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Comment by jrmg | Hacker News Reader

I am absolutely sure that if I had been given the out of ‘having anxiety’ as a young adult, my life would’ve gone very differently, and probably very much worse, than it has. I think I would’ve allowed myself to lean into my tendency to be introverted and possibly ended up friendless and alone, and in an unfulfilling job.

Note that I’m not denying that people might have mental illnesses that have deep rooted or physical causes that _need_ therapy or medication in order to live a fulfilling life.

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That and the cultural norm that we're creating around mental illnesses. I mean, it's great that the few who truly do have mental disorders can be accepted socially but what are we doing to the thousands of kids that just need some structural social target to aim at?

Personally, I was an emotional basket case until well after college when I decided that I should give the "be normal" thing a try. Turns out being normal makes a lot of things easier in life.

It's amazing how much freedom you have to be weird on the inside when you're normal on the outside.

I try to see things less from a "mental health" perspective and more from an "emotional health" one. I'd be really curious to see how people who work as psychologists and psychiatrists might delineate between a mental health issue and an emotional health issue. Perhaps it's just semantics and they wouldn't see a difference, I guess I'm just looking for ways to address some emotional challenges separately from potential mental health challenges.

How do you define being "normal?". How do you manage the tension between your inward and outward presentations of yourself? It seems exhausting, and that's coming from someone who does that currently and idealizes some magical place when those selves merge into the same person.

That's "normal" to me, when I don't have to put masks on to fit into a preconceived notion of who society wants me to be. That's also a big part of mental health, not boxing people into mental disorder diagnoses, but helping people figure themselves out and be comfortable in their own skin.

I define "normal" as things like wearing unremarkable clothing, eating at trendy restaurants, going sightseeing, saying grace at family dinners, keeping a decent job, bringing food to parties, keeping my lawn tidy, driving an unremarkable car, learning the art of small talk, etc.

People use these things to calibrate their interactions with a person they're meeting for the first time. Once people see you as "normal" they're more prone to listen when you start throwing out the weird ideas.

I've come to believe that weird is normal. No one has their shit together 100%.

Your version of normal is "don't rock the boat" normal. Rocking the boat is painful emotionally so don't do it normal.

I've spent a lot of time in therapy trying to undo that version of normal and figure out who I really am. And you're probably perfectly fine in your version of normal. Which really illustrates that mental health is very personal and multidimensional. It doesn't mean I'm fucked up and you're not or visa versa. Gotta meet people where they're at.

Trying to be normal is normal. Being normal may have never been normal, but trying to be was and is.

That's what were losing, people don't even try to be normal anymore, because having a mental illness has been normalised.

It's not the right side of history, it's not progressive, it's not inclusive. There will be a price to pay and we'll only find out how much it is once we get the bill.

That is trivially falsified, the prevalence of mental illness is not really related to the acceptance in society (outside of society declaring things to be a mental illness, e.g. homosexuality). For example in Germany the incidence of people missing work days for mental health reasons is higher in regions with less academic jobs (a milieu which tends to be more open to these topics) and in the formerly socialist parts (where there was a higher tabooization of mental health topics). Similar patterns exist for suicide.

I think I know what you get at, but it is important to differentiate between e.g. someone with social anxiety overcoming their anxiety to take part in society (the good way of "trying to be normal") and someone repressing what should actually be worked on (the bad way, hurting both the person, and, long term, society).

The important point with all things regarding the human mind (education, psychology etc.) is that one strictly can't infer what actually happens from outside observation alone. Let's say there exist two persons, A and B, and both play 6 hours of videogames a day. But person A is a perfectly healthy introvert, while with person B this actually is addictive behaviour concealing mental health problems the person hasn't found the strength to confront yet. It depends on how they feel while playing, and how they feel when not playing.

That’s conflating what people present to the world with their mind. It’s a very shallow understanding of what’s going on.

Regularly BASE jumping is seriously dangerous to the point where almost nothing else people do that’s “living on the edge” really compares. Think active war zone levels of danger, but they don’t need to dress up in spikes to show off how edgy they are. It’s possible to come off as a calm high school librarian while still being an extreme adrenaline junkie.

Next time you walk past a middle aged banker type in a sports coat consider they could be a furry, you just don’t know. Assuming someone seeming normal is actually normal is being blind to the possibilities.

>> That’s conflating what people present to the world with their mind. It’s a very shallow understanding of what’s going on

I was trying to contrast the external and internal presentations of self, not conflate them. My point is that a "normal" external presentation doesn't make someone a "normal" person. Someone can act, consume, and behave certain ways that help them feel normal, but in the end it's a coping or survival mechanism of sorts. If I fit in with the "in" crowd it affords social and economic status. That's the version of "normal" my comment was responding to.

