Then other thing is, no matter how smart you are, you can’t debug yourself, you need other people. If you have a distorted negative feeling of yourself, then when you try to fix yourself, you’ll be more inclined to feel something isn’t working or you are doomed the first time you hit a roadblock or relapse.

And ultimately sometimes medication can help you get through the initial hurdle of such negativity, another reason you need to see a professional to evaluate this.

Go check out YouTube and Wikipedia for some cognitive behavioral therapy sources to see if it might fit.

This is very true, and not always realized.

Another way I heard it said which is easy to remember: "You can't read the label from inside the bottle."

John Forbes Nash: Why not? Why can't I?

Dr. Rosen: Because your mind is where your problem is in the first place!”

- 'A Beautiful Mind'.

Sometimes we have internal parts that need love and care more than they need lecturing on cognitive distortions.

CBT is effective for many people which is great, but there are other options.

Personally, I found it helpful to read some of the books on these and related concepts, as a supplement to therapy. Also, it can be a frustratingly slow journey.

I didn't go through CBT with a therapist. I just read the first few chapters of The Feeling Good Handbook, then tried to establish a habit of confronting my negative feelings, and the thoughts that were feeding them by identifying the distortions in those thoughts.

YMMV, but it may be worth a try.

You should reword that. Otherwise how did humanity last this long? Psychotherapy is less than two centuries old. You should instead say something like, "One option is to see a therapist."

There are friends, elders, books, and a number of other ways to climb out of a mental rut. Traipsing "Psychology Today" for a therapist who will charge the insurance $150 for 40 minutes of a session, through Zoom no less, with your $40 co-pay after deductibles is such a commercial approach to what is fundamentally a human problem.

You know a very modern problem? You can't sit easily and talk with friends over a drink about your issues and have someone give you constructive advice. Everyone is remote, busy, prefers chatting online, and as a result a lot of loneliness manifests as "Oh my god, what am I doing with my life."

I say this as someone who rather successfully turned things around with a therapist - I simply did not have it in me to have those conversations with others and I didn't feel I had the relationships or support to do so (in retrospect I probably did, but that's the thing about mental health).

I don't think your diagnosis is wrong, particularly - there's a lot in the modern world that promotes alienation, feelings of low self esteem, and depression, but I think a lot of people find themselves at the bottom of the well before realizing quite what's happening and without the support structures to get out on their own.

(Edit just to note that, like physical health, mental health is not just the consequences of one's own actions - both genetic predispositions and unexpected life events can necessitate professional intervention by no fault of one's own. It's not what we're talking about, but just so nobody takes my post to be a psalm from the church of the self-sufficient.)

It's just a sad state of affairs that there are so few other options for people. I continue to pin the blame on the remote-first nature of society, which seems to make in person interaction secondary. It perpetuates loneliness which perpetuates mental health issues.

I suspect that the number of people who could benefit from quality therapy, greatly outnumbers the amount of quality therapists that exist in the world.

To the point where, I surmise, a vast majority of the world's population simply would not have meaningful access to it, due to location, finances, availability, introversion, etc.

So for me, it's not that "get therapy" is bad advice. Good thing is good. Therapy has proven techniques and results. But that doesn't help the majority of the world's population, who do not have access to the luxury of visits to high end trained professionals that only exist in suitably affluent settlements of certain countries.

I also suspect that the broad lack of coverage for therapy and other kinds of mental care in most medical plans, as well as a "treatment/cure"-type paradigm when it IS covered ("we expect your 40 years of accumulated neurosis to be adequately addressed within 6 months, otherwise we're not going to pay anymore") is part of why this is out of reach for many people.

(I also suspect providing the population with broad access to mental health care would almost immediately pay for itself in terms of better physical health outcomes, improvements in the crime rate, and better economic outcomes, but that's the kind of second- and third-order thinking we're pretty notoriously bad at in this country, policy-wise)

1) what I refer to as "psychiatric" therapy, with a specifically "medical" way of doing things. It's based on diagnosis and pathology, with a focus on treating the underlying causes of mental health problems. This typically amounts to chemical intervention. The provider will always be someone with a medical license, typically an M.D. or PsyD, although it can also be an RN or PA; someone who can prescribe drugs. While not always the case, talking with them is generally limited in scope to what is necessary to provide a diagnosis and appropriate medication management. It's normal to have appointments on a monthly basis initially, often stretching to a brief visit every 3 months as one's condition stabilizes. You will need to continue to see them for as long as you take medication (although you can sometimes convince a primary care physician to take over medication management once an effective treatment regimen is established).

2) what I refer to as "psychological" therapy, this is often in the form of talk therapy, and focuses more on cognitive understanding and behavioral modification, and can even be as simple as having someone listen to your shit, put it into a reasonable perspective, and provide emotional support or even just providing human interaction. Often the provider will have a Master's or Doctorate in psychology, which is NOT a medical degree. While some psychiatric doctors will also handle this type of therapy, it's much more often they'll refer you to someone who does this. It's quite common to see this person for an hour each week, but can be more or less often and may also include group therapy. They focus on teaching coping skills and can provide CBT and the like. Some people may continue to benefit from this therapy and go for years, others may stick around just until they establish the coping skills needed for their situation.

I'm probably over generalizing, but it's uncommon to start out not knowing what to expect at all, so if even one person reads this and benefits, it was worth me writing this long post on my phone at 2 a.m.

