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Mental Illness and Startups (tesser.org)
166 points by fractalcat on May 13, 2011 | hide | past | web | favorite | 54 comments

While I don't disagree with this statement:

There are people who think that depression means 'feeling low', and that if you try hard enough, you can 'snap out of it'. These people are idiots. It's not a matter of being strong enough or dedicated enough. For me, like most people with depressive illnesses, there will be times when I just plain can't. In my worst states I can barely remember what a for loop does, let alone code one. Accept that there will be times when you can't work, and make the most of the times when you can.

There is an approach called "behavioral activation" that my psychiatrist taught me. Basically, instead of saying "I'll do it when I feel better", you say "I'll do it so I'll feel better".

Doing things I didn't feel like doing, that felt almost impossibly difficult (like putting on real clothes and going outside) was probably the most effective tool I've ever had with dealing with depression.

Coping mechanisms like that one definitely help -- especially if they get put to use early on in a depressive cycle. A high level of self-awareness, acknowledgement of depression (or other mental illness), certain hobbies, "sunshine therapy", all help to mitigate depression and other mental illnesses.

Still, though, there are severe forms of depression that can become invulnerable to all the self-help approaches.

This post really spoke to me because I deal with the same feelings as the article writer, and I too consider programming to be a therapeutic experience. However, it can also be a bit of an escape mechanism, making it a pyrrhic victory.

In code if something is wrong or not working right you know it can be fixed. Sometimes the fix is not easy, and requires lots of work, and research, and testing but after nearly ten years of coding experience I know that if something is wrong I can fix it. There is no problem in code which can't be solved. (Obviously excluding some things like the traveling salesman problem, etc.)

Real life isn't like that, because many factors are out of your control. You can not debug a relationship, or undo a mistake like you can roll back a code update.

At times I find myself retreating to the dependable, stable world of coding, in which changes can be implemented easily and quickly, and where mistakes are easily discovered and corrected. That's isn't necessarily a healthy thing though.

I agree. In my dreams, I keep grasping for the undo/revert command -- for life. I close in on my shot at redemption, then I wake up. The cycle turns.

Absolutely, I pointed out a type of cognitive behavioral therapy (behavioral activation) because it's easy advice that may help people.

The science is pretty clear that a combination of medication and professionally-guided CBT has the most effective rates for treating depression, and that some specific treatments specifically don't work at all for some people.

There are tons of other types of therapies as well:


Which one is "most effective" (by what measure?) is very debatable.

Here's a Jungian critique of CBT ("Psychology's New God") :


I completely identify with this point. A member of my family suffers from depression and she's generated a list of things that she has to do when she feels particularly depressed. They are all pretty basic things for most people -- things like showering, making a cup of coffee, doing her hair, etc -- but things that can feel impossible. She gives herself the ultimatum that she has to do these things and it usually helps.

That's basically what he's saying in the very next sentence, isn't it?

That said, if I can write code, I find that work is sometimes one of the most effective ways to stop the depression from worsening

Depression is at the end of the day not a single illness. It's like cancer in that. Just like there are all kinds of cancer and what worked for yours might not work for others, so it is with depression. Behavioral activation might have been effective for you and you might have been able to snap out of it, most cases of depression don't have that luxory.

"you don't have to be mad to work here but ...."

i've found smaller companies are much more tolerant & flexible with nutters (like me).

there seems to be more focus on results than politics. in larger places I've felt more pressure not to rock the boat, and produce the illusion of work, rather than actually delivering things on time. it doesn't seem to matter if you actually do anything as long as you look like you're not doing /nothing/.

and I don't mean a startup. even startups can grow into kafkaesque nightmares because it's the only way they've ever thought to run a company. really, you have to be in a small, autonomous group if you want to get away with not being that normal.

the moral is: being a startup in and of itself is no guarantee of tolerance for off kilter people, the people and culture within the company are important. there is a correlation between small companies/startups and tolerance, but it isn't causation.

I've worked for Microsoft for over a year now, and they've been exceptionally supportive of my peculiarities. I've suffered massively from depression and sleep disorders, and everyone's pretty willing to reschedule meetings, allow for an altered work schedule, or just let me work from home when it gets bad.

