Tag Archives: depression

Mar 30 2015

Suicidal Thoughts and Pilots…and the rest of us

flying

CNN tells me this morning that Andreas Lubitz was depressed and suicidal back in 2009, before he got his pilot’s license. It is unclear at the moment if he was experiencing only thoughts or had actually made an attempt. We also don’t know what prompted him to think about suicide. We do know that becoming a pilot was a dream of his, something he was apparently passionate about.

We do not know how he was doing psychologically between 2009/2010 and now, about 5 years later. Depression doesn’t necessarily linger. It is treatable or can even go away on its own in come cases. Suicidal thoughts also come and go. And it’s important to point out that many, many people — I’d actually say most people — have suicidal thoughts at some point in their lives.

In the US, pilots can apply for a waiver if they are suffering from mild to moderate depression and are on certain medications. It is not an automatic grounding in the US any more for a pilot to be depressed. I don’t know what Germany’s standards are. If any of you know, please let me know!

When I’ve dealt with suicidal patients (and a lot of them were at some point or another), I asked about plans and intent. Most had no plan or intent. They’d insist that they’d “never do that” for a variety of reasons and in most cases, I believed them. I’d be more concerned if they had a specific plan. “I’d blow my brains out.” However, if they didn’t have a gun or access to one I’d be less concerned. However, I would be concerned. As a psychologist, my duty is primarily focused on taking care of my patient, so I’d be working hard to convince the patient that hospitalization would be a good move. On a couple occasions, I’ve called the police out for clients who’ve called me and led me to believe they were suicidal. Some got mad at me for doing this, but I was glad they were still around to be mad. Yes, under the law, I can break confidentiality if I think a person is a harm to self (or others). Calling an employer … that’s something I’ve never done and I wonder if, given the confidentiality laws, I’d be allowed to do that. I think if I had a pilot who told me he was suicidal and planned to crash an airliner, I’d call the employer or at least a doc working for the airline and take the hit on my license later.

I suppose that if Lubitz was still in therapy (that’s still unclear to me) and he told the therapist that he was suicidal and planning on crashing an airliner, the therapist would have taken some action to prevent this. More likely, if Lubitz mentioned anything at all about being suicidal at present, he was vague about it. Consider also that this guy loved flying. It was important to him. Very important. Perhaps the most important thing in the world to him. As a therapist, I’d have to consider this. If I take steps to ground him, am I actually increasing the odds that he’ll take his own life? Have I then removed the last thing that mattered to him? It’s a horrible dilemma, one I’m glad I’ve never had to face. (BTW: for you writers. This could make a really interesting short story.)

Mar 27 2015

Duty to Warn

I’m seeing on CNN some discussion about what the physician should or should not have done regarding notifying Lufthansa and/or Germanwings about the copilot’s (Lubitz) medical condition and his reported unfitness for “work”.

Here in the US, as a psychologist, I have a “duty to warn” based on various court cases in the past. This duty to warn involves situations during which a client makes a specific, imminent threat against an identifiable individual. This derived from the Tarasoff case. The rulings in this case have been extended over the years. I don’t know what the requirements are for German doctors. If someone knows, please let me know!

So, would a “duty to warn” pertain here? Maybe. Let’s take the case to the US and say the pilot is seeing me. The pilot comes in and reports feeling very depressed. He hasn’t been sleeping. He’s refused medications (because of flying) but has engaged in therapy on a regular basis. Now he reports having some thoughts about wanting to die. I ask if he has a plan. No, he replies. It’s clear to me that he’s depressed and at some risk for suicide, but there’s nothing that would set off alarm bells here. In this case, I’d ask more about his ability to concentrate. I’d try to engage the pilot in a conversation about whether or not he feels able to fly. He says, “I don’t know.” Perhaps in that situation, I’d give him a note that would cover him if he chose not to go in to work.

Now let’s up the ante. Same initial situation, but now he reports some strong feelings of wanting to die. When asked if he has a plan, he looks up with a half smile and says, “I could always crash a plane into some mountains. That’d be the way to go.” His risk for suicide just goes up. He actually has a plan but it’s still vague. He could mean taking a private plane up and crashing it. I think in this scenario, I’d work really hard on getting him admitted to a hospital. But, he’s likely to refuse to do that since it would come to his employer’s attention and likely result in being grounded. This puts me in a real dilemma. If I take away something he loves (flying), am I increasing his level of depression and actually giving him even more reason to suicide? I think I’d put him on a daily call in to me and strongly recommend he take a few days off, perhaps even see me more frequently while he’s on sick leave.

Now, let’s say he says “Doc, I just want to die. I keep thinking about getting into the jet, waiting till the pilot goes to the bathroom, and then crashing the plane into a mountain.” I argue about the other people involved. “Their families will get over it.” or “People die all the time.” I ask when he’s going to do this. “Soon.”  Okay, the threat is imminent and specific enough that I’d feel compelled to do something. True, the victims as individuals aren’t specified, but it’s clear he’s talking about crashing an airliner. Needless to say, I’ve never been in this situation. However, I think, given the laws here in the US and my own morality, I’d act to get him involuntarily committed to a hospital. He clearly (at least to me at that point) is a danger to both self and others. I think I’d also contact his employer, just in case anything fell through and he was released and tried to go back to work. I could be faced with a lawsuit due to break of privacy, but I think I could fight that with the help of a good lawyer.

Mar 27 2015

To Fly or Not: Thoughts about the Germanwings crash

I’d like to talk about the crash in the French Alps, apparently caused deliberately by the co-pilot, but with things developing so rapidly, I hesitate. Still, I’m going to go ahead with the caveat that much of what I have to say at this point may later prove moot.

What do we know? The plane crashed. The co-pilot was in the cockpit; the pilot was not. There were apparently deliberate actions taken by the copilot that set the plane on its trajectory into the mountains. He apparently was under doctor’s care for some illness and had received at least one note providing a medical excuse from flying, including on the day of the crash.

What we don’t know: we don’t know what illness he saw the doctor for. We don’t know why he had the break in training a couple years ago. From what I’m getting on CNN, I can’t tell exactly what the note from the doc said.

I am a licensed pilot, although I haven’t flown in many years. When I was actively flying (private), I was required to see a flight doc every couple years. The rules for airline pilots are different, requiring more frequent checks. The flight doc was not my regular doc. There may have been some questions about my mood, stress, but it was cursory and easy to fake had I so chosen.

I have also worked with populations, including AF pilots, where reporting of any condition that would render them unfit for work would be required. Since I have never been a flight doc, nor worked with civilian pilots, I don’t know the requirements on the doc to report. It seems like …. and I could be very wrong here….. the onus is on the pilot to self-report. But there are a lot of reasons a pilot would not do so. One of the worst things you can do to many pilots is to remove their wings, ground them.

So, where does that leave us? I’m not sure. The story isn’t finished yet. Was Lubitz depressed? I have heard nothing credible to say that he was or wasn’t.

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There is another issue here. Let’s face it. Most people who commit suicide don’t involve other people. On the other hand, most perpetrators of mass murder do not expect to live beyond the act. Many kill themselves; others set things up so police will kill them. So, where does Lubitz fall? Suicide or mass murderer? There are some different dynamics that go with each way of looking at this. Unfortunately, mass murder has not been studied as well or written about as much as with serial killers. Perhaps one of the reasons is that so many mass murderers do end up dying before we can question them. So, we are left wondering what was going on with Lubitz. Will a diagnosis of depression really answer the questions? For some of us, probably not.

UPDATE:   A clinic Lubitz had visited in Dusseldorf just reported that Lubitz was NOT seen for depression.