So I finally sorted out what happened to my brain | Hacker News Reader

So I finally sorted out what happened to my brain

twitter.com

394 pointsronyfadel289 comments

This reads out exactly how a manic or hypomanic person would experience things and rationalize past events and feelings. The idea that it has to be something complex and in a sense grandiose compared to "just being burned out" is often a very telling sign.

Perhaps it's Twitter forcing the format a little, but I could see myself thinking like this during a hypomanic episode. I'm diagnosed with bipolar disorder (type 2, rapid cycling). I could see a lot of people with undiagnosed behavioral disorders being thrown into a complete mess of a situation with any resemblance of a functional system being thrown out of the door when Covid-19 hit.

I think that would just be a misdiagnosis. Seizures don’t typically accompany manic episodes and not being able to come up with words that are used in everyday situations is also an oddity.

Seizures during a manic or hypomanic episode is very common, it's often what lands undiagnosed people in hospital to begin with. Lamotrigine and Lithium was primarily used to treat epilepsy, now they're also used to treat mood disorders like bipolar disorder and schizophrenia as well.

The problem is often that there are compounding issues. There's nothing that stops you from having TIA at the same time. People often describe being overworked and stressed as burning the candle from both ends. Hypomania can more aptly be described as setting the entire thing on fire.

My post wasn't meant as some form of medical diagnosis, more of an observation from someone that lives with this. The feeling of numbness and having some sort of brain fog is how a lot of people with mood disorders like ADHD and bipolar disorder would describe things.

Do you have any sort of citation for this? I’m not trying to be snarky, I’d really like to read more.

My understanding of the med lit is that bipolar and epilepsy aren’t particularly associated, and pure BD in particular is a rarity - when epileptic patients were assessed for BD symptoms, they were mostly only found in the confusional states pre- and post-seizure, which isn’t BD at all.

At least in my hospital, the most common way we get BD patients hospitalized is either during a severe depressive episode, or when their mania results in violence or law-breaking. We do sometimes have patients land on our floor whose first presentation was seizure, but that’s after they’re assessed by neuro and found that it was pseudoseizure (factitious seizure).

I don't really have anything like that. People diagnosed with bipolar disorder in Norway are given the opportunity to attend a six months intensive and in-depth group therapy where the primary focus is to learn about the disorder by psychiatrists that specialize in bipolar disorder. I've always taken what they said at face value. At least a couple in the group was first admitted after having had a seizure during a manic episode.

I think you're right in that we don't think they are directly associated. I was more trying to explain that people might experience something that looks like a seizure without having epilepsy. And that medication (previously, mostly) used to treat epilepsy seemingly have great effect on people that suffer from bipolar disorder, which would lead us to believe that there are some neurological similarities.

And you're right, the most common way to end up in the hospital is from having a manic episode with all that it usually entails. I shouldn't have written it was often the reason, just one of many reasons people might end up in the hospital from mood disorders.

Maybe serotonin syndrome? That causes seizure like stuff and mania.

Serotonin syndrome is due to an excess of serotonin almost exclusively due to serotonin agonists. Seizure is pretty rare - it produces stuff that looks like seizure (myoclonus, tremor, delirium), but actual seizure is only seen in SS so severe that it’s usually fatal.

Unrelated but have you seen our friend TedPetrou recently? He seems to have gone quiet.

May be more common than you think (or perhaps you are a doctor with more recent info than I have, in which case I would love to read about it.)

https://www.health.harvard.edu/newsletter_article/Epilepsy_a...

> Psychiatric symptoms may also resemble epilepsy, and in that case they are sometimes called psychogenic seizures or nonepileptic seizures. Conversion disorder (formerly called hysterical conversion disorder) can produce symptoms that look uncannily like generalized seizures but actually occur in connection with a need for attention or relief from stress that the patient is not aware of.

I don’t think OP is claiming he experienced seizures, rather he’s using the “thrown out back” metaphor to explain what he felt when he attempted to work — that is, a re-triggering of the initial symptoms.

> T his reads out exactly how a manic or hypomanic person would experience things and rationalize past events and feelings. The idea that it has to be something complex and in a sense grandiose compared to "just being burned out" is often a very telling sign.

Bingo. FND is another name for “conversion disorder.”

This sounds exactly like a psychotic break to me. I had a massive one and it started with a pop in my mind followed by half a year of similar symptoms. In the end, I was diagnosed Bipolar type—1.

Some people often ask, the story is here: https://kayode.co/blog/4106/living-with-psychosis/

I experienced something like this in my early twenties. It was very scary. I was fully incapacitated for two weeks where I couldn't do anything or make decisions, even play games, and I couldn't touch code for months.

I pushed myself too hard with too little sleep and that was combined with pressure from family.

There was a feeling in my mind of something snapping and it was like throwing a switch. One minute I was tired but still myself, the next I was incapacitated, delusional, paranoid, unable to sleep or relax or focus.

Have you recovered entirely by now? How long did the symptoms last for to get back to normal, did you take other measures to recover or just giving some time and less stress did it for you?

I took lexapro (anti depression drug, ssri class drug). It took about 1 month to be mostly functional again and about six months to be back to normal.

I took all the pressure off, stopped coding but continued university. I still finished the semester with excellent grades - but it was business school.

Never experienced anything like that ever again. I work hard, usually 7 days a week, but I'm careful not to push past my limits and I keep stress down, exercise, sleep well, and try to eat healthyish.

Thanks for sharing the details. Glad you made it through pretty fast, sounds like a valuable experience to know your limits.

That physiological (it seems phy to my lay self) snap at the onset is really interesting.

Is the understanding that it is a TIA/mini stroke?

I don't think so, but I remember the moment it happened. That day I was feeling more stretched and tired than I've ever been. It was the last day of university before spring break. Then my parents started pressuring me over my recently declared non belief in Christianity, and I felt like something in my "spirit", just broke or snapped in that moment. It was clearly defined instant in time where I was completely changed afterwards. I don't remember if it was like a physical pop, but I knew as soon as I felt it that something in my brain had just dramatically changed for the worse.

The words on that webpage were in no way what I was expecting when I clicked on that link.

Do you still experience yourself as a wolf with paws and wind in your fur?

No, but I have developed a different issue with disassociation.

If I’m outside under bright sunlight in an open area, I can sometimes see trees starting to become pixelated. I slowly find myself thinking in a character in a video game. This is somewhat dangerous. Actions in a video game generally has few meaningful little consequences. In the real world, death has a annoying tendency to be rather permanent.

This will sound very stupid or like a joke, but I'm not joking: Maybe if you play (almost) exclusively games with permadeath, where the consequences of dying are bigger, could at least hard-wire some kind of survival instinct in your head in case you get lost in this surreal feeling? In the worst case scenario you played some good games.

I don't think it's stupid or a joke. It's actually a pretty interesting suggestion that may work pretty well under different circumstances. Unfortunately, I haven't been able to focus on video games for a long time. What little energy left after work goes into the continuous maintenance that is life (showering, eating, cleaning). Sometimes I have enough focus left to sacrifice one of those to write stories.

I wonder, what could other people have done differently, so that you'd found help sooner?

What signs could they have reacted to, and then done what, I wonder, in case I meet someone with similar undiagnosed bipolar some day?

Nice sketches -- I wonder, you sketch the avatar (the wolf / wild dog) yourself? Seems like fun.

I’m not going to say this doesn’t sound manic or hypomanic, but “just being burned out” is not an actual explanation.

Being burned out like he’s describing is a physical phenomenon, like many neuropsychological problems. It’d be nice if we advanced the state of our knowledge about these things beyond “just being burned out.” I’m skeptical as well about “burned the glucose out of my brain” being a good physical explanation, but there’s a physical thing going on.

We often treat burnout as an idea thing. (And this somewhat makes sense as ideas are incredibly powerful.) Having more insight into the physical (ie chemical and/or mechanical) mechanism of burnout would be interesting and probably very helpful.

It wasn't supposed to read like that, but I can see how you'd read it like that. It was definitively not meant as a put down to those that suffer from being burned out, whatever the cause might be.

I don't see it close to resembling any kind of manic episode, and the professionals didn't either.

Sounds like somebody worked too much, started having seizures, and burnt out.

I'm not particularly fond of diagnosing people, I think it's part of reducing "bipolar", either through projection or through normality, which it's not, it's miserable.

But I am particularly fond of having companies be responsible for the health of employees, regardless of what it is, or what they need.

Does anyone remember that Reddit post where a guy thought his landlord was sneaking into his apartment and leaving him notes? He insisted the handwriting was completely different. Then a poster suggested he get tested for CO poisoning, which it was, and the “different handwriting” was actually a part of his delusion.

“Burning out all of the glucose and dopamine in your brain” isn’t a thing. “Functional Neurological Disorder” is another name for Conversion Disorder - a condition of apparently neurological symptoms inconsistent with neurological anatomy or mechanisms, triggered (most often) by significant stressors, often suffering a longer duration in patients who strongly believe “this is definitely a physical disease!”

> “Burning out all of the glucose and dopamine in your brain” isn’t a thing.

This sort of narrative-based grandstanding is something the author is previously known for.

His "lol oops I hacked too much" doesn't hold up to scrutiny, otherwise this would be an extremely common thing in overworked knowledge workers. It's not.

I’ve had similar things happen. It’s not uncommon.

It is a physical thing. I’m not sure it’s caused by burning out all the glucose or whatever (as that is short term addressable). Dopamine, that’s possible.

In my case, it was caused I think by not getting enough sleep combined with cognitive load, perhaps exasperated by high sodium, and poor nutrition. Stimulants (such as caffeine, but also Ritalin, adderall, etc) if not carefully moderated both cause you to continue to work beyond the point your brain physically needs rest while also causing a kind of dopamine resistance where you need more stimulant for the same effect.

And you get migraines. In my case, optical migraines (expanding noise/patterns... in your visual cortex, not in your eyeball... that is me with somewhat foggy thinking and a bit of a head ache). A little like seizures but limited to certain parts of the brain. A little like micro-strokes as well as there’s evidence that migraines like that are somewhat vascular in nature in that similar damage is seen (in folks with lots of migraines) as in small strokes. And they seem to happen when combined with high sodium, low water intake, combined with lack of sleep and high cognitive load.

But I wouldn’t be too certain about the causes. It’s hard to tell with these things.

I suspect it has something to do with the glymphatic system (as drinking enough water seems to help as does getting enough sleep).

I’m more careful with my sleep schedule and generally don’t push myself overly hard like in grad school and try not to have too much sodium (eating Ramen—with the packet—triggered one of my episodes) and I really have them only extremely rarely—less than once a year—instead of multiple times a week like in grad school.

Recognizing limits on yourself is important. I think hard work is really wonderful and feels amazing, but you should be careful to sleep enough (7-8, maybe more if you’re recovering from something... I aggressively try to get at least 7 hours every single night), drink enough water, don’t over do it on stimulants, and make sure to eat enough.

There's nothing in your comment to suggest that your constellation of symptoms is in any way related to the constellation of symptoms (or purported underlying cause(s)) in TFA.

He mentions seizures and micro stroke. This isn’t too far off. Qualitatively different effects, so the underlying physical cause could be different, but I wasn’t intending to imply that mine and his effects were identical.

Burnout and stress related disorders are very real, but trying to explain them away as purely physical illnesses isn’t accurate, nor does it help with finding a resolution.

> It is a physical thing. I’m not sure it’s caused by burning out all the glucose or whatever (as that is short term addressable). Dopamine, that’s possible.

No, you don’t simply run out of dopamine, nor can you use it up by thinking too hard. The body is extremely good at keeping the brain fed and stocked with neurotransmitters, even between meals.

This pop-science concept of running out of dopamine isn’t real.

