If you’re depressed or anxious, you’re not weak and you’re not crazy — you’re a human being with unmet needs,”


5 Emotions You Didn’t Know Were Part of Grief

Disillusionment during the grief process.

Key points

  • Our understanding of grief fails to include many common emotional experiences.
  • Grief can include guilt, numbness, disillusionment, relief, and gratitude.
  • Naming our experiences as part of grief helps us grieve better.

Many people’s frame of reference for grief comes from Elisabeth Kübler-Ross’ five stages of grief. In her analysis, a grieving person will move through denial, anger, depression, bargaining, and acceptance. And while all of these may be part of the grief experience, the simplified description of these phrases fails to chart the wide emotional range of experiences a grieving person may experience. Here are some other emotional experiences a grieving person may encounter.

1. Guilt

Many struggle with guilt in the aftermath of a loss. Some feel guilty that their loved one died while they survived; others grapple with things said in anger or left unsaid. They may fixate on their most unflattering moments with the person lost rather than thinking about the relationship as a whole. When a person dies, sometimes a person will brush over a nuanced relationship with broad strokes, creating a distorted picture of reality. In addition to death, when grieving a lost job, opportunity, or relationship, a person may feel guilty for things said, unsaid, done, not done, done poorly, or done well but not soon enough to prevent the loss. Guilt after a death or other loss can lead to rumination at what could have or should have been,

2. Numbness

While not an emotion per se, numbness describes the lack of feeling that may come over a person in grief. That absence may feel alarming, but numbness is the mind’s way of protecting a person from feeling overloaded. We simply cannot sit in a constant state of overwhelming pain and so the mind responds with periods of numbness. Kubler Ross may aptly file this under the heading of denial, but the details are worth describing. Some may worry that numbness means something about their feelings about their loved one’s death. Not so. While less intense grief may speak to feeling ok with the loss, numbness can be a feature of profound sadness.

 Alex Green
Source: Pexels: Alex Green

3. Disillusionment

When a person suffers a loss, they may become profoundly disillusioned with the world around them. Most commonly discussed is the loss of faith in God in the face of a loved one’s suffering, but it may take other forms. A person may feel disillusioned by the medical establishment after a difficult hospital experience. They may feel disillusioned by their family or community if they felt unsupported or abandoned during their time of need. Disillusionment can set a person emotionally adrift, feeling unable to count on the institutions and people that helped them feel grounded.

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4. Relief

After a loss, a mourner may sigh in relief that the ordeal is over. Whether that ordeal is a death after a long illness, the end of tumultuous relationship, or a lost friendship, the lead up to the ending can be profoundly depleting. Many begin mourning before the loss even occurs (a phenomenon called anticipatory grief). When all is said and done, when money is drained, energy expended, and hope depleted, the person may feel glad that the loss has finally occurred and the process of healing and moving forward can finally commence.

5. Gratitude

As we make sense of the loss, some find gratitude in their grief. They may feel grateful for the time with the person lost, grateful for an opportunity they received, or grateful for what that lost thing gave them. Gratitude while grieving can occur fleetingly, intermittently, or in a sustained way. A person may feel resentment and anger one moment and gratitude the next. The key with gratitude is to accept it when it comes without forcing its hand, as sometimes happens with well-meaning loved ones in times of suffering.

Grief is a complicated, nuanced emotional experience that fluctuates, ebbs, and flows. The more nuance we can infuse into our collective understanding of grief by naming its component parts, the better we can honor our own experience and support loved ones going through it.


7 Downsides of Hope


Leon F Seltzer Ph.D.

There’s good hope and bad hope. Here’s how it can be harmful and sabotage you.
 Max Pixel/Free Photo
Defeated Hope Can Lead to Hopelessness
Source: Max Pixel/Free Photo

Throughout history, hope has been viewed favorably, as virtually essential to our welfare. True, many writers have inveighed against “false hope.” But it’s generally been perceived as a positive, almost essential, motivating force. And in any case, it seems inextricably woven into the fabric of human nature.

Take the famous line from 18th century English poet Alexander Pope: “Hope springs eternal in the human breast.” And far more recently, writing for Blogspot (10/24/11 ), a physician in training named Isaac suggests pretty much the same thing—though here the tone is unquestionably cynical toward this abiding universal tendency:

I hate the word ‘hope.’ It’s a cruel and bitter emotion that won’t leave you alone. In meditation, one is taught to ‘let go’ of attachments to emotions. I can often do that with anger and grief and anxiety … but not hope. I despise it because even if I let go, it never lets go of me.

Other writers as well have investigated the “darker side” of hope, elaborating on how it can actually ensnare you, and far more than you might think. So it’s of considerable practical value to explore the often unrecognized problems with such a curiously optimistic—or aspirational—emotion.

In reviewing the literature on this most paradoxical of subjects, I’ve come up with no fewer than seven “downsides” related to hope. All of them merit scrutiny since it’s crucial to distinguish between good hope and bad.

Put simply, not all hope deserves to be regarded as advantageous; an asset. And because its positive facets are much more publicized than its adverse ones, this post will focus on why it’s a good idea to be mindful of how certain kinds of hope—as well as degrees of hope—can wind up defeating you. For, as the acclaimed German philosopher Nietzsche (admittedly) overstated the case: “Hope in reality is the worst of all evils because it prolongs the torments of man.”

So, let’s examine the many negatives that have been linked to hope, so we can better grasp the at least partial truth of Nietzsche’s extraordinary pessimism about this expectational feeling.

