Screw stigma. I’m coming out. | Hacker News Reader

Screw stigma. I’m coming out.

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420 pointsmarkmassie135 comments

This is admirable and I wish the author well. His example may also help others.

It should not be taken as a signal that "outing" oneself is advisable for others in comparable situations. This guy is very fortunate that he is well established in a career and can point to good performance in his positions, unaffected (from the employer's point of view) by his condition.

Others are much more vulnerable to prejudice and discrimination, and might be better advised to stay closeted.

US law means you must disose your illness if you wish to use anti-discrimination protections.

(As I understand it; I am not a lawyer; corrections welcome).

That's absolutely ridiculous.

I've outed myself as being depressed and the reaction has been entirely positive.

There have been a few people who have reacted "strangely" but, to be honest, having these people clearly identify themselves by their behaviour has been a net positive ;)

However, I haven't tried interviewing for jobs yet. I suspect the negatives will really show then. The rational argument (that 40% of our society will undergo treatment for a mental condition at some point, so would they prefer someone who might be mentally ill but in denial, or someone who is aware of the problem, and able to deal with it?) should work in theory.

However, almost everyone I've spoken to has either had the same issue themselves but never admitted it publicly, or has a close relative or friend struggle with the same issues and so understands to a certain extent.

I think we're seeing the beginning of the end of the stigma.

One thing I'd like to add to this discussion. It may be difficult, and it may not be something you should do until they're older, but talk to your children about issues that you have and that run in your family. It can save them a lot of heartache and difficulty down the road if they have similar issues. In particular, knowing my family's history of alcoholism and drug abuse helped me avoid both. Given my issues with depression, if I was drinking like my peers in college, I probably wouldn't be here today. Similarly, I didn't know the cause of their issues (depression) until I was already deep into an episode that lasted a couple years. If I'd known beforehand what to look out for, and that it wasn't uncommon in my family, it might not have lasted as long.

I used to struggle with Bipolar Spectrum disorder. After 9 years of medication, therapy, prayer, and a lot of ups and downs I've been declared free of the diagnosis by my psychiatrist.

I gained a lot of weight because of medications (normal weight is 210lbs, which is fine for my 6' 4" frame, but medication caused me to balloon up to over 444lbs). I have not been able to work at my peak for many years. I'm now almost 45, and I feel like I'm starting to get my life back. Now that I'm off the main drug that treated my disorder (risperidone) my weight is starting to drop.

I know people are scared of mental illness. I see it in their faces, or the way they treat me differently as time goes by. But that's okay, I have close friends who have accepted me for who I am without that fear.

My wife wishes I wouldn't tell people about my history. My health is no one's business but mine. However, I choose to tell people about it, because of the stigma. Because I'm neither ashamed or afraid for people to know. I _will_ lose friends, work, and opportunities because of my choice to be open about it, but I don't care because I want to fight the stigma.

Everyone has a friend or family member that struggles with some form of mental illness. Everyone. I have seen too many people suffer in silence, and some even take their own lives because the pain is too much.

I was suicidal years ago. I suffered horribly for many months on end, waking up in the morning and just focussing on getting through the next hour, until I finally reached the end of the day and could go back to sleep so I could have some relief.

There is no shame in mental illness. People used to be afraid of people who had heart disease, as if they might "catch something" from them. The brain is the most complex organ in our bodies, and it's prone to have problems just like any other organ.

My name is Miles Forrest. I have wrestled with mental illness for many years, and I'm happy to say I have overcome it with help from doctors, family, friends, and God (if you're offended by my attribution to God, please don't be. I respect a person's right to believe whatever they want, all I ask is they respect my right to believe whatever I want). I can't say I'm cured, because there's a possibility I might relapse at some point in the future. But I have acquired the skills, knowledge, and support network that I know, without a doubt, I would be able to beat it back down again. Mental illness doesn't define me, but learning to fight, persevere and lean on others when I need to has made me a better man.

You can mock or ridicule me if you want, but I'm not talking to you. I'm talking to the man or woman out there who is afraid there might be something wrong with their mind, and who feel alone and afraid. I know how scary it is. I know how you feel like you're the only person in the world who has felt the way you do. You're not, and you are not alone. If you are that person, email me at miles@coderpath.com, and I will walk with you as a friend and stranger to get you help.

That was very moving. Comments like this make me proud to be a part of this community, despite its flaws.

Seconded. And by the way, speaking as someone who's about as atheist as they come, anyone who would be offended by your religious beliefs is just a dick. Thanks for your outreach and I suspect you'll get more than a few emails.

Yeah, there's a time and place to challenge a person's religious faith, this definitely isn't it.

Thank you. Thank you. Thank you.

Congratulations for standing up and confronting the HOURS. Until it is time to sleep and no more. That is really an achievement. I went through it some times and man, does it hurt!

Yes, I also put a lot of my regaining health to God. And to my family. Thank you for your openness.

My name is Pedro, I am just an ordinary guy who has gone through depression and OCD and now leads what I may call an "ordinary life" as a university lecturer and who -thank God- is reasonably happy with this life. I am also open for support, I am a mathematician who happens to love music, philosophy and computers, in case anyone feels like chatting. This kind of suffering can be alleviated. But seek help, you need it.

If you are ill, that is what matters: reality. If anyone gets annoyed for it or dislikes you for it, it is THEIR problem. Stigma is about fear: their fear.

pfortuny@gmail.com

Let us help each other more.

I think one of the benefits of mental illness is it makes a person incredibly empathetic and in tune with other people's pain. Being in such a dark place and succeeding in getting into the light makes you want to save everyone from ever having to relate your experiences.

It is still hard to be this honest and open. To put your full name on something like this. I respect the hell out of you and we share a disorder, thank you for your post.

It depends on the illness. Psychopathy, antisocial personality disorder, and similar diagnoses, are marked in large part by the lack of empathy presented.

That is a really good point and something I hadn't really considered. I could also see a lot of my feelings of empathy being instead turned into anger if things had been different so I might have generalized a personal experience.

I'm well out of my pay grade, but with the various anti-social / psychopathic disorders, it's not an empathy/anger axis so much as just not caring about consequences for others. It's a total disregard. More troubling: there's very, very little by way of treatment for many of these disorders, whether you're looking at pharmaceuticals or talk therapy. The DSM can make for interesting late-night reading.

You're a good man.

It's great that you believe that you have succeeded in your approach. However, it's dangerous to hold your anecdote up as a recipe for success, more broadly. The 'tough it out' strategy is common, and it's forced upon us as a general solution. But, it's a terrible approach. If one doesn't 'tough it out', one is viewed as weak, and this often leads to self-medicating and other related illnesses.

But, let's try a simple experiment to determine rough odds of 'toughing it out'. Let's say that someone reads this who has been diagnosed with depression, anxiety, bipolar, or similar illnesses. That person should count the number of people in their extended family (these illnesses frequently have genetic components). Then, of that group, they should count the number who have had highly stable, productive, and predictable lives. Divide the latter by the former, and check: is the percentage low or high? If one has 12 people in their extended family, and 8 of the 12 haven't lived amazing lives, well the odds probably aren't great for them to 'tough it out'.

Some of us come from families who are quite intelligent but who just can't keep their shit together, otherwise. Luckily, we happen to live at a time when people can finally be treated for these diseases. So, what you're saying is almost like saying, 'if you have a genetic predisposition for heart disease, you should ignore any symptoms, and it will go away.' Yes, lifestyle changes can help, but at a certain point we have to agree that sometimes our genes are not meant for the type of world that we live in. And, Humans cope with genetic deficiencies, as Humans do best, with technology.

You missed the point. My story is not a recipe. It's simply an admission of what I've been through, and to offer inspiration and hope to others who are at the beginning of their struggle.

I'm also confused. How did you read my comment and come to the conclusion that I just "toughed it out"? Did you read the whole thing?

Also, you called my post an "anecdote". I do not think that word means what you think it means.

I got the point. But, you clearly tried to stress that someone can be cured of mental illness. When, this goes against the evidence.

Maybe there are a few people who can be 'cured'. But, many mental illnesses have factors that are based in the chemistry and structure of the brain. It's not that these brains are 'bad', it's just that the brains may not be suited to the types of worlds that we live within.

My post was meant primarily as a counter-point - that what you're saying is not true, generally. If someone believes that they may easily 'cure' their illnesses, they are able to really hurt themselves, badly. For most, a stable mixture of medications to balance out dopamine and serotonin is the best approach, until the neurosciences are able to learn more.

Also, I apologize for using the word 'anecdote' - I always had assumed that 'anecdote' was the root word for 'anecdotal'. But, I guess it's not. So, read what I had posted as me claiming that your story is 'anecdotal', rather than 'scientific'.

From the comment: "I can't say I'm cured, because there's a possibility I might relapse at some point in the future." Don't know how I could have stated that any clearer.

My particular diagnosis was treatable, but you're right in saying that many cannot be cured. I think your points are important to make, and I'm glad you made them.

