HealthyGamerGG - How Dysthymia Steals Your Happiness

Episode Date: September 19, 2024

In this video, we discuss "Dysthymia" - what it is, what causes it, and how it can continue to affect your mental health and personal growth if left unchecked. Check out more mental health resources here! https://bit.ly/3xsk6fE Learn more about your ad choices. Visit megaphone.fm/adchoices

If we look at these people, the main problem that they have is they cannot derive a sense of pleasure from their own actions. They're doing all the right stuff, right? They've done a lot of research and it doesn't seem to work. But then there is a second component, which is like patting myself on the back, and this helps most human beings feel good. The problem with people who have dysthymia is that that part is absent. So normally when we think about depression, we think about it like an episodic thing. So human beings will get depressed for some amount of time, maybe after a breakup or after they lose their job or some kind of setback. And then there's this idea that human beings will kind of bounce back. About 30 to 50% of people will experience depression at some point in their life.

But there's another group of people who seem to be depressed all the time. Depression isn't something that happens to them. It is a characteristic of their life. It is a constant. And this is what we call this thymia. And the problem with dysthymia is that it is very, very hard to treat. So when I work with people with dysthemia, I'll start with a very common psychiatric question. So when did your depression start?

And they'll say that I've been depressed my whole life. It is my constant way of being. And then the other problem with people who have dysthymia is that solutions tend to not work. So a very common experience for these people is that other people around them will be like, oh, you're sad, like, why don't you go for a run? Why don't you just put yourself out there, try to socialize more, pick up a hobby, and they'll even say things like, man, maybe you should see a psychiatrist or therapist. You should start meditating. All of these things that have a lot of scientific evidence, but for some reason, when you are dysthymic, these things don't appear to work.

And there's actually literature that backs that up. And that's the real challenge of being dysthymic. You're depressed all the time in the standard solutions for some reason. don't seem to work for you. You may meditate, you may start journaling, you start going for walks, and this is what happens when I work with these people, like when these are my patients, is that they're doing all the right stuff, right? They've done a lot of research. They're very, very, like, self-motivated. They've felt this way for a long time. And they've tried a lot of stuff, and it doesn't seem to work. So today what we're going to dive into is understanding

why this depressive, almost personality or characteristic develops, how it develops, and thankfully what to do about it. Because while a lot of studies show that things like psychotherapy and medication are not as effective for dyshthymia as opposed to something like major depressive disorder, I've actually had a lot of success with some patients who have been dysthymic and they've actually learned how to sort of change their life in a pretty significant way. At the same time, I've also had two patients in my career that had dysthemia and really didn't get better. So I have to be a, you know, offer a little bit of a caveat here that like what we're going to lay out, today, I think is a very, very solid solution for dyshthymia. And at the same time, it's something

that is very, very, like, refractory to treatment in a lot of ways. And there's a reason why people who suffer from dysthia will oftentimes go to therapy and not get magically better. Hey, y'all, if you're interested in applying some of the principles that we discuss to your life to actually create change, check out Dr. Kay's guide to mental health. The guide synthesize my years of training as a monk, along with years of clinical experience as a psychiatrist to cover common topics like meditation, ADHD, and trauma. The guides include over 100 additional videos that can be navigated based on your needs or interests

or in a more open, choose-your-own-adventure format. The guides are now available in the YouTube store below, and if they're a little bit outside of your price point, you can check out a piece of them with our free resource packs, which are also linked below. So definitely check them out. So let's dive in to understand where dysthymia comes from? How is it that someone can, you know, grow up and be depressed all the

time? And this is what's really cool. We've sort of like figured it out, right? There's this concept of something called the dominant other. So it's interesting because in the psychoanalytic literature, they had to develop new vocabulary to describe these people's experiences because their experience of life is so different from normal people. And that's what we want to share with you today. So we're going to develop some new vocabulary. So let's take a quick, look at a paper. So this is a concept that was actually discovered in about 1960, right? So this is stuff that's pretty old. And I think this is a really good description of it. So one of the characteristics of the depressive that has been emphasized is excessive dependency on a dominant

other as a source of meaning and gratification. The depressive excessively derives his sense of his self, his self-esteem from being rewarded by the dominant other and appears incapable of securing satisfaction independent of this intermediary. Now, I know that was kind of a mouthful, so we'll sort of explain it, okay? So here's how most human beings work. So I am over here. I am a human. And there is something outside of me, like a parent or a company.