As long as I deliver what I'm supposed to, when I'm supposed to, they're very reasonable.

Though I was in a "channel" (as they call(ed) it) that was perhaps less attuned to freaks, I had the opposite experience at EA.

Speaking as someone who has a family member with mental illness: if you have such an illness then please seek professional help right away. If you suspect that someone you care about might have a mental illness then you should urge them to seek professional help right away.

Sometimes it is all manageable or heals on its own, but sometimes the illness progresses and the results are tragic, so it needs to be viewed seriously.

Eh, psychology and psychiatry are still fairly young sciences. I'd say it's worth a shot, but people put too much faith in it. I've had family members in professional help forever with no noticeable improvements. They'll even admit to it.

My personal opinion is that, while sometimes useful, we just don't know enough about how humans work to really fix a large number of issues. People tend to go to psychiatrists persistently even after no track record of improvement out of the fear that they'll get worse. No one will ever recommend that anyone 'give up' on professional help out of the fear that saying so will make them responsible for the negative consequences.

True. I think the best way to approach it is to acknowledge that there is no certain outcome, and that the best you can do is to maximise the probability of success. If it doesn't work then it doesn't, but that doesn't mean that you don't try at all.

Young in what regards?

Pursuing therapeutic response without success may point (especially with continued "They'll even admit to it") to problems with the therapist specifically. Finding a "good" therapist is very difficult. Personalities "gel" or "click" or "culture is important to us at company _ with programming skills _."

Hypochondriac behavior with therapy should be treated as such, not discounted due to perhaps a false sense of "therapy is bullshit, everyone I know is in therapy." The tragic stories of "noone even knew he/she was depressed" of suicide exist for a reason in abundance.

The problem is how to measure improvement? I have personally seen cases where the person stopped treatment because of "no noticeable improvements", and it was disastrous. In certain conditions (bipolar, for example), just the fact that the patient is stable and somewhat functional is already a huge victory. Wouldn't that be an "improvement" over the alternative?

Unfortunately, professional help isn't free, and there are quite a few people who can't afford it right now.

...alcohol's a cheap medication, anyway.

Alcohol makes mental illnesses vastly worse. (As, apparently, do most psychiatric drugs in the long run.)

As, apparently, do most psychiatric drugs in the long run.

I have to disagree with this statement and ask you to provide better sources than just the result of some Google search. The evidence gathered with citations to peer-reviewed literature in one of the definitive medical textbooks on the issue,


strongly suggests that lithium for bipolar mood disorders has long term benefit. (That's based both on the decades of human use of lithium in some countries and on the basis of animal studies followed up by necropsies of brain tissue.)

Apparently we are all in agreement that "self-medication" with alcohol is a very bad idea. But prescribed medication under supervision by a medical doctor can be a very good idea indeed.

After edit: Thanks for the mention of the interesting book in your reply. I read some of the reviews, and found this useful interview


with the author, who has a balanced point of view:

"Q: So do you think psychiatric drugs should be used at all?

A: I think they should be used in a selective, cautious manner. . . . I think we should look at programs that are getting very good results. This is what I love about Keropudas Hospital’s program in Finland. They have 20 years of great results treating newly psychotic patients. They see if patients can get better without the use of meds, and if they can’t, then they try them. It’s a best-use model, not a no-use or anti-med model."

After one more edit, an interesting review of the book mentioned in the reply to first version of this post:


Well, the author does have a balanced point of view, but there are a couple explanations for why Whitaker would offer a more reserved view sometimes. First, critics of psychiatry get easily lumped into the 'anti-psychiatry' group where all drugs are bad, which is not where Whitaker wants to be. He knows empirically that this has weakened the effectiveness of critics (like those who get lumped in with scientologists). Moreover, he's just a really SMART person it seems to me. He is more concerned with the truth than an agenda, unlike probably other critics like Peter Breggin, who seem to manipulate much of the evidence.

Also, that Finland program as described in Anatomy uses very few psychiatric drugs, and it does in low doses and tries to keep people off them. Whitaker is just explaining that his opposition is not to 'psychiatric drugs' like some groups, but to unscientific & harmful practices, which is exactly what gives him so much ethos. The Finland program is from what I remember of it, far from modern psychiatric practices.

