I have had a friend since High School who was diagnosed with bipolar in the 80's. She's been more or less stable since then, with a few exceptions.
Unfortunately, she got a new therapist who concluded that she had been misdiagnosed and took her off her meds.
She then pretty much blew up life. She has cut off all of her friends, thinking we are plotting against her. She has cut off her entire family, except for her 20 year old daughter. She sold her house and is living in a shack somewhere along the pacific crest trail now. I really hope it works out for her.
My mom thought the back up singer from Wham was flirting with her on Facebook so she flew to Spain to go be with him. Sent me a text message from the airport to ask me to go look in on my brother and sister who were still living with her. She dated the guy who scammed her for about a year.
She has no idea why she hasn’t been allowed to meet my son. It’s heartbreaking but she’s not crazy enough to be involuntarily committed but she’s too crazy to be involved in my life without physically endangering my family, usually because she finds some scummy man she’s fallen in love with and just has to bring him around everyone.
Haven’t talked to her for over a year now. Told her we could have contact if she agreed to see a therapist and I would even go to a few sessions with her but she refused. Like trying to give a bath to a cat.
People keep asking things like “well why would she do that?” and the answer that it’s because she’s nuts just doesn’t make sell it because everyone wants there to be some rational reason.
"everyone wants there to be some rational reason."
I know exactly what you mean, and when people do this, it makes *me* feel nuts. I just cannot fathom what's so hard to understand about the fact that the person is mentally ill in a way that affects rationality.
I don't hold Ye's antisemitism against him because he is obviously unwell. I said and did a lot of horrible things when I was psychotic. And yes, the most racist thing I ever saw was in a mental hospital, when a woman started shouting the n-word at a black guy over and over for no reason.
The thing I would fault Ye for is going off his meds (if that's what he did. I haven't read much about it).
Ye, when manic, has claimed that he doesn't need meds, which was one of the many reasons for the breakdown of his marriage. (I hate that I know this, but I know this.)
From personal experience with a bipolar person, believing you don’t need meds when you’re manic is not unusual. “This is who I am, meds take away part of me”. Being very confident you are not ill is one of the symptoms of the illness.
It's kind of childish to just completely go off your meds though because someone is threatening you like that. Maybe he'll learn after this episode, seeing as how the consequences are pretty severe.
Kanye is clinically manic. They could (and, oh, one day may) show footage of his Alex Jones appearance to medical students when they’re learning about bipolar disorder and manic psychoses. Social workers, EMTs and cops might benefit as well.
His ranting about Jews is a classic paranoiac symptom. Though, thankful, one less prevalent in the 21st century.
Most of us use words like “paranoid” and “psychotic” colloquially. Well, this is the real deal. Kanye can seem oddly cheerful and everyday he’s somewhere new, doing something batshit. That’s mania. He’s a literal maniac. (Understandably we don’t use “maniac” in that literal sense much these days.)
Tragically, people in this state die at a high rate. Often from suicide. Even people whose bipolar disorder is less dramatic (hypomania, bipolar II) kill themselves at an exponentially greater rate than the general population. You can Google the incredible numbers related to bipolar disorder and suicide. Sufferers also manage to get themselves killed in other ways. Then there’s the matter of crimes or simply impulsive behavior that hurts others.
I’m Jewish and my ratio of dread & indignation to magnitude & persistence of antisemitic expression has seldom, if ever, presented more of a contrast. The little anger I feel is almost entirely reserved for those allowing this to happen, the exploiters and enablers. Though Kanye does bear responsibility for going off his meds.
The best case scenario is probably Kanye spends the rest of his life taking prescription drugs with unpleasant side effects and is sincerely repentant.
Right now, though, we could be having one of those “valuable learning experience”s people loved taking about a decade ago. This is untreated bipolar disorder. The statistical chances of this going from ugly, titillating farce to real harm or violence (in their pre-woke literal sense) are high.
Kanye’s recent problems and reading this piece brought back a really awful feeling I sometimes got during from my stats as an patient in hospital mental health units and in therapy groups: the feeling of being completely helpless to help someone in a severe mental health crisis.
There were people with problems like awful living situations, no family or friend support, problems that completely limited their ability to function, and people who’d made ruinous decisions during manic episodes. There was absolutely nothing I could do or say that would fix their problems and help them get back to normal. I still think about the woman who was going to be homeless when she got out, the guy who was there after a suicide attempt and seemed so hopeless that I was terrified was going to kill himself when he got out, the lady who’d destroyed a relationship with her husband and kids in the span of a manic episode, and the big tough looking guy who broke down sobbing during a group session. I hope they’re doing ok.
I have such a complicated relationship with Ye's whole narrative. As someone with bipolar myself, and who works with severely mentally ill people, I have no doubt that Ye's mental illness is contributing to if not driving his bigoted statements. Sadly and for whatever reason, antisemitic conspiracy theories are absolute catnip to the paranoid, distressed brain. I definitely felt the pull towards a certain lizard person conspiracy when I was at my most manic in the past; the idea that you're a lone crusader who knows The Truth and is persecuted by enemies plays right into what the delusional brain wants to believe.