I also have a bit of a warning, with either type of therapy, it's not uncommon for patients to think they should see results pretty quickly, and when they don't they will assume it's not working and discontinue treatment or assume their therapist is inept and jump between several in short order. Imo, this is the worst thing someone can do, it may take a few months for medication to show results and more often than not the first few tries can fail to help, and it can literally take years to develop behavioral changes and coping skills to the point they show real benefit. People that give up on therapy too quickly can end up losing all faith in therapy for the rest of their life, and losing that kind of hope can even worsen their problems. I struggled from my late teens and all the way into my 30s before I really began to really feel like I hit an appropriate balance in daily life, and that isn't guaranteed. However now if I fall apart, I can put myself back together in a matter of days instead of wallowing for years.

For me it took a long, long time to see results. Like 2 sessions a week for 6 months... then see slight improvement... then a major regression after some difficult life events... then another year of thinking I wasn't seeing progress... then rapid improvement.

But, in retrospect, there was constant progress that I wasn't in the right frame of mind to observe. One of my issues was that I had spent decades learning to ignore my issues. It took a lot of progress on that issue before I could see most of the other progress I had made.

One thing I could observe quickly was just how bad things were. Almost every session was revealing new ways my thought patterns were making things hard when they didn't need to be. Not what to do about those thought patterns yet, but just that they were there. That convinced me to keep doing the hard work. I'm glad I did.

That's really not how you framed your comment.

> There are friends, elders, books, and a number of other ways to climb out of a mental rut.

> I continue to pin the blame on the remote-first nature of society, which seems to make in person interaction secondary.

Which doesn't concern the majority.

> It perpetuates loneliness which perpetuates mental health issues.

You seem to think mental health issues originates in loneliness. I can see how convenient that outlook is but it's nowhere that simple.

This is an important data point and a general trend toward the cheapening of human relationships. Friendship means something very specific, and for a lot of people now it means only the superficial. Anything deeper than that is actively discouraged. I think of those surveys about friendship took this kind of friendship into account. The number of people without any friends at all would be outrageously high.

Person 2 is first of all, hard to find, unavailable, and extremely expensive. They don't know you, and in general aren't willing to share their own personal experiences with you. The interaction with Person 2 is transactional and does nothing to affirm the importance of your suffering to someone other than yourself.

It's a little like your suggesting to have sex with a prostitute because they're better at it. But that misses the point of what sex is even for. A lot of the time we just want to be assured that we matter, that our experience matters, and that we aren't alone. But yeah, a lot of people see it like you do, and I think that makes it a worse culture.

I do agree that today's generations seem to be less deeply connected than older generations. Relationships take work and vulnerability, but today's distractions make everyone feel they are short on time and make us too absorbed with the perfection of the masks we wear. Its a shame, because deep friendships are truly something to be cherished.

"True friendship is a plant of slow growth, and must undergo and withstand the shocks of adversity, before it is entitled to the appellation." - George Washington

And then also there are just less and less friends. In any friend circle there are some people that are just better to lean on. As you get older these people move away, get married, etc.

OP: Life can be good and does indeed gets better, if you are not in a good place, please do talk to someone, try to make a change, no matter how small, and stay strong.

I tried lyra. All the wording and questions ask screamed to me "these are not my type of people". I'm not going to go into specifics but imagine you walked into a help conference and every table had energy stones, power of pyramids, astrology books, etc... If you're anything like me you'd walk out.

Once I made it past all that it recommended some therapists all of whom were white. The metro area I live in, 8 million people, is only 60% white in total and many areas are majority not white. I tried changing my location to an area known for being majority not white but it just gave me the same people.

It just got me wondering how much of therapy is a white culture thing because it seems statistically unlikely that of the 11 therapists it recommended, all 11 would be white if the demographics of the area say that only 60% of the population is white.

It was no different on BetterHelp.

Another possibility is there are cultural norms: psychotherapy originates in Europe / Central Europe where it had a blossoming in the late 19th century and spread, and became quite fashionable in among the educated classes (up to and especially in the 1960's, for example).

I assume non-white majority countries also have psychologists/therapists, though.

If you take this:

https://www.who.int/data/gho/data/indicators/indicator-detai...

and plot it against a GDP per capita data source, they're basically aligned.

https://www.huffpost.com/entry/what-therapy-is-like-around-t...

Poor people generally avoid discussing issues in public and then discuss them with family.

But far more frequently violence and alcohol are the default "therapy".

Religion and procreation?

How can I find someone I trust and is actually good? Not like the movies where the clock is up and ok next issue.

My work offers a mental health service but I’ve looked at their TOS and no thanks.

Sometimes I feel like just suspending the world background process and being still would be nice. But I don’t have sudo.

Also, read through https://www.psychologytoday.com/us/basics/therapy/how-find-t...

I immediately told him I wanted more time, and within a couple of weeks, he had other openings in his calendar and we established a cadence that works much better for me.

All this to say that, psychology today is a legit resource that works, and just getting your foot in the door with any therapist is the most important thing you can do to get treatment. It’s not easy, but it can be done, and for me it has been worth it.

Starting to talk to someone is key; that gets the process rolling. Asking for help is the start, and after doing that if one doesn't get a satisfying answer, they can ask someone else. But if they never take that first step and try to ask, they've gone nowhere.

Seek referrals from real people in your area.

You do have to be prepared to be vulnerable to some extent, but if they’re any good they’ll earn trust and develop a working relationship with you that is comfortable.

Source: multiple years of therapy. Definitely worth the effort and the cost.

I remember it being really hard to know what I wanted from therapy the first time I did it which made choosing a therapist feel pretty overwhelming. Had to drop the first therapist I saw after a couple sessions because it wasn't for me (and a good therapist will tell you "you might want to seek out another therapist").

If you really want to, you can read about the different therapy methodologies that therapists commonly use, but as a first-timer I found that to be pretty overwhelming and just reading the therapists' descriptions of the kind of work they do and clients they typically work with ultimately more helpful in choosing someone I could work well with.

