Living with Depression with Dr. Scott Eilers
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Hello and welcome to Being Well. I'm Forrest Hansen. If you're new to the podcast, thanks for joining us today. And if you've listened before, welcome back.

About one in five people will experience at least one major depressive episode in their lives. That number comes from the World Health Organization, and personally, I think the real number is probably a lot higher than that. There are so many people who might not meet all of the formal diagnostic criteria for a diagnosis like depression, but they still regularly feel sad, lost, disconnected from others, and generally like they're moving through life with a lead weight wrapped around their ankle.

Today I'm joined by a clinical psychologist who's described their life as a 40-year case study for figuring out what helps somebody with depression and anxiety, Dr. Scott Eilers. Dr. Eilers is a practicing psychologist and coach. He has a very popular YouTube channel and podcast, and he's the author of the book For When Everything is Burning. So Scott, thanks for joining me today. How are you doing?

I'm good, Forrest. Thank you so much for having me. I realize there's one thing there that's a little bit out of date. It is now a 41-year case study. I've had a birthday. A 41-year? I was like, oh, I know I nailed this intro, but it's a 41-year. No, that's my fault. Congratulations on the birthday. Happy birthday, Scott. Thank you. I appreciate it. I'm actually close to 42 now, but who's counting?

Right. And I try not to. Every time I count, I get slightly more depressed, so I try to avoid it. But as somebody who has a really direct relationship with this topic, I just want to start by asking you, what does depression feel like? And how did you know that you were depressed?

Those are both excellent questions. I'm going to give a caveat. You know, I'm going to describe my own experiences because what I've learned in my clinical work is it doesn't necessarily feel the same for every person. I could describe what other people have told me it's like, but I can give you the most depth of experience if I talk about my own experiences with it.

And for me, although it can vary from one episode to the next, it most often just feels like a hollow, empty, pointless feeling. And it is that. It is a feeling. And it's a feeling that can be completely detached from your thoughts and your beliefs. And so you can logically be looking at your life or yourself or your family or whatever it is that you have.

and say, this looks pretty good. I think I should be feeling fairly decent about my setup right now. But internally, there's just something missing. Like your ability to feel enjoyment when you're with your friends or engaging in your hobbies or achievement when you're at work or at the gym or connection when you're with your family. It's like something blocks all of that. Sometimes it's partially blocked. Sometimes it's fully blocked.

And for most people, for people who experience major depressive disorder, which is by far the most common type, what gets really confusing is that it's episodic, meaning it'll just pop in, sometimes prompted by a very minor stressor or situation, sometimes with no apparent rhyme or reason. It will also go away just as randomly and just as sporadically.

And if you tend to be a very logic and rational minded person like me, it's very disorienting and confusing because especially the first few times that happened, I kept thinking, what is wrong? What happened? What changed? What is the problem in my life that's making me feel this way? And really just grasping at straws, trying to find a reasonable explanation for it. I don't actually know anything.

when the first time I knew I was depressed was. I can tell you the first really vivid memory I have of what I would now say was certainly a depressive episode. Sure. Yeah. Seventh grade, I was 13 years old and we was gym class and we were in the swimming pool, which I love. I love water. I love swimming. And I remember just, you know, messing around with my friends or whatever. And all of a sudden I just like

It was like I just felt all the joy drain out of me. It was just gone in an instant. And I like I was scared. I thought something was happening to me medically. I remember getting out of the pool and just like sitting on a bench and putting my head in my hands. And that feeling just didn't go away. It lasted weeks and I didn't know what caused it.

In hindsight, I don't actually think that's the first time that happened. I have some kind of vague, fuzzy childhood memories of being really unreasonably upset over really, really minor things. But it took me a long time to get to the point where I could label that as depression.

Is that kind of age of onset for people pretty common? It's pretty common. It really can vary a lot, but it typically, it's rare for someone to have like first experience with depression in adulthood. So it is going to be

Sometimes it looks different in kids and adolescents. A lot of times in younger people, any unpleasant emotion just looks like anger. So like a kid with a behavioral problem looks angry, but sometimes a kid with depression looks angry and a kid with anxiety looks angry. Kid with ADHD looks angry. Yeah, sure. Totally. Yeah. I mean, I'm trying to think of what the earliest age of onset I've ever seen is.

I know there was stuff happening in my life. Like looking back now when I was like three, four, five years old and I'm like, why in the heck did I do that? Like I remember one day my dad was going for a run in the morning

And one day I was just really sad and didn't want him to leave. And so I waited till my mom wasn't looking and I snuck out of the house and followed him. This is in rural Minnesota, by the way. And I apparently got like a mile down the road, like three years old. And I remember I was sobbing the whole time. And like, there's no, my dad wasn't like an absentee parent or, you know, my parents were together. It's not like that was the one day a month I got to see him. He's going to be back in like an hour.

So, I know, you know, clearly there was something going on emotionally for me there. So, what helps people distinguish between, "I feel really sad," and "Maybe I feel really sad for an extended period of time," and "Wow, I'm depressed." It's going to be a combination of the intensity of it, the duration of it, and the correlation it has to what's actually happening in your life.

So almost everybody listening to this has probably felt the depth of what depression can feel like under certain circumstances, like the death of a loved one, a job loss. We all face major tragedy and major hardship in our lives. And the way you feel under those circumstances can feel almost indistinguishable from depression. But if you can clearly draw a correlation between I feel this way and this thing is happening right now,

I know that's a subjective thing, but that would be more along the lines of a typical emotional experience. And also, how long does it last? Because if you're five years out from something and still feeling like it just happened yesterday, that's typically going to be outside the realm of what we'd consider to be a normal, air quotes, emotional response.

If you feel like someone you love has died randomly, nothing has really changed in your life, that's definitely a sign that this is more probably a mood disorder of some sort. If it just doesn't go away, if it seems completely out of proportion, if you can't explain it to anybody else, that's what's tricky about it. And same with anxiety, by the way. Both depression and anxiety...

You know, they're normal human emotions. They're things we have all felt under the right circumstances and they're things we are all capable of feeling. But it's when you start to feel them chronically in the absence of situations or scenarios that, you know, again, air quote should, there's a lot of subjectivity in this, reasonably make you feel that way. That's when it's worth starting to consider, is there some sort of chronic mental health condition that I'm experiencing?

In your initial story for yourself, I think there were already some hints there for people because you talked about how there was this gap between your objective appraisal of the way you thought your life was and how you were experiencing it.

And a really good question for people who are sort of wrestling with, okay, am I going to put myself in the depression category or I'm going to put myself in the something else category, which can be helpful for people in terms of accessing services or deciding how they want to deal with this moving forward, is am I depressed or is my life depressing? Because there are a lot of people who are in circumstances that objectively you look at them from the outside and you're like, wow, that's a pretty depressing circumstance. I probably wouldn't feel great if I were in that circumstance too.

