Why You Feel Like a Ghost in Your Own Life - Dr Scott Eilers

1. 0:00 – 14:42

   What Does Depression Feel Like?

   1. CWChris Williamson0:00

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

   2. SEDr. Scott Eilers0:06

      (sighs) It's tricky 'cause 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 rewards 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, I hear a lot of people describe it as, uh, 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 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, 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, that's where you see the person who, you know, can't get out of bed, can't take care of their home, can't take care of their hygiene. It, it, 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 gonna be able to pay you again, but we still want you to come in and do all your stuff, you're just not gonna 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."

   3. CWChris Williamson2:28

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

   4. SEDr. Scott Eilers2:34

      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, 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 human beings experience under certain circumstances. So somebody you love dies, you lose a job, your house burns down. These are extreme examples. I know 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 gonna feel like that. They might feel like someone they 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, m- depression isn't technically a diagnosis, right? Mood disorders are a category of diagnoses. Uh, there's no such thing as, as depression, just, you know, as a, as a, like a Z code. When s- 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 mood disorder."

   5. CWChris Williamson4:34

      Why is it intermittent? Is, is there a category of depression that's just always on that, that doesn't come off?

   6. SEDr. Scott Eilers4:41

      There is. It's called persistent depressive disorder. Used to be called dysthymic disorder up until 2013, and we changed it 'cause no one knew what the heck the term-

   7. CWChris Williamson4:48

      (laughs)

   8. SEDr. Scott Eilers4:48

      ... 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, I don't know this person. I have no idea if this person's diagnosed with anything, but the person that always comes to mind when I think of dysthymic disorder is, uh, or, or PDD, is Bill Belichick, uh, 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 hap- It, 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. (sighs) 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, um...... 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 'cause it's fake or 'cause 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.

   9. CWChris Williamson7:56

      What else don't we know about mental health disorders? What are- 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?

   10. SEDr. Scott Eilers8:07

       (laughs)

   11. CWChris Williamson8:07

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

   12. SEDr. Scott Eilers8:15

       Oh my goodness. There are hundreds of possible answers to that question. N- 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 right medications, the right dosage, best possible conditions, we're talking 50, 60% of people get better. So close to half-

   13. CWChris Williamson9:06

       What is- what is get better?

   14. SEDr. Scott Eilers9:09

       Experience some relief from symptoms. So not even like-

   15. CWChris Williamson9:13

       Right, okay. (laughs)

   16. SEDr. Scott Eilers9:13

       ... re- not... Yeah, yeah. I mean, it's- it's a low bar, is what I'm saying.

   17. CWChris Williamson9:16

       Yeah. Yeah, yeah, yeah.

   18. SEDr. Scott Eilers9:16

       That's not like get to asymptomatic. That's like makes progress.

   19. CWChris Williamson9:21

       Improves.

   20. SEDr. Scott Eilers9:21

       I mean... Yeah, improves. Maybe goes from, you know, severe to moderate on a PHQ-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, people who have tried maybe two or three therapists, two or three different medications, and- and have gotten, you know, 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. I, uh... 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? No one cares. It- at no point... I've been pr- I've been at- 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 gonna 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.

   21. CWChris Williamson11:37

       It feels a little bit unfair to say treatment resistant when between 50 and 40% of all people are treatment resistant. It just sounds like the treatment is solution resistant.

   22. SEDr. Scott Eilers11:48

       Mm-hmm. That's exactly what I think. I think we have, and- and I'm not just trying to push the buck or pass the buck onto 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- 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- some social quirks and- 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 s- and may never be able to live independently. Depression has a similar spectrum, so does 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, X, Y, Z 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. Like we don't, we don't often think about mood and anxiety disorders as, as being in the same category of things like, you know, autism or schizophrenia. But at these severe tiers which they can reach, they are disabilities, or at least they can be. They can ef- they can prevent you from working, they can prevent you from going to school, they can prevent you from having relationships, taking care of yourself. And I think we do not do a very good job of delineating these severity levels, and, and we just kinda put someone with a therapist who 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 gonna get better from that. That's not gonna do anything for you under most circumstances. There's a lot of work to be done 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 'cause 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 s- 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 people go into for the money. Um, and when I kinda 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 is gonna help people?

   23. CWChris Williamson14:33

       Oh, this is who's captaining the ship?

