- Email: [email protected]
We are so close, yet so far: Avowal of mental health problems following Germanwings 9525
Journal de thérapie comportementale et cognitive (2015) 25, 76—78
Disponible en ligne sur
ScienceDirect www.sciencedirect.com
POINT OF VIEW
We are so close, yet so far: Avowal of mental health problems following Germanwings 9525 Si proche mais si loin : le problème épineux d’admettre que l’on souffre des troubles mentaux suite à Germanwings 9525 Stacey Callahan Université de Toulouse II, 31058 Toulouse cedex 9, France Received 7 April 2015; accepted 7 April 2015 Available online 13 May 2015
The aftermath of Germanwings flight number 9525 has created a firestorm of questions and comments from the public, the media, and anyone involved in airline travel, and this with a nearly obsessive emphasis on mental health issues. First Officer Andreas Lubitz has been identified as having perhaps suffered from depression and there are some reports that he had expressed suicidal thoughts in the past. It has been intimated, through various and aggressive means that the crash was due to his unstable mental health. To suggest that the tragedy of Germanwings can be summed up as being the result of psychological disorder is simplistic and dangerous. At the time of writing this viewpoint, full information from the investigation is not yet available, so to comment on what may have happened is not the object of the current essay. Rather, we would like to highlight two important points, which are rather stunning and surprising when you consider
them in the light of our supposedly modern and evolved attitude towards mental health. First, if Andreas Lubitz suffered from depression, perhaps to the point of feeling suicidal, and tried to hide it, what does that say about the progress we have made to demystify mental health problems? Secondly, in light of this episode, calls to strengthen screening for mental health problems in pilots are being made. So if pilots, specifically, are to now be subjected to additional scrutiny regarding their mental health (in addition to the rigorous safety training and focus on their physical health), what message are we sending to these people who work so hard in the interest of so many people? Indeed, what are we saying about the place for mental health in general in most professions? Is suffering from a mental disorder to become an automatic denial of workers’ inherent rights? To start with the first point, it is clear that admitting in 2015 that one suffers from mental health problems is still a highly taboo subject. Not only is it difficult to make such an admission, but also in doing so, it opens up a series of questions and apprehensions in the interlocutor. The indi-
E-mail address: [email protected] http://dx.doi.org/10.1016/j.jtcc.2015.04.003 1155-1704/© 2015 Published by Elsevier Masson SAS on behalf of Association française de thérapie comportementale et cognitive.
We are so close, yet so far: Avowal of mental health problems following Germanwings 9525 vidual, be he or she a doctor or other health professional, or a non-health professional, such as a manager, often find themselves incapable of responding in a supportive and helpful way. They are often in the uncomfortable situation of not knowing what to expect of this person who is expressing mental distress, and indeed may not show any outward manifestations of it. The simple fact that mental health problems are not easy to outwardly identify should not make mental health problems any more dangerous or mysterious than other medical problems, such as high blood pressure. But given the rocky history of mental health and its treatment over the ages, it is clear that we have not made enough progress to allow people to freely admit mental difficulties, particularly in times when they are living within stressful contexts. Simply stating the need for assistance for dealing with mental health issues does not necessarily open up the means for attaining that assistance. It does, however, often open the door to potential discrimination and marginalization. It is ironic that the individual who has the courage to admit to mental health problems will most often be negatively viewed and risk severe sanctions to their professional, and perhaps personal, life. Even more distressing is the seemingly obstinate attitude to mental health disorders as being chronic and enduring. Just as for the aforementioned example of high blood pressure, it is entirely possible to stabilize mental health problems to the extent that they should not pose stronger peril to a high-risk profession than any somatic disorder. Yet this idea seems even harder for the public to grasp than the mere idea that individuals with mental health problems are just simply a danger and must be restrained. Which brings us to the second point. Pilots are already subjected to rigorous assessment over their career in terms of professional and personal competence for their jobs. The actions of Mr. Lubitz and the assumed link to his mental health status have now created a widespread call for additional scrutiny of airline navigation personnel, with particular attention to their mental health status. Ironically, this will likely have the opposite, and a very paradoxical, effect. Instead