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

Howie

Today’s episode is one of the most remarkable and really, unique, pieces of content we’ve ever produced (and I can say that because I had almost nothing to do with making it!).

The producer of this show, Keiran Harris, interviewed our mutual colleague Howie about the major ways that mental illness has affected his life and career. While depression, anxiety, ADHD and other problems are extremely common, it’s rare for people to offer detailed insight into their thoughts and struggles — and even rarer for someone as perceptive as Howie to do so.

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

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

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

Mental illness is one of the things that most often trips up people who could otherwise enjoy flourishing careers and have a large social impact, so we think this could plausibly be one of our more valuable episodes.

If you’re in a hurry, we’ve extracted the key advice that Howie has to share in a section below.

Howie and Keiran basically treated it like a private conversation, with the understanding that it may be too sensitive to release. But, after getting some really positive feedback, they’ve decided to share it with the world.

Here are a few quotes from early reviewers:

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

Someone who works on mental health issues said:

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

And another reviewer said:

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

We also hope that the episode will:

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

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

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

So we think this episode will be valuable for:

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

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

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

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

We’ve collected a large list of high quality resources for overcoming mental health problems in our links section below.

If you’re feeling suicidal or have thoughts of harming yourself right now, there are suicide hotlines at National Suicide Prevention Lifeline in the U.S. (800-273-8255) and Samaritans in the U.K. (116 123). You may also want to find and save a number for a local service where possible.

Get this episode by subscribing to our podcast on the world’s most pressing problems and how to solve them: type 80,000 Hours into your podcasting app. Or read the transcript below.

Producer: Keiran Harris
Audio mastering: Ben Cordell
Transcriptions: Sofia Davis-Fogel

Highlights

People around you are struggling with this

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

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

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

Micro goals

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

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

Howie: Yeah. I like that.

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

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

Seeking out treatment

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

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

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

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

Having a clear plan before something bad happens

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

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

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

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

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

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

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

Ugh fields

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

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

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

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

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

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

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

Balancing a job and mental illness

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

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

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

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

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

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

Moralising around diet, exercise, and sleep

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

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

Medication vs. therapy

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

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

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

Health insurance

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

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

Keiran: Oh wow.

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

Keiran: How expensive are we talking?

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

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

Howie's day-to-day experience

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

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

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

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

What anxiety feels like

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

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

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

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

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

ADHD

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

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

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

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

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

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

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

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

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

Imposter syndrome

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

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

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

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

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

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

Articles, books, and other media discussed in the show

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

Books

Blog posts

Other media

Additional mental health resources

Related episodes

About the show

The 80,000 Hours Podcast features unusually in-depth conversations about the world's most pressing problems and how you can use your career to solve them. We invite guests pursuing a wide range of career paths — from academics and activists to entrepreneurs and policymakers — to analyse the case for and against working on different issues and which approaches are best for solving them.

The 80,000 Hours Podcast is produced and edited by Keiran Harris. Get in touch with feedback or guest suggestions by emailing [email protected].

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