People with Serious Mental Illness Say Racist and Bigoted Shit All the Time

if you ever think "mental illness doesn't do that," then you've never been on a ward

a very normal person wearing the perfect outfit for an 80-degree day in southern California

There’s this conversation I have had repetitively for the past seven-plus years. It goes something like the following fake exchange, which is admittedly a little exaggerated for effect:

“Hoho! You’re hiding behind your mental illness to dismiss your bad behavior!”

“No, I’m not dismissing anything. Ultimately I am the only person that can shoulder blame for the things I’ve said and done. I do ask, however, that people take my condition into account when they consider my history.”

“So it wasn’t your mental illness! You’re fully and uncomplicatedly to blame!”

“No, it’s not that simple. Being in the throes of a psychotic disorder makes one’s control of one’s actions and thus one’s culpability for bad acts tricky. I would certainly hope that people would try to balance the things I’ve done against my condition, which repetitively ruined my life from the time I was twenty until the time I finally got religion about treatment in 2017. I say that even though I know that I must ultimately bear responsibility.”

“Aha! So you’re hiding behind your mental illness to dismiss your bad behavior!”

And so on. I have been religiously consistent on this point from the very beginning, before I ever wrote a word for the internet, when I was first hospitalized in 2002: I have done a lot of bad things under the influence of my bipolar disorder, and I am ultimately responsible for them. My 2017 public shaming was fundamentally understandable and not some sort of unjust act of “cancellation,” even though people said and say a lot of things about everything that happened that simply aren’t true. I lost a lot of friends around then that I didn’t get back, and while my feelings about each depends on the individual circumstances of a given relationship, I understand and do not bear a grudge. Likewise, I continue to pay significant career penalties for what happened that the average Twitter asshole has no ability to observe, and there too I understand even when I don’t agree. Because I really did do some bad things, most of them far from the eyes of the internet. That there are people who insist that I’ve demanded that I’m a victim of “cancel culture” because of what happened is not something I can control. I don’t think that and have never said that.

What I have asked for is not blanket forgiveness, nor for people to be good intersectional progressives by saying that I have a disability and they must extend me the accommodation of never saying anything bad about me. I have asked, instead, that my decades-long struggle with bipolar disorder mitigate my responsibility in people’s eyes, that it complicate simplistic judgment, that it be balanced against other concerns, that it be weighed. Some people have undertaken that project of mitigating and complicating and balancing and weighing and still arrived at the conclusion that I’m a scofflaw, that should be banned from polite society and from being published in fancy publications. I don’t like that conclusion, obviously, but for them to arrive at it is not an error but rather precisely what I asked for. I may disagree with the outcome but I must be grateful for the process. The problem, for many people, is that they can’t stand to do what I’ve asked them to, to judge with complication, to arrive at a conclusion other than a binary Good/Bad. A lot of people just can’t do that. They hate to do it. I’ve said before that I probably would have weathered all of that controversy better had I simply said, at the beginning, “Nope, sorry, I was sick, it was all my illness, I have nothing to apologize for.” Because they understand that request; simplistic exoneration exists in the modern liberal imagination, as does total condemnation. Qualified, complicated, partial, uncomfortable judgment is not.

Which is not healthy. Because only the left is going to stick up for the severely mentally ill, and the left right now is addicted to corrosive moral simplicity. Look, for example, at Kanye West and the bigger issue of bigoted language and conspiratorial thinking among those with serious psychiatric disorders. I sure do hear a lot of people saying “mental illness doesn’t do that” when it comes to offensive attitudes and speech. And it makes me think, otherwise, that a lot of people desperately need to learn about the world from somewhere other than a Chrome tab

For a good example of the position of the prosecution, consider that of Nathan Rabin, formerly of The AV Club. A charter member of the “I’m the Progressive White Guy Who’s ANGRY” cohort, a very large organization, Rabin was also the guy who coined the term “Manic Pixie Dream Girl,” a not-inapt description of a very specific and limited trope in a brief run of 2000s movies that quickly became every midwit’s favorite substitute for actual insight. (There is not a prominent female character from the past quarter-century of culture who has not been dismissed, often in straightforwardly misogynist tones, as a Manic Pixie Dream Girl.) Rabin is mad that Kanye West has said some genuinely horrific stuff in the past few years. What’s unfortunate to me, though it’s very common, is that Rabin doesn’t mention West’s longstanding diagnosis of bipolar disorder or his well-publicized serious head injury. (West himself now denies his bipolar diagnosis, which is very, very classically Bipolar Guy.) The evidence that West is unstable is not just his decade-old diagnosis by a medical professional but that he is, in fact… unstable. West acts in bizarre and unstable ways, his speech is frequently confused and difficult to follow, his thought patterns appear disordered and his actions dysregulated. He could hardly better epitomize the tragedy of the rich, famous, and unwell; he’s surrounded by yes-men and enablers that prevent him from having to serious grapple with how obviously, intensely unhealthy he’s become. Rabin has no time to think about that, or more likely, no moral mental space in which to consider it.

