#966 - Dr Scott Eilers - Why Does Life Sometimes Feel Emotionally Numb? | Modern Wisdom

How would you describe to somebody who's never felt it what depression feels like?

It's tricky because it can feel like a lot of different things.

It depends on the person, but for a lot of people, depression is not as much the sadness and the despair as it's often portrayed as, and it often is more of a numbness or an emptiness.

So one of the core symptoms of depression that nearly everyone experiences to some degree is what's called anhedonia, The literal translation of anhedonia is the loss of joy.

So the reward system in your brain, right?

Your dopamine pathway that causes you to experience emotions like enjoyment when you're doing something fun or achievement after you accomplish something, it basically stops functioning.

It can it can be a diminished functioning or it can be a completely absent functioning.

And what that feels like on a day to day basis is you can go out and do the things you would normally do that would normally make you feel some certain way.

And the emotional reaction that you would expect to experience upon completion of those tasks or activities is either significantly dulled from what you usually experience, or it is just not there at all.

It's very much, I hear a lot of people describe it as if there were a black hole inside of them where their emotions or their reactions should be.

And obviously for many people, when you start feeling this way, that's That's where the lack of motivation that we see with depression comes from.

It's not that these people actually stop caring about their lives or the people in them or their jobs or whatever.

It's that you don't feel anything when you do it.

And, you know, we're reward -based mammals, right?

And so if we don't feel anything when we do things that are hard or challenging that require effort, the natural reaction is to stop doing them.

And that's where you see the person who can't get out of bed, can't take care of their their home can't take care of their hygiene it's it's that there's no there's no reward in it it's like you know if you were going to work and your boss pulls you aside and says hey just so you know we're out of money we can't pay you anymore i don't know when we're going to be able to pay you again but we still want you to come in and do all your stuff you're just not going to get paid for it for a while that wouldn't be a really compelling proposition to most people right and that's kind of what it feels like

to be told you still have to like stay alive and do stuff when you're severely depressed is I'm working for no paycheck.

Hmm. What's the, what's the difference between feeling sad and actually being depressed?

Mainly the intensity, the duration and the causality, right?

So this, I really do think we need to rework some of our clinical terms because depression, you know, when a psychologist like me says depression, we're talking about a chronic mental health condition, right?

But depression is also an emotion and it is emotion that all all human beings experience under certain circumstances.

So somebody you love dies, you lose a job, your house burns down.

These are extreme examples.

They don't have to be that extreme, but we all face challenges in life that cause us to feel sad or depressed.

And that doesn't mean you have depression.

Where we draw the line is that a person who experiences a clinical or a chronic depression, they're going to feel like that.

They might feel like someone love died, for example, for no apparent reason, like nothing happened, nothing changed.

I just wake up one day and I feel like I'm grieving.

I feel like something horrible has happened.

I feel like my life has no meaning, but I cannot rationally explain to you, here's what happened to make me feel that way.

Here's what changed.

Here's why I didn't feel that way a week ago.

And now I do today.

And for most people, depression isn't technically a diagnosis, right?

Mood disorders are a category of diagnoses.

There's no such thing as depression, just, you know, as a, as a, like a Z code.

When most people, when they say they're depressed, they're referring to major depressive disorder.

Major depressive disorder is an episodic mood disorder when a person experiences depression in episodes, and they also experience non -depressed periods.

So they kind of go back and forth between these two states, sometimes with no rhyme or reason.

And so when a person is getting into these deep, dark places of depression, and this sounds a little subjective, I know, but when there's nothing happening in their life that would reasonably seem to make them feel that way, that is when we would start to say, maybe this person has a chronic root disorder.

Why is it intermittent?

Is there a category of depression that's just always on that doesn't come off?

There is. It's called persistent depressive disorder, used to be called dysthymic disorder up until 2013 and we changed it because no one knew what the heck the term dysthymic meant we're not always the masters of terminology in mental health persistent depressive disorder is usually categorized as like a low to moderate level of depression but it really it's not episodic it doesn't really have ups and downs it's almost just more like the person's personality um I think of like I don't know this person I have no idea what this person's diagnosed with anything but the person that always comes to

mind when I think think of dysthymic disorder is or PDD is Bill Belichick, the former coach of the New England Patriots.

You know, his team could win by 50 points and put up record numbers and he'd show up to the press conference just really not looking happy.

It seemed like he was never really enjoying himself, right?

That's, again, I'm not trying to diagnose him, but that's kind of the image in my mind when I think of persistent depressive disorder.

In terms of why is it episodic?

I mean, that's one of our million dollar, really, we should say billion dollar questions at this point, given how the pharmaceutical industry is, but that's one of the burning questions in mental health.

And, and one of the sad truths about mental health that I talk about a lot is we don't know as much as we try to act like we know.

We don't know on an individual person to person basis, exactly why any specific individual becomes depressed or has a mood disorder.

There certainly seems to be a brain chemistry component to it.

So when our neurotransmitters the chemicals in our brains that cause our neurons to interact with one another things like dopamine and serotonin when the functioning of those neurotransmitters shift our emotional experience in this world shifts even if nothing in this world has shifted outwardly to cause that so there certainly seems to be a chemical component to it I personally believe and this is not a super popular opinion in my field I believe that there is a strong lifestyle component to it and I believe that many people who experience mood disorders I don't necessarily know if this is what starts

it but they end up you know because of this anhedonia because of loss of appetite low motivation insomnia things like that they end up chronically living in a way in which their life isn't realistically going to produce a lot of opportunity to feel good and so sometimes they have these prolonged depressive episodes I, I don't mean this to sound judgmental, but I call them, I call it false depression, not because it's fake or because the person is acting or anything like that, but because this person is probably capable of feeling better, but they've been, you know, perhaps resigned to living in this certain way

because for a while, this, this feeling of reward was not accessible to them no matter what they did.

So they stopped trying and now they live a life devoid of reward opportunity.

For a lot of people, there seems to be a social component to it, right?

isolation disconnection from others is a huge piece of it but ultimately our current appraisal of mood disorders is that they're very multifactorial it's not like this one thing happens and you're guaranteed to have a mood disorder and that the causes can be very different from one person to the next which of course tremendously complicates treatment on the therapy side of things what else don't we know about mental health disorders what what are the big, you know, like the, um, they used to have that deck of playing cards that were the FBI's most wanted terrorists.

What, what are the, uh, as yet unanswered, but really should be when it comes to mental illness and depression from a medical lens?

Oh my goodness. There are hundreds of possible answers to that question.

Number one on the top of my list is why are we so bad at treating it?

And I'm sure that the answer to that question probably goes back to the question you asked before, which is what is it?

It's hard to treat something if you don't completely understand what it is.

But if you look at outcome literature for individual psychotherapy and psychotropic medication, which are the 1A and 1B of treating virtually every mental health condition, most effective medications, most effective, like best possible conditions, right?

This is assuming your therapist is on their A game.

They know you have a good relationship with them.

You're on the the right medications, the right doses, best possible conditions, we're talking 50%, 60 % of people get better.

So close to half— What is get better?

Experience some relief from symptoms. So not even like— Yeah, I mean, it's a low bar is what I'm saying.

That's not like get to asymptomatic.

That's like makes progress.

Improves. I mean, yeah, improves.

