This is a linkpost for #100 - Having a successful career with depression, anxiety and imposter syndrome. You can listen to the episode on that page, or by subscribing to the '80,000 Hours Podcast' wherever you get podcasts.

Note: 80,000 Hours wants to keep the interviewee's name off of Google in this context. You can use "Howie" in comments, but please don't use his surname. We'll redact the surname if any comment happens to use it.

You can see more discussion of the episode in this Forum post.

In the episode, Howie and Keiran discuss how mental illness is one of the things that most often trips up people who could otherwise enjoy flourishing careers and have a large social impact. We think this could plausibly be one of our more valuable podcast episodes.

We also hope that the episode will:

1. Help people realise that they have a shot at making a difference in the future, even if they’re experiencing (or have experienced in the past) mental illness, self doubt, imposter syndrome, or other personal obstacles.
2. Give insight into what it’s like in the head of one person with depression, anxiety, and imposter syndrome, including the specific thought patterns they experience on typical days and more extreme days. In addition to being interesting for its own sake, this might make it easier for people to understand the experiences of family members, friends, and colleagues — and know how to react more helpfully.

Several early listeners have even made specific behavioral changes due to listening to the episode — including people who generally have good mental health but were convinced it’s well worth the low cost of setting up a plan in case they have problems in the future.

So we think this episode will be valuable for:

• People who have experienced mental health problems or might in future;
• People who have had troubles with stress, anxiety, low mood, low self esteem, imposter syndrome and similar issues, even if their experience isn’t well described as ‘mental illness’;
• People who have never experienced these problems but want to learn about what it’s like, so they can better relate to and assist family, friends or colleagues who do.

In other words, we think this episode could be worthwhile for almost everybody.

Just a heads up that this conversation gets pretty intense at times, and includes references to self-harm and suicidal thoughts.

If you don’t want to hear or read the most intense section, you can skip the chapter called ‘Disaster’. And if you’d rather avoid almost all of these references, you could skip straight to the chapter called ‘80,000 Hours’.

When I found out that I was going to miss my flight, it would have just taken an email that said “I am not doing okay. … I might be out for a while.” And I think everybody there would have been so understanding and it would have been fine. It’s probably the biggest regret of my life that I didn’t do that.

–Howie

Key points

People around you are struggling with this

Keiran: In part, we’re doing this conversation to try and make it obvious that more people are struggling with this than everyone might think. Do you have any tips on how someone might actually internalize that?

Howie: I promise you it’s the case. So take it or leave it. I have tried to be pretty open about the fact that I had mental illness, including within the EA community. I’ve shared a list of somewhat vetted therapists in the Bay Area that’s been passed around a lot, which means that people who are depressed sometimes reach out, and then it also means that people have reached out to me to be like, “Are you okay, I have this too.” And so, I can promise you that at major EA organizations, I’m not the one person with mental illness. There’s something really striking about the way in which it’s affected me, but there are a lot of people who are experiencing this in some way or another. At least in the communities I am a part of, there’s not much stigma around getting therapy.

Howie: If I tell someone that I’m looking for a new therapist, it’s more likely that they will suggest theirs than that they will be like, “Oh, I don’t know about that therapy thing.” So, because this is a thing that has a lot of stigma, it’s just really, really easy to underestimate how many people around you are struggling with this on a day-to-day level. And if you open up to someone, it’s like — I mean I can’t make any promises, and you might be in a very different community or subculture or country from where I am, and you should take that into account — but it’s reasonably likely that they, or someone in their family, someone that they know has been seriously affected by this. And hopefully that can do something like reduce the fear and stigma a bit. Look up the numbers, if you can find them, of people who are using psychiatric medications in your country, or if possible, in an even more individualized region. A really large percentage of people are taking antidepressants. And it’s very unlikely that it’s the case that none of them are the people around you.

Micro goals

Howie: I think the right micro goal depends a lot on the person. So one possible goal is, do you have a friend who will help you make sure that something happens? And I have done this for several friends, where maybe I make a list of therapists and tell them in which order to call them, or maybe it’s teaching them a bit about the options for antidepressants. So they can just make one appointment with a doctor and then tell them what their preference is. Or maybe it’s just to start doing 10 minutes of exercise a couple of days a week. I think it just depends a lot on the person, but asking a friend I think can be a good way. They’ll be able to help you figure out stuff like what is your bottleneck? And what is a really minimal thing that you also feel comfortable with, but that can get you on a path?

Keiran: In our podcast with A.J. Jacobs, he talked about micro goals and one of them was for exercise. He said, don’t even just say, “I’m going to try and do 10 minutes of exercise,” because even that could be a bit intimidating. And don’t even say, “I’m going to do one minute on the treadmill,” but just make the goal be to put on your shoes. Just put on your running shoes. That’s it, that’s the goal.

Howie: Yeah. I like that.

Keiran: And once you put on the shoes, there’s a fairly good chance that you’ll get on the treadmill, even if it’s just for a minute. And once you’re on for a minute, you’ll probably do two. And that just seems to be a really effective way of doing it.

Howie: That does seem really good. Looking up the website of a therapist is at least one micro goal along those lines.

Seeking out treatment

Howie: Seeking treatment can be really hard to do, especially because a lot of the treatments are things that have a big effect for like 20% of people or have a small effect for like 40% of people and it takes weeks to see them; it’s unclear to you until those weeks are done whether or not it’s helping. So I think there are a lot of reasons why it can be really hard to get motivated. And so I think there are some ways in which it’s just incredibly valuable that are easy to lose track of. So in particular, especially if you’re young, but even if you’re middle aged, the value of trying treatments and finding out if they’re useful for you…the information value there is just so, so high. If it turns out that you try SSRIs for three months or six months and they’re not helpful, it does suck.

Howie: It’s a pain to take a pill every day. If you don’t wean off them really slowly, the withdrawal can be shitty. There are sometimes side effects. But if it turns out that it’s useful to you, you maybe found a thing that for years and years and years is going to make you happier or less anxious and potentially just solve one of the biggest bottlenecks in your life… Same with therapy. It can be awkward to have a therapist that you don’t like. And it’s a lot of time. And I don’t think therapy is right for everyone, because it does take a lot of time and can be disruptive. But if you think that maybe you should try therapy, I think it’s very likely that you should try therapy for this reason. Maybe you go and you find out that spending a year in therapy gives you the tools that you need to not be depressed anymore, or just that having weekly therapy in general for years just makes your life way better. And you can save all of your worrying for that hour in the week. And learning that then gives you just this huge tool that will make you way more productive and happier for the rest of your life. So, I can’t make any promises that’ll help, but finding out just seems incredibly valuable.

Howie: I wanted to also flag that Wellbutrin is a different medication that can be a reasonable first option. Some people with anxiety find it makes that worse, although that hasn’t been my experience. On the other hand, I think a lot of people find it has fewer side effects for them than SSRIs. So I just wanted to throw that out there as a thing that some folks might want to try.

Howie: And then I also wanted to mention that depression can have nutritional causes, like anemia or vitamin B deficiency, and this might be especially a risk for people who don’t eat meat. Since these are pretty easily fixed, getting some bloodwork to check for iron or vitamin deficiencies might be another really good first step if you think you might be depressed.

Having a clear plan before something bad happens

Keiran: When you’re thinking about what could constitute a minimum viable project, or maximum, it seems once you’re in a particularly bad period, this is a particularly bad time to be trying to work that out. So, would you recommend that people try and think about this ahead of time? Maybe you now should be like okay, if me, Howie, in six months is going to have something that was similar to three years ago, what do I think I should actually do? What are the steps? And then if it actually happens and you’re like oh fuck, here I am in this situation again, you just follow the steps that past Howie set out for you?

Howie: Yeah. That actually seems pretty good to me. I think that there are limitations to how much you can do that, because you just don’t know how bad future Howie’s going to have it. And also, it’s not just a spectrum, like a scale. There’s many, many dimensions. And so you just don’t know which abilities are going to take a hit, and where the ugh fields are going to be. But having some kind of a plan on this front seems pretty good to me. Having a plan for what to do if you have a mental health crisis in general. Especially for somebody who has reason to think that this might happen to you sometime in your life.

Howie: I think everybody has reason to think that. Some people have reason to think that it’s particularly likely it would happen to them. Having a plan in general seems good. But having a plan for this in particular seems good. Also, I think asking another person who you trust, and who will feel to you like they are on your side and make decisions according to whatever criteria you would endorse, I think can be really important for this.

Keiran: Yeah. Even if your plan was just, I am going to email this person, that’s my plan. That’s what I do. Every time this happens, I email them. Maybe even just a code word or something. It’s like, alright, marmalade. This is just, every time I say this, that’s all you have to do. It’s just one word, and they know, and then the process kicks off. That seems quite good.

Howie: I’ve at various times had things like that set up. Where it’s, if I send you a one sentence email that things are going to shit, I just need you to call everybody, tell them what’s going on. Just handle it.

Keiran: Yeah. And then I mean, even for those first few days of a potentially really bad period, if you knew that was being handled, you didn’t actually have to tell anyone, because this person’s already taken care of it for you, that seems very helpful.

Howie: Yeah. I mean, I think that probably would have been the difference between losing a year of my life and my job, and losing, oh, a week or two of my life. So, I don’t know, I just can’t encourage people more to do things like this. It’s amazing in these things where there are these feedback loops, how little decisions and little preparations that just cut out some of the tail events can just make a huge difference.

Ugh fields

Howie: Ugh fields are this phenomenon that I think is very familiar to a lot of people. As far as I’m aware, it was first named in a LessWrong post. Rob recently wrote a popular explainer of it. And the idea is that there’s this phenomenon a lot of people experience where there’s some task that you’re supposed to do that maybe is a bit aversive, that makes you want to procrastinate, but is basically a doable thing. And then you put it off. Maybe you try it for half an hour and have writer’s block. But whatever it is, something happens so that this task that felt a bit annoying starts to become really aversive.

Howie: And then because it’s aversive, maybe you put it off for a day, or two days, or three days. One classic example is it’s an email you’re supposed to respond to. All of a sudden you start feeling worse and worse about the fact that you haven’t responded yet. And there’s this terrible cycle where the worse you feel about not having responded, the harder it is to respond to the email, and the harder it is to respond to the email, the longer it’s going to take you to do it. And so you just have these things that under normal circumstances would just be…you could do it quite easily, that all of a sudden it takes everything that you have in you to even try to address it.

Howie: I think it’s pretty common that people have some email that they feel guilty about not having responded to, that makes their whole inbox feel aversive. But it could also be like a paper that’s overdue, or some work assignment where you know that you were supposed to have done your part of it a while ago or whatever. And they’re particularly pernicious because of this self-reinforcing nature. Once they get going, it gets harder and harder and harder to address them. And there’s a bunch of reasons for that. One of them is that it may not have been a problem that you were a day late, but sometimes it actually is a problem that you’re a week late.

Howie: And so the thing that wasn’t a problem at all until you got worried about it, by getting worried about it, you made it into a real problem, and now you’re going to really worry about it. So that’s one possibility. Another is, you build up negative reinforcement in your brain. This terrible association with the thing. So if every time you think about this thing for a week you feel panic, then it’s going to get you more and more to associate panic with whatever the task is.

Howie: I think it is a cause of a ton of suffering, and actually does risk keeping people depressed or making people depressed. I think it’s just super important to do something about this. Figuring out how to avoid them is really hard. A piece of advice that I really like and I try to take to heart is, if there is an email that you are avoiding and you realize that you are avoiding it, you’re not opening your inbox because it’s there, or taking any precautions to not look at it, or you know that you’re flinching every time you look at it, it is often a good idea to treat that as immediately your top priority in your whole life.

Howie: It seems stupid if you have some other urgent thing that is more important, but doing whatever it takes to overcome that ugh field today is going to take so much less effort than it will a week later when you feel a week more bad about it. And I think that creating these things that you’re avoiding is one of the best ways to be self-undermining and do things like really hurt yourself, including hurt yourself in the medium term, in ways that really matter. I feel like I’ve been super harmed by this, and I have this bit of a life mission that’s, please don’t do the thing that I did. And I think it’s often surprising to people how little you have to do in order to get the ugh fields cleared.

Howie: Often the thing to do isn’t even write the email. Sometimes you can literally just write a one sentence email that’s like, “Hey, I’m not going to get to this for a week. I’m sorry,” and that clears the whole thing. The person writes back, “That’s totally fine,” and you don’t have to feel bad about it at all anymore. And nobody was ever upset. And that’s literally all it takes. I think it’s just very easy to miss really quick, huge wins by doing things like that. People understand that you’re busy. Letting them know this isn’t going to come for a while and giving yourself opportunities to see that the person on the other side of it almost never cares as much as you do seems really important to me.

Balancing a job and mental illness

Howie: There is this difficult balance of wanting to keep the things that are giving you structure and meaning and purpose in your life, and then also wanting to make sure you’re not putting yourself in a life situation that’s self-destructive, or where you’re setting yourself goals that you just can’t possibly meet. That just means different things to different people.

Howie: I think there is one meme out there that I really strongly disagree with that’s like “Look, your mental health is the most important thing in the entire world. Do whatever it takes to get that fixed. If you’re feeling bad, take a break, focus on yourself. That’s your priority until you get healthy.” There are things close to that that I agree with. But some of us aren’t going to have a moment where it’s like, alright, you’re healthy now. You are officially normal, and you get a certificate or something. It’s just going to be a lifelong struggle.

Howie: And so I, at least, don’t want to put off living my life, and doing the parts of my life that will matter to me until this is fixed. That’s really important to me. Years where I’m trying to fix this thing are also years of my life. So it feels important to consider that. Some people are the type of people who can be super functional and be really anxious at the same time. And I think for some of them, the right choice is to just keep doing what you’re doing.

Howie: Also, one of the most valuable things you can possibly do is to get your mental health treatment better, and we’ll talk about that later. I just think it’s so, so valuable to see if there’s a way that you can do that. But also, just keeping your life the same is the right decision for some people. And for some people it’s, this is putting me at risk of failing in a way that is going to make me self undermine, and I just need a break, or just need the space, the headspace, to think things through, and actually work on myself, instead of every day being focused on the next deadline. I think it just varies a lot by person.

Howie: Questions that I have tried to ask myself, and sometimes suggested to other people they ask themselves is, think about the sort of things that they get out of their job that are important to them. That are important to their wellbeing, that are important to making sure that they stay, to the extent it’s possible, out of a spirally, horribly depressed zone. And ask, what is the minimal viable project that will get you what you need? And when you’re depressed and facing a rough patch, I think lowering your expectations of yourself, and lowering other’s expectations of you, is basically something that you owe the world.

Howie: It’s really hard to look the thing in the face and admit that it’s happening, but it just may be the case that you can’t do what you used to be able to do. So, I think it’s just very good to lower expectations, lower your responsibilities. That might mean reducing your hours. It might mean quitting a job. And so thinking about what are the most responsibilities I could possibly drop while still making sure that I have a sense of meaning and structure is one framing that I find useful.

Moralising around diet, exercise, and sleep

Howie: I think it is incredibly important to get diet, exercise, and sleep right. And often those things can have effect sizes that are just enormous relative to even some of the best medications out there. Getting your sleep cycle into a reasonable place or starting to exercise every day, I think the effects can just be like… For some people, it’s just all you have to do. That could be the whole issue. And so it’s just a huge win. I think that this is the conventional wisdom. I think exercise is one of the best things you can do for depression and anxiety. And if you feel like you can give it a try, it should probably be one of the first things that you try. I do worry that there’s a bit of sort of moralizing around this and a bit of ideology around this, where it’s like, the ideal thing to do is to fix it yourself by shaping up and living the right kind of life and being a real adult who’s responsible and has the right patterns.

Howie: And if you have to have a crutch of getting treatment, fine, but it’s unvirtuous if you don’t fix this stuff up first. And I just detest that. If there are things out there that could be helpful to people, this is a horrible reason to keep it away from them. And, often, if you’re feeling mentally ill, getting your diet and exercise and sleep in the right place is just a really big ask. And even honestly if you’re not. It’s one of the biggest New Year’s Day memes, at least in the U.S., that everybody gets a gym membership and the gyms are busy for a couple weeks and then they’re empty again. I don’t want to say it’s hard for everybody. You should find out if it’s easy for you. It can be really hard. And there is no need to do the really hard thing that tons of people find really hard before you try and see if things that you might find easier actually do the trick for you.

Medication vs. therapy

Howie: So I am now out of date on the evidence on therapy and antidepressants. But my sense is that the evidence is vaguely that they have a reasonably similar effect size. I imagine for some people it’s much bigger on one than the other. Some therapists are probably way better than others. Some medications probably are better than others, even though I think the science hasn’t done a great job of showing which those are. But I think that there is, again, a sort of ideology or a moralizing thing or something that says that you should try therapy first. And the virtuous thing to do is to figure out the fundamental, psychological root of what you are doing to cause your depression or what thought patterns are doing it, or something like that. And medications are a crutch or like the cheaty cop-out option. And I just think that’s wrong and horseshit.

Howie: For some people, therapy is what they need, and it can be fulfilling to understand yourself better in addition to it being helpful. And so by all means, I think people should try both. Because if you learn which one works better for you, that’s a huge win. But there’s no shame in trying medication first, if that’s right for you. And in particular, therapy requires spending an hour a week going to see a therapist who, depending on your health insurance, where you live, etc. might be expensive. You have to have time in your day for it. It’s costly to do that every week for long periods of time, and taking antidepressants requires swallowing a pill once a day.

Howie: And if they are equally useful, there is no shame in deciding to do the thing that is way less costly. I’m really not an advocate for either of the two. I think that there are things that you can get out of therapy that you can’t get out of taking medication, but I do just want to push back on this thing of like, you need to try therapy first, especially because a lot of people just can’t do therapy. You might have a job that just means you can’t take the hour off from work to go do it. And I wouldn’t want that to hold someone up from seeing if other things might help them.

Health insurance

Keiran: You were in the U.S. while all this was happening. Did you have any issues with health insurance?

Howie: Yeah. So we talked before about how I’m really glad that I saved up a year and a half of runway. On the other hand, I was definitely cutting corners, in order to make that runway into a year and a half, which I think is evidence that I probably should have been saving a bit more, and giving away a bit less. My last year at Open Phil, I was giving away half my income. I understand why past Howie was doing that, and I admire it. But I think it was probably too much. In any case, after my health insurance from Open Phil ran out, I was uninsured for basically the whole time until—

Keiran: Oh wow.

Howie: —I started at 80K. So I had a year where the plan was ‘don’t get hurt.’ And I started to go off of some of the drugs that keep me going. Because I just couldn’t afford them anymore.

Keiran: How expensive are we talking?

Howie: Adderall was going to be a couple hundred bucks a month. And by the end, I was pretty close to broke. It’s possible I would end up with help from some family money, if things really got to the place where I was out in the streets, but that is… That does not feel like an outcome that’s actually acceptable, or within the… I both want to acknowledge that I’m privileged and this exists, but I think I’d actually feel pretty uncomfortable taking that money, even if the choices became pretty dire. So anyway, I was basically out of money and trying to do what I could to make it last. I was at the point of just not taking medications I needed. It sucks that people can end up in that position.

Howie: And there actually is a resource that people should know about, which we can put in the show notes.There’s a website — GoodRx.com — that you can go to if you’re in the U.S. that gives you coupons for prescription drugs. Nobody who’s not insured can afford the actual prices, so they only really want to charge that to the insurance companies. So if you’re not insured, you can get these coupons, and then actually get the drugs for reasonable prices. Unfortunately, they stopped doing that for scheduled drugs. And so, because Adderall is abusable, they stopped accepting those coupons, so it’s just full price.

Howie’s day-to-day experience

Howie: I’m dealing with mental illness just about every day of my life, even when I’m not having an acute episode of anything in particular.

Howie: Part of it is just having a lower mood set point than most people. I experience a wide range of emotions, but my baseline is just lower than a more mentally healthy person’s would be. I think that that’s one bit of it. I struggle with maladaptive amounts of guilt pretty frequently. I have a very bad case of imposter syndrome.

