On Thursday, October 3, I was sitting in a doctor’s office, idly checking Twitter while I waited for my name to be called. No matter what you’re there for, going to the doctor is always a vulnerable place to be — you’re temporarily removed from all your usual stimulations and distractions, sitting among fellow humans who are all there because their bodies or minds are clamoring for attention. You can’t be cool in a doctor’s office; there is no irony in a doctor’s office. It was in that setting that I saw the tweet.

The tweet, from Miley Ray Destiny Hope Cyrus, one of the most ever-present and controversial figures of 2013, was in response to Sinead O’Connor, who had penned a passionate (if not a little projectional) but ultimately respectful open letter to the singer about what she had perceived as Cyrus letting “the music industry make a prostitute of [her].” The letter was partially in response to Miley’s comments that O’Connor had been an influence for her megaviral “Wrecking Ball” video. Regardless of whether you agree with O’Connor’s sentiment (I both did and didn’t), she was coming from a place of experience: Her belief in her convictions came not only from being a witness to Miley’s exploits in the last year, but from her own personal trials in the music industry. Sinead wrote over 1,000 words to Miley. Miley was not obligated to respond at all, but she made the decision to tweet five words back to Sinead, not including eight screen-grabbed tweets of Sinead’s from 2012, during one of several public cries for help the singer has made over social media during her battles with depression. Miley’s rebuttal was swift and to the point: “This woman is mentally ill, and therefore worthy of mockery.”

I remember feeling my pulse rise as I sat there in the office under a TV playing soothing Muzak and images of waterfalls. I had spent much of the past few months championing Miley on this very website, defending her right to dance and twerk and represent herself however she wanted. Her detractors, as well as those not paying very close attention, had often accused Miley herself of being mentally unsound, as if that were the only thing that could explain why a woman in her early twenties would want to present herself as anything besides another chastely sexy Disney Channel graduate. And yet here she was, using Amanda Bynes, a woman with a similar background as hers who had been placed under a 5150 hold in July and formally diagnosed as schizophrenic and bipolar just days earlier, as a punchline to hurt another woman who has attempted suicide at least twice.

I realized I was choking up, because Miley’s tweet wasn’t just a slap to Sinead and Amanda’s face. It was a slap to my face, and to more than a few of my friends’ faces, a slap to her self-proclaimed hero Britney Spears, and to some of the most important artists in history.

Mental imbalance has always been an key ingredient in pop culture, but 2013 was one of those years in which it came to the forefront in a way that forced us to reevaluate our attitude toward it. Bynes was one of the handful of high-profile diagnosed cases, but erratic behavior and/or performance was everywhere you looked these days, from Lady Gaga’s histrionic feud with Perez Hilton to Eminem’s caustic return to the spotlight to pretty much everything Shia LaBeouf did. You can basically file all these instances under two columns: behavior that informed or supported an artist’s work, and behavior that hindered it. Even then, where that line exists varies wildly depending on who you ask.

Muddling the issue this year even further was the degree to which contemporary conceptual art began to show its influence in some of the biggest pop acts in the world. There are a plethora of sociological and economic factors behind that, but the end result is that the pop world began to take on an aesthetic that, to a mainstream audience, could easily read as madness. Gaga cuddled with a crystal (link NSFW). Lana Del Rey made an unapologetically weird short film. Hip-hop dove headfirst into surrealism, with the help of the languid, abstract beats of Mike Will Made It. We’re beyond the mid-aughts explosion of wacky, conceptual outfits being relegated to the red carpet. Now they’re bleeding into the music, and strange has nearly eclipsed sexy as the ideal to strive for. It seemed as if anytime we weren’t being hammered over the head with the latest chart-topping EDM track, we were sitting in the corner, staring into space, contemplating the void. Pop music was no longer just a question of either being fun or a failure. There was a delightfully squishy gray area opening up in between.

If any work was at the forefront of the art-and-pop marriage, it was, well, Artpop, the embattled third studio album from Lady Gaga. It’s easy to argue that Gaga was first to the weirdness buffet when she burst onto the scene in 2008, wheeling herself onto the VMA stage to perform “Paparazzi.” Her debut album was titled The Fame; five years later, she’s embracing her inner washed-up, deluded former star through the amassed work of performance art that encompasses Artpop and all its promotion. I’m of the belief that Gaga’s pre-Artpop Twitter mania, including the Perez feud, was part and parcel of said performance. On social media Gaga was cagey, paranoid, defensive, and histrionic; the music had a rickety, highly silly, free-associative “let’s put on a show!” feeling to it. There’s something startling about a 27-year-old pop star singing in an old Broadway-dame voice about how hungry she is for approval, and I grew to appreciate “Applause” for its unflattering-yet-danceable bluntness (despite the worst single lyric in pop in 2013). It’s not intended to be pretty or cool or slick, it’s all variations on a theme of desperation. The subtext of “Applause” is that Gaga “lives for the way we scream and cheer for her” the way an addict does, because something else is missing from her life. It almost completed the thematic circle when Artpop failed to sell.

