Tag Archives: anxiety

Anxiety, heart attack, or stroke?

One of my friends who has regular anxiety attacks asked me to help her disambiguate between anxiety attacks and strokes. I wrote up a brief email, and then figured it might be worth sharing with the broader world. I’m not an expert on this, this is just the result of a little searching, so anything you hear from a genuine trusted expert who knows your particular situation should probably override this, but I expect it’s better than no info at all. I answered the question for her particular situation but it should be easy to modify as needed. Continue reading


As told to me by Sarah Constantin, the story of Melusine:

A lady is cursed by a bad fairy to turn into a loathsome serpent every Saturday. She meets a man, and they fall in love, and she says, "you can marry me, but don't visit me on Saturday, no matter what."

He responds, "Sure, sure, anything," and leaves her alone on Saturdays.

But his friends rag him about this. "What's up with your wife, what is she UP to on Saturdays?"

So he sneaks into her bathroom one Saturday and sees a giant snake in the bathtub, and runs away in disgust and abandons her.

Moral of the story: nobody can actually handle the snake. Nobody can be allowed to see the snake.

Of course that has to be the primary form of the story that is told, because it is a direct version of this basic fear, that if we are known, we will be reviled. But like Kierkegaard, I see other stories to unfold out of this one, that we might better comprehend its nature.
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Whatever Is Not Best Is Forbidden

At this year's CFAR Alumni Reunion, Leah Libresco hosted a series of short talks on Effective Altruism. She now has a post up on an issue Anna Salamon brought up, the disorienting nature of some EA ideas:

For some people, getting involved in effective altruism is morally disorienting — once you start translating the objects and purchases around you into bednets, should you really have any of them? Should you skip a gruel diet so you can keep your strength up, work as an I-banker, and “earn to give” — funneling your salary into good causes? Ruminating on these questions can lead to analysis paralysis — plus a hefty serving of guilt.

In the midst of our discussion, I came up with a speculative hypothesis about what might drive this kind of reaction to Effective Altruism. While people were sharing stories about their friends, some of their anxious behaviors and thoughts sounded akin to Catholic scrupulosity. One of the more exaggerated examples of scrupulosity is a Catholic who gets into the confessional, lists her sins, receives absolution, and then immediately gets back into line, worried that she did something wrong in her confession, and should now confess that error.

Both of these obviously bear some resemblance to anxiety/OCD, period, but I was interested in speculating a little about why. In Jonathan Haidt’s The Righteous Mind, he lays out a kind of factor analysis of what drives people’s moral intuitions. In his research, some moral foundations (e.g. care/harm) are pretty common to everyone, but some (sanctity/degradation or “purity”) are more predictive in some groups than others.

My weak hypothesis is that effective altruism can feel more like a “purity” decision than other modes of thought people have used to date. You can be inoculated against moral culture shock by previous exposure to other purity-flavored kinds of reasoning (deontology, religion, etc), but, if not (and maybe if you’re also predisposed to anxiety), the sudden clarity about a bestmode of action, that is both very important, and very unlikely for you pull off everyday may trigger scrupulosity.

EAs sometimes seem to think of the merit of an action as a binary quality, where either it is obligatory because it has the "bestness" attribute and outweighs the opportunity cost, or it is forbidden because it doesn't. You're allowed to take care of yourself, and do the best known thing given imperfect information, but only if it's "best.” This framing is exhausting and paralyzing because you're never doing anything positively good, everything is either obligatory or forbidden.

It doesn't have to be that way; we can distinguish between intrapersonal and interpersonal opportunity cost.

I'm not a public utility, I'm a person. If I help others in an inefficient way, or with less of my resources than I could have employed, then I've helped others. If last year I gave to a very efficient charity, but this year I switched to a less efficient charity, then I helped others last year, and helped others again this year. Those are things to celebrate.

But if I pressure or convince someone else to divert their giving from a more efficient to a less efficient charity, or support a cause that itself diverts resources from more efficient causes, then I have actually harmed others on net.

Cross-posted at the Effective Altruism Society of DC bloc.