"My brain just gave up"
April 30, 2021 10:10 AM   Subscribe

After working non-stop for months, a Dallas-based pen-tester/infosec guy suddenly... couldn't, anymore. And he's finally found out why. (SLTwitter, Threadreader version is here)
posted by hanov3r (101 comments total) 68 users marked this as a favorite
 
Holyshitballs. That's terrifying.
posted by Dressed to Kill at 10:16 AM on April 30 [18 favorites]


Well holy shit.
posted by showbiz_liz at 10:17 AM on April 30 [5 favorites]


This shouldn't be possible. Where are the failsafes? The human body and the human brain are, collectively, a half-assed mess held together by the biological equivalents of chewing gum and duct tape.

Or maybe this is just what we get for the hubris of crawling out of the ocean.
posted by Faint of Butt at 10:25 AM on April 30 [6 favorites]


Uh. I think...I may...have this?

Thank you for sharing this, hanov3r.
posted by greenland at 10:35 AM on April 30 [17 favorites]


I told my firm. They put me "on the bench" for a couple of weeks.
After a couple of weeks, they told me they couldn't pay me anymore.
I wasn't bringing in money at that point.
Mind you, I brought in millions of dollars leading up to that point.
But I wasn't producing...
A friend of mine and I have something we say to each other all the time: “I’m sorry about capitalism.” This seems like something we would say that to.
posted by Ampersand692 at 10:35 AM on April 30 [98 favorites]


From reading the transcript of one of his pen-tests his (former) job sounds like a nightmare of enormously stressful moments which require quick on-the-spot thinking and creativity. It sounds completely unsustainable mentally.
posted by Hutch at 10:37 AM on April 30 [5 favorites]


There's actually a lot about disability and gender / race that I could get into with this, but I'm not the best to speak on it. However, it is extremely unlikely he actually quantitatively 'depleted' his brain of glucose and dopamine. This is neuroscience as a buzzword, in part. He does demonstrate the interaction between psychic strain and function, but in such terms and from such keyboard that it will be taken more seriously than the complaints of less privileged folx who experience the same.
posted by cobaltnine at 10:47 AM on April 30 [66 favorites]


So your argument is the thesis is impossible: you cannot work so much your brain is physically depleted, this is not a physical condition? Or, if it did, it would be short-term and physically recovered in a day/hours/minutes (replenished via bloodstream..?) whereas we all know burnout can take much, much longer to recover from.
posted by cape at 10:56 AM on April 30 [1 favorite]


And this now explains to me why I am literally inhaling handfuls of penny candy while working on projects. Like, an obscene amount.

I had a similar cognitive break occur during grad school - no sleep, little food, and an unbearable amount of stress to submit my thesis while packing to leave town in the next 2 days. My brain straight up snapped; dazed in a fog, couldn't walk really, and couldn't get home because there was no way I could drive. Felt like someone had flipped an invisible "off switch", and that was all she wrote!

Terrifying experience.
posted by NorthernAutumn at 11:09 AM on April 30 [14 favorites]


fearing a stroke, I tried to "sleep it off"

Isn't that the exact opposite of what you should do for a stroke?
posted by Monochrome at 11:12 AM on April 30 [22 favorites]


Apologies, posted too soon...
It was in my grad advisor's office... we were meeting, and I temporarily lost my vision... got all blurry... couldn't make sense of anything ny advisor said. I remember wondering if I was having a stroke /dying, and desperately trying to end the conversation and escape without her noticing something was wrong... I think I left my car there and walked home slowly... I don't remember the walk, or getting into bed, or much of the next few days while I moved. Just, terrifying.

Since then, I have noticed that my vision will start to blur in very very stressful periods when I am running on empty.... which happens from time to time, due to the glories of ADHD hyperfocus. That's one of the signs I look for now to prompt myself to quit.

Glad to know the actual explanation for this!
posted by NorthernAutumn at 11:21 AM on April 30 [12 favorites]


This is neuroscience as a buzzword, in part.

Well, it's almost certainly some telephone-game paraphrasing amplified by tweet constraints, ran through a rather engineer-y filter. But the key points are: work can be very cognitively taxing. The human brain eats a lot of metabolic energy, and the exhaustion from a lot of it is literally exhaustion that no one can willpower past because "willpower" itself is cognitive activity that eats metabolic energy. Of course glucose etc factors into those metabolic pathways, but the thread's not saying there's a hole in the glucose tank and it all ran out. The especially key point is that he also recognizes that:

My brain treated the seizures induced by hacking as such traumatic event, that I was literally suffering from Post Traumatic Stress Disorder (PTSD).

Which is what really does the long-term damage, and the very real potential for it happening is part of why "crunch" type work is such an unrecognized health crisis.
posted by Drastic at 11:24 AM on April 30 [37 favorites]


Thank you for posting.
posted by firstdaffodils at 11:37 AM on April 30 [1 favorite]


I'm not a doctor, but his symptoms do seem consistent with hypoglycemia, and I can certainly see prolonged hypoglycemia leading too permanent impairment.

It seems strange to frame this as being caused by high mental exertion, though. There may well be serious psychological effects from burnout, but a heavy cognitive load should only increase the brain's energy expenditure on the order of 5%, surely not enough to cause hypoglycemia unless there is some underlying metabolic disorder.
posted by jamincan at 11:42 AM on April 30 [13 favorites]


He appears to be describing PNEA, aka non-epileptic seizures, which we don't know the pathophysiology for. We also don't know the pathophysiology for transient global amnesia, which also seems to happen under extreme psychological stress. My disagreement with the author is that, yes, within the constraints a, he is trying to give measurable type answers (glucose! dopamine!) for why he had this, as opposed to accepting that we don't know the actual 100% cause. This is a cultural way of coping, but arguably, may be part of the reason he ended up there.

Also yeah, don't try to sleep off your strokes, it doesn't work.
posted by cobaltnine at 11:48 AM on April 30 [51 favorites]


Presumably he was told what's happened to his brain by an actual qualified professional and is relaying as much of it as he understands/can frame in a tweet, so I'm not sure why anyone here needs to second guess his diagnosis, accuse him of using "buzzwords", or speculate on anything, unless you are yourself also a neuroscientist or qualified doctor, and even then I would argue that it's still not an appropriate thing to do.

Anyway, this is very alarming and I'm glad he's feeling better. The brain is a strange, fragile organ. I know people who have suffered TBIs and completely changed as people, entire 180s in personality, likes/dislikes, even speech patterns, from as small of a thing as falling off a sidewalk and bouncing their head on concrete. Scary stuff.

The points he makes about the US healthcare system are also fucking terrifying.
posted by fight or flight at 11:49 AM on April 30 [52 favorites]


Agree with some of the comments above that his insistence that this is “physical, not mental” is kind of a weird dichotomy that hints at a flawed “hardware/software” understanding of how brains operate. Still, the growing horror (and recognition) I felt reading this was immediate and visceral. We’ve built a culture of work where the default setting is to push people until they fail, and then treat that failure as aberrant and place the fault on the human. In some organizations the only way out is to find ways of shunting the pressure to coworkers and rise to a c-suite level, which is a pathway reserved for a narrow band of people. I work at an employee-owned company and still have to advocate and intervene continuously to prevent my colleagues from burning out.
posted by q*ben at 11:50 AM on April 30 [21 favorites]


surely not enough to cause hypoglycemia unless there is some underlying metabolic disorder.

The article you posted seems to basically agree with his description of his diagnosis:

"Even in this hypothetical instrument-learning session, the brain’s ability to stay on task would taper off as its stores of glucose dwindle. “You’d run into this depletion effect where you can’t sustain the same level of cognitive performance,” he says. Drinking Gatorade or gobbling a few jelly beans could replenish your glucose stores and help restore your brain to full power."
posted by The_Vegetables at 11:51 AM on April 30 [1 favorite]


surely not enough to cause hypoglycemia unless there is some underlying metabolic disorder.

