16 ms·

How Silicon Valley is dealing with mental illness

• andrewvc 11y ago
  I've lost 2 people I know to suicide in tech. I've known others who've come close. We need to do something about it. What, I don't know, but mainstream psychiatry isn't that effective.
  • TTPrograms 11y ago
    Why do you claim that mainstream psychiatry is ineffective? How do we know that people simply aren't taking advantage of mainstream psychiatry (to the degree necessary)?
    • mysticlabs 11y ago
      A lot of people who commit suicide are typically on antidepressants and seeing therapists. Yet they never report this in the media. Antidepressants even carry a black box warning they can increase suicidal thinking. Wouldn't surprise me if half the valley was on meds of some kind. Psychiatry is mostly based on an unproven hypothesis of chemical imbalance in the brain. Of which there's no actual scientific evidence to back up this claim. In fact, studies have concluded antidepressants can cause imbalances where nonexisted before, and can cause severe life threatening withdrawals if you stop taking them suddenly. Psychiatry is a pretty flawed practice in my opinion as well. I'm sure it helps some people, but it also does a lot of harm as well.
      • cgriswald 11y ago
        > A lot of people who commit suicide are typically on antidepressants and seeing therapists. A lot of people die in emergency departments under the care of doctors. There's a reason for that that has nothing to do with the ability of the doctors. > Antidepressants even carry a black box warning they can increase suicidal thinking. Which is in part due to the unscientific (but legally sound) way that such side effects are attached to these drugs. I'm less concerned with the fact that they are labelled thusly and more concerned with the fact that in some cases there have been statistical increases in suicides. Yes, that is a problem, but you're both separating that out of the larger picture of pharmaceuticals and dumping it in with psychiatry in general. > Psychiatry is mostly based on an unproven hypothesis of chemical imbalance in the brain. Of which there's no actual scientific evidence to back up this claim. This is an incredibly bold claim with no actual scientific evidence to back it up. There is, in fact, a lot of science backing up psychiatry and psychology (entire journals). Their experiments use widely accepted techniques that are also used in other sciences, like biology and medicine. > In fact, studies have concluded antidepressants can cause imbalances where nonexisted before, No study has made this blanket conclusion. Perhaps some studies have reached this conclusion about a specific class of anti-depressant or a single anti-depressant. But you can't use that as evidence that psychiatry is flawed. First, anyone in medicine who can prescribe medication can prescribe antidepressants even if they aren't trained in psychiatry. Second, many medications can cause problems in our systems; it's why we have the prescription system in the first place. Antidepressants are not unique in this regard and therefore do not reflect on psychiatry in the specific. > and can cause severe life threatening withdrawals if you stop taking them suddenly. Just like many other pharmaceuticals, some antidepressants can cause withdrawal symptoms when the patient is not weaned off the medication properly. Noncompliance is a problem in ALL medicine. In the realm of mental illness there is also the problems of stigma and lack of proper insurance coverage both of which can create additional problems with compliance. > Psychiatry is a pretty flawed practice in my opinion as well. I'm sure it helps some people, but it also does a lot of harm as well. I won't see anyone without a Ph.D. A Ph.D. means they've done some science. But (just as with MDs),it's no guarantee that they're critical thinkers and scientists when they get out into the world and practice. But mine can cite papers, recommend reading, form reasoned opinions, and his Ph.D. thesis is impressive (I asked to see it). I suspect you're largely judging the field from the current state of affairs: massive stigma, poor insurance coverage, and mediocre practitioners who are quick to write prescriptions but slow to make sure the long term healing is done. Find a psychiatrist, psychology, MFT, or whoever through your average insurance plan and you're more likely than not getting a counselor more than an actual therapeutic healer. But these are largely economic and social problems, not a question of the effectiveness of the healing.
      • gcr 11y ago
        Which studies? I'd be interested in reading your references.
        • messick 11y ago
          Those are pretty much Scientology's talking points, so here's a reference for you: http://www.scientology.org/faq/scientology-in-society/why-is-scientology-opposed-to-psychiatric-abuses.html http://www.scientology.org/faq/scientology-in-society/why-is...
          • gcr 11y ago
            Oy. Are any of these references accepted by well-respected scientists in the community?
            • DanBC 11y ago
              No, obviously not. But "don't just stop taking your meds" is on the patient information leaflet for every ssri / snri / nasa / etc style anti-depressant because suddenly stopping is significantly risky. (For some of them, eg venlafaxine, it's pretty unpleasant too.)
