That's not all that ridiculous, or overly cynical. In fact it would make a lot of sense. It would be similar to a caregiver suffering from Munchausen by Proxy. But instead of hurting others for attention and/or sympathy, it's done to oneself. That, however, wouldn't make it any less serious or tragic. Regardless of the motive, the thought process that eventuates in self harm, for whatever reason, is torturous...
We need to remember that the terms "mental illness" or "mental health" cover an extremely broad spectrum...
One individual is "socially awkward", another needs to wash their hands twenty times a day, and another hears voices telling them to kill their family...
They all fall under the umbrella of mental illness.
And that's only a small section of the spectrum. There are cases that span further to each edge of it.
It's not like being pregnant, where you either are or you're not. Mental health isn't definitive. Where and when, does a human behaviour go from a slight variation to a psychological issue? Some psychological conditions afford people extraordinary talents or abilities, whilst they can't perform the simplest of tasks, like tying their shoelaces. So when does the condition go from being an advantage to a disadvantage? And who decides?
Is sadness the same as depression? Is a bad temper, psychotic behaviour? When does a fear become a phobia? When does lethargy become CFS? Is your conscience merely a mild form of schizophrenia? We still don't know with any certainty. Don't forget, Homosexuality was once considered a "curable" mental condition. We're always learning...
So whatever has happened to James, whatever people think of him. He's arrived at a difficult and painful destination, regardless of the journey that got him there...