🎯保守做法：建议检查自己状况，担心承担责任

💡粗心做法：随意给出诊断和治疗建议

🧠专业看法：专家并非无可指责，经验有价值

🤔提出问题：感觉缺少某种'高级外行'概念

Published on March 23, 2025 5:38 PM GMT

Epistemic status: raising a question that I've found difficult

This topic has frustrated me some, and I think there are a variety of forces pointing in different directions.

Maximally conservative approach

"If you're not focused, I mean I can share what works for me but really there's a variety of mental illnesses that can cause lack of focus. I don't even want to share what they are because I don't want to bias that some might be more likely than others since they're all pretty easy to over or under diagnose. Also some of them do involve a fair degree of hypochondria so it might even be harmful for me to promote a wrong suggestion. Honestly just check yourself into the ER, I really can't bear the thought of having responsibility for anything you think as a result of what I've said."

Pretty careless approach

"Oh you didn't sleep well last night? You might be bipolar! Let me administer some screening questions I made up.""You definitely need to treat phobias with exposure response prevention. There's actually a great app that simulates a spider jumping at you when you least expect it, but obviously we can try something on lower intensity first.""I'm really skeptical you found a therapist that way. I have LOTS of opinions on this.""I've been thinking about how value systems interact with bipolar disorder lately. When someone is manic their intellectual defense rewires itself to <redacted - it's already harmful to make up this sort of fake example>"

Steelmanning "I am basically an expert"

Medical problems are on-topic for normal conversation anyway. "You should get that checked out" is in fact performing a nontrivial medical screen. Online spaces have mores to dissuade medical, legal advice but I'm still counting the default social acceptability to talk about ailments as "a reason to be more liberal".Experts are not above reproach. Their expertise must be legible some of the time or they will become a corrupt private club wielding too much power.
If it's not legible I get to criticize them. I might say something like "therapists just always recommend more therapy when you don't need it" without sinning.If it is legible then I in fact know some things and I get to share them. I might say "OCD patients shouldn't see psychoanalysts."
My patient-side experience is... substantial.
I am not publicly open about specific diagnoses but I hold a diagnosis that generally qualifies as a "serious mental illness" that has impacted me differently at different points in life and I have treated differently at different points in my life.I've been "in therapy" (what an awful phrase) for 10+ years with different types of specialists. This comparative experience seems valuable in spite of being patient-side.Some stuff seems worth making public: a lot of CBT/ACT seems helpful to be widely known, for instance.
A lot of opinions about mental health / therapy are more in the domain of society and culture than in a therapist's office.
For example: the social institution of the diagnosis. Diagnoses meet a variety of contradictory needs to a variety of different actors, including the patient, their employer by way of ADA protections, and society at large via the "disorder v diversity" debate.Pretty much everything related to a rule of living or a life hack is therapy adjacent. Therapy obviously does not monopolize this space.The border area between "therapists" and "coaches" is heating up. Not to mention friends and community, which are basically professionalized by coaches.
Therapy is supposed to be lived and in general it would be better if the people who know most about mental health to have more impact in society. That does imply randos like me ought to be talking about it even at some accuracy risk.
For example I have opinions on casual use of OCD, gaslighting, etc. This seems on topic to write about, from the viewpoint of someone with nontrivial knowledge of therapy, who is not a professional.

Steelmanning "I know just enough to be dangerous"

Therapy patients with XYZ disorder are ridiculous overfitters. They see it everywhere. Similar for ABC treatment; they want to apply it to everything.I have a strong prior to be really careful with medical stuff.
being wrong is costly here.
I have to be very epistemically careful. For instance:
I've used ACT therapy recently with some success.ACT suggests explicating your values. So does existentialist philosophy I guess. So that's cool.You could, presumably, apply that framework to something like bipolar+mania. And, ah, hmm. Now we're getting into some trouble.Am I trying to show values-ology can be applied flexibly? If the goal is to learn something about mania it's sounding more like I'm making up psychology research. And I certainly don't want to recommend ACT to manic people.

Raising some questions

So I'm just going to do what everyone does which is to say, "their best." Obviously I'm going to try to not commit the biases I already know about and be careful with epistemic status when going on a limb. But it does feel like I'm missing some sort of "advanced layman" concept in my atlas and I'd rather fill that hole.