“The meds made me do it” has become a familiar refrain whenever psychiatric treatment intersects with tragedy. It is a phrase heavy with implication, suggesting loss of control, a sense of medical betrayal, and a system that failed at its most basic task: keeping people safe. When cases like the Nick Reiner tragedy enter the public consciousness, that phrase resurfaces almost reflexively, offering a deceptively simple explanation for something incredibly complex.

According to press reports, Reiner had been diagnosed with schizophrenia, struggled with substance use for years, and was undergoing a medication change in the weeks before his alleged killing of his parents. Media coverage quickly compressed these facts into a single causal narrative: A medication switch led to mental unraveling, which led to violence. It is a compelling storyline. It is also incomplete and, in some ways, misleading.

High-profile cases involving serious mental illness often invite reductive explanations. Schizophrenia becomes synonymous with violence. Medication becomes the villain. Context disappears. What remains is an orderly chain of causation that reassures the public that tragedies have identifiable (and therefore avoidable) culprits. Real clinical life is rarely so obliging.

The complexity of schizophrenia

Schizophrenia is not a single disease with a single trajectory. It is a heterogeneous syndrome with wide variability in symptoms, insight, function, and outcome. Most individuals with schizophrenia are not violent, and most violence in society has nothing to do with psychosis. Decades of research show that diagnostic labels and people who use them are poor predictors of aggression. What matters are specific, active symptoms (paranoid delusions, threat-control override experiences, command hallucinations) especially when they intersect with acute stress, substance intoxication or withdrawal, and social instability.

Medication occupies an uneasy place in public imagination. It is alternately framed as a miracle cure or chemical menace. In practice, antipsychotics remain among the most evidence-supported treatments in all of medicine. Consistent, well-monitored use reduces psychotic symptoms, lowers relapse rates, and often improves quality of life. Periods of adherence are also associated with reduced risk of hospitalization and, in some studies, reduced aggression-related outcomes.

That said, psychiatric medications are not inert. Side effects can be deeply distressing, particularly during initiation, discontinuation, or dose changes. Akathisia (often misunderstood as anxiety) can produce unbearable inner restlessness, irritability, and agitation. Insomnia following medication changes can worsen paranoia, impair judgment, and lower frustration tolerance. In vulnerable individuals, especially those with active psychosis or substance use, these effects can contribute to rapid decompensation.

Confounding by indication

But here is the critical point that public narratives routinely miss: Medication changes are rarely random events. They are almost always responses to something already going wrong: breakthrough symptoms, nonadherence, relapse, escalating agitation, or renewed substance use. In research terms, this is confounding by indication. The same factors that prompt a clinician to change a medication may also be driving the patient’s deterioration. When violence follows a medication adjustment, the adjustment may be a marker of an accelerating crisis rather than its cause.

Substance use further complicates this picture and remains one of the strongest predictors of adverse outcomes in serious mental illness. Alcohol, stimulants, and sedatives can exacerbate psychosis, undermine adherence, provoke withdrawal states, and destabilize mood. They also introduce social chaos (legal problems, fractured relationships, unsafe environments) that erode the foundation treatment depends on. Reports describing repeated rehabilitation attempts underscore how persistent and relapsing addiction can be, even in resource-intensive settings.

Focusing public attention almost exclusively on medication risks obscuring this broader reality. It also risks reinforcing stigma. If every tragedy is framed as medication-induced, patients may become more reluctant to accept treatment, families more fearful, and policymakers more inclined toward restriction rather than investment in care. If tragedies are framed solely as acts of “evil,” we lose opportunities to strengthen early psychosis programs, crisis response systems, and integrated treatment for co-occurring disorders.

Risk management over scapegoating

The appeal of “the meds made me do it” in the legal and cultural imagination is understandable. It shifts responsibility from a person to a pill. It offers a tidy explanation. But it also asks the wrong question. The clinically meaningful question is not whether medications can ever contribute to impaired control (they can) but whether those risks are predictable and whether clinicians and systems respond appropriately.

The literature points not toward fear of psychiatric drugs, but toward disciplined risk management: informed consent that includes discussion of agitation and sleep disruption, not just metabolic effects; gradual cross-tapering of medication when feasible; close follow-up during high-risk transitions; and explicit monitoring of sleep, agitation, suicidal ideation, and violent thoughts. It also points toward better support for adherence through shared decision-making, long-acting formulations when appropriate, and involvement of trusted supports during vulnerable periods.

Public storytelling matters. It shapes stigma, policy, and access to care. The more responsible narrative holds tension: Psychiatric medications are powerful and usually beneficial; they can be destabilizing in specific contexts; and those contexts are well described in the literature. The challenge is not to find a chemical scapegoat, but to build systems capable of anticipating and managing known risks.

“The meds made me do it” is less an explanation than a warning. It challenges medicine (and society) to resist simplistic causality and to engage honestly with the complexity of serious mental illness, addiction, and care delivered under real-world constraints.

Arthur Lazarus is a former Doximity Fellow, a member of the editorial board of the American Association for Physician Leadership, and an adjunct professor of psychiatry at the Lewis Katz School of Medicine at Temple University in Philadelphia. He is the author of several books on narrative medicine and the fictional series Real Medicine, Unreal Stories. His latest book, a novel, is Standard of Care: Medical Judgment on Trial.