Episode: 1334
Title: HPR1334: Open Sourcing Mental Illness - Ed Finkler
Source: https://hub.hackerpublicradio.org/ccdn.php?filename=/eps/hpr1334/hpr1334.mp3
Transcribed: 2025-10-17 23:49:30

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Hi everybody, my name is Ken Falon, and you're listening to another episode of Hacker
Public Radio.
Today we're joined Dave Morris and I are joined by Cyan, who's listening, but mostly we're
here to interview Ed Finchler.
Ed, did I get that right?
Yeah.
Yeah.
So you're a PHP programmer and a famous podcaster.
Can you tell us about the podcaster, Jordan?
I don't know if I'm famous podcaster, but I do a podcast with a friend of mine, Chris
Hartges, who lives in Toronto and I live in Indiana in the US.
And we do a podcast called Development Hell, which is really just kind of an informal conversation
of two old web developers who are very cranky and grumpy about things.
So that's the, so we've been doing that.
I think we're up to, so shoot, have to count, we're under the 30s now, like 35 or something
like that, I think.
And so we've been doing it for about a year and a half.
And we, you know, both of us come from PHP circles because that's just how we know each
other.
We've both been doing a lot of, did PHP for a very long time.
So that's kind of our background, it has been as PHP developers.
I've more lately been doing web development with Python, and I've been doing a lot of
JavaScript for a few years now, so, but Chris is still doing lots of PHP, sometimes a
hischigrin.
But yeah, so we just kind of have as, kind of informal, try to kind of keep it light and
funny and just battle about stuff we're interested in, right?
Yeah, exactly.
Well, actually, we're not here to talk about the show per se, but, but I did, I did download
it and have a few listen, a listen to a few of the episodes, I look quite good, and as
I beat my health head against the wall on the PHP upload script, I'm resisting the
urge to troubleshoot it online with, here with, you know, what to do, yes.
And one of those episodes, you did a kind of special, and then it's through that, I think
that Dave brought it to our attention here in the HGRA community in the last month, so
I thought, well, let's get you on to interview about that, can you tell us what it was that
happened?
Yeah, so it was episode 15, so this was, there was a little over a year ago, and so the
background is that I've been going for many years to a, to a PHP conference called PHP
Tech, which has taken place for many years in Chicago, in the summer, in May, I think
it is, and I hope, and I hope I'm right about that, and yeah, and so in, I said, so it
was May 2012, I went up and I gave a couple talks, and I've spoken up PHP Tech for a
few years now, just about different things, and I've, I, this one was, through no fault
of the conference, this one was a really tough one to handle, for me, personally, I had
had a, sort of a, a few things kind of came together that made my experience really poor,
I had gotten, I have to use a, a thing called a CPAP, because I have some, a condition
called sleep apnea, which basically means that, yeah, yeah, so if you're familiar with sleep
apnea, it basically, you stop breathing while you're asleep, which is kind of not cool,
so you use the, the, the, probably the most common treatment is, use a thing called CPAP,
which is, it basically uses air pressure to shunt open your throat so that you can actually
breathe, um, and, uh, which is kind of important, um, and that, so that, uh, I had, I drove up
to Chicago, I only lived a couple hours away, but I had forgotten my CPAP, which is sign
of unfortunate, um, so I had a lot of trouble sleeping, I also forgot, I take a, a few
different medications, and I, I forgot a couple of them, and I, it was, so that was just
disaster planning all around on my part, um, and I, so I was just in a really bad place,
I, I forgot my medication a lot of times, even if you don't, it isn't necessarily like,
with some medications, it's not like you have a, it's, sometimes that, if you haven't,
if you don't, if you just stop taking them, even after a half a day or something like
that, it varies, but some things, if you, if you don't take them, your body's used to
them, and you know, I'll have some issues, like I might get a little bit of vertigo or
something like that, um, the combination is I also got sick too, which probably it's
got there wasn't sleeping, um, and I got pretty sick, and that whole combo really, really
was bad, um, and the medications that I take, um, I take for anxiety and depression, and,
um, so not having those and not feeling well because I didn't have the medication, which
kind of messed me up a little bit, um, and also just not getting the help that they give
me with those kinds of issues, uh, and being sick and not sleeping well, that was a really,
really bad combination, and I had, um, it was a real struggle for me, there were definitely
parts of me that wanted to go home, um, and just skip my talks and go home and, you know,
bail out of the whole thing, I think I ended up going home kind of early anyway, but the,
the whole thing was pretty unpleasant, um, I was upset and very down, um, about the whole,
you know, the whole thing, and again, the conferences was a good conference, it had nothing
to do with that, it was just my personal experience dealing with some stuff, um, and I guess
going through that and going, and it's something that on, this was one of the harder
experience I've had, but I have this experience, a fair bit when I go to conferences, there's
always sort of a time where I get kind of dark and down and, and, uh, I wish I was home
and I just don't like being there, cause in a weird place, I don't really know a lot
of people a lot of times and things like that, um, which isn't super helpful if you're
a person who speaks at a few conferences, I don't talk a lot of them, but I usually talk
it two or three years.
So, uh, thinking about that, it sort of came to a head a little bit, you know, what,
me thinking about this and I, I thought about what I kind of been through here and what,
you know, what it, I was thinking about it and thinking about what I was learning about,
you know, myself and what I was dealing with and in the context of being a developer and
being a, a member of an open source community and things like that, um, and I decided that
I wanted to talk about the, uh, things that I've struggled with, um, uh, regarding my mental
health, um, I wanted to talk about it on the podcast and I, so I talked about it with
Chris, my co-host and he said, well, okay, that doesn't sound very funny, but that we could,
I guess we could do that enough.
Um, he was, uh, I think he was unsure because he was kind of like, well, this isn't what
we usually talk about, you know, and, and it, it, but man, if you want to talk about it,
that's okay, right?
You know, he was, he was supportive of it, um, yeah, right, um, and so he kind of let
me just ramble on for, on the podcast for like an hour about, um, about my struggles with
my mental health, um, in terms of, uh, you know, for me, primarily it's been anxiety and
depression and, um, uh, I have adult ADD attention deficit disorder, um, and all three of
those things have, have just been, you know, things that I've had to deal with in terms
of my mental health, um, and, and so I talked about it and it was, it was kind of scary
because I, you know, I, I talked somewhat freely about it on things like Twitter or stuff
like that, uh, but not, not, I don't sit down and be like, hey, I'm going to tell everybody
my life experience with this, like from when I was a kid and go on and, and that's a tough
thing, um, and it's a different thing than I guess to do it, like on a podcast in front
of a bunch, you know, not, well, they know a bunch of people are going to listen to things
like that, right?
I was just going to say that you're, you know, here you are now wopling on, you know,
come on this old story, how do you, how is this different?
Yeah, well it's old hat for me now, right?
Like because, um, because what's happened is that I, when I, I did that podcast and released
it, we got just a huge response, um, it was by far the most popular, you know, episode, um,
the feedback we got was, we got lots of feedback and the feedback we kept hearing was really
it was kind of one of two things that was either, thank you for sharing with this, more people
need to talk about this. This is, you know, something I, I don't know that I really understood
what it was like until somebody sat down and was, you know, brave enough to explain about
other things like that. I don't, I don't know how brave I am. I just, eventually, you know,
I'm less and less embarrassed about my quirks as I get older, but, uh, so there's that, um, but
then the other, the other feedback we got, um, was from lots of people saying, uh, no one
else has ever talked about this so openly that I've heard and I have the exact same problems
or I have similar problems and only, oh, nobody knows about it or only a very, very few people
know about it and I've been struggling with this for a long time, basically in silence.
And thank you so much for talking about it. Um, you know, I just, I, I had tons of people
reaching out to me with those kind of same kinds of stories. I think, uh, yeah, just to put you all
there. I don't know, I wouldn't class myself with that, but I do have the traditional, like,
pre-conference phone call with my, with my wife go, what am I doing here? Uh-huh. Why should I be here?
I, and, you know, I'm trying to force myself in. Yep. I think a lot of us can relate to that in,
certainly. Yeah, it's, uh, a conference can be in a pretty intimidating thing and it can be hard
if you're, especially if you go to a conference and you don't, you don't have like a,
it's gotten easier for me to go to a lot of PHP conferences because I see a lot of the same people
and you have the same friends there and stuff like that. Um, the conferences that are particularly
hard for me are when I'm in it. I'm like in a new city and I don't really know anybody and there's
times where it's just like I just want to go back to my own bed and lay down and, and not be here
anymore. I don't, you know, some people are very outgoing and, and get excited about exploring new
things and aren't intimidated by those things or I'm kind of scared by those things and I,
I find being in places where I don't sort of feel like I know the rules or I don't feel like
at home here or things like that. I find that really intimidating and I find that kind of scary
and so that's the thing that I, you know, that's the thing that I struggle with a lot, particularly
if you're related to conferences. I think those things can be, can be, can be intimidating. Let alone,
I think a lot of people feel like, well, there's all these smart people here and I'm not that smart
and they have, you know, deal with the thing like, with a thing that you might call
Posters Syndrome. A lot of people talk about that and so, yeah, so I had a lot of that feedback,
right? And it's a really good feedback that I, and I felt like I'd sort of touched on something
that a lot of people wanted to, wanted to hear more about and talk more about, but they people
hadn't been doing that. And so I thought for quite a while about like what to do with this, what to
do with this information, like what's it, I feel like I kind of struck a nerve, right? And,
and I didn't know exactly what I should do and I thought about, well, maybe I could build something,
like, you know, a good building web stuff, so maybe I could build something like that or start,
try to start a community, I don't know, I, all of them didn't quite seem like they resonated with me,
at least. I had, I sort of struggled with ideas for what to do. And I kind of came the conclusion
after a few months that I think the good idea would be to just keep talking and just keep talking
about stuff. And so at the beginning of this year, I started, I wrote up a proposal that I was
going to start giving to, and proposed it at a few different conferences. That was me just
talking about my experiences with, my mental health experiences and my experiences with things,
I had an impression in the context of who I am, which is a developer and open source community
member and also, you know, family member and things like that, somebody works in IT.
Right. And so in doing that, I also, you know, I proposed it at a couple places I knew
was going to go. And then I started thinking a little bit more about it. And I am not the kind of
person who typically likes to, hey, you know, like ask for money. I've never, I've not done that before,
not really big fan of that. It's sort of, it's not like it's bad for other people just,
that's sort of not my style. I'm not really super comfortable with it. But I started thinking,
well, what if, if I had a little bit more money, I wonder if I could speak at more conferences.
Like there was, like I was thinking about the O'Reilly Open Torch Conference, which is a place
that I would like to propose it. But that's an expensive endeavor. There's, you know, they don't
cover anything for speakers. So it's, you know, they give you a ticket, but they don't cover any
hotel or airfare or anything like that. And, and, and so that, you know, you're talking about
$1,500, $2,000, just, you know, being within the US just to go there, right? Just for that
side of things. And, yeah, that's quite a bit of money. And so I said, okay, I asked people on
Twitter and I was like, hey, what do you think I should do? Do you think it would be bad to ask
for this and look people are like, you should totally do this. So I said, okay. And I did, I looked
at a couple of things and I decided that IndieGoGo, the, that website was a little bit of a better match.
Because with Kickstarter, I looked at Kickstarter and it's they sort of want you to have a product
at the end of it, which I wasn't sure 100% that I had a very well formulated product at the end
of this thing. And then the second thing was that, IndieGoGo had a setup where you could,
if you're not fully funded, you can keep the money you've gotten under certain circumstances.
So when I was like, well, I don't know how much money I'm going to get. And so that will just
figure it out from there. So, yeah, I mean, things better than nothing this. Yeah, right. That's
the idea. So I figured, in my case, if you haven't finally got like a couple hundred dollars,
that was still better than, you know, zero dollars. So that was, that seemed like a good match for
me. But both of those seemed, I decided to do it on a website, like I was supposed to just
doing it, like I don't know, put up a PayPal link or something or, or some other system of payments
because I was nervous about, I felt like it was easier to, it would be easier to market it if
I went to one of those sorts of things, like people understand how they worked and they, for
wonders, are another seem less shady and things like that. I don't, you know, it just, I felt like
that was a little bit, that would give me a little bit of advantage and fundraising. So,
I, I said a goal for three thousand dollars, which would allow me to go to Ozcon and probably
a couple other things. And I had some things planned out and said, hey, these are the things I'm
proposing and listed out. And this is what I want to do. And within a very quickly, I think we
broke the goal like it, but in the first day, which was really awesome. And then, so I, we got almost
two times what the goal was. So nearly six thousand dollars, I think it was like 55 or 56,
hundred dollars. And so that was really amazing. And just the way that people stepped up and it felt
like that was sort of a, you know, an indicator that, yeah, this is something that a lot of people
care about and are concerned about and, and want to hear people talking about more. And so,
I got that money and so I was able to propose at some other places. And so, the short version is
that this summer then, I've been speaking at different conferences. Like I spoke at PHB Tech this
year as an unconference session. That was the first time I'd done the talk. I spoke at
Open Source Bridge, which is a conference in Portland, in June, in Portland, Oregon. And then I spoke at
Lone Star PHP in Dallas. And then, let's see, where else there? Oh, the O'Reilly Open Source conference.
