Can we talk about mental illness?

post by riparianx · 2015-03-08T08:24:37.166Z · score: 39 (42 votes) · LW · GW · Legacy · 108 comments

For a site extremely focused on fixing bad thinking patterns, I've noticed a bizarre lack of discussion here. Considering the high correlation between intelligence and mental illness, you'd think it would be a bigger topic. 

I personally suffer from Generalized Anxiety Disorder and a very tame panic disorder. Most of this is focused on financial and academic things, but I will also get panicky about social interaction, responsibilities, and things that happened in the past that seriously shouldn't bother me. I have an almost amusing response to anxiety that is basically my brain panicking and telling me to go hide under my desk.

I know lukeprog and Alicorn managed to fight off a good deal of their issues in this area and wrote up how, but I don't think enough has been done. They mostly dealt with depression. What about rational schizophrenics and phobics and bipolar people? It's difficult to find anxiety advice that goes beyond "do yoga while watching the sunrise!" Pop psych isn't very helpful. I think LessWrong could be. What's mental illness but a wrongness in the head?

Mental illness seems to be worse to intelligent people than your typical biases, honestly. Hiding under my desk is even less useful than, say, appealing to authority during an argument. At least the latter has the potential to be useful. I know it's limiting me, and starting cycles of avoidance, and so much more. And my mental illness isn't even that bad! Trying to be rational and successful when schizophrenic sounds like a Sisyphusian nightmare. 

I'm not fighting my difficulties nearly well enough to feel qualified to author my own posts. Hearing from people who are managing is more likely to help. If nothing else, maybe a Rational Support Group would be a lot of fun.

108 comments

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comment by Alicorn · 2015-03-08T18:49:49.917Z · score: 12 (12 votes) · LW · GW

There are rationalists talking about mental illness, but mostly offsite. Ozy talks about BPD among others, Kate and theunitofcaring talk about eating disorders among other things, I'm probably forgetting some.

comment by riparianx · 2015-03-08T19:16:05.517Z · score: 5 (5 votes) · LW · GW

Thank you! I'll see if I can start compiling resources like this. If you think of any more, I'd appreciate it if you could message me.

comment by Alicorn · 2015-03-08T19:21:40.205Z · score: 5 (5 votes) · LW · GW

I suppose there's Slate Star Codex, which is written by a rationalist psychiatrist who sometimes talks shop but doesn't tend to dwell on mental illness stuff in the same instrumental way. (It is highly recommended for other reasons, of course.)

comment by KPier · 2015-03-10T04:54:48.889Z · score: 3 (3 votes) · LW · GW

Brienne's Löb's Theorem Defeated My Social Anxiety deserves to be among your resources.

comment by passive_fist · 2015-03-08T08:42:44.725Z · score: 7 (7 votes) · LW · GW

Disclaimer: My opinions are solely my own and not based on psychological science (at least as far as I know).

I've always thought that things like depression and anxiety have some genetic component (the mix of chemicals in your brain) and some environmental 'trigger' component. You may not be able to do much about the genetic component, but if you get rid of the environmental component you can go a long way towards getting better.

I also have anxiety disorder. A lot of happiness has to do with being financially secure, having a fulfilling job/career, having a good social circle, eating well, having a good mix of hobbies, and working out. I've noticed that in my life whenever I was lagging in one or more of these areas, the anxiety and depression started bubbling up again. But whenever I tried taking care of these issues, I was mostly happy.

If someone is depressed, I don't think it will do to just give them some medications or tell them to do yoga, as you say. But maybe giving them meaningful employment or an exercise regimen will make them happy. Of course, people who are depressed get 'stuck' in a cycle where they are unable to 'break out' and obtain these things.

Again, these are solely my own opinions. Some of them might be stupid, others obvious.

comment by riparianx · 2015-03-08T08:55:32.923Z · score: 6 (6 votes) · LW · GW

That's sometimes a very frustrating thing to read- the "get rid of environmental triggers" thing. Speaking solely for myself here, my triggers are either really, really difficult to do anything about (financial difficulties) or a bad idea to try and get rid of (my academics). Sometimes you're just stuck at a point in your life where you can't fix your triggers.

I think there must be more we can do than get rid of triggers, or add more meaningful things. Maybe not as effective, but mental illness is a complex thing. Complex things have weak points. Sometimes I wonder of we're ignoring the trees and just seeing the forest here. Mental self-help advice is so... formulaic.

comment by spriteless · 2015-03-09T04:21:43.671Z · score: 2 (2 votes) · LW · GW

Just getting rid of stuff is one way to stop a trigger. Building up a way to deal with it is another. Like, you could come up with a plan for your finances, and practice bringing up your finances and saying that plan, so you build another association with your finances that isn't a loop of anxious thoughts. Like role-play therapy, where you plan out and practice your reactions to someone saying something before hand.

I am assuming a heluvalot about you with that advice though, sorry if that doesn't even make sense.

comment by riparianx · 2015-03-10T00:11:16.072Z · score: 1 (1 votes) · LW · GW

Well, I'm not the only person who struggles with anxiety, much less mental illness in general, so while your advice may not apply to me it probably applies to someone else. Focusing all of the discussion of mental illness on the one mentally ill person who started the discussion is... well, not exactly what I started the discussion FOR. So, any advice you have is totally welcome and appreciated.

comment by spriteless · 2015-03-11T21:33:13.267Z · score: 1 (1 votes) · LW · GW

I guess that disclaimer was a bit of a cached reaction, since the main forum where I talk about mental illness issues is Tumblr, and I need to explain that I know I'm not omnecient on Tumblr, and can't prescribe treatments better than the people it would effect, just suggest ideas.

I did catch the extra disclaimer that you are not to use cognitave therapy on other people without their consent or knowledge, because in lw I expect you already know that and I won't get status from pointing out that people have, like, agency and stuff. You can't just do things to people. Wow. So much friendship for hitting such a low bar of decency. All the applause lights. Ramble ramble ramble.

comment by riparianx · 2015-03-13T01:04:43.041Z · score: 1 (1 votes) · LW · GW

I sometimes think that LWers actually underestimate the help that individuals suggesting ideas can be. More than once, a friend has said something that made me think, "holy crap, I've approached this not just from the wrong angle, but the wrong freaking plane." I also have noticed that suggestions without disclaimers tend to get downvoted here, so I suspect the cached reaction is a good cached reaction.

Also, thanks for the giggle.

comment by [deleted] · 2015-03-09T11:42:37.404Z · score: 6 (6 votes) · LW · GW

May I ask a stupid question? How do people find out they are mentally ill? Obviously, I mean the not too severe cases. Let's take this GAD or tamer panic thing. During your childhood and youth you have reactions that people call "timid", "nervous", high strung" or "cowardly", depending on the situation and on them. I see four possible courses there.

A)One is you don't give a damn, you just accept it. It makes you less than happy but why would you ever expect to be happy? So you just accept some aspect of your life sucks.

There are two possible sub-courses here. As it is hard to put up with suffering in the long run A1) you can end up with self-medicating with drugs or booze A2) you become a "compensation monster", constantly climbing rocks and suchlike to show yourself and others you are not timit or not a coward.

B) You hate yourself for it, because you consider yourself screwed up and less worthy than others, but you don't realize this is something doctors may be able to fix, because you are used to people being very judgemental about this. I.e. instead of seeing someone who needs help, they see a person who is a bad and should feel bad.

C) You realize (or maybe your parents did) that it is fixable by doctors. This is obviously the best solution although A2 is doable too, but how do people get to this?

Just yesterday, I had a little shock, my wife told me that things like me being unable to dance coordinatedly, beat out a simple drum rythm, or draw beyond kindergarten level, or even to write cursive readably, is not simply "ha ha I am clumsy" thing but probably a childhood neurological, neuromotoric (or maybe ADHD) development issue and if my parents paid attention and seeked help it may have been fixable .I am still dealing with this idea that I am not simply clumsy but in a certain sense "ill".

To me the whole thing is a bit confusing. I associate illnesses with people being in bed and having fever. To understand other conditions as not screwed-upness, inadequacies, things other kids point a finger at and laugh because you are worse than them, but as medical conditions, is quite new for me.

comment by riparianx · 2015-03-09T12:31:47.225Z · score: 4 (4 votes) · LW · GW

The brain is an organ. Like any other organ, things can go wrong. It's becoming the consensus that mental illness is caused by imbalances of hormones and similar things. Dopamine and serotonin in particular. It's an invisible illness, though, and so sometimes it's hard for people to take it seriously. Parents who don't think of "clumsy kid" as a potential problem might just assume they'll grow into their limbs. That's what people thought clumsiness in childhood was for a while- uneven growth that would eventually normalize.

People normally find out they're mentally ill when they realize the people around them don't struggle like they do. When I realized that constant soreness and tiredness and sense of dread was a thing most people didn't have, I called in to make an appointment and started searching the internet. Also, it's not a stupid question. Personally, I'm a mix of B and C. I hope you realize that it isn't your fault, because I haven't gotten there yet.

comment by RomeoStevens · 2015-03-09T06:50:25.123Z · score: 6 (6 votes) · LW · GW

Reminder that CBT workbooks for specific problems have been shown to be almost as effective as in person therapies and that you can just buy them on Amazon.