But if you look around and you're like, this looks pretty okay. I mean, it's not perfect because life isn't perfect, but it's pretty okay. But I still feel the way that I do. Like, wow, that can be a really great indicator for people. Exactly. And that was 100% my story too. And it was so confusing to me because I did not have an unusually hard or horrible life. I honestly would say, objectively, I had a pretty good life, at least average, if not above average. But my emotions didn't align with that. And

And that's part of why I ended up really isolated and lacking a peer group, because the people I related to, the people who felt the way I felt, were the people who had those lives where you'd look at and say, oh, yeah, I can see why you feel that way. Those are the people I related to and wanted to surround myself with. But when they got to know me a little bit, they were kind of like, why are you with us? I described it as being almost like trapped between worlds.

And talking about the group belonging aspect of it a little bit, the first thought that I had, particularly when I was reading your book but also just watching your videos, is, is this guy an existentialist?

Because it's very funny. There are so many very good technical explanations of depression and treatment, but you tend to, in my reading of your work, you frame it almost more as this kind of confrontation with being. How does that connect to how you approach these topics? To a degree, I definitely am. I think at least the way my mood stuff shows up is...

It shows up very big picture wise, very philosophical, very questioning. And I found that if I try to dodge or avoid those questions, it never gets any better. And that was one of the problems. I know I said there wasn't a clear reason for my depression, but I do think one of it is my brain started asking really big questions really young.

Like questions I had no cognitive capability to answer. I remember being six, seven years old and wondering like, you know, what's the purpose of life? Why am I even here? Like, what am I going to do when my parents die? So I spent a lot of time feeling very trapped inside my own mind and very defeated by my own mind, subdued by it for a while.

And eventually I started to feel like I was able to answer some of those questions much later down the road. And that was one of several turning points for me. Obviously, I don't know the answer for all people. I just know some of the answers that kind of came to me. But I think with depression in particular, the way it presents for most of us, we do have to honestly face some of those big questions because if you can...

If you can, at a moment's notice, you know, lose your zest for life, you lose your ability to emotionally engage with the things that matter to you. You got to have a fallback. You can't just be here to enjoy life. You can't just be here to have a good time because sometimes you're not going to have a good time and it's not your fault. And it's not because of anything you did. And it's not because you built your life wrong. It's because something happened in your brain that took it away from you.

And for me, I found that like my values, I would say, are my fallback. For a while, I really didn't have values or at least not values I could articulate to another person. And so when my emotions were not present or at least not pleasant, I had nothing. And that's when I would just basically stop functioning. I wouldn't engage with my friends. I wouldn't go to school. I wouldn't take care of my body. I just like sit around and wait to die, basically. Like I didn't care about anything. And

I still feel that way sometimes, but it's like now I know what I value in life. I know roughly at least who I want to be.

And those things don't change based on my emotions. So even if I have a week where I feel nothing, where I feel void of anything positive or motivating, I still have that to fall back on. I'm like, well, if my choices are be happy and be productive or like be unhappy and be productive, I'd still rather be unhappy and be productive than be unhappy and unproductive. So if I can't choose the emotion, I can at least choose the action.

Would you mind describing how that kind of shows up for you in practice or shows up also for the people that you work with in practice to try to broaden this a little bit? It's basically like I actually do think of it as a branching decision tree or like going to the gym is another one because that's something that's a huge part of my mental health. Like physical fitness,

may have been the biggest turning point I personally experienced. A ton of research on that. Exactly. I thought, okay, funny little side story. I have a tendency to think that I'm the first person to stumble across my respective discoveries. I mean, I've so been there, but yeah, go ahead. I remember when I was like 18, 19 years old, joining a gym with my buddy.

And just within three to six months, I'm like, I feel the best I've ever felt in my life. Not just physically, I'm motivated and engaged. I'm like, I think it was the gym. This is a very oversimplified way to say it. But if I can't choose not to be depressed on any given day, if I accept that there are some days, sometimes even weeks, it's really never longer than weeks anymore. It used to be months or years. But if there's going to be days slash weeks where

where I'm depressed, then that part's not a choice anymore. And my choice goes down one level. I can be depressed or I can be depressed and out of shape. So if I can't choose the thing I really want...

I'll choose the next best thing. That's where my control is. Or I can be depressed and employed or depressed and unemployed. And so since I can't choose the thing I really want to do, I don't currently have agency over that because there's not a switch I can flip in my brain that's just like, oh, I'm not depressed anymore.

I will focus on the areas where I do have agency, which typically is behavior. Because you can't choose your emotions. You can kind of choose your thoughts. That one's sort of a gray area. You have some level of control over them, but you can't just sit around and micromanage your consciousness all day. You wouldn't be able to do anything else. And ironically, you'd probably get very depressed if you tried to do that.

So I focus on behaviors and I try to engage in behaviors that I know are going to truncate the duration of my depressive episode. If I stay on top of sleep, if I stay on top of nutrition, if I stay on top of fitness, spirituality is important to me, religious practices, staying engaged with my family. If I just keep doing the things that I know matter,

What I know is going to happen is there's going to be a few days where I feel like crap despite doing all of them. And I'm going to be like, why am I doing this if it doesn't work? And then one day I wake up and I'm like, oh, I'm feeling a little bit better today. I guess it was working. And it's really like it's been trial and error. You know, it's a leap of faith every time. And every time I kind of put one more notch in my belt of like, OK, that does work. I can get through this. And, you know, once you're on episode 30, it's like this isn't that scary anymore.

There are a few things that stand out to me in what you're saying so far. The first is that you've accepted that you're in the world of harm reduction, to put it a certain kind of way. That you're no longer in the world of wrestling with, "Can I control the presence of my depression or not?" You're thinking about, "Okay, we've got these other practices that I know that on a day where I fill in the blank. I go to the gym, I interact with my family, then I go to bed at night, my head hits the pillow and I feel pretty good about myself."

And so I'm just going to rigorously focus on that relatively tight list of things that have an outsized impact on my overall happiness. And we recently did an episode on the kind of 90-10 rule for mental health. And

An intervention that's been huge for me is just finding what are my three things? What are the three areas of my life that really matter to me? What are simple things I can do inside of each of those areas day in and day out? And over long enough time, what happens to my life if I just kind of apply effort day after day in that way? And I think there's a lot of consistency there with what you're describing. I have a couple metaphors I use to explain it. One is I think of it as it's kind of like a budget, right? So if you have a financial budget, you have a certain amount of income every, most people do it monthly, right?

And a depressive episode is sort of like, you know, someone cut your hours at work. Maybe you're still working 40 hours a week, doing whatever you make doing that. And it's like this week, they say, hey, we only got 15 hours for you. So you're only going to get paid for 15 hours. So you're going to have to go back and look at your budget and say, I'm not going to be able to buy all the things this month. This is going to be a very lean, bare minimum kind of month, right? So what are the things that I absolutely do not want to lose?

