Perspective for those who observe mental illness, but for me, as a subject, this tree bore only dry and tasteless fruit. . .

I have a chemical imbalance; I really didn’t feel those things.

I have a chemical imbalance; I didn’t really experience those things.

I have a chemical imbalance; I didn’t really think those things…

Here is an insight! The entire human drama of love, suffering, ecstasy, and joy, just chemistry.” – D.A. Granger

We know more about Andreas Lubitz by the day. First we learned he was “mentally ill.” Then we discovered he “had depression,” followed by the revelation it was in fact “severe depression” and that he had “suicidal tendencies.” What we don’t know is what any of these categories mean.

“Mental illness” is the wastebasket that catches the leftovers of medical diagnosis. That is not to deny that mental illness is real, and that it can be as terrible as any physical ailment. It is only to say that mental illness is, almost by definition, that which we cannot explain, and if we can explain it, it is not mental illness. Huntington’s Disease and Multiple Sclerosis were once under the purview of psychiatry, until scientists came up with more convincing accounts of the biology behind them, at which point they left.[1] When we say that Andreas Lubitz was having vision problems, but that they appeared to have a psychological rather than physical origins, what we are really admitting is that neither he nor we can explain them.

Technically, we do have a widely-accepted explanation for mental illness, albeit one that changed drastically with the rewrites to the Diagnostic and Statistics Manual in the 1980s. Gone were psychoanalytic stories about social environment and upbringing, in were biology and neurotransmitters. We can see this shift in the media discourse around Lubitz. It’s not that he “was depressed” in the sense of some internal personality trait; rather, he “had depression,” a disease that had invaded his brain from the outside, and—to re-purpose Freud’s phrasing—sat there like a garrison over a conquered city. Admittedly, this is a metaphor that has given me much comfort in hard times: baby, I was born this way, and so, perhaps, was Lubitz.

A biological approach to mental illness was supposed to reduce stigma towards the mentally ill by suggesting that they bore little or no responsibility for their condition. This, however, was contingent on the idea that biological understandings would improve treatment; otherwise, those with mental illness simply become a class apart, indelibly marked apart until their faulty wiring can be corrected. As it turns out, as the promise of atypical anti-psychotics or second generation SSRIs has faded, this is precisely the view that has come to predominate: in one survey of 14 European countries, only 16% of respondents believed that the mentally ill were responsible for their condition, but over 50% described them as dangerous anyway.[2] In the U.S., the public is increasingly likely to endorse treatment for people with schizophrenia, but actually more reticent to live or work with them.[3] Science has convinced us that a cure is right around the corner, but until that point, we’d prefer to keep our distance.

Mental health advocates have already raised red flags of how the Germanwings crash could worsen exclusion of depressed people. What they largely haven’t challenged, though, is the very notion that we can say anything meaningful about “depressed people,” whether or not it is stigmatizing to do so. The DSM diagnosis of depression is an arbitrary five out of an arbitrary nine listed symptoms, present for an arbitrary two-week period. 20% of Americans will meet this criterion at some point in their lives; drop the bar slightly, though, and the figure jumps to 62%.[4] At this point, it becomes absurd to think of “depression” as a meaningful way to determine who is fit to take others’ lives into their hands. Depressive symptoms are distributed throughout the population. But if you follow the bell curve to its extreme, you never reach the point where “mass murder” becomes a predictable outcome.

Doctors like having an explanation. So do families who have lost loved ones in an act of unspeakable horror. But I think we should probably accept that the tragedy of the Germanwings crash—just like the tragedy of mental illness, which I see all around me in my students, my peers, and myself—is likely to remain, on some level, inexplicable.

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[1] Jutel, Annemarie Goldstein. 2011. Putting a Name to It: Diagnosis in Contemporary Society. Baltimore, MD: Johns Hopkins University Press: p.30.

[2] Evans-Lacko, S., E. Brohan, R. Mojtabai, and G. Thornicroft. 2012. “Association Between Public Views of Mental Illness and Self-Stigma Among Individuals with Mental Illness in 14 European Countries.” Psychological Medicine 42(8):1741–52.

[3] Pescosolido, B. A. et al. 2010. “‘A Disease Like Any Other’? A Decade of Change in Public Reactions to Schizophrenia, Depression, and Alcohol Dependence.” American Journal of Psychiatry 167(11):1321–30.

[4] Kessler, Ronald C. and Evelyn J. Bromet. 2013. “The Epidemiology of Depression Across Cultures.” Annual Review of Public Health 34(1):119–38.