Tyler Black, MD Profile picture
Aug 24, 2019 27 tweets 8 min read Read on X
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.

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/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

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More from @tylerblack32

Sep 3
🚨COVID-19 Vaccination saves lives and improves outcomes 🚨

In this UK study of >3 MILLION PEOPLE who vaccinated, the incidence of mental health problems was significantly reduced when a subsequent COVID-19 infection occurred.

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Looking at the totals who were infected with COVID-19, it is clear that COVID-19 diagnosis was associated with a ROBUST increase in mental health problems after the diagnosis.

/2 Image
This adds to the massive and still growing body of evidence that Covid 19 Vaccination was safe, effective, and extremely important especially considering that after this study, virtually everyone was infetcted with COVID-19.

/3
Read 5 tweets
Aug 29
Yet another study finding differential impacts (mostly with decrease of symptoms) on the mental health of youth comparing prepandemic to pandemic times.

The media far far far less likely to report on these now common findings.

/1


jamanetwork.com/journals/jaman…
My colleagues and I talked about this at length, that there were many reasons to be cautious about the early "expert predictions" and in fact when good evidence was considered, many so-called evidence based scientists were wrong: dire outcomes on mental health harder to find.

/2


Our '23 peer-reviewed commentary here, g despite many professionals who attacked my us for daring to suggest we interpret evidence cautiously rather than childishly reducing issues & acting like sensationalists, I am certain our publciation holds up well.ncbi.nlm.nih.gov/pmc/articles/P…
Read 4 tweets
Aug 4
❌Mythbusting❌
Youth suicide & COVID

❌Myth:
responses to COVID "caused" 🔼youth suicides

✅Reality:
We now have 4 years of pandemic data showing that school-aged youth did NOT have an increase in suicides; in fact, rates decreased 18.3% from recent trends AND averages.

/1Image
This is true for girls in the US (pretty much right on the 3-year average (-0.8%), and 16.3% less than expected from the 10-year trend).

/2Image
This is true for boys in the US (10% less than the 3-year average and 18.9% less than expected from the ten-year trend)

/3Image
Read 22 tweets
Jan 31
Talking to kids when they're struggling🧵
For parents (or anyone who cares for kids!)

It can be really scary to notice something in your kid & be worried suicidality/self-harm.

How do you approach kids?

I've had this conversation >10000 times so I have some tips!

Be CALM

/1Image
CALM is a memory-trick to remember the key concepts of communicating to a struggling kid but also to remind you to be in control of your own emotions. If you are prepared, you will defeat your initial instinct, which will be to FREAK THE BLEEP OUT!

/2Image
First, COOPERATE!

You & your kid are a team, and you have a common goal: their present & future wellbeing. Don't set yourself up as the security guard, jailor, punisher, or antagonist. Don't push. Don't pull. Be alongside them, tell them you're willing to walk with them.

/3Image
Read 17 tweets
Jan 30
Suicidology
Predicting Suicide Death

A recent study looking at >2M Americans presenting to ERs with MH concern shows the difficulty of "predicting suicide" - we can't predict suicide to help guide important clinical decisions.

The problem: Sensitivity vs PPV

/1Image
They used machine learning EMR-coded variables (outpatient visits, medications, previous appointments, age, etc etc) - you can see the entire dictionary used to "predict" here (word doc):

They had 2,069,170 ER visits and 899 suicides within 90 days.

/2ars.els-cdn.com/content/image/…Image
After running the model and letting machine learning do its thing, the best fit had the following predictive properties at the 95% percentile cutoff of risk:

Sensitivity: 34.8% (deaths/positive predictions)

Is this helpful?

/3
Read 18 tweets
Jan 20
Debunking Antivaxxer Tropes:
"Antivaxxer is a slur" 🧵

Many many many accuse me of using a "slur" when I say "antivaxxer". It is a twitter shorthand for sure, but it is not a "slur", and I use it without regret or remorse.

/1


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I certainly believe that if one is an "anti-vaxxer", they are not using science, reason, or reality to understand vaccines.

& I note a distrubing trend in antivax and some concerning other beliefs.

That being said, when I say antivax, I only mean "antivaccine belief holder"

/2


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Check out my "antivax misinfo" threads. Someday take a look at the "hidden replies" & note that the antivax profiles are quite.. well.. recognizable.

Note: Do not assume every "Antivaxxer" is, I just notice the trend. As do many of my colleagues here space fighting misinfo.

/3
Read 10 tweets

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