I am a doctor... (TW)
This is a modal window.
The media could not be loaded, either because the server or network failed or because the format is not supported.
Formal Metadata
Title |
| |
Title of Series | ||
Part Number | 24 | |
Number of Parts | 46 | |
Author | ||
Contributors | ||
License | CC Attribution 3.0 Unported: You are free to use, adapt and copy, distribute and transmit the work or content in adapted or unchanged form for any legal purpose as long as the work is attributed to the author in the manner specified by the author or licensor. | |
Identifiers | 10.5446/32769 (DOI) | |
Publisher | ||
Release Date | ||
Language |
Content Metadata
Subject Area | |
Genre |
00:00
Game controllerComputer programmingData conversionQuicksortComputer animation
00:39
GenderCore dumpProjective planeMultiplication signPlanningVideo gameMereologyFood energyDisk read-and-write headMathematicsRight angleLevel (video gaming)Hand fanCross-platformFeedbackIndependence (probability theory)Extension (kinesiology)Software frameworkCombinational logicObservational studyProgrammer (hardware)Self-organizing mapPattern languageVariety (linguistics)Product (business)Local ringGreatest elementMobile appOffice suiteComputer scienceBlogNumberCASE <Informatik>Online helpSoftware developerProcess (computing)Object (grammar)NeuroinformatikPower (physics)BuildingElasticity (physics)GUI widgetArithmetic progressionMeasurementAndroid (robot)Logical constantRevision controlMobile WebHypothesisText editorSelf-organizationMappingPiPressureEndliche ModelltheorieWeb 2.0Computer programmingTunisQuicksortoutputComputer animation
07:54
Multiplication signFrequencyForm (programming)Noise (electronics)GenderEntropie <Informationstheorie>Sound effectPhysical systemPoint (geometry)Different (Kate Ryan album)Set (mathematics)MereologyCategory of beingPattern languageTerm (mathematics)Type theorySummierbarkeitAutonomous system (mathematics)Data managementProduct (business)Artificial neural networkIntegrated development environmentBitEuler anglesSoftware testingLine (geometry)Real numberSubstitute goodDirection (geometry)Incidence algebraLinearizationConcentricRight angleNormal (geometry)Interactive televisionSystem callConnected spacePosition operatorAbstractionCodeNumbering schemeWebsiteObservational studyOnline helpTheory of everythingProcess (computing)Special unitary groupFlow separationSimilarity (geometry)Computer clusterDisk read-and-write headAuditory maskingGoodness of fitComputer animation
15:00
Sign (mathematics)Integrated development environmentGoodness of fitContext awarenessArithmetic meanAnalogySheaf (mathematics)Entropie <Informationstheorie>Multiplication sign1 (number)CognitionCommitment schemeSubsetDecision theoryCondition numberNatural numberPunched cardRight angleObject (grammar)Online helpLine (geometry)Personal digital assistantTheoryDifferent (Kate Ryan album)Form (programming)PlanningService (economics)Square numberSpacetimeInformationDivisorProcess (computing)SummierbarkeitMereologyData miningOpen setVideo gameSoftware developerResultantMedical imagingMathematicsSpring (hydrology)Group actionFocus (optics)Disk read-and-write headFrame problemLatent heatParameter (computer programming)Computer animation
22:05
Multiplication signComputer animation
Transcript: English(auto-generated)
00:03
Hi everyone, thanks very much Jeff. Just as a prior warning on this talk, in the program
00:21
it was flagged as a content warning. In this talk I will be discussing some fairly disturbing topics for some people. Issues of depression, suicide, suicidal thoughts, drug use and miscarriage will come up in the course of this conversation. So if that is something that is likely to affect you in a bad way, then please be advised and take whatever sort of controls you need. So, my name is Russell. I am a ten year veteran of the Django
00:43
core team. I'm a member of the Django Technical Advisory Board. I'm president of the Django Software Foundation. As you just heard, I'm also founder of the Bewear project, a project looking at the tools we use to develop Python. A big part of Bewear is Toga, a cross platform widget toolkit that allows you to build iOS and Android mobile apps in
01:00
Python. Bewear and Toga are both works in progress. If you're interested in Python development tools or Python on mobile, please come talk to me. I'm also the CTO and co-founder of a start-up company with all the pressures and stresses that come along with that. I'm also a doctor. I'm not that kind of doctor. My doctorate is in
01:22
computer science. My doctoral thesis was entitled models of learning and development in cajon and style self-organising feature maps. And that's three and a half years because I'm not getting back. The reason I say all this is what I'm about to say is not medical advice. It's personal anecdote. If you find yourself being affected by any
01:43
of the problems that I'm about to start discussing, please seek professional help. Don't rely upon me because I'm not the professional. My hope though is that by sharing what I've been going through, I encourage others to go and do something that I didn't do for a very, very long time. You may have noticed that I have my fingers in a lot
02:02
of pies. I have a stressful job. I volunteer with Django. I've got side projects. My side projects have side projects. I have a son. I also have a son with learning difficulties. I have a daughter. I have a wife. And in the last few years, the combination of the stresses of all of these started to take its toll. My temper started to grow short. I found
02:21
myself getting really frustrated both with myself and with others. I found myself genuinely doubting my own abilities, not just imposter syndrome level stuff. I'm talking a genuine belief that I was incompetent. My enthusiasm to go out and socialize with friends was almost completely removed. Picking up the phone to call a friend to go over for dinner
02:42
or to have them over for dinner felt like just too much effort to even be worth it. I also had some intermittent health problems. In particular, I started having real issues with my back, shoulder and back muscles, to the extent that I was spending sometimes three or four days laid out on the couch, doped up on some really, really great opiates.
