[This post is the first post of my thirty-day writing project, where I write one blog post per day for thirty days straight. Tune in for more!]
I, for most of my life, could have been easily identified as someone with strong ADHD, OCD, and anxiety symptoms. Now I don’t really have these symptoms. What changed, and why do I think most people can do something like this?
Disclaimer: this is an opinion post done by someone without a shred of laboratory evidence for their thesis. Take it as such. I’m going to use words in this post like “definitely” and “totally possible”—this reflects what I really think (i.e., what I’d bet money on), and it’s supported by my personal experience. The plural of personal anecdote is empirical, right? Anyway.... If you disagree with me, then fine. I don’t care. You’re right. You win. I don’t know you. I’m unaware that you’re actually the one person this advice doesn’t apply to. Awesome. You can’t get over it. You’re doomed forever. Stop reading now and save your time.
Introduction
The short answer on what changed from my childhood: I systematically changed my behavior to not exhibit any more symptoms of these disorders. To show you that this answer isn’t as trite as it seems, I’d like to take a step back and show you how I think about “three-letter disorders” (OCD, ADD, ADHD, GAD, MDD, etc.) in general. I think this is most easily introduced via an example.
Let’s say there is a kid named Johnny in your class in school, and Johnny is hyperactive, impulsive, forgetful, and a procrastinator. You end up getting tired of being around Johnny and his loser self, and so you ask him:
“Johnny, why are you so damn lazy? You are forgetful, impulsive, a procrastinator, and you distract everyone around you too! What the hell is wrong with you?”
Johnny replies,
“Well, I have ADHD! It’s not my fault that I do all of these things. My ADHD makes me hyperactive, impulsive, forgetful, and a procrastinator.”
Your eyebrow raises and you say,
“Seems suspicious Johnny—how do you even know that you have ADHD in the first place?”
With an eye roll, Johnny replies
“Ugh, I obviously have ADHD because I’m hyperactive, impulsive, forgetful, and a procrastinator!”
Wait—does Johnny have ADHD because he does all of those things, or does he do all of those things because he has ADHD? To answer this question, it might be useful to zoom out and see how psychological disorders are thought about in practice.
A rough picture of disorder classification and diagnosis
Let’s say you have some collection of traits, like forgetfulness, attention span, impulsivity, extraversion, agreeableness, etc. These traits are assumed to roughly be normally distributed—that is, it’s expected that most people have roughly average amounts of any given trait. As it turns out, some of these traits covary. Doing empirical tests tells you that for certain people, if you find out that they have a high degree of forgetfulness, they actually also have a higher likelihood of having a hard time regulating their attention span. You also find that they are unusually impulsive and tend to wildly procrastinate. You find that there are actually big clumps of traits—characterized entirely by behaviors—that tend to strongly covary in certain people, and in fact, the traits that are present are present to high amounts. Amounts that cause real negative interference in their life.
The most parsimonious explanation of this data is that there is actually one factor causing all of these different traits—let’s call this factor A for now. Some other names I considered were D and H, and actually D again. But anyway. If you find out that someone has property A, then you can reliably predict that they will exhibit a selection of traits, demonstrating each one of which to a level that negatively interferes with their life. [1]
This is roughly how psychological disorders are discovered and subsequently diagnosed. [2] Our property A can be something like OCD, ADHD, GAD, MDD, etc. (This psychometrics-style analysis is also the cause of the best personality and IQ classifications.) These properties are abstract labels meant to classify the fact that the person with the label exhibits a multitude of correlated traits that negatively impact their lives due to their severity. These traits are assumed to have a root cause largely in a single factor, like weird dopamine uptake in the brain, or an overactive amygdala.
Inferences
There are two pertinent things to point out here. The first is that the diagnosis of a disorder is entirely a behavioral analysis. (Note that I’m counting thought patterns as behaviors—they are simply behaviors of the mind.) Disorders are diagnosed by what you do. If you didn’t do any of those things, then you would be indistinguishable from someone without the disorder, short of a brain scan. The second thing to point out is that a disorder doesn’t makeyou do anything. It just biases you towards certain behaviors and not others. When you procrastinate on your homework, it’s not because a physical ADHD demon was sitting next to you, firmly gripping your right thumb, and swiping up on Instagram reels for three hours straight—it was because you chose to doomscroll!
