The pilot, depression, and the salacious headlines that feed stigma
BMJ 2015; 350 doi: https://doi.org/10.1136/bmj.h1874 (Published 07 April 2015) Cite this as: BMJ 2015;350:h1874
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When faced with anything unfamiliar and potentially dangerous, human beings have an innate ‘tendency to stigmatise’.[1] For people with depression, such stigma leads to serious disadvantage and exclusion (and more severe illness). The consequences of media coverage that turns a tragedy into a witch-hunt [2] are bad for everyone, for example the substantial number of doctors with any history of depression.[3] In reflecting on the late Germanwings pilot, it is important to recognise that British health professionals often find it difficult to engage with a distressed, suicidal person.[4]
During a recent visit to Britain, Kofi Annan [5] placed the experience of at least 350 million depressed people within Global health. Depression is now the leading cause of disability, Worldwide. Although evidence-based treatments were developed long ago, only a minority of depressed people engage with such care: stigma is a major barrier to seeking help.[5]
There is an evidence base around depression prior to homicide/suicide, for example approximately 1000-1500 American lives are lost each year in homicide + suicide events.[6] The American incidents typically involve guns, which are less freely available here in the UK. However, even in the heavily-armed USA, most of the millions of people with depression do not pose any danger to others. Annan [5] offered lessons from reducing the stigma around AIDS for safe employment and better productivity.
The first step is wider social acceptance of people with mental disorders... to adapt a slogan from Gay rights, “some people are Depressed: get over it”.
[1] Crisp A. The tendency to stigmatise. British Journal of Psychiatry 2001;178:197-199.
[2] Torjesen I. The pilot, depression, and the salacious headlines that feed stigma. BMJ 2015;350:h1874
[3] Stanton J, Caan W. How many doctors are sick? BMJ 2003;326:s97-s98.
[4] Smith MJ, Bouch J, Bradstreet S, Lakey T, Nightingale A, O’Connor RC. Health services, suicide and self-harm: patient distress and system anxiety. Lancet Psychiatry 2015;2:275-280.
[5] Caan W. The global crisis of depression: the low of the 21st century? Perspectives in Public Health 2015;135:62.
[6] Huguet N, Lewis-Laitermark C. Rates of homicide-followed-by-suicide among White, African American, and Hispanic men. Public Health 2015;129:280-282.
Competing interests: Member of the Royal College of Psychiatrists' new public mental health network.
All of us know people with depression, sometimes really severe. We want them to feel as comfortable as possible getting help and we know that they are almost never a danger to others though sometimes sadly to themselves. But nonetheless we can't just pretend that this was a minor incident, mouth PC platitudes and move on. Through the actions of one man 150 other human beings died in a brutal and horrific way. Should we just ignore his illness? He was not being denied treatment, much of the time he was deliberately spurning it. Holding our noses and calling headlines "salacious" is not much use, is it?
Competing interests: No competing interests
Mental health has been a topic of media frenzy for many years. It is common for media to use illnesses such as depression as a scapegoat, something to blame, to give the public an explanation for actions like those shown by this pilot. This shouldn’t be allowed. The headlines surrounding this crash portray depression in a denounced manner, fuelling the negative stigmatisation, of mental health, that unfortunately is still present in our society today.
Patients who are suffering from mental health problems such as depression will already find it difficult to go to their doctor in order to seek help. As the article described, many patients find it hard to talk to their employers about their mental health problem. Headlines negatively stigmatising mental health, in particular depression, will only discourage more individuals from looking for help and advice. The consequences of this could be disastrous, ultimately the potential loss of lives. It is our duty as healthcare professionals to help eradicate this negative stigma that surrounds mental health issues by encouraging the public to openly talk about these topics and increase awareness and understanding of mental health.
Competing interests: No competing interests
Re: The pilot, depression, and the salacious headlines that feed stigma
As I pointed out in my blog,1 this is likely to lead to calls to screen pilots for mental illnesses that are likely to lead to their commiting suicide and murdering their passengers by crashing a plane.
However, as the prior probability of this happening is extremely low, there is no screening test with sufficient specificity to be useful in this regard; especially as people who intend to do such things can usually conceal their intentions and are likely also to be able to conceal the mental illness driving them to do so.
REFERENCE
1. English PMB. The use of psychological testing to identify pilots likely to deliberately crash their planes. Peter English's random musings (blog) 2015; Updated 29 March 2015; Accessed: 2015 (9 April): (http://peterenglish.blogspot.co.uk/2015/03/the-use-of-psychological-test...).
Competing interests: No competing interests