In fact, in my email communication with Whitaker, he has stated that no patients would miss antipsychotics if they were banned. Based on his books and many interviews/videos I have seen of Whitaker, I think he would probably agree with the statement "The way most drugs are prescribed, they make the illness worse in the long-run." (note I don't know Whitaker personally)

This is a very complicated debate because one can't talk about psychiatric drugs in general, you have to look at the individual evidence for each one. For example, I have much less faith in the Harrow Study that Whitaker cites as evidence that antipsychotics do worse, because I found the critique that its just the worst patients who stay on antipsychotics very salient. This study indicated the health of the off-med and on-med groups diverged after two years (with the off-med group improving significantly.) However, there seem to be a dearth of studies that are this long testing antipsychotics versus placebo (because of the inherent difficulty of that study, I imagine).

Self medicated anything is generally bad. That definitely goes for psychedelics.

Anatomy of an Epidemic by Robert Whitaker sums up the academic research well.

For what it's worth, there's actually a lot of super interesting stuff in the book that you wouldn't get from just the reviews. Definitely worth reading.

I know that. I was referring to the popularity of alcohol among those with mental illnesses, not its efficacy.

Without disclosing personal details I would like to say this post spoke to me as it very much fits with what I've been through. Dropping out, the highs, the lows. I'm now 26, have worked at a startup for just over 4 years and we just sold to google. I found the freedom of a startup to be exactly what I needed.

I was once depressed. Now I have life by the balls. How? (this is purely anecdotal and should not be taken as advice).

  Take Meds. It's no solution, but it's the beginning of a solution.
  Quit school. 
  Go to the Italian country-side and *become a man*, Italian style (it involved a lot of wine and pasta).
  Work Mike Rowe-style jobs (like learning how to build an entire house in France).
  Refuse to do any more stupid shit (for others) in your life.
  Stop feeling guilty about anything. (Doesn't mean you lose your conscience).
  Do what you love, do what you love, do what you love.

How do you figure out what you love?

With a relaxed attitude, you can see what things are fun to do. Do you like fixing tractors? Making tractors? Here's a video of Open Source Backhoe: http://www.youtube.com/watch?v=dPgr_LV1dxY

On a remote olive farm in Italy my hosts needed help with their website. Armed with win95, notepad and a 56k modem, I hacked up their dreamweaver-generated html and css. I can't offer you more than the cliché "everyone has to find out for themselves".

Works great until the startup is successful enough to hire an executive who things that office hours are a more importamt measure of productivity than peer respect or checkins.

It's easier if you're a founder.

The moment an executive thinks that, it's no longer a startup, pretty much by definition.

I've seen it happen twice - once just after a series A, and once after a company made it incrementally to good profitability. Both had headcounts in the 20-30 range, and still considered themselves to be startups.

Yep, I saw similar trend pushed from top to a new development dept. in major bank during its first years growth. That said, I kept succesfully ignoring it and forcing my rule: I do my work well and I decide how and when - while reflecting the needs of team and project of course. It worked, mostly thanks to most local heads open mind. Yet, it's needed to push this contra-culture actively, things got much worse there for others since I left.

Trust me on this, most fiction writers can relate to that post 100%. Musicians too, I think.

I wonder how frequent is depression among programmers. That's not something people like to blog about.

Programmers especially, since they tend to live in a world of logic and rational thinking, which tends to lead to the notion that depression can be controlled by modifying certain behaviors or thought patterns -- the same way that any other function (or generic system of functions) can be controlled by modifying their parameters.

I don't think anyone likes to admit it. It took Kay Redfield Jamison's book, Touched with Fire, to reveal the extent of it with writers and other artists. Granted, those are the ones who became well-known. We'll never know of the ones who didn't survive their torment.

As a student and an amateur developer working for a magazine startup, my schedule is chaotic and busy. Doesn't help that I go through days and sometimes weeks of just laying in bed and watching babylon 5 DVDs. Sometimes the only thing that can snap me out of it is an impending deadline. I'll then end up stressed as I try to complete my workload. Needless to say, my burndown charts are skewed.

