The Plague

In this time of general upheaval and the upending of “normal” life I thought I would “entertain” myself by reading a book I have had for quite a while but never read – the aptly entitled “The Plague” by Albert Camus, written in 1947. Many of the observations and much of the storyline is very appropriate for what is happening in these COVID19 times.

The novel reports on the characters reactions to a plague in the Algerian city of Oran (which last had a real plague in the 16^th and 17^th Centuries with further outbreaks in the 1930s and in 1944). I thought the following passage, towards the end of the book, was quite apt, being applicable to many countries (unfortunately not all).

“Although this sudden decline in the disease was unexpected, the townspeople were in no hurry to celebrate. The preceding months, though they had increased the desire for liberation, had also taught them prudence and accustomed them to count less and less on a rapid end to the epidemic. However, this new development was the subject of every conversation and, in the depths of people’s hearts, there was a great, unadmitted hope. All else was secondary. The new victims of the plague counted for little beside this outstanding fact: the figures were going down. One of the signs that a return to a time of good health was secretly expected (although no one admitted the fact) was that from this moment on people readily spoke, with apparent indifference, about how life would be reorganized after the plague.

Everyone agreed that the amenities of former times would not be restored overnight and that it was easier to destroy than to rebuild.”

Sound familiar?

Germanwings flight 4U9525 disaster.

Shocking and senseless! A few general facts are necessary, however, to stop the various notions about why the unfortunate, and relatively inexperienced pilot, Andreas Lubitz committed  such a horrendous and apparently entirely selfish, mass murder/suicide – as is so far alleged to be the theory - before the actual facts (and suppostions) are presented in a sober and reasoned manner.

First up, no test (or tests) is (are) available which will confirm any “mental illness” (Alzheimer’s and Huntington’s diseases excepted). Mental issues are not (repeat not) similar to any physical illness such as the much quoted phrase “diabetes or heart disease”. Any person presenting with a mental issue is “diagnosed” by observed behaviour and by the presenting person’s self-reported mental state – and then subjectively judged, by a Mental Health professional, using an “approved” check list of “depression indicators”.

The operative word is “presenting”. Anyone with any intelligence and who has been psychologically tested many times before will “know the ropes” and be able to circumvent questions which may be “compromising” or which may impact unfavourably on that person’s future.

It was therefore not possible for any mental health professional to have determined, with any degree of absolute certainty, that Lubitz was “mentally ill”- whether he was depressed or a closet sociopath or had psychopathic tendencies. Possibly he was just someone who was trying to fulfil a dream and was found wanting – something he may have had difficulty in accepting.

We will never know.

My second point is that, as I understand it, anyone working for an airline must attend that particular airline’s approved doctor or doctors. It is that doctor who has the responsibility to inform the airline of any misgivings he (or she) may have about a particular employee’s health – mental or physical. I am sure that an airline with Lufthansa’s standing would have had such a medical regime in place.

It would appear, therefore, that either the doctor involved did not pass on the medical details (regarding prescriptions or any other concerns) to Lufthansa. Or, and I would find this very difficult to comprehend or believe, Lufthansa ignored the doctor’s concerns and/or advice regarding Lubitz.

Either way – if there is blame to be apportioned (and believe me there will be) it should lie somewhere in the orbit of the medical doctor and/or the pilot administration of Lufthansa.

Lubitz’s life, family, friends and career will be eviscerated by the investigators and the media trying to find any possible reason or reasons for such a horrendous and callous act. This is to be expected because the airline industry survives on trust and its fiercely protected safety record. Anything which impacts on this will be examined as never before.

And so it should be.

However research into suicide is notoriously difficult. It is always referring to an historic act – something that has already happened. Police, coronial, autopsy, psychiatric and psychological and counselling reports are analysed and carefully combed to try and establish some reason or motive for the suicide. This is fraught as it is impossible to know what was actually going through the person’s mind at the precise moment in time when they took their own life and (particularly, as in this case) when this includes the lives of so many other innocent people. At some moment – sometime earlier that fateful day - Lubitz made a choice.

