Silicon Valley has a mental health crisis too (2019)
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I feel like I'm in a better spot, but one thing I've learned consistently is that this is a universal, human issue. Very few people are lucky enough to go through life without what some would call mental illness.
We're also woefully underprepared to deal with these realities. You don't take a mental health class in high school, or college. At what point is someone supposed to train you to take care of yourself? Well, your parents, of course. But they usually have their own issues.
One thing that helped me was to get into therapy. BetterHelp is $320/mo, which is frankly a massive cost. But it was good to be in therapy on a weekly basis, and to explain all of the things that I felt were going on.
"Safe space" has been used pejoratively, and it's hard to say it without wincing. But if a safe space is important at all, therapy is the exact place that needs to be safe. And having a spot where you can simply vent to someone for 45 minutes straight was... quite therapeutic.
One advantage you have as a programmer, if you are one, is that you probably have more money than average. So if you're going through similar struggles, I encourage you to throw $320 at the problem and see what happens. It's not a cure-all, but nothing is.
For what it's worth, my therapist felt pretty genuine. One thing that helped is to actually ask about his day, and how he's been. I think he was surprised I cared.
Another thing that helps is that BetterHelp makes it effortless to try out someone new. Maybe we've been lucky, but me and two other people haven't needed this feature; we all stuck with the first one we matched with. But it's there if you need it.
The therapists I know do certainly work with every day people struggling with (perhaps existential) anxiety/fear/depression. Where those concerns are negatively impacting someone's life, they are real and pressing concerns - if common.
These therapists also regularly work with clients that are dealing with the effects of being victims (or perpetrators) of various forms of physical, sexual, and physiological violence. Even in wealthy areas, people do terrible things - particularly to the weak and the young.
That job can be very intense.
I think the unvarnished therapist response to existential questions is something like: that’s fine, those are valid, but they do in fact have no answer; the only way out is to turn our attention to the day to day problems of living.
If you keep harping on unsolvable problems, I think they’ll mostly feel annoyed.
That said, if your therapist was "destroyed" by your unsolvable but grave questions - you should just move onto someone else. That isn't likely to be a common occurrence.
Most therapists I know agree that there are many grave questions which are not "solvable" in therapy.
I am a member of a Christian Health Sharing ministry which is not insurance, so they work with my therapists to share the costs. My mental and medical health costs are shared by other Christians in a community of mutual support, rather than being bankrolled by insurance company premiums. And all I need to do is arrange "self-pay" terms with the provider and have the bills sent to the ministry!
Even though it is not insurance, health sharing ministry members are exempted from the tax on Americans who do not carry health insurance. It's a pretty sweet deal; my monthly shared amount is about half of the premiums for a "catastrophic" Obamacare plan found on the market.
If you're going to be spending out of pocket for anything, at least try getting help through in-network therapists. There are so many fantastic mental health practitioners who are amazing that do not subscribe themselves to online platforms like BetterHelp.
What's better? By spending less out of your pocket, you can see them on a more frequent basis.
The cost of therapy is covered by an increasing number of insurance plans, so it's worth doing a few minutes of research/phone calling before paying out of pocket.
And personally, I have beef with the continuing commodification of what communities used to offer. Nothing against therapists (a man's gotta eat), but making transactions the first line of defense sits wrong with me.
Church has been on my mind a lot. Religion is a tricky topic to bring up publicly, but regardless of how you feel about it, it's true that having a shared community context every Sunday is something that's hard to find a replacement for. After all, priests were the OG therapists. And after each session you felt like you made some progress, or at least that you got your sins off your back for a bit.
Regardless, religion of old is more or less gone, and it's not coming back. If there's an alternative, I imagine it might become pretty popular. But the digital age is moving us further apart; http://www.paulgraham.com/re.html seems even more prescient after covid moved us away from offices too.
Beyond religion, we are much more individualist and busy mentally and emotionally. If it isn't one's immediate network being unavailable, odds are they themselves are. Neither of which is inherent to becoming more digital alone.
Like, do people even notice the advice we were given the last 2-3 decades? Of course we're more lonely collectively, it was practically a self-fulfilling prophecy.
Religion of old is gone in some bubbles and more than thriving in others.
At church I learned how much I am loved and valued by God. The priests and the faithful at Mass demonstrated that love to me in many ways. In Catholic school, these lessons were reinforced and again, demonstrated by religious sisters in habits with their strict rules and adorable Irish brogues, as well as celibate priests and deacons who were faculty and staff in my high school. Every one of these Catholic men and women under vows always treated me with utmost respect and upheld my dignity, always and everywhere.