Depression: http://www.amazon.com/Cognitive-Behavioral-Workbook-Depression-Step-/dp/1608823806/ref=sr_1_4?ie=UTF8&qid=1425883773&sr=8-4&keywords=CBT+workbook

Anxiety: http://www.amazon.com/Cognitive-Behavioral-Workbook-Anxiety-Step-/dp/1626250154/ref=sr_1_5?ie=UTF8&qid=1425883773&sr=8-5&keywords=CBT+workbook

referral link is for Slate Star Codex if you're wondering.

comment by riparianx · 2015-03-13T01:05:36.546Z · score: 2 (2 votes) · LW · GW

I got the anxiety book, and I'm starting to go through it. I absolutely recommend it- a few pages in and I was thinking "This guy just completely destroyed a lot of my justifications for having low self-esteem."

comment by Cariyaga · 2015-03-09T16:23:16.213Z · score: 2 (2 votes) · LW · GW

Oh, that's rather interesting. Do you have any citation for them being so effective? I've a friend for whom they might be quite useful, as he's a bit of a shut-in.

comment by RomeoStevens · 2015-03-09T22:58:10.526Z · score: 1 (1 votes) · LW · GW

Popular take: http://www.scientificamerican.com/article/are-all-psychotherapies-created-equal/

There is a blog post floating around explaining exactly how much workbooks in particular were shown to be around 80-90% as effective as in person IIRC but I can't find it right now. Also IIRC Anxiety is one of the more responsive to treatment disorders.

comment by k_ebel · 2015-04-07T17:50:14.284Z · score: 1 (1 votes) · LW · GW

One modified form of CBT that I have personally found very helpful (and - frankly - served as something of a primer for skills I have been learning through this website) is DBT (http://en.wikipedia.org/wiki/Dialectical_behavior_therapy).

Honestly, a lot of the skils are things I think any person could really use. (For me, emotional regulation and interpersonal effectiveness were incredibly helpful and not something that had ever been spelled out to me prior to encountering this).

As a disclaimer: I do think that my experiences may have been very influenced by the fact that I had a really good group and coach who didn't rely on the more rhetorical elements and was happy to provide research-based information upon request, but it's definitely another place to look.

comment by riparianx · 2015-03-09T12:32:47.708Z · score: 0 (0 votes) · LW · GW

Ooh, cool. I did not know that. Thank you for posting these!

comment by CAE_Jones · 2015-03-08T14:34:39.040Z · score: 6 (6 votes) · LW · GW

On Akrasia:

And it goes on and on, with no victory in sight.

I feel like I could fight the rest of my problems effectively with what I have (or at least, quickly learn otherwise) if I wasn't so paralyzed by Akrasia that the only resource I actually have is the ability to type incoherent comments into a small selection of websites.

I couldn't solve all of them (the technology isn't available yet), but with some of that sweet, sweet Executive Function/Conscientiousness/Free Will/Whatever we call it these days, I could at least approximate functional, and--dare I say,--not prodominantly miserable.

comment by riparianx · 2015-03-08T16:55:44.998Z · score: 4 (4 votes) · LW · GW

Exactly. LessWrongians focus so hard on akrasia that I think they often fall into the trap of ignoring some of the causes of akrasia. If akrasia is your only serious problem, it's really easy to find ways to help. If you have akrasia because the idea of doing your work is terrifying, LessWrong isn't much help. So people like us get left shafted- too on the fringe for the majority of help to help, too in the middle for the rest to help.

comment by Nick_Roy · 2015-03-09T00:55:39.603Z · score: 3 (3 votes) · LW · GW

Agreed. Personal anecdote: once I redefined my "motivation problem" as a "depression and anxiety problem" a number of months ago, and began treating this depression and anxiety instead of wearily trying out yet another willpower hack, I have made more progress in being motivated in months than I had in the previous years.

comment by riparianx · 2015-03-10T00:13:59.871Z · score: 1 (1 votes) · LW · GW

This is exactly what I was doing- constantly looking for the system that would let me be successful while ignoring the root problems. I only accepted the anxiety when it got too bad to ignore. Can I ask what you've been doing that's been so effective?

comment by Nick_Roy · 2015-03-10T13:58:12.950Z · score: 2 (2 votes) · LW · GW

Two Disclaimers: First, I am not a doctor. Second, beware of other-optimizing. This advice is working well for me, but it may not work well for others.

The depression became obvious and major enough that I was forced to take action to stop it. The rationalizations had run dry, so I fully realized in both System 1 and System 2 that I was not "unmotivated", I was mentally ill. Years of life hacks and half-assed lifestyle interventions had accomplished some, but not enough, so it was time for medications, which I had previously feared due to bad experiences with bupropion years earlier.

The constraints in my investigation: something effective for major depressive disorder in both the short-term to fight what I was then feeling and in the long-term to prevent relapse, non-serious side effects, anxiolytic properties, as there is comorbid OCD and social anxiety disorder (SA, also this is why I chose medications before psychotherapy), and a reasonable price. Tianeptine met these constraints, with the nice bonus of plausibly being a cognitive enhancer.

Within six weeks of use, the tianeptine decreased the depression such that it was time to focus on the next most serious drag on my productivity and happiness: OCD. Not being majorly depressed allowed me to develop exercise and meditation habits that reduced the OCD down to a similarly manageable level. The anxiolytic effects of the tianeptine and the reduced stress of not being seriously depressed probably also helped.

The depression and OCD were still there and still a nuisance, but they had become minor enough that it was time to continue prioritizing elsewhere. By then tianeptine's anxiolytic properties had faded to mildness due to tolerance, though it has continued to be effective as an antidepressant that at least does not increase anxiety, which was my primary issue with bupropion.

Next on the list was either SA or an uncontrollable sleep cycle, both being about equally problematic. I chose to address the sleep cycle first because modafinil immediately came to mind as a plausible treatment, plus we've all heard of its reputation as an anti-akratic. In hindsight, I should have thought about this more thoroughly before leaping into it. Availability bias at work. Anxiety is an uncommon side effect, but I decided to take the risk. In hindsight, I ought to have realized that for people already dealing with multiple anxiety disorders, that anxiety side effect probably becomes a lot more more common. A statistics fail on my part.

So, I tried modafinil to control my sleep cycle and reduce akrasia, and instead I produced the unshakable certainty that unnamed, unseen monsters were out to get me. Whoops. Looks like my suspicion was correct that I have subclinical generalized anxiety disorder, because the modafinil had exacerbated it to unacceptable levels. The stress of experiencing this also triggered a depression relapse, so I then took myself off the modafinil. Soon enough I recovered to where I had been before trying it.

This leads me to the present. Now I am faced again with the choice of confronting either the sleep cycle problem, SA, or both. My System 1 is wary of fighting the sleep cycle again just yet after being burned last time, so SA it is. I have already taken the edge off, because of social skills training I started months ago and because of the interventions I've taken against OCD, but it is still serious enough to pursue a pharmacological solution.

First on my To Be Scrutinized list is kratom, as I have already been taking theanine for years now. I will investigate effectiveness, safety, cost, and personal fit. Whatever I try, I will also attempt exposure therapy alongside the anxiolytic effects of a medication. If I am successful, I will next have another go at fixing the sleep cycle, then I will either consider my options regarding the notoriously untreatable fact that I am on the autistic spectrum, or else move on to address the much decreased but still niggling depression and OCD.

comment by riparianx · 2015-03-13T01:08:23.778Z · score: 1 (1 votes) · LW · GW

Wow. You've been thorough. Note to self: modafinil is probably something I want to avoid if it can exacerbate anxiety that badly.

comment by Nick_Roy · 2015-03-13T03:39:24.728Z · score: 0 (0 votes) · LW · GW

If you do decide to try it, start with a very low dose.

comment by [deleted] · 2015-03-10T14:23:15.258Z · score: 0 (0 votes) · LW · GW

i think I am inadvertedly doing something like this. Here is what I started recently:

  • stop drinking, the evening reward is only non-alcoholic beer
  • fairly heavy exercise, boxing 3 times a week and 100 pushups on other days
  • instead of feeling like fighting my addiction or laziness, doing the opposite, stopping fighting my better judgement (to work out and to not drink) even when I don't feel like doing so. I don't know how better to explain it. I am reinventing the bicameral mind basically: everything decided rationally is casted into an "upper self" that gives orders, and my normal self can only sigh and follow its orders even when it makes me feel not comfortable, still it is a submission to and not fighting the decisions of the upper self, instead of fighting the urges and instincts of the lower self
  • when having little to do at work, and spend a lot of time on LW or Reddit, schedule the day so that productive work is in the last 1-2 hours so I can go home with some pride and not feeling the day was worthless
  • counter-act the complete lack of socialization during work by listening to vocal music with interesting lyrics in the evening

However I have no idea if I am depressed or not and I strongly suspect that if your upbringing or culture is not exactly optimistic it is not such a clear cut case. I have clear anhedonia, but it does not make me passive or dyfunctional: I am able to do my duty in a "shut up and soldier on, feeling good is not required" way. I think if people don't really expect happiness, it is hard to tell if they are depressed, if they find anhedonia normal and can function in it.

comment by Nick_Roy · 2015-03-10T15:12:27.712Z · score: 0 (0 votes) · LW · GW

The similarity between our approaches is as you say: the realization that akrasia defeats frontal assaults with heavy casualties. The difference is that you are doing something like the "take right action without resistance" approach that I've encountered before in Buddhism, which matches up nicely with anhedonia (personally I am a hedonist, so this does not work for me); while I am attempting to root out the basic causes of my akrasia, down to the very sources, to change the way I feel in the first place. Both approaches have their merits, and I agree that proper choice of approach relative to the individual depends on factors like personality and culture. Have you encountered any other indirect approaches to defeating akrasia, as we are attempting at present?

comment by [deleted] · 2015-03-10T16:02:36.570Z · score: 0 (0 votes) · LW · GW

The difference is that you are doing something like the "take right action without resistance" approach that I've encountered before in Buddhism, which matches up nicely with anhedonia (personally I am a hedonist, so this does not work for me);

That is interesting - you correctly predicted I was exposed to Buddhism (indeed practiced it for years, although this non-forced-action, wu-wei is from my earlier exposure to Taoism.