03:00
But long term, that's not a productive situation. It wasn't constant. It wasn't a continuous decline. I had good days. I had bad days. I had good weeks. I had bad weeks. But this pattern had probably been going on in a serious way for 18 months and probably even for years before that. But in early this May, I hit rock bottom.
03:23
For about a week, I would wake up in the morning and the only thing that got me out of bed was habit. I felt absolutely no joy in what I was doing, in anything in my life. The only reason I was getting out of bed was habit and contractual obligation, the fact that I knew my kids needed to be fed, so I suppose I'd better get out of bed then.
03:44
And then one Wednesday, I went into my office, I started work, and by about 9.30, I just had no energy to continue. I couldn't summon the energy to give a damn about anything. I went back to bed, I buried my head in my pillow, and I cried.
04:02
That was the final straw for my wife. She pushed me out the door to go see a doctor, a medical one, and I was diagnosed as being in the middle of a major depressive episode. Now, I am being treated now. I am, relatively speaking, at the start of my treatment, so it's way too early for me to just declare victory. But even in this short time,
04:21
the last couple of months, I've noticed a huge positive change. At some level, it's probably just the cathartic release of knowing that what I was feeling wasn't right and can be treated. But frankly, at this point, at that point, I would have taken any improvement I could get. The reason I'm going public is because, in retrospect, I put off getting help for far too long. I didn't want to admit failure. I didn't want
04:46
to attract the stigma of admitting that I was mentally ill. I didn't want to see a doctor because of pride. Successful people don't get depressed. Successful people power through. Successful people win. And that's bull. Studies universally agree that depression
05:06
affects at least one in ten people in the general population, and it's higher in some demographics. And guess what? This is one of those demographics. Computer science and programming people. Our industry is particularly prone to the tune that discussions of burnout are almost a constant undertone. I want every single person in this room to know that
05:25
you're not alone. I am, by almost every conceivable measure, a successful member of this community. And I have depression. Now, I've given a version of this talk as a lightning talk twice now. Once at DjangoCon Europe, when I sort of came out, as it were, and once
05:42
at PyCon Australia about a month ago. And what has amazed me is that both times, the number of people who have sought me out afterwards to thank me about being so open, because they had depression, but they were afraid to seek treatment. Well, they had sought treatment, but they didn't want to tell anyone about it because of the shame. And it's the shame that is quite literally, in some cases, killing us. And when I
06:04
say us, I mean that quite literally. People who could have, should have been in this room today aren't. A little over 10 years ago, Django received some contributions from this little 19-year-old guy named Aaron Schwartz. You may know him from some of his other projects, Reddit, Markdown, his Activision work on SOPA. I never met Aaron myself, and at
06:24
the time, I certainly didn't recognize him for the intellectual powerhouse that he was. He was someone who contributed to the discussions about Django's ORM. He was a major contributor to the magic removal discussions. And the model.objects.filter API design we have today is at least partially due to some of his feedback. Now, Django never really stuck for Aaron.
