Sharing about my mental illness and popularizing future-oriented thinking: feedback appreciated!

by Gleb_Tsipursky7 min read7th May 201528 comments

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Personal Blog

I'd appreciate feedback on optimizing a blog post that shares about my mental illness and popularizes future-oriented thinking to a broad audience. I'm using story-telling as the driver of the narrative, and sprinkling in elements of rational thinking, such as hyperbolic discounting, mental maps, and future-oriented thinking, in a strategic way. The target audience is college-age youth and young adults. Any suggestions for what works well, and what can be improved would be welcomed! The blog draft itself is below the line.


P.S. For context, the blog is part of a broader project, Intentional Insights, aimed at promoting rationality to a broad audience, as I described in this LW discussion post. To do so, we couch rationality in the language of self-improvement and present it in a narrative style.


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 Coming Out of the Mental Health Closet


My hand jerked back, as if the computer mouse had turned into a real mouse. I just couldn’t do it. Would they think I am crazy? Would they whisper behind my back? Would they never trust me again? These are the kinds of anxious thoughts that ran through my head as I was about to post on my Facebook profile revealing my mental illness to my Facebook friends, about 6 months after my condition began.


I really wanted to share much earlier about my mental illness, a mood disorder characterized by high anxiety, sudden and extreme fatigue, and panic attacks. It would have felt great to be genuinely authentic with people in my life, and not hide who I am. Plus, I would have been proud to contribute to overcoming the stigma against mental illness in our society, especially since this stigma impacts me on such a personal level.


Ironically, the very stigma against mental illness, combined with my own excessive anxiety response, made it very hard for me to share. I was really anxious about whether friends and acquaintances would turn away from me. I was also very concerned about the impact on my professional career of sharing publicly, due to the stigma in academia against mental illness, including at my workplace, Ohio State, as my colleague and fellow professor described in his article.


Whenever the thought of telling others entered my mind, I felt a wave of anxiety pass through me. My head began to pound, my heart sped up, my breathing became fast and shallow, almost like I was suffocating. If I didn’t catch it in time, the anxiety could lead to a full-blown panic attack, or sudden and extreme fatigue, with my body collapsing in place. Not a pretty picture.


Still, I did eventually start discussing my mental illness with some very close friends who I was very confident would support me. And one conversation really challenged my mental map, in other words how I perceive reality, about sharing my story of mental illness.


My friend told me something that really struck me, namely his perspective about how great would it be if all people who needed professional help with their mental health actually went to get such help. One of the main obstacles, as research shows, is the stigma against mental health. We discussed how one of the best ways to deal with such stigma is for well-functioning people with mental illness to come out of the closet about their condition.


Well, I am one of these well-functioning people. I have a great job and do it well, have wonderful relationships, and participate in all sorts of civic activities. The vast majority of people who know me don’t realize I suffer from a mental illness.


That conversation motivated me to think seriously through the roadblocks thrown up by the emotional part of my brain. Previously, I never sat down for a few minutes and forced myself to think what good things might happen if I pushed past all the anxiety and stress of telling people in my life about my mental illness.


I realized that I was just flinching away, scared of the short-term pain of rejection and not thinking about the long-term benefits to me and to others of sharing my story. I was falling for a thinking error that scientists call hyperbolic discounting, a reluctance to make short-term sacrifices for much higher long-term rewards.


To combat this problem, I imagined what world I wanted to live in a year from now – one where I shared about this situation now on my Facebook profile, or one where I did not. This approach is based on research showing that future-oriented thinking is very helpful for dealing with thinking errors associated with focusing on the present.


In the world where I would share right now about my condition, I would be very anxious about what people think of me. Anytime I saw someone who found out for the first time, I would be afraid about the impact on that person’s opinion of me. I would be watching her or his behavior closely for signs of distancing from me. And this would not only be my anxiety: I was quite confident that some people would not want to associate with me due to my mental illness. However, over time, this close watching and anxious thoughts would diminish. All the people who knew me previously would find out. All new people who met met would learn about my condition, since I would not keep it a secret. I would make the kind of difference I wanted to make in the world by fighting mental stigma in our society, and especially in academia. Just as important, it would be a huge burden off my back to not hide myself and be authentic with people in my life.


I imagined a second world. I would continue to hide my mental health condition from everyone but a few close friends. I would always have to keep this secret under wraps, and worry about people finding out about it. I would not be making the kind of impact on our society that I knew I would be able to make. And likely, people would find out about it anyway, whether if I chose to share about it or some other way, and I would get all the negative consequences later.


