That said, I realize I might be in the minority on this, so I’m curious what others are doing to preserve their sanity.

You're not alone in thinking that. I would not say it is unusable but it is indeed way too littered with, well, with certain type of content I'd rather not have to deal with.

• For me, a careful selection of the communities I follow combined with limiting my home feed to 'subscribed only' does the heavy lifting quite well. I find it really efficient.
• I do have a couple filtered keywords, a couple like in two names (both being names of certain people that use to make the headlines around the world).
• Then, on a day to day level, when I'm faced with anyone that is not trying to participate in a conversation but is enjoying making a fuss, trying to create drama or anyone being constantly rude, or turning any disagreement in a personal matter, I will not hesitate to block them.