You know, there's something outside of me. And if we look at most human beings, we derive our self-esteem and even a sense of pleasure, okay, from our relationship with this other thing. So, for example, when I'm growing up and I have a set of parents, and if you think about, like, where my self-esteem comes from, if my parents are proud, then that increases my self-esteem, okay? But for people who are not dysthymic, this is really important to understand. We get some amount of pleasure and self-esteem from this, but we also derive some degree of pleasure and self-esteem internally. So if I take a child who's like, like, you know, when I was a kid, right, I would like to

play with Legos. And when I'm playing with Legos, like the pleasure that I derive from that and the self-esteem that I get from building something cool has nothing to do with things outside of myself. The basic problem with people with dysthymia is that they actually get 100% of their sense of self-esteem and even a sense of pleasure and gratification from the dominant other. And we see this in the literature as well. This pathological dependency is exemplified in the depressive sphere of autonomous gratification, meaning the ability to derive pleasure directly from one's activities or accomplishments.

Okay. If we look at these people, the main problem that they have is they cannot derive a sense of pleasure from their own actions. they don't derive a sense of like internal self-esteem. And this explains why solutions don't work for them. So now we have to understand something about a solution. So let's say I go to therapy or I do anything else. Let's say I journal.

So when I journal, there are two places where the value of journaling come from. One place is from the journal itself, right? The exercise itself brings some amount of like insight into my life. But then there is a second component which, brings progress and self-esteem, which is like patting myself on the back and saying, you know what, I did journal. Good for me. I am taking steps to improve my life. And this helps most human beings feel good. The problem with people who have dyshthymia is that that part is absent. So the most that they can ever get from an activity like journaling is 50%. Because even though we sort of place

100% emphasis on the things outside of us, we cannot derive 100% pleasure from things outside of us. And that may be a little bit confusing, but it's sort of like fundamentally as human beings, you know, I can't derive 100% of my pleasure from things outside of me. Some of that has to come from me. So if I, let's take the example of like mountain climbing, right? So if I climb, when I was, you know, 22 years old, I went and I climbed a 14, 14,000 foot mountain. Okay. So when you climb a 14,000 foot mountain, there's a certain amount of pleasure that comes from the experience.

You stand at the top of the mountain, you look around, you're like, wow, this is magnificent. But that's not where the majority of the pleasure comes from. The majority of the pleasure comes from, holy crap. I woke up at 4 in the morning this morning. I started climbing at 6.30 a.m. And I climbed for eight hours, and I've now accomplished this feat. There is a sense of autonomous or internal gratification. And this is what is denied to people with this thymia.

And this is also why people with dysthymia, why solutions don't work for them, because they go on and they're like, okay, so someone saying, go climb a mountain, they climb a mountain. But they only get 50% of the pleasure. People say, start journaling. They only get 50% of the pleasure. People say start meditating. They only get 50% of the pleasure. They are denied this sense of internal accomplishment.

So then the question naturally becomes, why is that? How are these people different? And this is where you see particular patterns in these people's upbringing. So I'll illustrate what I've seen very commonly kind of as a therapist, okay? So the first is that there's something outside of you that determines all of your self-esteem. So this can be something as simple as parents who expected way too much of you. So when I work with patients, these are the kinds of things where it's like, okay, if I get a 95 on a test and I get an A plus, my parents are still unhappy with me because I'm not number one in the class. That kid down the street is number one in the class. My, you know,

my, I'm a doctor practicing in this particular city and there's a colleague of mine who's also a doctor who's practicing in this particular city. And that colleague's child is number one and you're not number one. Therefore, I feel inferior and nothing you do is ever good enough. So if you sort of grow up with this kind of pattern, what that means is that like your sense of gratification, comes entirely from this omnipotent being, right? You struggle so hard to do a good job. And if this powerful figure above you that dominates your life is happy, then you are happy. And if they are unhappy, then you are unhappy.

