APRIL 7TH, 2015

Most of the news coverage of the recent airplane crash has described the co-pilot, Andreas Lubitz, as a depressed person; one with suicidal tendencies who had recently researched suicide and cockpit security on his computer. He apparently sought medical help for an undisclosed mental health issue. It is also suggested by the news media and law enforcement that the co-pilot might have been on medication recently for a mental health issue.

25869324_sAlthough suicide does happen more frequently in the depressed population, we should remember that it is not that common, and violence is rare. To understand this co-pilot you have to go beyond the criteria for diagnosing the usual major depressive episode and consider that some people become so depressed that they develop psychotic depression sometimes with delusions. Delusions can convert a person’s perception of the world so dramatically that it becomes a very bad place, even a place that one should leave. Sometimes taking others with you is not perceived as a murderous act but as one of saving them from suffering in such a terrible world. On occasion, you will see this in suicide notes left by parents who kill their children and then commit suicide so that everyone is “safe and together” in a better place. As bizarre as all this might sound it might explain what happened in this horrendously destructive act and decrease our perplexity to a degree.

It would not be the first time that the mental health of a pilot has been called into question. Alpo Vuorio, MD, PhD, an aviation specialist in occupational medicine at the Mehiläinen Airport Health Centre in Finland, led a study in 2014 that had researchers looking at the last 20 years of data for “aircraft assisted suicide”. What they discovered was reported in the Journal of Aviation, Space and Environmental Medicine. The study found that from 1993-2012, 24 of 7,244 plane crashes were thought to be deliberately caused by a pilot.

In TIME magazine last month, Vuorio said in response to the study, “I really wish that we had some kind of deeper thinking about this issue, because it’s one of the most difficult in aviation medicine.”

Screening pilots and cabin crew of commercial airlines for mental health issues is tricky. I just wrote last week about the fear of disclosing a mental illness to your employer. In this particular case, declaring that you have a mental illness, however temporary, could be a career-ender for a pilot. Disclosing your disorder to your employer raises questions not only about pilots disclosing their mental health issues but also how do you treat them and what is the criteria for deciding if they are capable of flying. Many people in many high-profile professions work while being treated for their mental illness. There certainly is a lot to consider here. The good thing is that the dialogue has started, and the discussion needs to include all professions and not just airline pilots. So let’s remember, this case of possible depression should not warrant any great worry that suicide and homicide are frequent outcomes of this disorder. The majority of depressed people can receive treatment and recover without tragedy.

This blog is intended for educational purposes only. It is not intended as medical or psychiatric advice for individual conditions or treatment and does not substitute for a medical or psychiatric examination. A psychiatrist must make a determination about any treatment or prescription. Dr. Paul does not assume any responsibility or risk for the use of any information contained within this blog.