Preview

We often think that the key to good mental health is to have good behaviors and good thoughts. We might think of things like anxiety, depression, suicidal ideation etc as bad things. We might believe that good mental health means never feeling anxious, never feeling sad, and certainly never wanting to die. We might believe that if we get better at managing all these negative behaviors and thought patterns, then eventually we are better and no longer mentally ill.

This isn't actually how mental health works, though. This mental model of mental health sets you up to view life as a neverending battle where you are never fully not mentally ill. It pathologizes what are totally normal biological and psychological processes.

Things like anxiety, depression, suicidal ideation, panic, etc., evolved alongside other emotions. They are tools developed over millions of years to help us thrive and survive. None of them are inherently bad or good. They are all just tools our brains (and bodies) utilize for behaviors.

Something that helped me understand this was stress. Stress is actually good for you in small doses. Stress evolved as a way of responding to threats. When your stress response is triggered, the following happens:

1. Your liver converts stored glycogen in the liver into glucose, providing a burst of energy.

2. Cortisol is released, which inhibits non-essential bodily functions.

3. Adrenaline and norepinephrine are released into the body, increasing focus, attention, and awareness.

4. Re-uptake of dopamine, serotonin, and other neurotransmitters improves.

Sounds great! And it is great! For short periods, stress is incredible and highly useful. More than that, many of our systems have evolved to rely on the stress state to modulate and regulate their states. For example, stress is actually necessary for a healthy gut and digestive system. The problem is when stress becomes chronic; it starts creating all sorts of havoc.

All the things our bodies and minds do are just like this. Anxiety isn't our brain or body malfunctioning; it is a system that serves a purpose. You might hate the state of anxiety and protest at this idea a bit. But if you have ever watched a scary movie or been on a roller coaster and enjoyed it, then at some point you felt anxiety. The anxiety didn't ruin those experiences; in fact, it was a necessary part of them. Imagine how less enjoyable a roller coaster would feel without the anxious anticipation beforehand.

Anxiety is just a tool. Depression is just a tool. All of the things your mind (and body) does are just tools. Mental wellness is about learning to utilize these tools in a healthy way, appropriately adapted to the environments and situations we find ourselves in.

Some tools are more central than others and serve as foundations for the other tools. We are going to cover the core tools of mental health here. Then we can build off of those tools.

There is a type of person who takes a while to get into therapy. Not because they think therapy or mental health is stupid, are afraid of it, don't want to put in the work, or even because they think they are well. They are often very keenly aware that they are unwell. They have often accumulated a mountain of coping mechanisms. They don't go to therapy because they think they are too smart for it. All that time spent finding a therapist who is not an idiot? When they could just read the books and fix themselves? What a waste of time and money.

In "Crazy Ex-Girlfriend," there is a scene where Rebecca Bunch first goes to therapy. She arrives with a binder full of material, ready to put in all the work, having read all the books, of course. Rebecca is probably more educated about mental health and psychology than her therapist, but she has hilariously missed the point of therapy. And all that reading hasn't directly translated into mental health improvements.

This is the overly intellectualized "not going to therapy because therapists are useless" person. It's a perspective often reinforced by the mental health industry. For many of us, our first forays into therapy are at best useless and at worst traumatic. My first therapy was when I was 12 in a Christian counselor's office – a real, twisted moron who believed in things like conversion therapy and masturbation being evil. Every encounter I had with mental health professionals as a kid and teen was like that initial experience, full of pseudoscientific nonsense. By the time I really needed therapy, I already had a firmly cemented view of it as dumb, useless, an industry for peddling hate and pseudoscience.

It wasn't that I thought all therapists were useless. I was convinced my access to better therapists was nonexistent. Sure, if I had money and free time, I could therapist-shop and find a good, sane one. But walking into a crisis center wasn't going to help me. Some sliding-fee random professional was likely to traumatize me more.

And I was right! When I was forced to receive mental health care, it was almost entirely negative and resulted in significant regression in my mental health. In fact, the main reason I am alive today is my spite toward bad mental health professionals. Being so misunderstood, so attacked, receiving such poor care made me want to live out of spite.

Sometimes the benefits of therapy aren't clear. Sometimes just the act of seeking out help can help even if the therapy is harmful. Ironically, that initial journey into therapy did keep me alive – just not because of the therapy.

Unknown to me, I was learning a core mental health tool that, until then, had been unfamiliar: Radical Pragmatism. What keeps you alive is good; it doesn't matter if it is correct, wrong, or toxic.

Much of the typical narrative about therapy suggests you must overcome toxic behaviors and seek treatment. But for many, therapy is negative. If you are marginalized and misunderstood, you are likely to have a bad experience in therapy. The more desperate for therapy you are, the more likely you are to receive harmful care. The good therapists aren't working at your local crisis center; they're charging $120/hr and have a six-month waiting list.

For decades the mainstream mental health view of, e.g., homosexuality was that it was a mental illness. Even now, many mainstream therapists will be abusive to those with gender issues. If you are autistic and "high functioning," you are almost certainly going to be misdiagnosed. Have trauma and experience hallucinations? Good luck with that! At best, you'll frighten the help; at worst, you'll be taken to a psych ward and receive a $10K bill as thanks for seeking help. Everyone who is chronically suicidal learns the hard way not to answer all the questions truthfully on intake forms.

Therapy can be an unpleasant experience. It can be traumatic and painful, and it can create real, lasting, and serious harm to your mental health.

You can still go to therapy, though. You can survive the bad things and take the good. Being misunderstood is painful and traumatic. Being misdiagnosed can lead to a lifetime of additional struggles. It might take another decade to figure things out afterward. But all of this will be okay. You will be okay in the end.