The only way to define normal is the external representation, you never see the internal one.

Therefore someone that seems normal to all appearances is normal. If in the privacy of their own mind they pray to the invisible fairy living in their left nostril, well how do you know that’s not what 90% of people do?

Related: a lot of intellectual people don’t have a tv, and like to make a statement of it.

I was like that for a while, but then as I got older I realised it was much smarter to buy a tv, put it in the living room, and never use it. Now people think I’m normal and I never get questioned about why I don’t have a tv, why I read so much, do I think I’m above popular culture etc.

Amusingly, I did once get busted when a friend wanted to use said TV and it turned out the card in the cable box had expired months before. Didn’t even know it had a card - the cable box came with my broadband/phone line package. Got rid of the box after that.

I guess the more modern equivalent would be to watch an episode or two of Netflix shows now and then.

I think the more normal thing to do would be not to buy a TV and just don't make a meal out of explaining why. 'I would never use it, ' is pretty sufficient

If you do that, people would think you very odd (at least before streaming dominated content). Which is my point.

I think you're living in a bubble in this regard. It seems odd to me to worry about this, and in fact odd that visitors would both notice the absence of a TV and comment on it.

Data point: We don't have a TV in my student house, and no one has commented on that, even though we have had on average maybe 5 visitors per week for over a year. Offhand I'd estimate that about 50 unique people have seen our living room. I'm in Sweden.

Speculation: The common factor is you. You influence your visitors with regards to what topics to talk about and how to treat these topics.

I don't think it is the right mindset. Mental health is a spectrum as much as "being fit" is a spectrum. Just because you aren't morbidly obese doesn't mean you won't benefit from learning how to take care of your body. Most people don't need a personal trainer and a dietician when they gained a few kilos extra. The same way everybody needs to understand how to heal their mind and recognize when things get difficult enough to benefit from professional health.

And I’d argue the self help industry - which has existed for a good 100 years now - has served this purpose for these types of folks.

I guess my point is that I think kids should be hoping they don't have any medical condition instead of asking a therapist "Doc, can you find me a diagnosis that fits my current mood somewhere between asbergers and schizophrenia with a dash of manic depressive"

Of course. We are just going through a strange period of mental health. It used to be: "only very very serious problems are worth attention and in this case only professional can help you". This is why it was (and to an extent still is) stigmatized. Now we are moving towards "we all have mental health problems of different severity, mental health isn't binary". However, people still operate with the old dogma: "have a problem? Go to therapy, you can't help yourself, don't even try". That's why people tend to go to psychologists (and psychiatrists) more and more. Of course, many expect to get a prescription that fixes them magically the same way they want to have a pill for literally any medical problem.

However, just saying "there is nothing wrong with you" often means "your state does not fit any of predefined diagnoses" rather than "it is perfectly normal to feel that way". The same way people often complain about back pain and doctors can only say "there is no acute injury, Xray is fine, nothing I can do for you". It doesn't mean you can ignore it and go about your day. It means that most likely you have to find a lifestyle change to fix this yourself. It can be yoga, it can be getting a better chair and being more active, it can be a new mattress, etc.

Physical pain is more straightforward because most people understand that feeling pain is not normal, it means something is wrong. Nobody will tell you "if doc said you are okay, then your back pain is made up, you should stop being so dramatic".

I don't know anyone who thinks of 'having anxiety' as an out, identifying it as something that's negatively impacting your life is just the first step in making changes to reduce its presence. Furthermore the vast majority of people, with or without mental illness, are happier and more supported with some amount of therapy. If you can get that from your friends/partner alone, great, but often times it's quite beneficial for your relationships to take some of that emotional burden off of those people as well.

I'm quite concerned about the rate of medication being prescribed these days, often as a band-aid fix when people really are in need of serious life/habit changes. But I'm really surprised by the amount of people in this thread talking down on psychology and psychotherapy.

Someone I know has social anxiety. They told me that when they read about it and could finally give it a name, it really helped. Up to that point, they just felt like they were an oddball. They couldn't really explain to anyone, which made it feel like they couldn't get help or do anything constructive about it. Being able to name it lets you know that other people also have it. It can help you feel more "normal". It can help you research ways to work with it.

