What About Mental Health Privilege? (Extended Distillation)
My 🔥 take of the month.
I’m struggling with theory of mind lately. Theory of mind is the ability to see things from the perspective of others.
This is most noticeable for me in mental health.
For a bit of background, while I’ve never had a professionally administered Big 5 personality test, I did take a professionally designed self assessment from clinical psychologist Dr Jordan Peterson and his associates a few years back.
The result of that test is that I’m very low in Neuroticism — the tendency to experience negative emotion — in the 7th percentile.
Meaning, if we trust the test, 92 % of people feel more negative emotion than I do.
That isn’t to say I’m immune. There were years in my teens and 20s where I would experience poor symptoms. The most notable being a tendency to anxiously lie awake for hours unable to turn my brain off.
Knowing what I know now, these symptoms were likely caused by environmental factors. Poor sleep hygiene, lack of exercise and poor diet.
Aligned with my low neuroticism, my life is now remarkably stress free and has been for 5+ years. Despite never having A+ versions of those habits.
Here’s the thesis I’m playing with this week:
Is therapy actually the right choice for most people?
I’m recording with 3 time USA memory champion John Graham on the podcast today. His mission over the last year since escaping his own panic attacks has been helping others treat their emotional state to relieve their chronic stress and panic.
His method unearths the emotional root causes of mental health conditions. Other solution oriented therapies attempt to do the same from different angles.
You take time to examine dormant memories or suppressed emotions that might be the cause of destructive thoughts or patterns in your life.
I want to say unequivocally that this is helpful for a subset of people who struggle with chronic mental health challenges.
For people experiencing panic attacks, 100%.
People with depression so debilitating they can’t get out of bed, try anything that could help.
I think now though that the commonly held belief is that everyone could find therapy useful. This is where I wonder if my bad theory of mind skills are leading me astray.
I’m not sure…
I don’t believe unpacking issues you’ve forgotten about, if they don’t usually have a negative impact in your life, will be a net positive for most people.
I’m talking about the 80% of people who occasionally feel stressed, anxious or just general malaise.
Could underlying issues be causing some negative mannerisms or patterns? Probably. But, overall I think they are best left to dissipate.
Left alone, people are more likely to recover even from deeply traumatic events.
My largest justification for this idea is called, The Focusing Illusion:
Focusing on an issue causes it to take up extra space in your head, making it seem bigger & badder than it actually is. In truth, almost nothing in life is as bad as your mind portrays it. As Seneca said, “We suffer more in imagination than in reality.” - H/T Gurwinder
Again, anyone with a gratitude practice knows how this works.
We’ve done such a good job eliminating stigma around mental health that we may have inadvertently encouraged too many people to go to therapy.
I believe there is a subset of people in therapy who are actively making their lives worse by being forced to share their negative emotions in a weekly therapy session. Abigail Shrier talks about her experience of this in Bad Therapy.
Because she needed things to talk about with her therapist, she would focus on negative things throughout her week. Mundane things she would have otherwise dropped.
This results in what’s known as the Treatment Prevalence Paradox. In which, the increasing availability and effectiveness in treatments doesn’t result in a corresponding decrease in depression.
Here’s another common belief I think is wrong:
It is impossible to use cognitive horsepower to overcome issues affecting the mind.
There are plenty of instances from my past that could have caused me to be “traumatized”. Losing my dad at 14 being the largest.
Instead, I learned strategies to deal with those instances. Or I learned about tactical ways to improve my life — linking back to what I mentioned earlier about sleep, diet or exercise.
As a result I’ve sidestepped whatever “traumatizing” potholes existed.
Now, any time I’m stressed or anxious it is because I have a knowledge gap or I’m putting off a decision. Both of these are fixed with cognitive horsepower.
Sahil Bloom mentioned this in a tweet last week:
An important truth I've learned: Stress is the result of not having a clear plan to close the gap between your expectations and your present reality. Once you have the plan, the stress goes away, as it just becomes about daily execution, which you know you can handle.
Even if I’m wrong about both previous beliefs we run into a third problem, infinite regression.
Infinite regression means the answer to a question requires you to know the answer to an underlying question.
In this case let’s use: “Where does my anxiety come from?”
We would need to answer every other question below:
Why did my girlfriend actually betray me?
Why did I pick that partner?
Why did I think they were a good fit?
Why did I ignore the red flag?
Why did this happen again?
Where did my ignorance originate?
What problem did that ignorance solve when I was younger?
Why was that a problem to begin with?
This is the problem you run into with every inquisitive 4 year old. Why? Why? Why? Why? Why? Because I said so.
The problem with therapy is that ending with “because I said so” isn’t an option.
There is no end to the rabbit hole you can go down. You don’t eventually find the Mad Hatter, you become the Mad Hatter.
Another wrinkle, the farther you go back in your life to answer these questions, the more likely you are to misremember or fabricate memories to fill in gaps.
If I was to apply this method of going to therapy to fix my own problems I might arrive at 3 issues.
A higher than average degree of shyness.
Being a people pleaser.
A moderate degree of self-censorship.
I’d argue #3 could be attributed to environmental (cultural) factors, like before.
If I solve the regress problem, the issues likely come from getting rebuffed by a 6 year long crush through middle and high school.
So, when I weigh the options of a therapeutic framework for fixing my problems I have to choose between:
Being a little more shy than I want and be overly accommodating…
Or, unpacking all the negative emotions associated with something that happened when I was 12?
In my privileged mental health position it seems like a pretty easy choice.
For any of you in the messy middle, maybe my theory of mind is wrong and you are better off unpacking the negative emotions.
From my vantage point the scales tip in favour of avoiding therapy and objectively improving your life where possible.
The mental health improvements should follow.
If you’re someone who does find yourself with chronic struggles or you’re someone in the messy middle I’d love to hear your thoughts and learn where I could be wrong.