13 ms·

Screw stigma. I’m coming out.

420 points by markmassie 13y ago

markbot 13y ago
This was really well written. It says a lot of things that I feel the tech industry tends to ignore.
ds9 13y ago
This is admirable and I wish the author well. His example may also help others. It should not be taken as a signal that "outing" oneself is advisable for others in comparable situations. This guy is very fortunate that he is well established in a career and can point to good performance in his positions, unaffected (from the employer's point of view) by his condition. Others are much more vulnerable to prejudice and discrimination, and might be better advised to stay closeted.
- DanBC 13y ago
  US law means you must disose your illness if you wish to use anti-discrimination protections. (As I understand it; I am not a lawyer; corrections welcome).
  - chris_wot 13y ago
    That's absolutely ridiculous.
- marcus_holmes 13y ago
  I've outed myself as being depressed and the reaction has been entirely positive. There have been a few people who have reacted "strangely" but, to be honest, having these people clearly identify themselves by their behaviour has been a net positive ;) However, I haven't tried interviewing for jobs yet. I suspect the negatives will really show then. The rational argument (that 40% of our society will undergo treatment for a mental condition at some point, so would they prefer someone who might be mentally ill but in denial, or someone who is aware of the problem, and able to deal with it?) should work in theory. However, almost everyone I've spoken to has either had the same issue themselves but never admitted it publicly, or has a close relative or friend struggle with the same issues and so understands to a certain extent. I think we're seeing the beginning of the end of the stigma.
joyeuse6701 13y ago
I enjoyed that read. I think the world is a better place getting to hear his story.
natural_capital 13y ago
Showcasing your own story to set the precedent for people to acknowledge mental illness as a real illness is a bold and admirable move. I would note however, that the recovery process for every individual is wildly different and shouldn't be overlooked. Acknowledgement of the mental illness issue is one part of the problem, which will hopefully lead to better, more integrated treatment lines in the future.
insensible 13y ago
It's wonderful to have a courageous person breaking the ice on difficult topics. Bravo to Mark. And the love shown by his wife is deeply touching.
teahat 13y ago
Aside from medication, for OCD in particular there are therapeutic options that can be (life-changingly) effective. The OCD centre [http://www.ocdcentre.com/about-us http://www.ocdcentre.com/about-us] is one such place. If you think you might have OCD (last I read the incidence was around 1/30) talking to someone about is the best first step. Especially as one common and pernicious effect of OCD is that it will convince you that you do not have it.
michaelochurch 13y ago
Cyclothymic. That's a bipolar spectrum disorder, but it doesn't match the lay image of the manic-depressive. The episodes are milder and shorter, but they come on quickly. A "depression attack" can last 3 hours, resolve in a panic attack, and be gone 20 minutes later. Most people who know me wouldn't know that I have it. The one "insane" thing I've done (trolling, back in the day) had the specific purpose of keeping insanity out of my "IRL" existence. As with all spectrum disorders, people seem to focus on the visible, uncontainable, and publicly dangerous 0.1% and ignore that 99.9% of people with the disorder or "on the spectrum" are not dangerous, wouldn't fit most people's image of "mentally ill", and can be very well-adjusted. I tend to think of mood disorders as anti-psychopathy. Psychopaths have low or nonexistent mood and emotional sensitivity, which is why they're social high performers and (if ambitious) excel in the work world. Some mood disorders seem to be uncorrelated to context (i.e. episodes happen "for no reason") and that's probably more true of the severe cases, but most people with mood disorders are normal people with hypersensitivity, such as the OP whose brain would take personal criticism extremely seriously, unable to block it out or cope. Aaron Swartz comes to mind as a archetypical anti-psychopath. They tend to be moralistic, less fearful of negative consequences when doing what they think is right, and prone to mood and anxiety disorders. Anti-psychopathy isn't a desirable thing. It can be just as ill-adjusted. Just as psychopathy tends to be good for the individual (in terms of material prosperity, social rank, and sexual access) but bad for society, anti-psychopathy tends to be good for society but harmful to the individual. What's happening right now, in Silicon Valley, is a battle to the death between real technologists (who tend to be anti-psychopaths) and the mainstream business culture of entitled executives and board-whores (psychopaths). With Snapchat and Clinkle setting the tone in the current Valley, rents becoming unaffordable, and no-poach agreements all over the Valley, psychopaths seem to be winning. I think that mood disorders in particular require a certain balance. People tend to do unwise or harmful things, especially when inexperienced, and those with mood disorders are not exceptions. You have to own your actions, even if you made them in a struggle that most people wouldn't understand. That said, it's also important to realize "it's not me, it's them" and keep your pride intact. Mental health issues often give you a front-row seat for how shitty people can be when they think you're weak. Much of what comes out of these disorders isn't harmful in the least. It's just slightly embarrassing, but plenty of people will hang you out to dry just because they're weak, useless cowards. This may be why people with mood disorders (at least, the milder kind that won't interfere with ethical behavior; a truly "manic" person, noting that mania-- not the milder hypomania-- is very rare even in people with bipolar, does not know who he is) tend to evolve into moralistic, hyper-ethical anti-psychopaths. I'll give a semi-fictional example. Let's say you're a programmer and you have a hypomanic episode. You still go to work, don't cause any issues, and spend 2 weeks building something you were never assigned to do. It turns out to be really good work and useful to the company (as much, or moreso, than putting that time in on your assigned work) but your boss is pissed off that you were working on this side project, instead of your assigned work, and tags you as "unreliable". A morally decent person would recognize that as wrong (it's health discrimination, and counterproductive, to punish people with "creative flare-ups") but, even still, stories like that are so common in Silicon Valley as to be unremarkable. Anti-psychopaths tend to need an R&D environment where they're measured by performance over time, rather than minute-by-minute superficial reliability (at which they can't possibly compete) and those, sadly, tend to be turning rare in the current anti-intellectual (and pro-psychopathic) environment.
