What psychological evaluations has your airline put in place ?

[Denti]

Why would he? His mental problems were well documented and part of his medical special approval. The real problems only started after he was already on the job and didn't disclose the resurfacing problems, as he should have done. Any pre-employment letter from his GP wouldn't have prevented anything.

And of course he passed (twice) a rather comprehensive psychological screening during his cadet selection and after he came back from his time out to deal with his depression. Didn't help at all, and it isn't designed to do it anyway, it is just there to see if he conforms to a certain psychological profile and fits into the pilo team of Lufty.

[abgd]

What qualifies the average GP to determine such such a thing?

Equally to the point, what do your employers do when your sensible GP states that this is not NHS work that they're obliged to do it, they're not qualified to do it, and consider it to be highly medicolegally risky and don't want to take it on as private work?

I'm not an AME but I was under the impression that for a class 1 medical your AME would request for your GP to send a summary anyway.

[Jodelophile]

Dear Mr Snuggles, The extreme German medical confidentiality laws mean that even after death we cannot see what the many medics he saw, recorded about their consultations and diagnosis. Before the disaster they were afraid to contact the authorities to stop him flying in case they were sued. We have therefore no significant detail about his mental state in the period leading up to Lubitz's actions.
The vast majority of people with depression would not harm others, except by causing psychological distress to friends and family by their suicide.
There is no clear evidence that Lubitz was psychotic as we cannot see his medical records. He did have anxieties about his eye sight which was probably more of a psychosomatic or hypochondriacal nature rather than being psychotic.
Due to German extreme secrecy we are losing an opportunity to understand what went on in Lubitz's mind in the weeks leading up to the crash. The Germans need to reform their confidentiality laws both so that we can understand this disaster and hopefully identify any future Lubitz.

[Radgirl]

Why do you think we can learn from Lubitz's medical notes?

Either he was bipolar (depressed) and the severity of the disorder increased to the extent that he was prepared to kill others as he committed suicide, or his bipolar disease resulted in a psychotic state.

I doubt if anyone would allow a pilot a medical with evidence of psychosis so the question is simply how do we allow for the fact that some patients with bipolar disease deteriorate, and deteriorate rapidly, without taking medicals off every pilot who is a tad depressed.

I have read lots of third hand reports about his previous problems but the fact remains that he was given a medical so at that moment in time he was considered 'safe'

A number of my colleagues have committed suicide. As doctors we dont really have the capability to take others with us but it does demonstrate that aviation is not the only profession with this problem although on the very rare occasions when pilots do become unsafe they do have the capability to cause much more harm to others.

[Jodelophile]

If we had full access to his notes we may begin to understand how he got into the state where he killed 149 others, this may help us to identify and prevent a future similar incident. You suggest he was bipolar in a depressed phase, but we do not know because the Germans will not release his notes. I think there was a degree of personality disorder but unless we can see the notes we won't know, neither do we know if he became psychotic. He had a sick note for the day of the crash, and maybe whoever gave him that note should have made sure he didn't fly. He was also prescribed four different medications before the crash, none approved by EASA.

[abgd]

whoever gave him that note should have made sure he didn't fly

How? Even in the UK, you would need a clear indication that he was going to fly despite being unfit, before you would be justified in breaching confidentiality.

If I breached confidentiality every time I told people not to drive, but half suspected they would anyway, I'd have lost my license to practice many times over.

[Jodelophile]

I did say 'maybe' whoever gave him the sick note, but we do not know why he was given the note because access to the files are denied to us.
I think in the UK it would have been more likely that he would have been made unfit by his AME. In Germany medics are terrified of breaching confidentiality. Yes, a pilot could get a sick note from his GP and not let his AME know then continue to fly but I think there is more openness and better communication in the UK because there is not the great fear of being sued or struck off for any breach of confidentiality. The DVLA doesn't have such strict rules as the CAA so it is more difficult to justify informing them, nevertheless it can be done and should be done at times.

[abgd]

I suspect it depends on whether the AME is made aware of it. If you see a psychiatrist privately then your GP need not necessarily be informed - though arguably if you did not want your GP to be informed and the psychiatrist knew you were a pilot that might be fishy enough for them to breach confidentiality. Any doctor can write a sick-note. It doesn't have to be a GP.

