Movie review: Who Killed Alex Spourdalakis

Alex Spourdalakis was an autistic youth. An autistic youth who faced the sort of crisis we all hope never happens. And that is even before he was killed by his mother and godmother. Much of the last year of his life was spent in a search for a way to treat his sleep disturbance and aggression, with his mother concluding at one point that these stemmed from gastrointestinal disease (she would later decide that lyme disease was at play), a conclusion which apparently put her and her advocates at odds with some of Alex’s doctors some of whom proposed a psychiatric approach. His hospital stays included four point restraints for days and weeks. As a recent study has shown, restraints are not unheard of for autistic patients. This is a topic that deserves attention to limit or end the practice. It is impossible to do justice here to just how serious this crisis was. And that’s leaving out the fact that in the end he faced murder by those closest to him.

He was murdered by his mother and godmother who poisoned him with an overdose of prescription medication and, when that failed, killed him using a kitchen knife to slit his wrist and inflict multiple stab wounds.

We now have a video showing some of the story. A one-sided view of the story. A video by Andrew Wakefield. Mr. Wakefield has a long history with the autism communities and, quite frankly, that history is marked by many less than accurate accounts of fact by Mr. Wakefield. I’ve watched his “Who Killed Alex Spourdalakis” a few times now and tried to put my thoughts into words.

“Who Killed Alex Spourdalakis” is not a true documentary in that the film makers were a part of the story. It appears to have started out as part of their “Autism Team” reality TV show project. Mr. Wakefield’s “Autism Team” was not just standing back and documenting events, they were acting as advocates and advisers to Alex’s mother. For example, they put Alex’s mother in contact with Arthur Krigsman (pediatric gastroenterologist and former colleague of Andrew Wakefield) and arranged transporation for Alex to be seen by Dr. Krigsman. Roughly a week before his death, Alex was in the hospital again, where he was visited by the “Autism Team” in the person of Polly Tommy and it sounds like Andrew Wakefield. Alex’s mother discusses how they’ve been offered a placement in a psychiatric facility, but this would involve Alex being separated from his mother and godmother. A separation we now know was necessary to save his life. In this screenshot we see subtitles for Alex’s mother stating “not in a psych unit. Once a week” (referring to the chances to visit Alex). The godmother is stating, “it’s a psychiatric facility”. And the closed captioned words belong to Polly Tommy who is stating, “No, we can’t do that”. We? The Autism Team are documenting themselves as part of the story.

Before “Who Killed Alex Spourdalakis” was produced many questioned how much did Mr. Wakefield’s “Autism Team” contribute to the horrific outcome. Not directly, of course, but in terms of whether a different group of advocates or different advice from Wakefield’s team would have averted the murder. Alex’s mother was offered help from other groups, and declined it. This is a question that can not be independently explored given this team’s dual role of advocate/advisers and documentary videographers. We are also talking about Andrew Wakefield, who in the introduction to one of his books glorified a murder-suicide involving an autistic and his mother.

But I am now falling into the same trap as Mr. Wakefield: losing sight of the actual story. Because the story isn’t “who killed Alex Spoudalakis”. The story is Alex Spourdalakis. A young man, 14 years old when he was murdered, who was a valuable and often happy person who had reached a point in his life when he needed support: medical and other support. He was a person worthy of respect. Disability did not diminish that. His extraordinary needs did not diminish that. In fact, his extraordinary needs were a big part of the story that needed to be told clearly. While one can pick some of his story out of the video, it gets obscured as the video uses Alex and his story to promote the Wakefield message that vaccines cause autism and a harsh criticism for psychiatry and mainstream medicine in general. And the video argues that Alex’s mother is not responsible for the murder due to alleged use of antidepressants.

Alex needed help. A great deal of help. He couldn’t sleep. He had episodes of aggression. He was in the emergency room for weeks in restraints. Much of the video centers around a division between one side, his mother and the “Autism Team”, who felt that these were signs of an underlying gastrointestinal problem and another side, many of the medical staff, who were often pursuing a psychiatric explanation. It would have been valuable to see an honest account of the question of what was behind Alex’s crisis. But we don’t get that in this video. We get an antagonistic approach to psychiatric care and statements that instead “autism is medical”.

Mr. Wakefield and others would do well to recall that psychiatric care is medical care. For some it can be life saving.