   24. SEDr. Scott Eilers14:35

       Yeah. It was not what I was expecting to see, and it, my first thought was, "This is not enough. This isn't gonna do it."

   25. CWChris Williamson14:41

       Mm.

2. 14:42 – 30:06

   What Are The Biomarkers of Mental Illness?

   1. CWChris Williamson14:42

      Do mental health illnesses have biomarkers? Like i- i- is there anything happening neurologically? Can we, can we look? Because I think there's, you know, an additional, 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-

   2. SEDr. Scott Eilers15:03

      Mm-hmm.

   3. CWChris Williamson15:04

      ... snapped an Achilles or broken an arm, people go, "Oh, it is a thing. There's a real impediment to your ability to move forward in the world, and I, I should treat you as such."

   4. SEDr. Scott Eilers15:15

      Yeah.

   5. CWChris Williamson15:15

      But there's e- the ... Am I may- maybe I'm making it up. Why can't I just sort myself? You n- no one ever says, "Why can't, why can't I just fe- uh, heal my own broken arm?" That's not the sort of thing that we think. It, you know, we get frustrated at the process but we understand that it's something that needs fixing a- and other people behave accordingly as well, but the reverse isn't true. So I guess, yeah, I- I- I'm interested in the biomarkers, neurological side of what's going on with depression.

   6. SEDr. Scott Eilers15:42

      Yeah. 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. 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.

   7. CWChris Williamson16:41

      (laughs)

   8. SEDr. Scott Eilers16:41

      It would not go well. I don't know how to do that. And so it's, 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 j- 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, and 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 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, some of them are people who are in exceptionally good shape, take wonderful care of themselves, have immaculately maintained 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 'cause 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 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. Um, prior to opening my practice, I used to work at a hospital, and so my colleagues were, you know, surgeons, oncologists, et cetera, um, and many of them were deeply struggling with their mental health. And, and, no one would have ever known from the out- I only knew 'cause they told me. I didn't even know. I didn't even look at these people as a psychologist and think, "Ooh, I see. You know, there's some subtle little tell I see that tells me this person-"

   9. CWChris Williamson19:29

      Oh.

   10. SEDr. Scott Eilers19:29

       ... "is not doing as well as they're letting on." I don't even know. That's how good people are at hiding those things, because a lot of us don't have a safe place where we can let that out.

   11. CWChris Williamson19:40

       Also, there's a lot of shame around-

   12. SEDr. Scott Eilers19:42

       Yeah.

   13. CWChris Williamson19:43

       ... 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.

   14. SEDr. Scott Eilers19:57

       Mm-hmm.

   15. CWChris Williamson19:57

       Or, uh, uh, 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. Uh, it's interesting around the, 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?

   16. SEDr. Scott Eilers20:53

       Yeah.

   17. CWChris Williamson20:53

       Or perhaps it's that your leverage, your having to get for every 100 units you get in, you only fill 10 of them, or something like that, as opposed to with somebody else who for every 100 units that they got, they would fill 100.

   18. SEDr. Scott Eilers21:04

       Yep, that's exactly it, Chris, and you're- 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 'cause 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?"

   19. CWChris Williamson22:13

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

   20. SEDr. Scott Eilers22:18

       Sure.

   21. CWChris Williamson22:18

       And, uh, I- I was thinking about the, uh, Viktor Frankl quote that was- I guess it 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 the lack of meaning causes people to seek temporary relief, uh, 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, that people sort of become a- 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- 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, s- 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- and keep going. Uh, and they go on to become workaholics and insecure overachievers. A- 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 sort of perpetually promise yourself that happiness might finally come tomorrow, like- like running toward the horizon, sort of something that never arrives. Uh, congratulations, you've managed to subjugate your joy as a tribute to your work. And I think, uh, w- we quite easily confuse or we- we mistake humorless and sort of fun-lacking seriousness with being sophisticated and caring about your pursuit. 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 ne- 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.

   22. SEDr. Scott Eilers24:41

       Mm-hmm.Yeah. I think we might be talking about the same group of people here. And it's something ... (sighs) It- it's tricky because, you know, this goes back to mood disorders and, and, and their episodic nature. And, and it depends a little bit on, are we talking about a person who always feels this way or 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 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?

   23. CWChris Williamson25:29

       Mm-hmm.