Their parents don't allow their children to be happy on their own. So what this results in is I'm over here, right? And then there's, here's the dominant other. Here's my parent. And normally 50% of my self-esteem comes from my parents. 50% comes from me, but in people who are dyshthymic, this 50% gets converted over here to 100%. And now my whole life is about satisfying this person. Now, this does something very, very subtle and very, very important, which is that this person,

then the child, learns one really important lesson about life. Happiness from the outside, right? They are denied the ability to be happy. happy with themselves. Now, this frames the way that they start to live life. But there are a couple of other scenarios that can result in this fundamental change. So this is another one that I think oftentimes is missed by a lot of people. This is so interesting.

Sometimes the dominant other is actually someone that you as a child take care of. So this is going to be kind of hard to understand. So I'm going to try to explain it. But it's really important to understand, okay? So sometimes I've worked with patients who have parents who are, are like physically ill, chronically ill. And what happens is this parent starts to rely on the child for their health, their happiness, and their well-being.

So I have mom or dad who's chronically ill, and whether they have a good day or they have a bad day depends entirely upon me. So if I'm available to take care of them and cook them the food that they need, and if I'm available to like bring them a report card that shows them an A-plus, like now this person is so miserable, but I can bring them joy. If I work extra hard and I bring home an A plus report card, my parent who's complaining all the time, suffering all the time, now they'll look at me and I see a slight smile. And I'm like, oh, thank God, I can make their day a little bit better.

The parent's happiness depends on the child. Now, you may wonder, how does this create a situation of dominant other? So this is what's really interesting. It's the same kind of situation because what the child learns is an adult's happiness is not in their control. An adult's happiness depends on the circumstances around them. So if you are someone who has a parent who's chronically ill, what you as a child will learn is a human being's happiness

has nothing to do with them. Their parent doesn't exercise any autonomy or responsibility over their own happiness. So the principle is the same. It's just kind of in the opposite direction. So in this scenario, right, here's the child. and here's the parent, and the parent is sick. So what does the parent's happiness depend on?

It depends 100% on the actions of the child. Is my child getting good grades? Are they available to rub my feet, administer medicine, right? All kinds of stuff. So what is the child learning about the script or the way that the world works? This person's happiness is 100 dependent on this person's actions. And so then what happens is, is as this child grows up, now you're in this column.

And now what you're thinking is my happiness depends on this external thing, depends on this external thing, this external thing, this external thing, and this external thing. And here's the thing that makes me just incredibly sad, which is that people who grow up in this pattern, who are dyshthymic, when they're growing up, their parents can count on you, right? Because you're, like, working so hard to make your parents happy. The problem is when you grow up to be an adult, there is no one that you can count on in the way that your parents could count on you.

You sort of started to craft your entire life around your parent. But when you grow into an adult, no one else is willing to make that sacrifice on your behalf. And so then you run into serious trouble. This episode is brought to you by Nordstrom. Ready to refresh your wardrobe, Nordstrom has all the latest styles for spring, from elevated dresses and denim to standout tops and accessories. Discover the trends and essentials you'll reach for again and again. We've got brands you love like Waif, Princess Polly, Mango, Adidas, and Favorite Daughter.

Plus free shipping, free returns, and quick order pickup make updating your closet effortless. Shop in stores at Nordstrom.com or download our app. There are a couple of other features that I tend to see in my patients with Desimia. So let's see if this tracks for you. So one is that they like think a lot of things are frivolous. So oftentimes growing up, like their parents or their conditioning or their upbringing or their thought process now is like, this is frivolous. Like you should, this is silly. Like we shouldn't spend our time.

What do you mean like waste a whole day doing nothing? Like that's a waste of time. Sometimes they think that things are frivolous. Sometimes they think that things are inefficient. Sometimes they feel it's like too indulgent to do this thing. The concept of treating yourself is like completely foreign to them. Oftentimes the other thing that we see in people with dyshthymia is that they, their attempts at self-gratification are accompanied by intense feelings of guilt, right?

So if we go back to the scenario of parent who's got health problems, and then you one day sort of are like, well, I want to go to like, I want to go to prom or I want to go to a party with my friends. And then when you go to a party with your friends, you feel an intense sense of guilt. And where does that come from, right? Because your parent is sitting there, they're lying in bed and they're like, oh, like, you know, you should go and have fun. I'll be okay. Like, you know, it's okay.