I just, I spoke at, yeah, I was at Oscon in July. And then I'm going to speak at Madison Ruby,
which is in Madison, Wisconsin. I'm going to do that next weekend. I'm going to speak there.
And it feels like I'm forgetting one. So, let me even look this up. But the point is,
that those are the places that, oh, oh, and then distill, which is a conference that
engineer has put on. I just last week went to San Francisco and spoke at that. So, that's the other one.
Um, was I, I went and was able to speak there. And, uh, that's really cool. It's gone very well. I've
been able to, the first one I only had audio up, but the, all the other ones I've been able to
videotape, um, well, not tape record. Um, well, enough to still call it tape. Yeah, I know. I
still say, can you tape that for me? Um, uh, and so I've been able to videotape, I said it again,
record, uh, on my phone, uh, all the talks and they turned out decently, at least that you can hear
and see what I say and you can, and, and see me talking and then you can see that you get the slides
and you can mostly follow along. Um, uh, and then, um, so yeah, that's, that's the, that's the,
that's the playing right now. So I'm going to speak at, at Madison Ruby next weekend. Um,
and then after that, I'm going to take a, I think, well, deserve break, because I'm very tired
been speaking a lot like past two months. Um, and then, uh, September, I don't have anything,
October, uh, I, I may be speaking or doing something related to Brooklyn Beta, which is a conference
that my company Fickdivkin puts on. Um, and then in November, I'm going to go to True North PHP,
which is a PHP conference that's, uh, co-organized by my podcast co-host Chris Hartress, so, uh,
so he has to let me speak. That's part of the rules. Um, and, uh, so that's, that's like that
for this year. Um, and the feedback I've gotten has been really good. Um, people seem to enjoy
and relate and, and, and, and, and find, relate to the talk or find it eye-opening. Um, so everything's
really gone very well with it. Um, and one of the kind of cool things is that, um, you know, since
the beginning, I've kind of been talking with, uh, you guys at Engine Yard, particularly with
Aiman Leonard, um, who, uh, uh, you know, contacted me and we've been talking with him and a couple
other guys who've been, who've been talking about the, the mental health issues within the tech
community. And, um, they at, at, uh, at the still, at the end of the still, they launched a, uh,
uh, a new campaign called prompt. So it's at prompt.engineyard.com, PRLM, PT, dot,
and new yard.com. And basically the idea is to, uh, start, is to do more and have engine yard
and hopefully other organizations do more to help raise awareness and keep this discussion going.
Um, and, uh, so they highlight, uh, works of, uh, Greg, you be, uh, great vouchers on
PRLM, his name wrong, it'll hurt me. And also John Dalton, um, who's another guy, and he actually
works for, uh, uh, engine yard, but he's been speaking about this stuff too. Um, and, uh, basically
give you opportunities to kind of like get involved and support what we're doing and also get
in contact if you want to speak or to come to a conference. Um, and so that's basically the idea
with, uh, with prompt. Um, and, uh, so we're kind of taking that, that's sort of a step where, uh,
yeah, an organization that has a little bit more financial resources can help keep this going.
And I think that's pretty cool. Uh, so I'm excited about like what, what engine yard wants to do
with prompt? And, um, I'm hoping that other organizations will get involved too. So we can kind of,
kind of keep that going and, and get people talking about this stuff. So, um, it's been exciting.
Uh, it's been a little hard, uh, because I get kind of nervous traveling a lot. Um, um, I, uh, I get
real nervous about things like planning stuff out and, um, worrying that I'm going to forget
something. And as particularly with flying, I get really nervous about that. And, you know, I have
a few things I have to take with me like I have to take my seat path and I take my medication. I
have to, if I don't have those things, I get real nervous and I get kind of nervous about going to
places I haven't been before and stuff like that. But, um, I, you know, all in all, it's really worked out
well. Um, you know, the responses have been really good. Uh, things have been going well. Uh, and I
think, I think we're doing some good stuff in terms of helping people feel freer to talk about these
things. Um, and I, so that's, that's the key for me really is to do that. And so that's been
really helpful to hear people, you know, acknowledge that that really is helping. So, uh, that's kind
of where we're at right now, like with the campaign. And, um, and I think, so I think it's gone really
well so far. I have a few questions, obviously. Absolutely. Um, your employer, uh, where do you,
uh, first of all, you're a family man. I am. Um, uh, how is your family taken to you've been
away so often? Well, that's a good question. Um, I, uh, I don't like to travel a whole ton,
and one of the reasons is that I don't like to put that burden on my family where I'm gone. Um,
that, uh, but the nice thing, the great thing is that, uh, I have a wife and a son and my wife has
just been incredibly supportive of it. You know, I had to talk to her and say, look, this is going
to involve me being, you know, a couple of these months, I might be gone for, you know, I've gone
off to two conferences in a month, and that means that I might only be here, you know, like half the
month, right? And, and how is it, you know, I, I need you to be okay with that because if you're
not, I can't, I can't do this, right? I can't, you know, I, uh, I can't leave her and, and just say,
this is something that, you know, to, to take care of our son on, on, on, on, on her own. Um, and,
you know, my son's got a lull, or so it's a little bit easier, but, uh, I, she has been incredibly
supportive and said, this is an important thing, and I think that you're supposed to be doing this.
So it's okay. Take the time. And it's, you know, it's not always easy. You know, sometimes she's
like, this is, you know, it's been a little bit tough, but she's just been incredibly supportive.
And, and, and really it, uh, you know, without her, I wouldn't be able to do this. Um, and without the
support of, of, of, of her, um, that, that, I mean, not just, uh, practically, but emotionally,
I wouldn't be able to do this. Um, and so she's been just incredible about it. Um, and that,
that certainly has been key in making this happen. Uh, I, like, I wouldn't, I wouldn't even be out here
if it wasn't for her. So, so it's been really good. And, uh, your employer, do you get time off
there? Or is it just for them to? So no, I actually have to take time away. And, um, uh, they've
been really good. They've been really good about it. Um, I work for, I'm a partner at a company
fictive kin. And it's not a huge company. And we try to not keep it too crazy, you know,
start-up-y, you know, we don't do things like work 70-hour weeks or stupid stuff like that. But,
um, you know, I, of course, had to talk with them and say, Hey, this is something I think I want
to do. And here's like the initial schedule I'm looking at. These are these conferences. And I,
you know, uh, it's just going to be okay. And, and, uh, you know, typically I think it was just
the thing where it's like, I'm just going to a bunch of conferences. And I'm going to, you know,
I don't know, even if it was like, I'm going to go talk about, you know, how to build websites.
They know that's, that's not as interesting or as compelling or probably as something that they
would be like totally okay with. But, um, given the, the, the, the topic and, and, and, you know,
this is a little bit of a different kind of deal, uh, work has been incredibly supportive. So,
the guys that, that effective kind of been, you know, my partners there have been very, very good,
in supporting what I do. Uh, and, uh, I tried to, you know, as much as I can take days to work.
So, when I'm not speaking, you know, I try to put time in on work. Uh, but it's hard, you know,
you have it, I, you know, you have to take days to travel. And if it's, I can't really work very
well in days. I have to speak because I have to think about my talk and stuff like that. So, um,
it does, it certainly interrupts how much, you know, I'm around and has interrupted how much
I've been around this summer. So, it's, uh, thank, I think they're glad that it's calming down some,
and September is going to be free completely and, and things like that. So, uh, but they've been
just incredibly supportive. Uh, so I could, I certainly could not do that without, without work,
you know, my workplace being that supportive of the, you know, that wouldn't happen.
Do you, how long do you intend to continue doing this?
Well, it's a good question. Um, you know, my idea was that the, the, the, the money we were talking about,
the fundraising we did, uh, uh, at the part that the Indiegogo campaign would be something that I
would talk about, uh, that would probably, you know, do this year. Uh, so it'd get me to a few
conferences this year. Um, I, my suspicion is that there will be, I'll, I'll keep talking about
it into next year, although I'm not going to, I don't think my intention is not to plan anything
more for this year because I want to kind of take it a little bit easy. Um, just, uh, not get super
burned out on it. Um, uh, the great thing is that one of the great things about prompt, the
NJDR campaign is that, that, um, some other people that they've identified can, you know,
are able to speak about these kinds of things too. And, uh, they can, you know, maybe if, if there's,
I, if I need to take a little downtime, you know, they can, they, they maybe have an opportunity to
get some other folks and maybe want to speak if people want them at a conference. Um, and so that's
really good. Um, and, uh, I, but I expect that I will continue talking about this, uh,
into next year at least. I don't want to, you know, I don't want to plan out too much ahead of time,
but I, I expect that I'll, I'll keep talking about this, um, because I think that there's better,
there's more people to reach. I think there's more discussion that we had, um, and, uh,
you know, to keep, to keep working at this and, and, uh, you know, get the conversation, keep that
conversation going. And, and I guess the idea really is to make it so it's not so stigmatized.
Um, a lot of people are really afraid to talk about their mental health issues and, um, or, you
know, don't know how to bring them up or understand sort of what's going on with folks who do have
issues, who do have struggles with it. And, and that's something that I think is a big part of the
problem is that our fear of discussing it, um, I think leads to people not getting treated,
and people, uh, having, uh, serious, uh, physical, and, uh, you know, problems because of that.
One of the interesting things I've been reading about is just about how, um, anxiety and depression,
um, how, uh, they can, uh, physically affect your well-being. So it's not simply just a matter of,
mentally, you're sort of not there, but physically it's okay and everything like that.
Now it's actually, uh, there's a pretty strong correlation between those things and, uh,
and, and, and your mortality rate. And essentially, you die sooner if you have, uh, if you struggle
with those kind of things. Um, and that is not entirely just say, uh, consideration from say,
something like suicide rates or something like that. No, it actually compromises your health, um,
and makes it more likely for you to, uh, be affected by a health issue by, you know,
things that are acknowledges just purely physical health issues or things like that. So, um,
that, you know, people don't get treated for this kind of stuff, um, because they're, because they're
scared. And because, uh, culturally, we're afraid to talk about this stuff. And, um, and off too
often time to get treated as if it's a matter of, well, you just need to calm down or you just need to
deal with it and, and, uh, and, and, and that is something like that where it's something like you're
just scared or you're just not tough enough. And that's, that's just not true. Um, it's a,
a real, you know, uh, depression, for example, is a real physical condition, um, uh, where your
body is actually going through a severe stress response, um, but it's doing it at a completely,
uh, inappropriate time or like constantly going through one. Um, and, uh, that dramatically impacts
your physical well-being. Um, so there are enormous biological elements to it. And perhaps
entirely biological. And it's just that we don't really know how the brain works very well. Um,
but there's a really good talk that I reference a lot, um, by a guy named Robert Sapolsky. Uh,
and I link to it if you go to, if you go to, uh, try and get in the show and old story. Yeah. Yeah.
Funkatron.com slash OSMI, open-source mental illness, open-sourcing mental illness, excuse me.
So if you go to Funkatron.com slash OSMI, it, uh, uh, it has this talk on the link from their
Robert Sapolsky on depression. And so Sapolsky is a biologist and, uh, a neurologist at Stanford
University. And he talks about, um, he talks about the nature of depression and biology of it
and also the psychology of it. Um, but essentially he posits that depression is the most damaging
disease that you can experience. Um, that, uh, it's, it's hugely disabling for people. Um, on a,
on a true physical level, it is not just in your mind. Uh, and it, it has a dramatic impact on
your physical well-being. Um, and is an enormous cause of disability in the US and becoming more and
more common. Um, but we don't treat that the same way that we treat things like heart disease
or lung cancer or diabetes. Um, we have a very different relationship with mental health issues.