of encouraging airline crew members to openly discuss any potential problems they might be experiencing, it is likely to marginalize them even more, discouraging them from seeking the help they need. If a pilot needs to express his or her mental distress, how can they do it without jeopardizing their livelihood? Are they given the same rights as all employees who might need, from time to time, support in dealing with the normal stresses of everyday life in addition to the stress inherent to their jobs? When we consider other high-risk occupations where lives are at stake, it is striking to note that few of these occupations impose the same sort of scrutiny that is levied on pilots. Moreover, mental health is rarely an issue that is immediately brought up when problems arise for members of these other occupations. For example, high-speed train conductors, who operate in full isolation, are responsible for a vehicle weighing approximately 440 tons, with two engines and usually 10 cars carrying 480 passengers — nearly twice the number of passengers on an A320 (the plane that was lost in Germanwings 9525). While it is possible that Mr. Lubitz suffered from some sort of mental disorder, it is shocking to see the nearly obsessive focus imposed on pilots following
77
this episode as other professions (such as train conductors) should, logically, be under the same scrutiny. In a related example, most surgeons would be careful not to overstep their own limits, but there are not consistent laws that would risk medical licensure if a surgeon goes over a certain number of hours in the operating room. Yet, if a pilot goes over the legislated number of hours in the cockpit, he or she can risk losing his/her license. Similarly, if any member of a high-risk occupation who deals with other human lives expresses burnout or stress, are they immediately called into question with regards to their ability to carry out their professional duties? Some may be, but others may not be. Moreover, do these people who are responsible for human lives on a daily basis dare to express their psychological malaise? It can be argued that not all high-risk occupations carry the same risk, or can have the same impact on other individuals. Yet, the fact that treatment and acceptance of mental health problems varies between professions already indicates the complexity of the problem. While it may be admissible to apply different rules to different professions, it seems clear that a better understanding of how mental health affects individuals in their capacity to work is an important issue to consider. While for many years work has been considered a source of stress, recent research suggests the opposite: work may be a haven from the stress of the rest of our lives [1]. The fact that any potential mental problems from which Andreas Lubitz suffered were either not well identified or well treated is then, not surprising. He certainly would have had difficulty admitting any problems given the generally taboo attitude we have to mental health problems, which is even more taboo for pilots both before and now in the light of this event. Add to this that Mr. Lubitz probably did not manifest any problems at work; indeed his work may have been a haven from other parts of his life causing him genuine stress. It is no surprise, then, that any difficulties he might have had did not fully come to light while he was on duty. The whole situation regarding mental health and how it is treated has been made worse, not better, by this catastrophe, yet it could provide us with so much to learn and the possibility to move forward in a positive way. The overall question remains: when will mental health problems be given their just place in the scheme of a full health service delivery to all individuals? At any given time, 20% of the population suffers from some sort of mental health problem and over 80% have expressed considering suicide at some point in their lives; yet it remains problematic to admit and seek help for these disorders. The inconsistent attitude to mental health makes admitting mental health problems difficult, and potentially threatening to one’s livelihood. Even worse, when those who suffer do not seek help, the problems do not just go away, they cause a myriad of other problems in other domains. And that is perhaps one of the most important lessons to take away from this catastrophe: until we change not only our attitude but also our approach to mental health, the problems will remain, and multiply without control resulting in disastrous and tragic consequences. As practitioners of CBT, we can encourage the attitude endorsed by Ellis, Beck, Linehan and others in the field: that
78 of total and complete unconditional acceptance. By fully accepting patients in their differing states of mental health or distress, we are already on the road to making it easier for them to admit and ultimately overcome their difficulties.
Disclosure of interest The author declares that he has no conflicts of interest concerning this article.
S. Callahan
Reference [1] Damaske S, Smyth JM, Zawadski J. Has work replaced home as a haven? Re-examining Arlie Hochschilld’s Time Bind proposition with objective stress data. Soc Sci Med 2014;115: 130—8.
