HealthyGamerGG - How the World Makes Us Depressed

Episode Date: August 1, 2022

Today Dr. K dives into the mechanism of depressions, responsibility, depression in society, and more! Support this podcast at — https://redcircle.com/healthygamergg/donationsAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy Learn more about your ad choices. Visit megaphone.fm/adchoices

And so, oddly enough, I think actually part of the problem right now is that individuals are accepting too much responsibility for societal problems. So let's start with why we evolved to get depressed. Why do we, why we evolved to experience sadness and depression? So the first thing to understand is that to a certain degree, depression is like within the normal range of human experience. And we're not talking about a clinical illness here, but we're talking about periods of sadness, okay? So if we kind of think about it, why is the human being brain capable of sadness? Like, why doesn't our human brain just experience positive emotion? In order to experience, since we experience depression and anxiety, what that means is that

these emotions, or sadness, let's call it sadness and worry, these emotions must have positive effects. Like, they have to have evolutionary survival benefits. And we sort of see that this is the case. So, for example, anxiety or worry allows us to predict future problems. And once we are able to predict future problems, if we get anxious about them, we'll alter our behavior to avoid that problem. Right.

So if I'm worried about running out of food in the winter, that worry is going to drive me to look for more stuff, store more food, you know, prepare for a rainy day. And so what we tend to see is that even squirrels will put. prepare for winter, right, by like burying food. So there may be some amount, we don't really know. I mean, I haven't looked at research on this, but I imagine that the squirrel experiences some degree of anxiety where it's like, oh, I better take care of this, otherwise I'm going to be in trouble. Well, what about sadness, right? So why do we feel sad? So sadness is a good way to correct our own behavior, right? So if I do something mean to someone else and other people get upset

with me and they shame me and then I feel sad, that sadness is going to essentially be an internally imposed punishment that prevents me from engaging in the behavior again. When I get ostracized for something and I feel really bad about myself, ostracization, if I was like completely numb on the inside, being ostracized like wouldn't really affect me very much. And we actually see that with people who have like sociopathy or antisocial personality disorder, where they're in a to experience things like sadness or guilt or stuff like that, causes them to oftentimes have trouble in terms of interacting with other people, which is one of the reasons why we see a higher amount of antisocial personality disorder in jail.

So if you look at prisoners versus the rest of the population, what you'll tend to find is that prisons have a higher amount of antisocial personality disorder. And why is that? It's because they're not controlled by their negative emotions. they're not restrained by their negative emotions. So they end up doing worse stuff. And our society has decided, hey, if you're going to continue doing this stuff and taking advantage of people, hurting people, you're going to actually like, we're going to put you in jail.

So we can see that like negative emotions absolutely have a positive impact. Another good example of this is the grieving process. So when I lose a loved one, I feel really sad. I don't feel like doing anything. It hurts, you know, bothers me, things like that. And so what do we do when we feel sad and when we grieve? We have something like a funeral. Everyone gets together.

We share our experience of sadness. We all miss these people because we feel alone when someone passes away. And when I get together with a group of people and I say to the rest of the world, I'm alone. And then someone else is like, I'm alone too. I miss this person too. not only do we vent that negative emotion, but then we actually like facilitate connection now that we've lost this person because, oh, you missed this person? I miss this person too.

Let's talk about it. And what we tend to find is that, you know, grieving processes, funeral processes, are conserved throughout humanity, right? So this isn't culturally bound. It's like in our brains. And even I've seen like articles and stuff about even elephants will grieve, right? animals will grieve. So this is such a basic part of like processing loss and recovering that we grieve. And so the grieving process involves essentially venting some amount of negative

emotion and then also connecting with other people who struggle with the same things you do. And it turns out that like almost on a biological level, right, because animals do it, that improves our life in some way. We feel better about ourselves, but it also improves like objective levels of function. So y'all will understand this, by the way, if you kind of like, if you know people who haven't grieved appropriately, right? People who get hung up on the one that got away and can't grieve a relationship. And then they're stuck in their life.

I used to be captain of the football team 25 years ago. And man, I had all the glory. And now it's like they're so resentful and caught up about being captain of the football team but never doing anything better, that that's what all of their identity and ego is based on. They feel stuck in life. You can't move forward. And so these basic principles of like connecting with other human beings and experiencing sadness and venting that emotion actually causes like improvement.