I will caveat by not knowing what country you are in and the norms there, so this is coming from a US centric approach.

1. Talk to your health insurance; they often have scheduling services

2. Talk to the Kassenärztlicher Bereitschaftsdienst of your state, e.g., Bavaria has this on offer: https://www.kvb.de/service/patienten/terminservicestelle/ter... If you don't know where to head to, call 116117. Easiest way.

3. Go to your GP - he can guide you through this or can forward you to a psychiatrist

4. Use the online service from the association of psychotherapists: https://www.psychotherapiesuche.de/pid/ersteschritte

If you have suicidal thoughts, search for a local Krisendienst Psychiatrie (https://duckduckgo.com/?t=ffab&q=krisendienst+psychiatrie&ia...), they can help you immediately.

The most important thing that OP has to learn is that he is not alone, there are professionals out there that can help you. But you have to make the first step.

Here is a good (long) guide in English: https://www.bptk.de/wp-content/uploads/2019/09/2019-09_bptk_...

  (1) go to a GP (Hausarzt) and explain my situation so they fill up a report and confirm that the issue is indeed psychological and not physical,  

  (2) go to a therapist that works with public insurance so they can write another report, your therapist might refer you to one of his/her colleagues, and  

  (3) email five therapists that work with public insurance and ask them how long their waiting list is. They likely will all tell you it's longer than 3 months, which is what you need to hear.  

It's like dating. I think within the first 4-5 visits you'll know if someone is trustworthy and is giving you some insight. Note, they won't be able to give you the really great insights until you feel you can trust them, but they should be able to give you a couple of things to ponder / act upon even in the initial stages.

Remember, if you meet a therapist and you aren't feeling it isn't a good fit, that's ok. There is nothing wrong with you (or them), it's just not a good fit. Be honest in your feelings, and don't worry about disappointing anyone in the process. This is about you and what's best for you.

The professional is there not to be a regular person to know, but someone to who you can emote and feel openly your hardest things you hold inside. This expression of those things makes them less haunting and distracting inside yourself. This technique does not necessarily fix your material problems, but it allows you to clear the way within you to take them on.

It is not for everyone, and it is worth a try when you are feeling hopeless.

There are lots of good online therapy things now. Although I’d recommend doing in person if you can because the latency of emotional exchange is much higher in the space of the world. Even still the online work can be hugely beneficial.

Even if your worldview has left you bereft, your body deserves a chance to reformulate your mind for this opportunity at existence.

I still believe that any therapist is better than none, because it forces you to do something, which will change the narrative from "it's hopeless" to " I'm working on it just haven't found the right match". That shift alone is worth the cost.

You can do this free of charge just by visiting the library, or finding pdfs online.

Metacognitive Therapy. Effectively, when dealing with persistent unwanted thoughts, it teaches you to let them pass without judgement / evoking response, and to divert your attention elsewhere. I find that this complements CBT well if one has already done the work of recognizing that some thoughts are unrealistic distortions. Proponents of MCT seem to bash CBT needlessly; they needn't be mutually exclusive, and at any rate, evidence suggests that CBT is generally effective (and there's a much larger body of it than for MCT).

> someone who keeps you accountable and committed to a course of treatment/training. Many people could probably do these things by themselves, but many others struggle to keep it up for one reason or other.

It depends on preference and self-efficacy, notwithstanding that intrinsic motivation is necessary whichever way. However, most people don't seem to realize that self-administration is an option, and walk away from the prospect of therapy entirely if they deem it too costly.

The other problem is, as with personal trainers, whether you'll have a good one is a roll of the dice. Trainers have a perverse incentive to divert people to use machines and away from compound movement exercises like deadlifts. Similarly, many therapists don't offer much insight or homework. And all the while you can leverage the most powerful approaches by yourself at zero cost.

Seeing a pro is still a decent heuristic, most people will want to avoid the labor of doing research which can be daunting, tiresome, and is a skill in itself. Pressing the "just tell me what to do, here's money" button is arguably more optimal depending on the circumstances.

Thanks for the explainer; I feel like I've heard of this modality before but not by name.

>The other problem is, as with personal trainers, whether you'll have a good one is a roll of the dice.

True, though at least there are some measure of professional standards in therapy that act as a heuristic - I don't know the situation in the States, but the 'standard' PT certification in Canada, the CanFitPro, has no educational requirement and can be achieved over a weekend in which you watch some videos, do a workshop, and write an hourlong exam. But yeah, as you said, intrinsic motivation is necessary.

You don't have to unpack everything in the first session. Generally you want someone who is trying to build a one-on-one relationship with you where you feel comfortable doing this.

> Not like the movies where the clock is up and ok next issue.

I mean, all appointments end at a certain time and then you get up and leave.

> Sometimes I feel like just suspending the world background process and being still would be nice.

You could try meditation. I do both therapy and meditation.

If you don't have insurance, consider looking at your background and find a 12-step program that fits. ACA (adult children of alcoholics, but it also considers family dysfunction) is one example. It doesn't benefit from having a trained therapist, but it's effectively free group therapy.

In reality, you don't really know the kind of people you'd trust to talk to in the first place, you don't really have an informed opinion. Just jump in feet-first, don't think about. You just need someone to talk to ASAP and any decent therapist is your first step. Just try it, there's nothing to lose whatsoever.

Except hundreds or even thousands of dollars you may or may not have to pay the counselors until you find the right one. I don't mean to be discouraging anyone from getting help, but keep in mind the counselors are not fungible, and, at least in my experience, many of them are useless or just plain weird. (This is not to stereotype, just stating the reality.) I wish there was a way to prefilter them out, but it is such a subjective field and the treatment options are highly individualistic.

