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
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 :)
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
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"?
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.
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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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
/1
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!
/2
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.
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
/1
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.
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:
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
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
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.
Debunking Antivaxxer Myths
"🇪🇺 Vaxxed Countries have higher mortality"
No, they don't.
This is COMPLEX:
a) countries had different PRE-VACCINE infection (offers more dangerous protection than vax but indeed protection). Obv, vaccination NOT correlated with pre-vax death.
/1
b) The FIRST VACCINATION SERIES against OG COVID was phenomenally effective at preventing infection, transmission, illness, hospitalization, and death (VE >80-90% in all).
This is clearly evident by one of the most striking correlations you'll see!
COVID deaths vs Vax:
/2
And because COVID was the primary driver of excess mortality in 2021, excess ALL CAUSE mortality was almost identical to COVID MORTALITY.
He presents data to scare people into believing that vaccines have caused harm, & he continuously is on the bandwagon that C19 vaccines cause cancer. This is contrary to the damage.
Here, he's using a report using 1998-2019 data.
/1
In fact, there was such a DROP in incidence (assumed to be due to lack of access to health care) in 2020, that they had to amputate the model at 1998-2019 so that it wouldn't project a decrease! (a reasonable thing to do!)
/2
In their report, they clearly show that their trending is based off of models that ONLY end at 2019. ZERO PERCENT of this report is suggesting, implying, or reporting that vaccines have led to an increase in cancers.
He will have a huge platform & can say what ever he wants as long as there is right wing grift.
He is a licensed professional being held standard.
/1
It is against his license to publicly suggest to die by suicide.
It is against his license to publicly & intentionally call physicians 'criminals,' people "not beautiful" or "appalling self-righteous moralizing things."
His license prohibits misgender people intentionally.
/2
The standards of his college are publicly available; including social media. By being licensed, he represents his college and the profession, and that college/profession gets to have a say in how they are represented.