When the abuse scandal broke I couldn't quite understand it, but I realized later that I'd been subjected to decades of trauma in my childhood, only at home by family members--women. The abuse I suffered was just as real but it was ignored and denied while people went after the priests and sisters who had loved me and shown so much solicitude for me and my classmates.
I'm coming to terms with that now and I'm beginning to explore the root causes of my mental illness--which incidentally became severe when I lived in Silicon Valley and had a high-paying consultant career.
Thankfully I returned to my faith in Christ, rather than rejecting Him, and I receive daily reminders of my dignity, my self-worth, and how much we are loved. And that's worth more than any Silicon Valley career.
When people are left to deal with these issues alone, the instinctual thing to do is to suppress it rather than confront and actually manage it. I think that distinction between motivations is what causes unhealthy coping mechanisms, like seeking drugs, to be the first pursuit of people suffering from these issues.
Finding someone to talk to encourages one to actually evaluate and understand what the issue is simply by trying to explain it to someone else. This can be done with anyone you trust. Although, as you say, it's certainly not as effective as someone with training and experience that can keep the expression going in the right direction, I'd posit it's much more effective than trying to do it alone because the approach just tends to be circumstantially different.
In dysfunctional family dynamics, children take on different roles that persist into adulthood. Some children are always scapegoated for the family’s problems. But others are the “golden child” who feels their love depends on their personal success. Parents project their needs and own personal shortcomings onto this kid, and the kid can feel like they carry the burden of the whole family’s success on their shoulders. It’s pernicious. I feel it drives a lot of people that are obsessed with work.
In my family there’s clearly a dynamic where my Dad uses my success to “brag” about how well we’re doing to his own siblings or friends. As if I’m the exemplar of the families success My other siblings are mentioned less. It’s a lot of pressure, and I’ve learned that it’s his issue, bot mine. But it took a lot of work.
I wasn't a "golden child," but growing up, the thing adults praised me for was my intelligence. Not being in a good school district, I skipped a grade. Thinking about the different opinions of the therapists, I wonder if my emotional immaturity relative to my peers, always being eager to show off my intelligence, and disadvantage at sports isolated me from my peers, hurting my social development.
As anecdata, my brother and I are the exact opposite. He was always the Golden Child, and I the scapegoat.
He turned out as - what I think normal people expect this child to turn out as - somewhat spoiled & entitled, and less ambitious. As a result, he ended up not being very successful.
I on the other hand, am doing much much better.
My brother is - without doubt - substantially smarter than me. But this dynamic did not appear to work in his favor.
I imagine this dynamic is mostly random noise.
I just wanted to give a piece of anecdata to support it's probably random noise.
One thing to consider is cause and effect. Mental health conditions often stem from deep-rooted needs and desires. The need for people to be founders, to get rich, to have power, etc... may stem from mental health needs that have been present in their lives for a long time. The entrepreneurial spirit can be a defense mechanism to ensure control of your life.
I'm not saying all founders are mentally ill - that would be an absurd stance. But I am saying that it is unlikely that being an entrepreneur causes mental health concerns on its own - it is more likely that pre-existing concerns may have led some folks to have the drive to go that direction in the first place.
Surely it causes higher than average levels of stress?
We've finally reached the point where it's starting to impact the ability to get work done so I'm optimistic that change will follow.
[1] The thing about multi-generational toxicity is that almost no one remembers when it used to be different so it just becomes "normal", "best-practice" or worst of all: "high-performance".
-Ernest Hemingway, The Garden of Eden
Still, interesting anecdote.
Anecdotes are historical or much more rarely fanciful but never fictional exemplary stories. The fictional variety may be called a vignette.
One of my favourite books of quotations features a number of same on the subject of women and/or marriage by Oscar Wilde.
The editor includes this gem of a note: "Oscar Wilde cannot be taken as an authority on the subject of women."
To which I can only say: consider the source and weight accordingly.
Though, in this case... maybe.
For example, if society moved in a way that rewarded behaviour that would have been considered pathological in the past, would those people who cared enough to actively resist the tendency be more likely to be deemed mentally ill?
I know psych was weaponized like this in communist countries, but I can imagine it happening more pervasively and organically in democracies, from the bottom up.
Back to your point, instead of eg anxiety being something disordered, maybe it’s a normal expression of human behaviour but in a world where the opposite traits are rewarded. Maybe 500 years ago or 100 years hence, the anxious are normal and confident optimism will be pathologized.
However, high functioning autism or mild schizotypal/schizoid disorders probably would not be debilitating unless the society had a low tolerance for eccentricity.
I am learning Python right now, got an Ubuntu PC loaded with language compilers.