I would suggest any kind of community involvement with people you have an affinity for. In person, preferably. That brings on a set of new problems, but at least it will help get you out of yourself and away from too much navel-gazing.

I'm certain there are plenty of good therapists who will take their time with you at the discount implied by insurance, but you're more likely to get that experience if you're paying full rate.

How to find how to find a therapist in Berlin (Germany): https://docs.google.com/presentation/d/1YQYTXBkypxc1DaCRWIjk...

You absolutely can do this if you go on a meditation retreat. I went to https://www.dhamma.org/en-US/courses/search though I am sure you can find other schools of meditation. My experience was that you are not allowed to talk for the duration of the course and just focus on breathing & meditation (10 days in my case). It brought a great deal of calm and focus into my life.

Keep an open mind, but... it takes looking. I've had therapists with all the right degrees who were... meh. Well-meaning, but just not that good at it.

Unfortunately, this isn't a zero-effort path. You have to look, and fire therapists who aren't doing what you need.

https://www.therapyden.com/

You need to fix your brain. Spending 50% of your income/spendings for at least one year on therapy is the minimum you can do.

It is just like a broken leg you need to get it fixed you have no choice.

In Ireland, at least, you ask your doctor for a recommendation

Be prepared to pay out of pocket, my insurance pays about half of what my sessions cost. You get what you pay for. You don't want a therapist who is stretched too thin, overworked, or financially struggling themselves.

Also, ask friends and family, you may know more people in therapy than you realize, and talking about MH with people you know is incredibly helpful.

If you have a good PCP, ask them for a referral both to a therapist, and consider an IOP - an Intensive Outpatient Program. When you're trying to get out of crisis, it can be helpful to have more than just a weekly or biweekly session. I am in such a program now, it includes group therapy every day (I can choose which groups) and more intensive individual therapy and case management.

The particular program I am in also does ketamine therapy, which can help to rewire your neuropathways so that behavioral changes are more permanent. There are some online programs - Better U and Mindbloom come up in a quick search - which will offer this and other IOP-like services remotely, though I'm not sure how they compare to traditional IOP.

Above all, seeking help in any way that you can will make you feel better and I am personally proud of you for coming and asking a bunch of strangers for help. It shows a readiness to take on your challenges.

Good luck on your journey! <3

And regarding to life goals, wife and kids in particular, although I have decided not to have a family, so take my advice with a grain of salt, but I think there are many single mothers out there who would appreciate a stable and solid partner with 2nd income.

That said, while therapy is one thing(and very hard to find someone that actually helps you out of your misery instead of reinforcing it), I'd maybe suggest creating a fixed schedule. Some basic cardio sports at a fixed time and day once a week(if that is too much once every two weeks). Ideally a group practice that gives some social pressure. It's much harder to get out a tough spot when you're alone. Maybe a beginner Capoeira class. No real requirement to socially engage if you don't want to, but warms your heart nonetheless.

And maybe one usergroup of some sort once a month. No need to engage with people. Worst case, you just listen to some talks and get free Pizza.

One thing that's very important in Germany when getting help is to never EVER say that you have suicidal thoughts. The moment you do that you slide into a bracket out of the social system that you can never get out of on your own. Any doctor or psychologist may now force you to take medication or put you in the asylum whenever they chose.

That is terrifying. Those medications are mediocre in the long-term. If you have a problem with a side-effect and they deem it trivial, you may be forced to take a medicine for life. Some of the alternative approaches to medicine are proving far superior for moderate level depressions (which can still be suicidal ideation).

Disclaimer: I have two very close friends and one relative who struggled with suicidal thoughts. None of them were put on meds against their will, or put into an "asylum". There was staionary therapy though, sometimes multiple ones, but not against their will

When I lived in the UK they wouldn’t offer me even a waiting list

The process is roughly like this:

* GP prescribes therapy.

* You call seven public therapists who are busy and note their information and when you called. There's a specific form for this.

* You find a private therapist that satisfies certain conditions (e.g. degree granted in Germany) that is a good fit for you, and your public insurance is obligated to pay for your care.

Here's a long guide on it:

https://www.bptk.de/wp-content/uploads/2019/09/2019-09_bptk_...

Also if you can provide tech stuff (like a website or what not) see if they will trade in kind services.

I would check out eastern europe or Asia. They will cost around $15-25/hour.

You can book therapists online next week in the US, but they're not cheap.

The problem is more related to the problem of „fixed budgets“. Every health practitioner in Germany’s public health system receives a fixed quota of money per quarter. In regions with few doctors and therapists this means practitioners would operate on a loss if they accept too many patients. That’s why you wait forever for a doctor if you got bad luck.

It’s an effect similar to the case a private good is regulated to have a maximum price. This way politicians create a shortage of that good. You can have a public system where everybody is forced to have insurance (or receives welfare if one cannot afford it) but where healthcare prices are allowed to float more freely. But German policy makers rarely understand basic economics (or don’t care) — but they are acting on good intentions.

That being said: There was a time I needed to see a therapist (after getting through a divorce) and didn’t have any trouble finding a therapist around the corner within two weeks. Five hours were covered by public health care provider immediately, then the therapist had to write a proposal and another doctor had to sanction it as others described. The proposal was smoothly granted.

Bottom line: Your mileage varies in Germany.

First of all the fixed budget don't apply for everything, there are budgeting hierarchies. Radiology for example is not limited at all. First radiologists get paid whichever amount they want.

Second, when migrants flooded the healthcare system the following happened:

- The political leadership of Germany had a meeting with the political leadership of the healthcare system

- Due to the lack of technical competence on the side of the political leadership of the healthcare system they threw the migrants into a special accounting bucket. I think it was 4, but I don't fully remember

- The accounting bucket was chosen mainly because the custom made accounting system had been built over decade and most of the knowledge about it is either retired or dead and no political leader wants to invest in changing it, because nobody wants to be responsible if there is a problem with doctor payouts for one quarter during a migration.