Of course, falling back on a diagnosed condition and using it as a crutch or an excuse for bad behaviour can be awful. I used to know a person with BPD, who absolutely loved being able to let herself off the hook for terrible behaviour. She would easily make friends, and sometimes would keep them for a few years. But eventually, one by one and sometimes in groups, they would cut her out of their lives because she was utterly toxic and selfish. So naming your problem can be positive or negative, but I think that depends on the nature of the problem.

I found putting a name to anxiety helped a great deal. I spent most of my childhood not really sure why some situations filled me with crippling fear - and felt like a failure because of it. As an adult I've realised it's a form of anxiety - and also that anxiety definitely runs in my mother's family.

I think my teenage years would have been easier if my family had been willing to talk about our anxiety rather than just pretend it didn't exist.

There is of course a danger that the diagnosis becomes an excuse - which is a particular problem with something like social anxiety where (at least in my experience) the only path to improvement is to face your fear and do whatever you're anxious about.

I’m struggling with this now with one of my children. All of the professional/medical support she is receiving is reinforcing the same notion and I’m left with nothing but an intuition that it’s ultimately destructive or at least limiting.

She has been and still is going through some tremendously stressful situations however and I’m trying to balance that against the fact that more stress is on the way. I completely agree with you but it’s tough.

This is a tough one and also one of my fears with my child. Take comfort in knowing that despite how powerful external forces may seem that you as her parent have an even more powerful influence. A wise man once told me "kids will never ever do what you say but will always do what you do". I would show her that obstacles are intrinsic to life. We are wired for struggle. Our struggles are what define us. Even when we have no struggles we tend to manufacture them just so we can overcome them and give meaning to our life. If she wants to give her struggle a label as x condition then that's fine, what matters is what her path should be to overcome that condition.

Jordan Peterson talks about this a lot, especially in "12 Rules For Life" and in his lectures about his daughter's medical condition. I couldn't find the relevant quote but he touches on it in this lecture segment [1]

[1] - https://youtu.be/VrNM-JCGGfI

Thank you, I appreciate it. Will definitely check it out.

Just letting you know that I downvoted you not because of the advice - which is pretty good - but because of the link to Jordan Peterson, who is generally a pretty nasty pseudo-intellectual piece of work.

With enough of a benzo habit that he had to detox in an induced coma, besides.

Can happen to anyone, of course, and it's not necessarily a reflection on character in its own right, but it is worth taking some thought on the value of advice on how to keep your life together when it comes from someone who's demonstrated such an inability to keep his own life together.

Even on the simplest things - his constant line is "clean your room", and every time you see him on a Zoom interview from home it's wall-to-wall clutter in the background. Granted, "clean your room" is pretty uncontroversial, and is good advice - as is that you should pet a cat when you find the chance. But, in this as in everything else, epistemology matters: you do want to consider the source.

Thank you for your opinion. I figured a lot of people would have mixed feelings about him but I wanted to give credit to where the advice was coming from. Personally, I've gotten a lot of value from his work.

Consider that maybe you had some luck, good fortune, or support structures that helped you pull yourself out of your anxiety, and it didn't turn inward on you.

Anxiety is not a disorder that causes or relates to introversion or extroversion.

Glad you're in a good place now but be careful on pumping yourself up at the expense of people who are truly struggling with anxiety. It's a mothafuka, not an out.

A diagnosis of anxiety is usually not an out but the beginning of the hard work of improvement. The generally accepted treatment for anxiety is therapy that will encourage you to put yourself into manageable but challenging situations where you can practice overcoming your fears, while finding and rooting out the mental fallacies that those fears are originating from.

No competent medical professional would've told you "You have anxiety, so go sit at home neglecting your social life." That's the OPPOSITE of what people with anxiety should be doing.

I doubt these apps are providing high quality mental counseling.

Having it as an out is doing it wrong and totally missing the point. It's a framework for understanding yourself/the patient, and how they behave, and not as an excuse for poor behavior. That's not to deny that some people certainly use it that way, but anything, including treatment plans, can be misused.

It's not a question of whether it's misused. It's whether it's misused so often that it's a bad idea.

And while I hope most professionals can be trusted to use it appropriately, I think the whole "awareness" thing makes a lot of laypeople (including self-diagnosed people and people connected to them or actual patients) misused it horribly. The latest I've seen is "mental health days". I'm sure some professionals would advocate taking some time off in specific circumstances, but is it wise to reward yourself for being stressed by having a holiday? That seems about as wise as telling an alcoholic to take sick leave as a reward for their big hangovers. I'm not a mental health professional, but the people who give advice on taking "mental health days" do not seem to be either.