Surely no hacker would be downing 2 liters of mountain dew to fuel late night hack sessions, or if they did, wouldn't do so often enough to acquire type 2 diabetes.
posted by pwnguin at 11:52 AM on April 30 [6 favorites]


y'all.
posted by seanmpuckett at 12:00 PM on April 30 [12 favorites]


Prior to covid stopping travel, it was not uncommon for the consulting companies like the one he described to expect employees to fly to a new location Sunday, work 40+ hours on-site with the client and spend their evenings writing the last week's report in the hotel, then fly home Saturday. Then repeat the cycle again. You can make a lot of money doing that but you can guess what the effect on mental health and families is.
posted by Candleman at 12:01 PM on April 30 [15 favorites]


The glucose thing is a bunch of horseshit, and I speak this as someone who has actively worked on glucose metabolism and diabetes for a long time. If your liver is functioning normally, and you are not hypoglycemic, you will never run out of glucose for your brain until you are under starvation conditions and all fat and muscle has been burned off your body. The only other way to do this is to inject insulin or other hormones that disrupt the normal glucose homeostasis levels. No responsible doctor would say you used all the glucose in your brain from thinking too hard.

Persistently low blood glucose kills you if your brain is low on glucose for too long.

I feel bad for the guy's mental burnout issues but the glucose thing is just self-serving nonsense; instead of saying "I worked too hard and burned out" it diverts into "I drove the brain car too damn fast cause I was being just too damn smart and ran out of gas".
posted by benzenedream at 12:07 PM on April 30 [100 favorites]


I'm not sure why anyone here needs to second guess his diagnosis, accuse him of using "buzzwords", or speculate on anything, unless you are yourself also a neuroscientist or qualified doctor, and even then I would argue that it's still not an appropriate thing to do.
I respectfully disagree.

I think we can absolutely acknowledge the humananity of his lived experience and the tragedy of a corporation that extracted millions of dollars of value from a person and then threw them in the garbage. We can see that the healthcare system was cruel and gave him no health or care. Oh, and not to forget the toxicity that leads to someone trying to sleep off a stroke, I totally understand how a person ends up in that place.

And at the same time we can interrupt the game of telephone that leads to counterfactual ideas about health and medicine. Being uncritical or criticism avoidant about the objective facts included within subjective reports is a rung on the ladder to antivax 5G conspiracy theories.

Also, he's not in this thread? We're not accusing him. I don't have to treat every published piece of media as if I were having a personal conversation in the same room with the author. Like, for a second just imagine the ways that could be exploited by bad faith.
posted by Horkus at 12:21 PM on April 30 [78 favorites]


And at the same time we can interrupt the game of telephone that leads to counterfactual ideas about health and medicine.

And where are the citations and facts to back up those interruptions? Where is the reason to rely on Mefites coming in here to disagree with his diagnosis instead of believing the (presumably) professional who diagnosed him? How is it helpful when it's one random internet person instead of a different random internet person?

I don't have to treat every published piece of media as if I were having a personal conversation in the same room with the author.

I would argue given that he only posted this 4 hours ago, that he's online right now dealing with the fallout, and that it's supremely easy for someone to click on this post, read the comments, then decide to go and DM him with their "findings", yes it is possible for what's being posted here to, in turn, start a game of telephone that potentially ends with faceless internet people accusing a disabled man of making up his diagnosis.

And yes, that is already happening. Where's the harm, you say? Right there is the harm being done in real time, just because some people took it upon themselves to dictate the terms on a stranger's health.
posted by fight or flight at 12:31 PM on April 30 [16 favorites]


For what it's worth, if anyone here is actually a qualified neuroscientist or doctor specialising in these sorts of conditions and wants to weigh in, that's fine.

Otherwise I wish Metafilter would learn to write out "I am not a doctor" and just stop there, occasionally.
posted by fight or flight at 12:33 PM on April 30 [7 favorites]


Yeah, I had somewhat similar symptoms after a kind of 8-year hell run with a baby, baby+high powered media job, child almost dying of appendicitis during high-powered media job, high-risk pregnancy, family illness, back to media with a massive change in position, fielding texts from my boss at 11:45 pm about work while my child threw up next to me.

In my case the series of stroke-like symptoms which worsened and then didn't entirely go away led to a demyelination disease diagnosed via MRI and also a nerve conduction study which pointed at my brain. I also had a big cluster of migraines. For me, I never ended up at a full halt, but I did have to prioritize sleep and exercise. It may be coincidence that it helped, but I don't think so. I've stepped my career differently since.

I don't think brain glucose was ever mentioned as a possible mechanism for my issues. I did have blood glucose testing though, which was for diabetes I believe.

I have all the sympathy in the world for this person, regardless of the biological mechanism, because crunch/emergency IT jobs without time to recharge, or having to work 3 jobs, or never being able to unplug, are all seriously long term unhealthy, kind of like being up all night with a baby and then having to go to work all day long, 24/7 for years.

I hate the way we lionize an unrealistic level of productivity because it burns through people. And now that everyone's working that way it's become the norm. I'm 50 years old and I remember when the lean organization became a thing, and I worked a few years in the old way where when you went home at the end of the day, your work was done. And since then I've had maybe the first 2-3 weeks at each job? Maybe? Where my work was 'done.'
posted by warriorqueen at 12:42 PM on April 30 [47 favorites]


Metafilter: I HATE when people try to give me advice about my health it is SO RUDE
Also Metafilter: heh well have u considered your brain doc was wrong???? allow me, an internet poster, to explain
posted by Ghostride The Whip at 12:45 PM on April 30 [16 favorites]


I am a neuroscientist. I'm not the only neuroscientist on Metafilter and others may disagree with me. I'm not qualified to or interested in second-guessing this guy's diagnosis, but it is true that his condition, as he described it, doesn't quite match what we know about neurochemistry. I suspect, as others have suggested, that this is his best attempt and understanding and reporting what his doctor told him, filtered through a lens of dualism that presumes that "psychological" is not "physical", and that if he can ascribe his disability to a "physical" cause, that makes it more valid than if it's "only psychological". (Quote marks are not direct quotes but inferred positions.) The reality is that the psychological is physical, and the only difference between them is whether we yet have a solid scientific reductive explanation for a particular psychological phenomenon in terms of physical processes (or whether the phenomenon is emergent and not entirely reducible, though in this case it will still be explainable in terms of physical processes). If the reductive account is helpful for him processing what's happened to him, that's great, but we need to be quick to point out that even if no such reductive account is available, that doesn't make his experience any less valid, or his disability any less real. And this is the real problem with the response of the first psychiatrist he saw.

Regarding glucose, it is true that it should be almost impossible for him to metabolically deplete his brain's glucose levels as he describes. But in addition to its metabolic role, in the brain glucose also serves an important role as a signalling molecule, especially in processing physiological stress. It's a second messenger for epinephrine/adrenaline, for example. I suspect that the neuropsychologist, responding to his desire to have mechanistic explanations for what happened to him, gave him a quick overview of this system, and his explanation of "I used up all my brain's glucose by hacking too much" is a not-quite-right-but-not-entirely-wrong interpretation of that conversation.
posted by biogeo at 12:46 PM on April 30 [184 favorites]


I'm 50 years old and I remember when the lean organization became a thing, and I worked a few years in the old way where when you went home at the end of the day, your work was done.

I don't doubt that a whole industry of middle management have brought the 70+ hour work week and (their misinterpretations of) lean production/organisation methods in in tandem, but they don't really have anything to do with each other. If anything, optimising your processes and reducing waste (which is what lean thinking is about) should make it possible to deliver the same value with less work.
posted by Dysk at 12:47 PM on April 30 [4 favorites]


We've created a system that literally eats people alive. That tosses people on the trash heap when they can't perform to its ridiculous expectations. And worst of all, makes it a badge of honor to be eaten and disposed of.
posted by tommasz at 12:55 PM on April 30 [13 favorites]


Okay, well, I'm not a neurologist, but I am a doctor, and one who deals with issues of glucose and metabolism in my specialty, and I absolutely agree with the commentary above that this is likely a game of medical broken telephone. And this is not to place blame on the author of the piece, since in my experience the biggest cause of medical broken telephone is physicians who cannot communicate.

