Welcome to Sheeper Assisted. I'm your host Sadie Sutton, a 19
year old from the Bay Area studying psychology at the
University of Pennsylvania. Sheeper Assisted is the teen
mental health podcast made for teenagers by a teen.
In each episode I'll bring you authentic, accessible and
relatable conversations about every aspect of mental Wellness
you can expect. Evidence based teen approved
resources, coping skills including lots of DBT insights
and education, and each piece of content you consume.
She Persisted offers you a safe space to feel validated and
understood in your struggle while encouraging you to take
ownership of your journey and build your life worth living.
So let's dive in. This week on She Persisted.
It's OK to talk about. I mean, I think for me, that's
one of the main motivations for studying and talking about life
after depression is to do my part to make it OK to talk about
these experiences and their full measure of beauty and ugliness
and confusing this. I think it all needs to be part
of the picture. Hello, hello, and welcome back
to another episode of She Persisted.
We've done a mini hiatus because this is the busiest semester I
have ever had. I am working on grad school apps
and the GRE and my normal course load and a thesis and research
and all the things. I will of course, do a grad
school episode for you guys regardless of how things pan
out. But I think if you want to go
into psychology, it's really important and helpful to just be
aware of what the field looks like.
And a lot of the times you don't become aware until you're very
far into the process. So if you guys have interest in
a grad school episode and questions for that, let me know.
But I'm so, so, so incredibly excited for today's guest.
We have a Dr. Jonathan Rotenberg on the podcast.
He is a professor at Cornell and he has some really, really
fascinating research about depression and positive outcomes
after depression. And so this conversation just
gives a lot of nuance and insight about what it's like to
function through the world when you're depressed.
And then why do some people have really positive outcomes and
high levels of well-being after experiencing depression?
And I just absolutely loved every moment of this
conversation. It was so fascinating.
And I think it just adds a lot of information that we aren't
aware of when we're struggling. And I think a lot of the fear
and anxiety and discomfort from these things stems from not
knowing what you're experiencing.
You're like, I feel this way. What I used to do to try and
cope with things like this isn't working.
I don't know why I'm having these reactions to these things
in my life. It's just distressing and
overwhelming. And what I know how to do isn't
working. And so I think conversations
like this, at least for me, offer a lot of insight and peace
and kind of take away some of the mystery of that internal
experience and hopefully give you more answers rather than
leaving you with just questions about your experience.
So I'm so, so, so glad to have Doctor Rotenberg on the podcast.
He is a professor of psychology at Cornell and the director of
the Better Outcomes Laboratory. His research is on long term
functioning and well-being after depression, and his research has
been featured in things like the New York Times, The Washington
Post, Wall Street Journal. He has two books you guys can
check out in the show notes, and he also has a digital project
called Ever After which talks about life after depression.
So you guys should definitely check that out.
Like I mentioned, he's doing really incredible work in the
space and I hope you guys enjoy this conversation as much as I
did. So with that, let's dive in and
learn about things you didn't know about depression.
Well, thank you so much for joining me today on G Persisted.
I'm so excited to have this conversation about depression
and outcomes and a lot of nuance that most people don't get if
when they've been diagnosed or they're in their psychiatrist or
primary care's office and hearing that this is what
they're going through. And so I'm really excited to
dive into your research and your story and also give people a
greater level of understanding about what they're experiencing
and what the path ahead might look like.
Well, I'm excited right there with you, Sadie.
I'm glad to be here. Amazing.
Well, to get started, you have a really interesting area of
research, which is depression and now more of the outcomes and
why some people have better outcomes after experiencing
depression. And so I'd love to hear how you
landed in that area of psychology, why that became your
research specialty and kind of your background there.
Sure, I mean my like a lot of people who end up studying
clinical topics, my Rd. went through personal experience.
When I was a graduate student, the first time studying history,
I had quite a significant episode of depression, lasted a
number of years, Was profound, interesting, strange, horrible
experience, and I was forever changed by it.
But not least of which, deciding that I needed to understand this
better and going into psychology in the 1st place, knowing I
wanted to study mood disorders and to study that part of mood
disorders that was this kind of overwhelming experience of not
being in control of your feelings, not understanding your
feelings, not being able to change your feelings.
So scientists also sort of agree that mood, they call it a mood
disorder, that mood is at the center of the mood disorder.
That is, people feel this terrible low depressed feeling
and they can't enjoy things and it diffuses their outlook and
how they think, and it really alters their behavior in
profound ways. So we did experimental studies
where we were showing people standardized emotional stimuli
like films and looking at how they responded, how they
reported emotions, how they showed emotion behaviorally.
And we also measured Physiology. And I did that for a number of
years and I guess one of the major findings was Contra to a
lot of the thinking of the time, which was informed by cognitive
theories of depression. So in these cognitive theories
of depression, the main idea is that depression alters how
people are perceiving the world, how they're perceiving ongoing
stimuli in a very negative way, such that you'd be prone to
notice negative information. Remember, negative material
better than neutral material. And from this theory, the
expectation was if you present this standardized negative film,
like a sad film to a depressed person, they're going to show
this really vigorous response. This is going to match this kind
of cognitive template in their head.
And that's not what we found. We found a a very different
pattern such that being in this mood disorder seemed to diminish
or shut down people's reactivity to all manner of different
stimuli in the environment. So it's sort of a different
understanding of in part what this mood disorder is and what
it does in that it turns a person inward.
And it's not that they're not having emotions, but they're not
necessarily having emotions to the same kinds of external
normative stimuli that that non depressed people are.
So in my career, I've always been open to the possibility
that the conventional wisdom might not be right and that that
can really open a lot of doors. So like in a related line of
work, we looked at whether or not depressed people were more
likely to cry in the laboratory when you expose them again to
kind of a standardized stimulus that we know non depressed
people are likely to cry to. And again, the hypothesis going
in based on a lot of clinical lure, like if you read the
Diagnostic and Statistical Manual for Mental Disorders, the
DSM, it mentions crying as an associated sign of depression.