   24. SEDr. Scott Eilers25:30

       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 i- 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 'em, 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 early adolescence to early adulthood, like 13 to 23 was, 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 (laughs) 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 don't, 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, um, 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. And so I remember, you know, we fly out there, we're, we're out in the water and we, we, we take this boat out, you know, three miles out to the reef or whatever, get in the water, and I'm, 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? And I remember looking down and just seeing all these bright colors, like there was just fish all around, and I remember thinking, "That's cool." I didn't know there was g- like, I thought I was at least gonna have to get under water before I saw the fish. I had this conscious recognition, almo- 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, 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, that it just died before it reached my emotions, and I was consciously aware that this was a neat thing that was happening, but I felt nothing from it-

   25. CWChris Williamson28:09

       Mm-hmm.

   26. SEDr. Scott Eilers28:09

       ... and 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. Like, I knew it was special but I didn't feel like it was special. But 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, um, 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, to work around 'cause 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 'cause 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 'cause they don't care 'cause 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-

   27. CWChris Williamson29:36

       Mm-hmm.

   28. SEDr. Scott Eilers29:36

       ... but it is possible.

   29. CWChris Williamson29:37

       Yeah, uh, the sort of circular, uh, 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 gonna last forever. And even if it doesn't, I, I'm gonna look back on this and I'm gonna remember that I actually ruined a trip for myself and that photo that I took was me not feeling good." And think yeah, in, in, in some ways, but tragedy plus time equals comedy is about the closest thing that psychology's got to an equation, I think.

3. 30:06 – 48:00

   Five Ways To Handle Sadness & Emptiness

   1. SEDr. Scott Eilers30:06

      Mm-hmm.

   2. CWChris Williamson30:06

      Um, th- uh, how else would you recommend people cope when they're in a period where sadness is more readily available and happiness is more limited?

   3. SEDr. Scott Eilers30:17

      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 gonna 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, 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.W- 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, 'cause 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. There- there's- you're not gonna wake up and just, like, angels are- saying 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 w- w- 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. A- an example would be, uh, 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 gonna 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 gonna 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 motivat- 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 that and learned about protein synthesis, and I'm like, "Okay, so my muscles are growing while I'm eating food. That's kinda 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 and, 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-"

   4. NANarrator34:11

      (laughs)

   5. SEDr. Scott Eilers34:11

      "...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- c- 'cause 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 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 has a nice-looking lawn." It's sort of this... it- 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 accomplishment's still present sorta in my mental ecosystem, 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 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 kinda numb, and so it's sorta like... I don't know if you lost your s- 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's kind of the same way. Like, your food kinda loses its flavor, and that's why a lot 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 break through for me. I don't know why that is. I don't remember how I figured that out. That I... doesn't matter how bad it is. 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 (laughs) , 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 u- when we're looking for loopholes, our world is gonna shrink a lot. We're gonna end up repeating a very, very small range of behaviors over and over and over again, 'cause 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 earlier. It's very similar to what you described in your essay. It's what I call apathy-ception. And I- I've heard, he didn't use this word, but I've heard Alex Hormozi, who I know you have on here from time to time, he's described something very similar, which is e- 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 they're 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- 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.

   6. CWChris Williamson38:42

      (laughs)

   7. SEDr. Scott Eilers38:42

      Because who says I have to- 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.

   8. CWChris Williamson38:51

      Mm-hmm.

   9. SEDr. Scott Eilers38:52

      And it works. That was a long-winded-

   10. CWChris Williamson38:55

       Yeah, that's fun.

   11. SEDr. Scott Eilers38:55

       ... answer, wasn't it (laughs) ?

   12. CWChris Williamson38:55

       No, dude, that's- I mean, that's brilliant, and obviously a very hard one between personal experience and professional research as well. I imagine that a lot of people maybe try to just sort of chase joy very aggressively. Uh, you- you try to peak experiences one after another. Is that a solution? Just b- big injections of excitement?

   13. SEDr. Scott Eilers39:16

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

   14. CWChris Williamson39:24

       Dang it.

   15. SEDr. Scott Eilers39:24

       That- 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, a- 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 i- it's just never gonna 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 tho- 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 any time 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 than on things that feel good when I do them. And these are the very basic, unglamorous parts of life, right? This is- 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 gonna mean, like, minimal or none. Um, this is paying attention to how you talk to yourself all day long, 'cause you're gonna hear your own voice more than you hear the voice of every other human being combined, and so the relationship you have with yourself is tremendously important. You are- y- 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- it's not that they didn't have the things. They clearly had the 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've gone differently. The skill with which we take care of ourselves is the maintenance of that road into you.

