Sick People Are Sick

fucked up people are fucked up

I was on Ethan Sherwood Strauss’s podcast this week, talking about the NFL season.

This week, The Cut published the kind of piece that they are so adept at putting together, a perfectly-machined dose of salacious celebrity gossip that also functions as an endorsement of vague identity bromides about mental illness, the collision of the live-laugh-love school of psychiatric illness and Perez Hilton-style scandalous detail. It concerns Wondermind, a vague mental health-related startup founded by Selena Gomez and her mother, Mandy Teefey. They have a fraught relationship; the mother has bipolar disorder, or she “used to,” as she has apparently recently received a vanity diagnosis of “ADHD and PTSD.” (This is a whole thing among more affluent patients with bipolar disorder, recently; I will just say again that there is no such thing as an ex-bipolar person.)

Teefey is alleged to have exhibited a variety of erratic behaviors while serving in her role as CEO of the company, including unpredictable angry outbursts and unannounced disappearances from the office for days or even weeks at a time. Staffers reported that Teefey would sometimes sleep in her office, neglecting personal hygiene for days, and would allow takeout boxes and luxury brand packages to accumulate to the point of attracting flies. Additionally, there were concerns about substance use, with some employees believing she was intoxicated at work, and one staffer claiming to have witnessed her snort a line of Ritalin. It was also noted that she received injections of what employees believed was liquid Benadryl in the office, which caused her to speak slowly and appear drowsy. She is also alleged to have hallucinated an intruder at the office. Beyond these personal issues, the company experienced severe financial problems, including missed paychecks for employees, which a spokesperson claimed was a result of Teefey's poor management.

In other words, Mandy Teefey was someone who was known to have been diagnosed with bipolar disorder and acted exactly like someone with bipolar disorder, and despite running a company all about having positive vibes towards mental illness and despite being written about in America’s most unreconstructed social justice-y publication, that she exhibited behaviors perfectly in line with the severe and debilitating mental illness she was known to have was treated with exactly zero understanding, deference, or accommodation. Because, you see, when you treat mental illness as some glib and generic personal challenge for high-achieving women to rise above, when you reduce these profoundly disabling disorders to identity markers to wear with pride, when you insist that it’s stigmatizing to ever straightforwardly acknowledge that bipolar disorder fucks people up such that they are permanently fucked up people, like I’m fucked up - well, under those conditions, no actual accommodation can ever survive.

Did it occur to The Cut’s Angelina Chapin to ask, “Is it, on some level and to some degree, cruel to acknowledge that someone has a psychotic disorder and then to treat behaviors that are perfectly predictable from that psychotic disorder as some sort of Fauxmoi-fodder celebrity gossip, destined to be hoovered up by social media in a way that minimizes the chance that said psychotic disorder would be taken seriously in the way it should be?” I don’t know. You’d have to ask her. I mean, it’s like I keep saying: Kanye West is a guy with bipolar disorder who acts exactly the way people with bipolar disorder act, and yet the people who fall all over themselves to “honor” mental illnesses and decry ableism extend him literally no accommodation for his bipolar disorder at all. Same thing here.

It will never stop amazing and depressing me, really, when the public reacts with shock when people with mental illness behave like people with mental illness. That’s where we are, now. In our cheery, existentially dishonest era of identity maximalism, the concept of mental illness has been so sanded down and softened in our culture that the lived reality of it - its volatile, unpredictable, disruptive, ugly, sometimes violent nature - feels like a betrayal. We talk about mental illness all the time, but the discourse is so abstract, so mediated by aesthetics and identity politics and social branding, that when it comes into our lives in its actual form we don’t know what to do. Hey! What are you doing, acting like a crazy person? Don’t you know schizophrenics are merely differently-abled? Don’t you know it’s stigmatizing for schizoaffectives to act the way that schizoaffectives have always acted? Don’t you know that, in this enlightened era, people with mental illnesses are supposed to be confident, proud, and endlessly capable? To have a psychotic disorder and to allow that psychotic disorder to provoke embarrassing, pitiable behaviors - well, it’s a kind of betrayal of the mentally ill, isn’t it? All those hard-charging high achievers with ADHD and anxiety and depression and self-diagnosed dissociative identity disorder, they don’t deserve to live in the shadow of yours stigmatizing failures.