Many therapies at their core have concepts that are abstract and metaphorical. These abstractions often seem incredibly silly and pseudoscientific. Take IFS, for example – "parts"? What is this new-age, non-scientific approach? All psychology includes elements that come across like this because psychology is fundamentally a heavily abstracted domain. We can't reach into people's brains, so we must convey psychological concepts loosely and figuratively.

The figurative and metaphorical nature of it all can seem inadequate, especially to those who have an over-intellectualized approach to the world. If you're used to citing studies and reading papers to validate your opinions, much of psychology appears questionable.

What seems like reasonable word choice to one person will seem stupid and idiotic to another. A metaphor that makes perfect sense to one person will fall on deaf ears for another. This occurs because our inner worlds and concepts are often fundamentally different. A person who thinks primarily in words and has an incessant inner monologue has an entirely different conception of, e.g., an inner critic than someone who thinks in pictures.

Language is limited and cannot capture our inner worlds. Moreover, only recently have we expanded our understanding of what an inner world looks like. Much of psychology, for example, assumed everyone could visualize. It turns out this isn't the case at all! Our inner worlds are varied and diverse. The words we use to express our inner worlds and the abstractions we use to convey psychological concepts can suffer from our lack of shared understanding. We don't know what another's consciousness looks like, yet we often assume it must resemble our own.

Most modern therapy has, at its core, an approach of radical pragmatism. The current state of science for mental health is to take what works to help people and work backward from it. If something works, it doesn't matter whether it accurately models the human mind or even if it's real. From a therapeutic perspective, this allows practitioners to be "radical" and do what works for their patients, regardless of their feelings or beliefs. This was an incredibly important development because, for a long time, large numbers of humans were failed by existing therapies and approaches. It was clear that something in existing psychology and neuroscience was wrong because so many were suffering.

From a scientific perspective, radical pragmatism lets us overcome gaps in our knowledge about how brains work. We no longer need to understand consciousness and the building blocks of the mind to begin exploring it. We can instead observe what works and then form theories about the mind from that.

The approach to psychology for many decades was the opposite. Advances in neuroscience in the 50s and 60s gave us some rudimentary understanding of how the brain worked. From this, we started to extrapolate theories of psychology. For example, we might discover that brains store memories in long-term and short-term ways, and exposure and conditioning drive the process that stores memories. From this, you can theorize that higher functions might also work on an exposure-learned response basis. This is the bottom-up approach to psychology.

Much of psychology during the behaviorist renaissance from the '60s to '90s was predicated on this approach. It emerged as a reaction to the lack of science in the field. Psychology before the modern age lacked the scientific rigor of other fields. Behaviorists came along and said, "We need actual science here." There was much debate, but ultimately, the behaviorists prevailed, partly because of discoveries that advanced our knowledge of the brain further than ever before. Where once we knew almost nothing, we started to know some things.

What unfortunately happens in all fields is that ignorance is rarely accepted. Partly driven by a lack of further advancements, psychology spent decades extrapolating brain science further than it was ever meant to go. Before long, we had formed entire theories about the nature of consciousness from what amounted to very little knowledge about brains. In the '80s and '90s, it was practically required for all aspiring psychologists to invent a new therapy.

If you're from a tech background, it can be difficult to accept and internalize the idea that we don't understand how the mind works. Strong AI leaders often act as if the jury is in and we've already figured this out. The scientific consensus is that we haven't. We don't understand the human mind. Many questions in psychology are simply answered with "We don't know."

Some people have personalities where radical pragmatism comes naturally. I am not one of those people. I found it very hard to accept many things I learned in therapy. At the root of this resistance were my preconceptions about how the brain works. I had a mental model for mental health that I thought was the right science, and I wasn't going to let go of it, no matter how much I was suffering.

I don't know what it is about a certain demographic, but some people really, really don't like the notion that we don't understand the mind. The notion of radical pragmatism, meditation, etc., comes off as new-age nonsense. Someone who has read too much LessWrong and Daniel Dennett has a high likelihood of both wanting to die frequently and being convinced that we fully understand the human mind. "I am too smart for therapy!"

You can approach this struggle with internalizing radical pragmatism in a few different ways. The first is by applying a mental model of "prove it!" You have mental health figured out? Then do it, get better. If you have it figured out, it should be easy.

I think many people have this realization, which is why it is common for many people in STEM with chronic mental health issues to have a cynical view of mental health. They want to believe we have it all figured out, but they also can't seem to fix themselves; the only logical conclusion is that suffering is just part of the human experience.

This, for many people in STEM, can be part of their core personality. They think they are smart enough to recognize how awful the world is and how irrational everyone is not to see how much it just sucks. And because so many of us are also suffering from mental health issues, this perspective can be reinforced. I'm here to tell you a harsh truth: if you think suffering is the rational, smart way to feel, you are deeply mistaken. I have been that mistaken person. It is okay to be wrong.

A way to work with our brains and accept radical pragmatism is to recognize the elements in tools we accept as rational and scientific. Radical pragmatism is a form of abstraction. We use a wrong but working abstraction in lots of domains. In fact, radical pragmatism is a core part of the engineering approach to problem-solving. We are often limited in our scientific understanding of how something really works, but we can develop math and tooling that works without fully understanding the thing. Much of technology is built upon things that we figured out how to do without fully understanding how or why it works. Poetically this approach, rather than hurting science, is often how it is advanced. We do things we don't understand with tools not fully developed and this allows us to learn more about the thing. Eventually, the ability to experiment outpaces the pure theoretical approaches because the theoretical lacks the tool of pragmatism. Radical pragmatism is powerful.