   16. CWChris Williamson42:45

       Hmm.

   17. SEDr. Scott Eilers42:45

       And if that road is blocked, if that road is not well-maintained, it really doesn't matter what is out here, 'cause you can't touch it. You can't access it, and it won't make you feel anything.

   18. CWChris Williamson42:58

       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, uh, 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 kind or more patient when we have shortcomings?" Um, 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.

   19. SEDr. Scott Eilers43:26

       Mm-hmm.

   20. CWChris Williamson43:26

       How do you think about the other way? How much of a role does that have? Uh, I don't know. I- I- I've become increasingly skeptical about being able to think your way out of healing problems.

   21. SEDr. Scott Eilers43:37

       Mm-hmm. Exactly.

   22. CWChris Williamson43:38

       Um, I don't know.

   23. SEDr. Scott Eilers43:40

       I think they're both tremendously important. I- I- 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- 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 (sighs) it, this is, this is a weird thing that always comes up for me, but y- 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?

   24. CWChris Williamson44:35

       Mm.

   25. SEDr. Scott Eilers44:36

       Before you try to produce joy or connection, make sure your brain is healthy enough to feel that, because if 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 gonna 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 gonna change the fact that your brain is lacking the resources it needs to do its job. It works on a, uh, on a system very similar to a power grid, right? You've probably heard, you've probably heard that term, "We only use 10% of our brains," right? Do you know how that's, it- it's kinda true but it's a half-truth? You, okay. (sighs) So the implication there is, like, that there's this secret 90% of your brain that's, you know, never gets used and could be unlocked to give you super powers or something. That would be stupid. Like, we are not that poorly-designed. Our brains are unbelievably efficient. The- the accurate statement would be you only use about 10% of your brain at any given time. Your brain is k- if- 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, 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, ox- 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- it's battery-saving mode 'cause it doesn't have enough juice, and things are gonna run slower, the screen's gonna get dimmer. It's not gonna 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 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 gonna 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- I- 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.

   26. CWChris Williamson47:52

       Mm.

   27. SEDr. Scott Eilers47:52

       And I think when you try to do 'em out of order, you get stuck.

   28. CWChris Williamson47:55

       It's the difference between being depressed and living a life that is worthy of depression.

4. 48:00 – 1:02:44

   What Should We Be Doing To Increase Happiness?

   1. CWChris Williamson48:00

      Like, okay, I, th- th- this is not the sort of thing that would make anybody feel happy. It's e- e- an easy question, right? It... 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. E- e- they, w- the disrupted sleep pattern. You go, okay, so if that's how you make a happy person miserable, then we have to at least assume that the foundation... So if you're going straight to an SNRI or, or s- treatment-resistant, I- I need t- t- the psych therapy thing, it's like, whoop. 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.

   2. SEDr. Scott Eilers48:48

      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 wor-, 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- 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 get the opposite results.

   3. CWChris Williamson49:43

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

   4. SEDr. Scott Eilers49:47

      Hm.

   5. CWChris Williamson49:47

      It's more sort of a shield born out of unprocessed trauma. How's- how so?

   6. SEDr. Scott Eilers49:52

      Well, there's a... There's a diff- I actually just made a Short about this. But yeah, the- 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 gonna 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, 'cause 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?

   7. CWChris Williamson50:58

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

   8. SEDr. Scott Eilers51:08

      Mm-hmm.

   9. CWChris Williamson51:08

      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 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, or actually, you're kind of not holding the keys 'cause 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, uh, no, a- a sense of cosmic unfairness. Like why do I need to work so hard-

   10. SEDr. Scott Eilers51:48

       Yeah.

   11. CWChris Williamson51:48

       ... to be happy? Like everybody else, like they're just, fuck, it just comes to them for free, any time that I go to, leave the gym with a coffee in my hand, playing my favorite song, talking to my friends, and the sun shining, and the birds are tweeting. It's like, why- why? Why- why-

   12. SEDr. Scott Eilers52:00

       Yeah.

   13. CWChris Williamson52:00

       That just feels unfair.

   14. SEDr. Scott Eilers52:02

       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-

   15. CWChris Williamson52:22

       Yeah.

