We are in triage every second of every day

We are always in triage. I fervently hope that one day we will be able to save everyone. In the meantime, it is irresponsible to pretend that we aren’t making life and death decisions with the allocation of our resources. Pretending there is no choice only makes our decisions worse.

https://www.wnyc.org/widgets/ondemand_player/radiolab/#file=%2Faudio%2Fxspf%2F655987%2F

Spoilers ahead— listen to the episode beforehand if you don’t want to hear rough summaries first.

I quite liked the above episode of RadioLab. The topic is triage, the practice of assigning priority to different patients in emergency medicine. By extension, to triage means to ration scarce resources. The episode treats triage as a rare phenomenon– in fact, it suggests that medical triage protocols were not taken very seriously in the US until after Hurricane Katrina– but triage is not a rare phenomenon at all. We are engaging in triage with every decision we make.

The stories in “Playing God” are gripping, particularly the story of a New Orleans hospital thrown into hell in a matter of days after losing power during Hurricane Katrina. Sheri Fink from the New York Times discusses the events she reported in her book, Five Days at Memorial. The close-up details are difficult to stomach. After evacuating the intensive care unit, the hospital staff are forced to rank the remaining patients for evacuation, because moving the patients is backbreaking labor without the elevators and helicopters and boats are only coming sporadically to take them away. Sewage is backing up into the hospital and the extreme heat is causing some patients and pets to have seizures. Meanwhile, on the news, the staff hears exaggerated reports of looting and lawlessness in the city. Believing they have no choice, some of the staff begin to think euthanizing the sickest patients (and those hardest to transport for evacuation) may be the merciful thing to do. It is alleged that some patients were euthanized, though no one involved was ever charged. Tragically, the possible killings took place on the same day that the rescue vehicles returned.

The crux of this story is that giving in to the logic of triage put the hospital staff on a slippery slope to “playing God.” The episode goes on to discuss ways of formalizing triage so people don’t have to rely on their own judgment at such a fraught time. (Utilitarian triage is discussed, and you can almost hear the speakers holding their noses.) Very often, concerns for the caregiver’s conscience take center stage, though no one acknowledges how selfish this is. Triage is portrayed very unsympathetically throughout, as if the people being forced to make the choice must be at fault somehow for having gotten in the situation.

But it was the last story that made me want to write this. Sheri Fink, the guest reporter, describes a woman she met in a American-run disaster-relief hospital in Haiti. Nathalie was a charming middle-aged woman whose life was spared because she went to the hospital for difficulty breathing. When the earthquake struck, her entire family was at their home, which collapsed and killed them all. Nathalie was putting on a brave face, just glad to be alive, and she radiated gratitude for the care she had received. But there was a problem. Nathalie needed oxygen, and the hospital (indeed, the nation) did not have enough to go around. Because she was suffering heart failure, the triage nurses had decided she should receive no more oxygen and return to a local Haitian-run hospital, most likely to die. Fink mentions ruefully that the nurse who made the call had never met Nathalie, as if that makes any difference at all. Fink rides in the ambulance with her to the new hospital, where she coughs and sputters and receives no oxygen to help. Fink’s heart breaks. But when Nathalie gets to the Haitian hospital, a clever doctor does what he can to drain the fluid from her lungs and manages to get her through the crisis without supplemental oxygen.

This story reinforces for Fink the fantasy that you never have to choose– that agreeing to choose is already going too far. Fink was so moved by Nathalie that she helped her to get a humanitarian visa to the US. It turned out Nathalie needed a heart transplant, and she died before she could get one. But, Fink says, she was a delight to everyone she met in those hospitals, and she even took up a collection for the other patients back in Haiti. So who were the doctors to say that she didn’t deserve every chance?

This is, of course, the wrong question. Of course Nathalie deserved every chance. No one should have to suffer heart failure in the first place. But did she deserve the oxygen more than all the other people who needed oxygen in that hospital? No. Did Nathalie’s time alive matter more than the greater amount of time the doctors could give other patients by employing the oxygen carefully? Absolutely not.