By the way, that's part of the reason we have group coaching because we sort of recognize this, right? That actually it's kind of interesting. All you have to do is get a group of people together, help them vent their emotions and help them share common experiences and those experiences will actually get better. Now, you can improve that process by throwing in a coach who is a trained facilitator who can sort of help people overcome those things, get unstuck, you know, like not get hung up on the one that got away, right?

Because it's interesting because if I talk about the one that got away and you talk about the one that got away, I start to realize, oh man, this guy's really stuck. And then I'm like, wait a second, I'm really stuck too. Holy crap, I never realized it. Anyway. So this is a very conserved thing. So even sadness, depression, grief, these are like very conserved things. We've evolved to have them.

And so once we start to experience some of these things, like let's try to understand a little bit about what is the mechanism of depression. So when someone gets depressed or when someone gets sad, how does that manifest in their mind? So the first way that we sort of kind of can understand depression is through identity. And this is what's so tricky about a generation that gets depressed. Because what happens is even if it's a generational effect, even if it's a societal effect. And there are all kinds of things happening in society, right?

It's harder to find a partner now because of online dating. It's like so difficult. It was supposed to be easier because of online dating. but it's actually gotten harder. Now people are saying, oh, if you want to find a partner, get off of dating apps. Then it's like,

what's the point of a dating app if the best way to find a partner is to get off of a dating app? We're dealing with, here's the other thing about what we're dealing with. You know these once-in-a-lifetime kind of things? We've had like four of those

in the last decade. 9-11 was a once-in-a-lifetime kind of event. A global pandemic is a, a once-in-a-lifetime kind of event. The subprime mortgage crisis was a once-in-a-lifetime kind of event. The current crypto crash is a once-in-a-lifetime kind of event. It's like how many once-in-a-lifetime events do we need to get bodied by before, like, the world kind of chills out?

Now, here's the tricky thing about depression, is that if you get depressed, you think it's your fault, because that's what the depression does to you. right so like if you're alone at home and you can't find a job you can't afford rent because of the crazy disparity between wages and housing prices and how that disparity has increased astronomically over the last 30 years and then like whose fault is that well if you're depressed it's your fault because a key part of depression is something called negative self-aditude. So you feel guilty. Oh, it's my fault.

And we'll see this a lot, especially in things like unhealthy relationships where someone's depressed. And so we'll kind of see this where like you'll have, you know, let's say you've got two people who are dating or in a relationship. They live together. And one person starts to get depressed. And then they feel responsible for all of the problems in the relationship. But the problem here is that they're only.

responsible for half the problems in the relationship, right? Your partner is contributing. The issue is that once you become depressed, your mind is happy to take responsibility for all of it. And now what we have is a generation of people who thinks that, oh, the reason I'm living at home with my parents, and by the way, 52% of people under the age of 29 still live at home. When you live at home with your parents, you think that's pathetic. Even people will tell you that's pathetic. You'll see on online dating profiles. You need to have your own place. Well, that knocks out 52% of people.

And this is the tricky thing, right? It's like we don't acknowledge when we're depressed, we don't acknowledge that they're actually societal factors that are making it this way. Because sure, 50 years ago, if you were 28 years old and living at home, maybe that was a little bit suss. But now it's like more than half. So does that mean that it's my fault that I'm saying? still at home because the depression will actually make you think that way.

So the first thing to understand is that depression is about identity. That's one of the primary mechanisms of it. We also know this scientifically. For example, we have a part of our brain called the default mode network. The default mode network gives us is the capacity for self-reflection. And what we tend to find in people who are depressed is that the default mode network is hyperactive. And we can't shut it off.

and what it's constantly doing, it produces thoughts like, this is my fault. It's always thinking about you. It's always thinking about me. It's reflecting about myself. So a certain amount of self-reflection is healthy, right? But if I'm in a relationship and we have a fight, a healthy mind will think, well, what did this person do? And what did I do? We'll sort of balance that.

A very egotistical mind will think only about the other person, right? So if we lopside it towards 100% this person, person's fault, this person's fault, this person's fault. And if you look at a hyperactive default mode network, that's going to be thinking 100% about you. You're only going to be looking at what you did wrong. And you're going to be assuming all of the blame. So that's one of the primary mechanisms through which depression happens. The next primary mechanism that we sort of see in depression is cognitive distortions. So this is where the depressed mind starts to see things in a different way. So there's no point in trying because there's no way that I'm ever going to

get a job. No point in applying. Other people may be able to do this, but I won't be able to. And the funniest one is if you take a depressed person and you ask them, hey, you know, you have a friend or let's say you talk to someone else and they're depressed too, even if you're depressed, you can encourage them to go get therapy. You can be like, hey, you deserve to feel better. Like, I'm so sorry that you're struggling this way. Right? Like, you should go see a therapist. It would really help.