Maybe goes from severe to moderate on a PH2 -9 or a GAD -7.

those are depression and anxiety screeners.

So this is a low bar.

We're not talking, yeah, cured and asymptomatic.

We're talking like, do you notice a difference in your life?

Do you feel marginally better, even maybe half, maybe slightly over?

And so we have this huge swath of the treatment -seeking population that is getting little to no relief.

And we don't necessarily know why that is.

I have a lot of frustrations towards my own field about that how that is handled.

Because people who have tried maybe two or three therapists, two or three different medications, and have gotten unsuccessful outcomes, let's say, in all of these conditions, they are often given the label treatment resistant.

And I understand what we're trying to accomplish with that label.

We're trying to say, this person seems like they need something more or something different than kind of our boilerplate approach here.

I really don't like the term though, because I feel that it places some of the blame for the poor outcome on the person seeking treatment.

So to me, it's like, there's this underlying assumption, we're doing everything right.

So if you're not getting better, it must be a you problem.

And frankly, I don't think we have enough information to say that.

The quality of care you'll get from a therapist varies dramatically from one person to the next.

It is not as standardized a field as I would like for it to be.

Our licensure exams, for example, and this is true for both psychologists and master's level therapists.

The licensure exams are basically like Trivial Pursuit Mental Health Edition.

It's like, who invented this treatment and when?

when no one cares at no point.

I've been, I've been practicing for 15 years at no point.

Have I had a therapy client be like, well, when was that treatment invented?

Was that in 1976 or 1975?

Cause if you don't know, I'm not going to listen to you.

No one cares. We train people on the wrong things.

And then we're shocked when we aren't getting great treatment outcomes.

outcomes. It feels a little bit unfair to say treatment resistant when between 50 and 40 percent of all people are treatment resistant.

It just sounds like the treatment is solution resistant.

That's exactly what I think.

I think we have, and I'm not just trying to pass the buck on other people.

I'm trying to be a part of this mission.

I think we have a lot of work to do to understand what people actually need when they come to therapy, when they're struggling with various conditions.

Because even, let's just take depression as an example.

The difference between a person who experiences mild depression and a person who experiences severe depression is night and day.

It's like comparing level one and level three autism, right?

So level one autism is like a person who maybe just has some social quirks and makes some gaffes in social situations and maybe gets a little bit obsessed about the things they're into.

Level three is like typically more profoundly disabled, like I cannot communicate without use of a device and may never be able to live independently.

Depression has a similar spectrum.

So there's anxiety for that matter.

And so someone with level one depression, they may just need someone to talk to every now and then.

They may not need a lifestyle overhaul.

They may not need, you know, XYZ set of strategies.

They need an outlet.

They need a safe place.

They need to just talk through their feelings and talk through some of the stuff they're going through.

And that's probably all they need is literally any competent therapist and they'll get better.

Severe depression is a different beast entirely.

It is disabling. We don't often think about mood and anxiety disorders as being in the same category of things like autism or schizophrenia, but at these severe tiers, which they can reach, they are disabilities, or at least they can be.

They can prevent you from working.

They can prevent you from going to school.

They can prevent you from having relationships, taking care of of yourself.

And I think we do not do a very good job of delineating these severity levels.

And we just kind of put someone with a therapist to say, okay, you have depression, this person treats depression.

And if you have severe depression and you go to therapy and the person just kind of chit chats with you for an hour, you're not going to get better from that.

That's not going to do anything for you under most circumstances.

There's a lot of work to be done on here.

I, like many therapists, this is a spoiler alert, but it's probably not a super well -hidden thing.

Most of us get into this field because we have a personal stake in it.

It's either us, either like we think we're screwed up and we're trying to figure out what the heck is wrong with us and hoping that we can also help some other people along that journey.

Or in some cases, it's maybe like, you know, I had a close friend or a family member, whatever.

It's not a career that people usually just go into out of pure academic interest. It's certainly not a career of people going to for the money um and when i kind of saw behind the curtain of what professional mental health was my first reaction basically was like this is it you know this is what we think oh this is happening the ship yeah it was not what i was expecting to see and it my first thought was this is not enough this isn't going to do it do mental health illnesses have biomarkers like Like, is there anything happening neurologically?

Can we look? Because I think there's, you know, an additional type of discomfort to anybody who's dealing with any sort of mental malady because it doesn't present externally except for in your behavior.

You know, if you've snapped an Achilles or broken an arm, people go, oh, there's a thing.

There's a real impediment to your ability to move forward in the world and I should treat you as such. touch but there's the am i maybe maybe i'm making it up why can't i just sort myself you know no one ever says why can't why can't i just feel heal my own broken arm that's not the sort of thing that we think you know we get frustrated at the process but we understand that it's something that needs fixing and other people behave accordingly as well but the reverse isn't true so i guess yeah i'm interested in the biomarkers neurological side of what's going on depression i am interested in it

too. And unfortunately, there's not a lot right now.

For depression, we don't really have anything consistent we can point to as a biomarker.

For some conditions like ADHD, for example, there is some preliminary evidence that at least structurally, there are differences in brain maturity and brain development.

So most people who have ADHD seem to have delayed development of the prefrontal cortex, for example, and it lags one to three years behind their chronological age.

That being said, because that's a very early finding, insurance is not approving MRIs as a test for ADHD in most cases.

So even for the relatively few conditions where we do potentially have biomarkers, we aren't really able to look at them unless the person is really wealthy and wants to pay out of pocket for a medical procedure.

seizure and the people who are trained to assess those biomarkers aren't necessarily mental health professionals like i as a psychologist i you would not want me giving you an mri i would probably kill you it would not go well i don't know how to do that and so it's sort of like a one hand is not talking to the other thing but what you said before about i know it's a little bit cliche to say it this way but like these are invisible illnesses right because of the lack of biomarkers because of the lack of the general lack of physical manifestation.

Sometimes you can look at a person and be like, I think that person is probably depressed, but that's not always the case.

There's an entire subset of the depressed population.

I think this probably exists for most mental health conditions that are considered high functioning.

So there are people, you know, just like there's people with high functioning autism, right?

There are people with high high -functioning depression, and high -functioning depression does not mean mild depression.

This is very important to know.

There are people with high -powered jobs, spouses, families, homes, cars, and they look fine.

In fact, some of them even look better than most. Some of them are people who are in exceptionally good shape, take wonderful care of themselves, have immaculately maintain homes and they are severely depressed they feel hollow empty and numb inside and this is kind of a weird way of thinking it but i think you'll i think you'll appreciate this i often think of depression in particular as a disorder of leverage and so if you think of if you think of leverage in life as being like the difference between what you do and what you get right a person who has a lot of leverage in life can accomplish

things and feel good from those accomplishments.

They can go out socially and make friends and feel connected and loved and valued.

They can get a promotion at work and feel competent and skilled.

They can spend the money they get from that promotion and feel joy and excitement because they're on a vacation or a concert or whatever.

With depression, we lose our leverage.

There becomes this discrepancy between what we put in and what we get out.

But everyone who looks at our lives from the outside side looking in, they don't know what's inside our heads, right?

So they judge our output.

And they see he is doing these things, therefore he must feel good enough to do these things.

And there's this whole group of people, these high functioning depressed people that are being very, very missed in society and in treatment.

Prior to opening my practice, I used to work at a hospital.

