Latest / Lucid Interval Podcast / Why Did We Evolve To Get Depressed? - Paul Andrews, PhD
Transcript
- speaker-0: Paul, thanks for joining me. ⁓ so can you tell us a little bit about what your educational background is and what you study now? speaker-1: Thanks for having me, Andrew. Sure, I've got a very strange, ⁓ windy, tortuous ⁓ educational background. ⁓ I got my bachelor's degree in aerospace engineering, and then I went and did a a law degree after that. And ⁓ then I went ⁓ and got my PhD in evolutionary biology and ⁓ and now I'm a professor of evolutionary psychology at McMaster University. speaker-0: So I have to ask, ⁓ can you just take us through the decision making process starting with, you know, because it's three really four I guess really d really different things. I mean, how did you start with aerospace engineering and then make it to evolutionary psychology? speaker-1: ⁓ well I think like most adolescents I came out of high school not really knowing what the hell I wanted to do. And ⁓ I went a a lot of my friends were going into university and get going into engineering and ⁓ I decided I guess I would follow that path. ⁓ and aerospace just sounded the coolest. So That's really the how I got into engineering. I did not enjoy it, although there were moments when I did could do really, really well. But motivation was a real serious ⁓ issue for me. and I sort of towards my junior senior year, I became like I've got a Even if I finish this degree, I've got to figure out something else that I wanna do. And I became interested in multiple things simultaneously. I got interested in medicine. I got interested in ⁓ evolutionary biology, particularly the evolution of social behavior, ⁓ which is the thread of which I'm still pursuing to this day. But I also got interested in in law. And ⁓ I did take the tangent to law school, I did finish it. ⁓ But it also was not fully interesting to me. I needed to do something I felt passionate about. And so I decided to throughout that whole time my interest in the evolution of social behavior in psych the evolution of psychology was ⁓ was was something that I was passionate about. And and so that's really the ⁓ origins of my present ⁓ profession. I I will say that I started off being interested in the evolution of altruistic behavior, you know, sac self sacrifice, etc. ⁓ but I was at the University of New Mexico and my two advisors were both interested in psychological pain and the evolution of it. And ⁓ one of them specifically was interested in depression. And ⁓ so ⁓ He had an important influence on me. and it it started me on this path to being interested in depression from an evolutionary perspective, anxiety, suicide. ⁓ and I eventually realized that ⁓ I had something different to contribute than what psychiatry and clinical psychology were offering and stemming from this influence from my advisors. ⁓ So I eventually decided to to focus on that. So anyway, I'm a I'm a depression researcher, but without any clinical training, my training is in evolutionary biology. speaker-0: So you mentioned something there that I thought was an interesting parallel. You we were talking about psychological pain and you know, that that is is that how you see depression? I mean, is that how you conceive of it as a research? speaker-1: Sorry, yeah, why wouldn't I? I mean, I've just by the way, I don't I if you just kind of get one overall impression from me, it's like I go into this area without any real thoughts, ⁓ any training from the conventional wisdom. I I would just say I mean, that doesn't mean that I don't have my own experience with depression, but almost everybody agrees that depression is aversive. It's painful. And so why wouldn't I call it a form of psychological pain? Of course it is. I mean, you know, that now framing it that way might mean something different to different people, but it's like, yeah, it's psychological pain. speaker-0: Yeah, I think a lot of people ⁓ that think of depression as painful would think of it at that in metaphorical terms though. You know, I mean when we think pain, I think most the average person would think of pain as a physical phenomenon. and yet, I mean, I completely agree with you from my own experiences with depression that it it be emotional pain behaves just like pain at the level of the mind. You can't think about anything else but making it stop. ⁓ which I think is kind of the point of what pain does. But it ⁓ to me I think it is kind of an interesting way of approaching it. Definitely I I don't think that's how clinicians would think of it. speaker-1: No, but it it's really interesting. I mean, if you go back ⁓ through the history of painful feelings, you know, Aristotle, as near as I can tell, really didn't distinguish between physical pain and the kinds of aversive feelings that you get that are triggered by, you know, bereavement or you know, ostracism or anything like that. ⁓ and then of course the modern perspective on ⁓ on pain really is is that it's physical pain and emotional pain is that they use overlapping neurocircuitry. ⁓ so you can you can ⁓ you know mask some of the painful feelings of you know sickness or ⁓ whatever with SSRIs and you can treat social exclusion with Tylenol. so w well I mean they have symptom reducing effects. Interesting. Yeah. Yeah. so speaker-0: Yeah, I guess social isolation is probably pretty inflammatory. Honestly, like I'm I'm sure there's probably a connection there if one went to go look for it. speaker-1: Ha ha ha. Yeah, of course there is. I mean the other there are a few other things to sort of throw into the the works here and and one of which is that what we call depression really you know, if we think about how the DSM class, you know, diagnoses or the criteria that make up a major depressive episode, you can see that it's clear that it's encompassing multiple diff phenotypes. Because in the DSM you can have an increase in appetite or a decrease in appetite, an increase in sleeping or a decrease in sleeping. You can have psychomodra agitation or lethargy. You know, and and these things are just bouncing around in multiple ways. ⁓ so it you know, everybody who's thought seriously about this would recognize that the the the DSM's you know classification of major depressive episode is ⁓ is is it's not carving psychological nature at its joints. It's it's it's a catch-all, it's a grab bag of different ⁓ traits. ⁓ and I like to think about three different types, and I'm not maybe even four, and I'm not saying that it's the whole list of possible things that would fit into a major depressive episode. But in principle when you get sick within an infection, you get a type of depression that's called sickness behavior. When you are starving, you get another type of depression. and ⁓ then the kind that's sort of like the classical one that ⁓ that we tend to think about as depression is ⁓ you know maybe ruminative depression the stuff that's triggered by complex social situations. ⁓ There may be multiple types of that as well. ⁓ but ⁓ but technically all three of those it all three of those could fall under an episode of major depression. And and I think all three of them are clinically relevant. ⁓ so that's that's one thing. We I mean it that may be important over the course of our conversation to be Clear about what kind of depression we're talking about, although I think most of the time we're talking about ruminative depression that is feelings of worthlessness and guilt and et cetera, et cetera. ⁓ And then the other thing to bring into the mix that you've already kind of alluded to it, and that is I think I agree with you. I think that there are All sorts of different kinds of aversive feelings. Pain, ca the kinds of aversive feelings caused by physical injury, which sometimes is called pain, but I think we ought to use a ⁓ say that even emotionally ⁓ painful feelings are another type of pain. But whatever. We're they're all aversive feelings and they probably have similar functions. natural selection has given our bodies the capacity to feel so many different kinds of. of pain, we gotta think about understanding them from a functional evolutionary purpose. And when we do that, we'll be in a much better situation to understand depression or many of the other things that you might be interested in. speaker-0: Yeah, I mean it just from a basic it I think there's a basic question, which is why do we get depressed? Which is essentially what you're what we're talking about here. I mean, why would we have that Why would we have pain is also kind of a more ultimate question. And obviously if you look at people who can't feel pain or can't or don't know that they feel it, you know, they don't live very long, you know, because they don't they'll they'll die from, you know, not shifting their their their weight in a chair, they'll get bed sores or things like that because they're just not aware. So like pain literally tells us, I think at a basic level, to move away from something that hurts. I think that's kind of almost technically what aversion is. You know, it's just to move you can either move towards something or away from it. You know, if we were a you know, a a single celled organism and we could move. So there is this it would I think that's what you mean when you say like an aversive purpose to it, that it's to to move away from something that's not good for us, right? speaker-1: Yeah, you're speaking my language. ⁓ this is exactly the stuff that I write and think about. ⁓ I think of all painful feelings as having that ⁓ moving away from or avoiding kind of motivational property. They ⁓ and and then of course they evolved to respond to harmful situations in our lives that ⁓ that would be better to avoid. ⁓ and their aversiveness is what does it. ⁓ so ⁓ speaker-0: Pain is kind of the the mechanism, it's like essentially that that makes us want to behave that way. speaker-1: Yeah, it's crucial. Yeah. Yeah. speaker-0: ⁓ last week I talked with ⁓ Andy Thompson, who's your ⁓ partner and collaborator. ⁓ and we talked a little bit about evolutionary theory, but ⁓ I I he d deferred to you specifically in a couple moments. And one question I've always wanted to ask an evolutionary scientist is can you just explain the terms adaptation and byproduct and and how we think about those things and and how you would differentiate from one from the other? speaker-1: Sure. okay. So maybe ⁓ the the way to think about it, ⁓ let's take ⁓ you know the classic example of an adaptation that nobody disagrees about, and that's the eye. Okay. and the the eye does several things. It ⁓ of course we s know it it's promotes vision. But it's also got this watery, filmy substance, you know, on the outer layer ⁓ that ⁓ you know technically could be useful in convective cooling. It could dissipate heat. And then of course it also produces tears. Now what is it that the eye evolved to do? Well, you know. I think that intuitive answer is it's vision. And if you said that the eye evolved solely to produce tears, it would just make no sense. ⁓ And then all same thing about convective cooling, even though these things are both plausible effects about what the eye does. And that's so we have to ask the question: why is vision the intuitively right answer and the others are not? And the answer to that is that the eye exhibits a high degree of organization. You've got, you know, the lens, the cornea, the retina, the vitreous fluid. ⁓ you know, I'm not an ophthalmologist, I can't even tell you all of the parts of the eye. But I do know enough about the anatomy to know that it's incredibly complicated. And that ⁓ All of the pieces are organized to in in facilitate in one way or another, directly or indirectly, vision. Now, so in some sense, the fact that ⁓ you would I think we would