But if I ask the depressed person, well, what about you? Should you go see a therapist? Nah. I don't deserve it. A therapist, someone else deserves to be helped by that therapist. Not someone as pathetic as me. This is all my fault. I'm wasting someone else's time.

I'm taking someone else's slot in therapy. Right? Like, so you'll see all these different. cognitive distortions. You'll start to think that you're not going to be successful. Other people can seek therapy. You can't seek therapy. So this is another big mechanism of depression.

The third reason that people are depressed, and we sort of talked a little bit about this already, is because it's actually appropriate given your circumstance. So our brain has the capacity to, like, make predictions about our likelihood of success. Or make predictions about the future. and sometimes the future is objectively bleak. And so it's not a malfunction of the brain. And this is where I'm sort of tossing around the word depressed, but what I sort of mean here, this is important.

I've seen this in my office, and we talk about this in terms of Dr. Kay's guide in what I call congruent depression. Some therapists will talk about existential depression. So I don't know that this is like a neurochemical imbalance. But sometimes the reason that we get depressed is because our life is genuinely crappy. And it's actually an appropriate response to our circumstances. And this is the thing. So even as a medical doctor who prescribes medication,

there's a big assumption that depression is caused by a neurochemical imbalance. But I don't know how to say this. Like, we don't actually know that. Right? That's the prevailing theory. But I want you all to just think a little bit scientifically. How do we diagnose to? depression, and even the treatments for depression, what are we actually measuring? We're measuring subjective feelings. We're using questionnaires and scales in clinical assessments. We're not doing brain biopsies and measuring serotonin concentration in humans. We're not doing things like spinal taps to measure serotonin concentration.

In a spinal tap wouldn't even be successful. You really need to do a brain biopsy. and look at the neuronal space, the synaptic cleft, and measure serotonin concentration in that. We don't do that. We've done it some a little bit in animal models. The reason that we assume that it's a neurochemical imbalance is because if we jack up the neurochemicals, people seem to get better. Right?

So if I take a medication that increases the serotonin in my brain, that appears to help. But by the way, just so you all are aware, there are some kinds of depression, like dysthymia, which is, I think, what I would kind of call congruent depression, which is like a more constant state of depression that is not really improved by like neurochemicals. So there's this assumption that it's all just a neurochemical imbalance. The truth is, as scientists and medical doctors, we actually don't know that. And there's also all kinds of other things that are like super simple in a sense, but it's so complicated people don't even realize it, is that we don't know that the neurochemical

imbalance came first. Right? So there's this interesting division of medicine that I was studying briefly for a little while back when I was going to be an internist called psycho-neuroimmunology. And so the interesting thing there is if I get a phone call that a loved one of mine is in the hospital, that's a psychological impact first. So do you think when I get the phone call, suddenly all my neurochemicals get messed up? No, the first thing that happens is psychological. I hear something. It has an implication for my mind. Over the course of the next three days, I start to feel depressed. Is there a neurochemical change at that point? Probably. But which came first? Is the root of the malfunction a neurochemical imbalance? Or is the root of the malfunction the mind? And essentially, what research in psycho-neuroimmunology shows us is that the root of the problem isn't necessarily in the brain. In fact, the brain, is the mediating step between the original psychological insult in the immunologic manifestation.

So psycho-neuroimmunology looks at, for example, why stress makes arthritis, asthma, eczema, worse. Stress makes autoimmune diseases worse. So even though we talk about neurochemical imbalances and even though we treat, quote, imbalances, we're not actually sure that brains are imbalanced in terms of neurotransmitters. All we know is that throwing more neurotransmitter in there helps.

That we're sure about. But does that make sense? Like, there's a subtle but very important distinction here. The other interesting statistic is that 60% of people who have depression recover without any kind of medical intervention. How did that happen? So we see this in our community. People start putting their lives together.

And this is the key thing about this third sort of cause of depression is that sometimes it's actually appropriate to your life. Right? If I get caught cheating in school and I get kicked out of school and I've got two and a half years of loans, but I'm not going to get a degree. I don't know if I'll be able to transfer. It's like appropriate to be depressed. This is not a malfunction of the mind.