- The leadership of the KVs were too scared to touch their own accounting system and as a result searched for an accounting bracket to dump migrants in.

- The only two states that were competent enough to build their own that is easy to change were Schleswig-Holstein and Bavaria.

- The migrants are outside of fixed budgets due to the special status are in, meaning that if a German retiree goes to the doctor the second time at the end of the month the doctor is not paid, but if an asylum seeker goes 10 times the doctor gets paid in full 10 ten times. It creates an imbalance in who certain doctors would like to treat.

During one of the sessions with the policymakers in Hamburg the leadership openly said that they would like it to be more like the dentist situation, where only basic care is covered and the rest is paid in private.

You have to understand that German retirement money can be as low as 40% of your last working salary, which is extremely low for most people and it's the lowest of all of western Europe. Although I imagine that after this whole evaporating European wealth for Ukraine the situation might end up looking even worse in other places of Europe.

The whole situation is completely avoided, but the political leadership has been systematically blocking attempts at solving the technical challenges. They have inherited a system that was built for a completely different demographic of Germany decades ago and have refused to reform it, because they are extremely scared that they would lose the support of the doctors that elect them.

I would however be careful equating having kids to being successful in life. At best, they can be a joy to have. At worst, they can be little sources of chaos and stress that you can pass your own worst traits to.

I don’t believe any life is past its time. We all follow our own twisting paths, and it is an easier path when we don’t have to face it all alone.

Many will offer a first appointment for preliminary diagnosis and to check if they can help you, but then you are put onto the waiting list

For example you can't do analysis without being physically present with your doctor [1].

[1] https://en.wikipedia.org/wiki/Psychoanalysis

Why not?

There's also a lot of evidence of remote therapy being just as effective as in-person therapy.

Sure, I will cite the Wikipedia page on Psychoanalysis, which itself has many citations which you can follow:

1. "Psychoanalysis is a controversial discipline, and its effectiveness as a treatment has been contested"

2. "Linguist Noam Chomsky has criticized psychoanalysis for lacking a scientific basis."

3. "Evolutionary biologist Stephen Jay Gould considered psychoanalysis influenced by pseudoscientific theories such as recapitulation theory."

4. "Psychologists Hans Eysenck, John F. Kihlstrom and others have also criticized the field as pseudoscience."

5. "Philosopher Frank Cioffi cites false claims of a sound scientific verification of the theory and its elements as the strongest basis for classifying the work of Freud and his school as pseudoscience."

6. "Karl Popper argued that psychoanalysis is a pseudoscience because its claims are not testable and cannot be refuted; that is, they are not falsifiable:

....those "clinical observations" which analysts naively believe confirm their theory cannot do this any more than the daily confirmations which astrologers find in their practice. And as for Freud's epic of the Ego, the Super-ego, and the Id, no substantially stronger claim to scientific status can be made for it than for Homer's collected stories from the Olympus."

7. "Imre Lakatos wrote that "Freudians have been nonplussed by Popper's basic challenge concerning scientific honesty. Indeed, they have refused to specify experimental conditions under which they would give up their basic assumptions.""

8. "Scruton nevertheless concluded that psychoanalysis is not genuinely scientific, on the grounds that it involves an unacceptable dependence on metaphor."

9. "The philosopher and physicist Mario Bunge argued that psychoanalysis is a pseudoscience because it violates the ontology and methodology inherent to science. According to Bunge, most psychoanalytic theories are either untestable or unsupported by evidence."

10. "Cognitive scientists, in particular, have also weighed in. Martin Seligman, a prominent academic in positive psychology, wrote that:

Thirty years ago, the cognitive revolution in psychology overthrew both Freud and the behaviorists, at least in academia.… The imperialistic Freudian view claims that emotion always drives thought, while the imperialistic cognitive view claims that thought always drives emotion. The evidence, however, is that each drives the other at times."

11. "Historian Henri Ellenberger, who researched the history of Freud, Jung, Adler, and Janet, while writing his book The Discovery of the Unconscious: The History and Evolution of Dynamic Psychiatry, argued that psychoanalysis was not scientific on the grounds of both its methodology and social structure:

Psychoanalysis, is it a science? It does not meet the criteria (unified science, defined domain and methodology). It corresponds to the traits of a philosophical sect (closed organisation, highly personal initiation, a doctrine which is changeable but defined by its official adoption, cult and legend of the founder)."

12. "Richard Feynman wrote off psychoanalysts as mere "witch doctors""

13. "Likewise, psychiatrist E. Fuller Torrey, in Witchdoctors and Psychiatrists (1986), agreed that psychoanalytic theories have no more scientific basis than the theories of traditional native healers, "witchdoctors" or modern "cult" alternatives such as EST."

14. "Psychologist Alice Miller charged psychoanalysis with being similar to the poisonous pedagogies"

15. "Psychologist Joel Kupfersmid investigated the validity of the Oedipus complex, examining its nature and origins. He concluded that there is little evidence to support the existence of the Oedipus complex."

> Psychoanalysis is widely practiced

Astrology is widely practiced as well. Doesn't mean it's scientific.

> and it’s efficacy has been repeatedly scientifically demonstrated.

That is a very controversial statement within modern psychology.

Although I have no doubt that most psychoanalysts believe that, just as homeopaths and other pseudoscientific practitioners also believe that their disciplines are scientific.

It was not an argument. It was an answer to the parent poster which requested a citation. Which is why I gave him citations.