Howie: At the end of the year we do our performance evaluations. You have a self-evaluation, and then your boss and people who work with you evaluate your performance. And the difference between the way that I see my work and the way that people around me apparently see my work is laughable.

Howie: I go around day by day just thinking I’m doing a very bad job, which sucks. And then I struggle with anxiety a lot. So I think I probably lose hours of work time to anxiety in an average normal week when I’m doing what’s like, doing well, for me.

What anxiety feels like

Howie: It varies for different people. Anxiety generally has both physical symptoms and cognitive and psychological symptoms. Some people only have one or the other, some people have both. For me, the physical symptoms basically feel like being chased by a bear, or chased by a lion, or something like that.

Howie: It’s like having your fight or flight response that is supposed to be for when you have a predator going after you. Except the thing that you’re actually worried about is can I, in the last hour before this meeting, get three more projects done so I can feel good about my week. Which is just unreasonable in the first place.

Howie: So you’re sitting at a computer, trying to reason through some difficult research papers, but it feels like there’s just a lion chasing you the entire time. That was basically my experience with it. And it’s a cognitive cycle associated with it too.

Howie: So for me, it’s just a lot of repetitive thoughts of like, “You fucked up again, you’re not going to be able to do this. You fucked up again, you’re not going to be able to do this.” That flavor of thing or like, “Okay, you said that you would get this much done in the next hour before the meeting, it’s now been two minutes. You weren’t productive in those two minutes. Oh God, does that mean you’re not going to be productive for this entire time?”

Howie: And the lion just gets faster. And then it’s like, “Oh, well now the lion is faster. So I’m even less able to write it.” And so now it’s been 10 minutes and I haven’t started. Now the lion really fucking speeds up. So there’s a real feedback loop between the cognitive stuff and the physical symptoms for me.

ADHD

Howie: I was unusual in the sense that I was not diagnosed until my mid-twenties. It’s actually pretty hard to get diagnosed as an adult, because all of the diagnostic infrastructure is set up for kids. But it’s actually shocking to me that nobody noticed anything earlier in my life. I think it was because I was good at school. I was doing fine, and so nobody noticed.

Howie: It’s some combination of feeling like it takes a lot of effort to put my attention on anything that isn’t grabbing to me or isn’t interesting to me in the right way or something. I don’t know any of the science, but it feels like my dopamine receptors are really on overdrive. So all of the addictive content, notifications, pings…but also Twitter… New stimulation just feels so tempting. Sitting and writing out my own thoughts that I already have for other people just feels like nothing new is happening at me, and it feels very hard to stay on target.

Howie: Signs that could have been noticed when I was a kid are like… In high school I would show up half an hour early every day so I could do all of my homework for the day on the floor before class. I was just unable to get myself to do it at night. And it was too boring to do unless I was terrified about the time pressure. I wouldn’t start papers until midnight or 2:00 AM the night before they were due. I would try, or I would sit around knowing that that’s what I should be doing or something. I needed the deadline. I needed the adrenaline, basically. I couldn’t motivate myself without adrenaline. And then there were things that I couldn’t get myself to believe mattered, like administrative things.

Howie: At one point, I did my science homework every night for an entire quarter and printed it out, but never bothered to put it in my backpack and hand it in. I knew that I knew the answers, what the hell is this other part for? So I was a bit of a mess. I eked through, because up until a certain point of my life, all of the assignments were fairly short. And so it was possible to do it the night before. When you get to adult life, you’re not doing these discrete projects anymore. My first job at Brookings, I was working on the same book for months. And it’s just like, how much are you going to get done today on this book?

Howie: It can’t be, I’m going to wait for three months and then do it all in a day. That started to hit me there. When it was at its worst, it was at the level of, when I was writing things — and successfully writing them, and getting enough done by working tons of hours that my bosses were happy — it was good if I made it a sentence without flicking over to another tab and getting some stimulation. I think half a sentence might’ve been more likely. I would know the whole sentence I wanted to write, but typing it out felt so boring to me. I was like, I’ll do half of it and then come back to it. So yeah, I think to the extent that anybody who hasn’t experienced this can get some sense of the way it has felt to me when it’s been at its worst, it’s just like being really addicted to a video game or something like that.

Howie: Experiencing this craving to go back to the thing. Constantly having that pulling at you is the way that I’ve experienced it. There are other things that I do that maybe are also in this cluster, but it’s hard to tell.

Keiran: And having now been treated for it, do you feel like it’s made a significant difference?

Howie: Yeah. So it’s still a thing that I struggle with on a day-to-day basis. In part because you build tolerance to the medication, and it wears off towards the end of the day. But treatment for me has just been a huge miracle. One of the biggest life improvements I’ve had. And so, I don’t know, for people who have never tried Adderall, or are just curious about stimulants in general, the way that I have experienced them is basically, there’s this sense of craving that I have for more stimulation and more novelty, and it just turns that off and makes me feel satiated. It doesn’t make me necessarily focused on the thing I want to be doing, or any particular thing. But all of a sudden I feel like I have agency over it. There’s no pull. It’s like, oh, I could feel satisfied doing the thing that I intend to do.

Howie: Or I could feel satisfied reading The New York Times. It seems really easy, I know I want to be doing the thing I intend to do. I think that’s the effect that it has had on me, which is a huge difference in productivity and the frequency with which I get myself into trouble by procrastinating and then get really anxious and get myself into a hole. One of the biggest mental health risks for me is that spiraling dynamic, and it’s just been an incredible way to limit the number of times that comes up.

Imposter syndrome

Keiran: When you hear all this positive stuff about you, do you intellectually think they’re wrong, or do you accept that they’re probably right but it’s just something that you can’t internalize?

Howie: That’s a good question. It’s actually pretty confusing to me. It’s the area I’m aware of where I’m most able to keep two entirely inconsistent beliefs in my head at the same time, and I don’t know how you can believe both. So, I know what the right answers are, in some sense. I know what the answers are that will get people to tell me that I am right if someone asks me, “How good are you at X?” But I deeply believe the other thing. I think one thing going on is that I am just really, really good at coming up with stories for why any given thing that somebody told me I did was useful, actually was not. And I just will dig in my heels so hard. And I would not do this if it were about anybody else. But, there’s always, always, always, a story that I can find. I honestly don’t know how to describe why I’m so desperately drawn to that. But, it just feels so true and so important to dig my heels in on it.

Howie: A lot of what I do at 80K is just be available to give advice and decision support to other members of the team. People tell me it’s useful, and in some sense, I trust them. The people at 80K, they’re my friends. They like me. They would hate to have to give me bad news. But they’re also incredibly dedicated to the mission of the organization. I think we have a duty to people in future generations to be actually doing the shit that will benefit them, even if it’s hard.

Howie: And if what I was doing was not useful, I really think that these are the types of people who would, it’d be hard, but they would tell me. People tell me that they find my strategy advice useful. I mean, if you pick any bit of advice, I will come up with all of the ways in which me bringing up this particular critique caused X person and Y person to spend hours of extra time investigating to make sure it wasn’t a problem. And then meanwhile, we came away afterwards, and what, did we flip from 52% sure of one thing to like 52% sure of the other? It was a coin flip anyway. There’s just always a story I can tell myself. Why am I doing this? I don’t totally understand it. And the problem is, I actually believe it.

Howie: But the thing that I think I actually believe, and it’s a little bit tongue in cheek, is just somehow, there is this one skill that’s fooling other people into thinking that you’re smart and helpful, and it just happens to be orthogonal to everything else. So one could max out on that skill, while being awful at literally all of the other things. And it turns out that you wouldn’t think it, but that’s just such a natural category, that genetically, or whatever, just to be good at that. It doesn’t require you to be smart in general. Nothing, you just have that nailed. And there is a real sense in which that is my belief. It’s unreasonable. That is my felt answer to that is just, I am fooling everyone. I am good at fooling everyone. If you want to convince me otherwise, let’s go into each of the specifics, and I would just dig in my heels.

Howie: And there are a lot of strengths that can also be weaknesses. I’m good at framing many of my strengths as also weaknesses. I have the imposter thing just really, really hard. So I guess one place to go with this is, why do I have it? I don’t really understand it. It just feels so true to me. It’s one of the things I just feel the most strongly. It’s also the area where I can most do the thing of taking a step back, being mindful about what this Howie creature is saying, and be like, that is not a person who is truth tracking. If I saw any other person making arguments like this, I would be like, obviously they were false. For whatever reason, it just does not make me think that the things are false. And I just have very few experiences like this. Something’s wrong there.

Articles, books, and other media discussed in the show

If you’re feeling at risk, try this for the the U.K.: How to get help in a crisis, and this for the US: National Suicide Prevention Lifeline

Books

• The Precipice, by Toby Ord
• Against Depression, by Peter Kramer
• Overcoming Perfectionism, by Roz Shafran
• The Noonday Demon, by Andrew Solomon
• The Center Cannot Hold, by Elyn R. Saks
• An Unquiet Mind, by Kay Redfield Jamison

Blog posts

• Guide to finding a therapist (series of blog posts)
• A mental health resource for EA community
• Things that sometimes work if you have anxiety, Slate Star Codex blog
• Things that sometimes help if you’re depressed, Slate Star Codex blog
• ‘Ugh Fields’, or why you can’t even bear to think about that task by Rob Wiblin

Other media

• Adventures in Depression, Hyperbole and a Half
• Depression Part Two, Hyperbole and a Half
• Harm reduction by Robot Hugs
• The Depressed Person, by David Foster Wallace
• Two excerpts from the book Infinite Jest by David Foster Wallace

Additional mental health resources

• Get help in a crisis and Respond in a crisis from the Treatment Advocacy Center
• Coupons for prescription drugs in the US
• LorienPsychiatry, Scott Alexander’s new practice
• eMoods, mood-tracking app
• Brief overview of advance directives or ‘mad maps’
• Brief overview of wellness recovery action plans
• Navigating crisis, from the former Icarus Project (now see the Fireweed Collective)
• Reducing bipolar triggers
• Helping your loved one manage a manic episode
• Dealing With Psychosis: A Toolkit for Moving Forward with Your Life
• National Alliance on Mental Illness
• NHS talking therapies, or Improving Access to Psychological Therapies (IAPT) services

Transcript

Rob’s intro [00:00:00]

Hi listeners, Rob here – the usual host of the 80,000 Hours Podcast.

Today’s episode is pretty different from our usual podcasts, which generally focus on people’s research or other work trying to solve the world’s most pressing problems: This episode is a lot more personal.

Keiran Harris, the producer of this show, interviewed our colleague Howie about how mental illness has affected his life and career — and I think it’s one of the most remarkable and really, unique, pieces of content that 80,000 Hours has ever produced.

Mental illness is one of the things most likely to trip up people trying to have a large social impact with their career, or just have a flourishing career in general, so we think this could plausibly be one of our more impactful episodes.

The first half of this conversation is a searingly honest account of Howie’s life story – including losing a job he loved due to a depressed episode, what it was like to be basically out of commission for over a year, how he got back on his feet, and the things he still struggles with.

The second half covers Howie’s advice for listeners. Conventional wisdom on mental health can be really focused on cultivating willpower — telling depressed people that the virtuous thing to do is to start exercising, improve their diet, get their sleep in check, and generally fix all their problems before turning to therapy and medication as some sort of last resort.

Howie tries his best to be a corrective to this attitude and pragmatically focus on what actually matters — doing whatever you can to get better.

Howie and Keiran basically treated it like a private conversation, with the understanding that it may be too sensitive to release.

But, after getting some really positive feedback, they’ve decided to share it with the world.

Here are a few quotes from early reviewers:

“I think there’s a big difference between admitting you have depression/seeing a psych and giving a warts-and-all account of a major depressive episode like Howie does in this episode… His description was relatable and really inspiring.”

Someone who works on mental health issues said: “This episode is perhaps the most vivid and tangible example of what it is like to experience psychological distress that I’ve ever encountered. Even though the content of Howie and Keiran’s discussion was serious, I thought they both managed to converse about it in an approachable and not-overly-somber way.”

And another reviewer said: “I found Howie’s reflections on what is actually going on in his head when he engages in negative self-talk to be considerably more illuminating than anything I’ve heard from my therapist.”

We also hope that the episode will:

Help people realise that they have a shot at making a difference in the future, even if they’re experiencing (or have experienced in the past) mental illness, self doubt, imposter syndrome, or other personal obstacles.

Give insight into what it’s like in the head of one person with depression, anxiety, and imposter syndrome, including the specific thought patterns they experience on typical days and more extreme days. In addition to being interesting for its own sake, this might make it easier for people to understand the experiences of family members, friends, and colleagues — and know how to react more helpfully.

Several early listeners have even made specific behavioral changes due to listening to the episode — including people who generally have good mental health but were convinced it’s well worth the low cost of setting up a plan in case they have problems in the future.

So we think this episode will be valuable for:

• People who have experienced mental health problems or might in future;
• People who have had troubles with stress, anxiety, low mood, low self esteem, imposter syndrome and similar issues, even if their experience isn’t well described as ‘mental illness’;
• People who have never experienced these problems but want to learn about what it’s like, so they can better relate to and assist family, friends or colleagues who do.

In other words, we think this episode could be worthwhile for almost everybody.

Just a heads up that this conversation gets pretty intense at times, and includes references to self-harm and suicidal thoughts.

If you don’t want to hear the most intense section, you can skip the chapter called ‘Disaster’ – that’s between 44 and 57 minutes. And if you’d rather avoid almost all of these references, you could skip straight to the chapter called ‘80,000 Hours’ – about 1hr 11 minutes in.

If you’re feeling suicidal or have thoughts of harming yourself right now, there are suicide hotlines at National Suicide Prevention Lifeline in the U.S. and Samaritans in the U.K.. You can find links and phone numbers in the show notes for this episode.

Oh, and Howie’s role has changed since this recording – he is now Chief of Staff at 80,000 Hours.

Alright, without further ado, here’s Howie and Keiran.

The interview begins [00:04:22]

Keiran: I’m here with Howie. Thanks for doing this.

Howie: No problem.

Keiran: So you’re currently our strategy advisor at 80,000 Hours. And in your role, you advise the CEO and program leads on major decisions. You write content for our website, you host podcasts, and you do a bunch of other important things. You used to work on white collar crime at the Manhattan DA’s office, and on U.S. economic policy as a research assistant at The Brookings Institution. After that, you went to Yale Law for two years, the top law school in the U.S., where you spent your summers as a public defender in Louisiana suing prisons with poor conditions for the ACLU.

Keiran: And you left Yale Law to be one of the first staff working full time at a $10 billion foundation. That’s Open Philanthropy. As the first program officer for global catastrophic risks, you helped to found program areas on potential risks from advanced AI and biosecurity and pandemic preparedness, as well as making millions of dollars in grants. So to almost everyone in the audience, that’s an intimidatingly impressive list of things. So is it safe to say that your life has been smooth sailing so far?

Howie: Smooth sailing would be pushing it a bit. There have definitely been some ups and some big downs. So, I guess when you read my bio off like that, it sounds pretty good. But I guess as we will talk about, there are some mental health-related gaps in there also, as well as some pretty rough periods personally and professionally, during times where the resume line seems perfectly fine.

Keiran: So, this isn’t going to be as carefully structured as a lot of the 80K podcasts are. But broadly, I thought we’d start with your backstory and some of your current personal challenges, and then get into some concrete advice. And then finally chat a bit about the effective altruism community and mental health. Does that sound good?

Howie: That sounds good to me.

First experiences with severe depression [00:06:12]

Keiran: Alright. Let’s dive in. Can you tell us about your first experience with severe depression?

Howie: Yeah. So there are two episodes that I think of as contenders for my first experience. My sophomore year in college, I did this interdisciplinary social studies program that was known for having a particularly intense sophomore year.

Howie: And it was ungraded, which actually made me a good student for the first time in my life, because I had a bad attitude about the status competition of getting grades, and so I was just self-undermining and I didn’t even try. And then all of a sudden it was like, “Well, do I want to learn a lot or not?” “Yes, and I think I’m probably obligated to, also.” And I started just working incredible amounts. Unhealthy amounts.

Keiran: What does that mean? How much is unhealthy?

Howie: I think there was a period of a few months, where I was probably… Six nights a week, I was sleeping for four hours a night, and then just not sleeping the other night. We had a paper due once a week, and so on that night, I would just not sleep.

Howie: There was an inappropriate amount of caffeine that I was using. So, it was also the most productive time of my life. Up until that point, my anxiety was not close to as bad as it is now. So, I was able to do that. Uup until that point, I basically did all the work I ever did right up at the deadline. I would procrastinate by just trying to learn tons of stuff all week, and then pull an all-nighter at the end of the week, and write a paper on it.

Howie: And so, yeah, so I was actually happy for most of that period in my life. But I was pushing myself a lot. And then I went home for winter break, and I had a rough stretch there. And then when the year ended and I spent the summer back in the New York suburbs where I grew up, I think that’s an environment that is bad for me in general.

Howie: But I also think about the contrast between this lifestyle where I had one very clear, structured goal. It was like, “Here are your classes, this is the thing that you’re trying to succeed at,” almost in a totalizing way, just putting everything into that…to running a day camp, because I didn’t know what to do with my summer. Hanging out and killing time until school starts. So I had my first real rough spot that summer. The first thing that I would call a real, clinically depressed episode started then.

Keiran: And what did you do? What was your response?

Howie: Basically didn’t respond to it at all. So… what was that like…

Howie: This is now 15 years ago, so my memory is not 100% anymore and I can’t remember if I would have used the… Yeah, I think I would have used the word “depressed” at the time, to describe what was going on. I was just really down, and when I get down, it’s largely an angry, self-hating type of thing. In combination with a lack of energy. I was just very miserable.

Howie: And I think I had a view of depression at the time where I think I basically thought that it was instrumentally useful. And so I did literally nothing about it at all. So, a lot of the way my depression works is, I will feel guilty about something or other I did. At the time, it had a lot to do with spending money on myself, when I thought I ought to be giving it away, and just really beating myself up over that.

Howie: But also about minor interactions I fuck up, like social interactions with the people around me and that kind of thing too. Then just reacting in a way that’s really disproportionate, that’s something I do in general. And then I have these stretches that were depressed episodes, where that just goes into overdrive and has positive feedback loops and just gets much more extreme.

Howie: So yes, so the answer is I did nothing about it because I was like, “Oh, well I guess this is an incentive to do the right thing.” Also, I was 19 and didn’t really know how one goes about handling… I guess that’s not quite true.

Howie: I had helped a lot of friends through mental illness at that point, but I wasn’t being thoughtful about… It didn’t even seem like an option. I just waited it out. And this specific depressed episode, it was not as severe as some of the things that we’ll talk about later.

Howie: I was able to function for the whole time. And so it was plausible to wait it out. And I waited it out. My environment changed when the summer ended, I went back to college. I liked college a lot, and let it run its course. I guess the one thing that did happen that was in the direction of doing something about it — which I actually think is probably pretty common — is I think over the course of college, there were probably maybe two to three times where I signed up for an intake session at the mental health clinic, to see a therapist.

Howie: I may have gone to intake once. I think I did. Yeah, I think I went once. The other two times I canceled two or three days later. And when I did do the intake, I canceled after that. And it was some sort of a thing where I’d be feeling really bad at some point, and I’d get myself to the threshold of making an appointment, even though mental health care just felt scary.

Howie: And then, when I was feeling a bit better and whenever the acute thing was gone a few days later, I would just cancel it. I actually think that this is super common and most people do not end up getting mental health treatment the first time that they make a decision to get mental health treatment.

Howie: So I guess people should know that if that’s a thing that you’ve done, that’s a thing that I’ve done too. I think a lot of other people do it too. And also it may not feel — once you’re doing better — like you need the treatment anymore. But in my opinion, a lot of mental health care, it’s a marathon, not a race. And so it’s hard to motivate yourself to go do something while you’re feeling better. But I’ll make the pitch for doing that anyway.

Keiran: So you were 19 when this happened?

