Rule #1 - YOU are Responsible

Diagnoses and Disabilities and Conditions Do Not Remove Personal Accountability

We live in a society which has stopped discussing virtue. It’s considered foolish and uncouth to refer to moral causes or vices or character flaws as explanations for behavior. This will need to be rectified in order to redeem the practices of psychology and therapy (which are, by any reasonable metric, failing). The abandonment of the conceptions of ‘right’ and ‘wrong’ behavior have thrown us into confusion regarding individual responsibility and the implications of mental health diagnoses. We see signs of this everywhere in our culture.

When society refuses to deter and punish antisocial behavior it guarantees that others will have to take on this burden themselves… or be victimized.

Jordan Neely had mental health conditions but that in no way reduces his culpability for striking and threatening subway passengers on multiple occasions. His diagnoses are only helpful for mental healthcare providers-they’re not licenses for violence or misbehavior.

Crimes must be punished before all else. Society requires this and any reasonable conception of mental health also requires that people answer for their own behaviors. Then, AFTER the punitive debt has been levied, we can work on treatment. Giving mentally ill people special dispensations only allows them to remain sicker for longer.

People with Serious Mental Illness Say Racist and Bigoted Shit All the Time

I very much enjoyed the piece by Freddie DeBoer (People with Serious Mental Illness Say Racist and Bigoted Shit All the Time) which I’ve pasted, in toto, at the bottom of the page. After reading it, I jotted down some thoughts… which I’ve already written about at length (link below). These subjects constantly engage my attention because they’re so widespread, and so frustrating. I’m watching an epidemic of utopian nonsense spread through the professional classes, and people are getting hurt because of these misapprehensions. Bail reform laws and ‘health at any size’ propaganda and efforts to remove standardized tests from our schools all grow from these fundamental philosophical errors. They originate from places of profound ignorance about the nature of human psychology and behavior, and are related (I believe) to personal envies and resentments. They are probably also connected to a kind of warped maternal instinct, in which professional women desire to infantilize and care for the ‘marginalized’. These tendencies should be ruthlessly interrogated and resisted.

Bring Back Invalidation

There are some profound moral errors in our conversation about culpability and disability, and how they intersect. There are two intense desires which I always detect within the intelligentsia (students, writers, therapists, journalists, activists). They want:

1. A way to sort people into categories which offer opportunities for status games or for professional/academic accommodations

2. A moral sorting system which reduces all disorders/actions/beliefs/policies to either “good” or “bad”

   This may sound like an exaggeration but I promise you it’s not. There are MANY, many members of this class who believe that (for example) black/neurodivergent/progressive/indigenous/anti-carceral are “good”. Therefore ANY policy which promotes (“centers”) ‘neurodivergent’ (a label which has become almost meaningless now) people or any policies which erodes the ability of the state to arrest people or commit them for mental healthcare are good-full stop. Do your policies patronize neurodivergent people and allow a bunch of lazy ‘autistic’ people (yes, autistic people are also often lazy, or mean, or dishonest) to shirk work, or hurt an organization’s effectiveness? It doesn’t matter! It’s a “good” policy, because it uplifts the neurodivergent (or at least those claiming to be)! Does a policy reduce the ability of the police to arrest thieves (thereby leading to store closures and unemployment in already poor areas) or the ability of courts to temporarily force psychotic and possibly dangerous people to get treatment? Doesn’t matter! Anti-carceral things are “good” things!

   This is policymaking and worldview formation based purely on intentions, and a silly and simple and ultimately unworkable picture of reality and human nature.

Despite being based in some rather simple misunderstandings about human nature, these assumptions tend to spread out and become inextricably tangled in large and important areas of policy and organization. Here are some associated errors:

Error: labels and diagnoses are tools to seek treatment, not routes to special accommodations

I have been diagnosed with substance use disorder (which I certainly do have) and have been diagnosed with depression in the past. I would NEVER ask the people around me to adjust their needs or expectations to accommodate me. These are both valid mental health labels but they are irrelevant to my employer or my friends or cashiers or my teachers. (Notably, they are rarely adopted as fashionable by attention-seeking weaklings online-especially the first one). Treatment is about learning to be able to meet the world’s expectations. A diagnosis is not a flag to wave to make people behave better towards you or give you longer breaks at work and if you behave as if that’s the case you will only enfeeble yourself. This kind of behavior should be ruthlessly shut down and MOCKED. I’m usually against mockery but I actually believe it will be an effective strategy against this kind of behavior.