What’s the punchline of this? It’s that disorders are characterized by behavior, and you control your behavior, and thus you can control whether or not you “have” a disorder. If I’m focused, don’t forget things, am not impulsive, and don’t procrastinate, then I consider the fact that you ascribe the 1st, 4th, 8th, and 4th letter of the alphabet to my behavior a causally effete description. If a label can’t predict what I do, then it’s irrelevant.
*You control whether or not you have a disorder. Period.*
There are clear objections to what I’m writing here. I’m not going to exhaustively respond to them, at least in part because some of them are actually right. I believe that a small fraction of people can’t change their behavior to the point of their symptoms not dramatically impacting their life. I’m lucky that I got the level of disorders that only caused one super serious breakdown and a few failed classes instead of, like, a lifetime of misery and agoraphobia. If you are one of the unlucky few with serious mental conditions, you have my overwhelming empathy.
However, if you’re reading this, that’s simply not you. There is an overwhelming chance you are not one of these select few individuals that God chose to YOLO the serotonin and dopamine receptors of. And if you think you are, you’re probably wrong.[3] Stop coping with your own failures, and take accountability for your actions. You can change the fact that you have a three-letter disorder. It just takes effort and the right way of going about things.
Steelman of the opposing viewpoint and objection handling
I think the strongest steelman of the opposing viewpoint is something like this:
“This post is wrong on a few levels. First, a psychological diagnosis is far more complicated than you let on—it takes a trained professional multiple sessions to be able to reliably discern whether or not someone has a disorder, and they have to train for, like, a decade to be able to do it accurately. Second, rejecting a label is just cope. You just don’t like the fact that you have [X] disorder, so you say that it’s all a behavioral thing and blah blah causally effete blah blah. Just because you refuse to ascribe a label to yourself obviously doesn’t mean that it doesn’t still affect your life. Third, by making this into a heroic sigma-grindset willpower thing, you’re foregoing some of the best actual treatments for your disorder. Psychologists aren’t idiots—if telling someone to ‘just change your behavior, bro’ worked, they would have done it by now. The things that actually work are medication and therapy, which show really good results in most cases. By placing the burden entirely on yourself, you ignore the most effective ways to get treatment.
Also, was your armchair nice and comfy when you wrote this post? I hope it wasn’t. You are really showcasing your ignorance about (a) psychology in general and (b) the lived experience of people with these disorders by writing this piece. Also, if you take what you said to its natural conclusion, then it would follow that psychologists shouldn’t study people with these disorders to try and make their lives better—y’know, since it’s all a behavior thing, right? All of the people helped by CBT, ERP, SSRIs, antipsychotic medication. Yeah, those people should have just tried harder instead. Lmao. Do better man.”
Whew. That was a scathing takedown of my position. Because of this, I’d like to respond with some clarification of what I actually think.
First, the psychological diagnosis picture I painted was indeed a picture, and not a photorealistic one at that. It’s more complicated than that. But really, the essential characteristics are there. The actual way psychological disorders are characterized in the DSM is by expert consensus and clinical observation—not the factor analysis picture I was painting earlier. Diagnostically, it takes a psychologist or psychiatrist interviewing you, along with first-order evidence from your childhood, to come to an accurate diagnosis of a disorder. The point I really wanted to make with the rough scene I depicted was that a “diagnosis” isn’t a psychologist reading the tea leaves and telling you they saw The Grim—it’s simply a behavioral-level analysis that could have been done if someone had followed you around with a video camera your whole life. (It’s actually the case that many disorders have overlapping trait profiles, and thus this isn’t really accurate. But I think you can see my point.) This is really what I mean by saying that a diagnosis is a behavioral thing—saying that “OCD” made you do something is reifying an abstraction. You made you do something. Yeah, maybe it seemed like pulling on the door handle three times is Definitely The Right Number of Times To Pull On A Door Handle™, but you were still the one who did it. And you could have not done it, despite the fact that your brain is telling you that if you don’t do that, your entire family will burn in Turbo Hell forever or something.