But also, Ye's been an awful person entirely independently of his mental health for years, and I do have some grim satisfaction at the idea that he'll finally stop being adulated. It just baffles me that people consider his posting inflammatory bigotry online to be an immediately cancelable sin while turning a blind eye to his treatment of women while he's been purportedly lucid. Remember when he released a music video with simulated nude bodies of people in bed with him, including his ex-girlfriend, who he'd blasted in the lyrics of his earlier album, and a public figure he was in the middle of a high-profile beef with? Remember how messed up that was? Remember how he's basically stalking his ex-wife right now and has made threats to her safety and the safety of other people in her life?
It makes me feel some kind of way, not a good way, that what people most want to crucify Ye for is the words he says and images he posts when he's at his least culpable, as opposed to the threats he makes towards women when his accountability is less in question.
I hear you. This happens in so many different contexts. When something is racist, it’s immediately condemned. Sexism is tolerated to a far greater extent, in the behavior of individuals, in the trans movement, and especially in entertainment and media of all kinds - from advertisements to movies and tv to pornography. No one cares if women take it on the chin and their interests are always subordinated so that men can swing their dicks around (or worse). That’s what we’re here for, after all. To be sexual service modules for men, until we are replaced by younger women or sex robots.
This is gonna sound really crude, but I think it's obvious by now. These people appear to think that mental illness is something that affects ONLY liberals. That it ONLY affects people who have the "correct" viewpoints as handed down to us by Tumblr.
And if mental illness symptoms are happening to a conservative or anyone else? Nope. Can't be mental illness. It just means they're bad, full stop.
And I just don't know how that idea can work in any functional society.
Not to take a universal-theory approach--I dislike those--but this phenomenon reminds me of a tendency I see in the new left, the Woke...whatever you want to call them. These folks don't care much about doing good, as long as they feel good. So *feeling* good is viewing the mentally ill like Forrest Gumps, special and ultimately benign and even benevolent, but *doing* good is actually dealing with the messy reality of mental illness, and for many that's just too much goddamn work. Easier to tweet angrily about Kanye than to think in a nuanced way about him or, heaven forbid, actually take action to maybe make things better.
I admit I generally take a consequentialist moral view, so I tend to evaluate people not by their words or their stated beliefs, but by the good (or evil) they introduce to the world. There are other moral views, definitely, but for myself I've had it with moralizing self-righteousness that extends no further than the Internet. I'm tired of being lectured to about mental illness by people who wouldn't lift a finger to help someone who wasn't mentally ill in a way that Ernest Owens or Robin DiAngelo would approve. I wish those who speak the loudest were those who actually worked the hardest.
Jesse, as someone with aspergers and a slew of mental health issues from growing up with mentally ill and abusive parents, I wish I had more friends like you.
This is the reality of having mental illness and/or neuropsych disorders. People love to say how they totally understand and want to help (including employers) until they see the reality of what it's like to need extra supports or the bad times where shit hits the fan.
There's definitely a magical thinking about therapy and resilience - I'm alive, I'm gainfully employed, I take my meds and fought for years to get the therapy I need... But therapy isn't magic, and therapists aren't supposed to be your friends.
I'm very open about my issues, but I've become totally isolated because I cannot cope with being dumped as a friend by another person who doesn't get that what I live with every day isn't always cute or quirky. The gentrification of ADHD and autism (that Freddie De Boer has written about and I agree 90% with his take) has totally ruined what little community there was for us who are high functioning. And what little understanding there was from normal people.
I'm not Sheldon Cooper or Attorney Wu, I'm a real person with a brain that doesn't process or filter information in the usual way. I can't read your facial expressions, I can't soften my language to sound appropriately deferential, my emotional expression is either 0 or 100 regardless of how I'd actually rate how I'm feeling, I get lost when the seasons change, I can't evaluate the importance level of details and get stuck, etc etc.
Watching Kanye succumb to what is clearly some kind of psychosis has been heartbreaking. It's the same exact reception that Terry Davis got (the programmer responsible for Temple OS and whose slur filled diatribes were picked up as 4chan argot) got 20 years ago.
My son is an autistic brain injured (encephiitis) adult. You are 100% correct. If I hear one more person telling me "my nephew is autistic and has a Ph.d from ______), I will scream. My son will probably never be gainfully employed. I am happy he has progressed as far as he has.
Autism is not a different kind of normal, it's an F'ing disability
You make a slight concession to the shallow ally’s who say “well it can’t be bipolar.”
It’s not even that clear cut (it’s complicated!)
I have learned in the aftermath of some very sad goings on that there are different types of mania, and can even include psychosis. It’s not all hyper confidence and erratic behaviour - it can also be extremely dark and conspiratorial.
Indeed. Psychosis isn't rare in mania--it's about as common as not to become psychotic in a "proper" BP1 manic episode. And bipolar psychosis isn't necessarily much different than what schizophrenics experience--the difference is the temporal pattern and the association with mood state (bipolar psychosis will remit when the mood episode ends, whereas schizophrenic psychosis can be more cyclic/episodic than you might expect but isn't associated with mood episodes). And catatonia is actually more common in bipolar psychosis than in schizophrenia despite "catatonic schizophrenia" having been a thing for awhile. If (for some reason) you stumble on someone so thoroughly psychotic that they have lost the ability to move, speak, or respond to stimulation, it's more likely that their diagnosis is bipolar than any other. Tl;dr a lot of the people you might parse as schizophrenic because they are behaving strangely in public are actually bipolar. There's often no way to disambiguate between schizophrenia and bipolar if you only see a slice of someone's psychotic behavior at one point in time.