And it's not necessarily money, although obviously depression can impact your earning potential, but it's like time and energy. You don't literally lose time, but everything takes longer because you feel foggy, you're not very motivated, you're fatigued, you're sleeping like crap. Everything takes you longer, everything's harder. So you have functionally fewer resources available to tackle the day. So if you don't budget for that and say, okay, today I feel like I'm at about 20% of what I normally am, so my output's probably only going to be about 20%,

What are the most important things? What are the things that no matter how bad this gets, I do not want to lose when it feels like nothing. I'm going to keep doing these things because I know that that's what's eventually going to get me out of this. The other thing, there's a quote that sticks in my mind a lot. It's a Dave Ramsey quote. So it's another, I use a lot of financial metaphors, which might be dangerous because I don't know that I understand money that well.

But something I've heard him say a lot is when you budget properly, crises become inconveniences. When you know how to navigate yourself through a depressive episode, that's kind of how depressive episodes feel. You know, the first few times that they happened to me, I was like, is my life over? Is this me forever? And now it's like, kind of like, really brain? Like, you want to do that today? Like, I would have preferred that you not, but whatever. Yeah.

It goes from a crisis to an inconvenience when you know your steps out of it, if that makes sense. We'll be right back to the show in just a moment. How did you learn about money growing up? And how did those lessons prepare you for the real world? If you're a parent, you probably really want to help your kids build some money skills, but hopefully without the painful experience that developing those skills usually takes.

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Now, back to the show.

Maybe you're just a unique person in this regard, but you've worked with a lot of people. And so I'm curious what you've seen in other people as well, where there's an incredibly, I mean, the reason that depression is treatment resistant broadly, not just treatment resistant depression, but depression as a thing is treatment resistant, is because there's kind of an inherent catch-22 inside of it.

which is that the symptoms that define the condition, low energy, hopelessness, diminished self-worth, apathy, fatigue, you know, whatever, can make it very, very difficult for people to do the things that we know tend to make it easier

for them to recover from those experiences. So you're talking about one of the examples you gave is the kind of like more fitness exercise oriented example. For somebody who's in a major depressive episode, you tell them to like, hey, go exercise. They're going to be like, what are you talking about? I can't get out of bed sometimes, particularly when you're talking about more severe symptomology. So

I'm wondering how you think about that broadly. If somebody's walked into your office to work with you in the first place, they're probably already part of a kind of unique group of people just because they've been able to make that move. But I'm sure that you've thought about this a lot, so I'm just wondering how you think about it for starters. Yeah, there's a lot to that. If someone has a very episodic mood disorder, major depressive disorder, bipolar disorder,

Starting your physical fitness journey in the midst of your depressive episode, not a realistic expectation. And like that's not going to happen.

Ideally, what we're doing is when things are a little bit better, because there's probably a lot of ups and downs for most people, what we want to do is really work on setting these things up during the relatively better periods of your life. Yeah, you want to establish the habit or establish the practice when things are going up, not down. Exactly. Totally. That's still very hard to do though, because a lot of people, especially if you experience severe depression,

The discrepancy between how you feel when you're in an episode and how you feel when you're not is like night and day. So much so that you almost doubt it a little bit. Like when I'm feeling good, I have a tendency to look back on periods of time when I was depressed and I was like, that wasn't as bad as I thought. I was probably exaggerating that. I think, you know, there's no way I actually felt the way I think I remember feeling. And then it happens again. I'm like, oh, no, I was right. It actually was terrible.

But when you're doing well, like this happens all the, this happens with meds too. This happens with therapy. There's a tendency to be overly optimistic with that and be like, I think I, I think I'm good. Yeah. I think I'm done and I don't need to do this stuff anymore. So I'm just going to go live my life now and everything's going to be fine. And,

Then it comes back and then you're like, oh, no, I should have done those things. So when it backs off a little bit, that's when you go hard at it. That's when you really work on setting up the things that you think you're going to need to deal with this. Because, you know, if you're like me and some of the feelings and struggles I'm articulating kind of sound like you, then...

I'm not trying to be pessimistic. I'm just trying to be real here. Like this might be a lifelong battle for you. I mean, I do think for most people who experience severe mental health symptoms, these are chronic conditions, right? So think of it, think of it maybe kind of like diabetes, for example, like this might be something you're dealing with for the rest of your life. That doesn't mean it's going to ruin the rest of your life. Hopefully for large portions of it, it's just sort of this background presence that's not doing a whole lot. You just know it's there and you know it exists.

But setting up, you know, proactively setting up your protective mechanisms during periods of better mood is ultimately what you want to do. And even then, especially with something like fitness, take a stepwise approach. You know, we know that meta-analyses suggest it's kind of a wide range, but three to five days a week, 15 to 45 minutes a day, moderate intensity, any format, right? That's like for mental health benefits, that's the peak, right?

So you don't need to go any further than that for your brain. But that doesn't mean that that's where you have to start. If physical fitness has not been a part of your life, like at all consistently up until now, don't just like do that tomorrow because you're probably going to burn yourself out. Start by just going for a five minute walk a couple of days a week and, you know, go three, four, five, six steps before you reach that plateau. Take it easy on yourself. Let yourself adapt to each step along the way before you expect yourself to kind of turn up the intensity.

That's what I think will really help lock it in to the point where it's something you can hold on to and you can maintain even during an episode. But I mean, you're absolutely right that, you know, when you tell someone like, oh, all you need to do is eat well, sleep well and take care of your body. And they're like, well, those are all the things that I can't do. I really struggle with. Yeah. Yeah. It's it's extremely, extremely difficult.

If you have one or more severe mental health conditions, this can't be like a side quest for you. Like this really has to be something. I'm not saying it has to be the most important part of your life. But if you treat your mental health as this afterthought and like, you know, when I have time and I have energy, I'll do the things that help. Then that's the irony is then it will control your life.

Because then you're actually not giving it the resources that it requires to be well managed. And then it's just going to be something that happens to you. Whereas if you are able to set up those things and maintain them and try to hold on to them at all costs, no matter how bad it gets, then it's going to be something again, like the Dave Ramsey quote, it's going to be like this inconvenience that occurs sometimes like, oh, that's annoying. I would have preferred not to be in an episode right now, but I'll do my things and I'll get through it.

A major feature of depression for many people that you've already mentioned while I've been talking is the emotional numbness aspect of it all the way up to anhedonia, which is where essentially good things don't feel good anymore, bad things still feel pretty bad, but just in general, the ceiling has way come down on a person's possible emotional experience. It's one of the more challenging aspects of it for people. It's also the one that tends to lead to a lot of suicidal ideation for people because it just doesn't feel like there's any real purpose in keeping on going here.

Are there things that you've found help people with that aspect of it, particularly just in terms of writing out an episode of it? Absolutely. So okay, this is gonna be a long answer because this is one of my packed ones. Yeah, it's a big one.

I have a few techniques that I encourage people to use when they're struggling with anhedonia. The first is, I call it checking the locks. I liken anhedonia to like being in a mental or emotional prison. Like you're jailed, you know, you're in this cell, the ceiling's 10 feet high. The thing with anhedonia is, you know, when it starts, you don't feel anything. You can't connect to anything. You can't enjoy anything. You feel like you're in this glass prison.