The real problem here is that mental illness still carries too much stigma. Some people are so resistant to accepting a mental health diagnosis and treatment that they will go to great lengths to reframe their problems in physical terms, thereby dodging what they feel (incorrectly) would be an admission of mental weakness.

Even this Tweet author’s doctor diagnosed him with a mental illness, and he even cites the diagnosis from the DSM. However, for some reason he still tries to reframe it as what he calls a “physical” thing.

I don't agree with the OP's interpretation of the organic causes, but:

The PTSD seems quite plausible, as either a consequence of the original phenomenon or, yes, even a factor in it.

For an organic component, if any, I prefer hypoperfusion & ischemia.

I wonder if circulation can be impaired by chronic high levels of stress (and the inflammation caused by stress).

If so, I wonder if this can happen selectively, affecting most strongly the areas used most intensively during stressful times (and receiving the most exposure to high-cortisol blood).

I wonder if narcolepsy and/or something like this may work to protect the brain (from whatever mechanisms) during periods of high stress.

If ketogenic diet helps with narcolepsy, I wonder if one mechanism is that burning glucose is a source of oxidative stress...

> The real problem here is that mental illness still carries too much stigma. Some people are so resistant to accepting a mental health diagnosis and treatment that they will go to great lengths to reframe their problems in physical terms, thereby dodging what they feel (incorrectly) would be an admission of mental weakness.

I feel like suggesting that someone would try to ‘reframe’ their condition to avoid stigma inadvertently perpetuates stigmas by reinforcing the false dichotomy of mental vs physical illness.

Cognition is an extremely complex and poorly understood physical system, but a physical system nonetheless. There’s no separate ethereal plane where consciousness lives, no great uniqueness to its dysfunction. It’s not surprising to me that some people would introduce their own worse pseudoscience when physicians claim their problems are not physical problems, and I think that can happen regardless of stigma.

I believe we would do well to stop cleaving ‘mental illness’ (and, you know, ‘dentistry’) into a separate category from any other physical health problem. These conditions are physical conditions, just with such complexity that we’re not currently able to measure, understand, or treat them with the same level of precision as others. This sucks, but at least it’s honest.

Also odd is that OP uses the term 'seizure' but I think he means 'seized-up', like an engine that wont run. He explictly mentions at one point that the EEG didnt show anything like epilepsy.

But then he says things like "I'd work for 30 minutes, seize, sleep for 2 hours, then work, then seize, then sleep, ad nauseum."

If he was actually having siezures (absence seziures or focal seizures or myoclonic seizures or tonic clonic seizures) then presumably the EEG would have picked that up and he would have been diagnosed with and treated for epilepsy. At least I hope so because Tonic Clonic seizures (for example) can be extremely dangerous if they are uncontrolled.

Anyway I'm glad he has been able to get back to doing things in a way that feels sustainable and enjoyable.

It could be like you said, but poor choice of word if that is the case.

But are you even able to see that someone had a seizure from looking at an EEG after it happened? I was under the impression that it sort of have to be happening while you're measuring.

I've been through multiple rounds of both MRI and EEG, mostly to be able to rule out things like brain damage as a precaution. I'm a little fuzzy on the details as this was done so long ago.

You're correct. Routine EEG (~30 minutes) can capture active seizures and sometimes patterns that might lead you to think someone is predisposed for a seizure. Often patients need long-term monitoring ("LTM") where they are connected to an EEG for several days to tease out the source of their problems.

Yes that's it. But if op was seizing every time he worked for a few hours it would be fairly easy to capture that on an EEG

> Burning out all of the glucose and dopamine in your brain” isn’t a thing

You may be right that it can't happen from overwork--I've never heard of it--but glucose starvation of the brain is very much a thing. That's what hypoglycemia causes. Type 1 diabetic patients get brain fog when they take too much insulin (which causes hypoglycemia). When it's mild, they can tell it's happening and they seek sugar, which fixes the problem very quickly, if temporarily. When it's severe, they lapse into a coma and sometimes die.

If this person's diagnosis was accurate, sucking on a sugar cube would fix it instantly. If that didn't work then the diagnosis is suspect.

AFAIK, when it's mild your brain is not actually starved of glucose at all, and hypoglycemic symptoms (e.g. brain fog) are caused by your endocrine system changing hormone levels (such as cortisol) to "signal" your body that it needs glucose to increase blood sugar levels. If it gets severe enough, then the brain can run out of glucose and the person can die - but AFAIK the body prioritises the brain for fuel above all else, so it really is the last thing to go.

Glucose can be present in blood but the brain can be still unable to consume it due to diabetes (insulin absence) or some form of a mitochondrial disease (inability to transfer glucose to ATP via oxidation).

In both cases this is a panic situation from brain's point of view which is compensated by a spontaneous "stop" (seizure as OP seems to call it) and by injecting adrenaline with a corresponding response from endocrinal system (more glucose + more insulin).

Neuronal glucose uptake is via transporter GLUT1, which is insulin independent. Insulin-dependent glucose uptake is primarily GLUT4. Even in insulin absence, the brain gets its sugar.

Yeah, I'm a type 1 diabetic and nothing about this person's post made sense. It's just not how blood glucose works. There's not a store of glucose in the brain that can just suddenly be depleted because you worked too much. Glucose travels in the blood and its uptake is regulated by insulin. If he was suffering from hypoglycemia he would feel effects in his entire body, and it would be at least temporarily resolved by eating sugar.

But https://en.wikipedia.org/wiki/Hypoglycemia is a thing.

Same exact symptoms (the bass guitar string he heard is a thing that gave me ptsd like symptoms/crippling anxiety for a long time after) I had from a TIA when I was overworked. He waited getting a scan so they could've missed it later; my office was next to the hospital: nothing showed on the CT one hour after but on the RMI a couple of hours after they found a tiny lesion in one of the regions involved in forming speech (which, like him, I had issues with for a bit). Sounds more likely than glucose to me but that is because this looks too familiar to me.

Edit: with symptoms like this, treat it as an emergency, do not wait. I do not even understand how you go to sleep and not the hospital if you actually suspect a stroke? Within 3 hours they can do a lot even for far more serious strokes.

Is that "bass guitar string" thing common? I had it twice, both times in a hot and cramped train and shrugged it up to "heat stroke".

I'm curious about this too. I have also experienced this at times, although I wouldn't have found these words to describe it. I don't think it's been tied to any particular conditions like heat or stress. Usually it happens when I'm in bed and beginning to fall asleep.

Googling turns up https://en.m.wikipedia.org/wiki/Exploding_head_syndrome which sounds like what I've experienced.

Mentioning the falling asleep part reminds me of a few cases myself. I have trouble sleeping myself and when I fall asleep very slowly I've noticed similar 'illusions'. flashes of light, voices, fractal patterns, a conscious state while dreaming and the very rare loud noise that comes from nowhere. Usually the noise doesn't prevent me from finally falling asleep. I've always wondered how many people experience these effects.

>Despite the name, the sufferer's head does not actually explode.

Oh good, now I can sleep at night again

Hallucinations, particularly the auditory ones, are relatively common when falling asleep. If you haven't already, you could consider seeing a sleep medicine doctor to help with falling asleep and sleeping "deeper", which could also fix the hallucinations.

Purposefully inducing the "out of body experience" (whether it's imaginary is besides the point) is almost always accompanied by this rare roaring sound during the transition moment. I guess that most people freak out and snap back to the normal awake state. Edit: I find the wiki article describing the "problem" highly entertaining. It reminded me of a quote (from that gervais principle book probably) that the modern healthcare manufactures well adjustedness, i.e. they try to square peg everything unusual into their rigid grid of normalcy and if something unusual doesn't fit the square hole, the healthcare system doubles down with rough chemicals.

Not sure, but I had 'lighter versions' of that sound before getting a migraine after this(never had migraines before the tia): those episodes immediately caused extreme anxiety, as in: it is happening again, while I knew it was not because I had no speech issues or foggy brain, just an aura floating in front of my eyes. This is a long time ago and the way of getting rid of all of this was getting rid of and learning to cope with stress. Now I work more hours and take on far more responsibility than I did at the time but I do not feel any stress, at all. Never had any migraines or other symptoms I used to have anymore. For people who do not know what it is: chronic stress is living hell and dangerous. Better recognize it in time so you do not lose years of your life.

I would love to hear how you changed how stressed you feel.

For me: accepting I have "down" days. And trying to never push during those days. Put breaks, read a book (not related to work, not reading it to be better at anything because thats work as well), go out, exercise. Learning to say no. Not overengineering things (because thats a time sink and I have to throw away 2/3 of the prototypes I'm making anyway). Freeing weekends (or free days). Taking time to talk to people about things not work related. Reduced the "arguing because someone is wrong" (on the internet or not) helped as well, it takes a LOT of emotional energy.

edit: typo

I forgot! Reducing caffeine from coffee and using tea instead when I feel stress is increasing or when I didnt sleep well (thats the worst time to drink coffee for me as it starts a tiredness and anxiety circle that may last a few days). This reduced my anxiety a lot. And I also noticed that coffee increase my procrastination. Not sure why but I would likely put that on increased anxiety.

How do you not feel stress anymore? I started taking on less and expecting less in order to manage my stress levels and it worked. I also started listening to my own rhythm but that translates sometimes to brain dead days and other times with very productive days. I accepted that and am no longer pushing. But I still take on things but at a slower pace. Id still avoid taking on as much as I was doing in my early 20s, that would not end up well for me. How do you manage it?

I'm not tluyben2 and really interested in his secret, but here's what helped me most:

– not taking what my inner critic says too literal. I imagine someone else saying such critical things to me – it would be ridiculous and I'd tell them to go to hell. So I just accept that something fuels my inner critic and take care of it in a different way.

– enjoying the little things in front of me instead of obsessing about processes which outcomes I can't control. This has a purely hedonistical side too: I can focus on the pure pleasure on squashing this software bug. My food tastes so much better if I actively taste it. When I look outside the window, I see trees moving in the wind or some other tiny movement. It would be laughable to even try to imagine a world where I control the wind in the trees, so why obsess about other complex things outside my control?

– do some imagination/self hypnosis exercise. Write them for myself. Some (lizard) parts of our brains can't distinguish between imagination and reality, so it's exactly these parts that get anxious/stressed. I find it helpful to just dictate some calming exercise (a story how everything goes right) and listen to it in a relaxed state. It works really well since it's my own voice. I wrote an exercise for a friend and just yesterday did a recording of it: https://rybakov.com/blog/being_an_octopus/

one thing for me, was to realize that whatever is happening, its not about "me"

i think sometimes we internalize situations and make it about "us", and while we do indeed cause our own stressful situations sometimes, usually things are in motion (work, poliics, environment) that have really nothing to do with us and internalizing it, as if we are "100% responsible for it" can make one more stressed than it should be

another bad situation to be in is, being responsible but not "in charge", meaning one gets blamed but is powerless to fix the situation (work), then in those cases again, its better to not internalize because in a lot of those cases its politics or bad general management etc... better to see the big picture and put things into perspective...

then even if something was "100% our fault" then just take it as a learning experience "debugging reality", we can do everything right and still completely fail, and that is normal... better to learn and move on (easier said than done, i know)

at least for me, this kind of thinking helped alot with overcoming stress

Exactly, being responsible but not in charge is the mother of all stresses.

it certainly is...

In a hot, cramped train it could also be a panic attack. Go see a doctor in any case.

I've had that as well. Especially in stressful or tiredness situations. Exercising and better food made them go away. That may be a spurious correlation with my n=1 but I guess exercise and better food will help long term anyway.

Had very similar symptoms as post. Was getting constant tia symptoms. 3 years of doctors visits later. Oh you have a genetic disposition for clotting. (Factor 5) Started on blood thinners and the TIA symptoms stopped in a few days, brain fog lifted. Plus lots other symptoms.

