A Psychiatrist Explains What’s Really Wrong With Kanye West.

It’s not the bipolar disorder or the racism.

Hi everybody. Let me introduce myself, if you’re a new reader: my name is Owen Scott Muir. I am a medical doctor. I am a psychiatrist, and a sub-specialist at that: I did four years of general psychiatry, residency training, and two subsequent years of child and adolescent psychiatry fellowship thereafter. I have over 60,000 hours of direct clinical experience. I also have bipolar disorder myself. We call that “lived experience” in the game.

I also used to work in the music industry. My first full-time job after college was as an assistant recording engineer at Sony Music Studios.

So the coverage of Kanye West, it’s not only personal impactful, it’s very much right up next to things I care about. Music, mania, family, all the hot spots.

I’m a father. I have two children. They are cute.

Mr. West is not a patient of mine. We’ve never met. According to the guidance of the Goldwater Rule, my professional guild, the American Psychiatric Association, says Psychiatrist Members are not to opine on the diagnosis of anyone they haven’t examined. I’m thusly not going to weigh in on any DSM-5 diagnoses as they relate to Mr. West.

For years, we’ve gotten to watch the unraveling of someone who is undeniably brilliant. He wouldn’t tolerate any denial of that brilliance. He’s like a walking textbook of what someone with acute mania might look like, absent the limitations of polite society around one’s behavior. But he could have a brain tumor. What do I know? It turns out, the following…

He decided to start the antisemitic and anti-black racism stuff in even more loudly and finally it was too much for most people.

Crucially, in my mind, the pontificating about the ways in which this person is or is not unwell in this way leaves out a crucial assessment we are all equipped to make:

Kayne West is an Assh*le.

The word is defined thusly:

So as you can see from the definition, Mr. West is indisputably irritating and, to many, contemptible. You can see this is extremely consistent with the definition of the term racist:

Mr. West is prejudiced against, and demonstrably antagonistic towards marginalized people. That’s what a “white lives matter T-shirt” is. It’s a clothing choice of antagonism. It’s racial animus as a fashion choice. It almost doesn’t matter who! Mr. West seems hell bent to deploy nastiness against anyone who is marginalized. He’s even willing to go to bat against himself as a black man. That doesn’t make him not a racist. It does make him a huge Assh*le—who happens to also be a racist. And because we didn’t believe it with the white lives matter T-shirt, he made it perfectly clear with the antisemitic comments. Thank you, Ye, for clearing up any misunderstanding.

To be extremely dense, this is not what the diagnosis of bipolar mania describes. These are not symptoms of bipolar disorder. Bipolar disorder leaves an individual— and often their love ones —suffering with both episodes of depression and mania. The depression looks very similar to anyone else’s depression.¹

As a public service, I will now provide a quick reference to the symptoms of the psychiatric illness that is mania in bipolar disorder:

• Feeling very up, high, elated, or extremely irritable or touchy

• Feeling jumpy or wired, more active than usual

• Decreased need for sleep

• Talking fast about a lot of different things (“flight of ideas”)

• Racing thoughts

• Feeling able to do many things at once without getting tired

• Excessive appetite for food, drinking, sex, or other pleasurable activities

• Feeling unusually important, talented, or powerful

Astute observers will realize very quickly that the above symptoms can combine in a particularly explosive way with actually being unusually important, talented, and powerful. Furthermore, the lack of impulse control that comes with an acute phase of this illness can be difficult for everyone else. If the impulsive individual happens to be an assh*le.

There is no requirement in the above symptoms for a person to be mean or nasty. Often times people with bipolar disorder have ideas that are actually pretty good, visionary, etc., they’re often just too impaired to be able to meaningfully execute on them. Some of these ideas become far-fetched or detached from reality. But many people with bipolar disorder, even in the most ill state, are a joy to be around (for a little while). It’s not fun to have to deal with, or to help a person get back to the much more productive and less combustible life they left behind when their illness grabbed a hold of the reigns. But there is an infectious quality to joy and euphoria, even if it goes too far.

People don’t feel the same Contagious euphoria around assholes. Kind people, people who aren’t assh*les, can have symptoms of mania and go out of their way to do unbelievably kind things that they really shouldn’t do. They will give away all their money. They embark on charitable, if ill faded attempts, to save the world. Mr. West appears trying to prioritize his world. He wants to build an entire city for ass*les.

Racism is usually under some degree of “tonic inhibitory control” by social factors. Most people, fear of the social disapproval that comes from naked hate mongering is enough to at least dress it up like Tucker Carlson. Given the boundless energy from the acute phase of mania, individuals with underlying racist ideology are more able to express those ideas freely. More energy, more grandiosity, more terrible ideas? It’s like a recipe for disagreeable and contemptible people, who enjoy antagonizing marginalized groups to really make a mess of things. But it’s not because of their illness. It’s because they’re not nice in the first place. And one of the really useful checks on this is taking a look at whatage of illness. If people do things that are horrible or embarrassing__which happens regularly in bipolar mania—afterwards they often feel quite ashamed. Particularly if they’re nice people! After an an episode, in which someone does something awful, we can see if people do tasks like:

• Apologize

• Make amends

• Express guilt or shame

• Take steps to ensure the recurrence of the bad behavior

Kanye West. He’s a lot of things. But one of them, that I hope we can now put to rest as an issue of argument, is certainly that he’s a huge assh*le. His behavior is frankly pretty insulting to those of us who actually are nice people, or try to be, and struggle with the symptoms of bipolar disorder, which sometimes have us behaving in ways we’d rather not. People working on their recovery make amends. They make massive changes in their life to not create suffering and others. They apologized to friends and family— often more than one strictly speaking be helpful. I don’t see any of this from Mr. West. We have an extremely long track record with which Mr. West could have expressed kindness for his fellow humans. It is largely absent.

Yeezus, what an Assh*le.

But he’s been a dysregulated one.

The important takeaway is not that rather obvious observation.

There is a path that leads back from the abyss. When hurt, or hurting, it’s really common for people to say outrageous, or hurtful things. It’s common for them to do hurtful things. All sorts of things can happen when people are really suffering and literally loose the ability to control themselves.

On the other side of that journey is a bridge back to goodness. The great news is that bridge is always open to us. There is only one toll.

The bridge asks us to be accountable. That means owning the hurt we cause. It means making meaningful amends beyond a performance. Kanye is a brilliant wordsmith, and so I’m going to suggest some really simple words he can use later. “I’m sorry.”

In fact, we can even reference other rappers, who have nailed this concept:

“I’m sorry Ms Jackson,

I am for real.

Never meant to make your daughter cry,

I apologize a million times”

—Outkast

You can even make a hit song out of it. I’ve had to apologize a lot in my life. And for all the mistakes I’ve made, I spend most of my time working to help make a world better. A place where feeling understood and cared for can be real for everyone. For those with Bipolar Disorder, it also means working together with your treatment team if you have an illness, like bipolar disorder, to get well and stay well. Even when it’s hard. I have endured a lot of side effects and made a lot of apologies for understandings and misunderstandings.

We have to acknowledge that marginalized people get the brunt of awfulness. If that wasn’t the case, what Kanye says or did wouldn’t be provocative or harmful. So, just in case, Kayne reads this, or anybody else who needs to take accountability, I present this helpful Guide²:

• Acknowledge one’s responsibility for one’s actions

• Acknowledge the impact of one’s actions on others

• Express genuine remorse

• Taking actions to repair the harm to the degree possible

• No longer committing similar harm

—O. Scott Muir, M.D.

1. but often it’s a little bit worse or a lot worse, and shorter lasting than unipolar depression.

2. This borrowed from Danielle Sered