I'm Not Trying to be Dramatic, But I'm in Hell

Ladies, is your man engaging in the method of quasi-scientific self-improvement that’s currently mandated by high-status urbanites aged 21-45? If not, run, girl.

Before you go worrying or lecturing over my title here, let me say my personal life has never been better, really. But my total alienation from what I take to be my culture and its various attitudes and assumptions just grows and grows. Every day, it seems, there’s a fresh horror, and nowhere does it smack me in the face more than with mental health.

The above advertisement, which I think premiered in 2022, takes the medical tool of therapy and renders it a bit of dating-market gamesmanship, something bros just have to get on board with in order to hook up with high-value gals. I don’t expect a 30-second advertisement to reflect the reality that therapy is a frequently-adversarial process, that it’s at times uncomfortable by design, that it only works for certain kinds of problems, or that there are times when it can actually exacerbate them. And while I certainly do hold it against them for contributing to the corrosive “everybody should be in therapy” attitude - which is little different from believing that everybody should be on antibiotics - I also know that a for-profit therapy company is going to be pushing that line. (A macro-problem with for-profit medicine lies in the fact that the financial incentive is always to go on treating a medical problem forever without curing it.) What really gets to me is how a therapy company is going out of its way to make therapy appear so trivial, how the characters appear deliberately portrayed as unserious people and therapy so unapologetically represented as just a dating-market football. The commercial is somehow both grandiose about therapy’s purpose and dismissive about therapy’s actual use.

I don’t know how it is that we’ve simultaneously spent so much time validating and honoring people who struggle with their mental health and at the same time made mental health as a topic so frivolous.

I appreciated this conversation about TV therapy from The New Yorker. In it, Inkoo Kang says “I feel like there’s this idea that therapy is easy. And then you actually go to therapy, and you’re, like, ‘Oh, this is actually the worst.’ That particular realization is very rarely dramatized.” I would argue that if therapy never feels like the worst, then you probably aren’t getting as much as you could out of the therapeutic process. Part of what makes finding and sticking with a therapist so difficult is that it’s close to impossible to divide your sense of what you want from a therapist from a broader understanding of what you need from a therapist. Are you sure you don’t like your current therapist because you’re “just not vibing with them”? Are you sure you want to fire your therapist because they seem “toxic”? Or is it because you signed up for therapy expecting it to be a constant exercise in validating everything you think and say and instead you’re one of the lucky few with a therapist who actually does their job and sometimes calls you on your bullshit? Of course, some therapists really aren’t very good, or more commonly, you can be a receptive patient and the therapist can be a competent practitioner but you have communication styles that just don’t gel. These things can be very difficult to parse on your own, which is why I always tell people to give it more time than they think they need. But either way, nothing is served by this effort to make therapy just another elite checklist item that shows you’re an enlightened person, except maybe Betterhelp’s share price.

Whenever I post about contemporary mental health ideology, I of course get a lot of replies talking about social justice politics and similar. And, sure - much of what’s ruinous in our conversations on psychology and psychiatric medication is deeply influenced by (for lack of a better term) Tumblr culture and the ideology of the “LOOK AT ME” school of mental illness. But it’s also influenced by the anti-psychiatry movement that has rattled around in American conceptions of mental health for sixty-plus years, and by the grift of “wellness” and the entrepreneurial self-improvement industry, and by Instagram quasi-mysticism, and by girlboss culture, and by a whole host of other influences that are sometimes conflicting and sometimes complementary but always contributing to the toxic stew we’ve got today. Therapy is merely the most quotidian, widest-ranging object of this culture’s interest. (Honestly, I want to say that people overpromise about what therapy can do, but therapy’s current cultural position is so malleable and instrumentalized at this point it’s hard to say what the promises even are.) I almost wish that my complaints were nakedly political, partisan, so that they would be easier to convey in shorthand. The only such shorthand that I have to offer is that the tragedy of our mental health culture lies in the emptiness of positivity, the desert of validation, awareness, and respect. Those always break upon the rocks of tragedy. Mental illness is a man shitting his pants on the subway. If you can’t understand it in those terms you can’t understand it at all.

When you feel as alienated as I do from your culture, you’re constantly asking “How could both of these bad things exist at the same time?” Observe.

You will recognize this attitude from things that I have written about mental illness in the past - the person who has Great Respect for The Mentally Ill, who maybe Has a Mental Illness Themselves, and who definitely Validates Their Struggle but will nonetheless extend nothing to even the sickest in terms of mitigating judgment of their actions. I must, apparently, make this point over and over again.

• The claim is “not all mentally ill people are guilty of behavior X, therefore behavior X can never be excused through reference to mental illness”

• But there is literally no behavior that all mentally ill people share

• Therefore this claim is really “there is no behavior that can ever be excused through reference to mental illness”; this is an inevitable and inescapable practical consequence of this thinking.

