A colleague of mine, an obstetrician-gynecologist, was doing a lot of airplane travel this winter. It got him thinking about the pressure he might feel before entering the operating room. He remarked in February, “Every time I get on a plane, I think, in surgery I have one life in my hands. These pilots are responsible for hundreds!”
The crash of Germanwings Flight 9525 in the French Alps on March 24, 2015 brought this sentiment home in ways my colleague and I never could have predicted. And as information emerges about copilot Andreas Lubitz, the man who apparently brought down the plane in an act of suicide and murder, many observers are now thinking about how to prevent such tragedies.
Last week, I had the chance to talk to Robert Siegel of NPR’s All Things Considered about the opaqueness of mental illness. We talked about how difficult it is to know when a person is struggling with private psychological and emotional pain that might lead to dangerous or destructive behavior.
We all wish — as in the 1956 science fiction story, “Minority Report,” by Phillip K. Dick (turned into the 2002 movie by Steven Spielberg from a screenplay by Scott Frank) — that we could somehow get behind that opacity to predict future crimes and violence and prevent bad things from happening.
All of us tend to keep our thoughts, especially our most disturbing ones, to ourselves. Even when encouraged to speak those thoughts aloud — to a mental health professional, for example — it is very difficult to do so. We may be ashamed. Or we may simply fear being misunderstood.
If an individual tells a mental health professional, “Help me, I’m planning to kill someone,” the clinician can act protectively. If a person chooses to keep the professional in the dark, however, he or she is going to stay right there, in the dark.
There are no “tools” to predict events like suicide that occur relatively infrequently. Murder-suicide is even rarer, while the number of deaths in the Germanwings suicide crash makes it an unprecedented event.
Nonetheless, specific assessments do help clinicians reduce risk. They can look for factors that make a person more likely to cause harm, such as low mood, psychotic thinking, a life stress or loss of social support. By targeting such problems for treatment, the calamities we fear become less likely.
In the aftermath of this tragedy, there will likely be calls for increased scrutiny of pilots. That’s not necessarily a bad thing, but it could lead to the unintended and undesirable consequence that pilots will become even more wary of seeking help. The Germanwings pilot was seeking help which did not prevent him from carrying out a violent act. But policies that cause pilots with psychiatric disorders to avoid treatment and drive them “underground” will likely do more harm than good.
To honor the lives lost will require policies that protect the public while not being punitive to pilots. We will never walk that line perfectly, but if both values are held dear, it will be the best way to give pilots relief and make all of us safer.