The Incoherence and Cruelty of Mental Illness as Meme

Here’s what we’ve done with mental health in the popular American consciousness in the span of a few years.

1. Created a pleasant series of lies about mental illness such that it is defined as a set of attractive and romantic quirks which do nothing to stop someone from participating in public life as a savvy and politically correct person.

2. Defined any behavior that is genuinely ugly or unpalatable or against contemporary social-political norms as therefore necessarily not the product of mental illness.

3. Excused the people who comfortably fit in the former category from essentially any of the work of adult life, and insisted that expecting such people to still do that work is “stigma.”

4. Removed the basic social protections we had in place for people who were guilty of the latter types of behavior, under the theory that “mental illness doesn’t do that,” with “that” meaning “anything not approved by social media users.”

So it’s a great time to be an upwardly-mobile Swarthmore graduate with a professional-managerial class job who never shuts the fuck up about having adult ADHD and whose penalty for failing to take their medication is that they send only 80 emails in a day instead of 100. Those for whom mental illness is a hashtag. It’s a less cool time to be someone with severe paranoid schizophrenia whose medication comes with punishing physical and mental side effects and whose penalty for failing to take that medication is that they start muttering bizarre conspiracy theories about the Jews. For the former, online culture has limitless patience and support. For the latter, who violate identity norms when sick, online culture has only censure and blame. For years now, the severely ill have been pushed further and further into the backseat of the public discourse about mental illness. With the new insistence that mentally ill people never do anything really bad, that process is complete; those who suffer the least from mental illness now blot out the sun.

This piece is by Jody Serrano, but she's merely a stenographer for the consensus. As such, she dutifully tells the worried well exactly what they want to hear: Kanye West’s instability and conspiracism are entirely, entirely, entirely disconnected from his mental illness, and we are all free to judge him - to discard him, to make him an unperson - without any guilt or shame at all. There is no complication: anyone who evinces any sympathy or consideration for Kanye West is simply a handmaiden to bigotry and anti-Semitism. Says Serrano, “Several mental health experts that spoke to Gizmodo stressed that mental illness does not cause antisemitism or racism and should not be used as an excuse for such hateful behavior.” And that is that. Serrano relies on the word of a small handful of people working in mental health, who speak in generalities and offer no evidence for what they’re saying, and yet speaks with the voice of God. So certain. So righteous.

She quotes psychiatry resident Amanda Joy Calhoun as saying, “Many people exist who have mental illnesses and are not racist or offensive. I work with many of them.”

This is the gotcha that you hear again and again: since not every mentally ill patient does Bad Thing X, no one can be excused for Bad Thing X thanks to mental illness. “I have mental illness” - this is almost exclusively the opinion of those whose conditions have minimal negative impact on their lives - “and I’m not anti-Semitic.” But because there is no behavior that all mentally ill people undertake, this means that no behaviors could be excused because of mental illness! Most mentally ill people don’t stab people, so should we give no legal protections to psychotic people who stab others? I knew of a guy in a facility who was said to play with and eat his own excrement. But most mentally ill people don’t play with and eat their own excrement. Should we therefore say that this behavior could not have been the product of mental illness? It’s a bullshit, jerry-rigged standard that’s been invented just to enable people’s desire to judge freely.

We understand the category of the paranoid schizophrenic. We understand that mental illness compels some people to become paranoid to a truly pathological extent. And sometimes people with schizophrenia become convinced that they’re being surveilled by the CIA, or the United States Postal Service, or the lizardmen. In each of those cases, most everyone understands that the mental illness compels the paranoia. But I’m now to understand that if a paranoid schizophrenic fears they’re being surveilled by the CIA and USPS and the lizardmen and the Jews, they have been immediately revealed to not be mentally ill at all, and they’re just standard-issue bigots. The fact that anti-Semitic conspiracy theories are some of the oldest and most common on earth is irrelevant - not everyone with mental illness has anti-Semitic conspiracy theories, therefore anyone who does hold such theories cannot be mentally ill. QED, kindof!

Take, for another example, the statement of Bedford Palmer, a psychologist who says that “in general, people with mental illnesses do far fewer negative things and are far less violent than people who don’t have a mental health disorder.”

This is comical. First, what are “negative things”? How is this quantified? Where is the research demonstrating this? If the mentally ill do fewer “negative things” in general, then how on earth could we call them ill? People who do fewer negative things are better people! This is the absurd “positivity” of modern mental-health rhetoric taken to new heights: if you think that the mentally ill do far fewer negative things than the norm, then you think the mentally ill are better than others. And of course if you think mentally ill people are better than others, rather than a set of frequently-desperate people trying to manage painful and at-times debilitating conditions that hurt them and hurt society, then you need have no actual human sympathy at all. Who needs to sympathize with those who are better than the rest of us? Why would there be any need to mitigate blame from those who do better than others?