Nowhere in the episode were the beneficiaries of the triage discussed. There was no attempt to determine how many more people were saved because hospital staff took difficult, decisive action. There is no discussion of who should have died in that situation if not Nathalie– someone with many healthy years ahead of them? two people who could have been saved with the same amount of oxygen?– only denial that anyone had to die at all. There is no gratitude for the extra lives saved– only loss aversion. There is no acknowledgement that Fink would very likely not have wanted any other patient to die, either, had she met them, much less an acknowledgement that people matter whether you have personally met them or not.

Making better choices through conscious triage is no more “playing God” than blithely abdicating responsibility for the effects of our actions. Both choices are choices to let some live and others die. The only difference is that the person who embraces triage has a chance to use their brain to improve the outcome. The suffering of the person who doesn’t receive the scarce resource is no less because you, personally, haven’t witnessed it. When Fink saw Nathalie’s suffering, it should only have informed her as to the gravity of the situation both for Nathalie and for those who did receive the oxygen.

I understand that it’s hard, that we will always instinctively care more for the people we see than those we don’t. There’s no shame in Fink’s deep feelings for Nathalie. They are a key component of compassion. But there should be great shame in letting more people suffer and die than needed to because you can’t look past your own feelings. This is the kind of narrow empathy that Paul Bloom is against.

There are millions of people around the world dying of entirely preventable causes. Why should it make any difference that they aren’t in front of us? You know they are there. They know the suffering they feel. Poverty is a major culprit, as are neglected tropical diseases that could be cured for pennies per person per year. Money that you won’t even miss could be saving lives right now if you put it to that purpose instead of, say, home improvement or collecting action figures. Every decision we make bears on the lives of the myriad others we might be able to help.

We are always in triage. I fervently hope that one day we will be able to save everyone. In the meantime, it is irresponsible to pretend that we aren’t making life and death decisions with the allocation of our resources. Pretending there is no choice only makes our decisions worse.

Maybe it’s not me– it’s grad school

Just a low effort post. I would love a mutually supportive comment discussion about it (because I’m not on facebook). Twitter replies would be nice, too. 

I appreciated this post from Ben Kuhn, Grad school is worse for public health than STDs. In it he calculates that the disability-adjusted life years (DALYs) caused by grad school (mostly through depression and anxiety) exceed those caused by STDs.

I wonder how much time I waste agonizing over how to fix my problems, trying to control my angst and confusion through willpower and daily habits and acceptance, when maybe a large chunk of my problems will disappear on their own after I defend. Being a grad student really is like being the frog in boiling water. I don’t know what’s normal anymore with work. I went straight from college to grad school, and 6.5 years later grad school has been my whole adult working life. The already long feedback loops get longer and the isolation steadily increases over the years as exernal structure disintegrates. And I’ve had major extra difficulties in grad school: having two advisers leave in the first two years, falling through the cracks with advising because of trying to salvage my early work with my now out-of-state first adviser while working with a new adviser at Harvard, 5th year basically lost to illness…

I have a bias against blaming external circumstances. I feel like it’s jinxing myself to say “just finish grad school– then it will all get better.” I feel like the problem has to be me. But it’s really not irrational to think that things will massively improve after I defend, since that is what most of the people who’ve been through it say, and considering how routinely negative being in grad school seems to be for the mental health of thousands of other grad students.

Since I have a month until I have to turn my dissertation in, and I will find this belief motivating whether it turns out to be true or not, I’m going to allow myself to believe that most of my current bad feelings are due to grad school. I’m still in the tunnel. I need to focus on getting out of the tunnel. Pretty much every other plan or self-reflection can and should wait until then. Fingers crossed that everything makes sense when I’m back in the light.