Second—am I just coping super hard here? I don’t think I am. If someone asked me if I have ADHD or OCD, I’d probably say no. This is because I don’t really exhibit symptoms of these disorders, and by my personal ontology, this means that I don’t “have” these disorders. But if you really pushed me, I’d tell you that I “used to” have these disorders. I’m not ashamed of this, which is why I’m putting it in a public blog post for everyone to see. And I’m not pigheadedly rejecting a label just for the sake of it. I genuinely think it’s unproductive to view disorders as reified abstractions—the power you gain by viewing them accurately is dramatic. Things like “procrastination” stop being these vague, unchangeable truisms about your character, and start becoming dry, third-person observations you can change. For example, you go from saying things like “I procrastinated on my work for like three hours by going on Instagram because of my ADHD” to “When I go on social media after I get back from school around 5pm and I am tired, I tend to spend too long on it.” The first thing, “procrastination” and “ADHD”, you can’t change. The second? You definitely can. And in fact, this holds for more subtle things as well. Things like “I’m ruminating on my upcoming test because of my OCD” turns into,
“I’m obsessively thinking about my test later because its presence triggers anxious feelings in me. I check and re-check my test preparation to ease my anxiety, and compulsively play out disaster scenarios and what I’d do in response to try and prepare myself for if I do poorly.”
If you’re anything like me, I can come up with pretty plausible solutions to end the behavior of the latter two examples, but I can’t end the former. Ending the former behaviors would require me to vanquish the grand beings of “procrastination” and “OCD”, while the latter are simple behavioral modifications that I can just... do.
[Thank you to Claude for generating this photo.]
Another way you could phrase this is that you are giving up personal power by being vague with your failure modes. Saying that something bad happened “because” of your three-letter disorder is simply false. You may have a greater incidence of unproductive tendencies due to the way your brain chemistry works, but all this is is probabilistic up-weighting of negative options in your purview. You can still choose the positive option. Doing this on a consistent basis will probably require you to structure your life in a way that neurotypical people don’t have to, but this is just something you can do to get the results you want. It’s behavior all the way down.
The final sub-point I’ll make on this second point is that people oftentimes over-ascribe behavior to their disorder rather than themselves. That is, if a person knows they have ADHD, and then they see themselves procrastinate, they will frequently ascribe this to their ADHD rather than just normal human behavior. You could say their “It’s my ADHD!” gun is a bit trigger-happy. The truth is that everyone procrastinates. It’s a normal thing. But the tricky part about being neurodivergent is that you don’t know what it’s like in anyone else’s mind, so you’re liable to see every deficiency in yourself as the consequence of some ethereal disorder rather than the normal human experience. This is obviously a really bad thing, as (a) it’s inaccurate, and (b) it creates a sense of powerlessness in the person experiencing it. I think really the only solution here is to not identify with a disorder in any meaningful sense. You just have to take responsibility for everything in your life and treat it as a behavioral issue. That’s the only way I’ve found to consistently and effectively change the behaviors that I don’t want in my life.
Third, am I advocating for an austere, willpower-based, grindset approach to curing disorders, thus foregoing the more effective treatments of therapy and medication? Kind of, but not really. I think there is no real way that you can consistently mitigate the symptoms of your three-letter disorder if you just try to be a sigma and grind through the pain. At least, I can’t do this. I instead advocate for using systems to change behavior. I, for example, have to implement a strict system to avoid procrastinating like crazy. If I instead tried to not procrastinate by flexing my David Goggins Just Try Harder muscles, I would wildly fail. I know this about myself at this point, and so I instead mitigate my failure modes with a system.
The rough-and-ready definition of a system is that a system is a structure that you put on your life to reduce the amount of willpower you have to use to make good decisions. The idealized version of a system that people should strive for is a system that requires you to use zero willpower to make good decisions. In practice, a “system” really just looks like some sort of schedule or to-do list for the day, along with some habits that you consistently practice. I will give some concrete advice that you can build into your own life later in this post.
I also think that therapy and medication are great! I think you should do what works, and these things work! A good therapist and/or psychiatrist is super useful in helping you get over your three-letter disorder. Talk therapy and CBT are first-line defenses for a number of disorders. And although I can’t speak from experience here, I have heard that medication is a wonderful addition to many people’s lives, especially for things like ADHD and anxiety. I think that building a good system is the crux of improvement for a disorder, and that therapy and medication can greatly help this improvement along.
