To answer your question, yes. My 30's were a mess with a divorce, a parent with dementia, a kid who had a unknown behavior problems they said was autism, and trying to keep my dad's business running all while maintaining a full time job. You can get better, but you need help doing it and have to actively accept you aren't all alone.
Then other thing is, no matter how smart you are, you can’t debug yourself, you need other people. If you have a distorted negative feeling of yourself, then when you try to fix yourself, you’ll be more inclined to feel something isn’t working or you are doomed the first time you hit a roadblock or relapse.
And ultimately sometimes medication can help you get through the initial hurdle of such negativity, another reason you need to see a professional to evaluate this.
Go check out YouTube and Wikipedia for some cognitive behavioral therapy sources to see if it might fit.
This is very true, and not always realized.
Another way I heard it said which is easy to remember: "You can't read the label from inside the bottle."
John Forbes Nash: Why not? Why can't I?
Dr. Rosen: Because your mind is where your problem is in the first place!”
- 'A Beautiful Mind'.
Sometimes we have internal parts that need love and care more than they need lecturing on cognitive distortions.
CBT is effective for many people which is great, but there are other options.
Personally, I found it helpful to read some of the books on these and related concepts, as a supplement to therapy. Also, it can be a frustratingly slow journey.
I didn't go through CBT with a therapist. I just read the first few chapters of The Feeling Good Handbook, then tried to establish a habit of confronting my negative feelings, and the thoughts that were feeding them by identifying the distortions in those thoughts.
YMMV, but it may be worth a try.
You should reword that. Otherwise how did humanity last this long? Psychotherapy is less than two centuries old. You should instead say something like, "One option is to see a therapist."
There are friends, elders, books, and a number of other ways to climb out of a mental rut. Traipsing "Psychology Today" for a therapist who will charge the insurance $150 for 40 minutes of a session, through Zoom no less, with your $40 co-pay after deductibles is such a commercial approach to what is fundamentally a human problem.
You know a very modern problem? You can't sit easily and talk with friends over a drink about your issues and have someone give you constructive advice. Everyone is remote, busy, prefers chatting online, and as a result a lot of loneliness manifests as "Oh my god, what am I doing with my life."
I say this as someone who rather successfully turned things around with a therapist - I simply did not have it in me to have those conversations with others and I didn't feel I had the relationships or support to do so (in retrospect I probably did, but that's the thing about mental health).
I don't think your diagnosis is wrong, particularly - there's a lot in the modern world that promotes alienation, feelings of low self esteem, and depression, but I think a lot of people find themselves at the bottom of the well before realizing quite what's happening and without the support structures to get out on their own.
(Edit just to note that, like physical health, mental health is not just the consequences of one's own actions - both genetic predispositions and unexpected life events can necessitate professional intervention by no fault of one's own. It's not what we're talking about, but just so nobody takes my post to be a psalm from the church of the self-sufficient.)
It's just a sad state of affairs that there are so few other options for people. I continue to pin the blame on the remote-first nature of society, which seems to make in person interaction secondary. It perpetuates loneliness which perpetuates mental health issues.
This is an important data point and a general trend toward the cheapening of human relationships. Friendship means something very specific, and for a lot of people now it means only the superficial. Anything deeper than that is actively discouraged. I think of those surveys about friendship took this kind of friendship into account. The number of people without any friends at all would be outrageously high.
I do agree that today's generations seem to be less deeply connected than older generations. Relationships take work and vulnerability, but today's distractions make everyone feel they are short on time and make us too absorbed with the perfection of the masks we wear. Its a shame, because deep friendships are truly something to be cherished.
"True friendship is a plant of slow growth, and must undergo and withstand the shocks of adversity, before it is entitled to the appellation." - George Washington
And then also there are just less and less friends. In any friend circle there are some people that are just better to lean on. As you get older these people move away, get married, etc.
OP: Life can be good and does indeed gets better, if you are not in a good place, please do talk to someone, try to make a change, no matter how small, and stay strong.
