Failing to update

acutely aware that my fear of going to the doctor is based on a fear

The loose definition of a clinical-grade mental problem is that it noticeably affects your ability to function in the real world.

IANAD (I am not a doctor), but while driving past the doctor's office looks marginally OK to me, punching a mirror does not. I think you want to talk to a psychotherapist (not a psychiatrist -- they're quite different people and based on what you said you don't need one).

I understand that getting to see one is somewhat of a catch-22, but given that you're reflexive enough I hope you can work out some form of misdirection or a game with yourself. If your fear is only of physical illnesses that should make things easier.

P.S. Maybe contact Yvain? He should be able to offer much more competent advice.

It sounds like some of these emotional issues could be helped by working through the exercises in a book like The Feeling Good Handbook, which has been shown to be about as effective as therapy for treating depression. Make sure you actually write out the exercises, don't just read them or think about them, you have to actually write for them to be effective.

This seems like an excellent if somewhat extreme example of a common problem most of us have from time to time, the infamous akrasia: "the state of acting against one's better judgment". (Insert the appropriate "wants vs meta-wants", "limited introspection" and "weak willpower" mutterings.) My guess would be that attempting to trace every minute detail of your thoughts and feelings (which are reflections of thoughts unavailable to introspection) and writing them down may give you a hint at where and why your rebellious subconsciousness takes over and says "STFU, I aint going to no doctor".

Another approach is to contact jimmy, who can probably fix you in no time flat.

What do you do when your computed probabilities and utility function have NO EFFECT WHATSOEVER on your actual behavior?

Cede the battle, heed the war. Learn to fail better. Vague comments, but some some cognitive module buried in your brain says "yes." Be okay with being dumb as a rock sometimes, maybe much of the time. Abandon the quest for why this is happening, because that's not helping you change the course of the behavior. Stop looking for the source of the river, and stop trying to dam it up. Redirect it. Maybe take a friend to his or her doctor's appointment as a 'dry run.' Or because it's a nice thing to do.

Example:

I worked at a needle exchange where IV drug users could put their needles in a sharps box instead of random trash cans or on the street, plus pick up some first aid and referrals. One guy would come in every now and then. He came in one time with a red nose. A few weeks later, a nose with a boil on it. A few weeks later, a big open sore on his nose. A few months later, the guy was walking around with a rotten hole where his nose used to be. In the 20th Century, in the United States, in a city with a social service offering him 100% free medical care on demand, he let his nose rot off. I'm very sure he's dead now. And he wasn't dumb, wasn't even below average, and wasn't crazy. Just got lost in his own thinking and put things off.

Don't be that guy, you big dummy. You blew it recently, try again later. Try new ways.

I think the way out here is to take seriously the idea that "you" are multiple agents.

I think the ramifications here are not entirely obvious (I am still working through them). Personally, I am leaning towards the Hansonian view that one should apply insights from coalition politics to resolving internal disputes. That is, it makes more sense to make peace and compromise with one's internal factions over doing what amounts to beating parts of yourself down over and over (which inevitably results in "radicalization", etc.)

Short term: Tell your friend/family/acquaintance/random person in the street that you need someone to escort you into the doctor's office because you're having trouble doing it by yourself. Ask them to be that someone. Offer them a small amount of money if need be so that you're not wasting their time, or buy them lunch or something else for them if they refuse to accept money directly.

Slightly longer term: Repeat the above process to get yourself into a therapist's office, because you have reached the stage of depression where you need outside insight and accountability to be able to improve, and providing that help is a therapists' job. (I also second what other people have said about inquiring around for a therapist who charges on a sliding scale, or taking advantage of local residency/intern training programs to get cheaper access to care. In the latter case you'll also be providing a service for the therapist in training by giving them someone to practise on)

I've deleted this post, in the hopes that it will stem the tide of my recent set of downvoting. I apologize to anyone that this collection of posts offended or annoyed, and will try to not post such things here in the future.

These are things I have done to deal with these kinds of feelings:

1. Programs like Medicaid (in states that are expanding it to all low-income and not just disabled low-income people, at least) and food stamps are funded with the number of people who are expected to use the service. When you use low-income services like this, the people running the service can then mark you down and then use "we got more people using the service this year than we did last year" to ask for more funding. This also works for community clinics that get some or most of their money from private donors, who can make the same argument for the same reason.

2. If you can't make the phone call, have someone sit next to you and dial the number and then press the phone to your ear. If you're selectively mute like I am, use text chat and someone else in the same room as a relay service. If you have phone anxiety, offer to book salon and pet care appointments for other people until you burn the phone anxiety out.