This also addresses the last point in the steelman above: I think studying these disorders is the only way to fix them permanently, and so psychologists, psychiatrists, and a number of other mental health professionals are integral to this project. By “fix”, I mean that an afflicted person doesn’t have to undergo a system of behavioral modification to achieve normal results—if you “fix” them at the level of their brain chemistry or similar, then they just by default do the normal behavior. I think that as long as AI doesn’t kill everyone in the next few years, these disorders will be a thing of the past by 2035. For example, I think that there will be a “tirzepatide for ADHD” in the next ten years.
Practical methods to get rid of your three-letter disorder
These are some methods that I’ve found useful for reducing various symptoms I have had in the past:
ADHD:
Keep Do Not Disturb on at all times. This is obvious and I almost forgot to write it. Clearly having notifications interrupt you at all times of the day is not good for your focus.
Get rid of social media. Short-form content demolishes your attention span. Try going without it for two weeks to see what I’m talking about. Even long-form content isn’t really safe in my opinion. I’d recommend setting your screentime on these apps and websites to zero minutes per day and then having a friend or partner set the password so you don’t have access to it. You will act like a rabid caged animal to try and get access to social media. You need to make it extremely difficult for you to access it. Do whatever you need to do to block things for yourself. Succeeding in this, however, pays wild dividends, not only for your attention span, but in your overall mental health as well.
Single-tasking only. When you do something, just do that thing and nothing else. Don’t scroll social media while you’re talking to someone. Don’t listen to music while studying. Don’t have a conversation with your friend while doing your homework. Just do the thing in front of you and do literally nothing else.
Corollary: Do not switch your attention. This is the same thing as multi-tasking but it sounds different. You should organize tasks and your environment in such a way that you do not have to switch your attention basically ever. It dramatically worsens your ability to focus, as by constantly task-switching, you’re literally training yourself to not focus for longer than five seconds. Interestingly, I’ve found that when I was deep in my vibe-coding days, my attention span got noticeably worse—I think this is because I was bouncing between five Claude Code tabs at all times, and thus constantly switching my attention.
Control your environment. The ideal working environment is a small room with a single desk, nothing on the walls, no noise, and no other people in it. This is the ideal you should try and aim for when working. Anything that isn’t the work is a distraction. Practically, this means you should try and study in an empty library, or in a room in a library. Some people can study in their room and some can’t. Experiment and figure out what works for you. Something to be critical of: do not confuse loneliness or boredom for a lack of focus. Yes, studying without anyone else around and with no music is more boring than otherwise—grow up.
Stick to a schedule. Do everything at around the same time every day. Wake up, go to bed, eat meals, work out, work/study, and do your hygiene on a schedule. The good thing about schedules is that you get to make them, so if you don’t like something, you can just change it!
Practice being focused. Who would have thought that actually practicing being focused increases your focus? I’ve noticed that when I get many (4+) hours of consistent deep work in, my brain chemistry changes. I get more focused everywhere by being focused for long periods of time.
Exercise and sleep well. These have been proven to dramatically increase quality-of-life, as well as improve ADHD symptoms. They should be your baseline attacks in the war for more focus.
OCD
Get therapy and learn about the basic tools. This is a two-parter. First, if there are specific life events that you tend to obsess over, talk therapy might be a good idea. Second, a therapist can work with and expose you to OCD-treatment techniques. Some of the basic tools for OCD treatment are (talk to an LLM about these if you want to know more): CBT, ERP ⊆ CBT, meditation (for anxiety reduction), and SSRIs. Talk to Claude or a trained professional to learn more about these.
Lower your baseline anxiety. OCD is primarily an anxiety-driven disorder, and so lowering your overall anxiety will likely reduce your OCD—how to reduce anxiety has taken up many textbooks, but the basics are:
Exercise
Sleep well and keep regular sleep and wake times
Have and cultivate good social relationships
Do some form of religion or mindfulness practice
Have a quality life/romantic partner
Simply try to actively reduce your anxiety by, e.g., “un-clenching” or other similar cognitive reframing techniques
Be consistent. This is my biggest piece of advice. Just consistently try things, do more of what works, discard what doesn’t work, and be willing to listen to your own advice. Everyone has their own tips and tricks for their own psychology. The sad fact of pre-ASI life is that only you can really find these things out about yourself, and the only way to do it is to try stuff and see what works.