The AME will only know what he/she can glean from the patient, and the GP notes. And yes, you could be struck off for a breach of confidentiality even in the UK.

[Radgirl]

Agreed abgd, the differences between Germany and other countries are limited. Doctors are there to advise, and in the main not police.

Jodelophile people do this type of thing either due to bipolar disease (the medical term for depression) ie they are so fed up they want to kill themselves and dont care if they kill others, or because they have lost contact with reality, which is a psychotic state. Psychosis can be triggered by bipolar disease or schitzophrenia. Personality disorder doesnt really come into it - either he was a murderer or suffering from a mental illness, and in England at least it has to be on or the other. His medical notes wont IMHO help one iota as they wont teach us how to predict these states in other pilots.

Sadly psychiatry simply cant predict with accuracy who is going to become bipolar or psychotic, it can only identify those who are or have been. Unless we ground every pilot who has a history of bipolar disease, all we can do is monitor them and agree a certain level where we pull their medicals. Even then a small number of previously well pilots may become schitzophrenic or bipolar and not be picked up. It is far better to manage this hazard by a two person in the cockpit policy as the risk remains low and the harm to the pilot population otherwise is disproportionate

[Jodelophile]

Sorry but don't agree with you Radgirl! Bipolar is a type of depression with fluctuations of mood but is not the medical term for depression and the vast majority of people with depression may wish to harm themselves but not others. I think those who want to kill many people like the mass shooters in the US have a personality disorder and not depression. Psychosis is a mental disorder where there are abnormal experiences such as hallucinations or abnormal beliefs such as delusions,schizophrenia is a psychosis and does not trigger psychosis. Lubitz's medical notes may or may not help but they should be made available to the medics and air accident investigators involved in the aftermath of German Wings.
The vast number of pilots who develop some sort of mental disorder get a reactive depression which is secondary to stress at work and some domestic problem, it can nearly always be treated with some form of therapy and the pilot can safely return to work. Bipolar disorder and schizophrenia develop very rarely in pilots and would generally be disqualifying. Both disorders tend to manifest themselves quite early in life, teens or early 20s so would be unlikely to appear in an established pilot. It is the pilot with a latent personality disorder who decompensates who is the risky one.

[abgd]

I would agree that bipolar disorder is only one psychiatric disorder, but it isn't the only psychiatric disorder where you lose contact with reality, or even the only form of depression. Psychotic depression would be another. Agitated depression also often leads to suicide (non-agitated depressives often don't have the get-up-and-go to bother).

Whilst it's true that personality disorders can wax and wane in terms of severity, I think it's rare that they're truly 'latent'. That's why they're personality disorders - they're fundamental to someone's personality. Like having the flu, someone with depression can get better and has a 'normal self' to get back to.

[Jodelophile]

By 'latent' I mean they are there but not causing significant problems to others, like the shooters in the USA, after the event people would say, "He was a loner, interested in guns, polite but never really got to know him, he had no close relationships..." then something happens to cause the person to decompensate and there is another mass shooting.

[MrSnuggles]

From the BEA report. Page 8.

In December 2014, approximately five months after the last revalidation of his class 1 medical certificate, the co-pilot started to show symptoms that could be consistent with a psychotic depressive episode. He consulted several doctors, including a psychiatrist on at least two occasions, who prescribed anti-depressant medication.

And:

On 10 March 2015, the same physician [my comment: seems it is not one of those previously mentioned] diagnosed a possible psychosis and recommended psychiatric hospital treatment. A psychiatrist prescribed anti-depressant and sleeping aid medication in February and March 2015.

So we know that he suffered from depression. We know he suffered from a psychotic episode. He was medicated to treat both. He was put on sick leave. He never disclosed any of this to his employer, and the docs were too many to see the whole picture.

Radgirl: Bipolar is not another word for depression. Depression is a part of bipolar. Lubitz was not diagnosed with bipolar. Bipolar is another kettle of worms. You can not mix those terms like you do. It makes no sense.