And so So my colleagues were, you know, surgeons, oncologists, et cetera.

And many of them were deeply struggling with their mental health.

And no one would have ever known from that.

I only knew because they told me.

I didn't even know.

I didn't even look at these people as a psychologist and think, oh, I see, you know, there's some subtle little tell I see that tells me this person is not doing as well as they're letting on.

I don't even know. That's how good people are hiding those things, because a lot of us don't have a safe place where we can let that out.

also there's a lot of shame around you know having a life that from the outside seems to be going great but from the inside doesn't feel all that good you know ostensibly there's nothing wrong no one's died i'm not bankrupt my wife hasn't left me and i just don't feel that fired up about life you know joy isn't coming to me except for when i really really work and go out and seek it and sort of pick it up off the ground.

It's interesting around the sort of high functioning part.

I wonder whether we should be sort of more scrutinous of people that are real high performers because you think, well, any normal person would have taken so much pleasure and joy from their successes by this point that they would have given up.

But for some reason, you have this black hole inside of you.

And that's not to say that everybody who's a super high performer has this.

But that it is just a really obvious, you know, equation of drive that, hey, if you're the sort of person who keeps on pushing long after the success level that most people would consider to be reasonable or worthy of praise or worthy of relaxing a little bit, if you keep going, well, what's driving you?

Or perhaps it's that your leverage you're having to get for every hundred units you get in, you only feel 10 of them or something like that, as opposed to with somebody else who for every hundred units that they got, they would feel a hundred.

Yep, that's exactly it, Chris.

And you're absolutely right that there are people who just love their jobs and love their careers.

And it's not that everybody who is at the top of their field or who works more than 40 hours a week is secretly depressed.

But I think more of the people that meet those criteria are severely depressed than people would think.

Because when you get this anhedonia, when you get this numbness inside, very broadly speaking, there's two pathways you can take when that happens.

You can say, I don't really feel anything when I do things.

Therefore, I should stop doing things.

Or you might take the approach of, I don't really feel good no matter what I do.

Therefore, there is no point in me organizing my life around joy and leisure and fun.

So if everything feels the same, I may as well work as hard as possible, do as much good as I can for other people, make as much money as possible, maybe not even for me because because I don't feel anything when I spend it, but maybe for my friends or my family or my kids or whatever.

Because if being at work and being on an awesome family vacation emotionally pretty much feel like the same experience to me, I might as well do the one that produces something, right?

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Yeah, I've got an essay that I want to read to you that I wrote a couple of weeks ago.

Sure. And I was thinking about the Viktor Frankl quote that was, I guess, gets used an awful lot.

When a man can't find a deep sense of meaning, they distract themselves with pleasure.

And what he's arguing is that a lack of meaning causes people to seek temporary relief in superficial pursuits rather than to sort of address the underlying existential void.

And I think that perhaps for many people, maybe even for most people, this is a big issue.

But I think that there's another group who suffer with the opposite problem, which I called Frankl's inverse law, which is when a man can't find a deep sense of pleasure, they distract themselves with meaning.

so if ease and grace and joyfulness don't come easily to you one solution is just to ignore moment to moment happiness entirely and just always pursue hard things people sort of become a world champion at willing the marshmallow test and you convince yourself that delayed gratification in perpetuity is noble because you struggle to ever feel grateful in the moment so you sort of prioritize meaning over happiness because happiness doesn't come easily to you and obviously delayed gratification in the extreme just results in no gratification.

And yeah, I think some people are sort of hyper responders to working hard will give you good rewards, you know, the sort of just grit your teeth and, and keep going.

Uh, and they go on to become workaholics and insecure overachievers.

And from the outside, it looks like you've sort of transcended the shallow need for pleasure, but in reality, it's just cope to avoid facing the fact that you struggle to feel joy.

So instead, you perpetually promise yourself that happiness might finally come tomorrow, like running toward the horizon, something that never arrives.

Congratulations, you've managed to subjugate your joy as a tribute to your work.

And I think we quite easily confuse, we mistake humorless and fun -lacking seriousness with being sophisticated and caring about your pursuit.

compute um thoreau's got this quote where he says the price of anything is the amount of life that you exchange for it and by this logic i think a lot of us are paying into a bank account that we never withdraw from so yeah this this odd sort of inversion of that when people can't find a deep sense of pleasure they distract themselves with meaning that feels like kind of the curse of the high functioner yeah i think we might be talking about the same group of people here and it's something it's tricky because you know this goes back to mood disorders and and their episodic nature and and it depends

a little bit on are we talking about a person who always feels this way are we talking about a person who has some ebb and flow in their mood because some of this in my opinion can actually be a healthy coping tool for anhedonia because if you experience episodic depression and you have periods of life where you can't feel joy but then you do have periods where or at least to a degree it returns, then you can at some point withdraw from that bank account that you're constantly paying into.

You just can't withdraw from it at will.

The bank just kind of tells you when it's open and you just sort of have to accept that.

Right. And something I learned just through repetitive trial and error in my own life is the way something feels while you are doing it is not necessarily the way it's going to feel later.

And, and that relationship can move in either direction, which is really important to understand.

I think all of us understand that things that feel good when we do them can feel bad later.

You think about like a drunken night out with friends or something like that might feel really good while you're doing it, but you don't necessarily feel great the next day or a relationship that you were in and it ends.

And now all the happy memories you had with that person are now sad memories because you're grieving.

So I think we all understand that directionality, but it is important to note that it can go the other way as well.

And if you're in a depressive episode and you're experiencing a state of anhedonia, and so you don't enjoy anything that you're doing, you might be able to withdraw from those experiences later.

The, the story that always comes to mind when I think of this concept is when I was 17.

So my, my worst years depression wise were like like early adolescence to early adulthood, like 13 to 23, that was my rock bottom.

I'm kind of thankful I got it out of the way early.

But 16 and 17 in particular were very, very dark times for me.

And I think on some level, my parents recognized that.

They had no idea what to do.

We're small town people.

They're not mental health savvy.

I don't blame them for that.

But my dad knew I was really into like fish and water and stuff.

And so he planned, when I was 17, he planned a trip, just the two of us a scuba diving trip to the florida keys which was like the apex like that was the coolest thing i could imagine at the time so i remember you know we fly out there we're out in the water and we we take this boat out you know three miles out to the reef or whatever get in the water and i'm not even in i mean i'm in the water but like my head is still above i'm just treading water right but i remember looking down and just seeing all these bright colors like Like there was just fish all around.

And I remember thinking, that's cool.

I didn't know there was like, I thought I was at least gonna have to get underwater before I saw the fish.

I had this conscious recognition, almost like this outside looking in of like, this is a really awesome experience.

And I remember thinking, it should feel that way too.

And it was almost like, it was almost like this slow motion thing where I could feel the awareness of the moment get, not that emotions literally happen in your heart.

They happen in your limbic system, but whatever.

That's what we say.

I could feel that it just died before it reached my emotions.

I was consciously aware that this was a neat thing that was happening, but I felt nothing from it.

I felt that way the whole day.

It was like this three or four -day trip.

We did all this cool stuff.

I even took pictures, which was really unusual for me back then.

I knew it was special, but I didn't feel like it was special.