Like, I can't really make myself food, but I'll be all right. Like, you should go and live your life, right? Don't leave me here. Like, you know, I don't want you to ruin your life because of me. Like, don't do that. And then your parents starts crying. And then they feel bad. They're telling you, oh, go and live your life.

But how do you feel looking at this? You're like, I can't, I can't fucking leave, right? Like, my parent is willing to make all of the sacrifice and they're suffering so much. Oh, I won't go. I'll sort of stay here. So once again, the problem here is that you get conditioned. You get conditioned that any kind of pleasurable activity you take automatically has a sense of guilt that comes with it. And this is true of the child who grows up with super high expectations as well, right?

So I got a 95 on a test. I didn't get 100. You want to play video games? That's a waste. You should get 100 first. So all of these pleasurable activities that you want to engage in are actually denied pleasure. Right. So when you engage in the activity, you don't experience pleasure.

instead what you feel is like guilt or shame or that you should be doing something else or this is a waste of time. And now we begin to see how this creates dyshthymia because what is this, what are these people's experiences of life? Their experience of life is that things don't bring them pleasure, right? Other people are able to socialize, they're able to go to parties, they're able to go on vacation. But people with chronic dyshthymia, there's always this depression lurking in the background that is squeezing the joy out of your, life from all of these different like activities that normies can experience joy from. Therefore, the future depressive has been trained to fear his own activities. He requires a mediator to grant him pleasure, a dominant other who breathes meaning into

their life. In order for your life to have meaning, it requires someone else to give you meaning, this dominant other. And it doesn't even have to be a person, by the way. It can even be things like a religion or like something like the army, like where there's this other factor outside of you that determines whether your life is good or bad. This is the crux of people who have dysthemia, is that they're not able to extract pleasure from life on their own. So one kind of surprising feature is that oftentimes

people with dysthymia are like externally incredibly capable. Remember earlier in our example, we talked about someone getting a 95, and this is what I've seen a lot, right? So in my practice, I work with people who are like coming to me for like learning about becoming a happiness and attaining moksha and all of this kind of like inner peace and stuff like that. So oftentimes people will come into my office who are very like financially successful, very like externally successful, but they're constantly depressed. And so early on the reason that they became so successful is because they were trying to satisfy unrealistic expectations from parents. And then when they grow up and they've like sort of checked all the boxes, they're like 32, 33, making a ton of money. like maybe even dating, but they have this subsurface constant sense of depression. So let's take a quick look at that paper again.

The problem with the helplessness model is that many depressives are capable of excellent work and are convinced of their effectiveness. They derive, however, no pleasure of meaning from their efforts. It is not the realistic inability to perform, but the intra-psychic inability to obtain satisfaction that seems more typical of depressives. This means that a lot of y'all who are people, chronically dysthymic are not as debilitated as people who may even have something like major depressive disorder. When we think about something like MDD, we think about severe depression

where you can't get out of bed, you can't clean your room, you can't do anything, so you are impaired. But people with dysthymia struggle constantly and are successful, but no amount of success seems to bring them some sense of joy or autonomous gratification. They're not incapable. They're very capable, but for some reason, they're eating food all the time, but it has no taste. The other thing that we tend to see in people who are dyshthymic is that as a result of this kind of like, you know, upbringing and their inability to derive like meaning from things like work or relationships, they tend to gravitate towards a lot of like dopaminergic activities. So now we're going to take a quick kind of side note into the neuroscience of something called anhadonia. So

Anhedonia is the inability to feel pleasure. And if we look at sort of the circuits for pleasure in our brain, it's not just dopamine. There's one kind of pleasure that's called consumatory pleasure. So this is like when I consume something, I get a spurt of dopamine. So people who are dysthymic can actually experience that. So they can get some degree of dopamine. But a lot of the pleasure that we experience in life comes from a sense of like satisfaction or contentment. It's not just the dopamine.

It's like climbing to the top of the mountain where, sure, I get some amount of dopamine rush because I'm seeing something super cool. But then there's also this sense of like internal contentment. And that kind of stuff is actually denied to dystimic people on a neuroscientific level. So we sort of know that from Anhedonia. And what this results in is that if you are denied sort of the sense of contentment, but your consumatory pleasure is still capable, right? You still like, your dopamine circuits are somewhat intact.