Disponible en ligne sur
ScienceDirect www.sciencedirect.com
POINT OF VIEW
We are so close, yet so far: Avowal of mental health problems following Germanwings 9525 Si proche mais si loin : le problème épineux d’admettre que l’on souffre des troubles mentaux suite à Germanwings 9525 Stacey Callahan Université de Toulouse II, 31058 Toulouse cedex 9, France Received 7 April 2015; accepted 7 April 2015 Available online 13 May 2015
The aftermath of Germanwings flight number 9525 has created a firestorm of questions and comments from the public, the media, and anyone involved in airline travel, and this with a nearly obsessive emphasis on mental health issues. First Officer Andreas Lubitz has been identified as having perhaps suffered from depression and there are some reports that he had expressed suicidal thoughts in the past. It has been intimated, through various and aggressive means that the crash was due to his unstable mental health. To suggest that the tragedy of Germanwings can be summed up as being the result of psychological disorder is simplistic and dangerous. At the time of writing this viewpoint, full information from the investigation is not yet available, so to comment on what may have happened is not the object of the current essay. Rather, we would like to highlight two important points, which are rather stunning and surprising when you consider
them in the light of our supposedly modern and evolved attitude towards mental health. First, if Andreas Lubitz suffered from depression, perhaps to the point of feeling suicidal, and tried to hide it, what does that say about the progress we have made to demystify mental health problems? Secondly, in light of this episode, calls to strengthen screening for mental health problems in pilots are being made. So if pilots, specifically, are to now be subjected to additional scrutiny regarding their mental health (in addition to the rigorous safety training and focus on their physical health), what message are we sending to these people who work so hard in the interest of so many people? Indeed, what are we saying about the place for mental health in general in most professions? Is suffering from a mental disorder to become an automatic denial of workers’ inherent rights? To start with the first point, it is clear that admitting in 2015 that one suffers from mental health problems is still a highly taboo subject. Not only is it difficult to make such an admission, but also in doing so, it opens up a series of questions and apprehensions in the interlocutor. The indi-
E-mail address: [email protected] http://dx.doi.org/10.1016/j.jtcc.2015.04.003 1155-1704/© 2015 Published by Elsevier Masson SAS on behalf of Association française de thérapie comportementale et cognitive.
We are so close, yet so far: Avowal of mental health problems following Germanwings 9525 vidual, be he or she a doctor or other health professional, or a non-health professional, such as a manager, often find themselves incapable of responding in a supportive and helpful way. They are often in the uncomfortable situation of not knowing what to expect of this person who is expressing mental distress, and indeed may not show any outward manifestations of it. The simple fact that mental health problems are not easy to outwardly identify should not make mental health problems any more dangerous or mysterious than other medical problems, such as high blood pressure. But given the rocky history of mental health and its treatment over the ages, it is clear that we have not made enough progress to allow people to freely admit mental difficulties, particularly in times when they are living within stressful contexts. Simply stating the need for assistance for dealing with mental health issues does not necessarily open up the means for attaining that assistance. It does, however, often open the door to potential discrimination and marginalization. It is ironic that the individual who has the courage to admit to mental health problems will most often be negatively viewed and risk severe sanctions to their professional, and perhaps personal, life. Even more distressing is the seemingly obstinate attitude to mental health disorders as being chronic and enduring. Just as for the aforementioned example of high blood pressure, it is entirely possible to stabilize mental health problems to the extent that they should not pose stronger peril to a high-risk profession than any somatic disorder. Yet this idea seems even harder for the public to grasp than the mere idea that individuals with mental health problems are just simply a danger and must be restrained. Which brings us to the second point. Pilots are already subjected to rigorous assessment over their career in terms of professional and personal competence for their jobs. The actions of Mr. Lubitz and the assumed link to his mental health status have now created a widespread call for additional scrutiny of airline navigation personnel, with particular attention to their mental health status. Ironically, this will likely have the opposite, and a very paradoxical, effect. Instead of encouraging airline crew members to openly discuss any potential problems