The funny thing is I still have those pictures.

when I look back on those pictures now I feel joy about having been on the trip even though I did not I'm it's not like a nostalgic it's not like I'm feeling what I felt back then because I did not feel joy on this trip I was also nocturnal on this trip so the schedule was really hard to work around because I was dealing with severe insomnia so we couldn't do half the stuff we wanted to do but that was an important life lesson for me and this is important to remember when you're depressed and when you're experiencing anhedonia is just because you don't enjoy it while you're doing it doesn't mean it

is a waste because that that's what I hear people say especially like these high functioning people you know like they have they have the resources to go on the family trip or whatever or go to the cool concert but they don't because they don't care because they're like why bother why spend money why spend time if I won't enjoy it you may be able to draw from that well later on when you're in a different mood state we aren't locked in to only experiencing the emotions that we experienced at the time when we reminisce.

And so, in my opinion, it is still worth doing those things to hopefully be able to draw from them later when you're in a better place, which I know is a big assumption, but it is possible.

Yeah. The sort of circular white flag waving that you have when you think, well, I don't feel good in the moment, so it's pointless doing anything in the moment, and this is going to last forever.

And even if it doesn't, I'm going to look back on this and I'm going to remember that I actually ruined the trip for myself and that photo that I took was me not feeling good.

Yeah, in some ways, but tragedy plus time equals comedy is about the closest thing that psychology has got to an equation, I think.

How else would you recommend people cope when they're in a period where sadness is more readily available and happiness is more limited?

I have five go -tos for anhedonia and for emptiness.

And one is the one I just described.

So I call that investments, which is basically still do the things, know that you're not going to feel great while you do them.

Don't expect to feel great while you do them so that you're not disappointed when that good feeling isn't there.

But don't catastrophize it and say, because I didn't feel good while it happened, I will never feel good.

Or like you said, I ruined the trip.

Not necessarily. You banked something that you may be able to draw from later.

So investments is one.

the second is what i call checking the lock so this is all kind of based on the metaphor that anhedonia is like an emotional prison right it's like someone's locked you into this sensory deprivation prison if you stop doing things that bring you joy because for a prolonged period of time you are unable to experience joy you will not inherently realize when you have left that state because you won't just wake up some morning and feel joy because you woke up because that's not an inherently enjoyable experience so if nothing you do in a day has the potential to create joy you might end up in a period

of anhedonia a period of depression for years or even decades in some cases when you were capable of feeling something and the reason you didn't experience joy isn't because you were unable to, but because you stopped doing the things that would produce it.

So I encourage people, even if it's something small, do one thing every day that at least theoretically could produce joy.

Otherwise, you won't know when this comes back and you'll just assume it's not there.

There's no marker. You're not going to wake up and just like angels are singing to you saying, it's over, you're better.

You won't know unless you do something that prompts it.

Another strategy is something I call stacking.

So sometimes we all have a threshold for joy, right?

And there are, there's little things that happen every day that are technically good things, but they don't cross our threshold.

And so we feel nothing.

An example would be stopping at a stop sign successfully.

Like you're driving and you don't crash that's kind of the default assumed thing and but it is technically a good thing right but you probably don't get a dopamine hit every time you successfully break your vehicle um and so sometimes what happens with anhedonia is it's not that our ability to feel joy is actually literally gone it's that this threshold has been raised quite a bit and so it's going to take a lot more to get you to clear it.

And a mistake people often make is just stacking joy on joy on joy and just trying to be like, okay, I'll, you know, watch the game with my buddies, with some drinks and just do a bunch of pleasurable stuff all at once.

But what I have found is more, more effective is stacking multiple, I'm going to say enjoyable emotions rather than just all joy or all pleasure.

i have found achievement plus pleasure is a really really potent combination this is another one i stumbled across completely by accident but i'll give you the short backstory here around age 18 i started going to the gym even though i had no motivation i basically got peer pressured into it and i was like yeah whatever i'll go i didn't i wasn't super excited about it at first but as i as i got into it it was like okay i start to see some value in this and there was this one day i specifically remember after i had started learning about kind of nutrition and rest and stuff like about protein synthesis and I'm

like, okay, so my muscles are going while I'm eating food.

That's kind of cool.

And I had gone to the gym with one of my friends that morning.

And then that evening, I was hanging out with another friend playing a video game, eating pizza, stuff like that.

And I remember like I'm playing the game with one hand, like eating my pizza with the other hand.

And I remember thinking in that moment, I'm getting stronger right now.

I'm sitting here playing a video game and eating pizza.

And my fitness level is rising because I'm resting and consuming protein.

And I remember in that moment, I had this burst of joy that I had not felt in years.

And I have found that that combination in particular is relatively reproducible for me.

When I, because when you do something that produces a feeling of more like achievement or accomplishment, that often tends to be more of a slow burn, right?

It's not, it doesn't always feel amazing right away, but you kind of stay feeling good about it all day day long like from the gym or you know mowing the lawn or whatever every time you look out your window you're like yeah that's a nice looking lawn it's sort of this it's sort of like proteins and fats versus carbohydrates right it's that slow burn so I found that if I try to stack the early part of my day with more like achievements and accomplishments and then later in the day try to hit the joy while the achievement and accomplishments still present sort of in my mental ecosystem system, that stack

often gets me across this threshold that I don't typically seem to be able to cross with just joy and pleasure and leisure alone.

Third is what I call loopholes.

Anhedonia is not always total.

And so what happens sometimes is you lose your ability to experience joy from the majority of experiences within a category, but maybe not all of them.

There might be one or two two things in an individual category that still work.

So if you take food, for example, people often experience, so it's called physical anhedonia.

Basically your sensory inputs are kind of numb.

And so it's sort of like, I don't know if you lost your, if you ever got COVID and lost your sense of taste.

I did. And I am one of the people that loses my sense of taste and eating just became this monotonous chore because nothing tasted like anything.

And I hated to eat food.

Anhedonia is kind of the same way.

Like your food kind of loses its flavor.

And that's why a lot of of people lose their appetite when they're depressed because it just becomes this thankless job again.

For whatever reason, I'm sure there's some nostalgia reason to it.

I have found that no matter how depressed I am, cheeseburgers from a charcoal grill breaks through for me.

I don't know why that is.

I don't remember how I figured that out.

That doesn't matter how bad it is.

That That is the one food where my body's still like, yep, this is, this is pretty good.

So yes, when I'm depressed, I eat a lot of cheeseburgers and that's okay.

Cause that's part of what gets me through.

You might also experience the loopholes with like socially, you know, maybe normally you have this large, you have a lot of different people you enjoy interacting with.

Maybe when you're really depressed, you find there's really only one person you want to be around.

Maybe it's your partner, your best friend, your mom, your kid, whoever you find, you still get joy from this.

maybe there's one hobby or one very specific way you play out that hobby that still breaks through so when when we're you when we're looking for loopholes our world's going to shrink a lot we're going to end up repeating a very very small range of behaviors over and over and over again because they're the only things that make us feel anything but if that's what it takes to get you through then sometimes that's what you have to do and the final one is actually kind of what we talked about out early it's very similar what you described in your essay it's what i call apathyception and i i've heard

he didn't use this word but i've heard alex hormosi who i know you have on here from time to time he's described something very similar which is basically the idea of like do i have to feel something when i do things and can i continue to do the things that i know i should do whether that's because they're in alignment with my values or because there's still things that kind of raise my my floor and prevent me from getting to a really you know like suicidal or disabled place can i keep doing them even if i feel nothing and it's harder to be sure but it's not impossible i i have to put myself in a mindset

sometimes of like reward is optional it's great when i feel reward for what i do but sometimes i won't because that appears to be just a thing that my brain does sometimes i basically think of it as like a glitch in my system Sometimes this thing doesn't happen.