I tried lyra. All the wording and questions ask screamed to me "these are not my type of people". I'm not going to go into specifics but imagine you walked into a help conference and every table had energy stones, power of pyramids, astrology books, etc... If you're anything like me you'd walk out.
Once I made it past all that it recommended some therapists all of whom were white. The metro area I live in, 8 million people, is only 60% white in total and many areas are majority not white. I tried changing my location to an area known for being majority not white but it just gave me the same people.
It just got me wondering how much of therapy is a white culture thing because it seems statistically unlikely that of the 11 therapists it recommended, all 11 would be white if the demographics of the area say that only 60% of the population is white.
It was no different on BetterHelp.
Another possibility is there are cultural norms: psychotherapy originates in Europe / Central Europe where it had a blossoming in the late 19th century and spread, and became quite fashionable in among the educated classes (up to and especially in the 1960's, for example).
I assume non-white majority countries also have psychologists/therapists, though.
Religion and procreation?
How can I find someone I trust and is actually good? Not like the movies where the clock is up and ok next issue.
My work offers a mental health service but I’ve looked at their TOS and no thanks.
Sometimes I feel like just suspending the world background process and being still would be nice. But I don’t have sudo.
Also, read through https://www.psychologytoday.com/us/basics/therapy/how-find-t...
Seek referrals from real people in your area.
You do have to be prepared to be vulnerable to some extent, but if they’re any good they’ll earn trust and develop a working relationship with you that is comfortable.
Source: multiple years of therapy. Definitely worth the effort and the cost.
I remember it being really hard to know what I wanted from therapy the first time I did it which made choosing a therapist feel pretty overwhelming. Had to drop the first therapist I saw after a couple sessions because it wasn't for me (and a good therapist will tell you "you might want to seek out another therapist").
If you really want to, you can read about the different therapy methodologies that therapists commonly use, but as a first-timer I found that to be pretty overwhelming and just reading the therapists' descriptions of the kind of work they do and clients they typically work with ultimately more helpful in choosing someone I could work well with.
I will caveat by not knowing what country you are in and the norms there, so this is coming from a US centric approach.
1. Talk to your health insurance; they often have scheduling services
2. Talk to the Kassenärztlicher Bereitschaftsdienst of your state, e.g., Bavaria has this on offer: https://www.kvb.de/service/patienten/terminservicestelle/ter... If you don't know where to head to, call 116117. Easiest way.
3. Go to your GP - he can guide you through this or can forward you to a psychiatrist
4. Use the online service from the association of psychotherapists: https://www.psychotherapiesuche.de/pid/ersteschritte
If you have suicidal thoughts, search for a local Krisendienst Psychiatrie (https://duckduckgo.com/?t=ffab&q=krisendienst+psychiatrie&ia...), they can help you immediately.
The most important thing that OP has to learn is that he is not alone, there are professionals out there that can help you. But you have to make the first step.
Here is a good (long) guide in English: https://www.bptk.de/wp-content/uploads/2019/09/2019-09_bptk_...
It's like dating. I think within the first 4-5 visits you'll know if someone is trustworthy and is giving you some insight. Note, they won't be able to give you the really great insights until you feel you can trust them, but they should be able to give you a couple of things to ponder / act upon even in the initial stages.
Remember, if you meet a therapist and you aren't feeling it isn't a good fit, that's ok. There is nothing wrong with you (or them), it's just not a good fit. Be honest in your feelings, and don't worry about disappointing anyone in the process. This is about you and what's best for you.
The professional is there not to be a regular person to know, but someone to who you can emote and feel openly your hardest things you hold inside. This expression of those things makes them less haunting and distracting inside yourself. This technique does not necessarily fix your material problems, but it allows you to clear the way within you to take them on.
It is not for everyone, and it is worth a try when you are feeling hopeless.
There are lots of good online therapy things now. Although I’d recommend doing in person if you can because the latency of emotional exchange is much higher in the space of the world. Even still the online work can be hugely beneficial.