And the most shocking things, I'll share a really interesting study. Someone was looking at what percentage of people who are suicidal actually have a mental illness. And there are a lot of methodological problems with the study, so I'm not going to like cite it too heavily. But the shocking thing that they discovered is that a surprising amount of people who were suicidal were not actually mentally ill.

There are some serious methodological problems with the study. The biggest of which was they were looking at historic diagnoses, which doesn't account for the fact that a lot of mental illness never gets formally diagnosed and people just live with it. But sometimes, I know it sounds weird, as I say this as a psychiatrist, like the way that I can help sometimes people who are suicidal is this is important to understand is by not assuming that, oh, this person is suicidal because their brain is malfunctioning. Sometimes that's true. Sometimes someone has everything to live for. They're happily married.

They have kids. They have a successful career. They go on vacations. And their mind is so cognitively distorted. And they really do have almost like an organic. mental illness that is like distorting their thoughts, that I've absolutely seen where the suicidality is inappropriate. But the tricky thing, the devastating thing, is sometimes the suicidality actually makes a lot of

sense. Sometimes the people that I've worked with really don't have a reason to wake up in the morning. It's not like their mind can't see all of the good things in their life. That's what we really see sometimes with a depressive episode. But the really scary thing is that sometimes people don't genuinely. have a reason to wake up in the morning. Now, those people can still be helped. I don't think they should kill themselves. In fact, they can be helped quite profoundly, right? Just the kind of help is going to be different. It's about building a life that is worth living and how that

can absolutely be a struggle. But it's not like a pill is going to fix that. And so what are we seeing in society where depression is getting worse? We started this off. It was great. It was a beautiful question. The older generation sees us as weak. Well, like, if you want to accept, if you want to sort of attribute that to an individual problem, you know, there's two options for depression. One is that it's an individual problem. It's like a neurochemical imbalance in your brain. But if it's happening to like a whole generation, if we're seeing a three times, a 300% increase, if we're seeing the point prevalence doubling over the course of three years, I don't think that that that's on you. I think what's actually going on is people are appropriately losing hope,

right? And it's manifesting in all kinds of weird ways. We see this in terms of like antinatalism. I once had a patient come into my office. This is my first exposure to this, where they were like, I don't know that I can ethically bring children into this world because I don't know if the world, like human life will be unsustainable over the next hundred years. Like, I don't know if climate change is going to get so bad that we will, like, it'll actually be like an apocalypse. And I don't know if I want to bring a child, like, into this world. Now, do you diagnose that person with an anxiety disorder? Right.

Is this like their mind malfunctioning? Or is this, like, a legitimate concern? We also see it in terms of anti-work, right? Where we'll sort of see that people are getting, like, fed up. I just saw that, for example, 225 workers at a major publishing house or have authorized a strike. And so the thing is sometimes the future is like actually bleak. And what we tend to find in our society is that society is actually changing to make us more depressed.

Not only in terms of the world is looking bleak, but also even in terms of the identity and the cognitive distortions, So, for example, part of the reason that we feel so negative about ourselves is because technology and the way that our society is evolving is making us feel more inadequate. Right? So a big part of feeling inadequate when you feel depressed is comparison. And it's so easy to compare yourself to other people and find yourself wanting. Right? Our sense of identity, we get to see like Instagram reality and all these other kinds of

photoshopping and stuff like that. altered beauty standards and like all this kind of stuff. And it's like, we're also seeing, by the way, kind of interesting. So body dysmorphic disorder and body image issues are getting worse for everyone. What's even more disturbing for that is that historically body image issues have been, women have been the primary sufferers of body image issues historically. So if you look at like body dysmorphia, like what percentage of women and what percentage of men, it used to be predominantly women. But men are catching up because equality. So we're seeing an alarming rise in body image issues in men. And I think that's, you know, I'm not saying, I'm not trying to comment about

society and society is good or bad or like is discriminatory against women or whatever. Like, that's not what I'm saying. I'm just saying that when it comes to mental illness, like everyone's screwed. So we're seeing all kinds of things, right? Because the internet, social media, all of these things make us feel less about ourselves. And so this is like very, very fertile soil for depression to grow in. We also see that in terms of cognitive distortions, we'll see this a lot. And I think our subreddit is actually one of the healthiest places on the internet where people have these kinds of discussions. I'm not saying it's healthy.

