Good advice, from a 36 year old middle aged man 3 years into a midlife crisis after a massive work-related burnout event.
A couple more pieces of advice from me:
* A midlife crisis has its own glacial pace. Be prepared to be upside down for a long time.
* Be prepared not to be the same person you were before. Be prepared to learn there is no turning back.
* If you're in a midlife crisis, your previous life was simply not good enough and reality has caught up to you. Go through the process, and you'll become a better person.
* Outsource your mental health during this phase to professionals. Not even your spouse might be able to accept what comes out of this reconfiguration of yours. You will probably need the help of someone that is not invested in your previous existence to hold you in this trying time.
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3 years in, it's getting better, I miss part of my previous life, but I know who I am now, how I operate, and I won't compromise to fit someone else's mould anymore. In your childhood you had no say in how you were grown and pieced together. You had to carry whatever they had built for you until you broke down. Now is your chance to start over and do a better job at it.
It was being a little cheeky. And if a massive burnout whose first month was having daily panic attacks and 3 years to recover is garden variety, I am afraid to know what a serious one entails ;)
Depression was part of the baggage I was carrying around all my life. It's hard to say, given the state of things, but perhaps depression is one thing I was lucky to shed during this phase.
I remember that a few years ago, after a few months during which I dabbled in street cocaine (which may not actually have been cocaine for all I know), I started to have occasional panic attacks. I then stopped doing that nasty stuff and would not do it again for many reasons, the danger of fentanyl being one of them, but I kept drinking alcohol regularly and continued to have occasional panic attacks. Even though I continued to drink alcohol, the panic attacks stopped happening when I started to take vitamin supplements daily: B1/thiamine, B complex, magnesium, calcium, niacin, and D. Most likely, panic attacks can also be caused by pure psychological factors, but I just want to leave this information here because it might help someone who is experiencing panic attacks. Of course, I am not a medical professional, so take this information for what it's worth, which might not be much.
What exactly is a panic attack? Like your just watching TV and suddenly convinced you'll die? Or was it like at work, something woukd happen and you freak out?
Panic attack is very hard to describe, but has a unique symptom: the feeling of impending doom.
Everything about you is telling you something is very fucking wrong right now and you're about to perish. Your survival instinct kicks in, fight or flight, heart races, chest feels tight, tunnel vision, you sweat and hyperventilate. You basically are having the sensation of a heart attack or something equally catastrophic, but nothing is actually going on.
It is the most terrifying thing that can happen to you. The first 5 times are hell, then you learn that it tends to be relatively short lived, even if it feels like eternity. What I do is take my phone out and look at the time. Come hell or high water, in 20 minutes I will be fine. Relief often is sudden, but there's times you stay in a state of sub-panic for longer than that.
Truth be told, full blown panic attacks are, even for a very anxious person as I was, rare (and twice so unbearable I called emergency services), the vast majority I call anxiety attacks which are a little milder version of oh fuck I'm going to die now.
I'll attempt an answer: it's your flight-or-flight response kicking in, without any obvious reason for it to do so. Oxygen intake goes up, muscles tense up, adrenaline production kicks in, but there's nothing for your body to "spend" these physiological changes on (like running for your life), so it just sloshes around causing panic attack symptoms (eg sweating, trembling, shortness of breath, chest pain, nausea, detachment, fear of dying).
without any obvious RATIONAL reason for it to do so – sometimes there is an obvious something, or a sequence of somethings, that lead up to the attack, if you trace it back.
Like with a phobia where the fear not being based on rational reasoning doesn't make the reason for the fear reaction any less real.
In my twenties I had some years of severe panic attacks. It is funny, it completely dominated my life but I totally forgotten about it. Feel writing it off my chest, maybe it can help somebody.
For me they were hypochondria related. My vision would turn black, my heart would start racing and I got the feeling that ants where crawling from my heart to my arm. At these moments I was convinced I was dying of a heart attack or some artery was torn from my heart. Doctors would find nothing wrong with me, this increased my fear because it meant I couldn't receive any help. They attacks could last for hours, making me unable to sleep and mentally depleting me.
I have actually been close to death a couple of times for real. Once falling through the ice and once having a rare disease. These moments did not feel the same. Actually I was rather calm in these moments.
They attacks made such an impact on me that after a while I started being mortally afraid of having a panic attack. Thinking about it, thinking about my body, feeling the slightest discomfort in my body all these things would trigger another attack. Because of that I lost touch with my body. Worse thing was that I would sometimes wake up in the middle of an attack. This made me afraid of falling asleep. I would walk or cycle at night because I was too afraid to sleep. This made things much worse.
At one point I mentally saw the vicious circle I created for my self. I remember seeing it as one of those smoke circles some people make while smoking. I saw that my focus on this was what kept that circle alive. I saw that I simply had to stop identifying with it, step away from it. Almost magically the attacks have never returned.
The “I’m going to die” variety of panic attack is only one of many. Other people have them when driving on the highway, just stepping outside their door or meeting too many people at the same time.
There’s generally a more direct trigger than watching TV, but sure, see the wrong show, think the slightly wrong thought, notice that little bulge on the left side of your big toe when you’ve propped them up on the table. Take a few more cycles of things you worry about and you’re well and truly in the middle of a panic attack (which is as described in another comment).
The nasty part is that it’s hard to recognize as such when you’re in the middle of it.
> The nasty part is that it’s hard to recognize as such when you’re in the middle of it.
Oh yes. The first time it happened to me, I asked my wife to drive me to the hospital because I thought I was having a heart attack.
Turns out it wasn’t and the doc reassured me by saying me that half the heart attack suspicions they got in emergencies were in fact panic attacks. So it’s something as common as it is frightening.
