...this is something that I haven’t actually talked to my psychiatrist or my close circle of friends and relatives about, partially because it’s minor among my other maintenance operations, but really because I’m afraid it would upset them. If this is too alien, I’m not sure I should try talking about it, and in some way, this post is testing the waters.
My guess is that if anyone became upset in a justified way, it would grow out of a fear that you might be cultivating habits of mind that appear dissociative and which might increase the chances that this becomes a new and additional symptom of a larger complex of poor mental health.
Suppose that self-ontologies involving multiple agentive subselves makes it easier to fall for certain kinds of bad reasoning, or suggest planning mistakes that lead to obviously maladaptive behavior, even as it allows more nuance and better models in certain circumstances where a clear mind can understand the details and prune the obviously dumb plans will not actually go off the tracks. From experience talking with smart people about these subjects, this seems very reasonable to me.
For example, some really really dumb versions of hedonism suggest that you shouldn’t bother to look both ways before crossing the street because if you are hit by a car and killed then you’ll simply not exist with any happiness state (so scenarios with fatal dangers “don’t count” because your “self” disappears in those and your standard of judgment evaporates) but if you don’t pause to look and aren’t hit then you’ll get to the other side faster and be slightly happier than if you wasted time checking for danger when there wasn’t any.
Obviously this is wrong… but if you put enough hand waving between the stupid parts of the argument and changed the context from a familiar danger (like crossing the street where you have cached answers that are obviously right) to an unfamiliar danger (like investing or choosing a medical treatment?) it might convince someone. Perhaps it might convince your “hypomanic self” who doesn’t stop to think very much?
The fact that the bargain between your subselves involves a promise by “a self that does things without thinking” to enact a desire of “a self that can safely contemplate horrors because it won’t thereby do something rash” makes this worry particularly vivid. It makes sense that both depression and mania are bad versions of cognitive states that have a mild and adaptive version which is functional for some environments… using trade-between-subselves to give the bad parts of each extreme more effectiveness seems at least potentially unwise.
My guess is that the part that would concern your psychiatrist is the fact that you’re actually making a negotiation that involves increasing the odds of killing yourself so that you can decrease the odds of killing yourself. It makes sense to me and probably most people here, but I suspect it’d bother most people.
Count me bothered. I really really don’t want you to kill yourself, either consciously while depressed or through “more than normal recklessness” while manic. Your comments here are striking because you’re the one who has been diagnosed with bipolar II disorder and yet you are also one of the more level headed commenters in this thread, offering gentle encouragement and insight to people who are bouncing around ideas that relate to intellectual issues raised right next to discussion of suicide.
You clearly have a lot to offer the world and it would be bad if you don’t explore more of that potential. Your suicide would be tragic. I want you to live.
I think it might be wise to print out this article and the comments and show it to your therapist or someone else whose intellect you respect and who you can interact with face-to-face. If your logic is clean then it should be fine, but if not then maybe they will be able to see something important that you missed. Getting a second opinion like this seems like something that would make your friends and family (the people you’re trying to protect from your chemically induced suicidal tendencies) very happy.
You clearly have a lot to offer the world and it would be bad if you don’t explore more of that potential. Your suicide would be tragic. I want you to live.
I agree. I don’t know if this is a useful reaction, because it is emotional (tell me if you find it offputting so that I can modulate in future) but I found this whole post incredibly winning and incredibly bittersweet. I like you—the reflective, self-aware “you” who is striving diligently to protect his loved ones from the parts of his brain that might harm them—and I ache for you, because you have a tough road to hoe. I experienced a brief and situational bout of suicidal depression about fifteen years ago, and I remember how hard it was. You have to go through that over and over. You’re so matter-of-fact about the pain of living, but I feel it in this post, and I have both admiration and sympathy for you.
The negotiation that you’re performing with your subagents seems reasonable the way you’ve laid it out here, especially considering Footnote #2. I would, however, encourage you to share it with your psychiatrist—or find another psychiatrist that you can share it with. If your psychiatrist wouldn’t understand this post, he or she is the wrong psychiatrist for you. You should not feel like you have to protect your psychiatrist from your thoughts.