So depressed people, of course, they cry more, but they didn't,
not in the lab. And this again suggested not
that all the clinicians were wrong about what they had been
seeing in their patients, but that the nature of the crying
might be different in depression.
That is, yes, when you have someone who is sympathetic to
you, who's ready to hear your story and you've been keeping it
all bottled up, you might cry a lot, but it doesn't mean you're
going to cry when Lassie dies. So it really changes kind of the
how the behavior works in ways that were not what we expected.
This is why you do your research.
You do research to learn things. And that was sort of the 1st
chapter of of having some unexpected findings.
Yeah, it's, I think it's something most people
subjectively have experienced and that especially if they're a
little bit further into young adulthood or adulthood itself,
is that they feel depressed. And then they go and try these
things that in the past have made them feel happy or feel
better or invoked these different emotions and it's just
not working. It's like it doesn't have the
same effect that it it used to. And like you're saying the
emotional experiences are literally different and the
depressed versus non depressed population.
And I think that's really challenging and gives people
that huge lack of control, which I think is, is really hard thing
to navigate. There's a lot of unknown and
then there's just that I I can't control what I'm feeling and
also what I've done in the past to try and control these
experiences or cope with them. It's just not working, which is
really, really difficult. And so I'd love to kind of hear
your perspective based on the research and literature and also
subjective natively, are there any of these other shifts that
we see in people that are depressed with the way that they
feel and think? And behaviors also are a facet
of that where you're literally thinking and acting differently
when you're depressed, which when you're first diagnosed, a
lot of people aren't told that it's, it's really a challenging
thing to understand. Yeah, I think what you're saying
is really quite profound, Sadie, this inability to change the way
that you're feeling. You know, people who haven't
gone through depression, they might be sympathetic, but not
understanding this, they could be quite confused about why
depressed people are doing certain things.
So for example, depressed people might do things to themselves,
like they might burn their arm or pick their skin and do other
things where the person's like, well, how could that be helpful?
And, and don't they know, don't they know that you should go for
a walk and do yoga and drink water?
And depressed people are not stupid.
They have a they have this unique experience of cycling
through all manner of emotion regulation strategies, including
all the ones that were suggested to them on numerous occasions,
and finding that they didn't work.
So then depressed people might start doing things that that
they might actually not be such great ideas, but they're trying.
They haven't given up and they might get locked into some of
these counterproductive strategies.
But you can only, you can only really understand that if you
have, you know, empathy and also knowledge that depressed people
don't. On day one, the first day I'm
depressed, I go immediately and start screaming into a pillow
or, you know, banging my fist through the door.
Like that is not what happens on day one.
So not as much research as you would imagine tries to take
people through time to understand how the experience
changes. Because you're right, it's not
the same as is everyday life when people experience all
manner of disappointments. In real life.
For most people, when you experience sadness or
dejectedness, you don't get what you want, you feel disappointed.
That's a rather transient experience.
And one of the interesting things, and we know from basic
research I find this fascinating, is that non
depressed people, they tend to mispredict.
So, for example, if you have a favorite team and someone asks
you, so if your team doesn't win the Super Bowl, how are you
going to feel? And the people systematically,
they overestimate. They say, I'm going to feel
horrible. And I can't even imagine.
It's going to take a long time to recover from.
But the truth is that even things that are more significant
than your football team not winning, people tend to bounce
back from. And so this is the normal
experience that people have that these really strong moods don't
last. So it's only people who are in
the these clinical states where the the mood might last for
three months, six months, a year, 2 years, that they really
don't experience as much relief. And it's quite confusing because
of their whole previous life, when they were able to either
change what they were feeling or just spontaneously experience
changing what they're feeling. They're no longer experiencing
that and it's confusing. Yeah, it's really overwhelming
and disorienting. And all you want is to feel
differently and everything you're trying isn't working.
And you're not hearing that narrative that like, you're
feeling things differently and you're thinking differently and
the skills you've worked before might not work now.
We're just not told that until you're like very deep into the
depression world and treatment process, which is really
unfortunate and, and really, I think makes a lot of people feel
really hopeless and confused and overwhelmed.
Another thing that you've touched on in your research is
this emotional reactivity idea, which we talked a little bit
about with people crying and the emotions that are elicited.
But I think this is another piece of the puzzle that is also
very confusing and disorienting and overwhelming, which is that
you're feeling these things differently.
And the degree to which you're feeling them is, is also on a
whole other level in addition to how you're coping with them.
And just like you were saying, the way that you used to operate
within your life and the way you used to feel about different
things, like it's completely different.
It's like you have a different brain and you don't know how to
navigate with those new levels of emotional reactivity.
So what is the the research say there with how we are reacting
to these situations when we're depressed and versus when we're
not feeling depressed? Yeah, I consider emotional
reactivity, even negative emotions.
They're not the enemy. And so I think when people start
to come out of depression and then they start experiencing
sadness when something sad happens and happiness when
something happy happens, and even outrage when something in
just happens as rather soothing and reassuring.
Because the research with the emotion context insensitivity,
one of the main morals is that the way that people are feeling
has become disconnected from the usual environmental stimuli.
So I think that again, that is what's can be terribly
frustrating because all the things that a person normally
could experience and expect experience a different feeling.
So whether that's going out with friends or having a delicious
meal, you know, going for that walk, it doesn't seem to have
much immediate impact on the way the person is feeling.
So, you know, again, in our in our common lore, I think there
is sort of the idea that, oh, so it's better to always feel good.
We don't want to feel bad. But emotions do serve us.