3. Pay someone else gas money ahead of time to drive you to the appointment, and then walk you to the waiting room and sign you in. A firm hand on your elbow works wonders.

4. Seconding this recommendation for using a workbook to get yourself over the initial hump.

5. Most therapists will offer free initial phone or email consultations. Note your money problems upfront. If the therapist says that they can provide you help and is offering you a significant sliding scale discount out of their own pocket, it's rather harder to turn that down. Note that independently practicing therapists are basically sole proprietors and thus it is one person saying that you deserve help, rather than an agency, because you seem to be worried about agencies running out of money (though see #1).

6. Once you are with the doctor, you can tell them you had trouble making the appointment for these reasons and need help. (If you think you may end up not saying these things aloud, write them down ahead of time and then make sure they get the paper.) Either they will prescribe you a relatively inexpensive medication or they will refer you to a different doctor or therapist. For help getting to that appointment, see #3.

7. There is a lot of screening and paperwork involved when getting this kind of assistance. It is their job to determine whether you deserve to be helped, not yours. Even people you (probably) think do not deserve help, and/or who are costing far more than you would probably cost to treat in a lifetime, are getting help that you could at least be considered for. Be honest about how much of a problem you have with "deserving" help and they will be honest about what your chances are.

My experiences with this sort of thing have been resolved using brute force. When my logic and long term planning conflicts with some inner module that 'believes something different', I can't ignore the conflict. Ever. There is no putting it off to the side, there is no "I'll think about it later". Think about it, and beat on it, until you resolve it. Every time. Eventually, those spurious pieces of your head will stop fighting so hard.

It takes effort, and I'm not talking about small amounts of effort. There's something painful there you're shying away from, some conflict you're avoiding, something too painful or hard to face. Facing it down is what it will take to fix the problem, and that's that - you're not going to get off easy, you're not going find an easy out or a magical fix. You're going to have to work, hard, to change the way your head works, and it is going to be extremely uncomfortable.

Don't just be prepared for it to be difficult - be prepared for it to be as difficult as running a five minute mile, as difficult as bench pressing twice your body weight, as difficult as staying awake for five days straight without drugs or help. Be prepared for it to be Hard, with a capital H, one of the five most difficult things you've ever done in your life. That's the barrier you need to break through.

But as hard as it is, it's entirely doable. It's not magic. There are fast ways to do it (brute force), and not so fast ways to do it (easing into it.) Personally, I prefer the fast, hard way whenever possible, because it's less work overall. The easier ways have other drawbacks, such as falling into the trap of making continuous minor improvements that never actually solve the problem or bring you closer to a solution.

Good luck!

Anxiety is disabling your thinking. Remove the cause of anxiety

--a) Can you think of any good ways to increase your income or decrease your spending?

--b) Can you think of someone who would be willing to help you in some way? (financial support, emotional support, help finding better income, providing free or cheaper-via-sharing housing , etc)

--c) If it's severe - can you acquire some anti-anxiety medication?

Is there anywhere else in your life that you do this?

(This is a question to ask about any apparently incomprehensible problem within oneself. Incomprehensible = there is something going on that I am not aware of. This implies that the real problem -- the thing that a solution would involve changing -- is not the particular manifestation of it that I am looking at right now.)

There is no free will, remember? You can't actually update anything. Enjoy your determinism.

Or stop thinking of yourself in terms of functions and probabilities and updates and utilons (you are not a computer in any meaningful sense of the word) and try to find a way to trick yourself. Talk to your relatives, they may be able to shame/scare/peck you into going to the doctor.

Step 1: Learn the difference between 'affect' (verb, transitive, meaning to influence, change, or alter; "The zerblig affected the doonand". Also a noun meaning the outward signs of emotion; "The robot had an eerily flat affect") and 'effect' (noun, meaning a change or alteration; "The zerblig had no effect on the doonand". Also a verb meaning to execute or put into action; "The robot effected its robotic plan.") Putting it all together: "The robot, still maintaining its flat affect, put into effect its plan to affect the doonands by using the Zerblig Effect".

Step 2: Having learned something today, you can go to bed.

Step 3: Possibly a case for public precommitment, such as telling someone in your immediate social circle "I'm going to the doctor today, wish me luck"?

Step 4: If there is really a serious disconnect between your conscious thoughts and your actions, that would seem to be somewhere on the spectrum of problems that are usually assigned to psychiatrists rather than doctors. Perhaps - I'm sorry I don't have better advice - you should go to the doctor.