It happened a second time but I finally managed to recognize what it was. This one was really random, I was effectively just watching TV ^^
Unfortunately it can have the same symptoms as a real heart attack or stroke. Tightness and pain in the chest. A feeling of dizziness. Visual things like not being able to focus or darkness around the edges. For me the most pronounced thing is a crawling sensation under the skin of my head and down my face and the weird feeling that something is sticking out the side of my head. And yea, the intrusive thought that you're going to die, which your brain seems to rationalize with a bunch of stupid reasons.
You can also hyperventilate and not really notice it in your breathing. That makes your hands curl up by themselves and then pins and needles. I only got that once, after that I learnt some breathing exercises.
I think Panic Attack is overused just to mean someone is uncomfortable with a situation they're in or they're hyperventilating, but I think I had one several years ago but I'm open to being corrected.
I was driving from LA to OC every day which is probably 3+ hours of driving normally working for a client that was an absolute ass. I was working 9 "real" hours a day meaning I didn't even have time to click around on the internet like most jobs I've had since. I was having issues with my prostate hurting in my mid-20s (turns out it was a lifting belt for squats) and I had just moved to a new city.
After 9 months, I was about halfway home where my prostate started hurting again and I just got tunnel vision where I couldn't see ANYTHING. It looked like I could only see a pin of light in each of my eyes and my ears felt like they were under water. I was in the left lane and I couldn't see for shit so I just said a quick prayer and swerved 3 lanes over to the shoulder when I promptly passed out and came to about 5-10 minutes later. I found a new job a month later and said fuck it to driving that much ever again.
I should say that this has only happened once and that I'm very very happy and confident with my life 99% of the time. I've never experienced anything like this before or after and I assume it was a panic attack.
For people who are curious about my prostate problems, I went to several urologists and no one could find anything after several uncomfortable examinations. I decided to try to scientific method and finally removed my lifting belt from use for a few weeks and the pain has been gone since. I figured it was related to my pelvic floor muscles and how they bunched up during a really tight belt/squat session doing pretty heavy weights (365-405) pretty frequently.
I'm not the person you're responding to, but both my parents passed away in their mid-50s, and after my startup failed at 35 I hit something like a midlife crisis.
If you believe mid 30s is middle-aged, then it becomes middle-aged - and unfortunately, for some that might be true.
Fortunately for me, this crisis led to a serious investment in my health and fitness, and though I obviously cannot predict my future, I'm far healthier now than anytime in my adult life. I fully agree with the sentiment to not waste a midlife crisis.
"Categorical age", if you'll allow me to coin a term for this phenomenon (infancy, childhood, adolescence, middle age, ... - your conception may vary) is more or less a qualification of our personal relationship to time and mortality. So while we might have broad consensus that a 5 year old is a child and a 70 year old is a senior, it's not determined by numerical age. Just a near 1 correlation.
After all, we never know our numerical middle age except in retrospect.
This is similar to my experience (mid 30s now). I remember sitting at my desk at work, staring out of the window, thinking "wow..so this is it". Would've been about 28-29. I think a combination of things got me to that headspace: end of the education-career pipeline, having bought and settled into a house, and having no kids. I reached a point where I was no longer occupied with achieving "my" goals, and I was left to figure out what my life was going to be. I guess suddenly becoming aware of that responsibility isn't very pleasant; before, I was just on the rails society lays out. School, job, marriage, house, kids, career, etc. Easy.
I'm not much interested in the pedantic debate taking place elsewhere in here about what truly qualifies as an x-life crisis. To me, it's a point in your life where there's some anxiety associated with the direction of your life. I'm more interested in how people came to think about their lives in and after those moments.
Roger Waters of Pink Floyd was 28-29 when “he realised he was no longer preparing for anything in life, but was right in the middle of it” and was inspired to write the song Time for Dark Side of the Moon (the reader is encouraged to listen to it now). Each individual responds to this realization in their own way.
"No one told you when to run, you missed the starting gun."
Tame Impala's Currents is an album written around the same age with a similar theme in mind, and fittingly part of the new guard of psych rock/psychedelia.
I'm sorry to say I don't think it's struck yet! Not to say what you experienced wasn't real by any means, but I think it just sounds more like a different, but normal thing. The coming to terms with reality after your 20s. I think you'll see another round more characteristic of the mid-life crisis as you all enter your 50s.
No age is too early for a crisis. One model I have heard is that we need to reinvent ourselves every 7 to 10 years. I had one crisis of reinvention at 30. Now at 38 I am in another one.
isn't a midlife crisis is just a label for burnout / depression at the end of the day? everybody who is depressed feels like life is stuck and going nowhere.
Burnout and depression can be connected to, but aren't the same thing as a mid-life crisis.
I would distinguish a mid-life crisis (or in the positive case, mid-life inspiration) by the realisation that you don't have infinite time left to do everything you dream to do.
In your 20s, it's easy to think that your entire life is still ahead of you, and you will have time for everything. It doesn't matter if you spend a few years in a mediocre relationship, a career that won't work out in the long run, on a terrible startup idea, and so on.
Somewhere in your 30s you realise that you do need to get started on what you really dream to do, or you might never have the chance to. Whether it's a crisis or inspiration depends on how far off your previous life was from it.
A midlife crisis implies, imo, that you haven’t reached the things you wanted to and are running out of time. Not that you aren’t moving forward per se.
yes, but practically speaking (and also from painful personal experience) this just seems like semantics. it boils down to the same issues. it's just that the person connects those feelings with age. but then again - no depressed person ever felt young - not even those who are objectively young. even at 20 i felt old. i knew i wasn't old in a general sense but i felt old relative to what ever i thought should have been at that age. same with midlife crisis. luckily i discovered that pattern and i'm getting better at dealing with it.