And the worst thing I can do if this thing doesn't happen is to stop doing the thing that produces it.

So I can choose. It's a mindset, in my opinion.

I can choose to not care about the fact that I don't really care about this right now.

I can out -apathy my own apathy.

Who says I have to care?

Why is that a rule?

Do I have to care? Can I do something if I don't care about it?

Yes, it sucks, but I can.

and it works. That was a long -winded answer, wasn't it?

No, dude, I mean, that's brilliant and obviously a very hard one between personal experience and professional research as well.

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I imagine that a lot of people maybe try to just sort of chase joy very aggressively.

A ton of peak experiences one after another.

Is that a solution?

Just big injections of excitement?

No, having thoroughly experimented with that coping strategy for an entire decade, Kate, I can confirm that it in fact does not work at all.

Dang it. But that is, I mean, I think that is the natural response, right?

Especially if you had like a pre -depressed period of time when you enjoyed life and then, and generally enjoyed life anyway, right?

And then something shifts and you're like, I am not feeling the way I used to feel.

This, this equation seems to have been upended somehow.

And now everything kind of feels like a slog.

It feels like a grind and it feels like the work and the non -enjoyment is outweighing the enjoyment, I think it is a very natural response to say, well, then let me just kind of increase the volume of the joy.

Let me spend more time on these things or make them more prevalent in my life.

And it's just never going to produce, in my opinion, anything beyond the moment.

I don't think we can get out of depression by chasing momentary joy and pleasure no matter how strong or how compelling it may be and my metaphor for this is basically there's two approaches to life you can either try to do things that feel good or you can try to do things that make it feel good to be you and those sound almost the same but they are very very different if i'm trying to do things that feel good i am essentially externalizing everything.

I'm saying I am dependent on external inputs to give me a reason to live and a reason to keep going.

And anytime my ability to access those inputs gets disrupted, I'm pretty much guaranteed to feel awful.

I have gotten so much more value out of spending time and energy on things that make it feel better to be me on just a normal average day today than on things that feel good when I do them.

And these are the very basic unglamorous parts of life, right?

This is your physical health.

This is sleep hygiene.

This is nutrition. This is moving your body.

This is having a healthy relationship with substances, which usually in my opinion is going to mean like minimal or none.

This is paying attention to how you talk to yourself all day long because you're going to hear your own voice more than then you hear the voice of every other human being combined.

And so the relationship you have with yourself is tremendously important.

You are, your body and your mind are the gatekeepers for everything out there, right?

Every external input has to come through you before it does anything, before it means anything to you.

You're the road it has to travel on.

And if the road is broken and nothing can get in, it doesn't matter what you have in life and that's again i'm talking about people i don't know here which is a dangerous thing to do but that's usually my conceptualization or my theory when you see you know celebrities famous people talented people rich people struggle tremendously with mental health and addiction in some cases even succumb to suicide that's usually what i tend to think probably happened it's not that they didn't have the things they clearly had the things things but did the things get all the way to their heart did the things

matter to them were they able to feel the things and i i would assume probably not or that would have gone differently the skill with which we take care of ourselves is the maintenance of that road into you and if that road is blocked if that road is not well maintained it really doesn't matter what is out here because because you can't touch it, you can't access it, and it won't make you feel anything.

Yeah, it's interesting, the difference between sort of what do you do physically to prepare the system to make sure that the road is as well -maintained as possible.

I think a lot of the time when we talk about, well, how do we improve self -talk?

How are we more self -compassionate?

How can we be kinder and more patient when we have shortcomings?

A lot of that is kind of top -down rather than bottom -up.

Bottom -up being, did you sleep enough?

did you train enough?

Did you eat enough?

Did you see some sunlight today?

Did you speak to a friend, et cetera?

How do you think about the other way?

How much of a role does that have?

I don't know. I become increasingly skeptical about being able to think your way out of feeling problems. I don't know.

I think they're both tremendously important.

I would even argue they're probably equally valuable in the net overall outcome, but I do believe in an order of operations here.

And the order of operations I subscribe to is bio -psycho -social because physical health is brain health.

Your brain literally lives inside of your body.

Your body is your brain's home.

And you're not going to be able to have a physically healthy brain if you don't take at least decent care of your body.

And this, this actually kind of goes back to something we were talking about earlier.

These poor treatment outcomes, right?

The biological component of mental health in my experience is often skipped over by professionals and we go straight to the psychological and the social we go straight to the thoughts the feelings the relationships and it this is this is a weird thing that always comes up for me but when you see the commercials for like um like erectile dysfunction medications and they always say make sure your heart is healthy enough for sex right before you try to produce joy or connection make sure your brain is healthy enough to feel that because if you're you're getting three hours of sleep a night, snacking

all day long, and then like binge eating one meal at night, abusing caffeine and alcohol, and you're sedentary.

No, you're not going to feel great.

Your brain is not able to feel great.

It is literally not healthy enough to do the things you want it to do.

And no amount of changing how you think or how you talk to yourself or whether you're assertive or have boundaries with other people is going to change the fact that your brain is lacking the resources it needs to do its job.

It works on a system very similar to a power grid, right?

You've probably heard that term, we only use 10 % of our brains, right?

Do you know how that's...

It's kind of true, but it's a half -truth.

Okay. So the implication there is that there's this secret 90 % of your brain that never gets used and can be unlocked to give you superpowers or something, that would be stupid.

Like we are not that poorly designed.

Our brains are unbelievably efficient.

The accurate statement would be you only use about 10 % of your brain at any given time.

Your brain is, if you ever look at an fMRI, for example, you'll see like when they say this part of the brain lit up when this person like looked at the Mona Lisa or did their taxes or whatever, what they're showing is which part of the brain was receiving blood, blood, oxygen, and caloric energy.

So your brain is constantly redirecting resources to different parts of itself, depending on what it thinks you need for what you're trying to do.

But it's also important to remember your brain is an organ.

And like every other organ in your body, its primary concern for you is survival.

And so if you don't have enough resources, your brain needs rest, blood, oxygen, so obviously rest comes from sleep.

Blood and oxygen come mostly from movement, right physical fitness it needs caloric energy which comes from food if it is lacking in any of those things it's going to go into a low power mode similar to your phone or your tablet it's battery saving mode because it doesn't have enough juice and things are going to run slower the screen's going to get dimmer it's not going to be able to do all the things it's capable of doing the least of your brain's concern is making you feel happy your brain is actually pretty indifferent different to your happiness.

That's like the absolute top of the line.

If I have nothing better to do, sure.

But if there's any other more basic unmet need, that's going to get prioritized first. And so we've got a lot of people who are, and I'm not trying to be mean or judgmental.

I don't think we do a good enough job of explaining this is our job in mental health.

