Having a successful career with depression, anxiety and imposter syndrome | 80,000 Hours

Episode Overview

• This episode features a personal interview with Howie Lempel, Strategy Advisor at 80,000 Hours, discussing his history with severe depression, anxiety, imposter syndrome, and ADHD.
• The conversation aims to correct conventional wisdom that prioritizes "grit" and lifestyle fixes over professional mental health treatment as a first resort.
• Content includes explicit references to self-harm and suicidal thoughts; a specific warning is given to listeners to skip the chapter "Disaster" (minutes 44–57) or start at "80,000 Hours" (minute 71) if desired.
• Early reviewers described the episode as a "searingly honest" and "tangible" account of psychological distress, with some reporting specific behavioral changes regarding their own mental health planning.
• Howie Lempel has since been promoted from Strategy Advisor to Chief of Staff at 80,000 Hours.

Howie's History with Mental Health

• First Episode (Age ~19–20): Occurred after a highly intense sophomore year in college where he slept roughly four hours a night for months; the episode began during a summer break and lasted until the school year resumed.
  • Howie initially ignored the symptoms, viewing depression instrumentally as a motivator to do "the right thing" rather than seeking help.
  • He attempted to access university mental health intake sessions 2–3 times but canceled appointments shortly after scheduling them.
• Second Episode (Age 26, Law School): Triggered by a breakup and intense academic pressure, leading to a severe period where he avoided school, friends, and daily tasks.
  • He attempted to self-harm by stockpiling Tylenol PM, which his roommate immediately discarded.
  • He sought help at Yale's campus health system, which had a notorious wait time of one month for an intake and another two weeks for a psychiatrist.
  • Treatment & Misdiagnosis: A psychiatrist prescribed Klonopin (benzodiazepine) and Lexapro (SSRI). After feeling better, Howie developed "brain zaps" upon discontinuation.
  • His doctor then suspected a hypomanic episode (Bipolar II) and attempted to force a switch to mood stabilizers, claiming SSRIs increase mania risk despite Howie presenting research contradicting this.
  • Howie later concluded the doctor was overly risk-averse and that he was simply recovering from depression, not experiencing bipolar disorder.
• Current State (Ages 30–34): Howie reports functioning with a lower baseline mood, frequent maladaptive guilt, severe imposter syndrome, and daily anxiety.
  • He estimates losing hours of work time weekly to anxiety, describing the physical sensation as "being chased by a lion."
  • He receives positive performance feedback from colleagues but intellectually rejects it, believing he is "fooling everyone" and that his perceived competence is a unique, non-generalizable skill.
  • He attributes his ADHD diagnosis (mid-20s) to a major turning point, noting Adderall has been the "single thing" that helped his anxiety by removing the stress of task initiation.

The "Disaster" Episode (2016–2017)

• Trigger: At Open Philanthropy (a $10B foundation), Howie missed a critical trip to the UK to represent the organization due to a budget airline policy denying him boarding because his passport had two months remaining validity.
• Reaction: Despite the airline being incorrect regarding the rule (no such rule exists for US/UK travel), Howie spiraled into self-hatred, believing he had committed an "enormous failure."
• Consequences:
  • He went "dark" for two weeks, ignoring work, refusing to email his boss (Ellie), and hiding in bed.
  • His avoidance lasted over a month and a half, during which he did not communicate with colleagues, causing a significant operational burden on his team.
  • He eventually returned to work after being convinced by a friend to leave his environment for a month, where he lived with a friend in DC.
  • He resigned from Open Philanthropy, describing the departure as a mix of quitting and being fired.
• Recovery Phase: Spent approximately 18 months out of formal employment.
  • He lived in bed for nine months, occasionally engaging in self-harm (punching trees) or playing video games to escape negative self-talk.
  • Recovery began after moving in with an ex-girlfriend to escape guilt over being a burden, then moving to the 80,000 Hours house in Berkeley.
  • He credits the EA community for offering housing, social reintegration, and a supportive environment where he could rebuild.

Career Integration and Community Dynamics

• Re-hiring at 80,000 Hours: Howie was upfront with CEO Ben Todd about his history before accepting a role, detailing the risk of future episodes.
  • Ben Todd and the team accepted the risk, offering a role with flexible responsibilities and accommodations to mitigate potential disruptions.
  • Howie notes that the EA community has proven more accepting of mental illness than the corporate sector, though he acknowledges his own privilege (long tenure, high visibility) likely influenced this outcome.
• Financial & Insurance Struggles: During his unemployment, Howie exhausted his savings and went without health insurance for nearly a year.
  • He was forced to stop taking prescribed medication due to cost, highlighting the high financial risk of leaving a job for mental health reasons.
  • He emphasizes the necessity of having significant financial runway (6–12+ months) before entering a vulnerable period.
• Accommodation Strategies:
  • Howie utilizes a "minimal viable project" approach, lowering expectations during rough patches to avoid failure spirals.
  • He advocates for pre-established emergency plans, such as a "code word" email to a trusted contact who can manage professional communications during a crisis.
  • He describes the "Uggfield" phenomenon (procrastination cycles where tasks become increasingly aversive) as a major cause of suffering, urging immediate action on avoided tasks.

Clinical Advice and Recommendations

• Treatment Hierarchy: Howie argues against the moral imperative to try therapy/lifestyle changes before medication.
  • He states there is no shame in prioritizing medication if it is cheaper or more accessible, noting that effect sizes for therapy and SSRIs are roughly similar for many people.
  • He recommends checking for nutritional deficiencies (e.g., anemia, Vitamin B) and considering alternatives like Wellbutrin (bupropion) for depression.
• Therapy vs. Medication:
  • He challenges the "heroic melancholy" narrative (the idea that depression is creatively necessary), referencing Peter Kramer's Against Depression.
  • He suggests that medication often provides the stability needed to engage in therapy effectively.
• Practical Tools:
  • Exercise: Howie recommends exercise as a primary intervention, noting its high effect size for mood, despite the difficulty of starting.
  • Community Support: He highlights the importance of the effective altruism community, citing a specific instance where a stranger reached out to suggest ketamine therapy, which he found to be a "miracle" treatment.
  • Resources: Recommended reading includes Kate Donovan's guide to finding a therapist, Scott Alexander's blog posts on anxiety/depression, and the book Overcoming Perfectionism.
• Systemic Advice:
  • Listeners are encouraged to set up a plan for future crises rather than waiting for a breakdown.
  • He suggests that "looking for a therapist" should be a micro-goal, potentially assisted by a friend who can narrow down options.

Personal Anecdotes and Identity

• Perfectionism: Howie struggles with setting unmeetable standards (e.g., "do the most good"), which leads to feelings of failure; he is currently working on setting smaller, measurable daily goals.
• Excessive Empathy: He notes that his tendency to assume others are suffering "several times worse" than they are leads him to withhold critical feedback and avoid causing others any discomfort, even when it is counterproductive.
• Moral Identity: Howie describes a conflict between his utilitarian belief in giving away resources and the need to maintain his own mental health; he has shifted to accepting that protecting his own capacity to do good requires spending money on himself (e.g., food delivery).
• Happy Moment: He recounts a memory of caring for a lost Pitbull/Boxer mix in Brooklyn, culminating in an emotional reunion where a "biker-looking" owner broke down in tears hugging his dog.