Sometimes They're Crazy, Sometimes They Aren't

I’ve spent this week and weekend driving across the country again; as it happens, I drove through El Paso two days before the recent shooting there. As of this writing, the mass-murderer managed to kill twenty people on the scene, and wound nearly thirty more, but I expect that some of those thirty-odd will die, or will have died already by the time that you may be reading this. I haven’t looked up an absolute ranking in terms of fatalities and injuries and terror, but this is a massacre which, even in a country largely numb toward these events, was terrible enough that it provoked no fewer than four people to get in touch with me because they remembered that I was in Texas somewhere.

I was in Big Bend National Park during the shooting itself, and so didn’t watch it unfold in the news. I’ve been driving since — I’m in Oklahoma now — and so I haven’t followed too closely since. But I have seen that, as is always the case after a shooting like this, a series of dull takes and counter-takes about what role (if any) “our mental health crisis” played, and how urgently, if at all urgently, we need to “fix mental health care in this country”. Who happens to be fixated on mental health after any given shooting tend to depend on the circumstances of the shooting itself. In this case, it is reactionaries (including the President) who have stressed the mental health angle because the shooter was himself a reactionary. They’ve also raised violent video games, and, I imagine, rap music as possible culprits, which feel a bit like a throw-back affectation, given that “mental illness” was the extrinsic non-firearms-related-factor which largely replaced the Grand-Theft-Auto-and-Eminem explanation over the past decade in virtue of sounding significantly less ridiculous if you needed to avoid talking about NRA money and neo-nazi websites.

Of course, liberals have also trumpeted the “mental health crisis” alarm after certain shootings, which is to say, after shootings where the ideology of the shooter is less transparently attributable to the right. Liberal invocations of the "mental health issue” are less transparently cynical than their ring-wing counterparts, but it doesn’t feel entirely beyond cynicism. Worrying over mental health as a cause of mass shootings can, after all, lend a kind of sensitivity and sophistication to your post-shooting Facebook update that just going on about the NRA for the hundredth thousandth time can’t manage on its own.

Regardless of who is blaming mental illness after a given shooting, they are inevitably met with the woke retort: it’s stigmatizing to be talking about mental illness here at all. These shooters are evil not ill, and in fact, it hurts mentally ill people who are actually did you know like, more likely to be the victim of a violent crime than the perpetrator? to act like a symptom of insanity is buying an assault rifle and shooting up a school. They point out, correctly, than the vast majority of gun homicides are not committed by people with a serious mental illness. But this point is about as valuable as the point that the National Alliance for Mental Illness is making when it points out that actually, the majority of violent crimes aren’t committed by schizophrenics. Which is true. Schizophrenics make up less than 2% of the population. They are not committing 51% of the violent crimes.

I’m on the road and don’t want to dig, at great length, into parsing what we mean by “mental illness” and what we mean by violence. Are we talking about all mental illness, regardless of severity? Or do we mean only “severe” mental illnesses, like bipolar disorder? Only do we mean what most people probably imagine when we talk about “mental illness” after mass shootings, i.e. largely psychotic illnesses which involve elaborate delusions, hallucinations, and bizarre behavior? Are we talking about all violence? Are we talking about all violence plus the non-violent acts rhetorically refigured as “violence” by humanities graduate students? Or do we mean only serious violent crimes? Or only homicides? Or only gun homicides? Or only this particular genre of American massacre: the mass shooting?

(And when we gather these statistics, are they based on patient reports? Police reports? Are we only including those crimes for which charges were filed? Or only those crimes where a conviction was obtained? If a schizophrenic proffers a defense of not guilty by reason of insanity, and this plea is rejected, not because the defendant is a malingerer, but because their illness doesn’t satisfy the strict legal boundaries of “insane” at the time of a crime, do they count as a mentally ill criminal, or is there crime added to the pile of those committed by people without mental illness? What if their illness is only diagnosed after they enter the prison system, and are, for the first time, able to see a psychiatrist at all? Are the statistics updated? Are we sure they ought to be updated? After all, it may have been the extreme stress prison which brought on the first episode, as is often the case, meaning that the illness was not present at the time of the crime.)

You could combine any set of answers to these questions and get a wildly different account of the relationship between mental illness and violence, and I don’t propose to get into all of the permutations right now. Suffice it to say, according to the best meta-studies, people with severe mental illness commit violent crimes at a slightly higher rate than the general population, although these are usually more impulsive acts of violence. Mass shootings, which tend to involve quite a bit of planning, are not the ordinary domain of manic depressives and schizophrenics.

