Sharing Public Breakdowns: What We Can Learn From Jason Russell

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San Diego police recognized that the Invisible Children founder's episode this week was not a criminal one. Why have most of us ignored that?

Jason Russell during a recent interview about Kony2012 Screenshot

Some responses to Jason Russell's detention by San Diego police this week, after the co-founder of the charity Invisible Children was found ranting and raving in the street in a state of undress, betray an insensitivity to the nature and frequency of brain diseases. Russell's nude fit was no mere "meltdown" as Slate political writer David Weigel describes it. This is not an office temper tantrum. Much of this tasteless commentary is searchable on Twitter via the hashtag #Horny2012, chosen to mock the witness reports of "public masturbation." Russell's Kony2012 video inspired young people toward a higher cause, and in an instant he's become the subject of base, juvenile name calling on his Facebook page. But this type of involuntary behavior is no Paul Reubens moment.

Just as we recognize that it's abhorrent for roommates to record the private sexual activity of gay teens in their dorms, we must cultivate societal norms around the recording of acute medical events.

Based on my read of the reporting out Friday and after viewing TMZ's video -- and this is only one brain injury physician's reading -- it is highly unlikely that Jason Russell's behaviors in the streets of San Diego on Thursday March 15th were intentional. It is much more likely that he was experiencing a psychotic episode -- a manic state -- an event as recognizable to some clinicians as a heart attack. There are many possible endogenous or exogenous causes for such behaviors beyond a "purely" mental illness such as Bipolar Disorder (antibodies to certain regions of the brain, for example, or LSD), and these will have to be ruled out by Russell's doctors. Depending on his medical and psychological history and any other symptoms he may be exhibiting, numerous lab tests and studies could be necessary to determine his diagnosis and treatment.

Whatever the diagnosis, it should not "shred" Russell's reputation, as Weigel asserts. This was not willful. A similar episode may never happen again. The spell was clearly of an episodic nature as Russell's usual public comportment suggests. Some on Twitter are starting to point out the atypically high-energy or hypomanic features of Russell's public persona as a human rights advocate, and are speculating about Bipolar Disorder in particular. Bipolar may well be the diagnosis, but it is a condition shared by many high-functioning CEOs, scientists, lawyers, writers, etc.

The revival of the 1960 play The Best Man, now on Broadway, features a Secretary of State (played pitch perfectly by John Larroquette) who suffered from a depressive "breakdown" in his past and now faces down rumors about the period while he's in the running for his party's presidential nomination. We are still condemning good people for no reason. Maybe more of us need to see Gore Vidal's play.

I do think that by now Russell's doctors will have ruled out the unlikely explanation offered by Invisible Children on Friday: "exhaustion, dehydration, and malnutrition." Mild metabolic disturbances can result in some unpredictable behaviors in already medically and cognitively fragile people, but Russell doesn't fit that description to my knowledge. While running about in the street nude and ranting might have been attributable to exhaustion a few decades ago, I think his medical team will be able to do better than that.

Events like this -- spells of altered mental status accompanied by odd, violent, or lewd behaviors and incoherent or illogical speech -- occur with startling frequency in the general population, though rarely to a public figure while in the midst of navigating one of the most successful publicity campaigns ever seen while simultaneously defending himself and his organization from an onslaught of armchair criticism. These episodes are handled quietly and routinely in ERs across the country. Many police departments train their officers to recognize some of the basic features of psychotic episodes so that people are not inappropriately arrested. From the reported accounts, it appears that, in communicating with Russell on Thursday, San Diego police recognized features consistent with just such a brain problem, not a criminal problem. Good for them.

As for the rest of us, we can and should do better. With all the celebrity illnesses they uncover, the folks at TMZ should have known the minute they viewed the Russell video that he was not in his right mind. It should be beyond the pale in civil society to videotape and publicly ridicule people who are in the throes of an uncontrollable disease process. TMZ should take down its video.

Here's where a public education campaign the likes of Kony2012 could do good for millions of Americans. Just as we recognize that it's abhorrent for roommates to record and share the private sexual activity of gay teens in their dorm rooms, we must cultivate societal norms around the recording and displaying of acute medical events like the one experienced by Russell. There will always be a lowest common denominator out there to vandalize and to ridicule, to record and to Tweet for cruelty's sake. I only hope that most of us can cultivate a sensitivity to the fact that any of us could drop to the floor and convulse with a seizure, or appear stark raving mad in the street after a stroke, or suffer an episode of psychosis as the sentinel sign of a tumor. I will expect that our media institutions not display these events for the world to see.

I do hope Russell will choose to share his story. Perhaps he could help improve public sensitivity about brain diseases as much as he's hoped to increase public awareness of Joseph Kony.

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Ford Vox, MD, is a physician based in Atlanta, who specializes in caring for people with complex brain injuries. He has written for Newsweek, Slate, and the Los Angeles Times.

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