They're time tested kind of responses to the world that over
evolutionary time have proven their worth.
And so if you could choose whether to have emotions or not
to have emotions, the better choice is to have them.
And actually, I think depressed people, in some ways, they would
wish that they they would have appropriate emotional reactivity
rather than either perceiving that they feel nothing or that
they feel overwhelming kind of negative states like anxiety or
sadness that suffuse everything and they feel that little
control over. So I think, you know, yes, there
is of course some dynamism. It's not that nothing ever
changes when people are depressed, but there does seem
to be some disconnection between what ordinarily prompts changes
and how the person is feeling, you know, and what the person is
actually feeling. Yeah, it's also so tough when
you kind of dive into that emotion education piece a little
bit with depression. And we think like, OK, our
emotions are serving a purpose. They get us to do these things
that help us survive and thrive. We're scared we get away from
that thing. If we're feeling lonely, we go
find other people so we can connect and survive in a tribe
and not be left in the middle of the wilderness alone with no
resources. And when you're depressed, a lot
of your emotions are telling you to do the opposite thing.
It's like withdrawal from people.
Don't engage all these negative thoughts about yourself that
increase fear and anxiety, which may not be totally effective or
accurate given the facts of the situation.
And so it's just really tough thing to grapple with where it's
like we know our emotions are good and they're telling us
something. And when we're depressed, it's
like they're telling us the wrong things and the messages
are not the things that will work or be helpful.
And like you're saying, even when you do the right things and
go through the motions, it may not have that return on interest
when it comes to improving your mood immediately or shifting the
way you're thinking about your environment.
Yeah, so I have a lot of things to say about meta meta emotion.
I think it's really interesting. So thoughts and feelings about
emotions, these are largely learned.
These largely come from mark surrounding culture.
And you know, one of the great mysteries is, is why there is so
much depression now and in in certain demographics, like young
people that people that are listening to your show and are
interested in what people are talking about here.
And So what are the meta emotional beliefs that are kind
of in the air? And, and what are some that
might be kind of depressigenic, but we don't have all the
answers here, but it strikes me that we have some kind of
unnatural views about feeling states.
So if you watch TV, for example, and you watch commercials, they
show people that are in these really high activation states of
positivity, people kind of jumping around like, you know,
jumping beans and really excited and Pepe.
Can't believe there's a sale. Exactly.
Yeah, It's between that and people's common social media
persona where life is basically just a series of peaks and
people start to represent this idea that that's normal to
experience this really pumped up, jacked up positive
affectivity. And so people walk around and
they compare what they believe to be what other people are
experiencing and what is normative in the culture to what
they're actually experiencing. And they're noticing this
enormous difference. The tragedy or the also the
fascinating thing is that it's a myth that people are actually
experiencing this peppy activated positive affect all
the time. You know why?
Because it's impossible. That's not how the affect system
works. It's, it's sad, but it's true
that you know when you get the promotion or when you get, get
the new car and again, you expect I'm going to be excited
for the next three weeks that in fact you're, you're excited and
you're really happy and then it drops off it, it slows down.
That's really how the FX system works because it's in perfect,
because it's forward-looking and always wants you to get to the
next, you know, the Bunny to the next carrot now the, the wage
worker to the next payday and so forth.
It's always about what's next. But in any case, I think it it
does trap people in this belief that what they're feeling is not
normal. So you have a double whammy.
You feel bad, and feeling bad feels bad, but you also feel
like I'm alone in these feelings.
Other people are feeling something very different, and
why can't I get out of it? And it sets people up to start
monitoring their emotional experience in a way that
probably is not well precedented in human history.
Some of our solutions, I wonder if they're really solutions.
So all these apps that people are wanting to make graphs of
their mood with 15 minute intervals and so forth, again is
making us very focused on on the ways that our feelings are
falling short of some expectation rather than.
And again, this may sound like someone telling someone
unwelcome news, but some degree of acceptance of these even
sometimes negative emotions can go a long way to helping people
be OK with at least some of these feelings states.
And not feeling like I'm a freak, I'm a failure.
Why can't I control this? And so forth.
Unfortunately I don't think research has given meta emotion
fully its due. But we know that it's important,
we just don't know quite how it's important in like a
systematic way. Yeah, you mentioned that there's
this huge increase in depression, which most people
are aware of, especially with young adults.
And there's been a lot of buzz recently about that topic and
research that's come out about smartphones.
And then there's differing opinions that this was on the
rise prior to that. What are your thoughts there?
Do you have a strong opinion on on why we're seeing this
increase, especially in that demographic?
I think what you mentioned with the the Meadow emotion piece and
how we're seeing emotions represented is definitely a
piece of the puzzle. But do you have an opinion or or
theory why we're kind of in this position?
Yeah, like anything interesting, there's almost certainly a
multitude of factors that are going into it, rather than a
single factor. And the world's not a controlled
experiment where you can isolate the factors.
So all these things are happening simultaneously.
But I will say, as you're saying, there are some real
cohort effects. So depression surprisingly more
likely among those who have lived fewer years on Earth than
people who are in their 70s, they've accumulated about the
same amount of lifetime risk, even though the younger people
have been alive much less long. And it does appear like that's
real, not just a reporting bias in all of the kind of worst
correlates of depression like hospitalization, suicide
attempts, again, densely clustered in these younger
folks. So there's something real
happening. It's not just people whining or
just a greater tendency to report depression, which is
another possible explanation for it.
So I do believe that Blake meta emotions that depression often
is about expectations. So not only the expectations for
the way that you're feeling, but also expectations about where
you should be in life relative to where you're actually in
life. So again, this is a hypothesis.
I think there are some data that are, you know, consistent with
this, that you do have a lot of people who have very, very high
aspirations that may not be fully plugged into reality.