I really appreciate your posts on this topic. They’re very informative & helpful.
I think the term “bipolar” (and to a slight lesser extent the increasingly anachronistic “manic depression”) can give laypeople a false impression. They did me.
Two problems with “bipolar” as the term ignorant civilians have as our frame of reference. The first is that it implies a dramatic either/or when the person’s life can be consistently messy. The second (and greater) is that it doesn’t address delusion.
I understand that “delusion” is an insufficient term covering too broad a range for a clinician, but if the common folk term had been “manic delusional” I think I might have recognized what was going on. (Though perhaps it’s not as evident in all patients.)
I would suggest that every society has its fault lines, social conflicts, etc., and that people with certain mental health issues become  particularly sensitive to whatever controversial ideas are "floating in the air".
they will tend to obsess about them, and become vulnerable to the most extreme versions of them.
Which is why I tend to believe that progressive politics exacerbates the problem by making these issues particularly urgent and salient and therefore most likely to attract the attention of people with severe mental issues .
 What would have been under the radar earlier now becomes the focus point for a lot of toxic emotions.
 And people with extremely negative toxic emotions in the first place are drawn to them as explanations for their feelings.
In a banal sense, it's obviously true that mental illness doesn't make someone antisemitic, anti-Black, etc. But as Jesse says, it can make people susceptible to conspiracism, hateful speech, and anti-social conduct. In a society that's the product of Christian European civilization, antisemitism and white racism are two of the more likely hatreds that might afflict someone who is mentally ill. If that's what happened to Kanye West, then it's likely that were he the product of a different civilization he would have fallen prey to a different hatred. As Jesse also says, however, mental illness can be disinhibiting. West may have held antisemitic views or tendencies for some time, only to express them publicly as, due to mental illness, he lost control over himself.
To the extent West is unwell, he needs help, which virtually none of us is able to provide. What we can and should do is reject and combat his antisemitism, just as we should be rejecting and combating Nick Fuentes's white supremacism (and, of course, his antisemitism) regardless of whether Fuentes's conduct is a manifestation of mental illness.
You wrote, "antisemitism and white racism are two of the more likely hatreds that might afflict someone who is mentally ill." Did You come to this knowledge with some previous experience in the mental health field. Because I don't think that logically follows.
I'm assuming Reb did not mean that people with panic disorder and Tourette's are more likely to be racist but rather was using mental illness as a shorthand for psychosis, in which case it does logically follow:
It's well documented that delusional content is culturally informed
Paranoid delusions are some of the most common delusions in psychosis
Paranoid delusions involve an enemy group who is targeting the individual
Psychotic individuals tend to identify enemy groups based on the beliefs of their culture
Anti-jewish and anti-black racism are common hateful belief systems in our cultural
--> Antisemitism and anti-black racism are common themes in paranoid delusions in our society.
I had a patient years ago who had Tourettes. He also had an intellectual disability , and was living in a group home on the south side of Chicago.
Anyway, he got out of the home, and wandered around calling black people the N word along with every other bad word that popped out of his mouth. He couldn't control it.
He was beaten very badly, and lost nearly all of his teeth. His jaw was broken, and his whole body was covered in severe contusions.
Tourette's involves irresistible impulses to utter "taboo" words. Those can be whatever is most taboo in a culture, and in ours, besides swear words involving sex and bodily functions, the n word and antisemitic slurs are among the most taboo, so it stands to reason they would be part of the taboo words that sufferers would feel compelled to utter.
Tourette’s can involve the urge to use inappropriate language, but it’s not a common manifestation of Tourette’s and is not required for diagnosis. Most Tourette’s cases involve things like unusual movements such as blinking or mouth movements, or vocalizations like grunting.
I wasn't attempting to analyze Kanye West, which is beyond my competence. Nor am I saying he's a racist, although he certainly has made antisemitic statements. According to my understanding, to the extent his conduct is beyond his control he's not responsible for it, at least not morally. That's why, for example, we don't treat as guilty of murder those who are unable to control their actions and cannot tell the difference between right and wrong. Neither, of course, do we simply release them back to society as a continuing danger to others (and possibly also to themselves). (Whether we treat them humanely and productively is a separate question I note but do not address.)
Well, I think any "kind" of psychosis (not sure what's meant by this?) can produce paranoid delusions, but not all instances do, and there are plenty of other ways to be delusional and even paranoid as well. You can have delusional paranoia that your spouse is cheating on you and that has little socially-relevant content. Some paranoid delusions are deeply bizarre and clearly weren't plucked from the newspapers. You can have a powerful sense that everyone is out to get you without identifying who they are per se (my own experience with paranoia during psychosis). The earlier remarks all just go to the question, given someone has psychosis and hateful beliefs, what is the content of those beliefs likely to be? And paranoid delusions are the ones that most lend to hateful beliefs. It doesn't speak to the question of likelihood of holding hateful beliefs and I'm definitely not trying to promote the idea that people with psychosis are snarling racists. Just that people who are trying to make sense of their experiences during psychosis will often use culturally available narratives.