Howie: About. It would’ve been between my sophomore and junior years in college. So I guess I probably would have been 20, something like that.

Keiran: And then how old were you when the next major experience came around?

Howie: The next one that was really bad, actually much more severe, was 2012. So, I was probably about 26 years old. I was in law school. It was towards the end of my first year in law school. And in the meantime I was definitely like… Even when I’m not having a depressed episode, I’m a depressed person and an anxious person. So my mood is just low on average. I beat myself up too much, on average. Months where it gets worse are moderate depressed episodes or something. And there are these severe things that just felt super qualitatively different. So, I knew that I was a person that had some mental health problems going on. But I hadn’t had anything where I was non-functional.

Howie: And so, in law school I had a period of time, maybe a little bit more than halfway through my first year, where I started to get a little bit more depressed, a little bit more anxious. I don’t really know why. I think it was a bit of, “Oh shit, being a lawyer requires some public speaking. I’m terrible at public speaking. Now I have to face that, that sucks.”

Howie: I shake in front of even a small audience. It’s very noticeable, unmistakable. I have some horror stories from high school about this. So it was a little bit of having to do that and confront that. It was a little bit of just, I am not academically interested in the law. I think it can be practically useful, but I was just not interested in my classes.

Howie: And yeah, so for whatever reason, I was feeling anxious, feeling a bit depressed, and it started taking a real toll on my romantic relationship at the time. I was at Yale, which is in Connecticut. My partner at the time was in Boston, which is a two and a half-hour or three-hour bus ride away, so we would see each other every weekend.

Howie: And it turns out that when you wake up every morning and you’re sort of just curled up in a fetal position, anxious about your ability to do work and then spend half an hour or an hour just coaxing yourself out to go face the day that you don’t want to face, you’re not as good of a romantic partner and less attentive to the people around you.

Keiran: You don’t even have enough time to get there.

Howie: Yeah. So it took a toll on our relationship, and then — very unexpectedly, from my perspective — my ex broke up with me. It was a really particularly rough breakup, and then I just really went down a hole where I knew it basically immediately. I asked my roommate to like… I had a bunch of Tylenol PM because I have trouble sleeping, and I was like, “We need to throw that out, I don’t want access to anything that I could use to hurt myself.” Because like—

Keiran: You knew that immediately?

Howie: Yeah, immediately. This is the sort of thing where I was like… It’s funny that I haven’t had that bad of a depressed episode yet despite… And it was like, “Oh fuck, this is the thing.”

Howie: Yeah. So basically I had one of the worst weeks of my life, and then it sort of transitioned away from being about the really hard and heartbreaking breakup, but that was the catalyst and it just was really awful. And I was really hung up on it for a long time. And this was someone I had been dating for two years and we had talked seriously about getting married.

Howie: It was a real “Oh, fuck my life.” The life I expected to have, I’m not having. But the other thing going on was that I had a paper that I was supposed to write at the very end of the year. And so we broke up maybe a week or two before the paper was due. I was not doing any paper writing over the next two weeks.

Howie: And then I did this horrible thing of spending the entire summer, maybe four or five days a week after my internship, I would go home and be like, “This is going to be the day that I start working on this paper,” and I would look at this blank computer screen. And every day, the guilt and anxiety from not having made any progress up until then made it increasingly impossible to get started at all.

Howie: And it got into this… “Ugh field” is often the term that people use for these things, where you’re so upset that they’re not already done, that all of a sudden they get way, way, way harder to do than they would be under normal circumstances. Which then means it’s going to be even later, and there’s a real potential for a spiral there. So that actually ended up becoming a much more serious problem, and I think had lasting impacts on my relationship to writing.

Howie: Partly for this reason, partly for other reasons, I’m much more anxious about writing than I ever had been. Anyways, I spent the summer very miserable and then I went back to law school, and I sought actual mental health care for the first time around then.

Howie: And I was in a really bad state. I was just not particularly safe, and I was doing things like avoiding the law school, except for when I had to be in class. Because what would I say, if I ran into the professor who I owed this paper to? I was avoiding my friends, because it was embarrassing that I had done this. Yeah. So it was pretty rough.

Getting help for the first time [00:17:30]

Keiran: So what did it look like to actually seek out help? Were you doing research to try and find psychologists or psychiatrists, or were you just going on campus?

Howie: Yeah. So at the time I was on the campus health plan, and so you basically didn’t have options. So I actually came back, my internship ended in early August, so instead of going back to my parents’ house, I went straight back to Yale a month before school started. I was like, “I need to start seeing a therapist ASAP, this is no good.” And so I called them, I basically said that I came back because I had felt desperately in need of help.

Howie: I told them that I was not suicidal, but was thinking about suicide all of the time. And I asked “Can I set up an intake appointment?” and they were like, “We’ll get back to you.” And then a month later, I got a phone call. So, this is a notorious problem at some U.S. universities, including some that have a ton of resources. The wait times are just really long.

Howie: So got an intake appointment, then waited another couple of weeks, then finally saw a psychiatrist. So, that was the start to actually getting health care. And so there’s this whole process of finding a therapist that I basically didn’t go through, because you just use whoever the university assigns you to.

Keiran: Did you have a positive first experience?

Howie: I had a very negative first experience. So I started seeing somebody, he was a psychiatrist. But psychiatrists are the folks who are actual MDs or doctors. Most of them spend most of their time prescribing medicine, though some of them will do therapy also. I was getting both therapy from this guy and also being prescribed medication. And so he prescribed me Klonopin, which is a benzo, it’s an anti-anxiety medication.

Howie: It’s basically a fast-acting, acute-anxiety type of thing. It’s often used for panic attacks. So it’s like, if you are feeling just incredibly anxious in the moment, you take one. Hopefully if it’s working well, 15 minutes later, 30 minutes later, it’s like the volume is just turned down a whole bunch. You feel more relaxed (depending on the dose, etc.).

Howie: They can be habit forming. You feel good, like you’re getting a little bit high. And so there are a lot of reasons why you might not want to take them daily for extended periods of time. But just as a stop-gap, having anything that could allow me to sleep and allow me to have any hours where I wasn’t just rolling around in some terrible ball of self hate and alcohol was really useful for a few weeks.

Howie: I also started taking an SSRI at the time, Lexapro. Which is the standard, typical, first-line antidepressant that people start on. For most people they take weeks before they start working. It’s much more subtle, hard to tell if it’s working. So I had the benzos to just get me through “I can’t sleep tonight” or “I need to do anything to turn this down for a few hours.” And then, the SSRIs are hopefully the more long-term treatment option.

Keiran: How long was it until things started to get better after that?

Howie: That was September, and I think it was maybe December or January where I started feeling like my normal self again. I was able to go and socialize. I was able to enter the law school without waves of guilt and self hate. Basically able to function again. And it was a pretty quick switch, over the course of two or three weeks, from…

Howie: It was gradually getting better, but it definitely felt like there was a moment where I started getting success spirals or something. All of a sudden it was like “Oh, I’m able to hang out with friends again, and that gives me the confidence to talk to that professor I want to be a research assistant for, and get a job working for him.” And then I realized “Oh, he’s really happy with the idea of me working for him,” and very quickly over the course of a few weeks, I got my life back together.

Keiran: Cool. [Jokingly] And I guess that was just everything sorted. The rest of your life is fine now?

Howie: [Jokingly] Yeah, exactly. Here I am today, telling you that you too could have all your mental health problems solved, with the first pill that you tried, the first time that you try it!

Keiran: Okay, so where do we head to next?

Howie: Apparently I got better a bit too quickly for my psychiatrist at the time, who became worried that I was having what’s called a hypomanic episode, which is basically a mini manic episode. So, it’s probably really actually a spectrum, it’s more complicated, but psychiatry now labels bipolar as two types of bipolar.

Howie: There’s bipolar 1, which is the stereotype of bipolar, where people have full-blown manic episodes, sometimes including psychotic symptoms. It often includes lots of risk-taking, lots of behavior that’s just very unusual for that person. Just a real, real noticeable shift. I think in retrospect, very few — although not zero — people are glad that they had a manic episode. A lot of people spend tons of money, end up doing things that upset their friends and family, etc. So, bipolar 1 involves those full-blown manic episodes and then usually also some depressive episodes.

Howie: Bipolar 2 is a condition where your depressed episodes are a much bigger part of what’s going on. And then you sometimes have these hypomanic episodes, which are sort of mini manic episodes. And something can be a hypomanic episode, even if it has no negative consequences.

Howie: And so for me, I believed at the time — and I still believe — that there were no negative consequences. To the extent that anything was going on, it was like, “Oh, I’m confident now and able to talk to strangers and able to start projects. This seems pretty good.” Does it look a bit like a period that I talked about in college where I was going overboard, I guess you could identify a pattern there. I was willing to listen to my psychiatrist, but this was all that was going on, and it didn’t seem like a problem to me.

Keiran: Right. It seems sort of indistinguishable from just…getting better?

Howie: Yeah, or getting better and then being better than normal, which is great. The problem is that it’s sometimes the case that hypomanic episodes progress towards eventually becoming manic episodes. I’m not a psychiatrist, and not an expert in mental illness, but I did do some research because I was personally affected.

Howie: I think there’s not that much known about what effect hypomanic episodes have on your likelihood of having a manic episode. So my psychiatrist thought I was having a hypomanic episode, and basically told me that I had to decide between going on a mood stabilizer — which is a drug that’s an antipsychotic, it’s often used to treat some forms of bipolar disorder, it’s also used sometimes to treat schizophrenia…a lot of people have very good experiences with it, but, well, there are many different types of mood stabilizers and most of them have somewhat severe side effects — so basically he told me that I could either add one of those, or he was going to stop prescribing my antidepressants.

Howie: There are some theories that maybe SSRIs make it more likely that somebody with bipolar 2 who’s never had a manic episode before has their first manic episode. I asked my psychiatrist for some information about the evidence for this and asked how big of a risk we were talking about. If these periods of time are actually really good, I want to know what trade-off is going on.

Howie: He first told me he was going to send me some research, but then he came back and told me that he actually makes decisions based on rules of thumb, and not based on research. I showed him all these research papers saying that actually it doesn’t look like SSRIs make you more likely to have a manic episode, and he was just uninterested.

Howie: From there, I fairly rapidly went through going off of SSRIs, which for me was a somewhat miserable experience with some withdrawal symptoms. And I found that experience of the mental health care system really disempowering and frustrating. And I have since come to believe pretty confidently that I do not have bipolar disorder, any form of bipolar disorder, and that I was just getting better. And that makes it more frustrating that I was put in that position and not allowed to make that trade-off for myself.

Keiran: It sounds like a really good example of how important it is to find the right therapist or psychiatrist.

Howie: Yeah. I think that’s right. And I am a big believer in the value of trying to get mental health care, which we will talk about later. And so, I tell this story and I worry that I’m going to scare people off from ever seeing someone. And so I just want to make it clear, this is not a typical experience.

Howie: I think at universities there’s a specific thing where they are less likely to give patients agency over the decisions that they’re making. They feel more responsible for paternalistically protecting them. I think that there’s a conservatism thing and risk aversion and litigation management thing where if you don’t give an antidepressant to a depressed person, maybe they go home. It doesn’t seem like you really fucked up. Whereas, because there’s a lot more stigma around manic episodes, it’s just unacceptable to ever make the trade-off where it’s like I’m going to increase the risk slightly that someone will have a manic episode in order to help them treat their depression.

Howie: Which sucks because it’s just not necessarily the trade-off that patients would make. And this isn’t a medical question exactly. The question of, “What trade-off do you want to make in your life?” in my mind is not a thing that there’s this special expertise someone might have on. So I think it can feel very frustrating when doctors take that choice out of your hands.

Options for college kids [00:27:31]

Keiran: If the options were open to college kids, would you recommend that they try and look outside of campus, to try and find help?

Howie: That’s a good question. I think the quality of mental health care on university campuses in the U.S… I really don’t know anything about mental health care on campuses in other countries. I think that the quality just varies a ton across campuses, and even places where it’s good, you’ll sometimes hear horror stories.

Howie: Every once in a while, they just get worried that a student might commit suicide, and then just kick the student out because they don’t want it to happen on their turf, which is absolutely tragic. They tell a story about how the student needs some time to rest and relax and recuperate. Which sometimes I think is absolutely true, and that’s the right decision for some people. But for some people, being ripped out of your social network, the thing that is giving you purpose, is not helpful.

Howie: So it’s a thing that happens sometimes. Even in places where it’s very unusual, it will happen. And then that can just be a really salient news story, somebody writes in the college paper and it sounds like a total horror show.

Howie: Just wanted to point out that some schools have policies against removing people from campus because they might hurt themselves. If you’re worried about this at a particular school, there’s a good chance you can find out what their policy is. Alright, back to the conversation.

Howie: The thing that I really recommend is if you’re in a position where you can comfortably talk to your friends and see who among them have used the university mental health care system, talk to them and see what kind of an experience they had. I think that’s the way to go. And then if the answer is “I had a great experience,” absolutely use that.

Howie: If the answer is, “It was okay, I didn’t love my therapist, but I learned some techniques, or I got put on the medication I wanted,” or whatever, then if you have the financial resources and other resources to do some shopping and actually get to choose somebody who seems like a good fit for you outside of the university healthcare system, I think it can be a really good decision for some people.

Howie: But it’s really expensive, because the insurance that you’re on usually as a student is specifically covering stuff at the university. Although also check that too, because some universities will have some amount of coverage. So, everything I say, the details just matter a lot, and I only have one person’s experience. So I hope people don’t generalize from it too much.

Keiran: So where do we head next? I guess we’re still at Yale Law?

Howie: Yes, so I got a bunch better. I went through withdrawal from SSRIs, which sucked. It was not horrible. It didn’t put me out of commission. The main thing that I experienced was something called brain zaps.

Keiran: What’s that? It sounds made up.

Howie: It felt made up. I questioned my sanity the first time I told my psychiatrist “Hey, with you bringing me off these drugs, here’s what’s happening.” It really feels like static electricity, just buzzing around in your brain. And you just have a few seconds of that.

Howie: And I told my psychiatrist about that and he was like, “Oh yeah, those are brain zaps, that just happens.” I was like, “Well, nobody warned me about the brain zaps.” And then I was like, “So is there a technical term for this?” And he was like, “Nope, just brains zaps.” I was like, “Do we know why this happens?”

Howie: And he was like, “Nope.” I said, “Anything you can do about it?” He was like, “Nope.” So that was unpleasant, but I was fundamentally okay. And sometimes I found it reassuring, in the sense that it did give me very concrete evidence that antidepressants do something at all. It’s very hard to tell if you just got better from depression because it has been months and months, or if the drug was helping.

Howie: And so, not that it’s totally rational, but going off of it and then seeing “Oh shit, I have never had a subjective experience like this before,” then very clearly something’s happening. So, I was very lucky. And while that experience was unpleasant, I did not relapse into depression from going off the antidepressants and finished out the year of law school in a relatively stable place.

Keiran: So what does your life look like while you’re in a stable place? What’s the day-to-day experience like? Is it still very noticeable that you’re having a different experience to people who aren’t having any issues with mental health?

Howie: So it’s changed over time, and it’s gotten worse over time for reasons that we can talk about later. Partly for those reasons and partly for reasons I don’t understand. But basically I’m dealing with mental illness just about every day of my life, even when I’m not having an acute episode of anything in particular.

Howie: And so for me, what this means is… Well part of it is just having a lower mood set point than most people. I experience a wide range of emotions, but my baseline is just lower than a more mentally healthy person’s would be. I think that’s one bit of it. I struggle with inappropriate amounts or I guess maladaptive amounts of guilt pretty frequently. I have a very bad case of imposter syndrome.

Howie: At the end of the year when we do our performance evaluations, you have a self-evaluation, and then your boss and people who work with you evaluate your performance. And the difference between the way that I see my work and the way that people around me see my work is laughable.

Howie: I go around day by day just thinking I’m doing a very bad job, which sucks. And then I struggle with anxiety a lot. So I think I probably lose hours of work time to anxiety in an average normal week when I’m doing what’s ‘doing well’ for me.

Joining Open Phil [00:33:01]

Keiran: So soon after this I guess you left Yale Law, is that right?

Howie: Yep. That’s right. I lucked into a really amazing opportunity to go work at what was then called GiveWell/GiveWell Labs and became a spinoff called Open Philanthropy. So I ended up getting a summer internship there that turned into a, “I know you’re in law school, but do you want to come and potentially help start this $10 billion foundation instead?” to a job that I spent several years at, helping to get that organization spun up. And I moved out to the Bay Area to do that, from Connecticut.

Keiran: While you’re in those first few years at Open Phil, are things basically the same that they were at Yale Law, or have they changed? Are you seeing a therapist or psychiatrist?

Howie: As far as what my new normal was, it was similar to the non-depressed parts of law school, but a little bit worse. I still felt anxious very frequently in a way that interfered with my work. Still felt depressed, or at least in a low mood, even though I wasn’t having an episode. I was basically okay and functional for those years.

Howie: To give an example of what that means for me, I’d have weekly check-ins with my boss. At some points in time it was Holden, who runs Open Phil, at some points it was Elie, who runs GiveWell. The hour before those check-ins, I would basically not be able to work because of the level of anxiety that I felt. And it was guilt and anxiety.

Howie: Because every time I had to reflect on, “How did the last week go?” the answer was always, “You didn’t do enough, you didn’t meet your expectations of yourself.” Now you have to tell this person that… It wasn’t really about telling them though. It was more about having to confront the fact that you failed again. And so every week before that meeting, I’d have to lose an hour of being productive to this really un-useful negative self-talk.

Keiran: So, for people who’ve never had that kind of experience before, is there a way to get a sense of what that actually feels like, that hour?

Howie: It varies for different people. Anxiety generally has both physical symptoms and cognitive and psychological symptoms. Some people only have one or the other, some people have both. For me, the physical symptoms basically feel like being chased by a bear, or chased by a lion, or something like that.

Howie: So, it’s like having your fight or flight response, which is supposed to be adapted for being out in the savannah and having a predator going after you. But here the thing that you’re actually worried about is can I, in the last hour before this meeting, get three more projects done so I can feel good about my week? Which is just unreasonable in the first place.

Howie: And then also, you’re sitting at a computer, trying to reason through some difficult research papers while it feels like there’s a lion chasing you the entire time. That was basically my experience with it. And there’s a cognitive cycle associated with it too.

Howie: So for me, it’s just a lot of repetitive thoughts of “You fucked up again, you’re not going to be able to do this. You fucked up again, you’re not going to be able to do this.” That flavor of thing. Or “Okay, you said that you would get this much done in the next hour before the meeting, it’s now been two minutes. You weren’t productive in those two minutes. Oh God, does that mean you’re not going to be productive for this entire time?”

Howie: And the lion just gets faster. And then it’s like “Oh, well now the lion is faster. So I’m even less able to write it.” And so now it’s been 10 minutes and I haven’t started. Now the lion really fucking speeds up. So there’s a real feedback loop between the cognitive stuff and then the physical symptoms for me.

Keiran: Had you been playing around with cognitive behavioral therapy at this point? Were you actively trying to catch these negative thoughts as they arise?

Howie: I don’t remember exactly when it was, but three months to a year after I started working at GiveWell/GiveWell Labs out in the Bay Area, I started seeing a psychiatrist there. This was a much more positive experience than the first one was. So first, after taking a whole bunch of sessions to get to know me, get to know my story, try and figure out how I think about stuff, he quickly prescribed me the SSRIs again.

Howie: I’m still not sure if they did anything for me, but it was a thing that seemed worth trying. And I was very happy that he was just immediately like, “Yes, if you want to try this, you should be able to try this.” So I just got back on all of my medications, and then also did therapy with him.

Howie: So I did CBT, which as you said is a set of techniques that is supposed to try to help you catch these types of negative self-talk and notice that you are having these thoughts, and ask yourself, “Are they actually connected to reality?” To think through types of biases that anxious and depressed people might have and ask “Is this just one of those things?”

