Andreas Lubitz’s apparent intentional crash of Germanwings flight 9525 has brought discussions of the intersection of violence and mental disorder back to the front page.
As the story unfolded I anticipated two reactions that typify the polarization of public discourse surrounding mental health issues. First, news reports that moralize about ending “stigma,” but that characterize people with mental health diagnoses in ways that perpetuate negative stereotypes.
Gretchen Carlson from Fox News offered a particularly Orwellian example saying:
“I’m just wondering today if it’s, once and for all, time to take on mental health as a serious medical issue — and stop stereotyping it as something we just want to brush under the rug and not really discuss. As a victim of a stalker who was mentally ill I can speak to this. I know for the most part the law is on the side of the mentally ill person — not the victims. I think it’s time to revisit mental health once and for all. Bring it out of the darkness. Call it what it is. Get people help. Get rid of the stigmas. Time to move forward.”
Second, I anticipated that there would probably be speculation on Mad in America and related spaces about the potential causal role of psychiatric medications in a tragic event like this. Indeed there has been not one, not two, but three such posts.
In my view, whether one seeks to blame psychiatric symptoms or psychiatric medications the result is often a deepening of pervasive negative attitudes towards those whose experiences often fall under the description of mental disorder.
As much as we might like a simple explanation for such an unfathomably destructive act, I do not think tragedies like this are reducible to such explanations. What I would like to see is for all of us who care about these issues to cultivate spaces that can accommodate the complexity, uncertainty and humility that will be required of us in creating communities that neither promote shame and fear of these difficulties, nor deny how difficult it can be to effectively and compassionately respond.
Cultivating a space like this will require moving beyond polarizing rhetoric, and engaging with the messiness and grey areas that can more credibly contain these issues.
When we deny that states under the description of mental disorders are “real,” deny that psychiatric diagnoses describe—however imperfectly—actual patterns of experience and behavior…we cease being credible to many who experience such states, or their families and others who would try to be of help. Likewise, when we deny that both these patterns of experience and behavior and the language that has been developed to name them are, in large measure, socioculturally determined…we cede something of all human experience to biological reductionism.
I wholeheartedly agree with Gary Greenburg who wrote in The New Yorker that “ Our experience and our theories don’t allow us to predict who the next Andreas Lubitz will be.”
Indeed, Smuckler and Rose—in a 2013 paper I was dismayed didn’t receive more public discussion — wrote a detailed account of the problem of such risk assessment from a statistical standpoint, concluding that it was not possible to predict who will carry out such acts, that the desire to predict them arises out of “moral outrage” rather than rational deliberation, and that the focus on risk management “offer new markers for discrimination and social exclusion.”
We do not know why Lubitz destroyed that plane and took so many lives with him. But I do not think a single variable can explain it, be it psychiatric symptoms or psychiatric treatment. Nor do I understand why, if we are seeking single variables, male gender, for instance, isn’t more often discussed by those who would seek such explanations for these heinous performances of violent spectacle.
Male gender socialization may well play a role in these sorts of acts (and I for one think it’s quite obvious that it often does) and yet as Greenburg wrote of Lubitz, “the multitude of vectors that move someone to heinous and incomprehensible acts cannot be apprehended with the inexact instruments of diagnosis deployed by imperfect people like me.” Just as the vast majority of people who experience psychiatric distress or use medication will not engage in these acts, nor will the vast majority of men.
But if such experiences were diagnosable by laboratory test, could we then conclude that biological abnormalities they were the cause of such violent acts?
A 2013 This American Life piece, Dr. Gilmer and Mr. Hyde, provides some insight into this question. (spoiler alert) Dr. Gilmer went to prison for killing his father. He complained for years of neurological and behavioral symptoms which he said explained the murder and required a very specific treatment with an SSRI. Prison authorities concluded he was malingering. However, after much protest Dr. Gilmer acquired genetic testing that confirmed a diagnosis of a neurological illness, Huntington’s Disease that indeed is associated with psychiatric symptoms.
In other words, it turns out there was a biomarker for Dr. Gilmer’s illness. But does it really explain what happened? In the end, does it resolve how we might untangle where Dr. Gilmer ends and Huntington’s Disease begins?
I don’t think this is a question that can be resolved in a straightforward way, even when there is a clear biomarker. I point this out because I think we can embrace biology without caving to biological reductionism. But also that explaining complex human behavior with appeal to psychiatric drugs also amounts to biological reductionism.
The truth is either one may be a factor in any given case, but that the vast majority of persons who experience “extreme states” or take psychiatric drugs will not engage in such acts.
Smuckler and Rose characterize a “risk society” as one in which popular consciousness and media become obsessed with some types of risks and irrationally focus on predicting and preventing them. They suggest that such attempts may actually result in contributing to contexts of harm. They recommend some ways forward including speaking out against recommendations that broadly discriminate against persons who experience mental health difficulties, as can be seen in the “risk approach” that many call for in response to these sorts of tragedies. Population level approaches should be focused on communicating acceptance rather than fear of struggling persons, and creating the kinds of supports that the broadest number of persons will find acceptable. At the same time, on an interpersonal level, we must also be more creative in responding collectively when someone’s capacity is diminished or overwhelmed with distress.
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.