I had been having minor strokes constantly, just not large enough to show up on MRI.

My old-aunt had this. She would have small ones a lot even with blood thinners.

If I miss 1 days doses I start getting visual artifacts. Recovery is about a day.

2-3 days and I start to lose feeling one side and can no longer write. Recovery is usually 1-6 weeks.

I had more leeway before catching covid.

Older ones had higher chance of not being effective.

I wouldn’t go to the hospital either. It’s funny because the more one tries to work and escape debt and financial ruin, the higher the chances are of needing to take an unexpected hospital and getting an unreasonably high medical bill.

Some people aren’t in a place to pay insane medical debt, especially in the case where a multitude of tests need to get run and a problem isn’t found.

There are a lot of weird things that can happen with the body that some have observed goes away with time, and this “wait it out” approach is sadly encouraged by the American healthcare system because the insanely high bills from previous emergency situations (coupled with the subpar treatment) are typically not worth the price.

Ah sorry, I am in the EU, so I guess it is slightly different. I see your point if this risks paying yourself. These visits cost me 0$ even in countries I frequent but am not resident in the EU.

But yes, since this scare, I definitely go faster, especially considering how bad this can get. You might wake up in a better or in a far worse state.

On top of that it sounds like this person was a contractor, which means their health insurance situation was probably even more shaky and/or non-existent

A stroke deprives your brain of oxygen, you literally do not want to ‘wait it out’ or ‘sleep on it’ cause you might not wake up from it and the damage is acute, to put it bluntly.

What the f is there in the head that can make a sound like a bass guitar string?

Neurons constantly oscillate - firing at least to us randomly. It makes sense that after a “reboot” of sorts, your neurons may fire in something resembling the “frequency” that triggers “bass string” experience. Like the “bong” when you boot an old Mac.

So an auditory hallucination?

Could be auditory processing of random synaptic firings.

I wonder how random that sort of thing is. I mean if the brain needs to make you pay attention because you’re overworked / burnt out, what better way than to fake a bass string sound?

That would totally freak me out.

Your brain. All sound perception ultimately comes from there.

It’s wild that the brain can just make sounds up like that. Now I’m wondering how much of the soundscape I hear is real.

Seems like that’s something that could be exploited.

to go all sophomoric on you; that sure depends on what you think “real” means!

(you might like listening to the mcgurk effect, or shepard tones)

Real as in generated by the external world, rather than generated by the brain.

what’s the difference? where does “external” start and “brain” end?

Unfortunately if the brain has been trained to create fake sounds, then that becomes really difficult to determine.

But conceptually there is an thing which is the brain and there are things that are external to the brain.

The same is true of every sense. How do you think hallucinations work? I’ve experienced phantom sounds and sensations. Visual almost never though.

My impression was that hallucinations only happened under extreme conditions, like drugs, alcohol, heat etc, but it’s a bit worrying that it could happen basically anytime.

If the brain “learns” that it can accomplish things via this method, then that could be really problematic.

Possibly... I have had minor auditory hallucinations while I'm falling asleep. Most often it is a single sound, like a high pitched ding or bong. It sounds like a notification, but very unlike one from my phone. It is definitely purely internal.

That’s interesting, I hadn’t considered the falling asleep state. Yeah maybe that has happened to me too.

It’s hard / practically impossible to determine exactly what it is though. It might be someone in the next room, someone walking past, another sound entirely that got morphed into the sound you heard to fit your brains narrative as you were falling asleep. Might even be that your phone was hacked!

Something sort of similar: I used to feel phantom phone vibrations when I had the vibration feature activated.

It's more than that; the soundscape you hear is all in your head. You don't have "direct" experience of anything! So there's not really any distinction between "real" and "made up" sounds.

And yes, it's exploited in every lossy audio codec.

Yes of course, ultimately the brain generates all the sounds, but they tend to be “copies” or at least in some way in sync with something happening in the outside world.

The exploitation I was referring to was surreptitiously (or maybe even in some unentered way) training the brain that it can get what it wants by self generating sounds.

The brain exploits these powers all the time. The most well known example is the blind spot, but that's just the beginning of it.

Our wiring is incredibly improvised throughout and the brain works hard to paper it all over.

A generous reading of Kahneman and Tversky suggests your brain even hides its own workings from itself.

A quite simple demonstration is to be in an environment with constant but not overwhelming repetitive noise, such as a slightly loud fan. While you are concentrating to do something else, perhaps reading, the sound will disappear from your awareness. Now suddenly the sound stops. It is a strange sensation, as if a new noise was present, but in fact it is a silence or lack of noise. An auditory illusion like some optical illusions of staring at a spot then looking elsewhere and having an afterimage.

Nothing sensual is presented directly: it is all contextual.

I don’t think I’ve experienced that. Noises do ‘go into the background’ so to speak, but even when they disappear completely from consciousness, when they re-appear I know / remember they were in the background. Maybe occasionally I’m a bit unsure if it’s a new sound or not.

sounds in the world and percepts of sounds to you are at best loosely related.

What do you mean by loosely? Whenever I hear a car horn, they always sounds very similar.

pressure waves in the air are objective. Your conscious experience (“percept”) of them are subjective and contingent on your current mental state, health, attention, etc. Psychoacoustics is a real wild trip.

my point was that in order for you to hear a bass guitar sounding noise, no external stimulus is required.

I agree a suspected stroke deprives your brain of oxygen, you do not want to sleep on it! Slurring speech and facial droop are textbook warnings to call 911 immediately, you might not even be able to speak anything but gibberish so get someone’s help immediately if possible. Stroke awareness is sadly lacking by the young and generally healthy SV demographic.

I don't necessarily doubt the author, but how do you chronically deprive your brain of glucose?

Afaik you would get glucose back whenever you ate anything. Unless you were doing keto, but then your body and brain run on ketones. And if you did somehow deprive your brain of fuel, you would get symptoms in a much shorter span.

Maybe undereating, but he doesn't list weight loss, and if you're rapidly losing weight and start to notice these symptoms it would seem pretty obvious to try eating more.

It seems very much like confirmation bias. The state of the art of research on FND might be ahead of wikipedia, but it states under 'causes' only this:

> A systematic review found that stressful life events and childhood neglect were significantly more common in patients with FND than the general population, although many patients (around 70%) report no stressors. https://en.wikipedia.org/wiki/Functional_neurologic_disorder...

The OP doesn't state what diagnostic data or opinion led him to the glucose/dopamine depletion conclusion: https://twitter.com/TinkerSec/status/1388114584209350658

With you on this. There is no diagnostic test for glucose/dopamine depletion, and it is unlikely theory in my opinion. Even when you haven't eaten the circulatory system keeps the brain flushed with glucose from the liver or muscle glycogen, and then ketone bodies from ketogenesis. Unless you have a constant flow of these nutrients supported by a normal blood pressure, you pass out quickly. I don't think it's a surprise that he started to improve when he started antidepressants, started seeing a therapist (the psychologist), started exercising more, and took a less stressful job. To me it sounds like anxiety that built up repeatedly after 30 minutes of working. He states that he felt a numb nothingness (anhedonia), had trouble concentrating, and had psychomotor slowing. Only needs one more to hit the criteria for major depressive disorder, and I'm guessing he was having trouble sleeping at this time. From what he wrote ("It was a physical issue.") it looks like he was going to search until he found a non-psychiatric diagnosis, seeking out a neuro-psychologist (someone with likely no biochem/physiology background), to propose a theory about something that is unlikely.

Regarding the post up above about a TIA (thank you for sharing this story) or the one below about the Microsoft engineer who had neck pain and then a stroke (carotid or vertebral artery dissection, often caused in younger people by car crashes or neck manipulation by a chiropractor..), I think a TIA/stroke is much less likely in this guy's case because of the recurrence of the symptoms after being able to work for a period of time. Someone who's had a TIA hitting Broca's area (motor speech) won't be able to work for a little and then have to stop, they're just not going to be able to speak/type. And unless they're very unlucky they're not going to have them repeatedly only after working for a short period of time. Maybe it is an exact match with the TIA post above with anxiety/PTSD after the initial TIA with word finding difficulty, but it doesn't seem like this guy had word finding difficulty at first because he was able to work after sleeping off his stroke.

If you want to run with glucose, he could have type I diabetes or an insulinoma if you want to go rare, but the symptoms are going to be resolved immediately after eating anything with carbs.

But what do I know, just a student in the American medical system.

I'm not an expert but it does seem incorrect. As I understand it (correct me if I am wrong), the brain cannot function alone on ketone bodies and always needs some glucose. Even when fully depleted and in deep ketosis, the liver will synthesize glucose via gluconeogenesis.

People usually get "hangry" / feeling like they're going to die like a diabetic does before entering a coma if their glucose actually crashes. My dad was an adult-onset type-1 from exposure to Agent Orange who ended-up in the hospital more than once from either insulin misadministration or glucose-management issues.

They might've actually had something like a nervous breakdown or a TIA.

PSA: Don't self-diagnose, esp. if you're not an MD. 99% of the time, you'll be wrong.

It isn't my intention to doubt Tinker, only to continue discourse here, but I was going to say something similar. I have reactive hypoglycemia and it is very, very obvious when my blood sugars are too low - it really is an absolutely horrible thing.

At first I start to feel a little bit "stupid", like my brain isn't functioning properly, and is working in slow motion. Talking is more difficult. Next I start to feel a bit weak/shaky/trembly. Next I start to feel anxiety/dread. Sometimes now I can get very aggressive (which isn't in my nature at all!). Then comes an incredible desire to eat sweet things - once you start eating, it can actually be difficult to stop! Depending on how bad things got, I might feel too confused to actually just go and eat something.

Now, all being well, I did eat something, and will start to feel a lot better within 10-15 minutes.

If I didn't eat something (because there wasn't anything available, or because the "stupid" feeling had given in to confusion, and I didn't know wtf was happening), everything ramps up - the anxiety becomes full on dread, the world seems to be caving in on me, and I literally feel like I'm going to die. The weakness feels like I need to lie down (a couple of times I have, but thankfully my partner was at home and found me). The "stupid" feeling gets much worse - my speech is slurred, and finding the right words to talk is very difficult - mostly what comes out it is "umm.. err.. what?.. uhh..".

T1D here, and you explained the experience of hypoglycemia very well. This is very close to what I get as well.

> Then comes an incredible desire to eat sweet things - once you start eating, it can actually be difficult to stop!

This sucks a lot with diabetes. The survival mechanism kicks in and tells you "eat something, anything, everything", which can subsequently cause your blood sugar to skyrocket, which you then have to correct with more insulin...it can send you on a blood sugar roller coaster than can ruin your entire day. Diabetes sucks.

Yeap. There were blood sugar test strips and lancets in every nook and cranny of the house. Yo-yoing all over the place and developed a phobia about going anywhere in-case "something happened."

My dad was using low blood sugar as an excuse and insulin as an enabler to eat crap, and gained a lot of weight.

He eventually got an insulin pump and cut down on simple carbs.

Diabetes, especially T1 diabetes, is so unbelievably mentally taxing. It's a constant source of cognitive load and stress, as your conscious brain is being forced to take on the functions of your pancreas. A lot of diabetics develop mental health issues and unhealthy habits as a result of it (which is what it sounds like happened to your dad).

For me, a CGM was the biggest game changer, by far. Second was cutting down to eating one (larger) meal per day.

I'm not diabetic but I know what low blood sugar feels like from both exercise depletion and long-term fasting.

If you're not diabetic and have low blood sugar from exertion, just stop what you're doing and drink some water and rest. Your body will handle it just fine. Carbs should be reserved for real emergencies.

So what is a good and healthy way to address the situation aside from eating something? Using an insulin pump?