And what 99% of people will do when that happens is after probably a few days, you stop doing things that have the potential to produce joy. Because when you're going out there and doing the things that used to make you feel good and suddenly you get nothing from it, it's like, well, this is a raw deal. Like, why am I going to bother doing this? Why am I going to go out with friends if I just feel alone and miserable the whole time? Because that's a lot of work and I, you know, or I spend money on it or whatever. So at some point we stop doing those things because it's diminishing returns.

The trick with that is then you can end up in what I call false anhedonia, which is when your life is devoid of joy, not because you are incapable neurologically of feeling joy in that moment, but because you have cut all the sources of joy out of your life. And I say this with all the love in the world. No judgment. I get this. I've done this. I know how it goes. Because for a while you weren't able to feel it. So you stop doing the things. But the thing is, then you don't know when it ends.

There's not going to be, you're not going to wake up someday and just feel joy because you exist. You have to do something to prompt that joy. It doesn't just come upon you. It's not like when you're physically sick and you wake up one day and you're like, I'm not sick anymore. You may not notice when the anhedonia ends and it will end. So I encourage people every day,

even if it's brief, do at least one thing that has the potential to bring you joy. Because you might be surprised when you do something maybe two or three weeks after an episode hits and you're like, wait a minute, I think I felt a little bit of something there. I noticed a little spark of joy there. And then here's the really hard part. Don't obsess over it. Don't over interpret it. Because sometimes it's kind of like a deer in the field. Like if you're like, oh, I think I'm

better and like hyper fixate on it then it goes and it disappears so you have to kind of like pretend you don't see it but just keep doing the thing that made it it's really frustrating and i know i wonder about that sometimes because i say like my first depressive episode lasted like 10 years but i didn't do anything i mean i did nothing and it makes me wonder how much of that was just self-imposed based on lifestyle it's interesting because another thing that i've heard you talk about is

is not chasing acute experiences of joy so much and instead orienting more, as you said just at the very beginning of our conversation, orienting more toward values or things that you feel give you a better sense of connection to others, fulfillment in life, all of that. And I'm wondering how you balance that when you talk to people about this. How I balance that has changed a lot over my life. And if you ask me a year from now, I'll probably have a different answer than I do right now.

I am, maybe this is a 40s thing, I don't know, but I am more and more geared towards, you know, if I'm at this branching pathway and I can either spend energy on something that feels good to do or something that makes me feel good about myself. And I know those sound very similar, but I can break it down. I'm choosing the latter almost every time.

And this is going to sound very like rah-rah, whatever, I know. But so, for example, I enjoy playing video games more than I enjoy working out. Like if you're talking acute joy, and I like working out, just to be clear. I actually think it's kind of fun. We're in the same category, I got to tell you, Scott. Exact same category. It is not as fun as video games. And I'm not going to pretend it is. I'm not going to lie to you guys.

So if I were to make a decision based on how will I feel in the moment while I do the thing, I'm not going to actually choose working out that often. As far as my career goes, I'm going to kind of do the bare minimum. I'm going to do enough to get by and that's going to like, I wouldn't have a YouTube channel.

I wouldn't write a book because honestly, none of those things are super fun to do while you're doing them. But having a YouTube channel is cool. Making the videos just, you know, obviously very unglamorous, especially if you don't even have a guest. It's literally just you talking to a webcam. It's not an empty room most of the time, which is a very weird experience, but okay. It is not a super fulfilling experience in the moment. So I think of behaviors like that. They're like investments, right?

I try every day to invest in my own life. So I try to do things that I know are going to feel good more than one time. If I go to the gym in the morning, I'm going to experience more than one experience, more than one moment, I should say, of joy from that. A lot of the activities that produce immense acute joy in the moment produce nothing beyond the moment.

I focus dramatically more, I'd say it's probably somewhere between 80-20 and 90-10, on engaging in activities that I know are going to produce multiple reward experiences for me. And again, reward can be joy, it can be achievement, it can be connection. Whatever it is you value in life, whatever the emotions you want, if you do things that are going to make you feel that way again and again and again, even if they produce less in the moment you do them,

It kind of has this snowball effect. And if you keep doing those things, you eventually get to this point, which I never thought I would get to because I'm not, I'm sure this is a shocker, but I'm not the most naturally happy person in the world.

I actually get to the point where I kind of enjoy just being alive. And that has not been the story of most of my life. Like I have needed a reason. I'm not the kind of person who wakes up and I'm just like, oh, there's birds. I'm happy. Like it takes more than that for me. And that's something that's been built through a lot of repetition and investment because I don't inherently have this like zest for existing that a lot of people seem to.

I think this is a piece of the experience for many people who have depression, and it can also lead to the feelings of loneliness that are often associated with it. And it's what took me to the question of like, are you an existentialist? So existential psychotherapy is a very, very cool branch of this whole thing. And Irv Yalom is one of the big wigs of it, and his book's one of my favorite books.

or his textbook, I should say, is one of my favorite books. And so one of the key features of existence and existentialism is this idea that we're all sort of fundamentally isolated from other people, that there's this unbridgeable gap between us and them, and we can never truly fully know somebody else in the way that we would want to, and will therefore never be truly fully known by another person.

And I thought it was really interesting that you start your book with the complete uniqueness of being you as a person, and therefore the pains of that uniqueness where there's this aspect of us that wants to be known by others and won't be. And I feel like people who struggle with depression

often feel that existential isolation in a really acute way. They feel that this is a fundamental aspect of reality and like, oh my god, that is such an awful thing. And then therapy becomes less about symptomatic relief and more about bearing witness to the nature of reality and the complexity of being you as a person and that separateness in a way that makes it more tolerable for them.

Where do you go with helping somebody with that when they're in that kind of confrontation? Yeah, I think I actually was just having this conversation with someone in a therapy session the other day. But I mean, I ultimately do more or less agree, you know, it's all theoretical with Yalom's characterization. And as a general model of understanding mental illness too, there are a lot of people in my field who ascribe to like a unique theory of mental health, meaning every mental illness we see

ultimately traces back into one thing, right? Some people think mental illness is caused by trauma and it's just different manifestations of trauma. Some people think there's all like there's something in the brain. There's something we haven't discovered yet that explains all of it.

I actually think the complete opposite. And I'm going to give a disclaimer, like my model is kind of depressing, ironically, but this is truly what I believe. You know, we identify people by symptom clusters, right? Like most mental illnesses do not have biomarkers. That's why we don't use, you know, brain scans or blood tests to diagnose them. You talk to somebody and they ask you your symptoms and that's how we diagnose.

And we found that, you know, a lot of people are describing kind of these same experiences. So we start to call that the same thing. This is depression. This is anxiety. This is ADHD. And obviously some people's symptoms are more similar than others. You know, if you talk, if you put me in a room with another person with depression and also someone in the room with like OCD, I don't have a ton in common with the OCD person. Our stuff is very different.

But I do honestly believe that if you like traced it all the way down, that ultimately everyone's struggle is somewhat different. You know, what I call depression for me might be like a cousin of what someone else is dealing with. We're closer than, you know, this other person who has something totally different.