I do not exaggerate when I say that at least 70% of the time, I can't past the second date without men admitting to having feelings of depression, or hopelessness, or anxiety, or lack of self-worth, or just a general bitterness toward their lives and world. Or they will spend an alarming amount of the date seething about politics and how doomed they feel the world is.
Now, of course, all those emotions are a normal part of the human existence, and everyone feels them from time to time. But these men are not feeling these things "time to time." Their existence is defined by mental turmoil and acute pessimism. And, of course, women are feeling these things too. But it seems so much more acute in men in Silicon Valley.
It's extremely alarming. I've been trying to figure out what is causing this trend, and there are a few core things that I think makes Silicon Valley worse than other areas in the country for men.
1) Workaholism. So many of these men are only ever told they're worth anything at work, which leads to them investing all their time into work, which leads to severely neglected social and romantic lives, which only amplifies the problem of work being the only place they ever hear anything positive about themselves, which leads to more work. It's a really vicious cycle.
2) Hyper-competitiveness. Everyone is always comparing themselves to each other, and in a land filled with unicorns and freshly-made millionaires, it's easy to have a 300k+ salary and still feel like you're "behind" or "not living up to your full potential."
3) Start-up culture. As this article points out, it's a roller coaster of highs and lows. For those working in start ups, it leads to emotional whiplash. For those outside of start ups, it leads to enviously watching the highs and feeling intense FOMO.
4) Skewed ratio of men to women. I am stunned by how difficult it is for my male friends to get a date in this area, but there just aren't as many eligible young women as there are men. I think this leads to a feeling of despair, especially for the shy, geeky types who already struggle with dating as it is.
5) The casual hatred of men within leftist circles. At dinner the other night, when someone was complaining about a boss, one of my friend's wives just casually made the comment, "Well yeah, what do you expect, men are terrible." This was said in front of her husband and the four other men at the table. Seemingly unthinkingly. And when I corrected her and said, no, terrible people are terrible, not men, she got visibly angry, and her husband jumped in to soothe her by saying, yes, she's right, men are terrible. No one else at the table objected. I could list off dozens more anecdotes about this sort of casual bigotry dressed up as progressive values. And I have no doubt it's part of what's wearing down men's mental health. When you're told you're terrible, and your mind is miserable, it's easy to think, "Well of course I'm miserable, I'm a terrible creature." This only amplifies the feelings of low self worth and guilt, and makes people less likely to seek help.
I have no idea how to solve any of these issues, other than being there for my male friends to talk to. But I think a good first step is to be able to talk about the issues men face openly, without being accused of misogyny or "not caring about women."
>Their existence is defined by mental turmoil and acute pessimism.
I’ve been trying to find the words for this - I (cis male and married) don’t feel this way but many of my peers do. It is disheartening; a very real black hole of anguish.
There was also a This American Life episode last week about physician-assisted suicide, so maybe I'm just primed to feel this way.
- Economic insecurity makes future uncertain. This immediately introduces a level of anxiety to people. Not only in Silicon Valley - its everywhere. There is no social mechanism left to use as a safety net to protect people because everything is privatized now. Its pay or die.
- Needing to work for survival. Because you can't be sure of even the next year, with rising prices, expensive services weighing on the budget, it feels like you are always in a fight for your survival even if you are a 6 figure paid person. Survival of you and your dependents.
- These add up: The society is in the same state, everyone is in a survival mode and stressed, with anxiety. The atmosphere is the same everywhere and its inescapable. Which exacerbates your own anxiety and induces it even if you didn't have anxiety to start with.
- Things are going downhill. Profits and stock market are rising, but everything else is descending down into a hellhole. Societal collapse is visible. We humans are social creatures, we know that our survival is tied to the society because we evolved to be like that since it ensured our survival and success as a species. So when your society is going downhill, you get extra anxiety.
If you receive no replies or other feedback you would have no way to know if your comment was ever read by anyone. This differs from the real world where you can usually determine by various cues that someone heard you.
I also don’t really agree that giving a up or down vote really means someone read your message.
You weren't talking about anything other than indicating that you need clarification on what face-to-face cues are missing.
> I’m saying the indicator on the top should be able to be removed if you don’t want to see it.
That's all well and good, but what does that have to do with the aforementioned cues?
> I also don’t really agree that giving a up or down vote really means someone read your message.
Ultimately they can't tell you anything at all other than that something triggered an event that was recorded in a database. But, assuming bots and programmer error are sufficiently filtered out, you can determine that a human was in proximity to your message and as such it is likely that they read it.