In fact let me underscore a common problem. Many people who are treated for mental illness (especially Bipolar) often want to go off their medication without doctor supervision. Bad idea. If you need to find a better doctor, do that, but don't think you can tackle this stuff on your own.

I don't know if we are really disagreeing here. There is fantastic help for people with mental illness. Hopefully this discussion will continue, and as a society we can put an end to stuff like this: http://www.huffingtonpost.co.uk/2013/09/26/asdas-mental-pati...

Showcasing your own story to set the precedent for people to acknowledge mental illness as a real illness is a bold and admirable move. I would note however, that the recovery process for every individual is wildly different and shouldn't be overlooked.

Acknowledgement of the mental illness issue is one part of the problem, which will hopefully lead to better, more integrated treatment lines in the future.

This quote seems apropos:

Though many object to psychiatry’s perceived encroachment into normality, we rarely hear such complaints about the rest of medicine. Few lament that nearly all of us, at some point in our lives, seek care from a physician and take all manner of medications, most without need of a prescription, for one physical ailment or another. If we can accept that it is completely normal to be medically sick, not only with transient conditions such as coughs and colds, but also chronic disorders such as farsightedness, lower back pain, high blood pressure or diabetes, why can’t we accept that it might also be normal to be psychiatrically ill at various points in our lives? The answer seems to be that psychiatric disorders carry a much greater degree of stigma compared with medical conditions. People worry that psychiatrists think everyone is crazy because they make the mistake of equating any form of psychiatric illness with being crazy. But that’s like equating a cough with tuberculosis or lung cancer.

http://aeon.co/magazine/being-human/have-psychiatrists-lost-...

This was really well written. It says a lot of things that I feel the tech industry tends to ignore.

Aside from medication, for OCD in particular there are therapeutic options that can be (life-changingly) effective. The OCD centre [http://www.ocdcentre.com/about-us] is one such place. If you think you might have OCD (last I read the incidence was around 1/30) talking to someone about is the best first step. Especially as one common and pernicious effect of OCD is that it will convince you that you do not have it.

This will not be a popular opinion, nor is it a nice opinion, but sometimes the truth is neither and I think it is valuable to be explicit about these things sometimes.

The "stigma" against mental illness makes sense in a lot of ways.

I do not mean: that the mentally ill deserve fewer legal rights than others, deserve any kind of bad treatment or violence or ridicule, shouldn't be "accepted", or bear any "responsibility" for their condition.

I do mean: life is full of subtle social contracts that mental illness often causes people to flout. Mental illness (in many cases) makes people less predictable and reliable. Harder to deal with.

Some people reading this will say "obviously that is true, which we all acknowledge but have no reason to dwell on, and that is why it is a complex situation that demands awareness". Others will say "that is false and you are a bad person". First group, I refer you to second group.

If you are 100% committed to the goals of your organization (growing a startup, winning a war, whatever), you will be very hesitant to add a mentally ill person to your team/company/platoon. This makes sense. It sucks. Being mentally ill sucks. This is one of the ways.

That doesn't necessarily mean anything needs to or can be done to change it.

There's a huge list of highly successful, productive people who are a credit to the projects they work on, who have or have had mental health issues in the past.

If I had the chance, for example, I wouldn't be at all "hesitant" to work with actors Hugh Laurie, Stephen Fry, or Johnnie Depp, despite all of them having well-documented mental health issues.

I'd also be very happy to work with Richard Branson (ADHD), or if he were alive today, Nikolai Tesla (OCD and anxiety).

But these examples stand out because they are unusual exceptions.

Also, it is possible that acting is a profession unusually accessible to people with certain mental illnesses.

I've also worked with multiple people with various mental health conditions, who weren't actors, but whom were extremely good at their jobs and I'd cheerfully hire again.

Honestly, I've never seen a correlation between "mental health issues" and "would not hire".

No, the ones who are so much of a mess that they cause major problems are the unusual exceptions.

Many, many people have mental issues that they manage to control (through a variety of resources). It's a spectrum, from those people who are slightly, and occasionally, inconvenienced, to those who really aren't able to work well.

Tarring all of those people with the same brush really doesn't help anyone, including yourself.

Well, some of them just have overblown mild issues, the kind millions have. Say, Fry had some depression -- well, more than one in five people had similar experiences, and the kind of depression that still lets you have a long, succesful career, star in movies and tv and write several books, is not the kind of depression people suffer bad from. That's surely not a "lose job, ruin marriage, get alcoholic, stay isolated for months or years on end, attempt suicide several times" depression.

People with actual, serious issues have screwed a lot of people over.

Stephen Fry has tried to kill himself twice. That's not "mild" depression.

http://www.telegraph.co.uk/health/10104138/Stephen-Fry-is-th...

Plus, from the article: "In 1987, when I was 31, I suffered a suicidal episode, which I fortunately lacked the courage to bring to its conclusion. I stood swaying on high buildings; I teetered on the edge of Tube platforms".

Please. Those "attemps" are a dime a dozen. Heck, most people think about it one time or another, including myself.

And I personally know several people who tried (far more than "teetering on the edge of the subway") to off themselves at various points. It's more common than you think. You don't even have to be that depressed. For some it was merely an attempt at attention grabbing.

Bi polar is not "overblown mild condition".

Your ignorance is bordering on bigotry.

Richard Branson, as far as I know, does not have ADHD. He has dyslexia.

http://www.psychologytoday.com/blog/entrepreneurs-adhd/20090...

http://www.independent.ie/lifestyle/health/from-jamie-oliver...

Fairly reliable sources listing him as having ADHD.

This is interesting, because Mental illness is so common that you are basically weeding out the only ones getting help, and hiring the ones who are ignoring (and therefore not treating)their mental illness.

Probably the most productive, well adjusted, and successful person I know, attempted suicide and went through years of treatment, before becoming so well adjusted. He had an illness, he got treatment, he got better.

I would rather hire someone in therapy than someone who isn't getting therapy. Even if they are both functional and normal. Why? because the guy in therapy is being proactive about self improvement and personal growth. I want that guy on my team!

...and the person who has had therapy has some tools to increase resilience.

Are there functioning alcoholics? How about people that take weed on a regular basis? Are all these people unable to do their work?

Please do not categorize people with mental illness as mostly being less predictable and reliable. You are doing exactly what the article is speaking out against.

There is many levels of being able to function well or not at all with people with mental illness. Even within each area (OCD, depression, schizophrenia,etc.) people have different capabilities.

So please don't judge with a broad stroke.

I would caution you to separate mental illness from a person's predictability & reliability. Therein lies the stigma.

As for hesitant to add a mentally ill person, that means because of your bias you would have excluded all of these people:

Buzz Aldrin, Woody Allen, Adam Ant, Roseanne Barr, Ludwig van Beethoven, Marlon Brando, Drew Carey, Jim Carrey, Dick Cavett, Winston Churchill, Agatha Christie, Dick Clark, Rosemary Clooney, Kurt Cobain, Calvin Coolidge, Jean-Claude Van Damme, Rodney Dangerfield, John Denver, Princess Diana, Charles Dickens, Patty Duke, Kirsten Dunst, Richard Dreyfuss, T. S. Elliot, William Faulkner, Carrie Fisher, Harrison Ford, Connie Francis, Paul Getty, Mel Gibson, Vincent Van Gogh, Macy Gray, Linda Hamilton, Ernest Hemingway, Abbie Hoffman, Janet Jackson, William James, Billy Joel, Samuel Johnson, John Keats, Jack Kerouac, Margot Kidder, Vivien Leigh, Abraham Lincoln, Mary Todd Lincoln, Jack London, Martin Luther, Henri Matisse, Kristy McNichol, Burgess Meredith, Michelangelo, Bette Midler, Spike Milligan, Wolfgang Mozart, Edvard Munch, John Nash, Isaac Newton, Friedrich Nietzsche, Florence Nightingale, Sinead O'Connor, Eugene O'Neill, Ozzy Osbourne, Marie Osmond, Jane Pauley, Edgar Allen Poe, Jackson Pollock, Charlie Pride, John D. Rockefeller, Theodore Roosevelt, Axl Rose, Mark Rothko, J. K. Rowling, Charles Schultz, Peter Sellers, Brooke Shields, Robert Shumann, Sarah Silverman, Britney Spears, Rod Steiger, Ben Stiller, James Taylor, Peter Illyich Tchaikovsky, Leo Tolstoy, Ted Turner, Mark Twain, Tracy Ullman, Kurt Vonnegut, Mike Wallace, Walt Whitman, Tennessee Williams, Jonathon Winters, Brian Wilson, Owen Wilson, Virginia Woolf, and Boris Yeltsin

Still want to cling to your filter?

> That doesn't necessarily mean anything needs to or can be done to change it.

We fight against mental health stigma for several reasons.

1) it stops people seeking treatment for MH problems

2) it stops people with physical problems accepting treatment if that treatment has any psychological element to it.

3a) often the stigma is based on fear or ignorance.

3b) sometimes the stigma is just bigotry

4a) it pointlessly reduces the quality of life for people with MH problems

4b) it pointlessly reduces the quality of life for people who do the stigmatising.

