2018-07-09 RRG Notes
- Every so often, there's a post on social media, arguing that we need to end the stigma on mental health
- Is anyone actually in favor of there being a stigma on mental health these days?
- If most people are against stigma, why does it still exist?
- Why is there such a huge gender difference in the people willing to talk about mental health publicly?
- People who post publicly about mental health tend to be women
- People who post anonymously about mental health tend to be men
- People who write about the need to talk about mental health online rarely say what talking about mental health actually looks like
- Even though depression has a chemical basis, the trigger is often environmental
- People who are secure in their identities don't feel depressed
- The problem with most videos about mental health is that they
- Show the speaker as confident, attractive, "not your typical mental-health patient"
- Suggest the speaker is heroic just for talking about mental illness
- Ignore any details about the speaker's life that may have contributed to the mental illness
- Do not give any actionable advice
- No advice on treatment
- No advice on recovery
- In practice, there's a huge difference between the sanitized picture of mental health issues that we get from inspirational videos and the actual ugly reality
- The problem with mental health awareness campaigns is that they can make it okay to talk about mental health, but they can't erase the fact that mental health is perceived as weakness
- People compare mental health to physical ailments, but they compare mental health to the wrong physical ailments
- The correct point of comparison is chronic diseases
- The same "stigma" surrounds e.g. irritable bowel syndrome or celiac disease
- This stigma is present around anything that makes you look weak
- How does mental illness suck
- Sadness can be enjoyable, in its own way
- But mental illness is not sadness
- Mental illness is pain
- Depression feels like you have the flu, complete with aches and muscle weakness
- Anxiety feels like you're having a heart attack, over and over again
- The first step to alleviating pain is communicating it
- However, there is no good way of communicating pain reliably
- There's also a strong incentive to "cheat" and to exaggerate the amount of pain that you're in
- Moreover, pain itself isn't a strong signal of the severity of the underlying condition
- People with gastrointestinal bleeds only notice they get a bit dizzy when they stand up
- Pulmonary embolisms may be asymptomatic
- Pain is part of the map, not the territory, which is why doctors ignore pain whenever possible and treat according to the severity of the underlying condition
- In this sense, people with mental illness are similar to people with chronic pain, and unsurprisingly, there's a strong correlation between chronic pain and mental illness
- They both face the problem that even if people try to listen, they won't get it - there's no way to empathize with chronic pain or mental illness if you haven't also suffered chronic pain or mental illness
- Talking about mental illness and pain alleviates symptoms, but it doesn't address the cause
- Drug addiction
- People try to draw a difference between drug dependence and drug addiction
- Dependence - need drugs to function; spiral of tolerance and increasing doses
- Addiction - uncontrollable cravings; compulsive use
- These people don't understand how addiction works - addiction is dependence
- Drug addicts don't take drugs to get high, they take drugs to make the pain of withdrawal stop
- The problem with using an opioid painkillers for chronic pain is that it's a time bomb - addiction is not a matter of if, but when, as tolerance builds
- Eventually you'll need massive doses of painkillers just to reach normalcy, and at that point there's no distinction between dependence and addiction
- So what does this have to do with mental health and talking about mental health?
- Talking about mental health feels good the first time you do it
- People are sympathetic
- You feel like you've unburdened yourself to some extent
- The need to seek empathy is an understandable reflex, but it only address symptoms, not causes
- The difference between publicly proclaiming suicidality and complaining to a friend about work is a difference of degree, not a qualitative difference
- How does this tolerance build
- Depressed person feels more depressed than usual
- Vents to a friend or family member
- Depressed person feels better
- This cycle is repeated, but that rush of relief is less and less each time - depressed person thinks that other people just don't get it
- So the depressed person escalates their behavior a little bit - maybe screams and cries instead of talking
- This escalation spiral continues until, in the end state, you have people broadcasting suicidal thoughts to an audience of thousands and still not feeling any relief
- Eventually the person can't communicate their depression at all, because everything they do is interpreted as attention-seeking drama
- It is a myth that expressing emotion is an force for good
- Expressing emotion is better thought of as a painkilling drug
- Effective for acute cases
- Long term use leads to dependence
- Inpatient psychiatric hospitalization is the strongest form of this drug - the rate of suicide is highest for people the first week after discharge - which corresponds to a model that sees the removal of the inpatient support as withdrawal
- While it is not possible to be neurotypical, not all neurodivergence is neutral - some of it is unambiguously bad
- This is why it's toxic to make your neurodivergence part of your identity a.k.a. speaking about mental disabilities rather than mental illnesses
- Illnesses are treatable, disabilities are not
- Once you become the sort of person who needs accomodation, it becomes harder and harder to stop
- Example: trigger warnings
- If you tell yourself you need trigger warnings, you've given every bully out there an easy way to hurt you
- You've made yourself weak for nothing in return
- Suffering doesn't guarantee a payoff - some people spend their entire lives miserable, and then they die
- So what can we do about this
- First let's model depression not as an adaptation, but as a bug resulting from the interaction of other adaptations
- Results from a series of negative events which trigger our instinct to find causes
- Think that negative events were your own fault, and therefore things you do are now doomed to fail
- The thought loop is the cause of the depression, not the initial trauma
- So how do we deal with the thought loops
- Anti-depressants
- Address the physical symptoms associated with the thought loops, not the loops themselves
- But if you're not constantly dealing with physical symptoms, then it can be easier to deal with the thought loops
- Hallucinogens
- Drug trips reset the way the brain thinks, so for a while, you don't fall into the familiar thought loops
- However, these too have diminishing returns
- Behavioral therapy
- If perfectly executed, behavioral therapy can work
- However, the execution is hard
- Failure can reinforce the depressed person's belief that they suck at everything
- The thing that seems to work to help with depression is just doing things
- As long as you can keep up a certain sense of momentum, you'll break out of the depressive thought loops eventually
- The act of doing things allows you to redefine your identity, which lets you see yourself as being defined by something other than your mental illness
- My thoughts
- This is a good essay, but it seems a big glib
- The metaphor of people being addicted to empathy sound good, but I'm wondering whether it's predictive, or whether it's just based upon surface similarities
- This pieces is very long for what it's trying to say, like most neoreactionary writing