It's not where we want it to be because sometimes it can be quite emotionally heavy. But I've seen like a lot of, I think, really productive posts that I haven't seen. anywhere else on the internet. So I saw a post the other day where a woman was sort of saying, like, I have a lot of, like, emotional hatred towards men. And I recognize that this is unhealthy, but I don't know what to do about it. And then we'll also see, like, other gender variations, right? So it's not just women hating men. We'll have men posting on our subreddit where they'll sort of say, like, I have a lot of unhealthy attitudes towards women. Or I have these attitudes. And, like, I think they're unhealthy. I just don't know how to change them. And that's really,

awesome that people are having that discussion. Because in most places on the internet, what we actually have is reinforcing of cognitive distortions. The COVID vaccine is going to inject 5G networks into my, like what? That's not even physically pot.

Like what? So the cognitive, like what the internet does is it takes a cognitive distortion from depression and transforms it into a delusion. When we reinforce cognitive distortions, time and time and time again. And when you have a group of people who all share a cognitive

distortion, it, like, rises to the level of, like, delusional. I'm not saying clinically, right? So I haven't evaluated any of these people for a delusional disorder. But it becomes this, like, a better idea than that is, like, these sort of mass mental illness kind of outbreaks. We've sort of seen that where it's almost like a mass psychosis. There's some interesting papers about that. The point is that our current society takes these core. aspects of depression, like identity and cognitive distortion, and amplifies them. And then the last thing is that actually, like, I know it's terrifying, but part of the reason that people are depressed now, I think you can't blame the individual if everyone is feeling

this way. And is everyone feeling that way? No, like half of us are pretty lucky and aren't that depressed. But half of society is basically depressed now. a little bit less, 40% over the course of one year. And that's terrifying. So what do you do about this? So this is one of the situations where, as much as I'm a fan of coaching,

I think the right thing to do is actually go see a medical professional. So this is where we don't know, right? So if you're struggling with these kinds of feelings, you don't know whether this is a neurochemical imbalance type or this is a congruent depression type where the world is actually going to help. and that's why you're upset, we don't know. And so the most dangerous thing that you can assume is that it's one versus the other. So that's why what you should really start with is getting a mental health evaluation. I'm not saying treatment. I'm saying just get evaluated. Have an expert

who knows how to tell the difference, sit down and try to help you. Because the good news is that about a third of people who start things like antidepressant medication, their life completely transforms. And if you're in that third, and this is what's really interesting, is when I talk to patients, some people consider that to be lucky and some people consider that to be unlucky. So if I'm a high medication responder, does that mean I'm lucky or unlucky? They think that, oh, this means I'll develop a tolerance on the medication, I'll become dependent on it. I don't want to be dependent on it. But on the flip side, it's like you can actually take a pill every day for about a year and your life will be like so much easier. And then you can get off the

medication. You can, you know, there's a lot of evidence that shows that people will have single depressive episodes that are medication responsive, for example, and then you can pull people off of medication. They'll actually be okay. So you should start by getting evaluated. Second thing to consider, and this is really important, is when it comes to your depression, you should only take as much responsibility as is truly yours. So we see this. When the mind is sad, right, when the mind sort of when the default mode network is hyperactive, we're not talking about necessarily like this is a major depressive disorder or bipolar disorder or depressive episode. We're just talking about general aspects, right, more from an evolutionary standpoint.

We tend to accept responsibility for a lot of things that are not our fault. And so now, like, not only is the economy in such a way where you're forced to live at home, remember 52% of people between the ages of 18 and 29 live at home. And each and every one of those 52 people out of 100 is thinking that they're pathetic. They're thinking, oh my God, I'm so pathetic. And they beat themselves up. And so then something tricky happens because you're starting to accept responsibility for things that are out of your control. And that is when you're doomed. Because now you're accepting responsibility for something that you can't actually change. And it feeds your depression, right? Instead of being compassionate towards yourself,

you start to beat yourself up. So oddly enough, and this is what's so weird, is everyone is talking about taking personal responsibility, right? Like it's healthy to take personal responsibility. Even we advocate for living your Dharma. Take responsibility for your life. Part of the problem in the world today is people are taking too much responsibility. And we're taking it away from the people who are actually responsible.

My favorite is when I see a major, you know, oil company, talk about tweeting out about what are you going to do for the environment? It's like, my pledge is I'm not going to spill five million barrels of oil into the ocean. That's what I'm going to do for the environment. Right? It's like, what's going on here? And I'm not saying that all oil companies are evil. I think fossil fuels are a useful tool for human society.

