Failing to update

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

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

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

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

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

1ialdabaoth12y

No, my fear is of any condition that needs treatment, that I can't afford to treat. My fear is of getting caught in a double-bind of "you know what the problem is, why aren't you doing anything about it" / "why are you spending money on a doctor when you can't even afford to pay rent? You poor people are all alike."

4gattsuru12y

The general costs of anti-anxiety and anti-depression treatments are very low : the primary drugs of first resort are generic and on the discount prescription list of stores like WalMart or Target, and Idaho allows talk therapy at a level of licensure that keeps costs from being prohibitive. Most clinics have or can direct you to a location with a "sliding scale" payment system, and they'll have low-income offers that are less than the cost of transportation and significantly less than the costs of a no-show fee. You may also, depending on your situation, qualify for Medicaid, and the Idaho state Medicaid group does cover behavioral and mental health services. This is also a situation where knowing the exact issue provides tools to at least mitigate the effects even before you go to further treatment sessions, so it's very useful. If you're the ialdabaoth from rpg.net, go to Intangibility.org and check some of the recent threads there.

1ialdabaoth12y

I was once, yes. I'll look at that. EDIT: Why... why was THIS one downvoted?

2NancyLebovitz12y

There's a sub-routine I call "the op-ed writer in my head"-- a sort of "habitual outrage that people like me exist" meme. I'm not sure what's helped tone it down, but after a while it occurred to me that outrage is a very easy habit, and I imagine mediocre real world op-ed writers who are unable to find anything interesting to say, so they just dump the usual insults. Maybe it helps to get cynical about status so that it's possible to assign higher status to oneself than to the attack voices in one's head.

1Lumifer12y

If you are in the US and are actually, bona fide poor (which essentially means having no significant assets) you can have quite good health care for free. But I do believe you realize that your fear is irrational so throwing in random rationalizations isn't going to help you. I think you'll need either to bite the bullet (via a supreme exertion of willpower) or game yourself somehow.

1ialdabaoth12y

I have not experienced this to be true. How do I know if I'm deluding myself?

4Lumifer12y

Um. Well, I'm not going to write a guide to free health care in the US, but: * Large cities have things which are usually called something like "community health centers" which have doctors and will treat you for free. * Medical colleges and teaching hospitals will typically not charge you for procedures performed by students. While it might not be the best idea for a coronary bypass, it works well for things like dental -- your cavities are very carefully examined and fixed under the supervision of a professor. * Doctors cannot deny treatment for lack of funds. If you go to a hospital with some symptoms they have to do something about them before releasing you. * Hospitals are quite adept at manipulating a variety of government programs, they (not you, they) might find some insurance under which you qualify. To illustrate, I know a girl who was in the US on a student visa (and so was neither a US citizen nor a resident alien -- no rights to any governmental assistance) and pregnant. Oh, and poor, too. She had full pre-natal checkups, tests, vitamins, etc. and she gave birth in a normal American hospital under normal circumstances. It didn't cost her a cent.

1ialdabaoth12y

nod I'm aware of most of those processes. The problem is, I'm the sort of person that it's very easy to convince to turn away, and I'm acutely aware that every dollar that is spent on me and not reimbursed contributes to either the poor financial health of the hospital, or the poor financial health of the government/society as a whole. Ultimately, I need a lot of mental health assistance to get to a place where I can afford to deserve the mental health assistance that I need to get to that place, and I'm not comfortable being a leech on society.

[-]solipsist12y150

I'd like you to meet Mr. Odialdabaoth.

Mr. Odialdabaoth: Hello.

Mr. Odialdabaoth, I hear you are an Effective Altruist utilitarian who, with one exception, attempts to maximizes the welfare of society.

Mr. Odialdabaoth: I am, and I do.

I also hear you hate ialdabaoth.

Mr. Odialdabaoth: Yes. Fuck that guy.

Mr. Odialdabaoth, you may be pleased to hear that ialdabaoth is suffering from depression.

Mr. Odialdabaoth: You warm my twisted little heart.

You may also be pleased to hear that he's reluctant to seek medical assistance using public programs because of the cost of those programs to society.

Mr. Odialdabaoth: Well, damn. It pains me to say it, but ialdabaoth should take as much mental health assistance as he can.

Oh?

Mr. Odialdabaoth: Yes. Ialdabaoth is, I must admit, a talented and intelligent person. He is currently employed at a level well under his potential. If he escaped his current doom-loop, the social value of his added productivity could be in the hundreds of thousands of dollars.

Ah yes, I see.

