I am writing this aboard a commercial airplane, where my fear of flying is overcome by my implicit belief in the pilot’s unerring ability to bring me safely from point A to Point B in this case from Los Angeles to New York. Am I naive? The news media’s excessive focus on the homicidal suicide crash of Germanwings co-pilot Andreas Lubitz would make me think so.
But how common are this co-pilot’s extensive mental health concerns which apparently ranged from severe depression and suicidal tendencies to possible psychosis. The answer is not common at all. If Lubitz left a trail of warning signs that were shockingly ignored by his doctors, does this automatically mean there are others like him still up in the sky piloting planes? The answer is no.
And yet, I question, and I am not alone. Are the mental health screens sufficient? Do the three thousand FAA approved primary care doctors who examine American pilots every six months ask the right questions about relationships, sleep, anxiety, hopelessness? Do the pilots themselves give honest answers?
A bigger tragedy than the one that occurred in Switzerland would be to deepen the stigma against mental illness, which would cause more of those afflicted to hide their symptoms and go underground.
To be fair, the vast majority of the 50,000 pilots in the U.S. and Canada as well as others around the world are physically and mentally sound, not only that, many have an extra degree of mental toughness having trained in the military. No other profession demands this level of medical certification. Bus drivers, truck drivers and train operators do not receive the same kind of screening and they also have our safety in their hands.
Finding a physical or mental health problem before it puts others at risk is the job of a good primary care doctor. it is my responsibility to develop a sufficient enough rapport with my patients so I can effectively screen for depression. If I believe my patient is impaired and their job involves keeping the public safe whether he is a pilot or a bus driver or a fellow doctor, it is my job to report this impairment to the supervising agencies. Public safety must always trump patient privacy.
I don’t know whether Andreas Lubitz’s behavior was bizarre or impaired enough in advance to spur his doctors to action or whether the sudden shock of a failed relationship precipitated the awful crash. I do know that the vast majority of depressed patients can be effectively treated with therapy and medication. The key is to find them before it’s too late to help.
In the meantime, a bigger tragedy than the one that occurred would be to deepen the stigma against mental illness which would cause more of those afflicted to hide their symptoms and go underground. Currently, the FAA allows pilots to fly while taking anti-depressants if they have responded well to the medicines. That should not change, even if we rightly enhance the screenings and ask more probing questions.
Our trust in our pilots also should not change, though media-driven fear erodes and is more contagious than any virus or bacteria.
When my flight landed in New York, the passengers broke into applause and the flight crew, including the pilot and co-pilot, were all smiles, shaking hands. Was it my imagination, or had the need to reassure increased due to the impact of one deranged killer?
Marc Siegel MD is a professor of medicine at NYU Langone Medical Center and author of False Alarm: The Truth about the Epidemic of Fear.