Insulin lowers blood sugar, rather than raising it. For T1s, I would imagine an insulin pump would help prevent mistakes where you misjudge how much insulin you need - but I'm not a T1, so can't comment on real-world effectiveness.

In my particular situation, the best way to manage things has been to go keto - any more than around 5g of carbs causes me to have a hypo, presumably because my body over-compensates and releases too much insulin. I switched to keto a few years back, and my life has been so much easier since then - I went from having a hypo multiple times a day, to very rarely. It's been several months since my last one.

If I hypo (or in the more general case when a T1 takes too much insulin by mistake and hypos), the "healthier" option is to use glucose tablets or a glucogel tube (a measured dose of glycogen, often carried by T1s).

But when you're having a hypo, you don't always think clearly - it's fine if you catch it early enough, but otherwise it really is like you're under a magical compulsion to eat as much sugar as you can; I'm not sure there is another experience I can relate it to. And once you eat some carbs, it's 10-15 minutes before you even start to feel better - believe me, you can eat an obscene amount in that time!

The brain actually burns a lot of energy so I think its not unreasonable to expect it to burn the fuel it has access to. There was this study on chess players or something in a competition, I don't remember what the study was called exactly, but they found the chess players despite sitting down the whole time burnt an extraordinary amount of calories.

In China there is even sort of a common saying for this. Generally when someone starts sort of acting stupid or in a daze its commonly related to, half jokingly, as “低血糖” or "low blood sugar"

There are tons of psychological and physiological mechanisms that would activate before reaching literally 0g of glucose if your brain, most that would send you straight into the ER or into complete loss of consciousness.

Dangerously low blood sugar doesn't cause losing the ability to speak or to function that you can ignore and just keep working.

I might be wrong but I dont think the brain actually expends 'more' energy in intensive cognitive tasks in the way you suggest.

"As Harrington explained, "The brain is able to shunt blood [and thus energy] to particular regions that are being active at that point. But the overall energy availability in the brain is thought to be constant." So, while there might be significant spikes in energy use at localized regions of the brain when we perform difficult cognitive tasks, when it comes to the whole brain's energy budget overall, these activities don’t significantly alter it."

"Elite chess players are under intense pressure that causes stress, which can lead to an elevated heart rate, faster breathing and sweating. Combined, these effects burn calories over time."

https://www.livescience.com/burn-calories-brain.html

I agree with what you wrote, but additionally, one can get glucose deprivation by just starving, for example. I can't imagine a way to deprive just the brain of glucose. In effect, sustained physical activity should also lead to "depriving the brain of glucose".

Maybe it depends how long you starve for?

As long as you have the fat reserves, it's possible to fast for weeks with nothing more than water. As long as you have a functioning liver, your body uses glycogenesis to create enough glucose for your brain to function.

Too late to edit now, but I forgot to say that even before glycogenesis, there are stores of glycogen in your muscles that can be used.

Anyone who has been around a type I diabetic knows how quickly the brains shuts down when glucose levels drop. It doesn’t even have to get that low before cognition takes a massive hit.

Exactly this. I'm a type 1 diabetic, and the explanation that this was happening due to "burning out all the glucose in my brain" is bogus. It's not how it works at all, and it's not even close to how it feels.

It sounds like this was the diagnosis he was given. I have done extended water fasts for multiple days and often eat keto (<20g carbs per day). And so I am respectfully doubtful about this diagnosis.

Nevertheless, who knows what combination of medical peculiarities might be involved, so I guess it cannot be ruled out.

My prior assumption would still be that a case of burnout/exhaustion, or micro stroke seems like a more probable explanation.

He writes

> talking to other hackers & infosec folk, they have said they've felt similar symptoms. The brain fog after working too hard & too long.

I really get the feeling that being overworked, not resting enough is the problem. I get the feeling that the work ethics and self-concept of being a hard worker makes it somewhat hard to admit that one is being overworked and thus a medical explanation for breakdown is very welcome for some individuals.

> It sounds like this was the diagnosis he was given.

Not quite. He cites the specific diagnosis the doctor gave him and the associated DSM-5 code, but his extrapolation about dopamine and glucose is not part of that diagnosis. It’s not actually physically possible as he describes it.

This is a decent overview of the exact diagnosis he cites: https://www.mayoclinic.org/diseases-conditions/conversion-di...

In short: It’s a stress-triggered disorder that doesn’t correspond to specific physical conditions, contrary to how he describes it.

ah ok, really confusing in the twitter thread but I guess it fits that the odd bits are his interpretation.

The trick is that your burn rate of glucose might exceed supply rate. Especially if stress conditions or dietary situation results in misbehaving supply, too.

Not to mention getting warning signs and pushing through, which I'll be honest I'm guilty of doing as well (though I never got that far, and mostly it was sleep deprivation)

That does happen, but the body is very good at making sure that levels of blood-glucose are maintained. If it is not, as in the case of diabetes, then very bad things happen. Things like a diabetic coma.

As other commenters have said, absent any extreme weight loss or undiagnosed metabolism disorders like diabetes, there is nearly no chance that glucose burn-out occurred in an otherwise 'healthy' person.

We may all be wrong, or missing some key information, at which point I look forward to the cuhbbyEmu video on it.

But the glucose amount in your brain is more like f(t,x,y,z) + constant . So what happens in those situations is that the variable part gets reduced, but the constant part needed for keeping tissues alive doesn't change.

I don't know about the glucose ...

... but burning out can really destroy your life. I know it destroyed mine. It took me years to recover, and I'm still not 100%.

I started working for an early stage startup right after school when I was 19yo. I didn't sleep. I didn't eat properly. Our team was small. Responsibilities super high. And I burned out.

Oh, I have so many stories from this time... like when I hadn't slept for 3 days and my body shut down when I was driving home from the office – I was so tired that my body went to sleep behind the wheel.

I wrote about it here: https://remotehunt.com/blog/4-day-work-weeks-in-remote-compa...

Edit 30m later: I went for a run after writing this comment (you know, to be outside and be less stressed out), and while running, I remembered that I once had a "pop" in my head too. My "pop" could have been different from the author's, of course, but I would describe it as a "pop."

I went to the ER immediately, and they did some basic blood pressure tests, etc. Then concluded that I probably had an anxiety attack (they get this often). Docs gave me some pills that took my anxiety away, and I was fine afterward. It was another sign for me to slow down.

But it's hard to slow down when you're already far down the burnout road. In debt, but a family to support, etc.

If I hadn't had a family at the time, I would have probably just quit the whole society game. Moved to a small hut somewhere near the beach. Alone, without a phone to reach me.

Sometimes i wonder if i'm in the path for that. Because even though i do 13h days every day of extremelly stressing work (putting out fires all the time), i do always get 8h sleep and 1h exercise. And so so food.

You know, I think it may not have to do with the long hours specifically. I mean, when you work 13h a day, and you enjoy it, this could be totally fine?

But when you say "extremelly stressing work," I guess you're not enjoying it. :)

And well, I felt physically OK for 3...4 years. Psychologically not OK, but physically OK.

Until one day, I wasn't anymore.

Compare it with how you feel when you are on holidays. If there's a noticeable difference (not having muscle micro spasms, better sleep - or very tired just when you start them -, better breathing, more inspired or willing to try new things, etc) then you should reconsider to reduce the amount of stress/work in your life.

Holi-what? People on the path to burnout are usually the ones trying to push away time off. 'I'll rest when this is finished' - narrator: it never ended, the exceptional became nominal...

Research is conflicting, but burnout many times is not caused by the amount of hours worked, whether you are exercising, eating right, etc. Those may be components to it or make you less resilient in general, but burnout seems to really come from things like feeling lack of meaning/purpose, inconsistency in values, perceived or actual unfairness, etc.

Another interesting perspective I have heard describes burnout as being an imbalance between what you want to do/work on vs. what you have to do/work on.

Similarly, while we like to think of “self care” as part of the cure to burnout, self care does not necessarily mean eating right, exercising, etc. Those things are important and may help, but self care also includes things like living a life consistent with your values, finding time to fulfill work that is viewed as meaningful/aligned with a purpose, etc.

The article linked below is worth the read if you’re interested.

[1] https://www.psychologytoday.com/us/basics/burnout

One can argue about compounding factors, but working too hard is always there in burnout cases.

I disagree and I do not see why it would not be possible to become burned out when your workload is too low-pressure. Some people thrive under such conditions and languish under others. However, some issues unrelated to working too hard are far more universal, such as feelings of being unfairly treated, lack of autonomy, feeling trapped or stuck in a position due to other responsibilities, etc.

I think there is an implication in the name: to burn out you have to burn in the first place. My personal experience, that of some colleagues and multiple accounts of other people I've read over the years suggest that.

There are certainly other ingredients than just overwork (despair, low project morale, lack of stewardship, blame culture) that make people fizzle out. But working too much is there in all accounts.

Your anecdotal evidence supports your view, mine contradicts yours. So no, I don't think it can be unequivocally stated that "working too much is there in all accounts".

To your point regarding "burning", flames burn at different intensities and temperatures based on a variety of factors (e.g., material being burnt). The fact that a flame is burning, or has stopped doing so, is not indicative of a specific intensity.

We are right in the discussion threads about a person who worked themselves into unconscious, just saying.

It's not like general workplace toxicity, heartbreaks etc are not equally huge personal problems of their own, but that's why they have their own names.

The person was not diagnosed with burnout. People have died playing video games too long and too hard - is that burnout? We're going to have to just agree to disagree here as I'm not sure either of us are really going to persuade each other from our respective viewpoints. I did enjoy the conversation though and thank you for taking the time to offer your perspective on the matter!

One issue with "self-care" is that it reinforces the idea that those problems are just individual problems.

And to some extent, they are. But to let an employee go and send them on a quest to fix their personal issue is such a very easy distraction from more systematic causes. No need to fix work culture if it was just that one person. No need to question social norms that might nudge people into working an unhealthy number of hours. I guess this is a good day to think about this.

True and all fair points. However, I think it may also suggest that people are not powerless/helpless in their situation, even if they are stuck in a job or society that places too much pressure on some.

Personal opinion, but where I think many may begin to really suffer from burnout is when they feel like they cannot do anything to improve or change their situation, and that it is futile to even try.

If nothing else, self care is something an individual who is struggling can control in the midst of a bunch of things they cannot.

The problem is that the culture kindof pushes people to extremes where they inevitably burn out. After the first burnout, which is a very scary new experience, people learn not to push to those limits, but there’s always new people to burn out. We’re lucky that the stigma of burning out is diminishing, before we’d have to suffer in silence and shame.

But why? There are plenty of good companies that have work life balance. Why not move to one of them?

I'm also curious!

Self employed and making 8x more tha my peers. I keep saying i'll stop it next year for 8 years.

still not 100% in what way? physical impairment? ambition? appetite for work? damaged relationships? personality? ability to socialise?

For a while, I wasn't even able to work properly. And I started having thoughts like, "maybe I will never recover and be able to support my family." It was scary.

I physically didn't have the necessary energy. I was exhausted all the time. I could code for an hour max, and then I just couldn't anymore. But this improved a lot over a couple of years.

But today: my physical body hasn't fully recovered from the sleepless nights, wrong sitting positions, etc. Lower back, neck, for example. I know these can be improved through exercise, and I do it more and more.

Oof yeah this resonates with me too. I did two failed startups back to back a number of years ago and had a lot of health issues after that which I’m sure were due to the stress and burnout.

And... I’m actually sitting on a hospital bed this very moment because of high blood pressure and some other symptoms that are probably caused by the blood pressure, but they want to do some more tests to be sure.

> but burning out can really destroy your life.

However, does burnout occur when one is doing stuff they like?

I was under the impression that it occurs only when there is some negative aspect to the work one is doing (like setbacks, uncooperative colleagues, impossible deadlines).

