look at both of those things and that in some extent that's the same thing that you have to do in a particular incident. So one of the things I do a lot is when there's, for example, an insanity plea and there's somebody who has maybe also been using drugs, you have to try to figure out, okay, is this the drugs? Is this the, you know, is this the mental illness? I mean, sometimes it's both. But of course, juries look at those very, very differently. If you're voluntarily taking meth or heroin or whatever, then that's on you. If it's a severe mental illness, then it's a whole nother issue and a whole nother set of criteria to look for. So it can be very, very complicated when you have, you know, when you have these, these things going on. But, but, you know, I, I have to say my experience has been, and of course it may be the population that I tend to be seeing is that you have this severe mental illness that starts before, at least before heavy drug use. If somebody does enough math over years, you know, they can start having psychotic symptoms that can persist independently even when they aren't doing math. But that's over the years. And from everything we know about Nick Reiner that's been publicly made, he had a severe mental illness that was separate from his drug use but likely exacerbated. Right. By his drug use.

A (14:52)

Well, and we did hear rumblings, and I don't want to speculate, but I did, there were a lot of rumblings about prescription drugs that he was also dealing with. Because of course, if you're dealing with, with any severe mental illness, you're trying to control some of these symptoms. Right, with prescription drugs.

B (15:10)

Yes, yes.

A (15:11)

I guess as we go into these court hearings, as he's being accused of these murders. And is this something that they can blame the. The. The drugs, the prescription drugs that they're prescribing for the schizophrenia even?

B (15:26)

Well, and I think what. And tell me if this is. If this is correct. So it sounded to me like there's been some allegations that this medication change might have something to do with this exacerbation of symptoms. And we certainly know that, you know, psychiatric medications, unfortunately, for they've come well on the. On the. Plus, they've come light years from where they were 30, 40 years ago in terms of their effectiveness. There's oftentimes kind of a trial and error when it comes to psychiatric medication. And obviously, if you're trying different medications and you're adjusting doses, you can have behavior changes associated with that. So I can, you know, that might be something the defense tries to use and say during this medication adjustment period, he was less stable than he might have been if he was on this regimen. Now, it doesn't, you know, a medication change doesn't make you murder somebody. It doesn't make you become violent, necessarily. That's, I think, is a pretty big hurdle to climb over to say, you know, because it was targeted, it was somebody that he knew. I mean, I think you would have more success perhaps, with that. If you have somebody down the street, a random kind of. The person just kind of went out of control when they're on this medication and they did something that was bizarre in terms of they don't know this person, it was a random kind of attack. I mean, these are the kind of things I tend to see in those situations.

A (16:52)

In a case of a. Of a schizophrenic patient who would take some kind of heavy drug like a. Like a methamphetamine, something like that, you know, that is the kind of scenario, you know, if that's the case, can they still go towards an insanity plea? Do you know if insanity plea is going to be relevant in a case like that?

B (17:17)

I mean, I would imagine it's something that's going to be considered. You look at the situation, you kind of go, I mean, again, I don't want to pretend like I'm an attorney, because I'm certainly not. So I'm not going to say, okay, here are the legal options. However, I have done many, many insanity plea evaluations, and this is the kind of case that I would be called in to evaluate somebody for that. You have somebody who, you know, there's a lot of evidence, you know, against this person as the person who did This, I don't think there's a lot of questions about who did this, who committed this murder, you know, and then it becomes, okay, this is a person who has a pre existing history of mental illness. So that then, you know, nobody can say, oh, this person's making up. They have a mental illness and they did this. It's like, no, this is somebody who has a history of mental health treatment, a long history. He was actually put on a conservatorship at some point. So yeah, this is somebody. So yeah, I think this would be something. I would not be surprised if his defense attorney would want him to be evaluated. And, and that of course means not. The question is not going to be did this person have a mental illness? It's going to be did this person's mental illness at the time he committed this particular act. Right. Cause him to either, you know, to either not understand what he was doing was wrong or not be able to appreciate what he was doing was wrong. And that of course is what's going to be the. Probably the big question is did he appreciate at the time that what he was doing was wrong?

A (18:46)

And you know, when you talked about that conservativeship, that's, that's a, that's very important, isn't it? Because to be in that voluntary scenario where you're actually going to be treated for a mental illness, I mean, this was 2020. What requirements does it take to be put under such intense care so that conservatorship.