pyduan 13y ago
This is a courageous article. Sadly, it seems mental illnesses are one of the great taboos of today (and don't even get me started on the state of mental health care in the US). Similarly, mental illnesses are extremely misunderstood, and people tend to distrust people who suffer from one even though illnesses such as depression may affect 5 to 10% of the population [1] and as much as one in four adults are affected by a mental illness in general in a given year [2]. A significant portion of the population is affected, but for the most part it remains unadvisable to talk about it. It's the elephant in the room. This is compounded by the fact American culture in particular tends to disproportionately value extroversion and appearance of happiness. This leads many people to remain closeted by fear of repercussions, both on one's social and work life. Even worse, it prevents people from seeking necessary help because of the attached stigma ("but I'm not crazy!"). There are known cases where people are punished for having seeked professional help. For exemple, people who admitted to "suicidal tendencies", however serious, may be refused US visas [3]. The discrepancy between how willingly people talk about their trip to a doctor vs. a therapist is huge and obvious, and it shouldn't be. Now why should this be relevant for the HN crowd? As someone who's very close to these issues, it seems to me this is one of the few social issues where the tech industry is not as progressive as it could be. Our industry tends to produce myths of super(wo)men with alpha personalities; we admire leaders, disrupters, bigger-than-life personalities, sometimes even assholes. Furthermore, this is a small world where, for better or for worse, a lot depends on word-of-mouth and personal reputation, and where "cultural fit" is openly hailed as a criterion for employment despite the vagueness of the term, which can hide what would otherwise be considered blatant discrimination (cf. that article on ageism not so long ago). The same goes for founders: would you think twice about investing in a non-established individual with a history of OCD? Depression? What I am getting at is that mental illness is a combination of neurobiological and psychological causes, not a weakness in character -- but in an industry that values strength of character above everything else, the fact many ignore this can be extremely destructive. We can do better. The author has done the world a great service by publishing his story. I hope more follow suit. [1] http://www.nimh.nih.gov/statistics/1mdd_adult.shtml http://www.nimh.nih.gov/statistics/1mdd_adult.shtml [2] http://www.nimh.nih.gov/health/publications/the-numbers-count-mental-disorders-in-america/index.shtml http://www.nimh.nih.gov/health/publications/the-numbers-coun... [3] http://www.nolo.com/legal-encyclopedia/how-health-issues-can-make-you-inadmissible-the-us.html http://www.nolo.com/legal-encyclopedia/how-health-issues-can...
JackFr 13y ago
I'm not sure what to think about this. I accept that the author is suffering and in anguish, and I truly wish him well. Despite his obvious accomplishments and all the trappings of success, I would not trade places with him. His subjective experience seems to be painful and is no less real to him than mine is to me. At the same time, I don't think he is ill. While I don't doubt that he is suffering, I don't think it it is helpful to class his suffering as an illness. I don't think anyone argues that his symptoms are caused by an infection or a defect in an organ, so his disorder lacks the physical basis for a typical illness. At the same time, he has symptoms. And therapy, and possibly drugs, make him feel subjectively better. He chooses to engage in a regime of therapy which (presumably) has self reported benefits. But I don't think it is helpful to think of his plight like we think of malaria or polio or heart disease. When we talk about 'emotional disorders', we implicitly take on an enormous amount of cultural context as well as normative judgements about how someone 'should' feel. And the danger is that one will come to believe that an unpleasant mental state in an otherwise healthy brain is something to be cured through the application of science. That being said, I agree with the main point -- that there is no shame in his mental state. I suppose my point is that it is not necessary (and should not be necessary) to reclassify what a disease is in order for a class of people to maintain their dignity. And above all, I wish this man well and by no means mean to diminish his pain, or the courage it took to write this.
- moron4hire 13y ago
  This attitude--that mental illness is not a real disease--is what helps the stigma to continue. You mince it up with nice words around the edges, but it boils down to this: you're part of the problem.
  - Einstalbert 13y ago
    Agreed. I've dealt with mental illness in my family since I was a young child. It's affected my entire life. It's not just some meandering mood or state of mind, it's a frightening thing for which most people have no time or patience.
  - JackFr 13y ago
milesf 13y ago
I used to struggle with Bipolar Spectrum disorder. After 9 years of medication, therapy, prayer, and a lot of ups and downs I've been declared free of the diagnosis by my psychiatrist. I gained a lot of weight because of medications (normal weight is 210lbs, which is fine for my 6' 4" frame, but medication caused me to balloon up to over 444lbs). I have not been able to work at my peak for many years. I'm now almost 45, and I feel like I'm starting to get my life back. Now that I'm off the main drug that treated my disorder (risperidone) my weight is starting to drop. I know people are scared of mental illness. I see it in their faces, or the way they treat me differently as time goes by. But that's okay, I have close friends who have accepted me for who I am without that fear. My wife wishes I wouldn't tell people about my history. My health is no one's business but mine. However, I choose to tell people about it, because of the stigma. Because I'm neither ashamed or afraid for people to know. I _will_ lose friends, work, and opportunities because of my choice to be open about it, but I don't care because I want to fight the stigma. Everyone has a friend or family member that struggles with some form of mental illness. Everyone. I have seen too many people suffer in silence, and some even take their own lives because the pain is too much. I was suicidal years ago. I suffered horribly for many months on end, waking up in the morning and just focussing on getting through the next hour, until I finally reached the end of the day and could go back to sleep so I could have some relief. There is no shame in mental illness. People used to be afraid of people who had heart disease, as if they might "catch something" from them. The brain is the most complex organ in our bodies, and