150, not 149, crash vic­tims

Los Angeles Times - - OPINION - By Robert M. Sapol­sky Robert M.S apol­sky isa pro­fes­sor of bi­ol­ogy at Stan­ford Uni­ver­sity and of neu­rol­ogy and neu­ro­surgery at Stan­ford’s med­i­cal school. He is a con­tribut­ing writer to Opin­ion.

What are we to make of An­dreas Lu­b­itz pi­lot­ing a Ger­man­wings air­plane into the side of a moun­tain? There is an un­help­ful tau­tol­ogy, meant to be ex­plana­tory, that arises at times like this. How could some­one have done some­thing this evil? Be­cause they were evil. Or: How could some­one have done some­thing this heart­less? Be­cause they were heart­less.

In the case of Lu­b­itz, we have to grap­ple with the re­al­ity of an­other tau­tol­ogy. As far as can be determined at this time, this sick act was com­mit­ted by a sick in­di­vid­ual with a long his­tory of men­tal ill­ness. Which puts us into familiar ter­rain but with a rel­a­tively novel twist.

The familiar ter­rain is of men­tally ill in­di­vid­u­als with a psy­chosis act­ing vi­o­lently, pum­meled by dis­or­dered thought, delu­sions and voices in their heads com­mand­ing them to do the un­think­able. This is the world of the likes of John Hinckley, David Berkowitz and Charles Manson, all di­ag­nosed schizophren­ics. One press­ing chal­lenge with such cases has been to con­vince the public of the ex­treme rar­ity of acts like th­ese — the vast ma­jor­ity of schizophren­ics are danger­ous only in­so­far as they break the hearts of loved ones watch­ing the tragedy of a wasted life.

There is no ev­i­dence sug­gest­ing that Lu­b­itz suf­fered from schizophre­nia. In­stead, the novel twist is that his mal­ady ap­pears to have been se­vere clin­i­cal de­pres­sion. This is the dis­ease in which ev­ery cell in the body drowns with ground­less an­guish, and with suf­fo­cat­ing feel­ings of be­ing hope­less and help­less, in which any at­tempt to keep de­spair about the ex­i­gen­cies of life at bay with ra­tio­nal­iza­tion fails, re­placed with a chest-crush­ing, metas­ta­sized sad­ness. It ap­pears as if Lu­b­itz had to put his pi­lot train­ing on hold years ear­lier be­cause of in­ca­pac­i­tat­ing de­pres­sion, had been tak­ing an­tide­pres­sants, had a his­tory of sui­ci­dal thoughts.

Ma­jor de­pres­sion is enor­mously danger­ous to its suf­fer­ers — for ex­am­ple, about 40,000 peo­ple com­mit sui­cide an­nu­ally in the United States, and most of those cases in­volve ma­jor de­pres­sion. But it is im­mensely rare for de­pres­sion to re­sult in vi­o­lence to oth­ers.

There are in­stances of a deeply de­pressed in­di­vid­ual killing his fam­ily and then him­self. Such an act is usu­ally a mix­ture of re­venge and of a dis­in­te­gra­tion of ego bound­aries, in which it is un­clear to the sufferer ex­actly where he ends and his loved ones begin. Or re­call the ghastly tragedy of An­drea Yates, lost in se­vere, delu­sional post­par­tum de­pres­sion mixed with evan­gel­i­cal Chris­tian­ity, drown­ing her five chil­dren in the be­lief that this would guar­an­tee them an eter­nity in heaven.

It seems un­likely that such sce­nar­ios ap­ply to Lu­b­itz — there’s no ev­i­dence of mo­ti­va­tions along those dam­aged lines; plus, some­one mired in that de­gree of delu­sional de­pres­sion would have raised red flags long be­fore set­tling into a cock­pit. Thus, all we have is some­one with a his­tory of sub­stan­tial — and on­go­ing — de­pres­sion who has com­mit­ted an act of mass mur­der/sui­cide.

We yearn for ex­pla­na­tions, and this does not ex­plain a whole lot. But as we wait for in­sight that may never come, a few crit­i­cal things must be re­mem­bered, things that men­tal health pro­fes­sion­als would say in their sleep, but which need to be end­lessly re­peated be­cause they rarely stick.

First, de­pres­sion, like all men­tal ill­ness, is an ill­ness , a dis­ease, a sit­u­a­tion in which some­one’s essence has been made un­rec­og­niz­able by bi­ol­ogy gone wrong. De­pres­sion is a neu­ro­chem­i­cal dis­or­der rooted in ge­netic vul­ner­a­bil­ity and stress­ful en­vi­ron­men­tal trig­gers, in which there are func­tional ab­nor­mal­i­ties through­out the brain, in the im­mune sys­tem, en­docrine glands, vir­tu­ally down to the toe­nails. De­pres­sion is as real a bi­o­log­i­cal dis­or­der as ju­ve­nile di­a­betes, and just as no one chooses to have a pan­creas that can­not make in­sulin, no one is able to over­come that lit­tle-ol’ prob­lem just by show­ing some gump­tion. It was not Lu­b­itz who did this; it was his dis­ease. Or to state this as ex­plic­itly as pos­si­ble, the Ger­man­wings crash had 150, not 149, vic­tims.

Sec­ond, de­spite the supreme rar­ity of Lu­b­itz’s man­i­fes­ta­tions of de­pres­sion, it is a stag­ger­ingly com­mon dis­ease. This is a dis­ease des­tined to af­flict about 1 in ev­ery 6 hu­mans at some point in their lives, a dis­ease that, ac­cord­ing to the World Health Or­ga­ni­za­tion, is closing in on be­ing the sec­ond lead­ing cause of med­i­cal dis­abil­ity on the planet. De­pres­sion is the com­mon cold of psy­chopathol­ogy.

And here is where there is the great­est dan­ger. Men­tal ill­ness of ev­ery stripe is al­ways shrouded in stigma, com­pro­mis­ing fair ac­cess to em­ploy­ment, hous­ing, health­care and so on. An un­treated ma­jor de­pres­sion is one of the most life-threat­en­ing dis­eases on Earth; if the un­prece­dented act of An­dreas Lu­b­itz drives de­pres­sion suf­fer­ers to hide, deny, ig­nore their dis­ease even more than is al­ready so of­ten the case, the num­ber of in­no­cent lives lost will dwarf the heart­break­ing num­ber of 150.

It wasn’t An­dreas Lu­b­itz who crashed the jet; it was his dis­ease.

Michael Mueller As­so­ci­ated Press

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