   16. SEDr. Scott Eilers52:22

       ... 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 gonna make you feel better about it. I don- I don't have a- a pep talk I can give you where you're like, "Oh, here's why it's okay, here's why it's cool." 'Cause I struggle with those same thoughts too, to be honest with you. But what I have decided is, it simply exists, right? If- 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 they can take this kind of laissez-faire approach to life and still be happy, and I'm just gonna live like them and just hope that works out. Spoiler alert, it won't. Or I can say, "Okay, I- I was born with a chronic condition. That means I have to live my life a little bit differently." And I often quote, I- I'm using it differently, but I often quote Dave Ramsey on this. 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- the people around you have, y- you can't, 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.

   17. CWChris Williamson54:20

       Mm.

   18. SEDr. Scott Eilers54:20

       Mental... If- 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- they- 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. You wouldn't necess- if I like live streamed 24 hours of my life, it... 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 gonna take me down, it's gonna 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, the part of your... W- When you think about your brain and you think about, like, your thoughts, your narrative, your decisions, you gotta remember, that's a very small fraction of the brain, that you... Everything you're talking about there is the prefrontal cortex. 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, like, 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. You have to... For everything in your body, you have to coax it into 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- You have to- You have to do some kind of middleman activities that make that organ 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 gonna do what I can do to manage it." It's functionally no different than if you say, "I have diabetes. I can 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.

   19. CWChris Williamson57:42

       Yeah. It's, uh, a kind type of tough love, I guess, to say to someone.

   20. SEDr. Scott Eilers57:48

       Yeah. That's why I strive... I appreciate that 'cause that's what I'm going for. Sometimes I worry, I go... At least by therapist standards, I think I drift a little more into the tough side of things than a lot of therapists would, so I appreciate that.

   21. CWChris Williamson57:58

       Look, you're trying to motivate people to take some action. And I think-

   22. SEDr. Scott Eilers58:02

       Exactly.

   23. CWChris Williamson58:03

       ... one of the challenges of modern psychotherapy and one of the reasons that stuff like ACT and CBT is having a- a good resurgence at the moment is that it actually gives you something to do about it. Oh, well, we're gonna do something as opposed to it just being this rumina- t- 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."

   24. SEDr. Scott Eilers58:36

       Yeah.

   25. CWChris Williamson58:36

       "That was really hard that you went through that thing." But after a while there's, okay, and what are we gonna do about it? Right? And if you can 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- is even quicker.

   26. SEDr. Scott Eilers58:52

       Exactly. And I- And I do think it's- it helps to know that the person saying this isn't just some academic. Not that there's anything wrong with scientists, obviously, but I'm not just saying, "Hey, uh, guys, I've read the research and the research says this is what we should be doing." Um, 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, here are the... and- 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- a- a replicatable outcome and- and that I don't know that I am so unique that this only works for me and nobody else. And- And that's essentially my core hypothesis is that my results are generalizable-

   27. CWChris Williamson59:47

       Mm.

   28. SEDr. Scott Eilers59:48

       ... by sharing the case study that is my life with people... And usually if I u- if I do come off snarky or mean, it's 'cause I'm thinking of me 'cause sometimes I'm a little irritated.

   29. CWChris Williamson59:56

       (laughs) Yeah, this isn't directed at someone else, it's directed at myself.

   30. SEDr. Scott Eilers59:59

       Yeah. I'm actually talk... 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 the things that he did.
5. 1:02:44 – 1:07:37

   Can We Have Too Much Self-Awareness?

   1. SEDr. Scott Eilers1:02:44

      outcome.

   2. CWChris Williamson1:02:45

      Has being a psychologist ever made your own mental health harder to manage? Is- is there such a thing as too much self-awareness?

   3. SEDr. Scott Eilers1:02:52

      Yes, actually. Oh, I'm so glad you brought that up. I- 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- we tend to con- we tend to confuse bell curves with linear relationships because we start from the bottom, and we work- we work our way up, and we see progress. Um, this is- this is gonna be a slight tangent, but then I- I promise I will actually answer that question. There- there's a fascinating concept in psychology called the Yerkes-Dodson law. The Yerkes-Dodson... This is from industrial/organizational psychology, so 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 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 it- 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- 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 just need about three data points: low, medium, and high stress. If you go to a job interview, and you don't really care about the... 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. Uh, this would be life-changing if I got this job." And most people don't do well under the... It- 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 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, and 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- it was about three years into my career, actually. I- 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- you know, we'd videotape our sessions 'cause when you're an intern, that's what you do. And she'd be like, "Why'd you say this? Why'd you do this? Why are you sitting that way?" And I'd be like, "I don't know." And I started to just, (laughs) I started to just overthink everything and- 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 now?" And I sucked at therapy because I couldn't get out of my own head. And so I- 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.