Anxiety
See above (first two bullet points apply here—just replace “OCD” with “anxiety”). Anxiety is a tricky thing, because the ways to reduce it are actually really obvious and straightforward—you just have to be consistent with them for it to actually work.
Summary
In summary, I believe that you can “get over” your three-letter disorder by implementing a system of behavioral change in your life. Disorders are labels we give to parsimoniously describe bundles of behaviors—they are not abstractions that have “power” over your life. Change your behaviors and the label becomes causally effete. That is, the label can’t predict what you do, and thus there is a real sense in which you do not have the disorder. This advice doesn’t hold for some people, but I would bet that it holds for most. A good system should aim to minimize the amount of willpower you need to make good decisions. A system like this may include the components of therapy and medication. It should definitely include exercise, good sleep, and consistency above all.
There is another characterization of disorders called the network model of psychopathology (Borsboom 2017), as opposed to the latent factor model that I’m proposing here. Basically, the network model posits that there are sort-of “equilibria” when it comes to systems of behaviors, and that doing any one behavior in a system reinforces you to do the other behaviors. So there is not some global latent factor causing all of these things separately—it’s the symptoms themselves that reinforce all of the other symptoms. See this post for an introduction.
Really, psychological disorders à la the DSM are characterized by clinical observation and expert consensus, but this picture still gives the right idea. I will address the accurate way of diagnosing psychological disorders later in the post, but nothing changes for our conclusion.
I strongly believe that if you’re offended by this, you are part of the group that can change their behavior. Offense tends to occur when, at some level, you think what’s being said is true. If you were a lifetime housebound agoraphobe, it would be so obvious that you are one of the few this doesn’t apply to that you likely wouldn’t be offended. I realize that this is an unfalsifiable heuristic, and that necessarily it will produce false positives, but I think it’s more reliable than not.
Surprisingly, I came to similar conclusions in regards to behavior modifications to reduce symptoms of ADHD and OCD. One place I would like to see the argument fleshed out more is in behavioral genetics; even though we can't see if in a brain scan, it can definitely be apparent from the behavior of the individual that one's genes drives proclivity to a behavior. In a sense, I've had this experiment and it's something that I weigh when I take my actions as a specific behavior of mine can start to mirror a family member who was never in my life. But as you said, there is power to awareness of changing behavior.
One more behavioral note: there are roles that do require some level of context switching. What I found is that if you streamline it (condense your browser to 2-4 tabs at most for example) and find ways of connecting contexts, less switching occurs.
“This post is wrong on a few levels. First, a psychological diagnosis is far more complicated than you let on—it takes a trained professional multiple sessions to be able to reliably discern whether or not someone has a disorder, and they have to train for, like, a decade to be able to do it accurately.
It may differ by country, but at least in the United States individuals can (and are often, including me) be diagnosed in the first session, and mid-levels like PMHNPs are required at minimum 500 faculty-supervised clinical hours (typically ~600-1000) before they can start diagnosing and treating independently. But that only goes to build on your point.
[This post is the first post of my thirty-day writing project, where I write one blog post per day for thirty days straight. Tune in for more!]
I, for most of my life, could have been easily identified as someone with strong ADHD, OCD, and anxiety symptoms. Now I don’t really have these symptoms. What changed, and why do I think most people can do something like this?
Disclaimer: this is an opinion post done by someone without a shred of laboratory evidence for their thesis. Take it as such. I’m going to use words in this post like “definitely” and “totally possible”—this reflects what I really think (i.e., what I’d bet money on), and it’s supported by my personal experience. The plural of personal anecdote is empirical, right? Anyway.... If you disagree with me, then fine. I don’t care. You’re right. You win. I don’t know you. I’m unaware that you’re actually the one person this advice doesn’t apply to. Awesome. You can’t get over it. You’re doomed forever. Stop reading now and save your time.