There are many potential ways for neurohormonal changes in the brain to manifest that are more physiologically probable than actually depleting your neurotransmitters and blood glucose -- for example, upregulation of reuptake transporters. I don't know what this person's physician told him personally, but his reporting of the physiology involved is not consistent with how we understand the body to work.

How he was mistreated by his employer and how he personally suffered are not in dispute. And I doubt that he is making up this physiological explanation just for fun. Again, this is probably the result of faulty communication from his medical team, which is something we have absolutely no shortage of I tell you what.

Edit: what biogeo said, more eloquently than me.
posted by saturday_morning at 1:03 PM on April 30 [86 favorites]


I am a neuropsychologist/clinical psychologist. I agree with others above that his tweets would not be how we'd explain Functional Neurological Disorder (basically a diagnosis where there are documented cognitive impairments but unknown aetiology/physical causes/nothing shows up on scans). A typical neuropsychology report would never say "depleted my brain of dopamine and glucose", although "cognitive overload" or FND may be terms that can appear. I feel that he is using quotation marks quite liberally in the thread (he also uses it to make metaphors about his brain) so I would not take it as a direct quote from the report (hopefully). A neuropsychologist would also not be in a position to make definitive diagnoses about any dysfunctional glucose/neurotransmitter signalling in his brain purely via neuropsychological testing (which is what it sounded like he had) - as biogeo has pointed out it may be an attempt at elaborating a possible mechanism behind his test results to him, but very much a hypothesis.

I totally see the false dichotomy between "physical" and "psychological" at play in his tweets too - unfortunately our devaluation of mental health issues (and dismissal of the very physical roots of psychological problems) means that having a "hardware" or medical reason one is struggling makes it so much more explicable for most people, especially for a hacker/computer specialist who may gravitate toward clear-cut explanations.
posted by monocot at 1:09 PM on April 30 [87 favorites]


Isn't that the exact opposite of what you should do for a stroke?

My Grandma always said "Starve a stroke, but feed an aneurysm"
posted by thelonius at 1:20 PM on April 30 [55 favorites]


Neuroscientist here. N'thing the med/sci people above that (without contradicting the intensity or experience of the physical symptoms this person experienced), it is relevant to note that the dopamine/glucose mechanism doesn't seem physically possible.

And I do think the it is particularly important to clarify in this situation, because there is all kinds of questionable information (and marketing) that targets the tech community related to things like "hacking dopamine levels" or "dopamine fasting." This is the space where entrepreneurial pseudoscience loves to live and profit off of people's pain and fears. I think it's possible to have support and compassion for the harmed person's experience while still defusing disinformation.
posted by BlueBlueElectricBlue at 1:24 PM on April 30 [71 favorites]


I don't doubt that a whole industry of middle management have brought the 70+ hour work week and (their misinterpretations of) lean production/organisation methods in in tandem, but they don't really have anything to do with each other. If anything, optimising your processes and reducing waste (which is what lean thinking is about) should make it possible to deliver the same value with less work.

I wish this matched with my lived experience, but it doesn't.

Like, I agree that you can create lean processes. I'm now an operations manager and that's a lot of my job - with mostly people paid hourly so I can't learn on their backs, so to speak, without paying them. (Which we do!)

But my lived experience is that when people get obsessed with "leanness" and "not having waste" what ends up happening is incrementally, the expectations on individuals grow - because people design lean processes for the normal situations. Especially in salaried work.

As a relatively straightforward example, if someone's sick and someone else has to pick up the slack, they likely won't be as efficient or effective at those tasks, just inherently, plus communication time. So it might take 10% more time, or achieve 7% less.

Now you would think -- and if you work in such a place, great -- that building that buffer in would be critical but my actual experience is that instead, people just don't account for it, or underestimate it. Sick days, dentist trips, the amount of time spent watching planes fly into a tower on 9/11, the amount of time it sometimes takes to figure out a solution, etc., all come up.

I haven't found that people who are obsessed with leanness are willing to run with excess capacity for those times. And that's in a good organization, which...only my latest was. Most were totally fine to overload people ridiculously and then just - hire new ones at a lower salary.
posted by warriorqueen at 1:28 PM on April 30 [26 favorites]


"Even in this hypothetical instrument-learning session, the brain’s ability to stay on task would taper off as its stores of glucose dwindle. “You’d run into this depletion effect where you can’t sustain the same level of cognitive performance,” he says. Drinking Gatorade or gobbling a few jelly beans could replenish your glucose stores and help restore your brain to full power."

Glucose consumption effects are found for physical performance extremes like long distance running and it kicks in even before the ingested glucose can possibly be metabolized suggesting that human body has defensive cutoffs that activate well before any kind of actual glucose situation getting to a dangerous state of depletion.
posted by srboisvert at 1:56 PM on April 30 [1 favorite]


I literally tried to type.
Nothing would happen.
My thoughts were empty. I couldn't think of words.
My fingers wouldn't move.

The more creative work I did, the more my brain would almost "cramp" up, until finally all thought would cease and I couldn't do anything else.

I sit there, staring at my computer, & nothing would happen.

Kinda like running a car engine without oil (or fuel in this case) and having the engine seize.

So when I went to hack again... my brain recoiled.


I haven't had symptoms quite as extreme as he describes; for example, I have a hard time speaking, and thinking of words, when I'm tired, but not the severe aphasia he talks about. But all of these parts quoted above are so familiar to me. I eventually had to drop out of an important project because of it -- I could do some rote work, but not any kind of creative thinking or integrative processing, and eventually my brain started rebelling even at some of the rote stuff. And to this day, more than a year later, it still recoils (that's the exact sensation) when I try to read faster than usual or skim for information. I remember when it started; it felt like I'd broken my brain.

I don't think it's glucose, or at least it's not about not consuming enough sugar -- I intentionally consumed plenty, and I think I was eating decently besides that. Whatever the mechanism, in my case I think it was related to stress, to trying to work not just a lot but at speed, and I assume to my CFS. And I've had attention issues all my life, and sitting in front of a computer empty of all thought was not a new experience. But this recent stuff was way more dramatic than anything I'd ever experienced before, and it's a terrible, helpless feeling. I was used to my body malfunctioning, and I was used to brain issues on a less acute level. But suddenly being completely unable to actually process information and do all these things that I'd always been good at -- that was a frightening, disorienting shock.
posted by trig at 2:00 PM on April 30 [18 favorites]


I have also been experiencing something like this, not nearly as extreme. But I have definitely felt something similar. When I go to that part of my brain it feels spongy & bruised and I don't want to go there, but I have no choice but to continue smashing that bruise.

I think his bigger point is that our healthcare system is completely broken & unable to provide care to those who need it. If you can't take time off unless you're in the hospital, but you don't just go live at the hospital for everything that you can be sick from, we are just expected to work continuously until our bodies crap out, which does not take very much. And the reason we're living like this is because of individuals making decisions like the psychiatrist who didn't approve his short term disability paperwork. Like just fucking do it. We have our humanity ground out of us by the system which compels us to grind it out of everyone else. It's really sickening and stupid.
posted by bleep at 2:08 PM on April 30 [15 favorites]


I find myself thinking about this all day, can nothing be done? Do we all have to suffer every day of our short lives, for no natural reason except other people's bad decisions?
posted by bleep at 2:11 PM on April 30 [7 favorites]


Anyway I would love it if we could get some cultural understanding that a brain is a meat organ that has its own hard requirements and tolerances and it's not a sin to have born with one and to be beholden to those requirements. Jesus Christ.
posted by bleep at 2:19 PM on April 30 [10 favorites]


I was under the impression that “functional” in a diagnostic label was code for “we have no idea WTF is wrong with you and some nontrivial fraction of the profession suspects you’re making it up.” (I say this with more sympathy for the patients than for the doctors.)

Regardless, a diagnostic label can still be useful sociologically, in convincing people to show you grace in practical ways like disability insurance, and I hope that it’s helping this writer — it sounds like it’s been awful to live through.
posted by eirias at 2:47 PM on April 30 [13 favorites]


I find myself thinking about this all day, can nothing be done? Do we all have to suffer every day of our short lives, for no natural reason except other people's bad decisions?

The overwork side can be at least some what combated with unionization.