Um, because culturally there's a sort of a belief, I think, that people who have mental ill health
issues, probably because we don't understand how the brain works. Um, and, or our understanding has,
has getting better, but it's still not great. Uh, we still have this expectation as well, really,
what they are. They're lazy or they are, uh, you know, just scared or, or tired or just don't
want to do things or just overreacting. And, um, well, I do think that a person has to actively
choose to get better and actively has to engage in their treatment. At the same time, um, I think it's
entirely unhelpful to be completely unsympathetic to folks who suffer from this. Uh, and, you know,
one of the worst things I, I hear from people is they say, just, it's no big deal. Just calm down.
Like that. If I could just calm down, my life would not be a problem. All right. None of this would
be a problem. If I could just calm down, I mean, believe me, I've been trying for almost 40 years
and it doesn't work that way. Um, it's, uh, it is far more complex than that and far more debilitating.
And, uh, but there are things that we can do and there are treatments that we can, we can, we can,
we can, uh, work with, uh, you know, these are not, um, unsolvable problems and, uh, these are not
issues that are can't be treated. Um, I think the biggest problem is that instead of treating them,
we're scared to talk about them. And as a consequence, people don't get the treatment they need.
And so, so that's kind of, that's what I'm really hoping to do with this is to get people
feel like they can be more open about it. And therefore, uh, feel the, and remove that stigma and,
and help each other, you know, uh, deal with these kinds of things.
And, uh, it sounds like one of your biggest triggers, uh, was being in places that you're unfamiliar
with in front of large crowds. And I'm just curious, what's it like now as you go about speaking
because you're, you're putting yourself, uh, through all that stress that seemed to land you in
the first place, uh, to depression? Yeah, it's funny. I, uh, I actually have gotten comfortable
with speaking in front of people. And that's not as big a deal. And it's, so it's, it's interesting how
there are some things that trigger you, but they're not, it's, it will be very specific. And it
of course varies from person to person, what can trigger somebody. Um, I know some people who are
super uncomfortable just talking on the phone with people, but if they speak in person, it's fine,
you know, if they don't have a problem with it. Um, for me, speaking in front of people actually
isn't a huge deal, although it can vary and certainly is not, it's not an unsreasable situation,
but I am comfortable with it. And I kind of deal with it. I think in a good way where I know how to
get myself ready for it and, and take positive energy into it and stuff like that. Um,
and I think part of that is because I've become comfortable and familiar in that position,
when familiar with the experience of that. Um, things that I do have problem with,
to have problems with are more likely to be issues, uh, where here's a, here's a great example.
I, uh, am often, like if I, if I go to someplace and I don't know how their public transportation
system works in, and I'm putting this in, you can't see, but I have little, little hair quotes.
How it works in the sense that like, well, how much does everything cost and where do these buses
are trained to go or things like that and where am I supposed to sit and how do I give them the
money and I do, they take cash and they credit or whatever. I don't understand how any of this works,
right? So, being putting myself in a situation like that, particularly when it, I know they're
going to be like a group of people on the bus who probably know how to use it and are going to
wonder why I'm, you know, like, or might be, I perceive as being annoyed because I don't really
know what I'm doing. That will immediately put me in a very, I will be very uncomfortable with that.
And while usually opt to avoid that situation entirely. Um, so, uh, like I've learned places where
I'm comfortable, like, okay, I can get to the airport and I can usually figure out where how to
take a taxi and if I know where to go, I just tell that taxi, take me here and I'll be okay,
just take me to the hotel where I'm staying and then I can figure out where the conference is and
then I go from hotel to conference and I can, if I need to, if I'm tired, I need to nap or something,
I mean, I can go back to the hotel and I know my way around stuff like that. Then everything is
probably going to be okay, right? Um, but, uh, I, I get, like, if I don't know what all the steps are,
or they fall out of it, it's like, well, you can do this, but you're going to have to, you know,
take some public transportation you've never heard of and I, and there's not going to be anybody
with you. You can, but just figure it out yourself. That puts me in a really, really bad place
where I'm very freaked out about like, uh, how I'm going to do that. And for a lot of people,
that's not something they deal with because it's like it might make them a little nervous,
but not really. Um, but what I have is I have a really severe stress reaction to that situation.
Is that ADD? Uh, no. Uh, I would chalk that up as to the, I have a diagnosis of generalized
anxiety disorder. Okay. And that would fall into that. So ADD really, um, has to do with like,
your ability to stay focused on tasks, um, and say, particularly doing tasks that you're not
compelled to do at the time, like not very interested in. Um, that's what I struggle with a lot
regarding that. Um, so, and it's just more tooth and that somebody could certainly look up
attention deficit to sort of their interest in it. But for me, it's, it's my anxiety and that
anxiety disorder that I have is that's where that's coming from where I have anxiety in play,
it like severe anxiety about things that do not that don't really warrant it. So it's not like
something that should give you anxiety, like somebody pulls a gun on you, right? Uh, it's
something like I had another example, it's one time I was going to some friends of mine were
getting together at a bar downtown in the city I live in West, in, in, in, yeah, in Lafayette,
India. And I was, uh, going to, I wanted to, they invited me to come meet them.
And it was a bar I hadn't been to before. And I didn't know like what it was like inside.
And so all of that kind of freaked me out. And I got there and sort of walked in front of the
place and decided that I just couldn't go in and was just going to go back to my car and leave.
And then a friend of mine who was inside texted me and said, hey, we're all here in the back.
And I was like, okay, that like pushed me enough to like get me in the door. Um, but I was super
super nervous about it. I was ready to just walk away because I was so uncomfortable with that
feeling of going into a place that was new. And I like, I didn't know sort of the etiquette.
And I didn't know like what it would be like. And it just just put me in a really bad spot. And
um, one of the things that I tend to do is, uh, I'll imagine like a four negative outcomes
really quickly. Um, so like if I, I'll form these different negative outcomes, like if I can't,
uh, like if this happens, then I will follow a chain of events down to suddenly I end up like
in a Turkish prison in jail for the rest of my life. Um, and it started off with like I got the
wrong kind of bread. Um, I, I can have sort of that, I could just form those kinds of things
really fast on my head. And that can be kind of problematic when they're particularly negative.
And you tend to kind of focus on like like, well, this is really going to happen. Um, and it's not,
and I know that I'm not, and I'm conscious of the fact that it's not logical. But it doesn't,
I'm still having severe anxiety about it. And that's what's, I think most frustrating about it is
that I know damn well that it's not logical. But the problem is that I feel like I'm not in control
of what my, my body's responses are to it. My emotional and physical responses are to the situation.
And that's, that's very challenging. And that's, that's one that, that's one of the reasons I
take medications because that helps me deal with those, uh, those things and, and reduces that
level of anxiety and problems, uh, to, to some extent. So for me, that helps a lot.
Yeah. It can I ask you, um, how this, the, the campaign and the, the talks you've done and so
forth have affected you? Have you found that in some ways it's, it's acted as therapy for you?
Yeah, I think so. It's, there's a couple things that have happened. One, it's, I think it helps me
when I get to talk about the stuff. And, um, I think that that's a, that's a helpful thing, um,
because each time I talk about it, it sort of makes me think a little bit, it makes me rethink,
you know, over that and wonder, you know, okay, well, what's some things that maybe I could do
differently about that or Halema, it's, it's, it's kind of helping me stay actively engaged in,
in, in treating it. And I think that's kind of a key thing for people is that, um,
people who do suffer from this. Uh, sometimes there's a tendency to just sort of go to their
general practitioner doctor and get a medication and that's sort of the extent of which they engage
in their treatment. And that helps for some people and that, that works for some people, but there's
a lot of people where it, there's, this is really, it's an ongoing thing where they're going to need
to kind of constantly be evaluating where they are, um, speaking with a therapist about things,
and then maybe additionally taking medication to and stuff like that. Um, this is a good way for
me to kind of keep engaged with these things and, and can it keep on top of them? It's certainly
been the case that it's pushed me to, you know, find, to sort of think about things in new ways and
I've introduced new things into the talks since when I started, um, based on things that where it
compelled me to kind of go up and research stuff or I learned about things from the, the, the people
shared with me or other people who are speaking about this stuff. Um, and, uh, and so those things have
been really helpful for me. Um, I think that, you know, and it's at a base level, if the fact that I
keep getting good feedback on this and people keep coming up and talking to me about their own experiences,
um, that makes it really, really, that's, that's just a very satisfying thing. Um, I feel like,
uh, the thing that I like most about open source culture is the idea of shared learning
and building things. And for me, I really, really enjoy that aspect of sharing what I've learned and
trying to help people that way. And so I really enjoy that when I can, if I help them, you know,
understand a technical thing or learn how to build a new kind of thing or, or just get a better
understanding of some kind of issue like that. And for this, this is just particularly compelling
because a lot of people seem to be getting something out of it and that, that helps me, it helps
me feel better. And, um, I think the other aspect of it is it's, it's made me sometimes
challenge some of my anxiety when I said, you know what, this is something I need to do.
And if I didn't have this sort of compelling me, I might be more likely as kind of back off and
not do this or not sort of challenge myself a little bit in terms of going out of my comfort zone
a little bit, maybe in terms of travel or things like that. And I've done a little bit more of that.
And this is, this is, it's, that's, that's been because I've done this. And I think that's been
helpful for me. In, in Britain, um, if you go and see your, your general practitioner and talk
about depression, they often, and of course, this is an experience I've had myself, I should say,
you're offered the possibility of CBT cognitive behavioural therapy. And that
tries to get you to sort of almost hack your own brain to the extent that you
are asked to look at the way that you respond to things and, and, and change the way you do it.
Have you had that experience at all? Is that something you're offered at all in the States?
Um, a lot of people have had very good success with CBT, um, uh, particularly people who deal
with anxiety. I have not, uh, pursued, uh, cognitive behaviour therapy yet. But in fact, based
on when I've kept hearing about it, as I've been talking with people, I'm actually intent to
pursue that. I, uh, right now, I just see a psychiatrist who kind of checks up on my meds every
few months and stuff like that. But I am, my intent is actually to contact our office and say,
hey, I would like to look at cognitive behaviour therapy and can you recommend somebody?
Because a lot of people have had very good success with a lot of people who have general
anxiety disorder or other anxiety related issues. Have had very good luck with it. Um, and, uh,
that, that that's been a, they've, that's been a treatment that, that people have had a lot of
success with. So, uh, I'm interested in doing it, but I, I don't have any experience with it myself
yet. So hopefully, like, you know, in a few months, maybe I will have some experience to try to
deal with that, um, because, uh, it sounds interesting. And anything that says that they've had
that much success with, that is compelling to me, uh, to try to, to do that and try to reduce my
symptoms. So, yeah, absolutely. Yeah, it's, it's, it's the sort of, um, it was, it was put to me as
here's a potential toolkit that you can use to, to modify your own behaviour. You know,
that seemed to be a very positive way of, uh, of approaching the problem. Exactly. Um,
you know, I, uh, I, and I think it varies for different people. One of the things that I try
really hard not to do and I encourage other people not to do is something they call, um,
okay, uh, cure evangelism, um, in which if you've had success with a particular therapy type,
um, the cure evangelism would be tell everybody you know who suffers from a similar,
uh, condition. Oh, well, you should do this because I had luck with that, you know, or, um,
you know, this is going to solve your problems. And the, the fact is that it, it, it seems to
vary dramatically. Uh, some people have, um, just have different experience with it, different
medications. People have different reactions to, um, different kinds of therapy. People have
different, you know, experiences with, uh, there's a lot of variables that we don't understand well.
So it's often very difficult to, uh, to say, uh, oh, well, this will obviously solve anybody who
has, say, generalized anxiety disorder. Um, and so, so CBT is something I'm interested in because
it seems like a lot of people have had luck with it. One of the things I'll, I understand kind of
going in though is that that does not guarantee that I will have luck with it. Um, and so that's
one of the things that I, uh, am, I, I try to keep in mind with everything. And, and that's why I kind
of talk about with being engaged in your treatment is you're got, you really need to kind of constantly
be evaluating how are things going and, and, you know, thinking about that stuff. My experience has
been that, and I think a lot of people says like this, that they often have to try a few different
kinds of medications and, and, you know, if they do take medications and they may, so they may have
to kind of strike on a combination that works well for them. And at the same time, they also may
have to modify their medication over the course of years. And that's not uncommon. Um, so it's, uh,
you know, that just happens, right? And so as long as you're, uh, as, as long as you kind of keep
that in mind, I think that you can kind of keep it a little bit more of a positive attitude about
that, but also, you know, kind of realistic that, um, so CBT seems like it helps a lot of people,
but it's not, there is no panacea solutions for, uh, for folks either. Uh, so, so yeah, but it does
look like there's some helpful things there. And for some folks, it seems to be very effective. So
I think that's very encouraging. Yeah. Yeah. I've, one of the things I was looking at some of your
YouTube, um, uh, talks. Yeah. Oh, they're on today. Very, I enjoyed them very much, by the way,
they're very good. Um, the, the bit I missed was the, the Q and I obviously didn't have,
there was no chance to do that in the session. I just wondered what sort of feedback you got from
people, you know, how, was there, was there much dialogue that followed on from the, from the
talks themselves? Yeah. Um, it pretty typically there's a fair bit. And, um, I, I've had a few different
kinds of things. Um, sometimes people will ask me about specific things that I've experienced.