Based on this comparison, I saw that the first world was much more attractive to me. So I decided to take the plunge, and made a plan to share about the situation publicly. As part of doing so, I made that Facebook post. I had such a good reaction from my Facebook friends that I decided to make the post publicly available on my Facebook to all, not only my friends. Moreover, I decided to become an activist in talking about my mental condition publicly, as in this essay that you are reading.

 

What can you do?


So how can you apply this story to your life? Whether you want to come out of the closet to people in your life about some unpleasant news, or more broadly overcome the short-term emotional pain of taking an action that would help you achieve your long-term goals, here are some strategies.


1) Consider the world where you want to live a year from now. What would the world look like if you take the action? What would it look like if you did not take the action?


2) Evaluate all the important costs and benefits of each world. What world looks the most attractive a year from now?


3) Decide on the actions needed to get to that world, make a plan, and take the plunge. Be flexible about revising your plan based on new information such as reactions from others, as I did regarding sharing about my own condition.


What do you think?

  • Do you ever experience a reluctance to tell others about something important to you because of your concern about their response? How have you dealt with this problem yourself?
  • Is there any area of your life where an orientation to the short term undermines much higher long-term rewards? Do you have any effective strategies for addressing this challenge?
  • Do you think the strategy of imagining the world you want to live in a year from now can be helpful in any area of your life? If so, where and how?


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Thanks in advance for your feedback and suggestions on optimizing the post!

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28 comments, sorted by Highlighting new comments since Today at 4:45 PM
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[-][anonymous]6y 4

I think I am very confused about the idea of mental illnesses.

First of all to understand an illness, we need a ideal of health to compare to. Where does this ideal come from and what it is? When I come to LW (or even Reddit) I feel like i am depressed compared to you because I never really had much of a goals or passions or interests in life, so generally being anhedonic and alway have to keep fighting boredom. On the other hand, as far as I can tell, my attitude is not different from that of my parents and family members, I was raised so that they told me life is hard and it is about survival, not fun, and indeed my parents had their two hands full and more with just securing a comfortable middle class existence, they did not really have any energy for personal goals. If my father was alive and I would complain about boredom, he would say "you have it too good, when I was 37 I was standing 12 hours on top of a ladder painting houses so that we can pay off our flat" and things like that. So compared to LW, I am depressed, compared to my family norm, I am normal (except having it too good, obviously). The point is, there is no cast in stone definition of what is healthy. It may depend on culture, on age, on time, on a lot of things how we define the healthy.

A decade or two ago I had a strong interest in Buddhism. And my teachers were of the opinion that what most people consider healthy, in the sense of happiness / non-depression, is still a very low level and we can improve on that. They kept quoting Freud, saying the goal of psychotherapy is to turn abnormally unhappy people into normally happy people. And they claimed to take over from there, to try to turn people into being radiantly happy, through meditation. Their philosophy was that only complete happiness can be defined as healthy.

So, the point is, we do not have a "cast in stone" level of mental functioning that we could call unanimously "healthy", so we cannot really objectively define mental illness as a comparison to that. Pretty much it seems like the question of whether people like me or my parents / family members are depressed or not just depends on whether they want to change their mood or not , seek therapy or not. They can be seen as pretty normal, in a society that not too "dreamy" (i.e. not US-type "follow your dreams" type of society, but a more grim one).

Another weird issue is blame, stigma etc. In my childhood it was very confusing. It is the natural instict of children to be cruel assholes to people who seem to have some deficiency or problem. And then they tried to teach us e.g. "do not make fun of this man who sits in a wheelchair, he cannot help being disabled" so we tried to learn the distinction that sometimes you can be an ass to people, if it is about something they can help, but sometimes not, when it is about something they cannot help. As children we developed roughly this model, a milder defect is usually something that "can be helped" and thus you can be an ass to people who have it, and a harder defect is something "cannot be helped" and thus to be met with compassion. So for example we could make fun of a child for being clumsy, but not if a neurological disorder made him very clumsy. We could call a child stupid as long as he was only little stupid, but someone with serious mental retardation, very low IQ not. Our model of illness was largely a more severe version of normal defects, the kind of normal defects we made each other fun of for. Or bullied each other for verbally. When we grew up, of course we stopped behaving like little pricks about it. Still the essential distinction stayed there: if, for example, a man is only somewhat stupid, you can think "haha what an idiot" and consider this an insult or censure. If a man is very ,very stupid, clearly mentally retarded, then not, then your appropriate atttude is compassion, not censure. Later on I learned that there is no reason why not think that moderate versions of the same problem do not work through the same pathways as illness. So this distinction is not tenable. Since then, I cannot tell the difference if a person is simply an ass or has antisocial personality disorder, is a fucking coward or suffers from anxiety disorders and panic attacks, and so on. I can no longer tell the difference what could rightfully drawn criticism, scorn, censure, and what should be met with compassion. The only consistent solution would be to consider virtually everything an illness, and think "he cannot help being what he is" and meet everything with compassion, but that is an entirely unusual and weird human norm. It is not how people normally feel. If for example a soldier runs away from battle leaving his comrades in the shit, they will not think "poor fellow has anxiety disorder and panic attacks". They will think "fucking coward". This is the normal human attitude. And we are trying to wall it off into illnesses that "he cannot help being what he is" in which cases we do not use this normal attitude but more like think with compassion and understanding. But this distinction is not really tenable. Ultimately the illness and non-illness are very much the same thing. So what is the truly proper attitude? Give up all kinds of censure and criticism? I am really confused by this.