I had a similar much less severe thing happen too me. Work and stress levels were high and one afternoon at home my spouse found me just standing outside oblivious to the world and unresponsive. They took me to the hospital who scanned my brain a couple ways, ran about a hundred blood tests and didn't find anything at all. Eight hours later I was mostly back to 80% of normal and with a couple weeks rest no long term effects. The neurologist basically shrugged and mumbled something about viruses. Which, ok the symptoms disappeared, but that isn't the sort of thing you want to hear about your brain.

Freaky to hear it could have been so much worse.

You got to think variations of this happen all the time. Most people know (of) someone who went from super cognitive worker to ditch digger because they couldn't handle the thinking anymore.
posted by Mitheral at 2:53 PM on April 30 [7 favorites]


I find myself thinking about this all day, can nothing be done? Do we all have to suffer every day of our short lives, for no natural reason except other people's bad decisions?

Short answer: Yes.
Longer answer: you'd need a lot of cooperation out of other people--and them not making bad decisions--and if you don't have any leverage/control/way to get better results out of them, then....yes.
posted by jenfullmoon at 3:03 PM on April 30 [3 favorites]


Okay, so. The author quoted DSM-5 diagnosis codes, so I am going to talk about this in the DSM-5 context. Functional neurological disorder = conversion disorder. The historical understanding of conversion disorder is "mental stress gets converted into physical symptoms," though there have been enough cases without an identifiable stressor that we've removed the requirement for a stressor to be present. Conversion disorder is diagnosed when there are motor and sensory symptoms present with "clear evidence of incompatibility with neurological disease." If it were the case that his brain glucose/dopamine were depleted, assuming that were a thing that can happen, he would not have been diagnosed with functional neurological disorder. If there were a biological reason that doctors could point to, he would not have been diagnosed with FND. Eirias is spot on in their description of the meaning of "functional."

I don't know what the doctor told him, but either something got garbled, or the doctor is not using the diagnosis as it's written in the DSM-5. I suspect, based on sitting in the room while doctors give people functional disorder diagnoses, that the doctor was trying very hard not to use the words somatizing or conversion disorder, and was probably talking about the effects of stress on glucose and dopamine in the brain. There is currently no neurobiological model of conversion disorder. There are one or two small studies showing people with severe somatization have lower glucose metabolisms, but certainly nothing like a model of causality.

That doesn't mean there wasn't a biological reason for what happened. Of course there was. Our brains are biological. Everything that happens in them has a "physical" cause. And I think it's deeply tragic that medicine has spent so much of its history trying to draw boundaries around certain experiences and call them "all in your head" when the science nowadays is very clear that there is no such thing. The brain affects the body affects the brain affects the body affects the brain. Doctors are finally starting to catch up to this, but all that history has left us with a culture that now believes that it only "counts" if there's an identifiable biological cause. "Identifiable" causes are basically just simple ones. "Psychological" processes are equally biological, but usually too complex for us to understand at this point in time. (Less so then you'd think, though. Look up the neurobiology of PTSD sometime. It's pretty damn clear.)

What I am reading very clearly in these tweets is "this counts because there is a biological reason." If he was just stressed, if it was just his feelings, it would be okay to abuse him like this. But because there's a "physical" reason, it's understandable that he had to take a break. If it were "just" his feelings, "just" stress, then it would not have been. But he deserves to take a break, because it broke his brain, physically.

I am here to say that everyone deserves a break. There is no such thing as "just" stress. Stress kills. We already know this. Read Why Zebras Don't Get Ulcers for an overview. The fact that he did not get a break until there was a "physical" (read: obvious) manifestation of how badly he was functioning is horrendous. There is no such thing as "just in your head" and while I think corporations are happy to overwork their employees to the point of mental or physical breakdown with no qualms, the conversations we have as a society around that very much reinforce "stress sucks but you get through it." No! Stress will kill you! It doesn't need to be more complicated than that! Stress is enough of a reason to take a break!

Conversion disorder may in fact be a manifestation of that, though we aren't sure--the majority of cases are preceded by significant stress, but they can't all be explained that way. Still, as a theoretical model, it makes sense. It is essentially your body screaming at you to stop doing whatever the fuck you're doing. I saw someone once describe it as "you have been ignoring regular stress signals for so long that your body just starts flipping random switches to make weird shit happen until you pay attention." Again, we don't have a neurobiological model, so I can't say for sure that's how it works. But it is true that stress will do weird fucking shit to your body and that there are long-term effects.

Anyway tldr; we all deserve a break whether or not glucose depletion is a thing, physical distress is not the only distress that counts (but on a meta-level all distress is physical and it's all semantics anyway).

(Here's some of the literature I referenced while gathering my thoughts on the above.)

Nicholson, T. R., Stone, J., & Kanaan, R. A. (2011). Conversion disorder: a problematic diagnosis. Journal of Neurology, Neurosurgery & Psychiatry, 82(11), 1267-1273.

Hakala, M., Vahlberg, T., Niemi, P. M., & Karlsson, H. (2006). Brain glucose metabolism and temperament in relation to severe somatization. Psychiatry and clinical neurosciences, 60(6), 669-675.

Hakala, M., Karlsson, H., Ruotsalainen, U., Koponen, S., Bergman, J., Stenman, H., ... & Niemi, P. (2002). Severe somatization in women is associated with altered cerebral glucose metabolism. Psychological medicine, 32(8), 1379.

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
posted by brook horse at 3:50 PM on April 30 [182 favorites]


^ I appreciate the heck out of your comment, brook horse
posted by elkevelvet at 3:54 PM on April 30 [12 favorites]


To quote my partner: "Of course it's all in my head, THAT'S WHERE THE NEURONS ARE."

(Edit: Thanks elkevelvet, glad there was some value there for you. ❤️)
posted by brook horse at 3:57 PM on April 30 [62 favorites]


I LOLed, brook horse!
posted by eirias at 3:59 PM on April 30


But my lived experience is that when people get obsessed with "leanness" and "not having waste" what ends up happening is incrementally, the expectations on individuals grow - because people design lean processes for the normal situations.

Yeah, the same middle management types that push lean (especially in situations where it isn't necessarily particularly relevant, or is stretching the definitions) are very often the same types that run and create abusive work environments. But there is nothing inherently abusive about e.g. creating a kanban system for managing stock flows. Lots of people will push overwork alongside lean, possibly even try to conflate the two, but they are absolutely distinct things, and there are plenty of workplaces that do lean to varying extents (often without using the term, or not being very pushy with it if they do) without being assholes creating toxic workplaces.

It's particularly in knowledge and creative industries (as opposed to manufacturing or logistics/warehousing) where lean as a term is redefined and abused by management and consultants. That shouldn't tar the very concept itself, however.
posted by Dysk at 4:01 PM on April 30 [2 favorites]


But yes, I suspect lean going hand in hand with awful overworking of employees probably is typical in office jobs, particularly in the anglosphere. It's less true for blue collar work in my experience.
posted by Dysk at 4:04 PM on April 30


I have started to observe in my "workplace," or at any rate the vague internet-based environment that counts as my workplace, an extremely high number of just pure nonsense emails/slacks. Not quite word salad, but just very strange, disjointed, ways of phrasing things such that the meaning is completely unclear even though all of the words are familiar and apply to the project.

And an equally high number of messages that simply go unanswered, forever.

Some of us are now in the habit of checking in with each other throughout the day--"hey, did I stop knowing how to read? Or did X stop knowing how to write?" Sometimes it's one and sometimes the other.

People are shutting down; we just can't do it anymore. And by "it" I mean...basically anything, really.
posted by We put our faith in Blast Hardcheese at 5:06 PM on April 30 [31 favorites]


Not quite word salad, but just very strange, disjointed, ways of phrasing things such that the meaning is completely unclear even though all of the words are familiar and apply to the project.