Mr. Odialdabaoth: Absolutely. Now, of course, successfully treating ialdabaoth would have some regrettable side effects, such as ialdabaoth being happy. However, the benefit to soci... (read more)

2ialdabaoth12y

Heh. Do you know I used almost that exact argument once, with one of the social workers? Although the figure I used was $80,000/year, because that's what I used to make - and I added something about "I've already paid in AT LEAST grabs calculator ($80,000 x 2 x 0.35) + ($65,000 x 1.5 x 0.35) + ($50,000 x 2.5 x 0.35) + ($45,000 x 1.5 x 0.33) + ($40,000 x 1.5 x 0.30) + ($35,000 x 2 x 0.30) + ($27,000 x 2.5 x 0.28) + ($25,000 x 1.5 x 0.25) = $223,000 and some change in taxes over the past fifteen years. Are you seriously going to tell me that none of that was for social programs that I'm entitled to see benefit from?" I was subsequently referred to security and escorted out for taking a belligerent tone.

0A1987dM12y

I don't think that's how tax brackets work.

4maia12y

Not sure if this is at all helpful, but: Do you see the contradiction in that sentence? This is a situation that is unfixable unless you go into debt to society a bit in order to pull yourself up. As a taxpayer, I would much rather you get help, even if you don't feel like you "deserve" it, than see you be sad forever. I don't care if you are a leech or not; you're a person, and therefore you being sad is a bad thing.

1ialdabaoth12y

Why? Why shouldn't bad people be sad? And why aren't people who are useless to the powerful bad people? (note: this is likely a rationalization of my actual fully general counterargument, which is "because fuck you.")

0irrational12y

I really don't see what your usefulness/uselessness to powerful people has to do with you being bad. I can't even imagine what premises you are relying on for such a statement.

6ialdabaoth12y

It's a modification of Hypercalvinism / Dispensationalism / Dominionism / Divine Command Theory that I was taught as a child. Essentially, power defines morality, because "fuck you, what are you going to do about it?". And (to quote the actual book Catch-22), "Catch-22 says they have a right to do anything we can't stop them from doing". Basically, the strong are morally justified - in a sense, morally compelled - to dominate and torment the weak, because they can. And the weak deserve every minute of it, because fuck them. I've spent... roughly four to five hours a day, every day, for 35+ years, trying to update out of that belief system, and yet I fundamentally still operate under it.

7witzvo12y

... it's hard for me to imagine what you've been through. I'm sorry. When you say that you operate under this belief system, I don't quite believe you. You don't seem to identify with it. Maybe you've updated out of it in some regards but not others? Maybe you apply it to the way you would let others treat you / how you treat yourself, but not to the way you treat others? Also, I'm going to guess that you're still punishing yourself for your mistakes of the day. I hope you can let them go. You're obviously working through something painful. Have you given yourself credit for taking the bold step of making this post to try to find a way out? As for your original question, the only approach I know of for failure, generally, is to try again the next day, possibly trying something different/smaller, possibly with help. Failure to act according to your "system 2"-intention happens to everyone, so I'd say the most important things are (1) not being to hard on yourself (2) setting things up for a new trial with a high success probability (3) recognizing small successes. E.g. set things up so you can avoid most of what your averse to, without completely avoiding all of it, and/or find ways to be less averse to it. I hope this post isn't too off-base. I wish you well.

5irrational12y

Well then, 1. you should want to be powerful yourself - so certainly go and exploit the society:) 2. the powerful are really not paying for it, and if they are it's completely peanuts to them. If you are screwing up anyone by so-called leeching, it's the middle class:) You are not bad to "them", they don't care about you one way or another. 3. I am rich and powerful (compared to you, at least), and I hereby command you to do it:)

2ialdabaoth12y

Heh. I'm coming back to this, now that I'm in a different mindset. Unfortunately, that leads to a "thrashing" unstable loop, because this: is cached shorthand for the actual system, which is "the powerful dictate morality". In general, "the powerful dictate morality" can be easily cached into "the strong deserve to dominate and torment the weak", because most ways of gaining power over the weak involve dominating and tormenting them, so the people who have that mentality tend to get and keep power - hence a stable loop. The problem is, when I find my own power rising, my external moral compass ("the powerful define morality") notices that I'm entering that "powerful" reference class, and thus my internal moral compass ("don't dominate others, and seek to distribute power fairly") gains more moral weight. As I said before, this leads to an unstable loop: while I'm powerless, my own internal moral compass doesn't enter into the moral calculus, and therefore it is moral for me to dominate and torment others in order to gain power. But as that becomes successful, I become more powerful, and therefore my internal moral compass enters into the moral calculus - and suddenly, the actions I have taken to gain power are no longer morally justified.

2NancyLebovitz12y

Have you looked into the possibility that you're letting morality be too important?

2Lumifer12y

Not quite. Power defines what happens in reality, aka the descriptive part. Morality, on the other hand, defines the normative part. Power often trumps morality but it does not define it.