"But this distinction is not really tenable. Ultimately the illness and non-illness are very much the same thing", Sure, if you consider having not having use of both of your legs to be 'very much the same thing' as having two perfectly working legs.

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[-][anonymous]6y 0

That is a bit extreme. My point is more like, if unable to walk is 0 and being Michael Flatley is 100, there is a 20 or 40 level of leg clumsiness which you can see either as "normal" clumsiness or a neurological disability, neuromotoric illness, and my point is that humans tend to react radically differently to which interpretation is being used. A normally clumsy guy gets laughed out of the dancing course, the guy with the disability gets sympathy, pity and points for just trying. My struggle is trying to figure out a consistent and logical approach.

From a Buddhist perspective it doesn't make much sense to talk about mental illness. Mental illnesses are narrow intellectual concepts that create a sense of identity and Buddhism is about not attaching yourself to labels. The Buddhist ideal is simply to show compassion to everyone.

At the same time a concept like depression can have some use. Depression is more than just being unhappy. If you use it to simply mean the opposite of happy you devoid it from meaning. It's a cluster of symptoms. Having the concept allows us to research that cluster and come up with things that aren't obvious.

So what is the truly proper attitude? Give up all kinds of censure and criticism?

Give criticism based on the utility of the effect of giving criticism. If you give someone constructive feedback that allows him to improve, that criticism is good. Censure is similar. If someone violates social norms punishing him was disapproval is useful to enforce those social norms.

[-][anonymous]6y 0

If someone violates social norms punishing him was disapproval is useful to enforce those social norms.

But there is a long standing rule / norm that e.g. being officially insane (not having mens rea) exemps one from punishment.

Later on I learned that there is no reason why not think that moderate versions of the same problem do not work through the same pathways as illness.

Just because they work through the same pathways doesn't mean that they are the same with respect to ability to overcome them.

Someone who is clumsy because of a neurological disorder cannot do anything which prevents himself from being clumsy. Someone who is "normally" clumsy can. The fact that they both have similar causes doesn't change that.

Someone who is clumsy because of a neurological disorder cannot do anything which prevents himself from being clumsy. Someone who is "normally" clumsy can.

Given that placebo's do seem to have an effect on mental illnesses, I don't think there reasons to believe that people with mental illnesses can't do anything affect their state. On the other hand the fact that change is possible doesn't mean that a person can change simply by trying very hard.

But there's a difference between being able to change their state, and being able to change their state far enough to achieve normality. Someone who is very clumsy because of severe neurological problems could, by effort, get somewhat better, but even with a lot of effort he will still be clumsy, just less clumsy. Someone who is clumsy in the way that most clumsy people are, on the other hand, can entirely alleviate the clumsiness by effort. Even if they have similar causes, in one case the gap is a size that can be made up for by effort, and in the other case it is not.

Someone who is very clumsy because of severe neurological problems could, by effort, get somewhat better, but even with a lot of effort he will still be clumsy, just less clumsy.

The fact that something isn't changeable by investing effort doesn't mean that it isn't changeable by another strategy. Sometimes the key to change is investing less effort.

Biological issues and mental issue also also often interlinked. Making it part of your identity that you can't do something for biological reason X can often make change more difficult.

But there's a difference between being able to change their state, and being able to change their state far enough to achieve normality

Given someone in front of you, how do you tell? How can this difference be observed?

It is easy to imagine "someone who cannot change their state" and "someone who can change their state", but if you erase the XML tags and that your imagination has attached to the two, what would you actually be seeing?