But it has nothing to do with anhedonia! First of all anhedonia is not enjoying stuff, not not wanting to enjoy stuff. It is not a choice or attitude, it is the illness. If you have or used to have depression you had it too - it is rather part of the definition itself. Second, if anything, the attitude I gleaned from Buddhism was very optimistic about fun and joy, my teacher is almost extremely hedonistic. This has more to do with my parents being blue-collar, and my cultural background is Mitteleuropa - I tried to hint on that with "shut up and soldier on", it is a direct translation from "Maul halten und weiter dienen" (BTW my first language is not German but this saying describes the region rather well). Basically this is what you get from blue-collar parents. Don't like your job? Shut up, you have a family to support. Soldier on. And so on.

Finally, do you think wu-wei prevents hedonism? I think if enjoyment means resting effortlessly in the here and now instead of hoping for or worrying about something in the future, it is more like a precondition for it.

comment by Nick_Roy · 2015-03-10T20:46:33.570Z · score: 0 (0 votes) · LW · GW

Where this chain of reasoning breaks down for me is in the "without resistance" phase of "take right action without resistance". If the resistance, both conscious and unconscious, is too strong, there will be no right action taken, whether I will it or no. So what I do instead is undermine the resistance itself. This is my precondition for taking right action. Do you see what I mean? Wu-wei prevents hedonism if wu-wei is essential to hedonism but there can be no wu-wei.

comment by SanguineEmpiricist · 2015-03-13T06:24:05.648Z · score: 5 (7 votes) · LW · GW

Very important. I think a lot of us need to pool together one day and write and release a general F.A.Q. that people can recursively apply to help themselves. It's risky but worth it.

comment by riparianx · 2015-03-13T20:52:06.618Z · score: 1 (1 votes) · LW · GW

I like this idea. Sort of a "this journal article showed that this technique was statistically useful, this one said another technique was not" kind of thing?

comment by SanguineEmpiricist · 2015-03-13T22:34:13.144Z · score: 1 (1 votes) · LW · GW

Yes, we have the competence to achieve this and it would be extremely beneficial. For example people still say ADHD meds are equally as effective and you can't get legitimate discussion of efficacy because every conversation is just bogged down.

Few people with ADHD know that Stimulants plus Intuniv should cover the broadest range of their symptoms and that having medication last longer because it covers a higher duration of symptoms is better.

Random stuff like that is simple but there exists no place to get it.

comment by Ishaan · 2015-03-09T04:44:58.094Z · score: 5 (5 votes) · LW · GW

I think cognitive delusions often maintain themselves by being non-falsifiable, and an explicit knowledge of epistemology might help people better use logic to compensate.

I managed to get a schizophrenic acquaintance who had anxiety-causing delusional ideas which originated in mind-body dualism to reject mind-body dualism, after carefully explaining why parsimony is a good way to distinguish between the various non-falsifiable hypotheses and how one can roughly approximate what is and is not parsimonious and why the mind instinctively gravitates to mind-body dualism even though it's not necessarily true. After I finished explaining she kind of laughed and admitted there really was no good reason for her to believe those things. I might be imagining it, but she seemed relieved as well as amused.

We unfortunately lost contact, so I'm not sure if it stuck. This is the most extreme example, but I've seen other, less extreme cases where talking people away from odd beliefs was helpful to them. It's important to be convincing in these talks, and appealing to epistemically sound reasoning (as opposed to just dismissing it as most people do) is a good way to be convincing. Healthy people can instinctively tell that a delusion is silly, but for those whose instincts aren't working properly and take delusions seriously it's important to be able to explicitly explain why it's silly.

comment by riparianx · 2015-03-09T12:39:23.711Z · score: 6 (6 votes) · LW · GW

For some reason, your first sentence gave me the urge to hug you. I suspect it was a reaction to the fact that someone understood that. I've never been able to explain to anyone why "but it isn't your fault" doesn't let my brain believe it's not my fault.

Interesting. I suspect it did, except in particularly strong attacks (if her schizophrenia was periodic rather than constant).

comment by riparianx · 2015-03-10T00:12:51.481Z · score: 4 (4 votes) · LW · GW

If anyone is interested in actually being part of a support group of sorts, let me know- if enough people are interested, I'll see if I can find a good way to do it.

comment by Curiouskid · 2015-03-10T21:15:51.256Z · score: 3 (3 votes) · LW · GW

I overcame depression a few years ago and have been meaning to write about how I did it, but honestly, the current me is so different from the old me, that I don't even remember how being depressed felt.

I do remember some of the things that got me out of the depression:

  • Coming independently to the insight that I should "Avoid Misinterpreting my Emotions". One day, I was sitting there thinking the same old depressed thoughts I'd usually thought. Something like "what's the purpose of doing anything." But, I realized that when those words went through my head that day, I didn't feel depressed thinking them. Then, I realized that whatever words were going through my head were not the cause of my emotions. In general, it's true that we can unlike our emotions from our thoughts. By doing this we can optimize feeling better and resolving whatever epistemic issue you think is the cause of your emotions separately.

  • Discovering LW helped in a lot of ways.

  • Doing lots of mind mapping / writing therapy, using GTD for managing stress/productivity, and to a lesser extent CBT.

  • EDIT: Also, getting out of high-school.

comment by ChristianKl · 2015-03-08T09:51:25.273Z · score: 3 (7 votes) · LW · GW

There's risk involved in giving medical advice over the internet. It's hard to fully understand another person if you just have text and no face to face interaction.

I can debug someone's phobia in a face to face interaction, but it's much harder to do anything productive over the internet.

It's difficult to find anxiety advice that goes beyond "do yoga while watching the sunrise!"

Did you actually do that exercise and tried whether it's helpful for you?

comment by riparianx · 2015-03-08T16:30:18.398Z · score: 0 (0 votes) · LW · GW

That's true, obviously, but I was looking more for "people seeking out solutions together." There was a thread a while back where people ated akrasia fighting methods. Anxiety fighting methods could be rated the same way.

Of course. I love yoga. It's relaxing and fun. But it's no cure for anxiety. Yoga gives a very short "mental high" and doing it for months had no effect on the anxiety. This approach may work for a lot lf people, but as always, there's a fringe that needs some new approaches.

comment by ChristianKl · 2015-03-08T20:36:51.217Z · score: 0 (0 votes) · LW · GW

At our last LW meetup in Berlin one participant A said that he wills anxiety about the upcoming social interaction X. We did a Hamming Circle (spelling for Hemming might be wrong) and I was mainly leading the discussion. At the beginning he was shivering because of anxiety caused by thinking about the issue. Half an hour later he felt courage. I checked up later and he faced situation X in a relaxed way.

Another member of the circle B mentioned that it was like me talking a different language to A. The flow of the whole process was intransparent to B. As such it's unlikely that describing what I did in a LW essay would be much help.

A lot of what's written in the akrasia fighting methods carries little risk. Doing some form of trauma regression to combat your anxiety while you sit alone at home is qualitatively different.

A month ago the loud drilling machine of my neighbors produced an uncomfortable feeling in me. I recognized that having that trigger is stupid and removed most of it. Does that mean I can write a text that teaches you to get rid of it? No.

Of course. I love yoga. It's relaxing and fun. But it's no cure for anxiety. Yoga gives a very short "mental high" and doing it for months had no effect on the anxiety. This approach may work for a lot lf people, but as always, there's a fringe that needs some new approaches.

If I would meet you in person I would have information about your bodily state that helps to put the answer into perspective. Without that it's hard to estimate your state.

comment by riparianx · 2015-03-08T21:18:07.067Z · score: 1 (1 votes) · LW · GW

It's awesome that you're able to help people so well. At the same time, though, I get the feeling that you're falling into the trap of other-optimizing. In-person support is probably a lot more helpful than internet-based support, I suspect. But when the right people aren't around you, and you can't go to them, having instant communication over the internet is a good second-best. Certainly over the internet there's things you can't do, like determine a physical state. But if people refused to use any method but the absolute best, we'd spend more time trying to find optimal strategies than anything else, and humanity would die out because we'd be too busy designing soylent to eat.

comment by ChristianKl · 2015-03-08T22:40:43.216Z · score: 0 (0 votes) · LW · GW

It's not like I don't give out any internet based advice.

In this thread I did make a point to recommend gratitude journaling. It's good even if you don't do it in a group. I haven't heard from anyone messing themselves up with gratitude journaling.

Another recommendation would be meditating. Meditating is more risky. It makes suppressed emotions come up and you have to deal with them. I have no way of judging to what extend a person like you will handle that, because I don't know much about you. I know that on average meditating is great, but it's not without risks.

The standard advice would be to find a good local meditation teacher but I can't say anything about the quality of your local teachers.

I don't think it's impossible to give good advice via skype in principle but it's not a skill in which I'm well trained.

comment by riparianx · 2015-03-10T00:05:13.688Z · score: 0 (0 votes) · LW · GW

I meditate regularly- not quite daily, because when I get into a meditative state, I tend to not want to come out. When I do meditate, I'm still and quiet for at LEAST an hour. If I try to meditate for, say, 30 minutes, I end up setting another timer because I didn't get deep enough into quiet state. Meditation doesn't bring up suppressed emotions for me, though.