Howie: And then hopefully that cuts off the cycle. CBT typically is very structured. It involves weekly homework and a set sequence and pattern. Therapists mean very different things when they say they’re doing CBT, there’s a variety of what they mean. So, I was not doing a very structured form of real CBT. I was basically chatting about whatever was bothering me in a way that was influenced by CBT, something along those lines.

Howie: I liked that, it seemed nice. He helped me through some rough moments, but my best guess is that didn’t have a very noticeable, positive effect for me. But I think he tried a bunch of the right things and it was a good bet. And it might’ve reduced my anxiety by 10%, it’s just really hard to know.

Howie: And the other thing that he did that just made my life way, way, way better was I got diagnosed with ADHD while I was seeing him. And so, a year into seeing him, he prescribed me Adderall, which is a stimulant that helps with ADHD, and that just made my life much, much better.

Howie: It made me a much more productive person. It’s the single thing that has helped me the most with my anxiety. It turns out that if you have a lot of trouble getting started on whatever assignment you just said that you would do, that is stressful. Hopefully it’s not chased-by-a-lion stressful, but it just is something to worry about. And so cutting off — at least, in large part — one of those main catalysts for feedback loops for me was actually just a huge win from that perspective.

Keiran: Have you tried CBT since? Have you tried a more structured version of CBT in the year since?

Howie: Yeah. Out here in London, I spent two or three months doing a much more structured form of CBT with a therapist who I think is fantastic. It didn’t get to the point of helping — we both agreed that it was likely to take a long time, that a lot of the things that I was having trouble with were just some of my most deeply ingrained thinking habits that really connected to a lot of my deepest beliefs, that have had tons of reinforcement. The particular type of CBT I did was CBT for perfectionism, which apparently has notoriously long lifetimes. It really felt like it was going in the right direction in a way that no therapy I had done previously really did. It was just really aiming at the right things. But I just lost the energy for it. I was probably spending too much time being a really good sport and trying super hard to be very thorough on the homework when I started.

Howie: And that was just very taxing. Shocking, for somebody whose problem is setting unrealistic standards for themselves, that also in therapy they would set unrealistic standards for themselves. And then it turns out that doing that is self-defeating. And so I just became unable to sustain that level of effort invested into therapy, and basically just stopped doing a useful job of the homework, and then wasn’t getting anything out of it. I spent a bunch of weeks trying different things to attempt to motivate myself to pull out that time. I’m not great at making sure I have tons of free time, just was not able to get myself to do it, and I was like, this is not worth my while if I’m not going to seriously engage with it. Yeah, so I quit a year ago, and I think at some point I ought to give it another shot.

Keiran: Alright, so to continue our story, so now we’re at Open Phil.

Howie: Now we’re at Open Phil, and for better or for worse, I had just a really incredible experience there. Did incredibly meaningful work. I was the first program officer for global catastrophic risks. When I started working there, there were a bunch of people from GiveWell who were involved in helping to get it started up. But there were three of us that were full time. It was me, Holden Karnofsky, and Alexander Berger. And I think it was just a huge lucky privilege to get to see a foundation of that size get built from scratch, and then also to have a voice in it and to help take part in it. It was just a really incredible experience. I’m a bit of a true believer in the longtermism thing, but I had never, until that point in life, felt like there was anything I could do about it. And so I just didn’t work on longtermist stuff, didn’t give my money to longtermist causes, and then I got there, and it was like, oh, we’re also starting up this global catastrophic risk program area.

Howie: And I was like, wait a second. Oh, yeah. It does seem bad that our biological weapons non-proliferation policy is totally outdated and not up to current technology. Yes, that seems like it could matter for the long-term future. So discovering that there were things like that that I could contribute to meant a lot to me. And, for better or for worse, my work became just a huge part of my identity while I was there. Basically my entire identity. I just really felt like, and feel like, I had a mission. And that’s what I wanted to do with my life, was to feel like at the end of the day, I did everything I could to make sure that the future goes as well as possible. And I just felt like I was really in an unusually good, lucky experience to contribute to that. There were times when it was definitely a tough job. It’s a lot of pressure.

Howie: I was a 28 year old kid — or whatever, I don’t remember how old I was, 30, whatever it was — with no actual national security experience, and I was meeting with biosecurity and Department of Defense officials and telling them, “Well, we’re really interested in this set of priorities.” That’s a shit experience, because the power dynamic’s really awkward. And so it was stressful for me trying to do that. So, there were parts of it that were stressful, parts of the culture were stressful. It’s an explicit communication kind of place. So sometimes you make mistakes and you’re told that you made a mistake, and that’s a shitty feeling. But overall it was just a…it felt like it was a really meaningful, positive part of my life. And I think I really had the feeling that my life was going much, much better than 16-year-old Howie would have been able to imagine.

Keiran: But that’s also an additional level of pressure, where you now feel you’ve got this dream job and you’ve got to live up to the past Howie, and that seems incredibly stressful.

Howie: It felt very, yeah, just very high stakes. If we went into an area, it was likely we’d be the biggest funder of that area. And when I got there, we were all generalists. We hadn’t hired specialists yet because we were still deciding what program areas we were going into. And so as a non-expert in these areas I was trying to get up to speed enough that I could help to build up a program area and make initial grants and to hire somebody who’s actually an expert to run it. It did feel like a lot of pressure, but at the same time very meaningful.

Disaster [00:44:41]

Keiran: Yep. Okay, what happens next?

Howie: What happens next is disaster. So I was at Open Phil from mid 2013 to end of 2016, beginning of 2017. And I had my ups and downs during that period of time. I had months where it was clear to the people around me that Howie struggles with mental illness. Howie’s a very anxious person and it sucks for Howie. And—

Keiran: Had you spoken to them explicitly about it, or everyone just kind of knew?

Howie: Varying levels, basically everybody knew that I was seeing a psychiatrist. It was important to me — and has long been important to me, especially when I know it’s not going to negatively affect the brand of organizations I care about — to be as open as possible about my experience with mental illness. I think there is just a lot of stigma. And I happen to be fortunately often in a position where I feel I’m able to share without it being that costly to me. And so I was able to get other people in the EA community to start using mental health care, because I was able to be like, oh, there’s somebody who’s very public about the fact that they use this stuff. So it was known. I was very close friends with my coworkers. And so they probably knew different bits of it.

Howie: I don’t think most people knew how severe it had gotten in the past, exactly. But they all knew that Howie has some real bad days. Howie’s a little bit fragile. I felt very mixed about how much I should disclose, in part because at that point there was never a time where I was in a job where anyone thought I was underperforming because of this. I was very worried that if I made it super salient that Howie hears negative feedback and then he gets about 20 times as sad as you would want him to, I’m just gonna stop getting negative feedback. I’m just going to impose a cost on the people around me who now have to watch what they say around me and they’re not going to tell me, and that’s not what I want.

Howie: And so it feels important to me to have some ability to say yes, it’s going to be more unpleasant to me than it would be for a lot of people, but this is still something that I need. I think it’s a hard ask to make of people. And so it was a balance between wanting to be open and honest and also not making it salient to edit around you all the time.

Keiran: Yep. That makes sense.

Howie: Disaster time. So it was December 2016, I guess I’d been there for three and a half years, something like that at that point. And I had a slightly depressive month or two, at the level of probably I have this a couple of times a year. So it was nothing particularly out of the ordinary. I had some things at work that were stressing me out. I was less productive because of that, but not in a way that was super noticeable. I don’t think that my coworkers would have noticed or said anything, just feeling a bit down. And then — so it’s a bit embarrassing, because the actual stimulus for this huge, terrible spiral is something that in retrospect feels very small, but — I was supposed to go to the U.K. to represent Open Phil at a meeting of a bunch of funders who were considering funding work on gene drives, and I was supposed to just spend three days at that meeting.

Howie: I procrastinated buying the ticket for a while. And then when I bought the ticket, the best bet by far was at this budget airline. So I got the budget airline ticket, which I would’ve been really tempted to do anyway. I was always trying to cut costs because I was spending Open Phil’s money, which I valued as much as my own. So anyways, get my budget airline ticket, show up to my flight, and the airline doesn’t let me on. And so I guess the thing that happened was… So I had a return flight for three or four days later or whatever. I had no intentions to go for more than three or four days, but my passport was set to expire two months later. And this airline apparently had a policy that they don’t let you onto a flight if your passport is going to expire in two months, which was not my understanding of what expiration date means. But apparently some of the people I talked to had heard that this was a thing before.

Keiran: I’ve never heard of this being a thing.

Howie: It caught me entirely off guard. And when at first they told me, I was like, fuck. I don’t travel a lot. I traveled for work a bunch at Open Phil. But up until I moved to London, I just had very little experience outside of the United States. And I was like, well, shit, maybe everybody knows that your passport just stops working a couple months before it expires. Maybe it’s just a known thing. Eventually I looked that up, and it turns out that neither Britain nor the U.S. has this rule, you can look at the websites about visiting the other country, and they explicitly say as long as your passport will still be good until you leave, you’re fine. I tried to get a refund from the airline and the airline refused to give me a refund and gave me various stories about where the rule was written down, and each time it just wasn’t there.

Howie: So it was like, “It’s on your ticket.” I was like, “Look, here’s my ticket. It’s not on my ticket.” They’re like, “Oh, it’s on our frequently asked questions.” I go to the frequently asked questions, not there. So in fact the extent of responsibility I had for this, realistically, was very little.

Keiran: Zero, I would think.

Howie: I maybe should have not gone with a budget airline. It was maybe not the most responsible decision, maybe I should have procrastinated less and maybe it wouldn’t have happened. But—

Keiran: That seems like a stretch to assign you any real responsibility.

Howie: I think that’s basically right. I think none of my coworkers would have thought at the time that I had made a major fuck up. My reaction to this was just sinking into a pit of self hate, just furious rage at myself. And I immediately felt so bad that we were not going to be at this meeting, we were going to seem less professional as a foundation — which already was a bit of a worry, because Open Phil is much younger than the staff at a typical foundation, so when we’re interacting with other foundations, I really did not want that to be the vibe. I just felt like I had really let down… I guess Open Phil, but mostly just the world, or my expectations of myself. And I took it really hard, and knew basically immediately, I was like, “Fuck. I am at risk. This might be a very bad problem.” And unfortunately I just didn’t do anything about it.

Howie: I reacted by basically hiding in bed, camping out and just sitting around and drinking and hitting myself. I stopped checking email. I stopped checking any of my messages. I made it basically impossible to get in touch with me. The person I was dating at the time was the only person who was in touch with me. There was a week and a half, two weeks where I didn’t tell anybody at Open Phil or GiveWell what happened. Didn’t tell them that I was not going to be at work, just lay in bed and basically spent 16 hours a day looking at my browser, thinking about how, number one, I should open my inbox and email them and tell them about what had happened, and just say alright, I’m dropping a lot of balls, and set it up so that these people can pick up the balls that I’m dropping.

Howie: Number two, the thing that I wanted to do before that was obviously do all of the work to make up for the fact that I had committed this sin. So on day one, there wasn’t that much because I was supposed to be at this meeting. I wasn’t there. There wasn’t anything else for me to do, but I just couldn’t get myself to write the email. On day two, well I should have been doing stuff on day one. So I thought what if I do everything I was supposed to do on day one and everything I’m supposed to do today, and then as soon as I finish doing twice as much work in one day as is reasonable, while in the worst state of my life, then I can email them and tell them what’s going on. And it’ll be fine because by the time I email them, everything will have been fixed. At that point that’s what I expected of myself.

Howie: I knew it would not succeed. So that made me feel really anxious. So I was unable to even get a start. I was unable to even open my inbox. And then stuff spiraled out from there. And every day it’s more embarrassing. And it went from an understandable thing that happens to people who have depression or mental illness — if I had missed one day of work without saying anything, and then sent an email being like, “I’m so sorry that happened. This thing that was kind of out of my control happened and it just really shook me. I need some time off while I recover from this. I know it’s inconvenient. I know that I’m working on some things that will be hard to cover for, but I need somebody to cover for me” — I think the reaction would’ve been like, “You did a good job handling your mental health crisis. Thank you. This is fine. This happens. Everybody has sick days.”

Howie: And so I was terrified of sending this email and admitting my enormous failure. Whereas I think basically the people around me would not have thought it was an enormous failure. Once it had been a week, my thoughts were still disproportionate. I was feeling pretty suicidal. I do not think that suicide would have been a reasonable response to this. So I was certainly not having reasonable thoughts, but it actually at that point was the case that I had seriously fucked up. Not showing up to work for a week, while not telling anyone what’s going on. I’m in touch with many of the people there now, both professionally and as friends. And I still have not had the real conversation about exactly how much of a mess I caused.

Howie: I’m sure that there were tons of people who have incredibly important jobs — where I care a ton about them doing their jobs — who had to put a ton of their time and effort and energy into cleaning up the mess that I was leaving. It was a real thing, a real mistake I made at that point. That was a quite bad professional mistake. And that obviously I reacted to even more strongly. Then after two weeks, that’s a lot worse. And after two weeks I somehow, I don’t know how I did it, I dragged myself over and just showed up to work.

Keiran: Oh, you just showed up.

Howie: Yeah. I was just like, “I am so sorry.” And Elie was an angel, just could not have been sweeter about it. He asked, “What can I do? We want to get you back as soon as we can, but obviously you need to take care of yourself.” He just could not have handled it any better. Or at least, I would not know how to tell him to handle it any better. And then I just was in bed again for a month and a half, did not check email, did not check Messenger. Just shut myself off from any stimulus, because any exposure to the world could lead me to reminders of how bad I was.

Keiran: Was the month and a half after those first two weeks a different experience because now at least people knew you were home? Did they not know what was happening?

Howie: I think that they basically knew.

Keiran: Right.

Howie: Actually somebody who I didn’t work with that much years later was like, “Yeah, what the hell happened?” And I explained to him, and he was like, “Yeah, that’s basically what I assumed.” People knew. And also, people got in touch with my girlfriend at the time. I was still sometimes managing to drag myself from my bed to her bed. I could just lie and wallow there. So people knew what was going on, but certainly did not have me as someone who could be an active participant in helping to get things sorted that I was dropping.

Howie: I just wanted to mention that my friends and coworkers did a whole lot of checking in on me that didn’t really come through in the episode, and that I’m really grateful for. Alright, back to the conversation.

Howie: I still feel very guilty about this, and guilty about what I must’ve put these people through. And I just feel bad that I’m sure that important work in the area of biosecurity did get dropped.

Howie: It would have taken an email, when I found out that I was going to miss my flight, that was like, “I am not doing okay. I don’t even have the energy to tell you what to do about it. But FYI, plan for it. I might be out for a while.” And I think everybody there would have been so understanding and it would have been fine. It’s probably the biggest regret of my life that I didn’t do that.

Friends [00:57:10]

Keiran: So you’re in bed for another month and a half. So where does our story take us next?

Howie: Yeah. So then a friend of mine — who I always think of as a hero for doing this, who was a co-worker at GiveWell, Josh Rosenberg — he emailed one of my friends from law school in DC, who he did not know at all, but he knew that he had been really helpful during my law school depressed episode and was like, “Sparky, Howie’s a fucking disaster. Can you do something about this?” And Sparky convinced me to go to DC and just stay with him for a month. And it was so good to be taken out of… One thing that’s hard about this is, yeah, EA is now also my social community, and it’s also my professional community. And so there’s no way for me to be in my community without just being reminded about this all the time, especially then.

Howie: I was like, “Okay, great. So now I’m terrified of seeing almost all of my best friends because they’re also my coworkers.” So getting out of that situation for a while was really good. So I emailed Elie at GiveWell, my boss at the time, and was like, “I’m so sorry again. This is terrible. Obviously it looks like I quit my job. I didn’t mean to do it this way. This sucks.” I just apologized a lot. And then we got coffee. He was, again, just really kind about it. He didn’t sugarcoat the fact that yeah, people have had to clean up some of my shit, but he wasn’t trying to rub it in, he handled it as well as a person possibly could. And so I officially quit my job. I don’t know if… Quit my job, got fired from my job, it’s pretty unclear at that point, but some mix of the two. And I went and spent a month on the east coast, away from all of that, in a hopeful attempt to get better.

Keiran: That seems like something that might be very useful for people to hear. That just seems like such a good idea.

Howie: Yeah. Getting into a different environment was really good for me. Sadly, I don’t think that I can ask Sparky to take care of all the listeners of the podcast. I was incredibly lucky to have him in my life. And yeah, he was really helpful to me when I was very worried about myself in law school, and then also did this. So I just will never be able to repay that.

Howie: I do think that this is actually kind of a reproducible thing. Or it’s a thing that if you have the privilege of the savings that you can just pick up and go, and people that you can go to, who you feel comfortable with, but change your environment and put yourself in a place where you have no expectations of yourself… If you’re in one of these loops of constantly trying… It was a whole period of a month and a half, I was just sitting there telling myself what if I was productive today?

Howie: Maybe I can make up for all of the potential that I had lost over the last whatever amount of time…maybe I can make up for all of it today. It was everyday. I sat there hitting myself at the computer, not able to even try. So leaving the space, not having expectations of myself, and just putting myself in Sparky’s hands. I think it was a very good decision.

Howie: I just wanted to flag that people should definitely not take the way I handled all this as a model of what to do. In particular, I didn’t seek nearly as much treatment as I should have at this point in my life. It’s possible somebody in my position should have been considering some kind of structured outpatient treatment or an inpatient program. It was probably a mistake that I didn’t consider those things, so I just want to make sure that I don’t set a bad example. Okay, back to the episode.

Keiran: I feel like that is a really good piece of practical advice, and that’s a really good reason for making sure that you have sufficient savings, to be able to just do that. People would normally think oh yeah, I’ve got to have emergency savings for, I don’t know, they get cancer or something, but this just seems like a really good reason to be able to just do nothing for a few months and not actually be stressed about am I actually going to be on the streets?

Howie: Yeah. I think for people my age and socioeconomic status and people who are similar to me in a bunch of ways, if you’re going to need a ton of runway, mental illness is one of the more likely reasons that might happen. And yeah, I think having money saved for that kind of situation is really useful. And I’m a person who’s had a complicated relationship with money since I was pretty young. In particular, spending money on myself and keeping it for myself and saving it for myself when I know that it could be going to efforts to make the world a better place. Tons of people are more extreme than me, but I’m somewhat on the extreme side in this front.

Howie: Luckily I was pretty frugal, and I knew that this was a possibility. And so I ended up with a bit over a year of runway saved up. There had always been part of me that was like, “I should just give away this pot of savings. Why am I entitled to have this?” And I’m so glad that I didn’t do that. I ran out of runway at the very end of this period. I ended up out of work for basically a year and a half, and I didn’t know how I was planning to make rent or whatever. I think the answer probably would have been that friends would have helped me out. But at that point, I was able to be somewhat productive again, to start doing research and figure out what I was going to do with myself. I would have felt very bad about putting that burden on my friends, and that wouldn’t have been mentally healthy for me.

Howie: And also I’m super lucky to have some access to that kind of thing. A lot of people don’t. So I think it was really good that — good not just for me, I mean, it was good for me, but also good for the effective altruism community, good for the causes I care about, that I was able to take care of myself and also didn’t have to rush into some job where I wouldn’t be doing any good because I was about to be broke. So I think that was the right decision in retrospect from a utilitarian perspective, even though certainly saving that money felt bad to me at the time and felt selfish to me at the time.

Keiran: That definitely seems right. I mean, I think that’s also a really good point in favor of becoming part of something like the effective altruism community. There’s just a level of safety that you wouldn’t have if you were just on your own.

Howie: Yeah. I think that there is something to be said for that. And the effective altruism community has just been so, so incredible to me over all of this and just so supportive in more ways than I can name, and we’ll talk later about some of the specific ways in which this is the case. I’m just touched and grateful and I’m very lucky that I had this.

Howie: And I think the EA community does a bunch of taking care of people when they’re down. And even things like giving someone your couch can just make a huge deal. I mean, getting Sparky’s spare bed made a huge difference in my life, but I also was lucky to have some types of support that a typical person wouldn’t have. That’s not the type of thing that a community can provide to everybody when it gets thousands of people large.