What makes Rabin’s complete lack of interest in West’s mental state particularly callous is that earlier this year he demonstrated lavish concern for the “neurodivergent,” a vague and capacious meme term that sometimes refers to the severely autistic but which is more more often used as a cudgel by miminally-afflicted upwardly-mobile professionals with self-diagnoses of being “on the spectrum,” people who are perfectly capable of collecting fancy degrees and working enviable jobs but who insist that anyone who ever makes them feel less than fully “valid” is a terrible bigot. These are the same people who get Harvard conference panels shut down because the panelists dare to talk about treatment, the same people who try to get Amy Lutz deplatformed because her experiences with her severely autistic son has led her to conclude that the neurodivergence movement is destructive. Rabin refers to the elements of the “less romantic, idealized elements of neuro-divergence, of which there are many.” Well, guess what, brother, I can tell you from personal experience that in a culture that now sees developmental and cognitive and psychiatric conditions only through a thick lens of romanticized bullshit - thanks, in large part, to the “neurodivergence” movement - this insight goes for psychotic disorders too. They are not romantic; they are, in fact, relentlessly, punishingly dark and ugly. They lead people to very ugly places. Sometimes, into anti-Semitism and Nazi sympathies. I’m sorry if pop culture has convinced everyone that they’re all just countercultural Randle Patrick McMurphys and cool, subversive Lisas.

People really, really hate to hear that, that mental illness can be implicated in bigoted thoughts and language, for example the reason I described above - everyone, but especially 21st century liberals, hates to have their simplistic moral judgments complicated. In our current political era the right to judge has mistakenly been elevated to the level of our greatest gifts as free people. To acknowledge that, among other things, severe mental illnesses like psychotic disorders lower inhibitions and dysregulate language and prompt delusions and generally reduce the individual’s control over their thoughts, utterances, and actions might leave us in a position where we can’t just write self-aggrandizing screeds about how we’re the only beings in the universe steadfast enough to stand up against Nazism. But I’m afraid all those things are true; severe mental illness really does lower inhibitions and dysregulates language and prompts delusions and generally reduces the individual’s control. You can read all about that in a voluminous research literature about severe mental illness, if you’d like. Or you can spend a few weeks on a ward, if you’d like, not some Club Med(s) private facility with yoga classes and a sushi chef in the cafeteria but an actual, grimy state hospital. Because you know what you’re going to hear a lot of? The n-word! And other really offensive things. Ugly conditions prompt ugly behavior.

I really don’t think much of standpoint theory, at all, but I can’t help but feel it organically when I debate this stuff. People who insist that, for example, mental illness can’t prompt anti-Semitism leave me just utterly dumbfounded. Do you know how many schizophrenics mutter under their breaths about the Jews and how they control the universe? Delusion and paranoia are opportunistic; they grab hold of preexisting bigotries where they can. These pathological ways of thinking love nothing more than to grab onto some extant philosophy or perspective and exploit it, twist it; there’s a reason so many crazies are so attached to religious language and symbolism. Casual racism and prejudice are as common on a psych ward as shoes without laces. Should the people who act that way be fully and totally and simplistically exonerated for their bad behavior because of their conditions? No. Should we try to view them as sympathetically as possible given how their minds have been hijacked? Yes. Even when it’s frustrating to do so. Especially when it’s frustrating to do so.

Ah, but, you see, “mental illness doesn’t do that.” I could hardly better encapsulate my great frustration with modern mental health culture - which will all be expressed in a new book from Simon & Schuster coming in 2026 - than with the phrase “mental illness doesn’t do that.” It is the perfect statement of unearned superiority and addiction to simplification, voiced by people who claim to care about nuance and complexity. I’ve argued before that it’s an almost unthinkably destructive and cruel thing to believe, the idea that there’s a simple and direct List of Things the Mentally Ill Do and Thus Are Not Responsible For, which appears to have been coauthored by everyone with a Tumblr account sometime around 2014. The basic logic is utterly broken. The claim is “Some people with mental illness don’t do Bad Thing, therefore mental illness can never be implicated in Bad Thing,” but there is no behavior that all people with mental illness do, which means they are willing to excuse literally no behaviors thanks to mental illness! One of the very few affordances society has traditionally given to people with severe mental illness, the consideration of those illnesses when assigning moral culpability, is evaporating at the hands of ostensibly-progressive people who claim to love the mentally ill the most. And it’s all happening because the disability rights movement has made it so impermissible to ever acknowledge the truly awful consequences of mental illness; sadly but unsurprisingly, with the ugliness of mental illness cut off from polite conversation, too many people have decided that the mentally ill never do bad things. I am so glad that the twelfth person on the jury in the James Holmes trial was not a part of this tribe.

Were I Nathan Rabin, I would ask myself this question: why am I so eager to hand blanket exoneration for all misdeeds to the vast, vague, and medically meaningless group known as The Neurodivergent, when a clearly deeply-ill celebrity who’s said genuinely ugly things receives no such consideration? What could it be about Kanye West that makes him different?

It’s darkly comic, to me. The general elite opinion on Kanye West appears to be something like “I used to have some sympathy for Kanye, thanks to his mental illness - but now that he’s really unstable, I don’t.” It only matters when it’s hard, guys. Forgiveness only ever means anything when you really don’t want to give it. When you’re patting yourself on the back for being so accommodating towards a well-educated and upwardly-mobile coworker at your Fortune 500 company who claims to be neurodivergent and who maintains a life utterly indistinguishable from someone who is not neurodivergent, tell me - what exactly do you have to accommodate them for?