Given someone in front of you, how do you tell?

By just saying "most humans can compensate for X degree of clumsiness. This person has Y degree of clumsiness. Y is greater than X".

Of course, your ability to determine those two factors isn't perfect, so you will get it wrong sometimes, especially in borderline cases, but you can certainly do better than chance.

Better than chance is a low bar. If you have some problem in your life, how do you determine whether and to what extent it is solvable, when to carry on and when to give up? Where the problem is, for example, akrasia, clumsiness, social anxiety, despair at the magnitude of the ills of the world, being a refugee in a flimsy boat in the Mediterranean, or acne.

It is easy to invent examples in the imagination where it is clear that you can solve it or clear that you can't. There are fewer easy answers for the problems that life throws at you, which are not selected for solvability or unsolvability.

Going back to an ancestor comment:

Someone who is clumsy because of a neurological disorder cannot do anything which prevents himself from being clumsy. Someone who is "normally" clumsy can.

Again, it's not always easy to tell. I've seen people with severe cerebral palsy who it was clear were never going to walk or speak with a clear voice. I've also seen beginners in the taiko class who are competent at the ordinary movements of day to day life, but make a complete hash of what seem to me like the very simplest actions. I wonder if they are ever going to get it, and recognise that I don't know. So I point them toward the correct movements, see them do the wrong thing again, and repeat. When I first took up tai chi, maybe the teacher thought the same thing about me. Eventually I learned, but I've seen other people go on for years without advancing. Could they, with different instruction? I can't tell.

"Better than chance" is just another way to say "sometimes it actually works". It doesn't need to work every single time for it to be something useful.

[-][anonymous]6y 0

And given the human tendency to generalize from one example, it has to be hard to take another look... My own learned response is 'the person is clumsy and so has to be ignored if possible; it does not matter why s/he is so, since both a mentally ill or just careless can probably realize my rudeness if I stare.' On the other hand, if someone at my workplace has a disability, I would be very wary of them having to do anything with volatile chemicals, and quietly but unceasingly influence things to make her/him stop. (I am in a plant physiology Dept.) Possibly I would be most rude to such a person, but exploding centrifuges just aren't safe.

I would start the post by talking directly about your mental illness and the effect it has on your life instead about talking to want to share it.

Good idea, thank you (danke) for the suggestion! Makes sense, I'll play around with revising it to frontline my mental illness and see how it looks.

It would definitely be more relate able (especially to the greater blogosphere) with a start in personal story land.

Without an emotional story it feels like you are making an emotional appeal through system 2 (or through a calculating brain) which may work for some but if you are trying to appeal to a greater audience; maybe some emotional guidance would help people connect with the idea more.

Sounds like I should make paragraph 4 into paragraph 1, and expand on it. Thanks!

The ending can flow in a more natural format than a list - this is that "call to action" stuff my high school writing teacher was always on about :P Separating it out makes it more explicit but feels less compelling to me.

Here's my lazy translation from list format to imperative format:

You can apply this story to your life. Not only if you want to come clean to people in your life about some unpleasant news, but for overcoming the short-term emotional pain of taking any action that would help you achieve your long-term goals. Consider an action that you are not doing because of some barrier. What would the world look like in one year if you take the action? What would it look like if you did not take the action? From the point of view of a year from now, is it worth it?

Pick that world you want to live in, and decide on the actions needed to get to that world. Make a plan, and take the plunge. Be flexible about revising your plan based on new information such as reactions from others, as I did regarding sharing about my own condition.

You probably already have evidence in your own life. Almost everyone has put off acting on something important because of emotional distress. How did you deal with this in the past? What advice would you give you past self? Seriously consider the advice you would have given to yourself - you have the chance to follow this advice today. Seek out those areas of your life where you need to be oriented to the long-term rather than the short-term, pick the world you want to live in a year from now, and put it into practice.

EDIT: Also, I think this is really great, thanks for posting this!

I like that, especially the part about giving advice to your past self, great suggestions!

EDIT: You're welcome, and thank you for your good words!

Future-oriented thinking might not always be desirable. It seems to have helped you in that specific situation, so I don't want to discourage you from using it as a rule of thumb. But sometimes what people need is to start thinking more about the present, or past. It depends on the situation, and on the person.

Philip Zimbardo, the person who ran the infamous Stanford Prison Experiment, has a book about different time perspectives. It is called The Time Paradox. I liked it, and it gave me some insights into how the time-orientation of a person's thoughts can affect their perspective.