      • tedks 11y ago
        Antidepressants commonly cause suicide by treating the physical retardation symptoms of depression before treating mood symptoms. If someone is so depressed they can't get out of bed, then starts taking an antidepressant, they might continue to be just as depressed, but now have the energy to get out of bed. This is especially common with teens. SSRIs definitely do work for some people, but the mechanism isn't well understood and is well-researched. There is plenty of actual scientific evidence to back up the serotonin imbalance hypothesis, but of course no amount of evidence can ever prove a theory true. There are other findings that indicate other theories -- my personal favorite is that the antidepressant effect of SSRIs is from incidental neurogenesis, and NSI-189 looks promising as the first of hopefully many antidepressant drugs coming from this theoretical basis entirely. While a lot of people who commit suicide are being treated for a mental illness, the majority of people who complete suicide (i.e., actually kill themselves) are not in any sort of treatment. Suicide is actually a very impulsive behavior in most cases. For this reason, if you make the means of suicide less available (putting fences up on bridges, gun control, etc.), you actually decrease the incidence of suicide even though there are plenty of ways people can kill themselves. A few nits to your post: * Psychiatry isn't based on a chemical imbalance hypothesis. SSRIs, and some other drugs, are. Psychiatry as a whole is far too wide to be based on any particular theory, except maybe probabilistic determinism (the assumption that events have causes that can be used to predict the future). * Psychiatrists are medical doctors with a specialty in mental health. "Psychiatry" is not a very well-defined area, and usually indicates the speaker is a Scientology crank. The actual field you discuss in your post is psycho-pharmacology. You don't comment at all on diagnostic procedures, which is a major non-pharmocological component of a psychiatrist's job, nor on non-pharmocological therapies, some of which have been very well-studied and indicate to the best of our scientific ability to be reliably positive mental health interventions. As a final note, it wouldn't surprise me if all of the Valley, and indeed most of the world, was on "meds" of some kind. Most people drink. A lot of people smoke. Marijuana is legal in California and is going to be legal soon in the general case. Video games exist that are thin wrappers around psychological reward pathways, and are functionally equivalent to drugs, even if they don't involve ingesting or inhaling anything. There are very few "pure" humans. The question isn't whether or not someone is "on meds," but whether they're getting what they need as a person to self-actualize. PS: I recognize I have made a number of factual claims in this post. I have not included any links to scientific papers because it took long enough to type out and I didn't want to spend twice as long digging through sources. I'll provide the papers I thought of while writing this, but only under one condition: anyone asking for them shows convincing (to me) evidence that they have looked for these sources on their own. I help those who help themselves.
    • andrewvc 11y ago
      A starting point http://www.nytimes.com/2013/05/02/books/greenbergs-book-of-woe-and-francess-saving-normal.html http://www.nytimes.com/2013/05/02/books/greenbergs-book-of-w...
    • jonesb6 11y ago
      Anecdotally my personal experiences lead me to believe mainstream psychiatry almost always includes a bottle of pills.
    • 0xcde4c3db 11y ago
      It's not so much ineffective as insufficiently effective. At least for mood disorders, most patients need to try more than one treatment regimen before finding one that works (in the sense of having a sustained and appreciable reduction in symptoms without intolerable side effects), and a substantial minority never find a treatment regimen that they're satisfied with. The biggest study on this that I know of is STAR*D, which focuses on depression treatments [1]. [1] http://www.edc.gsph.pitt.edu/stard/ http://www.edc.gsph.pitt.edu/stard/
    • andrewvc 11y ago
      The idea that there is one "mainstream psychiatry" is somewhat naive. It varies quite a bit from country to country, and the US does it somewhat horribly. Don't take my word for it, the man who chaired the committee for the DSM-V thinks so (nd he wrote a book about it called "Saving Normal". Regardless of what you think about psychiatry from a theoretical perspective (e.g. what studies show), there is a MASSIVE gap between what practicing psychiatrists do and what happens in studies. As a country we are over-diagnosed (the DSM says x% of the population will have a given condition based on clinical research, yet somehow a massively larger # of people will be prescribed pills for it due to incompetent doctors and drug company advertising.. On top of that we have almost no idea what the mechanism of action is for any of these drugs. We take people, let's look at veterans for example, who have gone through traumatic events and say: "I guess going through that war there messed up some chemicals, take these!". It turns out there is a lot more in the way of treatment than just pills. At the same time these people are living in the streets and have no connection to community or family. There are more dimensions to mental illness than just chemicals in the brain. Here's an interesting non-pill related approach that's apparently helped some vets who were beyond treatment from pills ( http://www.nytimes.com/2016/01/31/magazine/what-does-a-parrot-know-about-ptsd.html http://www.nytimes.com/2016/01/31/magazine/what-does-a-parro... ). Here's another example, in convenient peer-review form "The findings, from by far the most rigorous trial to date conducted in the United States, concluded that schizophrenia patients who received a program intended to keep dosages of antipsychotic medication as low as possible and emphasize one-on-one talk therapy and family support made greater strides in recovery over the first two years of treatment than patients who got the usual drug-focused care." http://www.nytimes.com/2015/10/20/health/talk-therapy-found-to-ease-schizophrenia.html http://www.nytimes.com/2015/10/20/health/talk-therapy-found-... Unfortunately I can only open the door here, the material is complex and voluminous. I do encourage you to research and read on your own. The foundations of mainstream psych in American are shaky, and drug companies truly have an undue amount of influence in shaping research and policy.