   4. CWChris Williamson1:06:42

      "I'm gonna think harder, work harder, be more obsessive, ruminate more. I'm gonna find out all... ChatGPT and me are gonna develop an intimate relationship."

   5. SEDr. Scott Eilers1:06:50

      (laughs) Exactly, and it's too much of a good thing. And I think that's true for most things, like- like almost everything. The Yerkes-Dodson law is one of my favorite concepts because I actually think it's basically a rule of life 'cause 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, "Ooh, I fell off a cliff 'cause I did too much of that thing." And it happens with almost everything in life.

6. 1:07:37 – 1:13:55

   Is There A Link Between Intelligence & Depression?

   1. SEDr. Scott Eilers1:07:37

   2. CWChris Williamson1:07:37

      Is there a, a link between intelligence and depression?

   3. SEDr. Scott Eilers1:07:40

      (laughs) 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, 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 and high EQ, right, high awareness, high, high understanding, high empathy. (sighs) 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. The fi- so on an IQ test, the 50th percentile is 100. A, an IQ of 100 is the, 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 gonna have a great time, right? It's g- they're, they're gonna have a hard time bonding and relating to people, the class is gonna 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 130, that's a 30 point discrepancy between you and the average person, and so inter- it's, 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 130 is gonna feel like you're talking to a disabled person. And if that's, like, I, 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, it's, it seems like, oh, it'd be so awesome to be ridic- like, genius-level smart. I know some of those people, and they actually usually have pretty hard lives. They-

   4. CWChris Williamson1:09:47

      What's the, uh-

   5. SEDr. Scott Eilers1:09:47

      ... they don't relate well.

   6. CWChris Williamson1:09:49

      ... what's the mechanism there that you think between intelligence and depression? Uh, social isolation is one of them.

   7. SEDr. Scott Eilers1:09:55

      Mm-hmm.

   8. CWChris Williamson1:09:55

      Uh, uh, an increased ability to sort of pattern, uh, match internally, rumination?

   9. SEDr. Scott Eilers1:10:02

      I think that's a part of it, but I think it goes a little bit beyond that. So w- 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 f- 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 gonna l- what- 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 as reality. Uh, an average person, uh, 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, th- 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 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, 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. (laughs) But there also tends to be a relationship between IQ and, 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 kinda spoon-fed little bits and pieces of like, you know, this is not this 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, 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.

   10. CWChris Williamson1:12:33

       Be careful what you wish for in terms of traits.

   11. SEDr. Scott Eilers1:12:35

       Yeah. Yeah. It is very much a double-edged sword situation, yeah.

   12. CWChris Williamson1:12:40

       Vicious. Dude, you're awesome. Uh, I, I, I-

   13. SEDr. Scott Eilers1:12:43

       Well, thank you.

   14. CWChris Williamson1:12:43

       ... love your work. You are one of the, uh, very small bucket of psychology guys on the internet who aren't spouting total horseshit, and, uh, it, you've got some skin in the game as well. I, I really appreciate you. Where should people go if they wanna keep up to date with all of the stuff you've got going on?

   15. SEDr. Scott Eilers1:12:58

       There's a few places you can find me. I ha- 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's literally just my name. It's nothing special or fancy, so it's just DrScottEilers. I also post shorts on Instagram and TikTok. Um, I offer personal coaching on my website, drscotteilers.com. And for the relatively small number of people listening that happen to live in Iowa, I own a private practice here in Iowa, North Star Psychological Center. It's not just me, it's a group practice. Um, so if someone's in need of therapy or psychological testing and happen to live in Iowa, look us up.

   16. CWChris Williamson1:13:37

       Heck yeah. Scott, I appreciate you, man. Until next time.

   17. SEDr. Scott Eilers1:13:41

       Thank you so much, Chris. Truly appreciate it. It was a pleasure. Take care.

   18. CWChris Williamson1:13:44

       Congratulations. You made it to the end of the episode. And if you want more, well, why don't you press right here? Come on.

Episode duration: 1:13:55