My argument, were I to unpack it fully, would be historical and sociological. See, in part, David Nirenberg, Anti-Judaism: The Western Tradition (Norton 2013). If accessible, Michael Walzer reviewed the book for The New York Review of Books under the title "Imaginary Jews: Anti-Judaism as a constitutive idea and an explanatory force in Western civilization" (Mar. 20, 2014) https://www.nybooks.com/articles/2014/03/20/imaginary-jews/. Another review: Anthony Grafton, "Imaginary Jews: The strange history of antisemitism in Western culture (The New Republic, Oct. 11, 2013) https://newrepublic.com/article/114894/david-nirenbergs-anti-judaism-reviewed-sordid-representation-jews
Or, as Marx put it in The Eighteenth Brumaire of Louis Bonaparte: ""Men make their own history, but they do not make it as they please; they do not make it under self-selected circumstances, but under circumstances existing already, given and transmitted from the past." https://www.marxists.org/archive/marx/works/1852/18th-brumaire/ch01.htm
I suspect what is happening is a kind of self-reinforcing belief about the mildness of psych disorders. It basically goes like this: you express sentiments that say psych disorders don't contribute to any bad or obnoxious behavior, as a result everyone in your life with a psych disorder works overtime to prevent any REAL side effects from being aparent, so then you associate psych disorders with your friends and family who are actively hiding reality from you which reinforces the initial belief. The fundamental reality is that a psych disorder that does not meaningfully impact your day-to-day functioning and relationships is just not a disorder.
I suspect some of this “this isn’t bipolar” has to do with the shift in diagnosis of bipolar disorder. Way back in the day, severe depression was considered a separate illness from more common depression-it had different symptoms, tended to run in families and was associated with past head trauma. Eventually we just dumped most types of depression into one bucket and treated them similarly. As a result we had people diagnosed with depression and less severe symptoms “educating” people on things that depression allegedly was not. And so people with catatonic depression or depression which psychotic symptoms (which is very common in melancholic depression) we’re sort of left out. I’ve been around people with this type of severe depression and it really is different from the disease most people get diagnosed with.
Bipolar 1 used to be called manic depression but we now include bipolar 2 and bipolar NOS in the bipolar bucket. Those conditions seem to be different-people with bipolar 1 in the family tend to get bipoal1, not bipolar 2. With this wider diagnostic criteria for bipolar disorder most people with a bipolar diagnosis do not have bipolar 1 and their experiences of hypomania really aren’t relevant to the experience of people with full-fledged psychotic mania. Just like the experience Of someone with mild non-melancholic depression isn’t relevant to the experience of someone with severe melancholic depression.
Speaking as a woman of childbearing years whose friends are primarily in that demographic group I have also noticed that bipolar disorder is commonly diagnosed in women with not particularly severe depression that does not respond to SSRIs or has irritability as a symptom or shop in a non-dysfunctional manner to cheer themselves up. Hypomania is often a matter of opinion. So some of the “I’m bipolar and I don’t do that” maybe coming from people who were misdiagnosed.
Re: your 12/05 column. The same is true of "autism" and people with "cognitive disabilities". ( Formerly known as "mentally retarded"). I worked with both disabilities for about 4 decades. One loses one's vision of the poster-child Down's Syndrome kid after the rabies shot needed as the result of him chomping down on your forearm, and needing another staff person to pry open his jaws. The relatives of my clients were well aware of what they were like, as you testified about your mom. Treat em' well, be wary, and get them treatment to GET as well as their brains and bodies allow.
I relate to this a lot. I just have regular old depression, except it can be severe and is treatment resistant. At one point when my wife and I were struggling a lot she said something like, "I'm so confused as to how you are one of the kindest, sweetest, most thoughtful people I know and yet I feel so alone and uncared for," or something to that effect. Note that of course I only see the bad in that comment. It's really complicated but depression somehow contributes to me not be as attentive as I'd like to be. It's easy to "blame" the depression, but I don't do that and I don't think it's accurate. I actually hate it (in true self-loathing fashion) when people say "it's not you, it's the depression!" But it *is* me who's messing up. The depression *is* part of me. I'm not trying to excuse any behavior or say it's all the fault of the depression, I'm just reinforcing what you're saying in that it really *is* complicated and to say it's all or none of the mental health would both be inaccurate.
I can use Josh's keen insight that the DSM-V does not exhaustively list every possibly manifestation of a disorder's symptoms to determine that nothing is a symptom of any mental illness! "I'm sorry, I've never heard of 'never doing your chores disease,' I don't see 'being a lazy loser' in the DSM, and I know someone with ADHD who just fidgets." I imagine people would be using the same logic to claim that depression doesn't cause suicide if suicide were still as taboo as it once was.
Thank you for this!!
You hit the nail on the head.
I have had a friend since High School who was diagnosed with bipolar in the 80's. She's been more or less stable since then, with a few exceptions.
Unfortunately, she got a new therapist who concluded that she had been misdiagnosed and took her off her meds.
She then pretty much blew up life. She has cut off all of her friends, thinking we are plotting against her. She has cut off her entire family, except for her 20 year old daughter. She sold her house and is living in a shack somewhere along the pacific crest trail now. I really hope it works out for her.