But let's just be clear about what percentage of the problem, When you tweet out at the general public about what they're going to do for something, what percentage of the problem are you actually responsible for? And so, oddly enough, I think actually part of the problem right now is that individuals are accepting too much responsibility for societal problems. And we see this when it comes to depression. And I see it a ton. I see tons of people who are blaming themselves for being unable to find a partner.

When the system is rigged, you spend more and more time. I'm on dating apps, dating apps, I don't know that dating apps, the primary outcome that dating apps are designed for is finding a partner. I don't know that. I'm not saying they're not. Maybe they are and I'm just ignorant of it. Right. So if you're like the CEO of like a dating app and you say, oh, Dr. K is wrong. No, that's absolutely what we do and we do it very successfully.

Here's the data. Then I'll be the first to say, okay, my bad. I haven't actually reviewed the data. But from my perspective, what I've seen is that it doesn't seem to be working. the way it's supposed to. So much crap in the world isn't working the way it's supposed to. And the problem is as we get depressed, we take responsibility for that. We start to think it's a personal shortcoming. And the interesting thing is as you start to take more responsibility for something that's not yours, what does it do to the person on the other side of the table? When everything

in the relationship becomes my fault, what does my partner start doing? Well, actually, they just continue doing what they're doing. They don't actually change. They don't contribute to it. As I accept full responsibility for everything, the other side of the equation is just going to even that out. Right? So another, like, simple example is I was looking at someone who's frustrated because, so

if I wake up my partner every day to make sure they're on time and then one day I stop waking them up and they're late and they get mad at me, whose fault is that? am I responsible for waking up my partner on time or is that their responsibility? And then this is where everyone's like, oh, it's like it's their responsibility. Like, you didn't do anything wrong. Well, hold on a second because why did it happen that way? It's because for a long time, I did accept responsibility. For the last three years, I wake them up three times before they actually get out of bed.

So even if it's not my responsibility, I've definitely contributed to the situation, right? This wouldn't be this way unless my actions were what they were. So the key thing that really needs to start happening for this generation is to accept responsibility for only what you are responsible for. And paradoxically, accept less responsibility. Don't give other people a pass for bad behavior. And this is what's so fascinating about, you know, like these dependent narcissistic relationships where one person is happy to take none of the blame and the other person is happy to take all the blame. So in a sense, it's a match made in heaven. And this is where I think there's a lot of practical stuff, right?

So you may say like, okay, but like I can't change society. Well, this is where like someone's asking a question, how do you know what you're responsible for? So you're responsible for a small change in society. But that's all you're responsible for. Right. So if you exercise some amount of political power, you can vote, right? You can vote for things.

And this is where you may think, oh, like, it doesn't matter if I vote. Like the world, like, the world is too corrupt. Yeah, the reason the world is that way is because they've tricked you into thinking that you don't have any power. And the moment that you surrender your power because you don't think you have any is like the moment they've won. No snowflake thinks it's responsible for the avalanche. But we've seen how individual people taking small actions and then other people piling on can actually affect real change. So the Me Too movement is a good example of this, right? where people were like, hey, by the way.

And prior to the Me Too movement, what was going on? Well, people, like, didn't think that they had any power. They're like, if I say anything, no one's going to listen. And so what should you do for if society is going in the wrong direction? Exercise whatever power you do have. What's up? Okay. And so this is really important that you stop accepting responsibility.

responsibility for what you are not responsible for and exercise whatever power you do have. And at the end of the day, the key thing here is that as you accept less responsibility, hopefully you blame yourself less. You can start to be more compassionate towards yourself. And then hopefully that'll help. So it's a good question about, is the current generation weaker? But my sense is that if something is happening on a societal scale, it's not the individual's fault, quote unquote. We each have an individual contribution. There are each things that we're

individually responsible for. But at the end of the day, it's like we have to recognize that the problems that we face today are not all going to be solved in an office with a therapist. Now, should we start there? Absolutely. I'm streaming, sweetie. Can you wash your hands somewhere else? Okay, you can wash your hands here. Okay. So we didn't do our disclaimer. today. So before I go further, I'll just sort of say, just a reminder that everything we discussed on stream today is intended to be for educational purposes only. Nothing is intended to be taken as medical advice. And if you all have a concern or question, just like we talked about, one of the first things that you should actually do is go see a mental health professional.

