Tag Archives: Lubitz

Mar 31 2015

Personality Disorders

I’m going to continue to talk about the #Germanwings case since someone on CNN has brought up the possibility that Andreas Lubitz had some sort of personality disorder. I’ll talk about the specific personality disorders in later posts.

Personality disorders are long-term, pervasive ways of relating to the world. There are a variety which include Anti-Social, Borderline, Narcissistic, Paranoid, Histrionic, and others. All are different. Note that: all are different. A Histrionic person will seem very different from the person with Paranoid Personality Disorder. Personality disorders are also more difficult to diagnose in many cases. They can underlie the more acute mental illnesses most of us think of when we talk about mental health problems. Or they can stand alone and the person with the personality disorder may never suffer from any other acute mental illness.

Nothing I’ve heard so far leads me to think that Lubitz suffered from a personality disorder. He may have or he may have not. I can’t tell from what’s been in the media. Yes, some people with a personality disorder may kill others. But not all. And not all killers have a personality disorder. To assume a personality disorder just because this individual killed 149 other people is not professional.

Back when I was in graduate school, my class was discussing the issue of insanity. During the break, the professor and a couple of us were sitting at a table talking about crime and mental illness. It was mentioned that anyone who could kill others had to be mentally ill. I mean, it just made sense. We all nodded our heads, but the professor cautioned us. We can’t diagnose by one action and insanity was a legal issue (as I’ve mentioned in a prior post).

Just a quick note: a person with Anti-social Personality Disorder (which includes psychopaths) rarely suffers from depression. The exception being when they get caught. So, in this case, Lubitz’s history of depression and anxiety argue AGAINST him suffering from Anit-Social Personality Disorder. Could he have suffered from a different personality disorder? Of course, but we just don’t have the information at this point. A person with Borderline Personality Disorder or Narcissistic Personality Disorder or Paranoid Personality Disorder could all commit murder, even mass murder.

For writers: if you decide you want your character to have a personality disorder, be sure to show the full picture. If you have a character saying, based on extremely limited information, “He’s got a personality disorder”, please have someone call that character out as an idiot who doesn’t know what he’s talking about.

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 29 2015

Generalized Anxiety Disorder

Just heard that the copilot, Andreas Lubitz, on the Germanwings plane that crashed in the Alps suffered from Generalized Anxiety Disorder. But I’m also hearing about some sort of “psychotic episode” in 2010 and had anti-psychotic medications. Let’s talk about each of these issues separately.

First off, just what is “Generalized Anxiety Disorder”. In a nutshell, it means that a person is having anxiety that is triggered by any number of things. If he felt anxiety related to just one thing, say heights, he would have been diagnosed as having a Simple Phobia. The sufferer from GAD feels anxiety and worries about all sorts of things “such as health issues, money, death, family problems, friendship problems, interpersonal relationship problems, or work difficulties.[2][3] Individuals often exhibit a variety of physical symptoms, including fatigue, fidgeting, headaches, nausea, numbness in hands and feet, muscle tension, muscle aches, difficulty swallowing, bouts of difficulty breathing, difficulty concentrating, trembling, twitching, irritability, agitation, sweating, restlessness, insomnia, hot flashes, and rashes and inability to fully control the anxiety (Wikipedia). As you can see, there are a lot of physical type symptoms related to GAD. How this may or may not relate to the previously mentioned “psychosomatic illness” is unclear at this point. Should Lubitz have been flying with this problem? It depends on the severity of the symptoms and which ones he was having. Could he have concealed these problems? Possibly, though that probably would have only added to the stress and anxiety.

Next, let’s look at “psychotic episode.” This is not really a diagnosis, but is often part of a diagnosis of some sort of psychotic disorder. In essence, it involves either hallucinations or delusions or both. There are other symptoms often associated with the psychotic episode, but these vary. Is this schizophrenia? It could be, but it could be related to a wide variety of other disorders or causes. This statement about Lubitz having had a psychotic episode tells us only that he had a period of time when he was not really in touch with the reality most of us share. It could have been brief. It could have been a one-off situation, never to recur. It could have been related to medication or physical illness (some illnesses like measles or other infection with high fever can result in hallucinations). Again, as with so much in this case, we just don’t know yet.