This is what mental illness is, now, everything and anything except being sick, being unstable, being pathetic. When someone announces that they have depression, we nod along like they’ve told us their favorite baseball team. We slot it into our understanding of them: “Ah yes, she’s the one with depression, that’s her thing.” People call anxiety “my anxiety” the way you might talk about “my freckles” or “my soft spot for old sitcoms.” There’s a knowing little smile when someone admits they’re “kind of OCD,” as though it’s charming, as though a habit of fussing with the dishwasher is the same condition as being so debilitated by intrusive thoughts about germs that you wash your hands until the skin sloughs off. Please read my memoir about how my borderline personality diagnosis prompted me to take a globetrotting jaunt to a variety of picturesque locales where I learned lessons about life, love, and everything in between. Mental illness, after all, is only a character trait, an aesthetic, a posture.

Yet when someone’s depression leads them to ghost their friends for months, or when their mania makes them blow up a work meeting, or when their OCD makes it impossible for them to leave the house without hours of rituals, causing them to lose their job and fall into total financial ruin, well, then all of these woke, ableism-decrying people act blindsided. It’s not just surprise; it’s a sense of grievance. As if it’s somehow unfair when someone who has declared themselves to be mentally ill actually behaves that way. Far better when mental illness lives on Instagram and Pinterest, when it leads to dainty little essays for the New York Times Magazine about how much deeper life is when you let go and accept the chaos!, giggle giggle giggle. Shit-eating coprophagics and bipolar alcoholics who beat up their girlfriends need not apply; that shit isn’t “aesthetic.” We like cute little badges of suffering, not the real thing, the desperate, ugly, immoral thing.

In our elite culture’s eagerness to destigmatize, we’ve made mental illness unserious. We’ve reduced it to TikTok dances and therapeutic hashtags. “It’s OK to not be OK,” says the cheerful lettering, but there’s always the implied caveat: it’s OK so long as “not being OK” looks like crying in an endearing way, journaling, eating ice cream straight from the carton, and then bouncing back with resilience. The real texture of serious mental illness - the paranoia, the rages, the breakdowns, the catatonia - doesn’t fit into that framework, so when it arrives people don’t know how to metabolize it. Do you know how many people in psych hospitals have domestic violence convictions? What do you want to do with that information? You feel that domestic violence is unforgivable, right? And it’s true that there are people with mental illnesses who don’t commit domestic violence. So we’re free to safely discard of all of those wife-beating schizophrenics moldering in forensic wards, to unperson them, to render them forever outside of the sphere of our compassion. Isn’t it nice, when our political fads keep us from ever confronting a genuine moral conundrum?

Of course, since there is quite literally no behavior that all mentally ill people are guilty of, the inevitable conclusion is that no bad behavior can be excused by reference to mental illness. Right? If you can insist that a given behavior deserves no accommodation because there are people with mental illness who don’t do that behavior, and there is no behavior that all mentally ill people do, then there is never a behavior that you ever have to accommodate. It’s pretty simple logic. This is where we’re heading, the most basic and important protection society has ever given to the insane, robbed from them by those progressive types who care oh so deeply for people with disabilities.

This cultural rebranding has consequences, profound ones, and ones that fall very hard on the exact people that “ableist” discourse ostensibly exists to protect, the most disabled. If mental illness is just another kind of self-expression, then why should anyone make space for it? Why would an employer make accommodations for someone with bipolar disorder if they’ve been taught to see bipolar disorder as just a personality note, a kind of creative eccentricity? Why should a friend endure the discomfort and frustration of supporting someone through a psychotic break if they think schizophrenia is just another identity, no more demanding than being left-handed? When you make illness into the kind of flavor that you proudly declare on your Bumble profile, you inevitably erase the reality that illness makes you ill, that disability disables.