call vision the ⁓ evol ⁓ the the the fun the function, the evolved function of the eye, ⁓ and that These other effects are byproduct effects. And why? Because vision is the only thing that explains the complex architecture, the organization, and the fa and and their their articulated coordination. And producing tears and convective cooling are just they don't they leave all sorts of other things about the eye unexplained. So technically, an adaptation Is ⁓ a trait that evolved by natural selection. Not all adaptations exhibit organization, but it is the hallmark sign of ⁓ what it's a telltale sign. If you've got a trait that exhibits a high degree of organization, the only known natural force that is capable of producing that is natural selection, period. Now that doesn't tell us what it's an adaptation for, but once that I've already shown you what you have to do. What you have to do is try to understand all of that organization, coordination, etc., in terms of a unique effect. If you can identify a unique effect of your trait that helps explain all of the organization of that trait, you've identified its ⁓ function. And then other things. Are more likely that other effects that the trait has that do not explain its organization have to we'd have to resort to other things. A good candidate is just a simple byproduct. Now, by the way, there are parts of the eye that are clearly designed to produce tears, but there's so many things about the eye that are not explained by tears. speaker-0: Right. So like tears kind of are ancillary. They ⁓ they sir it they w act in service of the larger function which is vision. speaker-1: Yeah, yeah. And you have to have the tiered I'm sure if we examine the tier ducts and everything, that would show a high degree of organization for the production of tear. speaker-0: So there's almost like a principle of like parsimony that like you you can't just have a bunch of unexplained parts or unexplained functions in a in this analysis. speaker-1: Yes ⁓ yes, but again speaker-0: Fluis would be another way of putting it, like a bunch of of vestigular unnecessary speaker-1: Organization. Yeah. But the the other thing is, and this is what makes it more than, you know, just a just so story, is that we're trying to explain organization. Okay, and and that is, you know, the word order is ⁓ you know, and organization ⁓ have ⁓ common etymological roots. and you know In principle we can quantify order in at least in certain examples, but a a lot of times we just darn know it when we see it, right? That ⁓ do you ever see the An Antikythera mechanism? You can look it up on on wiki. ⁓ it's a ancient rusted geared mechanism that was found speaker-0: No, I don't think I know what that is. Yeah. speaker-1: ⁓ in the ruins of a Roman ship off of the coast of the island of Antikythra, a Greek island. And it's a Greek mechanism, even though it's found on a Roman ship. and ⁓ it it's it's rusted, corroded, and yet you can see that it has a s a degree of order to it that means that it must have been man-made. and ⁓ And then of course, you know, there the it it was found in 1904, I believe, and then ⁓ the researchers spent a a ⁓ century trying to reverse engineer and figure out what it was that it did. But that was essentially the same kind of process. It's trying to decompose, figure out all the different parts of this rusted geared mechanism, figure out how they articulated together, ⁓ and through you know, trying to identify different ⁓ things that it could do that helped explain all the architecture. ⁓ anyway, we it it's a well it's a well known scientific procedure for trying to I understand an unknown trait or ⁓ mechanism. ⁓ but what you're essentially if you try to f ⁓ articulate what it is s ⁓ this process involves does it exhibit any kind of organization, which is order for an effect, and then ⁓ and then trying to figure out what that effect is, it helps explain all the that that order and organization. speaker-0: And and the effect would be insofar as it like it would increase our ancestors probability of reproduction or survival relative to alternatives, or I mean that's usually what we're talking about with natural selection, right? speaker-1: Well yeah, although I don't believe that anybody has ⁓ formally done a fitness ⁓ analysis of eyes and shown that they enhance reproductive success. What I am but I mean it the the the fitness links are kind of obvious. Yeah. But and and the but I think the formal thing you'd say is my gosh, there's just so much order here. speaker-0: Obvious. Yeah. speaker-1: organization just it it's not the kind of organization that occurs in nature by chance. Natural selection is the only thing that we know of that can do it. And so in s in an this kind of line of reasoning, the fitness effects are inferred by the fact that the organization for the effect occurs. speaker-0: It must be it must be for something, right? The eye's gotta be for something. speaker-1: Yeah, and it's I mean, I actually love these ⁓ philosophical questions, so I'm I'm glad you asked it. But you know, a lot of people like to complain about evolutionary science and say, ⁓ my gosh, you just can't go back through time and and see or observe what these ⁓ you know, ⁓ natural selective processes were. Right? You know, it's true we can't go back in time, but speaker-0: They the same argument about the birth of the earth too. speaker-1: Exactly. speaker-0: You seem to know a lot about it, you know. speaker-1: Yeah, exactly. I was going I was gonna go down that route, that there are many historical sciences, geology, ⁓ astrophysics, astronomy, ⁓ etc., that ⁓ where it is possible to make inferences about ancestral or historical events that are not directly observable because the present reveals the telltale signs of ancestral events. speaker-0: We have we have the yeah, exactly. ⁓ you mentioned a term you said just so story. I've seen that ⁓ criticism, quote unquote just so and I I don't really think I understand what that criticism is. Can you explain what people are meaning when they say that? speaker-1: Sure. ⁓ the the just so story ⁓ I think comes from Rudyard Kipling, who ⁓ produced I'm not an expert in Rudyard Kipling, but ⁓ I think he had a bunch of children's ⁓ type of stories for you know how the giraffe got its long neck or the elephant got its long trunk or how the leopard got its spots. you know, and they're, you know, crazy mythological stories that ⁓ he did ⁓ created just to entertain ⁓ children. ⁓ that in the late seventies, nineteen seventies, bec ⁓ became the ⁓ I guess some biologists Stephen J. Gould and Richard Lewontin, who were very, very critical of the application of adaptationist thinking to social behavior and psychology, particularly in humans, started claiming that ⁓ evolutionary or adaptationist stories ⁓ or hypotheses about a trait were equivalent to Rudyard Kipling's just so stories. So it became an epithet, is that the right word? ⁓ for a hypothesis that ⁓ they claimed was untestable and lacked any ⁓ real ⁓ foundation for for believing it. Now my so so and that has passed through the years ⁓ to be a common criticism of ⁓ evolutionary approaches to human behavior and psychology. ⁓ Again, I think it's ⁓ it's it's it it's not accurate. ⁓ it is true that it's really hard to do good research in human behavior and psychology from an evolutionary perspective. If you're trying to understand something about ancestral selection pressures that have shaped the way our brain works and how we think, feel, and behave. But ⁓ it's not impossible. And ⁓ so, you know, and in principle the the idea is again if we can find telltale signs of organization, high degree of coordination, ⁓ stuff like that in a psychological trait. And the I is a psychological trait, by the way, right? ⁓ then ⁓ we can make inferences about ancestral ⁓ selection pressures, etcetera. speaker-0: Yeah, ⁓ an example of this that I've I've mentioned a few times on this show already is our brain takes up more than twenty percent of our energy. And so obviously anything that leads to efficiency, neural efficiency, is probably gonna be selected for, at least over like geologic time, and that explains things like cognitive bias. You know, 'cause it's just the these informational shortcuts we take are low information rationality. It would make sense that rather than having to constantly reinvent every wheel, ⁓ and just constantly re redefine our our reality, we just kind of get used to things and we make little shortcuts that are heuristics that you know that allow us to function more because it's it's just better. It's also sometimes better to think very, very quickly, ⁓ than it is to constantly re-deliberate everything. Like if there's maybe a predator there, it's better that you don't really think about it. You just kind of have a a heuristic for what the what you might do in that situation. So y y we don't need to go back a million years to know that avoiding predators and by acting quickly was was adaptive. speaker-1: Yeah. ⁓ and I just want a a friendly amendment to that. It's it's also so there you can the way I've heard you characterize that, there's a trade-off between, say, an accurate depiction of the world and doing something that's quick enough and good enough for the moment. And ⁓ but another thing is that it's also there there's plenty of situations where it's not adaptive to view the world accurate. speaker-0: Interesting. speaker-1: It the ⁓ the idea that well, you know, ⁓ every I mean I'll just give you an example from from my area, which is, you know, depression and the comparison of depressed people with non-depressed people. ⁓ you know and if you don't mind, it's a little bit of an interesting s lesson in history. But the conventional Okay. Well, I'm gonna start off with the ancient Greeks and their view about melancholia, which I think roughly translates to the modern ⁓ form of depression. But it was viewed yes, it's an emotional state, but what it did was disrupt cognition and produce irrational, delusional thinking. ⁓ there are reasons why the ancient Greeks ⁓ thought that, but ⁓ fast f you know. Go it go through ⁓ the history of how depression is viewed and the idea that it involved distorted irrational thinking is you know the ⁓ pervailed for millennia. and ⁓ as time went on through the Enlightenment, it became progressively harder for physicians to maintain the view that all of depressive thinking was distorted. They made it a form ⁓ a partial insanity, ⁓ and then backtracked even further to there's one delusional thought. And ⁓ with ⁓ f for some people, ⁓ you know it became ⁓ there's a another tradition that goes back through history too, which is of the melancholic genius. ⁓ Which always competed with the melancholy ⁓ as a cognitive disorder ⁓ throughout history. But the the melancholic genius got its greatest boost during ⁓ the Renaissance and the Enlightenment. And ⁓ William Shakespeare's portrayal of Hamlet's probably the best port ⁓ portrayal of of that the melancholic genius ⁓ narrative. But anyway, really ⁓ there's this point where The melancholic genius and the melancholic ⁓ cognitive disorder were really kind of bumping heads into each other and ⁓ and it forced physicians to walk back the idea that ⁓ depression was really truly a cognitive disorder, or melancholia was. And one of the things that it ended up doing is is people in the eighteen hundreds set were starting to give up on the idea that it was a cognitive that it caught caused ⁓ disorder cognition said, you know what? It's an affective disorder. It went from being an effect a state that caused cognitive irrationality to ⁓ we give up on the whole cognitive disorder thing and ⁓ and it's an we'll call it a depression and call it a d an affective disorder. Well anyway, then you had back in