Why does the mental health movement leave out crazy people?

There’s been a lot going on in the past decade around mental health. Particularly in the pandemic, the “self-care” movement soared. There’s been a lot of work done around activism and “awareness,” and ableism as it pertains to mental health; we’ve seen some important anti-suicide work going on, big name celebrities have come out about their struggles, new apps for self care have been launched, an entire self-care industry is now in place, etc. 

So how did all this happen, and yet we’ve actually *obscured* the needs of people with severe mental illnesses — “mental health” in our movements simply refers to each individual’s state of mind, self-care is universally applicable to those with and without mental illness, and even in the case of therapy, plenty of people without mental illnesses get therapy all the time. So there’s been a significant flattening of mental illness and just normal people who are stressed out, into, nebulously, “mental health.”       

Even worse, where any of these movements have specifically addressed mental illness, it’s been about just a few diagnoses: anxiety, depression, PTSD, and BPD.

It’s very surreal to see a movement ban the word “crazy”, but to not see any crazy people in the movement. Crazy, insane — these are slurs thrown at people with specific disorders — psychotic disorders: bipolar 1, schizoaffective disorder and schizophrenia. It is not thrown at people who do not have psychotic disorders. 

This is the group of people who face the greatest stigma and the worst outcomes. 20% of bipolar people kill themselves. Up to 50%+ people with schizophrenia have had a suicide attempt. Bipolar and schizophrenic people have reduced life expectancy, with 13+ years of potential life loss. We make up 30% of people on the streets. Homelessness is presented as a very complex problem when it is in large part the very straightforward matter that people are not getting medical treatment; these are conditions that can be managed but they are being neglected and left for dead by the medical community. Again, these are diseases we KNOW about, we have DOCUMENTED, that we have MEDS AND TREATMENT FOR.  

We all know the symptoms of anxiety and depression and PTSD and even complex personality disorders, like borderline personality disorder. We know about the meds used to treat them: SSRIs, benzos, therapy, DBT. We know what accommodations are needed for them.  

But when it comes to psychotic disorders, we don’t know the symptoms, the treatments, the accommodations, the ableism that specifically affects us. We don’t know what these diseases are or how they work, much less how to help. The stigma remains as high as ever, and there is very little help for us. It is considered perfectly acceptable to the medical establishment that we die in the streets — the average time between when someone first starts experiencing symptoms and when they are treated for them, is 5-10 years. During those years, people live in hell, and often lose everything they have. 

I’m just going to do a quick run through how leaving us behind of the “mental health” movement negatively impacts and marginalizes people with psychotic disorders, and leaves us in serious danger: 

+ When we get sick, it is perfectly normal and acceptable to see people medically neglect someone with a psychotic disorder to a point of destitution, housing instability, physical harm and criminalization. When I was sick, people again and again abandoned me even when I was in the middle of clear medical emergencies. While they bear personal responsibility for their negligence, it is true that people have very little idea what psychotic disorders are, how to treat people who have them, and what to do if someone is having a medical emergency (psychotic break). 

When people don’t know anything about psychosis or what to do, they often escalate the situation and bring in harm, or most often, they simply abandon us — which can be deadly. This is directly related to us not getting treatment — no one helps us get the care we need.  

Psychotic disorders are “insightless” in that when you are sick, you cannot see that you ARE sick. We rely on our support systems and communities, but they have no idea how to identify what is going on or help. The appearance and presentation of psychosis is VERY identifiable — but no one knows thats it is a known quantity, with treatment, that it is a medical emergency, that it is something they can learn about that might end up allowing them to help or even save a friend’s life. 

+ The stigma against us remains off the fucking charts. When you have a psychotic disorder, oftentimes people seem to think you have gone crazy through some fault of your own, even though it is very strongly established that these are biochemical and structural diseases. Because there is so much stigma, and because we are blamed for our illness, we are kept from care and actually pushed out of communities at the very moment we need them most. 

Despite all these efforts to “de-stigmitize” mental illness, people are *fucking terrified* of people in the midst of a psychosis… which is incredibly dangerous to us. 

Yes, a psychotic episode can be quite disturbing to see, there can be all kinds of yelling and hallucination and delusion going on. We are often experiencing religious ecstasy, very extreme states of emotions, and an extremely different view of reality. Medical emergencies are frequently disturbing — strokes, seizures, blunt force trauma, etc. Yet those are not excuses to leave someone bleeding out, that you are disturbed by their blood. 

Everyone is fascinated and abhorred and horrified of the madman — but the truth of it is that a psychotic episode is a medical phenomenon, a medical emergency, that it actually is very predictable and looks the same across groups; that these are events we can very much do something to help. They are well-understood by the medical establishment. Yet it is allowed to remain an  incomprehensible, nebulous phenomenon. 

Weird. 

+ It’s dangerous that we don’t have a good understanding of how to help someone with a psychotic break. For example, that its important to be present if cops are going to come into the situation, so you can try to ensure your loved one’s safety. If you can’t manage to transport the person to the hospital, there is no way to get an ambulance alone; they are always accompanied by cops, but at least EMTs recognize these disorders. (Cops either don’t or pretend they don’t to justify violence again psychotic people). 