it's prone to have problems just like any other organ. My name is Miles Forrest. I have wrestled with mental illness for many years, and I'm happy to say I have overcome it with help from doctors, family, friends, and God (if you're offended by my attribution to God, please don't be. I respect a person's right to believe whatever they want, all I ask is they respect my right to believe whatever I want). I can't say I'm cured, because there's a possibility I might relapse at some point in the future. But I have acquired the skills, knowledge, and support network that I know, without a doubt, I would be able to beat it back down again. Mental illness doesn't define me, but learning to fight, persevere and lean on others when I need to has made me a better man. You can mock or ridicule me if you want, but I'm not talking to you. I'm talking to the man or woman out there who is afraid there might be something wrong with their mind, and who feel alone and afraid. I know how scary it is. I know how you feel like you're the only person in the world who has felt the way you do. You're not, and you are not alone. If you are that person, email me at miles@coderpath.com, and I will walk with you as a friend and stranger to get you help.
Jtsummers 13y ago
One thing I'd like to add to this discussion. It may be difficult, and it may not be something you should do until they're older, but talk to your children about issues that you have and that run in your family. It can save them a lot of heartache and difficulty down the road if they have similar issues. In particular, knowing my family's history of alcoholism and drug abuse helped me avoid both. Given my issues with depression, if I was drinking like my peers in college, I probably wouldn't be here today. Similarly, I didn't know the cause of their issues (depression) until I was already deep into an episode that lasted a couple years. If I'd known beforehand what to look out for, and that it wasn't uncommon in my family, it might not have lasted as long.
TAC1234567 13y ago
This will not be a popular opinion, nor is it a nice opinion, but sometimes the truth is neither and I think it is valuable to be explicit about these things sometimes. The "stigma" against mental illness makes sense in a lot of ways. I do not mean: that the mentally ill deserve fewer legal rights than others, deserve any kind of bad treatment or violence or ridicule, shouldn't be "accepted", or bear any "responsibility" for their condition. I do mean: life is full of subtle social contracts that mental illness often causes people to flout. Mental illness (in many cases) makes people less predictable and reliable. Harder to deal with. Some people reading this will say "obviously that is true, which we all acknowledge but have no reason to dwell on, and that is why it is a complex situation that demands awareness". Others will say "that is false and you are a bad person". First group, I refer you to second group. If you are 100% committed to the goals of your organization (growing a startup, winning a war, whatever), you will be very hesitant to add a mentally ill person to your team/company/platoon. This makes sense. It sucks. Being mentally ill sucks. This is one of the ways. That doesn't necessarily mean anything needs to or can be done to change it.
- thenomad 13y ago
  There's a huge list of highly successful, productive people who are a credit to the projects they work on, who have or have had mental health issues in the past. If I had the chance, for example, I wouldn't be at all "hesitant" to work with actors Hugh Laurie, Stephen Fry, or Johnnie Depp, despite all of them having well-documented mental health issues. I'd also be very happy to work with Richard Branson (ADHD), or if he were alive today, Nikolai Tesla (OCD and anxiety).
  - TAC1234567 13y ago
    But these examples stand out because they are unusual exceptions. Also, it is possible that acting is a profession unusually accessible to people with certain mental illnesses.
    - thenomad 13y ago
      I've also worked with multiple people with various mental health conditions, who weren't actors, but whom were extremely good at their jobs and I'd cheerfully hire again. Honestly, I've never seen a correlation between "mental health issues" and "would not hire".
deleted 13y ago
[deleted]
rokhayakebe 13y ago
One thing I would like to offer would be for American doctors to perform comparisons across cultures, countries, and societies. I am restricting the above purely to mental illness. There are many mental diseases I only witnessed in America, and not in Africa. I do not know what the meaning of this observation would be if proven factual, but I think it is worth exploring.
- quasque 13y ago
  This is definitely an observed phenomenon, such illnesses are known as culture-bound syndromes. There is the sub-field of transcultural psychiatry which examines these and other cultural differences with respect to mental disorders. Out of interest, what were the mental illnesses you refer to?
- kansface 13y ago
  Check out http://en.wikipedia.org/wiki/Culture-bound_syndrome http://en.wikipedia.org/wiki/Culture-bound_syndrome. Fan favorites include fan death, evil eye, blacking out, and probably multiple personalities.
DanBC 13y ago
People say the treatment in England is much better, and it is, unless you are under 18. MH treatment is underfunded in England (and this has recently been written into commissioning contracts) and it is worse for children and young people. In patient beds for children are limited. A child who needs an in patient bed may have to travel hundreds of miles to get that bed. They may even need to travel to a different country. A child in the south of England may not have a bed available anywhere in England and might need to go to Scotland for a bed. Apart from the obvious cost of distance and the distress of being so far from home (although getting distance from an abusive home can be useful) that child is now under a different legal system. Thus, the rules for detaining them against their will; force feeding; forced medication; etc etc are all slightly different.
- vacri 13y ago
  I used to work in an outpatient neuro department that had a large paediatric patient population. One of the paediatric neurologists there had done her training at a famous children's hospital in London (GOSH) and said that it was a fantastic place to train in, but terrible for the outcome of the children. Where we were in Melbourne, we had four paediatric neurologists for a catchment area of about 400k give or take. GOSH had six neurologists for a catchment area of 2 million. "By the time the kids in London got to see us, the symptoms were so florid and easy to see. Great for training, not so great for outcomes". She did her training in the 90s, so it may have since changed. It's also a story about neurologists, not psychiatrists, but I imagine it wouldn't be that much different.
h1karu 13y ago
