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Tuesday, March 31, 2015

A Collection of Thoughts on Depression, Perverse Incentives, and Misunderstanding Mental Illness

Listening to this interview  on NPR's Weekend Edition Saturday morning, I was not surprised to hear that Andreas Lubitz, the pilot who may have deliberately crashed a Germanwings plane into the Alps last week,  also deliberately hid his depression from Lufthansa (Germanwings' parent company).  Mental illness continues to be an embarrassment to people, despite the large numbers of those who suffer from some form of depression/anxiety or other condition.  

 I was more surprised to hear what the result would have been had Lubitz disclosed during his training that he was seeking treatment for depression.  According to  Matthias Gebauer of Der Spiegel Germanwings would have  "kick[ed] him out of education and pull[ed] away his pilot license."  When Scott Simon [the radio host] pushed back noting that many people suffering from depression are able to be highly functioning members of society, Gebauer's response was that "pilots . . . that is a very special job [with] strict responsibility."  While not speaking for the airline specifically, this seems like a weak response for an anachronistic policy.  And, instead of deterring those with "mental illness" from becoming pilots, the policy, in this case (and I suspect in others), forced Lubitz underground with the treatment he clearly needed. 

The perverse incentives created by the Lufthansa/Germanwings policy arise in the bar admission process too.  The Justice Department is investigating the Florida Supreme Court over its questions about the mental health of bar applicants.  Among the routine questions posed to would-be-attorneys is whether they have ever been diagnosed with a mental illness such as bipolar disorder, psychosis or depression.  Not surprisingly, this question (questionable in its purpose) drives applicants to lie on their questionnaire or, worse, away from seeking treatment.  Florida is not the first state to come under fire from the Justice Department for these potentially discriminatory questions.  In the past few years Vermont and Louisiana have received letters from the agency criticizing their invasive mental health-questions.  In Louisiana's case, Justice threatened to sue before an agreement was reached. 

Relatedly, to the extent it reflects our general cultural ignorance about mental illness, in recent months police have come under fire for their inability to peaceably handle the mentally ill, including using lethal force against unarmed, clearly ill people.  of  A particularly sad instance of this took place in Georgia a couple of weeks ago. Anthony Hill, who began to suffer symptoms of bipolar disorder after returning from his service in Afghanistan, was shot and killed as he, naked and unarmed, approached police despite warnings to halt.    Meanwhile, it is well known that a large percentage of those in prison suffer from untreated mental illnesses -- this is both an indictment of our choice to warehouse ill people and a waste of limited government resources.  We cannot condemn the criminal justice system's inhumane treatment of the mentally ill, however, without noting that it reflects similarly uniformed decisions made in numerous societal contexts.

Lubitz's suicide mission/mass murder  has led to knee-jerk responses by US airlines. Currently, "due to a growing public awareness that common mental disorders like depression are treatable," these airlines have more reasonable policies toward employees' mental health.  They are now reviewing these policies to determine if they are not doing enough to "detect" pilots with mental illness.  This seems like the wrong lesson to learn from the Germanwings tragedy but given the many contexts in which our culture and polity refuse to acknowledge the reality and complexity of a range of mental illnesses, it is sadly not surprising.


Posted by Kate Levine on March 31, 2015 at 01:29 PM in Blogging, Culture | Permalink


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Posted by: Sydney | Apr 4, 2015 7:13:24 PM

The issue raised by Howard is a significant one for our current and future students as well as more broadly for those in the disability rights movement who seek to challenge presumptions of incompetence associated with mental and psychosocial disabilities. The Bazelon Center on Mental Health Law commented on the Louisiana case, see http://www.bazelon.org/portals/0/In%20Court/Current%20Cases/Current%20Cases/Louisiana%20Bar%20Conditional%20Admissions/National%20Support%20Letter_1-8-14.pdf (discussing the pattern and practice of discrimination reflected in Louisiana's character and fitness questions).

Posted by: anon | Apr 2, 2015 12:31:26 PM

Howard, the Louisiana Supreme Court's bar examiners just lost (settled) an ADA dispute with the USDOJ over the bar examiners' treatment of mental illness in the character and fitness evaluation.

Your Florida examiners might be nudged to confer with their Louisiana counterparts (and USDOJ), so that they might avoid similar liability:

Posted by: Maggie | Apr 1, 2015 12:42:45 AM

"Depression" is a rather open-ended thing. If there was some reasonable chance of not mere "depression" but concern that he was thinking of harming himself, it would be a harder call. The need to "kick him out of education" would also be separate from allowing him to fly.

Posted by: Joe | Mar 31, 2015 2:30:12 PM

At FIU several months ago, during a faculty presentation from our student counseling center, several faculty members raised Florida's bar application questions in wondering how we can/should refer students to the center, given the likely effect on their career opportunities.

Posted by: Howard Wasserman | Mar 31, 2015 2:20:52 PM

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