the ⁓ trend fast forward through to You know, nineteen fifties and sixties, you had Aaron Beck reignite the idea that depression was produced distorted thinking, irrational thinking. That really is again the the the that older it's it he he he may not have I can't really tell you how much he was intentionally borrowing from that ancient Greek tradition, but it it's really nevertheless that same story in okay. Now Fast forward to the nineteen eighties, you had increasing evidence based on work by Alloy and Abramson, as well as some stuff ⁓ on attribution theory that showed that depressed people were sometimes more accurate than ⁓ non-depressed people in assessing the amount of control they had over situations and in how they were making causal attributions for successes and failures. Okay, more accurate than non depressed people. Then some researchers were facing with well, wait a minute, this is like a complete reversal of what millennia of research has said that you know the melancholic people were irrational and deluded. And now we're finding evidence that relative to non depressed people they're more accurate. And making better causal inferences. What are we going to do with that? Well, the conventional wisdom came that positive delusions about yourself are healthy, and accuracy and rationality by inference then represent the disordered ⁓ mental state. It's a complete inversion of millennia. of of thoughts about depression. So anyway, here that's a bit of a speaker-0: No, that's fascinating. I I can I can as someone who's lived with depression, I can tell you you get really, really hyper rational and hyper critical, hyper self critical. I'm curious, ⁓ what kind of experiments were done to determine that depressed people were slightly more realistic? I mean, like what what exactly what they're were they having them do? speaker-1: Well I ⁓ I some of my colleagues will you know they're they they will dispute this, but the f it really is the the the first studies that ⁓ showed this were ⁓ judgment of con control studies. So imagine that ⁓ you're a participant and you are asked To ⁓ on every trial, to either push a button or not push a button. And there's a light that will either light up or not. And it can light up when you push the button, but it can also light up when you don't push the button. There will be a certain degree of ⁓ contingency that the experimenter has control of, that they can make the button light up 80% of the time when you push the button and light up 20% of the time when you don't push the button. Or they can make the two contingencies about 50%. So half and half. Does this kind of make sense so far? Yeah. Okay. So and then the but what the person is asked to do after sampling the contingencies is to assess how much control do you have over the light over the lighting of the bulb through pushing the button. And a good rule of thumb is to take the percentage of you know like if you have if it lights up 80% of the time when you push the button and it lights up twenty percent of the time when you don't, is to subtract the twenty from the eighty and that gives you an estimate, ⁓ I have about sixty percent control over the lighting of the button kind of thing. speaker-0: Okay, let me let me make sure I understand those those numbers again. So like if in reality they had twenty percent but they believed they had eighty percent, they would how does that work? speaker-1: So the the experimenter actually controls the probabilities. Okay? Now the problem is that the participant is not told what those probabilities are. They have to sample it out. They have to like push the button a whole bunch of times and try and calculate from that the probability that the bulb will light when they push the button. And then they have to do the same thing. On those trials when they don't push the button. They say, how well, and when I don't push the button, how often does it light up? Sort of figure out it's about 20%. And then when you take the 80% and subtract the 20%, a good rule of thumb is, ⁓ I have about 60%. Now, this is ⁓ this is the kind of situation where in general depressed people outperform non-depressed people. They do better at judging the amount of control. But there's a particular condition in this where the depressed people t ⁓ tend to outperform. You see, if the bulb is lighting up like 80% of the time when you push the button, you kind of don't have to keep track of every fucking pardon my language. ⁓ Hope this isn't a family show. speaker-0: Nope, it's not. It's not. We're good. Yeah. speaker-1: Okay. Yeah. ⁓ you have to keep track of all of this stuff, ⁓ you know, ⁓ technically. But or actually you don't. If it's eighty percent, you just get you know what, almost every time that I push the button it lights up. That becomes a a rule of thumb too. And the twenty percent is ⁓ you can track that by just noting that you know what, it doesn't light up most of the time when I push the button. Okay. Where it becomes more complicated. Is when the two probabilities are actually closer together. Like 60% of the time it lights up when you push the button, and 40% of the time it lights up when you don't push the button. Or 50-50. Now remember, you're not told what the probabilities are, but once you start getting things closer and closer to each other, you actually have to keep track. ⁓ of things, it becomes a much harder, it's harder to use rules of thumb to figure out how much control you have. So the the thing is that depressed people perform better on this task, in particular in those situations where it's hardest. I realize that's a complicated thing, but that's actually the story about depression. It's helpful in helping you figure out complicated things. speaker-0: Yeah, so I wanna I wanna transition to that soon. I just kinda wanna wanna noodle about this experiment, about what I'm thinking now. Cause for one thing, I mean the word control immediately comes to mind is self-efficacy, obviously a sense of self-efficacy has a lot to do with mood and depression. Like if you feel like you have no no control over your life, that tends to be a pr a quite a depressing state of affairs. It almost makes me wonder if you could essentially train a person to believe that they had no control, could that affect their mood? Is one question that comes up. And another one was. ⁓ or just cognitively, is a depressed person more able to focus and hold something in their mind, or like do they have a better sense of these probabilities? Do we do we have an a a sense for like cognitively what's going on that enables them to do that? speaker-1: Well, ⁓ yes to the second question, we have ⁓ some idea of what's happening cognitively. And to the first question about whether or not it's possible to train people to think that they have control. ⁓ I don't think that's the right question to ask. I view depression as a normal response to things going out of control in your life, where, you know, gosh darn it, you gotta find a way to Get some control. You want your life to turn around in a better way. The problem isn't about changing the way you think. The problem is changing what's happening around you in, you know, ⁓ y if you're experiencing depression because you've had a a s you know, a pattern of repeated pattern of rejection, loss, and failure. Well the problem is the rejection, loss, and failure. speaker-0: Right. The the question I was really asking was it was the opposite. If you convince someone they don't have control, would that induce depression? Like essentially yeah, that essentially it's what you're saying. Like all these things are out of your control that that that could create that was kind of my thinking. It's like, yeah, I mean, if you if you could really convince someone that they lack control of what's going on in their life or what's around them, that I think depression would be a natural result to me, just based on my own experience with it. speaker-1: Yeah, particularly if there's some negative consequences, right? Yeah. Yeah. speaker-0: Okay. Okay. We're on the same page. Yeah. So ⁓ and so when you say like that okay, so there's a specific experiment, it's quite quite specific, but shows us where being depressed actually has advantages. You know, what what can we learn from that about what purpose depression serves generally? Well speaker-1: You know, it's I I have to say I my my thoughts about depression have slightly evolved over the years. But I'll start you off with ⁓ what I you know when I became like, ⁓ here's a really strong story I can pursue. ⁓ my one of my advisors back in my ⁓ PhD ⁓ had this idea that depression would essentially help you think through your problems. ⁓ when we were trying to write that up, I was always faced with this, you know, literature that showed that depressed people performed worse on many cognitive tasks. And ⁓ that was a puzzle, right? You know, it's like, well, how can Depression help you think through your problems if you're actually performing worse on cognitive tasks in the laboratory. ⁓ Eventually I realized something that a good cognitive psychologist would have ⁓ considered ⁓ much quicker before me, and that is attention is a limited resource. And if your depression is being triggered about some personal problem in your life, like failing romantic relationship, ⁓ what am I going to do with the rest of my life? Or, you know, financial difficulties. You know, and then you're brought into the lab to do ⁓ one of these abstract cognitive tasks. It's like, you know, then you've got two different sources ⁓ competing for your attention. And If the pull on your attention is stronger for your personal problems, that could actually make you perform worse on the abstract cognitive tasks in the in the laboratory. And I I began to understand from the literature that that was ⁓ that did make some sense. That essentially depressive rumination was so attentionally demanding that it could ⁓ does sometimes cause people to perform worse ⁓ on other things, other tasks that they could be doing. You can sort sort of imagine it too, like the a student who's, you know, going through ⁓ a really difficult romantic ⁓ relationship breakup and also having to do a test the next day. You know, it's like how do you study for the test when you're so consumed about the relationship breakup and everything like that? It's really complicated. So that's okay. So but that was not an speaker-0: Also the those kind of thoughts, rumination, they're they're intrusive too. Like, I mean it it you don't really have the ability to just go, I'm not gonna think about that now. I'm gonna focus on this other thing. It it won't let you do that. I think that what your research, my understanding of it, is that that's kind of a that's a principal feature of of depression is that it won't let you stop thinking about the thing that's causing you pain. Okay, okay. speaker-1: Yeah, that's right. Okay. But that was not enough for me to really help my advisor and and me to answer the question that or that we we thought was happening, that depression would help you think through your problems. And I eventually, after I finished my PhD, came upon this literature that showed that sad sadness, an evolutionary ancient emotion. And one of the key symptoms of depression is produces an analytical processing style. And I mean analysis in the way you think of analysis. It's a like a divide and conquer processing strategy. It's a piecemeal, you know, it's a ⁓ problem is complex, so you try and break it up into smaller, more manageable components, study the components one at a time. This is not the quick heuristic. Processing that you were talking about earlier. This is the slow, effortful, methodical processing style. And when I realized, wait a minute, this fundamental symptom of depression