It's like, well, what is it like if, you know, when you have this kind of thing? Um, so I've had a
few questions like that. Um, I've had some questions about, uh, like somebody asked me about like,
how, how do we help, uh, you know, what are effective ways of like doing within an organization,
like a workplace or something like that that deals with mental health well? What are the steps?
And I said, I am not sure because I haven't, I haven't, uh, I, you know, I've had pretty okay
experiences, but that's just not something I know a ton about. Um, uh, but one of the, but generally,
most of the feedback I get, um, will come, not just in the Q and A, but it'll come afterwards,
where people come up and talk to me. And I think that they feel comfortable sharing with me some
of the experiences that they may have had with, uh, mental health, um, or say people who they're close
to have had because they see that I'm talking openly about it and they feel like they can kind of
trust me about that. And I, I guess, I think that's good, right? Um, I, uh, I want people to be able to
talk more openly about it. Um, so the most common thing has been these, you know, where I get,
at least three or four people come up and talk to me and say, yeah, this is, you know, I have these
kinds of issues and to, you know, and talk to me about them and, and, uh, and, or they say, yeah,
my, my daughter, my sister, my brother, my wife, my husband, or, you know, things like that, um,
has gone through some of this stuff and, and, and so, uh, I just talking to me about that stuff.
And a lot of times I try to try to take away from that and find here, think about those experiences
and if there's something that I can take away from that and put back into my talks. Um, I had a
woman who talked to me about where she, uh, had to suffer from depression for like a decade until
she was finally diagnosed with a particular thyroid disorder. And she had been tested for some
thyroid issues, but wasn't tested for this particular thing. Um, and that, uh, turned out to be
the primary cause of her depression was that her thyroid was basically pumping these hormones into
her body that were causing it. Um, and that is not surprising necessarily, but it took her
a good 10 years to even figure that, to find that out, right? Um, and so that was an interesting
thing. I've kind of tried to take away from that as well. This is an example of sometimes it's not
necessarily what, you know, the average person I always expect. It can be, it can be a purely physical
cause, you know, and maybe it's not related to a psychological trauma or something like that.
Um, and, uh, so I think that, you know, those are really interesting. The other thing that I've done
is there's a website called bluehackers.org. Um, and at open source bridge, there was a
birds of feather session that was sort of related to the blue hacker site. Um, and I guess it was
it was started out. There was a, I think a Linux, um, conference in Australia. And they did a,
did one where they, and really it ends up being kind of a, a little bit like a, a, a, an informal
group therapy session where folks just kind of get together and talk about if they want to talk
about, you know, some of the stuff that they're dealing with, um, in a safe place where we don't,
you know, share it with folks. And we, I, you know, took that from the experience. I had
it open source bridge and then did a couple of other ones of them, uh, one at, at Loanstar, PHP,
and we did one at Ozcon. I did one with, uh, Paul Fenwick and, uh, who is also a great speaker
and is talking about his, his struggles with depression, really, really good stuff. He's PJF on
Twitter if you go there. Um, and, uh, so those have been really good and valuable and, uh,
interesting because I'm learning stuff from every one of those, you know, I'm learning what people,
different experiences are like and trying to take that into account. And, and feeling like, you
know, it helps me, uh, better represent a little bit and, and gives me a little bit more insight
that I can share with other people. And that's really, that's been really good. But yeah, from the Q&A
stuff, it's primarily been that like the biggest thing I get is people coming up and talking
me about what their experiences have been like. And, uh, most of those have been pretty positive.
And I felt like, hey, I dig where you're coming from and it's been pretty good. Um, I've had a
couple where it was tough because, um, a guy talked to me some about, uh, a family member of his,
who, um, has been dealing with stuff for a long time and really isn't probably, uh,
isn't getting the treatment, uh, the person needs and him trying to encourage her and he'd not
knowing what to do, right? Because it's, it's kind of feels like he can't do anything to sort of
encourage or to sort of engage in her treatment and actively try to deal with it. And that was tough
because, you know, you can't make people do stuff, right? And that's ultimately a really,
it's, it's, it's a painful thing, but something you kind of have to be able to forgive yourself for,
is that you're not responsible for even a siblings or a direct family member's happiness, right?
Um, and that, but that was, that was a tough one because there wasn't much I could really tell him.
I felt like I wanted to have some good advice for this guy, right? And I didn't, I didn't have
any good advice for him other than to try to say, I don't, I wish there was something I could
tell him, but I don't think that there's much you can do. You can't make somebody do something. And,
and you can't make them chew, you know, change and, and decide, yes, I'm going to, I'm ready to
get treated. So, you know, it doesn't, it doesn't work like that. We can't, we can't force people to
do the things that we think they should do. And that, so that was, that was tough. Like that was
probably one of the toughest ones I had, and sort of to feedback because I just felt like I wish I
had something better to tell them. And I knew it was hard. And it was really hard for this guy.
But I learned a lot from that too. You know, I think about, I think about his experiences and what
he told me every time I speak, because that's, that's part of it too. And he's not the only one
who has had to deal with that. It was had a family member who struggles with this stuff. And he,
and it seems like he can't get them to, to sort of deal with the problem and a really productive
ongoing way. And that's pretty common. And, but that's part of it too. And that's part of the
things that we need to understand and learn more about. So that was a tough thing. But, but in general,
the Q&A is just super valuable. Then the feedback, I get a super valuable from folks who,
who are willing to come up to me and talk to me about it. So, yeah. Yeah. It seems to be
a growing movement to do this type of thing. I'd heard of various talks, or at least a theme
of the last hackers on planet earth conference. I don't know if you spotted that at all yourself.
I don't think so, but let me look it up. It was, I think the last, the last hope conference,
whatever that was called, had something on mental health. Yeah, mental health. I heard that as well.
Yeah. And that was probably the most popular talk of the whole event. Yeah. So it looks as if,
you know, there's a change coming. There's a change in attitude that somehow or other,
we people who suffer from this sort of thing are prepared to get out there and talk about it,
can pass starting and can push forward, you know. Yeah. I think so. And I think that's really
encouraging. I, you know, I, and I think it's interesting that I think sometimes some of these
things happen not you're we're not conscious of there's some kind of movement or something like
that, but it's definitely the case that there are, you know, people who sometimes it's just so
they're so consciously that things that you see here, hear people talking about sort of start
to you thinking about that too. And so that has been, I'm, you know, it does seem that way.
It does seem like there's more people talking about this stuff within our sort of group is
open source culture and and tech culture. And I'm really encouraged by that. Like I said,
I think prompt, you know, it started off where it, you know, features three folks who have been
talking about this one, I'm one of them. And then, but encourages other people who, you know,
if they're speaking about this stuff to get in contact with them. And I think that's really,
really good. So, and I know there's other people, you know, like Paul Fenwick's been talking about
this stuff or for example, you know, we, so we start crossing paths because we were at some of
the same conferences, right? And it's been really good. So yeah, I've been very encouraged by that.
I think that's been all very exciting and and has kept me for being a, a very cynical pessimist
most of the time cautiously optimistic. So yeah, yeah, definitely. So yeah, I feel good about it.
I think more folks are talking about it. And I like the idea that that is going to increase awareness.
And my hope is, is not, is, is to keep that positive, sympathetic, and just to raise, you know,
more understanding about these kinds of things to, to have more empathy for folks who are going
through this to try to understand where they're, you know, what they're struggling with. And,
and how to enable them to seek the help that they need. And that's really what I, what I, I hope
is coming for that. And I think there's a, I think talking about this, that's going to happen. So yeah.
The, the various links that you have on your website, I've followed a few of them on your OASMI
page. And they look really good. I'm certainly going to delve into them in more, more depth. So thanks
for those. Oh, no problem. There's a couple of ones that I sort of like to, to, to point out,
there's depth press, which is a forum specifically for developers, I don't know, I guess it's not like
other people can't talk about, but it's kind of made for developers to talk about their, their
mental health stuff that they're dealing with. That's a really good forum, I think.
And a podcast that I find really valuable, it can sometimes be kind of heavy in the sense that
they talk about some pretty serious stuff. But there's a podcast done by a comedian called the
mental illness, mental illness, happy hour, that is really, really good. And I found it just
very, very interesting. This, by a guy named Paul Gilmarten, who's a, who's a comedian in the US.
And he has on lots of different people. Some of them, relatively famous comedians, some of them,
mental health experts, some of them, people who have just struggled with mental health.
And there's also a forum that's really good too. So it's pretty interesting stuff. Again,
sometimes it's kind of heavy and, you know, some of the topics are pretty, all right, can be a little
bit, you know, if there's not a better word for it, triggering in the sense that some of it is
a little, sometimes they talk about some pretty serious and hard stuff, but it's really, really good.
And to gain insight into what people go through and like what they struggle with, it's just
been really, really valuable. So I just learned a ton from these and really super good stuff.
And yeah, so it's, I think there's some good resources out there. I think the key thing is that
we can talk more openly about it. People are going to, you know, understand better, you know,
how to deal with it. And they're going to be more willing to get help. And that's really the key,
I think. Yeah, great.
Cool. Well, not cool, obviously.
No, that's pretty cool getting help. Not like that part.
Yeah, yeah.
So the thing I struggle with is, you know, I hear some of these got some sort of mental
issue, like, and we don't want you to say to the person, just,
break and run away. Yeah, right, right. Yeah, yeah, super not helpful, I guess, really, but,
I feel the third time I stop doing that. Oh, that's good. That's good of you.
You know, I think the thing that I found that, you know,
what I'm going to bring up because I have good notes on this, I'm actually going to open up
one of my presentations because I deal with this a little bit when I have a slide about, like,
helping people like friends and co-workers about stuff and how do you do that? And, you know,
I'm not necessarily an expert on these things. I'm just a person who struggles with it. That
doesn't mean that I know a ton about how, you know, how to speak to people in really productive ways.
I'm not a psychologist. I'm not a therapist. I don't really have any training in this stuff.
But I think the key things is that oftentimes I get people say, well, just take it easy, man,
it's okay. You know, and a lot of times I know that the intention is to be like, oh, well,
it's okay. They don't intend to, like, be unhelpful, but things where it feels like
the language is kind of dismissive of the problem. That usually makes it worse for me at least.
If somebody says something to me, like, well, don't get your paintings at a bunch or something
like that. That is both kind of sexist and also very dismissive. And that's a hard thing to deal
with. And I don't, you know, that I think there's four key things that I kind of put together.
We're talking about, like, if, you know, you know, that a friend or a co-workers maybe having
some problems with this stuff. And again, this is coming from my experience. And people are going
to have different experiences here. But the first thing I say is that I think it's really important
to help them feel safe. And I, you know, I know dealing with impression anxiety. I think a lot
of the key things is that at least my anxiety is driven by this, you know, what anxiety is is
really ultimately not feeling safe for one person or another being worried about something.
And so I think listening and trying to understand what it's like for the person is like really
key. Just listening and saying, okay, can you tell me about that, right? Can tell me what that's
like, right? Because the tendency is that people don't listen and really try to understand what
it's like. They sort of think it's like my worry about Mondays, right? Or something like that.
And it's really not. It's, it's a lot more severe. Even though it doesn't, and it's hard because
it doesn't seem, it's like, why are they all worried about this? This isn't a big deal. Well,
that's kind of the point is that they have a problem where they worry about stuff where it actually,
they shouldn't be worrying about it. The problem is their body is reacting in that way anyway.
Another thing is I think acknowledging that the person is really, is probably really frustrated.
I think it's helpful. You know, I know that I'm super frustrated with how I feel and how I'm
behaving. You know, I talked about that like, I logically know that I'm overreacting, but it doesn't
it doesn't change the fact that I feel like my brain and my body are screaming at me that
something's wrong and I'm not comfortable with it, right? So yeah, I do know what you mean.
The logic is not is kind of irrelevant, right? That's the whole point. That's the whole point
of the problem is that you're having it when it doesn't make sense to. And you have it,
unfortunately, it can become like a constant problem. I mean, that's why I have generalized
anxiety disorder because it's not tied to a particular thing like I'm afraid of say swimming
or I'm afraid of flying. No, it's about a lot of stuff like that that doesn't, you know,
that and all those things, I should say, you know, fear of those things, those are all legitimate
issues that people have to deal with and those are fine. In my case, you have a generalized
anxiety disorder or why I feel anxiety about lots of different situations
without good reason, you know, that where I have a much more severe reaction than I should.