I feel the chaos of a startup doesn't help things. I long for a structured 9 to 5 job in an office. Being alone at home just exacerbates things and having a bed behind me just makes me want to crawl under the covers and sleep. I tried going to various cafes to work but there's no free wifi (which I suppose I wouldn't use anyway) and the prices are ridiculous. Libraries are great when they aren't packed and when the homeless aren't using it for shelter.

I have to admit I do have a sudden burst of energy when I stumble across an interesting github repo.

Motivation to do X often comes after you start doing X.

Purposeful / meaningful activity is a great way to combat depression.

Just my opinion, I'm not a subject matter expert.

If you are depressed, why don't you just go out and do something really awesome? You have nothing to lose, right? So why not do something adventurous? Sell all your shit, move to Europe or South America, and go start a revolution.

I can't speak generally, but when I'm depressed none of the stuff you listed has any appeal. Even much simpler easier things, like sex or sunlight are covered in a terrible veil. The world looks drab and unfriendly. My sensory perception gets altered, everything looks and feels different.

It's hard to think, it's hard to talk with people--- the social scripts are all broken and the baseline feeling of my reality is warped into something ugly. When I'm depressed there is nothing "really awesome", it just doesn't exist.

On the other hand, I've found the whole condition can be fluid/mutable and have felt these sorts of low states much less often since I started meditating and paying attention to my internal state.

Indeed, that's one of the ways that you diagnose depression.

If the things that once made you feel really awesome (sex, motorcycling, coding, gaming, cooking, whatever) no longer hold any appeal for you, that means you're very likely not merely "feeling down" but actually clinically depressed.

The symptom is anhedonia -- the inability to experience pleasure. You can eat a delicious meal, play outside in the sunshine with little kids, have great sex, and through it all feel nothing.

It's like when a finger is numb -- you touch things with it thinking, "How odd, I ought to be feeling something." But you don't.

It's not just feeling down. It's your brain's ability to feel pleasure being physically broken.

So that's what it's called. I've felt that way for a good portion of my life, and only since I've started getting help in the past year did I realize something was actually wrong that could be fixed (it took someone else's genuine caring for a change to occur).

I originally thought I was just different from everyone else, or that "they" were wasting their lives on pointless pursuits. Now I actually understand why it's so great having a niece to take to the park.

Because depression doesn't work that way. It isn't a general feeling of malaise, it's somewhat a lack of positive value on everything (ish).

It is a lack of momentum and a heavy inertia to stay miserable and avoid change. It becomes a sunk cost where it's almost impossible to change something small in your life, let alone something big or huge.

Your advice is naive, and tantamount to asking "Have you thought about not being depressed, I hear that could work". If it were as simple as thinking your way of depression, it wouldn't be such a problem.

The best advice I've ever encountered is to take care of the little things, like sleeping on time, remembering to eat every day, doing laundry and getting out of the house. These are often the first things to go and often the hardest to get back into the routine of doing. Once you can manage a day at a time, it's easier to start to try managing a week at a time.

Large changes won't matter if you can't take care of the smaller things in life that support you. Depression isn't one of those things you can snap out of, but one that you can gradually work yourself out of.

It's not fun or easy though.

I hope this is sarcasm. People have been getting flamed online for saying this exact thing for a while now.

The issues of "doing something awesome" and depression are totally orthogonal.

Most people already are trying to do whatever they think is really awesome. For example, raise a family and have a steady income; or create a startup; or be an artist; or move to Europe.

In fact, the depressed person is probably already trying to do whatever he thinks is really awesome, or at least contemplating it, in real life, and being depressed is just getting in the way.

I got sent to field training, that cured my depression.

I don't get your point. Feel free to clarify. But, good for you.

Nevermind, for some reason I see what you're saying now, looking at this again 3 days later. That's awesome.

That's just not how it works. The simplest thing -- getting out of bed, showering -- seems impossible and just pointless. Everything seems pointless.

Everything is pointless: then again what is the difference between habit and ritual?

"just go out and do something" is the hardest when you are truly depressed. Even when you do, any sense of "awesomeness" fade so so fast.

Apparently you are getting downvoted, but I think this is some of the better advice in the thread. Breaking out of a stale routine and establishing new life patterns is a great way to also establish new thought patterns. It won't necessarily cure depression on its own, but it can help a lot.

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