What that means is that. people who are dysthymic are drawn to particular activities, like alcohol, substance use. And this, by the way, has been understood for like 60 years. And nowadays, it's things like technology and video game addiction. Other such individuals may fight a feeling of inner deadness by daredevil thrills or criminal excitement. And then this is also hilarious. They are chronically tired, withdrawn people who are drawn to melancholy aspects of life, often immersing themselves in existential literature or pessimistic things. Fiction. 50, 60 years ago, people were noticing that, okay, like if you're someone who feels

devoid of meaning on the inside, if you feel dead inside, you were drawn to these external dopaminergic kinds of things, and you're also like kind of a goth, dumer sort of kid, right? These tropes have existed for years way before we were born. And thankfully, we sort of have some insight into this. So now the question naturally becomes, if you're someone who's struggling with the Simeo, what do you do about it? So let's talk about it. So let's talk about a little bit of kind of evidence-based treatments. A lot of studies show that things like pharmacology, like using antidepressant medication, does have mild to moderate effects.

What I was kind of taught in residency is that it doesn't really work great, which is kind of fair enough. That's been sort of my experience as well. But it's still not something that you should avoid by any means. By all means, like sort of look into things like pharmacologic, you know, go see a psychiatrist get prescribed some antidepressant stuff. It could help you. Second thing is there are studies on things like psychotherapy.

and psychotherapy is also like mildly to moderately effective. And I think the challenge here is that a lot of these like protocolized therapies like sort of don't work because they, it's not that they don't work. The evidence shows that it can't help. But there is like a particular problem with like going to see a therapist, which has to do with the way that a dysthymic person sees therapy. So the problem is that going to see a therapist falls into the same trap that reinforce. forces the dysthymic person's patterns. Okay. Now, what does that mean?

So remember, this person grew up thinking that all of my joy comes from something outside of me. And the work that these people fundamentally need to do is to learn how to discover inner joy independent of anything outside of me. So when I go see a therapist, there is a subtle thing that can happen, which is I can fall into the same trap. Now, what is the source of my joy and my pleasure? it is the therapist.

I will go to the therapist who is now taking the place of the dominant other. It used to be that my pleasure or my happiness came from mom or dad,

but now I will go to the therapist and the therapist will bestow upon me some sense of happiness and meaning and self-worth. So then you go and then you actually fall into the same trap

where you go to the therapist and you're like, therapy. I'm here to do the work of therapy. I'm going to do everything that I'm supposed to be doing and I will be fixed at the end, right?

You're going to fix me. But that in and of itself is what keeps people with dysthymia stuck, because they're, once again, shunting the responsibility. Instead, what they need to do is learn how to derive pleasure from their own activities. Now, the question becomes, how do you do that? The first is that, like, we notice that all of their human relationships are not about the joy that you get by being with this person, right?

Y'all aren't just, like, chilling. You can't just hang out. Your relationship with this person is, once again, like the dominant other. Like if I am in a relationship, the relationship will make me happy. Instead of just chilling with your partner and viving and doing nothing and just enjoying their presence, you are engaging in relationships to extract pleasure and bring this happiness from something outside of you. This also applies to all of the work that you do, right? So instead of like work being about like being satisfied with yourself, you are always working for other people's approval.

This has to change. It starts by noticing this pattern of anything that you engage in. Are you thinking this is going to make me happy? And I want you all to really think about that phrasing for a second, right? Because in that who controls the making happy? This will make me happy. This is an outside thing. The dominant other is acting on me and will make me happy.

So I'm losing all of my sense of responsibility, which is the problem. So the first thing is to notice that pattern. The second thing to do is as you engage in particular activities, what you will find is that guilty voice, that voice telling you this is inefficient, this is a waste of time. It's going to be some kind of guilt or negativity that comes with pleasurable activities. Now, I want you all to think about, like, how screwed you are if that's what happens. Because there are some things that bring us pleasure in life. And when the things that bring us pleasure and meaning in life make us feel guilty too, it's like, wait, what? It's like, okay, here I have a sandwich and I'm going to put some trash on top.

