I am a doctor... (TW) by Russell Keith-Magee

Hi everyone, thanks very much Jeff. Just as a prior warning on this talk, in the program it was flagged as a content warning. In this talk, I will be discussing some fairly disturbing topics for some people. Uh issues of depression, suicide, suicidal thoughts, drug use and miscarriage will come up in the course of this conversation. So if that is something that is likely to affect you in a bad way, then um please be advised and take whatever controls you need. So, my name's Russell. I am a 10-year veteran of the Django core team. I'm a member of the Django Technical Advisory Board. I'm president of the Django Software Foundation. As you just heard, I'm also founder of the BeWare project, project looking at the tools we use to develop Python. Big part of BeWare is Toga , cross-platform widget toolkit that allows you to build iOS and Android mobile apps in Python. Beware and Toga

are both works in progress. If you're interested in Python development tools or Python on mobile, please come talk to me I'm also the CTO and co-founder of a startup company with all the pressures and stresses that come along with that. I'm also a doctor. I'm not that kind of doctor. My doctorate is in computer science. My doctoral thesis was entitled Models of Learning and Development in Cohen -Style Self-Organising Feature Maps. And that's three and a half years I'm not getting back. The reason I say all this is What I'm about to say is not medical advice. It's personal anecdote. If you find yourself being affected by any of the problems that I'm about to start discussing, please seek professional help.

Don't rely upon me Because I'm not the professional. My hope though is that by sharing what I've been going through, I encourage others to go and do something that I didn't do for a very, very long time. You may have noticed that I have my fingers in a lot of pies. I have a stressful job. I volunteer with Django. I've got side projects. My side projects have side projects I have a son, I also have a son with learning difficulties. I have a daughter, I have a wife. And in the last few years, the combination of the stresses of all of these started to take its toll. My temper started to grow short. I found myself getting really frustrated, both with myself and with others. I found myself genuinely doubting my own ability my own abilities, not just imposter syndrome level stuff. I'm talking a genuine belief that I was incompetent.

My enthusiasm to go out and socialize with friends was almost completely removed. Picking up the phone to call a friend to go over for dinner or to have them over for dinner felt like just too much effort to even be worth it. I also had some intermittent health problems. In particular I I started having real issues with my back uh shoulder and back muscles to the extent that I was spending sometimes three or four days laid out on the couch doped up in some really really great opiates but the long term that's not a pr not a productive situation It wasn't constant, it wasn't a continuous decline. I had good days, I had bad days, I had good weeks, I had bad weeks, but this pattern had probably been going on in a serious way for 18 months and probably even for years before that. But in early this May, I hit rock bottom.

For about a week, I would wake up in the morning, and the only thing that got me out of bed was habit. I felt absolutely no joy in what I was doing, in my anything in my life. The only reason I was getting out of bed was habit and contractual obligation. The fact that my knew my kids needed to be fed, so I suppose I'd better get out of bed then And then one Wednesday, I went into my office, I started work, and by about 9:30, I just had no energy to continue. I couldn't summon the energy to give a damn about anything. I went back to bed, I buried my head in my pillow, and I cried. That was the final straw for my wife. She pushed me out the door to go see a doctor, a medical one.

And I was diagnosed as being in the middle of a major depressive episode. Now, I am being treated now. I am, relatively speaking, at the start of my treatment, so it's way too early for me to just declare victory. But even in this short time, the last couple of months, I've noticed a huge positive change. At some level, it's probably just the cathartic release of knowing that what I was feeling wasn't right and can be treated. But frankly, at this point I would have at that point I would have taken any improvement I could get. The reason I'm going public is because in retrospect, I put off getting help for far too long. I didn't want to admit failure. I didn't want to attract the stigma of admitting that I was mentally ill. I didn't want to see a doctor because of pride.

Successful people don't get depressed. Successful people power through. Successful people win. And that's bull. Studies universally agree that depression affects at least one in ten people in the general population and it's higher in some demographics. And guess what? This is one of those demographics, computers, computer science and programming people. Our industry is particularly prone to the tune that discussions of burnout are almost a constant undertone. I want every single person in this room to know that you're not alone. I am, by almost every conceivable measure, a conce a successful member of this community, and I have depression Now I've given a version of this talk as a lightning talk twice now. Uh

once at DjangoCon Europe, uh when I sort of came out as it were, and once at PyCon Australia about a month ago. And what has amazed me is that both times the number of people who have sought me out afterwards to thank me about being so open because they had depression, but they were afraid to seek treatment. Well they had sought treatment, but they didn't want to tell anyone about it because of the shame. And it's the shame that is quite literally, in some cases, killing us. And when I say us, I mean that quite literally. People who could have, should have been in this room today, aren't. A little over ten years ago, Django received some contributions from someone from this little 19-year-old guy named Aaron Schwartz. You may know him from some of his other projects, Redditch, Mark. Down, his activision work on SOPA. I never met Aaron myself, and at the time I certainly didn't recognize him for the intellectual powerhouse that he was.