Introduction
The short answer on what changed from my childhood: I systematically changed my behavior to not exhibit any more symptoms of these disorders. To show you that this answer isn’t as trite as it seems, I’d like to take a step back and show you how I think about “three-letter disorders” (OCD, ADD, ADHD, GAD, MDD, etc.) in general. I think this is most easily introduced via an example.
Let’s say there is a kid named Johnny in your class in school, and Johnny is hyperactive, impulsive, forgetful, and a procrastinator. You end up getting tired of being around Johnny and his loser self, and so you ask him:
“Johnny, why are you so damn lazy? You are forgetful, impulsive, a procrastinator, and you distract everyone around you too! What the hell is wrong with you?”
Johnny replies,
“Well, I have ADHD! It’s not my fault that I do all of these things. My ADHD makes me hyperactive, impulsive, forgetful, and a procrastinator.”
Your eyebrow raises and you say,
“Seems suspicious Johnny—how do you even know that you have ADHD in the first place?”
With an eye roll, Johnny replies
“Ugh, I obviously have ADHD because I’m hyperactive, impulsive, forgetful, and a procrastinator!”
Wait—does Johnny have ADHD because he does all of those things, or does he do all of those things because he has ADHD? To answer this question, it might be useful to zoom out and see how psychological disorders are thought about in practice.
A rough picture of disorder classification and diagnosis
Let’s say you have some collection of traits, like forgetfulness, attention span, impulsivity, extraversion, agreeableness, etc. These traits are assumed to roughly be normally distributed—that is, it’s expected that most people have roughly average amounts of any given trait. As it turns out, some of these traits covary. Doing empirical tests tells you that for certain people, if you find out that they have a high degree of forgetfulness, they actually also have a higher likelihood of having a hard time regulating their attention span. You also find that they are unusually impulsive and tend to wildly procrastinate. You find that there are actually big clumps of traits—characterized entirely by behaviors—that tend to strongly covary in certain people, and in fact, the traits that are present are present to high amounts. Amounts that cause real negative interference in their life.
The most parsimonious explanation of this data is that there is actually one factor causing all of these different traits—let’s call this factor A for now. Some other names I considered were D and H, and actually D again. But anyway. If you find out that someone has property A, then you can reliably predict that they will exhibit a selection of traits, demonstrating each one of which to a level that negatively interferes with their life. [1]
This is roughly how psychological disorders are discovered and subsequently diagnosed. [2] Our property A can be something like OCD, ADHD, GAD, MDD, etc. (This psychometrics-style analysis is also the cause of the best personality and IQ classifications.) These properties are abstract labels meant to classify the fact that the person with the label exhibits a multitude of correlated traits that negatively impact their lives due to their severity. These traits are assumed to have a root cause largely in a single factor, like weird dopamine uptake in the brain, or an overactive amygdala.
Inferences
There are two pertinent things to point out here. The first is that the diagnosis of a disorder is entirely a behavioral analysis. (Note that I’m counting thought patterns as behaviors—they are simply behaviors of the mind.) Disorders are diagnosed by what you do. If you didn’t do any of those things, then you would be indistinguishable from someone without the disorder, short of a brain scan. The second thing to point out is that a disorder doesn’t make you do anything. It just biases you towards certain behaviors and not others. When you procrastinate on your homework, it’s not because a physical ADHD demon was sitting next to you, firmly gripping your right thumb, and swiping up on Instagram reels for three hours straight—it was because you chose to doomscroll!
What’s the punchline of this? It’s that disorders are characterized by behavior, and you control your behavior, and thus you can control whether or not you “have” a disorder. If I’m focused, don’t forget things, am not impulsive, and don’t procrastinate, then I consider the fact that you ascribe the 1st, 4th, 8th, and 4th letter of the alphabet to my behavior a causally effete description. If a label can’t predict what I do, then it’s irrelevant.
*You control whether or not you have a disorder. Period.*
There are clear objections to what I’m writing here. I’m not going to exhaustively respond to them, at least in part because some of them are actually right. I believe that a small fraction of people can’t change their behavior to the point of their symptoms not dramatically impacting their life. I’m lucky that I got the level of disorders that only caused one super serious breakdown and a few failed classes instead of, like, a lifetime of misery and agoraphobia. If you are one of the unlucky few with serious mental conditions, you have my overwhelming empathy.
