Thoughts on the Germanwings tragedy

When horrific tragedies like the recent Germanwings crash happen, people often ask mental health professionals what we can do about them.

My response? The answer is very similar to asking doctors if we can cure cancer.

You see, cancer treatment and mental health care have both improved tremendously in recent years, but a solution for many of the worst cases still eludes us. Whether it is metastatic cancer or the potential for violence, the answers often simply aren't there yet. So when the unthinkable happens, we instinctively grope for easy solutions that miss the mark:

-"We need better access to mental health care" (Many if not most recent mass killers had the best mental health care that money could buy - including the Germanwings co-pilot.)

-"We need better gun control"  (Nearly ever mass killer could still obtain guns legally, or used a family member's gun, or in this most recent case, was co-piloting an Airbus A320.)

-"We should do a better job of identifying these killers" (Even people with homicidal urges don't usually act on them - they don't like being dead or in prison any more than you do. But even if we could pick out the ones who might act, then what? Lock them all up just in case?)

By all accounts, this Germanwings pilot was skilled at acting normally, even on the day of the crash. Sadly, he would have needed to disclose a specific intention to harm himself or others before anyone could have done anything. Which, of course, he didn't. Like metastatic cancer, this is where we are still stuck.

So do we have an alternative to just waiting for the next tragedy to happen? Sort of. We can invest in research, and in particular, try to learn from the perpetrators who survive - some of whom have written or spoken eloquently about their struggles with their urges. (This would mean not executing them, by the way.) And while it may be small comfort to the families of the nearly 150 souls who lost their lives, we can go on with our lives knowing that situations like this are extremely rare.

We can also try to keep media reports from coloring our thinking toward the mentally ill. Every time a headline blares that this suicidal pilot suffered from depression or may have been a narcissist, it silently slanders the millions of people living with mental illnesses who would never harm anyone - which, statistically, is the vast majority of them.

I remain an optimist. We have learned more in the last century about treating mental health than in all of previous human history. Many previously intractable problems, such as severe personality disorders, are now highly treatable today. But bad things still happen that we don't yet have an answer for, and all we can do is carry on with our lives, hug our loved ones a little tighter, have faith - and keep learning.

The Wegmans Test

How can you tell how strong your relationship is?

As a marriage and family therapist, I use a number of assessment tools to test this. They tell me, in gory numerical detail, where a couple's strengths and weaknesses lie. But I have a much simpler one you can use on your very next trip to the grocery store: I call it the Wegmans test.

Here in upstate New York, Wegmans is an extremely popular local supermarket chain. Their stores are huge, and going there is a bit like grocery shopping at Disneyland. Here in my native Ithaca, NY the local Wegmans is roughly the size of two football fields, has everything from dry cleaning to a pizzeria, and is open 24 hours a day.

Which means that aisles at Wegmans are huge. Now, suppose you turn the corner into one of these aisles, and you suddenly catch a glimpse your partner off in the far distance. What is the very first thought that immediately enters your mind? That is the Wegmans test.

When I first see my spouse at the other end of the store, my first thought is always to smile and think, "Ahh ... there goes my beautiful wife." This powerful first relationship-defining thought is what lies underneath whatever ups or downs are going on between us that day. It undoubtedly governs the stance I take toward her when all else is at rest - the words I choose, the emotions I feel, and the level of partnership I bring to the relationship. It is likely the reason I am still deeply in love with her after over 40 years together.

Now, suppose you see your partner and your subconscious gut reaction is "Ugh, there is the curmudgeon I have to go home with." In all likelihood, your communications, your mutual problem-solving style, and your motivation to improve the relationship are very different from mine. And that, in turn, is why you are both so unhappy most of the time.

Marriage therapists like me make a profession of helping couples get closer, starting with learning new ways to talk - and more importantly, listen - to each other. But I could teach you all the communications skills in the world, and none of them would help if that basic, underlying spark isn't there. In fact, more often than not it would be like trying to bring a dead fish back to life. That is why the Wegmans test is so important.