produces an analytical processing style. ⁓ and and ⁓ yeah, I mean a fundamental evolutionary ancient emotion. Wow, this may this helps me potentially solve. Show how or could help me understand potentially how depression could help you think through a problem and also interfere with other kinds of cognitive tasks that have less salience for the individual. But this requires that attention under depression becomes selective, right? That and this is of course what we know about painful feelings more generally. You're faced with a predator. Well, you stop worrying about your next lunch. ⁓ you became hyper focused on that predator, routes of escape, whether or not you should fight or play dead or flee, right? You know, and ⁓ et cetera, et cetera. So ⁓ anyway, ⁓ yeah, ⁓ what I now what I can tell you now is that ⁓ this this analytical processing style does occur. in depression. ⁓ we can talk about the kinds of problems that require analysis and and why why this happens. ⁓ but you had asked do we know anything about the cognitive process and and yes we do. ⁓ so I guess I'll pause there and see what kind of ⁓ you know Where you want to go. speaker-0: Yeah, well, I mean, so this type two thinking, I guess, is what Danny Kahneman would call it, right? There's like type one, which is like fast, and then type two is slow and deliberative. And that's essentially what rumination is. I you did mention the word sadness and ⁓ I thought that ⁓ maybe we could take a little pause to talk about I think up for to a lay person, they would think that the depression means feeling sad. ⁓ and is there i I think that depression probably would encompass feelings of sadness and other things, but ⁓ a lot of times depression encompasses Not feeling anything at all. ⁓ so ⁓ can you just I don't to the degree that you think is necessary, is there any distinction to be made between like sadness or or painful feelings and, you know, the the technical term depression? speaker-1: Well, ⁓ I disagree with those who want to say that sadness is the normal non-pul pathological end of depression. They would reserve some of these some of my colleagues would say depression is a word that we reserve for the pathological state, and sadness is the normal non-pathological end. And the reason why I say that I disagree is because depression is ⁓ usually recognized to be a syndrome. A syndrome meaning it's ⁓ the co-occurrence of feelings and thoughts and behavioral physiological changes as well. And in depression, you the the the you know like the way the DSM classifies it, you'd say, well you gotta have sad mood potentially or anhedonia, then you have you can have ⁓ Excessive thoughts of guilt or worthlessness, you can have ⁓ increases in appetite or decreases, changes in sleeping, difficulty concentrating, ⁓ fatigue, left or fatigue or psychomotor agitation, and suicidal thinking, you know, are the the the things that are the group or the that the syndrome can ⁓ can encompass. But if sadness is one of the symptoms, then it can't be be the case that sadness itself dis is a marker of normal, right? It's something that exists across the continuum. It's one of the features of depression. And so that's the first thing I would say. Second thing is is I think ⁓ most emotions, most evolved emotions, whether it's anger, you know, ⁓ disgust ⁓ you know, fear, etc. You know, they don't just produce a f the feeling, they produce multiple effects in your physiology and behavior and cognition. So let's say sadness is ⁓ just like all these other emotions and it produces effects on ⁓ cognition ⁓ and physiology, I propose that it's very possible that the features of ⁓ the symptoms that are in depression in the DSM ⁓ are expectable under ⁓ the idea that sadness itself produces changes in cognitions and physiology and everything like that. So I'm I'm basically proposing you can get that sadness exists on a continuum. It produces ⁓ whole body responses to things which change cognition and attention and physiology and and behavioral things. And that's exactly what we have with the depression as the DSM diagnoses it. I I don't think it's really a a syndrome in a pathological sense. I think most depression is a normal response. It's just sometimes a sadness and its consequent effects. last for a short time and sometimes they last for a long time, depending on the severity of the the problem. speaker-0: Yeah, I mean, well, if ⁓ you can say that I was just thinking, if depression is a syndrome, if you think of it that way, you could also think of sexual arousal as a syndrome. ⁓ you know, as you defined it. You know, I mean it it yeah, I mean it's there's a collection of different things that happen both in physiology and psychology and behavior and attention and hormones, you know, I mean, blood pressure. ⁓ you know, there's all kinds of things that are there, but it doesn't necessarily mean that they're it's a disease. speaker-1: Fear is one that's been well studied ⁓ in terms of its effects on attention, ⁓ flight or fight or you know, ⁓ fight, flight or freeze response. ⁓ and we know in term mechanistically ⁓ the activation of the HPA axis during fear suppresses reproduction, the the HPG axis. and ⁓ you know speaker-0: Well, depression too is also something I was thinking when you were saying you're not thinking about lunch if you're running from a tiger and trying to avoid being lunch. ⁓ you're probably also not thinking about mating. ⁓ and of course, w depression notoriously affects appetite and libido. speaker-1: Yeah, yeah, yeah, yeah, absolutely. speaker-0: So so I mean, it just makes sense that it's almost like your body knows we've got another problem to solve that's more important right now, and that problem requires deliberative, iterative problem solving, which is like this this analytic rumination, right? speaker-1: Yeah. Yeah yeah. Do you wanna do you wanna hear more about that? speaker-0: I would love to hear more about that. speaker-1: Okay, so when we were s you know, Andy and I really kind of wrote the first detailed article ⁓ on how this ⁓ analysis as a ⁓ something that's promoted by sadness really can help ⁓ explain a lot of the features of depression. ⁓ but one of the things that we started thinking about is we You know, researchers, depression researchers have long known that stressors are can trigger depression. But not all stressors and or all the time. Like for instance, you know, sometimes a lot of times divorce is a depressogenic event. But sometimes it's not. Sometimes you might be happy to get divorced, right? You know? and ⁓ so Our question was: Is what is it about events that make them depressigenic? And it's not just the fact that it's a negative stressor. It's got to be something more than that. It's got to help explain why sometimes a stressor causes anxiety, other times it causes depression, sometimes it causes both, for instance. ⁓ When we started thinking about the analytical processing style as maybe one of the key features of depression, we started thinking, well, what's that analysis useful for? Complex problem, right? ⁓ a problem with multiple elements to it that make it difficult to solve through quick heuristic ⁓ type one thinking. And so ⁓ yeah, we started thinking about Depression then being an evolved response to complex problems, and the evolved function of depression was to promote an analytical processing style that could help you think your way through that problem. ⁓ I have since pro modified this ⁓ somewhat in my own thinking. I haven't written about it fully yet, but ⁓ that it might be a little more beneficial to frame it as instead of a complex problem, a complex question. and the there's a reason why I started ⁓ making that that slight change. First of all, if you've got a decision to make and that's your problem, do I do X or do I do Y? And it's really complex about what you're supposed to do. Well that is a question still. A complex problem is a is a can be defined as a complex question. But but through my interactions with ⁓ Steve Holland, who is a ⁓ an academic ⁓ depression researcher in your own ⁓ neck of the woods at Vanderbilt, ⁓ yeah, he he tends to think of depression as being characterized by you know beliefs about worthlessness. Or excessive guilt. That's of course one of the symptoms in the DSM. But the way a cognitive behavioral therapist is trained to think about ⁓ a patient who's expressing signs of worthlessness is that this is a fully formed belief that ⁓ the ⁓ the therapist needs to help the ⁓ patient ⁓ Test and and you know ⁓ evaluate. But they they tend to view thoughts of worthlessness as irrational. Why? Well, if you think that you're worthless ⁓ at a at a deep level, there's nothing you can do about that, right? It's like I'm worthless why? Because I'm unattractive or I'm un unintelligent or you know, these are It's a character when it becomes a characterological assessment, this is who I am, ⁓ then it leads to the idea, well, it's just who I am, I can't do anything about that, and it leads to passivity, and ⁓ that means ⁓ you're gonna under this characterization of depression, you're not reacting to problems in your environment, it's maladaptive, ⁓ etc. now one of the things that I have learned about this ⁓ symptom of worthlessness when you cross-reference everything that we know from different areas of psychology, it a sense of worthlessness, first of all, is like it's tied to low self-esteem. Right? The word worthless ⁓ it really just means I'm really, really low in my self-esteem. and ⁓ in a response to some kinds of negative events, it's actually is goes in the opposite direction of producing passivity. It can actually motivate you to improve. So here's a good example of this. It's an area that's pretty well studied, but ⁓ physicians ⁓ who ⁓ I I I think you have a a fondness for understanding psychiatrists and physicians, you're gonna love this stuff. Because ⁓ physicians sometimes make serious medical errors. As of course, it's just a human fallibility that makes this a possibility. And ⁓ a lot of research has been done on physicians' emotional responses to their medical errors. And here we're talking serious stuff. It could be a patient is irreparably harmed or even killed. And as long as the physician is not a psychopath, right, they're gonna feel miserable about it. This. They didn't get into the business of medicine to hurt people. They came in to help people. ⁓ And when they seriously hurt a patient, they they they can be miserable for that, that ⁓ they can also their jobs may be in jeopardy, lawsuits, ⁓ they the their reputations may be at harmed. You can kind of already begin to imagine that the emotional response of a physician who's made a serious medical error. Can reach clinical levels of depression, anxiety, and acute trauma. And and okay, that's the first thing. Second thing, we know that ⁓ the more angst they feel, I mean, I'm just imagining here's a graph here, the more angst they feel, the greater the depression, anxiety, etc., the more they take measures to change their practice to learn from their mistake, so that Nothing will happen again. So they won't make the same mistake again. And in this context, a sense of worthlessness or a loss of self-esteem after making this serious ⁓ medical error ⁓ can actually is part of a crucial thing that helps motivate the physician to make these corrective changes to learn from their mistake. So ⁓ If I may, I'll give you an example from that's published in the literature. ⁓ in Britain residents I guess are called public ⁓ health ⁓ gosh, officer, something else. Let's just call it a resident in Britain. This is a ⁓ a researcher was interviewing residents in Britain and asking them speaker-0: Please. speaker-1: if they had ever made a serious mistake that harmed a patient. And ⁓ this one resident who's