Our knowledge of gravity is terrible. We don't even know what gravity is. We can't model systems beyond two bodies. We don't know if gravity is a particle or a wave or some sort of emergent quantum property. This does not stop us from putting satellites in space or landing rovers on Mars. Why? It isn't because we just throw some formulas at things, launch shit into space, and hope the physics holds up. We understand the physics just fine, it works almost perfectly. The precision it gives us is almost mind-bogglingly impressive. It just isn't a "true" reflection of reality. Newtonian physics is merely just a model of gravity that works. Just because something doesn't capture the full reality doesn't make it any less useful or less accurate.

Radical Pragmatism is like our theories of gravity. You don't need to fully understand the human mind to do things that work. You can just do things, see what has positive changes, and then do more of that.

This can reveal our final approach to internalizing radical pragmatism. We can view it through an anthropological lens. Humans hundreds of years ago didn't have any of the knowledge we have today. Did they suffer because they didn't know any neuroscience? Without CBT were they doomed to suffering? A traditional intellectual view has been that human suffering has been on a declining curve for centuries. We live not only in the best time for technology to fight diseases and transportation, but also the time of the best technologies for our minds. Our suffering has always been there but we have gotten better in recent decades [strong-ai-religion]. There, of course, is lots of suffering to point to that indicates this narrative is false.

The scientific consensus has, of course, shifted to a far more nuanced view. It turns out that humans have suffered at various times, and other times we have not suffered so much. Sometimes the invention of agriculture turned us into murderous monsters, at other times it made some cultures explode in quality of life. It turns out that we are systems in complex systems. Sometimes we learn and collectively adopt more functional mental models that work for us in that time and place. In other times, human societies are ill and a mess. The factors that determine when we are healthy as a society and when we are ill are complex, there is no convenient solution.

Radical pragmatism provides a tool to sort through the impossible complexity surrounding mental health. What is a cause of x? Fix it and see what happens. Can't fix x? Look at a society where x doesn't exist and see if y still exists. If this sounds like a lot of sociology and psych studies, that is because that is the tool they use. To some degree, we are already accepting of this tool, we read books which rely on it all the time, we consume articles and share studies which rely on it. We just sometimes become uncomfortable when the radical pragmatism disagrees with our perception of the truth. But getting upset with radical pragmatism is like getting upset we use particle simulations to model gravity in video games. It is just an abstraction, babes.

A tool you can use to combat bad approaches is to just say "prove it!". I grew up evangelical and exposed to a lot of mental health and psychology. Much of this psychology was twisted and contorted from the influences of bad religion. I was and am given a lot of advice about my mental health. There is a tendency to get into arguments, to cite studies and the science; but a better method to respond to toxic mental health advice is "Prove it!". If something works for better mental health then it should make you better and happier. Often the case is that toxic mental health advice comes from people unable to manage their own mental health. You can shut this down by asking them to prove it. This also works with our toxic inner parts just as much as external humans.

It it works, then it works. We don't have to get caught up in what is valid scientifically or not. What is valid, is what works. For example, if we struggle with the concept of e.g. parts from IFS we don't have to view it as real, we certainly don't have to view it through a spiritual or religious lens. Maybe all parts are is just different neural nets, and you can access them through language and visualization. The metaphors and abstractions you use to internalize a tool don't really matter, the tool usage is what matters.

Mental health concepts don't have to be literal. In fact, none of them ever are. Just like in science, they are always just abstractions with tradeoffs. What works is what works. A lot of humans call this the engineering method. Whereas the scientific method focuses on hypotheses and data and extrapolates outwards; the engineering method works backward taking what works and drawing conclusions about how and why. Both are valid intellectual approaches with different strengths and weaknesses.

Most of us have a mental model of mental health that goes a bit like this. The default state of a human mind is healthy. We maintain this healthy state by regulating and controlling our thoughts and feelings in response to stimuli. When stimuli are bad, we learn responses that are maladaptive to other situations. When stimuli are good, we learn adaptive tools that are good. A healthy mind is one that accurately interprets reality and responds appropriately. An unhealthy mind is one that has inaccurate perceptions and/or responds in maladaptive ways.

This is "traditional" psychology and has been around since the 60s-70s. It springs from behaviorism. Much of what we think of as therapy is modeled after this. When we picture going to therapy, we are typically picturing something from this modality.

This model of how mental health works is in some ways very, very old. Most famously laid out in stoicism (that meditations book you probably read in high school). In stoicism, the ultimate indicator of a good mind is your ability to accurately perceive the world and react to it accurately (wisdom).

Some things are in our control and others not. Things in our control are opinion, pursuit, desire, aversion, and, in a word, whatever are our own actions. Things not in our control are body, property, reputation, command, and, in one word, whatever are not our own actions.

~Epictetus

This sort of stuff is ubiquitous in WEIRD culture. It pops up in everything from the serenity prayer to mass media portrayals of therapy. Even those not immersed in psychology are going to have a default mental model for mental health similar to the one taught in CBT.

A lot of us that have high ACE score backgrounds will learn some therapy just to survive. We often learn it extremely early. By the time we are into adulthood and really struggling, we have accumulated an almost exhausting amount of techniques for controlling our minds. One of the reasons we turn to maladaptive coping mechanisms is a belief that better thoughts is how we become healthy. The more controlled, more regulated, and more rational our inner world the better our mental health.

T. M. Luhrmann calls this the citadel model of the mind. Westerners conceive of their mind as having a central self that is fortified against the outside world. True mental health involves fortifying your mind and making it strong. Good mental health is when we are in control of self, of our thoughts and feelings. When our responses to stimuli are under our control we are well.

Therapy, in this vision of the mind, involves learning ever-better regulation skills. And mental illness is caused by either lacking skills or having been so damaged that those skills have been destroyed. A mental model like this is part of the reason why a lot of traditional therapy has ignored trauma. It simply isn't relevant how a brain became unhealthy, only that it is. To make a brain healthy only requires teaching it those skills that are lacking.