06:42
He was too much of an independent spirit, and he went off and started his own web framework, web.py. And about two years after he was engaged with the Django community actively, Aaron wrote a blog post. And in that blog post, he said the following. I have a lot of illnesses. I don't talk about it much for a variety of reasons. I feel ashamed to have an illness. Surely there have been times when you've been sad.
07:03
Perhaps a loved one has abandoned you or a plan has gone horribly awry. Your face falls. Perhaps you cry. You feel worthless. You wonder whether it's worth going on. Everything you think about seems bleak. The things you've done, the things you hope to do, the people around you, you want to lie in bed and turn the lights off. Depressed mood is like that, only it doesn't come for any reason, and it doesn't go for any either.
07:24
Go outside and get some fresh air or cuddle up with a loved one. You don't feel any better, only more upset at being unable to feel the joy that everyone else seems to feel. Everything gets coloured by the sadness. And then in 2013, Aaron took his own life. Now, it's really easy to reduce this to saying that Aaron was killed by the US Attorney
07:45
who was mercilessly going after him for no good reason. And to be sure, malicious prosecution was part of what contributed to his situation. But that wasn't why Aaron took his own life. He took his life because he was depressed. And when you're depressed, thoughts of self-harm start sounding like a good idea.
08:03
And the thing is, other people actually noticed this happening. After his death, Dana Boyd said, I knew he was struggling, but he was also a passionate activist, and I genuinely thought that we would see him through this dark period. This isn't something we can ignore or hope that will go away. This is, as I said, quite literally, killing us.
08:23
And Aaron's story isn't unique. Over the last two years, I've had conversations with at least two other prominent Janganauts who have told me that they've been in positions where they've seriously considered self-harm. I didn't ever meet Aaron, but we do actually have a connection. We share a birthday.
08:41
He's exactly 10 years younger than me. Now, that's a really, really dumb thing to fixate on, on the grand scheme of things. But when I found that out, that hit me really hard. The upside of that shock is that I'm going to be damned if I'm going to let any member of this community that I love so much fall by the wayside over something as simple as making sure they're okay.
09:02
My plea to each and every one of you, don't ignore the science. Don't put off getting help. If you've even got a vague feeling that you might be depressed or suffering from burnout, please seek help. Because you don't have to feel like this. Denying you have a problem won't make it any better. So, okay, you've
09:21
accepted you need help. What does help look like? Well, first off, it's important to get a good diagnosis. If you're looking to just kind of put your toes in the water, you can do some of these tests online. One example is the K-10 test for psychological distress. It's a bit like one of those, which superhero are you pop quizzes, but, you know, for reals.
09:41
But pop quizzes ultimately are no substitute for a real diagnosis, and there's no way to sugarcoat this, you're going to need to see a professional. They're going to administer some tests, and some of them are actually very similar to the K-10 test. And work out exactly what you've got. Because, to that end, it's important to recognise that depression is very much a blanket term.
10:01
There are lots of different types of depression and lots of different types of mental illness. I was diagnosed as being in the middle of a major depressive episode. My son, who is nine, has what's called generalised anxiety disorder. Some women get postpartum depression after giving birth, or after a miscarriage. Many of the symptoms of these illnesses are similar.
10:22
And many of the treatments are similar as well, but it's very important to get a good diagnosis because while they're similar, they are distinct. And the differences matter when it comes to treatment. And sometimes, just to complicate matters, they are comorbid. You can have both depression and an anxiety disorder. So what does treatment look like? Well, it can take a bunch of different forms, and they're not mutually exclusive.
10:41
You can do many of them at once. As I said earlier, I'm now taking medication for my depression. In modern Western society, this is obviously one of the big first ports of call. One pill makes you bigger, one pill makes you small. But be wary of thinking that a magic pill will fix all your problems. It won't. But it can help you manage symptoms. If what you have
11:02
is episodic, it can give your brain the kick-start it needs to start producing the right chemicals again. Some of them don't even need to be prescribed. St. John's wort is a herbal extract. It's available at health food shops in Australia. I presume it's the same in the US. It's a very, very mild antidepressant. But it's strong enough that if you
11:22
start taking something prescribed, a prescribed antidepressant, it's contraindicated. They say, stop taking St. John's wort for a couple of days before you start taking these other drugs. I used St. John's wort on and off for several years before I moved to the hard stuff. And it actually was helpful during that period. Melatonin is another supplement that's available without prescription.
11:42
Melatonin is a hormone that's important for regulating your body clock. And some studies have found that people suffering from depression have low melatonin in their systems. Now, supplements may help. However, for some people, taking melatonin actually induces depression. So, be careful. And one thing I will say, though, is even if things are even remotely serious, do not rely on self-medication.