> I do mean: life is full of subtle social contracts that mental illness often causes people to flout. Mental illness (in many cases) makes people less predictable and reliable. Harder to deal with.

I know lots of people who flout social conventions. Many of those people are total arseholes that I'm sure you'd hate if you met them. None of those people have a MH problem. They're just run of the mill everyday arseholes.

> life is full of subtle social contracts that mental illness often causes people to flout. Mental illness (in many cases) makes people less predictable and reliable. Harder to deal with.

it's hard to accuse someone of 'flouting' a contract which isn't written down anywhere. that's what i think causes a lot of problems for people with mental illness.

it took me years to learn things like "people often think things and but don't say them", "eye contact and facial expressions convey a lot of information" and even "it's important to think about how other people percieve you."

there are no classes in these things; no one teaches you this in school. most people "pick these thing up on their own" - but most people also struggle like hell with math and coding. i learned coding, math and physics quite easily. i 'picked them up' because they made sense to me, while i had to work really hard as an adult to learn basic social skills that most people seem to learn in grade school.

if we were more open about all the implicit social contracts we have in the world, people wouldn't break them so often.

Getting rid of the stigma doesn't mean "treat people with illness exactly the same as otherwise", it means "don't shame people for being ill, and don't shame them from seeking treatment".

But would I put a mentally ill person on the team? It depends on the illness and the role. I wouldn't put a hypomanic in charge of procurement, but they might glow in sales. Some people say that autism spectrum disorders make for good software testers, better than people without. What do I care (for the company) if a staff member struggles with depression, as long as the work is getting done? I've also worked in a couple of places where the 'company clown', the joker that everyone loves and raises morale, had a mental illness.

And most mild mental illnesses are not a problem, because most mild sufferrers have jobs that they are productive in. Having a couple of days off a year because of your mental illness is no different to having a couple of days off a year because you eat dodgy food and get food poisoning.

From day one here at HN my profile states that I am schizophrenic... Not that it's done me any good here, but I don't see why I should hide this fact from people I am likely to never meet in real life.

Kudos to those who could care less about social stigma.

In case you never considered it before there is a heavy PROFIT INCENTIVE for your psychiatrist to diagnose you with some form of mental illness that he is familiar with. You need to become a domain expert yourself in order to figure out if you're being manipulated for profit or if the diagnosis is legitimate.

Realistically, what do you think is the percentage of doctors manipulate diagnosis for profit because it sounds like a boogey man.

Most of them, but they don't consciously realize what they're doing in most cases. The norms for their profession slowly creep towards over-pathologizing because of the profit incentive and also because of the effectiveness of advertising campaigns by drug companies. Social norms have changed across a broad demographic to accommodate the large scale systemic misdiagnosis problem. Just because the manipulation for profit is widespread and well accepted does not mean it's not happening.

You're making some big claims with no evidence. Citation needed.

I was only giving my personal opinion based on the data I've seen. All I'm really advocating here is that every person should educate themselves before accepting any diagnosis. Do your own research and form your own opinions.

At this point, does it really matter if the diagnosis was legitimate? The treatment clearly helped him improve his life dramatically.

Fair enough, although I suspect it was the act of taking time to reflect on his own inner processes which helped him and this could have occurred outside of the context of a "diagnosis" and without drugs. It's sad that in modern society people are trained to not talk to each other about their emotions and feelings outside of the context of a "sick ward" where one party is being financially motivated to behave in a certain way.

I enjoyed that read. I think the world is a better place getting to hear his story.

It's wonderful to have a courageous person breaking the ice on difficult topics. Bravo to Mark. And the love shown by his wife is deeply touching.

This is a courageous article.

Sadly, it seems mental illnesses are one of the great taboos of today (and don't even get me started on the state of mental health care in the US). Similarly, mental illnesses are extremely misunderstood, and people tend to distrust people who suffer from one even though illnesses such as depression may affect 5 to 10% of the population [1] and as much as one in four adults are affected by a mental illness in general in a given year [2]. A significant portion of the population is affected, but for the most part it remains unadvisable to talk about it. It's the elephant in the room.

This is compounded by the fact American culture in particular tends to disproportionately value extroversion and appearance of happiness. This leads many people to remain closeted by fear of repercussions, both on one's social and work life. Even worse, it prevents people from seeking necessary help because of the attached stigma ("but I'm not crazy!"). There are known cases where people are punished for having seeked professional help. For exemple, people who admitted to "suicidal tendencies", however serious, may be refused US visas [3]. The discrepancy between how willingly people talk about their trip to a doctor vs. a therapist is huge and obvious, and it shouldn't be.

Now why should this be relevant for the HN crowd? As someone who's very close to these issues, it seems to me this is one of the few social issues where the tech industry is not as progressive as it could be. Our industry tends to produce myths of super(wo)men with alpha personalities; we admire leaders, disrupters, bigger-than-life personalities, sometimes even assholes. Furthermore, this is a small world where, for better or for worse, a lot depends on word-of-mouth and personal reputation, and where "cultural fit" is openly hailed as a criterion for employment despite the vagueness of the term, which can hide what would otherwise be considered blatant discrimination (cf. that article on ageism not so long ago). The same goes for founders: would you think twice about investing in a non-established individual with a history of OCD? Depression?

What I am getting at is that mental illness is a combination of neurobiological and psychological causes, not a weakness in character -- but in an industry that values strength of character above everything else, the fact many ignore this can be extremely destructive.

We can do better. The author has done the world a great service by publishing his story. I hope more follow suit.

[1] http://www.nimh.nih.gov/statistics/1mdd_adult.shtml

[2] http://www.nimh.nih.gov/health/publications/the-numbers-coun...

[3] http://www.nolo.com/legal-encyclopedia/how-health-issues-can...

Thank you for these comments. I really appreciate your thoughts.

I'm not sure what to think about this. I accept that the author is suffering and in anguish, and I truly wish him well. Despite his obvious accomplishments and all the trappings of success, I would not trade places with him. His subjective experience seems to be painful and is no less real to him than mine is to me.

At the same time, I don't think he is ill. While I don't doubt that he is suffering, I don't think it it is helpful to class his suffering as an illness. I don't think anyone argues that his symptoms are caused by an infection or a defect in an organ, so his disorder lacks the physical basis for a typical illness. At the same time, he has symptoms. And therapy, and possibly drugs, make him feel subjectively better. He chooses to engage in a regime of therapy which (presumably) has self reported benefits.

But I don't think it is helpful to think of his plight like we think of malaria or polio or heart disease. When we talk about 'emotional disorders', we implicitly take on an enormous amount of cultural context as well as normative judgements about how someone 'should' feel. And the danger is that one will come to believe that an unpleasant mental state in an otherwise healthy brain is something to be cured through the application of science.

That being said, I agree with the main point -- that there is no shame in his mental state. I suppose my point is that it is not necessary (and should not be necessary) to reclassify what a disease is in order for a class of people to maintain their dignity. And above all, I wish this man well and by no means mean to diminish his pain, or the courage it took to write this.

This attitude--that mental illness is not a real disease--is what helps the stigma to continue.

You mince it up with nice words around the edges, but it boils down to this: you're part of the problem.

Agreed. I've dealt with mental illness in my family since I was a young child. It's affected my entire life. It's not just some meandering mood or state of mind, it's a frightening thing for which most people have no time or patience.

I would say it boils down to this: I believe that mental illness is fundamentally different than infectious disease and defects and injuries to organs, and it is not productive to treat them as fundamentally alike.

If that makes me part of the problem, I guess it's not clear to me what the problem is.

You seem to be conflating the terms "disease" and "infectious disease", a common mistake

Chicken Pox and alcoholism are both diseases. Seriously.

I see what you're getting at, but a number of mental disorders are actually purely biochemical in nature, and not the result of psychological trauma. Treatment and diagnosis of these diseases would be nearly identical to the treatment of infectious disease or other internal medical issues if our diagnostic tools were better...

The brain is an organ, and medical terminolgy is very clear that something like major depressive disorder is a disease that adversely affects that organ.

This is medical science. Its really not up for debate. If you are really questioning the entire field of medical science and the vast corpus of research on mental illness, the only people who will take you seriously are lay-persons.

And thats precisely the problem. While I trust you mean well, attitudes like yours are extremely dangerous because they increase stigma and disuade people from seeking medical help for treatable illnesses.

The question of mental illness is much more complicated than that. This is an issue with a rich and long history and shoe-horning mental illnesses into biological diseases (I suspect) will prove to be a foolish error historically. It's wishful thinking.

It's true that yes, biochemically, the brain's abnormal activity often correlates with subjective experience. But a) the subjective nature of the condition is what makes it so damn tricky and b) we don't know what's causing what. It could easily be the case that an individual (organism) in a bad (social) environment leads to a biochemically abnormal brain state. Treating the brain state is like playing whack-a-mole. There could also be complex feedback loops. We don't know. We're throwing shit at the wall right now.