    • marincounty 11y ago
      Psychiatry is at the bottom of a deep pit. My hope is Millenials live long enough for this profession to pull itself back, at least half way up. We were lied to about the effectiveness of SSRI drugs by the drug companies. Psychiatrists were as much victims as their patients. I don't blame Psychiatrists. I have the look on my Psychiatrist face imprinted, when I sat in that chair, and told him "That drug did nothing." It got to the point where I felt like lying. "It kinda worked?" But I didn't. It was my life--I wanted to get better. I finally found a drug that worked, a little bit. I think that's the rub. You need to see a Psychiatrist to find a drug that works a little bit. Keep in mind that drug might be habit forming, so only go if you are certain your condition is Not Situational. If your psychiatrist just offers SSRI's, ot tricyclics; find another Psychiatrist. If you do find a drug that seems to work, be prepared for mandatory office visits. They need to make a living. (These drugs should be regulated differently, but that's another fight. By regulated, I mean, if you are on a long term drug; you shouldn't have to see a psychiatrist to get refills.) If I was to do it over again, I'm not sure I would take anything, but my anxiety was not situational. It came from "I have no clue. Just life?". I have found controlled use of alcohol helps. Try to keep the alcohol to a minimum. Two drinks for a panic attact. Don't drink socially. You are drinking to control that busted gasket. It needs time to heal. An understanding family really helps. I have said this before, and I have no reason to lie. You will get better with time. I have gotten to read my Psychiatrists face/non-verbal tells. I believe it when he says "Anti-depressants do work for some of my patients." I've looked into the litature, and they might help some really depressed patients? Might? If you are seriously suicidial go to the hospital. Don't rule out ECT. (Use it as a last resort, but don't kill yourself. Emergency room personal are prepared to deal with psychiatric emergencies.) And again, if you are reading this and just not feeling right, a little dizzy, just not right; you will get better with time. As to the original question; No--mainstream Americans does not need to see a Psychiatrist. Most good Psychiatrists only want to see the patients who don't respond to a Psychologist's therapy. As to therapy--give it a shot, I guess? I found it completely useless. I think they did more damage to a once innocent twenty something mind? They might have changed? My psychologist was a Freudian. I remember making an a appointment with another Psychologist. "What's your reason for seeing Dr.whatever?" Me, "I was told I have a Electra Complex." Office, "A what?" It's funny now. Good luck! If you know someone fighting these problems, don't give offer them worn our clichés. Whatever you do, don't take advantage of a wounded individual. I was financially abused at my worst. Will never forget that retched person.
  • 0xcde4c3db 11y ago
    For all the faults and limitations of mainstream psychiatry (which are varied and substantial), it's pretty much the only game in town with a verified track record. Arguments against mainstream psychiatry are a dime a dozen, but arguments for alternatives tend to be fluffy philosophical assertions and broad-brush accusations of misconduct rather than real-world demonstrations that something else works significantly better (with N >> 1, of course).
    • andrewvc 11y ago
      Yes, but that's comparing mainstream psychiatry to an alternative. Compared to just not doing anything mainstream psych is often bad. See http://www.nytimes.com/2013/05/02/books/greenbergs-book-of-woe-and-francess-saving-normal.html http://www.nytimes.com/2013/05/02/books/greenbergs-book-of-w...
    • spangry 11y ago
      On the upside, psychiatry and neuroscience are beginning to merge. The disease model of mental illness is such a poor abstraction. And diagnostics in psychiatry is mostly contained to subjective self-reported symptoms. And then treatment is basically a crapshoot; trial and error with antidepressants that don't have well understood causative mechanisms. As neuroimaging becomes ubiquitous and cheaper, it will replace self-reporting as the primary diagnostic tool. At which point we'll be able to do away from the 'DSM disease model' and actually see which 'neural circuits' are dysfunctional. Consequently, medication will be better calibrated and targeted. I really think we're on the verge of a psychiatric revolution, and will all be better off as a result.
    • throwawaymaroon 11y ago
      It would be more accurate and insightful, I think, to note that psychiatry is the attempt at a verified track record. It's not so much that it is the only game in town as it is the result of recording our attempts in a coherent fashion. Its failures point to the difficulty of the problem more than anything.
  • Mz 11y ago
    One of the problems with mainstream psychiatry is that it does not work to pay someone to care. It also does not work to pay someone by the hour for this type problem rather than paying them for results. I don't know how to fix it. I do think military shrinks have a better track record. They are still employed, even if you get better. They don't have an inherent incentive to want you to keep being in need of "help" so they can finance a second home or some shit.
    • superuser2 11y ago
      Good therapists are overbooked and have waiting lists for new patients. They will be the same number of hours even with substantially less contact per patient.
  • such_a_casual 11y ago
    Sorry for your losses.
• sarciszewski 11y ago
  Warning: Autoplay video.
  • chillwaves 11y ago
    You da real MVP
• goodJobWalrus 11y ago
  It seems to me that suicide in tech is talked about a lot (more than in any other profession, except for maybe armed forces), but I have never seen data that it is any more common than in other professions. Can anyone point to some actual data on that?
  • awqrre 11y ago
    I've heard that the more that you talk about it, the more it is likely to happen...
    • Mz 11y ago
      As someone who has attempted suicide and been hospitalized twice for being suicidal, I will suggest that how you talk about it is a huge factor in whether it makes it more likely or less likely.
      • Perihelion 11y ago
        Agreed. I think the stigma around mental illness has a lot to do with how people react to it. Society tells us it's embarrassing and a sign of weakness and many people suffer in silence until it's too late. Fortunately this industry appears to be more open about it.
        • Mz 11y ago
          I cannot wait until we stop using the term "mental illness" entirely. I have a serious medical condition. It is classified as a dread disease because enduring it is horrible. I also was molested and raped as a child. On the one hand, some of my suicidal tendencies are rooted in physical, chemical side effects of what my condition does to my brain. On the other hand, there is absolutely nothing crazy about wanting my suffering to end and feeling like death is the only answer. And it pisses me off, because it doesn't have to be that way. But that is a rant I do not even want to get into at the moment.
          • 11y ago
• trafficjam30125 11y ago
  It's disgusting and inconsistent that Y Combinator is claiming to be taking a stand against this when it sends people like Buchheit out to attack one of our most talented people, just because Paul Graham doesn't like what he says occasionally.
  • cpncrunch 11y ago
    What are you referring to?
    • coddingtonbear 11y ago
      I'm supposing he's referring to the public dispute Paul Graham and Michael Church have been having for some time.
      • trafficjam30125 11y ago
        Yes, that idiocy. Of course, Graham himself looks clean because he leans on his attack dogs.
      • dang 11y ago
        There's no such 'dispute'. It's 100% imaginary.