Why? We will never know.

Mental Health

It has been reported for years that the rate of mental disorders in Australia (and, I might add, most of the developed nations) is an alarming one person in five (1 in 5). This is a truly astounding figure. In fact I would call it a national catastrophe.

Just imagine the outrage and panic if 1 in 5 were diagnosed with AIDS or contracted influenza. There would be panic and a national enquiry and millions would be spent on research and medications of some sort. But mental health? If 1 in 5 of the population will suffer from some mental problem – what then is normal and how is this determined?

It is worth remembering that with mental health: “the facts are uncertain, values are in dispute, stakes are high and decisions are urgent”. In such circumstances it is difficult to resist the temptation to cherry pick data to suit whatever popular theory is being promoted at the time. The flow is from theory to observation to statistical analysis and back again – if great care is not taken then cherry picking will again take place in a misleading and apparently endless loop. Convention, it seems, must be followed – this is obvious from the fact that authors of articles that are not “politically correct” find it very difficult to have them published in mental health journals!

Prescribing mind altering drugs to people already suffering mental issues is counterintuitive. Yet this is what happens. The problem, which the “experts” seem to find difficulty in accepting, is that medications in various formulations and strengths have been prescribed for mental “illness” for something like one hundred years. Yet the problems remain. Logically this leads to the conclusion that, ipso facto, either the medications are ineffective or the aetiology (the study of causation, or origination) of mental disorders is misunderstood and therefore, by default, misdiagnosed – or all three.  

Using the same methods over and over again expecting different results each time is not very clever – in fact I believe this is an indication of some mental problem! Following the same course of action – prescribing medications that cause problems that further application of more powerful medications cannot alleviate is, also, not very clever. And yet this is what we seem to be doing with the current approach to mental health!!!

It is almost as if psychiatrists and psychologists are circling around the subject of mental health without fully appreciating what needs to be done (for example, after nearly one hundred years of research there is no effective biological test for any mental disorder – it's a matter of a health professional’s judgement regarding the apparent behavioural and thought disorder patterns presented by an individual. Furthermore if some mental disorders are deemed to have a genetic base the questions relating to any evolutionary advantage will need to be answered). I find it bizarre that there are over 360 different psychiatric disorders listed in the DSM-IV-TR (Diagnostic and Statistical Manual of Mental Disorders – fourth edition – text revised, published by the American Psychiatric Association) with the further understanding that U.S. insurance companies (through their close relationship with pharmaceutical companies) now require a DSM-based diagnosis before they will reimburse prescription drugs on health plans. So again I ask the question that needs to be asked - what now is considered normal?

In this regard an over reliance on pharmacology is fraught; a “chemical imbalance” in the brain means what, exactly? What is the “correct” chemical balance and how is this determined? There is no known test that can determine the “correct” level of chemicals in the brain! Furthermore it should not be forgotten that behaviour can never be considered a “disease”, as an illness. A person may behave in a seemingly bizarre fashion and may be ill at ease but this does not mean they are “sick” – unless there is a pathological (medical) reason, which would then be beyond the scope of psychiatry or psychology.

Nothing is more fitting or useful than to be considered a normal human being living a fulfilling life in society but then, if the Australian Bureau of Statistics is correct, and 19% of Australians will suffer some degree of mental disorder during their lifetime then, once more, what is normal?

The needs and necessities of individuals vary. What is a prison for one sets another free. Yet “normal” can range from mildly eccentric with not a few who are apparently happy when leading a life some may think as abnormal, non-social and “odd ball”. There are seven billion individual ways human life is currently being expressed. I repeat, what is normal and, more importantly, who is checking?

What is needed is a complete rethink on the “medicalization” of mental health; a complete rethink on the causes (aetiology) of mental problems and a greater realisation that there are real problems in the administration and application of the law - as it applies to mental health; real problems caused by the obscene imbalance of income between the very rich and the very poor and the continuing, corrosive, effects of injustice which is prevalent in all societies. These have a major impact on mental health generally.

More drugs are not the answer.