When I was at my sickest, what I needed wasn’t applause for my candor or retweets for talking about depression. I needed people to understand that my illness made me unreliable, sometimes unlikeable, occasionally even cruel. Sometimes, indeed, even violent; I assure you that I can be quite frightening. Did I need BlueSky hashtags about being #proudlymad? No, I needed a world that would grant me the grace to fall apart without assuming that my falling apart was a personal affront. What I got instead was a choice between two masks: the stoic survivor who “overcomes” mental illness through sheer grit, or the quirky eccentric whose neuroses are colorful character beats. Neither mask made room for the actual reality of being sick. I have done bad things, legitimately bad things, when I have been psychotic. Once upon a time, the fact that people with mental illness do genuinely ugly things was the basis of our legal accommodations for them - if they didn’t, there would be nothing to accommodate, would there? Now, we’ve completely inverted this principle; the hordes of people proudly displaying their boutique diagnoses and never doing a single embarrassing thing act as a collective excuse to never accommodate the genuinely sick, the genuinely ugly, for any behavior at all. What a country, huh?

When your illness doesn’t conform to that script, when you lash out, or collapse, or just sit blankly inert, you’re suddenly outside of the discourse, back to being incomprehensible. When you’re Kanye West, putting on some bizarre mask and tweeting about conspiracies by the Joos, you most certainly are not receiving any accommodation, to say nothing of any compassion. That you are actually acting like a crazy person makes no difference in a world in which “crazy” is by turns dismissed as a bigoted slur or celebrated as a “reclaimed” statement of proud self-identification - never, it seems, as an honest and uncomplicated statement of weakness and loss. The same culture that insists it is endlessly compassionate towards the disabled will treat you like a burden or a freak if your disability makes you into someone actually, genuinely ugly. You have no idea, the number of people who routinely decry “ableism” who have been among the most vocal and enthusiastic in trying to render me permanently unpublishable, permanently unemployable. And at this point, they’ve mostly succeeded.

What would it mean to take mental illness seriously, in the old, grave sense of the word? It would mean remembering that “illness” is not a metaphor. That when a sincere person tells you they’re mentally ill, they aren’t offering you a lifestyle brand or a tidy bit of self-description; they’re warning you that their mind does not always work. Sometimes it doesn’t work at all. It would mean acknowledging that giving people what they actually need (time off work, lowered expectations, patience when they cancel plans, forgiveness when they act out) is harder and less photogenic than posting a pastel infographic about self-care. It would mean reintroducing difficulty into the concept, after years of smoothing it over. Because mental illness is difficult. For the people who have it, for the people who love them, for the strangers who are caught in their wake. That difficulty is not a moral failure. It’s not anyone’s fault. But it’s real, and until we can say so without flinching, we will keep oscillating between trivialization and rejection. And in these discursive spaces where mental illness is an abstraction, there’s just no incentive to try and increase sympathy for those whose insanity is genuinely unpleasant, when it provokes violence, bigotry, and real harm.

The fantasy of mental illness as quirk or badge spares us from responsibility. The reality of mental illness demands responsibility. If someone is really sick, then we really do have to meet them where they are, even when it’s unpleasant, even when it disrupts our lives. And until we’re ready to do that, all our talk about awareness and destigmatization will remain a shallow pantomime. As the publication date of my new novel approaches, and as the usual suspects are doing their level best to disgrace its reputation before it arrives, I am now asking them directly for accommodation. I am saying: I have a serious mental illness, and it has dramatically damaged my professional life, and I need you to consider my mental illness when you consider whether to continue to harm my reputation as punishment; will you accommodate me? And if you won’t, what exactly does your commitment to “the disabled” really mean?

I feel for Mandy Teefey. I worry for her. I don’t mean to sound crude, but she’s exactly the kind of bipolar person who I worry will end up putting a gun in her mouth. The collision of girlbossery and debilitating mental illness is ugly indeed; recovering from severe mental illness means finding rock bottom and learning its lessons, and hard-charging career women are not allowed to fail in this way. Meanwhile, the Cut article can only further strain her relationship with her daughter, who is her financial lifeline as well as her biggest source of stability. What becomes of Teefey when she’s embarrassing enough that Gomez finally cuts the cord for real? What keeps her from being found in some sad motel somewhere, gone out the way so many people with bipolar disorder ultimately go out? 60% of us attempt suicide. One out of five succeed. Do they care, over there at the Cut, about the consequences for Teefey? Like I said, you’d have to ask them. But I’m sure they’ll have a killer hashtag next May, when Mental Health Awareness Month rolls around again. What else are allies for?