I think what helped make it work in your situation is that you could see a connection between your short term actions and your long term goals, that you could see how taking a specific course of action would likely take you closer to your goals. There are some situations where it is not clear what action to take that would get a person closer to their goals, and even when taking advice and consulting experts, choosing a course of action that would help can be murky. If a person wants to change something where the mechanism of how to change it is unknown, or unknown to them, future-oriented thinking can feel discouraging.

Hm, I can't intuitively model a situation where future-oriented thinking would undermine people's ability to change something. For example, if the mechanism of how to change something is unknown, then future-oriented thinking would lead to them taking steps to learn about how to change the situation, and then implementing this change. Can you give me a couple of examples where future-oriented thinking wouldn't work?

In general, I am in favour of long term thinking. I think we need more of it. But I don't think that's necessarily the same thing as future-oriented thinking.

Here are a couple of examples where I think future-oriented thinking can be problemmatic.

Example 1

Let's say you are diagnosed with a chronic illness, or terminal disease. There is no known cure. Either thousands of researchers are already working on the problem and haven't solved it, or it is little known and not enough research is being done. Either way, it is unlikely you will see a cure in your lifetime. You have other things that you want to do with your remaining days than become a medical researcher. Even if you became a medical researcher, you probably wouldn't find the answer in enough time to save yourself.

In this situation, I'm not saying don't get your affairs in order, or do the things to make a better future, but is it really helpful to focus on thinking about how awful it will be once your condition degenerates, or how nice it would be to have a cure? If the change you want is "Cure this disease" and there's no known way to do that, it may be better to focus on enjoying the present. Telling someone to take steps to learn how to change the situation then implement the change sounds glib and unfeasible in this context.

I'm not saying that there's absolutely nothing that people can do when faced with problems this difficult. Yes, people can fundraise for medical research, or take other actions to attempt to make things better for other people who face a similar situation in the future, but it's still not the same thing as "take these steps and it will fix your problem".

Example 2

Someone is suicidal, or is otherwise projecting their present misery into the future. When a person is feeling miserable or overwhelmed by pain, they often imagine that the future will be just as awful and miserable as the present. People tend to project the present into the future, it's a well-known cognitive bias. In a situation like that, sometimes the best thing a person can do is to recognize that their vision of the future is distorted at the moment, and decide not to make any major decisions based on that distorted vision.

When talking to someone who is suicidal, instead of focusing on their thoughts of the future, it can be helpful say to them something like "What is something you can do right now that could make you feel a little better?"

These examples are not theoretical to me. They have happened to people I love.

I can think of two, but I also think the number of people who don't use long-term thinking and should far outweighs the number of people who do and shouldn't, so I still think that teaching that skill is a great idea.

  1. If someone doesn't know the amount of time or effort to complete a goal, they could end up very unhappily pouring effort into a sunk-cost situation because they are imagining a long-term (but not guaranteed) future where that goal is achieved. In this situation, present-oriented thinking would be more useful.

  2. Future (or past) oriented thinking can be a form of rumination, often seen in depression. In this situation, someone imagines every possible future, over and over, and extremely pessimistically, which leads to a sense of powerlessness. Present oriented thinking is EXTREMELY useful to combat rumination, which is why mindfulness based depression interventions have the same success rate as actual drugs.

Nevertheless, this is promoting a more goal-oriented long-term thinking exercise that doesn't really run on the same circuits as rumination. Case 1 could still be a pitfall, but promoting long-term thinking will probably help far more people than it hurts.

I can see your point about Case 1, it depends on how the concept of long-term thinking is defined. A long-term approach to winning would evaluate the probabilistic estimate of a situation being a sunk-cost scenario, and factor that into long-term oriented goals. However, there can be some mistakes made with long-term oriented thinking in that context, so it's a complex one to get exactly right. Still, I think the overall point we agree on, namely that promoting long-term thinking will probably help far more people than it hurts.

[-][anonymous]6y -1

redacted

'If you're not working on your best idea right now, you're doing it wrong' - David Hansson, Creator of Ruby on Rails

I have a digitalsocial anxiety which doesn't extent into the real world, just online.

I'm socially anxious and have a poor history of phone interviews, so I asked if I could get feedback over email instead.

I am having trouble reconciling these two statements. (The best I can manage is to guess that you actually get anxious about non-face-to-face interactions and digital/non-digital doesn't have much to do with it.)

[-][anonymous]6y 0

Haha, that makes a lot more sense. My explanation was the best I could think of, but I prefer yours. I'm not the brightest...

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