He was someone who contributed to the discussions about Django's RM. He was a major contributor to the magic removal discussions And the model. objects. filter API design we have today is at least partially due to some of his feedback. Now Django never really stuck for Aaron. He was too much of an independent spirit, and he went off and started his own web framework, web. py. And about two years after he was engaged with the Django community actively, Aaron wrote a blog post. And in that blog post he said the following I have a lot of illnesses. I don't talk about it much for a variety of reasons. I feel ashamed to have an illness. Surely there have been times when you've been sad. Perhaps a loved one has abandoned you or a plan has gone horribly awry. Your face falls. Perhaps you cry. You feel worthless. You wonder whether it's worth going on. Everything you think you think about seems bleak.

The things you've done, the things you hope to do, the people around you. You want to lie in bed and turn the lights off. Depressed mood is like that, only it doesn't come for any reason, and it doesn't go for any either. Go outside and get some fresh air or cuddle up with a loved one, you don't feel any better, only more upset at being unable to feel the joy that everyone else seems to feel. Everything gets colored by the sadness. And then in 2013, Aaron took his own life. Now It's really easy to reduce this to saying that the Aaron was killed by the US attorney who was mercilessly going after him for no good reason. And to be sure, malicious prosecution was part of what contributed to his situation. But that wasn't why Aaron took his own life. He took his life because he was depressed. And when you're depressed, thoughts of self-harm

start sounding like a good idea. And the thing is, other people actually noticed this happening. After his death, Dana Boyd said, I knew he was struggling, but he was also a passionate activist, and I genuinely thought that we would see him through this dark period. This isn't something we can ignore or hope that will go away. This is, as I said, quite literally, killing us. And Aaron's story isn't unique. Over the last two years, I've had conversations with at least two other prominent Jenga nauts who have told me that they've been in positions where they've seriously considered self-harm. I didn't ever meet meet Aaron, but we do actually have a connection. We share a birthday. He's exactly 10 years younger than me. Now that's a really really dumb thing to fixate on on the grand scheme of things, but when I found that out, that hit me really hard.

The upside of that shock Is that I'm gonna be damned if I'm gonna let any member of this community that I love so much fall by the wayside over something as simple as making sure they're okay. My plea to each and every one of you, don't ignore the science. Don't put off getting help. If you've even got a vague feeling that you might be depressed or suffering from burnout. Please seek help. Because you don't have to feel like this. Denying you have a problem won't make it any better So, okay, you've accepted you need help. What does help look like? Well, first off, it's important to get a good diagnosis. If you're looking to just kind of put your toes in the water You can do some of these tests online. One example is the K-10 test for psychological distress.

It's a bit like one of those which superhero are you pop quizzes, but you know, for reals. But pop quizzes ultimately are no substitute for a real diagnosis, and there's no way to sugarcoat this, you're going to need to see a professional. They're going to administer some tests, and some of them are actually very similar to the K-10 test, and work out exactly what you've got. Because to that end, it's important to recognize that depression is very much a blanket term. There are lots of different types of depression and lots of different types of mental illness. I was diagnosed as being in the middle of a major depressive episode. My son, who is nine, has what's called generalized anxiety disorder. Some women get postpartum depression after giving birth or after a miscarriage. Many of the symptoms of these illnesses are similar.

And many of the treatments are similar as well, but it's very important to get a good diagnosis because while they're similar, they are distinct. And the differences matter when it comes to treatment. And sometimes, just to complicate matters, they are comorbid. You can have both depression and an anxiety disorder. So what does treatment look like? Well, it can take a bunch of different forms, and they're not mutually exclusive. You can do many of them at once. As I said earlier, I'm now taking medication for my depression. In modern Western society, this is obviously one of the big first ports of call. One pill makes you bigger, one pill makes you small. But be wary of thinking that a magic pill will fix all your problems. It won't. But it can help you manage symptoms. If what you have is episodic, it can give your brain the kickstart it needs to start producing the right chemicals again

Some of them don't even need to be prescribed. St. John's wood is a herbal extract. It's available in health food shops in Australia, I presume it's the same in the US. It's a very, very mild antidepressant. But it's strong enough that if you start taking something prescribed, a prescribed antidepressant, it's contraindicated. They say stop taking St. John's wart for a couple of days before you start taking these other drugs. I used St. John's What On and Off for several years before I moved to the hard stuff. And it actually was helpful during that period Melatonin is another supplement that's available without prescription. Melatonin is a hormone that's important for regulating your body clock, and some studies have found that people suffering from depression have low melatonin in their systems. Now, supplements may help. However, for some people taking melatonin actually induces depression.

