Why Does Life Sometimes Feel Emotionally Numb? - Dr Scott Eilers

The conversation explores the complexities of depression, emphasizing its varied manifestations beyond sadness, such as numbness and anhedonia, which is the loss of joy. The discussion highlights the challenges of diagnosing and treating depression, noting that high intelligence and self-awareness can exacerbate depressive symptoms due to increased rumination and awareness of the world's harsh realities. Effective coping strategies include maintaining daily routines that could potentially bring joy, even if they don't immediately, and focusing on physical health to support mental well-being. The talk also critiques the mental health field's treatment approaches and stresses the importance of personalized care.

• Depression is often misunderstood as merely sadness or despair, but it frequently manifests as numbness or emptiness.
• A core symptom of depression is anhedonia, which involves the loss of joy and diminished functioning of the brain's reward system.
• Depression can lead to a lack of motivation, as activities that typically provide emotional rewards no longer do so.

"Depression is not as much the sadness and the despair as it's often portrayed as. And it often is more of a numbness or an emptiness."

• This quote highlights the common misconception that depression is solely about feeling sad, emphasizing the emotional numbness many experience.

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

• Anhedonia is a critical aspect of depression, indicating a loss of pleasure in activities once found enjoyable.

• Sadness is a natural response to adverse events, whereas depression can occur without any apparent cause.
• Depression is a chronic mental health condition, distinct from the temporary emotion of sadness.
• Major Depressive Disorder (MDD) is episodic, with periods of depression interspersed with non-depressed states.

"When a psychologist like me says depression, we're talking about a chronic mental health condition, right? But depression is also an emotion that all human beings experience under certain circumstances."

• This quote distinguishes between clinical depression and the emotion of sadness, clarifying the chronic nature of the former.

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

• This explains the episodic nature of MDD, contrasting it with persistent depressive states.

• Persistent Depressive Disorder (PDD), formerly known as dysthymic disorder, is characterized by a continuous low to moderate level of depression.
• PDD is not episodic and can become a part of a person's personality, often without noticeable highs and lows.

"Persistent depressive disorder is usually categorized as like a low to moderate level of depression, but it really it's not episodic."

• This quote describes the continuous nature of PDD, differentiating it from episodic mood disorders.

• Mental health treatment faces significant challenges, with only 50-60% of individuals experiencing some relief from symptoms.
• The term "treatment-resistant" can unfairly place blame on patients when treatments fail.
• The variability in therapist quality and lack of standardized care contribute to treatment challenges.

"If you look at outcome literature for individual psychotherapy and psychotropic medication... We're talking 50-60% of people get better."

• This highlights the limited effectiveness of current treatment methods for depression.

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

• This quote critiques the term "treatment-resistant," suggesting it unfairly shifts responsibility to patients.

• Mood disorders are multifactorial, with causes varying greatly among individuals.
• Factors include brain chemistry, lifestyle, and social components, complicating treatment.
• The severity spectrum in mood disorders requires tailored treatment approaches.

"Our current appraisal of mood disorders is that they're very multifactorial. It's not like this one thing happens and you're guaranteed to have a mood disorder."

• This underscores the complexity of mood disorders and the need for individualized treatment strategies.

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

• This highlights the importance of recognizing the spectrum of depression severity in treatment planning.

• There is currently no consistent biomarker for depression, complicating diagnosis and treatment.
• Some conditions, like ADHD, show preliminary evidence of structural brain differences, but this is not widely applicable or accessible.
• The lack of visible symptoms in mental health disorders contributes to misunderstanding and stigma.

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

• This quote points out the current limitations in identifying physical indicators for depression.

"These are invisible illnesses, right? Because of the lack of biomarkers, because of the lack of the general lack of physical manifestations."

• This emphasizes the invisible nature of mental health disorders, contributing to societal misconceptions.

• High-functioning depression often goes unnoticed as individuals maintain outward appearances of success and normalcy.
• People may be deeply struggling with mental health despite having seemingly successful lives.
• There is a societal misconception that outward success equates to internal happiness.

"He is doing these things therefore he must feel good enough to do these things and there's this whole group of people these high functioning depressed people that are being very very missed in society and in treatment."