And if such a large list of citations from many experts in the fields of psychology, psychiatry, philosophy, history, cognitive science, etc, including many scientists and hell, even (at least) one Nobel prize winner, doesn't convince you... then I'm sorry to tell you this, but I don't think there could be anything that would convince you.

And I'm not sure why you think that you are more qualified than all of them to judge this.

The problem is that I’m a physicist so I see a wiki page with a bunch of quotes from people of all disciplines including a physicist who was famously a huge sceptic of psychiatry and I think of all the physics pages that have all these “opinions” that are wrong

Very few of those quotes mention evidence of outcomes of psychoanalysis but only mention very specific parts of it being questionable. I think you’re jumping the gun a bit. Don’t worry, that’s very common among people who are newer to science

There are many modern meta analysis assessing the (in)efficacy of psychoanalysis and comparing it to other approaches, such as cognitive behavioral therapy (which is the gold standard nowadays) and other approaches, which back my arguments.

I am not really interested in going more deeply about this, but I encourage you to research it, if you are interested. There is a lot of research about this.

And by the way, I am sure that you can also find meta analysis which will tell you that psychoanalysis works. This does not mean that it is necessarily true (or at least, not for the reasons that people think it is true), for various reasons, some of which I'm sure you can deduce.

The problems with psychoanalysis are not just about its (substandard) efficacy. There are many other troubling issues with this practice.

This is why it is important to follow a field of study and what current scientists, field practicioners/experts and academics know (from various disciplines and fields of study, in order to get a consensus as best as possible), and not just read some isolated meta analysis and extrapolate conclusions from it.

> I think you’re jumping the gun a bit.

I think what I'm talking about is pretty well established at this point, it's not news for someone who works in this field.

I suggest you do more research before arguing about a field you don't seem knowledgeable about.

Look, if you are so interested in this, why don't you do the research yourself?

I literally just googled "meta-analysis psychoanalysis" and the very first link that came up [1] was, surprisingly, a meta-analysis about psychoanalysis which concluded the abstract with the following phrase:

"In contrast to previous reviews, we found the evidence for the effectiveness of LTPP [long-term psychoanalytic psychotherapy] to be limited and at best conflicting."

I'm not interested in wasting more of my time on this topic, so don't expect any more replies.

[1] https://pubmed.ncbi.nlm.nih.gov/22227111/

I knew this was going to turn into this pointless debate.

I even mentioned it in my parent comment that you can always find some study which says the opposite of what I'm saying. That does not refute what I said and it is not how science works.

You have to analyze a bunch of evidence, from many studies and meta-studies together as a whole, you can't just pick and choose the studies that are more convenient to you.

Not to mention that you asked me to cite a meta-analysis (which I did) and then you counter-act with a single study about a single trial.

So here's the thing: I am not interested in you citing me any study or meta-analysis. As I said before, I'm not interested in continuing this discussion.

I was just arguing what I know about this topic and what I've learned from experts (in psychology and methodology, mostly) and my own research.

You can feel free to ignore me or to continue arguing, but I'm not going to answer anymore.

I don't have a horse in this race and I don't want to waste any more of my time.

There are a handful of problems I can think of for using a waitlist in the community receiving traditional psychotherapy as a control for a group receiving intensive inpatient treatment.

But the article you linked does not support your point in the context of this discussion.

The control group is corrupted, the control-treatment pairs for comparison were selected by the researchers, and the provided “psychiatric treatment” includes

> In addition to weekly individual sessions the inpatient program at both groups contained two 75 min group sessions each week. In addition, VITA had shorter group meetings each morning (15 minutes). Patients in both treatments participated in two physical exercise sessions per week, weekly psycho-educational lectures and art-therapy groups, and both groups finish each week with end of the week status groups. On average, patients in both treatments received seven sessions of therapeutic activity each week.

“Both treatments” here is not control and treatment but both intensive treatments.

You can get large effects in almost everything by completely changing a person’s experiential environment from their prior environment, which is what they did here. In addition to everything listed, their sleeping conditions, diet, daily routine, and social environment were probably dramatically changed, although the researchers didn’t record that so we can’t know.

It’s impossible to tell if the actual psychiatric interventions were effective. This fact, though, is particularly damning as to the efficacy of the actual treatments provided:

>The analysis also showed minimal differences between the two intensive inpatient treatments, suggesting that the differences in effect may not be due to the theoretical rationale within the inpatient treatment but rather the treatment context.

There were no significant differences between two very different treatment modalities. This essentially admits that “something else” and not the psychiatric treatments were responsible for the uptick. My guess is regular schedule, connecting with people (community formation) and mattering to someone, none of which do you get from psychiatric treatments.

Very far from discredited, as you seem to want to claim (with no evidence). Difficult to study != disproven

Which? Serious question!

> Which? Serious question!

Ok, well, the thing is, I'm not an expert in psychology/psychotherapy, so you shouldn't trust me.

But if you'd like to find out more, here are some avenues that I suggest you dig into. They are based on conversations I had with a psychologist that I know but it's been many years and therefore I could be wrong about almost all (if not all) of this (or at least, misremembering):

1. If I remember correctly, psychoanalysis encourages a long form of therapy in a way that may not be in the best interests of the client. It is fine to have long therapies when needed, but it is not OK to extend a therapy longer than it is necessary to deal with the demands of the client and/or any other relevant and substantial issues that might come up during therapy.

Many would argue that psychotherapy should be about dealing with the issues at hand and what's preventing you from achieving your goals, in an efficient and practical way, not going on and on infinitely about exploring your infancy and your past while the weeks, months and years go by and the dollars fly away from your wallet to the therapist's wallet.

2. Psychoanalysis may also encourage finding (some would argue manufacturing) "issues" and "traumas" that have nothing to do with the problems that the client was having and may only serve to cause additional and unnecessary emotional suffering, besides all the problems that the client was already having when he decided to go into therapy. In extreme cases, this may even lead to implanting false memories of traumas.