        • deleted 11y ago
          [deleted]
        • consz 11y ago
          Is this why michaelochurch account hasn't been posting as much lately? I always thought that was the most interesting user that posted here, why push him away?
          • dang 11y ago
            We banned michaelochurch because of https://news.ycombinator.com/item?id=10017538 https://news.ycombinator.com/item?id=10017538 after a long history of abusing this site and countless requests to stop. Since then he's made up all kinds of things, such as the comment upthread.
• MollyR 11y ago
  My cousin used to work there as startup developer. He attempted suicide due to depression and loneliness. He was on SSRI's and Klonopin?. He had trouble with relationships, and was isolated from family (all on the east coast). My uncle brought him back, and our extended family has been taking care of him. He's doing a lot better. I don't mean to be an armchair psychiatrist, but I think loneliness and or stress can exacerbate depression, and family or something like it can make a world of difference.
  • 67726e 11y ago
    At the very least, it doesn't help. I currently work remote, and I've definitely had more depressive thoughts being alone so damned much. I've also had plenty of thoughts when working in an office with lots of great people. Part of me wonders if part of what makes me a good developer also hurts my mental health. I have to focus on the grin realities of a situation. I can't just pretend things are all fuzzy and nice.
  • Theodores 11y ago
    Yay! I like what your family are doing, that is fantastic. Keep up the good work. Those pills cannot and will not ever be a substitute for what you guys can do with the love that you are offering this cousin. Hopefully it is not a one-way street, maybe through helping this wayward cousin your wider family have seen this 'getting better' and found reward in that, to be a happier family, even if there have been set-backs and disappointments along the way.
• taurath 11y ago
  People don't talk about having anxiety or depression in the office, or mood changes. Its expected that you just hide it. Tech gives you more leeway to do your own thing most of the time which I'm thankful for, but I can't call out to work because I'm feeling extra anxious one day. I DO end up working at home those days, rare as they are. The stigma that would be attached to me as a "weak-willed" person that sometimes has anxiety issues would be devastating for my career - people do not allow others leadership positions unless they can demonstrate a steady hand. Simply the suggestion that you are facing internal strife enough to mention it in the workplace can be a very large hit to your perception as a solid worker. Managers want consistency in the work output above all else frequently, despite all of our emotional hardware. Simply admitting that you have good days and bad days can sometimes feel like quite a feat.
  • whitegrape 11y ago
    Daily standups and a fear of being "caught" on those days where you maybe spent the whole day getting around to doing something that would take you 30 minutes in the zone add to the stress. Standups become vague/dishonest to further hide the issue. The truth is sometimes you just need to blow off the whole day, maybe even a whole few days. A lot of devs actually understand needing to take random days off here and there even without having underlying issues. But it's hard to justify to managers taking those off, even if unpaid (let alone a random week off after you've determined Monday morning you're just not into it at all). I suspect a culture of open slack would make the stressed out employees a lot less stressed out, but it probably isn't great for the business. There was a startup that was hiring in the Seattle area a few months ago that stated upfront they only sort of want you to work 20 hours a week, very loose, I wonder how it's going. This is even worse when you're recovering from burnout. If you reveal you suffered from burnout and are still recovering, you're effectively admitting your productive output is some percentage of what it used to be. Even if you used to be above average, you're implying that you're probably below-average now, and it'd make more economic sense to replace you or at least pay you much less. (And I bet a lot of devs actually would probably give up half their salary in exchange for only being expected to be around half the time, which may be a good compromise.) From the business owner side I sympathize with wanting to have a workforce full of Carmacks. But realistically speaking, that's very hard to accomplish, and there's something to be said for giving even us somewhat defective mortals something constructive to do so long as we're not contributing negative value that isn't based on pure economic utility.
• 20years 11y ago
  I may get down voted for this but I wonder if this is partly due to the false hype that is associated with being a software developer in Silicon Valley. Young kids with stars in their eyes go out there thinking they are going to hit it big with their startup or working for a hot startup only to discover it is not so easy. It would be interesting to see stats of suicides or attempted suicides for tech workers in Silicon Valley vs other areas. If much higher in SF to the ratio of workers then that should be something to look at.
  • pmorici 11y ago
    When you get out of college and enter the work force it is also the first time a lot of people will really see the world as it is instead of how they were taught it was. That can be depressing.
• eruditely 11y ago
  A mental illness that is actually dealt with perfectly with the line of medications on the shelves is ADHD, in which you get symptomatic remission as long as it's in your bloodstream. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3568402/ http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3568402/ It's not only severe, but will pretty much screw you up(not being able to perceive time and act on time across long distances and all), but hey it works! Nothing else works as well as what's available for ADHD for other mental disorders. http://www.medicalnewstoday.com/articles/289931.php http://www.medicalnewstoday.com/articles/289931.php <-- Showing that adhd doubles your mortality rate compared to the general population. Here is the abstract http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)61684-6/fulltext http://www.thelancet.com/journals/lancet/article/PIIS0140-67...
  • unimpressive 11y ago
    >It's not only severe, but will pretty much screw you up(not being able to perceive time and act on time across long distances and all), but hey it works! The medication, or the disorder? Because that's a pretty succinct description of ADHD.
    • eruditely 11y ago
      The disorder.
• gizi 11y ago
  Many things can help you to overcome feelings of depression. It is not an issue impossible to address. However, what certainly contributes to it, is social isolation. Therefore, the rampant individualization of western/urban society badly exacerbates the problem. Nowadays, many people do not even have something like a wife or a husband. Gone are the days when people would share their lives with someone special to them. They are too immersed in hardcore individualism for that. Another issue contributing to the problem is the lack of spirituality. People often underestimate the therapeutic value of things like religion. Growing levels of atheism and skepticism concerning the meaning of life take away this resource and in that way prematurely terminate lives otherwise worthwhile to live. Medication can obviously do its part to assist with depression, but not on top of the ruins created by hardcore individualization and totalitarian de-spiritualization.