12:02
Seek professional advice. I mentioned those two as simple things you can try if it's not that bad, but maybe you need a little bit of help. Also, keep an eye out for other forms of self-medication. In particular, alcohol and drug use. It's really, really easy to slip into the habit of getting drunk until you can't feel
12:22
feelings anymore. But that's not helping. In fact, it's part of the problem. It's even used as a diagnostic criterion. The same goes for illicit drugs. I never took illicit drugs myself, other than some really, really fine opiates for the codeine for the back pain. But I know people who have. And again, it's a mask for the
12:42
real problem. If you start noticing a pattern of excessive alcohol or drug use in yourself, seek help. And if you see it in others, intervene. Now, of course, the hard stuff is the prescription medication. Broadly, the category of drugs used to manage depression is generally the SSRIs, selective serotonin reuptake inhibitors. There are several
13:02
of these on the market. They all work fundamentally the same way. They have slightly different metabolisation processes. Some work for some people, don't work for others. I take Zoloft, and I was really lucky. It worked first time for me, and the effect was both profound and quick. A matter of days. For some people, it can take weeks. And for some people, it doesn't work at all.
13:23
If your issues are more anxiety-related, you might be prescribed an SSRI. You might be pointed in the direction of benzodiazepine. They work in a very similar kind of way. I say they work in a different way. Now, they're much better at an immediate treatment for onset anxiety symptoms rather than SSRIs, which need baseline blood concentration to work. Dosage is also very important.
13:42
When I started, I was on about half the dose that I am now. And while it did have a very dramatic effect on my mood, I found that I was sitting on the couch, completely calm and relaxed, with my shoulders tensed up around my neck all day. Strangely, increasing the dosage actually made that go away. Now, you have to work with your doctor on this to dial in the right dosage.
14:02
SSRIs also have some very interesting side effects, ranging from the awkward to the potentially dangerous. They also have some very interesting interactions with other commonly used medications, especially aspirin and codeine. So, again, my good friend's codeine has all gone away. Treatment doesn't just mean drugs, though.
14:22
There is a lot you can and should do without even popping a pill. Get exercise. Now, having me up here advocating exercise is more than a little hypocritical, but I should get a lot more than I do. But from a depression management point of view, it doesn't even need to be vigorous exercise. Even taking a 30-minute walk each day can be enough.
14:42
And, frankly, just clearing your head can be a wonderful thing. Part of the advantage of taking a walk is getting some sunshine. Exposure to sunlight stimulates vitamin D production, which plays into melatonin production, which is the whole other bunch of chemical processes. Now, this can be a problem for other reasons. There isn't enough sunlight at some latitudes. In Australia, the sun is actually trying to kill you. Thank you very much to the Northern Hemisphere for that.
15:05
You can also seek out therapy. As with the pharmacological solutions, there are many different forms of therapy as well. Two common ones that come up in discussions are cognitive behavioral therapy and acceptance and commitment therapy. Which ones work for you will depend very
15:20
much upon your own head space and how you tackle problems. It's not one-size-fits-all. If you go to a therapist and that therapist doesn't seem to be working for you, seek out another therapist. It doesn't need to be professional help either. Just talking to a friend can be helpful. Burden shared is a burden halved. There are also some volunteer groups out there in the
15:40
CODA developer space specifically. There's MHPrompt, Blue Hackers. There's also a group with wider focus like Beyond Blue and Black Dog Institute, the two that are in Australia. But much of the information that is there is applicable regardless of nationality. The US Department of Health and Human Services also has Mental Health.gov that provides some US-centric information. And if you're not depressed, if you're a well-adjusted, happy individual, well
16:04
first off, you're here, so liars. But seriously, I'm incredibly happy for you. Your job now is to make sure that everyone else around you is okay. If you've never been depressed, it may be very difficult to understand exactly what's going on. So let's be clear about what depression is and what depression isn't. Depression
16:23
isn't being sad. It's not something you can just snap out of. It is all in your head, but it's not just a frame of mind or a mood. It's the brain being broken. And broken limbs, broken parts of your body are actually a really good analogy here. If I was to break my leg, no one would tell me to shake it off.