I have noticed this too, and here on Metafilter as well. I can't remember what it was but the other night I read so many responses like this in a row that I started to feel disoriented and worried that it actually was me--like, did I have a TIA or something? Why can't I understand this? It was disturbing.
posted by HotToddy at 5:27 PM on April 30 [10 favorites]


ever so loosely related: 2021/04/28 nature podcast episode covers research of the relationship between neuronal activity & neuronal metabolism. The observed results of how the neuronal metabolism reacted to activity were were contrary to expectations:

> we demonstrate that even transient increases in neural activity result in rapid and persistent increases in cytosolic ATP, which suggests that neuronal metabolism predictively allocates resources to anticipate the energy demands of future activity. Finally, our studies reveal that the initiation of even minimal behavioural movements causes large-scale changes in the pattern of neural activity and energy metabolism, which reveals a widespread engagement of the brain

- https://www.nature.com/articles/s41586-021-03497-0 (paywalled)
posted by are-coral-made at 5:33 PM on April 30


Finally, our studies reveal that the initiation of even minimal behavioural movements causes large-scale changes in the pattern of neural activity and energy metabolism, which reveals a widespread engagement of the brain

I'm autistic with a lot of movement/coordination difficulties. People think I'm crazy when I say, "I can't do that series of complex motor movements, it exhausts my brain." It takes energy to do! And probably more so when your brain sucks at it! Chopping vegetables makes my brain hurt!

*walks away mumbling theories on the research on local vs whole-brain activation in ASD*
posted by brook horse at 5:48 PM on April 30 [5 favorites]


FWIW my wife, who is a psychiatrist, skimmed the Twitter thread and more or less agreed with brook_horse with the exception that

1) conversion disorder is psychological - there may be some biological component but you treat this with therapy, not glucose injections or something

2) he didn't mention if he had a EEG which confirms if he had a seizure or not. It could be that he's using the term hyperbolically which is understandable.

She also said 'who's sending you this crap' and when I said 'Metafilter' she just kinda rolled her eyes and went back to digging holes and smashing rocks in Animal Crossing.
posted by paimapi at 6:02 PM on April 30 [25 favorites]


> the same middle management types that push lean are very often the same types that run and create abusive work environments. But there is nothing inherently abusive about e.g. creating a kanban system for managing stock flows. Lots of people will push overwork alongside lean, possibly even try to conflate the two, but they are absolutely distinct things

e.g. one year ago the business decided it must have five TPS reports produced weekly by close of business wednesday, and sets up a team of five analysts to produce the weekly reports. this year, management decides it needs to cut costs. the cost of these TPS reports is too damn high.

overwork response: management lays off three of the five analysts, expects remaining two analysts to produce the same number of TPS reports according to the same deadlines as the previous team of five.

lean response: management/analysts/employees determine that the TPS reports are not actually used by the business process, they are non-value-adding, aka waste. there is no need to continue producing useless reports. team of analysts are (a) reassigned to more valuable activities or (b) laid off ...or perhaps (c) the manager of the analyst team has enough political clout to kill the lean initiative in order to preserve the status quo.

Separately from "lean", in many situations, there is usually conflict between the goals of "reliability / robustness" and "efficiency". E.g. if there needs to be an operations team on call 24 / 7 to support some critical function (ambulance dispatch, electrical grid failures, payment processing), it is more cost-efficient to have fewer people in the team but a team with more people will have more slack that is better able to handle such outlandish events as: someone goes on holiday for a month, someone gets sick or needs to take time off to care for a sick family member, someone quits for job with less corrosive working conditions, the critical function has an unusually bad week creating five times as much firefighting work as usual, etc. In a healthy work environment the entirely predictable consequences of a failure to allocate enough spare capacity to deal with events should fall on the organisation, not on employees.
posted by are-coral-made at 6:11 PM on April 30 [6 favorites]


1) conversion disorder is psychological - there may be some biological component but you treat this with therapy, not glucose injections or something

Yeah I might not have been clear, conversion disorder is absolutely classified as a psychological disorder--I just personally don't think the distinction of psychological/biological is very helpful, and clinical psychology has been moving away from it in recent years (I don't know if psychiatry feels differently). Psychological disorders affect biological changes, and biological changes affect psychological processes. Therapy affects biological changes because everything we do with lasting effect is going to show some sort of biological change. But yes, it's treated with therapy (and sometimes psychotropic medications), not glucose injections or anything we would call "physical/biological" treatment.
posted by brook horse at 6:39 PM on April 30 [16 favorites]


(Also, the way things are treated today is not necessarily the way they should be, or the way they will be in 5, 10, 20 years. There's way too much we don't know.)
posted by trig at 6:51 PM on April 30 [7 favorites]


Well, regardless of exact medical causation, I really appreciated this post and the comments in this thread. I experienced a similar "brain stop working now" event earlier this year that terrified me; I had been experiencing the whiteouts of a visual migraine more frequently in the month leading up to the event, and then on the day of it started again. I ignored it because what else are you gonna do, it didn't hurt at all just a little distracting. But then I just straight up lost the ability to remember and pronounce words correctly for about 20 minutes, like I was just combining syllables from the words I wanted in a random order. My coworkers said "boy I hope you're not having a stroke" and like a person with extremely poor judgment, I went, "it's probably fine but I should drive myself home." I didn't leave until I could carry on a perfectly cromulent conversation with my husband and was sure the event had ended, but I still shouldn't have driven. By the time I got home I had a raging headache and then slept for 12 hours.

When I reported it to my healthcare provider they said it was a common symptom of migraines and weren't really worried. I had been under some major long-term stress; I'm newly in a leadership position at my job that involved a lot of conversations and panic about how to take care of everyone in our organization during covid. So I was both learning the ropes and trying to navigate something unprecedented at the same time. My brain blue screen event happened at the end of the first day everyone returned to full in-person work, a day I had worried about for months and lost a ton of sleep over. The day itself went fine, and in retrospect I think I'd adjusted to the constant stress that it had turned into background noise so the day itself actually felt way less stressful than normal. But I was jittery, hyper-vigilant, it was the event I'd been dreading and discussing for a full year, and it was so chaotic I didn't eat that day. So when 5:00 rolled around and I got to have some genuinely fun small talk with coworkers, it was like my brain just melted.

My healthcare provider gave me a compassionate version of the "jfc you've got to eat actual food" speech, which I've been diligent about since then. I feel really good, but I'm still low-key terrified about it. My brain is all I have; my intelligence is how I define myself and make my mark on the world. Losing it for even 20 minutes was an earth shaking event, and the worry that I don't know exactly what caused this so it might happen again will drive me to insanity if I let it. I completely understand the twitter poster's desire for a tidy narrative with clear causal inputs that he can control, even if it's not a strictly accurate understanding of what occurred. Like even though I know that capitalism will systematically rob us all of our talents and joys and that the harder I fight to protect people from that fate the more I eat myself from the inside out, I can't face that yawning nihilism every day. "Eat good food or brain go bad" is something I can hold onto, even though it is overly reductive.
posted by lilac girl at 7:32 PM on April 30 [22 favorites]


I was under the impression that “functional” in a diagnostic label was code for “we have no idea WTF is wrong with you and some nontrivial fraction of the profession suspects you’re making it up.” (I say this with more sympathy for the patients than for the doctors.)

It sure is (e.g., Functional Abdominal Pain Syndrome). I'm sure the author was just trying to convey what he understood from a series of doctors against a backdrop of hacker culture assumptions, though.
posted by praemunire at 7:34 PM on April 30 [4 favorites]


If it were the case that his brain glucose/dopamine were depleted, assuming that were a thing that can happen, he would not have been diagnosed with functional neurological disorder.

what is funny, or sad, is that if I were to go to a doctor for such a problem as he had, the second I heard the word "functional" come out of their diagnosis parts I would have a knee-jerk reaction causing me to stomp out & shout at everyone I know about how THE DOCTOR CALLED ME A HYSTERIC AND THOUGHT A FANCY DIAGNOSIS CODE WOULD KEEP ME FROM NOTICING

and I would be right. notwithstanding the number of good doctors, who I know exist, who would apply codes as the system dictates but who would not confuse "psychological or psychiatric problem" with "imaginary" and would still try to help me.

whereas this guy, this guy is apparently so unfamiliar with the delicate language of convincing patients they are being taken seriously, and is so used to being taken seriously for real, that this went right over his head and he remains serenely confident that he has been Diagnosed with a serious important real measurable actual factual rare disease. a neuropsych said so, after all.

and he is wrong and I would be right, but being wrong has given him a lot of confidence and security and solace, and being right would make me nothing but miserable. and hysterical, no doubt, in the colloquial sense and probably the antique psychiatric sense, too.

funny old world
posted by queenofbithynia at 8:17 PM on April 30 [63 favorites]


and I would be right. notwithstanding the number of good doctors, who I know exist, who would apply codes as the system dictates but who would not confuse "psychological or psychiatric problem" with "imaginary" and would still try to help me.