If Gaga was the art-pop priestess of 2013, Kanye West was the art-rap’lic priest, building up his holy mountain of unchecked ego to see how tall it could get before it avalanched. Yeezus was an album whose prickly, shrunken heart took a good couple of months for me to warm up to, but once I did I deeply appreciated it for what countless year-end listmakers awarding it their no. 1 spot have called it: an unedited window into an at times unspeakably troubled mind — that also happened to contain some of the most raw, heart-rattling sounds of the year. The more Kanye said he was a god, the more it seemed to come true, simply because he had the gall and artistic curiosity to see what it would feel like to say it out loud. This, of course, looks like and possibly is a flaming case of narcissistic personality disorder, and anyone who has spent a good amount of time with Yeezus — or had the chance to see his eponymous tour — knows that giving a voice to every ugly, deviant, self-inflating thought in his head only helped them multiply. Kanye’s digging into the flaws of his mental state, and if you want to experience the album properly you have to be there digging right alongside him. I think both his fans and detractors would like to see Kanye find some peace at some point, but him publicly excavating his id — through his album, through his bonkers music videos, through his bombastic interviews — has been one of the more valuable cultural experiences of 2013.

We’re not comfortable with celebrities addressing the fact that they want to be powerful, or famous, or godlike, and all the emotional or psychological baggage those manic desires imply. We’re not comfortable with failure, or someone looking ridiculous — we’re unable to let it sit for more than five seconds before slapping a “rock bottom” label on it. Seeing an artist perform unconventionally and get punished for it is a national pastime, even though the necessity of unconventionality in any art is so much a fact as to be a cliché.

In the days after the initial Miley-Sinead blowup, Sinead penned several more letters and gave multiple interviews to further articulate her dismay at Miley’s reaction. Of course, if you weren’t reading them, all you saw was the headline “SINEAD WRITES FOURTH LETTER TO MILEY” and the attendant crazy that seemed to drip from those words. Sinead looked insane for continuing to respond, Miley looked cool and busy for barely giving her the time of day.

In an interview with Time, Sinead, somewhat optimistically, suggested that the incident had opened up an honest dialogue about mental health, and then went in on the mental-illness-shaming culture of celebrity media:

There’s a dreadful practice in this country going on at the moment, which is a complete breach of human and civil rights, of paparazzi lynching — that’s what I call it — young celebrities, young female celebrities, whether it’s Britney or Amanda Bynes or Lindsay Lohan or anyone who has either been diagnosed with an illness or is perceived by people to have a mental illness, and lynching them in the streets, trying to get photos of them looking like they’re having breakdowns, taking these pictures, selling them for tons of money to the newspapers with derogatory words written under them about mental illness and about these women, and making a buffoonery and a mockery of them … Unfortunately there’s such a stigma about mental illness or perceived mental illness that people are bullied and treated like shit and the illnesses are used as something with which to beat people, and in a manner than [sic] a physical illness wouldn’t be.

Amanda Bynes was committed to a psychiatric hospital in July after more than a year of increasingly strange behavior, including a string of car accidents in 2012. When “Weird Amanda” first started creeping into headlines, most reports seemed to barely be able to conceal their giggles, and “The Amanda Show” — Bynes’s sketch-comedy show from her Nickelodeon days — took on a new meaning as we waited, bemused, morbidly curious to see what bizarre new selfies and Drake-baiting tweets the fallen child star would release next. Our entertainment came first, her welfare came second. It was only in the summer, as things rapidly escalated and it was clear to even the most casual spectator that Bynes was seriously unwell, that we had to force ourselves to stop laughing.

Or at least, most of us did.

Miley was 14 and approaching the height of her Hannah Montana fame when Britney Spears, a woman she has often referred to as her idol and with whom she collaborated for a track on her album Bangerz, attacked a paparazzo with an umbrella. Maybe she was too young to process what was going on, maybe she never saw Britney strapped to a gurney, maybe nobody explained to her what a conservatorship was. Or maybe she chose not to integrate those historical facts into her appreciation of her hero because of how it gobs up the original narrative of high-functioning, teenage dream Britney circa 1999. I always thought Britney’s struggles were one of the things that has made her a sympathetic, compelling character. Experiencing her successes and disappointments was one of those pop-cultural sagas that built up our capacity for empathy, something it’s hard to have too much of.

The tabloids may scream that Miley’s “finally breaking down,” but an hour watching her recent MTV documentary/advertisement Miley: The Movement only served as evidence for how incredibly sane she is. We see her stress about Billboard charts and record sales, not her emotional or artistic life. The girl who made a nation clutch their pearls while grinding against Robin Thicke may just be the most traditional female pop star currently on the charts. And that’s great — she’s lucky to not be bipolar or schizophrenic or clinically depressed. Plenty of interesting, successful artists aren’t. But you can’t be an artist and hate on crazy. Crazy is what makes our creative world go ’round, and that’s been especially true this year. And I, for one, can’t wait to see Amanda Bynes’s first clothing line.