Posted tagged ‘geriatric psychiatry’

Pilots, Old People and Prediction

April 8, 2015

Unless you’ve been under a rock lately, you have probably heard about the pilot who appears to have purposefully crashed a flight full of 150 people.  There was another article recently too about a 100-year-old man who killed his wife and then himself.  Both of these incidents had some warning signs, that in hindsight, are felt to have been able to predict what ultimately happened.

I’m here to tell you that the belief that we can predict violence is absolutely false.  We (psychiatrists, police, people in general) have absolutely no ability to predict human behavior.  I have talked about this before, in my own work.  It makes people feel better to think that we can predict the awful tragedies that happen each and every day.  No.  All we can do is identify risk, and ideally, mitigate that risk as much as possible.  Unfortunately the way that most laws are written, we cannot do a whole lot unless there is evidence of imminent harm or danger.  This is what happened with the man that killed his wife–the police were called out to the home several times, but each time left because there was no evidence of acute risk.  Unfortunately there was not really any sign that this man would commit murder-suicide.  In retrospect, this man appears to have had signs of dementia, and some signs of aggression, but nothing (at least not reported) that would have led to what he did.

With our pilot, there appears to have been some premeditation.  Scary.  I had a conversation, or rather a debate last week with another psychiatrist and two psychologists about what the diagnosis for this man was.  We all had different ideas before some of this information came out.  We will probably never fully know what happened.  Regardless of what the underlying causes were, the whole thing is a tragedy.  Hopefully we learn and start to try to mitigate risk in a useful way, whether for the pilots who hold so many lives in their hands, or the older folks who seem to need some help.  I just hope we don’t fool ourselves into thinking that any of this could ever have been predicted.