In case you never considered it before there is a heavy PROFIT INCENTIVE for your psychiatrist to diagnose you with some form of mental illness that he is familiar with. You need to become a domain expert yourself in order to figure out if you're being manipulated for profit or if the diagnosis is legitimate.
- comrh 13y ago
  Realistically, what do you think is the percentage of doctors manipulate diagnosis for profit because it sounds like a boogey man.
  - h1karu 13y ago
    Most of them, but they don't consciously realize what they're doing in most cases. The norms for their profession slowly creep towards over-pathologizing because of the profit incentive and also because of the effectiveness of advertising campaigns by drug companies. Social norms have changed across a broad demographic to accommodate the large scale systemic misdiagnosis problem. Just because the manipulation for profit is widespread and well accepted does not mean it's not happening.
    - comrh 13y ago
      You're making some big claims with no evidence. Citation needed.
      - h1karu 13y ago
        I was only giving my personal opinion based on the data I've seen. All I'm really advocating here is that every person should educate themselves before accepting any diagnosis. Do your own research and form your own opinions.
- cperciva 13y ago
  At this point, does it really matter if the diagnosis was legitimate? The treatment clearly helped him improve his life dramatically.
comrh 13y ago
Another "coming out" story is from Michael Landsberg, a Canadian hockey analyst on TSN. His hashtag #sicknotweak inspires me when I'm feeling like crap. http://www.thelavinagency.com/blog-mental-health-speaker-michael-landsberg-on-the-cover-of-vista-magazine.html http://www.thelavinagency.com/blog-mental-health-speaker-mic...
D9u 13y ago
From day one here at HN my profile states that I am schizophrenic... Not that it's done me any good here, but I don't see why I should hide this fact from people I am likely to never meet in real life. Kudos to those who could care less about social stigma.
awakened 13y ago
You are suffering and that's OK. You are no less of a person than anyone else. Anxiety is the illness of our age. Don't feel ashamed. We all suffer to some extent. You are very brave for coming forward and you've helped many people by doing so. I suffer too, but I have found peace in Buddhism. I'm more content now than I ever have been (50 years of life). I've learned to live each moment deeply and just breath. Feel my lungs, my feet on the Earth and be happy. The sun will rise tomorrow, but some day it will burn out. Please remember that nothing but you, your family and your actions matter. Your character, integrity, kindness and interactions with others speak volumes. No one can take that away from you. I hope you find peace by learning to overcome your suffering. If you take this path you'll heal yourself and help those around you find relief from their own suffering.
mbesto 13y ago
Someone very close and dear to me has a mental illness. She was super nervous to disclose this to me for fear that I may think differently of her. The thing she most appreciated about my reaction was that I said "Let me know if there is anything that I should know about your illness that may affect you in a way that may make you behave differently than you normally do, otherwise I will behave and act as if it simply doesn't exist." Suffice to say, I don't actually remember what illness she has.
quanticle 13y ago
This quote seems apropos: Though many object to psychiatry’s perceived encroachment into normality, we rarely hear such complaints about the rest of medicine. Few lament that nearly all of us, at some point in our lives, seek care from a physician and take all manner of medications, most without need of a prescription, for one physical ailment or another. If we can accept that it is completely normal to be medically sick, not only with transient conditions such as coughs and colds, but also chronic disorders such as farsightedness, lower back pain, high blood pressure or diabetes, why can’t we accept that it might also be normal to be psychiatrically ill at various points in our lives? The answer seems to be that psychiatric disorders carry a much greater degree of stigma compared with medical conditions. People worry that psychiatrists think everyone is crazy because they make the mistake of equating any form of psychiatric illness with being crazy. But that’s like equating a cough with tuberculosis or lung cancer. http://aeon.co/magazine/being-human/have-psychiatrists-lost-perspective-on-mental-illness/ http://aeon.co/magazine/being-human/have-psychiatrists-lost-...
Camillo 13y ago
Speaking of stigma keeping people from seeking treatment, how does this interplay with the fact that most people in America get health insurance through their jobs? Aren't people afraid that some information will leak out if they seek mental treatment through their insurance? And what about the "counseling" services many large organizations offer?
ngcazz 13y ago
Thank you for posting this. The testimony on intrusive thoughts hits so close to home, I'm considering seeking professional help. I wonder if there is a different way to think and live!
ngcazz 13y ago
Thank you for posting this. The testimony on intrusive thoughts hits so close to home, I'm considering seeking professional help. I wonder if there is a different way to think and live!
greatsuccess 13y ago
I see situations that make me crazy as situations that could make anyone crazy. So in a sense it can be flipped. Most people who I know who are unsatisfied in their lives just flip it around and think if they just conform to abusive situations, they will feel better. So they try. In a sense just being a human on this planet is an abusive situation. So why do we call out mental illness?
vizza 13y ago
ERP and mindfulness are really, really effective in treating OCD. I know, because one of my children had a crippling case and now is free of it. I spent several months at UCLA's Pediatric Intensive Outpatient Program with him and have seen it work on about a dozen children. The same treatment can also be used on adults. ERP stands for Exposure and Response Prevention. The idea is that you progressively expose the person with OCD to their fear(s), during which, they cannot perform any compulsions. Eventually the brain is retrained and the OCD falls away. For example, someone with a fear of germs would be asked to touch a door handle and then not wash their hands for as long as possible. This is extremely hard for them. However, this simple technique, applied over weeks or months in conjunction with therapy and meds, can reduce a person's OCD to almost nothing. Another point is that the kids respond to the group setting. They form bonds and support each other during the process. The UCLA team is absolutely amazing at this: http://www.semel.ucla.edu/adc/ocd_treatment http://www.semel.ucla.edu/adc/ocd_treatment If you have or know a child suffering with the disorder, please look into this program or one like it! If you have any questions for a parent that has been through this with a child, contact me at capitalism99@gmail.com