So people saying, well, I'm going to be a millionaire before
I'm 20 years old, I'm going to be Instagram famous.
I'm going to be seen as the most beautiful or the most popular,
and I'm going to get into Harvard or wherever those most
desirable places are. And they may not to the extent
that they don't have a plan for making this happen.
That's opening the door to tremendous disappointment.
That's not necessarily depressional by itself, but
disappointed aspirations I think is a part of the mix and part of
that does this disappointing aspirations, and I'm sure you've
heard this from people who, who watch your show or listen to
your show, is the sense that it is harder, it is harder to make
it in a complex competitive society than than maybe it was
for parents or grandparents. It's hard to break in
economically. It's hard to finish your
education. There's such rapid change.
And yeah, I don't think it's, it's simple as there are these
screens that people are looking at that have evil messages.
You know, I, I think disconnection could potentially
be part of the, the mix on the ways that screens can be
isolating as opposed to IRL interactions and friendships and
so forth. But those are, those are a few
ideas. I mean, I think it's really
quite a rich area. And, you know, there again, like
that emotion, there's lots of room, I think, to improve our
ability to explain what's going on.
Yeah. Before we get into outcomes,
which I'm so excited to dive into, you mentioned earlier the
psychology research on our expectations about how things
pan out and how it can be kind of helpful to understand that
when we're depressed. Are there any other of those
like psychology facts or insights that you really enjoy
or find really interesting that are applicable to depression?
One of my favorite ones is how people estimate the consistency
and important of things going on in their life now.
Like if how I do on this test is going to drastically impact my
life in 10 years, I'm going to like the same bands and these
relationships are going to have such a big impact on my life.
And then when you ask people 10 years later, like, I don't even
know what you're talking about with that test and I don't talk
to that person anymore. And, and the way that we're
thinking about those things in the moment is really ineffective
and also inaccurate and can add to these emotions that we're
experiencing and the pressure that we're placing on ourselves
and the goals, like you were saying that we have for
ourselves in the future. Kind of these like psychological
and effective things that we're doing that we're we're not aware
of when we're feeling and thinking these things, but also
might not be serving us. Yeah, so something that really
strikes me as deeply related to a lot of phenomena and
depression that we don't always give it's due is just how mood
dependent a variety of processes are and it's and it's amazing.
But so like if you ask, this is even goes to diagnosis.
If you ask someone who's in the middle of a depressive episode
to talk about times in their life when they were experiencing
depression, they'll have no trouble.
They'll go into great detail in and if you ask them, so could
you tell me about times when you were feeling well, they'll draw
a blank. They'll really have a great
difficulty accessing that information because the the mood
suffuses their cognition in their attentional spotlight on
things that are congruent with the mood.
And the reverse is even more striking that you someone, if
you follow someone who was depressed and interview them 20
years later and you ask them about depression, there is
evidence that people literally forget the depressive episodes.
They're no longer salient. They don't, you know it's
because you ask the screening questions about depression.
Did you ever have a time when you felt depressed most of the
day, nearly every day for two weeks?
They're like nothing really bringing a bell there.
Let's hope we all get to that point.
That's what we hope for people. I mean, I, I don't know that I
hope for it because I, I like the idea that they remain
grounded in reality and are aware of all, all the ways that
we are kind of a amalgam or summation of all the experience
that we have. And we don't run, we don't run
away from the fact that maybe we had depression and we can still
appreciate that. But it it probably is, you know,
a tribute to how powerful the mood dependent phenomena are
that people literally forget episodes.
That's why I believe, yeah. And especially because when
you're in that depressive state, it's literally all you can think
about and it's impacts everything you're doing.
And so I remember being like, I there will never be a time where
I'm not constantly thinking about depression or my emotions
or how I'm feeling. And like you're saying, it's
very mood dependent, like the fact that we're feeling
depressed is pushing a lot of those thoughts, but also as our
mood shifts after the fact, our memories and the intensity of
that period also decreases. And it works the other way
around. So you you can show someone
information that shows conclusively that there was a
time before this when you appeared to be quite happy.
And the the person will look at you like you're completely
crazy. I almost have no memory of this
person. And again, this feeling of being
being trapped in depression because other parts of your life
become inaccessible if it goes on long enough.
Yeah, yeah, I remember that. I was like, I don't remember a
time when I didn't feel this way.
And you can logically be like, that's probably not true, but
you really do feel like this has been such a salient experience.
For sure. Outcomes, I'm really excited for
this because this is something that I think the general
population doesn't hear a lot about.
And your your research on why some people have positive
outcomes from depression and why some people don't.
I think it's really interesting. So can you give people a little
bit of an overview of this research for those who are not
familiar? I'd be happy to.
I'll start by saying that I was doing depression research like
everyone else. I was interested in outcomes,
and I was looking at the standard things that people
usually examine in mood disorders research, which is do
people have more episodes of depression?
Do they recover? Do they have symptoms of
depression in? We know a lot about that for
sure. But I started to get a little
restless and I started to wonder what about the things that the
average person would talk about as things that they want for
their life. So, you know, yes, I think it is
true that when people are depressed, they say I would
rather have fewer symptoms, but symptoms is not a very rich
mapping of of all of the domains of life and functioning.
So people want healthy relationships, they want to live
lives that are purposeful. They obviously want to be happy.
They want to function well in different domains like work.
And I realized that Wow research had really missed the boat.
They had almost completely ignored these outcomes in for
sure when we talked about functioning, they ignored good
functioning. So there used to be this thing
called the global assessment of functioning scale.
And basically they didn't weren't very interested.
If you were functioning fine, that was OK.
But when someone said they were doing poorly, that would really
affect the scale a lot. So basically the best you could
do would be like no problems functioning.
So that's how I got into it. And well, I was interested in
the first question, all these different outcomes you could
imagine that could be important to people, like how happy
relationships, doing well on the job.