being interviewed, I think it's a guy just by virtue of the language that's used, says, ⁓ yeah, well ⁓ yeah I've made some mistakes. ⁓ you can ⁓ there was this one time when I didn't call senior ⁓ my senior attendings ⁓ superiors ⁓ fast enough and that person died. And then there were two other times when they didn't check lab results quickly enough and those two people died. and ⁓ but you know you could almost say that it's not really my fault. Why? Because you know I'm a resident. I'm supposed to be supervised. So you could almost blame this on the the the my attendings. I mean it's just really off putting to see this person in you know in this account so blithely talk about three people that he he, maybe she possibly killed, because they were, you know, had made serious mistakes. And then to f essentially blame it on the attendings. And the reason why this is such a problem, what what is so poignant about this story is Actually, what you what you and I I think would want to see is some measure of like, yeah, this was horrific for me. I really screwed up, and I I'm I did everything I could to learn from my mistakes on this, right? To to own it, to take some responsibility. But what you don't see here, ⁓ actually you might say under one characterization of what's healthy. that exists in the literature, this person is exhibiting perfect signs of mental health. Right? There is no speaker-0: Like I'm sure their work was not impaired at all as a result after yeah. Yeah. But But maybe it should have been. I think that's the point. Maybe we would want their work to have been impaired a little bit so they could do something differently. speaker-1: You could imagine, right, the same s fact scenario, three patients killed, but the way the person responds is I'm mortified about it. ⁓ I I, you know, but there's no sign that this person really truly accepts responsibility for it. There's no sense that they're trying to learn from the event. And there's no real sign that they've lost any self-esteem from the event either. ⁓ And so that's where I was trying to go is to actually use this as a as a one and an anchoring point. No misery, no loss of self esteem produces no corrective changes in behavior. That was what I meant by saying the more agony, the more sense of responsibility, the more like I screwed up, this was my fault, the more the corrective change afterwards. So ⁓ and by the way, the researcher who ⁓ wrote this all up. She basically said ⁓ that our current training our current emphasis in training on making our residents, our trainees, feel, you know, okay about themselves after making mistakes is possibly counterproductive. Learning opportunities have been missed. And other researchers in this area have said You know, strong negative painful feelings are not forgotten and seem to be crucial to the learning process. speaker-0: Yeah. So before we were talking about just like the the problem of misdiagnosis. Yeah, I was bringing this up. and yeah, if ⁓ how would you ever get someone to recognize that they were wrong? If you know, if they if they just weren't willing to learn, you know, from their mistakes. ⁓ there's like a powerful incentive, which is this emotional incentive. It's also something I was just listening, I kind of had a light bulb go off. ⁓ You know, I often with evolutionary psychology, I tend to think about it from the point of view of the person. Like in this case, this this resonant. I just felt I was so I felt so ⁓ it was so repugnant, this person's attitude. Like I, you and I think you and I were sharing a feeling of this is so odious. Like I felt almost recoiled in disgust almost. And I was like, ⁓ of course the the way everyone else is gonna feel about their behavior has a lot to do with whether it's In this case, what kept coming to mind was this is so antisocial because other people would think, ugh, like, you know, I definitely don't want to marry that person or share my food with them or, you know, I mean, this is th it's almost psychopathic. You know, I mean, not quite, but you know, and it is interesting, I've made this point before that the word antisocial and maladaptive are are essentially, you know, synonymous or unhealthy. You know, antisocial or maladaptive and unhealthy are kind of all the same thing in in psychology and at least in mental health. ⁓ that it was like, ⁓ yeah, that everyone else would expect you to feel these feelings. speaker-1: I well yeah, and I think I I don't know if this guy is psychopathic. ⁓ by the way I'm not I think it just may have been really kind of dense because if he was really psychopathic he would not have been so willing to share this story. Because most psychopaths actually have a pretty good theory of mind. They know how other people are gonna react to this story, ⁓ and and know that their actions would not be viewed Positively. ⁓ so I I just I just wonder if this guy was, you know, particularly dense. speaker-0: Or narcissistic or or or also I could see how it's a compensating mechanism to just cause it's just not capable, assuming it's a he, not capable of truly recognizing the harm. So there's just kind of like a bypassing that happens, like an externalization of responsibility because it's it's just kind of psychologically intolerable to that individual to recognize that they've made a mistake. speaker-1: Yeah, you know, I just want to go back to that literature that I was kind of telling you about in the nineteen eighties that said that people have that healthy people have positive delusions about themselves. Right? ⁓ and that they ha they were forced into that narrative because depressed people were more accurate ⁓ about the amount of control they had over situations and in their causal attributions. So anyway, yeah, I mean again that literature The positive the healthy positive delusion literature would suggest that this this resident was ⁓ yeah, mentally healthy. Good job guy. speaker-0: I had a ⁓ torts professor my first year who was ancient, truly an ancient person. and he used to say there's two kinds of people in this world, the ones that don't know what's going on and the ones that don't even suspect that something's going on. And I suspect the second group of people are probably much happier. You know what I mean? There's this there's this saying, ignorance is bliss, and it's kind of like, yeah, I mean, the then this it this also relates to intelligence as well. The smarter you are, the more existential your level of worry tends to get. speaker-1: Yeah. ⁓ and I I am not of the opinion that we ought to be searching for happiness in the world. ⁓ I I'm not against you know, the ⁓ I'm not looking for the pursuit of pain either. ⁓ but each of it each of those things have it has its place, right? And ⁓ if you just think about the pursuit of happiness as a goal in and of itself, it doesn't it lead to just the mindless suppression of pain. and you know, why don't we just all just shoot up on heroin or cocaine speaker-0: There's an Epicurean Yeah, that's one way to go about it. ⁓ I think the Buddhists kind of have a better approach to it, which is that r by renouncing the need for happiness, you tend to get pretty happy. ⁓ and it's one of these many contradictions that I kind of I look at on this podcast. It's it's really the craving for happiness. It's really more like a a saying, I'm not happy with what I have now. I need something more. ⁓ but yeah, it's it's it's kind of a riddle. But you're I g I get what you're saying that I mean also in some cases. If I I I can just think I've known a lot of people who've had issues with things like addiction. and they've made a lot of mistakes in their life. And there's a part of the recovery is coming to is reckoning with the wreckage of your past. ⁓ and I I have been wondering, I wanted to ask a lot of this seems to touch on guilt. that that like there's the relationship between guilt because it's in essentially I have made a mistake. ⁓ is is a lot of what or or something has happened and I need to solve this problem. Is is guilt separable from your kind of your view of like this analytic rumination? speaker-1: Well, ⁓ you may remember we talked a little bit earlier that the DSM says that ⁓ one of the symptoms of ⁓ a ⁓ major depressive episode is excessive guilt or worthlessness. and so guilt you know, we can argue about what constitutes excessive guilt, but guilt is ⁓ part of this ⁓ the assessment of of depression. I would My understanding, I'm not a clinician, but I've spoken to clinicians, and this guilt is not necessarily guilt in the sense I have done wrong to someone else. It is ⁓ more of a self-blaming thing. ⁓ and that could be I've done harm to myself. I I am responsible for a harm that I did to myself. ⁓ Yeah. And so that's speaker-0: This is all my fault. speaker-1: that sort of self-responsibility, self-blame. So, ⁓ but that that is does seem to be kind of getting at some of the I I would say is is it central to all episodes of ruminative depression? I don't know that it needs to be that way, but ⁓ and probably not, but probably a lot of the serious ones, most of the serious ones. speaker-0: I think you kinda answered what I was getting at is you don't have to have actually done something wrong. It's it's enough to simply interpret everything as if it was your fault or to interpret most salient things as being your fault. speaker-1: Yeah. Now I I will come back to this thing about why I focus on people having complex depressed people having complex questions. This I think that most people who are depressed and have this sense of guilt and worthlessness have not that this is not an ir these thoughts that they're having are not irrational given their experiences. A lot of depressed people have, I mean, seriously depressed people, are ones who have a pattern of failure, loss, and rejection. Okay. And ⁓ you know, if it's just one little failure or one little rejection, a lot of us can shut you know, you know, throw that off our shoulders and move on with our lives and still maintain a positive self view. But when you start having Repeated instances of rejection, loss, and failure, it becomes hard to ignore. And you gotta s we need to have some mechanism for correcting courses of action in our lives so that we can try and change things for the better. And when you start asking why do I have this pattern of rejection, loss, and failure, it's not irrational to ask, did I do something that Or do I there are things that I'm doing that are leading to this? And it would be useful for me to know if I am, so that I can stop doing them or turn it around and make a correction, something like that. So I would say that the people who have these thoughts of guilt and worthlessness often have real events in their lives that they are struggling with, like why did I have these losses, failures, and rejections? And they have questions about are they my fault? Am I am I to blame? And am I not of high value to myself and others? And speaker-0: Yeah, it's also ⁓ I'm thinking of adverse childhood experiences as well. I mean, ⁓ especially in childhood, I've learned a lot about this recently, that you know, a child kind of can't i is at a certain age, ⁓ not even capable of conceiving the fact that it's their parents' fault. You know, I mean they just b they c there's children are very, very egoic, so they can just kind of tend to internalize responsibility for a lot of things and especially if that's the only thing you've ever known. So children who have bro grown up in an adverse environments ⁓ It's it's would only be natural that the natural conclusion will be I must be worthless, I must I must deserve it. ⁓ and so that can kind of set your model, like your your schema that you operate under well into adulthood. speaker-1: Yeah, I think I so it I would just say that