Now to talk about the “antipsychotic medication”. These include medications like Haldol, Thorazine, Seroquel, Zyprexa and a slew of others. Drugs like Haldol and Thorazine are often called “typical” antipsychotics, while the others are called “atypical” and are the drugs of choice nowadays. I’d like to know when this medication was prescribed. Back in 2010 or more currently? I guess it could be possible that he had left-over meds from that psychotic episode in 2010. If he was currently on an antipsychotic medication (which I’ve seen used as a sleep aid in patients who were NOT psychotic), that’s a whole different story…...UPDATE: just heard that he was given antipsychotic injections back in 2010 and that antidepressants were found in his apartment.

Once again, we’re left with a lot of questions still about this tragic case. BTW: It’s been my experience that docs often prescribe antidepressant medications for GAD. Also, the FAA (don’t know about the regulations in Germany, any help here would be appreciated) announced it would consider waivers that would allow a pilot taking certain antidepressants to continue flying.

UPDATE 3/30/15:  I heard a report on CNN that back in the 2009/2010 time frame, Lubitz was given Zyprexa. This medication is an “atypical” antipsychotic medication in wide use. It has some serious side effects, including sedation, weight gain, visual problelms, muscle problems, and a whole lot more. On the other hand, it’s very effective for individuals suffering from hallucinations and delusions. No, he wouldn’t have been able to fly while taking this medication.

Mar 29 2015

Psychosomatic Illness

It appears as of this morning, that Lubitz, the Germanwings copilot responsible for the crash in the Alps, was reported as suffering from a “psychosomatic illness.” Just what does that mean? Well, to put it in the simplest terms, it means that his emotions were affecting his physical functioning. For example, stress is well-known to have many physical effects. It is a strong contributor to Irritable Bowel Syndrome. What it does not mean is that it was a “made up” or imaginary illness. As a sufferer of IBS, I can tell you that my multiple trips to the bathroom are not imaginary! 😀

Wikipedia provides this definition (seemly derived from DSM 5): A somatic symptom disorder, formerly known as a somatoform disorder, is a mental disorder characterized by physical symptoms that suggest physical illness or injury – symptoms that cannot be explained fully by a general medical condition or by the direct effect of a substance, and are not attributable to another mental disorder. There are several somatic symptom disorders recognized in DSM 5 (Diagnostic and Statistical Manual, edition 5). In essence this definition means that Lubitz likely was presenting with at least one physical symptom that was not explained by a physical cause. We don’t know what symptoms he was reporting.

Just what the nature of Lubitz’ problems were is still unknown. And that’s important here. We just don’t know. I’m sure that the various investigators are looking into what was going on with this young man. But if they want to be thorough and come up with as accurate picture of what was going on with him, then it will take time. This, of course, is a problem for the media which needs to have a near-constant stream of new material, but this is the reality here. Diagnosis of a mental condition is difficult enough in a clinical setting with a cooperative (and alive) patient. And in this case, the investigators aren’t just looking for a diagnosis, but for the reasons for a specific act.

UPDATE 3/30/15:  Heard some psychologist on CNN saying that the reported psychosomatic illness suffered by Lubitz indicated that he was not in touch with reality and that he was psychotic. That’s just plain wrong.

It seems that Lubitz was having visual problems, but docs couldn’t find an organic reason for those problems so suggested that it was psychosomatic. Okay, that can happen. Think back to old WWII movies and soldiers suddenly unable to see but there are no physical wounds. That used to be called “hysterical blindness.” It doesn’t happen as much any more, but it does occur. But, it does not mean the patient is psychotic or out of touch with reality. It means that the psychological stress and upset the patient is suffering from is manifesting through the visual system.

I am also concerned about just who called this a psychosomatic illness. Was it the eye doc after finding nothing physically wrong with Lubitz’s eyes? Hmm. Reminds me of many, many years ago when I was complaining of pain in my knee. This was before CAT scans or MRIs, so when nothing showed up on X-Rays, the orthopedist called it psychosomatic, a way to get out of phys ed at school. Jump forward a couple years and another orthopedist decided to do surgery since at that point I’d been having pain for quite a number of years. Lo and behold, he found a torn cartilage. Bottom line: just because a doc doesn’t find something physically wrong doesn’t mean necessarily that it’s “all in your head.” Thank goodness my docs never suggested that I was psychotic. I wasn’t.

I’d need a lot more information to say whether or not Lubitz was psychotic in the past or at the time of the crash. Just because someone labeled him as suffering from a psychosomatic disorder DOES NOT make him psychotic!

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.