I do journal, but not gratitude journaling. I haven't tried that one because it seems more suited to a sad, apathetic person than a person who cares too much about everything and tends to minimize the good and maximize the bad. I like tracking the anxiety, though, and writing down thoughts lets me temporarily remove them from my mental state.

comment by ChristianKl · 2015-03-10T16:18:33.492Z · score: 0 (0 votes) · LW · GW

I meditate regularly- not quite daily, because when I get into a meditative state, I tend to not want to come out. When I do meditate, I'm still and quiet for at LEAST an hour. If I try to meditate for, say, 30 minutes, I end up setting another timer because I didn't get deep enough into quiet state. Meditation doesn't bring up suppressed emotions for me, though.

To me that description suggest that are not meditating in an effective way. An hour meditating alone is likely too much. You likely aren't present but are disassociating.

Doing 20 minute sessions where you focus on feeling your breath in your hara while sitting still in a stable position would likely bring up emotions from time to time.

Otherwise meditating with a good teacher beats doing it alone. But of course I don't know the quality of teachers where you live.

comment by riparianx · 2015-03-13T01:01:26.409Z · score: 0 (0 votes) · LW · GW

Huh. That actually does sound like what I do. Everything I've come across has suggested that's what you're supposed to do, though. And it is very relaxing.

I have no idea if any good teachers are around, but if they were, I couldn't afford lessons. Is there a reason why dissociating is bad? Because it's really enjoyable and makes me feel energetic and relaxed- even more than a full night of sleep does.

comment by ChristianKl · 2015-03-16T01:33:40.372Z · score: 0 (0 votes) · LW · GW

Is there a reason why dissociating is bad?

If you don't process the emotions that are in your body, they build up. In your case from time to time they release themselves in a panic attack.

Detachment from emotions is useful disassociation isn't. In detachment an emotion can dissolve on it's own. You are aware of the emotion but you don't get meta emotions. You don't do anything with it. Without a new trigger that usually means that the body can go and work through the emotions.

If there only one emotion in your system and no meta-reactions towards it, then the full processing ability can be used on that one issue. That's what happens during mindful meditation.

Instead of doing 10 things at once, there's actually rooms to really process on thing at a time.

I have no idea if any good teachers are around, but if they were, I couldn't afford lessons.

That doesn't have to be a case, it's quite frequent to have meditation events on a donation basis.

comment by ChristianKl · 2015-03-08T09:32:04.695Z · score: 3 (7 votes) · LW · GW

Considering the high correlation between intelligence and mental illness, you'd think it would be a bigger topic.

On what basis are you making that claim? Are there studies that suggest that such a correlation exists?

comment by James_Miller · 2015-03-08T16:41:39.136Z · score: 5 (5 votes) · LW · GW

Autism and superior math ability seem strongly correlated.

comment by riparianx · 2015-03-08T17:26:18.295Z · score: 0 (0 votes) · LW · GW

To my frustration, the majority of the results I found were not scholarly. Then again, the only database I have access to is Google Scholar, which is utter crap for finding specific results.

If anyone has access to a decent scholarly database, I'd much appreciate a quick search. It seems possible that this idea "mental illness is highly correlated with intelligence" is just another Lucy-esque pop psych idea with little truth.

I think my point still stands- mental illness is still really common. And I know a lot of intelligent people have a mental illness. I don't think we should ignore the skewed thinking of mental illness even if the ratio of metally ill to mentally normal people is exactly the same in average versus above average populations. The statistic I'm finding there is 1 in 5. I'm not finding anywhere that's properly sourcing that statistic, though. The article I read sourced the older report (in 2012) but didn't link to the newer one.

comment by Lumifer · 2015-03-08T18:31:09.520Z · score: 4 (4 votes) · LW · GW

mental illness is still really common

That is entirely a function of how widely do you define "mental illness". You set the bounds of normality narrowly and you get that mental illness is common, you set them far out and mental illness becomes a rarity.

comment by riparianx · 2015-03-08T19:13:48.357Z · score: 0 (0 votes) · LW · GW

Mayoclinic defines mental illness as such: "Mental illness refers to a wide range of mental health conditions — disorders that affect your mood, thinking and behavior. Examples of mental illness include depression, anxiety disorders, schizophrenia, eating disorders and addictive behaviors." This seems to be the standard definition.

The statistic of 1 in 5 that I used seems to pretty much only refer to diagnosed people with specific, named disorders. I don't think it was including "I feel sad sometimes" as a mental illness. And considering it was only used statistics based on diagnostics, it seems pretty clear to me that a LOT of people got left out. Many people can't get help. This also only covered the U.S.A., and statistics could vary widely in other areas of the world and based on methods.

If you like, we can taboo the "mental illness" phrase and instead use something like "badly defined and illogically based thinking patterns." That would cover the schizophrenic fantasy/reality disconnect, anxiety, depression, etc. Then it becomes pretty clear that "badly defined and illogically based thinking patterns" are really common and often not as specific as biases. I don't think anyone would claim mental illness is rare. According to the American Foundation for Suicide Prevention, 12.6 people out of 100,000 successfully committed suicide in 2013. That means over 41,000 people died, in one year, in the U.S. alone, not counting the suicides ruled as accidents or disappearances. The AFSP says it's not easy to get a good number for suicide attempts, but they believe based on self-harm caused hospitalizations that it easily exceeds 600,000 people a year. And that's just the people who want to die. Eating disorders are gaining attention as one of the more common kinds. Addictive disorders are so common almost everyone knows one or more people struggling. Depression, the same. There's a trend among students where anxiety and stress are causing serious issues.

Also, there's a difference between commonality and normality. Urine fetishes, for instance, are considered abnormal and uncommon. BDSM would be considered normal but uncommon (though 50 Shades of Grey seems to be making it a more common thing.) The urge to eat is normal and common. Mental illness, I would say, are considered common but abnormal.

Honestly, I can't think of a single definition of mental illness that would say it's uncommon. I may be misinterpreting your meaning, but it kind of seems like you're focusing on semantics when the problem here is that common diseased thinking patterns are killing, sickening, and limiting lives.

comment by Lumifer · 2015-03-08T22:34:24.345Z · score: 0 (0 votes) · LW · GW

Mayoclinic defines mental illness as such: "Mental illness refers to a wide range of mental health conditions — disorders that affect your mood, thinking and behavior. Examples of mental illness include depression, anxiety disorders, schizophrenia, eating disorders and addictive behaviors." This seems to be the standard definition.

Actually, I think the "standard" definition is provided by the current DSM. The Mayo Clinic definition is way too vague and general to be of any use.

If you like, we can taboo the "mental illness" phrase and instead use something like "badly defined and illogically based thinking patterns." ... Then it becomes pretty clear that "badly defined and illogically based thinking patterns" are really common and often not as specific as biases.

Sure, but then you are defining stupid people as mentally ill. Are you willing to do that for everyone with, say, the IQ under 85?

Honestly, I can't think of a single definition of mental illness that would say it's uncommon.

Go back a hundred years, for example. Under the definitions used then, was mental illness common?

common diseased thinking patterns.

"Diseased thinking patterns" is a dangerous concept. In the Soviet Union disliking communism was a diseased thinking pattern and people were actually put into mental hospitals for that. Not long ago being attracted to people of the same sex was considered to be a diseased thinking (and feeling, and behavioral) pattern, to be treated as a mental disorder. If I want to lose weight, is that a diseased thinking pattern and who will judge that? If I feel dissatisfied with life, is that a diseased thinking pattern and what kind of a pill will I be prescribed?

comment by riparianx · 2015-03-09T01:56:53.326Z · score: 0 (0 votes) · LW · GW

Vague, yes, but I disagree that it's useless. It at least is an extremely basic overview that someone can build on.

Hmm. I wouldn't call stupidity mental illness- low IQ doesn't necessarily mean they're an illogical person. it can mean they're slow, or challenged, etc. A person can be "stupid" and not, say, think the moon is made of cheese. Limitations on your complexity of thought doesn't necessarily mean the thoughts you have are wrong.

No, 100 years ago, a woman getting mad at her husband was a sign of mental illness. Mental illness was considered very common. People were put in asylums for anything from homosexuality to being too smart, or being transhumanist, or atheist.

I can see how the concept is dangerous, but only if misused. Cars are dangerous if misused. We use them daily. The idea isn't to toss pills at anyone unhappy or who happens to have different beliefs, the point is that some patterns are harmful and some people would like help with that. I think deciding for others what is harmful is, itself, harmful- if a person enjoys their hallucinations, and the hallucinations don't cause them to do harm, then honestly, we should leave them alone. If a person likes murder, we shouldn't. If you want to lose weight, you should get nutrition and exercise advice. It becomes a diseased thinking pattern if you think you still need to lose weight when you have a body fat index of 5%, or if you think no one will ever care about you if you weigh above 125. If you feel dissatisfied with life, the question is why. If you have everything going perfectly in your life and you're still constantly sad, that's a sign of a problem, and you should probably see a doctor. You might be prescribed therapy rather than a pill.

I think most people decide for themselves if they like their thinking patterns. I don't like mine. I'm seeking help. A person might be friends with the voices in their heads. A person might be tired of them telling him to kill himself. A transgender person may be miserable with their body-mind disjointedness and want therapy and/or a treatment plan to become what they want to be.

comment by ChristianKl · 2015-03-08T20:48:33.693Z · score: 0 (0 votes) · LW · GW

I may be misinterpreting your meaning, but it kind of seems like you're focusing on semantics when the problem here is that common diseased thinking patterns are killing, sickening, and limiting lives.