My mom thought the back up singer from Wham was flirting with her on Facebook so she flew to Spain to go be with him. Sent me a text message from the airport to ask me to go look in on my brother and sister who were still living with her. She dated the guy who scammed her for about a year.
She has no idea why she hasn’t been allowed to meet my son. It’s heartbreaking but she’s not crazy enough to be involuntarily committed but she’s too crazy to be involved in my life without physically endangering my family, usually because she finds some scummy man she’s fallen in love with and just has to bring him around everyone.
Haven’t talked to her for over a year now. Told her we could have contact if she agreed to see a therapist and I would even go to a few sessions with her but she refused. Like trying to give a bath to a cat.
People keep asking things like “well why would she do that?” and the answer that it’s because she’s nuts just doesn’t make sell it because everyone wants there to be some rational reason.
"everyone wants there to be some rational reason."
I know exactly what you mean, and when people do this, it makes *me* feel nuts. I just cannot fathom what's so hard to understand about the fact that the person is mentally ill in a way that affects rationality.
It’s hard to explain the lack of an explanation.
I'm sorry. That just sucks.
I don't hold Ye's antisemitism against him because he is obviously unwell. I said and did a lot of horrible things when I was psychotic. And yes, the most racist thing I ever saw was in a mental hospital, when a woman started shouting the n-word at a black guy over and over for no reason.
The thing I would fault Ye for is going off his meds (if that's what he did. I haven't read much about it).
Same!
That's the part I hold my friend responsible for.
She took the word of one therapist, who she hadn't known long, and went off the meds.
Gotta stay on the meds. Hope your friend will be ok.
Ye, when manic, has claimed that he doesn't need meds, which was one of the many reasons for the breakdown of his marriage. (I hate that I know this, but I know this.)
From personal experience with a bipolar person, believing you don’t need meds when you’re manic is not unusual. “This is who I am, meds take away part of me”. Being very confident you are not ill is one of the symptoms of the illness.
It's kind of childish to just completely go off your meds though because someone is threatening you like that. Maybe he'll learn after this episode, seeing as how the consequences are pretty severe.
Yeah that sounds fucked up. Being overmedicated isn't any good, either.
Kanye is clinically manic. They could (and, oh, one day may) show footage of his Alex Jones appearance to medical students when they’re learning about bipolar disorder and manic psychoses. Social workers, EMTs and cops might benefit as well.
His ranting about Jews is a classic paranoiac symptom. Though, thankful, one less prevalent in the 21st century.
Most of us use words like “paranoid” and “psychotic” colloquially. Well, this is the real deal. Kanye can seem oddly cheerful and everyday he’s somewhere new, doing something batshit. That’s mania. He’s a literal maniac. (Understandably we don’t use “maniac” in that literal sense much these days.)
Tragically, people in this state die at a high rate. Often from suicide. Even people whose bipolar disorder is less dramatic (hypomania, bipolar II) kill themselves at an exponentially greater rate than the general population. You can Google the incredible numbers related to bipolar disorder and suicide. Sufferers also manage to get themselves killed in other ways. Then there’s the matter of crimes or simply impulsive behavior that hurts others.
I’m Jewish and my ratio of dread & indignation to magnitude & persistence of antisemitic expression has seldom, if ever, presented more of a contrast. The little anger I feel is almost entirely reserved for those allowing this to happen, the exploiters and enablers. Though Kanye does bear responsibility for going off his meds.
The best case scenario is probably Kanye spends the rest of his life taking prescription drugs with unpleasant side effects and is sincerely repentant.
Right now, though, we could be having one of those “valuable learning experience”s people loved taking about a decade ago. This is untreated bipolar disorder. The statistical chances of this going from ugly, titillating farce to real harm or violence (in their pre-woke literal sense) are high.
Kanye’s recent problems and reading this piece brought back a really awful feeling I sometimes got during from my stats as an patient in hospital mental health units and in therapy groups: the feeling of being completely helpless to help someone in a severe mental health crisis.
There were people with problems like awful living situations, no family or friend support, problems that completely limited their ability to function, and people who’d made ruinous decisions during manic episodes. There was absolutely nothing I could do or say that would fix their problems and help them get back to normal. I still think about the woman who was going to be homeless when she got out, the guy who was there after a suicide attempt and seemed so hopeless that I was terrified was going to kill himself when he got out, the lady who’d destroyed a relationship with her husband and kids in the span of a manic episode, and the big tough looking guy who broke down sobbing during a group session. I hope they’re doing ok.
I have such a complicated relationship with Ye's whole narrative. As someone with bipolar myself, and who works with severely mentally ill people, I have no doubt that Ye's mental illness is contributing to if not driving his bigoted statements. Sadly and for whatever reason, antisemitic conspiracy theories are absolute catnip to the paranoid, distressed brain. I definitely felt the pull towards a certain lizard person conspiracy when I was at my most manic in the past; the idea that you're a lone crusader who knows The Truth and is persecuted by enemies plays right into what the delusional brain wants to believe.