Funny. For me it's when it ended. And while expected lifespan is some 80+ these days, I can't help but see expected useful life span to top out at 60-ish...
Probably. Note: this is not a rational belief, just an emotion. I feel that for me, my useful lifespan ends at around 60, meaning I have less than half of that to look forward to (and all of that on a downward quality slope). Objectively, I understand that there are important roles for senior citizens, and I do enjoy the company and services provided by many of such people. Just that trying to imagine myself getting to that age fills me with despair.
Yeah, I'm 49 and wondering if I shouldn't have a midlife crisis or something. Although reading the article, is it possible I had mine 12 years ago when I quit employment and became a freelancer? I've been a lot happier since, but it's really still the same career.
I've always wanted to create games, though. Whether computer, board or RPG. Should I quit my current freelancing and start doing that then?
I always wanted to write sophisticated game books (think choose-your-own-adventure, but with real impact of your choices for a real story). I wrote a small one to learn about how I feel in the process.
And that would be my suggestion. Try the process for some time. Something between one month and half a year. See if you like it, if you get into it, if feel like you want to continue this. The question to answer is: does the daily process of creating games makes you happy and feels right?
Speaking as a guy in his mid 30s referring to that article, yeah I'm middle aged.
Physical? I can feel and am acutely aware I just can't do what I could 20 or even 10 years ago. No more all-nighters for me, my body just can't take it. No more high speed action games for me, my body just can't respond fast enough.
Mental? My memory is noticably declining, and my ability to learn new things is significantly deteriorated from my prime. I find myself clinging to stuff I already knew because they give me some sense of familiarity and safety in an increasingly alien world.
Social? I've stopped bothering to actively make new friends or otherwise socialize, I just can't be bothered anymore with all the hassle that human relations entail.
If I were to describe my current phase in life as the four seasons, I'm in autumn.
This hits hard. In my 20s I was athletic, smart, and ran like a gazelle. Between my general inactivity and irregular heartbeat in my late 30s, I could probably run a hundred yards before collapsing. It's sad, because I often have dreams of running fast without getting winded, to this day.
I get frustrated nearly daily at my mental decline. I was always a math wiz who could basically do up to precalc in my head. Today, I have trouble carrying numbers doing basic long multiplication. Worse, I have trouble finding the words I'm looking for when writing.
Autumn feels optimistic. I don't know what the future holds, and maybe I'm being dramatic, but it feels like Winter. I feel like my body and mind greatly betrayed me in my 30s.
I’m right there with you. I feel a bit paranoid because I can feel the decline in real time. It’s just little things, but they add up. The advice is, “this is just getting older.” Perhaps true, but I don’t like it.
I was thinking about the learning part, as I’m investing a lot of part learning the phoenix/elixir ecosystem. On the one hand I feel it may be going slower than before, but I’m not sure if it’s because some mental decline or I just know a lot more now and every time I learn some new mechanism I run through a bunch of scenarios in my head from previous experience and have to integrate it with existing knowledge to make it stick.
I can no longer just learn the syntax for how the pubsub works, I have to stop and think how to build an architecture around it, how to create an abstraction for my use case, can it be integrated with Postgres triggers etc.
Wow, 3 years, that's a long way. Congratz on making it this far and good luck on the road still ahead.
39yo here, just stopped shy of a full burn-out & after a month with a lot of confusion, crying and panic decided to hand in my notice. That helped a lot, but I'm not really well yet ~3 months in. Mainly sleep is an issue. My body seems to enjoy triggering tiny panic attacks when I'm falling asleep, which makes falling a sleep complicated >_<
I've been struggeling with sleep and anger issues for many years now, but it had come to a point where I did not want to accept being angry anymore. Anger turned into crying and despair, but that is frankly progress. I got some help, it was not great, but it helped me understand a lot about myself. In the end, this gave me the courage to quit and think about life in a different way.
Now I just have to figure out where to go from here. Stick with what I know and do it better or do something different entirely. Not a clue how to figure that one out yet.
Anyway, thank you for sharing. It's good hearing from other people that went through similar things.
Changing your career doesn't necessarily mean you're having a mid-life crisis.
Changing your personal circumstances doesn't necessarily imply a midlife crisis.
Every definition I know of includes a sense of existential angst, a feeling of regret, of lost potential, of questioning identity, of a fear of mortality.
But simply realizing you're unhappy in your life or circumstances and want to change them isn't itself indicative of a mid-life crisis by any meaningful definition I'm aware of.
The lost potential is a key one I have seen. The idea that your youth is in the rear view mirror and that you didn't do all the things you thought you would do.
I was in my 40s and starting thinking more in terms of how much time I had left rather than what I wanted to do at some unspecified "later". I also had young kids and a depressed jobless wife, so I wasn't completely free to do what I wanted and felt trapped. Then my father died pretty young, from a cruel cancer, and that amplified it all.
Yeah I think everything in your comment is pretty understandable and I probably wouldn’t trust someone who claims to have not experienced nearly all of those feelings to some extent.
> Every definition I know of includes a sense of existential angst, a feeling of regret, of lost potential, of questioning identity, of a fear of mortality.
Oh, then that one started for me around 30. I've successfully managed to bottle up those thoughts for now, which is probably why I'm facing a mother of all burnouts right now.
A midlife crisis is quitting your desk job to sell ice creams on the beach in the Caribbean. Getting to the point of doing it, not just thinking about it.