I think it can but in a very different way. When I burnout from something I like working on, I want to work more but just don’t have the energy to do it. In cases where I’m not passionate and I’m doing something stemming from a place of need, not only is my energy depleted but my stress levels rise, I won’t be able to think properly about the problem, I get obsessive about finishing work at the cost of quality, etc

Burnout is from overpressure. You might love programming but if the startup is failing, the boss is slowly going mad and you don't know what bug to fix first, love won't help you.

Or it might be entirely internal and kind of caused by your love, e.g. turning insane from your inability to focus on programming and finish anything due to undiagnosed ADHD (my case).

No pressure - no burnout, I think.

TBH i wouldn't change that experience for anything.

During my early 20s, like you, i was working at a startup and had super high workload. Definitely burned out a few times but the motivation was high and i enjoyed every minute of it.

It pushed me beyond my limits and i learned so much in a very short time period.

Now, i'm closer to my 30s i don't think i could do this again. But with time comes wisdom and instead of high energy/high workload i choose to work smart/not hard.

I have had something similar to this (heavy fog and inability to continue creative work) and I use coffee, bulk vitamins and regular walks with music to work through it.

I also started eating more fresh food and less frozen food, even if it meant eating-out fresh, because it was much worse when I was reheating a lot of tasteless frozen food.

But no matter how hard I try, I have focused my career into an area that requires a lot of creative effort, and I think that this has given me nearly permanent long term memory problems. Over the years, my relationships always get irritated that I don't remember anything. Actually, I thought my memory was normal, until I started to contrast it with people around me who worked in hospitality and such.

This is all sounding very familiar to me :-/

Same here. Mid 30s and my memory is completely shot. Here's hoping it's not permanent or an early sign of things to come :(.

Sleep. Get enough sleep every single night, not just some nights. Sleep cements the memories of the day.

Do you use any drugs?

coffee, tea I used to drink a bit but not much compared to some and not anymore.

Never smoked or did any other recreational drugs.

Middle aged here. Almost, but not quite, no autobiographical memory. Been that way since I was really young. So that’s fun.

Often I remember that something happened. Order gets wonky, even a week back. Sometimes I can kinda remember an image or a snippet, but not reliably. I gather most people hold on to a lot more than that.

Fine with facts and such. Never a problem in school.

I do have trouble remembering the names of characters and details of incidents in books I read, shows I watch, et c. Not as bad as my autobiographical memory, but not great.

And yeah, it’s frequently annoying for my wife, too.

“Tell me about a time when…” questions in interviews are interesting. I have to prep things from my notes ahead of time or I literally won’t be able to answer them. I’ll not be able to come up with a damn thing. The most stressful questions in elementary school were ones like “what did you do over summer break?”

Can you visualize things in your mind as if they were physically in front of you? People with aphantasia cannot and they often can't remember visual events from the past as a result. Perhaps you have it too.

As someone else with similar issues, I'm pretty deeply aphantasic. The best mental visualization I can manage of even simple imagery (think "a red triangle on a black background") is roughly comparable to a half-transparent blurry watercolor, and I can't clearly picture faces at all (though I don't have any particular trouble with recognizing people when I see them).

Is that really aphantasia? I understood it to be the absolute absence of any mental imagery. Your description actually sounds similar to my own experience. I'm capable of summon up imagery with effort when I need to, but it's never very clear or frequent.

My visualization is somewhere between wireframes and chalkboard diagrams, usually closer to the later. Also have little autobiographical memory. I suspect I’m somewhat on the autism spectrum, but that wasn’t diagnosed much back in the 60’s when I was growing up.

Wait. You're telling me that you're supposed to be able to do so? I thought it was some mind hack that gives you the power to become an artist, not everyday stuff.

Interesting. Do you have dreams? Do you see things in “full 3D” there? When I’m awake I can visualize things but they definitely don’t have the full dream-like quality. I suspect it’s because so much brain “bandwidth” (not the right term) is going towards other stuff.

How can I tell if I am unable to do this? I think maybe I kind of can, but I have to focus really hard and it is a flickering image and I am not sure if I am actually imagining that I am imagining if that makes sense at all. Or the fact that I am not sure is already telling? I don't think I try to imagine anything in my daily regular life though.

Haha, exactly my thought! I can form a mental image (photo) in my mind, but how do I know others can "see" it similarly?

It's not very clear as I can't really see it in front of me, but it's in my head, and there's a different kind of "seeing" happening...

One evening I asked my 5yo daughter that when she imagines something in her head, does she see it almost like in real physical 3d? She said yes. I wouldn't say yes to that question. But again, it's so subjective...

I have terrible autobiographical memory- everything is out of order and I don’t know what happened last year or ten years ago. But at the same time I think mostly in images and visuals. If I want a fork the image of a shiny fork in my hand will flash in my mind but then sometimes I can’t think of the word for it and I’ll just say, I need the um, the ah, the thing, what is it called... while picturing it very clearly in my minds eye.

Yeah, seem to have middling abilities there.

I’m fairly normal in most other ways, mentally, with really high (tested) spatial reasoning, and a good-but-nothing-special (on HN, anyway) tested IQ.

Just badly deficient autobiographical memory.

I didn’t even realize there was anything wrong until my mid 20s. Turns out this is a relatively-recently-discovered disorder of some kind, and on reading accounts by people who have it, I was like “…oh.” Not super well studied, I think in part because it tends (incredibly!) not to actually impair living an OK life. You just don’t really remember it like a normal person does.

We have really similar stories. I'm 32, never used drugs (since other comments were asking for that). It's really hard to explain to the people why you do not remember something, they will just assume that you do not remember because you don't care.

It's really hard to explain to the people why you do not remember something, they will just assume that you do not remember because you don't care.

The typical mind fallacy should be taught a lot earlier in school.

Same here. I've always had terrible personal memory since I was young, despite dramatic lifestyle and diet changes over time. Distinctive characters in fiction stick with me, but not order of events: I couldn't tell you anything useful about the plot details of my favorite films and books despite revisiting them many times.

It applies to short-term memory, too. I give myself very specific places to put things, because if I didn't I would lose track of my keys and wallet literally every day.

Weirdly enough, these issues don't seem to apply to logical or spatial memory at all, which is probably the only reason that I'm an effective programmer.

> Distinctive characters in fiction stick with me, but not order of events: I couldn't tell you anything useful about the plot details of my favorite films and books despite revisiting them many times.

I can usually slowly work my way back through a book, maybe with a couple prompts from someone else to help me piece it back together, but only for stuff I’ve read in the past few years. Farther back and it’s gone. Character names rarely stick. I did watch the Star Wars trilogy so much as a kid that I could replay it in my head, every frame, sound effect, and line, every cut perfectly timed. Not anymore, but that part of me’s not totally broken, I guess. I think I’m not far off average on that stuff, maybe a bit below.

> Weirdly enough, these issues don't seem to apply to logical or spatial memory at all, which is probably the only reason that I'm an effective programmer.

Yep, exactly that here, too.

> Often I remember that something happened. Order gets wonky, even a week back. Sometimes I can kinda remember an image or a snippet, but not reliably. I gather most people hold on to a lot more than that.

Isn't this memory about your memory itself a pretty detailed autobiographical memory? Or is it that you can remember sort of templates and categories of things that happened but not a specific instance?

This hits close to home.

Sounds like you're trying to take care of yourself but one suggestion is to be rational about things - not sure why everyone hates on frozen food as if it's pumped with chemicals or something. It's literally the best way you can get the food on the table other than cooking it yourself. A frozen veg medley is healthier than a McDonald's burger right.

Frozen vegetables are some the cheapest ways of getting decent nutrition.

And if they're frozen soon after picking they can be more nutritious than fresh vegetables that have been out of the ground longer.

I wonder if you may have aphantasia, and I also wonder if it may be more common (selected for even) amongst engineers.

If I say: "imagine a red triangle", can you do it easily? Is it red? Does it visually exist in front of you?

I have asked many people this, and many people say it is laughably easy. This tells me it is "normal".

I can't do this. I also have a terrible episodic memory. But my semantic memory is fantastic.

I can not really imagine a whole object at once, I can only easily imagine the features/edges individually, although I know that they form a triangle.

Not sure if it's a useful data point, but my ability to construct things in my head improved dramatically after I'd been messing around with CAD for a few months.

My guess is it just got my brain to improve it's ability with that stuff, and the side effects helped in other areas (like this) too. :)

It exists but not in my visual field, so not in front of me. I can imagine it in my visual field but that is distinct from it actually being there, which may not make much sense unless you do the same.

Just echoing the other comments on this tree; hits very close to home. I admit I might have some other triggers, but it's just been so persistent from growing up until now, and it's getting worse the moment I switched my work to mostly developing/programming instead of talking to people.

Amazing the lengths the mind will go to to convince itself that it's not a stress or emotional problem that is the underlying condition. This person even convinced themselves that things improved because of FND rather than the improvements in life situation -- changing jobs, time passing from the loss of a partner, time passing from start of pandemic.

The distinction is a bit misguided anyway because of course all stress and and emotional problems also happen inside the body and thus have a physiological basis.

Yes, emotion is all chemicals and signals in your brain, but there's still a quite clear distinction to what the difference between physiological and psychological is.

it’s not so clear cut, instead it’s very interlinked.

what you think effects your body, what you do effects your mind.

e.g. worrying will cause your heart rate to increase ad your breathing to quicken, breathing slowly will reduce your heart rate, a lower heart rate will reduce your sense of anxiety.

your body is a sensor, your mind is the computer. emotions are like the ships diagnostic warnings from star trek.

edit:

id add that this is why “mastering your emotions” using the control sense of mastering, doesn’t make sense.

you don’t want to control your diagnostics, you want to be great at reading them and making decisions from them, aligning with them if you will.

I agree that it's all very interlinked, but that doesn't mean there's no distinction. Changing your way of thinking is purely psychological, whereas changing what you eat is both.

> id add that this is why “mastering your emotions” using the control sense of mastering, doesn’t make sense.

I'm not sure I understand what you mean here, it seems to contradict what you said in the earlier sentence? For example, if you have migraines due to stress, and you learn to control your emotions, you could reduce migraines. Breathing slowly is one way to do so, but there's also a lot of more or less purely psychological ways of doing it (e.g. CBT).

i didn’t want to imply there was no difference between the body and emotions. just that they are a integral parts of the same system.

> I’m not sure I understand you, it seems to contradict what you said earlier.

i did contradict myself because both are true at the same time. my example was one of malfunction, an over reactive warning systems. your example is one of, i assume, coping with unchangeable external stressors.

fyi, the later is a good example of how disconnected we can become. a migraine caused by stress (like any other painful symptom) is pretty late into the warning system that our emotions behave as. while breathing to reduce pain is a good coping tactic, as a long term strategy it isn’t removing the stressors and so only relieves that particular symptom. in that situation i would hope to align myself with my warning system and attempt to change my environment such that the stressor is removed.

if you’re in a situation where the you feel stressor cannot be removed, that is a different discussion.

in the situation where the stressor isn’t apparent then i would seek a therapist as perhaps there are past traumas that have been experienced which exacerbate your emotional response to some stimulus.

> It was a physical issue.

> My physical brain ran out of physical fuel.

A bit limiting of a view on the events in my opinion. Our mental state directly influences our health. Attributing these kind of symptoms solely to physical factors misses the point, that the mental space is as real as the physical one and ignoring it has real effects. In an effort to be more like machines I think programmers forget that we do not operate by the same rules.

I think the bigger issue with that statement is it reinforces the idea that mental issues are somehow meaningfully different than physical ones, and it's vindicating to identify a physical issue when a mental one was expected. IMO mental issues are pretty much just physical issues that we don't have even the slightest understanding of yet.