You are on LW. Clear thinking is valued here and that involves debating how to talk about issues. Semantics matter.

comment by riparianx · 2015-03-08T21:09:24.983Z · score: 1 (1 votes) · LW · GW

Semantics matter to the extent that everyone is on the same page. Mental illness is pretty clearly defined.

comment by ChristianKl · 2015-03-08T21:15:14.742Z · score: -1 (1 votes) · LW · GW

Mental illness is pretty clearly defined.

Yes, and that definition leads to a field that's not productive at solving the problem. Plenty of criticism surfaced in the wake of the DSM-5 which currently contains the official definitions for mental illnesses.

comment by riparianx · 2015-03-08T21:24:04.463Z · score: 0 (0 votes) · LW · GW

I'm aware. I do study psychology, although my personal passion is microbiology. The question Lumifer raised was if mental illness is really that common. It's pretty hard to find any evidence saying it's uncommon, and a LOT of evidence saying it's common. I'm curious- from your comments here, you seem to have a differing point of view than I do. Could you explain what you think mental illness is, and your related opinions? I think that would lead to a more productive discussion.

comment by ChristianKl · 2015-03-08T22:45:16.282Z · score: 1 (3 votes) · LW · GW

I'm not sure that the term "mental illness" is pretty useful if your goal is to do change work. Part of the societal role of the term is to distinguish mental phenomena where it's legal to take drugs to solve them from mental phenomena where it isn't. To decide what insurance will pay for and where it won't pay. Those concerns dictate how wide or narrow we have our net as to what constitutes "mental illness".

If we talk about anxiety I'm not sure that "mental illness" is a good framing. Every healthy human being sometimes has anxiety. There might be some brain damage that prevents certain people from having anxiety, but it's part of normal human functioning.

That means it's useful to learn how to deal with anxiety in a productive fashion. There are a bunch of emotional management skills that are useful for everyone.

I know little about schizophrenia but my general impression is that it's something that's qualitatively very different from a phobia.

comment by riparianx · 2015-03-09T00:12:33.036Z · score: 0 (0 votes) · LW · GW

Anxiety transcends a normal thing and enters mental illness when it becomes pervasive and unreasonable. My anxiety about having used a wrong word in a conversation I had last year is unreasonable. My constant feeling of dread is unreasonable because I'm not constantly in a situation that should inspire dread. Mental illness is really hard to define properly- there always seems to be something left out, or something that's implied to be illness when it isn't.

Honestly, I feel like the discussion has been derailed a bit- we're focusing on defining a very vague thing that we don't understand yet. I can't offer answers at to how we should define mental illness because that's a question that would take years to answer. And it seems like one of those questions no one will ever agree on, either. As a utilitarian, I think mental illness is a thinking pattern that causes unhappiness or harm over a period of time, or that blocks someone from being able to view the world realistically. Someone else might have a different set of values that has an entirely different set of "bad thinking patterns."

But people ARE suffering, we know that there ARE diseased thinking patterns, and we know that people want help. Maybe "mental illness" is a bad frame, but at the moment, do we really have another to work with? I don't think so, which is why I think that this is an important question. All of the answers we're getting are mysterious, and thus not answers.

Yes, I want to do change work, and I think that it's impossible to do anything if we refuse to start helping because we don't have a good frame yet. Sometimes you have to explore a problem for a while to even start to figure it out. We have an extremely flawed and basic understanding, and saying, "well, what can we do then?" is like throwing out a hypothesis because of one inconclusive experiment.

comment by ChristianKl · 2015-03-09T16:15:16.325Z · score: 0 (0 votes) · LW · GW

Anxiety transcends a normal thing and enters mental illness when it becomes pervasive and unreasonable.

If the thought of asking out a woman for a date raises anxiety in me I don't care at all whether or not that's "reasonable" or "normal". It's a trigger that I don't want to have regardless of whether it's classified as a mental illness.

Maybe "mental illness" is a bad frame, but at the moment, do we really have another to work with?

Yes. I have multiple different one's.

In Danis Bois perceptive pedagogy an answer might be: "You have problems with anxiety and worry about what you said last year because you constantly feel that you have to prove that you exist. If you would have a strong feeling of existence, your issues with anxiety would simply clear."

In NLP it might be: "There are a bunch of situation where you are ineffective triggers that produce unproductive emotions. Let's do the Fast Phobia Cure on all of them and get done with the problem."

Lefkoe Method would say: "You might have 40 limiting beliefs that produce that problem like "I'm not lovable", let's go and clear those beliefs by spending 30 minutes on each of them with the Lefkoe Method."

I haven't been at a CFAR workshop so I don't know their exact answer, but part of it seems to be: "Let's get clear about how our emotional desires differ from our intellectual one's and train comfort zone extension."

That's no complete list.

But when we go back to how to discuss the issue on LW, framing the issue as being around anxiety is likely more productive than framing it as being about mental illnesses in general.

comment by riparianx · 2015-03-09T23:37:22.912Z · score: 0 (0 votes) · LW · GW

Interesting, I haven't heard of most of these. When I get the chance I'll have to do some research.

Anxiety CAN be a good response. The fear-response that anxiety basically is can be a good "oh crap, I'm in a bad situation here." Getting nervous when asking someone out is uncomfortable and kinda useless. Getting nervous walking down a street at night when someone seems to be following you is normal, and helps you respond properly. The pervasiveness is a major part. If the anxiety is infringing on your life in a lot of useless ways, you probably have an anxiety problem. If a minor problem causes extreme fear, like an unbearable fear of close spaces, you might have a problem- almost everyone has to get in an elevator at some point, and having a panic attack because of it would be inconvenient and unpleasant.

Perhaps tackling specific problems at a time would be more effective. But considering the sheer number of kinds of problems here, I'm not sure. If I wanted to write a sequence on "general mental illness" (sorry, I'm going to continue using that phrase because it's not confusing and it's a good, simple term that doesn't require a lot of terms and you all know what I mean), and wrote, say, one article per mental illness... Well, I could say goodbye to ever getting anything else done. The research alone would take a lifetime, just on what we know now. Writing something worth having on LessWrong is a pretty big endeavor.

Once again, the problem is the sheer complexity of the problem. If we only tackled the really common ones (depression, anxiety, bipolar disorder, etc.) we might be able to do some good work, though.

comment by ChristianKl · 2015-03-09T15:36:43.051Z · score: 0 (2 votes) · LW · GW

I'm aware. I do study psychology, although my personal passion is microbiology.

I sometime do have some reservations against what happens in psychology departments, but I don't think they are completely hopeless.

You could start a self help group with fellow psychology students. It would likely be a more productive road then seeking help on the internet.

There are various CBT techniques in the literature for dealing with anxiety that you can do as peer training.

You might even use the daily gratitude sharing exercise in such a group.

comment by Lumifer · 2015-03-08T22:36:33.022Z · score: 0 (0 votes) · LW · GW

The question Lumifer raised was if mental illness is really that common.

Not quite. I pointed out that mental illness can be defined in different ways (DSM was not brought back on stone tablets from Mount Sinai) and these different ways will give different answers about the prevalence of mental illness.

comment by riparianx · 2015-03-09T00:15:34.109Z · score: 0 (0 votes) · LW · GW

Oh, sorry. I misunderstood.

I should hope not, that would make me seriously question a good deal about history and biblicism. That's very true, but narrowing the problem too much causes the same kinds of problems as opening it to everyone. If you give everyone with upcoming life changes a Xanax, you're not letting them learn how to cope. If you refuse to help someone unless their illness is ruining their life, you're letting a lot of people live seriously suboptimal lives. We don't have a good entry barrier for determining if someone is mentally ill or not. We simply don't know enough to make one.

comment by Lumifer · 2015-03-09T00:49:12.190Z · score: 0 (0 votes) · LW · GW

We simply don't know enough to make one.

Do you think that such an "entry point" could be discovered once and for all, an unchanging truth like a constant in physics, or do you think that the answer will always depend on who's asking?

comment by riparianx · 2015-03-09T01:42:12.566Z · score: 0 (0 votes) · LW · GW

It's possible we could. I certainly hope so. But it's such a complex question that, at the least, we probably can't have a simple universal answer.

comment by emr · 2015-03-08T18:58:35.520Z · score: 3 (3 votes) · LW · GW

I agree that the relationship is separate question. I did find some links though:

Here is a Swedish conscripts study, finding that pre-morbid IQ was negatively associated with later adult depression, anxiety, and schizophrenia, but positively related to mania, measured by hospital admittance. This New Zealand study replicates this: Low childhood IQ predicts depression, anxiety, while higher IQ predicts bipolar.

These are about the best "large homogeneous" population studies I could find, in two more-or-less standard Western cultures. There is one study that tracked some particularly high performing children through adulthood, but the results weren't much different regarding mental illness than a normal high intelligence sample would be. Needless to say, it gets complicated when you look at populations that are preselected (college students, etc) or more diverse. Most popular articles that claim a uniform association are looking at some narrow populations (e.g. famous artists), or reporting how intelligence relates to different presentations of a given mental illness (e.g. intelligence seems to the presentation of anxiety).