Keiran: Yeah. I mean, it’s good to be acknowledging that in many ways you were very lucky, countering the fact that you got unlucky in this other specific way.

Starting to work again [01:04:23]

Keiran: So what did it look like, the road from that point towards starting to work again?

Howie: I spent some time on the east coast, went back to Oakland, had a minor re-debacle. So going to the east coast helped a lot. And I got to the point where I was still very bad. I just did not know how to forgive myself over messing up at a job where it felt like my life’s work was helping that organization grow. But I was functional. I think this stretch of time may have been the first time I was a guest on the 80,000 Hours podcast, talking about biosecurity, but it was this two to three week period where I was doing much better. And one of the things I did was recorded that with Rob, who I didn’t know well at the time, and then proceeded to not respond to any of his emails about checking the transcript, because he got me in the one window of time where I was okay. Rob eventually just posted the episode.

Howie: So I got back. I was starting to become functional, and opened my inbox. Another way I was just so lucky and grateful is I had — not quite job offers, but people who wanted me to work with them just waiting for me in my inbox that I hadn’t opened for months and months and months because I was terrified of it. And so I actually started the process of doing a bit of remote work.

Howie: One of the emails that I got was from FHI. It was when Toby was just starting writing his book, The Precipice. This is Toby Ord, a philosopher at the Future of Humanity Institute at Oxford who wrote a fantastic book that’s sort of a canonical introduction to existential risk. And so I started doing some remote work, being a research assistant on that book.

Howie: I was starting to get back up on my feet, but it did feel like I hit the combination of, this is the type of work I’ve done before, and a less stressful, less responsibility type of it. So it actually did seem like a good way to start getting some success spirals. And it was on something that was incredibly meaningful to me, that felt important. I think it’s important that his book does well. I think the book turned out fantastic. So I got a visa. I was ready to go, and then I ran into a bit of a roadblock.

Howie: One thing that I think is a common experience for people with mental illness is that stuff is just up and down, and getting better and recovering often doesn’t look like a straight line. That doesn’t mean that it’s not getting better or that it’s not going to get better. But it was heartbreaking to get worse again. I stopped doing work for The Precipice and then just spent another nine months in bed.

Keiran: Mainly ruminating on now having stopped work on The Precipice, or is this just everything combined?

Howie: It was just a combination. It was some overall sense of what sort of person am I, or something. What will I ever be able to do in the future? Just hating myself for fucking up, fucking up again, but also fucking up in the first place, just this whole suite of… It was worrying about whether I am going to be able to contribute to the world again. This was my identity, who I was. And I think I did not, and honestly don’t really anymore, know who I am without that. And yeah, so I just really didn’t know what to do with myself or even where to start, but that all makes it sound somewhat complicated, whereas the actual experience of it was just, I was either experiencing just immense rage at myself, throwing out bits of self-harm, punching trees and that kind of thing and being sort of really awful in that way, or just playing video games.

Howie: I was at least able to have moments where I was in flow and not just self hatred mode with that. I hadn’t played computer games up until then since halfway through college, when I realized that they were addictive and I had to break all of them in half because I was either going to do college or I was going to do video games, but not both.

Keiran: How did that end? Is there a catalyst or is it just eventually you just had one day of strength?

Howie: So I began feeling really averse to seeing my roommates, which if they ever listen to this, I’m sorry, guys. You’re wonderful. It was me, not you. Anyways, I just worked a lot when I was at Open Phil, so I didn’t have a ton of time to get to know people. I had a really nice relationship with them, honestly, had some really vulnerable conversations that made me feel close. They were not the people who I wanted to talk about the worst depressive episode of my life with, but I also felt very guilty about not giving them the chance to be supportive. It would just suck to have your roommate so down just in your house, in their bedroom, this much of a disaster and not helping. And I felt very bad putting them in that position, which made me avoidant. That got very, very bad, not leaving my room for days and days at a time.

Keiran: And I suppose this is interacting with stuff about money, where my first instinct was, “Oh, you should get a place by yourself.” But that, presumably, was not on the table.

Howie: Yeah. That was not on the table. And having to have a conversation with them. I didn’t tell them I was going to the east coast. I felt very bad about that. I’m sure they figured out what was happening. They had enough friends in common that I’m sure they talked to someone, but I felt very guilty about it. If you don’t see your roommate for a day, that’s normal. Sometimes they just don’t overlap. If you don’t see them for three days, it’s pretty weird. And then it feels like it requires an explanation. And then you really don’t want to see them, because it’s like, “Oh God, how am I going to explain that the reason was that I was just in bed the entire time? What if I just don’t leave my room today?” And then it’s been four days, it’s been two weeks, and they haven’t seen you. And you’re sneaking out to the bathroom.

Howie: I ended up mustering up the moxie or whatever to go hang out one night with an ex-girlfriend of mine who had heard about this and was like, “You’re coming to live at my place. This is unacceptable.” So I spent maybe four or five months living at her place. There’s so many people who I just feel like I owe my life to, basically. And I’m just so lucky that this girl who I was not dating anymore did this for me. It’s very intrusive to have your ex-boyfriend living at your house, being depressed and really un-fun, so I’m super grateful for that. So I spent months basically living there. And then I think the thing that actually got me to emerge again — and this is not necessarily the most mentally healthy way to get myself to do it — was I just started feeling really guilty about being a burden on her.

Howie: A month was fine, but several months, she probably wants to have a dating life. She can’t have a dating life when I’m here. This is just too much. And one day just sort of through willpower or something I was like, “Okay, I need to move out and to move back to my apartment.” And at that point I had been doing better enough that interacting with other people was feasible. So I could sort of start to take baby steps.

80,000 Hours [01:11:17]

Keiran: And is this around about the time that 80,000 Hours starts coming into your life properly?

Howie: This is the time that 80,000 Hours starts properly coming into my life. So one thing that happens at this time is Rob, who, at this point, I’d done that podcast episode with him, so I knew him and we had interacted professionally once or twice. We had exchanged a bunch of Facebook messages, not all of them cordial. We did have somewhat testy disagreements, although I think that they didn’t leave a bad taste in anybody’s mouth, and years later we were able to get drunk and go back through them and re-litigate them, which was fun. But he was somebody who I did not know all that well. I can’t remember exactly how this happened, but he asked me to go to a party with him. I was like, “Well, I have not spoken to a friend in basically a year, other than people I was staying with. I need to do something to start a social life again.”

Howie: I get really socially anxious. I’m terrified of hanging out with new people. But I just got to get myself to do this. So Rob was just a hero and dragged me out a few times, and part of it was just an exposure therapy thing. Having spent that much time not socializing with anyone, it just felt very overwhelming to do it. And so sort of getting myself into the habit of it again was really good. And then Rob knew that I was feeling very awkward about being around my housemates, but there was a spare bedroom in the 80K house in Berkeley. And so he was like, “Stay here, be around your friends,” which at that time was a stretch. I think I had once Skyped with Brenton at that point who was living there and once ran into Peter. It’s not people I knew well at all. Ben I had talked to a bit more. And a touching thing about this, my experience with this community is, because we were in the same community, these people were my friends, or turned out to be.

Howie: And so I spent a bunch of time living at the 80K house, integrating back into the community, starting to think about… First just having friends again, setting up my social life. Emailing all of my friends like, “I’m sorry I didn’t talk to you for a year.” Some of whom I was able to email to do this, and some of whom I felt too guilty about it, and I lost friendships that way. But setting up my life again, since I had a place to do that from, which I was really lucky about. So that was the first way that 80K really entered into my life.

Keiran: That’s very cool. That makes me very happy to be associated with 80K.

Howie: It was really touching, and it meant a lot to me. And it always will.

Keiran: And then they started trying to convince you to do some work for us?

Howie: Yeah. So I spent a few months trying to set up my life, and then start seriously thinking about what I should do career wise, which I find to be an incredibly aversive, painful process. Turns out that — as you well know if you check out our website, or any of our resources on career finding — thinking about your strengths and weaknesses is very useful as you’re thinking about what jobs to apply to. And as somebody who in the best of circumstances is very bad at believing that I have strengths, and very good at really, really counting on those weaknesses, doing a realistic job of a job search, and not just having it turned into “Here are all the reasons I ruined my life by losing my last job” was just very difficult and painful.

Howie: And then there was a new obstacle there, which was, I felt genuinely unsure about how frequently this was going to happen to me in the future. And I didn’t know how much I should let mental illness limit the places that I’m willing to work. I’ve been lucky enough to work in places where I care about the mission deeply, where my life’s goal and meaning is the same as theirs. And so, I do not want to be in that position where I harm the organization by taking on work that my mental illness just means I can’t reliably do. And so I was very worried about that.

Howie: And with something that only hits a certain level every three or four years, I think it’s just very difficult to figure out, how do you think about that in a career-planning process? Because you can be… I don’t know, how old was I at the time, 32? And it’s happened two and a half times. And after each time I changed my treatment regimen. So maybe the new thing is going to work. And six years later, you’ll have enough data to know. In the meantime, it was very unclear how much I should be limiting myself.

Howie: I thought a bunch about, do I want to go work in DC? Do something in AI policy? Try and leverage having worked at a think tank way back when, and the network I still had from law school? It wasn’t clear to me if I could count on being able to have that type of career. And just thinking that through was fairly unpleasant.

Howie: So I was doing that, and also, I was trying to figure out what I believe about stuff. In a year, just a lot of things had changed. The AI world had changed. What EAs thought about a lot of stuff had changed. Trying to get caught up, reading a ton about AI policy. It was a self study period. Figure out what’s going on, figure out if this is an area I want to work in, that type of thing. And so I did sort of an abbreviated job search.

Keiran: One thing I wanted to talk about was that when you started working at 80K properly, you were super upfront with Ben Todd, our CEO. How did that conversation go?

Howie: Yeah. There’s two ways to think about this. One of them is that 80K as an organization is really important to me, and it was before I worked here. And so I wanted to make sure I was doing everything that was in 80K’s interest. Also, it’s not like I had that much of a choice. It is a small community. There aren’t that many organizations. It was impossible for people to not notice, oh, one of the people who’s been around since 2013 playing an important role at Open Phil disappeared there. And then he’s been hanging out on the couch. So, I don’t—

Keiran: You could have had an elaborate backstory.

Howie: I could have.

Keiran: You could have had a rumor that you were a spy. There were other options.

Howie: It would have gone really well until someone did a reference check with Holden. So it was just important to me — but I don’t want to sound like I’m super noble, and I was trying to win one for transparency, or something — to basically be as open with Ben as I possibly could.

Howie: And so after 80K had made me an offer, before I accepted it, I had a conversation with Ben where I just did my best to lay out everything that I knew about my mental health and say look, these, I think, would be good reasons to not hire me. I don’t trust my own opinion about this, because I will always find good reasons to not hire me. So, I think you’d be making a mistake, but also you just can’t put any weight on my opinion about this kind of thing. But I at least want you to know these things are real. There is some chance that I will start working for you, and then, I would like to think that I’ve learned my lesson, and if I have another serious depressed episode, I will immediately do the thing of, what’s the minimal thing I can do that will make sure that everybody who has to clean up after me has the smoothest experience possible, or at least has a heads up that’s happening.

Howie: I’d like to think I’ll do that. I can’t say for sure. I’m zero for one. It seems to happen every three to four years. It may be the case that all of a sudden I disappear. I feel terribly bad still about not being at my last job. I’m not sure what that’s going to do for team morale. I’m very worried about that. Having somebody who’s still hung up over this terrible mistake that made them leave the last place.

Keiran: It’s like being in a relationship and pining after the last person.

Howie: I think it was very much like that. It felt, and feels, like a breakup. And yeah, I was just having a very upfront conversation with him, where I was like, “If you say that having taken all of that onboard, you want me to work here, then I will trust your judgment.” I think it’s a really nice thing about the EA community — you obviously cannot do this for every job, in a lot of places there’s just too much stigma around mental illness to have this kind of conversation, and they’re just not going to take the risk — it is incredible that there are places where you can do that.

Howie: And it just was the case that Ben and I wanted the same thing. We both wanted me to be hired in the cases where it would be good for 80K, and neither of us wanted me to be hired in the cases where it would be a mistake. And so we were actually able to be collaborative, where I was like, here’s everything I know about the likelihood that things would go wrong. And he basically said, “Look, we’re willing to accept that risk. Also, we will do things to — at least at first, until we get more information about how stable you’re better — to mitigate that risk. There are plenty of types of work where if all of a sudden you dropped off the face of the earth, nobody was relying on you so badly, in such a time-sensitive way, that it would be a huge disaster. We can make sure that you’re doing that, at least to start.” So we had a real conversation like that.

Howie: I guess one lesson from that experience is I think that some EAs have a perception that the community is this sort of… Because a bunch of people have these utilitarian values, are people who are so dedicated to the impartial good, people assume that it would be really cutthroat, or ununderstanding, or unsympathetic, where people hear that you made a fuck up, or that you have a problem, or that you have a mental illness, and tjhat they’re like, well, I am definitely not going to take a risk on that person.

Howie: I can’t sit here and tell anyone that it isn’t harder to get hired if you have some sort of mental illness that makes you worse at your job, which I just definitely do. But I think it just is a huge credit to the EA community that at least… I was privileged enough that people were willing to look past that for me, and willing to say, “Look, Howie definitely has some limitations. Are there still things that he could do that make him a really good hire?”

Howie: I know of other people who have had similar experiences, people who have chronic illness, people who have very real limitations on them, at various central EA organizations, and organizations are very willing to hire those folks and make accommodations to put them in a situation where they can thrive. 80K has certainly done that for me. I’m feeling very lucky to be in a community where that is the norm.

Keiran: Yeah. That’s fantastic.

Howie: I also do want to caveat that — and this is going to be a theme — I am in just a place of an enormous amount of privilege. I think having been around since 2013 at a high-profile organization, I just got a lot of chances to ‘prove myself,’ or at least have a big network, know everybody, have people who feel like they’ve benefited from my advice. And that helps to make it worth thinking hard about, well, exactly how much would these limitations limit a person? And so I think it speaks really well to the community that I’ve had the experience that I have, but — and it’s tragic — I don’t feel I can say I know that everybody else will have this experience.

Health insurance [01:22:18]

Keiran: You were in the U.S. while all this was happening, obviously — did you have any issues with health insurance?

Howie: Yeah. So we talked before about how I’m really glad that I saved up a year and a half of runway. On the other hand, I was definitely cutting corners in order to make that runway into a year and a half, which I think is some evidence that I probably should have been saving a bit more, and giving away a bit less. By my last year at Open Phil, I was giving away half my income, which is, I think… I understand why past Howie was doing that, and I admire it. But I think it was probably too much. In any case, after my health insurance from Open Phil ran out, I was uninsured for basically the whole time until—

Keiran: Oh wow.

Howie: —I started at 80K. So I had a year where the plan was ‘don’t get hurt.’ And I started to go off of some of the drugs that keep me going. Because I just couldn’t afford them anymore.

Keiran: How expensive are we talking?

Howie: So I think it was, Adderall was going to be a couple hundred bucks a month. And by the end, I was pretty close to broke. It’s possible I would end up with help from some family money, if things really got to the place where I was out in the streets, but that is…that does not feel like an outcome that’s actually acceptable, or within the… I both want to acknowledge that I’m privileged and this exists, but I think I’d actually feel pretty uncomfortable taking that money, even if the choices became pretty dire. So anyways, yeah. I was basically out of money and trying to do what I could to make it last. I was at the point of just not taking medications I needed. It sucks that people can end up in that position.

Howie: And there actually is a resource that people should totally know about, which we can put in the show notes. I unfortunately can’t remember the name of it, but there’s a website that you can go to if you’re in the U.S. that gives you coupons for prescription drugs. Nobody who’s not insured can afford the actual prices, so they only really want to charge that to the insurance companies. So if you’re not insured, you can get these coupons, and then actually get the drugs for reasonable prices. Unfortunately, they stopped doing that for scheduled drugs. And so, because Adderall is abusable, they stopped accepting those coupons, so it’s just full price.

Howie: So I was trying to get myself back on my feet, and figure out, hey, am I still a person that can do research? And meanwhile, skimping on the medications that let me do that. It was a pretty rough spot. It was a short period of time in my life, and I’m really privileged and lucky as an American — not all Americans have this, unfortunately, to have had good healthcare for my whole life. It felt pretty shitty and scary to be in that situation, so I at least want to say you can hit a place that really sucks, and then get yourself back up on your feet again, eventually.

Keiran: I want to double down on the runway thing that we were talking about before, where that obviously should come into it. Maybe just in terms of calculating how much you actually need, what you consider to be a year of runway, maybe actually needs to change, if you consider that you don’t have health insurance.

Howie: Yeah.

When it might be correct to quit a job [01:25:35]

Keiran: Do you think it’s possible to offer an opinion on when it might actually be correct to quit a job for mental health reasons? I’m imagining that there are real positives and negatives. Where if you just try to reduce your hours, and you’re still working somewhat, you would have probably a higher maintained sense of purpose. But then at the same time, if you were working 10 or 15 hours a week or something, you would constantly be getting reminders — if there were these specific projects that were due — that maybe you should be helping out there. I can imagine that being quite stressful. Do you have any feelings on that?

Howie: I think that’s a really difficult situation. And my main answer is, it just depends on the real circumstances. I have had thoughts in individual circumstances, and have given friends advice on this. I think it’s a real decision that’s a tough decision. I think it’s hard to say things that are generalizable.

Howie: A framework that I try to use to think about this is asking, okay, do you have a need for having a sense of purpose, having a sense of community or solidarity with your team, having the structure of a place to go? Those are things that jobs give a lot of people, that I think are important and helpful for mental health.

Howie: On the other hand, my experience is that for a lot of people, negative failure spirals are a big part of what takes a patch of depression and turns it into a serious period of real bad mental illness, that just ends up causing you a lot of suffering. And so avoiding those negative spirals is just so, so important.

Howie: I think one part of that is, if you are at reduced capacity because of feeling a bit depressed, or feeling a bit anxious, I think it’s really tempting to still have the same expectations of yourself as you did when you didn’t feel like you were getting chased by a lion, while at the same time attempting to do the work. And so there’s a real danger that if you don’t change your expectations of yourself, you’re just putting yourself in a position where you will definitely fail. And then being a person who’s a little depressed, and then is failing at things, and putting yourself in a position where you are just going to repeatedly do it, you’ve just decided to fail things. That is a very bad position to be in. It’s just a good way to feel worse about yourself and sort of spiral in that way.

Howie: So I think that there is this difficult balance of wanting to keep the things that are giving you structure and meaning and purpose in your life, and then also wanting to make sure you’re not putting yourself in a life situation that’s self destructive, or where you’re setting yourself goals that you just can’t possibly meet. That just means different things to different people.

Howie: I think there is one meme out there that I really strongly disagree with, that’s like “Look, your mental health is the most important thing in the entire world. Do whatever it takes to get that fixed. If you’re feeling bad, take a break, focus on yourself. That’s your priority until you get healthy.” There are things close to that that I agree with. But some of us aren’t going to have a moment where it’s like, alright, you’re healthy now. You are officially normal, and you get a certificate or something. It’s just going to be a lifelong struggle.

Howie: And so I, at least, don’t want to put off living my life, and doing the parts of my life that matter to me until this is fixed. That’s really important to me. Years where I’m trying to fix this thing are also years of my life. So it feels important to consider that. Some people are the type of people who can be super functional and be really anxious at the same time. And I think for some of them, the right choice is to just keep doing what you’re doing.

Howie: Also, one of the most valuable things you can possibly do is to get your mental health treatment better, and we’ll talk about that later. And I just think it’s so, so valuable to see if there’s a way that you can do that. But also, just keeping your life the same is the right decision for some people. And for some people it’s, this is putting me at risk of failing in a way that is going to make me self undermine, and I just need a break, or just need the space, the headspace, to think things through, and actually work on myself, instead of every day being focused on the next deadline. I think it just varies a lot by person.