Even if your worldview has left you bereft, your body deserves a chance to reformulate your mind for this opportunity at existence.
You can do this free of charge just by visiting the library, or finding pdfs online.
You don't have to unpack everything in the first session. Generally you want someone who is trying to build a one-on-one relationship with you where you feel comfortable doing this.
> Not like the movies where the clock is up and ok next issue.
I mean, all appointments end at a certain time and then you get up and leave.
> Sometimes I feel like just suspending the world background process and being still would be nice.
You could try meditation. I do both therapy and meditation.
If you don't have insurance, consider looking at your background and find a 12-step program that fits. ACA (adult children of alcoholics, but it also considers family dysfunction) is one example. It doesn't benefit from having a trained therapist, but it's effectively free group therapy.
In reality, you don't really know the kind of people you'd trust to talk to in the first place, you don't really have an informed opinion. Just jump in feet-first, don't think about. You just need someone to talk to ASAP and any decent therapist is your first step. Just try it, there's nothing to lose whatsoever.
Except hundreds or even thousands of dollars you may or may not have to pay the counselors until you find the right one. I don't mean to be discouraging anyone from getting help, but keep in mind the counselors are not fungible, and, at least in my experience, many of them are useless or just plain weird. (This is not to stereotype, just stating the reality.) I wish there was a way to prefilter them out, but it is such a subjective field and the treatment options are highly individualistic.
I would suggest any kind of community involvement with people you have an affinity for. In person, preferably. That brings on a set of new problems, but at least it will help get you out of yourself and away from too much navel-gazing.
I'm certain there are plenty of good therapists who will take their time with you at the discount implied by insurance, but you're more likely to get that experience if you're paying full rate.
How to find how to find a therapist in Berlin (Germany): https://docs.google.com/presentation/d/1YQYTXBkypxc1DaCRWIjk...
You absolutely can do this if you go on a meditation retreat. I went to https://www.dhamma.org/en-US/courses/search though I am sure you can find other schools of meditation. My experience was that you are not allowed to talk for the duration of the course and just focus on breathing & meditation (10 days in my case). It brought a great deal of calm and focus into my life.
Keep an open mind, but... it takes looking. I've had therapists with all the right degrees who were... meh. Well-meaning, but just not that good at it.
Unfortunately, this isn't a zero-effort path. You have to look, and fire therapists who aren't doing what you need.
You need to fix your brain. Spending 50% of your income/spendings for at least one year on therapy is the minimum you can do.
It is just like a broken leg you need to get it fixed you have no choice.
In Ireland, at least, you ask your doctor for a recommendation
Be prepared to pay out of pocket, my insurance pays about half of what my sessions cost. You get what you pay for. You don't want a therapist who is stretched too thin, overworked, or financially struggling themselves.
Also, ask friends and family, you may know more people in therapy than you realize, and talking about MH with people you know is incredibly helpful.
If you have a good PCP, ask them for a referral both to a therapist, and consider an IOP - an Intensive Outpatient Program. When you're trying to get out of crisis, it can be helpful to have more than just a weekly or biweekly session. I am in such a program now, it includes group therapy every day (I can choose which groups) and more intensive individual therapy and case management.
The particular program I am in also does ketamine therapy, which can help to rewire your neuropathways so that behavioral changes are more permanent. There are some online programs - Better U and Mindbloom come up in a quick search - which will offer this and other IOP-like services remotely, though I'm not sure how they compare to traditional IOP.
Above all, seeking help in any way that you can will make you feel better and I am personally proud of you for coming and asking a bunch of strangers for help. It shows a readiness to take on your challenges.
Good luck on your journey! <3
And regarding to life goals, wife and kids in particular, although I have decided not to have a family, so take my advice with a grain of salt, but I think there are many single mothers out there who would appreciate a stable and solid partner with 2nd income.
