#100 – Having a successful career with depression, anxiety and imposter syndrome

Episode Overview and Purpose

• The episode features a personal account by 80,000 Hours Strategy Advisor Howie Lempel, produced by Kieran Harris, focusing on how mental illness has impacted his career and life.
• The primary goal is to counter the "conventional wisdom" that mental health issues should be solved solely through willpower, diet, and exercise before seeking clinical help.
• The content aims to help listeners realize they can still have a significant impact despite mental health struggles, while reducing stigma regarding depression, anxiety, and imposter syndrome.
• Warning: The conversation contains intense descriptions of self-harm, suicidal thoughts, and depressive episodes; a specific chapter titled "Disaster" (44–57 minutes) is noted as the most intense section.

Howie Lempel's Clinical History and Diagnoses

• First Episode (Age ~20): Occurred during a college sophomore year, triggered by a high-pressure academic environment followed by an unstructured summer; Howie initially ignored symptoms for weeks before they subsided upon returning to college.
• Second Episode (Age ~26): Occurred at Yale Law School following a breakup and academic stress; Howie experienced a severe decline, including suicidal ideation, where he took precautions to remove access to painkillers.
• Initial Treatment Failure: Lacked immediate help at Yale; after a month-long wait for campus services, he saw a psychiatrist who prescribed Klonopin (a benzodiazepine) and Lexapro (an SSRI).
• Bipolar Misdiagnosis: Upon rapid improvement on Lexapro, his psychiatrist suspected a hypomanic episode and pressured him to start a mood stabilizer or stop antidepressants; Lempel believes this was a misdiagnosis of recovery and that he does not have Bipolar Disorder.
• ADHD Diagnosis: Later diagnosed with ADHD by a psychiatrist at GiveWell/Open Philanthropy; treatment with Adderall was identified as the single most effective intervention for his anxiety and productivity issues.
• Current State: Lempel describes a lifelong, fluctuating condition involving a lower baseline mood, chronic anxiety, imposter syndrome, and severe perfectionism, rather than "being cured."

The "Disaster" Event at Open Philanthropy

• Trigger Event: In December 2016, Lempel missed a critical conference in the UK because a budget airline barred him from boarding due to a passport expiration rule (2 months prior) that neither he nor the destination country officially enforced.
• Response to Crisis: Instead of immediately notifying his team, Lempel isolated himself for two weeks, engaging in severe rumination and self-hatred, believing the mistake was a total professional and moral failure.
• Consequences: He stopped checking email and effectively quit his role for approximately two weeks before returning to apologize; his team covered his work, but the incident caused a year-and-a-half period of unemployment and unemployment.
• Recovery Phase: Lempel stayed with a friend in DC for a month to remove himself from the environment, then spent nine months in bed at his apartment in Oakland, alternating between self-harm, video games, and intense self-loathing.
• Key Lesson on Preparation: Lempel regrets not sending a pre-emptive email; he emphasizes that having a pre-written crisis plan and a trusted contact to manage communications during a downturn could have limited the professional fallout from weeks to days.

Career, Identity, and Community Dynamics

• Identity Crisis: Lempel struggles with a profound mismatch between his self-perception and his actual performance, attributing this to "imposter syndrome" and a psychological habit of deconstructing any praise into stories of failure.
• Hiring Process: When rejoining 80,000 Hours, he disclosed his full mental health history to CEO Ben Todd; the organization accepted the risk, demonstrating a high capacity for accommodation within the effective altruism community.
• Financial Safety Net: Lempel highlights that saving 1.5 years of runway was crucial for his survival during his unemployment, allowing him to avoid rushing into a job he couldn't handle or relying on charity.
• Community Support: He credits the EA community for offering housing, emotional support, and job opportunities despite his history, contrasting this with the stigma often found in corporate environments.
• Ethical Trade-offs: Lempel discusses adjusting his extreme moral stance on giving away income (inspired by Peter Singer) to prioritize his mental health, reasoning that sustaining his ability to do good requires accepting certain personal comforts.

Practical Advice and Recommendations

• Seeking Treatment Early:
  • Micro-Goal: Set a goal to simply call a therapist or look up a website, rather than committing to a full treatment plan immediately.
  • Medication First: Argues against the ideology that therapy must precede medication; finding effective medication can be a "huge win" with lower barriers to entry.
  • Trial and Error: Encourages trying multiple treatments (medication, therapy, lifestyle) as the "information value" of finding what works is extremely high.
• Managing "Ug Fields":
  • Definition: Describes tasks (e.g., a difficult email) that become exponentially harder to complete the longer they are avoided due to accumulating guilt and anxiety.
  • Intervention: Treat the avoidance of a task as the immediate top priority; the act of sending a short "holding" email can often resolve the spiral instantly.
• Workplace Strategies:
  • Lower Expectations: Advocate for lowering one's own and others' expectations during rough patches to prevent failure spirals.
  • Communication Plan: Establish a pre-agreed protocol with a trusted friend or manager (e.g., a code word) to trigger support if a crisis occurs.
  • Accommodation: Suggests delegating aversive tasks to others or reducing hours rather than quitting entirely if a "minimal viable project" can maintain structure and purpose.
• Lifestyle Factors:
  • Exercise: Identifies exercise as one of the most effective tools for mood regulation, though acknowledges the difficulty of consistency.
  • Nutritional Checks: Suggests ruling out anemia or Vitamin B deficiencies as potential physical causes for depressive symptoms.
  • Ketamine: Notes personal experience with ketamine infusions as a highly effective treatment for depression when other methods failed.

Resources Mentioned

• Therapist Finding: Kate Donovan's blog post guide on how to find a therapist.
• Evidence Lists: Scott Alexander's Slate Star Codex posts on interventions for anxiety and depression.
• Books:
  • Against Depression by Peter Kramer (challenges the "heroic melancholy" archetype).
  • Overcoming Perfectionism (for setting realistic standards).
• Medication/Drug Assistance: GoodRx.com for prescription drug coupons in the US.
• Emergency Support: National Suicide Prevention Lifeline (US) and Samaritans (UK).
• UK Specifics: Information on free therapy via IAPT (Improving Access to Psychological Therapies) and free medication via the NHS.