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We are unlikely to ever know what was going through the mind of co-pilot Andreas Lubitz on the day he decided to bolt the cockpit door of the Germanwings passenger plane which he then deliberately crashed into a rocky ravine in the Alps, killing all 149 people on board.
A torn up sick-note, suggestions that he was recently jilted by his girl-friend and previous treatment for depression have all been used to suggest that this was a wanton act of a deranged madman intent on suicide and mass murder.
However, psychiatrists were quick to point out today that depression is a relatively common condition affecting one in six people in the UK, and yet cases of “murder suicide” are incredibly rare, especially outside of the arena of religious fanaticism.
Paul Keedwell, a consultant psychiatrist at Cardiff University and a specialist in mood disorders, says that only about two or three people in every million each year carry out murder while committing suicide, and most of these cases are men who end up killing their wives or partners.
“For obvious reasons we cannot know the perpetrator's mental state at the time of the homicide in these cases,” Dr Keedwell said.
In pictures: Germanwings Airbus A320 plane crashShow all 66 1 /66In pictures: Germanwings Airbus A320 plane crash In pictures: Germanwings Airbus A320 plane crash Germanwings Airbus A320 plane crash Flowers are left in front of the monument in homage to the victims of Germanwings Flight 4U 9525 in Le Vernet, southeastern France
In pictures: Germanwings Airbus A320 plane crash Germanwings Airbus A320 plane crash Andreas Lubitz was deemed ‘unsuitable for flight duties’ for a period of time during his training with Lufthansa and was receiving regular treatment for depression, sources have claimed as investigators focus their inquiry on his personal life and background
In pictures: Germanwings Airbus A320 plane crash Germanwings Airbus A320 plane crash People believed to be relatives of the deceased crew on Germanwings flight 4U9525 comfort each other at a reception centre in Le Vernet, France
In pictures: Germanwings Airbus A320 plane crash Germanwings Airbus A320 plane crash Rescue workers gather with friends and relatives of those killed onboard Germanwings flight 4U9525 at a reception centre in Le Vernet, France
In pictures: Germanwings Airbus A320 plane crash Germanwings Airbus A320 plane crash Flags representing some of the nationalities of the victims are seen as family members and relatives gather near the crash site of an Airbus A320 in the French Alps
In pictures: Germanwings Airbus A320 plane crash Germanwings Airbus A320 plane crash German and Spain flags symbolizing some of the nationalities of the victims are seen as family members and relatives gather for a ceremony in Le Vernet near the crash site of an Airbus A320 in the French Alps
In pictures: Germanwings Airbus A320 plane crash Germanwings Airbus A320 plane crash Flags symbolizing some of the nationalities of the victims, are seen near the memorial stele in Le Vernet during a ceremony to pay tribute to the victims of an Airbus A320 in the French Alps
In pictures: Germanwings Airbus A320 plane crash Germanwings Airbus A320 plane crash French gendarmes and investigators make their way through debris from wreckage on the mountainside at the crash site of an Airbus A320, near Seyne-les-Alpes
In pictures: Germanwings Airbus A320 plane crash Germanwings Airbus A320 plane crash French gendarmes and investigators work amongst the debris of the Airbus A320 at the site of the crash, near Seyne-les-Alpes, French Alps
In pictures: Germanwings Airbus A320 plane crash Germanwings Airbus A320 plane crash French gendarmes and investigators make their way through the debris of the Airbus A320 at the site of the crash near Seyne-les-Alpes, French Alps
In pictures: Germanwings Airbus A320 plane crash Germanwings Airbus A320 plane crash Wreckage of the Airbus A320 is seen at the site of the crash, near Seyne-les-Alpes, French Alps
In pictures: Germanwings Airbus A320 plane crash Germanwings Airbus A320 plane crash A body of a victim is evacuated by a French Gendarmerie rescue helicopter from the crash site of an Airbus A320, near Seyne-les-Alpes
In pictures: Germanwings Airbus A320 plane crash Germanwings Airbus A320 plane crash Rescue workers recover bodies of victims from the crash site of an Airbus A320, near Seyne-les-Alpes
In pictures: Germanwings Airbus A320 plane crash Germanwings Airbus A320 plane crash French military personnel work amongst the debris of the Airbus A320 at the site of the crash, near Seyne-les-Alpes, French Alps
In pictures: Germanwings Airbus A320 plane crash Germanwings Airbus A320 plane crash A helicopter of the French Gendarmerie flies over the crash site of the Germanwings Airbus A320 that crashed in the French Alps, above the town of Seyne-les-Alpes, southeastern France
In pictures: Germanwings Airbus A320 plane crash Germanwings Airbus A320 plane crash Search and rescue workers make their way through debris at the crash site of the Germanwings Airbus A320 that crashed in the French Alps, above the town of Seyne-les-Alpes, southeastern France