• gerbilly 11y ago
  I myself now know that I self selected for software development _because_ of my anxiety, and I think anxious people might be over-represented in the profession. As we all know programming is complicated, and even the simplest algorithm can produce wildly unexpected results. Anxiety makes you better at detecting danger, and in the realm of software the danger is bugs and bad interactions and so on. We all approach programming differently, there are some deliberative types, some who wing it etc, but I expect that anxious people may be a big sub-population. (Also if someone is anxious, it doesn't necessarily mean they are socially anxious or shy. I myself seem 'normal' and can be gregarious and give talks, but I do have trait anxiety.)
• orionblastar 11y ago
  I was doing alright until from the stress I developed schizoaffective disorder. I ended up on disability. Once people know you are mentally ill they don't want you around as an employee and find reasons to get rid of you. HR finds out when a doctor diagnoses you and you get psyche medicine on your health insurance. Then you are seen as a liability. So a lot of people don't seek help for fear they might get fired and not be able to work again. This has to change in the industry so that mentally ill people get help and support so they can keep their jobs and contribute to the company. When companies think about disabilities they think about people in wheelchairs, the deaf, the blind but not the mentally ill who have a hidden disability and still need support and accommodation.
  • nradov 11y ago
    I find it hard to believe that your health insurer informed your employer about a prescribed medication. That would be a serious violation of federal law and most insurers are careful about compliance. More likely your employer found out some other way, or fired you for a different reason.
    • orionblastar 11y ago
      Maybe they found out another way? When I got sick I filed for short-term disability in June 2001. I had doctor's excuse notes, and one of them was from a psychiatrist. I returned in November 2001 and was fired after being back on the job for two weeks. They claimed to have lost my doctor's notes and claimed I did stuff at work during the days I missed. When it went to unemployment the state sided with me as their days conflicted what they claimed, including I was in a hospital for some of the days they claimed I did stuff at work. Someone visited me at the hospital and asked me questions and wrote things down about me. I never knew who they represented. They might have found out by that way. Anyway since they had the conflicts in the dates, I should have filed a suit with the EEOC. But somehow they knew I was mentally ill and tried to get rid of me because of it. At work I had an episode where I heard two airplanes crashing into the building, so people knew I was hearing things. That could have tipped them off as well.
• donretag 11y ago
  I find this article ironic since every time I visit San Francisco, I see loads of homeless people, many with mental illness, on the streets. I guess Silicon Valley only cares when it is their own.
  • dang 11y ago
    "Only" is a bit uncharitable. The one doesn't exclude the other.
  • Mz 11y ago
    You know, I have had a class on homelessness through SFSU and I have spent a bit over 4 years homeless. I am still on the street. A few facts: The problems of homeless individuals are typically intractable and not readily solved. They often gravitate to larger cities both because you get to be more anonymous that way and because there are more support resources available than in a small town. When I took that class on homelessness through SFSU, I learned that New York is about ten times the population of San Francisco and they have similar numbers of homeless people on the street. Part of the reason is the beautiful weather in San Francisco. You are much less likely to freeze to death there or die of heat prostration there than in most other places in the U.S. and it rains relatively little. Part of the reason is the generous benefits in San Francisco. It actively attracts homeless people. When I first hit the street, I traveled from the East Coast to San Diego. It has less rain than San Francisco and a lower cost of living, but is a large enough city to have soup kitchens and other resources. I spent six months in downtown where there is a concentration if support programs, then traveled north as I became less needy. I later left the county entirely, seeking out a lower cost city, but one still large enough to have the resources I need and where I won't stand out excessively. Although I fervently wish that there was not so much prejudice against me for being homeless and I fervently wish I could get more help, I mostly do not want charity. I mostly want people online to take my need to develop an online income more seriously. I wish people online, in places like Hacker News, were more capable of seeing me as an intelligent, competent human being who is medically handicapped, not an incompetent dolt and not "just a skirt." I am on the street to get myself well. I very much need more earned income, a message that mostly falls on deaf ears while people treat me like a beggar, a charity case or a damsel in distress who is after their money. My pleas to help me figure out how to develop an online income stream of earned income are dismissed and ignored, often by the same people who would like for me to shut up and stop telling people I am homeless because they interpret that admission as a request for a handout. I have had at least three friends offer me a place to stay. I turned them down. They were on the East Coast or the Gulf Coast and the housing would not have been adequate to my needs for other reasons. I very much would like to get off the street, but not at the cost of the health improvements for which I have paid such a dear price. Your judginess of people in Silicon Valley is rooted in nothing but ignorance. It takes a lot more than good intentions and money to help people with long term, intractable personal problems. I absolutely would accept housing at this point, but only if it met the picky standards necessary to keep me healthy. This rules out both homeless shelters and rental housing. It is imperative that I somehow go from homeless to homeowner. If you think you are morally superior to the people in Silicon Valley, feel free to stick about $50k or $100k in my PayPal account so I can go house shopping. If not, perhaps you can at least rein in your ignorant contempt for a city that has more homeless people than average in part because it gives them more support than average.