I thought it is dumping wife of 20 years for silly blonde and driving red convertible one bought with use of shark loan because “you need to have it because you always wanted it” even if you couldn’t afford it.
It's the same thing. But it doesn't have to be as destructive or ultimately short-lived as that. It might an opportunity to radically change some things you have taken for granted your entire life.
It means you'll never be 18 or 23 or 30 or 35 again. The youth that you took for granted is gone forever and time will march with you until your death. Death may be maybe be 2 years from now or 40 years from now, fully knowing that you body will start failing. Even if you have 40 years, not all of them will be good years, especially the last ones. Once you are gone, that's it, all the time you spent improving yourself and building wealth will be for naught, at least for you.
So, not for naught? Seriously, we’re social creatures that live for others. You can have 40 good years serving the next generation, building wealth for them and sharing in their joys.
I’m sensing this strange notion in older generations where they absolutely refuse to let go and insist on keeping their youth and the spotlight to no or some avail. Technology is getting better and making people hold on for longer but I think it leads to your kind of statement that life ain’t that great unless we’re out there crushing it all the time.
I guess it fits nicely with the declining notion that having children isn’t worth it either.
Funnily enough this is a sentiment Ted Kaczynski pushed in his manifesto. That technology has replaced the drive for power in individuals to support themselves, because it has become so easy, so people try to find other means to fill the power principal. This can be social causes or political ones, or in your example, trying to hold onto youth for as long as possible. To be in denial of the reality of themselves.
There is some truth to it but I also feel like it is a far too pessimistic take on the issue.
I’ve got parents on both sides that are too busy going on cruises and vacations and only call us for the good times, so yea I can be pessimistic these days.
Friends and siblings though have been coming through like champs during these hard times.
> all the time you spent improving yourself and building wealth will be for naught, at least for you
There’s meaning in that work if you accept that it’ll have lasting effects beyond you.
> It means you'll never be 18 or 23 or 30 or 35 again. The youth that you took for granted is gone forever and time will march with you until your death
Your youth was taken for granted if you don’t think it added up to you being able to provide for a family.
I’m just trying to find meaning in the mundane, not trying to preach. This view that being alive and healthy and able to raise a family isn’t enough is always disheartening.
>There’s meaning in that work if you accept that it’ll have lasting effects beyond you.
Read what I said, "it will all be for naught, at least for you." Meaning all that time spent learning things and gaining knowledge and wealth won't matter for you because you'll be 6 feet under. It's along the lines of Jobs' quote, "you'll be the richest man in the cemetery." He was 56 when he died, how many years until you are 56? Probably not as many as you'd like.
>I’m just trying to find meaning in the mundane, not trying to preach. This view that being alive and healthy and able to raise a family isn’t enough is always disheartening.
I dunno where you got that from what I said. It's enough, it's great, it will be all over real soon because of the march of time. It's all for naught because we'll be worm food.
You completely misinterpreted what I said, you pretty much came up with the opposite.
Maybe not the best idea if you mean material wealth beyond staving off being poor. I know its all good intentions, but it more often ends up in spoiled entitled brats than it doesn't. People simply need a bit of struggle to stay humble and nice human beings, not too much but sweeping the road ahead of kids too well is one of the worst things a parent can do.
But its true this is US forum, so in that case one needs to build massive wealth just to send kids to university or have safety net for any kind of bigger health issues in family.
I agree though with kids being great for such a crisis, they give more purpose in life than anything else, give depth to otherwise often rather shallow life. Its like a computer game, playing on easiest difficulty (no kids) will make you progress faster and easier, but that doesn't translate well into overall worthiness of experience. Plus seeing your little ones play, having fun at 100% or grokking new stuff is such a nice heartwarming experience that it could melt a glacier or two, good luck getting such a kick elsewhere (and I do quite a bit of extreme sports so can compare a bit).
>Seriously, we’re social creatures that live for others. You can have 40 good years serving the next generation, building wealth for them and sharing in their joys.
Speak for yourself; I sincerely have no interest in deliberately serving humanity. We're by far the dumbest and most conceited lifeform on this planet, and even ignoring that I find serious interactions with humans to be an utter hellscape of drama and problems I can and will do without.
When I'm gone, that's it. My blood ends with me. I refuse to leave a legacy behind. If there's anything left, whoever is there to witness can pick it all apart as they please. I don't care because I'm dead, after all.
It's what people say they suffer when they made bad decisions for decades and figured out they missed the good part(s), happens a lot to people who sacrifice everything to climb the corporate ladder or focus too much on work or other artificial goals. Not everyone goes through it
"Studies indicate that some cultures may be more sensitive to this phenomenon than others; one study found that there is little evidence that people undergo midlife crises in Japanese and Indian cultures, raising the question of whether a mid-life crisis is mainly a cultural construct."
Japanese salarymen often undergo a crisis when they retire and suddenly find themselves with tons of time and nothing to do. Not exactly midlife, but it's of a similar vein.
May I ask for further advice on your fourth bullet point about “outsourcing your mental health”? I understand you might need to shop around like you maybe go to a cognitive-behavioral therapist, or psychoanalyst, or buy a Transcendental Meditation (TM) course.
Getting help from mental health professionals is just a way for that individual to foist their opinions onto you. Psychology is a highly subjective field whose studies have startlingly low reproducibility. You’re much better off finding someone in your circle that’s willing to listen to you and shares your values (though not everyone might have this available to them).
I might be the only person on earth that got something out of therapy, and I blame being and staying depressed my entire adult life because I listened to idiots like you. And trust me, I'm restraining myself here. We have a mental health crisis, a broken support system, male suicide at a all-time high, and your opinion is still mainstream. Shut up and listen.
