Medical Matters: Plane crash should not mean a return to a dark age

The tragic circumstances surrounding the crash of Germanwings flight 9525 in the French Alps on March 24th have given rise to many questions but few answers. Based on voice and data recordings recovered from the site of the crash, investigators believe the co-pilot, Andreas Lubitz, locked the captain out of the cockpit and deliberately crashed the plane into a mountain, killing everyone on board.

Unfortunate tabloid headlines such as “Killer pilot suffered from depression”, “Madman in cockpit” and “Why on earth was he allowed to fly?” suggest mental health issues played a part in the pilot’s decision.

But is there any evidence to back up the headline statements? And what does coverage like this say to people with depression and other common psychological conditions?

Murder-suicide is rare, with an incidence of between 0.2 and 0.3 per 100,000 people per year. Most perpetrators are younger men who harbour a grudge and who typically kill people they know or have been close to. According to experts, murder-suicide events should be seen as related to a specific individual and their particular circumstances, rather than looking for a simple explanation tied to a specific diagnosis. However, it must be acknowledged that some people with certain psychological illnesses are at a slightly higher risk of harming themselves or others, but the absolute risk is small.

Equally it has to be said that people like Lubitz are very much outliers; most violence in society is carried out by individuals who are experiencing what might be termed normal human emotions. Which is why calls for keeping people who are depressed from being pilots is hugely stigmatising. Where do you draw the line?

Return to a dark age 

Some commentators seem to be suggesting that after this tragedy no one with a history of depression should be allowed fly a plane or operate on a patient. The reflex return to a dark age of “mental illness = psycho = lock the person away” is most disheartening.

The evidence about the prevalence of mental health problems is clear: one in four of us will experience a psychological illness this year. Does that mean that 25 per cent of teachers, doctors and chief executives should be forcibly removed from their workplaces?

One of the best responses to the tsunami of prejudicial popular press coverage came from Paul Farmer, the chief executive of UK mental health charity Mind, who said: “Everyone is trying to understand what happened in this terrible tragic plane crash, but there is a real danger that a correlation is being made between depression and this act, which is overly simplistic and has no evidence attached to it all . . . The impression which can be given is that somehow people with depression are dangerous, whereas there’s no evidence to suggest that’s the case.

“There are thousands of people who work in stressful and important jobs who battle with depression and do their jobs very well.”

Destructive

Blaming and shaming in the way we have seen recently is enormously destructive. Twitter was full of comments from people with depression advising others not to tell employers and even loved ones because of the risk of being labelled mentally unstable. As one commentator said, it was like watching “five years on fast rewind, undoing all the sterling work done by mental health charities to normalise mental illness”.

Reflecting on this awful event, a recurrent thought is: would Lubitz have torn up his medical certificates excusing him from work if he had a physical disease?

If we had a more tolerant and non-stigmatising approach to psychological illness and it was viewed in the same way as, say, diabetes, would it have been easier for him to co-operate with his employers in managing the implications of his illness?

All of which brings me back to the belief that the only way to respond is to redouble our efforts to get young people to be open about their psychological wellbeing.

mhouston@irishtimes.com muirishouston.com