• Outdoorsman 11y ago
  Jobs in our industry are "intense"... Speaking for myself, I chose this profession, years ago, because I loved problem solving, absolutely loved it... I also knew I was the type of person who needed a certain amount of time away from other people, for long stretches of time, to "recharge" my social self... Which means I am, at heart, an introvert...I need time away from people to be at my best....my wife loves me for that...I can't explain why, but she does...I married better than she did in my opinion... Nevertheless, as our industry "speeds up" I wonder how many excellent "problem solvers" will be pushed beyond their "mechanical limits"...?
  • askafriend 11y ago
    She probably loves you for that because she gets her own space too, to do things that she likes without having to constantly always think about this anchor of another person. I'm horrified at the idea of being in a relationship where people don't get their own space to pursue their own interests and grow/learn together but also independently.
• grimmdude 11y ago
  I post a lot of dumb comments on HN, mostly because I find too many people take things too seriously here. But anxiety is something that I can very much relate to being a work from home developer. I'm still learning the best ways to cope/treat, but I can't say enough about getting enough exercise. I definitely don't do it enough now, but when I do there's an unmistakable decrease in my anxiety level the following day. But I'm talking like running, or something else that really gets me exhausted; not just a walk around the block. I'm a skinny guy too, which for me is another excuse to not have to exercise; which I think is not uncommon amongst developers.
  • such_a_casual 11y ago
    Not to start a flame war with you, but in the hope that maybe I can make this panacea a little less popular I want to get something off my chest. Every time someone has a problem with mental health, whether it's depression, anxiety, drug withdrawal, etc the answer from the audience is always exercise. I'm only one data point, but I've exercised more days of my life than not and have observed absolutely no difference in mental health between the me that exercises and the me that doesn't. What about athletes: students-athletes, NBA players, olympians. Do they show a significantly lower rate of mental health issues? This argument has been floating around in my head for a while. The reason I think this suggestion is harmful is because it is the most vocal and popular, and yet excludes anyone who already exercises. Who is recommending this? My hypothesis is people who only exercise every once in a while and so they get a huge hit of endorphins and think, "Man if I did this every day I would feel great." Maybe, some people with mental health issues use exercise as an escape and are really recommending it for its temporary relief. But I'm just in denial about the majority of people being people who didn't exercise, were miserable/anxious/whatever, started exercising and now they're happy/normal/perfect. Again, I'm not trying to start any arguments here. For those of you who have been saved by exercise, I'm envious. I would really just like to see more answers than this instead of seeing it as the go to answer. It makes the assumption that people who have mental health issues don't exercise.
    • andrewvc 11y ago
      If I had to guess people at the highest level of any profession are more likely to have mental issues. I wouldn't say that looking at the mood of Olympic weight lifters would say a lot about the general population's response to exercise.
• aswanson 11y ago
  A lot of it comes down to exercise and diet. Skipping breakfast after a night of drinking can lead to a low level of blood sugar; this gets worse as we age and has the effect of depression. You have to closely monitor your blood sugar level, even if you have never been diagnosed as having any psychiatric precondition.
  • gizi 11y ago
    Besides diet and exercise, there is also the issue of social hygiene. Many people have become hardcore individualists. They do not even have a husband or a wife, let alone have meaningful interactions with other family members. You see, regular sex is not just a way of having fun. It is also something that contributes to your mental well being and assists in keeping you out of depressions and other mental issues. The same holds true for meaning-seeking spirituality such as in religion and meditation. It is one of the things that helps keeping you mentally healthy. For hardcore individualists and anti-spiritualists is their entire lifestyle that is in question.
    • xxpor 11y ago
      So not being married is a sign of being mentally ill?
      • humanrebar 11y ago
        I think the point was that regular sex is good for mental health.
    • humanrebar 11y ago
      > The same holds true for meaning-seeking spirituality such as in religion and meditation. It is one of the things that helps keeping you mentally healthy. Ironically that's a fairly meaningless statement. "Finding meaning" can actually be counterproductive if I find a self-destructive meaning or one that hurts the people I care about. Now if you mean we should break out of day-to-day scurrying about and searching for actual truth... I can buy that. But I've seen people "find their own meaning" with catastrophic personal consequences.
• lr4444lr 11y ago
  ... Let me guess, by moving those afflicted into management? As for the founders, isn't it expected to some degree?
• PragmaticPulp 11y ago
  The comments here are a great example of why mental health treatment is such a difficult problem for the tech crowd: Most of the comments are from people who believe they have a better handle a mental health diagnosis and treatment than actual psychiatrists, and many of them are quite wrong. Some of them dangerously so. Depression, anxiety, suicidal ideation, ADHD, and other mental health issues are extremely complex issues that can't be universally explained away by blood sugar or lack of spouses or loneliness as some of commenters here confidently claim. Every case is different, every person has their own complex set of issues and maladaptive coping behaviors and external stressors, and everyone responds to medications and lifestyle changes differently. Perhaps more importantly, navigating all of those individual variations is best left to a close patient-doctor relationship, leveraging each patients' feedback against the doctor's years of clinical experience. The mistake many people make is trying to map others' mental health disorders on to their own prior experiences. That's why you see so many comments from people confidently declaring that curing depression is as simple as exercising because they felt sad a few years ago but felt better when they started running. That's great, and exercise is likely to help everyone, but that doesn't mean that another person's depression is simply a lack of exercise. Don't ever discount or downplay another person's mental health suffering, because that's only going to make things harder for them. Mental health sufferers often feel significant guilt about their symptoms, and having someone dismiss or downplay their suffering only compounds that. Modern psychiatry isn't perfect and has plenty of room for improvement, but frankly it's a whole lot better than the comments here make it out to be. If you're struggling with mental health issues, make it a priority to see a professional. Get a second or third opinion if you're not happy with your treatment. But whatever you do, don't get sucked in to the misinformed internet commenters trying to discourage people from seeking treatment. Psychiatry can take some time, but the area under the curve of even marginal mental health improvements can add up to a huge difference over the course of your life.
