To Make Them More Lost

So many psychological disorders have unfortunate names. Sometimes those names are the vestiges of long-discarded theories of the disorders’ origins or mechanisms, or even of antiquated ontologies; sometimes they are simply too ambiguous, general, or stigmatized to be of much use*. Perhaps the worst offender, however, is so not because of its origin, and it is not all that ambiguous; it is simply too benign to label one of the most debilitating, most personally and even culturally destructive human illnesses: depression.

It is simply not possible for me to describe how unfathomably awful depression is, but to provide some sort of gauge, let us consider this: suicide is one of the leading causes of death in both adolescents and adults, and more than two-thirds of all suicides are the result of clinical depression, but if we consider at what points in the progression of the illness sufferers tend to commit suicide, we see that it generally happens when depression is getting worse or when it is getting better. In other words, when it is not yet or no longer at its very worst, people find depression too unbearable to go on living, but when it is at its worst even suicide becomes too difficult. Perhaps then there is no label that could adequately represent something so horrific, and the inadequacy of “depression” serves as a sort of reminder of that.

Mercifully, if that is the right word, the worst sorts of unipolar depression, those given the label Major Depressive Disorder or Major Depressive Episodes, rarely last more than six months**. Of course, if you are mired in a major depressive episode, six months can seem like an eternity, particularly given depression’s tendency to radically distort the perception of time much as physical pain does, turning minutes into days and days into years, but at least there is an end in sight. What’s more, the end of a depressive episode can be hastened with treatment, of which one has many choices – different medications, different types of individual talk therapy, and different types of group therapy – with fairly high success rates by themselves or in combination. If only people seek treatment.

However, most people suffering from depression never do. This fact should give us all pause. What other extremely debilitating, potentially deadly disorders, disorders that can destroy families and ruin careers, go untreated at such a rate? In depression’s case there are many reasons why people do not get treatment, some of which are all too familiar: lack of treatment options or the ability to pay, lack of education about treatment, and lack of education about the disease itself (so that many don’t even realize that they are suffering from it even as it rips their lives apart), but with depression (as with many other mental diseases) there is another, more pernicious reason on top of these, the stigma that is so frequently attached to it.

Unlike that attached to many disorders, the stigma associated with depression can be difficult to pin down, because it can be subtle and multifaceted. At times we think of depression as a sign of weakness in those who suffer from it, for example, while at others we think of it as an indication of the failure of the people in their lives. Why is she so depressed when I try so hard to make her happy? What does her depression say about me? The stigma of depression is often the embarrassment and sense of failure in others. In the end, though, depression is a mental disorder, and as such it also carries the stigma of all mental disorders, the spectre of “crazy” and “insane,” the judgment of “not quite right in the head.” It licenses all sorts of inferences about the ability of its suffers to think and behave rationally, even when such inferences have nothing to do with the actual symptoms of depression and the way it can and does distort thought and alter behavior. Fear then, as much as ignorance and cost, can lead people to not seek treatment, to not tell anyone, even those closest to them, of their suffering.

It is with this fear in mind, a fear shared by millions of Americans each year, by people whom each and every one of us knows, that we should be disturbed by the coverage of the crash of Germanwings Flight 9525. While the investigation into the cause of the crash is ongoing, it is clear at this point that the filght’s co-pilot, Andreas Lubitz, is responsible, and that he deliberately caused the plane to crash into the French Alps. This is an act of violence on such a large scale that it is natural for all of us to want to understand what made him do it. What is unfortunate, and quite frankly irresponsible on the part of the media, is the amount of attention they are giving to his history of depression.

While it is true that there is some epidemiological evidence of an association between depression and homicidal behavior, the research indicates that this may be a result of other, comorbid disorders, particularly personality disorders and substance abuse***. There is little, if any evidence that depression alone increases violent or homicidal behaviors, and even if there were such a connection, we know that the vast majority of the tens, perhaps hundreds of millions of depressed individuals world-wide will never seriously harm another human being, much less commit mass murder. It is quite likely, then, that Lubitz’ history of depression is not at all related to his decision to kill 149 people.

Yet those who have suffered, are suffering, or will suffer from depression can’t help but notice how it is being discussed right now. Should a history of depression have disqualified him from being a pilot, we’re forced to ask ourselves? Why? Because it is a mental illness, and we are incapable of distinguishing between different sorts, or worse, because we associate all mental illness with violence? And if he should not have been able to be depressed and a pilot, from what other jobs should we exclude those who are or have been depressed? What about bus drivers? Teachers? Mechanics? Electricians? There are so people whose jobs regularly entail us placing our safety, or the safety of our loved ones, in their hands. Should no depressed or previously depressed individuals be able to have any such jobs?

And does this sort of talk make people with depression more or less likely to seek treatment, or even to tell someone of their suffering, when they might have to fear for their livelihood and risk people losing trust in them, perhaps even fearing them?

* I’m looking at you, schizophrenia.
**Depression often doesn’t let go so easily, though, and longer, milder bouts of depression, called dysthymia or dysthymic disorders, are not uncommon.
*** Links to some research:
Schanda, et al. (2004). Homicide and major mental disorders: a 25-year study.
Asnis, et al. (1997). Violence and homicidal behaviors in psychiatric disorders.
Eronen, et al. (1996). Mental disorders and homicidal behavior in Finland.