Anytime I take a bite of a sandwich, I'm going to put some trash on top. So you're depriving yourself of the positive experiences of your life by the feeling of guilt that you layer into it. So when I work with my patients, usually what we do is we really try to find that guilt. So when you try to do something that's pleasurable, like, you know, what are the things that you feel guilty. The crazy thing is you actually want to move towards those things and then really try to just experience that kind of in the moment, experience it, notice the guilt, set it aside, but really try to engage with it. So I had a patient who was like 36 years old and they really loved Legos and then like something happened and they got punished when they were at the age of eight.

They did something as an eight year old and their parents were like, no more Legos for you. They took all their Legos and they never got them Legos again. And they, you know, anytime they would ask for Legos, like the parents would be like, no, you shouldn't be doing Legos. You should be doing this instead. Like, you should be focusing on your studies, Alok. Focus on your studies. This isn't me, by the way. My parents let me play with Legos. So now what we really want to do is practice engaging in those things that actually make us feel guilty. And we want to kind of acknowledge the guilt. And we want to sort of, like, see if we can find some way to derive pleasure without the guilt. It's actually an internal work, not an external work. And that's the problem that these people slip into is they're assuming

that if I go through the motions, the good stuff will happen, then I will be happy. But they don't do the internal work. The next step that we usually have to take is we have to acknowledge all of the repressed thoughts. So usually what happens if we look at people who are dysthymic is as a result of this conditioning, there are a lot of natural reactions that arise within us, right? So like when I get a 95 on a test and my parents say, why couldn't you be number one? there's a natural reaction of like, hey, can't you be proud of me?

Like, I was proud. Like, I come home and I'm so excited because I got an A, right? And all you've ever wanted for me is get a 4.0 GPA. So I have this like natural reaction to my circumstances. And what happens when you're raised with the dominant other is that your natural reactions have to be repressed. Because you come in excited and your parents are disappointed and that's like whiplash for you. So in the stage of healing, what we have to do is start uncovering these reactions. A great way to do this, and this is kind of like practical advice that I give to my patients,

is do things that are a little bit impractical, do things that are a little bit indulgent. And when they engage in these activities, we already talked about the guilt, but then there's another thing that happens. So you start to feel the guilt, right? And the guilt is what represses. It's not just about noticing the guilt. It's about noticing what the guilt is covering up. Remember, there's the sandwich and there's the trash on top.

So one part is removing the trash. The second part is actually focusing on the sandwich. So what is it that I enjoy about this kind of thing? And this is basically what I find is that like the reason that these people aren't enabled to derive that internal satisfaction is because they repress these very actively and there's guilt layered on top. The next thing to do is to really try to become independent. And what do I mean by that?

So what I mean by it, and a lot of times, like, people who are dyshthymic, remember, they can be very capable and very successful. So they may be, like, financially independent. They have their own place. Sometimes they struggle in those dimensions, too. But what I mean by independent is if I, when I talk to my patients who are dysthymic, they're always thinking about someone else. Like, okay, do I want to go to, like, the gym today? Well, I have a buddy who works out and he likes to go to the gym, and I don't want to disappoint him, so I'm going to go to the gym. And they'll go to the gym and they'll work out, but they're afraid of disappointing people.

They're afraid of disappointing bosses. they're afraid of disappointing, you know, their spouses, they're afraid of disappointing other people. So their whole life is kind of constructed in relation to something else. That's the whole problem with the dominant other. So what we really strive for is independence. Go and do something by yourself, right? Go and do something irrespective of what someone else thinks. Go and do something that you can enjoy.

Now, this is, once again, the trap that they fall into. So when they hear that advice, there is a very easy way. way for this to end up not helping you at all, which it's kind of so subtle, it's so hard to understand. And this is why it's so damn hard to treat. So if you think to yourself, oh, if I do independent activities, the independent activities will bring me happiness. Same fucking trap.

Do you all get what I'm saying? I don't know even know how to put this into words, but oh, like the independent activity, that will be my salvation. If you fall into the trap of thinking a therapist will fix you, an independent activity will fix you, meditation will fix you, it will not. work. The independent activity will not fix you from the outside. When you engage with the independent activity, don't look at it outside of yourself. Pay attention to it within you. What do I enjoy about this experience? Am I feeling guilty? How do I derive pleasure?