  • milkytron 11y ago
    Your statements don't only apply to the tech crowd; I feel as though what you just said could easily be pasted across the web to provide a huge amount of help to anyone suffering from symptoms of mental illness. I am no expert, but this certainly helped my understanding of the issue a great deal, and I'm sure it would for others as well.
• jorgecurio 11y ago
  hey guys I hope to offer some words of comfort. The delusion is that life is infinite. It is not. Especially so when we are young. As we get older, we feel like we are running out of time, we haven't done enough. This is why I think some people commit suicide when their startups dont take off. They can't accept a reality that everything they are doing is ephemeral. So when your startup fails, or some software you worked on for 4 years without any pay goes to shit because you couldn't get enough customers, brush this shit off because life and universe is ephemeral and even more so ephmeral are the failures to meet your own expectations and others. So what? Failing at startup isn't a fucking crime? There's no Russian mob coming to reclaim the "equity" that you owe them. Similarly if you succeed, the world just goes on. You might get cover, you might serve as inspiration, you will have changed your life and everything money can buy. But I think that in the end, if you think about it, money is important but not the entirety of our human existence. At age 29, having boostrapped to failure for the past 6 years, I'm no longer hung up about it. Now this might sound like the fox claiming that the grape is sour because he can't reach it, but money, a single fixation on success or a particular product that you built (and you fall in love with your own creation), is unhealthy and frankly a waste of pure fucking energy. This is why I've given up on chasing one idea or marrying myself to one goal. I'm also slowly turning my back away from bootstrapping and focusing on how I can raise money. The only painful realization is that I could've done 6 years of work in just 6 months with 6 engineers. Now that I've done the entire shit myself from the ground up, I have a pretty fucking good idea how to build something from scratch and turn it into a product. Startup is not a one man game, it's really coming together, sharing the pain and growing as individuals and as a group. Success should be the goal but I believe the process is equally important in getting to that goal. I may not ever reach it and that's fine. What's important is that I've tried the best I absolutely can and being proud of what I've built. That's all you can do and just walk away and keep going. And don't get caught up with trends, noise, techcrunch and other non-essential activities that adds to the anxiety. Just do you. Remember that life is ephemeral. Suicide is a permanent approach at a temporary problem! This failure, the stress, the depression, the mania, all this, even the lack of money...all of this is just temporary. Nothing lasts forever.
• Theodores 11y ago
  I would like to invite some hackers out there to apply the 'hacker approach' of problem solving to the task of helping others that have depression. Please do so out of your own self interest (rather than pity, charity, guilt or social obligation). At time of writing I only have two people that I go out of my way to 'level the playing field' for. This costs me time and money, real time and real money. For one of my 'clients' I have taken time off work to help them find a proper roof over their head and I covered a few bills to make sure that worked out (things like furniture and food in the cupboards had to be magically paid for). Notionally they are expected to do some work in my sister's allotment when the weather gets better to repay the favour. Obviously I won't hold them to that, this was just a creative device to move things along a bit without there being any feelings of pride getting hurt. Importantly I don't pass on silly advice, e.g. 'you should get a job...' blah, blah. In this example, why bother??? I could have bought myself toys, or I could have gone on a really exciting city break given the time + money outlay. Well, to answer that question, yesterday, this mystery 'client' of mine sent me through some jobs that they really wanted to go for. I was hoping that might happen in about 3 months time, no pressure though. But yes, I was delighted that, out of the blue, they should send this stuff through to me. We don't normally talk work, I assumed it was not what they were ready for. I would describe my approach as fairly hands off, we text/message most days but not all. We do things together about once a week - meals, cinema, gigs, galleries and all those normal things that normal people do as well as just hang out in the reasonably appointed flat. At the moment I am on a bit of a winning streak with this mystery 'client'. Health has been restored, which to me is quite a miracle, something I did not expect to see. Mystery 'client' also has friends and other social invites out, again quite miraculous given the 'no mates' start. My 'clients' can be from any walk of life, any age, any gender. I mentor difficult teenagers too, one at a time, with work placement stuff. I am truly stoked with the success I have had on that front, the last two have been no-hopers, total worries to their respective mums. One of them is now at Oxford University, the other at Imperial College. I played a little part in that, helping them become sons their mums are truly proud of. I would say the process was 'osmosis' with no expectation of such stellar results. Furry animals and elderly neighbours are also on the books from time to time. I am proud of all of them. Sure I choose carefully, I do not reach out to those with alcohol dependency problems (I have tried though...). However, both of my current 'clients' would possibly be actually homeless without my on-going help. So, for anyone reading this, please do reach out to others, even if it costs real time and money with no promise of results. Just imagine what the world would be like if everyone able to do so did go the extra mile to help out a couple of others with depression related problems. Imagine how inspiring the world could be.
• tbrock 11y ago
  Oh my gosh, Austen was in my class in college. I didn't know he had passed away until reading this article.
• BananaPelican 11y ago
  I wish that I could be more vulnerable with my coworkers. Last year I grappled with intense impostor syndrome that ballooned into generalized anxiety and depression, exacerbated heavily by the feeling that I couldn't let any sign of weakness through. Eventually I reached a breaking point and had to say something to my manager; fortunately he was understanding, but I still worry that his confidence in me has been eroded. My breakthrough came when I was given an important task. It seemed logically inconsistent for someone who was hanging on by a thread and really not an effective employee (my self-narrative) to be entrusted with a task that genuinely mattered. I still feel weak for saying this, but hearing another person say, "It was hard for me when I first joined this team too. Don't worry, you're doing a good job." was all I wanted. Is Silicon Valley unique in lacking this openness? I suspect not, but have no basis of comparison.
