Did Copilot Andreas Lubitz Conceal His Illness?

He might have if he had a melancholic depression.

Posted Mar 27, 2015

We don’t know yet what was wrong with Andreas Lubitz, the Germanwings copilot who flew his plane into the side of a mountain. But if he had a melancholic depression, he might well have successfully concealed it.

There are two main forms of depressive illness. One is a mix of anxiety, dysphoria, fatigue and somatic symptoms that does not necessarily involve sadness. Over the years it has been called neurasthenia, reactive depression, and depressive neurosis, among other terms. It is very common. But patients with it are not customarily plagued with suicidal thoughts, though they may indeed commit suicide impulsively.

The other form of depressive illness is called melancholia, and patients with it are very much at risk of suicide. They may also have psychotic thoughts, and those thoughts may easily involve others. New York psychiatrist Landon Carter Gray reported in 1890 a mother with psychotic depression who admitted “so strong an impulse to kill the children and herself that she had been obliged to leave the house and get away from them.”  (Landon Carter Gray, “Three Diagnostic Signs of Melancholia,” Journal of Nervous and Mental Disease., 17 [1890], 1-9, 8) This would not have been altruistic murder, as in the case of parents who kill their children to save them from the fires of hell. Under the influence of a melancholic depression, this woman from 1890 simply felt an almost overpowering impulse to do away with her children.

The point is that under the influence of severe depression, murder may easily occur, and the melancholic delusional mind does not easily distinguish between four children and a plane full of 150 passengers.

The real point that I wanted to make, however, is that many patients with severe, melancholic depression dissimulate and pretend that everything is fine so that family and caregivers will not block their suicidal plans. This danger of dissimulation in severe depression is something that psychiatrists have always known about.

In 1838 William Charles Ellis, chief of the Hanwell Asylum near London, said of suicidal patients, “After finding that they are so unceasingly watched, and so carefully secured, that they have no opportunity of executing their design, they will assume a most cheerful manner for days and weeks together, in order to lull suspicion; and when a favourable opportunity offers itself, it is never neglected.”

Ellis knew of  “a man who had long been in a state of despondency, and had made many attempts to hang himself, but had always been prevented, who very suddenly appeared much better.” He cheered up, volunteered a desire to work, and was sent out in a haymaking gang. One evening on returning for dinner he told the farmer that he was a bit warmish and would prefer to stay at the door. The rest of the party went inside for “tea.”  “A short time afterwards his keeper came down to inquire for him, and being told where he had been left, immediately exclaimed, ‘Then he has hung himself!’” Indeed, the man’s body was found in the barn “suspended and dead as he expected.” (William Charles Ellis, A Treatise on . . . Insanity [London: Holdsworth, 1838, 123-124)

This awareness of dissimulation in melancholic illness was once very strong among psychiatrists, given that even today the gravest calamity that can befall a practitioner is for a patient to commit suicide. Yet on the whole psychiatrists today are less distrustful than clinicians of yore.

Why is this?

A couple of things are going on. Physicians put much emphasis today on the “therapeutic alliance,” in which you frankly ask your patients about suicide and accept their reassurances. As well, it is much harder to admit to hospital today patients whom you believe are potentially suicidal than it once was.

Even more important, the suicidal variety of depression, called melancholia, disappeared from view in 1980 when the DSM-3 abolished psychiatry’s traditional two depressions and merged them together into a single entity called “major depression.” Therewith, the melancholic flag disappeared from clinical awareness, and all depressions became the same, with the same rather low risk of suicide averaged out over the whole pool. The high-risk group had become invisible.

Therewith the index of suspicion in psychiatry has lessened. The field’s fundamental mistrustfulness of melancholic patients has been replaced with a kind of benign therapeutic optimism, a confidence that the meds will set in and recovery will eventuate.

Except that with the ineffective “antidepressants” prescribed today, melancholia often does not subside. The patients continue to plot their deaths, yet apparently cheerful and upbeat on the surface. They do not wish to be stymied, and sooner or later may well act.  Everyone is then horrified. No one saw it coming. “He seemed fine,” their partners say.

We don’t know what was wrong with the twenty-seven-year-old Andreas Lubitz. But we do know that he had interrupted his flight training for half a year because of what is now seen as a depressive episode. He had torn up several sick notes from doctors. Was Lubitz melancholic? Half a year is a long time for treated depression to last, unless it was inadequately treated (Most German psychiatrists ideologically reject ECT, which would have been the treatment of choice.) “He seemed perfectly OK!” family and friends all chorus.

Yet maybe he was dissimulating and was still ill.

How to deal with other melancholic pilots who dissimulate their illness? Make sure a second person is always in the cockpit? Great, except that a suicidal pilot may arm himself and overcome the flight attendant. 

The airlines now find themselves between a rock and a hard place. 

1.  A template has now been created for other melancholic pilots to commit suicide. You find yourself alone in the cockpit and, protected by the impregnable door, you fly the airplane into a mountain, or, as with the Malaysia Airlines Flight 370, off into the fathomless ocean. The possibility of copycat suicide-murders scares the wits out of passengers, airlines and regulators alike.

2.  Step up vastly the levels of psychological surveillance, creating an oppressive kind of Great Eye? Captain Smith once had an episode of depression? End his career!  “Captain, you’ve ben feeling a bit down? How does driving a baggage cart for the rest of your life sound?” Such a level of surveillance would be totally regressive in terms of the positive attitudes about mental illness we’ve been trying to create. The stigma of depression would, in aviation, be worse than leprosy.

These are not attractive choices. Yet lots is riding on this.