And to practice being by yourself and really digging around inside of yourself for some kind of pleasure. Now, the last step, which is absolutely necessary, which is oftentimes the reason that people also get sabotaged is as you start to walk down this road, the people around you will punish you for it. So this is something that is so sad, but I work with so many people who have all kinds of diagnoses. And what tends to happen when they start to make progress in their life is the people around them, punish them. So if you are of someone who has been dystimic your whole life and you've been like thinking about the dominant other right, you've lived your life to make your boss happy, your spouse happy, your parents happy. And then once you

start living for yourself, oh, they are not going to like it, right? Because they've expected, oh, like, this is the person that I can call at the drop of a hat. You may even derive some positive sense of ego. People call you a great friend. They're like, oh, yeah, this person is always available, no matter what, I appreciate you so much. They'll say this kind of crap to you, right? And you may derive some degree of pleasure from it. That's the problem from the dominant other, is the only time you feel good about yourself is when they tell you, oh, you're such a good person. But then in order for you to feel good about yourself, you have to continually sacrifice for the sake of the other person. And when you are continually sacrificing for someone else who does not sacrifice for you, you cannot be happy.

This is the trap of the dystimic. Something outside of me makes me happy. So I constantly have to chase it, chase it, chase it, chase it, chase it, chase it. And no matter how much I chase it, dude, you can never be. at peace if you are constantly chasing something. And so as my patient start to make progress, the people around them are not happy with it. And then they start punishing them. And if you have not done enough internal work, then that punishment will be too hard for you to handle

and you'll end up cracking and you will sort of go back to your old patterns. And so this is the tricky thing about sort of overcoming this dysthymia is that there are a lot of steps to it. But the challenge is that, you know, people will sort of say like, okay, if you're a dysthymia, and you're too dependent on other people, start by being independent. Just be more independent. Just go do these kinds of things. But that doesn't work.

In my experience as a psychiatrist, there is a sequencing to this stuff that is very important. You can't just strive for independence. Piss off all the people who have come to expect of you being a dormant. And the punishment that they give you is going to be too much for you to handle. Until you've done the work of understanding the guilt that you feel, right? Because when they impose guilt upon you. you, that's going to pile onto the guilt that you feel and it's going to make things like overwhelming. So the key thing about this process is that people will look at some of these

solutions and they'll say like, okay, I have to do the solution, then I'll be fixed. It doesn't work like that. Recovery from dysthymia, the best analogy I can give y'all is it's a little bit like assembling furniture. There's a bunch of pieces and you can look at a picture of, let's say, like, you know, a cabinet that's been put together. But you can't just put together the walls of the cabinet. You have to do a lot of internal work. You have to put together the drawers, put together the shelves, and then you slot them all into place. Then you create the outside of the cabinet. And that's what you need to do if you're struggling with dysthiaiaia.

You can't just jump straight to the end and become independent and find joy. It doesn't work like that. If you try to do that, what you'll end up with is something that looks like a cabinet but has nothing on the inside. Instead, think a little bit about the steps that we've laid out. Now, this is like, once again, just one clinician's take on what this has looked like when I work with them. Your road may vary, your mileage may vary. But the good news is that when I've worked with a lot of these people, like, it's pretty cool, like how transformed their lives are at the end of this. Like, many people are like, holy crap, like now I'm enjoying life.

Like, I'm deriving pleasure from my life without being dependent on other people. Leads to a huge sense of freedom. Leads to a huge sense of like putting down a burden. Leads to like, I'm not chasing anything anymore so I can just sit down and chill. So this time is something that, you know, is actually way more common than we realize. So we said that 30 to 50% of people will experience depression of some form at some point in their lives.

The crazy thing is like a third of those people will be dyshthymic. So we're talking about somewhere between like 10 and 20% of the population struggles with this constant sense of like emptiness, lack of meaning. And our hope today is that we can sort of illustrate a little bit of this problem for you so that you can take a couple of steps and hopefully move in the right. direction. But remember that just because you watch this video and you follow the steps doesn't mean that the happiness will come, right? You have to do the internal work, which I know is hard because you're like, I don't know how to do that because your parents conditioned you to never do that

internal work and just focus on making them happy. So it's like, it's a real tough nut to crack, but good luck with that.