Howie: Questions that I have tried to ask myself, and sometimes suggested to other people they ask themselves include thinking about the sort of things that they get out of their job that are important to them, that are important to their wellbeing, that are important to making sure that they stay, to the extent it’s possible, out of a spirally, horribly depressed zone. And ask, what is the minimal viable project that will get you what you need? And when you’re depressed and facing a rough patch, I think lowering your expectations of yourself and lowering other’s expectations of you is basically something that you owe the world.

Howie: It’s really hard to look the thing in the face and admit that it’s happening, but it just may be the case that you can’t do what you used to be able to do. So, I think it’s just actively very good to lower expectations, lower your responsibilities. That might mean reducing your hours. It might mean quitting a job. And so thinking about what are the most responsibilities I could possibly drop, while still making sure that I have a sense of meaning and structure is one framing that I find useful.

Howie: I think another framing is just the maximum viable project instead. And just saying, look, I don’t want to give up all the things that are still getting me meaning, or joy, or structure, or whatever in my life, and put my whole life on pause for this, just because it’s a problem. How much can I keep my life the same, while I am still putting myself in a position where I’m really confident I can meet all the expectations I’m setting for myself, and I’m not going to do the thing where I’ll feel like I let myself down, and sort of spiral from there.

Howie: Those are the types of things I think about when I think about whether you should quit a job to focus on your mental health. And there’s also practical career considerations. Having a blank on your resume sucks. If I go and try to apply in an EA organization, it feels like nothing to explain. But I haven’t figured out exactly how I’d talk about it in an interview elsewhere, if someone’s like, “Why weren’t you working for this entire year?” And so I think that there are real costs to that. I think there are real costs to losing your connection with your employer, there’s the health insurance thing, there are a lot of reasons to try to stay employed.

Howie: And I think also, a lot of people are surprised by how important the structure of being in a particular place every day actually is to them. One approach to treating depression is a cognitive approach. It’s, how do I get my thought patterns into a form where I’m not constantly hurting myself?

Howie: Another is the behavioral aspect. That’s just, how do I live my life in a way that enables me to get my shit together? I think on the behavioral side, just creating space for you to feel good again. Often having that feeling like okay, something’s going wrong, but I still have all the trappings of a normal life, can just be really important to people.

Having a clear plan before something bad happens [01:33:16]

Keiran: It’s occurring to me that when you’re thinking about what could constitute a minimum viable project, or maximum, it seems once you’re in a particularly bad period, this is a particularly bad time to be trying to work that out. So, would you recommend that people try and think about this ahead of time? Maybe you now should be like okay, if me, Howie, in six months is going to have something that was similar to three years ago, what do I think I should actually do? What are the steps? And then if it actually happens and you’re like oh fuck, here I am in this situation again, you just follow the steps that past Howie set out for you?

Howie: Yeah. That actually seems pretty good to me. I think that there are limitations to how much you can do that, because you just don’t know how bad future Howie’s going to have it. And also, it’s not just a spectrum. There’s many, many dimensions. And so you just don’t know which abilities are going to take a hit, and where the ugh fields are going to be. But having some kind of a plan on this front seems pretty good to me. Having a plan for what to do if you have a mental health crisis in general. Especially for somebody who has reason to think that this might happen to you sometime in your life.

Howie: I think everybody has reason to think that. Some people have reason to think that it’s particularly likely it would happen to them. Having a plan in general seems good. But having a plan for this in particular seems good. Also, I think asking another person who you trust, and who will feel to you like they are on your side and making decisions according to whatever criteria you would endorse, I think can be really important for this.

Keiran: Yeah. I was just thinking of, even if your plan was just, I am going to email this person, that’s my plan. That’s what I do. Every time this happens, I email them. Maybe even just a code word or something. Marmalade. This is just, every time I say this, that’s all you have to do. It’s just one word, and they know, and then the process kicks off. That seems quite good.

Howie: I’ve at various times had things like that set up. Where it’s, if I send you a one sentence email, that things are going to shit, I just need you to call everybody, tell them what’s going on. Just handle it.

Keiran: Yeah. And then I mean, even for those first few days of a potentially really bad period, if you knew that that was kind of being handled, and you didn’t actually have to tell anyone, because this person’s already taken care of it for you, that seems very helpful.

Howie: Yeah. I mean, I think that probably would have been the difference between losing a year of my life and my job, and losing, oh, a week or two of my life. So, I don’t know, I just can’t encourage people more to… It’s amazing in these things, where there are these feedback loops, how little decisions, and little preparations that just cut out some of the tail events can just make a huge difference.

Keiran: Yeah. I mean, that seems worth… Just to pause here for a second, just this micro goal of just, if this is the one thing you do. Yeah. If that could actually end up saving you 50 weeks of your life, this is maybe, the most cost-effective thing that you could ever do for yourself, is just to set up this system. Maybe it takes you, I don’t know, a little bit of time to think about who the right person is, and what’s the threshold for when you’re actually going to send this email. But yeah. I just wanted to, in terms of practical advice, it seems like one of those unambiguously good things.

Howie: Yeah, I’d buy that. And, I think it is just… The difference between, oh, this person had a mental health episode, and they responsibly handled it by letting people know that they were about to start dropping some balls, and then gave everybody a chance to figure out how to handle it. And, they didn’t do that. Look, if you don’t do that, I couldn’t have more compassion for you. I didn’t, and couldn’t have more empathy.

Howie: Also, a lot of people will feel that way too. A lot of people will get it. If you do do that, I think just so many people are like, oh. I’ve had to cover for people when they get the flu. Yes. Obviously, go take care of yourself. And the extent to which it feels like this embarrassing, shameful thing, the stigma there I think is just so harmful, because it just causes people to make decisions that are just so much worse.

Howie: And if you send an email to… Obviously, people are in different circumstances. Some people work at some corporation that’s faceless, and you just can’t do this. That sucks. If you are somewhere where you can do this, and you send this email that’s like, “I am worried. I’m getting really depressed. I might not be able to work for the next week. Can you please find a way to cover my stuff? I can’t even tell you what the stuff is, because that’s too stressful, but figure out somebody who will know.” If you do that, and then it turns out you were wrong, and the next day you’re functional, and you show up, and are like, “Hey, actually I can get back and do my thing now,” everybody’s just happy. And it wasn’t a problem that you did that. Maybe for a day, you made people stressed out. So leaning towards just giving people a heads up when things might be going wrong just seems like a huge one.

Keiran: Yeah. If you wrote that as a template email, exactly what you just wrote then, and then in these moments, the challenge was not that you had to write the email, and then go over and obsess over if the wording’s right and whatever. Maybe that takes days to actually feel comfortable with the text. If you instead just have to copy and paste something, and all you had to do was just get the email address in, and then click send, that seems like it’s going to be probably more achievable. I mean, you can tell me.

Howie: Yep. I have, at some point, had that email written. I do not have an updated one. I think this is a good prod for actually doing that. I think it’s a good idea. I mean, personally, I can still imagine myself not doing the thing, just feeling so ashamed. But anything you can do to lower the barriers just seems really good.

Imposter syndrome [01:38:46]

Keiran: Yeah. Okay. So one thing I want to talk about that we briefly covered earlier… It’s very apparent for anyone who knows you that you describe yourself and your achievements very differently than the way everyone else would describe you and your achievements. So, what do you think is actually going on with this mismatch between your self perception and how others perceive you? We talked about this with the performance evaluations. When you hear all this positive stuff about you, do you intellectually think they’re wrong, or do you accept that they’re probably right, but it’s just something that you can’t internalize? Or what’s happening?

Howie: That’s a good question. It’s actually pretty confusing to me. This is the area where I’m most able to keep two entirely inconsistent beliefs in my head at the same time (that I am aware of). So, I know what the right answers are, in some sense. I know what the answers are that will get people to tell me that I am right if someone asks me, “How good are you at X?” But I deeply believe the other thing. I think one thing going on is that I am just really, really good at coming up with stories for why any given thing that somebody told me I did was useful, actually was not. And I will dig in my heels so hard. And I would not do this if it were about anybody else. But, there’s always, always, always, a story that I can find. I honestly don’t know how to describe why I’m so desperately drawn to that. But, it just feels so true and so important to dig my heels in on it.

Howie: A lot of what I do at 80K is just be available to give advice and decision support to other members of the team. People tell me it’s useful, and in some sense, I trust them. The people at 80K, they’re my friends. They like me. They would hate to have to give me bad news. But they’re also incredibly dedicated to the mission of the organization. I think we have a duty to people in future generations to be actually doing the shit that will benefit them, even if it’s hard.

Howie: And if what I was doing was not useful, I really think that these are the types of people who would, it’d be hard, but they would tell me. People tell me that they find my strategy advice useful. I mean, if you pick any bit of advice, I will come up with all of the ways in which me bringing up this particular critique caused X person and Y person to spend hours of extra time investigating to make sure it wasn’t a problem. And then meanwhile, we came away afterwards, and what, did we flip from 52% sure of one thing to 52% sure of the other? It was a coin flip anyway. There’s just always a story I can tell myself. Why am I doing this? I don’t totally understand it. And the problem is, I actually believe it.

Keiran: That sort of makes sense to me for something that’s very specific. Where someone says, “This bit of advice you gave me was really helpful,” and you come up with a story. But how do you feel about the fact that… Okay, so this is my sincere belief: If I was polling the rest of the 80K team members, and I was saying, “Who would you be most unhappy to lose from 80K?” I would bet a lot of money that you would get a tremendous amount of votes. People just genuinely do really value you. It’s not something that they’re just saying to your face. So they would all have to have just very poor judgment for that to be wrong. So how do you think about something like that?

Howie: Yeah. Well, that’s very flattering.

Keiran: But it’s true. I’m not trying to be flattering, honestly. That’s my whole, my whole brand is to be honest.

Howie: That is your brand. Yeah. So it’s hard to even give my reaction, because I know it’s not the right reaction.

Keiran: Right.

Howie: But the thing that I think I actually believe, and it’s a little bit tongue in cheek, is just somehow, there is this one skill that’s fooling other people into thinking that you’re smart and helpful, and it just happens to be orthogonal to everything else. So one could max out on that skill, while being awful at literally all of the other things. And it turns out that you wouldn’t think it, but that’s just such a natural category, that genetically, or whatever, just to be good at that. It doesn’t require you to be smart in general. Nothing, you just have that nailed. And there is a real sense in which that is my belief. It’s unreasonable. That is my felt answer to that is just, I am fooling everyone. I am good at fooling everyone. If you want to convince me otherwise, let’s go into each of the specifics, and I would just dig in my heels.

Howie: And there are a lot of strengths that can also be weaknesses. And I think that I’m good at framing many of my strengths as also weaknesses. Yeah. But I think I have the imposter thing just really, really hard. I guess one place to go with this is, why do I have it? I don’t really understand it. It just feels so true to me. It’s one of the things I just feel the most strongly. It’s also the area where I can most do the thing of taking a step back, being mindful about what this Howie creature is saying, and think, that is not a person who is truth tracking. If I saw any other person making arguments like this, I would be like, obviously they were false. For whatever reason, it just does not make me think that the things are false. And I just have very few experiences like this. Something’s wrong there.

Howie: I think I’m terrified of thinking too highly of myself. There’s some way in which that just feels to me… I don’t endorse this, but it feels to me like the worst thing you could ever do. It’s like, oh, you’re one of those people who thinks you’re helping the world, and you’ve told people about it, and tried to get the credit for it. And you weren’t doing it as much as you… I wouldn’t think about this about anyone else who did this thing, but, if I were to do it, there’s something that just feels so bad about overestimating yourself, that I just feel terrified of ever doing that.

Howie: And then something about the… Even before I read Peter Singer, when I was growing up, I was a real Peter Singer guy. I was just like, look, I don’t see any reason why it’s better for me to have resources than some other person who needs them more. And the fact that this isn’t being handled is just horrifying. I was very horrified at the world over this. This was just a major part of how I saw the world, growing up. And I think I have this Peter Singer-ish impartiality type of thing, where the thing that I actually endorse is that every person’s wellbeing is equally important. No matter where they are, when they are, what species they are, if they’re a biological human or digital centered, it doesn’t matter. It’s equally important. It’s a fundamental commitment of mine. And then, there’s this sense in which saying that you’re better than anyone at anything, it feels like it’s abandoning that, even though it definitely is not.

Howie: So, I think that’s a bit of what’s going on. I guess it’s not the main thing. And then I think that’s there’s just 40% of my brain devoted to finding mistakes that I made and finding arguments for why anything good anybody says about me must be wrong. And it’s just always going. And I guess that’s the main thing. It’s always going, and it’s hard not to be convinced by it.

Keiran: IOne thing that helps a lot of people is if they’re in a time when they’re feeling really bad about themselves, they think about what they would say to a friend who was saying exactly the same thing. Do you find that’s helpful at all to cut through some of the negative talk? So if I came to you and I was saying — whatever the last time you can remember is when you had really strong negative thoughts about yourself, if I was saying exactly the same thing — presumably you would have quite a different attitude. Does thinking about that help at all?

Howie: It is a thing that I try to confront other people with all the time. I see it being helpful for them. So I see the logic. But it just doesn’t help me. I just think, well, yes, it would be unreasonable if they were doing it, but I just happen to be right. I’m the only person who’s right about how bad I am. And this has gotten worse over time by a lot. There’s a weird thing going on that’s a type of doublethink, where there’s some sense that I’m portraying myself as, look at how modest I am. And there’s part of me that I think has some appeal in the modesty thing. There’s also a thing where some part of me has an ego that’s just way, way outside. So it needs to chill the fuck out. And I do not understand how they coexist, but if I actually believe I’m this terrible, then my expectations for myself should not be very high.

Howie: And the things I expected of myself are way, way higher than that. And probably unreasonably high, and only would make sense if I’m actually a very talented, capable person who’s also in a lucky situation of being able to have high leverage. But yeah. So those things are very inconsistent. I think that the thing that I’m actually doing is it feels like there are very salient examples of ‘Howie Prime’ that are really nearby to who I actually am, that are way better. So I think partly because I was one of the first people at a $10 billion foundation, which is really a once-in-a-lifetime opportunity, I was in a position to do a ton of good. And I think I am still sort of mourning the fact that I messed that up.

Howie: Then there’s Howie Prime who is not mentally ill. And there are ways that you just can’t separate who I am from the mental illness. But there’s some sense in which it feels like that’s a thought experiment you can do, or at least a Howie who feels a little bit less anxious. And it opens up a ton of doors. And so it’s really hard not to identify with that person who doesn’t exist, but could. It’s the thing that I ideally see myself as in some ways. And ask, what would be reasonable to expect of him? And then I’m upset that I’m not meeting that.

Ugh fields [01:49:40]

Keiran: We’ve been mentioning ugh fields a couple of times. Do you want to give a clear explanation of what that is?

Howie: So it’s this phenomenon that I think is very familiar to a lot of people. As far as I’m aware, it was first named in a LessWrong post. Rob recently wrote a popular explainer of it. And the idea is that there’s this phenomenon a lot of people experience where there’s some task that you’re supposed to do that maybe is a bit aversive, makes you want to procrastinate, but is basically a doable thing. And then you put it off. Classic scenario is maybe you try it for half an hour and have writer’s block. But whatever it is, something happens so that this task that felt a bit annoying starts to become really aversive.

Howie: And the thing that happens is, because it’s aversive, maybe you put it off for a day, or two days, or three days. One classic example is it’s an email you’re supposed to respond to. All of a sudden you start feeling worse and worse about the fact that you haven’t responded yet. And there’s this terrible cycle where the worse you feel about not having responded, the harder it is to respond to the email, and the harder it is to respond to the email, the longer it’s going to take you to do it. And so you just have these things that under normal circumstances you could do quite easily, that all of a sudden it takes everything that you have in you to even try to address it.

Howie: I think it’s pretty common that people have some email that they feel guilty about not having responded to, that makes their whole inbox feel aversive. But it could also be like a paper that’s overdue, or some work assignment where you know that you were supposed to have done your part of it a while ago or whatever. And they’re particularly pernicious, because of this self-reinforcing nature. Once they get going, it gets harder and harder and harder to address them. And there’s a bunch of reasons for that. One of them is that it may not have been a problem that you were a day late, but sometimes it actually is a problem that you’re a week late.

Howie: And so the thing that wasn’t a problem at all until you got worried about it, by getting worried about it, you made it into a real problem, and now you’re going to really worry about it. So that’s one possibility. Another is that you build up negative reinforcement in your brain. This terrible association with the thing. So if every time you think about this thing for a week you feel panic, then it’s going to get you more and more to associate panic with whatever the task is.

Howie: I think of ugh fields as having been potentially counterfactually responsible for the worst parts of my life. So I talked before about the depressed episode I had when I was at Open Phil, and one framing on that is, I had a bad incident, I should’ve immediately emailed my boss and said, “Hey, they wouldn’t let me on the flight. They were being unreasonable. I’m sorry, I’m going to miss this meeting.”

Howie: But that felt really aversive, and so I waited until the next day. And already at that point it was like, how did I… Literally my boss thought I was successfully at a meeting in a different country. And I was just hanging around feeling sad in bed. And he didn’t know. That’s horrible, it’s entirely unacceptable. Which was not the case. It would have been fine. But now it felt really hard to even open my inbox. What if he had emailed me and said, “What’s going on? I heard that the people in London didn’t see you there.” So it got really scary. It spirals from there to the point where I’m going months without opening my inbox.

Howie: I think that a lot of people have much more minor versions of this, but I think it is a cause of a ton of suffering and actually does risk keeping people depressed or making people depressed. I think it’s just super important to do something about this. Figuring out how to avoid them is really hard. A piece of advice that I really like and I try to take to heart is, if there is an email that you are avoiding and you realize that you are avoiding it, you’re not opening your inbox because it’s there, or taking any precautions to not look at it, or you know that you’re flinching every time you look at it, it is often a good idea to treat that as immediately your top priority in your whole life.

Howie: It seems stupid if you have some other urgent thing that is more important, but doing whatever it takes to overcome that ugh field today is going to take so much less effort than it will a week later when you feel a week more bad about it. And I think that creating these things that you’re avoiding is one of the best ways to be self-undermining and do things like really hurt yourself, including hurt yourself in the medium term, in ways that really matter. I feel like I’ve been super harmed by this, and I have this bit of a life mission that’s, please don’t do the thing that I did. And I think it’s often surprising to people how little you have to do in order to get the ugh fields cleared.

Howie: So often the thing to do isn’t even write the email. Literally, a one sentence email that’s like, “Hey, I’m not going to get to this for a week. I’m sorry,” clears the whole thing. The person writes back, “That’s totally fine.” And you don’t have to feel bad about it at all anymore. And nobody was ever upset, and that’s literally all it takes. I think it’s just very easy to miss really quick, huge wins by doing things like that. People understand that you’re busy. Letting them know this isn’t going to come for a while and giving yourself opportunities to see that the person on the other side of it almost never cares as much as you do seems really important to me.

Keiran: It seems like developing the skill of being able to identify what could become an ugh field is incredibly valuable. If you can know at the time, the first time you feel aversive… Maybe you go to respond to an email and just go, ah, I don’t want to do that right now. Even that first moment.

Howie: Yeah.

Keiran: Some sort of system where you’re like, oh, I’m just going to actually write that down in an ugh field doc or something. This is now on the list. That seems potentially really helpful.

Howie: Yeah. I’ve had a list before. I’ve had friends who gave me their list so I could check in with them every day and be like, “Hey, did you get that thing done?” Often you can ask someone else to do it for you. Your friend will have so much easier of a time writing that email than you will. And it’s a huge win. I think that there are a lot of ways to get around these things.

Keiran: Yeah. I have that with my fiance. I have a system basically set up where it’s like, if anything’s particularly aversive, the other person does it. And even if it would have been aversive for that person if they were the ones who had a problem with it, it just automatically becomes somewhat easier. So for example, we were on a bus in Vietnam when we were traveling. And they just started playing this really loud music. And we were at the back next to the speaker. I was tired and it really bothered me. And I was like, I wish that they would turn this off. And Chloe was like, “Just ask them maybe.” And I’m just never going to do that. I’m never going to go to the bus driver. I’m just going to sit here for four hours.