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Advice for the people struggling: don't be afraid to fire your therapist. Going to therapy should feel like having someone to dump your crap and feel they've listened to you with no judgment whatsoever. You should feel you talked to a better, non-opinionated version of your $favorite-relative. If that's not the case, get another one.
AFAIU there's a lot of approaches to therapy. What worked for me was having a person that listen attentively for 99% of the time. In 3 years they have never told me what to do, nor prescribed their vision of the world.
We’re not idiots, just people with communities and appropriate support structures in place that people like you threw out the window on the altar of individualism and shortsightedness. Modern therapists turn around and attack the same ideas that enable people to have and maintain those communities and structures in the first place while leading broken lives and peddling their sorry wares to other broken people they put there in the first place. You really think an institution that has been around for 60 odd years can compare to a stable equilibrium human society settled on for thousands of years? You really think your psychologist who listens to your minutia while “chasing a career” and having her kids raised by some people at a daycare really knows what she’s talking about? She’s just unwittingly making future clients.
This %100. People don't seem to understand how pernicious and subversive the therapy profession is, and how self-replicating. The only point I would correct is the "60 odd years". Its roots go back to the early 1900s and there was an explicit anti-family program from the beginning. Destroy the family, destroy the culture. It's a cultural suicide pill.
I don't want to upset you but, imho, the so-called "mental health crisis" is, in part, caused by therapy culture. Of course there are people who are deeply disordered and those may need medical or institutional help. But, many people believe they need "therapy" who absolutely do not. Consider the possibility that having a good friend, sibling, or spouse might have helped you equally.
This is good advice. Sadly, many on HN are very pro "mental health professionals". I see the opposite advice proffered frequently. These "professionals" make things worse by pathologizing normal life. Their availability to function as ersatz "friends" discourages people from making the real kind, imho.
My family did a few group therapy sessions when my dad died, and it wasn't anything like you suggested.
At no point did the therapist suggest there was anything wrong with us or suggest medication. She just listened and helped us deal with the new situation.
Was it absolutely necessary to talk to a therapist? No it wasn't.
Did it make the situation easier to deal with? Yes it did.
Group therapy is basically like having a mediator in a room to facilitate conversation. It's not quite the same as individual therapy. I'm glad you got some value out of that interaction.
It's just inviting downvotes but I also agree with you.
Therapy is a scam and no doctor can explain how or why anti-depressants work (also why they have people "try" many before finding the "right one for you").
But people are too cool for friends and family now and hearing hard truths so they pay someone to be told they matter and how to run their lives.
I have seen different approaches to therapy being done to different friends and only one friend got better - this tells me it can work for some, but the odds are you're getting a grifter. In this case their therapist told them they didn't need anti-depressants (shocker) and after ~15 sessions said they were fine and didn't need help anymore. Everyone else is medicated and still going every month, presumably til they die.
> Therapy is a scam and no doctor can explain how or why anti-depressants work (also why they have people "try" many before finding the "right one for you").
We also don't know the mechanism behind how anaesthesia works, this doesn't mean anaesthetists are grifters.
Mental health issues are not easily distinguished, "depression" is a cluster of conditions which probably have different treatment responses but all present alike. It's not unusual that some people will respond to SSRIs, others will need beta blockers and a third group will need talk therapy.
I don't remember seeing many studies about anesthesia doubling the risk of going unconscious like anti-depressants and suicide. Or many situations in which someone just doesn't respond to the anesthesia. That's the track record we're talking about here. Not sure it even rises to the status works sometimes.
1) Length of therapy is strongly correlated to school. CBT and it's forks are relatively short and ability-oriented, where psychodynamic is very long with hazy endpoint. And generally CBT should be pushed much more, as it's faster, more goal-oriented, and less prone to, let's say, therapist biases.
2) Although I get the idea that people need friends and family, it's easy to forget that people with severe issues do not look like they have them. And taking care of eating disorder/personality disorder/*PTSD/whatever else treated through therapy, not medication patient is a lot of work to which most people are not equipped, and which drains a lot, to the point of resentment (if they can't run away) or just ghosting. Also, it's not that people do not hear "harsh truths" - it's more about not being able to comprehend them, due to broken thought patterns.
I dislike immensely the idea of CBT and I reckon it's the reason therapy got such a bad rap. Talk therapy is immensely more free form. The goal-oriented approach works great in our modern productivity focused society, it's not a way to just learn to unleash what you actually want to be.
Not sure if there's a branch of talk therapy you are engaged in, but if you look back into the history of the "profession" you might have a good idea of why it got such a bad rap.
Agree that CBT or other behavioral approaches are preferable and that there are some legit disorders that can't be easily helped. Point is that most people don't need or benefit from therapy, and are more likely to be harmed.
I honestly believe that a small amount of people are better off being medicated, keyword being very small (<0.1%). Those that would be a danger to themselves or others in a real way. So I concede some ground.
Most of my friends on them are just bummed out about their life but not enough to change their situation. Perhaps CBT is the answer, my big issue is that the majority of therapists over-prescribes, and that makes me lose trust in the whole thing.
It's like trying to see the good parts of cryptocurrencies, you need to ignore a lot of shit and in the end you wonder if its worth it.
You ignorance on the matter shows. You are probably living in the US where pushing pills is the norm. Honestly, this entire anti-therapy subthread is a shitshow of misinformation.
Let me shed some light: there are psychotherapists, that are not doctor, and can't prescribe anything. Then there's psychiatrists, which are medical doctors, and might approach your depression with the pill du jour. SSRIs just cure the symptom, not the actual bloody problem one has.