But even us with the same diagnosis, like we're not actually experiencing the exact same thing. We're experiencing something, you know, those Venn diagrams overlap a good amount, but they're not one to one.

Well, I love that you're talking about this, Scott, and I'm very interested where you're going with this. But I couldn't help but just mention that there's a kind of irony in that. We have this fundamental sense of separateness and therefore a sense of isolation, and that can kind of lead to this feeling, the constellation of feelings that tend to lead to depression for people. And you're responding by saying like, yeah, we are all truly unique, and therefore it is very difficult for us to kind of categorize experiences in this sort of a way. I just thought that was kind of funny.

Yeah, it's a tricky thing. And, you know, we have to use a diagnostic system so that we have understanding of what a person's symptoms are and so that we can map out a treatment so we can say, hey, you're not the only person in the world who feels this way. But like, yeah, no, that's a hard thing to say because I run groups, too. You know, we have an intensive outpatient program here. It's a nine hour a week group for people with moderate to severe mood and anxiety disorders. So these are people who, in theory, have the same diagnoses. And yet when they talk, you know, some of them click really well with one another and some of them it's like,

I don't like the way this isn't how they say it. This is just my goopy car bubble in my head. It's like, I don't like the way that person's depressed. Their depression is not, you know, it's not the same as my depression. It's really interesting to see how, how certain people align and certain people don't and the implications of that on treatment because, because they didn't therapy, you know, based on my model, then I ultimately think every person's therapeutic journey is also going to be somewhat unique. I mean, you asked how you confront that in therapy. This is, I think what frustrates a lot of people. Therapy,

is an incredibly broad range of experiences, right? And therapists have different trainings and the difference between somebody and I, you know, everyone deserves help who wants help. Don't get me wrong. But like the difference in someone with mild depression versus severe depression, that's a completely different thing. And it should also be treated completely differently therapeutically.

And a lot of therapists don't really have the experience or the training to help people who are really down in the depths. And when you're depressed and you're feeling like, I think life is kind of a raw deal and I don't really know if I want to participate in it anymore. And sometimes I feel like I'm the only person who sees the true nature of what we're all up against. And someone's like, oh, don't look at it that way. It's not so bad.

That doesn't do anything. And you might think, oh, a therapist would never say that, but they do. Many do who don't understand that type of experience. My approach tends to be more along the lines of like, yeah, you're right. What do you want to do about it though? Like we still got to figure something out, but you're not wrong. When I'm talking to clinicians who really highlight the individuality of this kind of a process for people, which often happens, particularly I feel like when I talk to

the people who are much more clinically oriented than they're academically oriented, right? Because I think that some of those unified models that you're describing, there's a lot of yearning for them from people, particularly people in academia. And I think a part of that's because, man, that would be one hell of a research paper to write. But when we're appreciating the individuality, sometimes it puts us in a tricky position

in a form of media like this where we're trying to talk to a lot of people at the same time, right? So I'm wondering how you have, if there's a typical arc to the work, particularly around that more existential confrontation that people have with living. There is often a very big turning point hinging on acceptance. And when I say acceptance, that's a very loaded term.

I'm talking about acceptance as the counterpart of denial. So when you choose to accept something, that doesn't mean you're saying, I like this. This is good. I'm happy with this. It means you're saying, I acknowledge that this exists and this is the way things are right now. And this might be the way things always are to some degree. Because a lot of people, and I don't blame them for this because I've been on their side of it too, but

come into treatment thinking that, you know, if I do X, Y and Z, I'll never feel this way again. I'll be cured. I'll be healed. There is a small percentage of the treatment seeking population that does experience, you know, what we call total remission from symptoms. We don't necessarily say you're cured, but we'd say you're in remission. That's, you know, like 10 to 20 percent of the population. And it usually is more the people who come in with more mild symptoms in the first place.

If you have a chronic severe mental illness, it may never be eradicated. And I see a lot of black and white thinking around that. I see a lot of like, well, if I can't get rid of this, if this cannot be gone from my brain, then there is no point in doing anything. There is no point in putting forth all this time, all this effort, money in some cases,

If what we're talking about is fractional improvement and if this is something that I'm going to have to live with forever. And there's a lot of very fair, valid and understandable anger and pain and frustration and resentment that comes along with that. And I think it's really important, especially early in the therapeutic process to allow for that, to validate it, to acknowledge it, to say like, yeah, no, this is like in this particular way,

You have been dealt a raw hand by life and it's not your fault and it's not fair and it sucks. And I wish I could tell you differently, but that is in fact the current situation. And you know, you don't rush a person through that obviously, but then again, it's like, okay, so within that, even if this can't be gone, I'm telling you this can be better. And the better, in my opinion, is worth striving for as someone who's been, uh,

pretty far on both sides of this thing. The difference between being depressed 90% of the time, which I have been, and being depressed 10% of the time, tops, which I also have been, that is a different life. That is a night and day different existence. I would love to get the 10% to zero. I suspect that will not ever happen for me. If that's the case,

then I'm going to do everything I can to confine it to the smallest corner of my brain that I can possibly confine it to. Because at age 41, almost 42, I am living a life that I never thought I would have. I'm talking about like being alive. Like I didn't think I was going to see 40. I didn't think that was real. I never thought I was going to get married. I didn't think I was going to have a career of any kind. That's how bad it was for me.

And so if I can go from thinking I have no hope and no future to having even just like a basic life, that's all I ever wanted. Everything past that was just a bonus. And that's all I ever wanted. And I didn't ever think I was going to have that. So it is worth it, even if it's not curable. Managing it will give you a different life than if it is unmanaged and running your life.

Are there common traits, aspects of deep nature, however you want to answer this question, that you see in the people who tend to be more able to turn that quarter? There are. And now, of course, these are correlations, right? So it's not like a one-to-one.

And ironically, this is one that was kind of lacking for me personally, but support is a huge one. And you don't need to have a huge support network. If you do, that's awesome. It's going to help you tremendously.

But the value of having even one person in your life who is going to stand by you even through your episodes, who isn't going to give up on you and get, well, I mean, they might get frustrated with you, but they're not going to get so frustrated that they leave is the key. That is tremendously beneficial.

Physical health is a huge part of it too. Now that's a tricky one because that's, again, that kind of goes back to the catch-22 we talked about earlier. It's not something you have complete control over. Some of us are born with certain medical conditions or genetic conditions.

This is going to feel like a little bit of a tangent, but I like the stoic concept of the trichotomy of control because a lot of people get wrapped up in the dichotomy, right? And it's either I have control over this or I don't have control over this. And there's a lot of things that fall into the middle, which are things that we can influence.

So you alone through force of will or effort cannot make exactly what you want it to be, but you're not irrelevant to this process. And physical health falls into that category. I mean, even just think about sleep. Like I don't have complete control over whether I get eight hours of sleep tonight or not, but I'm not irrelevant to it. So being able to recognize that it's not black and white and that there are things that although we cannot make them exactly how they want, how we want all the time, but

That doesn't mean that we shouldn't put any effort towards them at all. That's an important one. I mean, I hate to say this because this is also one that's hard to control, but finances do matter. When people don't have a lot of financial resources, that's a huge roadblock. It's not even that...