Though there is good evidence for the basic nervous system strengthening properties of SSRI's, there's also very compelling evidence that SSRI's have absolutely zero impact in credible, controlled studies. From my personal experience and observations, I believe SSRI's can be good at 'stopping the bleeding', which sits well with why they are often known for having a dampening effect. But that will only get you so far, because there's no set way of determining what 'cured' is. There's no such thing as normal in the same way that it's normal to be free of strep throat. Functioning and succeeding in society has positive qualities, but can sometimes be at the expense of individualized growth and healthiness.

The point is, mental life is really complicated, and possibly wrapped up in broader, deeper things like spirituality, love, and economic and social conditions. Your bio-reductionist view (which isn't an insult, it's simply the view of much of the middle to upper middle class) doesn't match reality in my experience. I've found that most people suffer deeply with modern conditions (the less neurotic they are, the less they're aware of the causes of their malcontent) because there are fewer sources of authority, purpose, or truth. A la carte medicine and treatments won't solve that.

Besides all that, the drug industry just stinks of hypocrisy and deserves its popular skepticism. If a sufferer is to experiment with drug treatments, ayahuasca (and similar) should be legal and just as available as XYZ SSRI's.

The problem is that there is clear treatment available for many of these disorders, especially when its a result of a chemical inbalance.

However, people with your belief structure make it stigmatic to seek treatment, because they, like you believe that "its just in their head" that its just a "subjective experience".

The very idea that "its something wrong with you" as opposed to "being ill" is what makes people fear treatment. Very helpful and real scientific treatment for their ailments.

You are literally The Problem!

I will try to answer you authentically. Your belief is not necessarily a problem. Every illness is different; that's not really debatable. The problem is how you treat people who suffer from an illness.

Imagine a friend is lying in bed and refuses to get up and go to work.

Let's go through some scenarios: 1) His pelvis is broken from a recent car accident. 2) He has a fever and fatigue from the flu. 3) He has testicular cancer and is recovering from yesterday's chemo. 4) He is depressed.

These scenarios are all fundamentally different. It's common for people to have sympathy in scenarios 1, 2, & 3: "Of course you can't get out of bed, poor fella'. Anything I can do to help?" It's common for people to be skeptical and annoyed by scenario 4: "Why won't you just get out of bed? What is wrong with you? Jesus, go for a walk or something. You need to get your act together."

These responses are caricatures, but they represent "the problem" that often results from people saying they believe "mental illness is fundamentally different." Mental illness is not identical to other illnesses, but to the sufferer, it is just as real and just as debilitating. The problem is that people treat it as less real – not a disease but more of a personal failing that needs to be overcome. You wouldn't tell a cancer patient to just get over it, but for many types of mental illness that is society's attitude.

Does that clarify anything?

Very Well Said, but I would add...When it comes to Bipolar, not getting treatment and not getting medicated is extremely dangerous for everyone around you.

This mentality that its not a physical ailment literally has caused numerous suicides, spousal abuse, violent episodes, etc...

All completely avoidable if they were medicated and treated.

Thinking of mental disorders as fundamentally different leads people to fear seeking out treatment, which is the real problem.

You wouldn't tell a cancer patient to just get over it, but for many types of mental illness that is society's attitude.

Of course, because we understand how cancer works, enough to know that wishing it away, or meditating, is unlikely to address the problem, and has not been scientifically demonstrated to fight cancer.

There's a spectrum of severity and causes of mental illness. In some cases a patient needs to be medicated just to be able to get through a therapy session; in slightly less severe cases therapy can be tried first, but perhaps without medication the patient will never be normal. In a lot of cases, I think probably the majority, patients on psychotropic drugs could improve well into the normal range through therapy alone without meds. And there are cases where a particular social environment—like a middle class urban lifestyle, trying to make ends meet—may cause certain psychological disorders even when the same people in a different environment would be perfectly happy. Especially in that latter case, can that be called a "disease"?

If psychological intervention or environmental change is enough to turn someone normal, what does it mean to label them "diseased" before the intervention... particularly if the "disease" was due to bad prior psychosocial development (bad parenting and/or bad school/peer environments, generally), rather than genetics or something in the air or water? In other words, if the same person had grown up in a different social environment, or in a different culture, and failed to develop the psychological illness, can it be called a disease or illness at all?

(Of course, availability of professional therapy, or peers or parents who know how to intervene productively, may not exist in many cases. That's a separate issue.)

Psychiatry does not really distinguish the forms of psychological disease based on their likely cause, nor on whether they can be treated to acceptable norms without medication. I think that's what frustrates a lot of people who either object to, or are uncomfortable labeling DSM diagnoses as illnesses or diseases.

... But you can see that there's a difference between 8 hours of CBT (at one hour per week with a skilled therapist) and someone saying "Cheer up!"?

I've met people who had severe OCD but who had their life changed by talking therapy. I have no problem calling it a disease.

Exactly what I meant. Thanks.

You assume a false dichotomy, as there are infectious diseases that are linked to mental illness. For example, HIV can be causative of dementia.

You use "mental illness" as a monolithic term.

So if there's some "thing" that creates a mental health problem you'd call it an illness, but otherwise you'd call it, well, what?

That space of what to call it is problematic. Some people fill that gap with judgemental terms - sloth, laziness, weakness, etc.

And I'm not sure why you think treating MH problems as an illness is a bad thing - what are the negative consequences of doing so?

I think you're applying an extremely narrow and inconsistent criteria for deciding what is and is not a disease. Humanity as a whole, in the modern era, does not know how to treat mental health issues very well. We don't know what causes them, and we don't know how to fix them. Yes, for the most part, it's guessing. That's why there is no strictly scientific diagnosis system. But that doesn't mean there isn't a physical cause, It also doesn't matter a hill of beans to anyone that needs treatment for or treats mental illness. And neither is this distinction true for all mental illnesses, nor is it limited to mental illness, nor is it criteria for excluding an illness as a disease.

You're also misunderstanding the role that treatments for mental illness play. Psychoanalysis, meditation, medication, many of our current treatments for many mental illnesses do not cure you. Neither do most of the drugs we use for other, infectious diseases. It's akin to taking cough syrup when you have a cold; it just masks the symptoms until the disease goes away. Valtrax doesn't cure herpes, it just pushes it down and out of the way so the sufferer can live a more normal life. Cutting out cancer doesn't necessarily cure you of it.

The entire notion of "cure" is specious to begin with. There aren't any magic potions you can drink that restore your HP and get you back into battle. The only thing that makes sense to talk about is treatment. Treatment varies between all diseases, all patients, and over time for that patient.

For me, getting enough sleep, eating well, and staying hydrated properly are all parts of my treatment for depression and anxiety. They don't cure. I can have a bummed out day where I don't want to get out of bed even if I've been taking care of myself perfectly, just the same as I can still get a cold if I'm washing my hands religiously. But if I don't keep up with taking care of myself, it happens significantly more often.

The problem is that there are people who are suffering who could be treated and they are not seeking treatment because of social stigmas around treatment.

I think the grandparent post has a point, but rather than trying to bucket disorders into whether they're a "real disease" or not, it's a lot more useful to think of a spectrum where there are some illnesses that have really clear diagnoses and mechanisms on one end, and very vague things on the other end that we hardly understand at all. Mental illnesses cluster at that more vague end.

See strep throat for a counter example (http://en.wikipedia.org/wiki/Streptococcal_pharyngitis). There's a five point diagnosis checklist that looks a bit similar to checklists you might see in the DSM for a mental illness. But there's also a gold standard test of actually culturing the cells, which is 90-95% accurate at diagnosing strep.

It may be just my ignorance, but I don't see comparably accurate tests for diagnosing mental illness. It's extremely common to see someone's diagnosis change over months or years from depression to bipolar to something else. This tends to undermine the scientific credibility of mental illness diagnosis, leading people to wonder how much diagnoses are influenced by fashions, drug companies, or the practitioner's whim.

Ninja edit: For the counter counter example, see the Rosenhan experiment (http://en.wikipedia.org/wiki/Rosenhan_experiment). There are huge confirmation bias problems in mental illness diagnosis.

I strongly agree that diagnosis is problematic. This is especially weird when people can be forced to take a medication against their will based on that diagnosis. This is really fantastically intrusive and oppressive and etc.

Another problem with diagnosis: some illnesses haw a list of (say) 9 things, and the patient must match 5 of them for 6 months. So the patient is a good match of 3 and a weak match for 2 and a poor match for the other 4. But anyone seeing that patient will read the diagnosis and will apply all the criteria to everything the patient does. "You would say that. People with your diagnosis are {manipulative}" (even if the patient was a poor match for manipulative).

He is ill. https://en.wikipedia.org/wiki/Disease

Mental illness's are disorders, that can be disabling to normal daily life. Our society accepting that things like OCD, Anxiety/Depression and Addition are diseases will allow us to actually address them. Your brain is not a magical thing that is beyond being ill, unfortunately it is extremely complex. I say this as someone who has been "sucking it up" for years until I finally hit a point that I sought help for depression.

http://www.hhs.gov/asl/testify/2010/06/t20100623a.html https://en.wikipedia.org/wiki/Major_depressive_disorder

>Mental illness's are disorders, that can be disabling to normal daily life. Our society accepting that things like OCD, Anxiety/Depression and Addition are diseases will allow us to actually address them.

