The Pay Dirt of Mental Illness

Why is everyone suddenly so mentally ill?

This piece is inspired by a recent essay by Freddie deBoer which discusses the sudden re-emergence of Dissociative Identity Disorder (DID), formerly known as “Multiple Personality Disorder.” Having spent most of my career working in long-term inpatient psychiatric facilities, I was surprised and saddened to hear that this diagnosis was re-emerging on social media sites such as TikTok, especially as this particular condition was something I previously thought of as an eradicated pseudo-illness that stood out as the apotheosis of a culturally-reinforced diagnostic fad. There are quite a few of those swirling around as of late, so it’s been reassuring for me on a cognitive level to have this go-to example of something that burned hot and then burned out. It was something I felt most any thinking person could easily see as over-the-top bullshit, and therefore a useful comparison point for the many fast-sweeping identitarian manias of today.

Depression by Jacob Lawrence at the Whitney Museum of American Art

Any mental illness that is so readily ingested, metabolized, and reproduced by culture is apt to be suspect. Mental illness, as far as we know it, is a complicated constellation of behaviors and traits that stem from fuck-ups on the microscopic level modulated by life experiences and possibly (depending on your pneumatic bent) are influenced by the “mind” and “soul.” I’m not going to waste any time discerning the true source of mental illness, but suffice to say it stems from things that are so small and complex (genes, neurotransmitters, inflammatory cytokines), that it is near impossible that this molecular concoction would spew out something that’s just so damn…coherent? Dramatically structured? Adaptable to stage and screen?

It shouldn’t be something that you put together a tight five to explain.

Consider Major Depression. Though Depression has hallmarks of behavior and disposition (dysthymia, isolation, avolition, lassitude, etc.), it doesn’t present itself in any sort of coherent and organized way. Mental illness is often like this - it not only affects our cognition but also our metacognition (i.e. “our way of thinking about our thoughts”). This is why those in the throes of depression (or psychosis or mania) are so frustratingly unable to see the absurdity and danger of their beliefs or actions. The systems in their mind that normally do “quality control” on their thoughts are also being infected by the same mental illness.

This is perhaps why western society’s normal panacea of doling out suicide support hotline numbers is so annoyingly futile. So few people close to suicide have the presence of mind to process just how distorted their thinking actually is. They see suicide as a release - a final solution to an otherwise unavoidable problem. To simply give them a phone number is to say “you obviously know you’re sick, so just call these people to help you.” I’ve worked with thousands of suicidal people throughout my career, and I can tell you that they all share one common feature: all of them feel that their problem is unique and cannot be overcome by any level of problem-solving. They may or may not see themselves as “sick,” but they most certainly feel a level of clarity once they finally decide to commit the act, even if that decision is impulsive and lasts only a second (sometimes a second too long).

Side note: I always find it morbidly funny that the absolute meanest, most socially punitive individuals are always the ones most fervently pushing the “suicide help-line” path of intervention, when their bullying behavior probably has the highest correlation with suicide. “Just call the number!” Well then what? Is calling that number going to erase the last fifteen years of being treated like shit by people like you? Anyway…that’s neither here nor there.

A depressed person sleeps in until 2pm. They stay up all night. The next day they fall asleep at 2pm and sleep all night. They don’t shower for days. They don’t eat. Or they eat until they’re sick. Sometimes they carry on like everything is normal and then one day they go into their garage and don’t come out. Sometimes they lose interest in sex. Sometimes they masturbate until their genitals are sore. The point is that depression is exactly what the word is - it is a depression or slowing of neuro-conduction. This results in all sorts of frustrating and pathetic sensations that vary from person to person and manifest mostly internally and less so externally and performatively. The source of depression is myriad and microscopic, it presents in ways that are predictable and unpredictable, but almost always involves a level of withdrawal, decreased energy, and a morbid internal feeling state. The experience of being depressed is miserable and almost always entails a desire to not be depressed (if aforementioned metacognitive processes will even allow for such a formulation of desire). In whatever way depression does eventually “show up” in a person, it is rare that it shows up in a way that conforms to cinematic exhibition. In other words - depression rarely displays “good writing.”