No need to explain

I haven’t been posting much lately for several reasons, but mainly I just haven’t felt the desire to post. My posts usually come from trying to figure something out through reflection, or to explain myself to myself. I haven’t felt the need to explain myself much recently. This has also been a time of high wellbeing and dissertation productivity. The common denominator may be self-confidence, or perhaps lower anxiety.

I really like living this way, without constant performance anxiety and self-justification. I don’t want to turn this into advice, because it’s not what everyone needs and I’m not sure how to properly caveat it. But if you spend a lot of your time explaining yourself (especially explaining yourself to yourself), consider that by explaining yourself you may in some sense be trying to justify your existence. And then consider how you would feel if there was no need to explain.

My fantasy grunge band has the best name

IMG_0031

Ever since I first heard that Wonderland was the outbound end of the Blue Line (of the Boston T), I thought “Blue Line to Wonderland” was the perfect blend of whimsy, mundanity, locality, and a perverse children’s story allusion to IV drug use with which to entitle a grunge band. Even with so many musicians furiously writing songs about it, have you ever heard a more poetic description of shooting heroin into a vein? The use of subway signage hints at the low budget and urban alienation that surely made the singer turn to drugs, but also shows city-loyalty, which is very grunge. And then you’ve got your Alice in Wonderland and your anatomical, visceral-yet-distant-and-clinical artistic vibe all in one piece of found art. I will never have a grunge band (or, to be clear, use recreational IV drugs), and I’m tired of sitting on this amazing name.

Instead of “I’m anxious,” try “I feel threatened”

cw: teaching to learn

I have a long history with anxiety, and I’m pretty good at noticing when it’s happening. The problem is that I’m always anxious. Noticing anxiety doesn’t snap me out of anxiety– in fact, it often produces meta-anxiety, anxiety about feeling anxious. So I’ve tried a simple reframe lately, and I’m liking the results. Instead of noting “I’m anxious,” I say to myself “I feel threatened” or “I feel threatened by x” if I know what set me off.

Anxiety is just chronically being in a state of fight or flight, and fight or flight has a stimulus. I like Sapolsky’s thesis, which is roughly that for most animals, the stimulus is always something external, a threat to safety or status. For anxious humans, the threatening stimuli are internalized, and fight or flight is either triggered or sustained by thoughts. Anxiety is the condition of feeling threatened.

And yet, noticing that I feel threatened is much more specific than noticing that I’m anxious, whether I can identify the threat or not. It makes what I’m feeling less about me (I’m just anxious; my perception is inaccurate; oh, why don’t I just stop???) and more about the pattern of behavior (I’m reacting this way because I perceive that thing to be a threat; is it really a threat?; if it is, is it something I can handle?).

In the short time I’ve been practicing this, I’ve identified many things I had not realized I considered threats, although, of course, on the feeling level I had always known. I’m surprised by how mundane most of the threats are. Many of them are just “I feel threatened because that noise startled me.” But others are kind of embarrassing or incongruent with my self-concept. For example, I’m threatened by other people being better than me. I would find myself stiff and clearly in fight or flight when singing in a group, for instance, and I used to just nurse that anxiety for the entire practice thinking, “Fuck, I’m anxious, I can’t breathe, my singing is therefore terrible, and I must be blushing…” But with this technique, I notice the anxious symptoms and see if I can identify the “threat” that tripped them. To my shock, it was usually as simple as another person singing really well, or me not knowing how to sight read when others could. Such everyday, simple provocations! At this point, I don’t have much pride left to be embarrassed with, but it’s still humbling to see my mountains of anxiety for the molehills of petty jealousy and insecurity they could have stayed.

