Saturday, March 28, 2015

Psychiatry and Madness

Here we are again, at the point where public health intersects with psychiatric illness and individual rights.

Apparently, Andreas Lubitz, he mad co-pilot of the Germanwings plane that crashed into a mountain in Southern France suffered from severe mental illness. As the story is now being presented, Lubitz chose not to inform his employer that he had been declared unfit to fly.

But why, pray tell, did someone charged with the safety of passengers have the choice?

Apparently, German privacy laws prevent psychiatrists from informing an employer of a patient’s condition.

And yet, his illness was anything but a mystery. A French newspaper, Le Figaro, reported this morning that Lubitz's instructors at his flight taining in Phoenix had declared him unfit to fly. His psychiatric history should have been well known to his employer. Since German privacy laws allow psychiatrists to breach confidentiality in some cases, one wonders why this did not count as one of those cases.

It also seems clear that Lupitz had been taking psychiatric medication. Whether he was on or off his meds I do not know. But oughtn’t we to recognize that these medications, whatever their virtues and value, are of limited usefulness. Since Lupitz was clearly not a everyday depressed patient, ought we perhaps to redefine what we mean by treatment in such cases.

As for the question of motive, the New York Post offers this insight:

The stunning revelation came as a German newspaper quoted another of Lubitz’s ex-girlfriends recalling that within the past year, he had promised her that one day he’d “make everyone remember him.”

The ex, identified by Bild newspaper as “Maria, 26,” also said Lubitz would wake up in the middle of the night screaming, “We’re crashing!”
“When I heard about the crash, one thing that he said kept going through my head: ‘One day I’m going to do something that will change the whole system, and everyone will know my name and remember it.’ ” the woman told the paper.

“I didn’t know what he meant, but now it makes sense.”

An anonymous individual, preferring infamy to anonymity, wants to make an impact, wants to be remembered, wants to change the system.

Unfortunately, he did what he said he wanted to do.

1 comment:

Ares Olympus said...

re: Apparently, German privacy laws prevent psychiatrists from informing an employer of a patient’s condition.

Its a good question to ask, and there are two important sides. If you want patients to tell the truth to their psychiatrist (or lawyer or priest or anyone who needs the truth to help), then you're more likely to help a patient, while "fuzzy" boundaries of what information can be shared means distrust, more secrets, and less possible ways to help.

I'm assuming the privacy standards say a psychiatrist must report if a patient expresses a will to harm himself, or someone else, but therapy might also contain fantasy. If a patient says "I have a fantasy of killing someone" should that be treated differently than "I am going to kill someone."?

I expect the answer comes out in statistical arguments. If 99.999% of people who have fantasies of violence don't act on them, does it help or hinder the process of identifying the 0.001% who eventually will act on them?

The discussion I heard on the radio was over new rules that require at least two people in the cockpit (assumably awake!) and that would seem to be helpful. The report added this is a requirement for U.S. flights.

A related harder problem perhaps is "tattling", like if you're a pilot and your copilot starts talking irrationally, where is the line?

I would imagine pilots might sign an agreement with the airline, that they will follow certain agrements - in relation to drugs or alcohol used before flying, and sleep patterns, and even perhaps emotional problems, so if a pilot could say "I had a fight with my wife, and I don't feel focused to be able to fly safely today" and he could be replaced, without threatening his job, that might also help. And the other side, with an explicit list, if a copilot sees problems, he can ask questions, and say "I don't think you should fly today." and have specific warning signs. But this is more about ordinary human frailty rather than psychological issues.

Of course the radio program I heard had someone offering the opinion that he would feel safer in a commercial jet than on the interstate highway, and statistically I've heard that's true.

So as tragic this is, we don't want to overreact and start promoting random regulations that make people feel better that we're "doing something", while having no real chance of reducing similar future incidents.

On the other hand, perhaps when the lives of hundreds of people are at stake, we'd better off with a "zero tolerance" policy, and pilots who show any sign of emotional instability can be banned from ever flying again. Of course such a policy will also find pilots who will do their best to "look normal" however chaotic and alone they are inside in their irrational delusions.