In pictures: Germanwings Airbus A320 plane crash Germanwings Airbus A320 plane crash Flowers and lit candles are placed on the ground in Cologne Bonn airport
Reuters
In pictures: Germanwings Airbus A320 plane crash Germanwings Airbus A320 plane crash Victims’ relatives join carers outside the school gym in Seyne
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In pictures: Germanwings Airbus A320 plane crash Germanwings Airbus A320 plane crash Lufthansa CEO Carsten Spohr, left, and Germanwings CEO Thomas Winkelmann arrive for a press conference near the Germanwings headquarters in Cologne, Germany
In pictures: Germanwings Airbus A320 plane crash Germanwings Airbus A320 plane crash Andreas Lubitz, the co-pilot that crashed the Germanwings Airbus A320 in the French Alps
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In pictures: Germanwings Airbus A320 plane crash Germanwings Airbus A320 plane crash Buses loaded with relatives of victims are escorted after their arrival at Marseille airport, southern France
In pictures: Germanwings Airbus A320 plane crash Germanwings Airbus A320 plane crash Family and relatives of the victims of the Germanwings plane crash in the Alps are taken on bus to the Prat airport from a hotel in Castelldefels in Barcelona, Spain, to take a Lufthansa flight to visit the crash site in Seyne les Alps in France
In pictures: Germanwings Airbus A320 plane crash Germanwings Airbus A320 plane crash An Airbus plane of German airline Lufthansa carrying onboard relatives of the Germanwings plane crash victims takes off from the Duesseldorf airport in Duesseldorf, western Germany, en route to Marseille
In pictures: Germanwings Airbus A320 plane crash Germanwings Airbus A320 plane crash A Germanwings employee places flowers in commemoration of the victims of the Germanwings plane crash in the French Alps, at the airport in Duesseldorf, Germany
In pictures: Germanwings Airbus A320 plane crash Germanwings Airbus A320 plane crash Members of German Government Chancellor Angela Merkel, Vice Chancellor and Economy Minister Sigmar Gabriel and Foreign Minister Frank-Walter Steinmeier, from right, hold a minute of silence to commemorate the victims of the Germanwings plane crash in the French Alps at the parliament Bundestag in Berlin, Germany
In pictures: Germanwings Airbus A320 plane crash Germanwings Airbus A320 plane crash Realtives of passengers of the Germanwings airliner that crashed in the French Alps leave the Gran Hotel Rey Don Jaime towards Barcelona El Prat airport where a lufthansa plane will fly to Marseille, in Barcelona, Spain
In pictures: Germanwings Airbus A320 plane crash Germanwings Airbus A320 plane crash Olivier Cousin (R), director of the mountain rescue team, which is responsible for the safety of the emergency workers on site, gives an interview in Seyne Les Alpes, France
In pictures: Germanwings Airbus A320 plane crash Germanwings Airbus A320 plane crash Alpine climbers take off in a police helicopter in Seyne Les Alpes
In pictures: Germanwings Airbus A320 plane crash Germanwings Airbus A320 plane crash German Chancellor Angela Merkel (L), French President Francois Hollande (C) and Spain's Prime Minister Mariano Rajoy pay respect to victims in front of the mountain in Seyne-les-Alpes, the day after the air crash of a Germanwings Airbus A320
In pictures: Germanwings Airbus A320 plane crash Germanwings Airbus A320 plane crash A member of the search and rescue personnel stands at the crash site of the Germanwings Airbus A320 in the French Alps
In pictures: Germanwings Airbus A320 plane crash Germanwings Airbus A320 plane crash Search and rescue personnel at the crash site of the Germanwings Airbus A320 in the French Alps
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In pictures: Germanwings Airbus A320 plane crash Germanwings Airbus A320 plane crash A sealed container holds black box from the German Airbus operated by Lufthansa's Germanwings budget Airbus A320 crash
In pictures: Germanwings Airbus A320 plane crash Germanwings Airbus A320 plane crash The voice data recorder of the Germanwings jetliner that crashed in the French Alps
In pictures: Germanwings Airbus A320 plane crash Germanwings Airbus A320 plane crash The voice data recorder of the Germanwings jetliner that crashed in the French Alps
In pictures: Germanwings Airbus A320 plane crash Germanwings Airbus A320 plane crash Germanwings employees cry as they place flowers and lit candles outside the company headquarters in Cologne Bonn airport
In pictures: Germanwings Airbus A320 plane crash Germanwings Airbus A320 plane crash A student who knew some of the German students involved in a crashed plane, reacts during a minute of silence in front of the council building in Llinars del Valles, near Barcelona, Spain
In pictures: Germanwings Airbus A320 plane crash Germanwings Airbus A320 plane crash Photograph of victims, flowers and candles stand outside the Joseph-Koenig-Gymnasium high school where pupils had gathered to pay tribute to 16 students and two teachers from the school who were on Germanwings flight 4U9525 that crashed yesterday in southern France on March 25, 2015 in Haltern, Germany