Howie: That sounds impossible.

Keiran: It sounds impossible. And if she was the one that brought it up, it would have been impossible for her. But the fact that it was me meant that oh, you can just go and do this. And the framing is, you get to be a hero for this person you really care about. And it just changes everything. We do that all the time, where anything comes up. Maybe it’s a phone call that you don’t want to do or something. Oh, the other person can do it. And it’s nothing. It’s actually a positive thing. You actually, that’s a highlight of your day potentially, saving this person from a really aversive task.

Howie: People really like being able to help with this. Another piece of work-related advice around this that Rob came up with is that it might be a really good idea for managers to ask their reports, do you have an ugh field around anything today? And if you do it early enough and you make it clear that you’re not upset about it (if you aren’t, obviously, it’s a bit harder if you actually are), if you can cut it off really early, then you can assign it to someone else or you can make it clear… Just by making it clear to them that you’re okay with it, you might have made their ability to do that project twice as fast or something.

Excessive empathy [01:58:05]

Keiran: One thing that I know you struggle with is excessive empathy. Do you want to talk about that a bit?

Howie: God, the phrase excessive empathy just feels like such a humble brag. I swear I don’t mean it as humble brag. When people around me get upset, I take it on. And I think often I’m right about what they are upset about, but I assume that it’s many times worse than it is. And I think I’m doing a typical mind-ing thing where I think well, I get really sad really easily. So how would I feel if I was in that situation? And I think this causes real problems. If people can tell that sharing bad news from their life with you is going to make you upset, they’re less likely to do it.

Howie: They’re less likely to be able to lean on you for support. I think it’s reasonable on their part, but really sad. Not the thing that I want my empathy to be doing. It feels related to some cluster of mental health things I have going on, and yet it’s counterproductive. I think the other thing that it does to me that I wish it didn’t is it just makes it much more costly for me to give negative feedback to people or basically to do anything that I think is going to make someone I care about — or even someone I don’t care about — sad, or inconvenience them at all. And I’m just willing to pay these ridiculous trade-offs, pay 10 times the cost to save one of my friends 1/10th of the cost or whatever, which they would not want me to do.

Howie: And so one thing that causes to happen is I think I just give… There are times where I have critical feedback for friends where I think it would be helpful for them. And I think I’m too unlikely to give them the feedback. Because I’m thinking so hard about how much I think it’s going to crush them. And actually, number one, they might endorse hearing it and being crushed, and they ought to have that agency and they ought to be able to make that choice. And sometimes I know that that’s what they would prefer. And then number two, I’m probably overestimating how bad it would feel to them. Because it’ll feel bad, but not as bad as it would feel for me, probably. And so I think one loss is that I often just don’t tell people things when I could be helpful and give them information they want.

Howie: Another thing that it caused me to do at work that I think is an actual real problem that makes me less effective, is — I’ve gotten a bit better at this than I used to be — but for a long time, whenever I left comments on documents, which used to be one of my main jobs, I would just think really hard about how to make sure every one of them was framed as nicely as possible. I would go to the lengths of making a copy of the document for myself, making all the comments, going back through, making them all nice, then copying them onto the thing that was actually shared. And it just takes so much time and means that the people who want my help are getting less of my help because I’m obsessing over not doing anything that would make me feel bad that they feel bad.

Keiran: And this may be less helpful too, because the watered down version is maybe not going to get to the heart of it as much as the original would’ve.

Howie: I think I was obsessive enough that usually I found the balance.

Toning down Singerian approach [02:01:36]

Keiran: So we’ve talked a bit about you taking a Peter Singer-like approach to things, feeling this moral obligation to make the world substantially better for other people. And that’s formed a very large part of your identity. Do you feel like you have successfully managed to tone that down a bit? Or do you endorse turning that down a bit?

Howie: That’s a good question. I have really complicated feelings about that. And I think this real instinct of holy shit, I have money that I’m spending on myself and there are people who need it — or potential people who need it — so much worse…it feels really core to me. There was a long period of my life where I was honestly counting the spending that I did on everything in bed net equivalents. And I was really feeling it. I felt bad when I bought a plane ticket. There’s no really direct way in which it caused me to be depressed that I can point towards, but I endorsed these beliefs really strongly. And when I went to therapy for like, Howie, can you set more reasonable standards for yourself, I made it very clear that this is not open to negotiation.

Howie: But I can endorse those beliefs, and also that’s different from asking what standard should I be holding myself to on a day-to-day basis? And I have changed a lot on that front. Not as much as perhaps I ought to. I think a lot of my coworkers would push me to change more. But I have started not to sweat the small stuff about small amounts of spending like eating out or getting delivery in a way that me of five years ago I think would be horrified by. And I guess the way that I have thought about this is, my ethical beliefs haven’t changed. And if I think hard about it, it still feels wrong in some sense when I do this, unless I can tell some crazy efficiency/expected value story, but it feels wrong.

Howie: I think it is the right decision. I think that for many types of people, doing the act of constantly self-monitoring, where you’re always asking, “Is that thing I have a desire for a little bit unethical? Is that thing unethical?” Being in that frame and mode, doing this self-monitoring and building this habit of self-criticism I think for some people is very mentally unhealthy. And even though I can’t point to a way in which it has definitely screwed me over, it certainly seems plausible to me that it is more likely that I will have another bad depressed episode if I continue with that stuff. And that’s actually really hard for me. And there’s a very long time where it both felt so clear to me that I ought to be living frugally and giving away as much as I could, and that I had no right to all the money that just happened to be in my bank account because my job paid it to me.

Howie: It felt very core as a commitment, and also as part of my identity. Before I found EA, I was the only person any of my coworkers knew who was doing this thing, so I was that guy. It felt like it was a real big change for me. And I don’t feel I’ve totally successfully changed that way of thinking. But the way that I think about it is, there is this really satisfying thing about feeling like all of your actions are aligned with your deepest core principles. And I lost that, and it’s hard. And I sometimes do things where I think I am doing a wrong thing, and I guess I think it’s also good for the world that I have attempted to develop a disposition that isn’t constantly monitoring that.

Howie: Because it keeps me mentally healthier in expectation and makes it more likely that I can sustainably do the bigger stuff. And the way that I framed that which has helped me to find this acceptable at all is basically that being able to do the thing I used to do is, in some ways, a privilege. Being able to have that feeling that my whole life is aligned in that way, and some sense of, I don’t know, moral purity or whatever it was. I’m judgemental towards it. And for people who can do that, don’t change it if it’s right for you and if it’s working for you. But at least for me, that was a privilege that it’s clear that I just don’t actually have. But now it’s clear that I am a person who’s a bit fragile and has to take some steps to keep myself protected if I’m going to do good in the world.

Howie: And so I guess I feel like I just owe it to the world to do whatever I can to not think obsessively in that way. I think this is a thing that’s morally required of me. I attempt to internalize that, that this is not me overall being selfish, even if any of the individual consequences of it are. This has been very important to me, and is a thing that I guess I recommend to anybody who feels like they’re beating themselves up for this stuff or has some sort of a scrupulosity thing that is putting their mental health at risk or just taking up energy, but should be going to the ways of doing good that are actually the best way for you to contribute.

Keiran: This strikes me as being tied up with a lot of the other things we’re talking about. Where, if you accept that an extra 15 minutes of you working at 80K is going to have a positive impact on the world, and 80K is doing generally a good job and you’re contributing to that, then something along the lines of getting food delivered, to me, it seems like even outside of the benefits to your mental health, it just seems correct to make a lot of those decisions to save you time. I’m wondering if you actually agree with that. Or would you be okay with, I don’t know, other people at 80K cutting corners to save themselves time, even if you would have found that horrifying when you were younger.

Howie: Yeah. So I am certainly okay with people doing that. And I think that this is not the sort of thing where I want to be monitoring anyone else’s behavior. I think it’s a commitment of mine that feels important to me to not do that, at least at that level of granularity. So I certainly think it’s okay to make the trade-offs that make sense to them. I guess if you’re asking is it effective from a utilitarian perspective or something like that, it depends a lot on the specifics. I guess I feel like I was able to do just fine on peanut butter and bagels or beans and rice for a really long time and set up systems where it was quick and efficient. And so I don’t think it really feels like there’s some real time-money trade off here for me. There might be some more complicated thing of am I doing something I’m less excited about, and is it wearing me away over time.

Howie: Some of this might be true for me, but other people, that might just be so boring that they actually can’t tolerate it. It’s not a reasonable expectation. And so for them there really is this, “Should I spend more money on getting the takeout” type of trade-off. And yeah, absolutely. Sometimes the benefit of the time is absolutely worth the spending. I guess it just is tempting to make that argument even in times where it’s not true, and it’s just really hard to know when it’s true. And then I guess I think even from that stuff, the main benefit is mostly from the attitude shift and not from saving 10 minutes of walking down the street. I just think there’s a real benefit to a laser focus on the thing that matters most, and not trying to also optimize for a billion other ways to do good.

ADHD [02:09:28]

Keiran: Can you talk a little bit about your experience with ADHD? What does it feel like and how does it affect your life? And how effective has the treatment been?

Howie: I find this a little bit hard to talk about because I don’t feel like — despite being diagnosed with it and despite thinking it fits me very well, I don’t feel like I really understand ADHD as a category of like it’s an area where I particularly feel like I can talk to my experiences with attention deficit or something. And maybe that’s representative of other people who are in this category. I was unusual in the sense that I was not diagnosed until my mid-twenties, and it’s actually pretty hard to get diagnosed as an adult because all of the infrastructure, the diagnostic infrastructure, is set up for kids. But it’s actually shocking to me that nobody noticed anything earlier in my life. And I think it was because I was good at school.

Howie: I was doing fine and so nobody noticed. But I guess my experience with it… It’s some combination of feeling like it takes a lot of effort to put my attention on anything that isn’t grabbing to me or isn’t interesting to me in the right way or something… I guess it feels like, I don’t know any of the science, but it feels like dopamine receptors are really on overdrive. So all of the addictive content notifications/pings-type stuff. But also reading Twitter… New stimulation just feels so tempting. Sitting and writing out my own thoughts that I already have for other people just feels like nothing new is happening at me, and it feels very hard to stay on target.

Howie: So I guess there were signs that could have been noticed when I was a kid. In high school I would show up half an hour early every day so I could do all of my homework for the day on the floor before class. I was just unable to get myself to do it at night. And it was too boring to do unless I was terrified about the time pressure. I wouldn’t start papers until midnight or 2:00 AM the night before they were due. I would try, or I would sit around knowing that that’s what I should be doing or something, but I needed the deadline. I needed the adrenaline, basically. I couldn’t motivate myself without adrenaline. And then there were these things that I couldn’t get myself to believe mattered, like administrative things.

Howie: At one point, I did my science homework every night for an entire quarter and printed it out, but never bothered to put it in my backpack and hand it in. Because I knew that I knew the answers. What the hell is this other part for? So I was a bit of a mess. And I eked through, basically, because up until a certain point of my life, all of the assignments were fairly short. And so it was possible to do it the night before. But when you get to adult life, you’re not doing these discrete projects anymore. In my first job at Brookings, I was working on the same book for months. So it was more about how much are you going to get done today on this book?

Howie: It couldn’t be, I’m going to wait for three months and then do it in a day. That started to hit. When it was at its worst, it was at the level of, when I was writing things — and successfully writing them, and getting enough done by working tons of hours that my bosses were happy — it was good if I made it a sentence without flicking over to another tab and getting some stimulation. I think half a sentence might’ve been more likely. I would know the whole sentence I wanted to write, but typing it out felt so boring to me. I was like, I’ll do half of it and then come back to it. So yeah, I think to the extent that anybody who hasn’t experienced this can get some sense of the way it has felt to me when it’s been at its worst, it’s just being really addicted to a video game or something like that.

Howie: And experiencing this craving to go back to the thing. Constantly having that pulling at you is the way that I’ve experienced it. There are other things that I do that maybe are also in this cluster, but it’s hard to tell.

Keiran: And having now been treated for it, do you feel like it’s made a significant difference?

Howie: Yeah. It’s still a thing that I struggle with on a day-to-day basis, in part because you build tolerance to the medication and it wears off towards the end of the day. But treatment for me has just been a huge miracle. One of the biggest life improvements I’ve had. For people who have never tried Adderall, or are just curious about stimulants in general, the way that I have experienced them is basically, there’s this sense of craving that I have for more stimulation and more novelty. And it just turns that off and makes me feel satiated. And so it doesn’t make me necessarily focused on the thing I want to be doing, or any particular thing. But I just, all of a sudden feel like I have agency over it. There’s no pull. It’s like, oh, I could feel satisfied doing the thing that I intend to do.

Howie: Or I could feel satisfied reading The New York Times. It seems really easy, I know I want to be doing the thing I intend to do. I think that’s the effect that it has had on me, which is a huge difference in productivity and a huge difference in the frequency with which I get myself into trouble by procrastinating and then get really anxious and getting myself into a hole. One of the biggest mental health risks for me is that spiraling dynamic, and it’s just been an incredible way to limit the number of times that comes up.

Anxiety and depression during COVID [02:15:25]

Keiran: So what has the pandemic been like for you in terms of anxiety and depression?

Howie: I was actually very worried about this when it started to become clear that there was going to be a lockdown. I have in some ways been incredibly lucky. My partner lives in New York. I live here in London. She’s a school teacher. Her work became remote. So she was able to be here for five and a half months. We don’t usually get to be in the same place for that long. So that was a huge, very lucky thing and that affected my experience a lot. A thing that I struggled with is that having the team in one place is very motivating for me. Or not the whole team, but having a sufficiently sized cluster of people who I feel like, these are the people I’m going to war with. Or whatever. I want their projects to succeed and I’m helping them. That feels important to me. And I’m also socially anxious and to some extent just introverted, but also social contact is really important to me. And so getting that automatically through work is really important to me because I’m unlikely to actually reach out and make it happen actively. Yeah. So I think there’s a bit of a loss there. So I had a pretty rough patch for a month or so where I had trouble getting some work done, and did a bit of an ugh field thing.

Howie: And I think being out of the office, being out of my routine made it more likely and made it harder to come back from it. So I had a rough patch, but for the most part, I think having my partner in town meant that there are some ways in which it luckily was much better for me. I don’t know how I’ve lucked out in this. I have very little health anxiety for whatever reason. I was spared. So I wasn’t anxious in that way.

Howie: There’s some sense of, even though I’m shy and, honestly, very scared of strangers, seeing them feels very important because it makes me feel like I’m in the world in some sense, and not just in some bubble. So that’s gotten me a bit down and I feel a bit lonely because of that. And then a bunch of the things that I do to blow off steam or to make sure that, even when I’m in a rough patch at work or there’s something rough going on socially or, I don’t know, I’m going to be working on a thing that makes me anxious for a week or two… I think it’s really nice to have a thing I am looking forward to, where it’s like, there will be an end and there’ll be a thing that I know will make me happy and let me blow off steam.

Howie: For me, a lot of that is seeing music. Being able to go out and see punk music is just important to my happiness. Even if I am in a bad mood, this will give me an hour or two where I can leave that away and keep that at the door and just be in the moment. I think losing that has actually been pretty tough and gets tougher over time.

Keiran: Do you think you have any broad tips for anyone else who’s really struggling? I mean, obviously they can’t specifically ask their partner to come by for five months. Just for even people who have never consciously thought of themselves as being anxious or depressed. Obviously that has showed up a lot. Do you have any thoughts on how people can best get through this period?

Howie: I’m not sure. It’s a really unusual situation. And I think a lot of things that are making people down are just reasonable things to be down about. Like not being able to see people that you really care about. It sucks. I think it’s really useful to look for reframings that don’t make you feel that way. But also it’s tough. And so I don’t feel like I have great suggestions here. I guess one thing that’s going on, as you mentioned, is I think there might be some people who are experiencing anxiety or low mood or are down in a way that they haven’t really experienced before. At least I’ve seen some numbers saying that anxiety in certain populations is way up. And I worry that there is generally a thing that’s something to do with stigma and something to do with just how we think about mental health and mental illness where people feel like they shouldn’t get mental health treatment.

Howie: Because they think, I feel bad, I feel anxious, but I’m not mentally ill. I’m just stressed, but I’m not anxious. I’m burnt out, but I’m not depressed. I’m not one of those people. And also there’s a sense that, if you go get treatment, if you see a therapist — at least in certain communities, I think this varies a lot by country and by sub-community, but it’s like — if I go see a therapist, now I’m deciding I’m mentally ill. And that’s a big, scary sounding word. There’s probably a lot of people who are experiencing these things for the first time, or at least more frequently than they usually do. And I would love to encourage an attitude where the point is to make you feel better. The point isn’t whether or not these fairly arbitrary diagnostic criteria happen to cover you in particular.

Howie: If there’s a set of feelings or behaviors or emotional reactions to things that you would like to change, and there are tools from therapy to help you change it, it doesn’t have to change your identity or your image if you don’t want it to.

Howie: It just may be the case that you don’t meet the criteria for generalized anxiety disorder or whatever. But if you’re noticing ways in which you are suffering or just could be better off, the value in finding out if this stuff helps I think is so high. And it just doesn’t require you to answer all these thorny questions about “Am I really depressed?”

Keiran: Yeah. That’s great. Do you feel happy to share your main mental health-related goals at the moment with the audience? What would you most want to improve at the moment?

Howie: Yeah. So one type of answer is, I probably should have a more thought-through plan for improving my mental health. I feel like I’ve tried a bunch of stuff and feel a bit exhausted from it. And it’s very tempting to get into a mood where I think, I’m 34. I’ve tried a lot of things. This is how it’s going to be. I think that’s the wrong decision, but I definitely fall back into that. That said, I have been working on a couple of things. One of them is I’m just trying really hard to exercise more frequently. Which I think is just clearly one the best things I can do for my mood, and I also find it so hard to stick with.

Howie: I will have months in my life where I can run every day, although I think I may have now gotten old enough where that’s no longer healthy and I get injured too much from doing that. But if it feels like a choice at all, there’s always reasons why it’s the wrong time. There’s always something like, “Oh shit, I’m actually being really productive right now at work. I’m not going to stop that to go do this.” So it’s just never urgent. We have an optional Slack channel that’s the daily check-in Slack channel where you can list your goals for the day and then cross them off if you do them. And it’s both to encourage you to plan and to encourage accountability, if you would find it useful to have the team see it. It’s very informal, but I started doing that as sort of a productivity/mental health-type of experiment.

Howie: So one of the things on there is “Did I exercise today?” And so, I’ve been exercising more in the last month than I had in the last couple of years. So it has been a success in that sense, but still not where I would like it to be. I think that’s just one of the best things I can do for my mental health, and one of the bigger life mistakes I’m probably making is not actually making that happen. And then the other thing that I’ve been working on that I think is just a constant drain on me is that I just don’t feel successful at work, and I don’t even know how I’d go about doing that. And I’m really able to tell stories about every one of my days. About how I prioritized the wrong things, or I wasn’t useful, or whatever.

Howie: I think this is due to pretty deep parts of my psychology, and actually a pretty hard thing to change. But I’ve been starting to do experiments with different things that are like, “Can I come up with a way to lay out goals for days such that they are meetable, you would know if you met them, and I will feel like I did an at least acceptable job for the day if I’ve successfully done those things?” So yeah, posting on this daily check-in channel is at least an attempt to move in that direction. I’ve not yet found, honestly, that balance between making sure that they’re actually meetable and making sure that if I accomplish them all, I will actually feel good at the end of the day, but I’m working on it. And one of my coworkers, Brenton, has been meeting with me once a week to sort of encourage me to do this kind of thing and help me brainstorm ways to move in this direction. I feel really lucky to have coworkers who are helpful in this kind of thing.