I don’t blame myself for getting carried away. Anxiety is the master of false narratives. An injection of anxiety causes my thoughts to speed up and start going down rabbitholes of what to do, all premised on unseen assumptions I’m making about the nature and severity of the threat. There’s no time or brainpower to examine every hasty conclusion when you’re swept up in that wave. Reigning in anxiety is necessarily a process. It can be embarrassing to realize just how simple the “threat” that led to hours (or days, or months, or years…) of anxiety was, but it’s also such a relief! Admitting I’m jealous or petty or flawed is a small price to pay to reclaim some peace.

Scrupulosity: my EAGxBoston 2019 lightning talk

This was a 5 minute talk, so I basically only had time to read the slides (dynamically!). I’m going to provide the slides and whatever extra info I said at the time in italics and give commentary and context in plain text.

Scrupulosity_4-26-19

Slide2

Obviously, this is a matter of degree. It’s not a disorder unless it’s distressing and interferes with your functioning, but I was more interested in the way of thinking than what counts as clinically significant symptoms. I should also mention there’s a lot unimportant disagreement about whether Scrupulosity should technically be considered its own thing or a form or OCD or as a part of Obsessive Compulsive Personality Disorder (OCPD). Again, this introduction is so broad that you can ignore all of these subtle distinctions. The general pattern of relieving guilt and anxiety from obsessions with compulsions is not in dispute.

I neglected to give an example then, but here are a few:

I feel wretchedly guilty because I think about sinning all day long (obsession), so I spend hours each day reciting prayers for absolution (compulsion).

I am plagued by guilty and sad thoughts about the deaths of animals in factory farms (obsession), so I keep looking for more ways to make my vegan diet 100% cruelty-free (compulsion).

I feel guilty and undeserving of my money (obsession), so I devote myself to being as frugal as possible (compulsion).

Most people do not realize when they are acting compulsively because we think of compulsions as physical rituals, such as tapping and counting in “classic” OCD. But you can do any physical or mental behavior compulsively. One of my personal compulsions is self-doubt, though it’s only compulsive when I do turn to it to relieve anxiety from feeling exposed rather than simply noticing organically arising doubt about specific things. I learned to do this in part from dicourse norms in science and rationalism, because it’s a very safe position to say you don’t know or don’t trust your own thinking. Because self-doubt is such a virtue in those worlds, both my healthy doubts and my compulsive, goodharting doubt get reinforced.

There are many stories of compulsions starting when the person has an experience of great relief from their guilt or anxiety by adopting a certain belief or performing a certain behavior. Scrupulosity is also called a process addiction because it’s an addiction to a certain algorithm for dealing with distress: in this case, making or obeying rules. I first remember experiencing this when I stopped eating meat as a little kid. All the guilt and turmoil I had been feeling about the blood on my hands was gone as a result of sticking to this rule. It made me think on some level that all distress could be prevented or dealt with if you just followed the correct rules.

Slide3

An excessive sense of personal responsibility is also called “overresponsibility,” “hyper-responsibility” (in the context of OCD), or the dysfunctional attitude of omnipotence. In Cognitive Behavioral Therapy (CBT), it is considered one of three universal attitudes anxious people share (the other two are perfectionism and intolerance of uncertainty). I have a lot more to say about overresponsibility and its relationship to EA in an upcoming blog post.

Thought-action fusion is this diabolical cycle that’s very common in anxiety and OCD. Essentially, when we are in fight-or-flight, the distinction between thoughts and actions gets blurred, so that just thinking something can have the weight of having done it. This usually makes the person more anxious, thoughts and actions get more blurred, and the downward spiral continues. 

The doubt and confusion is usually fixated on the true meaning of moral precepts or rules. When scrupulous people begin to doubt their own ability to discern moral behavior, it is understandable that they would want to conform to ideologies. Unfortunately, this makes them very vulnerable to cult behavior and fundamentalism, simply because each addresses their need for certainty.

“Long periods of highly distressing moral rumination”– this is is the thing that made me want to give this talk. The paper I drew from went on to say “that patients believe are helping them solve their problem rationally.” So, obviously, in EA we recognize long, highly distressing periods of moral rumination. I’m not saying they are all unproductive or symptoms of a problem, but I think we could stand to remember that we aren’t always trying to solve a problem in the external world. Sometimes we’re trying to solve our feelings in the guise of the problems we’re most comfortable solving. 