Truth.
posted by praemunire at 8:22 PM on April 30 [3 favorites]


"Conversion disorder" is a useful term I learned (relearned? not sure. I once got a psych degree) from this thread. Thank you.
posted by limeonaire at 8:38 PM on April 30


Perhaps this is wrong but his experience just seems like some form of aneurysm or stroke. Not at all to invalidate anything he's expressed, but is there a conclusive reason it isn't?
posted by firstdaffodils at 9:02 PM on April 30


Um, if he actually had low glucose in his brain wouldn't that be cured by eating a few jellybeans? I thought one of the things our bodies are good at is delivering glucose to our brains
posted by medusa at 9:15 PM on April 30 [1 favorite]


Also I spent a while being confused about why an infosec worker was so taxed by testing pens. Surely you just do a quick scribble on a scrap of paper and call the pen tested?
posted by medusa at 9:18 PM on April 30 [8 favorites]


Haha- except answer my question.

Apologies if it's answered before. The thread is incredibly long and I'm sincerely asking.

Pen-testing jokes are always.. fresh.
posted by firstdaffodils at 9:46 PM on April 30


Cobalt sort of answered. I have family members with hypoglycemia, it does sound similar but really gray area. Mostly asking for friends/family with hypoglycemic conditions in mind.

"He appears to be describing PNEA, aka non-epileptic seizures, which we don't know the pathophysiology for. We also don't know the pathophysiology for transient global amnesia, which also seems to happen under extreme psychological stress. My disagreement with the author is that, yes, within the constraints a, he is trying to give measurable type answers (glucose! dopamine!) for why he had this, as opposed to accepting that we don't know the actual 100% cause. This is a cultural way of coping, but arguably, may be part of the reason he ended up there."
posted by firstdaffodils at 9:53 PM on April 30


Perhaps this is wrong but his experience just seems like some form of aneurysm or stroke. Not at all to invalidate anything he's expressed, but is there a conclusive reason it isn't?

Stroke/aneurysm was probably ruled out by the MRI.
posted by mr_roboto at 10:20 PM on April 30 [2 favorites]


That is a perfectly cromulent answer.

Thank you.
posted by firstdaffodils at 10:27 PM on April 30


2) he didn't mention if he had a EEG which confirms if he had a seizure or not. It could be that he's using the term hyperbolically which is understandable.

I think he did actually say that he had an EEG along with his MRI, which apparently came back clean and thus probably (though not definitively) rules out seizure. He later references "seizure" in a way that suggests he either didn't understand or didn't accept the results of the EEG, which might have confused the issue a bit.
posted by biogeo at 10:37 PM on April 30 [5 favorites]


This is partly metatalk, but hopefully relevant within the discussion: why is the favorite/post rate so high here? Why are there so many posts over 20+ favorites?

This isn't a social media question at all; I'm wondering if this kind of burnout / ailment / stress / health diagnosis quandry is so prevalent that it's making everyone say, "YES!"?

Again, not credulous, just curious.
posted by Reasonably Everything Happens at 10:55 PM on April 30 [1 favorite]


"This isn't a social media question at all; I'm wondering if this kind of burnout / ailment / stress / health diagnosis quandry is so prevalent that it's making everyone say, "YES!"?

The above and I'm sorry, but if you have a thread online regarding neuropsych/neurology with dozens or even hundreds of possible answers and multiple neurologists reply with even partly conclusive /reaffirming data, it feels really good to read.

I almost asked a question in relation to flat-lining or burnout today (I recently did something simply fantastically burnt that confused my approach to working standards and felt.. well.. as described): I didn't have to. I could read instead. I'm really grateful.

I actually wanted to stay away from the internet awhile, but this felt too on point to avoid, so I asked a few questions.
posted by firstdaffodils at 11:04 PM on April 30 [2 favorites]


It's braggadocious, is what it is: "I got burnt out from overwork like a normal person" v. "I brained so hard, harder than almost anyone has ever brained, that my brain literally physically consumed all the brain fuel"
posted by save alive nothing that breatheth at 11:09 PM on April 30 [20 favorites]


It does read as very "but my burnout is special, different, and totally real and valid!" with a heavy implication that this doesn't apply to other people's 'regular' burnout.
posted by Dysk at 11:16 PM on April 30 [21 favorites]


Yeah. Like if it were contextualized slightly differently, it might be more helpful for everyone, including the author.
posted by firstdaffodils at 11:21 PM on April 30


This is partly metatalk, but hopefully relevant within the discussion: why is the favorite/post rate so high here? Why are there so many posts over 20+ favorites?

Because I read the article, thought, "They told him he had a 'functional' disorder, which means they think he's probably faking it, and somehow he turned that into 'I thought so hard I ran out of sugar in my brain!!!'...or at least that's how it sounds to me, but I'm not an expert, possibly I should withhold my modestly-informed opinion," and then people with expertise came along and explained clearly exactly what I was thinking, only with, you know, expertise. And then I hit 'favorite' a lot.
posted by praemunire at 12:07 AM on May 1 [14 favorites]


I'm a neurologist. His description of his events was pathognomonic for FND (of which PNEA, referenced by cobaltnine, is a subset; conversion disorder is a deprecated term in neurology but I think might still be used in psych?) The only other syndrome where people start losing their words like that is a nasty bugger called primary progressive aphasia, which is what I'm guessing the neuropsychologist was looking to rule out.

The classic setup for FND is someone with a high-intensity role either at work or in their personal life, suddenly begins experiencing neurological symptoms that don't follow a neuroanatomical distribution. But there are plenty of patients who don't fit that profile. What all those people have in common is that their illness is not structural, then, but functional. As he references in his tweets, there is a lot of overlap between FND and PTSD. If you know anything about the history of PTSD, you'll know that it used to be called "shell shock," and the WWI soldiers who suffer from it were also accused of faking their symptoms, just like patients with FND. A century later, we understand that PTSD is not only not just a soldier's disease but also that it is, fundamentally an overwhelming reaction to an overwhelming stressor that your brain/body decides to apply to a whole bunch of other contexts that should be non-overwhelming. I hope it won't take another century before we get to the same level of understanding for FND.

The glucose/dopamine stuff is indicative, to me, of how our culture (or perhaps engineering culture) needs to validate itself with quantitative sciency sounding things, when the truth is we don't understand yet why FND happens to some people and not to others. FND is not pseudo-science, and amplifying a pseudoscientific explanation as much a disservice as accusing people of faking their illness.

Some good resources I often direct patients to are FNDHope.org (US advocacy org) and NeuroSymptoms.org (patient website put together by the world expert in this, Dr Jon Stone in the UK).
posted by basalganglia at 12:15 AM on May 1 [50 favorites]


I think he suffered some kind of brain insult when this all began:
In February of 2020, one evening, I felt a "pop" in the middle of my head. Like a bass guitar string being strummed.

A migraine ensued. I lost my vocabulary. When I tried to speak, it came out as heavy stutters.

I couldn't look loved ones in the eye, it was too much stimulus.
but he is maddeningly nonspecific about the circumstances and what he was doing at the time. "loved ones" makes it sound like he was home with his five year old son and a girlfriend or member of his family, since he mentions elsewhere that the reason he had to work so much was that his partner left him for another man and it was the only way he could afford to keep living in his house. It would be very nice to know whether he had a history of migraines, or this was the first one. I'd say a history because he doesn't mention any confusion about what it was.

