Saturday, April 4, 2015

Psychiatry Explains Andreas Lubitz

Writing about Andreas Lubitz in The New Yorker, psychotherapist Gary Greenberg asserts that psychiatry could not have prevented Lubitz from committing suicide and mass murder.

Greenberg is correct to say that it is impossible to predict accurately what someone who is mentally ill will do, but one comes away from his article with the impression that he wants to absolve psychiatrists of all responsibility for their patients' actions.

In Greenberg’s words:

But as any mental-health professional will tell you (and as many did in the wake of the crash), nearly one in three Americans meets the criteria for a mental-disorder diagnosis in any year, and more than half of us will qualify at some point in our lives. Once diagnosed, people with mental illnesses, even severe psychotic disorders like schizophrenia, do not commit violent crimes at higher rates than the rest of the population. And most people who have had suicidal thoughts do not go on to kill themselves, let alone a planeload of strangers.

Psychiatry is an imprecise science. Then again, so is climate science… and some people are convinced that the state of the earth’s climate a few decades from now is “settled science.”

And yet, mass murderers like James Holmes, Jared Loughner and Adam Lanza were known to be psychotic and dangerous. It is not that difficult to tell when someone is stark, raving mad. Anyone who says that it all depends on self-reporting has not had very much experience with psychosis or even with severe depression.

We might not know who is going to do what, but we can know who is severely mentally ill.

One should clarify one point. Today’s psychiatry considers schizophrenia to be a brain disease. This is not the same as a mental illness.

Unfortunately, it is still seen as such in many quarters. And the civil liberties lobby has made it very, very difficult to treat schizophrenics when they do not want to be treated.

Even if it is true that very few schizophrenics commit mass murder, what harm is done by involuntary commitment. When a patient’s brain disease makes it impossible for him to make a rational choice about treatment, the state might well, for his good, impose the proper treatment.

We would also like to know whether Lubitz was correctly diagnosed? Was he suffering from an everyday mood disorder, or was he more seriously ill? After all, there are a number of types of depression and one should not lump them all together.

Or else, we can ask whether he was a psychopath or a sociopath, both of which are psychiatric categories. Note well that a psychopath will be especially adept at hiding his condition from those near and dear to him. A psychotic or someone who is severely depressed will rarely be able to fool very many people.

While everyone is anguishing over the fact that pilots are disinclined to report their mental illness because it might cost them their jobs, we also know that Lubitz voluntarily disclosed his mental illness to his employer in 2009.

When it comes to psychiatric responsibility Greenberg neglects to mention a point that has been widely reported. Lubitz was prescribed an anti-anxiety  medication, Lorazapam, that might very well have aggravated his condition.

The Daily Mail reports:

It also emerged that the 27-year-old was prescribed an anti-anxiety drug so strong doctors have to warn patients of the increased risk of suicide. People who use Lorazapam are advised not to drive a car, let alone fly a commercial jetliner.

Medical experts say it can also increase the risk of self-harm at the start of treatment.

Also, from the time of his pilot training in Phoenix Lubitz was flagged as being unfit to fly. Surely, Lufthanza could have made psychiatric treatment a condition of employment. Or better, it could have rejected him as a pilot.

In America, Jesse Singal reports, the Americans with Disabilities Act forbids an employer from firing anyone because that individual is mentally ill. Of course, there are exceptions.

Singal explains:

In general, the Americans With Disabilities Act protects employees at big companies from being fired because of mental illness. There are many exceptions, though, as laid out in this primer from the National Alliance on Mental Illness (NAMI). Businesses can terminate an employee whose illness would cause an “undue hardship” to the business in question, or if there’s a credible reason to think the individual could pose a threat to themselves or others.

One suspects that someone, somewhere either underestimated the extent of Lubitz’s illness or overestimated the ability of psychiatry to cure him. Surely, the psychiatrist who prescribed Lorazapam to an airline pilot ought to have to answer for his decision.

What can psychiatry tell us about Andreas Lubitz? Greenberg suggests that mental health professionals can concoct narratives that appear to explain what went wrong.

He writes:

Our experience and our theories don’t allow us to predict who the next Andreas Lubitz will be, but they do give us the ability to assemble the fragments of his life into a coherent narrative that ends in an explosion in the Alps. We can, in other words, retrodict, and if we are good at it—if we can find a story that incorporates the events and fits their magnitude—we can bring the consolations of narrative to otherwise inexplicable occurrences. Nothing that we come up with is likely to prevent the next disaster, but it will at least provide an explanation, and with it some respite from the discovery, which we make again and again, that life can turn on a dime, and that when it does it is often for no reason at all, or for reasons that cannot be grasped.

When I described psychoanalysis as “overpriced storytelling” I was not fully aware of how much this unfortunate habit had invaded other forms of psychotherapy.

Surely, it is true that you can concoct a story that seems to explain almost anything. You can cobble together a narrative that appears to explain cancer, heart disease, automobile accidents, neurological disorders… what have you.

The narratives, Greenberg suggests, provide something of a consolation. They do not tell you what happened or how it happened. They do not offer a path to treatment.

Their primary purpose is to comfort those who are confused by a seemingly inexplicable event and to burnish the authority of psychiatrists.

If therapists cannot treat or cure, at least they can explain it away. But, they are also explaining their own failure to cure a man who was manifestly ill.

Since psychiatrists in Phoenix had seen that Lubitz was unfit to fly, the notion that no psychiatrist anywhere could have prevented him from doing what he did makes no sense. And that's without saying anything about the psychiatrist who gave him Lorazapam.


Anonymous said...

Looks like Jews will mostly stick with Dems.

JP said...

"Or else, we can ask whether he was a psychopath or a sociopath, both of which are psychiatric categories. Note well that a psychopath will be especially adept at hiding his condition from those near and dear to him. A psychotic or someone who is severely depressed will rarely be able to fool very many people."

I thought that psychopathic tendencies showed up on brain scans, too.

Schizophrenics are also quite capable of functioning with active hallucinations, so I'm not sure quite what you are trying to say here.

Stuart Schneiderman said...

I was trying to point out that psychopaths and sociopaths are notoriously good liars and are notoriously good at appearing to be perfectly normal.

I was also noting that Loughner, Holmes and Lanza were notably psychotic. It did not take any special training to see it. And, those who had special training were very clear about the diagnosis--the problem was that there was nothing they could do to help without consent.