3. Psychoanalysts may also tend to (inadvertently or "advertently") inflict and/or encourage emotional dependence between the client and the therapist, in a way that is not healthy, desirable nor in the best interests of the client.

4. The above issues may all feed into and magnify each other.

I am sure there were more issues that I've discussed, but I simply can't remember.

Note that I'm not saying that all psychoanalyst practitioners fall into the above traps, or that practitioners of other forms of psychotherapy don't, I'm only suggesting that psychoanalysis is more prone to the above issues than other forms of psychotherapy that are usually considered more scientific (like CBT).

And once again, please take all of the above with a huge grain of salt and don't trust me. I'm not an expert and I could be completely wrong and/or misremembering the above issues. So I encourage you to do your own research.

It has no relevance with regards to my knowledge.

OP’s username seems somewhat German so I would cordially invite OP to make use of our pretty decent Krankenkasse system that makes it a relative breeze to get therapy sessions. Shop around if you don’t vibe with your therapist.

1.) Just talking to a therapist who you feel heard and understood by (whatever their method: CBT or any of the others below) will be a massive help - you'll feel less alone and the challenges and mindsets you wrote about will begin to feel less all encompassing. The world will be a less frightening place.

2.) I think Deutscher's post is one of the most courageous personal posts I've ever seen on a message board/social forum (certainly the most courageous in 2022). One of the hardest things for anyone to do is to admit their life hasn't/isn't going the way they expected and instead of lying to themselves, they do the incredibly brave thing of admitting they need help.

Anyways, I just wanted to commend Deutscher for that (hopefully before my comment gets buried hours after the original post)

Did you read the bit about $25K in savings? Or the part about there are "no mental health facilities in the small town where I live"? How's he afford a therapist, time or money wise?

HN is hugely biased towards people who live in cities. A lot of the posters simply do not understand how a lot of us outside the cities live, and the resources they take for granted that we don't have access to.

For me the drive to the nearest therapist is measured not in minutes, but hours. That's impossible for someone who has to work full time.

It might make sense to take "under-" employment with a company that offers good health benefits, which would at least provide income and insurance to buffer the cost of therapy. It might be helpful to think of it as a "launchpad" or "staging" job. It can also be an opportunity to exercise the muscle of befriending new people (coworkers, regular customers).

In the US, Starbucks and Trader Joe's are popular launchpad choices of employer, at least in my metro area. There might be similar ones in your current home country, if it makes more logistical sense to stay local.

The parent comment about therapy is correct (I regret not getting some myself), but I wanted to address this line directly.

I was stuck being overwhelmed from 2003 to 2019 after the death of a friend, because I had a spiritual awakening but denied it. I tried to satisfy my ego and win the internet lottery and gain external recognition of success which never came. So I lost the better part of 2 decades just going through the motions, utterly exhausted.

I had another spiritual awakening climbing out of burnout and surviving through the pandemic. This time I watched the world wrestle with every existential truth that I had suspected but which had been suppressed by the might of economics steamrolling everyone until that point.

Now I feel that reality is akin to a dream, or at least a Matrix like the movie. There are logical rules we must follow on the micro scale in the day to day where we push atoms around for income. But on the macro scale, it's more like the universe reads our mind and lays a path for us to follow whose main goal is to put us through the wringer for our spiritual growth. That can be as painful or as effortless as we choose. Western culture has no real description for this outside of religion, so all but denies its existence. But it's deeply connected with karma/sin and how we've integrated our shadow self with our outward existence.

Basically the stories I had told myself for most of my life were no longer enough to sustain me. My inner monologue had became toxic like the line above, a false exaltation to cling to when I couldn't face the road ahead of me. Here is an alternative way to write the same sentiment:

I was struggling for a long time but am grateful for the lessons that pain has taught me, even though I can't continue to cling to that pain any longer.

I found that most of the code in my brain had been co-opted by negative self-talk, to the point where it no longer worked and I lost my executive function. It was like I had a stroke and the part of my brain that controlled motivation was no longer there, or worse, actively talked me down from starting any task. I believe now that my subconscious intervened and broke the negative feedback cycle I was trapped in where the harder I tried, the harder I failed.

Once that happened, I finally understood that my mind is not my soul. My physical body and even my thoughts may suffer profoundly (or be elated) in the day to day, but I mostly observe that process playing out now. I don't subscribe to external meaning anymore. I choose what's meaningful. Because meaning isn't objective, it's subjective.

Now I meditate and have faith that I can handle life, even when it doesn't turn out the way that I want. I've found that practicing non-attachment has a funny way of revealing what's really important. Mantras help too, like aligning with heartfelt causes, for example service or being of service to others. Kind of like, strengthening the love inside to give love to others who need it. And allowing myself the same dignity to receive love. My struggles became training, my successes became miracles. And reality seems to be shifting towards this more integrated physical/spiritual whole with divine timing.

Hope something in this helps you on your journey.

For me, the healing really began when I started communicating and setting boundaries. Expressing sentiment, even if I can't make good on what I'm trying to do, goes a long way. And stepping outside myself, so that I can vouch for myself the way I would for someone else, also does wonders for quality of life.

But everyone has their own struggles. I know people who battle video game addiction, and drinking, and saving for their kids' college fund. My difficulties seem almost quaint in comparison sometimes. Like really? I got to grow up and program computers and have a bunch of cool jobs doing web stuff, and all I can do is complain? Well yes actually, because for all of that, I never really quite did what I originally set out to do. That can weigh on a person more than anything else sometimes.