-1A1987dM12y

Certain people here sometimes seem to measure someone's value by their income, i.e. by how much people with money are willing to pay them to do stuff.

0maia12y

Um... because I terminally value people being happy? (There are sometimes situations where making some people sad makes other people more happy, but I don't think this is one of those.)

1Lumifer12y

You don't have self-worth issues, by any chance? If they are the underlying cause you'll have to deal with them and not with secondary symptoms. Otherwise let me point out that early interventions are usually VASTLY cheaper than trying to fix problems which have advanced to the point where you're delivered to the ER. Going to annual check-ups is much more efficient than heroics of a large highly-paid team of medics trying to save your ass from some late-stage nastiness.

2ialdabaoth12y

Yes, but dealing with them requires dealing with the belief that I don't deserve to have them dealt with.

1[anonymous]12y

I don't really believe that, but let's say you don't. Perhaps other people deserve you happy and functional, not dead or disabled? You're a smart guy. Get your shit fixed, everybody benefits. Do nothing, everybody loses. It's a really simple and easy decision, but I completely understand how difficult it can feel.

1Lumifer12y

Yeah, well, that is the catch-22...

0hyporational12y

You don't really know that, do you?

0ialdabaoth12y

In this circumstance, it doesn't seem particularly relevant what I "know"; what matters is how I behave.

0hyporational12y

What you know influences your behaviour. Not necessarily as much as you'd like right now, but that doesn't mean the effect is null. Given that I'd start small, like stop making claims you rationally disagree with so that you don't reinforce your negative thinking by giving it more credence than it deserves.

0ialdabaoth12y

hrm. Historically, when I've done that, I've got called on it, and then socially sanctioned. (I.e., "you say you think , but then I see you doing . I'm going to stop believing anything you say until you start being more honest.") I think I may be bogged down with too many cached constraints, but I have no idea which ones to purge, let alone how to stop following them. Also, knowledge is a tricky thing. While I've always followed something like a Bayesian heuristic for knowledge when left to my own devices, it's reasonably easy to convince me to abandon it in favor of a kind of radical skepticism against my own thoughts and qualia.

0hyporational12y

In person that can certainly be a problem with some emotional/irrational people but luckily we can't read facial expressions and body language here on the internet :) It's a possibility you can't do that alone. I also suggest some of them would simply disappear were you in a different state of mind. That is, they might not be the actual problem, but caused by it, and fixing them from the wrong end could be incredibly ineffective. Would I be wrong to claim the uncertainty is more general than philosophical?

0ialdabaoth12y

Yes, but non-philosophical language is somewhat lacking in terms to explain it. I can spend 10 hours in separate 1-hour sessions trying to explain to a therapist that I don't feel comfortable asserting the existence of my own subjective experience and qualia, or I can simply say "do you know what the term 'p-zombie' means? Do you understand me if I say 'I can't maintain proper perception of my own qualia if someone else tells me that I'm faking my perceptions'?" - in the latter case, replacing "qualia" with "feelings" injects a nuance that typically leads a therapist in an unfruitful direction, but explaining that to them is tedious and difficult, especially considering that they're the expert and I'm just the (damaged and delusional) patient. At $200/session (or even at $25/session with co-pay, if by miracle of miracles you have insurance), all that explanatory time adds up, especially when you rely on (already-beleaguered) others for every dollar you spend. And even if it was free, it's hours and hours (and thus weeks and weeks) of tedium before we actually GET anywhere, which is exhausting and discouraging (unless, of course, I'm faking all that).

-1NancyLebovitz12y

That's remarkably harsh. People tend to be reliable or unreliable in spots. Reliability should be modeled as % reliability in whatever part of life there's evidence for.

0ialdabaoth12y

I don't really see it as my place to judge what's harsh and what isn't; we work with the culture we're given. If that kind of criticism is the norm, then who am I to say that it's harsh?

-1NancyLebovitz12y

I don't think that particular criticism is common in the culture, or at least I've never seen it before.

0[anonymous]12y

Having mediocre (or sometimes even poor depending on how you look at it) health care is better than having no health care, if you really need it.

0[anonymous]12y

Whatever condition you can't afford to treat you can better manage if you know what it is. If I correctly suspect you're in your 20s, that alone makes it unlikely you have any such condition. Most conditions are easier to treat the sooner they're diagnosed, so by waiting you might turn a cheap to treat condition into an expensive one. I assure you, that is a very unrealistic assessment of how most people think. More importantly, why should you care if some fringe eccentric happens to entertain ridiculous and malevolent non sequiturs about you?

0Richard_Kennaway12y

Who are you imagining talking to you like that?