You don't need a pill, nor a doctor unless it's an actual curable condition (bipolar, ADHD, etc.). You need someone to talk to.
Some of us are saying that paying a professional because you just "need someone to talk to" is a situation created, enabled, and perpetuated by this talk therapy culture. Some of us are pointing out the history of this profession and its incredible lack of scientific rigor and perverse incentives.
Not a coincidence. It's significantly more common in the profession[0]. They get divorced at a higher rate, and they recommend divorce to their clients. Therapists and psychiatrists are massively responsible for the divorce rates among boomers (the first widespread consumers of these services). Their children apparently learned nothing and are rushing headlong into the same therapy-culture that destroyed so many of their parents' marriages.
It isn't bad if you are in an objectively bad marriage ofc. But if you're in a marriage that "can be worked out" then yeah it's a bad thing, for the kids especially. There is definitely something to be said about making things work because there is no easy "out" called divorce.
In a healthy society, divorce should be difficult, expensive, and rare. Social incentives should be structured to make it less appealing than working on the marriage. Conversely, marriage and children within marriage should be incentivized by law and social programs. It may such policies are unworkable in our present configuration.
There are lots of bad outcomes in a marriage, but many marriages aren't given much of a chance.Anyone who has been successfully married after decades can tell you that it's ups and downs and takes work and there are many moments when you might want to give up. This culture encourages people to cut bait when things aren't fulfilling the spouse. But that's just more of the same individualistic attitudes that Psychodynamics helped create support for. When you enter into a marriage you are less an individual, when you have children, you are even less an individual. It shouldn't be so easy to divorce and there shouldn't be a whole industry that tries to make it easier. This idea that you can detach from your commits to family because you're "unhappy" is insidious and has too many perverse incentives to list here. Predatory industries like therapy are particularly distasteful because they clothe themselves in virtue when they are actually extreme toxic to the culture at large. That culture, if allowed to be healthy, would obviate the perceived need for most therapy (outside of seriously disordered people). Such needs would be supplied by extended family and friends.
IRL, divorce is devastating for everyone involved, especially the children. I believe therapists diagnose divorce and breakups in general so often because it eases their conscience a bit. You can see this same reasoning with abortion and such topics.
A divorced therapist is like a dentist with bad teeth or a tee-totaling drug-dealer. Can't trust any of 'em.
Staying together when you hate each other is much worse. Sometimes divorce is just the best out of several bad options.
(BTW, what is bad about teetotaling for a drug dealer? "Don't get high on your own supply" has allegedly been a credo for them since basically forever)
Hating each offer to the point of violence? Sure. But that’s now his this works IRL. That’s why there is the common movie trope of the wife leaving her husband gif the therapist.
People divorce cus they “fall out of love” and, since society today puts self-interest, especially if its related to sex, above all else, and the nuclear family is seen as worthless and “problematic”, people ignore any evidence against their politically correct sheepish opinions.
On your second question, drug dealers often start dealing to support their habit. Only in movies will you get that line. Y’all live such incredibly sheltered lives.
Stay together for the kids. Once they leave the nest, sleep with all the therapists you want. But to pretend like divorce is anything but cringe and pathetic is twice as cringe.
> This is a preview of subscription content, access via your institution.
Unfortunately, since I can't view the article, I can only guess that they evaluated a large number of professions. Since the abstract focused on law enforcement, it seems unlikely that they adjusted their criteria for statistical significance for psychologists in consideration of the number of variables they evaluated.
Looks like my hypothesis is supported by the evidence: On page 4, you can see their regression results. In fact, they don't estimate the statistical significance of any occupation as a factor, not even the law enforcement occupation that they focused on.
The "media and communications equipment workers" category had a reported 0.00% divorce rate! It seems implausible that we should infer causality from this.
There are a few other studies on this. Maybe I'm reading these incorrectly so would appreciate your analysis. As far as I can interpret, the pattern is legit. What is especially counter-intuitive (unless you have a negative view of the profession, as I do) is that so-called professionals in mental health have a higher divorce rate even than respondents who score high on the "anger scale". So what's that all about?
> Survey results from 2008 through 2013 included responses from more than 40,000 physicians; 200,000 other health professionals—dentists, pharmacists, nurses and health care executives; and more than 6 million other adults who reported currently being employed and ever being married. While 24 percent of physician respondents had ever been divorced, the probability of being divorced was 25 percent among dentists, 31 percent among health care executives and 33 percent among nurses. Only pharmacists, at 23 percent, were less likely than physicians to have been divorced. Lawyers had a 27 percent probability of being divorced, and *in all non-health-care occupations, the probability of ever being divorced was 35 percent.*
> A subsequent, larger study of 1118 medical graduates of Johns Hopkins University found cumulative rates of divorce of 29% *with rates higher among psychiatrists (50%)* and surgeons (33%) but was limited by its analysis of physicians from a single institution.
> The choice of specialty was significantly associated (P>0.001) with the risk of divorce (Fig. 1 and Table 2). The cumulative incidence of divorce was highest
for *psychiatrists (50 percent)*, followed by surgeons (33 percent) and “other” physicians (31 percent). Among internists, pediatricians, and pathologists, the incidence of divorce was similar (22 to 24 per-
cent).
> When we examined psychological variables, we found that physicians in the highest quartile for the anger scale had a higher risk of divorce than those
scoring in the lower three quartiles. *Moreover, the cumulative incidence of divorce among the physicians with the highest anger scores was higher than
that of any other subgroup, with the exception of those practicing psychiatry.*
Looking at the "Medical Specialty and the Incidence of Divorce" article, my first thought on reading "Scores on these [psychological characteristic] scales were grouped according to quartiles for analysis" is that the researchers aren't experts in statistical methods, or else are hiding something by bucketing arbitrarily. It's a widespread problem in life sciences. They don't explain (not by this point in the article, at least) why they chose quartiles. I'm skeptical of any analysis that reduces the fidelity of the data without explanation. It smells like p-hacking.