The same goes for schizophrenia, bipolar disorder, autism, or any other mental illness that exists on a level that severely impacts one’s quality of life and ability to relate to others. Despite what you may have seen in movies, actual schizophrenia usually does not involve “code-breaking,” mastering violin, or uncovering occult stock market algorithms. It mostly involves staring at a wall, posturing for no reason, losing affective response, and being generally disturbed by hearing voices inside your head that seem to be emerging from outside of your head. The life of someone with schizophrenia is bleak and limiting and so very different from what it could have been should they not had the illness in the first place.

These diagnoses: depression, anxiety, bipolar disorder, schizophrenia, etc, are merely categories that we use to group together similar manifestations of things that generally can be called “malfunctions.” Maybe I am venturing into the realm of speculation here, but I would defy anyone to present evidence to the contrary. Yes - we do not know exactly what causes mental illness - but I do not think it is controversial to assume that mental illness is not a gigantic red lever in someone’s brain that is in either the “on” or “off” position. Like many diseases, there are many “brands” of one disease that manifest in mostly the same way, but we do not know what all of those diseases are. And this is not just limited to mental illness! Genetic research, for example, uncovered an enormous amount of genes that, when expressed, all manifest as “kidney disease.” But there are many different sub-types of kidney disease. To call it kidney disease, or autism, or ADHD, is the simple act of participating in a necessary fiction of genus and species categorization, a short-hand that is assumed to be imperfect but is nevertheless used in good faith in order to attempt treatment.

What I am trying to get at - and not sure if I have yet succeeded - is that the average base physiological state that yields mental illness is a total fucking mess. It is a parade of deficiencies, surpluses, dislocations, early-firing and late-firing nodes, degradations, oxidizations, reabsorptions, presences and absences. That’s not even considering the “nurture” part of things which adds an infinitely higher level of possibilities to the illness matrix. As such, it seems rare that all of these random phenomena would converge to create several well-partitioned personalities within a single person. And if they somehow did, it would be even more unlikely that these personalities would be aware of one another and cooperate. And if they somehow did, it would be even more unlikely that all of these personalities would all want to cooperate toward the same end, which to be precise in this case is a TikTok video.

It was foolish of me to think that Dissociative Identity Disorder was dead and gone. After all, it represents the perfect platform for one who is inclined to participate in the growing hobby of conflating mental illness with identity. As a disclaimer - if someone suffers from a severe, intractable mental illness or cognitive deficit, there is absolutely no reason that they shouldn’t be accepted by society, and there is no reason they shouldn’t push for acceptance. They have no control over these things and therefore should not be mistreated or outcast. In fact, a good society would go to great lengths to extend care, understanding, and protection to these individuals. That being said, if a diagnosis is not severe and intractable - if it can be cured, treated, or even well-managed - then the goal should be to do those things first. It should not be - by definition of it being an illness - accepted and celebrated as a part of one’s identity.

To think otherwise would indicate that there is a higher perceived value in maintaining or sustaining the illness state than there would be to overcome it. It is most certainly not a recent impulse to seek the easier path of surrender in lieu of struggle. This impulse has been around since calling your dad from the Garden of Gesthemane was a thing. But it is fairly recent that society en masse went along with this impulse. More than go along with it, they encourage and celebrate it. This form of external validation is the new social technology that has made way for this identity-based shift in the conception of mental illness, a shift that no doubt will have dire consequences for years to come.

This seems completely obvious to me. But these are not obvious times. To suggest that something changeable should be changed is now anathema in many circles. The idea of overcoming an impairment is now considered an assault on one’s comfort of remaining the same, and by extension their identity. You already know the examples of this dynamic I could list out here, but I won’t belabor the point. I will say, however, that the answer being offered right now as to why this is happening is wholly unsatisfying. The idea that we simply have more “awareness” and “acceptance” is absolute horseshit.

Let me speak specifically to acceptance, and let me be bold about it. I have a severe Axis-II diagnosis. I have received medical treatment for it my whole life, sometimes successfully, sometimes not so successfully. When I choose to share my diagnosis with others, their first move is usually to indicate in any way they can just how much they accept me. How totally okay they are with my illness. Here’s the thing though - they might accept that I have the illness. But they do not accept me when I am the illness. They don’t accept me when I have paranoid thoughts, or when I harass them with phone calls at 3am with an idea I have to take over a local animal shelter. They don’t accept me when I tell them to fuck off when they’re trying to help me. These things are all features of my illness. The illness they say they accept. They don’t.