Psychogenic non-epileptic seizures (PNES) are one of the more fascinating examples of this, because there is a direct parallel to epileptic seizures. Aside from the fact it's not uncommon for people with epilepsy to be initially misdiagnosed as PNES (and vice versa), it's interesting what a stigma there is against PNES. The seizure-like behavior those patients display is completely beyond their control, yet it's often treated in a dismissive fashion such as "it's all in your head".

PNES is often overlooked in medical research, so most of the literature focuses on psychological explanations like childhood trauma. Trauma can certainly be a risk factor, but that is also how disorders like Schizophrenia were talked about way back in the day, and now we are at least starting to have some more physical explanations. I'm usually the last person to harp on women's issues, but I'll note PNES diagnosis is overwhelmingly female. Feels like we still have a long way to go from the days of "female hysteria".

If anyone wants to read a good memoir about dealing with epilepsy check out "A Mind Unraveled" by Kurt Eichenwald. At one point a neurologist tries to override his original diagnosis of epilepsy as actually being psychological in nature, but there are a number of other infuriating moments in that book.

The truth is all mental illnesses are real, we are finding more and more underlying evidence of the neurological underpinnings of mental disorders (including with FND) using functional neuro-imaging techniques.

And yet these debilitating illnesses are too often stigmatized because their effects are often invisible to the outside observer. This person was let go because they talked about their mental illness with their employers, which is, I believe, not even legal.

People should treat those with mental illness with compassion and consideration, just like how they'd want to be treated if something like this happened to them. And if you think it couldn't, remember you might crack your head on the pavement tomorrow when someone knocks you down and get brain damage.

The truth is that just as we wouldn't want people to work in ways likely to injure their bodies or damage their health, and expect good employers to consider worker's physical well being, we must also have workplaces in which people's mental being is considered.

I consider how this person's employers behaved to be problematic to say the least.

One unfortunate problem is how easy it is for employees and employers alike to contrive a situation, with respect to mental illness, to force a desired outcome.

For the employee, good luck proving that management was complicit or negligent in the formation and continuation of a hostile working environment. At-will employment means it's your word against theirs in a wrongful termination suit, assuming someone mentally ill even has the resources and conviction to pursue a legal remedy. And ADA-related laws and protections, even if they can apply to someone with an "invisible disability", are difficult to invoke without social fallout. It's a catch-22.

For employers, how can you discern and remove a truly disgruntled, incompetent, malingering or indolent employee (from management's perspective) in an efficient manner, when perhaps the first-principle reason for those employee's shortcomings are related to mental illness?

ADA ought not to be intertwined with employment, rather there needs to be a more sophisticated social safety net and support programs for people with mental illness, instead of burdening employers with some of the responsibility which they have no business-rational reason to respectfully abide by.

Some issues in his thread probably sound familiar to many here on HN. One thing that helped me tremendously is conversations with peers in similar situations to share experiences.

With this I want to make myself available for chat or audio/video calls for anyone wanting to talk about burnout/autism/adhd. I am not a therapist, just a peer with similar experiences. I have limited time and might be slow to reply. Check bio for contact info.

Reading this, many will relate and yet would of put it down to burn-out. We know if you push your body physically too long you increase risk of injury and whilst initially can get over an injury, aspects can play up and increase chances of the injury repeating - say ligaments as one example or cartilage. Heck even if you break a bone, you may find aches and pains in later life for an injury that seemed to of healed back to new.

The brain we are still trying to understand and to get a diagnoses and explanation for somebody who was able to run 1000MPH mentally and now falls flat, the not knowing in itself, I would imagine of been impacting and getting an answer would be huge - just to put a curious mind at rest. I know that is how I would feel and burned out many times, and can relate to too much of this that it's a bit deja vu.

it’s wild how far we’ll try to go to reassure people we’re not having emotional problems.

even though emotions are physical, and he mentions developing ptsd.

his body (brain being a part of that) must having been telling him for ages that shit was going wrong but he’s so disconnected from his physical emotional experience that he just ignored it.

Saying it wasn't burnout in the usual sense, and instead was an actual physical issue ... Well, that's just medieval.

Good story though.

What led him to those physical issues is however psychological. People need a work-life balance. No matter how interesting or awesome your job is.

He unfortunately is still not looking inward for the actual cause of his problems. He just switched jobs to one less prone to overwork.

Sadly the story lacked the "why?"

Why are you working so hard to give yourself seizures and ignore them? When is it a good time to just tell your boss fuck off I'm out?

I don't know the guy, but I would understand if it was the case if he was trying to provide for his starving family in a third world country. One thing is reaching burnout, one thing is literally reaching the point of permanent physical damage and just carrying on.

For what?

Third world countriness might not only happen there.

The status game is very strong in the US. The need to provide for one's family, house, car, tuition, the very best food, savings, etc.

And when it's just one more stupid report, it seems easy. OP seems to have a very high tolerance for delayed gratification. (Which doesn't seem that surprising for a pentester.)

It's a Game of Society, and it's not our friend. When you're sold the story of how your life should look like through ads, people around you, etc, of course you struggle to achieve that.

I think OP said he was in debt, and needed money to come out of it while supporting his family.

So here's the result of the game called "society".

> Sadly the story lacked the "why?"

This is his 2nd post. It seems pretty why-ish.

In an effort to pay off debts & get ahold of my financial situation, I took every gig & side gig that I could.

I didn't have much choice. I had a family to take care of & a house I could no longer afford as my previous partner had left.

I worked every day, night, & weekend.

Yes, that's what I got from the article: There's no difference from mental / physical processes, both are carb-driven molecular machines that can break.

Well, the whole description is pretty much what people call "burnout".

Almost unrecoverable burnout? I'd say this is more severe on an order of magnitude.

It sounds intense for sure. Seizures aren't a usual symptom of burnout, nor that extent of cognitive impairment, but I certainly think that lots (maybe even the majority) of burnout in the tech industry and in other fields that require constant intellectual output is unrecoverable to some extent.

Even many of the people that found a way to code for fun (or even money) again will often say it's not the same, and the moment they hit a certain level of stress everything just shuts down.

I do think it is a form of post-trauma/post-stress in some ways. The brain associates the intellectual activity so strongly with the negatives that it just doesn't want to do that activity anymore.

US Healthcare system definitely sucks, though in this case the entire social safety net is kinda implicated.

But is burnout the same as severe PTSD? I guess I've never thought of it this way, but I can see how that might actually be the case - certainly I've burned out and it affected me for a long time. I just never have heard it this severe.

The U.S. healthcare system does indeed suck, at least from an outsiders perspective. I live in a country that doesn't have such an awful system. I feel very lucky!

> But is burnout the same as severe PTSD?

Not in my experience. Sustained, sub-traumatic stress can cause burnout without any major traumatic event.

Cortisol ain't a good friend.

That is what burnout is.

My burnouts all went with long-term persistent consequences.

Maybe, but burnout is a very broad term, and doesn't tell you what's going on in the brain. We're very limited in diagnosing brain problems and I wish there was more tech to help us with that.

I burned out hard during quarantine and developed both sudden onset tinnitus and a migraine for the first time in my life. The migraine was with a visual aura and was terrifying and debilitating. I was so sure I was having a stroke. I saw a neurologist and a psychiatrist just like the author. Nothing. It was all a “stress-induced” episode. No fancy label, no satisfying diagnosis. And the symptoms have persisted here and there since. I have constant tinnitus and my brain feels different since then. I can’t think or focus as well. It sucks. And for the record, no, I didn’t get COVID (this is asked regularly when I describe my experience, especially after describing what sounds like brain fog).

I’m still not doing well. Just like the author, I’m not “better”. I’m barely hanging in.

I’ve heard numerous similar stories. Stress can do horrible things to the body. Almost everyone I’m close with has shared some kind of anxiety-induced medical something or another story with me. Last year was rough for society as a whole.

Reducing stress is something a lot of us could benefit from, but there are also some underlying medical issues that can be exacerbated by stress.

If you are still getting migraines you might want to see another doctor. They aren't super well understood yet, but there are pretty clear physiological signs and there are also some prophylactic treatment options. Chronic migraines are a very real neurological disorder, and for some people severe enough to be disabling.

In general I think it's a very hard line to walk to avoid over-pathologizing things while also not missing actual medical issues. Nobody really understands the brain, and the entire discourse around phenomenon like "brain fog" kinda bums me out. It's both easy for doctors to unfairly dismiss and easy for internet forums to spin pseudoscience about. The two reinforce each other even.

Keep hanging in there, and best of luck sorting out these issues.

Seems more related to starvation than hacking.

Yeah, or some form of diabetes. The body is great at making glucose out of pretty much anything, specially muscle and fat tissue. I don’t buy the diagnosis, there has to be something else on the metabolic side that’s missing if that were the case.

Occam’s razor points to a psychological disorder, he went straight to psychiatric medication with no attempt to deal with the compulsive component of his behavior.

I have to agree with a psychological disorder, brought to a severe point by stress (note: I'm not a doctor or psychiatrist).

I don't see how at any point a person can be so deprived of nutrients brain convulsions occur. Something had to be wrong before hand, maybe he should get his wife's side of the story.

Thiamine (B1) deficiency can cause exactly that. It leads to mitochondrial disfunction depriving high-energy cells (mostly neurons) from ability to consume glucose via oxidation. As the result, a person develops insulin resistance that causes a swarth of consequences like an induced type 2 diabetes. If the situation with thiamine deficiency is not getting fixed, lactic acidosis proceeds as a dangerous side-effect of the backup metabolism path (anaerobic glycolysis) and gradually leads to progressive peripheral neuropathy including panic attacks (false hypoglycemia), burning sensations and numbness in the limbs and so on with ongoing neuro-degeneration.

Not sure if this is the author's situation but he should be very warned.

This sounds incredibly unscientific, and I can't wait for it to be cited as a primary source in breathless made-for-netflix pop-neuroscience documentaries.

Sounds like burnout, he had mentioned that being something in his history when he did some work with my team a few years back. Burnout is real, it's also probably not glucose depletion triggered seizures, but I think his internal diagnosis says enough.

In general people need to be better aware that you do have real limits to what kind of stress levels you can handle effectively and you need to back off when you start feeling overwhelmed and not try to "push through".

I’m dubious about the diagnosis. If sustained overthinking could regularly cause seizures, I think it’d be ubiquitous in competitive chess players.

Based on the authors description it sounds much more due to lack of sleep and stress.

I also believe it was a multitude of factors. Creative thinking being a catalyst just doesn’t add up. I can’t speak for the physiology of others so it may very well just be that for him, but it’s be nice to get more details on what the doctors diagnosed.

I agree it's probably not creative thinking, but I also kind of doubt the doctors identified specific triggers unless he did an extended in-patient monitoring stay. One of my friends, who in daily life on meds would have 1 or 2 major seizures a month, stayed in an epilepsy unit for 6 weeks with not even a focal seizure detected. He had had epileptic seizures detected in the past but was undergoing monitoring to evaluate for other treatment options/possible surgery. They took him off of meds obviously, and as the stay extended they started sleep depriving him, giving him caffeine, giving him booze, etc. Trying to identify what might actually trigger them. They now think it was mainly work stress, since he was on medical leave from work during the stay.

Why does it take 33 posts to tell a story on Twitter? I know why, but _WHY_?

What's the point of being a micro blog platform if long-form text is written anyway? Twitter either needs to disallow long text in threads or just remove the character limit.

Both of your proposals would make Twitter significantly worse.

- Removing the character limit would just make the feed unwieldy and unpleasant, especially when reading it in chronological order (bottom-up) like it was meant to be read. Typically a follower's feed will contain a collapsed version of the thread showing only the first one or two tweets and a "Show whole thread" button, so they can read a short summary in order to decide whether or not to go into the entire thing.