B (19:10)

And again, this is more of a legal question. So this is not a 5150 hold. So the 5150 hold would be this person's a danger to himself. He's a danger right now to himself or somebody else or he's gravely disabled. Conservatorship oftentimes. And again, this is not my area of expertise, it's more of a decision making function. In other words, we're putting the parents, we're putting this person in charge of Nick's everyday life, his, you know, because we don't think he's capable of making these everyday decisions, which is more of a, almost more like of a civil issue as opposed to a treatment issue.

A (19:49)

Okay, that's, that's really helpful. So as far as us understanding exactly what conditions he was in, you know, during that period, it, it just means that he wasn't able to make decisions for himself.

B (20:02)

Exactly. The courts have determined and it's on the, you know, it's really on the burden of the person who's petitioning for conservatorship. Meaning, you know, you have to, you have to have some pretty good evidence. You know, the courts are relatively, you know, concerned about taking away anybody's freedom or liberties.

A (20:22)

Right.

B (20:22)

So that the bar is going to be on the per. The person or the family who's saying, we believe that we need to have this conservatorship because this person is so impaired that they're not able to take care of themselves. So it's not an easy thing to do.

A (20:37)

And I don't know if you saw the video that was going around, like, after the, after these horrible murders when they were trying to find Nick Reiner and find out where he had gone. There's video that popped up and you, you know, you. And you heard that. That he had gone and gotten a drink at a gas station, that he was and was later arrested near usc. You know, as far as. What does that tell you about his mental state after the murders that he was able to do something like check into a hotel room, you know, go to a gas station. And again, he hasn't been found guilty of anything. You know, this is. He is not. These are just that he was. I'm just speaking about Nick and what we saw on. On camera. Really?

B (21:26)

Yeah. And those are such good observations because all of us are going to be looking at those actions in those videos. And I think, you know, it's going to be kind of common sense in a way to kind of go, well, he could do this and he could do this, and he left the scene and he went and went into a hotel. And that'll be all part of the evidence in terms of if there is some kind of mental health defense that's raised. That'll be part of the fat pattern. Right. So the jury will have to look at that and you'll have people explaining why this person, why he did this. So it's not so much. I mean, does it get. Does it tell us something? It does tell us something. It tells us he was able to drive, he was able to go get a drink, he was able to. To have some purposeful movement over to, you know, by USC where he was located. That's evidence. Does it mean that he was not psychotic? No, it doesn't necessarily mean that, but it, so it's evidence that he left. And I think I'm saying that because it's, it is going to be information, but it doesn't, you know, it doesn't. It isn't a smoking gun. I think that's what I'm trying to say. This isn't like, okay, look, he obviously knew what he was doing. He obviously did know enough, like I said. To do those kind of things.

A (22:32)

Yeah. To do things like buy a drink, get into a hotel room.

B (22:37)

Right. I mean, yeah. He wasn't walking down the street mumbling to himself after the fact, which would have been a different set of facts. So that will be part of the fact pattern. But I can tell you, you know, it will be important, I think, to look at the totality of the circumstances. I mean, I had a case that. That always comes to mind for me, where this young man had a serious mental illness and he had been diagnosed, you know, a few years before that. This is right after 9 11. And he was driving down the highway and he was hearing voices, and this voice told him that this guy who was driving next to him was a terrorist who was going down to the San Diego airport and he was going to basically hijack a plane. And so what did he do? He ran the guy off the road because he was going to be a hero. He was trying to prevent, you know, another 9 11. Right. So this is a person who's driving down the road. He was going somewhere purposefully. When he did that, he was going to. I don't know where he was going, but it wasn't to the San Diego airport. Before he heard this. He was here, heard this voice. So he was engaging in some purposeful behavior at the time that he heard this voice, you know, these voices telling him. So again, it is evidence, but it's not a smoking gun. It doesn't prove anything to us without having all the other information to take into account.

A (23:55)

And, you know, allegedly, like, if he, you know, left the scene of where these murders happened and he went to do this. So you're saying this doesn't. It probably doesn't help an insanity plea, but it doesn't. It doesn't necessarily negate it exactly.