Or you know, it will allow us to "invent" them, because we have drugs to sell, and because we have the luxury to overanalyse every whim.

So people are "inventing" symptoms? This just sounds cynical and unhelpful.

Really?

Your response to this guy owning up to something taboo is to chide him on his use of terminology? What kind of priorities do you have, and why is you being right on the Internet ahead of respecting the vulnerable?

You cite heart disease as a "real disease", but all that term means is "the heart's operation is being impacted by a pathology". What makes the brain so different from the heart that it can't be ill, even when it's dysfunctional?

Sadness is a normal part of life.

Grief is a normal reaction to death of a loved one.

Sadness for no reason, that persists for weeks or months or years, that interferes with your ability to live your day to day life is not normal.

Talking therapies help most people. Medications help some of the rest. For extreme cases ECT (electro convulsive therapy) might help. There are other extreme interventions being looked at such as vagus nerve stimulation.

Leaving people to experience these feelings of hopelessness because we do not want to interfere with their right to be depressed means some of them will die by suicide; or by neglect or alcoholism; and many of these people will not live their life to anywhere near their potential.

J.G. Ballard wrote a short story where psychiatry had been outlawed to prevent people having their rights to honest emotion interfered with. (I can't remember what it's called but it's good!)

I think the opprobrium you are receiving here is unfair. You've been very careful to say that you're not trying to bring back the shame and the stigma. You're just asking a very important question: is the medical model really the most appropriate for problems of this kind?

I agree with you that it is ultimately not the most appropriate. However, for many people it is a big improvement over suffering alone and without help.

And in our world, the things that really can heal emotional problems -- psychotherapy, meditation, spiritual practice, hypnotherapy, therapeutic bodywork, breathwork, psychedelic therapy, etc. etc. etc. -- are much too "woo woo" for most people. They're too scary, or short of that, people's belief systems don't admit the possibility that such things can work.

Taking a drug, though, is something familiar to people. And the drugs do help people live with their problems, though not as well as the drug manufacturers would suggest. The unfortunate thing, though, is that people get the message that all they need to do is find the right drug and dosage. The drug can help them stabilize their lives, but then they need to start in on the emotional work. That's what can eventually get them to where they don't need the drug.

I don't know why people are down voting your comment! You seem very honest and sincere in your opinion. I disagree with you that you don't think he's ill, but I've upvoted you because disagreeing with someone is not grounds to end their inclusion in the discussion.

You might be interested in WHO's definition of "health"[1]:

"Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity."

[1]: http://www.who.int/about/definition/en/print.html

From what you write, I can only assume you have had very little conscious experience with mental health disorders.

Some (most?), like OCD and BPD have extremely specific symptomatologies that are often counter intuitive and quite surprising similarities between people. The generalized, lay-person, conceptions of these illness miss these specific symptoms.

As such it doesn't make sense to call them anything but diseases.

One thing I would like to offer would be for American doctors to perform comparisons across cultures, countries, and societies. I am restricting the above purely to mental illness. There are many mental diseases I only witnessed in America, and not in Africa. I do not know what the meaning of this observation would be if proven factual, but I think it is worth exploring.

This is definitely an observed phenomenon, such illnesses are known as culture-bound syndromes. There is the sub-field of transcultural psychiatry which examines these and other cultural differences with respect to mental disorders.

Out of interest, what were the mental illnesses you refer to?

Check out http://en.wikipedia.org/wiki/Culture-bound_syndrome.

Fan favorites include fan death, evil eye, blacking out, and probably multiple personalities.

Speaking of stigma keeping people from seeking treatment, how does this interplay with the fact that most people in America get health insurance through their jobs? Aren't people afraid that some information will leak out if they seek mental treatment through their insurance? And what about the "counseling" services many large organizations offer?

People say the treatment in England is much better, and it is, unless you are under 18.

MH treatment is underfunded in England (and this has recently been written into commissioning contracts) and it is worse for children and young people.

In patient beds for children are limited. A child who needs an in patient bed may have to travel hundreds of miles to get that bed. They may even need to travel to a different country.

A child in the south of England may not have a bed available anywhere in England and might need to go to Scotland for a bed.

Apart from the obvious cost of distance and the distress of being so far from home (although getting distance from an abusive home can be useful) that child is now under a different legal system. Thus, the rules for detaining them against their will; force feeding; forced medication; etc etc are all slightly different.

I used to work in an outpatient neuro department that had a large paediatric patient population. One of the paediatric neurologists there had done her training at a famous children's hospital in London (GOSH) and said that it was a fantastic place to train in, but terrible for the outcome of the children.

Where we were in Melbourne, we had four paediatric neurologists for a catchment area of about 400k give or take. GOSH had six neurologists for a catchment area of 2 million. "By the time the kids in London got to see us, the symptoms were so florid and easy to see. Great for training, not so great for outcomes".

She did her training in the 90s, so it may have since changed. It's also a story about neurologists, not psychiatrists, but I imagine it wouldn't be that much different.

Someone very close and dear to me has a mental illness. She was super nervous to disclose this to me for fear that I may think differently of her. The thing she most appreciated about my reaction was that I said "Let me know if there is anything that I should know about your illness that may affect you in a way that may make you behave differently than you normally do, otherwise I will behave and act as if it simply doesn't exist." Suffice to say, I don't actually remember what illness she has.

Another "coming out" story is from Michael Landsberg, a Canadian hockey analyst on TSN. His hashtag #sicknotweak inspires me when I'm feeling like crap. http://www.thelavinagency.com/blog-mental-health-speaker-mic...

Thank you for posting this.

The testimony on intrusive thoughts hits so close to home, I'm considering seeking professional help. I wonder if there is a different way to think and live!

Cyclothymic. That's a bipolar spectrum disorder, but it doesn't match the lay image of the manic-depressive. The episodes are milder and shorter, but they come on quickly. A "depression attack" can last 3 hours, resolve in a panic attack, and be gone 20 minutes later. Most people who know me wouldn't know that I have it. The one "insane" thing I've done (trolling, back in the day) had the specific purpose of keeping insanity out of my "IRL" existence.

As with all spectrum disorders, people seem to focus on the visible, uncontainable, and publicly dangerous 0.1% and ignore that 99.9% of people with the disorder or "on the spectrum" are not dangerous, wouldn't fit most people's image of "mentally ill", and can be very well-adjusted.

I tend to think of mood disorders as anti-psychopathy. Psychopaths have low or nonexistent mood and emotional sensitivity, which is why they're social high performers and (if ambitious) excel in the work world. Some mood disorders seem to be uncorrelated to context (i.e. episodes happen "for no reason") and that's probably more true of the severe cases, but most people with mood disorders are normal people with hypersensitivity, such as the OP whose brain would take personal criticism extremely seriously, unable to block it out or cope.

Aaron Swartz comes to mind as a archetypical anti-psychopath. They tend to be moralistic, less fearful of negative consequences when doing what they think is right, and prone to mood and anxiety disorders. Anti-psychopathy isn't a desirable thing. It can be just as ill-adjusted. Just as psychopathy tends to be good for the individual (in terms of material prosperity, social rank, and sexual access) but bad for society, anti-psychopathy tends to be good for society but harmful to the individual.

What's happening right now, in Silicon Valley, is a battle to the death between real technologists (who tend to be anti-psychopaths) and the mainstream business culture of entitled executives and board-whores (psychopaths). With Snapchat and Clinkle setting the tone in the current Valley, rents becoming unaffordable, and no-poach agreements all over the Valley, psychopaths seem to be winning.

I think that mood disorders in particular require a certain balance. People tend to do unwise or harmful things, especially when inexperienced, and those with mood disorders are not exceptions. You have to own your actions, even if you made them in a struggle that most people wouldn't understand. That said, it's also important to realize "it's not me, it's them" and keep your pride intact. Mental health issues often give you a front-row seat for how shitty people can be when they think you're weak.

Much of what comes out of these disorders isn't harmful in the least. It's just slightly embarrassing, but plenty of people will hang you out to dry just because they're weak, useless cowards. This may be why people with mood disorders (at least, the milder kind that won't interfere with ethical behavior; a truly "manic" person, noting that mania-- not the milder hypomania-- is very rare even in people with bipolar, does not know who he is) tend to evolve into moralistic, hyper-ethical anti-psychopaths.

I'll give a semi-fictional example. Let's say you're a programmer and you have a hypomanic episode. You still go to work, don't cause any issues, and spend 2 weeks building something you were never assigned to do. It turns out to be really good work and useful to the company (as much, or moreso, than putting that time in on your assigned work) but your boss is pissed off that you were working on this side project, instead of your assigned work, and tags you as "unreliable". A morally decent person would recognize that as wrong (it's health discrimination, and counterproductive, to punish people with "creative flare-ups") but, even still, stories like that are so common in Silicon Valley as to be unremarkable. Anti-psychopaths tend to need an R&D environment where they're measured by performance over time, rather than minute-by-minute superficial reliability (at which they can't possibly compete) and those, sadly, tend to be turning rare in the current anti-intellectual (and pro-psychopathic) environment.