we that that story, that narrative about adverse childhood experiences ⁓ i is probably ⁓ a little bit more complex than than the way it's normally described. For instance, by the time I mean, you know, y children who have these horrible experiences and they grow up to adulthood, their cognition changes and they're a lot more sophisticated. Now I think again there if you've had parents mistreat you or others, it is a strong message that ⁓ you know it's like heck if your own parents are mistreating you, what's the rest of life gonna be like, right? You're that's the I think the the the the the narrative there. But I I still think that what's happening in adulthood, at least the those who Go and seek treatment is, you know, it's still a question. It's like I've had all these experiences, my own parents treated me poorly, whatever. is this what I have to look forward to for the rest of my life? Or is there something better for me? I I I mean, if you talk to Steve Holland, which I suggest you do, he's got a number of ⁓ former clients where you know they've had Here's there's a story of this woman that ⁓ had been ⁓ sexually assaulted when she was ⁓ something like fifteen from her father's friends. And ⁓ she tried to tell her father about it, and the ⁓ father for whatever reason ⁓ ignored her. Maybe it for him it was the most convenient thing to do. But it had a real dramatic effect on her, of course. ⁓ And her mother had passed away a couple of years earlier, so she couldn't rely on her mother to protect her. So you would, you know, you could say she developed a schema ⁓ of ⁓ worthlessness and and everything. But she did seek out treatment later, and she apparently understood that not all men were as bad as what she had experienced in her teenage years. And but she didn't know how to not treat men as the fearful thing that she had learned to from that experience at age 15. She needed some help at ⁓ as an adult to get out of that or to maybe reset the schema, if you will, or something like that. But even that story that I'm telling you there is just a little bit more complicated than ⁓ she's just got a negative schema. that affects her ⁓ into adulthood. In this case, she she still has questions. Yes, I learned this through my adolescent years, but it's like, do I need to carry that same lesson forward to me now that I'm an adult and now that I've had some maybe some more positive experiences with men? What can I do to change things? And so ⁓ but again, depression I think helps you deal with those kinds of complex questions. And maybe it's the thing that leads you to go seek treatment. speaker-0: So you mentioned treatment now twice, and I I guess I want to talk about what that means because something that we've sort of been dancing around here ⁓ and talked about in the pre interview is the way that medicine approaches this problem is is does makes no sense in regard to what you're talking about. I mean, it typically is to prescribe antidepressants, SSRIs or S N R I's. ⁓ what you seem to be describing involves therapy. like talking with someone, either in ⁓ sort of supportive therapy or experiential therapy, and we could sort of get into that at a certain point. But ⁓ what's your view on the way that that like medicine is viewing depression? speaker-1: ⁓ yeah, I mean of course medicine is a that's ⁓ speaker-0: That's a huge yeah, that's not a monolith, right. speaker-1: Yeah, yeah. ⁓ I mean, even the field of psychiatry has a bunch of different kinds of people within it with different viewpoints. and ⁓ you know ⁓ I work with some excellent psychiatrists. But I would say that the the model ⁓ that treats depression as a mental disorder, ⁓ if you meet certain criteria, say in the DSM or the OCD or whatever, ⁓ I think is seriously problematic. ⁓ If we think of depression as a signal, ⁓ like physical pain, that something is wrong and there's a harm ⁓ that is you're facing or is threatening that would be best to avoid. The question is what is the nature of that harm? But but our bodies have to have signaling systems that something is wrong. Okay, we need to have that. The problem with the DSM's approach and and ⁓ and and most of psychiatry ⁓ is that it treats the pain as if it is an index of something going wrong in the nervous system. Rather than being a healthy nervous system telling you that there's something wrong that you need to address. ⁓ I don't know if this is making sense, but the the the the it's like there are different ways, I'm just put it in a different domain. There are like I'm gonna say four different reasons for having a fever. By far the most common is that you've got an infection. But you could have a heritable disease, it could be Caused by a tumor, or it could be caused by an adverse drug reaction. Okay. But you know, one of those ⁓ for sure represents essentially the product of a healthy nervous system and immune system. That is fever producing ⁓ being the response to ⁓ an infection. and it's ⁓ it's in some sense a signal, hey, you've got an infection. You know, you need to slow down and it and it does ⁓ it it helps ⁓ your adaptively coordinate your immune response to the infection. speaker-0: This is this is ordinarily what they we would call a symptom in the disease model. speaker-1: Yes, that's right. ⁓ but but I'm just sticking with, you know, the way internal you know, the the f the different fields of medicine would deal with the fever is technically what they want you they should be doing is trying to rule out ⁓ you know, consider all four hypotheses and and the the how you treat it depends on what the cause is. If you've got the fever because it's ⁓ caused by an infection, maybe an antiviral and antibiotic is actually a a good treatment response. But ⁓ you know, and if you've got ⁓ it being a ⁓ heritable disease, you the better idea maybe to suppress the fever ⁓ you know, with drugs. I there are particular drugs for for that kind of thing. And of course, if it's ⁓ caused by an adverse drug reaction, well, you want to either train drop the drug or change the drug. How you treat is related to the cause. That that is the problem that we are ignoring in psychiatry, particularly when it comes to depression. We have a diagnostic system that most people understand. Over pathologizes normal emotional responses. It is not accurate distinguishing between a normal emotional response and true pathology in the nervous system. And yet it's the major treatment is to treat it as if there were something wrong in the nervous system. The use of medications that that do, you know. And if what the depression is really, we should be interpreting depression. If we should be interpreting depression as a signal that something in the environment is wrong, suppressing that signal is actually going to be counterproductive. speaker-0: Right. Exactly. So that's again, like pain. It it serves a really important purpose. If you just have like if you're in constant pain and you just take painkillers, but like what if the pain is telling you that like you have an abscess on like your backside? You should want to know about that. You know? I mean it's important to know or if you've been shot. I mean you can imagine if like if you in medicine, if someone had a gunshot wound and they're like, ⁓ my god, it hurts so bad the doctor's like, We'll give you some opiates, you can go home. Like I mean, that that it it's it's it's kind of almost a fatuous way of thinking about the problem. To say like, ⁓ this person this person they're in such pain they think they've been shot. speaker-1: Absolutely, absolutely. Well, and if you think of depression as being caused by complex problems or complex questions, and you suppress the ⁓ the symptoms with medication, well you gotta we gotta s I can't tell you I know for the answer to this for sure because I consider it ⁓ frontier science question. We have to worry. about the potential that we're actually interfering with people's ability to answer their complex questions. Right? speaker-0: Right. So may the may the the like the the medications like impair the cognitive processes is a one question that I would have. But also just like do they do they negate the motivation to do it in the first place? speaker-1: Well, here's an angle that might you might find interesting. I view suicidal ideation and behavior as largely it's a question. It's a complex question. Sometimes people's sense of worthlessness, you know, just imagine, you know, it's that the pattern of systematic rejection, failure, and loss becomes so great. That people's sense of worthlessness becomes like, yeah, this is irreparable. I'm never going to get out of this. ⁓ and that is the kind of thing that could potentially lead to suicidal ideation and behavior. But what happens during ideation is fundamentally a question, a complex question about whether or not it's better to live or to Stop the pain and end it all. And what we know about that process is it is it is not the impulsive thing that we have been made out to believe. It is very much an analytical process. ⁓ I by the way, you go back and read Hamlet's soliloquy, to be or not to be. speaker-0: Be or not to be, right? It's a deliberation. speaker-1: Yeah, absolutely. Another great one is ⁓ Alfred Tennyson's The Two Voices. ⁓ he had a period of suicidal ideation after the death of his best friend. And it's a much longer poem that's all about, you know, two voices inside of him battling it out, you know. and what we you know, most people when they go through this ideation process, they end up deciding You know, most people who ideate don't go on to make a plan. And most people who make a plan don't go on to make an attempt. And of those who make attempts, most of those don't go on to complete. That's, you know, you know that. But that's my evidence. I would take that as a sign that the most of the time as people are going through this analytical process, they exit it without going further. Because they end up deciding, you know what, it's better for me to live than to end it all. And speaker-0: They've come to the conclusion, basically. speaker-1: Yeah. ⁓ now I'm not trying to dismiss the fact that ideation is a risk factor for completion. I it's true. It's just that it's not a great risk factor. You know, it's not perfectly predictive by far. And anyway, the ⁓ the people who have studied suicidal ideation in detail, ⁓ I mean there's this guy, Richard Maris, who in nineteen eighty one ⁓ produced this book on his he's a sociologist and he basically produced an in depth ⁓ analysis of ⁓ people who completed and he basically said that the people who complete have made a fairly accurate assessment that their chances for a relatively stable life ⁓ relatively stable, tolerable life are indeed minimal. That's those are the ones who complete. They have made an accurate assessment over the course of you know a long ideational process that ⁓ you know anyway, it's speaker-0: Yeah, no, I I wanna I wanna say on that, like, 'cause this is something I've thought about a lot myself, that the idea that that the the ideation around the decision in your own life is always irrational. ⁓ is is per se pathological, is a complete misunderstanding of what it's like to experience that. And ⁓ this is the thing in medicine, the first thing they're gonna do is is try to you know, and maybe not the first thing they'll do, but Typically it's just to to contain you, you know, to have you committed and to make sure you're so either you're observing that you don't do it. There's various degrees of risk factor that I think a clinician would assess, but ⁓ whether or not that level of intervention is needed. But in many cases, I think it's it's a it's like a hyper rational conclusion. If you if your assumption, the premise, which is that you have no good reason to believe