  • Infinitesimus 11y ago
    I think it's up to us to begin to make that change in our work environments. I've made it a point to be a bit more vocal with new devs whenever I can about the reality of impostor syndrome and that it's 100% normal. Use your experience as a way to guide new hires on your company and slowly, change will come
• lettergram 11y ago
  There's a good book/presentation by Greg Baugues I saw a while back about developers and depression. Essentially, it's about how he had a lot of issues, how he dealt with it, and how we as a whole culture need to help improve repport about mental health. https://vimeo.com/72690223 https://vimeo.com/72690223
• timwaagh 11y ago
  I suppose they don't. but its still much better to dislike your life and be rich than to dislike your life and be poor. after all one can always get treatment after getting rich and retiring.
• hackercomplex 11y ago
  I'll tell you an open secret: Focusing very intently on difficult maths for an extended period of time can make almost anyone begin to experience aspects of mental illness. The physics community has dealt with this, DOD code breakers deal with it, the manhattan project, etc. It's a well studied phenomena because of how it related to the war effort and much of the research documentation is declassified, in the public domain, and is a matter of the historical record. My point is software development is just another domain where this research applies. This information is generally recognized by the pop culture as evidenced by the fact that there are several blockbuster movies about it, for example the film 'Pi' by Darren Aronofsky and 'A beautiful mind'. However this phenomena is generally not accepted by the startup community. I assume that the reason for this is because recognizing it could theoretically lead to a rise in insurance cases by engineers who developed serious mental illness over time due to prolonged exposure to what were known to be unsafe working conditions. In my opinion it should be thought of as a high risk job akin to scuba instructor, or roofer. So the whole thing is swept under the rug. Never the less I will give my recommendations as a developer who works all the time and has wrestled with this phenomena in the past: - Force yourself to hike/walk/bike outdoors for at least an hour per day. I'm convinced that merely jogging on a tread mill or gym excercise does not have the same benefit. Think of the outdoors (and the sun) as a relief valve for the "cabin fever" effect. - A daily Zazen practice (15 minutes+) This is the kind of meditation from Japanese buddhism where you're not trying to accomplish or "do" anything, you just sit, in a good posture. I think of this as putting your overclocked CPU in hibernate mode long enough for the heat sync to do it's thing. I think this can provide a similar effect to having had a couple extra good hours of sleep, and all it costs is a few minutes of your day. The more you practice it, the better it works. - healthy diet and exercise - yoga (or just plain stretching) - Do not under-estimate prolonged caffeine consumption as a likely co-factor for many symptoms. Always eliminate this as a possibility whenever you can - As a relaxation excercise take a break during your day and spend a few minutes in a quiet place directing your attention to any area of your back, neck, shoulders, or even your face whereever you expereince a sensation of pressure or weight. Sometimes just stopping to pay attention that these muscle groups are becoming tense is enough to help them relax some. - super mellow music at a low volume even if it's not what you prefer generally can help when writing software. Classical music, downtempo, ambient, chill-out, atomospheric drum and bass, even unusual stuff like gregorian chant. It can be slow and boring, after all it's less about entertainment and more about the cumulative effect it has on your brain when used as background music. example of downtempo genre: https://www.youtube.com/watch?v=tYdebVcZDPw https://www.youtube.com/watch?v=tYdebVcZDPw soma.fm/groovesalad plays a good mix imho. There's good studies on this on mice. A good rule of thumb is asking yourself this question "could this song be characterized as 'intense' in any way ?" if so then save it for some other activity
• mettamage 11y ago
  Perhaps this link is slightly relevant. I just received it last night through an IFTTT alert. exercise + meditation one hour for two days per week --> 40% reduction in symptoms of major depressive disorder. To me the results sound a bit too staggering but the most interesting idea is that the researchers believe that exercise + meditation have an additive effect. So meditation or exercise alone is less effective than doing meditation first (breathing meditation, they didn't body scan) and then exercise right after it (running). In my humble opinion, that's an idea worth considering and that's an idea worth implementing in the company's culture. Provided that this study replicates well and is actually true ;) http://www.sciencedaily.com/releases/2016/02/160210134834.htm http://www.sciencedaily.com/releases/2016/02/160210134834.ht... Sam Altman suggested in Startup School to "fix it" (w.r.t. burnout) because when doing a startup you don't have the luxury of taking time off. This is a way of how to fix it, and if you don't have the luxury to take an hour off to boost productivity, then there's an uneven trade going on (more hours working for less productivity). It's not a silver bullet unfortunately, but then again what is?
  • thephyber 11y ago
    I always find it curious to treat "exercise" as a boolean. I have played basketball, football, ran cross country, multiple events in track & field, jogged, lifted weights, snowboarded, played ultimate frisbee, and done daily situps by the hundreds (a la American Psycho). They all have a different affect on your body and they require differing amounts of preparation and concentration. I don't think all forms of exercise are considered equal and I suspect that different kinds of exercises would likely yield different results. Notice that many of the examples of exercise I used are team sports and others are individual activities. I don't think this distinction can be ignored. Also, having concrete goals for exercise gives a person a different level of motivation than just a vague "allot X minutes in my schedule for some sort of exercise". The idea of the combination of exercise + meditation is interesting. I feel like this would also lead to better sleep habits and more concentration and self-regulation of your schedule, which are both beneficial in their own ways.
    • mettamage 11y ago