Another horrible tragedy. 149 people murdered by an apparently suicidal co-pilot of a respected airline.

Who was being treated by a therapist for depression. A former girlfriend describes mood swings. Nightmares. Perhaps grandiose ideation.

We may find out more in days to come.

I have certainly had patients discuss their fear that an employer would discover their struggle with mental illness. It would ruin their risk of promotion. Maybe they would be banished to a back office. Or let go because suddenly, "You aren't living up to your potential".

There is a "duty to warn" in the mental health profession. Different states in the US and various countries have laws governing under what circumstances confidentiality can or must be broken between a patient and his or her treating professional. Suicidal and/or homicidal ideation or plans require mandatory reporting in some states and/or at least highly serious consideration by the professional. There is a fine balance between creating a relationship where people can talk to you about serious issues, and assessing whether or not they will act.

I have no idea what was shared with this man's therapist. Or if he acted ethically on the knowledge he had.

I don't know how his family or other friends viewed him. How much he hid from them. How much they didn't want to see. Or simply didn't understand.

The obvious tragedy are the innocent deaths. There isn't one that can compare to that.

When all of this was occurring, I happened to be reading the new book "Resilience" by Jessie Close and Pete Earley  Pete is known for his book "Crazy", which describes his son's appalling journey into the world of 1970's institutionalized mental health treatment. Or really lack thereof. Jessie is the sister of the actress Glenn Close. She has Bipolar Disorder that went undiagnosed for many years. Why? Her family was educated. Tuned-in. Glenn even played a highly mentally disturbed woman in "Fatal Attraction", one with major mood swings, emotional neediness, manipulativeness.

But Jessie was viewed as making "bad life choices". Having problems with drugs and alcohol. "Going from man to man". Nobody looked underneath those choices. They saw the car but not the engine that was whirring underneath, driving her deeper into desperation. Part of that was because she relished the manic highs. At those points, she was creative. Highly productive. Full of intense energy. When things could get no worse, she and her family were finally ready to see her illness for what it was, and that it could be managed with medication and sobriety.

There were "victims" of Ms. Close's illness as well. Her children were moved constantly. Were the target of her dark moods. Hurt by her bouts of drinking and many chaotic relationships.

Mental illness can hurt more than the one suffering. If it's severe enough. If it's intense enough.

All this makes it clear that we, as a culture, as a world, must change how we talk about mental illness. And it's treatment. We must drag it out of its closet. Hang it where all can see.

In this video, Glenn Close describes mental illness as a family affair. That 1 in 4 people that you pass on the street have had or are having their lives touched by mental illness in some way. A brother. A grandmother. A best friend. Or you.

She and her sister have begun the non-profit group BringChange2Mind. I am joining. I urge you to do the same.

We cannot stop every tragedy. Or every child that will watch their mother or their father weave their way through mood swings. Hearing voices. Addictions. Or "bad choices".

We can begin changing the culture. By talking openly about your own mental and emotional struggles. With your family. Your children. Your friends. Men and women alike. Actually especially men. Who do not tend to enter this realm easily. Encouraging others to do so. Advocating for better mental illness treatment, especially with chronic mental illness.

We can make a difference.

Dr. Margaret Rutherford is a clinical psychologist who has been in private practice for over 20 years in Fayetteville, Arkansas. She began blogging in 2012 after her only son left for college, coining the term "NestAche" for her empty nest experience. Not only here on Boomeon, she has been featured on the Huffington Post, Midlife Boulevard, BetterAfter50, BlogHer, Readers Digest, The Cheat Sheet and ArkansasWomenBloggers. Her new eBook, "Seven Commandments of Good Therapy", a basic guide on choosing a therapist or evaluating your current therapy, is available for free on her website. You can find her at DrMargaretRutherford.com or on Twitter @doctor_margaret.

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