According to the report, none of the doctors seems to have suggested any personality disorder so us speculating about that may be a fun pastime, but please do not consider it more than that. I have already explained how the two diagnoses Lubitz had, can work together in many many ways, and in his case they found the extreme.

I just want to stress that the possibility of this being a "mercy killing" is very real. "Mercy killings" has been seen before. As I wrote, some family murder-suicides and several parents killing their small children has been due to the belief that "this world is too cruel and I will spare my children the struggle of coping with the disappointments life hits you with". I know, that is a totally deranged logic but in their head it makes sense at the time. While in a psychosis you have no real connection with anything except your own feelings - whatever they might be at the moment.

I am however reluctant to draw similarities between the average US mass shooter and those "mercy killers" out there. Most mass shootings seems to the untrained eye to be brought on by some kind of jealousy/wish to be noticed and infamous/hatred towards a particular group in society/social status.

[Radgirl]

MrSnuggles your quotes seem to have provided the information requested. It appears any mental health issues were inadequate to withold his medical but he then deteriorated. Dont blame the doctors who were not AMEs - their role is to provide medical case not operate a police state.

The question is simple; how often does this situation occur such that a pilot passes a medical but then develops an unsafe medical health issue? I suspect rarely - if we look at the number of alleged deliberate CFITs (Air Egypt, Air Malaysia, German wings) compared to the millions of flights the risk is low. The two persons in the cockpit seems sensible. Is there evidence to indicate we should do more ie refuse medicals to more pilots? I think not, and I also fail to be convinced there is an objective assessment that can do so. I am not a psychiatrist, but IMHO psychiatry is more an art than a science, whose underlying process are in the main unknown and whose terminology varies with time and country - as the finger wagging confirms

[Jodelophile]

Because of the German refusal to release the full medical notes the BEA report on his mental condition is limited. Possible psychosis was referred to but we do not know how the interview with him led to this diagnosis, we don't have access to the recording of the mental state examination. Again, in the absence of details from the notes, we have to speculate and personality disorder is a possibility. Maybe there was a wish to be infamous, he allegedly said to his girlfriend "Some day everyone will know my name" and he seems to have put some planning into the crash, on the way to Barcelona he fiddled with the altitude setting, he had researched the cockpit door locking mechanisms, he had apparently ordered new cars for him and his girlfriend and then cancelled the order for his.

[Radgirl]

Sorry Jodelophile but we seem to be in parallel medical systems. Why do you think the interview was 'recorded'? Does it really matter? Are you criticising the other doctor, whose speciality is unknown? I find your phrase 'German refusal to release' rather telling. A number of countries have strict confidentiality rules for good reasons.

This pilot had mental health issues. He was a victim the health system could not help. Time and again we see people with mental health issues who commit crimes being treated as common criminals rather than additional victims, often let down by their carers. I for one do not want to rake over his illness, merely to ensure that we have an aviation system that is as safe as is practical.

With that I will bow out of this thread

[rantanplane]

Personality disorders are not looked at that often in the German medical system. Especially GP's and psychiatrist fail, they often think everything can be treated with some pills. With personality disorders, the side effects of psychiatric medication could be a recipy for disaster, when the dark side in s.b. Brain is released and really turns out like a sledge hammer. Some comments L. made clearly show significant signs of a narcissist personality disorder.

[gingernut]

What qualifies the average GP to determine such such a thing?

They ask the question, "do you feel like hurting yourself or anyone else."

Surprisingly, when they ask the question is asked, patients tend to give a very honest answer.

[Jodelophile]

Responding to Radgirl, by 'recorded' I meant that notes should be made to 'record' the meeting and to justify a diagnosis and treatment. And from these notes we should be able to try to analyse what made him do what he did.
Confidentiality is excellent but not when it puts others at risk, there has to be a point where confidentiality is justifiably breached.
I think we do need to 'rake' over or analyse his illness/disorder so we can try to understand what went wrong.
I think narcissistic personality disorder is quite a likely explanation and he decompensated when something happened to puncture an overinflated self-esteem, maybe it was a fear that his eyesight was deteriorating.