"If someone remains in the hospital [after an event like this] it may just mean that they need to be in the hospital that long to get well," Dr. Jody M. Rawles, a psychiatrist and the Vice Chair of Clinical Affairs in the psychiatry department at the University of California-Irvine, told Billboard. Dr. Rawles, who has no first-hand knowledge of the situation and has not treated West in the past, said when his team admits someone under similar circumstances they will keep them in the hospital as long as is necessary, but not a day longer, because staying in a hospital environment for too long can be detrimental to a patient's health.
"Physical exhaustion and sleep deprivation can lead to erratic, psychotic and paranoid thinking and many performers and other professionals -- and our society in general -- don't get enough sleep," he added. "Certainly someone who has a lot of pressure to perform, present [their art], do interviews and be seen can feel a lot of pressure. If the alleged reason for admission is dehydration and exhaustion, part of keeping someone hospitalized for a longer period is to figure out if that is all that's going on.
The hospitalization came after a bizarre series of incidents involving the hip-hop superstar, including rants endorsing President-elect Donald Trump, calling out Beyonce and Jay Z, cutting a concert short, canceling the remainder of his Saint Pablo Tour, and posting 99 fashion catalog images on his previously spare Instagram feed in the hours before he was transported to the hospital.
The emergency hospitalization brings to mind similar incidents involving two other pop stars who exhibited bizarre or troubling behavior before -- in their cases -- being placed under what's commonly known as a "5150 hold," or involuntary psychiatric hold. In January 2008, Britney Spears was hospitalized on a 5150 after a series of erratic incidents and placed under a temporary conservatorship that put her day to day affairs in the hands of her father, and which continues to this day. And, in July 2013, former child actress Amanda Bynes was put on a 72-hour 5150 hold after setting a fire in a stranger's driveway; that hold was eventually extended for several months, after which Bynes was moved to a residential facility for further treatment.
Bynes' mother was also granted a temporary consevatorship over her daughter's affairs. Both appear to have taken to the treatment they received -- though neither have spoken publicly about what ailed them at the time. Spears went on to resume her career, while Bynes has lived quietly and not returned to the spotlight.
"If this were an isolated incident and there was no other evidence of anything happening before -- certainly someone who is sleep deprived can get into an altered state of reality," Rusty Selix, a California lawyer, mental health advocate and director of policy and advocacy at the California Council of Community Mental Health Agencies told Billboard. Selix -- who is not a physician and also has no first-hand knowledge of the West case, but who consults with a number of California mental health non-profit agencies -- said Kim Kardashian's alleged comments about various medications could indicate an underlying mental illness.
"Sleep deprivation alone is very severe and can cause all kinds of conditions... and when someone gets into a manic phase where they don't sleep for days they can get a powerful high from that manic energy and then crash," he said. "From the comments made by his wife there seems to be an awareness that there is a mental illness involved that it has to be managed and they likely don't want to talk about it because it's a highly stigmatized [thing]. But once an incident like this happens things might go the other way and you get sympathy and empathy as opposed to when there's no mental health component and it's much harder to explain."
West's Saint Pablo Tour, which had the rapper performing solo on a floating platform that flew over the crowd, kicked off on Aug. 25 in Indianapolis and had the rapper performing every or every other night for September and October before its final 21 dates were canceled at a refund cost estimated by Billboard to be $27.3 million on a tour that had grossed $34.5 million according to Billboard Boxscore (based on the 26 dates reported at the time). Before pulling the plug on the 22 dates that need refunding, West played 40 shows in 86 days.
If there are other issues that factored into West's hospitalization, Rawles said doctors need to eliminate those factors if possible and see how the patient reacts once they are stabilized and the right medication mix is administered. "That might explain why longer hospitalization is required," he postulated. "If you are starting a new medication you want to keep that person in the hospital for a day or two to make sure they are not having any side effects and you have the right dose."
West's week-plus stay is not that unusual in Rawles' experience, but because of the star's notoriety and the public fashion in which it played out, an undue focus might be placed on the length of his hospitalization so far. "It's not unusual to have someone in the hospital for 14 days for a condition like this," he said. "Just to make sure everything is okay, they are getting adequate sleep and are starting their medication."
The good news is that hospitals are protected environments where someone like West can feel safely out of the usual glare of the cameras. In fact, though patients often complain, at Rawles' facility patients have no access to their smart phones or computers for protective reasons. "If you're not in your right mind and you have access to your phone you can tweet something that could damage your reputation or make business decisions that could be harmful," he said.