The Context 

I was having a conversation with Ruby a while back–the gist of it was that I was upset because of a nightmare I’d had the night before, and mad at myself for being upset about something that hadn’t even really happened, and trying to figure out how to stop feeling terrible. He said a thing that turned out to be surprisingly helpful.

Life involves feeling bad, often with good reason, often, not. A lot of the time the best response is to say 'Yes, I'm feeling shitty today, no, I'm not going to able to focus, and that's crap, but that’s today.’

It's different from tolerance or resignation, it's more 'this is reality, this is my starting point and I've got to accept this is what it is'.

Then if you can find a way to make it go away, great, if not, most things pass soon enough, and even if didn't, you could accept that too.”

I’m not good at this. I’m frequently using System 2 to fight System 1: for example, when I’m feeling introverted and really don’t want to be at work having face-to-face conversations with patients and co-workers, I basically tell that part of my brain to suck it up and stop being a baby.  I get mad at myself for wanting things that I can’t reasonably ask for, like praise from random other nurses I work with. I get mad at myself for wanting things for what I think are the wrong reasons: for example, wanting to move to San Francisco because I’m friends with lots of people there, and reluctantly accepting that I would need to leave my current job to do that, is one thing, but wanting to leave my job because it’s stressful–not okay! And then I mistrust my brain’s motivations to move to San Francisco at all–heaven forbid I should behave “like a groupie.” I ignore my desires for food that isn’t the same bean salad I’ve been eating for four days, for an extra evenings of sleep, or to cancel on plans with a friend because I just want an afternoon alone at home.

And even though I’m pretty good at overriding all of my desires, the sub-agents that represent those desires don’t go away. They just sit there, metaphorically, fuming at being ignoring and plotting revenge, which they usually achieve by making the desires ten times stronger...and then I go out and buy hot dogs at midnight, or stay in bed for thirteen hours, or spend an entire stretch of days off hiding in my apartment reading fanfiction. Or I just end up confused and conflicted and not capable of wanting anything. In other words, I’m a society of mind that’s frequently in a civil war with itself.

I hadn’t thought of trying to accept the civil war. Of saying “tonight, during this hospital shift, I will not be able to solve the civil war. Rather than adding to the negative affect by getting mad at myself, I will accept that today will simply suck and I will feel shitty. Going into the future I will work on peace talks, but today I must endure.”


"And that’s okay."

There’s one area where I’ve successfully taken a thing that I was confused and conflicted and frustrated about, and turned it into a thing that’s okay, even though the original conflict hasn’t been solved. That thing is relationships. At some point, around the time that I started applying the term asexual to myself and first read about tactile defensiveness and suddenly had words for the things that were ‘wrong’ with me, I stopped being frustrated about them. I haven’t solved all the problems. I’m still confused about relationships, I still get super anxious and avoidant in the face of being wanted too much, and that’s okay. Maybe it’ll change. I haven’t given up, and I’m trying things on purpose. It turned out that most of the suffering from this problem was meta-suffering and now it’s gone.

Somehow, when it wasn’t okay, it was a lot harder to try things on purpose. 

I hypothesized that adding the mental phrase “and that’s okay” onto all your problems would be a good general-purpose strategy.



Ruby disagreed with me: “One of my strongest virtues, but I pay a cost for it, is how not-complacent I am. I'm not good enough, the world's not good enough. And I just see it. It's there. And I'm not okay with it.”

The problem is, even though I don’t have the virtue of acceptance, I don’t have the virtue of non-complacency either–in the sense that seeing the things that aren’t good enough, and not being okay with them, rarely causes me to do something to make the things better. It causes me to not think about them, unless it’s something as object-level as “my patient is in pain and the doctor refuses to give me an order for more pain meds.” And sometimes even then, I’ll retreat into it no longer being my problem.

I think that I, and probably others, need a certain amount of acceptance, a certain amount of “and that’s okay”, to let the wrong things into the circle of our awareness–to admit that yes, they really do suck. It’s a bit like the Litany of Gendlin. What’s true is already true, and even though thinking about it being true makes me feel like I must be a bad person, it can’t cause me to be more of a bad person than I already am.


"You need to own it." 

Once, I had a fairly awful nursing school placement at a very large, stressful ICU. I made mistakes, despite the fact that ‘I knew better’ in theory. (I’ve since learned that nursing is something that takes place under average conditions, not optimal conditions, meaning that you will have good days and bad days and that on your bad days, you will make dumb mistakes.) 