However, if you’re reading this, that’s simply not you. There is an overwhelming chance you are not one of these select few individuals that God chose to YOLO the serotonin and dopamine receptors of. And if you think you are, you’re probably wrong.[3] Stop coping with your own failures, and take accountability for your actions. You can change the fact that you have a three-letter disorder. It just takes effort and the right way of going about things.
Steelman of the opposing viewpoint and objection handling
I think the strongest steelman of the opposing viewpoint is something like this:
Whew. That was a scathing takedown of my position. Because of this, I’d like to respond with some clarification of what I actually think.
First, the psychological diagnosis picture I painted was indeed a picture, and not a photorealistic one at that. It’s more complicated than that. But really, the essential characteristics are there. The actual way psychological disorders are characterized in the DSM is by expert consensus and clinical observation—not the factor analysis picture I was painting earlier. Diagnostically, it takes a psychologist or psychiatrist interviewing you, along with first-order evidence from your childhood, to come to an accurate diagnosis of a disorder. The point I really wanted to make with the rough scene I depicted was that a “diagnosis” isn’t a psychologist reading the tea leaves and telling you they saw The Grim—it’s simply a behavioral-level analysis that could have been done if someone had followed you around with a video camera your whole life. (It’s actually the case that many disorders have overlapping trait profiles, and thus this isn’t really accurate. But I think you can see my point.) This is really what I mean by saying that a diagnosis is a behavioral thing—saying that “OCD” made you do something is reifying an abstraction. You made you do something. Yeah, maybe it seemed like pulling on the door handle three times is Definitely The Right Number of Times To Pull On A Door Handle™, but you were still the one who did it. And you could have not done it, despite the fact that your brain is telling you that if you don’t do that, your entire family will burn in Turbo Hell forever or something.
Second—am I just coping super hard here? I don’t think I am. If someone asked me if I have ADHD or OCD, I’d probably say no. This is because I don’t really exhibit symptoms of these disorders, and by my personal ontology, this means that I don’t “have” these disorders. But if you really pushed me, I’d tell you that I “used to” have these disorders. I’m not ashamed of this, which is why I’m putting it in a public blog post for everyone to see. And I’m not pigheadedly rejecting a label just for the sake of it. I genuinely think it’s unproductive to view disorders as reified abstractions—the power you gain by viewing them accurately is dramatic. Things like “procrastination” stop being these vague, unchangeable truisms about your character, and start becoming dry, third-person observations you can change. For example, you go from saying things like “I procrastinated on my work for like three hours by going on Instagram because of my ADHD” to “When I go on social media after I get back from school around 5pm and I am tired, I tend to spend too long on it.” The first thing, “procrastination” and “ADHD”, you can’t change. The second? You definitely can. And in fact, this holds for more subtle things as well. Things like “I’m ruminating on my upcoming test because of my OCD” turns into,
“I’m obsessively thinking about my test later because its presence triggers anxious feelings in me. I check and re-check my test preparation to ease my anxiety, and compulsively play out disaster scenarios and what I’d do in response to try and prepare myself for if I do poorly.”
If you’re anything like me, I can come up with pretty plausible solutions to end the behavior of the latter two examples, but I can’t end the former. Ending the former behaviors would require me to vanquish the grand beings of “procrastination” and “OCD”, while the latter are simple behavioral modifications that I can just... do.
[Thank you to Claude for generating this photo.]
Another way you could phrase this is that you are giving up personal power by being vague with your failure modes. Saying that something bad happened “because” of your three-letter disorder is simply false. You may have a greater incidence of unproductive tendencies due to the way your brain chemistry works, but all this is is probabilistic up-weighting of negative options in your purview. You can still choose the positive option. Doing this on a consistent basis will probably require you to structure your life in a way that neurotypical people don’t have to, but this is just something you can do to get the results you want. It’s behavior all the way down.