420 points by markmassie 13y ago

This was really well written. It says a lot of things that I feel the tech industry tends to ignore.

ds9 13y ago

This is admirable and I wish the author well. His example may also help others. It should not be taken as a signal that "outing" oneself is advisable for others in comparable situations. This guy is very fortunate that he is well established in a career and can point to good performance in his positions, unaffected (from the employer's point of view) by his condition. Others are much more vulnerable to prejudice and discrimination, and might be better advised to stay closeted.

DanBC 13y ago
US law means you must disose your illness if you wish to use anti-discrimination protections. (As I understand it; I am not a lawyer; corrections welcome).
- chris_wot 13y ago
  That's absolutely ridiculous.
marcus_holmes 13y ago
I've outed myself as being depressed and the reaction has been entirely positive. There have been a few people who have reacted "strangely" but, to be honest, having these people clearly identify themselves by their behaviour has been a net positive ;) However, I haven't tried interviewing for jobs yet. I suspect the negatives will really show then. The rational argument (that 40% of our society will undergo treatment for a mental condition at some point, so would they prefer someone who might be mentally ill but in denial, or someone who is aware of the problem, and able to deal with it?) should work in theory. However, almost everyone I've spoken to has either had the same issue themselves but never admitted it publicly, or has a close relative or friend struggle with the same issues and so understands to a certain extent. I think we're seeing the beginning of the end of the stigma.

joyeuse6701 13y ago

I enjoyed that read. I think the world is a better place getting to hear his story.

natural_capital 13y ago

Showcasing your own story to set the precedent for people to acknowledge mental illness as a real illness is a bold and admirable move. I would note however, that the recovery process for every individual is wildly different and shouldn't be overlooked. Acknowledgement of the mental illness issue is one part of the problem, which will hopefully lead to better, more integrated treatment lines in the future.

insensible 13y ago

It's wonderful to have a courageous person breaking the ice on difficult topics. Bravo to Mark. And the love shown by his wife is deeply touching.

teahat 13y ago

Aside from medication, for OCD in particular there are therapeutic options that can be (life-changingly) effective. The OCD centre [http://www.ocdcentre.com/about-us http://www.ocdcentre.com/about-us] is one such place. If you think you might have OCD (last I read the incidence was around 1/30) talking to someone about is the best first step. Especially as one common and pernicious effect of OCD is that it will convince you that you do not have it.

michaelochurch 13y ago

Cyclothymic. That's a bipolar spectrum disorder, but it doesn't match the lay image of the manic-depressive. The episodes are milder and shorter, but they come on quickly. A "depression attack" can last 3 hours, resolve in a panic attack, and be gone 20 minutes later. Most people who know me wouldn't know that I have it. The one "insane" thing I've done (trolling, back in the day) had the specific purpose of keeping insanity out of my "IRL" existence. As with all spectrum disorders, people seem to focus on the visible, uncontainable, and publicly dangerous 0.1% and ignore that 99.9% of people with the disorder or "on the spectrum" are not dangerous, wouldn't fit most people's image of "mentally ill", and can be very well-adjusted. I tend to think of mood disorders as anti-psychopathy. Psychopaths have low or nonexistent mood and emotional sensitivity, which is why they're social high performers and (if ambitious) excel in the work world. Some mood disorders seem to be uncorrelated to context (i.e. episodes happen "for no reason") and that's probably more true of the severe cases, but most people with mood disorders are normal people with hypersensitivity, such as the OP whose brain would take personal criticism extremely seriously, unable to block it out or cope. Aaron Swartz comes to mind as a archetypical anti-psychopath. They tend to be moralistic, less fearful of negative consequences when doing what they think is right, and prone to mood and anxiety disorders. Anti-psychopathy isn't a desirable thing. It can be just as ill-adjusted. Just as psychopathy tends to be good for the individual (in terms of material prosperity, social rank, and sexual access) but bad for society, anti-psychopathy tends to be good for society but harmful to the individual. What's happening right now, in Silicon Valley, is a battle to the death between real technologists (who tend to be anti-psychopaths) and the mainstream business culture of entitled executives and board-whores (psychopaths). With Snapchat and Clinkle setting the tone in the current Valley, rents becoming unaffordable, and no-poach agreements all over the Valley, psychopaths seem to be winning. I think that mood disorders in particular require a certain balance. People tend to do unwise or harmful things, especially when inexperienced, and those with mood disorders are not exceptions. You have to own your actions, even if you made them in a struggle that most people wouldn't understand. That said, it's also important to realize "it's not me, it's them" and keep your pride intact. Mental health issues often give you a front-row seat for how shitty people can be when they think you're weak. Much of what comes out of these disorders isn't harmful in the least. It's just slightly embarrassing, but plenty of people will hang you out to dry just because they're weak, useless cowards. This may be why people with mood disorders (at least, the milder kind that won't interfere with ethical behavior; a truly "manic" person, noting that mania-- not the milder hypomania-- is very rare even in people with bipolar, does not know who he is) tend to evolve into moralistic, hyper-ethical anti-psychopaths. I'll give a semi-fictional example. Let's say you're a programmer and you have a hypomanic episode. You still go to work, don't cause any issues, and spend 2 weeks building something you were never assigned to do. It turns out to be really good work and useful to the company (as much, or moreso, than putting that time in on your assigned work) but your boss is pissed off that you were working on this side project, instead of your assigned work, and tags you as "unreliable". A morally decent person would recognize that as wrong (it's health discrimination, and counterproductive, to punish people with "creative flare-ups") but, even still, stories like that are so common in Silicon Valley as to be unremarkable. Anti-psychopaths tend to need an R&D environment where they're measured by performance over time, rather than minute-by-minute superficial reliability (at which they can't possibly compete) and those, sadly, tend to be turning rare in the current anti-intellectual (and pro-psychopathic) environment.

