Thread by @tylerblack32

THREAD:
"What's wrong with this BS?"

If you are #depressed, you are living in the past
If you are #anxious, you are living in the future
If you are at peace, you are living in the present
- Lao Tzu

WRONG! But good for teaching.
#meded #psychtwitter #somepsych #medtwitter

(quick trigger warning)

This is intended to be educational re: depression & anxiety. It mentions concepts that can be difficult to read about suicide, trauma, and depression. If you're not in a place to read it now, come back later :)

My cat distracts: instagram.com/chasiuthecat/

A psych mini-tweetorial and a bit more #philosophy, but this is important in #medicine and #psychiatry.

Ultimately, I hope it'll be obvious that this quote is simplifying, stigmatizing, and harmful. It's classic pseudo-profound bullshit.

gif.co/tV6G.gif

/2

First, the quote is likely fake.

It is attributed to Lao Tzu (Laozi) the (likely) mythical author of the Tao Te Ching, foundation of Taoist philosophy and religion.

It's been attributed to many (inc. Warren Buffet). Many believe it's from a Brazilian motivational speaker./3

Laozi (if real at all), almost certainly did not mention depression or anxiety, modern concepts. He mentions fear and shame, but only occasionally. Generally, Taoist principles aren't mindfulness principles, which came later. Past accomplishment matters in Taoism.

/4

Second, the attribution of this pseudo-profound BS to Laozi is very likely intentional.

Often, "eastern wisdom" is brought to the west as "magical" and "mystical truths," a common stereotype that is NOT HELPFUL. Even modern applications of mindfulness fall prey to this.

/5

So far, with this quote, we've established:
* the dude is maybe not real
* quote doesn't exist
* its contrary to Taoist principles
* whoever first faked it is trying to evoke a pseudo-profound "Eastern Mystical" stereotype

NOT A GOOD START!
/6

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But, third, and most important...

THE CONTENT IS TOTALLY WRONG. There is no profound statement WHATSOEVER in this wrongly-attributed, fake, stereotypical quote.

/7

Let's break it down.

"If you are #depressed, you are living in the past."

This is a stigmatizing, simplifying, hurtful stereotype of a view of depression that leads to all sorts of hurtful "advice", assumptions about weakness, and other problems.

DEPRESSION IS COMPLEX.
/8

Depression affects how one perceives THE PAST:
* guilt about events and actions of the past
* regret about past relationships
* grieving a previous loss
* self-hatred regarding a past trauma
* negative misinterpretations of past events

/9

Depression affects how one perceives THE PRESENT:
* worthlessness and guilt about self
* burden placed on friends/family
* boredom
* active/current suicidal thinking
* malaise; fatigue; appetite change; lethargy
* negative misinterpretations about present moments

/10

Depression affects how one perceives THE FUTURE:
* hopelessness about the future
* shortening of future
* overprediction/unacceptability of failure
* contingency / expected suicidal planning and thinking
* negative misinterpretations about future events

/11

Unsurprisingly, a depressive episode can distort and affect all areas of cognition.

NOTHING is true about "#Depression is living in the past."

It is a common myth; a stigmatizing thought that leads to unhelpful suggestions, and a gross oversimplification.

/12

What about "If you are #anxious, you are living in the future"?

Guess! WRONG WRONG WRONG WRONG

/13
gph.is/1DKWZXr

Anxiety can affect how one sees the PAST.

This is called "retrospective" or "review/edit" anxiety:

"What did they think of me?"
"What if it's the last time I saw them?"
"What did I say?"
"What if I said <x> instead?"
"Did I make a mistake?"
"Do they like me?" etc.

/14

Anxiety can also affect the PRESENT moment.

It's called "experiential" anxiety.
Eg:
"what are they thinking right now?"
"is this person mad at me?"
OR
- hypervigilence in PTSD/trauma
- obsessions in OCD
- panic attacks and symptoms
- helpful anxiety: car horn

/15

And of course, anxiety famously includes many apprehensions about THE FUTURE.

These are called "prospective" or "anticipatory" anxieties.

- foreshortened future in PTSD

"What if I fail?"
"There's no way I'll get it."
"I'll get sick."
..etc.

/16

So once again, this fake quote by a mythical person contrary to the ideologies of the book in evocation of an eastern stereotype IS WRONG.

Anxiety can distort many things about how one perceives the past, future, and present.

/17

Finally, lets tackle the idiocy of:

"If you are at peace, you are living in the present."

This entitled, selfish, privileged, narrow bullshit statement is completely unrelated to reality.

I value mindful practice. I value quiet moments. But I am damned lucky to have them.
/18

Can you think of anyone living in the present who isn't at peace?

I'll give you a subtle hint:

VICTIMS AND SUFFERERS OF WAR, TRAUMA, ABUSE, HOMOPHOBIA, TRANSPHOBIA, VIOLENCE, POVERTY, RACISM, SEXISM....

If not you: Be peaceful PRESENTLY when a bear runs into the room.

/19

Of course, when you ARE SAFE and FREE/AWAY FROM OPPRESSION AND VIOLENCE, it can be very helpful to practice mindfulness, or other forms of relaxation (mindfulness is a good package for relaxation, but it's not magic).

/20

In moments of distress, it can be helpful to think of a goal in the future, or a happy moment/memory of the past.

When in an argument with a loved one, your history with them helps you still love them.

I wanted to be a doctor, so I sometimes sacrificed present for future.

/21

So why did I call it pseudo-profound? Because, like many, when I first read it I was like, "huh. cool." But when you think about it, the profundity goes away. It is not a helpful statement, a true statement, hell, it doesn't even have the proper author.

/22

And, worse, it's "helpful hints" like this that completely marginalize, mock, degrade, and devalue the true experience of depression and anxiety, and make it seem like some three line prop-quote can cure these problems.

/23

So the next time you're at a conference (HEY LEADERS, I know you like quotes!!!), and you see some quote like this, take a moment to REALLY digest it. More times than not, it's Deepak Chopra Generator - level BS.

wisdomofchopra.com

/24

If you are someone reading this and you know someone with anxiety or depression; instead of offering superficial advice, try listening and asking "is there anything I can do to be helpful?" This question is probably 1,500 times more useful than "you should..." advice

/25

If you are a physician, please try and remember that depression is a HETEROGENEOUS set of pathways and causes leading to a variable but common phenomenology. It's not simple... it's complex.

/end