It's not even that most of the things that help with depression are expensive per se. It's just that when you're dealing, like when you're in poverty, for example, it's this whole other giant stressor that you have to manage 24-7. Ultimately, one of my core premises, I guess you would say, I truly don't think anyone is hopeless. I really, really don't. I think some people have a harder road ahead of themselves than others, to be sure. And what the research says about

treatment resistant depression, for example. Now I can't speak to the, you know, I'm not a psychiatrist, so I can't speak to what that means in terms of like psychopharmacology. But, you know, if people have tried like two or three different therapists and haven't made any progress and they get labeled as treatment resistant, there's a huge assumption in that process that I have a big problem with. And the assumption is that those therapists, you know, had the tools to help this person. As someone who's on the inside of this industry, you know, looking out,

I see a lot of therapists who I frankly don't think have the tools to help a lot of people. I won't get too far into this because it's going to sound very jaded, but our licensure process is mostly based on memorizing facts. It's like, who invented this theory? What's the date? That doesn't make you a good clinician.

The tools that help you get through grad school and get licensed, I think, have minimal correlation with being an effective therapist. And so when I see people who haven't been helped by therapy, my first assumption is usually that's probably an us problem, not a you problem.

My partner right now is going through the licensure process, so she's 2,500 hours or something into her 3,000 hours, so she's approaching. And you do have to accrue the hours. The hours, particularly in California, is definitely a schlep for people. But to your point, there are no outcome metrics attached to the hours. It's just, did you do the hours? It's not, did you do the hours and help a lot of people along the way, which is just one example of what you're talking about. That

there are a lot of really great therapists, and then there are a lot of perfectly good therapists, and you can go to a perfectly good therapist. And if you don't have a good fit with that clinician that you're working with, even a perfectly adequate therapist may not be able to help you, and it's not necessarily your fault because you just weren't working with the person who was sort of best suited for your unique situation, kind of like you're describing with everyone's a little bit unique in this process. CB1

I'm not going to act like I've got it all figured out and have this better system that we should all implement. I'm just, you know, backseat criticizing here, but...

If anyone listening to this is disenchanted and frustrated with their experiences in the mental health system so far, this is a doctoral level psychologist saying this. You're not wrong. I get it. We have a lot of work to do. I hope that you keep trying because every experience is different. And this might sound a little snarky, but if you've seen three different therapists, none of them have really helped you and you've kind of given up on therapy. And you're like, well, I guess therapy doesn't work for me. I guess therapy is not for me.

That's functionally equivalent to dating three people, breaking up three times and saying, well, that was worth it. I'm guessing I'm going to be alone forever. I guess relationships are not for me. I know this sounds very trite, but it doesn't work until it does.

And we do know that the relationship you have with your provider is critical. And that's not necessarily based on did they go to a prestigious Ivy League school? Do they have a master's or a doctorate? Are they existential or gestalt or cognitive behavioral? It's basically like, do you like them? Do they like you? Because if you do, you're probably going to get better working with them. And if you don't, they might be literally the most world-renowned expert on the thing that you have. And if you find them kind of insufferable, you're probably not going to get a lot out of therapy with them. And that's just the reality of it.

Something I saw you do recently that's tangentially related to this topic is you did a video where you tried on various AI therapists. And this has become a major topic in the field, and it's only going to become more so over time as we're hearing more about people talking to chat GPT and interacting with it like it's their best friend or like it's their romantic partner or like it's their therapist, whatever it is. What was your experience doing that? What did you find from it?

They honestly weren't as bad as I thought they were going to be. Yeah, honestly, there's some aspects of them that are not the worst, yeah. But they still weren't very good. And people tell me I should do it again because I totally...

Softballed them. I kind of gave them the answers to my questions. The two big things I noticed that really frustrated me, they were super... I'm a very behavioral therapist. I'm like, you got to do stuff. If we just sit here and talk, that's not going to make it better. I'm a very action-oriented person, but they were far too action-oriented even for me. Literally, this first or second...

they'd communicate to me and be like, well, what do you think you can do to get better? I'm like, 30 seconds into our conversation, really? They would just jump to action way too quick. But the other thing

is they use these super generic blanket validations. And I was trying to be kind of descriptive. I'm like, you know, I feel hollow and empty sometimes. Sometimes I feel life has no purpose and kind of, you know, waxing poetic about my own despair a little bit. And then the AI would be like, I understand how you feel, period. Like that was, I'm like, even if a human being said that to me, I'd be like,

Do you? Because you've not used enough words to actually show me that that's... You can't just say... You got to like demonstrate that. And AI clearly does not know how to... They literally just say, I get it without doing anything to prove that they get it, which they're AI, so they don't. But that was the biggest thing is like...

The validation that you would get from talking to a therapist who to some degree really does get it was so just tacked on and surface level. And again, for some people that might be fine. My gauge is always, this is both with AI and like other therapists I talk to or people I'm looking to hire at the clinic. The question in my head is always, could you have helped me in my darkest times?

And at least with the three AI chatbots that I use, my answer was very much no. I don't hate the idea because...

Access to therapy is very difficult. Like I am all for if we can make therapy more affordable, if we can make it something people can access. I mean, we have crisis lines and stuff, but like if people can access something 24-7 for low or no cost that helps them with their mental health, I want that to happen. So I'm not anti, I'm not like, oh, I'm not afraid that they're coming for my job here. I want this to be good.

But it's not yet, at least not the ones I tried. There's a long way to go with that. Yeah, my general view on it is that having only just begun to scratch the surface on even thinking about this as a topic. So just for the record, these are very early opinions that I reserve the right to change them.

My prior is that they're going to get a lot better, and they're going to get a lot better very quickly because all of these models are getting a lot better very quickly. I'm not sure if it's possible for a...

for the way that they are right now, which is text only. I mean, I can imagine a future where you're talking to somebody who looks an awful lot like a person through your phone, and sure, they happen to be an AI whatever simulation, but you're really getting a lot of the juice that you would be getting from a person. But until we get to that point...

And even then, who knows? But certainly until we get to then, I'm not sure if you can really replace that kind of empathic connection aspect of it. I'm a big Rogerian in terms of how I think about how this actually works and the idea of just the talking cure itself and being seen by another person through the kind of process that you're describing. Man, certainly talking about my own experience with therapy, that was a huge piece of it for me. Feeling seen, feeling understood,

as best as a person could do, which is always going to be imperfect, but man, it's better than nothing. That was really what kind of did the trick for me. And I have a hard time imagining even just knowing that it's an AI I think would kind of get in the way of that to some extent. So that's the piece of it where I'm very uncertain that we'll be able to really fully get there. I think we might, but jury's out.

Yeah. I freaked, I don't know if you watched the whole thing, but the second one I talked to, I freaked him out a little bit and he tried to send me to real theory. He's like, you need to actually talk to somebody. Yeah. When you go to the crisis line level of it, they seem to be pretty good about saying some version of, hey, this is kind of outside of our area of expertise, which I'm grateful for. I would not want to mislead people about that. Yeah. That's what they should do. Exactly.