As a perfectionist, I found this really hard, even though I knew enough cogsci to recognize that my brain was behaving predictably and understandably. My mentor said a lot of things that weren’t helpful, but one of the things that she said is “you need to own your mistakes.” At that time, those words left her mouth and reached my ears and then got processed and turned into “you should admit that you’re hopelessly incompetent and a failure.” The only obvious conclusion to draw was that I ought to quit nursing school right then. I didn’t want to quit, and the only other option was to not think about the stupid mistakes–or, rather, try not to, and then end up thinking about them anyway and being anxious all the time.

Nowadays, when I process those words from a much better emotional place, they come through as “you need to let your mistakes into your self-concept, so that you can learn not to make them again even if you’re put under those same awful conditions again.” The fact that being distracted by an interruption and then trying to put an un-primed, full-of-air IV tubing in the pump is understandable and predictable doesn’t make it less likely to kill someone. The correct response is to develop habits and routines that cause you to predictably not make that mistake. But if thinking about it means automatically bringing up the possibility that you should just quit nursing school now before you actually kill someone, it’s hard to think of good routines or focus on training your brain to do them.

In this case, what eventually helped was letting my past mistakes be just okay enough that I could admit them into my mental autobiography, think about them, strategize, and learn from them–in short, own them. 


On Having Priorities

When I brought this up to my friend Ben Hoffman, he had another point to add. 

The obvious-to-me alternative here is the trick of putting EVERYTHING on a list, prioritizing, and optimizing for working on the "most important thing" instead of for getting all the "important things" done. (Or solving the most important problem, however you want to word it.) This is the strategy I've started using, and when I'm disciplined about it I feel nearly no badness above the baseline level from having some problems unresolved. 

This rings true with a part of my nursing clinical experience, and a thing I found especially frustrating about my interactions with my mentor. Once, I accidentally gave my patient an extra dose of digoxin because I misread the medication sheet. Which ended up doing basically nothing, but the general class of “medication error” contains a lot of harmful options. (The most embarrassing and potentially serious med error that I’ve made so far at my current job involved accidentally running my patient’s fentanyl infusion an order of magnitude too high.) There was also the IV-tubing-full-of-air incident.

Then, there was the thing where I would leave plastic syringe caps and bits of paper from wrappers in patients’ beds. This incurred approximately equal wrath to the med errors–in practice, a lot more, because she would catch me doing it around once a shift. I agreed with her on the possible bad consequences. Patients might get bedsores, and that was bad. But there were other problems I hadn’t solved, and they had worse consequences. I had, correctly I think, decided to focus on those first.

That being said, I wasn’t actually able to stop feeling bad about it enough to actually free up mental space for anti-med-error strategizing. This is partly because an adult in a position of authority was constantly mad at me, and I wasn’t able to make that stop feeling bad. But it’s partly because I genuinely felt like a failure every time I caught myself doing something wrong, whether it mattered a lot or not.

Making lists and prioritizing is a useful thing to do, but the physical motion of writing down a list isn’t all that’s involved. There’s the “being disciplined about it”, the ability to actually take all the problems seriously and then only work on the first and most important. I think that's non-trivial, and doesn't automatically happen when you make a list of Important Problems 1 through 5. 



There are two closely related concepts here. One is the idea that you can let go of struggling against unpleasant feelings–you can just have the unpleasant feelings and accept them, forgoing the meta-suffering and the useless burning of mental energy that comes with fighting them. If you apply this mental habit of not struggling against suffering, the result is that you have less overall suffering. 

The second concept is related to owning mistakes you've made, or personal flaws, or atrocities in the world. By default, it seems like most people either obsess over these or don't think about them–I expect that this happens because the things are too awful. If you apply the mental habit of admitting that you made that mistake and it really was dumb, or that poverty really is bad, but that that's okay, the result is that you can think about it sanely, set priorities, and maybe actually fix it. 

However, when I go through these mental motions, they feel like the same operation, applied to a different substrate. It's an habit that I would like to cultivate more. 