> You still go to work, don't cause any issues, and spend 2 weeks building something you were never assigned to do. It turns out to be really good work and useful to the company (as much, or moreso, than putting that time in on your assigned work) but your boss is pissed off that you were working on this side project, instead of your assigned work, and tags you as "unreliable". A morally decent person would recognize that as wrong (it's health discrimination, and counterproductive, to punish people with "creative flare-ups")...

Isn't this behavior psychopathic by your definition? the person goes to work, disregards agreements he's made with his coworkers and does whatever he wants.

Not in the slightest. You're being highly selective in what you focus on, and deliberately phrasing your description of the situation to spin it that way. You're just short of begging the question.

What's the part where it's anti-psychopathic then?

Anti-psychopath doesn't mean "good person". Many anti-psychopaths are good people but it's not a law of nature. Anti-psychopathy seems to be about sensitivity.

A common anti-psychopathic/hypomanic pattern is the creative "flare-up" in which a person is highly focused but intolerant of inefficiency. Such people, when faced with the slow pace and meaninglessness of most corporate work, often just elect to do something more useful, or try to solve the deeper and more important problem. It's hard to blame them.

> Such people, when faced with the slow pace and meaninglessness of most corporate work, often just elect to do something more useful, or try to solve the deeper and more important problem. It's hard to blame them.

Again, massive implication here. Why are you so sure that the anti-psychopaths are making the right call, that the work they are working on is more useful to the organization?

Why are you so sure that the anti-psychopaths are making the right call

Case by case, one can't be 100% sure on every call, obviously. But I will choose the beneficial and sometimes altruistic creativity of the anti-psychopath over the self-advancing vice, social competitiveness, and superficial reliability of the psychopath every time, and be right most of the time. No one can make the right call all the time.

> But I will choose the beneficial and sometimes altruistic creativity of the anti-psychopath over the self-advancing vice, social competitiveness, and superficial reliability of the psychopath every time, and be right most of the time

I do not accept the premise that the behavior your are describing is by definition "beneficial and sometimes altruistic." And I do not accept the premise that the reliability of the psychopath is superficial.

I'm talking about people reordering priorities. You seem to be jumping to ethical issues (breaking a commitment) right away.

For most people, the work isn't based on free agreements. They have no power, must do what they're told, and rarely get the chance to freely commit to anything.

I don't think there's much wrong with de-prioritizing an unfree commitment (especially if the delivery is only 2 weeks later rather than "not made"). The failure is on the people who created that context. Software companies especially need to understand that subordinate work will generally be of 1/10 the quality of work that people freely elect because it suits their vision, career goals, or intellectual interests. (A large part of the "10x" effect is motivation.)

Knowing myself, I don't freely commit to things unless I'm 100% (or, to be honest about it, more like 99.5%) sure I can deliver. (If keeping my job requires it, I'll unfreely commit to things because I need to eat, but not prioritize them over my own career needs.) And no matter how sick I may be, I will fight it and keep it from affecting my work as much as I can. Having fought this thing for over 20 years, I'm actually far stronger than 99% of people almost all of the time. I'm also more conscientious. The illness is only a weakness during (very rare, less than once per year) flare-ups.

If you work with a group of people you can't separate "reordering priorities" from the ethical issue of breaking a commitment.

You keep on implying that as a software developer you know better than the people asking you to do work. That even though you are not doing what was asked, you are doing something more important. That may be true, but I'm having a really hard time seeing the difference between the two types of people you are portraying (both seem very self-serving, regardless of motive), and neither of them seem like people I want to work with or have running large organizations.

If you have a condition that causes you to spend a few weeks each year working on non-management-approved activities then it is a minor problem and we should be compassionate about it.

If somebody had to spend a few extra weeks off work each year to get chemotherapy you'd be a complete bastard to say they were unethical and broke a commitment.

That doesn't change just because it is a mental health issue instead of a physical one. If you can accommodate it then you have the ethical obligation to do so.

If you have a condition that causes you to spend a few weeks each year working on non-management-approved activities then it is a minor problem

Disagree that it's a problem. Micromanagement is the problem. Side effects of high creativity (whether a person is or is not suffering from a mood disorder) aren't problems. If we desire progress for this world, then society should adapt to its best people, not the reverse.

More to the point: if you don't trust people to work on what they consider important, then don't hire them. The idea that every iota of work has to be approved by some silly priesthood is counterproductive and idiotic.

Couldn't you reword that to say "if you are unable to work on what bosses considers important then don't be an employee."

I tend to agree that some bosses are micro managing idiots. But I had a boss who told me what side of the desk my phone had to be on - even though I'm left handed.

Couldn't you reword that to say "if you are unable to work on what bosses considers important then don't be an employee."

I think we're now arguing about the ethical obligation of an employee, which is an open question. Is it (from the most restrictive to the least):

    (1) to subordinate wholly to one's immediate manager?
    (2) to act in the corporation's best interest?
    (3) not to act *against* the corporation's interests?
    (4) not to use one's employment with the corporation to act against its interests?
    (5) not to break laws or compete illicitly with the company?

The law puts it somewhere on the spectrum between 4 and 5. Breaking 4 is generally considered unethical, except in the case of illegal activity by the company (whistleblowing) or collective bargaining.

People I'm describing are at 2-2.5 on that subordinacy spectrum. They're pursuing the joint interest of themselves and the company in a way that attracts middle management opposition. They don't deserve the punishment they'll typically get (termination, possibly worse) for that.

Baby steps mate. I agree with you but think such a view is a bit too progressive for the majority of management.

In large organizations there tend to be a lot of pretty arbitrary deadlines and unfortunately overall good work does not seem to offset missing a few arbitrary deadlines. So upper management hammers middle management who in turn hammers the team lead who then either bottles it up or pushes it down onto the plebes below.

In startups being different (ehm sorry not a good "cultural fit") is enough to get you fired so good luck if you expect understanding and support.

I think the best option is to work in a large organization under a respected, strong, and results driven team lead doing important work.

Far stronger than 99% of people... on what basis? I assume you've tested yourself against a large population and found you came out in the 99th percentile? You've run though SEAL BUD/S training and succeeded? Or is that just more conjecture?

For the amount of words you regularly commit to speculating about mental issues on this site, ever think about just getting out of your own head once in awhile? You know, day-by-day just practicing to stop caring so much about every small emotional upswing & downswing? Ya know, just letting them be what they are.

The way you write about your emotions makes me think you take the sound of hoofbeats and start freaking out about zebras, not rationally concluding horses. Practice getting off the rollercoaster, a "3 hour depression attack" is you magnifying some tiny event into a giant mental battle. And yes, I've experienced panic attacks and depression before, so I explicitly know of the tendency to both fear them and how your mood colors every conclusion you're making about life. You draw up these massive narratives about emotional events that honestly don't need any explanation. They are what they are, the sooner you stop trying to analyze / write a book about them and focus on something else, the sooner they pass.

Maybe you need to stop fighting yourself so hard and just let go, ever think about that? Before you start defensively banging out a giant response too, let my words soak in a little. From an outside perspective, all you ever talk about on this subject is purely conjecture and stems from your own personal projections about the root of mental health issues, there is rarely any objective factual basis for your posts.

> For the amount of words you regularly commit to speculating about mental issues on this site, ever think about just getting out of your own head once in awhile? You know, day-by-day just practicing to stop caring so much about every small emotional upswing & downswing? Ya know, just letting them be what they are.

This reminds me of my friend's advice to me last fall. I'd sufferred an injury to my back which caused me to have a herniated disk. This in turn put pressure on my sciatic nerve. My friend told me to just walk normally. If I could have, I wouldn't have been limping and cringing with every step.

There's a time and place for grace, and there's a time and place for a little bit of exhortation. If you had been lying in bed for months or years, constantly moaning about your pain, maybe your friend would have been right to give you a little nudge nudge. Even in physical rehab, therapists prefer to get a patient acting "as if" they are normal as soon as possible, even if there is pain.

When it comes to changing one's own mental outlook/attitudes/moods, if someone doesn't have faith that reaching out to take those painful steps of courage will, in time, "fix their back", then it most certainly won't be fixed.

Not talking about your back pain at all:

For people who have long term pain (and who have had the scary dangerous stuff ruled out by a proper doctor) the old advice was "lie flat on your back and don't exercise". This is the worst thing those people can do. Modern advice is "carefully take paracetamol and keep moving as normally as possible; and when you're back to normal get some exercise to strengthen those back muscles".

Again, nothing to do with your pain.

I'll add to this, pay attention to your chairs. I originally thought my injury was in my leg (that's where all the pain was). It had lasted 3 weeks before it was properly diagnosed. After being put on steroids and starting PT I saw quick improvement, but I plateaued after a couple weeks. I realized that my chairs at home were the problem after I spent a few nights sitting at my kitchen table working on a project. That chair put me in a posture that helped a lot. Switched back to another chair for a couple nights, I got worse, switched back, I got better. So try different seats for a few nights each, you may find that the ones that feel comfortable to sit in are actually hindering your recovery.