They judge me for it. They say things like, “I understand he’s got issues but this (insert behavior) is not the illness, it’s him.” They break up with me, they ignore me, they kick me out of the house, they fire me from their company. They accept my mental illness when it exists only as a mild descriptor of my identity, but not when it reaches out its fangs and bites them in the neck. Then they have no patience for it at all.

And you know what - I don’t blame them. They shouldn’t have to put up with verbal abuse, or being afraid, or feeling anxious, or being awoken in the middle of the night to field my absurd thoughts. I have an illness. It’s a malfunction. It means that I have a burden on my life that I can mitigate but never eliminate. If my behavior were something that could very simply be accepted without much personal strife, then it would not be an illness. It would be a personality quirk. It is not a quirk. It is a defective aspect of my life. Can we not just speak plainly about what having a mental illness is? It is bad luck. Your life sucks more for no discernible cosmic reason at all.

Same way that someone born without arms, or with a weird left eye, or a birthmark on their face, or the inability to see or hear. I got fucked. It sucks. But it is what it iis. I shouldn’t be hated for it, or exiled, or persecuted. But I certainly shouldn’t be able to run roughshod over everyone else just because my brain goes poo-poo every two or three years. It’s entirely not fair that I have to deal with this. But it’s also not fair that anyone else should have to deal with it without being paid for their time.

There is personal responsibility involved on my part. I have to go to my appointments, I have to take my meds, I have to not drink alcohol or do drugs, I have to get enough sleep, I have to ask for help. By the time I “fly off the handle” (as I have a few times in my life), it is usually related to missteps that happened weeks or months before and my current behavior is merely the receipts. I am not the pilot, but I am the air traffic controller. I do my best to land the plane safely, and the pilots are skilled and experienced. But the extent of my control is ultimately only ever a proxy.

So why then do so many now wish for this type of life? Why do they make videos showcasing their Tourette’s tics and Multiple Personality “Alters”? Why do they wish to lean into the illness rather than recoil and run or stand and fight? What could possibly motivate them to instead sit and wallow inside of it, adorning themselves proudly with the robes of their illness? How do they even manage this?

Could it be that the reason they can so easily manage this is because they do not experience it at all? Who knows, right? DID for example cannot really be verified by any empirical means. There are no blood tests or fMRIs to confirm the illness, so we are forced to take their word for it. All that I can truly know is my own experience, and my own experience is one that tells me that showcasing my mental illness is the last thing I’d want do. I’d much prefer to showcase my states of wellness.

Wellness has far more payoffs as far as I’m concerned. Wellness gets me paid, makes me new friends, allows me to feel romantic love and have sex. Illness does the opposite. It’s hard to imagine someone who is truly mentally ill feeling differently. So ultimately there are only two conclusions here, and they are not mutually exclusive. The first is that most of the online self-diagnosed mental illness is overstated or completely fabricated. The fact that the illnesses with the most TikTok exposure right now also have the highest levels of physical performance and lowest levels of verifiability should give you a clue there. The second conclusion is that those who participate in the showcasing of mental illness are working off of a completely different social economy than I am.

In the second conclusion is where I think we more accurately diagnosis the zeitgeist. The idea of financial security, and hanging out with friends, and falling in love are increasingly becoming antiquated prizes. A confluence of capital and pandemic and technology has created a social ecosystem in which all of these other prizes are subsumed into the broader sweepstakes of attention. Money is replaced by views, friendship is replaced by affinity, love and sex are subsumed by “being seen.” What hope do we have of anything else when our lives are mostly spent staring at life through video calls and endlessly scrolling curated content?

Maybe I’m veering again into speculation. I can feel my arguments becoming more facile and instinctual. But I will say this: if I am even a little bit right, then the greatest irony of all is the end game of this whole racket. The ides that you can replace foundational human needs for connection and self-ownership and accomplishment with a listing of stats on a YouTube analytics page is deeply misguided. It simply never works. One need only achieve a modicum of internet fame to understand how ultimately hollow it really is. Yet if someone knows and feels all of this and continues to chase that rabbit no matter what - the end result will most certainly be a life of real, actual, non-cinematic mental illness. Will there be anyone left to take care of you then?