But that doesn’t mean that the mentally ill never commit mass shootings. James Holmes, the Aurora theater shooter, appears to be a clear case of clinical insanity. John Hinkley Jr., who shot Ronald Reagan, was schizophrenic as well, and while his crime wasn’t a “mass shooting” in the traditional sense, it did involve a good deal of preparation and planning. (Indeed, Hinkley was remanded to a psychiatric hospital after the assassination attempt, and back then it was Republicans insisting that mental illness is an ‘excuse’ we ought not to fall for, rather than liberals). The woke scolds are right that handwringing over a “mental health crisis” is a cheap way of avoiding the fact that the vast majority of these crimes are committed by the perfectly sane. But the woke scolds are wrong to pretend that insanity is never the cause of large-scale violence. It is. Every time a shooting like this occurs, it feels as if one gets to choose between believing that “mental illness” is a significant sufficient cause of the American gun nightmare, or believing that mental illness has nothing to do with it at all. But that’s a bad choice. Sometimes they are crazy. Sometimes they aren’t.

There are of course a good number of people who believe that in order to murder dozens of strangers, you must, in some sense, be insane. It’s the same reasoning that gets all serial killers called “crazy.” Very few of them have an actual biological mental illness — for the most part, serial killers are just sadists with a cluster of other undesirable personality traits — but how sane can you be if you chop up co-eds in your cabin? No matter what the doctors say, how sane can you be if you decide to walk into a high school, or a Walmart, or a movie theater, and open fire?

You might think of it like this: all mass shooters are insane. Only a few of them are Insane. The capital-I Insane ones are mentally ill; their trouble is that they are not accurately perceiving reality. They might start firing into a crowd because they’re convinced that everybody in that crowd is an alien, or out to get them, or is already not alive at all. The crime they commit is a tragedy because innocent people are killed, but the Insane murderer does not really know that. If the delusion were true — that is, if it were actually the case that everybody in the room was a dangerous alien on the verge of attack — then opening fire might be the right move. The Insane shooter is reacting appropriately to imaginary circumstances.

The insane shooter, meanwhile, is reacting inappropriately to real circumstances. Their insanity is not found in any confusion in their senses, but in the fact that they correctly apprehend a real fact — let’s say the fact that the United States is home to a great number of Latino immigrants — and conclude that this is a terrible thing that can and should be corrected by the random execution of two dozen people. This does not require mental illness. It only requires exposure to the dominant political climate of the United States and easy access to firearms. The El Paso murderer is, of course, insane. But he isn’t Insane. Maybe the next one will be. Probably not. But sometimes they are.

The Qualia Problem, Part 2

I’m out of the United States right now, which is partly why I haven’t written anything here for a while. But I want, very briefly, to look at a short essay published in the Times this week. It’s called “What Bipolar II Feels Like”, and its adapted from “I’m Telling The Truth But I’m Lying”, a new book by Bassey Ikpi. I haven’t read the book yet, so I don’t know what the rest of it is like. I don’t even know what the original version of this essay is like—”adapted” is a vague word, and in a case like this usually means “cut together from parts of a larger essay.” But this short version, as it appears in the Times, is worth looking at for what it is in this form.

What it is, I think, is another good example of the wall we’re running up against writing about mental illness. It’s the qualia problem I wrote about before, and will write about again: If one goal of literature is to get a reader to understand and even feel the what-it's-like-ness of an experience, what do we do with experiences that are alien to ordinary life? Extreme mood episodes and psychotic states are not like anything you’ll feel if you’ve never felt those things precisely. They strain the utility of metaphors. It’s difficult to build a bridge from something you may be familiar with to something so unfamiliar: the ordinary “imagine X Y and Z experience, but with P, Q, and R adjustments” rarely suffices. And that challenge only addresses the descriptive problem of writing mental illness. What about mimesis? Is there a way to simulate the subjective state on the page?

Ikpi’s essay doesn’t do a bad job trying. This is a deft essay, and worth reading. But I’ve read it before. I think I’ve even written it before. Its descriptive content is a mix of metaphors, hypotheticals, and hypotheticals (or metaphors) which are actually the incredibly particular experiences of its author. Like this:

You know how you can get a song stuck in your head? Imagine hearing that song even in your sleep — waking you up in the middle of the night to ensure you’re aware of the lap it’s running in your head. Then imagine you have to find out everything you can about that song and its singer. Where it started? Who wrote it? What inspired it? Why? You have to do all of this before there can be quiet in your head, before you can rest, before you can sleep.