And I don't think we're doing it well, but we got a lot of people who aren't checking these boxes and then aren't understanding why it doesn't feel good to be alive it's like your your brain doesn't have what it needs it's not charged and so I I wouldn't say I think of it very much like an algebra equation right like one part of that equation is not more important than the other part of the equation but if you do them out of order you will get the wrong answer and I firmly believe that the order of operations is biological psychological and social in that order and I think when you try to do them

out of order you get stuck It's the difference between being depressed and living a life that is worthy of depression.

Like, okay, this is not the sort of thing that would make anybody feel happy.

It's an easy question, right?

A hard question is, how do you make somebody happier?

An easy question is, how do you make a happy person more depressed?

Yeah, well, I'd cut them off from their friends.

I wouldn't let them see any sunlight.

They wouldn't move their body.

They wouldn't eat or drink particularly well.

They'd have no sense of purpose.

They disrupted sleep pattern.

You go, okay. So if that's how you make a happy person miserable, we have to at least assume that the foundation.

So if you're going straight to an SNRI or treatment resistant, I need the psych therapy thing.

It's like, well, I mean, it seems to me like the foundation should be laid.

And that's not to say that there isn't a use for those things on top, but surely that should be the primary focus you would think so I mean what you just described is actually a really useful tool it's that inversion thinking right like if you don't know if you can't figure out what you should be doing to feel better well what would you do if you wanted to ruin your own life like if you wanted to make things as bad as possible and I literally do this activity with people make all make the bullet point list of if I wanted to have the the word the most depressing anxiety provoking miserable life possible,

what would I do? And I'll have people make all their bullet points or whatever.

And then I'll say, okay, what do you think would happen if you did the opposite of everything on this list?

And that's usually like, oh, I've never tried that.

Our brains just don't seem, our brains are better at identifying problems than solutions.

But when we use that inversion thinking technique to, to, to answer that question, it gives you the next step.

The next step is built in.

It's just, well, then do the opposite of those things and you'll probably probably get the opposite results.

It seems like you're suggesting that numbness isn't neutrality.

It's more sort of a shield born out of unprocessed trauma.

How so? Well, there's a different actually just made a short about this.

But yeah, the numbness that comes with depression or anhedonia, it's not the same feeling as like a nondescript day.

So we all have those days, right?

That are just very generic days, days where nothing special, good or bad really happens, days when you don't have any strong emotional reactions to anything, days that you're probably going to forget ever.

Like you will not remember five seconds of this day a week from now.

We all have those days.

That's not depression.

That's not anhedonia.

Those would be more neutrality.

This is the absence of something that is supposed to be there.

This is the absence of the ability to experience those things, even in the presence of stimuli that should create them.

And that's, again, sometimes where the line is between pathology or a mental health diagnosis.

And just like, just life is not great for me right now.

Because I think we do all have even longer periods of life where things are just kind of blah, kind of mundane.

And we don't necessarily wake up happy or excited or thrilled, but that doesn't mean you're depressed either.

You just might be in kind of a rut, right?

right? Yes. Yeah. I think one of the main challenges that people will face here is kind of feeling at war with your own mind.

Like, hang on a second, you're supposed to be here serving me, making my life better, improving my day -to -day existence.

And I am my own worst enemy here, especially if you've got the additional shame of ostensibly nothing's wrong.

I'm not on the verge of bankruptcy.

I didn't just lose my job.

My mom didn't die. You know, okay.

So So you are exclusively the architect of your own prison here.

Not only are you the prisoner, but you're also the prison guard who's holding the keys.

But actually you're kind of not holding the keys because it's not as if you meant to put yourself in here.

And it's also not as if you know how to get yourself out.

So yeah, there's this, I don't know, a sense of cosmic unfairness.

Like, why do I need to work so hard to be happy?

Everybody else, like they just, fuck, it just comes to them for free.

And you tell them, I've got to leave the gym with a coffee in my hand, play my favorite favorite song, talking to my friends and the sun's shining and the birds are tweeting.

It's like, why? That just feels unfair.

Well, it looks that way.

It's important to remember, we were talking about high functioning depression earlier.

Some of the people who you look at and you think, man, it's easy for him.

Why can't I just be like that guy?

Some of them are not the guy you think they are.

Some of them on the inside feel exactly the same way you do.

That being said, I'm not saying that's everybody, right?

I really do believe there are healthy, well -adjusted people out there who inherently enjoy life, unless something aversive is happening to them.

I don't meet a lot of those people, but I do believe that they exist. It is unfair.

And that's not something I shy away from.

Having a chronic mental illness is an unfair thing to be saddled with.

There's, I don't have, I don't have an explanation for that.

That's going to make you feel better about it.

I don't have a pep talk I can give you where you're like, Oh, here's why it's okay.

Here's why it's cool.

Because I struggle with those same thoughts too, to be honest with you.

But what I have decided is it simply exists, right?

If this is just something that is true of me, I basically am back to, I have two options.

I can pretend that it is not true of me.

I can live the way I perceive other people living, which is that they don't have to be on their A -game all the time about how they live their life and how they think and what their relationships are.

And and they can take this kind of laissez -faire approach to life and still be happy, and I'm just going to live like them and just hope that works out, spoiler alert, it won't.

Or I can say, okay, I was born with a chronic condition.

That means I have to live my life a little bit differently.

And I often quote, I'm using it differently, but I often quote Dave Ramsey on this.

So I know with finances, he says, if you want to live like nobody else, you have to live like nobody else, right?

Meaning if you want to have a degree of financial security, more than what most people have, you can't spend like them.

You have to have different habits and different relationships with money.

If you want to have a level of mental health and just emotional stability and contentment from life that is more than what other people around you have, you can't just copy their template.

You're going to have to do something differently, probably a lot of things differently.

And that is unfair.

And if you want that outcome, It's still what you have to do.

If you have a chronic mental health condition, then managing your mental health should not be a side quest in your life.

And that's what most people do.

They put other stuff at the forefront and they say, I'll take care of my mental health when I can, when I have time, which we're busy adults.

There's not a lot of that, right?

Those are things that are in short supply.

fly. You wouldn't necessarily, if I like live streamed 24 hours of my life, I don't know that it would look dramatically different than most people's, but I put my mental health needs at the forefront.

That's the framework around which I build other things because that's the weakest link in my chain.

If something is going to take me down, it's going to be my mental health.

I know that that is my Achilles heel.

And so I have to plan for that.

Now, as far as, you know, our lack of control over the brain.

Again, I know this is very frustrating.

I know that because you have conscious thoughts in the brain, you feel like you should just have full autonomy or agency over it, right?

But what's important to remember here, when you think about your brain and you think about your thoughts, your narrative, your decisions, you got to remember that's a very small fraction of the brain.

Everything you're talking about there is the prefrontal cortex. text.

The majority of your brain is not involved in conscious processing at all.

Most of it is doing behind -the -scenes work.

And in that way, it does function like any other organ.

So yeah, it's frustrating to not just be able to choose to be happy right this very second or flick a switch in your brain and go to sleep right when you want to.

But you don't have that level of agency over anything else in your body either.

For everything in your body, you have to coax it into to doing what you want.

You can't just command it.

If you wanted to slow down your heart rate right now, you could do it, right?

You could do it by slowing your breathing, maybe doing a meditation practice, maybe doing some progressive muscle relaxation.

There are things you could do that would create that outcome, but there's not a thing you can do in your brain where you're just like heart slow down, right?

