ROBERT SIEGEL, HOST:
The emerging story of Andreas Lubitz, the Germanwings co-pilot, is a reminder of how opaque the psyche is to casual observers and sometimes to rigorous observers, too. If a man harbors, say, suicidal thoughts, how many people around him are likely to be aware of that - neighbors, colleagues, family members? When an apparently harmless soul commits an act of suicide-homicide, we often hear expressions of both alarm and surprise from such people. Dr. Michael Miller is a psychiatrist at Harvard Medical School. And I'd like to ask you, do you think someone who's as troubled as we're now led to believe this Mr. Lubitz was can carry that burden without it being evident to other people around him?
MICHAEL MILLER: Yes. It's actually quite common. We learn to keep many of our thoughts to ourselves, and when we are struggling with painful, emotional thoughts, experiences, feelings, we tend to not share them with many people. And some people are in a circumstance where they don't share them much with anybody.
SIEGEL: So a contradiction between one's public persona and what's going on deep inside is hardly surprising to you.
MILLER: That's correct.
SIEGEL: There's a paradox here. I think we want people with suicidal, if not homicidal, tendencies to seek help, but if we conclude that their condition permanently disqualifies them from the career that they're devoted to, that could scare off a lot of people from seeking help.
MILLER: That's exactly right. I think if there's one - I mean, there's the underlying stigma about having psychiatric difficulties, but without a system where people are encouraged to come forward without fear of losing their status, it creates an almost impossible situation. So it's very troubling. It's not just pilots that this is true of. It's true of physicians. It's true of bus drivers. It's true of anyone who is responsible for the safety and well-being of others.
SIEGEL: As a therapist, do you ever find yourself upon hearing the patient talk about her ex-husband - do you ever have the desire - I wish I could turn journalist and call up the ex-husband and check this out to see if it really happened that way?
MILLER: Yes, and in fact, when I started out in my career there was a real taboo against contacting other people in the family. The idea was that you only spoke to your - the person you were seeing. But nowadays, and particularly if there's a sense that there's risk, with the patient's permission it's actually a reasonable thing to do to be in touch with family members who might give you some insight. And there's often this image that it's all or nothing; that either the person is going to be reported and going to lose their job, let's say, as a pilot or as a physician, or you can say nothing at all. But there are a lot of steps in between where you can take some kind of protective action or invite a family member in to say, you know, can we bring your wife in, or your husband in, so that we can talk about what's going on?
SIEGEL: Quite apart from Mr. Lubitz's case, do you find that you can spend a fair amount of time listening to a person and still be completely puzzled by actions that - by extreme action - that they then take?
MILLER: Oh, yes, absolutely. The reality is that I'm - I mean, one of the things that I think probably makes journalism also interesting is that you're constantly surprised about how things turn out. You think you're getting one picture and then something happens to change the picture or to amplify the picture in surprising ways. And I think that, you know, when people say how could they not have noticed this, the reality is that there is a lot that goes unnoticed until the tragedy happens. And that's also true in the positive. People surprise you sometimes in what they're able to accomplish having come in with certain kinds of suffering. So - and by the way, I think that happens more commonly than the tragedy. I mean, the good news, I think, is that more people surprise you in positive ways than they do in negative ways by a large margin.
SIEGEL: Well, Dr. Miller, thank you very much for talking with us today.
MILLER: You're very welcome.
SIEGEL: Dr. Michael Miller is assistant professor of psychiatry and former editor of the Harvard Mental Health Letter at Harvard Medical School.
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