pyduan 13y ago

This is a courageous article. Sadly, it seems mental illnesses are one of the great taboos of today (and don't even get me started on the state of mental health care in the US). Similarly, mental illnesses are extremely misunderstood, and people tend to distrust people who suffer from one even though illnesses such as depression may affect 5 to 10% of the population [1] and as much as one in four adults are affected by a mental illness in general in a given year [2]. A significant portion of the population is affected, but for the most part it remains unadvisable to talk about it. It's the elephant in the room. This is compounded by the fact American culture in particular tends to disproportionately value extroversion and appearance of happiness. This leads many people to remain closeted by fear of repercussions, both on one's social and work life. Even worse, it prevents people from seeking necessary help because of the attached stigma ("but I'm not crazy!"). There are known cases where people are punished for having seeked professional help. For exemple, people who admitted to "suicidal tendencies", however serious, may be refused US visas [3]. The discrepancy between how willingly people talk about their trip to a doctor vs. a therapist is huge and obvious, and it shouldn't be. Now why should this be relevant for the HN crowd? As someone who's very close to these issues, it seems to me this is one of the few social issues where the tech industry is not as progressive as it could be. Our industry tends to produce myths of super(wo)men with alpha personalities; we admire leaders, disrupters, bigger-than-life personalities, sometimes even assholes. Furthermore, this is a small world where, for better or for worse, a lot depends on word-of-mouth and personal reputation, and where "cultural fit" is openly hailed as a criterion for employment despite the vagueness of the term, which can hide what would otherwise be considered blatant discrimination (cf. that article on ageism not so long ago). The same goes for founders: would you think twice about investing in a non-established individual with a history of OCD? Depression? What I am getting at is that mental illness is a combination of neurobiological and psychological causes, not a weakness in character -- but in an industry that values strength of character above everything else, the fact many ignore this can be extremely destructive. We can do better. The author has done the world a great service by publishing his story. I hope more follow suit. [1] http://www.nimh.nih.gov/statistics/1mdd_adult.shtml http://www.nimh.nih.gov/statistics/1mdd_adult.shtml [2] http://www.nimh.nih.gov/health/publications/the-numbers-count-mental-disorders-in-america/index.shtml http://www.nimh.nih.gov/health/publications/the-numbers-coun... [3] http://www.nolo.com/legal-encyclopedia/how-health-issues-can-make-you-inadmissible-the-us.html http://www.nolo.com/legal-encyclopedia/how-health-issues-can...

JackFr 13y ago

I'm not sure what to think about this. I accept that the author is suffering and in anguish, and I truly wish him well. Despite his obvious accomplishments and all the trappings of success, I would not trade places with him. His subjective experience seems to be painful and is no less real to him than mine is to me. At the same time, I don't think he is ill. While I don't doubt that he is suffering, I don't think it it is helpful to class his suffering as an illness. I don't think anyone argues that his symptoms are caused by an infection or a defect in an organ, so his disorder lacks the physical basis for a typical illness. At the same time, he has symptoms. And therapy, and possibly drugs, make him feel subjectively better. He chooses to engage in a regime of therapy which (presumably) has self reported benefits. But I don't think it is helpful to think of his plight like we think of malaria or polio or heart disease. When we talk about 'emotional disorders', we implicitly take on an enormous amount of cultural context as well as normative judgements about how someone 'should' feel. And the danger is that one will come to believe that an unpleasant mental state in an otherwise healthy brain is something to be cured through the application of science. That being said, I agree with the main point -- that there is no shame in his mental state. I suppose my point is that it is not necessary (and should not be necessary) to reclassify what a disease is in order for a class of people to maintain their dignity. And above all, I wish this man well and by no means mean to diminish his pain, or the courage it took to write this.

moron4hire 13y ago
This attitude--that mental illness is not a real disease--is what helps the stigma to continue. You mince it up with nice words around the edges, but it boils down to this: you're part of the problem.
- Einstalbert 13y ago
  Agreed. I've dealt with mental illness in my family since I was a young child. It's affected my entire life. It's not just some meandering mood or state of mind, it's a frightening thing for which most people have no time or patience.
- JackFr 13y ago

milesf 13y ago

I used to struggle with Bipolar Spectrum disorder. After 9 years of medication, therapy, prayer, and a lot of ups and downs I've been declared free of the diagnosis by my psychiatrist. I gained a lot of weight because of medications (normal weight is 210lbs, which is fine for my 6' 4" frame, but medication caused me to balloon up to over 444lbs). I have not been able to work at my peak for many years. I'm now almost 45, and I feel like I'm starting to get my life back. Now that I'm off the main drug that treated my disorder (risperidone) my weight is starting to drop. I know people are scared of mental illness. I see it in their faces, or the way they treat me differently as time goes by. But that's okay, I have close friends who have accepted me for who I am without that fear. My wife wishes I wouldn't tell people about my history. My health is no one's business but mine. However, I choose to tell people about it, because of the stigma. Because I'm neither ashamed or afraid for people to know. I _will_ lose friends, work, and opportunities because of my choice to be open about it, but I don't care because I want to fight the stigma. Everyone has a friend or family member that struggles with some form of mental illness. Everyone. I have seen too many people suffer in silence, and some even take their own lives because the pain is too much. I was suicidal years ago. I suffered horribly for many months on end, waking up in the morning and just focussing on getting through the next hour, until I finally reached the end of the day and could go back to sleep so I could have some relief. There is no shame in mental illness. People used to be afraid of people who had heart disease, as if they might "catch something" from them. The brain is the most complex organ in our bodies, and it's prone to have problems just like any other organ. My name is Miles Forrest. I have wrestled with mental illness for many years, and I'm happy to say I have overcome it with help from doctors, family, friends, and God (if you're offended by my attribution to God, please don't be. I respect a person's right to believe whatever they want, all I ask is they respect my right to believe whatever I want). I can't say I'm cured, because there's a possibility I might relapse at some point in the future. But I have acquired the skills, knowledge, and support network that I know, without a doubt, I would be able to beat it back down again. Mental illness doesn't define me, but learning to fight, persevere and lean on others when I need to has made me a better man. You can mock or ridicule me if you want, but I'm not talking to you. I'm talking to the man or woman out there who is afraid there might be something wrong with their mind, and who feel alone and afraid. I know how scary it is. I know how you feel like you're the only person in the world who has felt the way you do. You're not, and you are not alone. If you are that person, email me at miles@coderpath.com, and I will walk with you as a friend and stranger to get you help.