And I'm very frustrated by that. I know that it makes things harder for people around me
because I'm like this and I don't like that. I know that it makes it harder to deal with me
when I'm in a bad mood and that I can have a mood swing really fast and get in a really
like shitty mood and people don't think that that's, you know, then the people who have to deal
with me at work or in my family or things like that and other parts of my life, they have to put
up with that and they have to learn how to deal with that and that's not fun and I know that it
makes things harder for them and I don't like doing that, right? The third thing, go ahead.
But on one hand, at least there's an explanation, you know what I mean?
Yeah, absolutely. At least you can look at the checklist and go, okay, what happened there?
Did you take his meds? Did you blah, blah, blah, blah, blah?
Oh right, you might not have slept while last night just.
Yeah, and certainly those guys contribute to that so that that's certainly the case.
I think the thing for me, because dealing with anxiety,
um, change is really, really scary for me and this comes up a lot with you, like if you work
in IT or you've got any kind of workplace really, but I think change is hard for a lot of people
and tends to make people uncomfortable, right? But it's really, really hard if something is
happening that's putting us out of our out of our sort of comfort zone and that is, that's really
scary. And the worst times I've had like finding out something, like the worst place to tell me
something that's going to, that might be like that is like in the middle of a meeting with like
30 other people, right? That's really hard. You know, and I've, you know, where it's like, I feel
like I can't really say anything and we're not in a lot of one sort of dialogue or maybe I can say
that makes me kind of uncomfortable or things like that. And I can kind of talk about how it makes
me feel particularly, it, I feel like I can't, I don't want to say anything because I feel like
I'll put myself out there as this like, well, why can't he handle it, right? And what's his problem?
And that's a hard thing to deal with. So I often find that it's like important to,
um, like talk to a person about how they feel and what they need. You know, if you know
somebody has who has struggles particularly with anxiety, like I do, ask them like, and maybe talk
to them one-on-one like ahead of time and maybe say, hey, this is going, this is something that's
going on. And here's, you know, and I want to hear from you how that makes you feel and what we
can do to help you, right? That immediately makes me feel better because I now feel like I can trust
you to be honest with you about how I feel and that you want to help me, right? And I can tell you,
it would really help me if this happened or if I could do this or if I could deal with it in this
way or things like that, or we can just keep talking about it and that your door is open or whatever.
That just, that makes it for me a huge difference. And then the other thing I kind of list out is that
if you know somebody who's struggling with this stuff, they may not need this but encourage them
and then the second thing to seek health and the second thing is to enable them to seek health.
And the sense that if you're in a position where you have some control over their ability to
go out and seek health or you are in a position where you can help them identify resources that
may be available to them but they're not sure about how to get to or they may just, they may be
struggle with the process of seeking out those resources and you can really enable them by
by having some of those things handy and say, especially people who in the USA don't have
medical insurance, that's really problematic. And if they have, if they have private medical insurance,
sometimes it differs like what is going to get covered in terms of mental health.
It's not as like, you know, if you get diabetes, it's pretty clear you can go get help for that.
But there's different, there's often completely different terms like for what you can get help,
you can get for mental health and it's much more complex and you know, you don't really know where
to go and things like that. But typically, there's resources available to people but it's not
necessarily well known like where you would go and where to start. A lot of times it's really
scary to start. So encouraging them and enabling them to seek health I think is really important.
So for folks who if you're working with people or you have friends or things like that,
you know, being able to do that I think helps a lot. That those are things that, like I said,
I get tons of feedback from people who say that who've talked about how they have really not
been willing to seek treatment and sometimes they'll say, I sort of feel like maybe I can now,
I've tried to hear a talk. So what that tells me is that there's tons of people out there
who are struggling with stuff and they're not, they're scared for one reason or another or
unwilling to seek help and helping them along a little bit and sort of like sort of lowering
that hump. They have to get over to do it. If you can help them with that some, you know,
I talked before. You can't make people do stuff. You can't make them help themselves, right? But
there's things you can do to make it easier and you make it easier if you say, you know,
maybe help them out and here's some resources for you. Maybe you could go talk to this person.
Things like that. And, you know, if you want to talk to me later, that's okay. You know,
I'm here. If you want to, you know, if you're just scared or something, you can talk to me. And
that's all right. Being able to do that, I think helps a lot. So those are like the things I
always, like in my talk, I try to bring up in terms of helping folks who, if you know,
that are going through some of this stuff. I suppose everybody's condition is kind of different
what you can do. You know, I suppose the only thing you can ask is, you know, what can I do to
help us? Yeah, definitely. It is different for everybody. And there's certain there's common
traits. I mean, that's why they're able to group things under different, you know, conditions
and disorders and stuff like that. But at the end of the day, figuring this stuff out is really,
it's a personal thing where you have to, you know, you have to engage in your treatments,
what I say. And in some senses, it's kind of scary, but you kind of have to take responsibility
for yourself in terms of I need to figure out what it's like, you know, what I need. And
it's a little different than because of our not always very good understanding of how these
things work. It's different than you go into a doctor and the doctor does some tests and says,
you have this condition, this is what you need to do. Typically, for this kind of thing,
somebody is going to listen to what you describe as your symptoms. And then, based on what you say
and how you explain it, they're going to try to offer potential solutions for you.
And that's like, that in and of itself is very different because it is very much how you describe
it. So you need to be kind of like to get the best and most effective treatment. You need to be
pretty aware of like self-aware, right? You need to be thinking about how am I feeling today?
What are the patterns that I see in my behavior? You know, what are the kinds of things that trigger
me to feel a certain way? How do I describe how I feel and that really gets it across? Things
like that, right? And so because it relies so much on that and there often aren't like, there
aren't obvious biological things they can test for and say, oh, your brain is behaving that way
and we know exactly how to treat that, right? It doesn't work that way now at least, right? So
that it's pretty different and that's where it's really got to be like, you need to be,
you need to learn how to communicate about how you're feeling and that's really hard for a lot of
people because it's very scary for them to talk about it. And so that's where it's like you find,
you try to find somebody who you trust to talk about those kinds of things, you find a therapist,
you feel comfortable with to talk about that stuff and kind of go from there.
Yeah, just two things I would say about that. One is we seem as far as mental health issues,
you seem to be like in the age of leeches and you know, boils, piercing boils as far as
we've had some series here on HVR in relation to schizophrenia. It doesn't seem to be very
well-scientific to me to be honest with it. No, you know, I think there's, and there's some
conditions we understand better. I think we have a better handle on depression, for example,
and we've learned some things about how we think that the biology works behind it,
but the interesting thing is it talks about that Robert Sapolsky talk. He says he goes into
some detail about like how we think neurotransmitters work and what are the neurotransmitters we think
are related to depression and or the lack of those neurotransmitters or what have you relate to
that. But he talks about he says, okay, so we know this stuff and we have these medications that
will help treat those deficiencies in certain neurotransmitters. And what turns out is that if you
just treat the biological symptoms, he only help about 30% of people. So what that says is that our
understanding of it is still pretty poor. We don't, from all of these things, have necessarily
biological markers for them. Like I said, you can't, it's not like you can necessarily test for it,
you have to listen to people and what they describe. And oftentimes we just don't understand
why the brain behaves the way it does. So we don't exactly know how to treat it. What we do know
is that we have some medications that it seems like they help. I definitely take some medications
where I look up where it says, you know, they get that they did different testing and obviously
to do testing and to see that it's not, it doesn't seem to actually like say kill people or stuff
like that. And then they think that, well, the way that this structure is, we think that it may
help with this because we think that this chemical has something to do with the way that they'll
like say people feeling anxious or something like that. And, you know, there will be a description
for a lot of drugs for mental illnesses that will say that we think that the way it works is
but they really don't know exactly how it works. But they're speculating that we think this is
what's going on. But you don't really know that. And it's just because our understanding of what
these things are, it's not that great. And, you know, that's kind of the nature of it as it is
right now. And so that can be a tough thing to deal with, right? But I, because it's so wide
ranging, there's going to be conditions that aren't dealt with as well, you know, when schizophrenia
can be one of them where I don't know a great deal about it, but I know that it's very difficult
for people to deal with and it, but there are some medications that help. Sometimes they have
tough side effects and that can be really problematic for people too. And that's a pretty common
thing, I think, you know, I think medications for things like depression and anxiety have gotten
better and I think our understanding of it has gotten some better, but it's still not great
and it still requires us to kind of feel out things and try to figure out what works and what
doesn't. But we do not have a complete understanding of like how the brain and it is interacting
with the rest of the body and exactly, okay, you know, from this to this, this is exactly why
that's happening and we don't have that. I think, I'm, I suppose, what you're doing here is you're
making this more public, at least among the community of hackers and so forth. And hopefully
people will start coming out of the woodwork and the stigma of this will be removed and the research
that is due to this will be hopefully assigned. Yes, that is exactly what I hope for. So that'd be
a good plan, right? Yeah, that was close that book. I think that would be awesome. That'd be awesome.
So that's exactly what I hope for. You know, like I said right now, it's really I feel like
if I keep talking about this and other people keep talking about this, things are going to grow
out of that and I expect that, you know, resources are going to pop up more about this stuff as we
keep doing that. Like the way that open source does, you know, the, you know, a lot of things tend
to happen organically and so resources tend to pop up where people feel that they can contribute
and people feel that they can help and and that's what I expect to happen here. So I think we're
kind of on the cusp of some really good stuff and I'm excited about it. So, so that's that's it.
I'm just going to keep talking and and unfortunately we have no time limits here in HBR. So
you can continue talking for as long as you like. Yes, probably could. I eventually might my
family will come home or way and or my my voice will run out. So, well, I might have to give up
eventually. But yeah, links to all the stuff that you've spoken about. I have here and there'll be
added in the show notes. You're right. See some of the stuff, even the lecture is creation
commons by SA, which is completely compatible with the HBR here. Yes, probably throw that in the queue
as well at some stage. Yeah, police feel free. If people, you know, I I had a couple of questions
about it and I said, well, I don't care what you do with it. I would like it if you at least,
you know, gave me a acknowledgement of what you do. But if you need to take these resources and
and if I've done some stuff that's helpful to help, you know, prompt you to to do something and
maybe talk about some stuff or share some things with people, please go ahead, right? And
that's that's where I wanted to take it. So I did go through and made all the talks and all the slides
CC by SA. So you should be able to do pretty much whatever you want to with it. Please don't do
something bad with it. But other than that, you know, I mean, I don't. Yeah, there you go. But,
you know, yeah, please feel free. If you want to rebroadcast or you want to just share whatever,
that's totally fine. So that that would be great. That would be awesome. Please do that.
Anyone else got any closing questions? No, no, no, I'm coming. No. All right. Cool. We fixed
mental illness. Excellent. Next thing. Yeah, it's all done. It's all done.
Is there a place? What I'm what I'm concerned about is that if you're next year running an
interview, go campaign and we don't hear about it. How can we, how can we keep up with it? Well,
my website is funcatron.com and I try to keep stuff posted there. Probably the other place that's
easiest to follow me is on Twitter. If you can handle me cracking wise about lots of stuff, but that's
the other place to hear it. But my website, funcatron.com is obviously RSS feed from that and things like
that. So that would probably be the best way either that or my Twitter account, which is just funcatron.
So yeah, we'll be in the show. Absolutely. So very good. Yeah, those would be the best ways to keep up. So
I'll keep talking about this stuff and please visit prompt to the prompt.engineyard.com.
And if you have things that you can offer, if you're doing a conference and want to have
somebody come and speak about some stuff, if you're an organization that wants to get involved
in helping support people who are speaking about this with their costs,
we really want you to get involved and that would be super, super helpful. So I think it was
good things happening there. Well, thank you very much, Ed. Hey, thanks. We do appreciate it. Yeah,
thank you for having me on. It's really cool. Yeah, thanks, Ed. All right, very much. Yeah,
I will talk to you guys soon. All right. Thank you. And everybody tune in tomorrow for another
exciting episode of Hacker Public Radio.
Stanford University.
Okay, there are all sorts of interesting diseases out there and lots of them are quite
exotic. You've got elephant, man syndrome and you've got progeria, which is new disease.
It's really basically die of old age when you're about 10 years old and then you've got cannibals,
eating brains and getting pre-ion diseases. And those are very exciting and you're great,
you know, junior high school papers about disease and such. Oh, you know, okay, come up to the front.