• The quote highlights the societal oversight of high-functioning depression, where external success is mistaken for internal well-being.

• High performers may continue to push themselves due to an internal void rather than genuine passion or satisfaction.
• The relentless pursuit of success can be a coping mechanism for an inability to feel joy or fulfillment.
• Not all high achievers are depressed, but the correlation is higher than generally perceived.

"Any normal person would have taken so much pleasure and joy from their successes by this point that they would have given up."

• This statement questions the relentless drive of high achievers, suggesting it may stem from an inability to derive satisfaction from success.

• Anhedonia is a state where individuals do not feel pleasure from activities that are typically enjoyable.
• People may choose to work excessively as a way to cope with anhedonia, focusing on productivity over leisure.
• There are two primary responses to anhedonia: withdrawing from activities or immersing oneself in work and responsibilities.

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

• The quote explains the two pathways individuals might take when experiencing anhedonia: withdrawal or overcompensation through work.

• Viktor Frankl's quote about finding meaning in life is contrasted with the idea that some people seek meaning due to an inability to feel pleasure.
• This inverse law suggests that individuals may prioritize meaning over happiness when happiness is elusive.
• The pursuit of meaning can become a coping mechanism for those unable to experience joy, leading to workaholism and overachievement.

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

• This quote captures the concept of Frankl's inverse law, where the absence of pleasure leads individuals to seek meaning as a substitute.

• Mood disorders can be episodic, with periods of joylessness followed by times when joy returns.
• Engaging in activities during depressive episodes may not bring immediate joy but can contribute to future happiness.
• The emotional experience of an activity can change over time, highlighting the importance of continued engagement despite current feelings.

"The way something feels while you are doing it is not necessarily the way it's going to feel later."

• This quote emphasizes the potential for future positive emotions from activities that may not feel enjoyable in the present.

• Investments: Engage in activities without expecting immediate joy, banking experiences for future enjoyment.
• Checking the Lock: Regularly engage in potential joy-inducing activities to identify when the ability to feel joy returns.
• Stacking: Combine achievement and pleasure to surpass the joy threshold, rather than relying on joy alone.
• Loopholes: Identify specific activities or experiences that can still bring joy during depressive episodes.

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

• The quote introduces various strategies for coping with anhedonia, providing practical approaches for managing this condition.

• Apathyception is the concept of continuing to perform necessary actions even when feeling emotionally detached or apathetic.
• The idea emphasizes the importance of maintaining actions aligned with personal values, regardless of emotional reward.
• It challenges the notion that one must feel motivated or emotionally invested to perform beneficial actions.

"Can I continue to do the things that I know I should do, whether that's because they're in alignment with my values or because there's still things that kind of raise my floor and prevent me from getting to a really, you know, like suicidal or disabled place?"

• The quote highlights the struggle and necessity of maintaining beneficial actions even when emotional motivation is absent.

• Pursuing constant peak experiences or joy injections is not a sustainable solution for overcoming depression.
• Externalizing happiness by relying on external stimuli can lead to dependency and dissatisfaction.
• Focusing on internal well-being and self-care can lead to more sustainable contentment.

"I don't think we can get out of depression by chasing momentary joy and pleasure, no matter how strong or how compelling it may be."

• This quote emphasizes the transient nature of external joy and the need for internal stability.

• Internal well-being involves activities that improve one's overall quality of life, like physical health, sleep, and nutrition.
• External pleasure focuses on immediate gratification from external sources.
• The internal approach is more sustainable and aligns with self-care and long-term happiness.

"You can either try to do things that feel good or you can try to do things that make it feel good to be you."

• This quote contrasts two approaches to happiness: external pleasure versus internal well-being.

• The order of operations for mental health should be biological, psychological, and then social.
• Physical health is foundational for mental health, as the brain requires a healthy body to function optimally.
• Neglecting the biological aspect can hinder psychological and social interventions.

"Physical health is brain health. Your brain literally lives inside of your body."

• This quote underscores the importance of physical health as a prerequisite for mental and emotional well-being.

• The brain operates like a power grid, directing resources where needed, but prioritizes survival over happiness.
• When resources are scarce, the brain enters a low-power mode, affecting mood and cognitive functions.
• Ensuring the brain has adequate rest, nutrition, and exercise is crucial for optimal mental health.

