Mental health experts say that it was aggression — not just depression — that would have driven 27-year-old Andreas Lubitz to deliberately crash a Germanwings airliner into a mountainside, the copilot breathing evenly as passengers screamed and the plane's frantic captain pounded helplessly on the cockpit door.
Unless investigators recognize the toxic role of aggression and hostility in some patients' depression, they say, such troubled individuals will continue to elude detection — to the public's peril.
Lubitz's history of depression, acknowledged by his employer in the days after the March 24 crash of the Airbus A320 with 150 people aboard, left many mental health professionals in the United States openly skeptical that Lubitz's psychological troubles stopped there. In the parade of garden-variety depressives they see, psychiatrists and psychologists often hear about the physical symptoms of mental distress: sleep problems, stomachaches, even changes in vision. They routinely see sadness, guilt and hostility.
But a murder-suicide on this scale, they said, requires an explanation that goes beyond a simple diagnosis of depression.
"We need to stop talking as if this was a suicidal guy with access to an airplane," said Dr. Jeff Victoroff, a neuropsychiatrist at USC's Keck School of Medicine and a leading researcher on aggression. "This was a murderous guy who probably had elements of a mood disorder and personality disorders."
"People who have depression alone are much, much more likely to bring harm to themselves alone," said Dr. Steven E. Pitt, a forensic psychiatrist who consults with the Phoenix Police Department and conducted the Columbine Psychiatric Autopsy Project after the 1999 high school shootings in Colorado. "There has to be a maladaptive character defect, a character disorder here."
Sketchy reports of Lubitz's behavior in the weeks before the crash have hinted at some of the emotional distortion and likely underlying mental illness that may have motivated him, several forensic psychiatrists said in interviews. Though a full diagnosis cannot come from such bits of information, they are piecing together Lubitz's history of depression, possibly heightened by an unraveling romantic relationship and a perceived threat to his career: vision problems.
In the preliminary accounts of Lubitz's life before he killed himself and 149 others, they see a highly unstable and emotionally sensitive young adult who probably felt his world was coming apart.
A well-designed personality inventory alone — the kind of detailed questionnaire used by many employers —probably would have flagged traits that diverged dramatically from the standard profile of a pilot: emotionally stable, resilient and self-disciplined. To have declared Lubitz "100% fit to fly," as Lufthansa Chief Executive Carsten Spohr initially did, "was like pronouncing the Titanic unsinkable just after it's hit the bottom of the ocean," Victoroff said.
The German newspaper Bild reported last week that Lubitz, despite fearing for his job, had purchased two expensive cars in recent weeks. The paper reported that Lubitz tried to give one of the two cars to Kathrin Goldbach, his girlfriend of seven years, in a bid to cement their failing relationship. Another German press report cited a former girlfriend saying that Lubitz told her, "One day, I will do something that will change the whole system, and then all will know my name and remember it."
Such details offer evidence of what mental health professionals call a "disordered personality" coming undone. With the right tools, they said, the danger he posed might have been identified and stopped.
"This is a mass-murder/suicide," said Victoroff. "It appears to have been premeditated. And it was preventable."
Lubitz's apparently intentional act bears little resemblance to virtually all of the roughly 41,000 suicides that took place in the U.S. in 2013, experts said. Rather, they say, it more closely — in all but the weapon used — resembled the acts of Seung-hui Cho and Adam Lanza, who carried out mass killings at Virginia Tech in 2007 and at Sandy Hook Elementary School in Newtown, Conn., in 2012.
The perpetrators of these mass murders were intent on taking their own lives, according to the notes they left behind. Though as many as 90% of suicides are thought to be impulsive acts, the murder-suicide is virtually never impulsive, said Florida State University psychologist Thomas Joiner, author of "The Perversion of Virtue: Understanding Murder-Suicide."
Joiner says murder-suicides, which he estimates claim the lives of 1,000 to 1,500 in the United States each year, are almost always the result of extensive rumination, planning and self-justification. In cases where the perpetrator expects the death toll to be high, he said, that is especially so.
"Two things we're deeply afraid of in our bones: One is death, the other is killing, and these kinds of events combine those very scary thoughts into one act," he said. "That takes all the more planning. We're just not wired that way, and it's hard to overcome that wiring."
Overwhelming that wiring requires a perpetrator to recast his actions as a means to more virtuous end, said Joiner, who cited mercy, justice, duty and glory as common justifications. By this reasoning, a jilted lover must kill himself and his beloved because he reasons she will be unhappy without him; a parent committing suicide must take her children with her, lest they be left alone; or a government's actions must be avenged.
Those willing to kill others when taking their own lives are generally male and are extremely hostile, psychiatrists say. Most have a history of mental anguish that may extend back to childhood.
In personality assessments and in sessions with mental health professionals, they also tend to exhibit callousness and narcissism. They often have an inflated view of themselves and their powers, and a powerful sense of entitlement.
In manifestoes and personal accounts they leave behind, their sense of victimhood — and their vengeful drive to punish their tormentors — are common themes, experts say. And yet, they wish to be remembered for a grand and even glorious accomplishment.
Much of that is evident only in hindsight.
"Everyone wants us to believe this guy had a sign around his neck saying 'I'm depressed, I'm angry, and I'm ready to commit murder-suicide,' that it's that obvious," said Pitt. "The reality is that it's seldom that obvious.... These people, while troubled, can seemingly hold it together for a protracted period of time and not raise any substantive red flags till it's too late."
But Pitt said the lessons of hindsight are increasingly informing the ability of forensic psychiatrists and psychologists to spot red flags.
"How you tell the difference" between depressed and dangerous, said Pitt, "is where the art meets the science."
But experts are also guided by an increasing body of science.
Researchers are beginning to discern physical markers that suggest an individual's propensity to harm himself and others. Recent studies have linked low levels of the "feel good" neurotransmitter serotonin and the hormone oxytocin to a propensity for suicide as well as aggressive behavior.
Neuroscientists have also identified a small number of differences in the structure and wiring of key brain regions that distinguish extremely violent offenders. Victoroff said such abnormalities in the brain's prefrontal cortex — the seat of planning, initiative, self-control and social judgment — and in connections between the prefrontal cortex and brain structures responsible for emotional regulation and threat response could be detected on a magnetic resonance imaging scan that could be conducted at any community hospital.
Genetic science is also increasingly yielding clues about a propensity for aggression. In October, researchers canvassing a large prison population in Finland identified two sites on the genome that might serve as red flags for extremely violent behavior. One genetic variation they found was almost three times more common in prisoners convicted of 10 or more violent crimes than it was in a large comparison group of non-offenders.
Collectively, experts predict that a panel of such biomarkers — augmented by a psychiatrist's examination and by personality inventories that can help detect subterfuge and distorted thinking — might someday be used to keep problematic employees from positions in which they hold others' lives in their hands.
Though it's too late to conduct an MRI scan of Lubitz's brain, Victoroff said, a licked envelope or a hair left behind might reveal the presence of such a genetic red flag.
Experts acknowledge that predicting whether an individual is on a path toward suicide, violent behavior — or both — is anything but simple. And efforts to do so are likely to draw resistance from employee, privacy and civil liberties advocates.
Victoroff contends that such tools should be used where public safety is at stake.
"We don't want to pull people out of their careers for minor personal quirks, or even having had an episode of depression," Victoroff said. "But the combination of problems this guy was exhibiting was too much."