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

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

(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."

Mm. 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, 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."