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

• This quote explains the brain's prioritization of survival needs over emotional fulfillment.

• Inversion thinking involves identifying actions that worsen mental health and then doing the opposite.
• This method can offer practical steps for improving well-being by reversing negative habits.
• It leverages the brain's problem-identifying strengths to find solutions.

"If you can't figure out what you should be doing to feel better, well, what would you do if you wanted to ruin your own life?"

• This quote introduces inversion thinking as a strategy for identifying and reversing detrimental habits.

• Numbness in depression is not the same as emotional neutrality; it's an absence of expected emotional responses.
• Emotional numbness can be a result of unprocessed trauma or mental health issues.
• Recognizing the difference is crucial for appropriate intervention and self-awareness.

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

• This quote clarifies the distinction between emotional numbness and neutrality.

• Mental health conditions can feel unfair, as they require more effort for stability compared to others.
• Accepting the condition and adapting lifestyle habits is necessary for improved mental health.
• Comparing oneself to others can exacerbate feelings of unfairness and inadequacy.

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

• This quote acknowledges the inherent unfairness of mental health struggles and the need for acceptance and adaptation.

• Managing mental health should be a primary focus, not a side quest, especially for those with chronic conditions.
• Building life around mental health needs can prevent exacerbation of issues and improve overall stability.
• Understanding the brain's limitations in conscious control can help manage expectations and frustrations.

"If something is going to take me down, it's going to be my mental health. I know that that is my Achilles heel and so I have to plan for that."

• This quote emphasizes the necessity of prioritizing mental health management to prevent potential crises.

• The brain, like other organs, requires indirect methods for control; direct commands are ineffective.
• Practices such as meditation and progressive muscle relaxation can influence bodily functions like heart rate.
• Understanding the brain's workings, especially in the context of mental illness, is crucial for effective management.

"You can't just brute force it into doing what you want it to do. And in fact, if you try to do that, you actually usually get farther away from your intended outcome."

• Direct control over the brain is not possible; indirect methods are necessary, and misunderstanding this can lead to ineffective results.

• Managing mental health is likened to managing chronic physical conditions like diabetes.
• Acceptance of a chronic condition and taking actionable steps is essential for well-being.
• The consequences of neglecting management are significant and detrimental.

"It's functionally no different than if you say, 'I have diabetes. I can either take my insulin or not take my insulin.'"

• Managing mental illness requires the same level of commitment and responsibility as managing a chronic physical illness.

• Modern psychotherapy approaches like ACT and CBT are gaining popularity due to their action-oriented nature.
• Therapy should move beyond just acknowledging difficulties to implementing actionable strategies.
• Personal experiences and case studies can provide valuable insights into effective mental health management.

"One of the reasons that stuff like ACT and CBT is having a good resurgence at the moment is that it actually gives you something to do about it."

• Action-oriented therapies provide practical approaches to mental health management, emphasizing doing rather than just discussing.

• Severe depression can be accompanied by psychosis, including symptoms like hallucinations and derealization.
• Personal anecdotes highlight the severity and impact of depression on daily life.
• Overcoming severe depression requires significant lifestyle and mindset changes.

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

• Severe depression can lead to psychosis, showcasing the complexity and seriousness of the condition.

• Excessive self-awareness can be detrimental, leading to overthinking and reduced performance.
• The Jüks Dodson law illustrates the inverse relationship between stress and productivity.
• Finding a balance in self-awareness is crucial to avoid negative impacts on mental health.

"There definitely is a point and I have experienced this personally where you start second-guessing and overthinking everything."

• Too much self-awareness can lead to overthinking, negatively impacting mental health and performance.

• High IQ and EQ are unexpected risk factors for depression due to potential social isolation and rapid internalization of negative experiences.
• High intelligence can lead to quicker pattern recognition, sometimes resulting in negative self-perception.
• Awareness of the world's complexities can overwhelm high IQ individuals, contributing to depression.

"High IQ absolutely is a risk factor and is correlated with a higher prevalence of mood disorders like depression and bipolar disorder."

• High intelligence, while often seen as advantageous, can contribute to depression due to social isolation and rapid internalization of negative experiences.