So there are all sorts of these great made for TV and TV diseases out there. But when you want
to come to basic meat and potatoes of human medical misery, there is nothing out there like depression.
Depression is absolutely crippling. Depression is incredibly pervasive and that's important to
talk about. I'll make the argument here today, a number of things, but one critical thing being
that basically depression is like the worst disease you can get. And I'll make the argument for
that in the dip. It is devastating. It is wildly common. Current estimates are 15% of us in this room
will have a major depression at some point or other in our lives. So that is not good. What is
also clear is it is worldwide. Currently, World Health Organization says depression is the number
four cause of disability on this planet. And by the year 2025, it's going to be number two
after obesity, diabetes related disorders. So it is bad news and it is becoming more common.
Okay, so what I'm going to talk about today are seemingly two very, very different topics and
tie them together at the end. And what the main point is is if you live inside only one of those
topics, you're not going to understand this disease at all. First topic, gain, what does biology
have to do with depression? Second topic, gain, what does psychology have to do with it? Okay,
so starting off first, giving a sense of symptoms. And right off the bat, we've got a somatic problem,
which is we all use the word depression in an everyday sense. You get some bad news about
something and not have replaced the transmission in your car, somebody disappointed enormously. And
you feel bummed, you feel depressed, you were down for a few days. That's not the version of
depression, I'll be talking about. Next version, you do have some sort of large legitimate
loss set back to whatever losing a job, unemployment, death, beloved one. And you are extremely
impaired by a sense of malaise for weeks afterward. And then you come out the other end. That's
sort of what I'll be talking about. But even more so what I'll focus on is the subset of individuals
who, when something like that occurs, falls into this depressive state and weeks and months later,
they still have not come out the other end. Terminology, the everyday depression that we all have,
now and then, that's an inversion. The second one, the something awful happens and you feel terrible
for a while and then come out the other end or reactive depression. The third version,
where you are flattened by it for long periods afterward, a major depression. And what you also see
with people with major depression after a while is it doesn't take something awful externally to trigger
one of those again. Okay, so what are the symptoms about? If I had to define major depression in one
sentence, I would say it's a biochemical disorder with a genetic component in the early experience
influences where somebody can't appreciate sunsets. And that's what this disease is about. And when
you think about it, that is a very sad thing. You look at some of our major diseases,
somebody with cancer, somebody crippled by heart disease, and you see the most unlikely things
out there. You see somebody saying, well, obviously I'm not glad I'm dying of cancer, but without this
disease, I never would have realized the importance of friends. I never would have reconciled my
family members. I never would have found my God on a completely weird level. I'm almost glad
this has happened to me. Humans have this astonishing capacity to derive pleasure out of the most
unlikely domains. What could possibly be worse than a disease whose defining symptom is the
inability to feel pleasure. Plus, at the top of the list, ad hedonia, hedonia, the pursuit of
pleasure, ad hedonia, the inability to feel pleasure. That is what a depression is about.
And you get someone who has just had some enormous guacamole, a long, sought relationship,
works out well, whatever, and they feel nothing. An inability to feel pleasure. Way at the top
of the list. What else? Grief guilt. And that's where we've got the semantic problem again,
which is the everyday sort of depression. Something happens, bumps us out, and by definition,
we're feeling some version of grief. Often we start accessing at that point over some miserable
thing we did to somebody 12 years ago and sort of despair in that. When you're talking about
major depression, the grief and the guilt can be so severe that it actually takes on a delusional
quality. Okay, not delusional, in a sense, the schizophrenic with delusions hearing voices,
thought disorder, but a certain style of extreme depression. Let me give you an example. You have
late middle aged guy, perfectly healthy, and suddenly, out of nowhere, he has a major heart attack.
He's lying there in the hospital, and the reality is he's going to recover. He's going to have to
make some changes in his lifestyle, but he's going to recover. He instead falls into a major
depression. This has transformed his sense of who he is. Suddenly, he's an old man. Suddenly,
there's all these things he can't do. He falls into a major depression. Yet, he's recovering.
Every day, his family is in there saying, look, you're just depressed. You're getting stronger.
The doctors are saying you're getting stronger. You're just depressed. It happens. The hospital
is circular. It has a corridor that forms a circle. And one day, the family is in there saying,
you're getting stronger. Look, the nurses said yesterday, you did one loop around the hospital,
and today, you did two loops. You're getting better. You're getting stronger. And the person says,
no, no, no, no. You don't understand. They're doing some construction last night. They closed
down the outer corridor, and they opened up a new little one to the two version of this one,
two loops there, shorter than the large one. I'm getting weaker. I'm getting weaker. I'm getting
gone. This is like someone expecting to believe that last night, we're like, beavers digging
and making this new. This was the father of an acquaintance of mine, a structural engineer.
This is when a structural engineer looks like when they're delusional to the point of saying
that this is a world in which everything is inevitably getting worse. Depression builds around
that. Next, of course, one of the most dramatic and one of the most awful symptoms of depression,
self injury, depression, depresses, mutilating themselves at a high rate. And of course, most
notoriously, suicide, risks of suicide. And that is absolutely tragic. And teenagers, early adults,
that, along with accidents, are the leading cause of death, major bad news. Another set of symptoms
that wanted to be important, something called psychomotor retardation. Everything is exhausting.
It's exhausting to do stuff. It's exhausting to think stuff. You were there and, you know,
you can't do the laundry because where's the basket? And you got to find change for the machine.
And you've got to go get detergent and just, it's too much. Everything is too much. And you fall
into this paralyzed state. Something very interesting in that regard. You get someone who is severely
depressed, like, to the point of hospitalization. And when they are absolutely tripled with psychomotor
retardation, that's not when you worry about suicide. This is someone who's having enough trouble
getting out of bed and getting dressed each day. They're not going to figure out how to shred the
hospital mattress and make a new set of it. Where you've got your problems is when somebody begins
to get better. From a severe depression, when they're starting to come out, that's where the
psychomotor retardation relieves enough that suddenly they've got the energy to do something catastrophic.
That's when people are on suicide watches when you have clinicians who are oriented well.
Next, something really interesting. And in lots of ways, the single point I want to hammer in here
over and over and over is something that people with depression constantly battle with. Back to
semantics. We all get depressed. That's what happens to us. We all get depressed. We feel
lousy. We feel withdrawn. We feel all sort of the sense of grief and we're not taking much pleasure
and we withdraw all of it. And then we get better. We cope. We heal. We deal with things in life
once to deal with you that you can't do that. And there's this lurking sense given that all of us
have periods of being depressed and come out of the end when you look at people who instead go
down and stay down there to this crippling extent, there's always this little voice between the
lines there of, come on, pull yourself together. We all deal with this sort of thing.
I will make the argument throughout here that depression is as real of a biological disorder
as is juvenile diabetes. And you don't sit down a diabetic and say, oh, come on, what's
insulin stuff? I'm begging of yourself. So together, you will see this is just as much of a biological
disorder. Part of what makes that clear are a bunch of symptoms called vegetative symptoms.
The bodies of major depresses work differently. First sort of symptoms. No surprise. Lots of people
have trouble sleeping when they're having every day off the rack depression. There's a certain
pattern with people with major depression. What would you think, you know, you're depressed,
you have trouble falling asleep, toss and turn, that's not what you see with a major depressive.
Instead, you wake up early. You wake up four in the morning, five in the morning, you're exhausted,
but you're not going to sleep early morning, waking it. You wind up in an emergency somewhere,
emergency room somewhere deeply depressed, and the clinician there better ask you at some point,
how's your sleep been? Do you tend to wake up early in the day? Early morning,
waking in classic sign. Additional thing. You did, while sleeping, sleep is not this model of
the process. There's all these different stages of sleep, slow way of sleep, deep sleep,
REM sleep, all of that. There's a structure and architecture to how these sleep through 90
minute cycles. As you go through the different phases, you look at the brain of somebody with
depression or their sleep pain, and these different phases are completely disorder. The whole
structure of sleep goes down the tubes. Look at somebody when they're sound asleep, and their
brain sleeps differently. This is not, oh, come on, stop babying yourself. This screams biology.
More versions of it. Most of us, what we do when we're feeling kind of down is we eat more
out of this general belief that when you feel I love carbohydrates, make you feel better,
and bizarrely there's actually a brain chemistry of that, of carbohydrates, decreased stress
hormone beliefs. So for most of us, you're feeling bummed out about things you eat more. That's not
what you see in major depression, decreased appetite. Another thing you see is activation of
the stress response. A class of stress hormones are highly elevated, and people with major depression,
you also have overactivation of something that's called the sympathetic nervous system adrenaline,
overactivity of these components and stress response, and that's really important.
Because you look at someone with a major depression who's just mired in the psychomotor retardation
stuff, and there's this temptation to start thinking about them as some sort of like sea spun,
or some invertebrate thing, where you're just so wiped out, you can't even get out of bed,
it is just debilitating in that sense. That's not what's going on during depression.
What you have instead is somebody whose body is blasting through their overactivity of
stress response, this enormous battle all of it going on internally. And the fact that you see
changes like these tell you this is not oh just so wiped out, you can't even activate,
this is someone whose body is having a massive stress response 24-7, there's a huge battle going
on, and it's all internally increased metabolic rate, increased muscle tone, all of this again
screaming biology. The final thing that says tons of biology is lots of people with major depression
have rhythmic patterns to the depression. You will get somebody where they will fall into
depression, where it will have two months of extreme severe symptoms debilitating,
come out the other end, and a year and a half later the exact same pattern a year and a half
later exact same thing. You have some people who only get their depressions during the winter,
something known as seasonal affective disorders, sads, and this is someone where something horrible
happens to them in June, and they feel sort of sad for a couple of weeks, and they come out
the other end, and nothing happens in January, and they fall into a depression and they're hospitalized
for a month and a half just like every January for the last 10 years. And you see that, and that is
all about biological clocks that are out of whack there, it's biology. This is not oh come on,
pull it together. Okay, so hopefully what that begins to introduce is the notion of
amid all these debilitating symptoms, these are ones that are about biology, these are bodies
working differently. So starting to focus in more on the biology of it. What's going on in the
brain in major depression? What I'll start off with is the chemistry of okay what we got here
do not panic if you were not familiar with this, and I'm not wanting to think about science
in high school sort of thing, you got two brain cells, you got two neurons, a way they talk to
each other, they don't actually touch each other, in order for one neuron to send a message to
another one, it needs to release a chemical messenger that goes floating over here and does something
or other to this neuron. Chemical messenger called a neurotransmitter, and here we have a case of
this, and by law all neurons go from left to right, so this is a cell, and I can tell these down
this way, it's all excited, it's trying to pass on some news to this neuron, there's a space in
between called the synapse, and what this one is doing because it's all excited, it has these
little water balloons filled with neurotransmitters, excitation signal comes along, dumps the neurotransmitters,
they go floating across the synapse, bind to a receptor there, and then suddenly something changes
in this neuron, that's how neurons talk to each other, how many different types of neurotransmitters
there are, probably hundreds, and what we'll be pertinent here is, in depression there's just a
handful of them that seem to be implicated. First neurotransmitter, something called neuropenephrine,
neuropenephrine, first I'd implicated in depression in the early 50s, in the early 60s around
it, what was the evidence? Around that time the first generation of anti-depressant drugs had
been developed, something called MAO inhibitors, what did they do? Okay, so you got your neurotransmitters
released, the system neurons excited, what you have to do, it comes out, it does this thing with
receptors, and then you have to clean up after yourself, you've like dumped all the stuff in the
synapse, what do you do then? You got two options, you can take the neurotransmitter and you can be
green in your orientation, you can recycle it, you could take it back up in here and stick it back
into one of these, you can do this recycling business, or you could be terrible and carbon footprint,
you can throw out your neurotransmitter, there's like enzymes sitting around here that break it up
and flush it down the toilet, what's the toilet out into your cerebral spinal fluid, your blood
stimuli, you're hearing whatever, so either recycling or degrading this stuff, so what do these MAO
inhibitors do, they inhibit the activity of this enzyme that breaks down neuropinephrine?