B (24:17)

Just like, you know, what's come out about him having, you know, him acting bizarrely. Right. Allegedly at this party. He's telling people, are you famous? He gets to an argument or whatever. That can mean all different kinds of things. Right. It can mean he was angry at his parents and he was acting out. It could mean he was, you know, having psychotic symptoms and was just being bizarre. I mean, it could be all kind. So I'm saying you're right, it doesn't help that situation. But it doesn't, you know, without looking at the bigger picture in terms of, you know, what was he doing the entire day? What Was he doing the week before that? What was his mental state? I mean, all those other factors. It doesn't definitively tell us anything one way or the other.

A (24:56)

And I mean, as far as insanity, please go. And we don't know if that's what is going to be used yet. We will probably get more information soon, I would think. But, you know, the issue is, you know, they're incredibly hard to get through the system. Like, it's incredible, isn't it? Like, less than 1% actually succeed. Something like that. It's very, very, very low chances of succeeding.

B (25:22)

Very, very low. So less than 1% of all, you know, cases that go to trial attempt the insanity plea. And of those, about 25% actually succeed. So people know and the attorneys know how difficult those are. And I think it's for a couple of reasons. I think it's very confusing to try to wrap our heads around what does that even mean. And the burden is very high because, again, it's not just you have a severe health disorder or severe mental illness. It's got to be, you know, to the level of impairment that we're talking about. You know, it's. It's just a. It's very confusing. And also, there have been jurors who've come out and said, I really thought this person was psychotic, but I don't want them on the streets. Yeah. Because there's this myth still, I think, and it is a myth that people who are found not guilty by reason of insanity are going to just kind of walk out the door after the, you know, the trial is over, and they're going to go back to their lives, and everybody's like, well, I don't want this person in my neighborhood, so I'm going to vote guilty. Even if I think this person really, who, you know, was legally insane at the time, It's a very high burden of proof.

A (26:24)

Yeah.

B (26:24)

They.

A (26:24)

They have to be committed. Right. That. That's where they go. They're going to be committed to a mental facility if they are found guilty by reason of insanity.

B (26:33)

Oh, 100%. I mean, all the time. And then it becomes a matter of. Until they're no longer a danger. And, of course, I can tell you, as somebody who works in forensic hospitals on a regular basis, you know, people are pretty. You can imagine treatment providers are very conservative in making any assessment of that, because nobody wants the person to go out and. And, you know, reoffend. So it's. You're not gonna. You're not looking at a couple months stay in A hospital when you've committed something like this?

A (27:05)

No, we're. I mean, I look at the cases that I've. I've studied on this, and it, you know, you've seen some very high profile. Like John Hinckley Jr. Was released from prison, but that was literally, you know, after decades of being in an institution to treat his.

B (27:24)

A good example because, you know, there was such an outrage over him being found not guilty of reason of insanity that it really changed that landscape for those pleas that made it much more difficult after that. There's a couple. I think four states actually abolished the insanity plea in their state.

A (27:42)

Well, and I think, you know, the big hurdle here in my head is that the drugs, what they found in his system, if they found anything in their. In his system. You know, I think what you were alluding to earlier is that you had seen sort of these meth rages, the. The level of. Of destruction that can be caused by drugs on top of something like this. That is, to me, in my head, the biggest challenge for the defense.

B (28:14)

Yeah, I think that would be if there, if there actually is drugs on his system. I think that's going to be a very difficult one. I mean, it's not that you can't argue that the combination of the two has something to do with that, but I think you're now going to be looking at which came first and which symptoms came first. And I mean, this. That's a lot to ask of a jury to try to wade through that and then figure out, okay, when did this happen and why did this happen? Because I think most juries, you know, again, voluntary intoxication is not a defense from. From a mental health standpoint.

A (28:48)

And I mean, as far as the family going through this, Jake and his sister are now going to have to. Whatever comes forward, you know, if you. If you go through an insanity plea, if you have to go just going through this process, how, from what you've seen with families that have had to deal with this level of tragedy, you are the victim, and you are also the brother or sister of the person who allegedly committed the act. You know, you're just right there in the middle. How do you. How do you put one foot in front of the other?