The final sub-point I’ll make on this second point is that people oftentimes over-ascribe behavior to their disorder rather than themselves. That is, if a person knows they have ADHD, and then they see themselves procrastinate, they will frequently ascribe this to their ADHD rather than just normal human behavior. You could say their “It’s my ADHD!” gun is a bit trigger-happy. The truth is that everyone procrastinates. It’s a normal thing. But the tricky part about being neurodivergent is that you don’t know what it’s like in anyone else’s mind, so you’re liable to see every deficiency in yourself as the consequence of some ethereal disorder rather than the normal human experience. This is obviously a really bad thing, as (a) it’s inaccurate, and (b) it creates a sense of powerlessness in the person experiencing it. I think really the only solution here is to not identify with a disorder in any meaningful sense. You just have to take responsibility for everything in your life and treat it as a behavioral issue. That’s the only way I’ve found to consistently and effectively change the behaviors that I don’t want in my life.
Third, am I advocating for an austere, willpower-based, grindset approach to curing disorders, thus foregoing the more effective treatments of therapy and medication? Kind of, but not really. I think there is no real way that you can consistently mitigate the symptoms of your three-letter disorder if you just try to be a sigma and grind through the pain. At least, I can’t do this. I instead advocate for using systems to change behavior. I, for example, have to implement a strict system to avoid procrastinating like crazy. If I instead tried to not procrastinate by flexing my David Goggins Just Try Harder muscles, I would wildly fail. I know this about myself at this point, and so I instead mitigate my failure modes with a system.
The rough-and-ready definition of a system is that a system is a structure that you put on your life to reduce the amount of willpower you have to use to make good decisions. The idealized version of a system that people should strive for is a system that requires you to use zero willpower to make good decisions. In practice, a “system” really just looks like some sort of schedule or to-do list for the day, along with some habits that you consistently practice. I will give some concrete advice that you can build into your own life later in this post.
I also think that therapy and medication are great! I think you should do what works, and these things work! A good therapist and/or psychiatrist is super useful in helping you get over your three-letter disorder. Talk therapy and CBT are first-line defenses for a number of disorders. And although I can’t speak from experience here, I have heard that medication is a wonderful addition to many people’s lives, especially for things like ADHD and anxiety. I think that building a good system is the crux of improvement for a disorder, and that therapy and medication can greatly help this improvement along.
This also addresses the last point in the steelman above: I think studying these disorders is the only way to fix them permanently, and so psychologists, psychiatrists, and a number of other mental health professionals are integral to this project. By “fix”, I mean that an afflicted person doesn’t have to undergo a system of behavioral modification to achieve normal results—if you “fix” them at the level of their brain chemistry or similar, then they just by default do the normal behavior. I think that as long as AI doesn’t kill everyone in the next few years, these disorders will be a thing of the past by 2035. For example, I think that there will be a “tirzepatide for ADHD” in the next ten years.
Practical methods to get rid of your three-letter disorder
These are some methods that I’ve found useful for reducing various symptoms I have had in the past:
Summary
In summary, I believe that you can “get over” your three-letter disorder by implementing a system of behavioral change in your life. Disorders are labels we give to parsimoniously describe bundles of behaviors—they are not abstractions that have “power” over your life. Change your behaviors and the label becomes causally effete. That is, the label can’t predict what you do, and thus there is a real sense in which you do not have the disorder. This advice doesn’t hold for some people, but I would bet that it holds for most. A good system should aim to minimize the amount of willpower you need to make good decisions. A system like this may include the components of therapy and medication. It should definitely include exercise, good sleep, and consistency above all.
There is another characterization of disorders called the network model of psychopathology (Borsboom 2017), as opposed to the latent factor model that I’m proposing here. Basically, the network model posits that there are sort-of “equilibria” when it comes to systems of behaviors, and that doing any one behavior in a system reinforces you to do the other behaviors. So there is not some global latent factor causing all of these things separately—it’s the symptoms themselves that reinforce all of the other symptoms. See this post for an introduction.
Really, psychological disorders à la the DSM are characterized by clinical observation and expert consensus, but this picture still gives the right idea. I will address the accurate way of diagnosing psychological disorders later in the post, but nothing changes for our conclusion.
I strongly believe that if you’re offended by this, you are part of the group that can change their behavior. Offense tends to occur when, at some level, you think what’s being said is true. If you were a lifetime housebound agoraphobe, it would be so obvious that you are one of the few this doesn’t apply to that you likely wouldn’t be offended. I realize that this is an unfalsifiable heuristic, and that necessarily it will produce false positives, but I think it’s more reliable than not.