My second thought regarding their model is wondering why they didn't first build a model predicting divorce for the general population. I've heard (received wisdom) that financial stress is the primary cause. It seems unlikely that medical specialty is unrelated to household finances. Ignoring a likely confounding variable is sloppy. It makes the effort seem like a novelty article intended for amusement rather than serious research. It's in the "occasional notes" section of the periodical, which suggests less rigor.
They do little to address the question of causality. They muse that, "One explanation is the longer work hours required in some specialties," but never bothered to analyze the hours worked.
My conclusion: That article is literally a joke, published to give the community something to laugh about over beers after the conference.
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If I were to perform the analysis, I'd first build a model of causes of divorce for the general population. Some candidate variables: household income, household income as a ratio to each person's childhood household income, cost of living where the household lives, frequency of attending religious services, number of children, number of hours worked per week, age when married, etc.
I'm skeptical of psychological characteristic surveys, so I'd spend some time considering alternatives, but I'd want to include some measure of characteristics that might drive the choice of a medical specialty which might also be correlated with divorce. We want to isolate the choice of specialty as the cause as separate from confounders that cause both the choice and divorce.
If medical specialty holds up as a factor after controlling for everything else, then I'd investigate further.
Thanks. My first reaction is that this one is much better. Larger sample, better methods.
Again, I hate the arbitrary bucketing. There's no benefit to creating age buckets, as if there's some magical change that happens at 40, 50, and 60. I did have an atypically large birthday party, compared to other years, but I don't think that had a dramatic effect on my likelihood to divorce. Maybe some people have such spectacularly intense decade-related birthday parties that it increases divorce incidence for those years? Income doesn't benefit from bucketing, either. Having $199k annual income isn't much different from $201k annual income.
They do a decent job of controlling for confounders. Considering, among other things, that "if the annual rate of divorce was identical across occupations but physicians marry later in life, then at any given time physicians would be less likely to report ever having divorced compared with people in other occupations, simply because they were at risk for less time."
However, their inclusions of state and year fixed effects could have been more considered. These are proxies for other things, like cultural characteristics and neighborhood income levels. I'd like to see some discussion of why they chose to use state and year proxies instead of searching for more specific explanatory variables. Especially state, because some kind of urbanization measure might be more helpful. However, because state medical licensing regulation might affect the choice of occupation, the use of that variable is easily defensible.
Ugh! Bucketing again! Hours worked should be a continuous variable. Inexcusable, unless they feared misreporting. Perhaps they saw some banding at 40, 45, and 50 hours, so they figured it's not really a continuous variable anyway. Again, that needs explanation. Any rationale for bucketing should be thoroughly discussed.
Finally, the effects. First, with this population size, I'd be surprised if these weren't "statistically significant". I'm looking more for practical significance. Check out the estimates for dentists. Dentists appear to have lower incidence of divorce, based on the last year, yet higher prevalence of divorce. Strange. That means that dentists in past years had a higher annual incidence, but the rate has been declining, or declining relative to physicians. Has the practice of dentistry, relative to general medicine, changed that much over those years? This suggests spurious results, at least for the physician vs dentist comparison.
Hispanics were more likely to divorce? Bogus. I'll chalk it up to sampling weirdness. The CI includes 1 anyway, so they're saying it doesn't matter. They should put some asterisks in to highlight the variables we should pay attention to. It looks like they're including Black and Hispanic just to explain what Other means, because Other is the only significant one.
Wow! Income is irrelevant. Weird again. Maybe bucketing at work, turning 1 continuous variable into 4 binary variables, diluting the impact. It should have been log(dollars).
If you work more than 60 hours, you're more likely to get divorced. Makes sense. Again, log(hours) would have been better, though maybe a threshold at 40 hours would have been useful.
I enjoyed the article, but if I were the journal editor, I'd have returned it with some suggestions for improvement rather than publishing it.
Anyway, I hope my commentary was interesting/useful. This article doesn't say anything about psychology, so we've gone off on a bit of a tangent.
Yes, very interesting, thank you for putting in the time. I appreciate the detailed analysis. Were you able to make any inference at all about psychiatry and divorce from these data or no? It's interesting that you are using some background knowledge to evaluate the findings (e.g., hispanic divorce). I'm curious where that comes from and how it fits into our discussion. Is it that you have data about hispanic background divorce rates or is it because you know hispanics are largely Catholic and making a logical inference? As far as dentistry is concerned, it may be a hidden variable, such as makeup of those practicing dentistry. Maybe a change in composition of male/female overall. Or from different cultural or ethnic backgrounds with different background rates of divorce. My overall impression of your analytical tools is that you are willing to hypothesize causes with the caveat that they be subject to further investigation. If you reach such places in analysis and stop, do you just reserve judgment from that point? I would think not. Rather, your priors change and your probabilities change so you can go about life without perfectly constructed and complete statistical evidence, as all of us must.
To return to the topic under discussion, it sounds like you are saying, "there may or may not be a correlation between psychiatry and divorce, but these particular studies can't provide the answer." I assure you I am not basing my opinions about psychiatrists on these studies. Rather, I expect that properly constructed studies that meet your standards would bear out what I know from my own experience and encounters with people in the profession. Others in the thread provided anecdotal data that supports my own. And, I'm not making my judgment based solely on experience. My experience confirms an intellectual analysis based on the history of the profession. Those are my priors and probabilities. I would not be surprised if the data backed me up but I would be surprised if the data refuted my suppositions (and would question the study). It seems that my sort of reasoning doesn't have much place in your toolbox. Is that not the case?