I thought that psychological well-being shared a lot of
promise a because that is something that people will
identify as important. I want to feel positive
emotions. I want to feel that my life is
purposeful, that I have control and things like that.
And we know how to measure this pretty well.
There's a pretty deep literature on psychological well-being.
Some of these other domains like how you're functioning at work
or how's your spiritual functioning, they're a bit
harder to measure. So we capitalized on the idea
that we have big population samples that have completed
measures of psychological well-being that allow us to say
this is what it means to be doing well.
So for example, if you're in the top quarter of people who in the
non depressed population for well-being, that's pretty good.
So the question then became if you have a history of
depression, what's the likelihood that in the future
you will have recovered from your disorder?
So you're not reporting the symptoms of depression and
you're reporting high levels of psychological well-being.
So for example, being in that top quartile of a non depressed
group based on the epidemiology. And this, I guess maybe this
sort of speaks to whether this research should build people's
hope or how we should feel about the research going in.
The epidemiology of depression said pretty consistently that we
might want to adjust our expectations.
A lot of the epidemiology is based on clinical samples.
So people who had depression, who were seen in therapy, in
treatment, a lot of were inpatients and followed over
time. And the course of depression in
those groups doesn't look that terrific.
I mean there tends to be a lot of recurrence of depression and
not a lot of well periods. And so going in just like, Oh
well, this will be like 1% that recovers from disorder and
reporting high levels of well-being.
And so in that context, essentially what we found in the
first study was using U.S. National data that depression,
it about halved the likelihood that the person would report
well-being. And I'm a glass half full kind
of person as I'd say like that's far from eliminating the chance.
And so about 10% of the sample that had depression at the
initial point was reporting very high levels of well-being
consistent with that top quartile.
So I thought this is amazing that these people exist in much
larger numbers than the conventional wisdom, you know,
would have us believe. And we replicated this pattern
in a Canadian sample. And so I think the question of
whether or not there is well-being after depression or
whether there's systematic evidence, I think has been
answered. And we're kind of in the more
interesting phase of research, which is to begin to understand
what explains these good outcomes.
So in the initial studies, these were archival data analysis.
So they were collected for other purposes.
And they didn't really give us the tools to understand what are
the factors that explain why some people are attaining or
reporting well-being in the future where other people are
not. And so we might have a lot of
hypotheses about what would explain this, including some
things that are awfully hard to control.
So how severe your depression was in the 1st place, which
could in part be a function of someone's biological
vulnerability, or it could be a function of how much early life
adversity they they were subjected to.
But I also imagine that in this equation where we look at a
number of variables that influence future well-being,
that some of those variables are going to be within human
control. And that's very exciting because
those are things that you can do something about, Whether it's
your attitudes towards depression or all the things
that we were alluding to, ways that people try to influence
their mood through different habits like exercise or diet or
sleep, that may prove to be important.
It's also likely, I think it's almost certainly the case that
there is more than one pathway to well-being.
So what I think we'll be saying in five or ten years is that
there's several different pathways.
Some involve control more than others.
And though, you know, it's not as strong as you can just choose
your own adventure, this does kind of suggest that people can
experiment and find to what extent things that work for
other people are helpful for them in building this kind of
sustainable well-being over time.
Because, you know, I think having well-being in a snapshot,
that's what these research studies were showing is very
important. And as you're suggesting is very
helpful because I do think that there is a lot of gloom and
misery out there about what you can expect if you have
depression. And unfortunately, there isn't
fantastic prognosis information out there.
And this isn't to blame clinicians, but to say in
reality they are going largely based on the published
epidemiology, most of which is based on clinical samples.
I mean, you would be amazed by how few studies look at a
representative sample of depression as it happens in the
community and follow those folks for decades.
I think there's maybe 3 studies like that in the entire
literature now. It's a lot of work.
Population samples are a huge amount of work.
We have enough trouble saying who's gonna vote for president
in five days and getting a representative sample.
So when we're talking about things that are not as common,
like depression, that maybe only 5 or 6% of people might be
experiencing any given time, and then we're talking about how
people are functioning in 20 years, that that sort of work is
really challenging. But the work in community
samples, it definitely suggests that there are many people who
do not have these chronic courses of depression, including
many people who have only a single episode of depression.
There's probably a lot to that story that remains to be teased
out and understood. And there could be some overlap
between in the wider world that single episodes are pretty
common, even though the DSM still says when they just talk
about depression and it's epidemiology that it's typically
recurrent. I think it's like a 5050.
It's at about half of cases it's recurrent, and in those cases
it's often very recurrent. But the half that it's not
recurrent is not unimportant because it's half.
And I also think that there could be some ways in which it's
useful for people who experience more recurrent forms of
depression to simply know that there are other pathways and
understanding, again, what is the explanation?
Because anyone who has recurrent depression with would surely
like their depression to be less recurrent.
And so I don't think any of this is completely destiny.
So I'm very a big believer in what I call realistic hope.
So I don't think hope by itself is all that helpful.
And sometimes it can be, I want to say toxic, but it can be
almost demoralizing when people are giving you hopeful messages
that are not really well anchored in empirical facts.
But like this, 10 percent, 10% of people who have a history of
depression go on to experience high levels of well-being.
And now we're finding that in multiple samples, we found some
things similarly striking in a sample of adolescents who had a
history of a suicide attempt and survived, that the surprisingly
large percentage of those youth went on to report well-being.
And again, it's not the majority, but these are facts.
And so I think we can, once people accept that these are
facts, we can start to understand well, what are the
implications of these facts. And I think some of the
implications of these facts is that the course of depression is
not uniformly bad. It's just not, it's just not
uniformly bad. And I'm interested in to what
extent this knowledge could help us improve the average.