Keiran: Have you had a day in the last month, say, where you’ve ended that day feeling satisfied? Like you were genuinely happy with your progress that day?

Howie: Yeah. In the last month I probably have had three or four days that felt that way. All days where the whole day was dominated by one particular task or meetings such that I could just tell myself, “This day is only about this one particular thing. It has a beginning and an end. And if you do it, then the day has been done.” Unfortunately, work doesn’t always look like that.

Keiran: Kind of like this.

Howie: Yeah. So this actually is the type of thing where it’s like, I will successfully talk for the period of time that we are talking. So I will have done work hours and I will be really working during them. So I find it easier to feel like I did the thing that I set out to do in those circumstances. I haven’t found a solution really for other ones.

Advice [02:25:20]

Keiran: Let’s make sure that we cover as much advice as you feel comfortable giving out, with the caveat that neither of us are psychologists or psychiatrists or qualified in any real way. But do you have any broad recommendations for people in the audience who might identify with some of the things you’ve been talking about? If they haven’t sought any help yet, do you have any advice for a first step, like a micro goal?

Howie: That’s a really good question. I think the right micro goal depends a lot on the person. So one possible goal is, do you have a friend who will help you make sure that something happens? And I have done this for several friends, where maybe I make a list of therapists and tell them in which order to call them, or maybe it’s teaching them a bit about the options for antidepressants. So they can just make one appointment with a doctor and tell them what their preference is, or maybe it’s just start doing 10 minutes of exercise a couple of days a week. I think it just depends a lot on the person, but asking a friend I think can be a good way. They’ll be able to help you figure out stuff like what is your bottleneck? And what is a really minimal thing that you also feel comfortable with, but that can get you on a path?

Keiran: Yeah. Just on the exercise one, I really like… In our podcast with A.J. Jacobs, he talked about micro goals and one of them was for exercise. And he said, don’t even just say, “I’m going to try and do 10 minutes of exercise,” because even that could be a bit intimidating. And don’t even say, “I’m going to do one minute on the treadmill,” but to just make the goal to put on your shoes. Just put on your running shoes. That’s it, that’s the goal.

Howie: Yeah. I like that.

Keiran: And once you put on the shoes, there’s a fairly good chance that you’ll get on the treadmill even if it’s just for a minute. And once you’re on for a minute, you’ll probably do two. And that just seems to be a really effective way of doing it.

Howie: That does seem really good. I guess look up the website of a therapist is at least one micro goal along those lines.

Keiran: Yep. That’s very good.

Keiran: In part, we’re doing this conversation to try and make it obvious that more people are struggling with this than people might think. Do you have any tips on how someone might actually internalize that?

Howie: I promise you it’s the case. So take it or leave it. I have tried to be pretty open about the fact that I had mental illness, including within the EA community. I’ve shared a list of somewhat vetted therapists in the Bay Area that’s been passed around a lot, which means that people who are depressed sometimes reach out, and then it also means that people have reached out to me to ask, “Are you okay, I have this too.” And so I can promise you that at major EA organizations, I’m not the one person with mental illness. Something’s really striking about the way in which it’s affected me. But there are a lot of people who are experiencing this in some way or another. It is not, at least in the communities I am a part of, there’s not much stigma around getting therapy.

Howie: It’s more likely if I tell someone that I’m looking for a new therapist, that they will suggest theirs than they will say, “Oh, I don’t know about that therapy thing.” Because this is a thing that has a lot of stigma, it’s just really, really easy to underestimate how many people around you are struggling with this on a day-to-day level. And if you open up to someone, it’s — I mean I can’t make any promises, and you might be in a very different community and subculture or country from where I am, and you should take that into account — but it’s reasonably likely that they, or someone in their family, someone that they know has been seriously affected by this. And hopefully that can do something like reduce the fear and stigma a bit. Lookng up the numbers, if you can find them, iof people who are using psychiatric medications in your country, or if possible, in an even more individualized region, I think might be one thing. A really large percentage of people are taking antidepressants. And it’s very unlikely that it’s the case that none of them are the people around you.

Keiran: That’s a really good point. Do you want to give a pitch for just how important you think it is for people to seek out treatment?

Howie: Yeah. So I think it can be really hard to do, especially because a lot of the treatments are things that have a big effect for 20% of people or have a small effect for 40% of people and it takes weeks, and it’s unclear to you until those weeks are done whether or not it’s helping. So I think there are a lot of reasons why it can be really hard to get motivated. And so I think there are some ways in which it’s just incredibly valuable that it’s just easy to lose track of. So in particular, especially if you’re young, but even if you’re middle aged, the value of trying treatments and finding out if they’re useful for you, the information value there is just so, so high. If it turns out that you try SSRIs for three months or six months and they’re not helpful, it does suck.

Howie: It’s a pain to take a pill every day. If you don’t wean off them really slowly, the withdrawal can be shitty. There are sometimes side effects, but if it turns out that it’s useful to you, you maybe found a thing that for years and years and years is going to make you happier or less anxious and potentially just solve one of the biggest bottlenecks in your life. Same with therapy. It can be awkward to have a therapist that you don’t like. And it’s a lot of time. And I don’t think therapy is right for everyone, because it does take a lot of time and can be disruptive. But if you think that maybe you should try therapy, I think it’s very likely that you should try therapy for this reason. Maybe you go and you find out that spending a year in therapy gives you the tools that you need to not be depressed anymore, or just that having weekly therapy in general for years just makes your life way better; you can save all of your worrying for that hour in the week. And learning that then gives you just this huge tool that will make you way more productive and happier for the rest of your life. I can’t make any promises that’ll help, but finding out just seems incredibly valuable.

Howie: Howie here. I mention SSRIs a bunch so I wanted to also flag that Wellbutrin is a different medication that can be a reasonable first option. Some people with anxiety find it makes that worse, although that hasn’t been my experience. On the other hand, I think a lot of people find it has fewer side effects for them than SSRIs. So I just wanted to throw that out there as a thing that some folks might want to try.

Howie: And then I also wanted to mention that depression can have nutritional causes, like anemia or vitamin B deficiency, and this might be especially a risk for people who don’t eat meat. Since these are pretty easily fixed, getting some bloodwork to check for iron or vitamin deficiencies might be another really good first step if you think you might be depressed. Ok, back to the recording.

Keiran: Do you want to just say a little something about how important it is to sort out very basic things like diet, exercise, and sleep, the kind of things that people always say are so important but it might be hard to internalize just how important it is?

Howie: Yeah. I guess I have mixed feelings about this. I think it is incredibly important to get those things right. And often those things can have effect sizes that are just enormous relative to even some of the best medications out there. Getting your sleep cycle into a reasonable place or starting to exercise every day, I think the effects can just be… It may just be all you have to do. That could be the whole issue. And so it could just be a huge win. I think that this is the conventional wisdom. I think exercise is one of the best things you can do for depression and anxiety. And if you feel like you can give it a try, it should be probably one of the first things that you try. I do worry that there’s a bit of moralizing around this and a bit of ideology around this, where it’s like, the ideal thing to do is to fix it yourself by shaping up and living the right kind of life and being a real adult who’s responsible and has the right patterns.

Howie: And if you have to have a crutch of getting treatment fine, but it’s unvirtuous if you don’t fix this stuff up first. And I just detest that. If there are things out there that could be helpful to people, this is a horrible reason to keep it away from people. And, often, if you’re feeling mentally ill, getting your diet and exercise and sleep in the right place is just a really big ask. And even honestly if you’re not. It’s one of the biggest New Year’s Day memes, at least in the U.S. Everyone gets a gym membership and the gyms are busy for a couple weeks and then they’re empty again. I don’t want to say it’s hard for everybody. You should find out if it’s easy for you. It can be really hard. And there is no need to do the really hard thing that tons of people find really hard before you try and see if things that you might find easier actually do the trick for you.

Keiran: Do you have a view on how valuable therapy can be in comparison to getting the right medication? If someone was focusing on one thing over the other, do you have intuitions on which way they should lean?

Howie: I guess I have opinions on this that are sort of a bit similar to my opinions on the diet, exercise, and sleep thing. So I am now out of date on the evidence on therapy and antidepressants. But my sense is that the evidence is vaguely that they have a reasonably similar effect size. I imagine for some people it’s much bigger on one than the other. Some therapists are probably way better than others. Some medications probably are better than others, even though I think the science hasn’t done a great job of showing which those are. But I think that there is, again, a sort of ideology or a moralizing thing or something that says that you should try therapy first. And that the virtuous thing to do is to figure out the fundamental, psychological root of what you are doing to cause your depression or what thought patterns are doing it, or something like that. And medications are a crutch and the cheaty cop-out option. And I just think that’s wrong and horseshit.

Howie: For some people, that is what they need, and it can be fulfilling to understand yourself better in addition to it being helpful. And so by all means, I think people should try both. Because if you learn which one works better for you, that’s a huge win. But there’s no shame in trying medication first, if that’s right for you. And in particular, therapy requires spending an hour a week going to see a therapist who, depending on your health insurance/where you live, etc. might be expensive. You have to have time in your day for it. It’s costly to do that every week for long periods of time, and taking antidepressants requires swallowing a pill once a day.

Howie: And if they are equally useful, there is no shame in deciding to do the thing that is way less costly. I’m really not an advocate for either of the two. I think that there are things that you can get out of therapy that you can’t get out of taking medication, but I do just want to push back on this thing of you need to try therapy first, especially because a lot of people just can’t do therapy. You might have a job that just means you can’t take the hour off from work to go do it. And I wouldn’t want that to hold someone up from seeing if other things might help them.

Keiran: Or you might have kids, where it just makes it really hard.

Howie: Yep. Good point.

Keiran: Cool. Are there any specific resources that we could point listeners to in the show notes that you could name now without just reading out a list of URLs?

Howie: I’m not an expert on this. I was more up to date on the literature 10 years ago than I am now. But some things that I would recommend are, number one, Kate Donovan, who’s a therapist but who was not a therapist when she wrote this set of great blog posts that’s a guide to getting a therapist, just how do you get started on doing that. I think that tends to be really overwhelming. There’s so many different practitioners with varying amounts of information about them that are using varying techniques. It’s the best thing I know of on how to find a therapist. And I think that that’s a big barrier, and if you’re having trouble weeding through that morass, having your friend read the blog post and then give you a list to call might work too.

Howie: The blog Slate Star Codex has two posts that are things that sometimes work if you have anxiety and things that sometimes help if you’re depressed. And I would recommend both of those as a reasonably comprehensive list of the fairly standard set of things that people try, and some of the evidence behind them. I have some disagreements with some of the research there, but it’s a blog post. It’s not a peer-reviewed review of the literature, but I think it’s just incredibly valuable to have tons of interventions and links in one place.

Howie: And then there’s a book that I got a lot out of 10 years ago. I don’t remember it well enough to know if there’s some stuff in there that I totally disagree with now. And it’s also obviously out of date at this point, but it’s by a psychologist named Peter Kramer and it’s called Against Depression. And one of the main things he’s trying to do in this book is he identifies this meme, an archetype that he calls ‘heroic melancholy,’ and he tries really hard to argue that you should not get tempted by this vision of depression as heroic in some way. That it is probably not necessary for you to be creative, or… You can have basically all of the same thoughts, but also not have a fog following you around and slowing you down all the time. And for me, I think that the heroic melancholy thing has some pull as an aesthetic. There are some things about the world that make me feel sad, that make me identify with other people who are seeing it as it is and are appropriately upset about it.

Howie: I think that there might be a lot of people, especially in the effective altruism community, who have some amount of that going on, then some amount of, “I should feel guilty. Depression is good for me because it’s motivating.” At least I went through some of that. And so I found it really helpful to have a book that’s particularly pushing against that.

The effective altruism community [02:39:57]

Howie: I think a problem that a lot EAs have is just inability to set standards for themselves that they can possibly meet. I think that there’s just this sort of maximizing, optimizing type of attitude that can just make it really tempting to shoot for the stars and then not actually have a plan that could possibly lead you to be successful.

Howie: And I have found, and people I’ve recommended it to have found this book that’s CBT for perfectionism, it’s called Overcoming Perfectionism to be really useful on that front. There are a lot of people who aren’t sort of stereotypical perfectionists, I think in a lot of ways I’m not, in some ways I am, who I think would find it really useful, because they’re still doing this thing of setting unmeetable standards. It can be hard to tell if your standard is reasonable, but just the thing of asking, “Can you imagine successfully doing the thing that you’re setting as your criteria for success?” And if you can, it might still be too high, who knows, but if not, you need a new one. The standard of ‘do the most good’…you will never do the most good. And if that’s the thing, you are not going to feel successful. And there’s some temptation to do something like that. And I think this can be useful for people for whom that is difficult.

Howie: There are some really good, compelling memoirs of people who’ve had mental illness and also some short fiction that I have found is among the best descriptions I’ve seen of the internal experience of certain forms of mental illness, which I just thought some people might find interesting (also see these excerpts from the book Infinite Jest and these blog posts). Especially if they haven’t experienced it before and just want to know what it sounds like in a certain set of people’s heads.

Keiran: That’s great. Yeah. We’ll put all those up in the show notes. We sort of touched on this throughout the conversation that the effective altruism community has been unusually supportive. Is there anything else you want to say about what your experience has been like being part of this community?

Howie: Yeah. I will preface this again with I’m super lucky to have been put in a position where people in the community know me well and I’ve been around for a long time, but it’s just incredible how much support I have gotten, from people just welcoming me back when I was better enough from being depressed to show my face again— including people whose lives I made really difficult for a while — to people offering me a place to sleep, to people reaching out just with support or to say that they’ve been there too. That sort of thing. I had multiple EA organizations who were interested in potentially working with me and hiring me, even though they had full knowledge that I have some real problems and some real weaknesses and they do affect work.

Howie: And so it speaks well of EA organizations — to the extent that they are right that I could be helpful despite some real limitations — it speaks well that they were able to think about that reasonably and not just get stuck on the stigma. I think there might be some perception or can imagine there being some perception that you should hide it if you have these types of problems. And at least I can say there’s a proof of concept or something, like an existence proof, that it is not going to be an absolute bar on getting jobs at most/many EA organizations. And then, my experience being accommodated at work has been just really incredible. I’m just really lucky to have it.

Howie: So everything from my boss deciding that if it seems like I started finding something aversive, let’s just pass it off to someone else to working really hard to experiment with lots of different roles to see what functions best with my combination of things I want to work on, my desire to do something leveraged, and also just anxiety about a lot of the things that might be most impactful, to like, I sometimes miss a day, because I’m down or slept really badly. And having that be okay, as long as I handle it responsibly, to sometimes when I’m setting priorities, I’m just down enough on my ability to actually successfully complete anything, that I cannot do it. And I have just sometimes told Rob that he just needs to pick for me.

Howie: It would be really good if I could be an accurate judge of what I will and won’t be successful at if I can’t pass that off. And just being able to be honest about that has been hugely beneficial to me. I can’t really speak for other people’s experiences, but I think that there are a bunch of other people who feel similarly accommodated. And there’s obviously a trade-off and a line here. And I really, really, really hope that if it became the case that I had enough limitations, that I really wasn’t able to contribute, that the organization would notice and we would talk about it and we would find something else for me to do. But I feel really lucky about my experience so far.

Keiran: Yeah. I can just say that personally, the fact that it has been so welcoming for you makes me much happier to be part of the community too. It just reflects well on it without actually having these experiences myself. There’s a source of pride in being around people who are very caring and sensible about this. Even as you say, when they are so focused on doing the most good. And you can imagine that they could have been ruthless about this, but actually they’re just incredibly lovely people.

Howie: Yep. Something that I felt very touched by that somebody did that they absolutely did not have to when I was sort of at the depths of my depression and just starting to be able to look at the internet again, somebody who I had met once and did not know well at all cold messaged to me to say, “Look, I’ve heard things aren’t going so hot. Using ketamine as an antidepressant is sort of just on the path to being approved by the FDA, and it has been a miracle for some people. If you want to talk about it, I’m happy to talk about it.” They sent me some information and said “If other stuff isn’t working, you may want to give it a try.” And I thought that was just so kind to do for someone who you don’t even know and didn’t even ask for your help.

Howie: And ketamine is now approved by the FDA as an antidepressant. Though it’s a bit hard to access and very expensive to get from an actual infusion clinic. But I have now been using it as an antidepressant. And seen just enormous effects. And so I don’t know. Having somebody reach out and nudge me towards trying this thing that I had been meaning to try and just wasn’t getting to just made my life a lot better. I just find stuff like that where a person didn’t have to do anything to be really moving.

Keiran: Yeah. It’s amazing.

Happiest moments [02:46:46]

Keiran: Just to wrap up, I thought it’d be cool to ask, what is one of the happiest moments of your life so far?

Howie: One thing that brought me great joy was… I’m a total sucker for animals, for dogs, especially. Especially really big dogs, and also a sucker for people getting emotional when it feels like it runs counter to type, and you wouldn’t expect it. So I had this incredible experience years ago, back when I was living in Brooklyn, where I ran across a bunch of kids who were all kind of hanging out with this enormous part boxer, part pitbull, enormous dog. I came over and was like, “Hey. What are you guys up to?” And the kids just all bolt. So then it’s just me and this dog hanging out and I don’t know what to do with it. Seems like he’s probably lost. I think that they were just looking for an excuse to pass it off to anybody else.

Howie: Some really nice woman lets me borrow a leash because I’m just sitting there holding his collar. The dog probably weighs three times as much as me, not knowing what to do. So I ended up taking this dog for the night. Take the dog home. It was my first night in the new sublet and I hadn’t met my roommate yet. So my roommate comes home at one in the morning, and brings somebody back to the house. The dog is just so excited to see them. They are not as excited to see the dog. I got kicked out of the house. So I spend from 2:00 AM until 7:00 AM just getting dragged around the streets of Brooklyn by this dog that I have no ability to control whatsoever.

Howie: And then, finally, I managed to find a vet’s office that’s open at 7:00 AM. They’re able to look up the microchip and call the dog’s person. And this dude comes over to the vet and he’s this enormous guy, a shaved head, this biker-looking dude. He sees his huge dog, who then runs over and just sort of jumps up on him. And the dude starts balling. Just breaks down in tears and starts crying. And something about seeing a big, bald, biker dude crying over his big, enormous dog… I think it was optimized to the type of thing that really gets me personally going. So I found that incredibly charming.

Keiran: That is a wonderful story. Alright. Well I think this has been fantastic. You’re such a delight, Howie. Thank you so much for doing this.

Howie: No problem. Good chatting, Keiran.

Rob’s outro [02:49:34]

If you got something out of that episode, it’d be great if you could share it with anyone you know who might also find it valuable.

If you struggle with any of the issues covered in this episode, or know someone who does, you should check out the list of mental health resources we’ve compiled in the associated blog post.

And if you’re feeling suicidal or have thoughts of harming yourself right now, there are suicide hotlines at National Suicide Prevention Lifeline in the US and Samaritans in the UK. You can find links and phone numbers in the show notes for this episode.

If you’re in the U.K. we just wanted to point out that things are a bit easier than in the U.S.. The NHS will cover the cost of medication and some therapy. So listeners who are eligible should contact their GP if they have mental health problems, and they can get free medication and free therapy through the ‘IAPT’ programme. Or they can self-refer through IAPT — there’s a link for that in the blog post too.

Finally, two extra resources that weren’t mentioned in the episode:

1. The website Howie couldn’t remember the name of that gives you coupons for prescription drugs (if you’re in the U.S.) is www.goodrx.com.

And since the recording, Scott Alexander has launched a new practice, LorienPsychiatry, which includes a considerable and growing number of detailed explanatory pieces addressing different aspects of mental illness and treatment. You can find that at https://lorienpsych.com/.

We know that many of our listeners have mental health challenges, or have loved ones who do, and we’re planning to produce more mental health content for you in future.

The 80,000 Hours Podcast is produced by Keiran Harris.

Audio mastering by Ben Cordell.

Full transcripts are available on our site and made by Sofia Davis-Fogel.

Thanks for joining, talk to you again soon.

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