That said, while therapy is one thing(and very hard to find someone that actually helps you out of your misery instead of reinforcing it), I'd maybe suggest creating a fixed schedule. Some basic cardio sports at a fixed time and day once a week(if that is too much once every two weeks). Ideally a group practice that gives some social pressure. It's much harder to get out a tough spot when you're alone. Maybe a beginner Capoeira class. No real requirement to socially engage if you don't want to, but warms your heart nonetheless.
And maybe one usergroup of some sort once a month. No need to engage with people. Worst case, you just listen to some talks and get free Pizza.
One thing that's very important in Germany when getting help is to never EVER say that you have suicidal thoughts. The moment you do that you slide into a bracket out of the social system that you can never get out of on your own. Any doctor or psychologist may now force you to take medication or put you in the asylum whenever they chose.
That is terrifying. Those medications are mediocre in the long-term. If you have a problem with a side-effect and they deem it trivial, you may be forced to take a medicine for life. Some of the alternative approaches to medicine are proving far superior for moderate level depressions (which can still be suicidal ideation).
When I lived in the UK they wouldn’t offer me even a waiting list
I would however be careful equating having kids to being successful in life. At best, they can be a joy to have. At worst, they can be little sources of chaos and stress that you can pass your own worst traits to.
I don’t believe any life is past its time. We all follow our own twisting paths, and it is an easier path when we don’t have to face it all alone.
Many will offer a first appointment for preliminary diagnosis and to check if they can help you, but then you are put onto the waiting list
OP’s username seems somewhat German so I would cordially invite OP to make use of our pretty decent Krankenkasse system that makes it a relative breeze to get therapy sessions. Shop around if you don’t vibe with your therapist.
1.) Just talking to a therapist who you feel heard and understood by (whatever their method: CBT or any of the others below) will be a massive help - you'll feel less alone and the challenges and mindsets you wrote about will begin to feel less all encompassing. The world will be a less frightening place.
2.) I think Deutscher's post is one of the most courageous personal posts I've ever seen on a message board/social forum (certainly the most courageous in 2022). One of the hardest things for anyone to do is to admit their life hasn't/isn't going the way they expected and instead of lying to themselves, they do the incredibly brave thing of admitting they need help.
Anyways, I just wanted to commend Deutscher for that (hopefully before my comment gets buried hours after the original post)
Did you read the bit about $25K in savings? Or the part about there are "no mental health facilities in the small town where I live"? How's he afford a therapist, time or money wise?
HN is hugely biased towards people who live in cities. A lot of the posters simply do not understand how a lot of us outside the cities live, and the resources they take for granted that we don't have access to.
For me the drive to the nearest therapist is measured not in minutes, but hours. That's impossible for someone who has to work full time.
It might make sense to take "under-" employment with a company that offers good health benefits, which would at least provide income and insurance to buffer the cost of therapy. It might be helpful to think of it as a "launchpad" or "staging" job. It can also be an opportunity to exercise the muscle of befriending new people (coworkers, regular customers).
In the US, Starbucks and Trader Joe's are popular launchpad choices of employer, at least in my metro area. There might be similar ones in your current home country, if it makes more logistical sense to stay local.
The parent comment about therapy is correct (I regret not getting some myself), but I wanted to address this line directly.
I was stuck being overwhelmed from 2003 to 2019 after the death of a friend, because I had a spiritual awakening but denied it. I tried to satisfy my ego and win the internet lottery and gain external recognition of success which never came. So I lost the better part of 2 decades just going through the motions, utterly exhausted.
I had another spiritual awakening climbing out of burnout and surviving through the pandemic. This time I watched the world wrestle with every existential truth that I had suspected but which had been suppressed by the might of economics steamrolling everyone until that point.
Now I feel that reality is akin to a dream, or at least a Matrix like the movie. There are logical rules we must follow on the micro scale in the day to day where we push atoms around for income. But on the macro scale, it's more like the universe reads our mind and lays a path for us to follow whose main goal is to put us through the wringer for our spiritual growth. That can be as painful or as effortless as we choose. Western culture has no real description for this outside of religion, so all but denies its existence. But it's deeply connected with karma/sin and how we've integrated our shadow self with our outward existence.