I’d like to ask why it’s so hard for people to understand that there's a difference between avoiding stigmatizing people and treating them as blameless angels. There’s a world of difference. But then I’m confronted with the fact that the people whose behavior is most unpalatable are now excluded from those protections entirely. If I take an SSRI for depression and anybody tells me to do something I don’t want to do, they’re an ableist bigot. If I’m a schizoaffective homeless man and I mutter racial slurs to myself, I deserve to rot under a bridge.

Far less violent than people without a mental disorder? Really? According to who? By what metric? How much is “far”? A raft of invented facts has sprung up around the question of mental illness and violence. For example, you constantly hear that the mentally ill are more likely to be the victims of violent crimes than to commit them. But because a small percentage of people commit the large majority of violent crimes, this is true of literally any identifiable group. Still the folk wisdom has taken root: nope, mentally ill people aren’t violent. Which means that people whose mental illness does compel them to be violent no longer enjoy any benefit of the doubt from people who pretend to care about the mentally ill! It’s a neat trick - you deny that a particular bad behavior is a manifestation of mental illness, which means you have reduced the accommodation that you provide, all while patting yourself on the back for accommodating the mentally ill. A very neat trick indeed.

Let’s ask the NIH about violence and mental illness.

Certain psychiatric conditions do increase a person’s risk of committing a crime.  Research suggests that patients with mental illness may be more prone to violence if they do not receive adequate treatment, are actively experiencing delusions, or have long-standing paranoia. Such patients are often under the influence of their psychiatric illness such as command hallucinations….

Individuals with a severe mental illness that fall through the cracks or for one reason or another are non-adherent to treatment are particularly at higher risk of committing grave acts of violence. Untreated profound mental illness is particularly significant in cases of homicide—the zenith of the criminal spectrum, and such illness is even more significant for mass murders of strangers.

So, no. No, it is not the case that mental illness never compels people to be violent. But you knew that! Everyone knows that. Guess what: psychotic people sometimes act out violently. It’s a sad reality of the severely mentally ill. The utter fantasy that that isn’t true could only happen in this bizarre discursive culture.

Actual mental illness is grubby, sad, gross, dispiriting, destabilizing, undermining, exhausting, unpalatable, ugly, and definitely not politically correct. But people like Serrano have marinated for so long in an online culture about mental illness that treats it as a positive set of charming personality quirks that they’re completely incapable of looking actual madness in the face. I so desperately wish people like that could spend some time in a psychiatric facility. Not some boutique upscale hotel for the Ivy-league grads with self-diagnosed depression and anxiety, but the kind of places where the involuntarily committed are sent after being taken off of the streets. The kind of people who left to their own devices would smear shit on the walls, who believe that the Jews are tracking them through the fillings in their teeth, who want to strike first before some shadowy threat strikes them. It doesn’t look like Tumblr.

Here’s what I can tell you for sure: so many self-styled supporters of the mentally ill support the mentally ill only when it’s convenient, only when it’s easy. What a convenient way to imagine mental illness, that it never makes you sympathize with the unsympathetic! What a beautiful mental construct you’ve created, where you’re never forced into the uncomfortable position of feeling for someone you don’t want to feel for.

Here’s what I would say to Jody Serrano and to all the rest of you. You see that motherfucker up there in the image at the top? In the mug shot, with the crazy eyes? He’s the guy who, under the influence of his blooming schizophrenia, shot 74 people in a movie theater. He’s spending the rest of his life locked up in a federal prison. That is not the ideal scenario; the ideal scenario is that he would spend the rest of his life locked up in an appropriate maximum-security mental health facility. He would still be locked up. Because, you see, no one, no one at all, thinks that the actions we undertake under the influence of our mental illnesses should carry no penalty, that we should not be held at all responsible for them. What is required is far harder than holding people totally blameless or throwing them in the trash. What is required is to mitigate judgment, to complicate responsibility. To live with that complication. To live without certainty. To not be able to rest easy, feeling comfortable, ladling out understanding and judgment in perfectly untroubled proportions. No one is forcing you to like Kanye West. Integrity is asking you to work harder to understand him. And that face, up top, the face of James Holmes - that is the face of mental illness you must be brave enough to comprehend. When it is ugliest. When it's hardest. If you actually care about the mentally ill, you find a way to care about James Homes too. In the full bloom of his violent and unspeakable insanity. If you don’t, or won’t, then you don’t have the right to call yourself a supporter of the mentally ill at all.