Ruby sourced much of his original thoughts on this from Acceptance and Commitment Theory, and from Russ Harris’ book The Happiness Trap

In stark contrast to most Western psychotherapy, ACT does not have symptom reduction as a goal. This is based on the view that the ongoing attempt to get rid of ‘symptoms’ actually creates a clinical disorder in the first place. As soon as a private experience is labeled a ‘symptom’, it immediately sets up a struggle with it because a ‘symptom’ is by definition something ‘pathological’; something we should try to get rid of. In ACT, the aim is to transform our relationship with our difficult thoughts and feelings, so that we no longer perceive them as ‘symptoms’. Instead, we learn to perceive them as harmless, even if uncomfortable, transient psychological events. Ironically, it is through this process that ACT actually achieves symptom reduction—but as a by-product and not the goal.


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21 comments, sorted by Click to highlight new comments since: Today at 12:14 PM

the term asexual (link) to myself and first read about tactile defensiveness (link)

I presume you meant to include links, such as to here and here.

Yup. And then I flew to SF and was really busy and didn't fix it until now. Thanks!

What’s true is already true, and even though thinking about it being true makes me feel like I must be a bad person, it can’t cause me to be more of a bad person than I already am.

A lot of what I do about this lately amounts to tabooing "bad person", and discovering that most of my evidence for my System 1 definitions of "bad person" amount to things said and done by idiots with ulterior motives, that I uncritically absorbed before I was old enough to know better.

Our brains tend to link feelings of "bad person" to whatever made other people speak or act towards us or others as if they were bad, and then we just think that those things make us bad. A kind of self-applied fundamental attribution error, as though a single act can have that much weight in determining your character.

Then, there was the thing where I would leave plastic syringe caps and bits of paper from wrappers in patients’ beds. This incurred approximately equal wrath to the med errors–in practice, a lot more, because she would catch me doing it around once a shift. I agreed with her on the possible bad consequences. Patients might get bedsores, and that was bad. But there were other problems I hadn’t solved, and they had worse consequences. I had, correctly I think, decided to focus on those first.

When I do this kind of triaging (the example that comes to mind first is learning competitive fighting games), I often (certainly not always) do end up trying to fix some of my lower-priority common mistakes at the same time, but just not caring about them as much. This often seems to make them easier to fix than if I had prioritized them, which seems related to the main point of your post.

I feel almost ashamed for asking that question, partly because it's quite impolite and inappropriate to ask a question like that (at least outside of LW) and maybe also because it might betray some kind of deeply rooted egghead-elitism on my part that I still can't quite manage shake off, but I simply can't resist this attempt to satisfy my raging curiosity: What's the reason why someone as smart as you chooses to become a nurse?

Also: Do you think of your perfectionism as largely useful, largely a hindrance, or kind-of-a-mixed-bag?

Lots of reasons. The reasons why I originally chose it at age 15 aren't all the same reasons why I keep doing it now.

At age 15: -I wanted to get better at social skills, and nursing seemed like good practice for that. -I wanted a steady guaranteed well-paying job after 4 years of university. Not many things promise that. Nursing does. (My hospital guaranteed me a job, in the unit that I wanted, a year before I even graduated.) -I read number of books by Tilda Shalof about working as an ICU nurse, and my response to them was a powerful "yes, that, I want to do that."

Now: -It's exciting and varied, and challenges and rewards many different parts of me. On a good day at work, I'm curious. I'm admitting a patient and we don't quite know what's going on yet and I stay after the end of my shift to look up their lab results because I fought to get that bloodwork (it's really hard to do blood draws on someone who's in severe shock) and I want to know. On a good day at work, I care. I have the same sweet old lady for a week and she's telling me her life story and keeping me laughing as I coax and cajole her to get up in the chair an extra time, walk an extra lap around the unit, eat one more bite of hospital chicken puree. On a good day, I'm a well-oiled part in a machine much bigger than myself, a necessary and essential member of a great team, and it feels awesome. On a good day, I'm proud: of the IV I put in, the infected central line site that I noticed first, of the antibiotics I reminded the doctor to change, of the help I gave the other nurses. There are some bad days, and lots of meh days, but the work that I'm doing is always important...and in a way that my System 1 can really grasp. No productivity hacks required; I don't need urging to work my butt off. -I'm 22 years old and I have $50K in savings. And job security forever. That's pretty rare. -I have skills that are unusual within the rationality community. Nursing, like engineering, takes in random first-year undergrads and trains them to have a specified set of skills–and, in the process, to see the world in a particular way. I think like a nurse. It makes me inexplicably good at some things, like running logistics for CFAR workshops. It's brought me up to average or above average in a lot of areas, like reacting under pressure and most types of social skills. It's made me generically useful. And I don't think it's done making me more useful. I'm not even a particularly good nurse yet; you aren't expected to be until ~5 years in.