Psychiatric and other medications can also result in extreme reactions. And this is a point Mr. Wakefield makes time and again, to the point of actually weakening the point. For example, we are told about how Alex had a serious allergic reaction to one set of medications, complete with a frame showing this event highlighted in his medical record. Not hightlighted but visible is the statement that this reaction cleared up with two doses of Benadryl. Making a big deal out of a reaction that cleared up with Benadryl, an over the counter medicine, struck me as overplaying this point.

Even with the possibility of adverse reactions to psychiatric medication, Mr. Wakefield would do well to recall that autistics can have psychiatric conditions. Mr. Wakefield is in the community that is quick to tell us that autistics often have comorbid conditions. But rarely does this community point out that a large fraction of comorbid conditions are psychiatric. This was explored by the Lewin Group for children. And by Lisa Croen’s team for adults.

Where GI complaints are 1.3 times more common in autistics, anxiety is 3.7 times more common and schizophrenia 22 times more common (just to name a few psychiatric conditions).

Autistics do have a difficult time obtaining appropriate medical care. One doctor told me that 75% of the information they use to make a diagnosis comes from listening to what the patient tells them. But what if a patient is nonverbal and doesn’t have effective alternative communication? Add to this the fact that autistics often have sensory issues. What happens when, as one friend of mine relates, a person can tell you “I’m in pain” but can’t say where that pain is? And this is before we consider issues such as poor insurance coverage for the disabled and other social factors that limit access to care. This is a story that needs telling. Psychiatric medications are prescribed more often to autistics in poor families than in wealthy families. And this video doesn’t do these points justice.

In the video one does get to see Alex. Yes, the images of Alex in restraints in the hospital that were common online shortly before his death. But also Alex before the hospital stay. . . Alex as a human, not a pawn. It’s telling that Alex’s father and sister do not appear in these videos. According to the video, Alex’s father declined to be interviewed. One does see a great deal of Alex with his mother. She is shown giving him a great deal of affection. I don’t doubt her love for her son. The intention, I suspect, is to portray her in a sympathetic light: the loving mother. She’s so loving that something else must have driven her to the brutal murder of Alex, right? At least that is the message I suspect the director was trying to get across. Well, except downplays the brutal nature of the murder. In the end, though, the scenes of affection between Alex and his mother are more jarring than sympathetic. Knowing that this woman would shortly be poisoning Alex and knowing that she is the one reported to have stabbed him repeatedly, well, the affection does not come across as endearing nor sympathetic. Knowing that Alex loved his mother makes the betrayal all the more painful.

One does have to address that horrific outcome, the question posed by the title of the film: who killed Alex Spourdalakis. Interestingly the first sentence of narration tells us: “what turned Dorothy Spourdalakis, a loving mother, and Jolanta Agatha Skordzka, a loving godmother, into killers?” While it is not contested that these are the killers, the video tries to make the case that it’s more complicated than just who actually committed the physical acts of killing. A critic’s statement, quoted on the facebook page for the group who produced the video tells us one interpretation:

The story of Alex is an indictment of our healthcare system’s ability to treat autism as a disease rather than a psychiatric disorder

In this interpretation, “the story of Alex” isn’t about him or how he lived. And we need to reject the possibility that autistics can have psychiatric needs, because autism is a disease.

The video argues that Alex would have had a happy outcome, similar to that of another “Autism Team” subject, had he followed a “medical” approach of treating GI disease rather than a psychiatric one. One sad irony is that Alex’s mother abandoned the GI approach to follow a different disease approach to his care: lyme disease.

The video downplays the events of the actual murder. Instead of giving the full details, the murder is used as one last critique of psychiatry. In Mr Wakefield’s telling of the murder presents it with a recreation of Alex’s father and uncle discovering the crime scene. The scene is merely described initially as Alex was found “dead in his bed”. This for a scene where a young man was stabbed multiple times and had his wrist slit to the point of nearly severing his hand. He had been dead long enough for rigor mortis to set in. The scene that Alex’s father and uncle found would have been grisly, to say the least. Alex had been bleeding and the blood had time to congeal. But we don’t hear those details. By the time the narration gets to the knife wounds, we hear only that he died of a knife wound to the heart. No mention of the slit wrist nor the other 3 stab wounds.

Instead the emphasis is given to the poisoning attempt. We are told how ironic it is that drugs which Alex is alleged to have had adverse reactions to did not kill him. Psychiatric drugs, alleged to have failed him in life, failed in killing him. This point is give far more emphasis than the actual act of killing Alex.

We are told how Alex’s mother and godmother were found near him, unconscious from a drug overdose. Alex’s mother and godmother had just failed to kill Alex with an overdose and yet chose this same method for their attempted suicide.