I mean, because ultimately, you know, epidemiology is not, it's
not destiny. We're not talking about
something like, I mean, there are diseases like this at least
in our present ability to intervene.
So, you know, Huntington's disease does not appear to be a
disease right now that we have an intervention or even
understand what explains its progression, but it is a highly
progressive disease. Depression appears to be more
reversible than a neurological disease like Huntington's
disease. And that's not just happy talk.
That really seems borne out in the facts.
Yeah, it's really interesting because it is such a gap in the
research and our understanding of depression, but it also makes
so much sense because these people that are experiencing
really high well-being versus still really in the struggle
like one population, you're like, it absolutely makes sense
that they're still in this clinical setting.
It's easier to follow these outcomes.
There is potentially more hospitalizations or incidents or
prescriptions being filled, whatever data you can look at.
And then these people that are doing really well and well-being
kind of makes sense why we see them like drop off the map when
it comes to these things that we check in on.
And so I think that's really interesting.
And I also wonder the reasons why these high levels of
well-being occur after depression.
I know for me anecdotally, going into college, I heard from so
many people that it was the hardest thing they've ever gone
through emotionally and going through that huge period of
change and deciding their own schedule and the stress levels.
Like a lot of people experience depression for the first time in
college. It's such a huge shift in life
and they've never experienced anything like it before.
And I remember getting to college and having gone through
DBT and had they done a lot of therapy and been through such a
worse time emotionally being like, I have every single skill
I could need to navigate this experience and navigate this new
arena and build relationships. And I know that schedule is
really important and and sleep is something that absolutely has
to happen. And so it did feel like there is
that skill set there that some people just didn't have.
And I did feel like that anecdotally correlated with
being able to maintain and improve well-being in college.
And so I'm curious if you have in speaking to people who have.
Kind of ended up in that camp with higher levels of well-being
post depression. Or subjectively, if you have any
thoughts or predictions on why some people have such positive
outcomes after those depressive episodes.
I mean, I love your story. I think it's, it's so telling.
And again, not the not the default or mainstream view of
how we think about the effects of depression mean ordinarily I
think people think, oh, if you have depression, you're damaged,
you got damaged. And so like the best you can do
is you have all these scars and just kind of like repair the
damage. But what you're describing,
Sadie, with your experience, if I'm understanding it, is that
depression was kind of a proving ground for you in some ways,
that you emerged with some knowledge and some skills, both
about yourself and about the world that you wouldn't have
had. And it doesn't mean that it's a
blessing for everyone or just a good thing that we just should
be more depression so we would all have these skills.
But I think that we ignore this at our peril because this is
like a really profound experience that people go
through. And it does change people.
And I think we've ignored the ways in which those changes are
changes that are helpful in later life, whether that's being
more empathetic to other people who might be struggling, better
self knowledge, a better tuning of your aspirations to projects
that are meaningful and purposeful.
And part of what happens in depression is people often
experience kind of a crisis of meaning and purpose.
And it doesn't always get solved, but sometimes it does.
I mean, I'll just say again, anecdotally and to relate my own
experience, I think that changing what I was doing from
the study of history, which I loved, to the study of
psychology, it wasn't 100%. It's hard to put on an exact
number, but it was a significant component, I think, in how I was
able to pull out of the depression and after the
episode, kind of gathered something that was meaningful
and purposeful for me. So understanding depression was
very near and dear to my heart. And the idea that my experience
could be something that actually leads to something good in
scientific knowledge and helping other people, that would be a
great example of how depression could change someone in in a in
a positive way. And I think that's really been
very badly neglected in psychiatry and clinical
psychology because of this almost exclusive focus on the
ways that depression creates different kinds of collateral
damage, you know, in cognitions and relationships, in income and
so forth, and you in other psychopathology.
And look, I'm not trying to put those people out of business and
talking about positive outcomes or positive life change.
I just, I'm asking for a little bit more balance.
So, you know, we could again have a discussion about what is
the right level of balance in terms of studying negative
outcomes versus positive outcomes.
And I'd say about 50-50. But realistically, even if 1/4
of the research was aimed at ways in which depression for
some people is a kind of a bridge to a better place, I
think it would be very useful. I think it could be very useful
clinically. That is people who are still
struggling because we don't have to always reinvent the wheel.
There are a lot of common themes that are shared between people
who have these experiences. And as you're suggesting, the
experience of depression as it is happening now is very
disconnecting. So you have people who are still
quote, UN quote, still in it versus people who feel like
they've come out the other side and they're now a different
person and very little conversation between those those
two groups and kind of almost like each is kind of threatened
by the other. And I think like, wow, everyone
has something to give here, you know?
And so I think this dialogue about the ways that depression
can change you and the ways that depression can change you even
for the better, or at least it can be an opportunity for
change, better or worse, is a kind of dialogue that I think a
lot of people who've had these experiences would be interested
in having, regardless of whether they're depressed right now or
not. Yeah, it's exactly like you said
earlier. It's literally a blind spot for
the people that have come out of it and now don't as vividly
remember the experience and the people that are in it that
aren't able to contemplate what it could look like on the other
side. And so I couldn't agree more
that that conversation is so, so, so needed.
But it is complicated because it sort of speaks to these issues
of identity. So identity is a complicated
topic, right? And say people have multiple
things that they identify that they comprise their identity and
and there's a question of how does mental health intersect
with that? So, you know, typically people
don't integrate mental health problems into their identity
very much or very well. And part of it is that there is
a fairly dominant model of mental health problems that's
biomedical that conceives of these problems as fundamentally
a disease. And so it's hard to identify
with the disease. It's harder because it's a
disease is something that happens to you, result of genes
or biochemical processes. It doesn't really feel like it's
you. But that I think is too bad in
the sense that for everyone, it is a profound experience and
does lead to changes in how people might think of themselves
or their experiences or their future.
