Saturday, March 28, 2015

Uncertain Health in an Insecure World – 30

“Going to Ground”

Does a twenty-seven year old man with his life ahead of him purposefully killing himself and 149 others by flying an airliner into the French Alps reflect a global health crisis? I don’t know.

But I reserve the right to ask this question, as I sit for six hours on an airplane directly facing a locked “Flight Crew Only” reinforced cabin door. The tragedy befalling the passengers and crew of Flight 9525 and other recent suicide-by-pilot crash victims remains “simply impossible”, in the words of Lufthansa’s CEO Carsten Spohr.

But clearly it is possible, Carsten.

Like others in the highly regulated airline sector, the German airline that is “extremely picky is choosing its pilots” is left grasping for an explanation as to how their industry standard pilot health & wellness vetting procedures failed.

When it comes to human health, and particularly the mental health of twenty-something males whose brains are still developing, there is no fail-safe button.
First, recall that according to the CDC and WHO, the most common cause of death in this age and gender demographic is suicide and accidental injury or poisoning (i.e. overdose). This risk is twice a great in males compared to females (26% versus 13%).

This fatal airplane crash was no accident. It was not preceded by the panicked reactions of someone losing control of a high-speed moving vehicle. According to the cockpit voice recordings, the co-pilot’s breathing remained calm and he said nothing during an eight minute programmed descent to certain death.

Second, let’s remember that the peak onset of schizophrenia and acute psychosis occurs in the 20-30 year age group, with a preponderance of young men being affected. One in 20 people with schizophrenia takes their own life; the risk is greatest at the disease's onset, often associated with a loss of employment or a relationship. Borderline personality disorder is another mental condition associated with a risk of self-harm, including suicide.

There is an as yet unexplained six month gap in Flight 9525 co-pilot’s training that will be very carefully scrutinized by after-crash investigators. Was this lapse an undetected early dissociative break or deep depression?

Third, we hear daily of the violent deaths of young combatants who have been radicalized to follow fractured ideals borne of religious fanaticism, and of the soldiers sent to fight them.

There have been no claims made by any terrorist group, and the search of the co-pilot’s personal files has not yet revealed any manifesto. But in these dangerous days, one can never be sure. 

So, in many sad ways, this victim-laden jetliner crash at the hands, quite literally, of an ill young man is ironically similar to other seemingly victim-less suicides and reckless behavior deaths of young men occurring daily around the world. 

I have posted on the lethal suburban overdose epidemic of illegally-prescribed narcotics. Your concentration has been distracted by YouTube footage of death-by-cop incidents in seemingly lawless urban ghettos.  The world cringes at continuing genocides at the hands of young thugs led by conscience-less war loads.

Just how do these global health crises and crimes against humanity differ from Flight 9525?

The obvious difference is that 149 innocents were acutely victimized by this youthful act of apparent lunacy. Every day in every corner of the globe, young men take up and run with dangerous behaviors, often beginning a slow and desperate dive into deadly chronic diseases like addiction and mental illness. Society recognizes the signs, often too late, and responds with long-term healthcare, imprisonment and/or institutionalization. In many of these instances, the only direct victims of these personal health crashes are the immediate families and friends.

But there are also collateral victims of youth-onset chronic illnesses.

The crime and strife and strain on services that accompanies youthful chronic illnesses have an indirect global health impact and economic cost that we all bear. Whether such youth-onset chronic health declines are genetically predisposed or not, their life-long impact on sufferers and society is massive.

So, while I might well ask myself the question asked by others flying 38,000 feet above the ground in a pressurized metal can, “Are these the people I want to die with?”, I am confident that the cockpit cabin door will hold.  And as I write this, there is a 100 pound flight attendant blocking access to the front cabin while one of the pilots heads into the bathroom.

What could possibly go wrong?

I am not as confident that the tens of thousands of ill young men who die suddenly or who put their long-term health at risk are being clearly seen by healthcare providers and global health advocates as the dangerously vulnerable population that they truly are.

In answer to my original question – YES! – there is a global public health problem that is symbolized by the Flight 9525 co-pilot, a seemingly well twenty-seven year old who proximately caused 150 deaths as a result of an undiagnosed but serious chronic disease that became manifest high in the skies over southern Europe.

We in the Square pray for all the crash victims and their grieving families, and for all of those around the world who are gradually going to ground from deadly youth-onset chronic diseases. 

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