So honestly I write for a younger me from 20 years ago, while I still maybe had a healthy bit of cynicism but was not yet disillusioned, in the hopes that it helps someone avoid stuff like the burnouts and bouts of depression that I went through. Which is perhaps a bit idealistic, because suffering and loss is something that everyone experiences as part of life.

It really comes down to the search for meaning for me. Stuff like: what comes after atheism? What's a dream, or a hallucination, or an alternate reality like those experienced when we pass out or have near-death experiences? How come science can't explain synchronicity or angel numbers or other coincidences, except dismissively? We literally have no evidence that our scientific models entirely describe our physical reality. They can't even explain consciousness. Those gaps in our knowledge are opportunities for finding meaning. Perhaps metaphysics can help us navigate such nebulous concepts. And also, how do we know how our experiences shaped our understanding? I sometimes look back fondly at some of the "worst" periods of my life. Often, the obstacle is the way.

Which is a book I'd like to read sometime. Also A Course in Miracles. Unlike reason, where we stand on the shoulders of giants, meaning comes more like discovering a truth of one's existence, only to learn that someone already wrote it down thousands of years ago. A different kind of validation.

So much more to say about all that.. but it's really more about finding one's own way than endlessly studying philosophy. But it's ok to do that, to work on oneself. These times are kind of rough not for all the blessings we receive, but for all the little things that seem perpetually out of reach. Time, rest, the esteem of our friends and colleagues, being with our families. My deepest wish is that we find a way to heal ourselves and then the world and seek faith/hope/love, peace and harmony together so that we can all self-actualize and manifest heaven on Earth in the New Age. And we're right there, so close!

So of course the cost is worth it.

And to expand on that, if you're not vibing or getting results from one therapist see another one. Don't give up after seeing just one. I know plenty of people that didn't see much improvement after one therapist but did well with others.

Look into medications, they are a lot easier to stick to than seeing a therapist especially if you're depressed. Even if the first drug doesn't work try another one. The non-response rates to a single medication are much smaller than if you didn't respond to one you try another one.

In the process get started with this book. https://www.amazon.com/Cognitive-Behavioral-Workbook-Depress...

This website has a lot of useful information too. (Written by a psychiatrist) https://slatestarcodex.com/2014/06/16/things-that-sometimes-...

Curious to know how that shook out. Did they get a different diagnosis eventually? Did anything in particular help?

Therapy can solve other issues too but one should first accept who they are

People need help understanding how to live. Therapists are trained to do that. Some of them are good at it, and some are bad at it.

But telling someone who is in need of structured introspection and practical cognitive and behavioral techniques to NOT go to a therapist is really pretty horrible.

In the end, it wasn't autism?

Clinical depression and mood issues need to be treated with medication. I would recommend finding a psychiatrist and get a referral for therapist from them if you are able to. You would be able to work together with both medication and theraphy to get better. It will take bit of a time to get better but don't be discouraged, OP. Progress will be slow and many goals you might think of may seem unachievable so it's very important you plan small steps and follow through them.

If theraphy is cost prohibited or have long waiting line in your country, from what I know of OP's situation - I recommend getting online sessions from therapist in other English speaking countries who might be cheaper locally.

What worked for me will not work for everyone. It's important to try everything that you can and see what works best for you. For me, medication was not the answer.

How to know someone is American before they even mention "other English speaking countries"

The HN guidelines include: "Don't be snarky." "Eschew flamebait." "Omit internet tropes."

https://news.ycombinator.com/newsguidelines.html

But there are certainly people in our present world who do need meds to get out of the depression hole. There are people that do not respond to therapy alone but do respond to meds with therapy.

I don't think there's anything wrong with your comment, indeed the statement you're quoting is extreme. But I think HN has the tendency to go too far to the other extreme. At the end of the day, clinical depression is very heterogeneous. You need to do what works best for you.

Btw in case it isn't clear how meds are supposed to work in practice - medication for depression is not something you just pop and forget about. Any reputable psychiatrist will include therapy as part of the initial treatment plan, they don't just write a prescription and send you away.

Yes bad clinicians exist, but I think the pill popping trope for psych is way less common than people assume. Perhaps part of the source of this stigma is the role of the general practitioner. It is not uncommon to see random non-psychiatrist MDs prescribing SSRIs or stimulants, and in those cases it's a lot less likely the corresponding behavioral therapy is happening.

Anyway, medication is an absolute life saver for those people who need help in making the behavioral changes to begin with. There is a large body of studies at this point showing that simultaneous meds and therapy can improve depression symptoms more than the sum of their parts. Gold standard practice is to try tapering off of meds after the course of therapy, and more often than not the symptom improvements persist.

OP should get a professional opinion specific to his situation. He shouldn't go with the intention of seeking meds, but they should be something he inquires about. Some of the sibling comments here are acting like needing meds is a lack of will power, which is just as unhelpful as indiscriminately pushing meds.

I didn't mean to say everyone feeling depressed should take medication as the default solution.

When I prefixed "clinical" above, I wanted to imply persistent and chronically present issues.

Any decent psychiatrist will not prescribe you medication unless you absolutely require it and will run multiple tests ruling out heart problems, blood pressure issues, thyroid, liver, and many more. A therapist isn't qualified to run and test for alternative medical issues which may manifest as above.

This is why I really wanted to assert that seeing a psychiatrist or medical practioner is important first step.

You may have persistent depression due to unrelated medical issues which may need medication.

Chronic health issues often have a persistent medical cause but not always.

That said, OP should probably look into both himself, see what the wait time and cost differences are between the two routes in his area.

A therapist isn't qualified to make any diagnosis or prescribe tests and medication.

It might very well be the answer, also.

OP is not asking for platitudes, he's asking for actual help, which is by necessity rooted in reality.