Okay, so what's the logic there? So you inhibit the activity of this enzyme, you don't break down
neuropinephrine, so it's just floating around there and for lack of anything else to do, it hits
the receptor a second time, and a third time, and a gazillionth time, and suddenly somebody's depression
goes away, what's your theory have to be at that point? Ooh, I bet there wasn't enough neuropinephrine
coming out, you find it means to increase the signaling, somebody gets better, and you now hypothesize
there's a problem with two little neuropinephrine, by the late 60s another class of antidepressants
came in and tricyclic antidepressants, what do they do essentially the same exact thing, what they
do is they gum up this pump that recycles this stuff, neuropinephrine doesn't get removed from
this and that has nothing else to do, hits the receptor a second, third, tenth time, person feels
better, ooh, I think the problem in my theory is two little neuropinephrine coming out, thus the
neuropinephrine hypothesis, more evidence for it, there are classes of drugs that will decrease
your neuropinephrine release, why would you want to do that in some parts of the body,
and excess of neuropinephrine has something to do with high blood pressure, so you take a class
of drug, something called recipe, and what it does is it disintegrates these things, and thus you
don't, don't, is much neuropinephrine, major side effect in lowering somebody's blood pressure
that way is they fall into a depression, so you take a depressed person, you find a way of
boosting up the neuropinephrine signaling, they feel better, you take a normal person, you drive
down their neuropinephrine signaling, they get depressed, there's got to be a problem here of
two little neuropinephrine, so that's incredibly convincing, so at this point what you got to say is,
okay great, that's convincing, that's irrefutable, what does neuropinephrine do, and people figured it
out in the fifties, and it's got something to do with this, take a rat and take a certain part of
the brain, you put an electrode down in there where you can stimulate the neurons, you can force
them to talk to each other, when otherwise they have nothing to say, stimulate this pathway,
and what you do is you make a rat unbelievably happy, okay, so of course the question is,
how do you tell them what a rat is doing, is you make it work in order to get stimulated there,
it presses a lever, and it presses a lever 25 times, and it gets a little buzz there, and it does
another time, and rats will work themselves to death, they get stimulated in this area,
it is better than food, it is better than sex, if they're addicted to a drug and going through
withdrawal, it is better than the drug, and what you see is this mediate's pure pleasure, and this
was called the Pleasure Pathway in the 1950s, so of course you look at it, and then what you have
to then say is, ooo, do we have the same pathway, can I have a new one, can I get a second one,
shortly after that people were looking, and saw the exact same thing in humans, and this would be
during neurosurgery, sort of classic when they're surgical techniques, you don't anesthetize the
person, the brain doesn't feel pain, once you've anesthetized the skin and the skull, you get through
there, and you can actually keep somebody awake during surgery, and they used to need to do that,
because you put plant on your little needle down one part of the brain, the person flaps their
arm, and another part, and they say, go pledge allegiance to rid of, and then you go,
if you're a little road map, and it says, okay, go three neurons and make a left, people have
to do that, so it was around the early 60s that people started stimulating the same area in the
human brain, and it is unbelievable what you got, there were transcripts of some of these,
and you read it, and the person is going on, and you see stuff like, oh, that's great, that's great,
that's kind of like sex, but you know when you have this itch, and finally you get to scratch it,
oh it's like getting back to bed, and you know, remember how like in the fall you'd go out and play
in the leaves, and Maul would call you in, and she'd make cookies, and then you get into your
jadges from the feet on, they'd just go on like, where can you sign up and have this happen?
The same exact sort of thing was in a wrap, and it was around that time that people discovered
that in this half-way, it uses your weapon effort, aha, so if you got a shortage of your weapon
effort in that part of the brain, what have you just explained, that's the loss of pleasure,
great, utterly convincing, here's all the reason why you shouldn't be convinced, problems began to
revert, first problem was there's something weird with a time course, you throw in any of the drugs
I've just talked about, and Nurepinephrine safely was changing within like an hour, you put a
depressed person on those drugs, and they don't get better for a couple of weeks, something isn't
working there, so that was mysterious, next problem was, they turned out Nurepinephrine is useful
in this pathway, another Nurepinephrine turned out to be even more important, Nurepinephrine
is called dopamine, dopamine protein works on dopamine systems, so suddenly Nurepinephrine
is just a minor player in this pleasure pathway stuff, but the biggest problem came in the late 80s
with the introduction of Prozac, which is an SSRI, a selective serotonin reoptic inhibitor,
what that does is we're going to complete a different neurotransmitter system,
this neurotransmitter called serotonin, what that drug does is it does the same deal,
it stops the reoptic, increased serotonin signaling, and then once your hypothesis,
ooh, you give somebody a prozac, SSRI, they feel better, I bet you there was two little serotonin,
so it was during this period where there was just endless tragic, you know, drive-by shootings
of Nurepinephrine people by the serotonin crowd, you know, they're having a huge, huge
controversy, and of course, like, middle of the road, where roles is, why can't we all get along,
it starts with a suggestion that, oh, maybe it's got something to do with Nurepinephrine,
I'm serotonin, I'm dopamine, and everybody hold hands and we pull my gosh, and that's
absolutely what's going on, the best evidence at this point to be insanely simplistic is that
dopamine has something to do with the acodonia, an absence of dopamine, the absence of Nurepinephrine
has something to do with the psychomotor retardation, the absence of serotonin is this obsessive
sense of grief, and interestingly, supporting that notion is you can have an obsessive sense of
something else, you can have an obsessive need to keep your utensils perfectly symmetrical,
and obsessively wash your hands eight hours a day, obsessive compulsive disorder,
that's helped by SSRIs like Prozac as well, whatever it is, you are just persevering over like
mad, getting increasing serotonin signaling can help, so you've got at least three different
neurotransmitters, relevant to the pleasure of the psychomotor retardation, all of this,
all sorts of other leads floating around the field, there's a neurotransmitter called substance
t, and what substance t is about is pain, like poke your finger and your spinal cord is neurons
there are releasing substance t's talking to each other, it's about pain, it's about chronic
pain syndromes, it's about whole body burns, everybody knew this, and then it was discovered that
if you get a drug that decreases substance pain, substance t signaling, sometimes depressives get
better, what is that suggest, it is not just a metaphor of depression or psychic pain,
your body is using the same brain chemistry to feel this sort of psychic pain of depression,
as just telling you, ooh I just stuffed my toe, interesting similarities there,
okay so we've got something about the neurochemistry, how about the neuro anatomy,
the structure of the brain, and what you've got here it is, this is the human brain,
this is exactly what it looks like, it comes in three colors, and this was this formulation that
came out during the 40s called the triune brain concept, which means once it really, really
inspires you, down here at the bottom you've got the really boring nuts and bolts part of the brain,
this was term, this is the reptilian part of the brain, take a lizard and it's basically the exact
same stuff down there, what is this part of the brain do, like regulatory boring things,
and measure your blood glucose levels, or if your blood pressure is dropped, it sends out a
signal to tighten up your blood vessels, just total boring plumbing type issues,
sitting on top of it is a much more interesting brain language, called the limbic system,
limbic system is about emotion, you don't see a big limbic system until you get to mallets,
lizards are not famous for their emotional lives, limbic system is much more about
the motive stuff here, and lust, and anger, and rage, and onions, and God knows what,
what you've got there are all sorts of ways, where the limbic system talks through this part of
the brain, and what it does is, rather than being hemorrhaged, you move part of this brain,
your body getting cold, whatever, you're some, you know, elk, and there's some scary other elk
there that's got you all upset, and you start secreting stress hormones, that's your limbic
system, saying, ooh, I don't like the smell of that guy talking down there, all sorts of means by
which your emotional part of the brain can talk this stuff down here, then you got the really
interesting area up on top, the cortex, cortex, all sorts of creatures out there have cortexes,
and we got more than anybody, it is this hugely expanded area, and primates, we proportionately
have the biggest one out there, what is cortexing you, it makes you do your taxes, and does like
processing visual information and tells you, aha, that's, you know, punk rock, and that's about
Beethoven, and all sorts of sensory stuff associated cortexes, but then there's an interesting part
of the cortex that's very relevant to all of this, okay, suppose you finish the lecture,
you go outside unexpectedly, you are gourd by an elephant, what are you going to do, you are going
to activate your stress response, you may feel a sense of grief at that point, you may kind of
hunker down at that point, a little psychomotor retardation, appetite, there goes the dinner arrangement,
sex may not be the most appealing thing under that context, you are having a stress response
in response to the sort of insult that this part of the brain is thinking about, so what's
a depression, you sit there and you think about kids in refugee camps, you think about the inevitable
mortality of your loved ones, you think about whatever, and suddenly your body does the exact same
thing as if you were gourd by an elephant, and what's going on there is you get the feelings,
the abstract sort of depressive stuff there, and this part of the brain is able to make the
rest of the brain go along with it as if this was an elephant gourd in you, on a certain totally
simplistic level, what depression is about is the cortex whispering in the ear of the rest of the
brain saying this is as real as you were just physically assaulted by some sort of a predator,
whatever, and you turn on the exact same thing, on a very simplistic level what the depression is
is the cortex having too many sad thoughts and getting the rest of the brain to go along.
Okay, so that's how you think about depression, which is insanely simplistic, you come up with
an insanely simplistic treatment for depression, which is get yourself a pair of scissors,
and separate that part of the brain to the rest of the brain, and you're home-free,
you guys are, oh yeah, right, well that's certainly an advancing medicine, that is a medical procedure,
it is called a singulonin, a part of the cortex, hold the answer to your singulonin,
a singulonin or a singuluvundal cut, and what you do is you sever this pathway, and people get
less depressed at that point. Okay, when does this happen? This is someone where every type of
medication, and every type of therapy, and electroshock interventions, all of that has been tried,
and every combination, and they're still on the back order of the state hospital, slashing the
risks every three months, that's when people try this, and the amazing thing of this
desperate measure is people get less depressed at this point. Okay, so at that point, you may want
to look at that and say, well, anything else about these people, when you've gone through, they're
just sitting away, mind you, this is not a frontal lobode, a frontal lobode is doing something very
undefined over there, but instead you're disconnecting here. What else is up with somebody when you
just disconnected part of that cortex, when you rest of the brain? Ooh, insofar as the cortex can
come up with abstractly sad thoughts, and get the rest of the brain to go along with it, maybe
the cortex also comes up with abstractly pleasurable thoughts against the rest of the brain,
if you just wipe out somebody's ability to have abstract pleasure, absolutely. So suddenly,
you are often running with a great philosophy term paper, who is important that we have pain in
order of pleasurable, this is nonsense. You get someone who's a candidate for this procedure
back in the state hospital there with the risk to start over, and this is not somebody feeling a
whole lot of abstract pleasure anyway. So what does this tell us? You come up with some ridiculously
simplistic explanation that, ooh, you make it impossible for this sad part of the brain to
whisper sad thoughts. The rest of the brain, the best people in the field thinking about this,
can't come up with anything a lot more sophisticated than that. So that tells you something about the
brain structure with depression. Final bit of biology here, hormones. What two hormones have to
do with it? One very important domain of hormones. You take somebody and they're having problems with
the classic hormones, thyroid hormones. What thyroid hormones are about is maintaining your metabolism,
keeping your body warm enough, all that sort of stuff. If you have a severe shortage of thyroid
hormone, lots of things happen, including you fall into a major depression. Hypothyroidism
is associated with major depression. There's an autoimmune disease called Hashimoto's disease,
which involves problems with secreting thyroid hormone, and that's a basic feature of it.
And somebody comes in, and you diagnose it, and you give them normal levels of thyroid hormone,
and awakens their depression. Lots of lessons with that. First one is, nest estimates are about
20% of major depressions are undiagnosed hypothyroid syndromes instead. The next one that demonstrates
is, you better, when somebody is thinking about your psychiatric state, you better have somebody
there who's thinking about your nutrition, your hormone levels, your nothing about what's
coming up here, because independent of the rest of the body. So a big role for thyroid hormones.
Next domain of hormones being relevant. You take women, you take women, and they have a higher
incidence of major depression than men do, approximately twice the rate. In addition, women have
their highest vulnerability to depression at certain points in their reproductive life histories.
After you've given birth, a post-parturational depression, around the time of your period,
around the time of menopause, all of these screen biology. So you look at why women have
elevated rates of depression, and there's biology, there's all sorts of other schools of
thought that had gone into it. There are ones having more kind of sociological framework,
lack of control, can cause depression, society after society. Women traditionally have less control,
no wonder they fall into more depression. There's another school that focuses on a certain style
of emotional differences you see between the genders. On the average, women tend to
lumenate more on emotionally upsetting things to focus in on more, in the sense totally stereotypical,
and when you do the studies, there's overlaps between individuals, but nonetheless, on the average,
what you see is these sorts of studies where you get someone after they just had a fight with
a close friend, and what do women do when they get the choice of a whole bunch of activities,
they choose to fill out questionnaires about how they met their friend and what the relationship
is with a friend having good marriage, and all of that. You do it to guys and they fill out
questionnaires about like trivia questions about the Civil War. Oh my god, they can express their
emotions. I wonder if they're impossible. And of course, in individual variations, this is
highly stereotyping on the average, though, women lumenate more on upsetting emotions than meant.