Part of me wonders how much of this is simply due to a feminization to the cultures and standards and incentives of our organizations.

If you’re “neurodivergent” (for example), that is NOT a reason to expect special breaks or consideration or license to underperform from the people around you. You should try to make your disability impact your life as little as possible… not try to change the behavior of others to suit you. Try to be your best self. That almost never involves making excuses for asking for dispensations.

Error: labels and diagnoses are tools to seek treatment, not cool things to advertise or gain status

“Neurodivergent” or “ADHD” or “queer” are all cool things to attribute to oneself now (in certain circles). If I only had a dollar for every time someone said that they suffered from “complex PTSD” on a digital bio! These labels are not shortcuts to wisdom and they don’t make you more interesting or give you special insight into ANYTHING. They’re so vague and medically unreliable (‘complex PTSD’ is not a diagnostic category) that they’re basically useless at this point but the only use they SHOULD ever have is for a provider, who seeks to treat you, to read a chart or make notes. At this point I actually believe that people shouldn’t be informed of their psychological diagnoses. It’s that disordering to our conversations and system of social accountability. There’s no good reason that I can possibly imagine to mention trauma on your Instagram bio. It also makes me believe that you don’t actually suffer from trauma, since sufferers generally don’t recognize symptoms in themselves. When I see such a label attached to someone’s online identity I DO believe they have mental health concerns: I believe that they’re attention-seeking and entitled and self-indulgent and probably evidencing borderline traits. I just don’t believe their problems have anything to do with trauma.

Error: labels and diagnoses do not have some special significance

Everyone seems to want to be known as “neurodivergent” but no one wants to say they have intense interests or are socially awkward or schizotypal… even those these are often the same things. The labels people use were created by insurance companies and providers to standardize mental health symptoms and categories. They have almost nothing to do with the nuanced world of human behavior and interaction. Many people are pretending to have diagnoses but even to those who received them from a professional: what does that tell me? It tells me you’re one of the privileged few who have had access to mental healthcare and that a social worker gave you a questionnaire one time. The only reasons people affect these labels is because they lend a person cachet or special authority in discussions, or accommodations (see previous paragraphs). None of these things are appropriate and all of the them are contributing to a culture which talks about mental health and self-care and trauma endlessly but suffers higher rates of anxiety and depression and other disorders with every year.

I firmly believe that people’s advertised mental healthcare labels should be carefully interrogated and, when necessary, ridiculed. I really think that having this category of labels which is unquestionable and socially advantageous is causing status-seekers to equivocate and pretend, while also hurting the mental health of many, many people. If you spend a lot of time thinking about yourself you are likely to become more mentally ill. If you believe you’re mentally ill you are likely to become more mentally ill. If you incorporate mental illness into your identity you are likely to become more mentally ill. I actually don’t think that these claims are deniable at this point.

Error: labels aren’t replacements for moral judgement-they are compliments to it

This gets to the fundamental psychological error of our civilization: we have erased the category or moral (and immoral action). as well as virtue and vice and compassion and wisdom. We have substituted identity categories and opinions and mental health diagnoses and credentials for these things and it’s simply not working.

Jordan Neely might have been schizophrenic but that doesn’t mean he wasn’t also cruel and greedy and ill-tempered and aggressive. We need to restore virtue to the conversation about personal responsibility. Perhaps you do have ADHD. That doesn’t mean you’re not also lazy and self-indulgent, and it doesn’t mean that harder work or smarter scheduling or better sleep hygiene wouldn’t improve your life.

Personal character interacts with mental health conditions-that’s the point. These questions are extremely complicated-but the assignment of blame for wrongs is usually simpler. Did you do something wrong to another person? Then you should feel remorse and, if necessary, pay a price.

I have Substance Use Disorder-a bona fide documented mental illness. To escape from its ravages I had to develop personal discipline and wisdom and compassion (even for myself) and perspective. Without moral development I would have remained sick, and that applies to every mentally ill person I know.

The best treatments for mental health conditions always involve moral improvement.

Trying to treat mental health conditions without addressing virtue (and pro-social behavior and wisdom) is like trying to treat diabetes without discussing insulin.