Right? If you're concerned about whether this is depression or not depression, the whole point is that you're not trained to know. And that's why we highly, highly recommend that you'll go actually seek medical care. Can you close the door, sweetie? Can you close the door, sweetie? Can you close the door, though? Yeah, she does that sometimes. Children, what are you going to do? There is hope in the world. All right, so questions.

So a couple of things. Someone's asking, could you lecture about dysthymia? So we could lecture about dysthymia, sort of. The thing is, half of Dr. Kay's guide to depression is overlaps significantly with a lot of the stuff that I would talk about in dysthymia. So what I talk about there is what I call congruent depression. Now, it's not clear whether that's actually that's not necessarily dyshthymia. But when I think about persistent depression, which is what kind of dysthymia is,

that tends to be unresponsive to medications. In my experience as a clinician, that's where like putting your life together seems to be the most effective, quote, treatment. So, you know, it's kind of like it's a weird, there's a lot of nuance there. But I think that a lot of people who experience sadness, let's say, or hopelessness in life, may not be clinically depressed or even clinically diagnosable with dyshthymia. And that's where a lot of like what we struggle with, right? So as we look at these evolutionary perspectives on depression, like why does the human mind get sad?

is it an illness, which is essentially a malfunction of what we're supposed to be doing? Or is it actually, like, appropriate, given our circumstances? And what really terrified me as a psychiatrist is the more that I actually got to, like, spend time with people, the more I discovered that I don't think this is actually a malfunction. I think this person has every reason to be depressed and suicidal. And the more that you begin to realize that this person, their experience is valid, right? So we understand this as a side. Even psychiatrists, therapists are trained to be validating.

But what I sort of found is that this is like way bigger than just validating someone's emotions. That this person really doesn't have a life where like that's like there's no hope for them in the future. And so does that mean they should kill themselves? Absolutely not. It just means that the focus should be different. It's sort of like in depression, in a clinical depression, I view the instrument that is making the judgments as busted. So the measurements are fundamentally flawed because your instrument is not calibrated. But sometimes what happens is your instrument is perfectly calibrated.

It's just the measurements it makes are very, very bleak because that's actually what they are. And that's the key thing to understand. And the reason that people are getting more depressed today is not, I don't think that everyone's measurement instruments are miscalibrated. I think actually what we're seeing is that people are accurately measuring. measuring a hopeless future. Now, that doesn't mean that it's going to remain hopeless. It doesn't mean that we should give up hope. It just means that the way that we need to fix that problem is going to be different. Because calibrating the instrument, like, for example, starting someone on an SSRI, if they have existential depression, even studies show that that's actually not going to be

effective. Because the instrument's working fine. It's actually building a life. It's actually, paradoxically, accepting responsibility for only what you control. Someone is, as Serosite is saying this really well. Not hopeless but bleak. That's a great example. A great way to put it. Because the future may be bleak, but I for one believe that a bleak future can be altered. Right?

Like you can fix that. It just takes effort. And the problem is when we start to get depressed and we start to blame ourselves for everything, we take that responsibility. away from some of the people who are actually responsible. And in doing so, we create a standard for ourselves that we can never fix. Because if I'm in an abusive relationship and I accept responsibility for the other person's behavior, oh, it's not that person's fault.

They just had a rough day today. The moment that I accept responsibility for their behavior is the moment that I have locked in that bleak future. because it really needs to be fixed by them. But not holding them accountable is going to do me. So for what it's worth, Schema Safe is asking future looks bright in some aspects. I think future looks bright in many aspects. I think future looks very bright. So let me give you all just a couple of things that makes me hopeful.

So even in terms of stuff like climate change, like, oh my God, are we going to like destroy the universe or the world and make it uninhabitable? So first of all, we're already moving more. towards like renewables and stuff, right? So like electric cars are the fad, like solar panels, like people are putting solar panels on things. Like, things are moving in the right direction. The other thing is I recently saw this article where scientists at MIT came up with some

kind of space bubble that would like cool the earth by a couple of degrees. So human ingenuity is amazing. Can you all think like 20 years ago, we didn't have smartphones? There was no internet on your phone. Didn't exist. So I have a lot of faith in human ingenuity. I also have a lot of faith in a lot of things like actually like things like Twitch and YouTube. So we have, how can I say this?