You have to do some kind of middleman activities that make that organ and do the thing you want it to do you can't consciously control your digestion but there are practices we can engage in throughout the day that improve our digestion right that's how the brain is you can't just brute force it into doing what you want it to do and in fact if you try to do that you actually usually get farther away from your intended outcome but if you understand how it works and if you understand a how brains work in general and b as a person with xyz mental illness here's how mine is different from the average

and here are the additional steps I have to do to get the desired outcome well then your choices are do them and usually get that outcome or don't do them and be miserable all the time and I'm not trying to I'm not trying to be trite or put the blame on people but at some point we do have to make a decision and say I accept that I have a chronic health condition and I'm going to do what I can do to manage it it's functionally no different than if you say I have diabetes I can either either take my insulin or not take my insulin i can either follow my nutritional plan or not follow my nutritional

plan but the consequences for not doing the things i need to do to manage my chronic illness that isn't necessarily my fault that i have the consequences are high and that's ultimately where my agency is is i can manage it or not yeah it's a kind type of tough love yeah that's why i try i appreciate that because that's what i'm going for sometimes i I worry I go, at least by therapist standards, I think I drift a little more into the tough side of things and a lot of therapists would.

So I appreciate that.

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Look, you're trying to motivate people to take some action.

And I think one of the challenges of modern psychotherapy and one of the reasons that stuff like ACT and CBT is having a good resurgence at the moment is that it actually gives you something to do about it.

We're going to do do something as opposed to it just being this temptation of rumination sort of cyclical talking about the same thing and it's hard and I see you and that's difficult and oh yeah that must be and you go dude I mean that is huge lots of people don't have anybody in their life that says yeah man that sucks that was tough that was really hard that you went through that thing but after a while there's okay and what are we going to do about it right and if you can do do something about it whilst you've got somebody that's saying, yeah, that's tough.

And that must have been really, really hard. If you can have that at the same time, I imagine that the progress is even quicker.

Exactly. And I do think it's, it helps to know that the person saying this isn't just some academic, not there's anything wrong with scientists, obviously, but I'm not just saying, Hey guys, I've read the research and the research says, this is what we should be doing.

In fact, some of the things I say, aren't always completely congruent with the research, but I, My life is a 41 -year case study.

It's a 41 -year case study of chronic depression.

And I can tell you that at least for me, here are the things I tried early on that produced very, very poor outcomes and made my life miserable.

And then here's the things I've been doing lately that have made me less miserable.

And my theory is that this is a replicatable outcome and that I don't know that I am so unique that this only works for me and nobody else.

And that's essentially my core hypothesis is that my results are generalizable by sharing the case study that is my life with people.

And usually if I have, if I do come off snarky or mean it's because I'm thinking of me because sometimes I'm a little irritated.

Yeah. This isn't directed at someone else.

It's directed at myself.

I'm actually talking, this is just me talking to my younger self.

And if you get caught in the crossfire, I'm sorry.

Cause I'm still a little frustrated with him for some of of the things that he did.

But I also understand, I mean, I do know what it is to be in that dark place.

At my lowest, something a lot of people don't know is that up to 40 % of people who experience severe depression experience psychosis with it.

We think we hear psychosis, we think schizophrenia or psychotic disorders.

Severe depression has a high frequency of psychosis.

What is psychosis? Psychosis means in some way, shape or form, you're disconnected from reality to the extent that you're experiencing hallucinations, delusions, derealization, depersonalization, things like that.

For me, it was more the latter too.

So I alternated between thinking either maybe I don't really exist or maybe the world doesn't really exist. And this is, the timing of this was terrible too, because early adolescence is when The Matrix and The Truman Show both came out.

Those did not help.

Not good for the depersonalization and derealization because then i'm like what if it's true um so that was terrible timing frankly i resent them for that no i'm just kidding those are great um but yeah i mean i like literally i didn't even know if i was real i just walked around like this this might all be fake this might all not even matter i remember i would for a long i had about a month sophomore year of high school where i was basically mute i didn't talk to anybody i just walked around with my headphones on all day long i'm listening this like this one minute instrumental chanting song

on repeat i mean it was a really it's funny now looking back on it i'm like that is fairly disturbing that that happened but that i mean that's how bad this stuff can get and so yeah when i tell people like you're gonna have to work really hard if you want this to not ruin your life forever that's That's because I know how bad it can get.

Like if you take a person like that, like me at my lowest, there's not going to be one or two little tweaks that you make where it's like, oh, this is fine now.

This is going to require an overhaul.

This is going to require dramatic change, dramatic modification because you are up against something big and we don't defeat big challenges.

We don't defeat massive enemies or demons with like, let's just make one or two little tweaks here.

they're like, no, it's going to be everything.

It's going to be a fundamental overhaul of how you live, how you think, and how you interact with the world and the people in it, because you want to have a fundamentally different outcome than the one you've been experiencing.

And there's going to be a proportional relationship between the amount of change you make in what you are doing and the amount of change you get in your outcome.

Has being a psychologist ever made your own mental health harder to manage?

Is there such a thing as too much self -awareness?

Yes, actually. Oh, I'm so glad you brought that up.

I do think there is such a thing as too much self -awareness.

I mean, it's like almost everything in life, I think, exists on a bell curve.

And we tend to confuse bell curves with linear relationships because we start from the bottom and we work our way up and we see progress.

There's going to be a slight tangent, but I I promise I will actually answer that question.

There's a fascinating concept in psychology called the Yerkes -Dodson law.

The Yerkes -Dodson, this is from industrial organizational psychology, it's like psychology of the workplace.

The Yerkes -Dodson law is a graphic delineation of the relationship between stress and productivity.

And most of us tend to perceive that as a linear relationship.

If you conceptualize stress as like, how much do I care about this this thing?

How much do I remind myself how important this is and all the good things that'll happen if I do it and all the bad things that'll happen if I don't?

That's stress, right?

And productivity is, you know, how well do I do?

Do I do this thing on time?

Do I do it well? Do I do it frequently?

We tend to think that that's a linear relationship because at some point in all of our lives, we probably had a thing we didn't care about very much and we didn't do a good job of it.

And then someone said, hey, you should care about that thing more.

And we cared about it more and we did better.

And we're like, aha, I figured out the secret of life.

But there's a point where caring becomes counterproductive.

There's a point it's an, it's an inverse curve.

So there's a point where stress becomes counterproductive.

And you can think of that really simply as like a job interview.

So think about it. It's a massive continuum.

You can get three data points, low, medium, and high stress.

If you go to a job interview and you don't really care about that, you're like, I don't really want this job.

I'm kind of just doing this as a formality.

I probably wouldn't accept it even if they offered it to me.

You probably won't come across great in that interview.

You might come across as a little detached, a little arrogant.

You're probably not going to wow them because you don't care enough.

And so there's this sweet spot in the middle, right?

Where it's like, I think this job would be really good.

I would like doing it.

It would pay well. It would be important to me.

And I think I'd be good at it.

I think I could offer a lot to this organization.

That's that midpoint.

And that's where you're going to do well.

But then there's high stress, right?

This is a once in a lifetime opportunity.

I need to make sure I don't screw this up.

This would be life -changing if I got this job.

And most people don't do well.

It inverts back to, it kind of looks like you don't care because you're so consumed with your own thoughts and your own emotional distress that you don't perform well.