But also, Ye's been an awful person entirely independently of his mental health for years, and I do have some grim satisfaction at the idea that he'll finally stop being adulated. It just baffles me that people consider his posting inflammatory bigotry online to be an immediately cancelable sin while turning a blind eye to his treatment of women while he's been purportedly lucid. Remember when he released a music video with simulated nude bodies of people in bed with him, including his ex-girlfriend, who he'd blasted in the lyrics of his earlier album, and a public figure he was in the middle of a high-profile beef with? Remember how messed up that was? Remember how he's basically stalking his ex-wife right now and has made threats to her safety and the safety of other people in her life?
It makes me feel some kind of way, not a good way, that what people most want to crucify Ye for is the words he says and images he posts when he's at his least culpable, as opposed to the threats he makes towards women when his accountability is less in question.
I hear you. This happens in so many different contexts. When something is racist, it’s immediately condemned. Sexism is tolerated to a far greater extent, in the behavior of individuals, in the trans movement, and especially in entertainment and media of all kinds - from advertisements to movies and tv to pornography. No one cares if women take it on the chin and their interests are always subordinated so that men can swing their dicks around (or worse). That’s what we’re here for, after all. To be sexual service modules for men, until we are replaced by younger women or sex robots.
This is gonna sound really crude, but I think it's obvious by now. These people appear to think that mental illness is something that affects ONLY liberals. That it ONLY affects people who have the "correct" viewpoints as handed down to us by Tumblr.
And if mental illness symptoms are happening to a conservative or anyone else? Nope. Can't be mental illness. It just means they're bad, full stop.
And I just don't know how that idea can work in any functional society.
Not to take a universal-theory approach--I dislike those--but this phenomenon reminds me of a tendency I see in the new left, the Woke...whatever you want to call them. These folks don't care much about doing good, as long as they feel good. So *feeling* good is viewing the mentally ill like Forrest Gumps, special and ultimately benign and even benevolent, but *doing* good is actually dealing with the messy reality of mental illness, and for many that's just too much goddamn work. Easier to tweet angrily about Kanye than to think in a nuanced way about him or, heaven forbid, actually take action to maybe make things better.
I admit I generally take a consequentialist moral view, so I tend to evaluate people not by their words or their stated beliefs, but by the good (or evil) they introduce to the world. There are other moral views, definitely, but for myself I've had it with moralizing self-righteousness that extends no further than the Internet. I'm tired of being lectured to about mental illness by people who wouldn't lift a finger to help someone who wasn't mentally ill in a way that Ernest Owens or Robin DiAngelo would approve. I wish those who speak the loudest were those who actually worked the hardest.
Sorry, but that last'd be too common-sensical to fly.
Jesse, as someone with aspergers and a slew of mental health issues from growing up with mentally ill and abusive parents, I wish I had more friends like you.
This is the reality of having mental illness and/or neuropsych disorders. People love to say how they totally understand and want to help (including employers) until they see the reality of what it's like to need extra supports or the bad times where shit hits the fan.
There's definitely a magical thinking about therapy and resilience - I'm alive, I'm gainfully employed, I take my meds and fought for years to get the therapy I need... But therapy isn't magic, and therapists aren't supposed to be your friends.
I'm very open about my issues, but I've become totally isolated because I cannot cope with being dumped as a friend by another person who doesn't get that what I live with every day isn't always cute or quirky. The gentrification of ADHD and autism (that Freddie De Boer has written about and I agree 90% with his take) has totally ruined what little community there was for us who are high functioning. And what little understanding there was from normal people.
I'm not Sheldon Cooper or Attorney Wu, I'm a real person with a brain that doesn't process or filter information in the usual way. I can't read your facial expressions, I can't soften my language to sound appropriately deferential, my emotional expression is either 0 or 100 regardless of how I'd actually rate how I'm feeling, I get lost when the seasons change, I can't evaluate the importance level of details and get stuck, etc etc.
Watching Kanye succumb to what is clearly some kind of psychosis has been heartbreaking. It's the same exact reception that Terry Davis got (the programmer responsible for Temple OS and whose slur filled diatribes were picked up as 4chan argot) got 20 years ago.
Nothing has changed.
My son is an autistic brain injured (encephiitis) adult. You are 100% correct. If I hear one more person telling me "my nephew is autistic and has a Ph.d from ______), I will scream. My son will probably never be gainfully employed. I am happy he has progressed as far as he has.
Autism is not a different kind of normal, it's an F'ing disability
You make a slight concession to the shallow ally’s who say “well it can’t be bipolar.”
It’s not even that clear cut (it’s complicated!)
I have learned in the aftermath of some very sad goings on that there are different types of mania, and can even include psychosis. It’s not all hyper confidence and erratic behaviour - it can also be extremely dark and conspiratorial.
Indeed. Psychosis isn't rare in mania--it's about as common as not to become psychotic in a "proper" BP1 manic episode. And bipolar psychosis isn't necessarily much different than what schizophrenics experience--the difference is the temporal pattern and the association with mood state (bipolar psychosis will remit when the mood episode ends, whereas schizophrenic psychosis can be more cyclic/episodic than you might expect but isn't associated with mood episodes). And catatonia is actually more common in bipolar psychosis than in schizophrenia despite "catatonic schizophrenia" having been a thing for awhile. If (for some reason) you stumble on someone so thoroughly psychotic that they have lost the ability to move, speak, or respond to stimulation, it's more likely that their diagnosis is bipolar than any other. Tl;dr a lot of the people you might parse as schizophrenic because they are behaving strangely in public are actually bipolar. There's often no way to disambiguate between schizophrenia and bipolar if you only see a slice of someone's psychotic behavior at one point in time.
