Comment by sillysaurusx | Hacker News Reader

Comment by sillysaurusx | Hacker News Reader

Very timely. I've been taking a month long break from HN, after realizing that I had been neglecting my mental health.

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.

Yet therapists can only provide coping mechanisms or listen to one's complaints if the root cause is out of reach. Many times, those aren't enough.

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.

For what it's worth, I agree with you. The trouble seems to be that society doesn't really have a better alternative at this point. Discord has become the institution of our generation, at least for teens and 20-somethings. In past generations, it was church.

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.

I don't believe the digital age necessarily requires us to turn support into a commodity, though.

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.

What about climbing gyms, run clubs, book clubs, gardening clubs, bars/trivia, etc? If you're near a city, almost any of these will be an option. And if you're not, a high percentage of those people are probably still going to church. It seems there are still a lot of opportunities out there for regular communion with others.

Hobby clubs are better than nothing, but religions have much better structure to keep community members in check and check their mental health regularly.

It’s actually interesting if you look at the data, outside of the tech bubble Religion is only projected to grow due to a confluence of factors which include much higher fertility rates and increased mental health (might be coupled).

Religion of old is gone in some bubbles and more than thriving in others.

I was adopted as an infant and baptized into the Catholic Church. My parents are active volunteers in the parish and attend regularly. They took me, my sister, and grandmother every Sunday and holy day.

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.

Lots of people need help learning how to cope safely and effectively. They may also need help avoiding self-destructive behaviors or thoughts that cause suffering. Of course, this kind of help can be provided by others in a community - but there's also something to be said for training and experience. My father taught me a hell of a lot about carpentry, but there is certainly a point where I call a professional.

I agree. More importantly, IMO, is a vast majority of people need a place to actually dissect and confront the issue. A lot of safe, effective coping mechanisms naturally come about when you actually understand what's wrong. A common symptom of mental illness, especially the more prevalent ones like depression and anxiety, is a lack of insight.

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.

I look forward to the day I can bill my employer for the mental health costs they keep incurring.

This is why all children in schools should be taught about emotions and emotional regulation. Then those skills should be reinforced daily until they are automatic.

One disadvantage of BetterHelp compared to a traditional clinic is that BetterHelp therapists often have a much higher client load than is typical elsewhere. This is not necessarily bad, but may be worth knowing.

Dated a therapist who was adamant she could only see 15-20 people a week and still give quality care; built her schedule around making sure she had adequate breaks because it felt irresponsible to her, otherwise. Anything past that it was a plaster-on empathetic smile and “that sounds hard, tell me more.”

My therapist is also married to a therapist, and although this isn't quite relevant, it was really cute hearing that they "therapy each other to death" when they have marital problems.

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.

Yeah dating novice therapists is bad because they are still trying on the tools and they’ve got a neophytes zeal, dating experienced therapists is bad because they’ve integrated the tools so much that it’s hard recognize when they’re pulling them out. Being wrong and very skillful at pushing your viewpoint can feel pretty isomorphic to gaslighting in the right circumstances.

Tho upside is they sometimes have good self knowledge and insight into other people. Naturally YMMV on all points

What if you destroy your therapist by asking unsolvable but grave questions you entertain? Are there any meta-therapists for therapists?

There are, but the idea that a therapist will be destroyed by your super duper nihilistic puzzle questions is not very realistic. The position of "client thinks their problems are so big and so unique that I won't be able to understand them" is one that is studied by mental health professionals and is actually pretty easy to deal with (although hard to resolve). Therapists get burnt out by listening helplessly to people with real problems in their life like abuse and addiction and poverty. Being able to navel gaze about the meaninglessness of the universe means you're in a pretty cushy spot.

An "unsolvable and grave question" doesn't have to be philosophical. "I'm unhappy with my life and I feel trapped by my responsibility to my family, and I wish I could fall asleep and wake up in a different life" is quite tricky, and I doubt anyone would say such a person is in a "cushy spot".

I meant existential stuff like this: "I am frustrated by the ongoing war that could have been easily prevented and seeing friends dying every day, including your family, just to increase amount of green paper in somebody's pockets; this doesn't cheer me up. The thought how helpless I am in the face of this is crushing me. I won't even be able to understand my own life, nobody around me will reach their true potential and will be just left to slowly die. All you can give me is just a short-term band-aid we both understand won't change anything." You can go arbitrarily deep to make the therapist question their standing in life depending on their sensitivity.

Not to diminish the concerns, but that is not particularly tough material as therapeutic conversations go.

An example would be helpful.

If you are indeed in a war zone seeing friends and family die, my comment is completely off base and I apologize.

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.

Therapists do indeed experience “vicarious traumatization”, which is exactly what it sounds like. But this comes more from descriptions of traumatic experience than difficult existential questions. As others have said, existential questions are softballs. The rough stuff is staying present and emotionally open while someone describes a personally horrific experience.

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.

I know a therapist that works with a demographic that very few people can muster even an ounce of empathy towards. These people struggle with deeply disturbing and intrusive thoughts, and I'm amazed how this therapist can help make their lives more livable and avoid acting on their impulses.

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.

That's their job that they are trained to do, so I doubt it will destroy them, but in general many therapists believe that all therapists should have therapists, yes.

Most therapists I know agree that there are many grave questions which are not "solvable" in therapy.

I learned of a therapist in my area that apparently doesn’t allow patients to use insurance, you have to pay out of pocket for everything. Apparently, this allows them to have longer sessions with individuals. I’m not sure how often they will typically see a patient, but if it’s anything more that once a month it would be expensive as hell at the rates they listed.

I've surveyed many therapists recently and I've found many who are like this. And it's a good thing; if you don't accept insurance then you aren't beholden to their terms and diagnostic criteria and policies which can all be very troublesome and present obstacles to healing.

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.

I would have to agree with this. When using services like BetterHelp, it has always felt super transactional. Like a drive-thru experience, but therapy.

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.

I'll add one more thing: prior to the pandemic, it was often hard to get insurance to cover telehealth therapy. Now, it is common practice. Many therapists working in clinics or private practice do a hybrid model allowing clients to visit in-person or via Zoom/etc.

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.

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