they might be experiencing, it is likely to marginalize them even more, discouraging them from seeking the help they need. If a pilot needs to express his or her mental distress, how can they do it without jeopardizing their livelihood? Are they given the same rights as all employees who might need, from time to time, support in dealing with the normal stresses of everyday life in addition to the stress inherent to their jobs? When we consider other high-risk occupations where lives are at stake, it is striking to note that few of these occupations impose the same sort of scrutiny that is levied on pilots. Moreover, mental health is rarely an issue that is immediately brought up when problems arise for members of these other occupations. For example, high-speed train conductors, who operate in full isolation, are responsible for a vehicle weighing approximately 440 tons, with two engines and usually 10 cars carrying 480 passengers — nearly twice the number of passengers on an A320 (the plane that was lost in Germanwings 9525). While it is possible that Mr. Lubitz suffered from some sort of mental disorder, it is shocking to see the nearly obsessive focus imposed on pilots following
77
this episode as other professions (such as train conductors) should, logically, be under the same scrutiny. In a related example, most surgeons would be careful not to overstep their own limits, but there are not consistent laws that would risk medical licensure if a surgeon goes over a certain number of hours in the operating room. Yet, if a pilot goes over the legislated number of hours in the cockpit, he or she can risk losing his/her license. Similarly, if any member of a high-risk occupation who deals with other human lives expresses burnout or stress, are they immediately called into question with regards to their ability to carry out their professional duties? Some may be, but others may not be. Moreover, do these people who are responsible for human lives on a daily basis dare to express their psychological malaise? It can be argued that not all high-risk occupations carry the same risk, or can have the same impact on other individuals. Yet, the fact that treatment and acceptance of mental health problems varies between professions already indicates the complexity of the problem. While it may be admissible to apply different rules to different professions, it seems clear that a better understanding of how mental health affects individuals in their capacity to work is an important issue to consider. While for many years work has been considered a source of stress, recent research suggests the opposite: work may be a haven from the stress of the rest of our lives [1]. The fact that any potential mental problems from which Andreas Lubitz suffered were either not well identified or well treated is then, not surprising. He certainly would have had difficulty admitting any problems given the generally taboo attitude we have to mental health problems, which is even more taboo for pilots both before and now in the light of this event. Add to this that Mr. Lubitz probably did not manifest any problems at work; indeed his work may have been a haven from other parts of his life causing him genuine stress. It is no surprise, then, that any difficulties he might have had did not fully come to light while he was on duty. The whole situation regarding mental health and how it is treated has been made worse, not better, by this catastrophe, yet it could provide us with so much to learn and the possibility to move forward in a positive way. The overall question remains: when will mental health problems be given their just place in the scheme of a full health service delivery to all individuals? At any given time, 20% of the population suffers from some sort of mental health problem and over 80% have expressed considering suicide at some point in their lives; yet it remains problematic to admit and seek help for these disorders. The inconsistent attitude to mental health makes admitting mental health problems difficult, and potentially threatening to one’s livelihood. Even worse, when those who suffer do not seek help, the problems do not just go away, they cause a myriad of other problems in other domains. And that is perhaps one of the most important lessons to take away from this catastrophe: until we change not only our attitude but also our approach to mental health, the problems will remain, and multiply without control resulting in disastrous and tragic consequences. As practitioners of CBT, we can encourage the attitude endorsed by Ellis, Beck, Linehan and others in the field: that
78 of total and complete unconditional acceptance. By fully accepting patients in their differing states of mental health or distress, we are already on the road to making it easier for them to admit and ultimately overcome their difficulties.
Disclosure of interest The author declares that he has no conflicts of interest concerning this article.
S. Callahan
Reference [1] Damaske S, Smyth JM, Zawadski J. Has work replaced home as a haven? Re-examining Arlie Hochschilld’s Time Bind proposition with objective stress data. Soc Sci Med 2014;115: 130—8.