Psychiatry cannot stop crazy airline pilots (or crazy shooters)

Really liked this piece in the New Yorker about Andreas Lubitz and the limits of psychiatry.  Love this analogy:

Pilots, disaffected adolescents, rapists and murderers, you and I—all of our mental lives may be more like the weather than like billiard balls, determined by innumerable forces that amplify and distort one another in ways that make accurate predictions very difficult. The National Weather Service, despite its supercomputers and satellites, not to mention its thorough understanding of the physics of weather, is often fooled. We clinicians have neither those tools nor that knowledge. To be sure, there are mental disorders in which we know enough of the vectors to say that people who have them should not occupy certain positions. A person prone to delusions should probably not fly an airplane, and a pedophile should not teach children. But these are the exceptions rather than the rule. From all we know so far about Lubitz, he was not one of those severe cases but rather someone who was among the millions of people who once contemplated suicide and was being treated for a mood disorder. It seems that he was too normal to have been identified in advance as someone who could do something so extreme.

It’s human nature to think we can identify what we could have done differently to prevent similar future tragedies, but it’s just not that simple:

It is comforting to think that Lubitz was mentally ill. That would mean, among other things, that wise doctors could have figured out what the problem was and have fixed it, or at least they could identify it in other potential Lubitzes. But it is unlikely that even the best psychiatric evaluation would have prevented the Germanwings disaster. The depravity of the human heart cannot be contained in a vessel as flimsy as a psychiatric diagnosis.


About Steve Greene
Professor of Political Science at NC State

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