So be careful. And one thing I will say though is even if if things are even remotely serious, do not rely on self-medication Seek professional advice. I mentioned those two as simple things you can try if it's not that bad, but maybe you need a little bit of help. Also, keep an eye out for other forms of self-medication, in particular alcohol and drug use. It's really, really easy to slip into the habit of getting drunk until you can't feel feelings anymore. But that's not helping. In fact, it's part of the problem. It's even used as a diagnostic criterion. The same goes for illicit drugs. I've I never took illicit drugs myself other than some really, really fine opiates for the codeine for the back pain

But I know people who have, and again, it's a mask for the real problem. If you start noticing a pattern of excessive alcohol or drug use in yourself, seek help. And if you see it in others, intervene. Now, of course, the hard stuff is the prescription medication. Broadly, the category of drugs used to manage depression is generally the SSRIs, selective serotonin reuptake inhibitors There are several of these on the market. They all work fundamentally the same way. They have slightly different metabolization processes. Some work for some people, don't work for others I take Zoroft and I was really lucky. It worked first time for me and the effect was both profound and quick, a matter of days. For some people it can take weeks, and for some people it doesn't work at all. If your issues are more anxiety related, you might be prescribed an SSRI, you might be pointing in the direction of benzodiazepine.

They work in a very similar kind of way. Now they're much better at an immediate treatment for onset anxiety symptoms rather than SSRIs, which need uh baseline blood concentration to work. Dosage is also very important. When I started, I was on about half the dose that I am now. And while it did have a very dramatic effect on my mood, I found that I was sitting on the couch completely calm and relaxed with my shoulders tensed up around my neck all day. Strangely, increasing the dosage actually made that go away. Now you have to work with your doctor on this to dial in the right dosage. SSRIs also have some very interesting side effects ranging from the awkward uh to the potentially dangerous. They also have some very interesting interactions with other commonly used medications, especially aspirin, aspirin and codeine.

So again, my good friend's codeine has all gone away Treatment doesn't just mean drugs though. There is a lot you can and should do without even popping a pill. Get exercise. Now having me up here advocating exercise is more than a little hypocritical. But I sh I should get a lot more than I do. But from a depression management point of view, it doesn't even need to be vigorous exercise. Even taking a thirty minute walk each day can be enough. And frankly, just clearing your head can be a wonderful thing. Part of the advantage of taking a walk is getting some sunshine. Exposure to stunt sunlight stimulates vitamin D production, which plays into melatonin production, which is the whole other bunch of chemical processes. Now this can be a problem for other reasons. There isn't enough sunlight at some latitudes. In Australia the sun is actually trying to kill you. Thank you very much to the Northern Hemisphere for that.

You can also seek out therapy. As with the pharma pharmacological solutions, there are many different forms of therapy as well. Two common ones that come up in in the in Uh in discussions are cognitive behavioral therapy and acceptance and commitment therapy. Uh which ones work for you will depend very much upon your own headspace and how you tackle problems. It's not one size fits all. If you go to a therapist and that therapist doesn't seem to be working for you, seek out another therapist. It doesn't need to be professional help either. Just talking to a friend can be helpful. Burden shared is a burden halved There are also some volunteer groups out there in the CODA developer space specifically. There's MHPrompt , Blue Hackers. There's also a group with wider focus like Beyond Blue and Black Dog Institute, are two that are in Australia. But much of the information that is there is applicable regardless of nationality.

The US Department of Health and Human Services also has mentalhealth. gov that provides some US-centric information. And if you're not depre not depressed, if you're a well-adjusted, happy individual, well, first off you're here, so liars. But seriously, I'm incredibly happy for you. Your job now is to make sure that everyone else around you is okay. If you've never been depressed, it may be very difficult to understand exactly what's going on. So let's be clear about what depression is and what depression isn't. Depression isn't being sad. It's not something you can just snap out of. It is all in your head, but it's not just a frame of mind or a mood. It's the brain being broken. And broken limbs, broken parts of your body are actually a really good analogy here.