The first time I had a hallucinatory flashback, I would have been about five years old. While I know consciously the details are probably wrong, the memory is still clear as day to me. I was in my grandfather's cabin in Idyllwild. As I started to fall asleep, my dad suddenly appeared. It was exactly like he was there. I would wake up screaming and having night terrors throughout my childhood. Waking up in the middle of the night terrified for my life, with shadowy figures standing over me, was a near-constant, almost nightly experience.

By the time I was in my teens, I had found what I thought were solid answers for things. I was fucking crazy. But this was just another problem I could solve. I would apply all my intellectual effort to controlling and regulating my broken brain. I got very, very good at this. I learned to do things no matter how panicked or anxious or terrified or out of my mind I felt. I felt like I had everything under control.

In a traditional therapy model, I had achieved good mental health. I had achieved what is the dream outcome for something like ABA or CBT. All my actions were correct, despite my mind being a hellscape. I could stay visibly calm and non-reactive when feeling under threat. No matter how terrified or scared or freaked out or emotional I might feel, I was always in control of myself. If you have a legacy of trauma, you learn coping mechanisms to "control" your thoughts pretty early. We learn to control our minds so that we are acceptable to others and ourselves. This allows us to manage in a world that is harmful to us. If you are ND, this behavior is labeled "masking."

The initial experience for a lot of us with actual therapy can be downright traumatic. By traditional standards, the better you are at, e.g., masking, the healthier you are. As a result, we get told to do what is essentially "try harder." And when we inevitably fail at this because we are already at our limits, this is used to pathologize us. At best people misdiagnose us and send us down the wrong paths; at worst, we accumulate pathologized labels.

Because of my hallucinatory flashbacks, which I now know are super common trauma and CSA symptoms, I was deathly afraid of being too open with therapists. And the first few mental health professionals I saw got very quickly concerned by me. I was a very put-together person, but clearly capable of being really fucking nuts. Instead of recognizing how hard I was trying…

This is a common experience for autists and other ND humans. It doesn't register for a lot of people that our baseline of trying is really 100%. Most people, if they experienced the world the way I do, would have broken long ago. Some of us play in a world that is, for us, hard mode.

Most of us will at some point experience a psychological break from this constant self-control and masking. Usually, a stressful event or new trauma pushes us over the edge. Despite knowing everything about therapy and considering ourselves to have perfect mental health, we seek help, or in some cases, out of shame, we withdraw from society.

When we get to therapy, we usually have a narrative like "I'm just extra struggling right now and needed to talk to someone." After all, we are the perfect model of mental health; we just got pushed over that edge a bit. We will get stronger though and really fix our brain this time.

Depending on the therapist, they might laugh at you or they might buy into this narrative. Often, those that do buy in do it because they have the same mental model of mental health themselves.

Once in therapy, you either start crying because you realize "holy shit, I have some things I have to deal with. Wait, that was trauma? I thought everyone's parents did that." Or you get validated. A little bit of extra help, the stressors go away, and back you go to your perfect mental health and life.

It can take several of these perfect mental health, stressor, get help, back to perfect self-control cycles before something really breaks. If you are poor, this will happen sooner rather than later. If you are privileged, it can take a very long time, maybe until your deathbed. Regardless of how, one day your environment will break you and the trauma will come barreling to the surface.

The alternative model to the citadel mind is the porous mind. In the porous mind, there is no central self. Instead of a fortress, our mind is like a membrane, isolated but permeable. Our mind is in a feedback loop with our environments, constantly shifting, changing, and absorbing.

What does a healthy mind look like in the porous model? In the porous mind, we are like a system; our mind is healthy when the system is healthy. The same way that an ecological system is healthy when all things are in balance, a mind is healthy when all the variables are working together. And just like any system, some variables can have huge impacts, some have small impacts, some variables only have an impact when coupled with another variable.

We might, for example, be rich, this can let us make up for a lot of other faulty variables. We might struggle with executive functioning but still be healthy because we can pay others to make up for that deficit. But if you are poor, then the executive functioning becomes a serious factor, instead of paying a maid, the dishes pile up, and before long your kitchen looks like an episode of hoarders. The difference between a healthy mind and an unhealthy mind can be as simple as a poisoned river or as complicated as an economic system designed by apes that incentivizes other apes to overuse fertilizers resulting in runoff into the river that increases algae blooms that only become a problem when the climate's temperatures are higher than usual.

A citadel mind places the emphasis on self always. No variable is so bad that it matters – the only thing matters is your level of control over your mind. If meeting our needs is tough on us because the economic system we have invented extremely disproportionately distributes resources, then the problem with coping with this is our control.

The porous mind looks at things through a system instead of self lense. Some variables really matter, like e.g having enough money, other variables are minor, some variables only become important when other variables are extreme or lessened. We might have a lot of stress, so how much money we has becomes more important etc.

A mental model like the porous mind cultivates mindfulness. When we conceive of our self as a system, we become more aware and more introspective about the variables that make up us. Then we can do that self-care thing because we recognize that self-care is an aspect of self. Instead of responding to suffering by trying to be better and "healthier," we are more able to accept it as just an aspect of our life, a variable. The suffering might be a lot or it might be a little, we might be able to lessen how much that suffering impacts us by tweaking the variables we control.