And that that can be true with almost anything.

And I believe that can be true with awareness.

When we have very, very low self -awareness and we gain some self -awareness, we're like, oh, I know why I do that now.

I figured out why I have this unconscious pattern that was kind of frustrating me and frustrating the people around me.

That's great. Now that I realize what's happening, I can take agency and I can modify that pathway.

Cool. But then there definitely is a point, and I have experienced this personally, where you start second guessing and overthinking everything.

And for me, it was about three years into my career, actually.

I had a supervisor.

She was great. But she was like super awareness -focused.

And she would always be like, why are you saying that?

We videotape our sessions, because when you're an intern, that's what you do.

And she's like, why did you say this?

Why did you do this?

Why are you sitting that way?

And I'd be like, I don't know.

And I started to just overthink everything.

And all day long, I'd be like, why am I doing this?

Why did I say that?

Why am I crossing my arms right And I sucked at therapy because I couldn't get out of my own head.

And so I believe there absolutely is such a thing as too much awareness.

And I actually think a lot of people, their default bias is already in that direction, especially people with anxiety in particular.

I'm going to think harder, work harder, be more obsessive, ruminate more.

I'm going to find out, or a chat GPT and me are going to develop an intimate relationship.

relationship. Exactly.

And it's too much of a good thing.

And I think that's true for most things, like almost everything.

The Yerkes -Dodson Law is one of my favorite concepts because I actually think it's basically a rule of life because almost everything works that way.

Think about fitness.

If you don't train, you will be in poor health.

If you train some certain amount, your health will improve.

If you overtrain, your health gets worse again.

You get injured, you get sick you can't recover it's too much of a good thing almost everything in life is actually this bell curve and we perceive it as linear because initially it looks linear because you're climbing that mountain and you're like the more i do this the better things get so i should just max this out and we sometimes don't realize like oh i fell off a cliff because i did too much of that thing and it happens with almost everything in life is there a link between intelligence and depression?

Yes, there is. And it's, that is a fascinating one because when you look at most of the risk factors for depression, they're all the things you would expect.

You know, it's like poverty, chronic illness, social isolation.

It's all like bad things, aversive situations, right?

And then there's, there's two that you're like, what's up with that one?

And they're high IQ IQ and high EQ, right?

High awareness, high understanding, high empathy.

Of course, as with so many things, we don't know exactly why that is.

I think it mostly comes down to two things.

One is high IQ can actually be a risk factor for social isolation.

Not even necessarily it's like you don't have friends, but think of it this way.

So on an IQ test, the 50th percentile is 100.

An IQ of 100 is the mean, it's the average, right?

An IQ of 70 is a person with a mild intellectual disability.

So the discrepancy between an average IQ person and an intellectually disabled person is 30 points.

If you took an average IQ kid and put them in a school for intellectually disabled people, they're not going to have a great time, right?

They're going to have to have a hard time bonding and relating to people.

The class is going to go too slow for them, et cetera, et cetera, et cetera.

So that's, that's a 30 IQ point discrepancy.

If you have an IQ of one 30, that's a 30 point discrepancy between you and the average person.

And so I don't mean this to sound arrogant, but it's just, it's just the statistics interacting with an average person.

If you have an IQ of one 30 is going to feel like you're talking to a disabled person and if that's like i know that sounds mean but it's it's true and if that's what most of the world feels like to you that's actually not great like it it's it seems like oh it'd be so awesome to be ridiculous genius level smart i know some of those people and they actually usually have pretty hard lives they don't relate well what's the mechanism there that you you think between intelligence and depression as social isolation is one of them an increased ability to sort of pattern uh match internally rumination i

think that's a part of it but i think it goes a little bit beyond that so when we talk about iq we are literally just talking about learning speed how many repetitions of a piece of information do you require before your brain says okay i got it this is now i understand this and i know it it doesn't inherently translate to improved critical thinking abilities.

It just means you learn stuff quicker.

So if you have a high IQ person who gets bullied, for example, they're going to, whatever the bully says, like, oh, you're so ugly, you're so fat, you're so stupid.

But like, whatever the rationale is, they are going to need fewer repetitions of that painful experience before it becomes a rule in their own brain, before they accept it as truth and accept it it is reality.

An average person, a person with an average IQ might have to face nine instances of social rejection.

Let's say I made up that number.

That's not the actual number.

Before they start to ask the question, is there something wrong with me?

Like, is the frequency of this is such that it makes me suspicious that this is a me thing and not a them thing.

A high IQ person sees the pattern more quickly and therefore potentially internalizes the negativity more quickly.

So they might get rejected just a couple of times and be like, what the hell is wrong with me?

Why does nobody like me?

Because it doesn't take them as long to get to that point.

There's also, this is sort of a middleman in the relationship, but there's also, this is really what I'm about to say is inherently very depressing just so you know, but there also tends to be a relationship between IQ and just general awareness of the state of the world and reality testing.

Like we learn everything more quickly.

So we learn a little bit more quickly that, you know, at least in my opinion the world in some ways is kind of a screwed up place and for a lot of people that awareness is like a slow burn you get you get kind of spoon -fed little bits and pieces of like you know this is not the super happy idyllic place all the time and you get time to adjust to those disturbing pieces of information as they come in if a high iq person gets bombarded with a lot of that stuff all at once it can completely overwhelm their coping ability at a very very young age and put them into a very, very deep hole that they

inherently want to think their way out of.

And it's kind of like struggling when you fall into quicksand or break the ice on a frozen lake.

Like that struggling, trying to use the mental processes to get out of your mental despair actually tends to put you further and further down that hole.

So yes, high IQ absolutely is a risk factor and is correlated with a higher prevalence of mood disorders like depression and bipolar disorder.

And those are my personal theories as to why.

supply be careful what you wish for in terms of yeah yeah it is very much a double -edged sword situation yeah vicious dude you're awesome uh i i love your work you are one of the very small bucket of psychology guys on the internet who aren't spouting total horseshit and uh you've got some skin in the game as well i really appreciate you where should people go don't i keep up to date with all of the stuff you've got going on there's a few places you you can find me.

I have a YouTube channel and everything I post on YouTube, I also just take the audio out of it and put that on a podcast that's available on every major podcast platform.

My YouTube channel is literally just my name.

It's nothing special or fancy.

So it's just Dr. Scott Eilers.

I also post shorts on Instagram and TikTok.

I offer personal coaching on my website, drscotteilers .com.

And for the relatively small number of people listening that happen to to live in Iowa.

I own a private practice here in Iowa, Northstar Psychological Center.

It's not just me. It's a group practice.

So if someone's in need of therapy or psychological testing and happen to live in Iowa, look us up.

Heck yeah. Scott, I appreciate you, man.

Until next time. Thank you so much, Chris.

Truly appreciate it.

It was a pleasure. Take care.

[The Nature of Depression: Anhedonia, High-Functioning Struggles, and the Path to Recovery]-[#966 - Dr Scott Eilers - Why Does Life Sometimes Feel Emotionally Numb?]

📋 Summary

Understanding the Core of Depression: Anhedonia

The Spectrum of Severity and High-Functioning Depression

Rethinking Treatment: The Biological Foundation

Practical Coping Strategies for Anhedonia

The Double-Edged Sword of Intelligence

🎯Key Sentences

📝Key Phrases

📖 Transcript