- Disallowing long text in threads would just push people into writing the first half of their post on Twitter and the second half on $THING (there were once specialized websites for this format, like Twitlonger), which makes the reading and commenting experience unnecessarily disjointed.

Another advantage of tweet threads is that people can share/like/comment individual tweets, which serves to surface the one or two interesting highlights out of a 30-tweet-long story. It's sort of like line highlights or line comments in some blog platforms.

(And if you disagree with my viewpoint, that's fine. I'm not intending to convince you to use Twitter, just explaining why things are the way they are to the best of my knowledge.)

These are good points.

I especially hadn't considered the commenting on individual tweets aspect. IMO it's a bit esoteric to click on an individual tweet to read the comments, because it breaks the flow of my reading. But I can totally understand the upsides of that.

After hearing your thoughts, Twitter could improve by removing the character limit BUT:

- Showing only the first 250 characters of a post on user's feeds.

- Putting a like button next to each paragraph

- Making it easy to inline quote sections of the text in comments by building it into a context menu when you highlight text

This UX would only apply to >250 character tweets, so the micro blogging aspect is not totally lost. Perhaps a option could be added to filter out long tweets for users who prefer micro blogging.

This way you wouldn't have to laboriously chain tweets together, and you would actually gain flexibility in quoting specific sections without breaking the flow of reading.

People who have experienced brain trauma present significant initial relief when they are told they have condition that has a label.

They tend to relapse every two years and select a new diagnosis after they don’t get better. It’s heartbreaking to watch when you know to look for the pattern.

My takeaway is the organisational design (one week hacking / writing report / planning) is not working at a sustainable pace.

The problem is finding ways to work at a sustainable pace, even ignoring medical emergencies.

I don't find his explanation convincing. He totally overworked for a long time, probably didn't exercise at all, didn't do anything at all - this by itself is likely already a symptom of an underlying issue. No sane person will spend all the time working if there is a choice. Maybe he was distracting himself from a depression or some trauma. To narrow the cause of his experience down to Glucose seems like quite a simplification.

I might not be sane (how would I know fully?), but there are several times in my life when I beyond-willingly worked 75-90 hours per week for months on end. I did it to ship a game, and two other internal products at other companies. Those periods look a lot like working, sleeping, eating, and walking among the areas where those activities happen. I loved my life in those periods and had plenty of freedom to choose to do or not do it, probably more than I do now with obligations to provide for my family.

I'm the last person to judge you. I myself am most certainly not "sane". My coping strategies lead me away from work. I need to maintain balance to actually work. Not even sure if I even have a real coping strategy. I do breathing exercises, ride my bike and in the evening I treat myself with a little bit of weed. So, that's that. It just seems to me that it might be worth digging a bit deeper and broader if you want to narrow down the cause/s. Good luck for sure!

how old were you at the time? if you were in your late teens-20s your body might have been strong enough to sustain the pace.

OP mentioned the anti-depressants only masking the physical symptoms and not treating the lack of ability to work, therefore OP did not think depression was the issue.

Uuuuh, that's basically a text-book description of anti-depressants "working". You take them to become functional enough to deal with the underlying issue of--in this case--having a really shitty job.

I have a lot happen to me but at this point I know these people from medical industry just don't have proper answers and will parrott you what they have been thought or heard because they need to make paychecks otherwise they are screwed like everyone. Also they cannot identify this major social symptom, showing how little they really understand complex systems. Medical students are chosen through a very competitive process and game that doesn't ressemble real theory at all. It merits parroting, memory, and greed. Psychologist are perfect analogs to priests, and psychiatrists are at this point glorified drug dealers.

Like in many high-skills high-competition jobs, people are selected on how much they can endure, not just how good they are. I've seen many excellent people just quit because the pressure with useless tasks was wearing them down. I often heard them tell me "I don't want to become a zombie like all of them" or things such as "Look at them, they are all trying to reproduce what they have been through because they have been convinced thats how you select good people"

I experienced something really similar a few years back. Lengthy post, but a topic close to me these days.

I had, a couple of years previously, changed job and had the opportunity to do a complete retake on a traditional business from a tech perspective.

Incredibly motivated and excited - spent my days talking to teams and management and nights coding and building things.

This is not in the US, and I had no pressure at all from management mind you - I just really enjoyed it and we made amazing progress.

Couldn’t wait til the family was asleep so I could start hacking away, often to 3 or 4 AM.

This went on for about a year, and I thought I had the best job, team and most fun ever in my career.

One day going home from work I could feel a spring in my brain let go, much as described in this tweet - the whole world stated to spin and I found myself leaning against a car in the lot not to collapse.

Weird... wth... ok, let’s see if it was just an issue or if we have a problem.

A couple of days later I’m in a conference room to do a demo. Someone throws me the keyboard and as I start to write everything seems to slow down and my fingers are moving in slow motion. I try many times to type my password - impossible. I try to speak - just slurring.

From this point on whatever is going on start to manifest itself on a regular basis. I get a “zing” in my brain, like physical, and loses train of though, words and balance.

Going to work one day my body just stopped, turned around and began walking home. On it’s own! Surreal. I was just taken for the ride back to the bus and home to bed.

At this point I’m starting to feel like “I’m not there”. Like my mind is in the back of my brain and not in front, at my eyes, if you get what I mean. My mind had kind of an out of balance, far back, tunnel vision of everything. This became the new normal. Really disturbing.

Obviously I started to investigate this. Went through the process with different doctors. Lengthy process. At some point I get this unbelievable pain in my shoulder, probably because I had started to work out again quite hard. Way inflamed somewhere.

I go to a naprapath to try to sort it out and he investigates my neck - “woha you seem to have massive inflammation in your upper neck”. He does the naprapath business for 30 min. Boom! I’m back! I’m “in my eyes” again, almost two years later. No more tunnel vision! W. T. H.

Couple of week later I’m scheduled for a neurologist who examines me. He specifically asks if I’m ok in the neck. I describe the above and he explains that issues in the upper neck can cause all kinds of weird neurological issues.

The MR came back clean as the doctor had figured.

Getting back completely have taken it’s time. A good couple of years, and I’m in general more weary and try to listen for signs.

These days - no coding after hours, exercise regularly and in general a better understanding of my body and mind.

Listen to your body, brain included! Stop clenching that jaw.

This neck issue is interesting to me.

Someone close to me, a former Microsoft developer, complained about neck issues for years. Doc said it was probably posture and stress, and this person never went to a specialist.

One day, after about a decade of untreated neck pain, this person collapsed at their desk and went into a coma. They eventually recovered, sort of, but what they describe is exactly how you feel and Mr. Glucose Depletion in TFA. Pop sound in the brain. Dizziness. Loss of speech and motor control.

The official diagnosis was stroke. The former Microsoft engineer had some kind of collapsed/pinched neck artery and they had a stroke. They are alive and well today, but completely incapable of coding for the rest of their life.

A nearly identical but more severe story as yours and the the author’s.

The neurologist I went to really recommended naprapathy and/or physiotherapy on a regular basis - he was in his 60s and had seen a lot of really weird things over the years.

It’s easy to chalk a burnout down to emotions and stress, and these might very well be the root cause. For me the above, however positive in nature, gave me physiological “blockers”, in a sense.

Had my shoulder not started to act up (bicep it turned out after a couple of months excruciating shoulder pain - a whole story on its own, fixed by sticking a needle straight in to the muscle to force relaxation) I would not have ended up at the naprapath.

A kind of burn-out - but rest and mindfulness on it’s own would not have been enough to get me back.

Low Dopamine and glucose in the brain leading to seizures. I wonder if taking adderall/stimulants as an external dopamine source + sugary drinks/food for the glucose could have helped with this.

I dunno about Adderall but Id experience similar cases (stuttering, brain fog, social anxiety) after working hard for extended time, albeit nothing as extreme, and figured out a long time ago it was probably low glucose (there's sort of a saying for it in Chinese) and I'd indulge myself a bit in sweet stuff like chocolate and sodas. Most of the time I try to eat healthy. I have no idea if it actually helps though lol

No. Adderall forces the brain to release the dopamine it already has and causes increased brain activity, using more glucose. It's more likely to cause this condition or make it substantially worse than it is to treat it.

The amphetamine molecule enters the neutron and does several things, two of which are:

1) Force dopamine that is in storage in the neuron to be released prematurely.

2) Reverse the direction of the dopamine transporter so that free dopamine within the neuron that hasn't been reclaimed yet is forced back out into the synaptic space. Usually the transporter moves dopamine from the synaptic space back into the neuron.

To restore dopamine levels you'd need plenty of rest and a healthy diet. Forcing the brain to use the last dregs of dopamine it has left with drugs would be the worst thing you could possibly do.

Edit: In short amphetamine doesn't replace or substitute for dopamine, it just forces the brain to use what it already has. If you're running low it's going to mess you up.

Yeah I distinctly remember on day three or so of bangface (a n extremely intense rave festival in the UK) just kinda sitting slumped against a mattress in our chalet with almost this feeling like air was whistling through my empty neurons because you go hard on uppers and whatnot again and again.

sidebar: I have a lay theory that childhood mistreatment can kneecap the reward system and that ADHD is one manifestation of that.

In the short-term amphetamines and sugar are great to push yourself. And in the long-term, some people find they function better with some amphetamine in their system.

But, I can think of no /quicker/ route to some sort of intense crash and possible health issues than using a constant diet of sugar and speed to push oneself beyond their capacity day in and day out 24/7.

The median diet in the USA can accurately be described as "using a constant diet of sugar". It's nothing special.

The author of TFA simply didn't run out of glucose as he claimed. The symptoms from that are entirely different than what he described.

When burnout similar to OP hit me, the company I was working at had free soda available all the time. I'd get slow while working stupid hours, and so I'd be guzzling soda to pep me up (or so I convinced myself... actually I was just addicted to the sugar). It was the lack of rest that was the cause of the debilitating burnout that destroyed me for years, and not for lack of glucose.

The conclusion that a glucose deficiency was causative to this episode is rather naive and far-fetched. This was either a severe migraine, a manic episode that possibly turned into a psychosis or a stroke. Episodic Migraines and strokes can both lead to loss of words and memory as well as auditory hallucinations (guitar string sound in the center of his brain) and could explain the other symptoms he describes.

It could also be a mix of the above.

> You have to do it yourself. You have to research things yourself. You have to hunt for doctors & specialists yourself.

This is one of the key things that establishes that Americans who don't see the problem with their healthcare system are completely insane. You are not supposed to have to research your own healthcare and choose your own specialists. That is the job of ... wait for it ... medical professionals.

Why didn't the psychiatry and GP want to fill in the Temporary Disability papers? Does the healthcare system disincentivize them from doing so?

There has to be a diagnosis. "Dunno " doesn't go on the form.

Sure it does, but it's spelled "idiosyncratic" on forms

Idiopathic

They might be some kind of just-world fallacy power-hungry sadists?

> I don't know how I would have done it without my family.

> My brain didn't work.

> I couldn't have done it myself.

Well that is scary.

The first two lines of that tweet:

> The healthcare system in the US is a failure.

> You have to do it yourself. You have to research things yourself. You have to hunt for doctors & specialists yourself.

It is pretty scary.

It's not a matter of whether you're going to need the healthcare system to work for you, it's when. Everybody gets older, everybody starts to lose function in various ways, and everybody dies.

The US healthcare system is an unmitigated disaster.

I think this is also, to a lesser extent, the case in other first world countries. A family member of mine in Germany who had a serious incapacitating health issue needed to be advocated for for almost a year to get a life-saving surgery.

> You have to do it yourself. You have to research things yourself. You have to hunt for doctors & specialists yourself.

That's true everywhere, though. Just because basic stuff is paid for in Canada doesn't mean we've got crack teams of doctors tracking down your diagnosis.

