This analysis explores the complex interplay of biological, psychological, and social factors that may have contributed to Nick Reiner's alleged actions, focusing on his history of substance abuse, potential mental health conditions like schizophrenia, and the psychological impact of growing up in a prominent Hollywood family.
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In 2016, Nick Reiner and Rob Reiner went
on a press tour for a movie they
ostensibly made together. As you've
probably seen, one line from one of
these interviews seems disturbingly preient.
preient.
>> You don't seem very fiery to me. You
seem like crazy. I get crazy. Okay,
>> you don't want to set me off.
>> But there's also a general air of
tension in those interviews that at
least in hindsight seems foreoding.
>> He could go deeper with it. I mean, it
was funny, but I felt the subject
matter, you know, should allow him to go
deeper with it.
>> Yeah. Well, that wasn't said at the
time. It was sort of just like, hey,
this is trash. But anyways, we went we
went along and uh
>> you're like, wow, my dad's Rob Reiner.
>> I never had thought about it. And then,
>> yeah, it didn't cross your mind, right?
Never. And Nick was there for all the
casting uh uh you know, all of the the
auditions. I was sitting there. But
>> yeah, but you had you you always gave
your opinion,
>> but anger or resentment of an adult son
for his famous father is one thing, and
homicidal rage is another. Right. I'm
Andrew Vandervart, a psychiatrist and
neuroscientist. Given that I have never
personally examined Nick Reiner, and he
is not my patient, I cannot give
professional diagnostic opinions.
However, we can discuss some of the
publicly available information and
speculate on the potential forces at
play in cases like this. Any opinions
expressed are my own. So, let's briefly
review the timeline of the murders. On
Saturday, December 13th, Nick Reiner was
brought along to Conan O'Brien's
Christmas party by his parents who were
reportedly worried about leaving him
home alone given his recent erratic
behaviors. At that party, there have
been multiple sources describing Nick's
behavior, although none have been
willing to go on the record. But
allegedly, he was walking up to
attendees, interrupting their
conversations, and kept asking people,
"Are you famous?" This does sound like
an odd question and one that I don't
really imagine someone would just invent
when talking to TMZ or People magazine
because it's both so odd but also so
specific to say he was going up to
everyone asking them if they're famous.
It's a it's a strange thing, right? And
to me it sounds like a sort of inside
joke, but one where Nick Reiner is the
only one in on the joke. Another
reported encounter, again an anonymous
source, is that Nick Reiner interrupted
a conversation the comic actor Bill her
was having, uh, but was then told the
conversation was private and that Nick
then stared, standing very still for an
uncomfortable period of time before
storming off. So standing very still and staring,
staring,
if nothing else, I think is a sign of
very poor social reciprocity. He was not
aware. Similarly to asking people a
nonsequiter about whether they were famous.
famous.
It is a sign of someone that does not
know or does not care how they are
coming off. Again, a bit like the world
to Nick Reiner at that time was only
occupied by one main character and
everyone else was supporting cast. Next,
there was apparently a verbal
altercation between Nick Reiner and Rob
Reiner. Again, anonymous reports, but of
a shouting match triggered by Rob
Reiner's embarrassment at his son's
behavior, described in the New York Post
and elsewhere as a massive blowup with
yelling between the two, such that at
one point, partygoers were discussing
calling the police for a mental health
hold, essentially an emergency
evaluation at a hospital. The fight
account has been disputed, however, with
uh an executive quote unquote at the
Conan party saying he saw no fight. It's
BS. Now, I'm not sure one report of not
seeing a fight means that there wasn't a
fight because it's it's sort of harder
to be sure of the absence of something
than the presence of something. But this
executive says he never saw it. So, it's
unknown when Nick Reiner left the party,
but the Riners were seen on video
leaving the event at 11:47 p.m. on
Sunday. Around 4:00 a.m., Nick Reiner
checked into the Purside Santa Monica
Hotel a few miles from the Reiner House.
A staffer of the hotel reported that
Nick looked quote tweaked out, which is
Californian for very nervous, maybe
disheveled, maybe overstimulated. I
believe Nick left the hotel Sunday
morning without formally checking out.
And then when staff went to clean his
room, they found the shower, quote,
"Full of blood, as well as blood stains
on the bed and the windows of the room
having been covered with bed sheets."
That same day, Rob Reiner and his wife
Michelle were found dead in their
bedroom from multiple stab wounds. Since
then, Nick Reiner has been arrested and
charged with homicide. Legally, he is
innocent until proven guilty, but at
least at this time, there seems to be
more so a discussion about his mental
health and a potential insanity defense.
Now, again, that question is not my role
here. I just want to provide what I
might think about if I were making a
formulation. And look, I don't have
nearly enough data, so this could all be
fog of war. But I do think there are
things pertinent to all of us. Questions
generally about substance use,
personality, and pathology.
So if you're going to make a
formulation, you have to think that
nothing ever has just one cause. And
least of all the human mind, which is
not an event that might be caused by
some preceding circumstance, but is a
process that is constantly in flux. So
there are many ways to break down a
formulation. And the most common being
the biocsychosocial model which says
look at the biological layer. Look at
the psychological layer and the social
layer and pay attention to all of the
cross talk between these layers. How one
influences the other and what the
feedback loops are between these levels.