I feel like we're at end game content in the world. So are the problems we face hard? Yes. Are things potentially catastrophic? Absolutely. But we also have tools at our disposal that are like we've never had before. So we have things like the internet where literally I was sitting in my office like four years ago when I was thinking about starting Healthy Gamer. And I was like, oh my God, there are so many people out there that need help.

And if this was 104 years ago, that's where things would have ended. But it's like now I can hop on Twitch and I can talk to 3,195 people at the same time. that's wild. Like if one person can help 3,1195, let's even assume half of y'all are AFK and this doesn't even apply to you and you don't even get help. Let's cut it in half.

Hell, let's cut it by two thirds. Let's say a thousand people got help to this hour. Let's be conservative, right? Because like most of y'all, I can't really help you because of, yeah. But that still means in one hour of my day, I can help a thousand people.

And if there were 10 people helping a thousand people, then we'd help 10,000 people. So in 10 hours, if you're able to help 10,000 people, that's wild. Does the world need a whole lot of help? Absolutely. And what's really cool is that we have this thing called the internet. And this is the other wild thing. So it's like sometimes on a YouTube video we'll get like, let's say, 100,000 views.

So we live in a world where like you don't even need to be awake right now and you can still get helped by this. Like, that's pretty neat. So I feel like we're sort of at endgame content where the bosses are harder. But our gear is, like, pretty friggin' sweet. So I'm actually pretty hopeful. You know, the sun is shining today. I'm in the middle of work, and I got to see my kid for a minute. Like, that was pretty cool.

Was it annoying that she kind of, like, came in here? Sure. Was it disruptive? Yes. But it was also, like, nice. Right? Like, the pain. pandemic was bad for a lot of different reasons, but there was also like all kinds of silver

linings that are coming out of it. And one thing that I think the pandemic did is it exposed the weaknesses in our system. It exposed the structural deficiencies. It made us realize that here's the thing. I don't know if you all realize this, but mental health was getting worse and worse and worse for years before the pandemic. Back in like 2010 or 2012, mental illness surpassed cancer and cardiovascular disease in terms of mortality and morbidity across the U.S. at least, and I think the world. So this has been going on for decades. The pandemic made everyone realize it.

Three years ago, I went to the American Psychiatric Association and I said, hey, I think we need to start focusing on video game and technology addiction. And their answer at that point was, sorry, we're too busy with the opioid epidemic. I was like, okay, cool. This year, a couple months ago, I go to the National Meeting of the American Psychiatric Association. There are four presentations about video game addiction. So we may be like a little bit slow to the party, but like things are actually looking up. I'm actually very optimistic. The problem is that when we live in a world where the most negative content

rises to the top, it's like there's a war in Ukraine, and we're going to like, that's going to be all of our news feed for a couple of weeks until the next thing happens. And then that's going to be our news feed for a couple of weeks. And then the next thing happens. Because the brain has a bias towards negative emotion over positive emotion. So all of these entertainment websites, I mean, not entertainment websites, news websites, what do people click on, the stuff that scares them the most. And if we click on something that scares me, and then the news organization figures that out, they're going to put scary stuff after scary stuff after scary stuff. And what happens is our mind gets bored of being afraid. We build a tolerance to fear. That's also adaptive. Right? Because

like once I see a tiger footprint and then I'm running away, like for the first couple hours, I want to be scared, but then I want that fear to calm down. And so then what they do is they find something else, something else for our mind to be afraid of. So there's like all this artificial, or not artificial, I'd call it inflated bleakness in our society. And that's part of the reason we're all depressed. Are things bleak? Sure. But they're not as bleak as we think. Right? If I go to, if I go to like R slash dating, dating advice, boy, is it a bleak place. because the people in happy, healthy relationships aren't hanging out there. So there's such a huge selection bias, right?

There's a selection bias in our news. And what's the selection bias in our news? It's a competition to get the most eyes on your things that you make advertising revenue. This is why we have clickbait. And we play this game too. We've had people criticize us. Your titles are too clickbaity. And it's like, so then we've got a question.

Okay, like, thank you for sharing that. And we definitely do consider that kind of stuff, right? And I don't know if you all have noticed, but we've started to be less clickbaity. But then it's like, okay, we've got an option. We can upload stuff on YouTube, and we can have people watch it or not watch it. Which one is more important? Right? So we appreciate all the feedback, honestly.

Like, a lot of people will give feedback, and like, it's good. Like, we'll read all of it. Oftentimes when people give feedback, they don't understand. all the pieces of the puzzle, but we appreciate it. Right. So we're here to try to do a better job for you.