And good luck. I hope to hear a lot more from you going forward.
Thank you, very much. Your and Jennifer’s care is really touching.
I will bring this up—gently—with my psychiatrist. I am in an uncomfortable position, in that my psychiatrist has a lot of power over me. If he decides that I am unreliable, I lose my job and gain around $50,000 of debt. I can change psychiatrists, but I can’t get a second opinion.
The US government payed for my masters on the condition that I work for a federal agency after graduating. I now need the continued support of my psychiatrist to handle classified material. If I lose that, I lose my job, have broken contract, and have to pay back the cost of my degree.
It is certainly less than ideal for the purpose of effective therapy, but at least I’ve finally found a therapist who is on board with non-pharmaceutical treatments.
Is there some reason why you can’t also see a second therapist, possibly without the first one knowing about it? It seems to me that it might be useful for you to do so.
I can have as many therapists as I can afford, and I wouldn’t need to tell them about each other (though it would probably be wisest to), but I do need to tell my employer about every source of help I’m receiving, and each source will be contacted.
What is the objection to pharmaceutical treatments? Mood stabilisers are a class of drugs that actually do work reliably (as opposed to, say, SSRIs for depression). Although I suppose you don’t really need a ‘pharmacutical’ company to use lithium. Doctors have been treating patients with lithium since the second century.
My objection is purely based on the side effects I’ve experienced, and I’ve only been on a limited number of drugs. Every mood stabilizer that I’ve been on has left me intellectually and emotionally crippled. That is perhaps putting it too strongly, but when I stopped the last drug I was on, my internal reaction was “Oh. This is what it’s like to be alive. I had forgotten.” The really upsetting thing was that I had slowly faded (cognitively) to where I didn’t even notice that I was impaired, even though I had stopped getting work done and stopped participating in relationships. I was a pre-op Algernon (or Charlie, I guess), and that’s not a person I’m willing to be.
I haven’t actually taken lithium. I believe it’s not as useful for treating depression, which is my real problem, but it’s probably a bad idea for me to have around anyway; psychiatrists avoid prescribing it to patients who have a history of suicidal tendencies, because it is so toxic that it is occasionally used by those patients in suicide attempts.
You said:
My guess is that if anyone became upset in a justified way, it would grow out of a fear that you might be cultivating habits of mind that appear dissociative and which might increase the chances that this becomes a new and additional symptom of a larger complex of poor mental health.
Suppose that self-ontologies involving multiple agentive subselves makes it easier to fall for certain kinds of bad reasoning, or suggest planning mistakes that lead to obviously maladaptive behavior, even as it allows more nuance and better models in certain circumstances where a clear mind can understand the details and prune the obviously dumb plans will not actually go off the tracks. From experience talking with smart people about these subjects, this seems very reasonable to me.
For example, some really really dumb versions of hedonism suggest that you shouldn’t bother to look both ways before crossing the street because if you are hit by a car and killed then you’ll simply not exist with any happiness state (so scenarios with fatal dangers “don’t count” because your “self” disappears in those and your standard of judgment evaporates) but if you don’t pause to look and aren’t hit then you’ll get to the other side faster and be slightly happier than if you wasted time checking for danger when there wasn’t any.
Obviously this is wrong… but if you put enough hand waving between the stupid parts of the argument and changed the context from a familiar danger (like crossing the street where you have cached answers that are obviously right) to an unfamiliar danger (like investing or choosing a medical treatment?) it might convince someone. Perhaps it might convince your “hypomanic self” who doesn’t stop to think very much?
The fact that the bargain between your subselves involves a promise by “a self that does things without thinking” to enact a desire of “a self that can safely contemplate horrors because it won’t thereby do something rash” makes this worry particularly vivid. It makes sense that both depression and mania are bad versions of cognitive states that have a mild and adaptive version which is functional for some environments… using trade-between-subselves to give the bad parts of each extreme more effectiveness seems at least potentially unwise.