Many experts say that a “debilitating fixation on moral issues” is scrupulosity’s most damaging symptom because it leaves little proccessing power for the rest of life. 

Slide4

Prioritization and economic thinking have scarcity baked in. There’s an acknowledgment from the get-go that not everything is going to get done and no one’s record is going to be perfect. 

I personally have seen a lot of respect for self-care in EA, moreso than in other moral communities I was a part of, anyway.

Maximizing is a hard one, because it’s only our whole thing. I think drawing a line as to how much you can do is difficult in principle, and if you’re a scrupulous person who doesn’t have a natural sense of their person line, it’s even worse. 

Totalizing: people who get really involved in EA tend to get REALLY involved in EA, which means being surrounded by messages of moral maximizing and sacrifice. I believe that EA selects for scrupulous people (like me), which concentrates these tendencies in a very connected community.

EA introduced me to things I would never have felt responsible for on my own. Such as picking the most effective career or the entire future.

Essentially, for me EA has helped a lot by taking morality seriously as a real world project. With evidence-based charity comes a lot of sobriety. But it’s also hurt because my way of thinking is magnified in this community and I’m constantly made aware of all the things I could, in theory, be doing to help the world.

Slide5

Your selfish desires are a part of you, worth keeping in touch with. If you actually don’t know your selfish desires or feel like that part of you is blocked, that’s a huge red flag. It means you’re not being honest with yourself, perhaps because you don’t feel safe being honest with yourself. Going from my personal experience alone, I would suggest that all people with scrupulous tendencies check in with their selfish desires regularly as on-going hygiene. Having trouble finding them is an early warning sign for me. (Plus, it’s kind of a fun “intervention” because there’s the promise of gratification when you figure out what you want. 😛 )

Exposure and response prevention is just “exposure therapy,” where the scrupulous person exposes themselves to the guilt- or anxiety-provoking stimulus without doing the compulsion to relieve the anxiety. After repeated exposure with no feared consequence, the limbic system learns that the stimulus is not dangerous, and the reaction extinguishes. Depending on how severe your symptoms are, you might want to do this with the help of a therapist. 

Be kind to yourself and forgive yourself for struggling with this. It’s okay to be small human with limited powers, it’s okay to struggle with scrupulosity, and it’s okay to be you. In my case, scrupulous symptoms are related to feelings of worthlessness, like I alone have to live up to this perfect moral standard because somehow I can’t afford to be as immoral as a normal person. I can’t effectively tackle particular obsessions or compulsions if I don’t start by healing my sense of fundamental worthiness, because then I’m just playing whack-a-mole with new symptoms.

Boundaries, here I’m talking about protecting your psychic and emotional space. Give when your cup runs over, but what’s in the cup is yours. It’s important to set expectations with others, but for scrupulosity I’m talking about setting boundaries with yourself to respect your own needs and happiness.

Alternative beauty: my tummy pokes out

I think I’m pretty good about ignoring what I’m “supposed” to be doing with my appearance to the extent that I don’t find it useful or fun. But I’ve been at war with my belly since it came on the scene at adolescence.

I write this post half in jest because, for the most part, I have a body that a lot of women think would solve all their problems. I’m thin and small and well-proportioned. Also I’m relatively young. I hope it’s obvious that I don’t think my body needs to be reclaimed as “alternative beauty,” and that I’m joking to cover up my embarrassment at not being able to grok what I know intellectually– there’s nothing wrong with my body and it happens to be to my society’s liking.