[-]PECOS-912y130

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

[-]Shmi12y60

This seems like an excellent if somewhat extreme example of a common problem most of us have from time to time, the infamous akrasia: "the state of acting against one's better judgment". (Insert the appropriate "wants vs meta-wants", "limited introspection" and "weak willpower" mutterings.) My guess would be that attempting to trace every minute detail of your thoughts and feelings (which are reflections of thoughts unavailable to introspection) and writing them down may give you a hint at where and why your rebellio... (read more)

2NancyLebovitz12y

Agreed. I'll add that I found it useful to separate finding out what I'm thinking from trying to change my behavior. This means that I kept asking myself what I was doing, and even if the answer was "playing a video game even though I'm not having fun with it", I was still under no obligation to stop playing. I think this is valuable because akrasia can result from having counterproductive methods of trying to motivate oneself.

-1NancyLebovitz12y

I also paid attention to how I felt when I did things-- this was mostly to give myself more data about what it was like when I wasn't blocking myself. And I focused on the fact that I wasn't struck by lightning when I made things a little better.

[-][anonymous]12y40

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

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

[-]IlyaShpitser12y30

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

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

1NancyLebovitz12y

That's plausible, though I've gone more the route of assuming I have a whole self which is worth more than the attacking bits. It still takes assuming that the attack bits have some purpose-- in my case, the belief that I must be very afraid of something to be constraining myself so much. I don't know what the something might be, but just framing the situation that way was a huge relief compared to the idea that the internal attacks were a sign that something was very wrong with me.

[-]erratio12y30

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

Slightly longer term: Repeat the above process to get yourself into a therapist's office, because you have reached the stage of depression where you need outside insight and... (read more)

[-]ialdabaoth12y10

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

8Shmi12y

I hope you don't mean that. Caving to one anonymous bully is pretty sad.

4hesperidia12y

Given OP's complaint, I assumed OP would be unusually sensitive to even small amounts of discouragement (as magnifying small negatives is a frequent habit of people with depression/anxiety problems). As such, when I saw a -1 in the comment thread where I was directly conversing with the OP, I voted them back up to zero. This is because I do not want to discourage someone reaching out for psychological help, even if they are probably asking for help from a community that might not be focused on providing appropriate help. That doesn't mean that we should encourage it (signal-to-noise ratio is a thing), but someone with depression may well see -1 as evidence that they should shut up and leave the world alone, because several other people may have read through the thread, decided that granting -1 karma for that post was appropriate, and didn't vote back up to zero. (For the record, I do not think that is what actually happened. Random downvotes from anon trolls are fairly common on the Internet.)

0Vladimir_Nesov12y

Don't retract your comments just to prevent them from being downvoted. The resulting strikethrough text is ugly, and I would downvote this behavior if it were technically possible.

[-]hesperidia12y10

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

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

... (read more)

1ialdabaoth12y

And here's a big part of the problem: historically, that screening and paperwork process serves to discourage me from continuing, and then sets up a sense of remorse/self-blame later. Also, whenever I'm in the screening process and someone tells me that they're suspicious of my right to be there, I tend to bow out immediately.

0hesperidia12y

At least some social services agencies have a position called "case manager", which is a person who is specifically hired to help other people get through the bureaucracy and to services if they cannot get these services themselves (due to lack of resources whether physical or mental). It may be worth your time to inquire as to how you could be assigned one of those, and then you only need to approach one person and ask.

2ialdabaoth12y

nod the two times I interacted with a case manager, they immediately expressed suspicion that I was malingering / gaming the system. (At which point, it's worth considering that I may be subconsciously doing so.)

2hesperidia12y

Sadly, a significant fraction of people working in public health are in the late stages of burnout, where they simply don't have any altruism left to spare and are only working in their jobs because of money/inertia/fear of unemployment/extrinsic rewards. People who are burnt out that profoundly will express suspicion of malingering as, I think, sort of a protective mechanism: "there cannot possibly have been this many people that need this much of my energy, so most of the people dropping by with sob stories are just trying to pull one over on me because I've proved myself to be an easy target". (This is a just-so story that has no citation. Salt as necessary.) If you're worried about this, you can also try, for example, therapists-in-training-programs at colleges or universities, which are cheaper (because the people doing the therapy are paying tuition, so you don't really have to pay much to make it worth everyone's while) and have younger/fresher people that are much less likely to reject you because of burnout.

[-]Dentin12y00

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

It takes effort, and I'm not talking about small amounts of effort. There's something painful there you'r... (read more)

0NancyLebovitz12y

Would you be willing to post an example of how you resolved something?

[-]Ishaan12y00

Anxiety is disabling your thinking. Remove the cause of anxiety

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

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

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

[-]Richard_Kennaway12y-10

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

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

[+]Locaha12y-100

[+]RolfAndreassen12y-140

LESSWRONG
LW

LESSWRONG
LW

6

6

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