16:44
Have you considered not having a broken leg? Everybody gets, you know, broken legs sometimes. No, you'd understand that it's painful. A bone has actually been broken. I'm going to need to use a crutch for a little while to get me around. You might need to hold some doors open for me for a bit. And, you know, while I'm doing that, I'm probably not going to be able to go
17:01
bungee jumping with you. And if it's a particularly bad break, I might not ever be able to resume some of the activities that I once enjoyed. If someone around you says they have depression, they're not saying they're sad. They're saying their brain is broken. And they need your help, assistance, and understanding to heal. Another analogy that's helpful in
17:22
explaining mental illnesses is what's called spoon theory. Spoon theory was first described by Christine Miserandino. She was using it in the context of having lupus. But it's actually an analogy that holds for many disabilities, including mental illness, particularly things like anxiety disorders. Spoon theory goes something like this. Imagine you have in your hand a handful of 20
17:41
spoons. And they're the only cutlery you can use to eat all day. When you use one, you throw it away. Now, you have to eat three times a day. Sometimes it's nice to have a snack. So, for a happy life, you need at least three and maybe five spoons would be nice to have. But every time you do something challenging during your day, it costs you a spoon to resolve that challenge. You have an argument with your boss, that
18:01
costs a spoon. You need to adapt to a last minute change of plans, that costs a spoon. Now, if you're a well-adjusted individual, you've got 15 spare spoons. Even on your worst day, it's hard to think that you might use up all those spoons. You'll still be eating three squares and two snacks. But if you're going through life with a major disability or a major mental illness, you don't have 15 spare spoons.
18:21
Getting out of bed costs you a spoon. Dealing with the fact that your son's just lost his shoes, again, that costs a spoon. Getting out of your house in the morning can cost you half your spoon supply. So you spend your entire day rationing your spoons, making decisions about the things you can and can't do, even though you'd like to.
18:41
And that costs spoons. Sometimes you can borrow spoons from tomorrow, but then you're starting tomorrow with spoon down, and unexpected things always happen. So you need to have a couple of spoons in reserve. That's why some of the things that you may want to say to someone with depression just aren't helpful. They're not even wrong. They completely miss the nature of the problem.
19:02
Saying it will all get better. You don't have it so bad. There's always someone worse off than you. Stop being so negative. They're not even wrong. This isn't about feelings. It's about a major mental condition. It's about someone's brain being broken. Another thing to avoid is making light of the situation. Casually referring to a desire to have a neat
19:22
desk as being OCD. Calling out something slightly unusual as crazy. Be aware that there are people out there who have actual OCD, and it's not a joking matter. There are people out there with serious mental illnesses. Reducing everyone with a mental illness to a punchline is really no better than reducing all women to sex objects.
19:42
So what can you do? Well, be there for people. If it looks as though someone might be having a bad time, be there for them. Ask if they're okay. They might not want to talk about it, but they might. And even if they don't, having someone ask is a sign that you're connected to the world. And that can be a
20:02
really big thing when you're in a dark hole. Also accept that you're not going to fix them. A five minute chat about someone's problems isn't going to make their depression go away, any more than it would fix their broken leg. You are, at best, going to give them a spoon back. Now sometimes it's also going to mean taking charge of the
20:22
situation. One of the big symptoms for me that I mentioned is that I lost all enthusiasm for organising social outings. The effort involved in picking up the phone and suggesting hey, maybe we should have a pizza and watch a movie was a spoon I didn't have. But you can provide that spoon. If someone said hey, I want to come over and order a pizza and watch a movie, I probably would have done it. Because connecting with friends
20:42
makes you feel good. And it would have done me the world's good to get out. And someone talked to someone about what was going on. And so you might need to lightly shove someone out the door. Make it as easy as possible. As spoon cheap as possible for them to do something that's good for them. And it doesn't mean you spend an evening playing therapist.
21:02
It just means an evening of taking someone's mind off things. It's not come out and talk about your problems. It's come out and be with us. Come out and connect with us. Come out and be human with us. So that's all I've got to say. I'm sorry for being such a down note at the end of what has been such a fantastic conference. So here's a picture of a kitty.
21:22
The reason I've done this is because I suffer from depression. And I put off getting help for far too long. The reasons I did that are, in retrospect, mind numbingly dumb. And they're really easy to fix. We need to talk about this. I love
21:42
this community. I love everyone that's in it. And I don't want to think that someone else is going through what I went through when it can be treated. It can get better. We just have to care about one another and break the stigma that makes people ashamed to admit that they've got a problem. Thank you very much.