So what should you do if the two of you flunk the Wegmans test? For starters, ignore most articles on how to be a closer couple. Candlelight dinners, holding hands, and even good listening skills aren't going to cut it when you fundamentally get under each other's skin. 

Instead, be honest with yourself - and better yet, each other - about what you might both need to change to bring the spark back. It might be as simple as learning to respect each other's preferences, or as complicated as unearthing past hurts and traumas in therapy. Either way, the keys to a good relationship are waiting for you right there in the produce aisle.

Of elevators and exposure

An old joke describes someone who gets stuck in an elevator, and the emergency phone rings a long-changed number that is now a therapist's office. At first the therapist tries to explain that he can't help him, to which the person exclaims, "Can't you do anything for me?" After a long pause, the therapist replies, "How do you feel about being stuck in the elevator?"

There is some truth in jest to this joke for me. I am a psychotherapist who specializes in treating anxiety disorders, and decades ago I recovered from some severe and crippling phobias myself with the aid of good therapy. Nowadays I am a pretty happy guy who experiences very little anxiety on a day-to-day basis. But one issue I've never really bothered to deal with is that I am claustrophobic and don't like to ride in elevators. And yes, I have been stuck in them before.

In a way, I am almost glad to have one piddling fear left, to observe and work with what I prescribe for others. For one thing, it isn't very life-limiting. When I go to Manhattan and have a meeting on the 38th floor somewhere, up the elevator I go. But if I am at a five-story hotel, I will ask for a lower-floor room and take the stairs. Either way there is very little motivation for me to work on this fear, so I just put up with it or accommodate it.

But what if I suddenly needed to be taking elevators a lot? Here are some of the things I would do if I were treating myself for this problem:

1) Examine my thinking. My fear is ultimately caused - and sustained - by a great deal of self-talk, most of which is false. "If we get stuck between floors, no one will know and we'll die like rats." "I'll yell and scream and make a fool of myself." "I am taking a big risk."

All of these statements are rich in what we call cognitive distortions, or errors in thinking. Elevators have alarms, emergency phones, and even the sound of my voice to people on a nearby floor. My cell phone will often work from inside the elevator. I can count the number of times I've actually been stuck on the fingers of half a hand or so, and in each of those cases I was out again within minutes. So changing my self-talk to be more accurate and rational can help the way I feel.

2) Create a gradual exposure hierarchy. I generally prescribe approaching a fear in small steps, and learning to be fully present at each step. But how can you gradually expose yourself to an elevator? After all, once the door shuts you're in, right?

In reality, there are all sorts of steps you can take with an elevator fear. Do you feel anxious just standing near an elevator, or watching people get on and off? You can start there! Then try going in and right back out of the elevator, or perhaps just go up one floor. And there are different kinds of elevators: fast, slow, glass-enclosed, and the like. Taking a small step and learning to lower its anxiety will strengthen you for every other step you take.

For example, when I did my psychotherapy internship at a large super-regional hospital in Pennsylvania, its 10-story hospital wing had slow, creaky elevators that I hated. But its attached five-story clinic had brightly-lit high-speed elevators that were always full of people - and in time, I actually learned to ride comfortably on these elevators.

3) Practice, practice, practice. Which leads to my last point: practice, even at low levels, will inevitably chip away at your fears and create progress.

During my internship, for example, I got a chuckle out of one of my fellow interns as I described how we were going to get to a meeting on the eighth floor of the hospital: walk over to the clinic, take the high-speed elevator to the fifth floor, walk back to the hospital, and go up three flights of stairs. But there I was on an elevator - and eventually I took this elevator regularly with much less fear.

Will I get over my fear of elevators someday? Stay tuned. In the meantime, there are evidence-based tools I can use if I ever need them. And I can keep them in mind even as I make my way up and down the stairs.