Like I said, a reasonable degree of confidence, not an absolute guarantee.
I have never checked my account total, but frequently look at post points to see if others are reading or getting value, particularly if there are no comments. I'd rather be contributing than speaking into a void.
I could write my HN comments on paper in my office, but don't because I like participating in a dialog or conversation.
After years of contributing to HN and feeling rather an outsider, I was surprised to find I'd made the leaderboard. Learning to not check that proved to be something of a difficulty, though I tend to do so fairly rarely now.
I've had others reach out to me with similar thoughts, and I've had a few email exchanges with dang over the advisability. For the most part, I try to ignore the fact and any specific standing, and take some cold comfort in the fact that others on the list range from insightful to trollish, including several who are or have been in the top-ten, whose rankings are shown without points.
Humans are status-conscious and seek feedback on both standing and their own interpretations of reality. Technically-mediated mechanisms for doing this ... tend to be fairly blunt, even in the case of HN's fairly subtle nods.
The difference between type II and type I is the intensity and length of the two extremes. Rather than "mania", type II has "hypomania", characterized by periods of heightened confidence, creativity, sexuality, rashness, productivity and ideas. Then the depression cycle is generally less intense, but usually lasts a longer time. The time between the extremes can last for many months. Hypomania can be confused with ADHD, which I've had been taking meds for for years.
This cycle of brilliance and despair describes my career perfectly. I am amazing for a month, do awesome work, have incredible insights and generally impress everyone around me - from bosses to relationships. Then, slowly, over months become less productive and have increased anxiety and self-doubt, less energy, care less about everything and longer and longer bouts of deep depression until I can barely get out of bed. Then I rally, think I've finally turned a corner and return to "normal". I'll apologize to bosses and coworkers, catch up on missed work, do something great again and feel that I've finally got a handle on things.
But what I considered my "normal" baseline wasn't real or sustainable, it was hypomania. The realization of what is actually normal has been a revelation, as the expectation of always performing at that intensely high level actually exacerbated my depression in a vicious cycle. "Why can't I think today??"
There are so many examples of famous people who did brilliant work, but also would end up struggling with depression for years. Ada Lovelace, Van Gogh, Churchill, Hemingway, Stephen Fry, Coppola, every other famous actor and more.
Every time I had my yearly psych evaluation for my Adderall, they would ask me, "Have you ever had episodes where you had out of control racing thoughts, and you didn't need to sleep for a day or more, exaggerated confidence and unusual talkativeness?" And I'd say, "No... Well, I'm normally talkative and distracted, but that's my ADHD, but never had moments of being out of control, or racing thoughts and no need for sleep." And my psychs (various, as they came and went from my HMO) would check off a box and continue on.
What they were describing is mania, not hypomania. So for two decades I've been under the impression that "normal" was my periods of hypomania and that I had ADHD, and that I also had clinical depression and that I needed to figure out the right meds or personal habits (eat right, regular sleep, exercise, etc.) to overcome. This was a horrible misdiagnosis which has affected my life in countless ways.
If you are ADHD, but also have depression, talk to your psych about bipolar disorder. It gets worse with age, so something that is minor now will get so intense later that it will ruin your life - you'll get fired, lose relationships, spend money recklessly, take risks you shouldn't - but not realize that when you "fix" these problems that you really haven't, and in a few months, or six, or a year - just long enough for you to think you're on the right track - it'll all start again.
The one "good" thing is that hypomania has its perks. Think of the movie Limitless - for a month year, I got to be a genius. Anyone who met me then still has the impression of me as a person with an endless font of knowledge and brilliant ideas. Those are the people I still have as contacts on Linked in. The ones who dealt with me during my episodes of depression have the exact opposite view and avoid me at all costs.
I would bet that there are a lot of really smart people here in Silicon Valley that are in a similar situation, but don't realize it. If this sounds like you, get yourself treated before it's too late.
The way it is analogized here [1] was interesting to me:
"If we told people that fear of flying was something everyone struggles with, that it was the result of what others have done to them, or structural racism or whatever, I’m sure we’d get more of it. Imagine further if TV, music, and movies taught kids that fear of flying made them deep and interesting, and schools and universities had fear of flying awareness weeks. This is pretty much the modern approach to mental illness."
[1] https://richardhanania.substack.com/p/how-i-overcame-anxiety...
Our trauma-focused mentality is so prevalent in the West that many Westerners cannot help but project it. For example, when presented with evidence that suggests quite few Sri Lankans developed PTSD after being victims of the tsunami, it's an automatic reflex, isn't it? What's preventing them from recognizing and discussing their trauma? Perhaps instead something about their culture or environment, prevents them from developing trauma? That would have interesting implications.