Way back in the late 20th century, I came out of a little chicken place on University Ave. in Seattle that I ate in four times a week at least into a sudden flood of sunshine and sneezed violently three times in close succession. No one was near me, so I didn't try to hold back and didn't think anything of it as I walked a couple of doors down to a newsstand. But on the cover of the first magazine I looked at, a Vogue, the model's face made no sense -- it was like looking down into an oval shaped puddle where lips, a nose, two eyes, and two eyebrows were swimming randomly around like small animals. I looked up at the man behind the counter, and he looked like one of those people who are waiting for a face transplant after being shot in the face. I knew I must have done something bad to my brain, probably caused a stroke, so I closed my eyes and tried to remember my partner's face -- and it was just as bad as the others. Then I felt despair, but also desperation, so I walked a block over to the UW campus to get away from auto exhaust and look at green things, but like Tinker, I could not bring myself to look people in the face.

After about 20 minutes, I had a fleeting image of my partner's face, and then seemed to get back to normal rapidly. But when I had my first migraine some ten years later, the initial symptom wasn't the usual flashing crenelations in my visual field, though those followed a few minutes later, it was face blindness like after those sneezes. And that was the pattern of my migraines for ten years, when for some reason I suddenly no longer experienced face blindness and the migraines went directly to fortification illusions.

I clearly didn't have a stroke, and since the fortification illusions of migraines are thought to be caused by direct contact between the occipital lobes of the brain and the meninges, I think it's likely that sneeze induced contact between the part of the cortex associated with recognizing faces and the meninges caused my episode of face blindness.
posted by jamjam at 1:08 AM on May 1 [17 favorites]


This is fascinating. For some reason I'm really interested in neurological stuff written for lay comprehension, and this thread is like coming across a new essay by Oliver Sacks.
posted by Joe in Australia at 3:01 AM on May 1 [3 favorites]


This is partly metatalk, but hopefully relevant within the discussion: why is the favorite/post rate so high here? Why are there so many posts over 20+ favorites?

Lots of intersecting interestingnesses, I think. You've got the angle of how fundamentally broken US healthcare is, which is obviously and tragically going to resonate with many. That's on top of just-as or even more broken societal attitudes towards unclear-unknown physiological causes of this kind of Functional diagnosis type. And that's on top of the stumbling blocks of unclear-unknown science being pretty fractally fraught when (very) non-expert folks try to talk about it. And that's mixed in with this particular fellow trying to talk about it being ran through that very obviously IT engineer-y filter with its own attendant deep structures of looking at and understanding the world; demographically, it's fair to say that Metafilter's population does not hold IT engineer-y filters in very high regard! (Contemptuous framings of "braining so hard" and whatnot, which I throw zero stones over--I can't think of the last time I ever said or thought "thought leader" without a sneer!) And that on top of strands of nevertheless, maybe cut some people a bit more slack and assumption of good faith, but also the fact that there's a lot of medical-science hokum out there that's deliberately aimed to mislead, which absolutely should be even clearer after a year-plus of pandemic, which also wraps right round to pretty much everyone being stressed out and wondering why more peoples' brains aren't making vacuum-tube-popping noises.
posted by Drastic at 8:05 AM on May 1 [3 favorites]


If you're finding this compelling and want to know more about functional/psychosomatic conditions, can I recommend Suzanne O'Sullivan?
She's a neurologist who's written several very readable and sympathetic books on the subject. I find this subject endlessly fascinating but also vaguely triggery, having spent a lot of time being told that my-very much physical, it turns out- symptoms were psychosomatic, in the bad way that means, "go away and get a grip, neurotic lady." Reading O'Sullivan actually helped me get back to the point where I was able to think constructively about the brain/body, feelings/ideas/symptoms interplay, which is actually very useful.
Plus her books are just really fascinating and she manages to make what psychosomatic actually means - it doesn't mean imaginary! It doesn't mean the patient is in control of the symptoms or causing them! It doesn't even mean mental illness! -very clear, in a way a lot of writing on the subject just doesn't.
posted by BlueNorther at 8:27 AM on May 1 [5 favorites]


A lot of people I've met have not heard of psychosomatic responses, or understand the correct definition. It's definitely not imaginary.
posted by firstdaffodils at 11:08 AM on May 1 [3 favorites]


I've been previously diagnosed with functional dyspepsia, by a gastroenterologist. He said he sees tons of cases like mine and so he knew for certain the problem is just stress. I didn't even get a blood test, just a technician to do an ultrasound.

So how does he know that I don't have a malfunctioning gall bladder or messed up gut bacteria, or something, that doesn't get picked up by simple tests? He doesn't. It's just the status quo of (capitalist) medicine based on incomplete human progress on medical science and technology.

The problem with practicing doctors is that they aren't trained like scientists and thus don't think like ones. Doctors are remarkably authoritarian and non-client centered. Basically we don't know what Functional X really is ("no known" being conflated with "doesn't exist"), and thus how to treat it, and if we did there people would be winning Nobels left and right. The previous dogma was that ulcers was caused by stress, now ulcer symptoms immediately invoke H. pylori eradication protocol.
posted by polymodus at 11:33 AM on May 1 [6 favorites]


polymodus, you might be interested in _The Second Brain_ about the large section of the nervous system which runs the digestive tract. A lot can go wrong which isn't a malfunction of an organ, it's a problem with the nervous system running the organs.
posted by Nancy Lebovitz at 11:35 AM on May 1 [1 favorite]


Polymodus, that helps some of my questioning, the answer is appreciated.
posted by firstdaffodils at 11:41 AM on May 1


Yeah there's emerging research on the "brain and gut connection" that doctors and scientists think is promising, but not much of that has made its way into everyday treatment for patients. Doctors don't think of themselves as psychiatrists so in my experience they pretend psychological interventions don't exist. They don't operationalize to the patient what it means when you have FX, why destressing is something that might work (and why "it's just stress" is privilege-laden), etc. It's an interdisciplinary gap.
posted by polymodus at 11:42 AM on May 1 [2 favorites]


There is a Hacker News thread about this which is HN's typical mix of insight and clueless speculation.
posted by epo at 12:07 PM on May 1


Very similar thing happened to a friend in college. Last year architecture degree, they had been working non stop for weeks on an architectural model (before 3d software and printing were a thing, all painstakingly hand made), wining a dominoes tournament, and doing freelance work. One morning they could not speak in words, or get dressed, or figure out how to open the door to the apartment. A concerned classmate found them 36 hours later, very dehydrated because they could not figure out how to operate the faucet and a drinking glass.

It took them a year to somewhat recover enough to finish school.

At the time the explanation given by the last of more than 15 specialists consulted was that "the brain ran out of neurotransmitters".

We know so little about how the mind works, the common understanding of "psychosomatic" I see as the god of the gaps of the dualists.
posted by Dr. Curare at 4:46 PM on May 1 [4 favorites]



"We know so little about how the mind works, the common understanding of "psychosomatic" I see as the god of the gaps of the dualists." This is a nice sentence.
posted by firstdaffodils at 4:52 PM on May 1 [2 favorites]


It does read as very "but my burnout is special, different, and totally real and valid!" with a heavy implication that this doesn't apply to other people's 'regular' burnout.
Yeah, that’s how I read it as well. My impression is the poor guy has internalized and is reinforcing the very attitudes that stigmatize and victimize people in his position: the idea that psychological problems stem from mental or moral weakness, that people “ought” to be able to carry on indefinitely, particularly in mental tasks, and that anything without a clear mechanistic explanation must be pathologically imaginary. Independent of whatever neurological correlates there may or may not be for it, he’s worked himself to exhaustion, but he doesn’t think that’s a valid diagnosis any more than his former employers do. His own experience was undeniably real to him, however, so he needs a story to tell himself, and others, to explain why his experience was special and non-imaginary without giving up any of the common toxic biases against other people who suffer mental and physical consequences of chronic overwork. You may have been tired, but you’ve never brained so hard your brain went pop.