"Psychopathy is traditionally defined...by enduring antisocial behavior, diminished empathy and remorse, and disinhibited or bold behavior." [0]

[0]: http://en.wikipedia.org/wiki/Psychopathy

It depends on the why. Using michaelochurch's classifications.

Psycopathic: I break the agreement because I want to do what I want to do.

Anti-psycopathic (particularly for the manic/hypomanic phase): I break the agreement because my brain is creating thousands of ideas a minute, I'm churning out code, I've solved 20 problems that we'd been having just this morning, but none of them are my assigned task(s). It's almost a compulsion, and not one driven from personal want. I don't want to delay the actual work, or procrastinate, but my brain keeps focusing on all the wrong (for work) things.

EDIT: Another fun bit is the after effect. After that spirited creative period, you realize what you've neglected and it feeds the part of the mind pushing you into depression as guilt.

You seem to be familiar with these feelings, any ideas for fixing this?!

1. I'm not a therapist and I didn't stay at a Holliday Inn Express last night.

2. If you really think that you have a problem, talk to your doctor and find a therapist. This is the #1 thing that helped me.

I'm trying to write a response and have deleted several in composing this one.

Depression with anxiety (for me, they feed on each other and dealing with one helps with the other) and hypomania are my issues. "Fixing" them, I haven't yet. I've learned to deal with and mitigate them. I'm going to focus on dealing with depression, because that's what I really have the most experience with and has impacted me the most. My manic episodes have been brief, and usually occur immediately before or after depression and they've not directly impacted my work since I've been able to focus that energy in a way that was productive. I didn't do it on my own. Seek therapy to develop the skills to help you.

On sleep: Sleep, but not too much. This is hard, especially with depression. For me, I found that I wouldn't sleep in either extreme state. The worst was a period of depression where I'd sleep an average of 1 hour a night for 3-5 days, and then crash for a day. I didn't want to be by myself in a dark room and an empty bed, and my dreams were far from pleasant. But I needed that sleep, I went insane without it. I was hallucinating. I saw things constantly moving out of the corner of my eye. I was convinced I was hearing things, but couldn't see what made the noise (didn't help when, once, it turned out that a spider had taken up residence in an errant grocery bag, that scratching noise was real). I felt that things were crawling on me (at one point I convinced myself that I had fleas I couldn't see, that scene from A Scanner Darkly where the guy goes nuts seeing the bugs everywhere, I could sympathize). So for the love of god, get some sleep. If you find yourself oversleeping (note: easier said than done), find a reason to get up every day. I had school at the time. I didn't miss a class. It forced me out of the apartment. Later, I quit grad school and got a full-time job. The responsibility of having to go somewhere really did help kick me out of that cycle. I was socializing with people, made new friends, and got out of the apartment for 9+ hours a day. Like I said, easier said than done, but find something to motivate you out of the house at least every weekday. I spent a lot of money eating out, but that walk to the restaurant got me out of my home and out of my head for a while. Just don't let food become a crutch, I nearly topped 240 lbs at one point (not good on my frame).

A note on exercise: Walk around the block. Walk around the office block. If you're in a city where this is feasible, walk to lunch. You don't need to become a gym rat, but getting a little bit more exercise and fresh air can help to brighten your mood and help you get through the day. I took up soccer a couple years back, it provides me with both exercise and socialization.

A note on socialization: Socialize, but don't hide yourself in it. In my worst depression I was trying to get other people to go out with me all the time or to do things at someone's place (never my own, it was a constant mess). I was overdoing it, and when I left I felt emptier than when I got there. I was all smiles, and sometimes they were genuine. But when I left I went back to a neutral face, and all the thoughts that I was hiding from came flooding back. Try and make some real connections, maybe meet with a support group. Finding someone, in addition to your therapist, that you can talk to about your issues is incredibly helpful. I've talked to several friends over the years about my issues and told them what some of my warning signs are. I've never stopped an episode with this, but they've helped me recognize it earlier so that I could deal with it before I lost myself in it (in my deepest depression, as noted above, I was not at all of sound mind).

A note on medication: I've never taken medication for my issues. There were a couple episodes of depression where I probably made the wrong choice with that, however. This is a personal decision that you should make with the guidance of your doctor. If you find something that helps you, good. I've just found that (most of the time, again some episodes got...dark) talk therapy and CBT have been mostly sufficient for me.

A note on work: Work is good, it keeps me from sitting around all day and thinking about whatever's driving me mad, and it puts me in a situation where I socialize. Socializing isn't always easy when you're depressed, sometimes it's just fucking painful. But if you can get past the pain, the benefits (for me) payoff. Hopefully you have a good boss you can go to for help. But you probably don't (at least by my measure, most bosses aren't good bosses). Find a way to state your need for a reduced workload when you're depressed without saying that you're depressed. Tell them that the 3 projects are just too much, you can finish 2 of them if they can hand the third off to someone else. This may not be as much as you want removed from your plate, but it's a start and you're not pressing your luck. If you've got a good boss (like I presently do) you can be honest, tell them you need a light load for a few weeks, and they'll accommodate you. But get diagnosed. If you can't get out of bed in the morning, get diagnosed and go through HR to get a flex schedule. Getting diagnosed is incredibly important to keeping your job when you have issues with depression. Work with a manic episode. Try to focus, I'm lucky that I can with mine (or I focus well enough on the tasks at hand). If you can't, sell them on whatever you want to work on. Don't try to ask forgiveness later for "slacking" on your assignments for a month, it may not go well. Convince them that the tool you're making will really payoff in the end. Convince them that the resources you're learning and studying can be used in the project, but you need this time to develop the skills. And don't lie to them about this. That'll come back on you, too.

A note on sympathy: Sympathy is not enabling. If you're looking for advice on how to help a friend, be sympathetic but try not to do anything to encourage their negative feelings. And don't dismiss them when they have problems. One of the cruelest things that I ever saw was when a friend attempted suicide and nearly all her friends abandoned her. You may feel angry and confused over their actions, why did they keep this from you for so long, because they didn't think they could talk to anyone. Your anger and confusion is normal and natural, but do not let it out on them. We need support in these situations, feeling abandoned will only drive us back down that hole. The friendship may not survive in the end, but as a decent human being at least give it a chance.

A final note: This may not be well-written, I'm under a time crunch here. I'll try and read it again when I get home later tonight and reply with corrections or a better post.

Thanks for taking the time to write this out.

You're welcome. Like the author of the story that prompted all of this, I've come to the conclusion that we need to be more honest and open about these things. If nothing else, just telling my family and a few of my friends got me past a lot of hurdles. I could stop faking things so much, I didn't have to hide from them. That required an immense amount of my already very limited energy to pull off. But, it's also helped some of my friends and people around me to realize that, yes, they could in fact go to therapy or talk about their problems and not it didn't mean they were bad people or something.

How did you find a therapist? It's tough realizing that maybe my unhappiness isn't due to my job, it might just be me. I'm worried that my entire life is going to spent job and home hopping in an attempt to find something not miserable.

Thank you for this, thank you.

Outside people tend to judge you on what you do, not on what you intend. The latter is invisible to them - they can't reach into your mind and understand what was going on. So from an outside perspective, someone who breaks the agreement because they want to and someone who breaks the agreement because they mentally have to is indistinguishable.

This is true. First, get help from a therapist. Second, if you're finding yourself unable to focus on the actually assigned work, but something still useful, try to sell your bosses on it. If you can't convince them, and still can't regain focus, hopefully your therapist/doctor can help you find a way to regain that focus.

It's neither. It's subjectively irresponsible (or from the other perspective, heroic martyrdom- "It needed to be done").

As someone who used to do this kind of thing occasionally, I think calling it psychopathic is too strong, but I agree it can be a problem.

Now I try to get agreement on the project before I start. I've found this is often possible.

Did you ever get a formal diagnosis for cyclothymia? Dysthymia is very strong on one side of my family, but cyclothymia is closer to my experience these days. In the past, I've been diagnosed with major depressive disorder and generalized anxiety disorder. I've read and observed these spectrum disorders (in myself and others), but never actually known anyone who was formally diagnosed (whatever that's worth).

Usually my symptoms track the seasons pretty closely. I tend to be hyper-productive in summer and a hermit in winter; it's likely just SAD + whatever I have.

> Mental health issues often give you a front-row seat for how shitty people can be when they think you're weak.

This cannot be emphasized enough. This is much harder to take than the symptoms themselves, which can be managed. In a sense, you will grow up very quickly.

> Anti-psychopaths tend to need an R&D environment where they're measured by performance over time, rather than minute-by-minute superficial reliability (at which they can't possibly compete) and those, sadly, tend to be turning rare in the current anti-intellectual (and pro-psychopathic) environment.

Bonus points for a lifestyle company. You do not want to be working under people who will exploit you so they can buy the next status symbol they've been told to grasp at. But, yeah, I'm only really happy in R&D for several reasons: hard problems, autonomy, and longer timeframes.

All software development should be like that. But we've sold out for a crappy lottery ticket that's rigged against us.