Self-reporting is fraught when it comes to psychiatric disorders for a lot of reasons.
>To put it in stark terms, if you are a single male, every time you see a woman that you might be interested in dating and you don’t at least talk to her, you have failed on a moral, intellectual, and spiritual level.
The claim to have overcome anxiety and fear is a popular self-help trope. In most cases, what really happens is that the person's baseline anxiety transmutes into a second order anxiety about being too anxious. The usual effect of this – which we can certainly see in Hanania's case – is to make them obnoxious assholes rather than cowards.
a) Having emotional/mental/psychological distress
b) whether you classify that as "mental illness", and what effect classifying it as mental illness has.
My gut reaction is that with regard to (a), people are having a lot of emotional distress these days, and that this is not a response or effect of focusing on mental health or suggesting that everyone has mental illness. I think it is probably cultural, but for deeper and more structural cultural reasons than "whether we believe everyone has mental illness" (or even whether we believe everyone has "emotional distress"... although clearly everyone does to some extent? i think in any culture?)
But as to (b), how we understand emotional distress and how we classify it is definitely very culturally defined. I am not convinced that, for instance, classifying it as a "disease" or "illness" is accurate or useful. (useful? In helping people experience less distress or live the lives they want, I suppose). I am especially not convinced that classifying it as the result of a "neurochemical imbalance" is accurate or useful. I think the way we classify and understand this kind of emotional distress matters for how well we deal with it, and we may not be doing so very well.
But I don't think that "unhelpful classifying" is what's causing the, I think, actually escalating levels of mental distress.
And in general, I think acknowledging that lots of people feel a lot of emotional distress these days is helpful, that you are not alone, that you are not broken, that in fact that you may not be "ill" or have a "disease" (which doens't mean you aren't having a problem, or that things can't change for you). The category of illness or disease, after all, is necessarily exceptional rather than universal, right?
You may or may not agree with my analysis (I'm not sure how we'd investigate in an evidence-based way, or if we can), but perhaps still find the distinction between (a) and (b) helpful.
This sort of reification of, well, everything, is absolutely relentless and been ongoing for 150 years now. Even if we do recognize it, which people have for just as long, we keep getting warned about it, it seems we are also completely powerless to stop this process.
I definitely agree with that. Sorry if I side-tracked your point, because you are 100% correct.
Unless one separates themselves from modern society, couldn't this criticism be levied against everything human?
The focus for mental health isn't to have people diagnose them selves with some condition. I think its more like going to the gym, but for your self to feed good mentally. Its more like telling people "hey your fat and this isnt normal and making your life worse in objective ways" (which we probably should do but off topic lol) At least Americans pretend that emotions don't exist and if they do acknowledge it internally, definitely don't ask for help. The idea is feeling anxious or sad, or whatever is normal and you might need help getting through it. These shouldn't be bottled up and ignored until it becomes something that can't be corrected.
Is this based in fact or just made up? I'm not sure I put a lot of weight behind this comment.
So it's a vicious circle: more drugs -> more violence -> more legislation -> more money -> more treatment -> more drugs.
We (Nudgelabs, W22) have created a service to help founders and employees to build and maintain sustainable performance.
"NudgeLabs is a service that helps enterprises improve team performance and employee retention. We pair each employee with an online coach and use smart watch data to improve their physical and mental health."
Each employee gets personal guidance and help to work on what would most help them, and, together with their coach as well as through physiometrics from a wearable, figure out how to work towards a more sustainable (and performant) state.
The employer gets periodic insights about what the most common obstacles for sustainable performance (read, recovery, pysical- and mental- wellbeing), actionable advice on how to work with those obstacles and measurements of how the measures impact the wellbeing of the teams.
As an example, one customer used data showing poor sleep quality, often due to stress in the evening to spark a discussion with their team. When seeing the numbers, seeing the cost of the 'free work' in the evenings had on the teams performance, they could more deliberately work on changing their communication culture.
We're right now entering the US market and would love referrals and/or advice on how to approach companies in the US. Either through comments here, or emailing me directly on javier@nudgelabs.com
We take the data integrity very seriously, it's not only personal data but health-data, with _could_ be use to discriminate towards an individual or cause harm otherwise. (Within GDPR, considered to be 'sensitive' data).
We only share data with the employer in a de-identified and aggregate format.
Any Personally Identifiable Information (PII) and personal health data are kept separate and pseudo-anonymous. Only 'connectable' by the individual themselves and their coach.
We're betting the company on maintaining that integrity. The fines for mistreating GDPR-sensitive data would be company ending.