And that's just the latest one that bugged me. There's an endless list of advice (both for people with mental illness, and people around them) that seems to be vaguely related to mental health advice, but isn't, and it's accepted because it sounds "nice".

I'm not sure I get what you're trying to say, what's wrong with advocating for people to take personal time off when they are feeling burnt out or tired from repetitive stress? I'm struggling to understand why that's misuse or in anyway similar to an alcoholic.

He thinks people cause their own stress at work.

Note - if a medical professional is saying someone is unfit to go to work and needs some recovery time, that's different. I'm talking about self-proscribed mental health days.

It's one of several things people are very confident are good for mental health, but I've not seen it actually pushed by any mental health professional (at least, not in the way that it's often used). I'm not totally against the idea of "chucking a sickie" (a time honored Australian tradition) to get some personal admin done, or just take a break. But I've seen no evidence that it's a good coping strategy if you're got actual problems.

If there's a problem at work, you're better off actually dealing with it either fixing the problem (which might be you or it might be external, or a bit of both) or looking for a new job.

Many mental health problems are cycles of short-term rewards for long-term pain, a lot like addictions. I think this is basically the "B" in CBT - maladaptive behavioural responses to stressors (which need to be replaced with more useful responses) - https://en.wikipedia.org/wiki/Coping#Negative_techniques_(ma...

> Whereas adaptive coping strategies improve functioning, a maladaptive coping technique (also termed non-coping) will just reduce symptoms while maintaining or strengthening the stressor. Maladaptive techniques are only effective as a short-term rather than long-term coping process.

> Examples of maladaptive behavior strategies include dissociation, sensitization, safety behaviors, anxious avoidance, rationalisation and escape (including self-medication).

> These coping strategies interfere with the person's ability to unlearn, or break apart, the paired association between the situation and the associated anxiety symptoms. These are maladaptive strategies as they serve to maintain the disorder.

Note, I'm not an expert on this. But I suspect neither are a lot of people disagreeing with me.

More generally, a lot of what seems like "good advice" on mental health could be just reinforcing maladaptive coping techniques, because the seem like common sense (they are how many people cope with problems, even though they're not helpful in the long run).

And I'm guessing that the people who would be most harmed by bad advice (or advice that might be good in some situations, but bad in others) will be the people probably should be taking very different advice (e.g. "deal with those underlying problems" instead of "take a day off if it's getting too much").

> is it wise to reward yourself for being stressed by having a holiday?

Yes. No matter what the fashion of the moment moves anyone to call it, it absolutely is wise to take a break and recover when you can do that without letting anyone down. The stress will still be there tomorrow, and if you're on a good team, you don't have to carry it alone. As long as you don't shade out when it really needs to be all hands on deck, you're fine. It's not hard to spot the ones who abuse it, and at this point in my career I don't find it hard to avoid places where they're welcome.

Better that than needlessly go one day closer to burnout, don't you think? Speaking of which - to conceive of it as a "reward", and an undue one at that, strikes me as sounding like nothing more strongly than burnout. There's a place you get to where it feels like you're thriving on the misery, but that's only because it's been so long since you had anything to compare it to. The next place down from there is worse.

So yeah, I don't begrudge it of my colleagues when they take the time they need, nor do they of me. We've all seen what happens when you don't. None of us wants to see any more of it. You don't want to either, especially not from the inside. Not everyone makes it back.

I don’t think you deserve to be downvoted for saying this. I agree. But I think there’s a bigger chance that I would have “done it wrong and totally missed the point” than not.

If my parents had noticed that I had severe social anxiety they might have considered getting me help and I potentially wouldn't have ended up as disconnected and friendless as I have via being enabled for much of my life.

I didn't know anxiety was a treatable condition until I was 21. And I've only been able to actually go get help years after that.

No doubt. To me all this relates to an implicit dualism and just not taking mental health seriously still. I just don't think we ever will while viewing the mind as one thing and the body as another. There will always be this bias that we would consider morally really off if discussing a "physical" health problem.

Even being aware of this I have a bias with typing out "mental health" without realizing it.

We are probably doomed until "brain health" replaces "mental health" in common language.

I had really bad social anxiety about a decade ago but the treatment for my ingrown toe nail was so much better and taken more seriously than a problem with my brain. The first person I went to about it had a community college degree and said they didn't believe in medication. Just incredible.

On the other hand if you have an undiagnosed disorder, you may live your life never being your own friend, always fighting with what you see as character flaws. This leaves you stuck in a rut until the diagnosis, which finally lets you look at and apply constructive solutions.

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