Basically the stories I had told myself for most of my life were no longer enough to sustain me. My inner monologue had became toxic like the line above, a false exaltation to cling to when I couldn't face the road ahead of me. Here is an alternative way to write the same sentiment:
I was struggling for a long time but am grateful for the lessons that pain has taught me, even though I can't continue to cling to that pain any longer.
I found that most of the code in my brain had been co-opted by negative self-talk, to the point where it no longer worked and I lost my executive function. It was like I had a stroke and the part of my brain that controlled motivation was no longer there, or worse, actively talked me down from starting any task. I believe now that my subconscious intervened and broke the negative feedback cycle I was trapped in where the harder I tried, the harder I failed.
Once that happened, I finally understood that my mind is not my soul. My physical body and even my thoughts may suffer profoundly (or be elated) in the day to day, but I mostly observe that process playing out now. I don't subscribe to external meaning anymore. I choose what's meaningful. Because meaning isn't objective, it's subjective.
Now I meditate and have faith that I can handle life, even when it doesn't turn out the way that I want. I've found that practicing non-attachment has a funny way of revealing what's really important. Mantras help too, like aligning with heartfelt causes, for example service or being of service to others. Kind of like, strengthening the love inside to give love to others who need it. And allowing myself the same dignity to receive love. My struggles became training, my successes became miracles. And reality seems to be shifting towards this more integrated physical/spiritual whole with divine timing.
Hope something in this helps you on your journey.
For me, the healing really began when I started communicating and setting boundaries. Expressing sentiment, even if I can't make good on what I'm trying to do, goes a long way. And stepping outside myself, so that I can vouch for myself the way I would for someone else, also does wonders for quality of life.
But everyone has their own struggles. I know people who battle video game addiction, and drinking, and saving for their kids' college fund. My difficulties seem almost quaint in comparison sometimes. Like really? I got to grow up and program computers and have a bunch of cool jobs doing web stuff, and all I can do is complain? Well yes actually, because for all of that, I never really quite did what I originally set out to do. That can weigh on a person more than anything else sometimes.
So honestly I write for a younger me from 20 years ago, while I still maybe had a healthy bit of cynicism but was not yet disillusioned, in the hopes that it helps someone avoid stuff like the burnouts and bouts of depression that I went through. Which is perhaps a bit idealistic, because suffering and loss is something that everyone experiences as part of life.
It really comes down to the search for meaning for me. Stuff like: what comes after atheism? What's a dream, or a hallucination, or an alternate reality like those experienced when we pass out or have near-death experiences? How come science can't explain synchronicity or angel numbers or other coincidences, except dismissively? We literally have no evidence that our scientific models entirely describe our physical reality. They can't even explain consciousness. Those gaps in our knowledge are opportunities for finding meaning. Perhaps metaphysics can help us navigate such nebulous concepts. And also, how do we know how our experiences shaped our understanding? I sometimes look back fondly at some of the "worst" periods of my life. Often, the obstacle is the way.
Which is a book I'd like to read sometime. Also A Course in Miracles. Unlike reason, where we stand on the shoulders of giants, meaning comes more like discovering a truth of one's existence, only to learn that someone already wrote it down thousands of years ago. A different kind of validation.
So much more to say about all that.. but it's really more about finding one's own way than endlessly studying philosophy. But it's ok to do that, to work on oneself. These times are kind of rough not for all the blessings we receive, but for all the little things that seem perpetually out of reach. Time, rest, the esteem of our friends and colleagues, being with our families. My deepest wish is that we find a way to heal ourselves and then the world and seek faith/hope/love, peace and harmony together so that we can all self-actualize and manifest heaven on Earth in the New Age. And we're right there, so close!
So of course the cost is worth it.
And to expand on that, if you're not vibing or getting results from one therapist see another one. Don't give up after seeing just one. I know plenty of people that didn't see much improvement after one therapist but did well with others.
Look into medications, they are a lot easier to stick to than seeing a therapist especially if you're depressed. Even if the first drug doesn't work try another one. The non-response rates to a single medication are much smaller than if you didn't respond to one you try another one.