This theory of mental illness and moral culpability is held by many of those who consider themselves the fiercest advocates for the mentally ill; it just happens that the reality of actual mental illness is inconvenient to their advocacy. This is the point that has to be repeated about Jordan Neely: if your urge to lament his death and call for repercussions for his killer comes paired with a constant tendency to minimize the ugliness of his illness, the ugliness of his behaviors, then you have no love for Jordan Neely at all. You only love a sick Hallmark card pastiche of what mental illness is. I don’t know who I’m plagiarizing when I say this, but there’s a difference between control and fault, between accountability and responsibility, between what you chose and what you must atone for. What I’ve learned, these past six years, is that one thing you just can’t ask of people is to live within that kind of complexity. They can’t handle it; they react angrily, violently, to being asked to handle it. They must judge - they are moved by nothing so intensely as they’re moved by their need to judge - and their judgment must arrive at a world of goodies and baddies. Woe betides those of us who have been forced by circumstance and neurology to simultaneously be guilty of very bad things, to not have been able to choose not to do them, and to need forgiveness. To endorse another cliche, mercy only accrues to the guilty. So give mercy. Or don’t, and have the courage to admit that you are not among the merciful.

And then there’s this.

Do you see what I mean? How can these exist in the same universe? How can “mental illness never acts as an excuse for any bad behavior” and “a self-diagnosed case of the probably-fake condition of dissociative identity disorder excuses you from committing sexual assault” exists so comfortably in the same broad moral universe? How can this attitude be so banal and unobjectionable to some that it’s commodified in a shitty cartoon?

And here we have a woman who was, at the very least, coerced into unwanted sexual activity and who marks her story with an emoji. I found the replies to this tweet something tragic - people kept saying to her that this scenario wasn’t OK, that this wasn’t something she had to accept, and she reacted with what seemed like genuine confusion. A person who had made a claim of protected status in her social world, the claim of having “alters,” is someone seen as holding the limitless right to overwhelm her basic right to sexual autonomy. Is that the norm, to feel that way? No. Is that extreme? Yes. Is she the product of a youth culture that has become immensely influential and which is busily creating ethical values that are totally alien to the basic moral intuitions many of us hold? Most assuredly, yes. And please understand that precisely because schizophrenia is not (yet) a meme, an uneducated laborer struggling with that condition who commits a sexual offense will receive no such equanimity. Fuck, Kanye West was diagnosed with a mental illness seven years ago, one which is not questioned as a legitimate diagnosis, the way DID is, by anyone outside of the most fringe anti-psychiatry niches, a disorder that we know compels erratic behavior and disinhibition, and nobody will forgive him for shit he said. Both of those things exist at the same time. And maybe the worst part is that there isn’t even some specific great evil powering any of this, just a lot of people, some with good intentions, who are unable to parse the idea that some things are inherent and also bad and that judgment must learn to live alongside patience and forgiveness.

Autism is not a mental illness. But autism is subject to all of the bad trends that I’m talking about. As Dr. Amy Lutz says, “the discourse has never seemed so detached from reality as it is in its present moment.” She says that, as the parent of a severely autistic child, in response to the recent social media meme that there is no such thing as severe autism and that anyone who claims there is must be an ableist bigot. This is of course the most emblematic example of the gentrification of disability.

This is all a mess. It’s an ugly mess that gets worse all the time. Nobody is piloting the ship, and yet it steers straight for the reef. When a drug company fights to keep its medicines under patent and in so doing denies them to sick people, I rage, but at least there’s something to rage at. Where do I put my anger, here? A bunch of teenagers under the spell of technologies that have compelled them into the most psychically diseased communities possible? The anti-psychiatry cultists, who combine menace and vulnerability in quantities I’ve never observed before? The hive mind of social media, which understands mental illness as it understands all things, as a facile synopsis of itself utilized for the needs of competitive morality? An establishment media which manages to combine the worst instincts of all of them? I don’t know. What I do know is this. Go spend some time in a forensic ward somewhere. There you will find the people who are both the most harmed and the most harmful, those who most need to be protected and those who we most need to be protected from. And you will hear racial slurs of all manner and variety from people of all races, you will meet many who see the Jews lurking behind every bush, you will find people who are on the sex offender registry who were definitely guilty of that which they were accused, and maybe people who shit into their own hands, and definitely people who beat up their girlfriends. What’s the right way to think about them? I don’t know; it’s complicated. But I can tell you for fucking sure that the right understanding is not going to emerge from the morass of mental health ideology. I have given up.

Someday no one will be able to find me and I’ll have wandered off into the night thousands and thousands of miles away.