Now imagine you do this with clothes. You can only wear 7 for All Mankind jeans or Citizens of Humanity because they were both created by the same people until one of them left because of a falling-out and started C.O.H. You know this because you researched and Googled and Wikipedia-ed everything there is to know about them and those are the only jeans you can wear now so who cares if they’re two hundred dollars?

For mimesis—for qualia—Ikpi turns to form. The essay builds in a satisfying way. It gets more and more manic (it is talking about hypomania, mainly, although it doesn’t say so explicitly) in fits between crashes. The pace flows until it leaps, in a way that’s meant to imitate the sudden irrational leaps in a mood episode. As the content turns from hyped to exhausting, the essay tries to exhaust you. “And then the packages come because of course you did overnight express and you feel crazy and stupid and silly and irresponsible and you’re exhausted because you know this isn’t normal,” Ikpi writes. It says ‘exhausted’, but the point is the and and and and and. The syntax wants to get you running full speed and then say, Look, you’re running on fumes. Something is wrong here.

Again, this is all very well done, and again, I’ve read it before, over and over; I’ve written it before, over and over, this form and content trick for trying to recreate mania, right down to the way the very last line— “Imagine you don’t fit anywhere, not even in your own head”—manages to to sum it all up neatly, while also giving a sense of the constant agitated difficulty of these illnesses, while also slyly suggesting something interesting, something worth-writing-about about it (don’t fit is not fitting is not fitting in, the classic tragic-to-cool literary subjectivity). I don’t think there’s anything wrong with what’s happening here, except perhaps wondering if this is really an essay about “Bipolar II” except in point-of-fact (you could say this was about classic mania in BP1, or even about a particularly severe kind of anxiety disorder, and it would be approximate enough to ring intentional and true). This is, I think, one of the best examples I’ve ever read of the current state of mental illness lit. It’s better than my own versions of precisely this essay; as good, at least, as some of the better installments which predate both Ikpi and me. But it’s still the current state of mental illness lit. And I want to see what the next step is. I want something that uses different tricks; that doesn’t rely on bizarre specific content deployed in mood-mimetic form. I’d like to write the next step, obviously, but I’d just be relieved to see it written by somebody else. Maybe the full book has what I’m looking for here. I’ll order it. And in the meantime, keep trying to think of something new.

In Which I Become Totally Incensed Over Something That Doesn't Really Matter

I don’t read twitter anymore, by which I mean, I don’t have twitter but people send me tweets they think I might find interesting and every time I follow one of the links I’m sent, I wind up clicking around for a few hours, and reading just as many tweets as I did when I had an account. This is fine. The posts are funny sometimes; more times, they are are a reminder that given five seconds of distance from that website, it’s inconceivable why anybody spends much time there voluntarily. Twitter is just a machine for snowballing a thousand small annoyances into a constant agitated, paranoid omnidirectional rage. It’s a machine for simulating the curse of Prometheus. A thousand little birds come and eat your liver every day.

For example, I’ve spent the last several days fuming over a tweet from a well-known media-and-culture fixture explaining why, actually, movies like Shutter Island are bad. Or, as the tweeter put it:

“Something I don’t love is horror movies where people are recently out of mental institutions and can’t tell if they’re delusional or if it’s ghosts bc this a real fucking struggle for my friends who have delusions! […] ESPECIALLY if the twist is ‘hahahaha, you’re just delusional’.”

A number of thoughts occur to me, roughly in this order:

  1. They’re called horror movies.

  2. “A thing I don’t like is cars where people go fast, because it’s a real fucking struggle for my friends who have motion sickness.”

  3. Is ‘hahahaha’ really the tone of any of these movies?

  4. If the point here is only that a movie (or any piece of art) might use something that has been difficult or even traumatizing for a subsection of the population as a narrative device, and that might be difficult to watch if you’re part of that subsection, then what, precisely, are we left with for plot devices? I suppose war movies are out, obviously.

  5. I don’t watch horror movies about serious mental illness much either, but I think if a friend denounced the genre in solidarity, I would feel more embarrassed than I do about having my hand twitch uncontrollably some days, and I used that hand-twitch as the basis for an entire essay about how embarrassing mental illness can be.