It turns out that the porous mind is actually more stoic and more resilient. Someone with mindfulness and a mental model that they are porous will see their inner world as more under their control, not less. This is because we have more access to tweak our inner world, more factors are available to us, we get to tweak all the variables. Then not only are you more willing to, e.g., self-care, you are more likely to see a positive effect from it because you see it as mattering. Instead of feeling like your mind is out of your control, you feel like you have so many ways to influence yourself. For example, no matter how bad things get, you can probably still go for a walk or listen to some music. A porous mindset views the walk as having an influence on your mental health, whereas a citadel mindset is likely to say "Why waste time going for a walk when I can just have more willpower?".

Often we are attached to the citadel mind model because it brings a feeling of security. By thinking of a healthy brain in terms of a mind under control, this makes us feel in control. The more in control we feel, the healthier we interpret our mental state. This is often because we have decided that our thoughts and feelings indicate our character. If our mind indicates our character, then the more in control we are of it, the more moral and good we can be.

We can also be attached to a citadel mindset because our thoughts are extremely intrusive. If we have suffered terrible abuse (usually of the SA and physical violence variety), we often have terrible thoughts that are very triggering to us. The citadel mindset is often born out of a quest to stop intrusive thoughts. This especially gets bad when we fear the thoughts indicate our character. We might, for example, have been sexually abused; now we have graphic thoughts as a result. The thoughts become almost a form of re-victimization; we are constantly reliving horrors.

The citadel mindset has been reinforced by bad science. It is often believed, for example, that thoughts indicate intent. There is no science to indicate this. In fact, all studies point to the possibility of the opposite. It seems like thoughts are more like a movie or a dream. We are simply generating ideas, scenarios, etc. Trauma triggers intrusive thoughts because intrusive thoughts can prime you to react to future abuse. The extremeness of your thoughts doesn't indicate likelihood either; in fact, it's useful, just like machine learning, to imagine outlier scenarios so that you can prune for them. [lower-and-higher-functions]

A porous mindset can be extremely freeing. It lets us start applying systems thinking to our mindfulness. Instead of living in a black and white world where we are constantly fighting a never-ending battle with our own mind, we become active participants in our mind. Counterintuitively, it is not the citadel mental model that helps us connect with self, but that of a porous membrane.

I paid to toughen up in therapy She said to me, "Soften up"

~Carly Rae Jepsen

I don't remember when I started hearing voices. It is one of those things where it just feels like that is how your brain has always worked, and there was never a time when it was different. Like trying to remember when you started talking - you know at some point you did, but there isn't a clear single moment when it happened. Ironically, I have never had much of an internal monologue; I mostly think in pictures, and the voices always felt like they came not from me but from elsewhere. And I thought for a long time that what people referred to as their internal monologue was the same as auditory hallucinations.

I do remember that at some point the voices stopped being a feeling of safety or comfort for me. The voices went from just how my brain worked to something that was hostile to me and that I feared. Thankfully, they were not completely terrifying, only mildly horrifying and a bit terrifying. Like somewhere between dad trying to murder you and sleep paralysis (ake spicy dreams). Right in that Goldilocks zone of "OMG, I think I might be insane" and "Haha, that's weird."

My struggle with intrusive thoughts started young and was extremely graphic. I would be there just chilling, doing whatever, when a sight or sound would set me off, and boom, there the voices would be. They would tell me all sorts of graphic and messed up things. Because I grew up in a high ACE score background (a polite way of saying white trash) and evangelical, I had both an enormous repertoire of fucked up things to draw from and little understanding of what hearing voices meant.

It is often cited that roughly 10% of people will experience auditory hallucinations in their lifetime. This is usually journalists hedging their bets and pulling a median either from a collection of studies or the stats in one study. In a pattern that is very familiar in mental health research, the statistics hide an important detail: the way the question is asked has a massive impact on the results. The way the question about auditory hallucinations is asked leads to as little as 0.6% of people reporting hearing voices and as much as 90%.

Lots of self-reported mental experiences are like this. Ask someone if they have anxiety in one way and you will get one percentage; ask in a different way and the percentage can plummet or skyrocket. Ask people if they experience outlier things and they will say "of course not!", but rephrase it slightly and suddenly an outlier experience is super common. The way a study is designed influences its results. Moreover, the context surrounding the study – when, to whom, and where, can change the results dramatically. Ask someone the same question while they're scared, and you'll get a completely different result; ask around lunchtime, and suddenly everyone will be hangry and answering as if they really need a snack and think everyone hates them or is irritating. These are, of course, classic and well-explored problems of conducting science around mental health; but they're only recently beginning to get the attention they deserve due to a larger crisis of replicability in science. Despite what the news and TikTok would have you believe, most research into mental phenomena is still in its infancy, and much of it is about exploring methodology and collecting data for the next group.

In times of stress or when I was triggered more, the voices would get really bad. On days that were particularly difficult or when outlier bad events would happen, I would often spend the following weeks in a sort of sub-hallucinatory dream state. I would have more frequent bouts of sleep paralysis and night terrors. The few times I would leak details about my suffering, I would be told I was seeing ghosts or that demons were trying to get to me. I learned to keep my mouth shut. Lots of people learn to keep their mouths shut when we talk about our outlier mental experiences.

This is driven in part by shame and stigma, of course, but also by how dissimilar our internal experiences are and how woefully uneducated we are of this fact. We are all walking around with vastly different mental worlds, processing and experiencing the world in wildly different ways, but completely unaware of how much of a "freak" we are compared to the person next to us. No wonder we react with shaming and stigmatization; we were told we were normal, and we constantly discover that normal doesn't exist.

Turns out even walking around with something we think of as a mental world isn't a consistent experience. Before the internet age, it was thought aphantasia was really rare; turns out it's not so fucking rare. taps the meme about left-handedness

I first learned that others heard voices from the book "A Beautiful Mind," which I read around the time the movie was released (2001ish so I would have been around 11). This led into a deep dive into every biography of every brilliant intelligent person I could find at the library. Instead of internalizing anything positive, I learned that I was likely mentally ill; the only positive thing my brain absorbed was that it was probably because I was hella smart. I resolved that I should keep my internal world a secret. If I didn't want to be taken to a psychiatric ward and lobotomized, I had better not say anything.