Jtsummers 13y ago

One thing I'd like to add to this discussion. It may be difficult, and it may not be something you should do until they're older, but talk to your children about issues that you have and that run in your family. It can save them a lot of heartache and difficulty down the road if they have similar issues. In particular, knowing my family's history of alcoholism and drug abuse helped me avoid both. Given my issues with depression, if I was drinking like my peers in college, I probably wouldn't be here today. Similarly, I didn't know the cause of their issues (depression) until I was already deep into an episode that lasted a couple years. If I'd known beforehand what to look out for, and that it wasn't uncommon in my family, it might not have lasted as long.

TAC1234567 13y ago

This will not be a popular opinion, nor is it a nice opinion, but sometimes the truth is neither and I think it is valuable to be explicit about these things sometimes. The "stigma" against mental illness makes sense in a lot of ways. I do not mean: that the mentally ill deserve fewer legal rights than others, deserve any kind of bad treatment or violence or ridicule, shouldn't be "accepted", or bear any "responsibility" for their condition. I do mean: life is full of subtle social contracts that mental illness often causes people to flout. Mental illness (in many cases) makes people less predictable and reliable. Harder to deal with. Some people reading this will say "obviously that is true, which we all acknowledge but have no reason to dwell on, and that is why it is a complex situation that demands awareness". Others will say "that is false and you are a bad person". First group, I refer you to second group. If you are 100% committed to the goals of your organization (growing a startup, winning a war, whatever), you will be very hesitant to add a mentally ill person to your team/company/platoon. This makes sense. It sucks. Being mentally ill sucks. This is one of the ways. That doesn't necessarily mean anything needs to or can be done to change it.

thenomad 13y ago
There's a huge list of highly successful, productive people who are a credit to the projects they work on, who have or have had mental health issues in the past. If I had the chance, for example, I wouldn't be at all "hesitant" to work with actors Hugh Laurie, Stephen Fry, or Johnnie Depp, despite all of them having well-documented mental health issues. I'd also be very happy to work with Richard Branson (ADHD), or if he were alive today, Nikolai Tesla (OCD and anxiety).
- TAC1234567 13y ago
  But these examples stand out because they are unusual exceptions. Also, it is possible that acting is a profession unusually accessible to people with certain mental illnesses.
  - thenomad 13y ago
    I've also worked with multiple people with various mental health conditions, who weren't actors, but whom were extremely good at their jobs and I'd cheerfully hire again. Honestly, I've never seen a correlation between "mental health issues" and "would not hire".

deleted 13y ago

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rokhayakebe 13y ago

One thing I would like to offer would be for American doctors to perform comparisons across cultures, countries, and societies. I am restricting the above purely to mental illness. There are many mental diseases I only witnessed in America, and not in Africa. I do not know what the meaning of this observation would be if proven factual, but I think it is worth exploring.

quasque 13y ago
This is definitely an observed phenomenon, such illnesses are known as culture-bound syndromes. There is the sub-field of transcultural psychiatry which examines these and other cultural differences with respect to mental disorders. Out of interest, what were the mental illnesses you refer to?
kansface 13y ago
Check out http://en.wikipedia.org/wiki/Culture-bound_syndrome http://en.wikipedia.org/wiki/Culture-bound_syndrome. Fan favorites include fan death, evil eye, blacking out, and probably multiple personalities.

DanBC 13y ago

People say the treatment in England is much better, and it is, unless you are under 18. MH treatment is underfunded in England (and this has recently been written into commissioning contracts) and it is worse for children and young people. In patient beds for children are limited. A child who needs an in patient bed may have to travel hundreds of miles to get that bed. They may even need to travel to a different country. A child in the south of England may not have a bed available anywhere in England and might need to go to Scotland for a bed. Apart from the obvious cost of distance and the distress of being so far from home (although getting distance from an abusive home can be useful) that child is now under a different legal system. Thus, the rules for detaining them against their will; force feeding; forced medication; etc etc are all slightly different.

vacri 13y ago
I used to work in an outpatient neuro department that had a large paediatric patient population. One of the paediatric neurologists there had done her training at a famous children's hospital in London (GOSH) and said that it was a fantastic place to train in, but terrible for the outcome of the children. Where we were in Melbourne, we had four paediatric neurologists for a catchment area of about 400k give or take. GOSH had six neurologists for a catchment area of 2 million. "By the time the kids in London got to see us, the symptoms were so florid and easy to see. Great for training, not so great for outcomes". She did her training in the 90s, so it may have since changed. It's also a story about neurologists, not psychiatrists, but I imagine it wouldn't be that much different.

h1karu 13y ago

In case you never considered it before there is a heavy PROFIT INCENTIVE for your psychiatrist to diagnose you with some form of mental illness that he is familiar with. You need to become a domain expert yourself in order to figure out if you're being manipulated for profit or if the diagnosis is legitimate.