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You know that moment when somebody asks, how are you? And you automatically say, I'm fine, even if you're not. At some point, I realized that I wanted to either mean it when I said it or feel like I had the freedom inside of myself to be more honest about how I felt. That's one of the reasons I started the podcast and why I use some other tools that support my mental health, like today's sponsor, Headspace.

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Now, back to the show. Another major thing as we kind of wander toward the end here that you talk about is this idea of getting more clarity about who you are as a person and more of an authentic sense of connection with your deep self as opposed to your sort of superficial wear a mask self.

One of the most common questions that we get from people is, well, you say connect to your values or find these things that you really care about and go do them consistently. But I have no idea what my values are. I don't know what I want. And honestly, if I look inside, I don't really feel like I see much there that is really me.

And then again, I think first or second page of the main body of your book, you're talking about this stuff. And so I know you have a personal relationship with it, and I'm wondering how you tend to help people through that kind of a process.

Values and self-awareness can kind of fall into two categories. They're going to be big picture, morals, philosophy, religion, things like that. If a person's at a point where they're like, I just don't know. I don't really have any clear sense of direction in any of those domains. The second inner experience we can focus on is sort of like your order of operations. I gave this metaphor a while back that a lot of people resonated. If we're all kind of like cars, some people are Toyota Camrys, Honda Civics, they're bulletproof, right? Some people can just face...

you know, loss and hardship and like, they're fine. And those people fascinate and amaze me because I am so unlike them. Cause I, one minor riddle, little roadblock and shut down. I am more like in a, in Italian seventies sports car, not in like a, I'm so cool way, but I don't work right kind of way, except like I,

I know I'm not personally a big car guy, but I know a lot of car guys. My father-in-law is a big car guy and he likes the really finicky, like to get this car started, you have to push three quarters of the way on the gas pedal. You have to turn the ignition four times. It won't start in the third. You got to turn it four times while singing Believer by Imagine Dragons with the top down. And then it will start, but only then.

But when it starts, it's the most rewarding experience in the world. And that, you know, he loves that. Engine sounds great. Yeah, exactly. And like, I'm that kind of car. Like if all the conditions are aligned properly, I can do some good stuff. But if any one of them's off, I just fall apart. And so then my job is learn my conditions and recreate them as often as possible because I am so ridiculous. I didn't choose to be that way. It's just the way I am.

No one else is ever going to be able to figure out

My instruction manual is 2000 pages long. I can't count on other people to make sure that my conditions are always met. It's my job. And ultimately, I think it's all of our responsibilities. So even if you don't currently have a moral compass, so to speak, just figure out how you work. Do some science on yourself. Look at your good days and your bad days and start to kind of figure out what's different here.

And what do I think I can recreate to have more of these and less of these? What do I think are the things that really matter to me? Maybe even not morally, but just functionally. Like I don't morally value sleep.

But I know how my brain feels if I don't get enough of it. And so it's important. And so really that's that case study you were talking about at the beginning is just I've looked at my life and I've looked at the common threads on better than average and worse than average days. And I've tried to recreate as many of the conditions that seem to be generally present in the better than average days as possible. And that turns things around. And that's

If that's all you can do, that's a fantastic starting point. As people are going through this process that you're describing, which is very pragmatic,

figure out your few things like I talked about on the 9010 episode we did. What are your buckets? What's in those buckets? What can we do day in and day out? And I love that kind of a pragmatic approach. I'm a bit of a pragmatist at the end of the day. My experience though is that pragmatism is often fueled by an increasingly intimate sense of who you are as a person and an increasing layer of self-understanding and self-acceptance for people.

Which can include a lot of what you're talking about, like a sense of yourself as a car that has a complicated startup system associated with it, right? And you move from a feeling of, oh my God, I can't believe I'm this car that has this complicated startup system to more of like, oh, this is the way that I am. And sure, it's got some complexities associated with it, but it's got some beautiful aspects of it as well. Do you find that there is a thing that you are doing in therapy that helps people get to that kind of

light bulb moment? Or is this just a long and beautiful process of self-exploration that a person kind of goes through? And hey, some people get there, some people don't. It's really hard to draw you a map. Anything you would like to kind of add to that? To be honest, I think a lot of it, at least for me, is humor, sarcasm, and snarkiness. Like...

A willingness to laugh at yourself could be a powerful cure. That's totally true. It just gets so dark if you don't. And that's why I use metaphors like the car metaphor. Because on one hand, I do think it's pretty apt, but it's also a little bit silly. And people like that, you know? Introducing some levity, yeah. Exactly. And if you can see yourself as like, oh, you know, I'm not this broken, miserable person. I'm more just like a really complicated, finicky vehicle. And, you know, love those. That's...

I think that perspective shift helps. I don't know if this makes sense because what it actually is in my brain and how I can articulate it probably aren't a perfect match. But I try to say, and I think this probably comes across in my tone of talking to you today, I simultaneously take this very seriously and also not that seriously. What I mean by that is this being mental health.

I live my life in a way that is very mental health centric. And I don't just mean because I do this for a living. I mean, in my personal life, like my 24 hour cycle is primarily focused on making sure that those cornerstones that I've learned through trial and error are essential to me having good mental health are as present as I can make them. So I take it very seriously in my allocation of time, energy and attention.

I don't take it super seriously in like a philosophical kind of way. I used to, you know, I used to, there was a real heaviness to this for me, you know, like, oh, these stakes are so high and my brain is so weird and complicated and everything's so hard. And like, and that's all true, honestly. But I try to have a little bit of a lightness about it. A little bit of, you got to be careful because you got to have rapport with the person who did this already. But

A little bit of silliness even like, yeah, our brains are just a little bit different, aren't they? And, and, you know, we can either acknowledge that and, and figure out what those cornerstones are and then put them in place or, you know, live in despair and turmoil and say, why me? Why was I made this way? What is the reason? What is the purpose?

likely never find those answers, at least not in a worldly sense, and just be miserable forever. That's, you know, what's the three, the DBT options? Yeah, the three options in DBT, right? You can either accept it, you can change it, or you can be miserable. You know, it's that snarkiness to it that I really resonate with that. And humor helps me. A lot of my darkest moments in life, it's been humor that's helped me finally come out of them. So

I think that's a big touch too. And that's also something that I don't see AI doing just yet. They can't, AI doesn't quite know how to make jokes about depression and suicide yet. It's a hard thing to do, to be fair.

That might be a new entry in the Turing test right there. If you can make jokes about the darkest things without them being socially unacceptable, that's how we know that you are a conscious being. So I really appreciate you taking the time here, Scott. Thanks for joining me. Absolutely. I really appreciate the invite. Hopefully the information I shared today is helpful to your audience and helps them in their battles.

I had a great time today talking with Dr. Scott Eilers. We talked about depression and anxiety, mostly depression. And Scott draws a lot from his personal experience in working with people. He himself has experienced major depressive episodes off and on since he mentioned he was an early teenager, even maybe a bit before that. And it's been a major feature of his life. So he's had to figure out in his own way how to come to terms with that, how to accept it, which was a major theme of the conversation.