Error: labels and diagnoses don’t erase personal responsibility

The biggest accommodation society can give to the struggling is to free them from culpability for crimes and wrongs. This is no boon though. If you remove restraints on bad behavior people will behave worse, and in the end no one will be better off. If you want to help people, demand that they behave well and evidence their best selves as often as possible. Depending on legal systems and court decisions some accommodations or diversions might be appropriate in certain cases (the details lie in the realm of law and public policy). However, a diagnosis does not remove moral responsibility for an action.

The idea that it might is based on a misunderstanding of moral responsibility and a desire to group people into neat categories (“good” and “bad” again). We hold people responsible for wrongs because doing so is necessary to deter bad behavior and because their actions (and motivations) are useful guides to their action in the future. That’s it. We need to continue to punish people (even medically diagnosed ones) because this is necessary to deter misbehavior, and we should only factor in their conditions or diagnoses inasmuch as they interact with their virtues and vices to help describe their behavior and predict their actions in the future. A mental health condition could never take away personal responsibility for a crime, even if it changed our understanding of the person’s motivations and state of mind when committing the crime (and therefore affected how likely they will be to offend in the future).

On the Left now there’s a push to remove the element of individual responsibility from everyone’s actions, in as many contexts as possible. This way lies chaos. When you subsidize behaviors or reduce disincentives (like arrest and imprisonment) you increase the prevalence of those behaviors. We would expect to see reductions in the criminal penalties for shoplifting result in more shoplifting and that is exactly what we see.

These debates grow out of a diseased and indulgent view of human behavior which wants people to do the opposite of improve themselves and behave morally and benefit society. These people want to create a society where no one is responsible for anything and no one is driven toward goodness or allowed to achieve excellence. They want the very ideas of wrongs and faults and excellence to be wiped from our culture entirely. I suspect that’s because these people don’t like the feeling of personal responsibility in their own lives, and they dislike seeing the glories and accomplishments of others. We cannot base our civilization’s procedures on the envies and psychopathologies of 15% of our population.

More pieces on the failure of therapy in our society:

An Alternative Narrative...

The Value of Therapy - Part 1 (of 2)

Good News: You Don't Have Trauma

From THE FREE PRESS: 'How Bad Therapy Hijacked Our Nation’s Schools'

The Insidious Deception of 'The Good Life'

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People with Serious Mental Illness Say Racist and Bigoted Shit All the Time

if you ever think "mental illness doesn't do that," then you've never been on a ward

By Freddie DeBoer

There’s this conversation I have had repetitively for the past seven-plus years. It goes something like the following fake exchange, which is admittedly a little exaggerated for effect:

“Hoho! You’re hiding behind your mental illness to dismiss your bad behavior!”

“No, I’m not dismissing anything. Ultimately I am the only person that can shoulder blame for the things I’ve said and done. I do ask, however, that people take my condition into account when they consider my history.”

“So it wasn’t your mental illness! You’re fully and uncomplicatedly to blame!”

“No, it’s not that simple. Being in the throes of a psychotic disorder makes one’s control of one’s actions and thus one’s culpability for bad acts tricky. I would certainly hope that people would try to balance the things I’ve done against my condition, which repetitively ruined my life from the time I was twenty until the time I finally got religion about treatment in 2017. I say that even though I know that I must ultimately bear responsibility.”

“Aha! So you’re hiding behind your mental illness to dismiss your bad behavior!”

And so on. I have been religiously consistent on this point from the very beginning, before I ever wrote a word for the internet, when I was first hospitalized in 2002: I have done a lot of bad things under the influence of my bipolar disorder, and I am ultimately responsible for them. My 2017 public shaming was fundamentally understandable and not some sort of unjust act of “cancellation,” even though people said and say a lot of things about everything that happened that simply aren’t true. I lost a lot of friends around then that I didn’t get back, and while my feelings about each depends on the individual circumstances of a given relationship, I understand and do not bear a grudge. Likewise, I continue to pay significant career penalties for what happened that the average Twitter asshole has no ability to observe, and there too I understand even when I don’t agree. Because I really did do some bad things, most of them far from the eyes of the internet. That there are people who insist that I’ve demanded that I’m a victim of “cancel culture” because of what happened is not something I can control. I don’t think that and have never said that.