But I can’t help it. I have an Achilles heel. Except for me it’s not my heel (quite pleased with them both), but my tummy. I have a paunch. A pooch. It’s not even fat. Like, there’s some extra fat there, but the size mostly comes from… bloating, I guess? It kind of feels like some days the insides of my abdomen are all in place and some days they are just sloshing all around and pooling in the front. Sometimes the cause is obviously food, but that’s not alwaysas consistent or clear as you might think. Propensity to pokiness seems to be related to hormonal fluctuations and sleep. Sometimes my belly is totally flat for a few days and I’m very quick to get used to that, but the gut always comes roaring back.

I know grossly bloated tummies on otherwise thin women are common. Presumably it’s universal even if it’s less noticeable on thicker body types. And internet ads make it clear that the secret to cutting belly fat and bloat is desirable enough to be clickbait. I even know that allowing for a little more puff used to be more popular. Some older corsets pop out over the belly to allow squished fat to be directed there, so it was obviously considered better in that situation to protrude forward than to have a thick waist. I see an amount of belly-popping that would embarrass me personally in a lot pin-ups up until ~the 60s. My husband even claims that he liked a little belly on a woman before he fell in love with my sparkling personality. But I was weaned in the era of completely flat stomachs on tv and started out string-bean skinny myself, so I was pretty upset when puberty came with a spare tire.

Now, I think I’m pretty good about ignoring what I’m “supposed” to be doing with my appearance to the extent that I don’t find it useful or fun. But I’ve been at war with my belly since it came on the scene at adolescence. I suck in my gut habitually, and I think this leads to a vicious cycle of exaggerated refractory poking out and then having to hold in even harder. Sucking it in constricts my breathing which probably exaberates my anxiety, not to mention the anxiety caused by dividing my attention between social interactions and gut control.

I want to make peace with my gut, but it’s hard. A deep part of me think it’s unacceptable. Like it’s rude or sloppy to show my face while I’m revealing just how far my tummy wants to be protruding. Like my belly is an unruly child and I’m terrified to be that maddening parent who’s too okay with it. I’m afraid if I stop fighting it, it’ll get stuck fully extended. I guess ultimately I’m afraid that I’ll deserve to be a schlub if I accept that this might just be how my body is. Maybe I’ve barely got a lid on it by sucking in and mentally resisting it, and who knows what else would come frothing out of that pot if I stopped holding down that lid?

But none of that^ makes any sense, right? What’s the worst that can happen, I accept my body and then it doesn’t meet the standards that only mattered when my self-acceptance was more conditional? This fear feels more like giving up (the illusion of) control. My badly behaved belly isn’t getting with the image I’d like to project whether I fight it or not. Might as well end the war.

This is actually very exciting to write. Every time I realize that I’m afraid to accept something about the way I am because I believe my mental resistance is the dam holding back something worse deeper inside, I get brave/vulnerable, stop resisting what is, and then very quickly I’m over the whole complex. It just takes a short time seeing the world through the lens of “It’s okay to be me and let the chips fall where they may” to realize how silly the idea that I need to repress myself is. Being comfortable in your own skin is the best feeling there is. I know because I’ve tasted it, and I want to live there no matter how exposed the journey back is. Like society teaches us to do, I’ve been trying to feel good about my body by conforming to standards. But I’ve already learned this lesson a thousand times– the only way to love your real self is to love yourself unconditionally. If I plan to love myself fully only when my tummy is flat, I won’t really be loving me for who I am whether that day comes or not.

If this were one of those alternative beauty videos, this is the part where I’d eat a huge meal, put on a gold sequin bikini, slather my belly with glue and roll around in gold glitter. Then I’d stand up, peel off letter stickers I’d been wearing around my belly button, and the negative space would read “My Belly is BEAUTIFUL.” Probably top it all off with some crying. Needless to say, that feels kind of contrived to me. More power to those that like that sort of thing, but I could only see myself doing that out of a need to justify myself to others. (This blog post is all the self-justification I need on this topic!) I don’t ever see myself glorifying my pokey tummy, but I do feel ready to call off hostilities and let it do its thing. That’s a pretty good start 🙂

Multiverse of minds

Everyone dwells in their own universe– a dream made up of sense data, culture, beliefs, historical contingencies, and idiosyncrasies. We all share an external reality (as far as we know), but none of us actually lives there. We live in our own universes in our minds.