This feeling that you will be dragged away in the middle of the night because you are deeply damaged and broken is a common symptom of trauma. Trauma rewires our brain in maladaptive ways, and then we become terrified of revealing those maladaptations. We aren't supposed to be maladapted; to run software for outlier events is to be running faulty software, to be broken.

Trauma is a double burden of isolation and hell: first, we have harm inflicted upon us, and then we receive further harm as punishment for the symptoms. I was a child who was surviving tremendous hardship and had survived tremendous hardship, but I felt I deserved no one, that I was a freak with a damaged mind, and I shouldn't burden anyone with my thoughts. The cruelest thing trauma does is strip us of connection. Humans should never believe they are too damaged or too broken.

Thoughts are often the most distressing aspect of trauma. Many of the accompanying maladaptive behaviors of trauma are techniques to manage thoughts. Humans turn to tactics like numbing substances, or substances that temporarily alter our thoughts or the way we experience them. We develop psychological tools that enable us to disconnect from thoughts, distance ourselves from them, and some of us do this to the point where many thoughts get confined to parts of us that are only able to communicate through hallucinations.

An interesting insight here is that one person's coping mechanism can be another person's nightmare. Some people might, for example, find dissociating incredibly useful, while others will freak out when the dissociation comes. Some find their thoughts racing on THC, others finally feel some peace. What is maladaptive seems dependent on the type of internal mental experiences. We end up in a feedback loop between the way we internally experience the world and our external coping mechanisms.

Why are our thoughts so distressing? Why does so much of mental illness have to do with and relate to our attempts to manage, regulate, and suppress our thoughts? We live in a culture that emphasizes the idea that our thoughts indicate our character or somehow represent parts of ourselves. Traumatized people will experience thoughts and ideas that are heavily related to the events they experienced. This makes intuitive sense; why would you experience something that is disconnected from the events that you experienced? You aren't going to, for example, experience physical violence and then constantly think of your favorite movie and have flashbacks to that time you had the best ice cream. You are going to relive that traumatic experience and think of related things.

This is how a brain processes and deals with traumatic data. It shows us potentially related data over and over again. Graphic and triggering thoughts are necessary because thoughts don't represent your self; they are data. Your brain is just doing a similarity search and playing back data. Getting angry at your brain for intrusive thoughts like it is you and something you are doing is like blaming yourself for what you imagine when you read a book.

The idea that our thoughts are in our control and represent the self is one that permeates through our culture and our media. Most of the mental health education we absorb through osmosis is rooted in this idea. It comes mostly from traditional CBT being the source for media on mental health, but the origins of CBT are much older.

Every nerdy kid with mental health issues is likely to have encountered stoicism at some point. If not through works of philosophy directly, through sci-fi and fantasy. A common thing I and my friends quoted as teens was Dune. One of the most iconic lines from Dune is "Fear is the mindkiller." To be smart, to be well, is to be in control of your mind. And to not be is a moral failure and weakness.

If you see negative thoughts as the source of negative mental health, all your approaches to getting healthier are going to be focused on controlling, regulating, and preventing the negative thoughts. Most of us are aware that something like depression is bad and should be dealt with. We think we deal with these negative mental health things by being better at our regulation of thoughts. We might intuitively, for example, tell ourselves to focus on what we have, to stop thinking negative thoughts.

This is often why highly educated or "nerdy" people can be avoidant of therapy. What could therapy possibly offer us when we are already constantly thinking and trying to better ourselves? At best, we see therapy as something that happens when things have gone too far and we need extra assistance; at worst, we see therapy as being for people who can't self-reflect or work on themselves.

Historically, the idea that negative thoughts are the cause of poor mental health is very old. Elements of this core concept are found in the oldest religions and philosophies. The Stoics were particularly focused on this, and many of their leaders wrote extensively about it. Even what we consider traditional psychology, not just modern approaches, has much in common with this core idea. A cocaine-addicted Viennese doctor wasn't convinced that thoughts weren't our problem; he just believed those thoughts were hidden from us. Behaviorism and CBT weren't entirely new concepts but rather modern, scientifically-backed versions of very old ideas.

I want to be careful here though and not create a false narrative where everything we know about mental health now is merely regurgitated knowledge from long-dead philosophers. Our understanding of negative thoughts scarcely resembles what humans used to think of as negative thoughts. The thoughts of past humans would have horrified and confused us, and our thoughts would horrify and confuse them. [humans-might-have-thought-differently]

That said, the idea that negative thoughts lead to negative mental health is the core of both Stoicism and traditional Cognitive Behavioral Therapy (CBT). In CBT, our thoughts lead to emotions, which lead to behaviors. The theory suggests that by learning to regulate and control our thoughts - by making them more positive - we will experience fewer negative emotions and thus have better mental health. [even-more-absurdley]

This is now widely regarded, as most things of the past are, as fundamentally wrong. The first cracks in the traditional CBT story formed rather quickly. It was many of their own who discovered this. Because that is how much of psychological science developed. Some scientists would conduct experiments, write studies, and then someone like B.F. Skinner or some Nazi scientist, or a Viennese cocaine addict would get it in their thick skull that their idea of how our brains worked was correct.

Behaviorism was born out of true studies. Operant conditioning and countless other phenomena were and are real things, backed up in repeated experiments. It just doesn't actually tell us much about how the human mind works, how we work. Turns out, you can't learn a lot about humans from experiments on rats in a maze.