What I have asked for is not blanket forgiveness, nor for people to be good intersectional progressives by saying that I have a disability and they must extend me the accommodation of never saying anything bad about me. I have asked, instead, that my decades-long struggle with bipolar disorder mitigate my responsibility in people’s eyes, that it complicate simplistic judgment, that it be balanced against other concerns, that it be weighed. Some people have undertaken that project of mitigating and complicating and balancing and weighing and still arrived at the conclusion that I’m a scofflaw, that should be banned from polite society and from being published in fancy publications. I don’t like that conclusion, obviously, but for them to arrive at it is not an error but rather precisely what I asked for. I may disagree with the outcome but I must be grateful for the process. The problem, for many people, is that they can’t stand to do what I’ve asked them to, to judge with complication, to arrive at a conclusion other than a binary Good/Bad. A lot of people just can’t do that. They hate to do it. I’ve said before that I probably would have weathered all of that controversy better had I simply said, at the beginning, “Nope, sorry, I was sick, it was all my illness, I have nothing to apologize for.” Because they understand that request; simplistic exoneration exists in the modern liberal imagination, as does total condemnation. Qualified, complicated, partial, uncomfortable judgment is not.

Which is not healthy. Because only the left is going to stick up for the severely mentally ill, and the left right now is addicted to corrosive moral simplicity. Look, for example, at Kanye West and the bigger issue of bigoted language and conspiratorial thinking among those with serious psychiatric disorders. I sure do hear a lot of people saying “mental illness doesn’t do that” when it comes to offensive attitudes and speech. And it makes me think, otherwise, that a lot of people desperately need to learn about the world from somewhere other than a Chrome tab

For a good example of the position of the prosecution, consider that of Nathan Rabin, formerly of The AV Club. A charter member of the “I’m the Progressive White Guy Who’s ANGRY” cohort, a very large organization, Rabin was also the guy who coined the term “Manic Pixie Dream Girl,” a not-inapt description of a very specific and limited trope in a brief run of 2000s movies that quickly became every midwit’s favorite substitute for actual insight. (There is not a prominent female character from the past quarter-century of culture who has not been dismissed, often in straightforwardly misogynist tones, as a Manic Pixie Dream Girl.) Rabin is mad that Kanye West has said some genuinely horrific stuff in the past few years. What’s unfortunate to me, though it’s very common, is that Rabin doesn’t mention West’s longstanding diagnosis of bipolar disorder or his well-publicized serious head injury. (West himself now denies his bipolar diagnosis, which is very, very classically Bipolar Guy.) The evidence that West is unstable is not just his decade-old diagnosis by a medical professional but that he is, in fact… unstable. West acts in bizarre and unstable ways, his speech is frequently confused and difficult to follow, his thought patterns appear disordered and his actions dysregulated. He could hardly better epitomize the tragedy of the rich, famous, and unwell; he’s surrounded by yes-men and enablers that prevent him from having to serious grapple with how obviously, intensely unhealthy he’s become. Rabin has no time to think about that, or more likely, no moral mental space in which to consider it.

What makes Rabin’s complete lack of interest in West’s mental state particularly callous is that earlier this year he demonstrated lavish concern for the “neurodivergent,” a vague and capacious meme term that sometimes refers to the severely autistic but which is more more often used as a cudgel by miminally-afflicted upwardly-mobile professionals with self-diagnoses of being “on the spectrum,” people who are perfectly capable of collecting fancy degrees and working enviable jobs but who insist that anyone who ever makes them feel less than fully “valid” is a terrible bigot. These are the same people who get Harvard conference panels shut down because the panelists dare to talk about treatment, the same people who try to get Amy Lutz deplatformed because her experiences with her severely autistic son has led her to conclude that the neurodivergence movement is destructive. Rabin refers to the elements of the “less romantic, idealized elements of neuro-divergence, of which there are many.” Well, guess what, brother, I can tell you from personal experience that in a culture that now sees developmental and cognitive and psychiatric conditions only through a thick lens of romanticized bullshit - thanks, in large part, to the “neurodivergence” movement - this insight goes for psychotic disorders too. They are not romantic; they are, in fact, relentlessly, punishingly dark and ugly. They lead people to very ugly places. Sometimes, into anti-Semitism and Nazi sympathies. I’m sorry if pop culture has convinced everyone that they’re all just countercultural Randle Patrick McMurphys and cool, subversive Lisas.