If I was to break my leg, no one would tell me to shake it off. Have you considered not having a broken leg? Everybody gets you know broken legs sometimes. No, you'd understand that it's painful. A bone has actually been broken. I'm going to need to use a crutch for a little while to get me around. You might need to hold some doors open for me for a bit. And You know, I might while I'm doing that, I'm probably not going to be able to go bungee jumping with you. And if it's a particularly bad break, I might not ever be able to resume some of the activities that I once enjoyed. If someone around you says they have depression, they're not saying they're sad. They're saying their brain is broken and they need your help, assistance, and understanding to heal. Another analogy that's helpful in explaining mental illnesses is what's called spoon theory.

Spoon theory was first described by Christine Miserandio. Mr. Indino , she was using it in the context of having lupus. But it's actually an analogy that holds for many disabilities, including mental illness, particularly things like anxiety disorders. Spoon theory goes something like this. Imagine you have in your hand a handful of 20 spoons, and they're the only cutlery you can use to eat all day. When you use one, you throw it away. Now you have to eat three times a day. Sometimes it's nice to have a snack. So for a happy life you need at least three and maybe five spoons it'd be nice to have. But every time you do something challenging during your day, it costs you a spoon to resolve that challenge. You have an argument with your boss, that costs a spoon. You need to adapt to a last-minute change of plans, that costs a spoon. Now, if you're a well-adjusted individual, you've got 15 spare spoons. Even on your worst day, it's hard to think that you might use up all those spoons.

You'll still be eating three squares and two snacks. But if you're going through life with a major disability or a major mental illness, you don't have 15 spare spoons. Getting out of bed costs you a spoon. Dealing with the fact that your son's just lost his shoes again That costs a spoon. Getting out of your house in the morning can cost you half your spoon supply. So you spend your entire day rationing your spoons, making decisions about the things you can and can't do, even though you'd like to And that costs spoons. Sometimes you can borrow spoons from tomorrow, but then you're starting tomorrow a spoon down, and unexpected things always happen. So you need to have a couple of spoons in reserve. That's why some of the things that you may want to say to someone with depression just aren't helpful.

They're not even wrong. They completely miss the nature of the problem. Saying it will all get better. You don't have it so bad. There's always someone worse off than you. Stop being so negative. They're not even wrong. This isn't about feelings. It's about a major mental condition. It's about someone's brain being broken. Another thing to avoid is making light of the situation, casually referring to a desire to have a neat desk as being OCD, calling out something slightly unusual as crazy. Be aware there are people out there who have actual OCD and it's not a joking matter. There are people out there with serious mental illnesses. Reducing everyone with a mental illness to a punchline is really no better than reducing all women to sex objects. So what can you do?

Well, be there for people. If it looks as though someone might be having a bad time, be there for them. Ask if they're okay. They might not want to talk about it, but they might. And even if they don't, having someone ask is a sign that you're connected to the world. And that can be a really big thing when you're in a dark hole. Also accept that you're not going to fix them. A five-minute chat about someone's problems isn't going to make their depression go away any more than it would fix their broken leg. You are at best going to give them a spoon back. Now sometimes it's also going to mean taking charge of the situation. One of the big symptoms for me that I mentioned is that I lost all enthusiasm for organizing social outings. The effort involved in picking up the phone and suggesting, hey, maybe we should have a pizza and watch a movie

was a spoon I didn't have. But you can provide that spoon. If someone said, hey, I want to come over, order a pizza and watch a movie, I probably would have done it. Because connecting with friends makes you feel good And it would have done me the world of good to get out and someone talked to someone about what was going on. And so you might need to love lightly shove someone out the door, make it as easy as possible, as spoon cheap as possible. for them to do something that's good for them. And it also it doesn't mean you spend an evening playing therapist. It just means an evening of taking someone's mind off things. It's not come out and talk about your problems. It's come out and be with us. Come out and connect with us. Come out and be human with us. So that's all I've got to say. I'm sorry for being such a down note at what the end at the end of what has been such a fantastic conference.

So here's a picture of a kitty The reason I've done this is because I suffer from depression and I put off getting help for far too long. The reasons I did that are, in retrospect, mind-numbingly dumb. And they're really easy to fix. We need to talk about this. I love this community. I love everyone that's in it. And I don't want to think that someone else is going through what I went through when it can be treated. It can get better. We just have to care about one another and break the stigma that makes people ashamed to admit that they've got a problem Thank you very much.