You can see what twitter does to you: as obnoxious as I find the original tweet, I’m also being obnoxious. I’m thinking of five different ways to roll my eyes at it, even though I know — I know! — that what the tweeter means, basically, is “There is a genre of movie that uses something my friends have a hard time with in order to generate a cheap thrill, and it’s not usually handled in a particularly sensitive way, and there’s a line, probably, between acknowledging pain and suffering in the real world, and exploiting species of pain as some kind of exotic dysfunction porn.” The tweet is cloying, sure, and soaked in the kind of performative solidarity where saying good is tantamount to being good, but even that isn’t the tweeter so much as the logic of posting (another definition: twitter is a machine for pushing JL Austen’s ideas about forms of speech which are actions, not descriptions, to its breaking point), and at any rate, it’s well-intentioned and trying to be nice and is ultimately harmless and I’d be a hypocrite to lather up my encounter with somebody trying to highlight an insensitive part of our culture into an instance of injustice by a fake ally who is actually getting it wrong and should feel bad. The tweet is wrong, I think, but there’s nothing really wrong with the tweet. Fine.

But what I’ve been fuming over is a mode of thinking which that tweet represents. A mode of thinking, The main problem with being mentally ill is that people might be insensitive about it. A mode of thinking that says, The main problem with being mentally ill is that people might judge you. Or, people might think you’re weird. Or, people might think your problems are Exotic and Interesting and kind of funny or cool, in a dark way. It’s a mode of thinking that says, the horror of mental illness is stigma against the mentally ill. I know this tweet isn’t saying that. But it’s a way to read it, and the culture that it came out of. Just let me riff here. It is a mode of thinking that treats mental illness as an identity marker with no predictive value except its ability to predict the fucked up ways people might be unfair about your bearing that marker. Discrimination against the mentally ill is real, and there are miles of misunderstandings and counter-misunderstandings muddling the discourse about it, and if somebody fired me for disclosing my diagnosis, I’d sue, but the illness itself is actually a problem. Being crazy isn’t like being black. It isn’t, there is no race but there is racism, i.e., there is no there there except a meaningless visible difference which people will kill you over. There’s stigma and discrimination and cheap cultural exploitation of the mentally ill, but there is also mental illness. The illness itself is a problem, not an identity. It’s right there in the world: illness.

There are, of course, mentally ill people for whom stigma is the main downside. They’re the people with moderate anxiety disorders and 21st century depression—with Anxiety and Depression(TM)—who do suffer to various degrees from the illness itself, but who are basically strivers and the drag, the real drag! I’m not beating up on this! is feeling anxious at parties or on dates and therefore maybe not being as cool or as well-liked as they’d like to be, which isn’t really fair, and is a kind of discrimination, I guess, so when they think about their illness, the biggest consequence they’re seeing isn’t the ways the illness makes them feel bad (although it does!), it’s the much larger and more life-impacting ways that their feeling-bad turns into acting-weird turns into social-consequences. The stigma is the problem. Unsurprisingly, these are the people who tend to be the most stable and functional and innocent of the mentally ill, and so they get most of the jobs writing and tweeting about Struggling with Mental Illness, and like any talented tenth, they purport to speak for the rest of us. Or they don’t. Maybe they’re clear about that. Some are. But they’re the ones speaking, so it makes sense that other people—the well-intentioned included most of all—come to understand mental illness in that way.

But I don’t know. There are a lot of us in institutions, and a lot of us in jail. There are a lot of us on the streets, or living with relatives, barely living, without access to good care, or worse, for whom good care still isn’t enough. I’ve been relatively lucky, but even I’ve never thought that the big bummer about all of this has been stigma, or judgement, or the occasional movie where it turned out Leonardo DiCaprio was just crazy the whole time. The bummer is the part where I lived in hell for years, and am sedated every day now, and in the process of going from hell to heavy sedation, I managed to alienate most of my friends, and blow most of my opportunities, and go from a life where I suppose I would have been a lawyer or something into a life where I am mad online, writing a blog about a tweet I don’t like between doses of seroquel. And I’d still take that over still being sick. I’d rather be sedated and poorly liked and lazy and barely employable than be back in the part where I put a knife in my neck to try to take the Holy Ghost out of my lymph node. Because that’s the horror movie. That’s something I don’t love.