And so it does intersect with with identity and people have
difficulty figuring out how do I relate to this thing?
Does this mean that I'm a bad person or what does it mean?
And so I think part of this dialogue, what it could do is to
help reconnect these profound experiences to people's
identities. And not only in ways where
people feel diminished because they had a mental health
problem, but also in ways that they feel a sense that this is a
important part of them that they maybe even want to hold close
that they appreciate. I guess that's a more radical
view, but I think there's something to it.
And, and maybe you experience something similarly in your
experience that it's become a part of you, you and you could
talk about it. It's not the whole of you but
but it would be a shame if you have to always put this in a
closet and never be able to talk about it.
Yeah, it's so interesting you say that, that people have that
resistance to identifying with a disease, because I remember for
some reason feeling the exact opposite.
I did an IOP program twice and we would do occupational therapy
and they'd have us do art and maybe it would positively impact
our mood. But one of the activities we did
was drawing or painting or your sense of identity.
And I remember my identity drawing and a lot of other
people's really prominently included depression and anxiety.
And it was like, I go to school, these are my interests and I'm
depressed. Like that was the the sense of
identity. And I think it was not only that
so much of my life was consumed by depression and I was in and
out of the hospital and doing intensive outpatient all the
time. And everything I was feeling and
thinking kind of had that negative tilt to it.
But it also was the selfless steam side of things.
It felt like depression was something that was maybe broken
or wrong or not normal or not how normal people are
functioning. And that was absolutely me.
Like something was wrong and I was depressed.
And that was, it wasn't like I have depression, it was I am
depressed. And so I, I think it's really
interesting, like you're saying that the positive and negatives
about how we talk about this thing, whether it's the chemical
imbalance theory or depression is more a signal and we need to
change something in our life. Or it's a disease that we're
experiencing and that happens to us, or we are the, the disorder
and it's something that follows us for the rest of our lives.
It's really interesting. It is really interesting.
Let me give you an example, sort of explain what I mean by
talking about it as a positive, because I don't want this to
come off as like, oh, John is saying that depression is good
and you know, we should all experience depression so we can
become better. People have a very specific
kinds of insights and experiences, you know, that I
think are pretty commonly experienced, even if they're not
discussed much. And some of them come from some
of the most awful parts of depression.
So for example, a lot of people, when they experience depression,
I experienced this as well, are obsessed with different aspects
of death, that things die, that the planet is dying, that your
life is finite. And people become even fixated
on the idea that maybe this wouldn't be a bad thing.
And they have passive death wishes and they think about
suicide. And this is really quite
alarming and horrifying. And it's horrifying not only the
person experiencing, but it's horrifying to the other people
around them. And what are the things that I
find really remarkable on the other side of depression,
reflecting on these experiences and on in some ways feeling like
I was immersed, I was saturated in in death and death
experiences for probably about 18 months of my depression.
I was thinking a lot about death.
On the other side, I realized, hey, I'm alive, BI don't want to
die. C, I'm really grateful that I'm
alive and D things actually seem more alive than they did before.
And it's kind of just like my head explodes sometimes.
And again, it's I don't think if I had had this experience that I
would be in this place. So it's it is a horrible
experience. It is a difficult experience if
there are some potential benefits if you if you look for
them and in talking about them, I don't think diminishes the
horror of the pain or make it all go away.
But I think there are a lot of people who experienced this and,
you know, we, we don't have much time we get in this world and
there are a lot of people who don't experience depression, who
are, you could say, maybe sleepwalking through all their
part of their life and not seizing on the opportunities
that they have and enjoying what they can.
And one thing that can happen, and I hope happens to a lot of
people who go through really painful experiencing and do get
some breathing space from it on the other side is realizing,
maybe not always in that order, but that ABC and D, but you
know, ending with like, it's kind of a miracle that I made it
and that I'm able to enjoy things.
And there's a lot of amazing things, you know, in this in
this world. Yeah, there's this thing on
TikTok called the butterfly effect, and it's like one thing
happened and there was all these positive repercussions.
And I think, like when I look at all the things that I love and
are my favorite parts of life and that I enjoy it, it really
all goes back to depression. Like my relationship with my
family that was built, there was nothing when I was depressed.
It was completely destroyed. There was no communication or
closeness or vulnerability. All those skills were learned
because I got depressed. And now we have an incredible
relationship. The podcast, it started because
I got depressed and have reached so many people.
What I'm doing for school and studying psychology and wanting
to go to grad school, All of that is because of what I went
through and all these other little things that I look and
I'm like, these are my favorite parts of life.
None of that would have been there if I hadn't gone through
that depression. And so I, I really agree with
what you're saying and I think it hopefully will give people a
lot of hope and that other side of the picture that it doesn't
just have to be downhill. It's OK to talk about.
I mean, I think, I think for me, that's one of the main
motivations for studying and talking about life after
depression is to to do my part to make it OK to talk about
these experiences in in their full measure of beauty and
ugliness and confusingness. I think it all needs to be part
of the picture because it's not like even the words that we use.
So language is very powerful. The word that we use that that
often it is people's goal recovery.
You know, we used recovery like you were working on a Word
document and then you got a message that the the file was
corrupted. And then you call IT and you're
hoping, can I recover my file? Your file was recovered.
You open it up and it's the same words, right?
So it's sort of like this idea of like, well, you went back to
the way things were before and this bad experience, this
corruption, you know, has now been purged.
And that's your life and the a I think that's not true because
you're going to change even if you didn't have depression and
BI don't really think the goal. I don't think most people's goal
when they really think about it, when they really think about it,
is just to go back and recover the words from the file.