that your life is gonna be anything other than constant and ever increasing misery, it would almost be irrational not to do it. ⁓ and it kind of gets back to what you were saying earlier, like there's something about being happy that might require a certain amount of delusional optimism. speaker-1: Yeah well. Yeah, yeah, absolutely. I I think I just to close the circle, because I think you were asking about treatments, I was I was proposing that antidepressant medications may interfere with people's ability to answer the questions that they're trying to answer. Particularly if depression promotes a careful, analytical, scientific even kind of approach to those questions. And if the medications suppress the symptoms that make that possible, then well, is it possible that the antidepressant medications might actually increase the risk of suicide? And isn't that one of the the the questions of concern about these drugs? Is that you know it's a complex area of research and I'm, you know, not an expert in it, but ⁓ I have some understanding of it and ⁓ You know, it there is that's there's a black box warning on these SSRIs that they may increase the risk of suicidal ideation. speaker-0: Rapid onset. Yeah, rapid onset. I mean just all of a sudden. Yeah, it's a real it's a real risk, particularly in young men. speaker-1: So that was me trying to ⁓ answer your question, but also feed in this other idea back to the idea that that depression is really about complex questions that people have in their lives. And ideation is geeze, it's such a powerful example of that. Right. It's it the question is, is do I go on living or do I end it all to end the misery? Yeah. speaker-0: So, you know, given what we've been talking about, one of the things that has concerned me a lot, ⁓ for basically since the very first time I even saw a psychiatrist is how they have that profession has decoupled from therapy almost entirely. I mean, it it's it's now it's strange to mention, you I've had a couple psychiatrists on the podcast and they're also therapists, but it's weird that we need to add that qualification. ⁓ it it does make me wonder I kind of have a I I I don't have to say I would fully develop a hypothesis yet, but ⁓ it it seems like that the the lack of attending skills that they have, the lack of skills for therapy, has a lot to do with why they're medicating, you know, using SSRIs. One problem that we have is they don't spend enough time with their patients to really be able to to differentiate between whether something is truly pathological versus whether it's, you know, an ordinary life response. ⁓ and another issue is that they just they, you know, they There's also a lack of communication because of the in the United States we have HIPAA loss. So they they're generally not in regular communication with the therapists. ⁓ do you have a sense for the kinds of when we say therapy, that that could mean a lot of things, but I think the ordinary person would think of it as going to see a psychotherapist. ⁓ do you have any sense for what kind of approaches to therapy might be more or less effective given like your hypothesis? speaker-1: ⁓ yeah. ⁓ I think actually in general I think talking therapies, psychotherapies are ⁓ probably better than the antidepressant medications. ⁓ we haven't fully talked about the reasons for ⁓ you know the the neg all the the mechanistic reasons to believe that antidepressant medications are problematic. ⁓ but the but they have to do with the fact that your the drugs are interacting with your nervous system and other parts of your physiology. ⁓ i and most people their physiology is fine and to monkey with it is gonna cause some negative effect. But the the other part is that the drugs won't help you deal with the stressors, stressor or stressors that are causing your depression. ⁓ They suppress the symptoms and that might be feel like somewhat of a relief, although it takes several weeks for that to develop. And ⁓ but but the therapy if but talking therapies in principle can help you work on you know in a positive way on on addressing the complex problems and situations that you've got going on in your life. I do think that those therapies that do more to help you with that, problem solving and and everything are ⁓ gonna be more helpful. One of the things I do like about cognitive behavioral therapy as developed by Aaron Beck and his ⁓ his followers is that it really does take a scientific approach to depression meaning ⁓ they ask they they use Socratic questioning to help the depressed patient ⁓ develop hypotheses about ⁓ their own thought processes and their situation and They encouraged the testing of hypotheses. And throughout this process, they encourage the use of analytical, deductive, scientific kinds of reasoning. I've already told you, I think that's what depression does. Okay, so cognitive behavioral therapy, I think, in many t many times is working with rumination rather than against it. However, I do think it does it can be tweaked in better ways. I think the idea that that comes from that tradition that depressed people who are expressing worthlessness or guilt are behaving irrationally is wrong. ⁓ and in my extreme example I gave you ⁓ of people who completed suicide who Researchers have assessed, no, they really understood they had little chance of having a stable, tolerable life. ⁓ speaker-0: In fact, like in fact, that ra as opposed to just it's their perception. Because sometimes you could think that and it's not rational. I mean, that's that's a possibility. That's plausible. But also for some people for whom I mean, ⁓ people who have terminal illnesses is a is a like a an obvious example of this. If you if you really are right that you're like you're just facing a nothing but ever increasing amounts of pain, kind of becomes arguably ra irrational not to consider it. speaker-1: Yep. Yep. So so I agree. So so anyway, I think if cognitive behavioral therapy could be tweaked to help the therapist understand that the patient's thoughts of guilt and worthlessness are often have a rational foundation, ⁓ you're you c you still it's the right thing to do to help them ⁓ figure out ways that they can Turn that around and gain a greater s greater sense of worth. ⁓ but ⁓ but just treating the depressed person as irrational, I think is is isn't is one of the counterproductive aspects of CBT. But I there's a lot, I hope you're hearing me say there's a lot that I like about CBT. I think it just needs to be tweaked, particularly in that that that dimension. speaker-0: Love to talk to Steve Holland, ⁓ about it for sure. 'Cause I've I mean, it's the the evidence base and every evidence based treatment is CBT. and I've always wanted to get a better understanding for what it was. I can just say, again, as someone who's you know, I I'm one of these people who's tried basically almost all of the treatments for depression except for I never did electroconvulsive therapy because I just wasn't willing to. I never had surgery. I mean, obviously I didn't have a radical singulatomy or something. ⁓ but other than those two things, I mean I I did basically everything that that you could do. And so CBT is one thing I went through and it's ⁓ it is counterproductive to be basically treated like you're crazy. You know, essentially I mean, because you certainly feel it feels very rational. And in some cases it it it like it is. I mean we've been talking about this in some senses being depression Being depressed and becoming hyper rational are kind of two sides of the same coin. And so it's very hard to just refute someone's rationality. You kind of have to meet them where they are. If for no other reason, then it's counterproductive to feel like you're insane. You know, if you just if you feel like you're being unreasonable, it it kind of for me just made me feel worse. speaker-1: So ⁓ yeah, Andrew, I mean, I'm not a therapist, but I can tell you how, you know, the way I think about ⁓ how patients should be approached. You know, first thing if if I if I were a clinician, I would want to, you know, I would start off under a r an ⁓ an assumption that I think is just a reasonable one to start off with, and that is this is a nor depressed patient is probably having a normal response to problems in their life. So I'd ask detailed information about, hey, tell me what's going on in your life. Sometimes depressed people are not very good at articulating why they're depressed. Now there can be for a number of reasons, but ⁓ one thing to do in that situation is, well, okay, if you're saying that you're not thinking about anything, what are you trying not to think about? Right? But the The other the thing that I would try to get at, and and you can tell me if this applies to you or not, and your own experiences. I've I've I've seen a little bit about what you've claimed about your experience. and but is it possible that you were struggling with complex questions in your life? Those complex questions could be, yeah, what am I going to do with my life? ⁓ and also, you know. ⁓ Questions about blame and value. How valuable am I to others? Am I going down a pathway that's gonna be useful to anybody? Is it something that's gonna be useful to me? I mean, here's another sort of thing that I think is just a problem in our society. Most people across cultures want to have something like, especially when they're young, think about having like one of ten jobs, you know, physician, lawyer, engineer, teacher, police officer, fireman, you know, whatever. It's it's like ten, ten things. Can we have a society that is based on only ten jobs? Hell no. ⁓ and trying to fit everybody in a society into one of these ten jobs is just it's just crazy. I think it's natural for people as they are going through you know, their lives, especially when they're young and developing, to like do I want to go to university? Is there, you know, d and what should I do I, you know, do I want to be a lawyer? Do I want to be a physician? Do I maybe what about something else? I mean the other thing is people are always trying, I think it's a natural thing for people to do, to figure out something special that they can do. That will set them apart from others. And for all of us to try and fit into one of ten jobs is work many of us are going to fail at standing out as being the spectacular physician, the spectacular lawyer, or whatever. But we might be the spectacular carpenter or you know something else. I I don't know. But there's questions about ⁓ yeah. Questions, complex questions about what I'm gonna do with my life. What am I am I valuable to anybody? Am I valuable to myself? ⁓ you know, and then there's questions just about romantic relationships and all sorts of things. Andrew, you must have had complex questions in your speaker-0: God, all of the above, this whole time. I mean, yeah. I mean, I was, you know, I was in law school when I I'd had depression before, but ⁓ you know, that was when things really set in. And it was essentially because ⁓ a a physician, a doctor, ⁓ talked to me for 30 minutes and told me I was biologically incapable of rational thought, which sort of negated my ability to to become a lawyer, which was where a lot of my self-worth was built into. And we talked a lot about that. And that that's you know, there were there are other things though too. I probably should never have there Part of the reason I ended up in front of that doctor, though, was I probably never should have gone to law school in the first place. I liked learning and I liked thinking, even though I never liked school. I probably would have been much happier if I'd either gone to film school or if I had gone into a PhD in psychology. but neither of those things were seen were valued where I was from. And for most of my life, what