In pictures: Germanwings Airbus A320 plane crash Germanwings Airbus A320 plane crash Pupils gather at the Joseph-Koenig-Gymnasium high school to pay tribute to 16 students and two teachers from the school who were on Germanwings flight 4U9525 that crashed yesterday in southern France in Haltern, Germany
In pictures: Germanwings Airbus A320 plane crash Germanwings Airbus A320 plane crash Students gather in front of the Josef-König secondary school in Haltern am See, western Germany, where some of the Germanwings plane crash victims studied
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In pictures: Germanwings Airbus A320 plane crash Germanwings Airbus A320 plane crash A Lufthansa employee signs in a condolence book in Frankfurt, Germany
In pictures: Germanwings Airbus A320 plane crash Germanwings Airbus A320 plane crash The flags of (L-R) Aragon, Spain and the European Union are lowered to half-mast at the Regional Assembly of Aragon in Zaragoza, Spain, as a sign of respect for the victims of the German plane crash in the French Alps
In pictures: Germanwings Airbus A320 plane crash Germanwings Airbus A320 plane crash The German and the European Union flags hang at half mast in memory of the victims of the plane crash in France in front of the Federal Chancellery in Berlin, Germany
In pictures: Germanwings Airbus A320 plane crash Germanwings Airbus A320 plane crash French President François Hollande with Spain’s King Felipe VI and Queen Letizia pay their respects to the victims of the German plane crash in the French Alps
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In pictures: Germanwings Airbus A320 plane crash Germanwings Airbus A320 plane crash Debris from the Germanwings Airbus A320 at the crash site in the French Alps above the southeastern town of Seyne
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In pictures: Germanwings Airbus A320 plane crash Germanwings Airbus A320 plane crash Search and rescue personnel at the crash site of the Germanwings Airbus A320 in the French Alps
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In pictures: Germanwings Airbus A320 plane crash Germanwings Airbus A320 plane crash Wreckage and debris lie on the mountain slopes after the crash of the Germanwings Airbus A320 over the French Alps
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In pictures: Germanwings Airbus A320 plane crash Germanwings Airbus A320 plane crash Staff members of Germanwings and Lufthansa hold a candlelight vigil outside their headquarters in Cologne
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In pictures: Germanwings Airbus A320 plane crash Germanwings Airbus A320 plane crash A photo provided by the French Gendarmerie shows the crash site in the French Alps
In pictures: Germanwings Airbus A320 plane crash Germanwings Airbus A320 plane crash A rescue helicopter from the French Gendarmerie flies over the French Alps, as day fades into night near to the crash site of the Airbus A320
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In pictures: Germanwings Airbus A320 plane crash Germanwings Airbus A320 plane crash A general view of the crash site of a Germanwings Airbus A320 in the French Alps above Seyne-les-Alpes is pictured in this photo provided by the French Gendarmerie
In pictures: Germanwings Airbus A320 plane crash Germanwings Airbus A320 plane crash Family members of people involved in a crashed plane arrives at the Barcelona airport in Spain
AP/Emilio Morenatti
In pictures: Germanwings Airbus A320 plane crash Germanwings Airbus A320 plane crash Rescue helicopters from the French Gendarmerie and the Air Force are seen in front of the French Alps during a rescue operation near to the crash site
Reuters
In pictures: Germanwings Airbus A320 plane crash Germanwings Airbus A320 plane crash A helicopter of the French National Gendarmerie is seen in Seyne, south-eastern France, near the site where a Germanwings Airbus A320 crashed in the French Alps
ANNE-CHRISTINE POUJOULAT/AFP/Getty Images
In pictures: Germanwings Airbus A320 plane crash Germanwings Airbus A320 plane crash French emergency services workers (back) and members of the French gendarmerie gather in Seyne, south-eastern France, near the site where a Germanwings Airbus A320 crashed in the French Alps
BORIS HORVAT/AFP/Getty Images
In pictures: Germanwings Airbus A320 plane crash Germanwings Airbus A320 plane crash An helicopter of civil security services is seen in Seyne, south-eastern France, near the site where a Germanwings Airbus A320 crashed in the French Alps
ANNE-CHRISTINE POUJOULAT/AFP/Getty Images
In pictures: Germanwings Airbus A320 plane crash Germanwings Airbus A320 plane crash Relatives of passangers of the Germanwings plane crashed in French Alps arrive escorted by police officer at Terminal 2 of Barcelona El Prat airport in Barcelona
David Ramos/Getty Images
In pictures: Germanwings Airbus A320 plane crash Germanwings Airbus A320 plane crash Relatives of passangers of the Germanwings plane crashed in French Alps arrive at Terminal 2 of Barcelona El Prat airport in Barcelona, Spain
David Ramos/Getty Images
In pictures: Germanwings Airbus A320 plane crash Germanwings Airbus A320 plane crash Relatives of passengers killed in Germanwings plane crash arrive at the airport in Duesseldorf, Germany