Another is the perspectives of
psychiatry model by McHugh and Slavny
which examines individuals through four
perspectives put simply as what the
person has. So, illness, disease, brain
pathology, who the person is. So,
personality traits, what the person is
doing, behaviors, maladaptive coping,
substances, and what story the person is
telling. So, what they have encountered,
what has been their life story, how do
they make meaning in life?
So, maybe here we can consider the
unique interactions that might occur
between all of these levels with the
caveat that it's a complicated web.
So on the biological layer and with the
perspective of something the person has,
it has been reported by TMZ and others
now that Nick Reiner had a diagnosis of schizophrenia.
schizophrenia.
What had also been previously well known
to the public, including via the movie
Being Charlie, which was based on Nick
Reiner's life and made by his father
Rob, was that Nick Reiner had a severe
substance use history, including
cannabis, cocaine, heroin, and meth.
really just a poly poly substance use
from the age of 14 onwards. Now if you
look at the DSM5 you'll see
schizophrenia which means essentially
chronic psychosis and you'll see
substanceinduced psychosis which is
psychosis triggered by intoxication or
withdrawal. But there are two issues
here. The first is what do you do when
essentially someone has chronic
substance-induced psychosis? Meaning
there is constant substance use and the
substance is constantly causing psychosis.
psychosis.
By the way, what is psychosis? Well,
it's a break from reality and typically
it looks like a combination of hypers
salience. So things seeming extremely
significant with an example being
paranoia where innocuous things might
seem extremely significant and
threatening um so that everything
becomes fearful and meaningful in a
scary way right
um and then disorganization or
fragmentation. So concepts or even words
not connecting in a way that makes
sense. And I think at least part of that
that breakdown and continuity of thought
may be from a working memory impairment.
There's certainly working memory
impairment in schizophrenia. And there's
also working memory impairment in say
very high doses of THC. So I don't know
if you've ever been extremely high, like
too high, but I hear that people start
saying something and then forget what
they had started saying by the end of
the sentence. Right? that sort of what
were we talking about?
>> Mhm. I was on set with him. We Yeah.
>> No, sorry. Go ahead.
>> I I don't I have no idea what I was
going to say.
>> So, if you imagine being in that sort of
state where you're trying to plow
through not remembering what you were
just talking about and still talking,
you can see how there might be kind of a
a discontinuity of thoughts, a
breakdown, a disorganization of
thoughts. So again, for some people, if
THC is causing a psychosis, like
paranoia and working memory impairment,
but they're also doing it constantly,
doing THC constantly, is that chronic psychosis?
psychosis?
Functionally, yeah. But is it
schizophrenia? Well, technically the
DSM5 would say it's not schizophrenia if
it's being caused by something else, if
it's being caused by a substance.
But what do you actually do in the case
of someone who has chronic
substance-induced psychosis? Obviously,
you try to get them to stop using
substances, but many times they just
don't or won't. So, functionally, what
happens in the very imperfect world of
clinical psychiatry is we essentially
say, okay, well, will you at least try
taking this antiscychotic, too? Granted
that they're going to keep taking
substances, they're they're not
stopping. The idea is, well, this person
can at least get some guard rails such
that despite continued use of
substances, let's let's say they they
keep using meth and getting these floods
of dopamine that make everything hyper
salient and they keep getting brought to
the hospital by police or they keep
destroying property or threatening their
family. Even if they keep using the meth
or whatever it is, the antiscychotic can
at least partially regulate the dopamine
and serotonin from getting to that
extreme level causing that hyper salience.
salience.
Okay. But the other issue is with
recurrent and heavy substance use if you
were getting psychosis with each
intoxication there sometimes can be a
kindling such that the psychosis does
continue. The fire keeps burning even
when the substance is stopped.
Particularly in developing brains,
adolescence and young adulthood, you are
potentially permanently altering the
dopamine limit thresholds in the
striatam with these high doses heavy
substance use and getting like a super
sensitivity psychosis from that aberant
dopamine andor you could just be causing
neurotoxicity. I mean we know that high
doses of meth do cause neurotoxicity to
dopamineergic neurons for example. So
sometimes you do get a durable psychosis
that started with meth psychosis. It was
substance induced but then it becomes
well it becomes what we currently call
schizophrenia once it persists for 6
months from stopping the drug. So that's
all to say there are people with a
schizophrenia that is a purely organic
if you like uh that is it started with
no substance use seems to be more
genetic or neurodedevelopmental in some
fashion and that's more like something
the person has in the perspectives model
it's the disease model and then there
are people with a pure substance induced
psychosis that is transient and
eventually resolves with full wash out
of the substances and getting over the withdrawal
withdrawal
But there is also this vast swath of
middle ground. And often times the
schizophrenia label gets used for for
all of this. And I actually think that's
to the detriment of our understanding of
these processes because to me it's kind
of like lumping things together that
obviously have some kind of different pathophysiology.