I really appreciate your posts on this topic. They’re very informative & helpful.
I think the term “bipolar” (and to a slight lesser extent the increasingly anachronistic “manic depression”) can give laypeople a false impression. They did me.
Two problems with “bipolar” as the term ignorant civilians have as our frame of reference. The first is that it implies a dramatic either/or when the person’s life can be consistently messy. The second (and greater) is that it doesn’t address delusion.
I understand that “delusion” is an insufficient term covering too broad a range for a clinician, but if the common folk term had been “manic delusional” I think I might have recognized what was going on. (Though perhaps it’s not as evident in all patients.)
Absolutely. And a lot of people don’t know this.
This is fair enough on an individual level, but I think the crappy reporting in a lot of media I have read us pretty inexcusable in this day and age.
I would suggest that every society has its fault lines, social conflicts, etc., and that people with certain mental health issues become  particularly sensitive to whatever controversial ideas are "floating in the air".
they will tend to obsess about them, and become vulnerable to the most extreme versions of them.
Which is why I tend to believe that progressive politics exacerbates the problem by making these issues particularly urgent and salient and therefore most likely to attract the attention of people with severe mental issues .
 What would have been under the radar earlier now becomes the focus point for a lot of toxic emotions.
 And people with extremely negative toxic emotions in the first place are drawn to them as explanations for their feelings.
In a banal sense, it's obviously true that mental illness doesn't make someone antisemitic, anti-Black, etc. But as Jesse says, it can make people susceptible to conspiracism, hateful speech, and anti-social conduct. In a society that's the product of Christian European civilization, antisemitism and white racism are two of the more likely hatreds that might afflict someone who is mentally ill. If that's what happened to Kanye West, then it's likely that were he the product of a different civilization he would have fallen prey to a different hatred. As Jesse also says, however, mental illness can be disinhibiting. West may have held antisemitic views or tendencies for some time, only to express them publicly as, due to mental illness, he lost control over himself.
To the extent West is unwell, he needs help, which virtually none of us is able to provide. What we can and should do is reject and combat his antisemitism, just as we should be rejecting and combating Nick Fuentes's white supremacism (and, of course, his antisemitism) regardless of whether Fuentes's conduct is a manifestation of mental illness.
You wrote, "antisemitism and white racism are two of the more likely hatreds that might afflict someone who is mentally ill." Did You come to this knowledge with some previous experience in the mental health field. Because I don't think that logically follows.
I'm assuming Reb did not mean that people with panic disorder and Tourette's are more likely to be racist but rather was using mental illness as a shorthand for psychosis, in which case it does logically follow:
It's well documented that delusional content is culturally informed
Paranoid delusions are some of the most common delusions in psychosis
Paranoid delusions involve an enemy group who is targeting the individual
Psychotic individuals tend to identify enemy groups based on the beliefs of their culture
Anti-jewish and anti-black racism are common hateful belief systems in our cultural
--> Antisemitism and anti-black racism are common themes in paranoid delusions in our society.
I had a patient years ago who had Tourettes. He also had an intellectual disability , and was living in a group home on the south side of Chicago.
Anyway, he got out of the home, and wandered around calling black people the N word along with every other bad word that popped out of his mouth. He couldn't control it.
He was beaten very badly, and lost nearly all of his teeth. His jaw was broken, and his whole body was covered in severe contusions.
Tourette's involves irresistible impulses to utter "taboo" words. Those can be whatever is most taboo in a culture, and in ours, besides swear words involving sex and bodily functions, the n word and antisemitic slurs are among the most taboo, so it stands to reason they would be part of the taboo words that sufferers would feel compelled to utter.
Tourette’s can involve the urge to use inappropriate language, but it’s not a common manifestation of Tourette’s and is not required for diagnosis. Most Tourette’s cases involve things like unusual movements such as blinking or mouth movements, or vocalizations like grunting.
I wasn't attempting to analyze Kanye West, which is beyond my competence. Nor am I saying he's a racist, although he certainly has made antisemitic statements. According to my understanding, to the extent his conduct is beyond his control he's not responsible for it, at least not morally. That's why, for example, we don't treat as guilty of murder those who are unable to control their actions and cannot tell the difference between right and wrong. Neither, of course, do we simply release them back to society as a continuing danger to others (and possibly also to themselves). (Whether we treat them humanely and productively is a separate question I note but do not address.)
TY for the explanation. But psychosis comes in several flavors, and they don't all produce paranoid delusions, right?
Well, I think any "kind" of psychosis (not sure what's meant by this?) can produce paranoid delusions, but not all instances do, and there are plenty of other ways to be delusional and even paranoid as well. You can have delusional paranoia that your spouse is cheating on you and that has little socially-relevant content. Some paranoid delusions are deeply bizarre and clearly weren't plucked from the newspapers. You can have a powerful sense that everyone is out to get you without identifying who they are per se (my own experience with paranoia during psychosis). The earlier remarks all just go to the question, given someone has psychosis and hateful beliefs, what is the content of those beliefs likely to be? And paranoid delusions are the ones that most lend to hateful beliefs. It doesn't speak to the question of likelihood of holding hateful beliefs and I'm definitely not trying to promote the idea that people with psychosis are snarling racists. Just that people who are trying to make sense of their experiences during psychosis will often use culturally available narratives.