Even assuming genetic risk for a mental illness was unrelated to education or intelligence, you'd expect something like this given the environmental correlates: Better family conditions early on, better social status later. While there are some environmental stressors that are probably associated with higher intelligence (graduate/medical/law school, perhaps more status anxiety?), these are probably not severe enough to outweigh the stressors in the opposite direction.

comment by Ishaan · 2015-03-09T04:26:48.991Z · score: 1 (1 votes) · LW · GW

To my frustration, the majority of the results I found were talking about were not scholarly.

If you do look, you will find odd little relationships and hints. Maybe there's more autism among the close relatives of mathematicians and engineers. Maybe there are little hints that ADHD and schizophrenia are linked to creativity. Maybe there's more bipolar disorder among performance artists. Maybe depressed people are better writers. Maybe. These little hints and bits and bobs of evidence indicating trade-offs are rarely as straightforward as finding elevated rates in a gifted population, the way you propose.

You won't find any links between general intelligence and mental illness. It's never "intelligence", it's almost always some weird, specific, difficult to study thing. I really doubt that high IQ puts you at elevated risk of anything. Sometimes people do come up with stuff, like "existential depression" (which I'm pretty sure is just normal depression with an intellectual rationalization), but it's pretty sparse.

There's supposed to be a body of literature (mostly pre-2000) with "gifted children" which I haven't really looked into demonstrating frustrations arising from atypical development, but I haven't seen any really good evidence for trade-offs or especially difficulties on that front either. It's been mostly collections of case studies. (That said, I haven't read that area much.)

comment by bageldaughter · 2015-03-10T14:32:48.154Z · score: 2 (2 votes) · LW · GW

I have anxiety/depression/ADHD and aspirations in conflict with my abilities and situation in life.

One strategy I have learned to employ which I consider "rational" is to approach maintenance of my mood and mental health as a limited resource allocation problem. One of the big leaps was learning to see my good mood as a limited resource which is spent as I think about potentially difficult or disturbing topics.

It is not "free" for me to consider all the ways I might do better in life, or past mistakes I have made, or ways the world is messed up. My ego is fragile. Dwelling on such topics, even when it may lead to an ultimately productive insight, is draining, and other things I value in life - my sense of motivation, my friendships, my work productivity - all suffer. My values discourage me from deluding myself to feel good, and so my approach is to allow myself to consider such difficult topics only in controlled doses.

If I am feeling particularly stressed out or guilty or ashamed, then I will deprioritize things like work and the needs of friends, and spend time and energy on improving my mood. And my model of the situation as a limited resource allocation problem helps me sidestep the ensuing thoughts of "you're being selfish/lazy/unproductive/ineffective" - such thoughts come from a place in my mind that does not recognize the resource is limited.

The result is, I keep my mood maintained more consistently, and as a result I am more effective overall.

comment by SanguineEmpiricist · 2015-03-13T06:28:41.629Z · score: 0 (0 votes) · LW · GW

Stimulants are extremely effective for ADHD, definitely make sure to take them if you are not.

comment by [deleted] · 2015-03-09T07:02:49.436Z · score: 2 (2 votes) · LW · GW

My advice for anyone with any mental illness is to talk to somebody you can feel comfortable around about your problems. Often a therapist is that person, but not always. If you don't think your condition is serious enough to require medication, trying to discern the often minute differences between therapies can be more trouble than it's worth. Even if you discover the optimum therapy, there's no guarantee you'll get optimum implementation, eliminating the difference in value.

comment by Daniel_Burfoot · 2015-03-09T02:26:44.057Z · score: 2 (2 votes) · LW · GW

It's hard to give good advice on the topic of mental illness without falling into the trap of Other-Optimizing.

comment by riparianx · 2015-03-09T12:41:51.309Z · score: 1 (1 votes) · LW · GW

Agreed. But mental illness is such a weird and complex thing that it's even hard for trained professionals to help with. A lot of the posts here about Akrasia helped some, didn't touch others. I suspect we'd see the same results with this.

comment by Salemicus · 2015-03-08T22:55:02.561Z · score: 2 (4 votes) · LW · GW

There are two battling narratives of mental illness. The first narrative says that mental illness is a disease of the mind, the second that it is a disease of the brain.

The "mind" story is that these illnesses come from bad ways of thinking, whether this be childhood trauma, diseased patterns of thoughts, etc. The treatment is therefore in psychotherapy, CBT, or other such. To the extent that this narrative is true, discussion of mental illness is likely relevant to rationality.

However, the other narrative is that mental illnesses come from chemical imbalances or other defects in the brain. The cure is therefore lithium, SNRIs, etc. To the extent that this narrative is true, rationality doesn't have a lot to say about mental illness.

Your post suggests you like the "mind" narrative. But to the extent that LW is a hive of reductionism, it may be that the "brain" story is considered more appealing here, and this may explain why there is less discussion of mental illness than you find conducive.

comment by DanielLC · 2015-03-09T04:40:18.396Z · score: 2 (4 votes) · LW · GW

To the extent that LW is a hive of reductionism, we believe that the mind is the brain, and psychotherapy and medicine can both be used to treat its diseases.

comment by Salemicus · 2015-03-09T11:49:34.435Z · score: 2 (2 votes) · LW · GW

I'm afraid you're missing the point.

If mental illness comes from (say) bad patterns of thinking, then pharmaceuticals won't work as a treatment, except as a temporary and generalised mood-alterer. According to this narrative, giving a depressed person SSRIs is like giving painkillers to a patient with a broken leg; worthwhile as a temporary measure, but unimportant compared to the crucial task of setting the bone, which only trained therapy can do. Advocates of this point of view typically cite the unimpressive performance of certain kinds of pharmaceutical therapies when compared to placebo.

If mental illness comes from (say) faulty synaptic function, then therapy won't work as a treatment, except as a placebo. According to this narrative, giving a depressed person CBT is like a nurse providing reassurance to a patient with a broken leg; worthwhile, but unimportant compared to the crucial task of setting the bone, which only biochemical intervention can do. Advocates of this point of view typically cite the impressive performance of pharmaceutical regimens in dealing with certain mental illnesses, the poor performance of various talking therapies compared to "placebo therapy"+, and the historical lack of interest of talking therapies in empirical validation.

Now I call these "narratives" because they are deliberate oversimplifications; riparianx is right that it may well be that some mental illnesses are "mind" and some are "brain," and some a bit of both. Nevertheless they express very real ways of thinking about the problem. In 1940 the medical consensus was that the first narrative was broadly true. By 1990, the medical consensus was closer to the second.

  • i.e. allowing the patient to discuss their problems with an untrained, sympathetic listener.
comment by riparianx · 2015-03-10T00:24:57.463Z · score: 0 (0 votes) · LW · GW

Coming from a reductionist "mind is brain" viewpoint, therapy actually does help. This is pretty well documented in the fact that 73% of patients who go through it say it helped in the long run. (statistic from my psych 101 textbook) Talking to a therapist may not increase your serotonin levels, but it does help teach you new mental "patterns" and ways to cope with the results. Saying the brain doesn't follow patterns is, well, wrong. The more you have a thought, the more the thought comes to you. If a chemical imbalance puts you in a mood that leaves you susceptible to a kind of thought, then you'll have that thought and start a negative pattern. So even then, if the chemical imbalance is fixed, you can still be stuck with the results. Therapy helps you build more positive patterns and maybe even let the old ones fade.

comment by Salemicus · 2015-03-10T09:56:43.416Z · score: 2 (2 votes) · LW · GW

Coming from a reductionist "mind is brain" viewpoint, therapy actually does help. This is pretty well documented in the fact that 73% of patients who go through it say it helped in the long run. (statistic from my psych 101 textbook)

You have to admit, this is weak tea. What would you think of a pharmacological study that relied on the fact that 73% of patients "say it helped." We don't need no stinkin' effect size or control! As I'm sure you're aware, there is a great deal of controversy about the effectiveness of talking therapies, and it is even controversial whether such therapy really does anything more than "just talking."

Now look, I too am in the reductionist "mind = brain" camp, and I too think therapy can be effective in principle. I am actually very sceptical of the idea that mental problems such as depression, anxiety and OCD result from a generalised "hardware" problem (such as faulty neuroendocrine function). Yet just by mentioning the (very widely held) notion that these problems do have such a basis, I'm apparently espousing dualism. It's very strange.

Saying the brain doesn't follow patterns is, well, wrong.

Who exactly said that?

comment by ChristianKl · 2015-03-10T17:03:31.031Z · score: -1 (3 votes) · LW · GW

Yet just by mentioning the (very widely held) notion that these problems do have such a basis

The issue isn't that you mentioned the notion that the problem might be due to faulty neuroendocrine function but that you assume that talking can't do anything about that.

I'm apparently espousing dualism. It's very strange.

If you limit talk therapy to the goal of changing the mind and ignore hardware than you lose effectiveness.

Granted it's impossible to get good feedback to do targeted interventions on the biochemical level but the body is still vitally important.

But even given SSRI isn't targeted intervention on the biochemical level. According to a recent article:

It is currently impossible to measure exactly how the brain is releasing and using serotonin, the researchers write, because there is no safe way to measure it in a living human brain.

Instead, scientists must rely on measuring evidence about levels of serotonin that the brain has already metabolized, and by extrapolating from studies using animals.

The best available evidence appears to show that there is more serotonin being released and used during depressive episodes, not less, the authors say.

SSRI might also work by reducing inflammation. They also hit targets outside the brain. Depression correlates with inflammatory cytokines. There are efforts underway to focus on diagnosing depression with blood tests and if those tests come the prime measuring stick the official definition of depression might even include inflamation.

comment by ChristianKl · 2015-03-09T12:04:41.963Z · score: -1 (5 votes) · LW · GW

Now I call these "narratives" because they are deliberate oversimplifications; riparianx is right that it may well be that some mental illnesses are "mind" and some are "brain," and some a bit of both.