This is much harder to take than the symptoms themselves, which can be managed. In a sense, you will grow up very quickly.

Yeah. It's made worse by the fact that technology's upper management are psychopaths here to exploit the cheap talent (and health issues, from their perspective, make you "bargain bin") and most of the low- and mid-level people are spineless weaklings who don't fight for themselves (because they think they'll be tech CEOs in 5 years, despite lacking social skills and savvy).

But, yeah, I'm only really happy in R&D for several reasons: hard problems, autonomy, and longer timeframes.

All software development should be like that. But we've sold out for a crappy lottery ticket that's rigged against us.

Well, perhaps not "all software development". If you're running a trading desk and have algos running during Hong Kong hours, you're going to need people who can handle drop-everything, short-term crises. I would say that all software development should be like that-- except for the few kinds that can't be, and those should be paid at $2+ million per year.

Any tips for coping/changing your lifestyle/having fewer totally hopeless existential crises? I spend a lot of time at the edge, feeling one second away from throwing everything away and starting over on a completely different path.

A few questions:

1. How old are you? It gets easier with age.

2. Who helps you balance your life?

3. What would you start over doing?

I have attempted #3, but I came back to development.

1. Mid heading into late 20's (common crisis age)

2. I guess it's just me. My girlfriend humors me occasionally but can't really relate and just thinks I have some combination of ADD/wrong career causing unhappiness/too many thoughts.

3. I'm not sure, it's always just something totally different. Live in my car, bum out of a backpack internationally working from a laptop, take design classes, work on a farm, work for a non-profit, build various startup ideas, go for a PhD and write/teach, figure out a way to help alleviate global suffering; real lack of healthcare, lack of clean water, lack of food, lack of education, suffering instead of being surrounded by first-world problems.

The suffering path is a big draw because the crises frequently lead to the conclusion that life is meaningless, the only sure thing in life is suffering, so the only meaning must be to try and minimize the total amount of suffering endured by humanity. That sounds kind of hokey but I don't mean it to be. I'm very empathetic but not very sentimental or religious or "ohhh change the world" optimistic. It's more of a get out in the field and do the dirty work because otherwise you're just wasting time kind of feeling.

What did you attempt?

I went on a sabbatical thinking I may not be able to do dev again, but I was wrong.

It's good you mentioned lifestyle changes; you'll want to get in the habit of constantly experimenting with these before you pull the plug completely. Consider:

* therapy

* being in a community (in real life)

* lifting

* the arts

* doing more/less work-type stuff on the side (open source, speaking, mentoring, etc)

* service projects (lots of different clubs do them)

I think a lot of the existential pain in my late twenties was due to feeling alone plus stuck at my job. I tried several things to deal with it (all safe) but couldn't get a handle on it, resulting in burnout.

All of those things you want to do are good; you could try doing some of them part time. When life tells you to pack up, you'll know it, so I'm not going to prescribe anything particular, other than letting you know to trust your instincts here. I had to find out the problem was mostly me (but other people also had to go). But one thing you need to know: all the good you do cannot patch you up on the inside. Whatever you're feeling will be there later.

The importance of someone who honestly balances you out cannot be understated. I did not understand balance until I had to see myself through my wife's eyes over and over again. It's humbling and hard, but it will change you to something healthier much quicker. I don't know what your relationship looks like, but I hope your girlfriend builds you up and supports you whatever your mood is.

Personally, I have to always be learning. I found a guitar teacher who does a great job teaching technique, and I'm constantly challenged. I also work in R&D at a lifestyle company.

I hope this helps a little.

Is this a real thing? Can you think of any other careers that might work well for this type of person? I've been leaning towards self-employment mainly for the "performance over time, rather than minute-by-minute" aspect. Have you had or do you know anyone who has had success "treating" this without medication? I've been looking into vipassana retreats and tend to do a lot of self-reflection but it frequently makes things worse.

Michael, you tend to make interesting points that get brushed under the rug because you can't resist throwing your hobby horse issues into every conversation.

"mainstream business culture of entitled executives and board-whores"

This ignores the huge and growing influence of engineer-led companies, YC empowering founders vs financiers, and technical VCs like a16z. The tech leadership here is miles better on average than any other city I've worked in or know through friends.

"Snapchat and Clinkle setting the tone in the current Valley"

I know these companies piss you off, but they're not setting the tone in the Valley. They're more like an NBA player getting a max contract without making the playoffs. Google, Facebook, Apple, Twitter are all waaaaaaay more important than anyone taking VC money right now. And if you're talking about "hot topic" companies, Whisper and Secret are relevant now than either of the two you mentioned.

"rents becoming unaffordable"

This is not a tech issue, this is a structural local government land use issue present everywhere in the US but more of an issue here because of SV's wealth (vs income) generation.

"no-poach agreements all over the Valley"

This is a big deal for a large number of employees, but Facebook crashed that party years ago, and it didn't apply to startups anyway. Besides, breaking that cartel probably raised rents even more.

This ignores the huge and growing influence of engineer-led companies, YC empowering founders vs financiers...

Do you think that engineer-driven companies are increasing? It seems to be going the other way. Maybe the bad guys aren't more numerous than before, but they've learned to speak our language. There are plenty of companies with horrible culture/management that claim to be doing machine learning and take in just enough talent to convincingly tell a story (see: Knewton, which presents itself as a "big data" company but (a) isn't really doing ML, and (b) has the worst kind of MBA culture).

I'd love to see you be right. I do think that, if you exclude elite tech-literate hedge funds, the Bay Area is still the most progressive employment culture in the U.S. That's damning with faint praise. It still has a lot of trash that I hope will be taken out when the bubble ends.

The tech leadership here is miles better on average than any other city I've worked in or know through friends.

I think you're right, sadly. For as much awfulness as there is in the Bay Area, I feel like the technical culture in the rest of the country is even less evolved.

The ethics are (surprisingly?) better in top hedge funds, and there's more of a meritocracy, but (a) that's not a very useful economic sector and (b) it can't scale up and employ more than a small number of elite people.

Google, Facebook, Apple, Twitter are all waaaaaaay more important than anyone taking VC money right now.

Point taken. But Google uses closed allocation and while that may be the right thing for Google, the idea that any company can be a cultural leader in technology (which Google still is, at least in reputation) and run closed allocation is cataclysmic.

this is a structural local government land use issue present everywhere in the US but more of an issue here because of SV's wealth (vs income) generation.

Fair point. The (mostly undeservedly) hated "techies" are almost an entirely separate set from the NIMBYs who are causing the problem.

The issue with rent, though, is that it encourages bad culture. Manhattan doesn't magically turn people into assholes, and neither does San Francisco. But when people absolutely need to be employed 12 months out of the year or risk total financial catastrophe, they can be taken advantage of in ways that you wouldn't see in more affordable locales, and that attracts... the kinds of people who want to exploit a pool of captive labor.

I don't know if the ratio of engineering led companies is growing, but with Twitter and Facebook going public instead of getting acquired, AirBnB, Dropbox and Github all getting huge, and Zuck's approach to big acquisitions so far (founders of Instragram, WhatsApp, and Oculus still running those companies), technical founders seem like they have more expectation of staying in control than before. I can't see any big tech co now bringing in a "grown up" a la early Apple or even Eric Schmidt at Google. And as an employee, it's super easy to find authentically tech-driven companies.

The "increasing" I mentioned had much more to do with a16z's surging influence and success as a VC.

"Knewton"

Never heard of Knewton, there are always going to bad examples. But you only work for one company at a time, and since there are so many great companies here, the bad apples don't matter as much. Bad/weak/deceptive companies are much more dangerous in smaller, thinner tech job markets (basically everywhere outside of SV/SF/NYC/Seattle/Boston).

And yes, the salaries in tech don't matter because tech workers without successful founder equity are still collateral damage between rich powerful companies and rich powerful property owners. I love my career intangibles here but I don't feel richer despite a big pay raise when I moved.

> I can't see any big tech co now bringing in a "grown up" a la early Apple or even Eric Schmidt at Google.

Sandberg? Costolo?

ERP and mindfulness are really, really effective in treating OCD. I know, because one of my children had a crippling case and now is free of it. I spent several months at UCLA's Pediatric Intensive Outpatient Program with him and have seen it work on about a dozen children. The same treatment can also be used on adults.

ERP stands for Exposure and Response Prevention. The idea is that you progressively expose the person with OCD to their fear(s), during which, they cannot perform any compulsions. Eventually the brain is retrained and the OCD falls away. For example, someone with a fear of germs would be asked to touch a door handle and then not wash their hands for as long as possible. This is extremely hard for them. However, this simple technique, applied over weeks or months in conjunction with therapy and meds, can reduce a person's OCD to almost nothing.

Another point is that the kids respond to the group setting. They form bonds and support each other during the process.

The UCLA team is absolutely amazing at this: http://www.semel.ucla.edu/adc/ocd_treatment

If you have or know a child suffering with the disorder, please look into this program or one like it!

If you have any questions for a parent that has been through this with a child, contact me at capitalism99@gmail.com

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