In the process get started with this book. https://www.amazon.com/Cognitive-Behavioral-Workbook-Depress...
This website has a lot of useful information too. (Written by a psychiatrist) https://slatestarcodex.com/2014/06/16/things-that-sometimes-...
Curious to know how that shook out. Did they get a different diagnosis eventually? Did anything in particular help?
Therapy can solve other issues too but one should first accept who they are
People need help understanding how to live. Therapists are trained to do that. Some of them are good at it, and some are bad at it.
But telling someone who is in need of structured introspection and practical cognitive and behavioral techniques to NOT go to a therapist is really pretty horrible.
In the end, it wasn't autism?
Clinical depression and mood issues need to be treated with medication. I would recommend finding a psychiatrist and get a referral for therapist from them if you are able to. You would be able to work together with both medication and theraphy to get better. It will take bit of a time to get better but don't be discouraged, OP. Progress will be slow and many goals you might think of may seem unachievable so it's very important you plan small steps and follow through them.
If theraphy is cost prohibited or have long waiting line in your country, from what I know of OP's situation - I recommend getting online sessions from therapist in other English speaking countries who might be cheaper locally.
What worked for me will not work for everyone. It's important to try everything that you can and see what works best for you. For me, medication was not the answer.
How to know someone is American before they even mention "other English speaking countries"
The HN guidelines include: "Don't be snarky." "Eschew flamebait." "Omit internet tropes."
But there are certainly people in our present world who do need meds to get out of the depression hole. There are people that do not respond to therapy alone but do respond to meds with therapy.
I don't think there's anything wrong with your comment, indeed the statement you're quoting is extreme. But I think HN has the tendency to go too far to the other extreme. At the end of the day, clinical depression is very heterogeneous. You need to do what works best for you.
Btw in case it isn't clear how meds are supposed to work in practice - medication for depression is not something you just pop and forget about. Any reputable psychiatrist will include therapy as part of the initial treatment plan, they don't just write a prescription and send you away.
Yes bad clinicians exist, but I think the pill popping trope for psych is way less common than people assume. Perhaps part of the source of this stigma is the role of the general practitioner. It is not uncommon to see random non-psychiatrist MDs prescribing SSRIs or stimulants, and in those cases it's a lot less likely the corresponding behavioral therapy is happening.
Anyway, medication is an absolute life saver for those people who need help in making the behavioral changes to begin with. There is a large body of studies at this point showing that simultaneous meds and therapy can improve depression symptoms more than the sum of their parts. Gold standard practice is to try tapering off of meds after the course of therapy, and more often than not the symptom improvements persist.
OP should get a professional opinion specific to his situation. He shouldn't go with the intention of seeking meds, but they should be something he inquires about. Some of the sibling comments here are acting like needing meds is a lack of will power, which is just as unhelpful as indiscriminately pushing meds.
I didn't mean to say everyone feeling depressed should take medication as the default solution.
When I prefixed "clinical" above, I wanted to imply persistent and chronically present issues.
Any decent psychiatrist will not prescribe you medication unless you absolutely require it and will run multiple tests ruling out heart problems, blood pressure issues, thyroid, liver, and many more. A therapist isn't qualified to run and test for alternative medical issues which may manifest as above.
This is why I really wanted to assert that seeing a psychiatrist or medical practioner is important first step.
You may have persistent depression due to unrelated medical issues which may need medication.
Chronic health issues often have a persistent medical cause but not always.
That said, OP should probably look into both himself, see what the wait time and cost differences are between the two routes in his area.
A therapist isn't qualified to make any diagnosis or prescribe tests and medication.
It might very well be the answer, also.
OP is not asking for platitudes, he's asking for actual help, which is by necessity rooted in reality.
Psychiatrists are real doctors with scientific, comprehensive, rigid education in STEM.
Last thing you want is a pseudo PhD from Berkeley who majored in psychology and studied "human rights" as her thesis.