Or that distinction simply doesn't make any sense.

comment by Salemicus · 2015-03-09T12:27:18.796Z · score: 2 (2 votes) · LW · GW

Do you really think it doesn't make sense to make a distinction between:

  • Mental illnesses are caused by negative patterns of conscious and unconscious thought.
  • Mental illnesses are caused by biochemical imbalances in the brain.

Or are you just trolling?

comment by ChristianKl · 2015-03-09T13:23:44.356Z · score: -1 (5 votes) · LW · GW

If I hug a person and the person feels better I can explain that with a raise in oxytocin or with changed unconscious thoughts about how the person feels liked. Making that distinction isn't useful for guiding actions.

Any psychopharmaceutical is going to affect thinking patterns.

Furthermore there are issues in depression that are neither mind nor brain.

Above I spoke about releasing a trigger against my neighbors drilling machine. That involved noticing that part of my head get tense in response to the sound and releasing the tension. There's no mind-body dualism in that approach.

comment by Salemicus · 2015-03-09T14:19:24.615Z · score: 1 (1 votes) · LW · GW

No-one's saying anything about mind-body dualism - except you.

Maybe a building is toppling over because of faulty design. Or maybe because the materials are substandard. These are separable issues, even though it is quite true that the design of the building is completely explicable in terms of materials.

Yes, psychoparmaceuticals affect thinking patterns, and yes, thinking patterns are fundamentally explicable in terms of biochemical states. But it is nevertheless the case that no amount of talking is going to fix someone's pre-synaptic uptake processes.

comment by ChristianKl · 2015-03-09T15:16:14.682Z · score: 1 (3 votes) · LW · GW

No-one's saying anything about mind-body dualism - except you.

Distinguishing the mind from the brain is what mind body dualism is all about.

But it is nevertheless the case that no amount of talking is going to fix someone's pre-synaptic uptake processes.

I have no reason to believe that's true. Talking can trigger hormonal release and those hormons can change pre-synaptic uptake processes.

comment by seer · 2015-03-16T01:59:54.723Z · score: 0 (0 votes) · LW · GW

Maybe a building is toppling over because of faulty design. Or maybe because the materials are substandard.

Using substandard materials is itself a design flaw.

comment by riparianx · 2015-03-09T00:22:26.033Z · score: 1 (1 votes) · LW · GW

My opinion is that saying that all mental illness falls into one camp is oversimplifying. Someone who's schizophrenic is definitely in the brain category, according to the current consensus I've seen. Depression is moving into that camp. Anxiety is on the fence- it can be chemical or mental.

If I were to answer "is mental illness a mind thing or a brain thing?" my answer would be "neither, both, one, or the other" because the brain is a complex thing and breaks in a lot of different ways.

Anxiety, for instance, is typically treated with temporary medication and long-term therapy. We treat it as "mostly mind, hint of brain."

Depression is treated with long-term therapy AND medication, or just medication. It can be a product of thinking patterns, but the consensus now seems to be that it's mostly a hormone thing.

It feels, to me, like if two groups were arguing "grass is yellow" or "grass is blue" when most grass is green but there are weird variants that are yellow or blue.

comment by ChristianKl · 2015-03-08T09:39:03.197Z · score: 2 (2 votes) · LW · GW

On of the best studied interventions for increasing happiness and thus help with issues like depression are gratitude exercises.

With a few friends I just started a group where everyone posts an audio message into a "What's up" before going to sleep about 5 good things that happened to him the last day. I'm just at day one, but I would expect the exercise to be very beneficial for both increasing happiness and creating group cohesion/friendships among LessWrong Meetup participants.

comment by [deleted] · 2015-03-09T11:46:58.113Z · score: 2 (2 votes) · LW · GW

Bragging may be more useful. I came up with that idea after reading this: http://slatestarcodex.com/2014/08/16/burdens/

If depressed people feel like burdens on others i.e. have low self-worth,self-esteem, it may be better to boost that than to feel lucky.

I mean, I always had this opinion, I felt good about myself, why would I have a reason to feel bad about anything? To feel still worthless but lucky - which gratitude exercises may cause - does not sound like fixing it. The opposite extreme, feeling worthy and great but unlucky, would sound quite cool to me, it sounds like being a tragic hero whom people respect.

That is why I think bragging, feeling better about yourself, may be a good idea.

comment by riparianx · 2015-03-08T17:29:08.482Z · score: 0 (0 votes) · LW · GW

So you think the idea of a rational support group could work? I'd certainly be interested in one. Any idea how one could be set up? Meetups are a little too far and few to be really effective, I think.

comment by ChristianKl · 2015-03-08T19:41:56.825Z · score: 0 (0 votes) · LW · GW

So you think the idea of a rational support group could work?

It's a vague general label. Part of what happens at our LW meetup in Berlin could be called a "rational support group".

Meetups are a little too far and few to be really effective, I think.

I don't think that's true. If there's no LW meetup nearby, start one. Bootstrapping trust is easier when one meets in person.

comment by riparianx · 2015-03-08T19:59:54.694Z · score: 1 (1 votes) · LW · GW

A meetup sort of requires more than one person. There aren't even any other HPMoR readers in my area, except the person I introduced to it. I'm sure this is a problem for others, too. Being the sole LWer in your area that you can find is frustrating. I'm in central Oklahoma, and according to surveys and the like, I'm pretty much the only Oklahoman here. And I'm pretty sure this is a common plight- Berlin is a big city full of interesting people with interesting viewpoints. What if you're from, say, Ukiah, Oregon, or Mobile, Alabama, or a place even smaller or further out of the way? Physical meetups are most effective, but kind of a luxury.

comment by CAE_Jones · 2015-03-09T07:15:41.150Z · score: 0 (0 votes) · LW · GW

I'm sure this is a problem for others, too.

Yes.

I'm in Northeast Arkansas. I considered trying to reach the St Louis Meetup Groups (my town's only cheap way out for someone who can't drive just happens to be to St Louis, and only St Louis), but for a number of reasons that never happened before that meetup group was defunct.

Meetup.com did briefly have a skeptics group in my town. Briefly--before I could get over my panic at the "describe yourself" requirement, it, too, was defunct. Otherwise, the meetups within 50 miles of me appear to include moms and a group of board gamers in Memphis.

comment by ChristianKl · 2015-03-08T20:34:30.169Z · score: -3 (5 votes) · LW · GW

If there nobody to talk about deep personal issues in the city in which you are living, why are you living in the city in the first place?

Maybe LW is the wrong banner for you under which to search, but having people to talk to on a deep level is vital.

comment by CAE_Jones · 2015-03-09T08:05:54.521Z · score: 7 (7 votes) · LW · GW

If there nobody to talk about deep personal issues in the city in which you are living, why are you living in the city in the first place?

The last time you posted something like this, I fretted for a whole day, trying to figure out how to respond. I found I could not do so without a mindkillxplosion at how offensive it is, so I settled for a silent downvote.

Welcome to the Mid-southern United States, where nothing is within walking distance of anything else, huge swaths of land have no sidewalks, gas mileage is artificially deflated, public transit consists of like three buses if you live in a huge town with at least 60k people, and there is no way to travel between towns other than owning your own vehicle or having people willing to drive you. (I did find a cab driver willing to get me to the nearest town with an interstate bus terminal; he estimated that trip would cost me $130. In a good month, that's over 10% of my cumulative funds.).

On the bright side, the cost of living is low enough that Wellfare is actually livable, if one min-maxes food and utilities and has no debt.

Now, add mental illness on top of that. Then, be careful never to so much as hint that you might maybe possibly be anything other than a practicing Christian (or at least be so damn smooth that you can get people to believe you're joking when you reveal your nonchristianity, on the grounds that "I don't believe you're a bad person" (an actual quote from one of my father's customers)). Not that religious discrimination matters when you're completely isolated.

Now, you have lots wrong with your life, but the tiny handful of things that you still manage to care about are staying here.

You're unemployed, disabled, friendless, have less than $2000 to your name, ~$90000 in student debt, and are drowning in anxiety/depression/akrasia/learned helplessness... and someone from a nice city with financial security expresses bafflement that you don't just move to a nice city like theirs. The pattern-matching alone was absurd enough that I couldn't trust myself not to quote The Grapes of Wrath.

I really don't feel like I handled this well, but I've been holding it in for a couple years, now, and clearly, something needed to be said.

comment by riparianx · 2015-03-09T23:55:26.239Z · score: 1 (1 votes) · LW · GW

I empathized maybe a little too much with this post. Thank you for writing it.

Sometimes I'll read something written by a person from a different area of the world and be utterly baffled- these people are WALKING to the store? I mean, there's a Braum's about half a mile away, but if you're actually buying things that can be pretty impractical. I live pretty close to the metro in my state, but even still, everything's pretty far away.

Something I've noticed about Europeans in particular- what to us is the next big town over, is the next country over to many of them. "Hey, there's a meetup in Austin! That's only about 300 miles away!" is like "Well, there's a meeting in France, but no way I'm driving 300 miles just for that." America is BIG. If you take a major highway, there can be a hundred miles between one town and the next.

