Fear and Loathing

Rakesh Agrawal’s explosive departure from PayPal and subsequent tweetstorm illuminates deep fractures in our framework for handling mental health issues

About 2 weeks ago, tech bloggers had a field day with ex-PayPal exec Rakesh Agrawal’s colleague-bashing spree on Twitter. The apparently alcohol-fueled tirade (which has since disappeared from Agrawal’s feed), published by Agrawal late on Friday, May 2 while he was at the New Orleans Jazz Festival, is full of incoherent statements and insults directed at his former co-workers. The following morning, Agrawal claimed that he meant for the tweets to be direct messages to a friend, blaming his newly-acquired Android phone’s keyboard and Twitter interface. He sent an apology tweet to PayPal president David Marcus, who was evidently not impressed. Though Agrawal had recently put in his two weeks’ notice with PayPal, Marcus chose to terminate his employment immediately and posted a memo condemning the behavior on PayPal’s website.

Most readers were quick to write Agrawal off as a drunken idiot who lacks basic self-control. I include myself in this group. The events which have since transpired indicate that, perhaps, the reality of the situation is not quite that simple.

Over the course of the next couple of days, Agrawal went on an intense Twitter bender, tweeting about everything from his new venture (ostensibly, the one for which he left PayPal) to the battery life on his phone. Quite possibly the most unusual of these were employment offers — in which the fresh hires could pick their own salary from a range determined by Agrawal — to people on Twitter who could, for example, explain pictures Agrawal posted to his feed. At least according to the former exec’s feed, a lucky few did successfully acquire employment through these unconventional channels. Those familiar with the symptoms of bipolar disorder probably suspected from these tweets that, in fact, Agrawal might be experiencing a textbook manic episode (note: I am not a mental health professional). Sleep deprivation. Delusions of grandeur. Excessive optimism. Impulsiveness. And many did notice, including Agrawal’s former boss: at the close of his otherwise critical post on PayPal’s website, David Marcus expressed concern for Agrawal’s mental well-being, suggesting that close friends and family members reach out to help him. Others were less diplomatic, treating Agrawal’s distressed condition with levity or mockery.

A sleep-deprived Agrawal on the Monday following the Twitter incident

It wasn't just that many people failed to recognize that Agrawal was not well. It’s that most who did reacted with hostility. If Agrawal had tweeted that he’d been diagnosed with cancer, there would have instead been an outpouring of sympathy, because generally speaking, society does not tolerate belittling those with physical ailments. Yet, mental diseases and disabilities, which are just as legitimate, diagnosable, and out of the sufferer’s control as physical ones, do not receive the same consideration. The difference is that mental disease often manifests as socially unacceptable behaviors, and socially unacceptable behaviors make people uncomfortable. And this is not entirely unreasonable — in some cases, behaviors induced by mental illness can be highly disturbing and even frightening. As humans, we are wont to attack and ostracize that which we don’t understand, rather than attempt to enlighten ourselves. We need look no further than the suppression of scientific endeavor during Europe’s Dark Ages or the gross injustices committed during the Salem Witch Trials for examples of this particular tendency. Note that in both of these instances, the effects of ignorance were devastating to particular individuals in those societies, not to mention the societies as a whole.

Ignorance about mental illness is no different. First and foremost, stigmatizing those dealing with something which is entirely beyond their control and often entirely overwhelming, thereby imparting further difficulty on an already hard situation (to see just how hard it can be, read Allie Brosh’s post on dealing with depression, and note how other people’s reactions worsened her situation), is simply wrong on an ethical level — the fact that mental illness makes the observer uncomfortable is a paltry excuse. When sufferers are targeted with ridicule rather than support, they are more likely to isolate themselves and engage in self-destructive behaviors and less likely to seek professional help. According to a survey on hunger and homelessness conducted in 2008, approximately 26% of single homeless people suffered from severe mental illness, compared to just 6% in the general population. The difference is statistically significant. It’s really not that surprising that people who don’t have a reliable support network — family, close friends — are more likely to, say, lose their job or develop a drug addiction when they contract a serious mental condition. Furthermore, professional counseling and medicine is prohibitively expensive for those who lack health insurance. The onset of a disease like schizophrenia is often the catalyst to homelessness for someone who is already struggling financially.

Chart from The United States Conference of Mayors Hunger and Homelessness Survey, showing high incidence of severe mental illness in homeless persons (2008)

For the well-connected and well-off Agrawal, the possibility of homelessness is unlikely to become reality, and whether he actually suffers from bipolar disorder is somewhat beside the point (although his behavioral patterns certainly fit the definition, and he should certainly be evaluated by a professional). Jokes about people who suffer from Down syndrome and pejorative use of words like “retarded” (fortunately, there is a movement to end the same) are still rampant. Words such as “bipolar” and “schizophrenic” are used too casually and — more often than not — entirely incorrectly, revealing both ignorance and insensitivity to those who struggle with these serious conditions. I am sad to admit that, at one point, I was once guilty of all these transgressions. But as a society, we can’t continue to ignore the negative impact that our collective ignorance about mental health problems has on those who unwillingly experience them. Remember, ignorance has very real consequences: crippling sufferers’ self-esteem and well-being, destabilizing social groups and destroying families, and fueling our severe homelessness problem.

In an age of constant and ubiquitous access to the Web, ignorance is completely inexcusable. While some of the problems mentioned in this article — such as ensuring affordable access to psychiatrists and medicine for impoverished individuals — are truly difficult to surmount, we are hardly powerless. The obvious first step in alleviating the negative impact of mental health ignorance is educating ourselves. We don’t need read the DSM from cover to cover. Simply reading the Wikipedia pages of the most prevalent mental disorders and familiarizing oneself with their general symptoms clears an enormous hurdle which defines the current state of collective ignorance; being able to recognize and understand the manifestation of a mental disorder reduces the odds that we’ll react to it with fear, confusion, or hostility. And it’s never too early to begin this education. Emphasizing mental health in middle school health classes rather than occupying a large portion of the curriculum with the stigmatization of soft drugs like marijuana — which is an exercise in futility anyway — would also be an effective means of achieving this goal. Ignorance drives stigmatization; enlightenment dispels it. We must actively work at changing our attitude toward mental health problems, particularly as is reflected in the media we consume and produce. Think before you tweet.

Flyer for the R-Word Campaign

If you notice that a friend or acquaintance is behaving unusually or consistently with a particular mental illness, resist the temptation to do nothing, or worse, exacerbate the problem by reacting as many of Agrawal’s followers on Twitter did. Would you do nothing if you noticed that, for example, a coworker came into work with worsening skin lesions every day for a week? Would you make fun of them rather than advising that they seek help? I would hope that your answer is “no”. Reach out and diplomatically express your concern. Offer to take them to lunch and provide a listening ear. If you are not close with the person, try to get in touch with someone who is, if at all possible. Remember that you might be saving them from prolonged suffering, homelessness or — in extreme cases — even suicide.

Mental health, like physical health, is inextricably tied to both our healthcare system and the social framework which we construct around it. Currently, our framework for mental health is significantly more flawed than that for physical health, and our healthcare system is flawed in general. While our ability to address the latter issue is generally limited on an individual level, we can certainly change how we treat the issue of mental health problems as individuals. We have a responsibility toward our fellow human beings that ultimately impacts all of us, and we have no excuse for shirking it. Let’s not shrink back in fear and loathing.