People really, really hate to hear that, that mental illness can be implicated in bigoted thoughts and language, for example the reason I described above - everyone, but especially 21st century liberals, hates to have their simplistic moral judgments complicated. In our current political era the right to judge has mistakenly been elevated to the level of our greatest gifts as free people. To acknowledge that, among other things, severe mental illnesses like psychotic disorders lower inhibitions and dysregulate language and prompt delusions and generally reduce the individual’s control over their thoughts, utterances, and actions might leave us in a position where we can’t just write self-aggrandizing screeds about how we’re the only beings in the universe steadfast enough to stand up against Nazism. But I’m afraid all those things are true; severe mental illness really does lower inhibitions and dysregulates language and prompts delusions and generally reduces the individual’s control. You can read all about that in a voluminous research literature about severe mental illness, if you’d like. Or you can spend a few weeks on a ward, if you’d like, not some Club Med(s) private facility with yoga classes and a sushi chef in the cafeteria but an actual, grimy state hospital. Because you know what you’re going to hear a lot of? The n-word! And other really offensive things. Ugly conditions prompt ugly behavior.

I really don’t think much of standpoint theory, at all, but I can’t help but feel it organically when I debate this stuff. People who insist that, for example, mental illness can’t prompt anti-Semitism leave me just utterly dumbfounded. Do you know how many schizophrenics mutter under their breaths about the Jews and how they control the universe? Delusion and paranoia are opportunistic; they grab hold of preexisting bigotries where they can. These pathological ways of thinking love nothing more than to grab onto some extant philosophy or perspective and exploit it, twist it; there’s a reason so many crazies are so attached to religious language and symbolism. Casual racism and prejudice are as common on a psych ward as shoes without laces. Should the people who act that way be fully and totally and simplistically exonerated for their bad behavior because of their conditions? No. Should we try to view them as sympathetically as possible given how their minds have been hijacked? Yes. Even when it’s frustrating to do so. Especially when it’s frustrating to do so.

Ah, but, you see, “mental illness doesn’t do that.” I could hardly better encapsulate my great frustration with modern mental health culture - which will all be expressed in a new book from Simon & Schuster coming in 2026 - than with the phrase “mental illness doesn’t do that.” It is the perfect statement of unearned superiority and addiction to simplification, voiced by people who claim to care about nuance and complexity. I’ve argued before that it’s an almost unthinkably destructive and cruel thing to believe, the idea that there’s a simple and direct List of Things the Mentally Ill Do and Thus Are Not Responsible For, which appears to have been coauthored by everyone with a Tumblr account sometime around 2014. The basic logic is utterly broken. The claim is “Some people with mental illness don’t do Bad Thing, therefore mental illness can never be implicated in Bad Thing,” but there is no behavior that all people with mental illness do, which means they are willing to excuse literally no behaviors thanks to mental illness! One of the very few affordances society has traditionally given to people with severe mental illness, the consideration of those illnesses when assigning moral culpability, is evaporating at the hands of ostensibly-progressive people who claim to love the mentally ill the most. And it’s all happening because the disability rights movement has made it so impermissible to ever acknowledge the truly awful consequences of mental illness; sadly but unsurprisingly, with the ugliness of mental illness cut off from polite conversation, too many people have decided that the mentally ill never do bad things. I am so glad that the twelfth person on the jury in the James Holmes trial was not a part of this tribe.

Were I Nathan Rabin, I would ask myself this question: why am I so eager to hand blanket exoneration for all misdeeds to the vast, vague, and medically meaningless group known as The Neurodivergent, when a clearly deeply-ill celebrity who’s said genuinely ugly things receives no such consideration? What could it be about Kanye West that makes him different?

It’s darkly comic, to me. The general elite opinion on Kanye West appears to be something like “I used to have some sympathy for Kanye, thanks to his mental illness - but now that he’s really unstable, I don’t.” It only matters when it’s hard, guys. Forgiveness only ever means anything when you really don’t want to give it. When you’re patting yourself on the back for being so accommodating towards a well-educated and upwardly-mobile coworker at your Fortune 500 company who claims to be neurodivergent and who maintains a life utterly indistinguishable from someone who is not neurodivergent, tell me - what exactly do you have to accommodate them for?

People with Serious Mental Illness Say Racist and Bigoted Shit All the Time