Dreams, delusion, and psychosis vividly demonstrate the extent to which we can generate our own world. Optical illusions, or even just learning the neuroscience of perception show us how much of our “external” world is merely the brain’s user interface or evolutionarily educated guess. What we experience is highly constructed, there is no denying, and that goes for all things. Including other people.

There are as many versions of you as people who have met you. You have an avatar in every mind you’ve ever met. On top of that, you see yourself– or a past self– with fresh eyes every so often, so there are many versions of you in your own mind. All these images of you are only inspired by your objective being– primarily, they are the property of the universe they live in. It’s the same for the characters in your universe– they are as much you as they are the minds of other universes.

In a way, we’re all gods made man. Our entire universe is within us, yet we are incarnated in a shared world, as humans among other humans.

It might seem like this view is saying “you are the center of your universe” but I actually feel it says the opposite. When you realize the whole universe is filtered through and filled in by you, suddenly there is no center. You are spread over all awareness just as much as you are the human body feeling self-conscious talking to the person in front of your face. Just like artist renditions of distant celestial bodies, everyone you know is a composite based on evidence from them and conjecture from you. And everyone else you know is equally their own universe, where their awareness represents a version of you.

I’ve always found the idea of making contact across vast gulfs of time, space, or culture deeply meaningful and spiritual. It’s not just because of the distance or the leap of faith on both parts. I think it’s because I saw great stretches of time and space as stripping messages to their core. The most crass or mundane message from ancient Sumeria, for instance– “Something which has never occurred since time immemorial; a young woman did not fart in her husband’s lap.“– becomes a touching testament to the universality of human nature.

And yet I’ve always had some awkwardness in connecting to people right next to me. Perhaps because all the layers of contemporary stupidity and meaninglessness are still caked all over their messages. Or perhaps because I’m holding them too close to myself in my universe. I think I know who they are, and the things I don’t like about them are an awful lot like the things I don’t like about me. The reality, of course, is that in my universe they wear a me-specific skin. The true message they send comes from very far away– another universe. I have to do the archeological work of stripping away my dirt and grime to hear them. When I remember how fundamentally alone we all are and how truly alien another mind is from mine, I remember to treasure whatever fleeting or mundane point of connection we share.

There’s a near and far to every person. Every time you truly see another person across that distance, and not just the nearby film of your own expectations, it is a miracle. You’re communicating with a foreign world! And the real you might be coming across in their universe. There really are other dimensions packed all around us, and we can touch them!

There’s something strangely beautiful, even sacred, about viewing myself as my own vast, spacious universe, yet overlapping with so many others in a crowded multiverse. It makes me feel simultaneously profoundly alone and utterly connected, touching others on all fronts, even in ways I’m not conscious of. It makes me care more for the world to realize that so much of what scares or repels me in it is coming from my own mind. It’s the most relevant way to any human that we are all connected. Loving others is loving yourself and loving yourself is loving others. How can you love others if you hate the skin of your universe that covers them? How can you love the world if you hate its source, yourself?

If each of our minds is an abode for a universe, self-hatred and depression are a house divided against itself. It’s the autoimmune disease of the soul. It’s not the symptoms you observe from the outside, but the mindwarp inside. It’s like fiddling with the hidden variables of reality and experience themselves and watching the whole system start to fade out. It changes everything and everyone. My experience with depression is part of what makes this multiverse of minds idea so intuitive. Coming in and out of depressive episodes makes it so obvious that the most important changes in your world come from within. You can’t love existence and hate yourself, because existence is being one’s self. The only way to love life is by loving what is, which is who you really are.