Describing and understanding the situation isn't making excuses. Folks shouldn't conflate the two. But you should probably note that mental illness and insanity are actual legal defenses used in our legal system sometimes and are much more of an "excuse" (he is just off his meds!) than noting aspects that match an intentional performance. I'm pointing toward accountability in terms of likelihood of actual deliberation on how to amplify the antiemetic message.
It is easy to accept "he is just off his meds" and then ignore what he is doing and how it fits with what else is going on in the world.
Accepting intention and deliberation leads me to consider why he is doing this now. I imagine Kanye is mostly just a pawn but it I'm not convinced it is a coincidence that his episode is occurring at the same time as Trump's announcement to run again and Elon taking over twitter. It is very possible his messages and methods are resonating on the darker side of the right and with some in the black community. Antisemitism was a huge part of the America First movement in the 40s, and when combined with Christian nationalism (the Christian Front) and propaganda (Father Coughlin, senators Lundeen, Nye, etc.). I think antisemitism has potential to again be a powerful current within today's GOP base.
A further step into the rabbit hole could also point out a more national intention to try and split groups that have traditionally been aligned politically in the US - blacks and jews. This could allow the right to carve off a slice. We know the right has been somewhat successful at carving off a piece of the hispanic vote to a certain extent, and I believe the potential exists that this may be part of an attempt to do the same with the black vote.