Whatever other conditions he suffers from, I’m pretty sure he’s got a raging case of Engineer’s Disease. I’m left hoping the guy doesn’t manage other people himself, because it seems like he took way the wrong lesson from his experience, in ways that might make him even less sympathetic to other people’s humanity.
posted by gelfin at 5:57 PM on May 1 [8 favorites]


Doctors don't think of themselves as psychiatrists

.....the ones who are psychiatrists certainly do. might as well say "doctors don't think of themselves as gastroenterologists." no, not all of them do, just the ones you need.
posted by queenofbithynia at 11:35 PM on May 1 [2 favorites]


"It does read as very "but my burnout is special, different, and totally real and valid!" with a heavy implication that this doesn't apply to other people's 'regular' burnout."

Similarly, I read it as a person who probably did have a significant burnout experience, and probably has a traditional western worldview where 65hrs/weekly is normalized, and possibly feels really ashamed(?) to have anything disrupt the schedule.. so there's a dash of compensation.

The tone is a little reductive, but it made me wonder how many other brains have 'popped', without caring for themselves afterwards or during.
posted by firstdaffodils at 11:38 PM on May 1


a traditional western worldview where 65hrs/weekly is normalized

65 hour work weeks might be common in some anglophone countries, but they are not normalised across the Western world, and certainly not traditional.
posted by Dysk at 11:59 PM on May 1 [5 favorites]


He may well be full of himself, but also I think a lot of people with chronic pain or chronic fatigue have come up against the situation where you try to explain to someone how abnormally tired you are or how abnormal the pain is and what you hear in response is, "well, we're all tired", or "well, everybody starts to pick up aches and pains as we get older". Your brain literally loses some functions? "We all get burned out sometimes." And it can be hard to convey the difference in quality or severity without sounding like you're making an unwarranted big thing about yourself, or feeling like other people are probably thinking that way about you. He was probably just trying to find a way to convey how shockingly different this was than anything else he'd experienced until that point.
posted by trig at 12:13 AM on May 2 [13 favorites]


What helped me move from loss of vocabulary and recoil at the thought of sitting down to concentrated work like a long piece of analytical writing was shutting down access to all fast moving content - news feeds, and twitter in particular. The latter we know is designed to maximize attention, and feed the dopamine transmitters intermittently in order to addict. I'm not a medical specialist but I am experienced in human centered design and the extraction of user data and inputs for profitable exploitation.

My attack of blankness and inability to daydream, idle thought, cogitate or reflect, much less connect the dots and synthesise - everything I needed for creative insights and thus the rent and food of life- lasted 10 to 12 weeks and I was totally offgrid from middle of January this year to the middle of March.

Once I emerged from it and felt strong enough to connect to the internet, I forced myself to go blog everyday the way I used to before social media was born - the early days were a struggle to compose coherent sentences and I'd sit there blankly trying to recall vocabulary. It took a month of this activity to start getting my brain to work again, even now its difficult to conceptualize or stare into space lost in thought, but my writing and thinking side has improved tremendously and assisted with healing in a way I deeply appreciate. And, I began to think about what might have happened and why.


For a few years before this event, twitter in particular took over huge chunks of my bandwidth - at the time, I felt justified since until about 2019, most of my new projects were coming from twitter contacts. My use of twitter was primarily curating news on a specific theme - combining the rapid scanning and fast moving aspects of content flow. And very rapid responses to queries or commentary on analytical work, often reviewing research or insights in threads. I would lose track of time but emerge after 4 or 5 hours as though I'd achieved something in analysis or synthesis of novel ideas.

Yet the efforts of the past 6 weeks in abstaining from news feeds and twitter, and only focusing on reading journal articles and writing introspectively or writing literature reviews, has shown me the vast difference in both the emotional experience of this slower more thoughtful UX as well as the noticeable difference in healing and a sense of balance and groundedness.

This has made me wonder what role does the prevalence of persuasive design and dark patterns driven by the attention economy and adtech's need for ever more data have to do with hastening such experiences of cognitive breakdown since we don't yet know enough of the impact of the intermittent feeding of our pleasure centers as well as the increasing acceleration of systems driving the phenomena of continuous partial attention?

Perception of time and events has sped up with the acceleration and increase of fast moving content - is it also accelerating the stress component leading to such events? Will these become more frequent? Should I be thinking of changing my use of computing technology entirely? these are my thoughts as I continue to experiment with breaking up old patterns and observing my own progress in re-acquiring cognitive ability that simply got blanked out and/or squashed. And, does intensive immersion in the social media UX relate to the dopamine issue?

Finally, it surprised me how many mentions there were in this thread of such an experience happening in the recent months and years. Is it becoming more common or do we have something in common that it happens to us?
posted by infini at 3:36 AM on May 2 [8 favorites]


Age may have something to do with it, Infini, but I think you're right in fingering the accelerating nature of our data feeds. I find I simply can't tolerate some current UX patterns: e.g., the ones with flickering feeds about other people's (purported) purchases literally make my mind seize up and I have to leave the page. Could I have tolerated them when I was younger? I really don't know: I've always been better at absorbing static information. But previously there wasn't this huge attention sink, not only from advertisements but from everything; every modern website is striving to capture my attention and interaction. Ironically, my habit of absorbing huge data feeds works against me now: it's like trying to swallow an octopus and I just feel mentally bruised.
posted by Joe in Australia at 3:52 AM on May 2 [2 favorites]


Yes, exactly, Joe in Australia, in agreement with your last two sentences in particular. As for age, I do not deny that might be a factor too, but the acceleration over 2020 and its discontents certainly had a part of play in my own brain breakdown. Not only was the past year extremely different from any in our lived lifetimes but the stress was being accelerated and thus intensified by political forces in addition to the usual profitable ones across the platforms of communication and interaction. It was like the internet had become a megathread.
posted by infini at 6:29 AM on May 2 [1 favorite]


Hm. "a traditional western worldview where 65hrs/weekly is normalized

65 hour work weeks might be common in some anglophone countries, but they are not normalised across the Western world, and certainly not traditional"

"*a common US perspective where 65hrs/weekly is normalized"

Dysk, you're absolutely right. Completely forgot about Canada's incredible healthcare system and like, a thousand other details.
posted by firstdaffodils at 6:33 AM on May 2


Just another neuroscientist here to note that "glucose depletion" is not a thing, nor compatible with, well, life or the brain as we know it.

It does read as very "but my burnout is special, different, and totally real and valid!" with a heavy implication that this doesn't apply to other people's 'regular' burnout.

This. It came across to me like a tech-bro assuming a cloak of credibility with terms like "dopamine depletion" and describing himself as so smart and hardworking that he'd just thought his way into an abyss. The problem is that it ultimately works against him specifically, here, and more notably it pits him against all the other mediocre lackeys with indeterminate neurological or functional problems. Which is really to say that it reeks of social privilege.

I believe that he burned himself out, but not more than anyone else who has developed a chronic, undercharacterized problem, and I really resent that he's asking me to believe that by using my words.
posted by Dashy at 2:29 PM on May 3 [10 favorites]


It is also extremely possible that a lot of people are experiencing the sequalae of undiagnosed covid-19 infections which features brain fog and exhaustion as some of the most prominent symptoms once you get past the basics of breathing. We are in completely uncharted territory with this new disease and have no real idea of what the medium and long term consequences are.
posted by srboisvert at 9:22 AM on May 4 [7 favorites]


I don't wanna get hung up on the specific claims made in the tweet thread but I do want to say that application pen testers are definitely ground up until they breakdown and are spit out.

I am a cybersecurity professional and I lead and build cybersecurity organizations for a living and I know so many pentesters that have flat out broken apart mentally under the work load, even before covid.

Mental Health and Wellness is the biggest current threat to the state of the future of Cybersecurity. Our current work methods are absolutely unsustainable and are quite literally driving people into suicidal actions and mental hospitals.

This is something I am actively working on every day with my security organization. We as a team are so acutely aware of this problem and we hire people out of these unsustainable groups and give them a manageable work life balance and make sure they get the mental health care they need to address the very real PTSD that happens in this line of work.

I'm talking like, pen testers I personally know doing onsite engagements have gotten kidnapped, gotten hits put out on their heads, gotten arrested, shot at, put in prison, etc. This work is so incredibly and ridiculously stressful, I want nothing to do with contributing to the problem and everything to do with fixing it.
posted by noiseanoise at 4:13 PM on May 5 [3 favorites]


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