comrh 13y ago
Realistically, what do you think is the percentage of doctors manipulate diagnosis for profit because it sounds like a boogey man.
- h1karu 13y ago
  Most of them, but they don't consciously realize what they're doing in most cases. The norms for their profession slowly creep towards over-pathologizing because of the profit incentive and also because of the effectiveness of advertising campaigns by drug companies. Social norms have changed across a broad demographic to accommodate the large scale systemic misdiagnosis problem. Just because the manipulation for profit is widespread and well accepted does not mean it's not happening.
  - comrh 13y ago
    You're making some big claims with no evidence. Citation needed.
    - h1karu 13y ago
      I was only giving my personal opinion based on the data I've seen. All I'm really advocating here is that every person should educate themselves before accepting any diagnosis. Do your own research and form your own opinions.
cperciva 13y ago
At this point, does it really matter if the diagnosis was legitimate? The treatment clearly helped him improve his life dramatically.

comrh 13y ago

Another "coming out" story is from Michael Landsberg, a Canadian hockey analyst on TSN. His hashtag #sicknotweak inspires me when I'm feeling like crap. http://www.thelavinagency.com/blog-mental-health-speaker-michael-landsberg-on-the-cover-of-vista-magazine.html http://www.thelavinagency.com/blog-mental-health-speaker-mic...

D9u 13y ago

From day one here at HN my profile states that I am schizophrenic... Not that it's done me any good here, but I don't see why I should hide this fact from people I am likely to never meet in real life. Kudos to those who could care less about social stigma.

awakened 13y ago

You are suffering and that's OK. You are no less of a person than anyone else. Anxiety is the illness of our age. Don't feel ashamed. We all suffer to some extent. You are very brave for coming forward and you've helped many people by doing so. I suffer too, but I have found peace in Buddhism. I'm more content now than I ever have been (50 years of life). I've learned to live each moment deeply and just breath. Feel my lungs, my feet on the Earth and be happy. The sun will rise tomorrow, but some day it will burn out. Please remember that nothing but you, your family and your actions matter. Your character, integrity, kindness and interactions with others speak volumes. No one can take that away from you. I hope you find peace by learning to overcome your suffering. If you take this path you'll heal yourself and help those around you find relief from their own suffering.

mbesto 13y ago

Someone very close and dear to me has a mental illness. She was super nervous to disclose this to me for fear that I may think differently of her. The thing she most appreciated about my reaction was that I said "Let me know if there is anything that I should know about your illness that may affect you in a way that may make you behave differently than you normally do, otherwise I will behave and act as if it simply doesn't exist." Suffice to say, I don't actually remember what illness she has.

quanticle 13y ago

This quote seems apropos: Though many object to psychiatry’s perceived encroachment into normality, we rarely hear such complaints about the rest of medicine. Few lament that nearly all of us, at some point in our lives, seek care from a physician and take all manner of medications, most without need of a prescription, for one physical ailment or another. If we can accept that it is completely normal to be medically sick, not only with transient conditions such as coughs and colds, but also chronic disorders such as farsightedness, lower back pain, high blood pressure or diabetes, why can’t we accept that it might also be normal to be psychiatrically ill at various points in our lives? The answer seems to be that psychiatric disorders carry a much greater degree of stigma compared with medical conditions. People worry that psychiatrists think everyone is crazy because they make the mistake of equating any form of psychiatric illness with being crazy. But that’s like equating a cough with tuberculosis or lung cancer. http://aeon.co/magazine/being-human/have-psychiatrists-lost-perspective-on-mental-illness/ http://aeon.co/magazine/being-human/have-psychiatrists-lost-...

Camillo 13y ago

Speaking of stigma keeping people from seeking treatment, how does this interplay with the fact that most people in America get health insurance through their jobs? Aren't people afraid that some information will leak out if they seek mental treatment through their insurance? And what about the "counseling" services many large organizations offer?

ngcazz 13y ago

Thank you for posting this. The testimony on intrusive thoughts hits so close to home, I'm considering seeking professional help. I wonder if there is a different way to think and live!

ngcazz 13y ago

Thank you for posting this. The testimony on intrusive thoughts hits so close to home, I'm considering seeking professional help. I wonder if there is a different way to think and live!

greatsuccess 13y ago

I see situations that make me crazy as situations that could make anyone crazy. So in a sense it can be flipped. Most people who I know who are unsatisfied in their lives just flip it around and think if they just conform to abusive situations, they will feel better. So they try. In a sense just being a human on this planet is an abusive situation. So why do we call out mental illness?

vizza 13y ago

ERP and mindfulness are really, really effective in treating OCD. I know, because one of my children had a crippling case and now is free of it. I spent several months at UCLA's Pediatric Intensive Outpatient Program with him and have seen it work on about a dozen children. The same treatment can also be used on adults. ERP stands for Exposure and Response Prevention. The idea is that you progressively expose the person with OCD to their fear(s), during which, they cannot perform any compulsions. Eventually the brain is retrained and the OCD falls away. For example, someone with a fear of germs would be asked to touch a door handle and then not wash their hands for as long as possible. This is extremely hard for them. However, this simple technique, applied over weeks or months in conjunction with therapy and meds, can reduce a person's OCD to almost nothing. Another point is that the kids respond to the group setting. They form bonds and support each other during the process. The UCLA team is absolutely amazing at this: http://www.semel.ucla.edu/adc/ocd_treatment http://www.semel.ucla.edu/adc/ocd_treatment If you have or know a child suffering with the disorder, please look into this program or one like it! If you have any questions for a parent that has been through this with a child, contact me at capitalism99@gmail.com