The whole, "well, why don't you just move somewhere better?" is particularly crazy when you think about this. Movers cost hundreds of dollars a day. Moving any great distance takes days. Getting a new residence is RIDICULOUSLY expensive in the "nice" places. Rent for a 1000sqft apartment in New York is more than I've made in the last six months. Then there's downpayments, utilities, setting up new accounts for phones and internet, etc. You'll probably need a new license. College costs TRIPLE if you move out of state, because there's this awful thing they do where if you haven't been a state resident for X period of time, they get to charge you triple tuition. Heaven forbid you have to move with another person- a kid, say. I'd have to save for YEARS to be able to afford the first three months of a new residence.

comment by [deleted] · 2015-03-09T11:52:07.859Z · score: 1 (1 votes) · LW · GW

In a conservative society/culture why do people live on their own? Why not in their extended family?

To be fair, being in love with living in nuclear families is a standard feature of Anglo cultures, some even proposed they actually caused them becoming richer than others. There are 13th century records of English villagers moving to other villages to work and then buying land and settling down and hardly ever seeing their relatives again in the old village. I find this mind-boggling.

Still, even in an individualist Anglo culture, I would expect its more conservative subsets would be in favor of blood relatives living under one roof. Which is an excellent idea for people poor and ill.

For example, in Eastern Europe (both poor and conservative) the idea of every adult child gluing another wing to the parents house, big enough to marry and have a child or two, is very popular. It is cheap, no mortgage, just buy materials and DIY with friends. And the generic conservatism of the region supports this, because it puts family and relations and community before the individual.

comment by riparianx · 2015-03-10T00:17:12.040Z · score: 2 (2 votes) · LW · GW

America actually has this weird cultural thing where living with your parents past 20 is seen as a badge of shame. You might have heard the "nerd in his parent's basement" stereotype a few times. The conservative families I know do have the "family values" thing, but they also have a huge "independence" thing. Most of them don't want their kids still in the home after they hit adulthood. They do tend to want to be near family, though. Obviously this is anecdotal evidence and should be taken with a grain of salt.

comment by CAE_Jones · 2015-03-09T14:53:48.855Z · score: 1 (1 votes) · LW · GW

It's hard to say; maybe there's a bit of cultural osmosis involved? Maybe it has to do with the combination of the vast amounts of unused space and the influx of jobs other than family farms (the one branch of my father's family that almost kept their own little extended clan together is so big on livestock, especially horses, that I honestly have no idea what jobs any of them have had. There was a family farm before I was born, but my father's oldest brother mismanaged it into oblivion).

My town has a significant manufacture sector, but it's mostly food products. It has some diversity by virtue of being a college town, though the college's primary majors are agriculture and business. So it's a bizarre sort of place that keeps growing, but refuses to stop being the biggest small town around in spite of a population literally 100 times the size of many nearby towns*. I think it's technically a city, but in practice it's an amalgamation of rural and suburban.

* I don't think this town has broken 100k yet. I haven't heard population numbers on nearby towns in a while, but I was not exaggerating my orders of magnitude, given the populations when last I heard them.

comment by ChristianKl · 2015-03-09T15:18:41.964Z · score: 0 (2 votes) · LW · GW

The last time you posted something like this, I fretted for a whole day, trying to figure out how to respond. I found I could not do so without a mindkillxplosion at how offensive it is

Of course suggestions to make radical changes can offend.

Here I have basically two choices: (A) Don't try to address the issue on a deep level (B) Say "I see this triggers your pattern of learned helplessness". "It needs a certain amount of pain for a person to decide that their suffering is enough and that they stop to suffer."

Unfortunately text isn't a good medium for doing (B) and even Skype isn't.

In your specific case being blind also adds additional issues that don't exist for most people.

expresses bafflement that you don't just move to a nice city like theirs

"Expressing bafflement" isn't a good description of what I'm doing when I'm asking for "Why do you do X?". I ask that question because I feel that the other person benefits from answering the question and getting clear about "why they do X". If you actually make a decision that it's for you the right choice to stay where you are at the moment, you feel more agentship.

comment by riparianx · 2015-03-08T20:38:33.957Z · score: 3 (3 votes) · LW · GW

Because not everyone has the practical ability to live where they want? If it were practical to do so, I'd be living in one of the Chicago suburbs by now. But finances, family, my current academic path, the people I care about, etc. are all here. I don't even have enough gas money to get TO Chicago. Much less enough to start a life there.

comment by James_Miller · 2015-03-08T16:39:43.232Z · score: 1 (1 votes) · LW · GW

Examine.com seems like a great resource to find supplements to help with different types of mental disorders.

comment by [deleted] · 2015-10-06T04:56:30.683Z · score: 0 (0 votes) · LW · GW
comment by Strangeattractor · 2015-04-21T06:56:13.325Z · score: 0 (0 votes) · LW · GW

One of the more useful books I've read on the topic of mental illness is Adventures in Psychiatry by Dr. Abram Hoffer, a research scientist and medical doctor. He did the first double-blind studies of using vitamins to treat schizophrenia in the 1950s. He gave LSD to an architect to help the architect understand what patients may experience, so as to make the design of a clinic better. Those are just two examples of interesting things he did in his life.

The book can be hard to find on Amazon, or in brick-and-mortar book stores, but it can be ordered from the International Schizophrenia Foundation http://www.isfmentalhealth.org/resources/booksfilm/

The ISF also has resources on other types of mental illness from an orthomolecular medicine perspective. I realize that the orthomolecular approach is controversial, but I think that it helps at least some of the people who experience mental health problems, and I think it is not just a placebo. That said, I don't think it has a complete picture of what the problems are and how to fix them. No one in the world has that yet, that I am aware of.

I'm not sure if this falls within the type of discussion you want to start, but I thought I'd give the book recommendation, and point out that there is another option for people with mental illness to look into besides talk therapy and prescription drugs.

comment by [deleted] · 2015-03-08T18:40:34.039Z · score: 0 (2 votes) · LW · GW

Why should LW be a mental consuler? No offense intended - but I bet there are people out there who will help more than anyone one LW can.

comment by riparianx · 2015-03-08T19:20:58.803Z · score: 4 (4 votes) · LW · GW

You're right that LW is definitely not going to be a cure-all, and obviously I'm not asking for everyone on LW to band together to fight this one problem. A lot of the people here have their own projects. But I think that LW could be a great help to people who are trying to get help and can't- either because they can't afford mental health care, or because their health care isn't helping. LW is a brilliant educational place that bases a lot on science and cognitive studies. I think this could easily extend to helping with mental illness.

Mental illness is a complex thing, and everyone who has one is complex in a different way. That's why mental illness is so hard to treat. Most of the theories about what the causes are (genetics, brain chemistry, etc.) aren't supported well enough by science to help. It can take years to find the right cocktail of drugs to fight a specific mental illness a person has, and that same cocktail won't work for someone else with the same problem. LW sort of has a talent for sorting out bad science.

comment by CAE_Jones · 2015-03-09T13:23:26.200Z · score: 3 (3 votes) · LW · GW

I wonder if MetaMed does mental illness. Last I heard, they're still in the early, way-too-expensive-for-the-likes-of-me phase, but they're more or less "LW-affiliated rationalists try to filter the science to optimize your solution".

comment by [deleted] · 2015-03-09T16:18:25.243Z · score: -3 (3 votes) · LW · GW

Argh. This post sounds like a lot of inefficiencies.

Let's be practical and use the KISS principle the right way. What are your problems? What are you trying to improve? I'm no therapist, and my english is too bad to produce a decent quote, but I'm still quite sure that you can get amazing results if you cross off "mental illness" and open a new page with "self improvement".

You're free to ad hominem me. You're free to do whatever you want. But the bottom line is that as long as you don't strive to better yourself, you're doomed, no matter who you are.

comment by riparianx · 2015-03-09T23:25:52.734Z · score: 1 (1 votes) · LW · GW

Your english is better than the english of a lot of native speakers.

Well... yeah, online discussion is inefficient. But when you're cut off from the efficient options, you probably shouldn't throw up your hands and give up. I'm not sure if that's what you meant, though.

I think you may be disregarding the viewpoints of others, here. You can't do any efficient self-improvement if you refuse to call your problems what they are. It might feel nice to say "You know what? I'm not mentally ill. I just need to improve myself." I WANT to improve myself. Most people here do. I've hit a roadblock here, and I want to talk to other people that have, or have in the past. I'd like to hear the viewpoints of others. What worked, what didn't, etc. Group therapy/discussions with people with the same problem or similar have been extremely helpful to a lot of people.

Also, "keep it simple, stupid" is only helpful when the problem can be simplified further. Simplifying things is really hard when we don't understand them, and mental illness is one of science's big question marks.

I'm not trying to ad hominem you, and I'm sorry if I came off that way.

comment by [deleted] · 2015-03-10T12:01:10.364Z · score: -1 (1 votes) · LW · GW

Your english is better than the english of a lot of native speakers.

I doubt it.

"You know what? I'm not mentally ill. I just need to improve myself."

Who cares about mental illness? There's action and inaction. Action WILL lead to something and if you do it well you'll get GOOD results.. Inaction gets you nothing no matter what you do.

Also, "keep it simple, stupid" is only helpful when the problem can be simplified further.

No, it's always useful and is a good way to think about things in general. Why should things be more complex when they can be simplier? Do you begin with a simple (or rather, minimal) model and later expand on it or just build a complex theory and try it? The time investment, effort, and return are way better on the simple route, the complex route sucks because by the time you do both you WILL get a sharper pencil using the simple way.

You should also remember that complex things are built out of simple things, so you won't be a complex master before you're a simple superhypermegaultragrand-master.

Simplifying things is really hard when we don't understand them, and mental illness is one of science's big question marks.

I think I need anger control.