His mother and godmother were reported to be “semi conscious” when found. And one document, apparently a police report, shown in the video indicates that the mother and godmother were able to answer questions while still in the apartment. Which begs the question, how many pills did they take in their apparent suicide attempt? Were they really in danger of death?

We need to face the grisly nature of Alex’s murder because glossing over the brutal nature of the murder does not do the victim service. It does help paint the killers in a more sympathetic light. We also must face questions raised by these actions. It is stated that when Alex did not die from the overdose, his mother and godmother took to using the kitchen knife. Why? Was he taking too long to die? Did they fear being discovered? Was Alex waking up? How long did they wait for the overdose to kill him? Why didn’t they call for help in that time?

Mr. Wakefield argues in the video that it was once again psychiatry that failed Alex, and at the same time builds an argument that his mother wasn’t really at fault. The video alleges that his mother was taking antidepressants and the side effects include suicidal thoughts and violence, setting the stage for an insanity defense. There are a few problems with making that argument stick, starting with the argument made by the district attorney that the murder was planned in advance. This argument is supported by the fact that Alex’s mother and godmother made his father and sister leave the apartment a week before the murder. This could be a sign of premeditation: that they wanted to the apartment free to commit the murder. This avenue of reasoning is not explored by Mr. Wakefield in his video. Next, this murder was committed by two people, and Alex’s godmother is not alleged to have been taking antidepressants. In this insanity defense scenario, why didn’t the godmother stop the murder? Report the plans? Next, this isn’t a violent murder–or wasn’t intended to be. It started out as a poisoning attempt. We do not know how long they waited for the overdose to kill Alex, but certainly long enough for either of the killers to have second thoughts and call for help, especially the godmother who is not alleged to have been taking the antidepressants. Lastly, the video tells us that there’s no physical evidence of the antidepressants. They allegedly brought from Greece by Alex’s father, who is further alleged to have removed the drugs from the apartment.

At this point in the narrative Alex is dead. We’ve heard heard an argument as to why his mother isn’t guilty of the crime. But Alex isn’t the story of this video. Even “who killed Alex” apparently isn’t the story. The video next presents us with “one vital piece of this puzzle”. This is the segue into claiming that Alex was a victim of vaccine injury. Mr. Wakefield wasn’t content with telling us this at the beginning of the video, he had to bring it up again at the end. We are told that Aex was a child “…whose life was over in so many ways from the age of 18 months.” In one sentence he negates all the video he invested in showing us Alex as a happy, complete human. Being autistic is being a person “whose life is over.”

Recall that Mr. Wakefield has stated that he makes videos target people who are agnostic on the question of whether vaccines cause autism.

We also get a pitch for the idea that what Alex needed in order to avoid his death was more support from Wakefield’s team. That they are going to start the “Alex Spourdalakis Recovery Center”, a place for autistics and their families after seeing Arthur Krigsman. I am at a loss for words other than to say this is absolutely not the solution that comes to mind to avoid another murder like Alex’s.

In the credits we get snippets of video of Alex. Starting with Alex near the end of his life, naked and rocking. While Alex does appear to be happy in these clips, showing him naked without his permission is inappropriate (note that while Mr. Wakefield does not show Alex’s full body, I have further blurred this image). Then, after showing Alex as a baby and flowers for Alex (complete with business card for Wakefield’s Autism Media Channel), the credits end.

But, apparently just in case we didn’t get the message of the video, we need to be shown two more short scenes appear after the credits. Niether shows or mentions Alex. The last message Mr. Wakefield wanted those watching this film to take away. Nothing about Alex, just a simple screen stating “Merck face legal action for alleged MMR vaccine fraud”. The additional sad irony in this is that even if you accept the claims that Alex was vaccine injured and the claims in the lawsuit, the Merck case is unrelated to Alex’s story. It doesn’t involve Mr. Wakefield’s hypothesis of the measles component of MMR being linked to autism. It doesn’t involve allegations of vaccine injury at all but, rather, the effectiveness of the mumps component.

Alex deserved better in life. He deserved medical care, be it psychiatric, standard medical or both, to bring him back to the happy person he was before his crisis. But Alex also deserves better in death. He deserves that his life and death not be used as a tool to promote Andrew Wakefield’s poorly supported one-size-fits-all approach to autism. He deserves to be the story, not have his story framed as “who killed Alex Spourdalakis”.

Alex deserves better.

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By Matt Carey