I appreciate your reply and explanation. However, I think we'll probably be speaking at cross-purposes because your description of the kind of variables you would choose for your own model strike me as (necessarily) limited and reflective of the data requirements of your preferred methods (McNamara fallacy?). (I don't actually believe you live your life via models generally, but maybe you do.)
My opinion is there is no room in such models for all the many things that are part of the rich fabric of psychological experience, without which all you get is a kind of significant/not-significant binary according to available imperfect data. I mean, yes, it preserves the null hypothesis, but it feels sterile to me to attribute so much to randomness when the model itself is so obviously curated to work with available data. Or even to hidden variables that will require further study, at some point, in the future, maybe... Not to mention the cases where the null hypothesis was subsequently rejected (smoking, ulcers,...). Yes, Maybe you believe these variables are the principal components of the theoretical complete data? The don't appear orthogonal to me.
Meanwhile, life has to be lived and if you've encountered "types" of people in the world but won't allow yourself to acknowledge their existence unless one can build a rigorous predictive model to verify the existence of those types and to be sure they are not noise or sample bias or whatever, then you are enjoying a life that I would find almost barren. There are so many locked doors in this way of seeing the world. You have problems with datasets, which you have to decide whether to trust. Will you apply statistics or heuristics to those problems? Absent trustworthy data will you just decide to defer judgment? It's a form of not trusting oneself as well, which I reject on principle, and of making oneself unbiased to the point of being inconsequential. In other words, a form of nihilism (perhaps nullism is the appropriate term).
No, I don't think I can make any inferences about psychiatry from those articles. My Bayesian update is the opposite of yours: because the evidence presented was weak, I'm more skeptical of any relationship between psychiatry and divorce. I was quite ready to believe it, and was disappointed to see such weak studies. It suggests to me that it's difficult to find positive results with stronger analysis.
You seem to be suggesting I'm philosophically a Frequentist. Somewhat true, but I am, like basically everyone, a Bayesian when it comes to practical decisions. Also, I have no fear of logical deduction when statistical inference is infeasible.
Nullism is a good term. I'm of the opinion that most things are random and that humans' imaginations frequently mislead us. Absent better evidence, I'm unlikely to believe any link between psychiatry and divorce.
If they are performing according to the profession's own standards, then they spend their working days involved in other people's problems, delusions, traumas, grievances, morbidities, obsessions, suicides, etc, (not to mention various mental disorders). This probably accounts for high rates of burnout among them. But, ask yourself, what about the ones who don't burn out? What is it about them that allows them to do this sort of thing day after day? Is it the $300/h? Is it a strange fascination? Is it some mental disease of their own? Questions worth asking.
By the same token, avoid seeing oncologists, EMTs, many kinds of surgeons. These people see death every day, ask yourself why: they must have a sick fascination with it. Or they stopped caring. Is that something you want in someone caring for you?
Well, those specialties at least have the benefit of medical science behind them but even so I wouldn't go to any of those specialists for mental health advice. Why are surgeons stereotypically arrogant and lacking in bedside manner? Is it, as you say, because they see death and disease every day? Do they cope by dehumanizing people? Or are the naturally that way and so well-suited to the profession? Worth asking.
> I wouldn't go to any of those specialists for mental health advice.
Or medical advice! Only damaged people would chose those professions. They are surrounded by death and injury. Are they killers? Will they kill you? These are questions you should ask yourself if you notice a skin abnormality.
It can be as simple as them having found coping mechanisms or support systems that work for them. No need to invoke weird conspiracies about them being mentally ill.
I'm not invoking conspiracies about them being mentally ill. I'm suggesting it as characteristic of the type that they are messed up. That's not a conspiracy, any more than saying that people drawn to fighting forest fires are brave or parachute instructors have a high risk tolerance.
People drawn to fighting fires are stereotypically brave, but they are also stereotypically arsonists themselves. The worst people to call when you notice a fire is the fire brigade. They'll just spread more fire! Evidence: they're admitting to burning undergrowth to stop wildfires. "Fighting fire with fire", these people are nuts!
Plus - firefighters: stereotypically buff and desirable. You'll lose your house and your partner.
The right person to call is a poet. Not otherwise associated with fire, handles a lot of paper. They hate fire!
Undoubtedly. Software engineering is a niche activity that takes a certain aptitude for abstract reasoning. Right away you eliminate a lot of people from the candidate pool. What's your argument?
Anecdotal: but all of the psychology students i've met were far from being stable and had serious issues of their own. But its just my own experience and a stereotype i have now
A couple more pieces of advice from me:
* A midlife crisis has its own glacial pace. Be prepared to be upside down for a long time.
* Be prepared not to be the same person you were before. Be prepared to learn there is no turning back.
* If you're in a midlife crisis, your previous life was simply not good enough and reality has caught up to you. Go through the process, and you'll become a better person.
* Outsource your mental health during this phase to professionals. Not even your spouse might be able to accept what comes out of this reconfiguration of yours. You will probably need the help of someone that is not invested in your previous existence to hold you in this trying time.
--
3 years in, it's getting better, I miss part of my previous life, but I know who I am now, how I operate, and I won't compromise to fit someone else's mould anymore. In your childhood you had no say in how you were grown and pieced together. You had to carry whatever they had built for you until you broke down. Now is your chance to start over and do a better job at it.
Good luck!