This is the unfortunate story of so much of the science that makes us who we are. The truth is, we don't know a lot about how our minds work. We know the definite causes of practically zero mental diseases.

Chances are, unless you get a bolt through your head, we won't be able to tell you exactly how it will play out mentally. Even then, it turns out that sometimes a bolt through the head isn't a problem. We barely understand the effects of bolts through brains, and we aren't even yet sure if all of what we experience is contained within our body. We thought for a bit that it was all contained in the brain, and then we realized that the body keeps score. And it turns out that even that is already somewhat wrong because stuff like gut microbes can influence your neurobiology.

Every box we try to put the mind in turns out to have never contained it at all. Which all sounds a bit quantumn spooky – and that might not turn out to be a coincidence, but that is a subject for another day.

Most of the read too much, hang out on LessWrong and HN type of humans have some degree of exposure to the idea that thoughts are just thoughts in the form of mindfulness and meditation practices. A standard part of the learning-to-meditate process is the "aha" moment when you finally internalize that trying to force yourself into a calm and relaxed state isn't how it's done. You learn that you don't quiet your mind by thinking calming and quiet thoughts; you quiet your mind by letting your mind be and think what it wants. When left alone, your mind will eventually calm and relax. This, of course, takes practice and more practice.

Many of us are very mindful. Many of us have become good at relaxing and just letting those thoughts be. We might have routines that involve a balanced work life, lots of self-care, and set-aside times for nature and meditation, etc. For many though, this doesn't bring us much baseline healing or better mental health.

We might, for example, do really well, but every day feels like a constant battle. Maintaining your mental health can feel like a never-ending chore. We might find that our zone of comfort is incredibly thin or lacking. We might do well holding it together, but it might constantly feel like all we are doing is holding it together.

For some of us, we might have had exposure to the idea (perhaps in therapy) that controlling ourselves and regulating our thoughts is negative, but we do it anyway. The same way we exchange sleep for more productivity and hustle, we can rationalize that it is okay to be less mindful, less self-kind, more cruel to ourselves, in pursuit of greatness. We want to be the best version of ourselves, and the idea we have is that the best version is the version that is most in control of our minds. Just like self-care and rest can be viewed as a means to an end, we can easily view mindfulness as a means to an end.

In Acceptance and Commitment Therapy, this is called cognitive fusion. We can become attached (fused) with judgments and ideas around our thoughts. We are fused when we are convinced that our approach to thoughts is rational and good. When you see something as moral, no amount of pointing out the flaws will work because you will always want to do the rational thing.

Often, many intellectualized, well-read humans struggle with ACT because the fusion is happening in unexpected ways. Even if we accept that something like mindfulness works well, we might think we are above it or beyond it. Other weak people need to just let their thoughts drift and flow; we, though, are in control, so smart and rational. We can even learn to only apply mindfulness in one part of our life, in one realm of it. We might be incredibly kind to ourselves while meditating but go on being terrible to ourselves about all our work. This domain splitting, rather than being rare, seems to be incredibly common.

The most insidious form of this tradeoff mental model is when we think our intelligence or success is linked to the content of our thoughts. We can be convinced that learning any kind of different approach to thinking could take away our intelligence. Like someone that believes their psychosis helps them, we can believe that our hostile approach to self is good for us. That if we correct our thoughts, we can control them. That if we control our thoughts, then we can think more efficiently, more optimized, and we will be healthier. And culture is very willing to cooperate with this; everything from self-help books on perfection to productivity guides can reinforce mental models that needing more self-control, more regulation is key to being a better you.

If you are disabled or otherwise really struggling in life, intelligence might be all you have left of your self-esteem. You might be a total mess but at least you can sort of code or do math or art or write. People who are really struggling are going to be afraid of anything that might make that struggling worse. We can be fearful of help and assistance not because we don't want it but because we think it won't be hard enough on us. So many traumatized people go to therapy expecting to be told, "You lazy piece of shit, try harder," so we skip the therapy and do that to ourselves; we try harder, we push ourselves hard. We keep trying harder until we break, and when we break, we just try to get harder.

I paid to toughen up in therapy She said to me, "Soften up"

~Carly Rae Jepsen

I was really into chess as a kid/young teen. I wanted to get really good. I had dreams of being a GM and perhaps stronger. I got relatively good pretty fast, catching up to my peers, but at the same time my mental health issues were getting worse and worse.

I was well into my 20s before my mental health issues got under control. And it was a lot longer before I was able to get my mental health issues while playing chess under control. I have always had a massive gap between my online results and offline results. Mostly because I cannot seem to think over the board. When online, I can get in the zone. When offline, I am prone to falling apart. I am infamously inconsistent, sometimes blowing 2100 players off the board, sometimes losing to 1300s, sometimes I will be crushing someone and inexplicably just hang a piece.

The dark reason behind this is that over the board my intrusive thoughts are often running wild. In the middle of games, I'm often struck by memories of terrible childhood experiences. For the longest time, I battled with this, trying thing after thing to get it under control. Chess became a testing ground for my quest for better mental health. It hurt my self-esteem to lose games not because of poor skills but because I was "crazy". Playing chess badly is fine, playing chess badly because you can't stop thinking about some horrific childhood memory makes the experience suck.

This intrusive thought problem has been felt my entire life in all sorts of domains. For years the same thing happened in interviews. Sometimes I would do fine, other times I would be in one after hours and suddenly the voices would be back. Instead of being able to code, suddenly I would be a complete idiot unable to even process words. I have bailed while crying in more than one interview and less than a dozen, which is too much. It wasn't that I was anxious or panicky; it was a different beast altogether, a temporary psychosis that followed me everywhere just waiting for something important.