Standard principal-agent problem.

It can be somewhat mitigated by hiring better agents (finding doctors that are more interested in patient outcomes than their OV/day stat). Unfortunately this usually means private physicians who don't usually take insurance; the costs are usually 2-10x higher.

Quality customized personal service from highly trained professionals costs Real Money, something I've not yet found a good workaround for. Insurance for catastrophes can mitigate it for unexpected outcomes but in the long run insurance for something everyone needs (basic medical attention and care) is going to approximate 100% of the actual costs of hiring those vendors.

Finding extremely good personal services vendors (attorney, accountant, doctor, dentist, trainer) is one of the most important investments in oneself that anyone can make. It can literally make or break you.

Yeah that's something I definitely need to do... Most people really can't afford it though

But wouldn‘t your main doctor refer you to the specialist if you want to?

If you even have a main doctor (many Canadians can't find one) sure - then you wait 6 months to see the specialist who may/may not know what to do. My wife was recently in a car accident and waited 3 months to see a podiatrist who said "maybe your foot's broken, go get another x-ray".

It's even horrible for some of the most common ailments people are diagnosed with.

Not just the healthcare system. Everything in the US is like this: Government bureaucracies (especially the ones the poor need to use), the legal system, the tax code, the educational systems. It goes on and on. Everything operates on the principle of "you better be able to fight for yourself, because no one else is going to." I'm always shocked when I encounter the rare instances when people in these positions actually help the people they're supposedly being paid to help, instead of putting in the absolute minimum of effort and cashing their paycheck.

In what country would one consider the healthcare system to not “be a failure” though, regarding these aspects or when somebody faces the same issues that the OP has? Sounds like an inherently hard problem given how things are structured now.

Easy to blame the US healthcare system, though in what country would one consider the healthcare system to not “be a failure”, regarding these aspects or when somebody faces the same issues that the OP has? Sounds like an inherently hard problem given how things are structured now.

I told my firm. They put me "on the bench" for a couple of weeks.
After a couple of weeks, they told me they couldn't pay me anymore.
I wasn't bringing in money at that point.
Mind you, I brought in millions of dollars leading up to that point.

But I wasn't producing...

Seriously.

Compulsive corporate apologists can byte me.

The employment agreement is one of work hours for money. It's not a revenue share; for that, you need equity or to start your own business. For-profit corporations not being charities for the benefit of their current staff members is fact, not an apology.

This is what insurance is for. Per the author's own admission, he didn't qualify because he didn't have a diagnosis when he made a claim.

Analytics seems like a fairly awful substitute for ethics.

and

I do like This is what insurance is for followed by sick guy operated outside of complex series of guidelines that help reduce the resources spent on actual care.

"Well if you're not in the hospital, why aren't you working?" wtf, hasn't this doctor ever seen people with disabilities or mental health issues outside a hospital? we all know or have family members in that situation.

Hmm this is somewhat scary... does anyone know how much actually is required for this to happen? I work 10-13 hour days quite often. I love every second of it, but it can be intense.

Also... what foods are high in glucose or whatever brain food I need?

You don't need any special "brain food." You just need to take breaks and eat regularly.

Edit: And of course you should try to eat a balanced, "healthy" diet, but the issue being described in the Twitter thread is pushing through far beyond what's physically or psychologically healthy.

Eating foods high in glucose seems like a good way to give yourself insulin resistance and diabetes. That does not seem like the answer.

Sounds unpleasant..

Next time I feel like an unintelligent imposter, I'll remember this story, and be happy that at-least I won't break my brain this way.

(We can probably still stress our brains into dysfunction by other means, if we're not careful)

Sounds like they were binging stimulants to get their work done. The brain needs regular sleep or you burn out hard. Nothing inherently wrong with drug use, but it must be done with compassion for your body.

I think trying to reverse engineer something that was protected multiple techniques to prevent it from getting reverse engineered can potentially drive anyone to getting a neural disorder.

I’m not a doctor, but I’m pretty sure that if your brain ran completely out of glucose and dopamine, you would die immediately.

I've got a feeling there could be some nootropic experimentation involved?

We do a pretty lousy job most of the time of providing the support the body needs. This story kind of touches on or points to the need for us to get better at understanding that kind of thing.

This is a weird edge case, for sure. Seems like it's still far from understood. It could be any combination of psychosomatic issues, trauma triggering, lifestyle factors, and undiagnosed organic issues, as not all diagnosticians are great when it comes to edge cases.

Just a thought to those who assume the brain diagnostics would have shown any seizures: There is something called "cognitive kindling." If a particular type and duration of mental activity can induce partial seizures, to confirm this any functional diagnostics (such as an EEG or fMRI) may have to be run during that type (and duration) of cognitive activity.

I've felt something similar to what the poster described -- subjectively or phenomenologically. It began to effect me in the 1990s at QCOM, where I did mostly troubleshooting of embedded real-time systems. I tried to get a leave of absence but (despite having won two performance awards, each with additional stock options) my last (new) manager accused me of being lazy, so, rather than keep getting paid to show up and produce nothing of value (despite racking my brain) I quit. I wanted to leave before I jeopardized my good reputation, and given that the scope of my project was months, it could have been many months before I'd have received my first performance review below 3 (of 5).

Thankfully, the last 50% of my initial set of QCOM employee stock options, plus 20% and 40% of my second two sets, vested near QCOM's all-time peak in 1999-2000. Thanks to that windfall, I was able to self-fund a deep dive into the peer-reviewed medical literature (because my own MD-PhD internist challenged me to do so*), see doctors who are good enough not to need to deal with insurance companies, and pay out of pocket for their diagnostics and treatments.

(*Even though medicine does generate so much research that reading the research and making sense of it might need to be partially crowdsourced to the set of people with sufficient means, motive (pain point) and opportunity -- which is what I had -- even so, society, please do not rely on the edge cases of partially-disabled, semi independently wealthy engineers to come up with our own solutions.)

Unfortunately, I don't take fools lightly, and I quickly label as fools non-Bayesian thinkers who can't see zebras because horses are so much more prevalent -- and make false assumptions about my history, motivations, and inner life. So I steered clear of perfunctory "show up in a white coat and get paid well" types who perform "nobody ever got fired for buying IBM" standard of insurer-covered care. I ended up hiring mostly "alternative" doctors, and while their treatments (and ones I found myself, including illegal ones) were the ones that ended up helping me, their diagnoses are not useful in proving anything to conventional doctors nor to the government.

Thanks to QCOM stock options and then profits on precious metals after the 2008 crash, plus my wife's support and a few entry-level jobs, I did not apply for Disability benefits until many years later. I was not approved for benefits, despite my psychiatric practitioner and case manager recommending it (for chronic PTSD, finally diagnosed after I suggested it myself), and an acquaintance who works for SSDI (US government Disability insurance) saying I'm "as disabled as most who qualify." Based on my experience, despite being a former Libertarian I believe the US social safety net has huge holes.

Eventually I found some relief with a keto-ish diet and then, since spring 2018, microdosing LSD or psilocybin in the morning. Cannabis or delta-8 THC I sometimes also use in a normal (non-micro) recreational dose at bedtime, which seems to prevent subsequent days of effort from accumulating toward a burnout. This allows me to work a normal entry-level job, as long as there's no drug screen. For the latter, microdosing LSD or psilocybin are more practical (though more-often fully-illegal) because they are less likely to be detected by standard drug screens ordered by current or prospective employers.

By the way, though I have been substitute teaching since October 2016, recently held a full-time factory job with mandatory overtime (48 to 56 hours per week) for 13 months (with a promotion to Electrician at $20/hr), and recently landed a full-time WFH customer service job to start May 17, this requires me to stay within 2.5 hours drive of the office, and I am looking for fully-remote work that pays a bit better than this $15.50/hour. I can do customer service just fine, and given my history in software development (mostly embedded, mostly the 5 years at QCOM, with degree in electrical and computer engineering) I think I could earn a premium doing a similar role, or perhaps some kind of technical writing, in a more specialized technical or scientific niche. (Along the way I did 40% of a Master of Public Health and later did most of Coursera/JHU data science course.)

If anyone has job or career ideas for me (who still has been unable to do software engineering beyond the hobby level without burnout) I welcome them at (see my profile for email adress).

> I "depleted my brain of dopamine and glucose" causing "Functional Neurological Disorder" (FND - DSM-5 code 300.11)

Is this a real thing? I can't find any evidence of Google about this and the author didn't link any sources. "300.11" is pretty vague and seems to refer to a problem that doesn't match any other criteria. I can't find any reference to it being caused by glucose or dopamine levels.

Edit: https://twitter.com/TinkerSec/status/1388269323295338501 says "I went to a neurologist first to make sure it wasn't a stroke or epileptic seizures. They gave me MRI and EEG tests. Then I went to a neuropsychologist. It was the neuropsychologist that diagnosed me." which means it was diagnosed by a psychologist rather than a medical doctor with an MD.

The parts about stress are probably valid but the "glucose and dopamine" depletion is probably bullshit.

Functional Hypoglycemia is a real thing. I did a high school paper on it back when I had a rotary phone and pet dinosaur.

At the time -- nearly four decades ago -- there was no known cause and the only useful treatment was diet and taking high doses of vitamins.

When glucose levels get depleted, the body starts drawing on stored stuff in the liver. The mechanism for releasing that is adrenaline.

When the liver stores run out, you have no further backups. So then you start waking up out of nightmares that involve running because your heart is racing in your sleep as the body tries and fails to access your depleted emergency stores.

I've never heard of it as a neurological diagnosis, but it is known to impact mental functioning and promote terrible anxiety.

> So then you start waking up out of nightmares that involve running because your heart is racing in your sleep as the body tries and fails to access your depleted emergency stores.

Wow, really thanks!

Wait, that's exactly what has been happening to me for the past few weeks. Each night I woke up after 2 hours of sleep with heart racing. Then I woke up another 2 times, due to tingling in my arm. My heart was calmer at that point. I was wondering what could be the cause..

That could be a lot of things, including sleep apnea. A formal sleep study is a good place to start.

When your body runs out of glucose in blood and glycogen in liver, it starts creating new one from protein and fat [1] for the few processes that need it, while switching most metabolism (including brain) to use fat-derived Ketone bodies as fuel [2].

This normally happens when fasting, and is no big deal. It's how people survive days without food.

Now there's something going on with how brain processes ketone bodies and glucose differently and there some research about how that affects things like Alzheimer's disease but I don't know that much about that.

[1]: https://en.wikipedia.org/wiki/Gluconeogenesis [2]: https://en.wikipedia.org/wiki/Ketosis

I find it all very doubtful. Sounds more like someone not wanting to admit to burn-out in order to protect their career.

Lol he lost his job - this didn’t protect his career.

As he said, his healthcare is shit, so he used his test data to diagnose himself.

Start a blog already.

^^^^^^^^^^^^^^^^^^^^^^^^^^

Totally agree, why do people keep using the 'tweet' format for long stories that obviously do not fit? The reading experience is not good at all. Not trying to be negative am genuinely interested in the reasons.

because that's where their readership is and that's where they're likely to be discovered by more readers? I dont like the format but I don't think the 'why' is a mystery at all.

So why not just post a link elsewhere for things that don't fit? It just seems strange to me, that people put up with the limit making the reader's experience worse, just to have the words on a particular platform.

https://threadreaderapp.com/thread/1388107620574171140.html

Sometimes when I push myself too hard I find that I become incapable of resting. Even if I’m very tired I can’t sleep properly because I keep having these “loops”, such that the moment I would fall asleep my whole body jolts and I’m thrown back to this half-asleep state, and this keeps repeating seemingly for hours.

I know that and there is an easy fix: Don‘t work after 6pm.

Reply on news.ycombinator.com