AP/Frank Augstein
In pictures: Germanwings Airbus A320 plane crash Germanwings Airbus A320 plane crash Police escort a family member of an aircrash victim at Barcelona's El Prat airport
LLUIS GENE/AFP/Getty Images
In pictures: Germanwings Airbus A320 plane crash Germanwings Airbus A320 plane crash French firefighters prepare to take-off in Digne-les-Bains for the crash site of an Airbus A320, in the French Alps
REUTERS/Jean-Paul Pelissier
In pictures: Germanwings Airbus A320 plane crash Germanwings Airbus A320 plane crash A family member of a passenger killed in Germanwings plane crash reacts as he arrives at Barcelona's El Prat airport
REUTERS/Albert Gea
In pictures: Germanwings Airbus A320 plane crash Germanwings Airbus A320 plane crash People arrive at a holding area for friends and relatives of passengers on Germanwings flight 4U9525 from Barcelona to Dusseldorf at Dusseldorf International Airport in Dusseldorf, Germany
Sascha Steinbach/Getty Images
In pictures: Germanwings Airbus A320 plane crash Germanwings Airbus A320 plane crash People waiting for flight 4U 9525 are lead away by airport staff at the airport in Duesseldorf, Germany
In pictures: Germanwings Airbus A320 plane crash Germanwings Airbus A320 plane crash A relative (C) of passangers of the Germanwings plane crashed in French Alps arrives at the Terminal 2 of the Barcelona El Prat airport
David Ramos/Getty Images
In pictures: Germanwings Airbus A320 plane crash Germanwings Airbus A320 plane crash A man who appears to have waited for the missing flight 4U 9525 reacts at the airport in Duesseldorf, Germany
AP/Frank Augstein
In pictures: Germanwings Airbus A320 plane crash Germanwings Airbus A320 plane crash epa04676936 A man looks at a monitor showing a map released on the webpage 'flightradar24 with the exact point where the radar signal of the crashed Airbus A320 aircraft operated by German budget airline 'Germanwings' went missing near Barcelonnette, in the department of Alpes-de-Haute-Provence, in Madrid, Spain
EPA
“Among cases of murder suicide in general, the rate of previously diagnosed depression varies from 40 to 60 per cent, depending on the context. Of those who are depressed, very few are being treated for it,” he said.
“In the vast majority of cases of depression, suicide is the main risk, not violence. So, depression is not in itself a sufficient explanation for murder suicide, but early detection and adequate treatment might reduce the risk,” he said.
Lisa Harrison, a counseling psychologist in South Wales who has treated people with depression and suicidal tendencies, agreed that it is difficult to comprehend why someone intent on taking his own life would want to cause the death of so many innocent men, women and children.
“Generally, the act of suicide is very self-oriented. It is an act of self-harm rather than an act against others,” Ms Harrison said.
Commercial pilots have regular, routine medical examinations which include psychological assessments. Pilots and airline staff are encouraged to report any signs that a pilot may be suffering mental problems, but whatever worries there may have been over Lubitz they did not prevent him from co-piloting flight 4U9525 from Barcelona to Dusseldorf.
Peter Kinderman, professor of clinical psychology at Liverpool University, said that while it is extremely rare for someone to take their life in this way, it is important for airlines not to overreact to media pressure for stricter psychological screening of pilots.
“When people decide to end their own lives, usually the story is individual to them and we do not know why this man did this action. Hopefully the investigation will find evidence about whether this was a planned or a spontaneous act,” Professor Kinderman said.
“Personally, I don’t want to fly in a plane where mental certificates are issued to allow pilots to fly. I want to fly in a plane where no one person is allowed to remain in the cockpit on their own,” he said.
If seeking help for depression is stigmatised, there is a danger that airline staff and pilots in particular will try to hide any symptoms to avoid being removed from their posts, as Lubitz appears to have done by tearing up his sick note.
“The biggest barrier to people getting help is stigma and fear of disclosure. In this country we have seen a recent fall in stigma, an increase in willingness to be open about depression and most important of all, to seek help,” said Professor Simon Wessely, president of the Royal College of Psychiatrists.
It is also true that previous treatment for depression does not necessarily tell us anything about a person’s present state of mental health, said Professor Seena Fazel, a forensic psychiatrist at the University of Oxford.
“Research on mass killings associated with suicide suggests that mental illness at the time of death is rare, and the individuals perpetrating them seem to be motivated by a complex set of individual and social factors that interact in unpredictable ways. This has meant that it is not possible to identify high-risk individuals,” Professor Fazel said.
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