From a diagnostics perspective, lack of understanding means people around you have literally no frame of reference. If you saw someone showing the symptoms of OCD or an eating disorder, you would have a sense of what diagnoses that could potentially entail or what help could start to look like. But no one knows the symptoms of mania and psychosis.

So in fact, though the symptoms of psychosis are known, predictable, and not mysterious in any way at all, they again seem a phenomenal novelty. 

There’s no reason that everyone in America can’t learn enough about these brain disorders to treat people with them better and get them help. (This is being optimistic as I must point out, people really do want to kill people with psychotic disorders. Constantly.)  

+ While everyone else’s mental illness is being celebrated and validated, people with psychotic disorders have continued to see many incidences of mass humiliation of people in the middle of psychotic episodes. Kanye is treated with total fucking brutality and inhumanity, and is CONSTANTLY being humiliated and tortured by the world. When I was sick, despite being a private person, literally hundreds of thousands of people made fun of me over the course of years, pushing me deeper and deeper into mania and depression. I am amazed Kanye survived such cruelty; I am amazed that I did.

 You see it happen on TikTok or streaming services all the time, where a sick person is broadcasting and people gather in hordes to gawk. And it is a national pastime to make fun of and provoke people with psychotic disorders on the streets. Being bullied to death as matter of course is a level of stigma that no other mental illnesses see. Society isolates and tries to kill psychotic people; it is neurotypicals that put us in danger. 

+ We are at huge risk of police violence and cops often shoot people in the middle of psychotic episodes; while this is usually framed as “mentally ill/mentally disabled”, much of this is VERY specific to people with psychotic disorders. Black men with schizophrenia in particular are in danger of police violence, but no one with a psychotic disorder is free of that risk. We know we are marginalized in the movement against police violence because no one even says the names of our diagnoses, as if these are just random people “going insane” as opposed to people with specific medical conditions, displaying known medical symptoms, being threatened and shot. 

+  Someone who is in a psychotic state is incredibly, incredibly vulnerable. They have no control or insight into their behavior, they can be almost trivial to manipulate. We are taken advantage of and abused constantly while sick. I was sexually assaulted several times and was used for money and sex and labor by multiple people over years. Ye has discussed extensively in his catalog how he has been taken advantage of by people in his life. 

The people around someone with psychotic disorders are often the ones most dangerous to them, who abandon, escalate, neglect, or abuse. The victim’s illness provides an excuse and cover. 

While everyone is damning people saying “crazy” online as ableist, neurotypicals abusing people with psychotic disorders is allowed to proliferate without any comment whatsoever. The abuses we endure while sick are terrifying and difficult to quantify. We lose entire lives and take on terrible trauma. Yet the “mental health” movement has nothing to say about it. 

+ In fact, stigma against people with psychotic disorders is so advanced we are CONSISTENTLY called “abusers” for our mental illness; it’s very common for the people around someone with a psychotic disorder to demand “accountability” for their episodes when this is very much a physical and biochemical phenomenon, and that there are significant differences between the brains of I.e., bipolar 1 and a neurotypical person. This is like asking someone to take accountability for having a stroke or getting a cancer diagnosis. Psychosis is a medical emergency. This is also bourne out in the fact that psychosis damages the brain. (NOT a corollary to borderline personality disorder, do not conflate).

So in fact, though the symptoms of psychosis are known, predictable, and not mysterious in any way at all, they seem a phenomenal novelty, and are the fault of the person with the illness… and something they should be punished for.

+ I’ll go into this in subsequent posts, but public misunderstanding of us proliferates, particularly in the case where you have a bipolar one genius like Britney, Amy and Kanye,  purposefully misunderstood and abused without comment. 

To sum: 

There’s no reason that everyone in America can’t learn enough about these brain disorders to treat the people with them better and get them help. (This is being optimistic as I must point out, people really do want to kill people with psychotic disorders. Constantly.)  

This marginalization is in huge part the fault of the psychiatric community and the American Psychiatric Association, an organization which considers it perfectly acceptable to let us go 5-10 years before getting treatment — many of us can’t get diagnosed until we show up half dead in, hopefully, the medical system and not a jail. Many of the people with psychotic disorders who you see that are very, very, very ill, is because the illness has been allowed to get to that POINT by medical neglect. These are progressive illnesses, and without treatment, they get worse and worse, delivering at least 20% to our graves.

 In fact, the APA inflames the situation with constant SSRI poisoning of bipolar 1 patients, it has said nothing about our beloved bipolar 1 celebrities, it has made no meaningful or productive effort to include us in this latest “mental health movement”, and it has said nothing where there have been criminal cases, such as Lori Vallow Daybell, who very very clearly had a psychotic disorder and experienced medical neglect again and again and again over years before an unspeakably tragic outcome. 

The reason why you see people with psychotic disorders in these devastating situations, is because they weren’t given medical care, and their (progressive) illnesses are allowed to progress for 5-10 years or even longer. 

I have more words for the APA another day, but my question remains: 

How in the fuck are you going to have a mental health movement that leaves out crazy people?