Germanwings Crash: Is Depression Really to Blame?

Germanwings Crash: Is Depression Really to Blame?

Did Germanwings co-pilot Andreas Lubitz commit a deliberate act to cause the crash of a plane in the French Alps, killing all 150 people on board?

Authorities are still attempting to determine a motive for Lubitz’s alleged actions in last week’s crash, and many questions remain unanswered. Reports
 have surfaced that Lubitz was treated for “suicidal tendencies” prior to getting his pilot’s license, and that he had visited a neuropsychologist and an eye doctor recently and been deemed unfit to work. 

Both of those doctors concluded that he had psychological issues, according to media reports. Antidepressants were reportedly found in his apartment, leading to speculation he may also have been battling depression.

But depression alone likely was not the cause of the actions Lubitz is thought to have committed, says Charles Raison, MD, a professor of psychiatry at the University of Arizona who was not involved in Lubitz’s case. Raison provides insight into what may have occurred.

Q: Reports have suggested that the co-pilot was suffering from depression, and that he had been prescribed antidepressant medication. Does that make somebody ineligible to fly?

A: Just because somebody’s depressed is not a reason for somebody not to fly. Somebody who is acting suicidal, that may be a different issue, but I don’t think it was depression that was the problem here, although I can’t say for sure.

If you think about what this entails, here’s a guy who plans this out, the door gets closed, then he hears people screaming, the other pilot is banging on the door, they’re cascading down from 30,000 feet. He’s calm as can be – that’s not usually depression.

I’m pretty sure that eventually it’ll come out that he had some kind of psychotic break. If you’re depressed and you want to die, you don’t want to do this to other people – that’s just not part of the gig. If you’re psychotic, you hear things, and you begin to develop these odd ideas where you actually think you’re doing the right thing.

We used to say in medical school: common things happen commonly. And when somebody does something this bizarre, the common explanation is that they’ve developed a psychotic condition.

Q: Millions of people have depression, and don’t carry out acts such as this. Knowing as little as we do about Lubitz’s full history, do you believe something else had to have been going on with this man’s mental state?

A: He may have been depressed and psychotic, but I’d be willing to bet that he had a break with reality. That is unusual in depression. It occurs in people who have manic depression, or bipolar disorder. In fact, if you get depressed and psychotic as a young person, it’s almost always bipolar disorder.

Psychosis is more common in mania than it is in depressions, so I don’t think it was just a simple case of depression.

At the end of the day, there’s really only a couple possibilities. If he was, on average, just depressed – he wasn’t hearing voices or anything, he was just depressed – and had not lost touch with reality, to do something so horrible to so many people, to have people screaming and other guys banging on the door, it’s going to come out that he had a chronic history of being horribly narcissistic or unbelievably sadistic.

As far as I can tell, this guy did not have a history of violence. He had a history of mental illness, but he didn’t have a history of violence, or at least we haven’t heard that yet.

This is a very violent act. This is a slow, long, horrible violent act.

Q: We do know that he had been treated for suicidal tendencies in the past. What does that tell you about this man’s mental state?

A: It tells me that this guy was sick. At lot of people with depression have suicidal tendencies, and some people with depression kill themselves. With really serious depression, somewhere between 8 and 15% of people commit suicide eventually.

Of those people, very few take anybody with them. When they do, there’s usually a personality problem too.

We do know that the worse depression you have and the younger you are, the more likely you are to have bipolar disorder. Young men don’t tend to get depressed – the rates for depression are less than half of what they are in women.

When you see young men with catastrophic depression, they have a very high rate of converting to bipolar disorder.

I’ve heard that he also received an official diagnosis of generalized anxiety disorder. Anxiety, chronic anxiety [is also more associated with] bipolarity, compared to [just] depression.

I’m fairly certain that this guy had a really nasty bipolar disorder, and my guess would be that in the last few weeks, he developed this crazy delusional system which caused him to do this very horrible thing.

Q: There are also reports that he may have had vision problems, and there is some suggestion that those could have been psychosomatic. What does that mean exactly, and does that give us any clues?

A: Psychosomatic symptoms are associated with mental disorders; there is no doubt about that. There are very powerful associations with many disorders – depression, anxiety. We actually have what are called somatoform disorders in psychiatry, where the primary problem is that peoples’ lives are destroyed by physical symptoms that no doctor can find an explanation for.

But it doesn’t provide you any specific guidance. It’s another piece of evidence that this guy was psychiatrically disturbed.

Q: Are there methods in place, or should there be methods in place to help catch things like this before they happen? Is that even possible?

A: This is a complex issue, and it’s a tragic thing that I’ve now been asked this question about eight times in the last five years. There has been a string of stuff like this – Newtown (Connecticut), Jared Loughner (2011 shootings in Tucson, Arizona) – and this is always the question.

In my thinking, the answer is it’s a balance between personal privacy and personal freedom, and public safety. Where you draw that line is not so easy. Something like this happens, and everybody says “OK, we need to do this, this and this.” But then you start putting all of those restrictions on people, and it starts to look like a police state.

So what I have said consistently is that people need to be on the lookout for friends and loved ones who begin to act strangely at any age, but especially over the age of 18. If somebody you know well begins to change strikingly in their behavior, in their hygiene, in the way they speak – if they begin to talk about strange ideas that don’t make sense, every bell should go off in your head.

Not because they’re likely to be violent. The vast majority of people with very serious mental illnesses where they lose touch with reality are not violent. The main reason to have that awareness is because we know that these disorders are catastrophic, and the sooner they’re treated, the more likely a person is to have a good outcome.

But also, every once in a while, these disorders are associated with violence, and we’ve seen that repeatedly. So that’s what we need to be looking for.

What I’d love to know is, did this guy show evidence that he was losing touch with reality in the weeks or months before this happened? Did his sleep change, did he start acting oddly, and to the degree that he did, it’s more and more certain that something like this could happen.