And then the kinds of practical interventions that, on a day-to-day basis, make things a little better for somebody. Scott mentioned how complete remission of depression is quite uncommon for people. Maybe 10% to 20% of the people who enter treatment experience complete remission. So it's less about never feeling depressed again and more about coming to terms with the reality that you will feel depressed sometimes.

and then coming up with some good strategies for managing that depression when it appears.

A few things really stood out to me from the conversation. The first is how much Scott emphasized consistency, doing something over and over again, day in and day out. We talk about this on the podcast all the time, and it was great to hear about it through the lens of his work as well. He also talked about trying to establish a habit not when you are in the pit of a depressive episode, because obviously that's going to be a very difficult thing for somebody to do, but instead trying to build practices when you're feeling a little bit better.

Because depression is episodic. It goes up and it goes down. So most of the time, there will be a moment in the future where you do feel a bit better. And when you feel a bit better, you can take advantage of that time to establish some behaviors that you start to integrate a little bit more into who you are.

And this is part of a larger movement that can happen in a person's life where managing a significant mental health condition goes from being something that they do when they're experiencing a lot of negative symptomology associated with that condition to just a part of their life as a whole. They understand that this thing is going to come along. They are not surprised by it when it appears. Sure, there is some very understandable sadness, disappointment. Ugh, this again.

when that comes up, but because it's anticipatable, it becomes a bit more manageable. And that was really all over Scott's story. And establishing these practices when you can, when you have the psychological and emotional and life bandwidth to do that, is so important in part because there's a kind of catch-22 associated with depression. The symptoms of depression make accessing treatment for depression very challenging for people.

We know a lot of things at this point that tend to help people when they become depressed. These are not perfect interventions, so I'm not going to act like they are, and I'm not a clinician, so I don't have personal experience trying to apply these with people. But we've got a big body of literature on this, and I've had a dozen guests on the show over the years that we've been doing it who have come on and said some version of, this stuff works if you do it.

The problem for a lot of people is doing it because when you do not want to get out of bed in the morning, it is very difficult to engage in some exercise or whatever other practice it is that somebody's kind of trying to pitch you. And in fact, being pitched that solution when you feel that way can really feel like the person just doesn't get it, which just ends up making things feel worse. You feel more separated and more isolated and like this person can't actually help you.

Anything that makes a person feel more isolated from others, more separate from them, is going to make it easier for them to experience depression or any other kind of low mood state.

And this can include anything. This can include aspects of your personality that you feel are really true and important to you but don't seem so present in other people or at least the people that you're around. This could be what Scott was talking about at the beginning where he didn't feel like his life story was very consistent with the life stories of the people that he was spending a lot of time with, or how he also felt that he was a pretty deep thinker from a young age. He was really interested in these kinds of existential questions.

And that inquiry itself led to this feeling of confusion and separateness and maybe even a sort of emotional overwhelm associated with that confrontation, a kind of confrontation with the underlying realities of life that are really emphasized in existential approaches to psychotherapy. One of these is the idea that we are fundamentally separate from other people.

I will never know another person as intimately as I know myself, and no one will ever truly know me as intimately as I know myself. So we are fundamentally separated. We can get as close as possible, and still a kind of psychic distance remains between us and others. And some people really feel that more acutely than other people do.

It doesn't mean that there's something wrong with you if you feel that very acutely. It doesn't mean that there's something wrong with you if you don't. Some people are just a little bit more prone to this experience than others. And so a big job of the clinician is helping the person feel understood, helping the person feel like the clinician gets it on some level.

And once that trust is then developed, they can try on different kinds of interventions. They can take what that clinician says a little bit more seriously. Or even, hey, just the feeling that there is somebody out there who understands can itself be really helpful for them. This is then really supported, according to Scott, by a big acceptance piece. You are accepting that, again, most people do not enter complete remission. You are accepting that this is a part of your life that is probably going to exist and is going to need to be managed.

You're accepting that fundamental separation from other people. And he mentioned a couple of things that tend to really help people get to that place of acceptance. One was levity for him. A certain kind of dark humor about the whole thing can be really helpful for people. Then some kind of social support, having a person around that you are reasonably confident will still be around if you open up about some of this stuff to them.

He also talked quite a bit about connecting to your values, finding the things that you really care about in life, going through a process of inquiry inside of yourself that really explores and values that uniqueness. That emphasizes that somebody else can't figure this out for you. You're going to have to kind of figure this out yourself.

You're going to have to go through a process of learning and discovery that helps you come to the answers to some of these questions. What does really light you up? What does help you experience some amount of joy? What does help you feel more connected to other people? Sure, a clinician can toss some ideas out there, but they're always going to be walking uphill because they're battling that fundamental separation that we were talking about throughout the episode. They will never know you as well as you will know yourself.

And I think this is something that the field almost inherently struggles with a bit because of course we can't create a completely unique treatment plan for every single person who walks in the door or every single person who has a particular kind of problem. But in order to test something, we need to create averages. We need to create something that's pretty good for a pretty large number of people.

That's what tends to lead to a good effect size if we run a study on it, right? We found that this thing worked pretty darn well for a reasonably large group of people. And because of that, it is a validated approach to treatment.

But it's important to keep in mind that for any one person, this treatment might just not work at all for them. And so there's this kind of balance between appreciating the expertise of the person who you're talking to if you're going to therapy, or even if you're listening to a podcast like this one, appreciating Scott's expertise, or hey, maybe appreciating what I've learned throughout this process, whatever it is for you. There's this balance there between appreciation of that

while not wanting to be ruled by that, while still wanting to claim maximum agency, maximum effectiveness inside of your own life, while also taking on some good advice from the outside. And I think that that balance is really difficult for people

many people tend to become either totally consumed by the external advice or totally consumed by their own view. And living in the gray, particularly for people who have some kind of significant mental health challenge,

is really hard to do. That is the hardest place to be in. And of course, this is classic middle path stuff. The middle path is the hard road to walk. It's the road between the two extremes. It is very easy to get consumed by one or by the other. But I do think this is an area where just knowing that, holding it in your mind and offering yourself a little bit of awareness or kind of correction when things go sideways, I think already helps people an awful lot.

I hope you enjoyed today's conversation with Dr. Scott. If you made it this far and you somehow haven't subscribed to the podcast yet, please subscribe. We'd really appreciate that. It really helps us out. If you'd like to support us in other ways, you can find us on Patreon. It's patreon.com/beingwellpodcast. And for the cost of just a couple of dollars a month, you could support the show and get a bunch of bonuses in return. If you're listening through the podcast feed, you can find us on YouTube. If you're watching on YouTube, you can listen wherever you get your podcasts.

And I just want to close, as always, by letting you know how much I appreciate it that people watch and listen to the show. It has been so cool to be able to do this as my job for the last couple of years. And I just really appreciate it. So thanks again. Thanks so much for listening. Thanks for watching. And we'll talk to you soon.