I was told was being a good person meant staying close to home and doing whatever it is that people around in my hometown did. And There are no s I I'm sure there are a couple of psychologists in my hometown, a few of them. There are very few filmmakers. So I lived in North Louisiana. And I was really unhappy there. I couldn't I couldn't really imagine honestly, I didn't become happy really until I left and I moved to Nashville to live in a major city. It's when things started turning around because I could envision a future where I could do things that that made me happy, like this. You know, I mean, having a be you know, being a media career, you know, having a media career, filmmaking, photography, and being able to earn a living doing those things, ⁓ being a part of the arts. It and so you're exactly right. That was the problem all along was that I was racing towards a life I never really wanted. I just never knew it was okay to to to consider an an alternative. It was being a lawyer would have been much better than being a doctor for me. ⁓ I don't think I would have fit in in medicine. I just would not have gotten along with the other people there. I would have been too busy asking questions like, Well, why? Like, why do we have why do we cry? Like, I mean, you know, that I mean, that's really my question I've had written down since the beginning. It's like, well, yeah, but why do we cry? Like, why when we're sad or sometimes not sad would we leak water out of our face? You know, and in medical school, they're no they would hate you if you stopped and asked those kind of questions. That that's just not what it's about. So ⁓ you know, it it you're right. It that was a lot of it for me. And there's I'll also add, There's a a man named Brian Johnson, who's this guy that's spending a million or two million a year trying to to l engineer longevity. Do you know of this person? speaker-1: God no. speaker-0: He was a Silicon Valley guy, ⁓ or he actually wasn't. I think he he was a tech guy, but he lived in Utah. And he's ⁓ he's spending like a million or more a year on his on his longevity protocol because he sold a company and he made a lot of money. And ⁓ he was on he's been on a bunch of podcasts, he's got his own channel now, but he was on one called Diary of a CEO, and I need to to watch it because he was asked about depression. He's a brilliant man, and he's got all of these s evidence based approaches to longevity, but he's also taken all these approaches to depression. And he went through all the things you did, all the supplements. I mean, he tried everything. And at the end, you know, ⁓ the host of Diarieva CEO, Stephen Bartlett, asked him, so what did you do that made the difference? And he was like, Well, ⁓ I got a divorce and I left the LDS church. I mean, like, and it's almost as if saying, like, I realized I had picked the wrong life. You know, I mean, if you're married to the wrong person and you're in a church and you realize you don't really believe in God and you don't fit into the you're not into the Mormon community at all, which is a very There's a very communal element of it. Well, of course you're depressed. I mean, it it would be irrational almost to not be depressed at that point. So that's that's what I have to say about that. Becoming radically myself, and that's an ongoing process, has tracked it's a linear correlation with with my happiness, has come with authenticity, like learning, like, ⁓ yeah, I don't I don't need to be an oil and gas lawyer. I'd I wanna, you know, I want to talk about the mind. I want to ask why do we cry and figure some out, some way, maybe to get paid for doing it. We're not there yet. speaker-1: Yeah, yeah, I I love it. ⁓ I I think ⁓ earlier on in the podcast here, ⁓ the conversation, ⁓ I was I said I think that the pursuit of happiness is overrated. ⁓ and I but I also said ⁓ I think pursuit of happiness ⁓ and that happiness and pain ⁓ have their their things. The th I I wanna just say for the record something which is very similar to you. My own belief is try and do something meaningful. Right? Meaningful is something that ⁓ it's personal, it's gonna be idiosyncratic to every ⁓ person. ⁓ but if you fail at something for which you're doing meaningful, that you're you're not gonna be happy at the failure, but you're not gonna feel like the effort was wasted. And in fact, you know, you maybe get up and try again at doing this this same thing. ⁓ And moments of happiness do come when you ⁓ succeed in pursuing this meaningful endeavor. But the the thing that gives you meaning is its meaning. and I wanted to say something about ⁓ Abraham Lincoln, ⁓ who was famous for being depressed most of his life. ⁓ he wanted he was living in the frontier of the United States as a young man. He was ⁓ believed in himself and believed he was capable of great things. He wanted to become a US senator in the model of Daniel Webster, and he failed at ⁓ most of his attempts at ⁓ politics and he was miserable in the process. But his life turned around when he decided to give up that dream. And instead do something meaningful. And that meaningful activity was to promote the anti-sl yeah, the anti-slavery cause. And through that, actually, it thrust him into the limelight, catapulted him all the way to the presidency. He ended up ⁓ you know doing this amazingly difficult job as president of the United States during the Civil War. And ⁓ At the end of his life, before he was assassinated, he finally had some peace and some sense of accomplishment. ⁓ he solved his problem of depression by pursuing something meaningful rather than pursuing something that he thought would make him happy. speaker-0: Yeah, just I that no, it's a it's a it's an important thought. ⁓ one of the important moments I had along my journey of of coming out of depression, I guess, in theory, in order to get out of a forest you gotta spend half your time getting into it. ⁓ it's just the the nature of the beast. And ⁓ this was somewhere for me along towards towards the beginning of the at the end of the middle, something like that. Started I started moving out at this point. I was exposed to the book Man Search for Meaning by Viktor Frankel, and it's it's an Austrian neurologist and psychiatrist who Went to Auschwitz kind of ⁓ willingly. I mean, he could have gotten out, but he had elderly parents and he couldn't leave them alone. So he ended up in Auschwitz and he detailed his his time there and ⁓ invented this type of therapy called logotherapy, which is all about finding meaning from your from your pain and meaning from your suffering. And ⁓ for me, ⁓ one of the things I've struggled a lot to explain to people is ⁓ how for my experience with depression, it was very existential. ⁓ there was a lot of existential questions about like, why am I suffering? Why is there this kind of suffering? Why are you know, why is the world the way it is? ⁓ why do bad things happen to good people? And in that sense, of course, in that in that in that question, I was the good person that bad things happened to. and you know, it's just it and it's it's hard to deal with those kind of questions, especially when a lot of people are like, Why do you ask these things? Quit quit worrying about that. And I can't. Like at a certain level asking why, again, it's the meaning that I've made out of my experience is. I think I will probably help other people understand it better. ⁓ I can maybe help other researchers and clinicians understand what it's like to be a to experience these kind of things better. But also, I had nothing else to do but then think about it. So like you know, I was disabled basically. So I spent most of my time thinking about thinking, thinking about the mind, thinking about mental health and mental illness and what those things mean to me and what makes us human. And so that's kind of the meaning I've made of it is all right, well I I don't want my whole life to be about the worst things that happened to me, but dedicating my life to ⁓ being able to help people understand the things I did to to come out of it, that would be, you know, a life well spent. Even if, you know, if this podcast doesn't take off, that's okay because I I love the conversations I'm having so much. It almost doesn't matter. And like it's it's its own reward just to do this. And then somehow got really great grades. And then and that's the weird thing. I didn't even I didn't I think probably one of the worst things that happened was my grades were so good. That now I I didn't feel any better. You know, and I was just now I was just mainly worried about losing my rank. Yeah. Some people did. Some people literally thought I was saying 'cause at one point I when I really finally made that, I tried several times to go back and couldn't finish, couldn't couldn't sit through the class. I ended up moving to Colorado to grow marijuana and people really thought that was insane. But honestly, it was the what was one of the first acts of actual originality individualism that was honest to to me that I ever did. ⁓ it didn't quite work out, but it was it was the right idea. Colorado I loved Colorado. I just just couldn't make it work financially there. Yeah. Most recent guessed. Yeah. Yes. Yeah. I mean, it's it's an important messenger. All of your emotions are. I mean, the idea, even sad I mean things, sadness, guilt, fear, all of it. Like that that's important information that is telling you something, suppressing it, ignoring it, numbing it out, wishing it wasn't there, feeling ashamed that you have these other feelings. You know, that's really unhelpful. ⁓ yeah, I mean it it it I think that most of Happiness is kind of, I think, a lagging indicator of how honest you've been with your major life choices, or honest you've been able to be with your major life choices. ⁓ that really seems to be, I mean, I've been in treatment with a lot of people for things like addiction or for depression. And almost all of the people I was there with, mostly men, ⁓ they were unhappy with who they married, where they lived, or what they did for a living. Or all three. And how could you not be deeply unhappy? If I mean really it's like you've You've just built the wrong life for yourself. You're living someone else's life. And that that will lead to, you know, I think depression. It would be surprising if you weren't depressed. If about that. So ⁓ yeah, what Andy would say about that, it is it does it would have been very validating for me if someone would be like, I would be surprised if you weren't depressed. If someone had told me that, I that probably would have made me feel so much better. Yeah. Yeah. Yeah. Right. Some of the craziest stuff. I think the psychodynamic approach to addiction makes a lot of sense. If you just view addiction as self-medicating behavior, ⁓ or self-soothing behavior. Again, and it's like, well, okay, then what are you self-medicating? You know, is it it could it be that you've you the life that you live offers you no real hope of happiness? I mean that that's and these are the kind of questions people don't really want to that that gets into things like the problems of neoliberalism. And and the life that, you know, that we built here to have a life in the suburbs with a house and the job and everything and that not leading to the happiness that everybody had had hoped it would. It's just sometimes easier to give someone a five dollar per month pres prescription for for SSRIs. But, you know, we see that the results are are I think kind of not that surprising that they don't work that well. So ⁓ we've we've come to the end of our time. Is there anything else that you'd like to ⁓ leave us with? I will. I absolutely will. Okay. I'm gonna Just stop it here and then I'll catch up with you for a second after.