Bob CollinsWhatever progress Americans have made in understanding and accepting mental illness — and it wasn’t much — has been fairly well undone by the breathless coverage of last week’s Germanwings Airbus crash in the French Alps.
You know by now, perhaps, that first officer of the flight is believed to have intentionally locked the pilot out of the cockpit and crashed the plane. Reports have indicated he’d sought help for a mental illness.
The New York Times yesterday suggested it’s time to go back to banning pilots with depression, reversing years of attempts to be more intelligent about the illness and encouraging pilots to step forward and get help without losing careers.
And identifying a person whose condition poses a threat to public safety is not always easy, said Dr. Andrew Brown, president of the Academy of Organizational and Occupational Psychiatry.
“You have to get a sense of who this person really is, of what their coping mechanism is, of what their defenses are, in terms of how they characteristically deal with adversity,” Dr. Brown said. “It goes without saying that you have to ask them specifically if they have ever had thoughts of suicide.”
The Times was at least honest — if massively ignorant — about linking depression to threats to public safety, suggesting the crash undermines the more rational approach to pilot help on this side of the Atlantic. How it does that, however, isn’t entirely clear considering the tragedy in the Alps involved a German pilot in a German airliner in French airspace in which procedures were used that run afoul of U.S. aviation regulations. What is the evidence that our “looser” regulations — as the Times described them — are a problem?
But, whatever. Crazed and murderous pilots running amok, you know.
The Atlantic tried to push back against the hyperventilating over the weekend, reminding people that “depression” isn’t a synonym for “dangerous.”
“It’s kind of natural to say ‘This just has to be deeply crazy,’” says Jeffrey Swanson, a professor of psychiatry and behavioral sciences at Duke University who studies violence and mental illness. But people who commit mass murder “are really atypical of people with mental illness,” he says. “The vast majority of people with schizophrenia, bipolar disorder, or major depression are not likely to do anything violent and never will.”
By one measure, only 5 percent of violent crime is actually attributable to mental illness. For depression specifically, a study of more than 47,000 people in Sweden found that 3.7 percent of men and 0.5 percent of women diagnosed with depression committed a violent crime, The Guardian reported. In the general population, those numbers were 1.2 percent for men, and 0.2 percent for women. Depression is a risk factor, then, but a very small one.
“There’s this disconnect, but that becomes a prism through which we see these problems,” Swanson says.
The public simply doesn’t want to believe what the science can prove. A 2013 Gallup poll conducted shortly after the Navy Yard shooting found that 48 percent of people blamed the mental health system “a great deal” for mass shootings. Thirty-two percent blamed it “a fair amount,” The Atlantic said.
“Bad behavior—even suicidal behavior—is not the same as depression,” Anne Skomorowsky, a psychologist, writes on Slate.
The patient with bona fide depression will benefit from treatment with antidepressants or proven psychotherapies. For the lonely great-grandmothers, the junk food addicts, and the violent paraplegics, there has to be another form of intervention. We must turn from the inappropriate use of the disease model of emotional distress and understand that individuals’ psychological pain arises within social systems as well as within their own brains.
Was Andreas Lubitz depressed? We don’t know; a torn-up doctor’s note and bottles of pills don’t tell us much. Most people who commit suicide suffer from a mental illness, most commonly depression. But calling his actions suicidal is misleading. Lubitz did not die quietly at home. He maliciously engineered a spectacular plane crash and killed 150 people. Suicidal thoughts can be a hallmark of depression, but mass murder is another beast entirely.
Using the word “depression” to describe inexplicable or violent behavior sends two false signals: First, that society has no obligations with regard to our happiness—because misery is a medical problem—and second, that a depressed person is in danger of committing abhorrent acts.
“An utterly bizarre and unpredictable event is not a good basis of policy,” professor Simon Wessely, president of the Royal College of Psychiatrists, tells The Guardian.
“What does cause trouble is saying that if you have ever had a history of depression then you should not be allowed to do whatever. That is wrong, as much as saying that people with a history of broken arms shouldn’t be allowed to do something,” he said.
“Ask one of the 10 million-plus Americans who are seriously depressed at any given time,” Dan Diamond at Forbes advises. “The bravest among them will admit: Depression is devastating. It makes you self-loathing, and lays you low.
“But it doesn’t make you a murderer.”