So that is solid science. What is completely unsolid science is the speculation at that point
that if you lumenate on bad feelings, you're more prone to depression. So that's a whole emotional
regulation argument. But you come back to that business of women are most at risk for depression
in the two weeks after being birthed, where the period of their period isn't in a pause,
and that's all about hormones. And by now, there's a huge literature having to do with the effects
on all that stuff over there of estrogen and progesterone, and probably most importantly,
the ratio of estrogen to progesterone, and what's going on around giving birth, what's
period meant, levels of this stuff is just shooting around all over the place, and the sense is
something goes out of whack with the ratios there and everything about estrogen and progesterone
or ratio, they change the number of receptors for these neurotransmitters, the extent to which you
do this reoption upon, whatever depression is going to turn out to be on as nuts and bolts level,
estrogen and progesterone can do something to it. Final class of hormones that are relevant,
a class of hormones released during stress. Okay, what's the most famous stress hormone on
our earth in adrenaline? The adrenaline is this vastly overrated hormone that I despise because
there's a much more important stress hormone out there, to which I've devoted the last 30 years
in my life, a class of stress hormones called glucocorticoids. They come out of your adrenal
gland, where you stress the human version is hydrochlorism, also known as cortisone,
all sorts of other species have their use to create these glucocorticoids when you are stressed.
You look at people with major depression and about half of them have elevated levels of
glucocorticoids through the roof. There is something out of whack with the regulation
of the stress hormone during depression. What's that about? That's back to people with depression
are not in good or with similar beds. These are bodies under going massive stress responses.
There's a huge emotional battle going on all of it inside their heads. So elevated stress hormone
levels. What's very clear is you get exposed to a lot of glucocorticoids and you're at risk now
for depression. You can see this epidemiologically, you get people and statistically before their
first major depression episode, something awful, stressful occurs. And that's where this happens.
And this is the subset of people who stay down there far longer. Have one of those first
depressed episodes due to some stressful event become the other side eventually. You were no more
at risk for depression than anybody else. A law comes the second major stressor and you fall
into a depression, come out the other end, no more at risk for anyone than anyone else for depression.
Somewhere around the fourth or fifth stress-induced depression, something happens and things start
cycling on their own there and you no longer need a major stressor to cause you to get depressed
like that. That's when the clocks are often running. That's the transition. Okay, so major stress
can predispose you towards depression. More evidence, there's a disease called Cushing's disease
where people secrete boat loads of this glucocorticoid stuff. People with Cushing's
fall into depression. There's a whole bunch of diseases where people have to be treated with lots
of glucocorticoids. They fall into depression. What are glucocorticoids doing? A whole lot of them
and your brain gets depleted of dopamine and you're right back in this domain that's probably
where you're at chemistry, how you get there. Okay, so what do we got at this point? We got
something about brain chemistry, depression, we got something about the structure of the brain,
we got something about hormones. You are a card carrying biological psychiatrist and that's
all you need to know about the subject. If that's all you know about the subject, you are going to be
kiddifully bad at making anybody get better because all of this knowledge winds up being
effective for treating maybe 30, 40 percent of depresses. The vast majority of people with
anti-depressant drugs don't give a whole lot there. All you got there is modern cutting-edge
biology stuff and that's not enough. So what I'll transition to here is now talking about the
psychology of depression because you better have that piece of the story or else you're absolutely
useless. Starting off with, I make apologies here, but I actually have to say the name of
Freud. Because he wants to be very relevant to depression. Freud, back when, dealt with this puzzle
of the difference between, we all get depressed and come out the other end and the subset of
people who crash. In the turn of the century, V&E's term for people who come out the other side
morning, you mourn something that you recover, turn the century, V&E's term for major depression,
Melancholia. Freud in this famous essay said, why is it that a subset of us fall into it,
Namka, wants the difference between mourning and Melancholia? And he came up with a really
interesting model. According to Freud, you have mixed feelings and people and seas about everybody
love out there, you love them, you hate them, you resent them, you hear them from them, you reject
them and all that Freud and stuff. So, in this Freudian view, you have lost a loved one.
That can also be a loved concept, a loved goal, a loved thing, you have lost a loved one.
What happens then is, in most people, you are able to focus on the love and the sense of
loss. You mourn and you come out the other end. In Freud's view, what Melancholia is about is
the subset of people who can't put the negative feelings in the background and instead you are a
wash and a love and a hate and a regret and a pain and a delight and all of that and what a
depression is, is this wallowing, this melancholic loss and the ambivalencies you have about the lost
love for. It explains tons. No wonder you have the grief, lose somebody and go through the
morning business and only one thing is wrong, you've lost this loved one, lose somebody with
melancholy up and two things have happened, you've lost the loved one and you have now lost the
opportunity to ever make things better with them. No wonder you have the guilt, you're sitting
there saying, thank God, I'm finally done with this person, you're never going to control my love.
How can I think such a thing like that, some crippling guilt, all sorts of other symptoms and
out of this came this wonderful sound bite, depression is aggression turned inward because you've
got nobody else out there to have these arguments with. This is the person who you have the most
love that looks hated and you've never said the things you needed to hear and pounding at the
door to get them to finally be able to tell them and now you've lost that opportunity forever and
all you can do is internalize all of that aggression turned inward. No wonder you're not feeling
a whole lot of pleasure, no wonder you're secreting stress hormones, no wonder you're not getting
out of bed all that readily with a psychomodery partation stuff, this really powerful sound bite
of aggression turned in. That's great. What isn't great is how and how do you turn like
Freudian ambivalent feelings into something about neurochemistry or like what do estrogen
progesterone ratios have to do with like love hate ratios, it's great, it feels very intuitive,
it can't do moderate signs on it, which is a problem with the best parts of Freud. Okay, so instead
you need to shift over to looking at experimental psychology and understanding what is the
psychology of stress, what is it that makes psychological stress or stressful and an enormous
literature now shows that for the same external misery you feel more stressed, you turn on stress
response, you need more risk or stress related disease if you don't have outlets for the frustration
caused by the stressor, if you feel like you have no control over what's happening, no predictability
is when it's occurring and you don't have anybody's shoulder to cry on. This is what psychological
stress is about and what a depression is is pathological extremes of this. You fall into the
cognitive psychology sound bite of what a depression is, it's to learn helplessness, it is learning
to be helpless. Something bad happens to you, you are rat getting some shocks now and then you
are human experiencing some loss and the logical thing you should do is learn this is awful.
When I'm in this situation there's not a damn thing I can do about it, it's awful, I feel terrible
but this is not the whole world. And what a major depression is about is you sit there and you
are that rat and in this setting you get uncontrollable shocks but put you in another setting and just
by hitting a lever a couple of times you avoid the shocks you don't bother doing it because you learn
to be helpless. Just like a human depression, what depression, what learned helplessness is,
is taking a circumstance where by any logic again you should be saying this is awful for
it is not the whole world and do this cognitive distortion and decide this is indeed the entire world
and I have no control, I am always helpless, I am always hopeless, this is the psychology
of what a depression is about. At that point you don't have a whole lot of trouble seeing how you
wanted up in here, stress affects on some adult and all that sort of stuff. Okay so we've got two
extremely different weak points here as to what depression is about. Modern technological stuff
and there's totally different world of psychology, loss, lack of control, one version of it, one of
the most reliable findings in the whole epidemiology of depression is lose a parent to death when you
are under 10 years of age and for the rest of your life you are more at risk for major depression.
This makes perfect sense. What is a lot of what's going on during your first 10 years of life?
You were learning about cause and effect, you were learning about, you were learning,
is this a world out there where I have any sort of efficacy where it means sort of control and you
have just learned in the most big time awful way, there are things you can control and sometimes
they are awful and what have you just learned, there's all sorts of reasons where one can be helpless
and that looks closer to this edge of this learned helplessness cliff for the rest of your life.
Extremely powerful model here of that. So you've got all the biology stuff, you've got this
weird Freudian aggression turned inward which just feels right but you can't do modern science on it.
You've got this whole world, how do you begin to put this world and that world to get
and the critical link turns out to be stress. Stress is the intersection of the two in a very
interesting domain. Okay, depression is a genetic disorder. What do I mean by that? Depression
has some degree of heritability, depression tends to run in families, depression runs more reliably
as you look at closely, closer relatives and you eventually look at identical twins and if one
of them has depression the other has a 50 percent chance. Full siblings who are not identical twins,
25 percent chance, half sibling, about 8 percent, person off the street, about a 2 percent,
50 percent chance when they share the identical genes. What does that do that tells you this is
a disorder that has a genetic component? What does that also tell you if we've got 50 percent
likelihood, if you've got all the genes in common and you've got a 50 percent chance of
not getting the depression, it tells you genes are important but they're not more important
than any other component. So genes in depression are not about inevitability, they're about
vulnerability. So what is the vulnerability about? A few years ago people discovered a particular
gene that's really relevant to whether or not you get depression. What was exciting about that?
It was a very clear finding, it has since been replicated. What else was exciting about it?
It made sense. This was not some weird little gene having something to do with how your
big toe functions. This was a gene having something to do with serotonin. And this was a gene
relevant to this whole reuptake pumping business all of that. The main point of it is this gene
comes in two different flavors. Each one of us has one of the two versions and you immediately
get this prediction. One of the versions by all logic should be predisposing to depression.
One of them is the one that should get you more trouble. So what does it look like when you go
and study it? First paper that reported this a few years ago and this I suspect is going to
wind up in the unit as the most important paper in biological psychiatry for a quarter of the
century. This was this massive study where a bunch of researchers looked at 17,000 kids growing
up in New Zealand following them year after year and looking at the genetic makeup of these
individuals and then asking in their early 20s who's got problems with major depression?
And then asking this critical question, what does it have to do with this gene?
There's the version of that gene that gets you into trouble. My all logic is that going to
set you up for more of a depression. You're more at risk for depression if you've got the bad
version of the gene and back comes the finding which is no, it doesn't increase your risk.
Look here and once you're likely to have depression and you've got the good version and it's
slightly and you've got the bad version and it's this likely doesn't make a difference.
And less something else is going on and less you have a history of exposure to major stressors
and what you are able to do is quantify how many major stressors somebody has had during
their childhood, their development and that involves trends of divorce and physical abuse and
death. The family member, all that sort of thing and what you see is in the folks who have
the good version of the gene as you have more and more of the history of major stressors,
your risk of depression goes up. Absolutely. Now you look at the people with the bad version of
the gene and as you have more and more of a history of stress, your risk of depression does this and
when you look at the major history of stressors, a 30-fold difference in the likelihood. This is not
about, ooh, genes control our brains and genes control our behavior. This is a gene that is
relevant to how readily we pick ourselves up after life has dumped us on our rear ends, how readily
we recover from stressors. What's the final piece of that story? Look at chord chords
regulate the function of this gene. All the pieces fall into place there, wonderfully logical
and suddenly you have a way of taking this whole world of psychological components of stress
and tying it into all that biochemistry wonderfully integrated model. Okay, so in lots of ways,
this is where the field is at at this point and what should mostly have come through here
and met all this, my notion, in fact, all of that is the role of stress and the intersection of
biology and the psychological stuff and childhood as an important time to imprint how vulnerable
you are to depression for the rest of your life. But again, the single thing I want to emphasize
over and over implicit in everything on that left side of the board there, which is this is not
oh, pull yourself together, we all get depressed. This is as real of a biological disorder as
is diabetes and that's the thing I most want you guys to take off from here and in the context of
a university setting is a life with major depression. The community of high achieving
typing individuals is a life with major depression. It is all around us and admittedly all around us
and there is this weird corrosive inhibition and baris mint discomfort. We have the world's
psychiatric diseases, one of the greatest things if you're a researcher of disease, one of the things
you pray for is for some powerful senator to have their loved one come down with your disease
because they're so foundation, it's actually fun and it's advocacy groups and all of that
not for psychiatric disorder. That's the one where people don't talk about it.
And amid the screen biology, this is a devastating disease of all of that in any place and especially
in a community like this where everyone who's supposed to be golden and functioning and
flawless and just gliding through life is one of the hardest diseases for people to admit to.
So it is there, it's all over the place and it's biology and you should be no more inhibited
about admitting that you've got something going on that's funny with this type of gene
then you would be to admit that your pancreas is into creating insulin.
So let me stop at this point and again, unfortunately I got to sprint out the door
otherwise, we'll take questions, but, uh, we'll do it. Thanks.
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