The co-pilot who deliberately crashed a Germanwings airplane into the French Alps in March has forced the international spotlight to focus on the difficult question of whether medical treatment for depression should be reported, particularly if actions of the patient could endanger the lives of others.
The issue has become a life-and-death question since the co-pilot, Andreas Lubitz, killed 149 innocent people with his suicidal descent.
The tragedy resulting from Lubitz’s mental state may have been premeditated. Investigators discovered he had been searching the Internet in the days immediately before the crash for information on how to commit suicide and security measures for cockpit doors, according to an April 2 report in the New York Times.
Authorities in Germany reported Lubitz was treated years ago for suicidal tendencies and doctors recently told him to stay away from work, according to an article in the Washington Post on March 30. But the directive that could have kept him out of the cockpit was hidden under Germany’s strict privacy laws.
Gary Kay, a clinical neuropsychologist who developed the cognitive test for pilots used by the Federal Aviation Administration and many airlines around the world, said on CNN’s Anderson Coooper 360 on March 26, two days after the crash, that pilots undergo initial medical exams and personality testing, but after that, the pilot has the responsibility to make sure of being fit to fly.
Now that this has come to light, what’s to be done about this volatile dilemma? Where is the balance between taking the stigma away from treatment for mental illness, and regulations regarding disclosure, and privacy that gives people the peace of mind that encourages them to seek treatment?
Clinicians can miss diagnoses, and patients can keep diagnoses private, according to an article by psychiatrist Carrie Barron on the Psychology Today website on March 30.
“Though we know Andreas Lubitz suffered from depression, we do not yet know what kind of depression, or if he had other issues such as a personality disorder,” said Barron.
“We can only speculate, as a diagnosis can never be accurate without direct examination. A depressive illness that includes ebbing and flowing or masked psychotic features is a dangerous condition,” said Barron. “Clinicians can miss this diagnosis because the psychosis is not always present at the time of the examination.”
Mental health issues can be hidden from friends and coworkers.
“Just because someone is conscientious, intelligent, charming and high functioning does not mean that their inner life is in harmony,” said Barron. “Fears, paranoia, intrusive thoughts and even delusions can haunt private moments. Trying to dismiss, mask or will away biochemical phenomena may work for a time, but it is difficult to maintain.”
While it is impossible to imagine what could have driven Lubitz to such horrendous action, Barron said the tragedy does suggest some general lessons to take away about the nature of mental illness.
- Competent, kind, lovely, high-functioning people can be mentally ill and others may have no idea of what goes on in their inner life.
- It is appropriate to keep a medical condition private unless it could endanger others.
- Personal responsibility and integrity play a part when it comes to a dangerous condition. Denial can be tempting.
- Intense immersion in activities can be a form of self-medication. This can help, but sometimes it is not enough.
- A combination of mental illness and personality disorder is not uncommon.
- People may only be in a psychotic state for a brief time and seem or be normal otherwise.
- Some cultures stigmatize psychiatric conditions more than others. Stoicism is an admirable quality, but a poor choice in some situations.
“We do not know exactly happened here,” said Barron. “But thinking through the possibilities can help us be more aware and perhaps protect future lives.”
Kulish, Nicholas; Eddy, Melissa and Clark, Nicola;“Andreas Lubitz, Germanwings Co-Pilot, Researched Suicide and Cockpit Doors, Prosecutors Say,” New York Times, April 2, 2015.
Birnbaum, Michael and Faiola, Anthonym,“Co-pilot of doomed plane was treated for suicidal tendencies, officials say,” Washington Post, March 30, 2015.
Cooper, Anderson, Anderson Cooper 360/CNN, March 26, 2014
Barron,Carrie, “After the Germanwings Crash, 7 Lessons About Mental Illness,” Psychology Today, March 30, 2015.