Raemon pointed this out but then dismissed it:
Count me bothered. I really really don’t want you to kill yourself, either consciously while depressed or through “more than normal recklessness” while manic. Your comments here are striking because you’re the one who has been diagnosed with bipolar II disorder and yet you are also one of the more level headed commenters in this thread, offering gentle encouragement and insight to people who are bouncing around ideas that relate to intellectual issues raised right next to discussion of suicide.
You clearly have a lot to offer the world and it would be bad if you don’t explore more of that potential. Your suicide would be tragic. I want you to live.
I think it might be wise to print out this article and the comments and show it to your therapist or someone else whose intellect you respect and who you can interact with face-to-face. If your logic is clean then it should be fine, but if not then maybe they will be able to see something important that you missed. Getting a second opinion like this seems like something that would make your friends and family (the people you’re trying to protect from your chemically induced suicidal tendencies) very happy.
I agree. I don’t know if this is a useful reaction, because it is emotional (tell me if you find it offputting so that I can modulate in future) but I found this whole post incredibly winning and incredibly bittersweet. I like you—the reflective, self-aware “you” who is striving diligently to protect his loved ones from the parts of his brain that might harm them—and I ache for you, because you have a tough road to hoe. I experienced a brief and situational bout of suicidal depression about fifteen years ago, and I remember how hard it was. You have to go through that over and over. You’re so matter-of-fact about the pain of living, but I feel it in this post, and I have both admiration and sympathy for you.
The negotiation that you’re performing with your subagents seems reasonable the way you’ve laid it out here, especially considering Footnote #2. I would, however, encourage you to share it with your psychiatrist—or find another psychiatrist that you can share it with. If your psychiatrist wouldn’t understand this post, he or she is the wrong psychiatrist for you. You should not feel like you have to protect your psychiatrist from your thoughts.
And good luck. I hope to hear a lot more from you going forward.
Thank you, very much. Your and Jennifer’s care is really touching.
I will bring this up—gently—with my psychiatrist. I am in an uncomfortable position, in that my psychiatrist has a lot of power over me. If he decides that I am unreliable, I lose my job and gain around $50,000 of debt. I can change psychiatrists, but I can’t get a second opinion.
How did you come to be in such an uncomfortable position with such obviously counterproductive incentives?
The US government payed for my masters on the condition that I work for a federal agency after graduating. I now need the continued support of my psychiatrist to handle classified material. If I lose that, I lose my job, have broken contract, and have to pay back the cost of my degree.
It is certainly less than ideal for the purpose of effective therapy, but at least I’ve finally found a therapist who is on board with non-pharmaceutical treatments.
Is there some reason why you can’t also see a second therapist, possibly without the first one knowing about it? It seems to me that it might be useful for you to do so.
I can have as many therapists as I can afford, and I wouldn’t need to tell them about each other (though it would probably be wisest to), but I do need to tell my employer about every source of help I’m receiving, and each source will be contacted.
What is the objection to pharmaceutical treatments? Mood stabilisers are a class of drugs that actually do work reliably (as opposed to, say, SSRIs for depression). Although I suppose you don’t really need a ‘pharmacutical’ company to use lithium. Doctors have been treating patients with lithium since the second century.
My objection is purely based on the side effects I’ve experienced, and I’ve only been on a limited number of drugs. Every mood stabilizer that I’ve been on has left me intellectually and emotionally crippled. That is perhaps putting it too strongly, but when I stopped the last drug I was on, my internal reaction was “Oh. This is what it’s like to be alive. I had forgotten.” The really upsetting thing was that I had slowly faded (cognitively) to where I didn’t even notice that I was impaired, even though I had stopped getting work done and stopped participating in relationships. I was a pre-op Algernon (or Charlie, I guess), and that’s not a person I’m willing to be.
I haven’t actually taken lithium. I believe it’s not as useful for treating depression, which is my real problem, but it’s probably a bad idea for me to have around anyway; psychiatrists avoid prescribing it to patients who have a history of suicidal tendencies, because it is so toxic that it is occasionally used by those patients in suicide attempts.
Yikes. In that case you have good reason to carefully screen what you say to your shrink—but this is a really suboptimal setup for successful therapy.