You may be right. My understanding is that paranoid delusions are less prevalent among bipolars than schizophrenics and schizoaffectives. ICBW.
Yeah, I understand what paranoid delusions are, and I agree with last sentence.
My argument, were I to unpack it fully, would be historical and sociological. See, in part, David Nirenberg, Anti-Judaism: The Western Tradition (Norton 2013). If accessible, Michael Walzer reviewed the book for The New York Review of Books under the title "Imaginary Jews: Anti-Judaism as a constitutive idea and an explanatory force in Western civilization" (Mar. 20, 2014) https://www.nybooks.com/articles/2014/03/20/imaginary-jews/. Another review: Anthony Grafton, "Imaginary Jews: The strange history of antisemitism in Western culture (The New Republic, Oct. 11, 2013) https://newrepublic.com/article/114894/david-nirenbergs-anti-judaism-reviewed-sordid-representation-jews
Or, as Marx put it in The Eighteenth Brumaire of Louis Bonaparte: ""Men make their own history, but they do not make it as they please; they do not make it under self-selected circumstances, but under circumstances existing already, given and transmitted from the past." https://www.marxists.org/archive/marx/works/1852/18th-brumaire/ch01.htm
TY. I didn't check the links, but on rereading Your post, I stand corrected. Sorry I misread Your intent.
No worries. Thank you for saying so.
I suspect what is happening is a kind of self-reinforcing belief about the mildness of psych disorders. It basically goes like this: you express sentiments that say psych disorders don't contribute to any bad or obnoxious behavior, as a result everyone in your life with a psych disorder works overtime to prevent any REAL side effects from being aparent, so then you associate psych disorders with your friends and family who are actively hiding reality from you which reinforces the initial belief. The fundamental reality is that a psych disorder that does not meaningfully impact your day-to-day functioning and relationships is just not a disorder.
I suspect some of this “this isn’t bipolar” has to do with the shift in diagnosis of bipolar disorder. Way back in the day, severe depression was considered a separate illness from more common depression-it had different symptoms, tended to run in families and was associated with past head trauma. Eventually we just dumped most types of depression into one bucket and treated them similarly. As a result we had people diagnosed with depression and less severe symptoms “educating” people on things that depression allegedly was not. And so people with catatonic depression or depression which psychotic symptoms (which is very common in melancholic depression) we’re sort of left out. I’ve been around people with this type of severe depression and it really is different from the disease most people get diagnosed with.
Bipolar 1 used to be called manic depression but we now include bipolar 2 and bipolar NOS in the bipolar bucket. Those conditions seem to be different-people with bipolar 1 in the family tend to get bipoal1, not bipolar 2. With this wider diagnostic criteria for bipolar disorder most people with a bipolar diagnosis do not have bipolar 1 and their experiences of hypomania really aren’t relevant to the experience of people with full-fledged psychotic mania. Just like the experience Of someone with mild non-melancholic depression isn’t relevant to the experience of someone with severe melancholic depression.
Speaking as a woman of childbearing years whose friends are primarily in that demographic group I have also noticed that bipolar disorder is commonly diagnosed in women with not particularly severe depression that does not respond to SSRIs or has irritability as a symptom or shop in a non-dysfunctional manner to cheer themselves up. Hypomania is often a matter of opinion. So some of the “I’m bipolar and I don’t do that” maybe coming from people who were misdiagnosed.
Re: your 12/05 column. The same is true of "autism" and people with "cognitive disabilities". ( Formerly known as "mentally retarded"). I worked with both disabilities for about 4 decades. One loses one's vision of the poster-child Down's Syndrome kid after the rabies shot needed as the result of him chomping down on your forearm, and needing another staff person to pry open his jaws. The relatives of my clients were well aware of what they were like, as you testified about your mom. Treat em' well, be wary, and get them treatment to GET as well as their brains and bodies allow.
I relate to this a lot. I just have regular old depression, except it can be severe and is treatment resistant. At one point when my wife and I were struggling a lot she said something like, "I'm so confused as to how you are one of the kindest, sweetest, most thoughtful people I know and yet I feel so alone and uncared for," or something to that effect. Note that of course I only see the bad in that comment. It's really complicated but depression somehow contributes to me not be as attentive as I'd like to be. It's easy to "blame" the depression, but I don't do that and I don't think it's accurate. I actually hate it (in true self-loathing fashion) when people say "it's not you, it's the depression!" But it *is* me who's messing up. The depression *is* part of me. I'm not trying to excuse any behavior or say it's all the fault of the depression, I'm just reinforcing what you're saying in that it really *is* complicated and to say it's all or none of the mental health would both be inaccurate.
I can use Josh's keen insight that the DSM-V does not exhaustively list every possibly manifestation of a disorder's symptoms to determine that nothing is a symptom of any mental illness! "I'm sorry, I've never heard of 'never doing your chores disease,' I don't see 'being a lazy loser' in the DSM, and I know someone with ADHD who just fidgets." I imagine people would be using the same logic to claim that depression doesn't cause suicide if suicide were still as taboo as it once was.