How can I reconcile my volunteer work to remove mental illness stigmas with learning that a man I once worked with and admired was the shooter in a recent Chicago murder and death by suicide in which depression likely played a role?

It’s a tough question; one I’ve been particularly contemplating since the Germanwings aircraft crash into the French Alps—a murder/suicide with 150 victims and a link to the co-pilot’s mental illness so clear that a psychiatrist’s note saying he was mentally unfit to work was found torn up in the co-pilot’s apartment.

The rare instances where mental illness contributes to mass tragedies—such as Germanwings, the Sandy Hook school slaughter and the Colorado theater massacre—dominates media coverage of mental health issues, creating a perception of a burgeoning issue particularly around murder/suicides. “The perception from media reports would be that the incidence is greatly increasing,” Dr. Scott Eliason reported several years ago in the Journal of the American Academy of Psychiatry and the Law, “but the data that we have collected show murder-suicide to be a very rare event that seems relatively constant.”

Regardless, because so few who struggle with mental health challenges acknowledge this aspect of our lives, exposure to mental illness as violent tragedy becomes the image of the disease to far too many.

Once this violent image is embedded, fear can spur a desire to stay away from those struggling to achieve mental health in much the same way as segregation metastasizes when those without regular interaction across racial, ethnic or other boundaries hear about another group only through media reports about a small percentage of its violent members.

Fear is best alleviated through exposure, an exposure almost every American unknowingly receives to mental illness on a daily basis. The extent of this exposure was clarified for me after publicly acknowledging my struggles with depression in Suicide Escape, and finding dozens of people I had known for decades newly willing to open up about their own struggles or struggles of family members.

I had seen the numbers: the U.S. Substance Abuse and Mental Health Services Administration estimates that 42.5 million American adults (18 percent of the population) are affected in a given year by illnesses such as depression, bipolar disorder or schizophrenia, and as much as half of the population will have a mental illness episode at some point in our lives. But opening up allowed me to truly sense the breadth of mental health challenges through ongoing personal interaction.

Why is it important that mental illness be discussed beyond the rarity of violent behavior?

The acute stress response of fight or flight behavior is a human physiological reaction to something we find terrifying, either physically or mentally. It’s an instinctive reaction to anything we consider dangerous.

Unfortunately, fleeing from those struggling with mental illness can exacerbate their conditions. In The Upward Spiral, Dr. Alex Korb noted that interacting with others is critical to mitigating or conquering depression. “Depression is an isolating disease,” he wrote. “It makes you feel separate and alone, even around other people, and this often makes people want to be physically separate. But that desire for solitude is just a symptom of the depressed brain.” In The Depression Cure, Dr. Stephen Ilardi observed that: “we humans find isolation an unnatural state of affairs… . We are literally born to connect.”

Yet, because of fears about mental illness—ranging from fear of physical injury to fear of making an unintentionally hurtful comment to fear of being dragged into an unending time commitment—some people back away from engagement at just the times that those struggling with mental illness most need real connection.

So we must talk about mental illness to keep tragedies from becoming the image of mental illness, even as we acknowledge and work to counter the real pain that mental illness can create.

Of those who suffer from mental illness, less than one-tenth of one percent die by suicide each year. Still, this is a large enough number that suicide ranked as the 10th leading cause of death in 2013, according to the Centers for Disease Control and Prevention. In addition, the true victims of death by suicide extend beyond the deceased to include everyone who loved and cared for them.

On very rare occasion, as we see reported in the media, murder/suicides occur. Numerous studies have shown that between 1,000 and 1,500 Americans die each year in murder/suicides, with slightly more than half of the deceased being homicide victims. Many of these deaths are not linked to mental illness. That means less than one-thousandth of one percent of those struggling with mental illness physically take one or more other lives before ending their own. More than 80 percent of murder victims in murder/suicides are current or former spouses or intimate partners.

A few common-sense solutions stand out as demanding attention:

  • In mass tragedies, a desire for fame appears to motivate at least some of those who take the lives of strangers. (Not wanting to contribute to this goal, I purposely left off the names of the co-pilot and my Chicago friend. I doubt this Chicago friend was driven by a desire for fame, but I don’t want to encourage anyone who might take inspiration.) Once a mass killer dies by suicide or is caught, I believe their name should be forever removed from public reporting. Fame and infamy should never be a reward for imposing horrors on others.
  • I’m neither a particular fan of guns nor of gun controls, but it does seem that certain combinations of mental illness and other attributes must not mix with firearms. Guns are the primary weapon of choice in both suicides and murder/suicides. The combination of mental illness with substance abuse and prior violent history (even minor physical altercations) is far more predictive of future risk than mental illness alone, particularly among men who are alone. A low-level cap, at one percent of the population or less, would make a valuable safety contribution without threatening the Constitutional right to bear arms.
  • Mental health is vastly underserved, and the interrelationships between mental and physical illness are often missed when treated separately. I don’t believe we should allow any bureaucracy—corporate, government or otherwise—to set limits on the types of treatments that should be available without ensuring that individuals have the right to test if alternative approaches work better. Whatever comes next with health care, we must prioritize individual treatment needs back ahead of bureaucratic compliance.
  • Prisons have wrongly become our de facto replacement for in-patient mental health care across America. Because mental illness combined with violence (as victim or perpetrator) increases the risk of future violence, it appears senseless to expose non-violent criminals struggling with mental health to the violent cultures inside our prison and jail systems.

All this said: how do I reconcile my desire and efforts to remove mental illness stigmas with the trauma imposed when a rare murder-suicide occurs?

I’m convinced that we will drive better outcomes by talking about mental health and working to provide those suffering with the support and resources they need to minimize or escape mental illness.

When we move this direction, the few, painful tragedies tied to mental illness will become even more rare.

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