(Perfectionism: useful overall. It might make my learning curve flatter at first, but I think I'll keep improving for longer.)

I probably won't do nursing forever. It's pretty varied, but it's not infinitely varied. Currently I'm having too much fun at work to want to leave; if I'm bored in five years, and I can find a way to legally work in the US in any capacity other than nursing, there are a bunch of interesting things I could do.

Thanks for the response, that was an interesting read.

As for perfectionism - In retrospect I think it was a huge drag on my own well-being and social relationships but helpful in getting things done. I am much less of a perfectionist nowadays and that has improved my life in many ways at the cost of making me somewhat less effective when it comes to work. Perfectionism for me wasn't just about my work but also about myself and others - seeing the imperfections and trying to iron them out. A pattern of perception if you will that didn't see the good things about myself and others and predominantly focused on optimizing the negatives. I feel much better now after changing that pattern of perception, so I was interested in how you thought of it - also outside of work.

Interesting. I don't have that kind of perfectionist view about other people. At all. I guess I have high expectations for myself (including my work) but I'm also okay with being human and doing things to take care of myself.

It seems like you're trying to ask this nicely, which is good, and I don't know how Swimmer963 feels about this so I'm not upset on her behalf, but in general I read this sort of comment as less insulting when it doesn't use a phrase like "someone as smart as you".

...I don't understand how that part is insulting. I don't use smart as a weak form of intelligent if that's what you mean, exactly the opposite in fact. I'm sorry maybe I'm losing some finer point of the English language as I'm not a native speaker, but I would really like you, or someone, to try to explain how that part could possibly be interpreted as insulting because I honestly don't see it.

Edit: I'm also not implying that it's work unworthy or anything at all, I'm honestly just genuinely curious why she chose that profession because where I'm from it's a respected job because people know (or imagine to know) how hard the work is, but simultaneously it's also a job that's very much at the bottom of the food chain in terms of pay and status. I'm simply curious why she chose it.

It sort of fits an (not very common) idiomatic pattern where the compliment is empty-to-sarcastic, but it seems pretty obvious that you didn't intend it that way, and I can't actually think of any examples I learned the idiom from.

I get it. Makes sense, actually now that you point it out I think I've also seen this phrase employed as a "pseudo-compliment". Rest assured that it wasn't intended that way.

I figured it wasn't.

Maybe because someone wants to?

It might fit one's preferences better than programming, and the pay isn't different by orders of magnitude.

Yes but the question is why do they want to? :)

I've worked in elderly care myself a long time ago when I was around 15 years old, which I imagine is quite comparable to being a nurse but I've found the work to be very hard both physically and emotionally (a lot of suffering and occasionally death to deal with). In fact it inspired me to do better in school just to not have to do work this hard for what back then I envisioned being "the rest of my life".

In Germany you either finish school with after 9, 10 or 12 (back then 13) years and you could only study at a University (without jumping through hoops) after attaining your 12/13 year school diploma. I was in the 10-year school type and working in elderly care was pretty much the type of work I might have to do if I left school after 10 years. My grades improved and I switched schools after 10 years and did another 3 just to "escape" hard work like that.

I like work that's hard. The difference between us might be as simple as that. I even like work that's physically hard. There's something really satisfying about getting home from work and how good it feels to sit down and rest your feet, and how you know that the tiredness means you were especially useful that day.

Well, why does anyone want to do anything? Your question implied that there one might want to "do better", which strikes me as underinformed.

EDIT I just figured out something really interesting but am almost out of charge in the computer, will update in a bit

Maybe it was, looking at that 50000€/y number solipsist quotes. In Germany you earn barely half of that before tax.

But that's not at all the main reason why I ask to be perfectly honest. I remember Swimmer portraying herself as having some form of social anxieties so this job strikes me as a particularly counterintuitive choice.

Healthcare in the US is more expensive than in Germany, and the relative status may be different. The mean salary for US registered nurses is just over €50,000.

I had similar meta-suffering relating to anger. One of the most helpful ideas was Society of Mind, in particular 'self-therapy' (Internal Family Systems Model). I would guess that it has similar effects pertaining to acceptance because it encourages you to consider inappropriate or undesired behavior as (at least partially) the actions of a distinct sub-personality.