People have rather more complex aspirations for the rest of
their life. So, you know, talking about ways
maybe that depression is transformative and changes
people as opposed to in ways that are good or bad is more
interesting to me than simply saying, oh, we're, we're all
aiming for this recovery state and it's all kind of, we all
know what that is just going back to the way that it was
before, whatever that is. Yeah.
No, I've never thought about that, but it's very true.
Our goal is not to revert to original.
There's so much beyond that. I mean, this is, this may also
interact with your experiences, the idea that, you know, the
goal is 0 depression, 0 depressive symptoms, you know,
sort of the recovery model, like, oh, I don't, I don't, not
even in the same zip code as depression.
That may not be super realistic for a lot of people.
And it, it may not be entirely healthy too, because you're
likely going to have to be coping.
If you're the kind of person who had a significant depressive
episode, you have that propensity towards a kind of
melancholic state. It's going to happen at some
point on some level. In being able to accept it and
cope with it and dial it back seems really vital, and I don't
know that the terminology of recovery really gives people
those kinds of tools. Yeah, when the fact that you
have those skills that like, you know, something's not where it
should be and you can then kind of shift your life and shift
these things to put yourself on the path you want to be on.
That's really something to celebrate and something you gain
from that experience. Even though it there, there
might not have been positive things there, those skills are
really incredible and a lot of people don't have that.
Yeah, I really love that idea that we should give people a lot
of positive reinforcement for going through the experiences of
depression. Again, recovery is like, you
know, the file was recovered. We have the words, you know,
yeah, you're relieved, but it doesn't really communicate the
the gravity of how much work was required to, you know, endure
this state because depression, anxiety, all these mental health
problems can be just so draining and so hard.
And getting to the end and outlasting them.
We're finding some clever way to get to their end really is
something that I think we just don't spend as much time in
really luxuriating and giving people the full measure.
It may be in part because it's not really widely appreciated or
understood what it is like to go through a full episode.
And it is hard. It is hard.
And language is not that well suited to conveying these
experiences. I mean, there are some good
books people can that I think gives some of the experience.
I think part of The thing is you may have encountered this in
classes you've taken and so forth, this whole idea of
phenomenology, So what it's like to experience.
And there is something, if you really think about it
incommensurate, that is hard to communicate between my
experience and your experience. We can use words.
You can tell me what you're feeling and you can say that's a
beautiful sunset. And I have an idea.
There's a famous essay by this man Thomas Nagel called What's
It Like to Be a Bat? Which really puts a fine point
on it because bats do echolocation.
And we really have no idea, right, really what it's like to
be a bat. But, you know, I don't really
know what it's like to be Sadie. You don't really know what it's
like to be John. We try with, with words and so,
so forth. And then we talked about these
really profound experiences, like depression, where even I
don't have trouble putting into words something that happened to
me. You really see that we have a
challenge here. And maybe that's part of why,
you know, at the end of these depressions, people are just
like, oh, I'm glad you're back. Yeah.
But not really understanding what the person went through.
Totally. I remember my sister was working
on her college applications and the first process was just like
writing down everything impactful that had happened
before. She narrowed down on what she
wanted to write a personal statement about.
And she was like, my sister was really depressed and she put up
a good fight. And I was like, you're making it
sound like I died, Like I'm still here, I'm on the other
side. I'm doing great.
And you're right, there's not a good way to distill that and
explain that and give space for all the painful experiences, but
also all the potentially positive things that have come
with that experience as well. Yeah.
But I honestly, I think you're doing, you're doing Yeoman
service is I think what I understand you're very
interested in what the experience is, is like in, in
good ways and bad. And I think the more people
become familiar with it, the more it gets detoxified and it
becomes a little bit less radioactive.
It's still not easy. There still is a tremendous
amount of discrimination that happens, for lack of a better
word, and often in high stakes, you know, situations like when
people are applying for jobs or people are forming
relationships, there's a lot of fear, a lot of fear of mental
health problems. And they can be seen as
absolutely disqualifying. And we're wasting of just a huge
amount of some of our most talented people because of the
difficulty of understanding what can be a wide gulf between
people's experiences. So I think we really do need
more of this and not just kind of speaking in some of the
cliches that do, but just not that helpful to give people of
the the 3D picture of these sorts of experiences and
bringing them back into the things that are discussable in
polite conversation. And it doesn't make you weird or
a bad person or needing to talk about this all the time, but it
it is a real shame and maybe it's generational.
I think that the younger generation is going to be the
one I think to to finally breakthrough here.
As bad as things are with mental health for younger people, that
will be a really good thing that comes of it, I believe and you
guys are going to get through it.
And I don't think that the situation is necessarily a one
way, a one way train. I mean, again, the picture that
we have of mental health problems is that they're
escalating, that if you had these problems, you're going to
accumulate other problems. So if you had depression, you're
more likely to get substance problems and anxiety and you're
you're going to be kind of trapped forever.
Again, understanding the the heterogeneity.
So knowing that there are a variety of outcomes and that
things are not set in stone, stone by any means to me is back
to this realistic hope that the people need, they need to know.
And, and, and I think, I think it's, I think it's really quite
important to, I could say morale, morale of morale of
younger people and, and people who are caring for them.
Yeah, well, people want to follow along with your research
or read your books or connect. Where can they do that?
Well, probably the best one stop shopping is to visit our website
at the Better Outcomes Laboratory.
So this is at my laboratory at Cornell University.
And if you go there, you'll see you'll see some of this
programming that I was talking about on life after depression,
which is happening both in research and on social media.
So we have a new set of channels that we're calling ever After.
And it talks about these some of these profound experiences in
ways that depression can change people, both for for the worse,
as as as many people have discussed, but also for the
better. And that potential for for
mental health problems to lead to a life that's more beautiful,
more meaningful, and more happy. Yeah, Well, thank you so much.
This was absolutely incredible. It was a real privilege.
Thank you for having me on.