B (29:21)

Oh, I mean, fortunately, these cases are extremely rare. I mean, to see a double parasite like this, I mean, is very, very, very rare. Not that it hasn't happened, but it's very, very rare. So it's almost like saying, what do you do if you see a unicorn? You know, I mean, it's just so hard to even predict. I mean, I think that it's a journey. And I mean, some of the things that Jake was saying in his substack let. Missing, you know, his parents, missing his wedding, or missing his, you know, the birth of his first child. I mean, that so resonated with me because it's such a part of grief for children at any age who lose a parent when they're relatively young because they're grieving not just the loss of that relationship, but the loss of the future of that relationship. So you have all that grief that kind of goes into it, and then it's just a matter. I mean, I'm just so hoping that his family can pull together his, you know, his. His sister. He and his sister and extended family and wrap each other in love. And they'll have to navigate, I think, you know, every day right now. I mean, it's so new. It's so new if any of us have lost somebody close to them. I mean, I look back at a time that when I lost somebody very, very close to me, and I thought I was kind of back to normal in a way after about six months. I look back now and I'm like, no, I was nowhere close to being much. So it's just. That's the other thing is I'm hoping they, you know, love themselves and trust themselves enough to let themselves navigate that process the way they need to and understand, you know, how, you know, what our process, grief can be for people and get that support.

A (30:57)

I guess my. My last question is, I mean, you have sat in the room, Dr. Johnson, with these patients who may have run someone off the road because they thought he was a terrorist or, you know, had done these unspeakable acts because they were being led by a different voice, possibly. What do you say to someone who. Who allegedly killed his own parents?

B (31:29)

Well, you know, I don't know what his mental state is now. There have been some rumors, rumors, I guess, about him wanting to do some kind of a documentary from behind Bar. I mean, there's all these rumors going around, which I just can't give any credence to. I think it's curious if those are out there. What I can tell you is that what I've seen from individuals who have. While actively psychotic. And again, this may or may not be Nick. But for people who have not just run somebody off the road and that that story had a happy ending. But seeing. I've seen it. I was seeing another young man who had killed his parents and. And one of his siblings. And he was so as suic. He was suicidal for months and months after that. It's like when he got on medication and all of a sudden those voices kind of went away. Then he had to deal with what he had done, which was. Ended somebody's life. Now he, you know, his situation was pretty straightforward in the extent that he was clearly delusional at the time. And it was just. All the violence was clearly a. Reflect just a function of these kind of command hallucinations which were telling him that his, you know, this body, that somebody taken over his. Their bodies and just a lot of stuff that was not true. And so of course, when he. His symptoms resolved, he had to then deal with the reality of what he had done. And I could not have said anything to him that would have been worse or more painful than how he felt, what he already thought and what he already felt. And so, you know, there's no winners obviously, in this situation. His life is over in so many ways in terms of just that, his connection with his parents and his relationship with his siblings and his future. And so it'll. It'll be. He's going to have a really difficult journey ahead of him, you know, and obviously his family, his siblings are victims in this situation as well.

A (33:41)

You know, we talk about rehabilitation, we talk about how do people move on from unspeakable tragedies, that sort of thing. But when you look at someone who has allegedly committed a. A crime like this, you wonder, how do they move on? So it'll be interesting to see.

B (33:58)

I know he was, I think, in a. In a suicide smock, I believe, when he came for his first term, which is pretty common when people go in anyway, just because there's a concern of suicidal thoughts and when people first go into jail anyway. And I would imagine, particularly in his case, it'll be interesting to see what he's wearing, you know, if he's still on suicide watch or if he has to be medically cleared. He may have to be medically cleared and. And not be on suicide watch to show up. But I won't imagine that his demeanor will be a lot different. I imagine him be pretty quiet and pretty, you know, pretty. Not sure, not. Yeah, pretty subdued. I think what's going to be interesting is as time moves on, as time goes on, how. How is he going to appear, Lisa? That's what I'm interested in, in terms of the medication, in terms of all that.

A (34:49)

Well, I appreciate you talking to us today. Thank you so much. The pain, you hear in Jake Reiner's essay about his mom and dad is heartbreaking. And he and his sister, essentially, are losing their brother as well. Do you think Nick Reiner will use the insanity defense, or do you think he's going to point the finger at someone else? How will this all play out in court?

B (35:09)

Court?

A (35:10)

I guess we'll have to wait and see. And tell me what other cases you're obsessing over right now, because I want to give you the cases that you want to see. I'll see you back here tomorrow.