17 January, 2022

From Obtuse Mental Health Issues to Acute

It can be difficult to talk openly about mental health. I’ve tried over the years to not shy away from talking about many of the issues in my life, many of which are quite serious. But when it comes to mental health, I tend to stay relatively quiet. I think this may be because I value my mental health more than any physical health or disability that I may encounter in life. It probably explains why I am a teetotaler, and why I take special care to exercise my brain far more often than my body.

Which is all why it still seems so difficult to me now to say the thing that I’ve come here to say. So I’ll just be out with it:

It came on suddenly.
I suffered a mental breakdown a few weeks ago.

If you asked me what caused it, I’m not sure I’d be able to give a good answer. There’s a lot going on in my life that has been causing me extreme stress. There are people who count me as an enemy despite my trying to work with them. There are issues with an employee I hired who is also family, and the relationship has grated as a result. There are undone tasks in my household which have dramatically hurt my ability to live well there. There are people I have let down, and my brain has not been able to make it up to any of them.

The extent of this problem has become severe. Since my ordeal in 2020, I have been instructed by a doctor to take life saving medication every day. Without these medications, I would die. So you would think that, even if other things in my life started falling down, at least when it came to life-saving medication, I would take it every day.

So far, this is true. I do take it each day, with my partner’s help. But my doctor retired last summer. Slowly, one by one, the prescriptions that they ordered for me started to expire. I no longer received the medications that I needed each day to live. Yet I found myself unable to call that doctor’s office. I could not get new prescriptions under another doctor’s name. One day, when my partner found out that I had only a few days left of a certain life-saving medication, she panicked and bought it online instead. The price was ~50 times as expensive as my co-pay would have been. But at least it meant I continued remaining alive.

This is what triggered awareness of just how bad things had become for me. After a few additional events like this, my mental capacities mostly shut down at the beginning of this year. I’ve been slowly picking up the pieces since.

Yesterday, I spoke with my family for the first time in quite a while. They were concerned because they had not been able to get in touch with me. I’d been avoiding text messages and email entirely since Christmas, with the exception of my EGQ email. I believe that every single other responsibility in my life, whether it’s shoveling snow or dealing with board issues, has fallen by the wayside during these three weeks.

By Katherine Hess.
For those that have never experienced something like this, I will try to explain my inner subjective experience. In a word, it is dread. But the dread is attached to something that should be innocuous. For example, I am owed ~$2700 by someone who wants to pay me. If they were to pay me without me having to do anything, I’d be happy about this. But I have to fill out a form, and that form fills me with dread. Not because it is a difficult form to fill out, nor because there’s some rational reason why I should be wary of it, but merely because my brain has singled this out as something that should fill me with utter dread, and so the filling out of the form becomes such a monumental task that I simply cannot move forward with filling it out.

Not all tasks are so monumental, but each task seems to have an outsized portion of dread attached that takes more effort than it should to complete. Ordinarily, I manage despite this. But in the past three weeks, it has built to a head: there are days where I’ve done little more than sleep. There are days where it takes all the effort in the world to just do the five hours of work I need to do in order to go on. There are weekends where, in order to enjoy the company of a friend for a few hours in the evening, I’ve literally sacrificed my entire day just to ensure that I can have those few moments of joy.

Although I’ve had a predisposition toward these types of things for my entire life, it has never been as bad as it has been these past three weeks. I wish I could point to a singular event that caused this. But even the precipitating event, being unjustly called racist and unwilling to work for a better society for all, was just the thing that pushed me over the edge. Nevertheless, this accusation consumed my thoughts, knocking over the precarious structures I had in place to allow me to function relatively well in society. It made me shut down. That’s when I had my mental breakdown.

Today, I am trying to pick up the pieces. But I will not be able to juggle what I once did, not until I rebuild the structures that allowed me to deal with my mental issues. To aid this, I will be making several changes in my life.

  • I’m cutting back on work significantly. Rather than have my fingers in lots of projects, I’m going to focus entirely on just Effective Giving Quest. This means I will be subcontracting out my current contractual obligations and turning down any other offers of work for the immediate future.
  • I’m planning on either resigning or cutting back significantly from my board duties. This will be a significant reduction in the number of hours worked for me.
  • I will be volunteering far less. This includes the intensive work I’ve put into WikiProject Effective Altruism and the works in progress I’ve had for the Effective Altruism Forum.
  • I will be using a therapist from here on out. Depending on what they recommend, I will be open to taking medication to help deal with these issues.
  • My days will revolve around three pillars moving forward: EGQ, exercise in and out of the house, and making time/space to spend on fun: with family/friends/books/games.

These are not small changes. While they will take time to implement, I do think that this is the best that I can do moving forward if I want to ensure that a breakdown like this never happens again.

By Katherine Hess.
(For small tasks in the immediate future, I will getting around the outsized feelings of dread not by eliminating the dread, but by putting a sticky note on these immense mental blocks in my mind, reminding me that this portion of my map does not correspond to the territory, and that doing these small tasks will not cause nearly as much discomfort as they appear to in my mind. Specifically, I will be accomplishing this by setting up trigger action plans associated with these small tasks, where the action will be noticing these sticky notes. From there, it will take mere courage to do these small tasks anyway. I'm not sure how effective this will work, but until a therapist recommends something different, this is the method I'll be using to at least reclaim the small things in my life that need to be done.)

To those I’ve let down, I am so very sorry. I will be sending personalized apologies in the coming weeks, alongside my expectations of how I can help mitigate any harms I’ve already caused and how we can set expectations moving forward so that this kind of thing does not recur.

To future me, reading this post in the future: I hope that I’m doing right by you as I make these rather extreme changes. While this will significantly reduce my output, I sincerely hope that by focusing on only a few avenues of change you will nevertheless be more capable of doing good than I am today, in this sad broken state. But even if not, I remain hopeful that these changes will at least make you happier and more capable of enjoying life that I am now. The former is something I am unsure of, but the latter is something that I honestly think these changes will genuinely come to pass. Wish me well, as I wish for you.

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