I learned, like many severely traumatized people, to be avoidant of things that triggered me. I was tired of being triggered and losing my mind. When you are constantly losing your mind, you will constantly mess everything up. You will get tired of messing up and you will begin to design your entire life around not messing up.

And because the messing up happens because of stigmatized reasons, you can't seek help or assistance; you are on your own. But that doesn't mean you won't get told how to fix yourself. An unexpected mistake is a magnet for advice and rescue. I have been told so much constant, contradictory, all-over-the-place advice and suggestions. This was because I was incredibly inconsistent. Sometimes I would kick ass at technical stuff and fail the soft skills screenings in epic fashion. This would lead to lots of advice about taking improv classes or seeking out anxiety meds. Sometimes I would ace the soft skills and then appear like a grifter trying to pretend to code. Sometimes I would do fine in all my work things but have a total freakout one day because my family triggered me. Everyone wants to know what the hell is wrong with you and why would the emotionally stable, kind, intelligent person suddenly start crying and sobbing in a professional context over Zoom.

I was all over the place and so incosistent so unstable because I was getting triggered. Sometimes by a phone call from my mom, sometimes by something an interviewer said or did. Hell, once I got very freaked out because I thought a CEO was going to dine and dash on me from a meal I could not afford.

When the triggers ceased for a while and I was able to calm down, the behaviors would stop. I would return to normal. But then the shame and embarrassment would come creeping up. The shame mostly of having messed up yet another thing.

People with trauma symptoms like this can go through cycles of this constantly. Messing up their life over and over until they are homeless. Sometimes regaining functioning brains enough to work for a while, only to mess up again. At best we continually derail our lives and fail to live up to potential, at worst we end up dea from suicide.

I have spent a lot of my life wanting to be dead because of my thoughts. I wanted to stop experiencing the terrible things constantly. I wanted the never-ending HD video playback of awful memories to just finally end. And most of all, I just wanted some sort of life.

People like me don't have high survival rates or good outcomes. Way too many than should be are fucking dead.

I was constantly trapped in a hell of my own making. Even worse, every time I sought mental health help, my brain would just ramp up things more. I saw mental health care as an exhausting play I had to perform through as punishment for messing up. Some months when professionals thought I was the most functional I had ever been, I was struggling more than ever. Lest you think I have actual undiagnosed psychosis, I once saw a therapist weekly for months while actively hallucinating through almost every session, and they never noticed a damn thing odd about my behavior.

This is a classic struggle though of traumatized humans, especially of the high-functioning autistic variety. We learn how to split ourselves into multiple parts; we can be simultaneously very functional and very disabled. In one context, absent triggers, we can be a totally different person. In another, we will regress so far we end up like little sobbing children. I am 6'2", 240 lbs. I am a big human, and I have curled into a ball holding a stuffed animal and screamed and cried.

I was in a constant battle with my own mind. I was always in a fight against my thoughts, always questing to finally be able to regulate them. I thought healing would look like the thoughts lessening, then disappearing. Sometimes it felt like I was heading there, and then—bam—the voices would be back, more vicious than ever. Then I learned I could just have those thoughts. Not all at once, but gradually.

The trick of learning that thoughts are just thoughts, the big secret of not getting fused, not becoming entangled, not having a part take over, is practice. The secret behind almost all trauma treatment is that it all works with just safety and practice. It is simply something you learn over time.

Because we are complicated systems, we can find safety in many different places. We might, for example, learn to meditate. It won't matter that the mindfulness only works in meditation. In fact, that is the whole point – you are just practicing mindfulness without any other distractions, without all the things that trigger you getting in the way. There doesn't need to be more than that. Gradually, over time, you'll be able to deploy that mindfulness in other contexts.

Too often, culture around things like self-care or mindfulness makes you want to do more than take little steps. We try to take on mindfulness all at once, or we think that the revelation of "Thoughts are Just Thoughts" is going to change everything. Then when it doesn't, we are disappointed in ourselves; we regress backward in one domain and start to believe things like we were broken all along. But we are systems, and while that means everything is complicated, it also means that we can pick up things in bits and pieces – a bit in one context, a bit in another. We can become more tolerant of the ups and downs of emotions in a hobby we are good at because being good at something gives us the feeling of safety and confidence that things will go right in the end.

The idea that thoughts are just thoughts is an extremely old one. It is core to many spiritualist and animist belief systems. It might have been around for so long because we have always been diverse as humans. We have, for as long as we have walked the earth, walked around with very different brains processing the world in very different ways.

What mental models or metaphors you use to learn that thoughts are just thoughts don't matter so much. In ACT, people are fond of metaphors for their thoughts; this helps them see their thoughts as something else, to personify them as passengers on a bus, or self as context, or self as a fruit bowl. In IFS, people are fond of thinking of thoughts as coming from parts of themselves; it's easier to identify with your thoughts when they aren't coming from you. Even in modern CBT, people are often able to defuse from their thoughts by seeing how irrational and ridiculous they are. Many computer science-minded humans like to think of their thoughts as simply data, like sensory input they process and observe.

You are a complicated system, and what works for you will be different from everyone else. But you are in this together with everyone else, and you've got this.

You might have encountered this one before because it is fairly popular and widely reshared. Mindfulness and grounding are all based on somatic techniques, and this technique is a simple way to remember to engage all of your senses:

The process:

• Name FIVE things you see around you

• Name FOUR things you can touch around you

• Name THREE things you hear

• Name TWO things you can smell

• Name ONE thing you can taste

You can also change it up a bit and just do see, touch, hear, smell, taste. Many people get caught up in the thinking bit of naming and only engage their thoughts. This can be less effective and, in the case of anxious or intrusive thoughts, can be even counterproductive. The point is the sensory engagement!