Dr. Andrew Mohanraj

Although not conclusive, the reports of the Germanwings airline mishap seem to indicate pilot suicide. The investigators continue piece together strands of evidence and conclusions are being drawn but ultimately it nobody can ever be totally certain as to all the implicating factors.

There have been several plane crashes that have been “proven” to be due to the pilot intentionally bringing down the plane but pilot suicide remains a very rare phenomenon. Even rarer are such incidents involving commercial planes. Professor Robert Bor , an  Aviation Psychologist and author of Aviation Mental Health: Psychological Implications for Air Transportation estimates that between 0.72% and 2.4% of general aviation accidents of such  nature  are as a result of pilot suicide, and a history of psychiatric or domestic problems have been found in such post-crash inquiries and investigations.

This latest crash has prompted calls for more rigorous mental health screening and evaluation for pilots. Dr Niccolo Della Penna, Aviation Psychiatrist at Johns Hopkins Hospital, USA says, “This tragedy raises again the question of the adequacy of measures in force for flight safety standards.  We may be merely cracking the door open on what could be a hidden gap in airline safety and the health of pilots”.

Currently, psychological assessments are done routinely as part of the overall medical examination as a requirement for continuity of licence to fly. Although these examinations are in line with internationally accepted standards, no detailed mental state examination is done. Often, the system relies on reports of odd or difficult behavior exhibited by the pilot examined, as reported by colleagues or subordinates. Rarely would the employee being examined seek psychiatric help voluntarily for reasons of risking invalidating the licence to fly. The fear of losing their jobs would override their admission of a mental health problem.

Any psychiatric examination should look out and pay particular attention to the presence of Depression and Psychosis. In addition, disruptive personality disorders and substance abuse may exist as a separate issue or as a cause or effect of Depression.

Are pilots more susceptible to develop psychological distress compared to many other professions? The answer is a resounding yes. Work load and unreasonable duty roster, disruption to personal relationships, safety and survival fatigue, jet lag and prolonged close proximity to colleagues on board, all can result in mental health issues.  There have been many cases of acute alcohol intoxication, sudden psychosis or unruly behaviour noticed and reported by conscientious and alert cabin crew. Such incidents have on many occasions caused the pilot to be “off loaded “or denied permission to fly the plane. Such cases are not always known outside the airline industry.

Why crash a plane full of people when there are other ways to commit suicide without involving the lives of passengers? This is the question that continues to trouble many since the day of the crash. Broadly, there could be three main reasons for this;

One reason is to make a “statement” .This could be a terrorist who is angry against a system or a disgruntled employee upset with the airline.  For the terrorist, it is an act of altruism and for the employee it is an opportunity to demonstrate his resentment against the stress of the job or his deep seated grudge against the airline.

The second reason is financial, namely to enable the family to claim the life insurance. In his book, Dr Bor suggests that the evidence it was a suicide might be thus destroyed, so protecting the family by ensuring an insurance pay out. It also spares the family of the “shame” of suicide.

The third and the most common reason for pilot suicide would be psychological distress like Depression. The person could be so troubled in the mind, that he hatches a plan to end his suffering by leaving the world that causes him so much pain that is the world of flying, to the “other” world, beyond the cockpit.

As mentioned above, this is usually seen in solo flights without passengers on board but there have been mysterious mishaps in the past involving commercial planes which also point towards pilot suicide.

A suicidal act is hardly impulsive. The plan is usually made very meticulously. In a person suffering from psychological distress, his mental state would have changed much before making such a decision. He would have appeared morose or would have given some clues about his hopelessness to others indicating that he is troubled. In some cases, once the suicidal plans are formulated and rehearsed in the mind, the appearance of the individual could be slightly euphoric because he is at peace with the decision made and is eager to end his suffering in “this” world. This is called “smiling depression” as was the case with the late Robin Williams where he was noted to have been cheerful just a day before killing himself.

Many argue for more rigorous mental health assessment not only for pilots, but flight engineers, cabin crew and control tower operators as well. History of taking psychotropic medication, relationship problems , alcohol abuse ,alarming pattern  of spending and borrowing leading to financial ruin and the presence of a “life event “ like divorce or death , all must ring alarm bells in a routine medical examination . This is in addition to the usual detectable change in mood.

Routine and detailed psychiatric assessment and review of flight records, reports, and medical history and life events would normally give some clues on the mental state of the pilot, because suicidal intent emerges over a long period of time. It is extremely rare for someone to suddenly decide to kill themselves.

The call for stringent psychological assessments, however, must be balanced by in-house psychological support. This is indeed a delicate situation. On one hand pilots are expected to be honest and forthcoming with their distress during examination but the very act of seeking help could invalidate their licenses. Solutions must be found to help the distressed employee, while keeping in mind that passenger safety is of utmost importance.

The decision to use the plane as the instrument of death is a complicated thought process, entwined with psychological distress and a bizarre mental state. We will never fully understand the workings of the mind of the pilot in this latest crash, although black box findings and medical history of the pilot strongly point in the direction of psychological distress causing suicide. The airline industry and civil aviation authorities must do everything it takes, including reassessing the current medical examination procedures, to prevent such painful tragedies from reoccurring in future.

*Dato’ Dr Andrew Mohanraj is a Consultant Psychiatrist with special interest in aviation psychiatry. He collaborates with Dr Niccolo Della Penna, Aviation Psychiatrist at the Johns Hopkins Hospital, USA.