1. Hope can be an inherently biased ideal.

Overall, it’s better to have a positive, or optimistic, bias than a stubbornly negative one. But ideally, when we make an evaluation, or come to a conclusion, we ought to base our judgment on logic and rationality—rather than on hope, desire, extravagant fantasies, or a relentless longing for change.

If we lived in a utopia, and so were justified in believing that whatever we wanted would inevitably materialize, then we wouldn’t need hope at all. But given the actual world we inhabit, we’re better off avoiding as much biased hope as possible.

Finally, if we want to succeed and feel fulfilled in life, we need to temper the idealism that “grants” us hope with the hard, unalterable facts of reality.

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2. Hope can set us up for disappointment and defeat.

The emotion of hope pertains to that which hasn’t yet transpired. So it’s only natural that the more favorable our expectations of the future, the greater will be our disappointment—or disillusionment—when these expectations aren’t met or are irrevocably crushed.

In this sense, it’s much better to consciously restrain our hopes so we can also limit the hurt that a defeat, failure, or setback likely would engender. Hoping may be pleasurable, but hope defeated can be quite painful.

Consequently, it’s useful to keep in mind that anticipating favorable results is not without its hazards and that these risks are best reflected upon in advance.

3. Hope can hamper us from adequately preparing for negative outcomes.

A flexible, forward-looking mindset is almost always preferable to a rigidly fixed one. But there are many situations in which a realistic acceptance of a possibly (or likely) negative outcome is more beneficial than clinging to a hope counter to what is quite probably (if not certainly) going to happen. If the odds of a favorable outcome are little to none, it just makes sense to moderate our perspective so that it’s more in line with real-life eventualities.

If you’re definitively diagnosed with terminal cancer, for example, and resolve to begin making peace with your mortality, accepting the fate that sooner or later awaits you, you’ll thereby optimize the chance of experiencing “a good death.” You’ll say your fond farewells to loved ones, express feelings that till now you’ve kept buried, and tie up whatever loose ends in your existence you can, completing your days in a state of gratitude for everything life offered you—even as you reconcile yourself to what it didn’t. Realistically, the only way to “triumph” over death is to embrace it as an intrinsic, though terminal, aspect of life.

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Compare this openness and receptivity in coming to terms with your ultimate demise to the obdurate determination to fight your fate till the bitter end, as though resisting what’s inescapable will assist you in bravely contesting your mortality. That’s simply denying your part in the human condition. And that’s not just grandiose, it’s also foolhardy.

Yet rather than cultivating humility and fortitude in the face of imminent death, many people willfully choose to turn their back on what’s best encountered head-on. To be sure, mounting a monumental fight against one’s ineluctable fate is frequently viewed as courageous. But a much stronger argument could be made that it takes more courage to open-heartedly accept it.

Consider what various writers and researchers have had to say about this reality-refuting aspect of hope:

Michael Schreiner, in his “The Problem With Hope” (11/13/15) , notes that “it’s easy to confuse the idea of mindful acceptance with unhealthy states of being like giving up, complacency, or settling for less.”

And Cathal Kelly, in her “Study Finds a Downside to Hope” (11/06/09) , reports on a University of Michigan research team that “followed patients who had their colon removed. One group knew the procedure was permanent [while] the second group was told that after a period of healing, their bowels could be reattached. / After a few weeks, both groups were struggling. But six months later, the group that had been permanently disabled showed far more life satisfaction. . . . The group awaiting a reversal procedure remained depressed and unhappy. / “They knew things would get better [concluded the team’s leading investigator] but that made them less satisfied with present circumstances. . . . While usually a good thing, we see that hope has a dark side.”

In this same article, the author goes on to quote Dr. David Casarett, a hospice physician and senior fellow at the University of Pennsylvania’s Center for Bioethics: “Our job as physicians is to point people toward the sort of hope that is achievable.”

And later in this piece, Kelly quotes yet another physician on the matter—the late British physician Robert Buckman: “Even if the news is bad, even in some respects hopeless, it allows you to know what you’re dealing with, and you can cope” [vs., that is, hope].

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4. Hope can be like prayer: wishing for something rather than more forcefully working toward it.

Not always, but definitely sometimes, hope inhibits taking necessary, or advisable, action. That is, hoping or praying for something doesn’t in itself imply doing anything about it. Rather, it can keep you in a holding pattern rather than prompting you to act to “achieve” your hopes.

One author suggests that, even more than this, it can be understood as a kind of “moral cowardice” (from Simon Critchley’s “Abandon (Nearly) All Hope,” New York Times, 04/19/14) . And whether this sort of hope comes from an enduring belief in a beneficent God or from a more secular position, all too often it leads to passivity—as though if you only wish hard enough for a desired outcome such an affirmative stance alone will maximize its possibility.

But here again, consider the research. An article entitled “The Problem With…Hope” (farnishk, The Earth Blog, 01/24/08) , in which the author refers to “a widely cited and carefully controlled study into the relative effects of prayer on post-operative coronary recovery” (see AHJ: American Heart Journal, 2006, 151, 934-942) “found no significant difference in recovery rates between those who received prayer unknowingly and those who did not receive prayer at all”—and also that “the group of patients who knowingly received prayer had a 15-20 percent worse recovery rate than the other two groups.

5. Hope can encourage you to forfeit personal power and control.

Closely related to the above, passively hoping for a desired outcome can be tantamount to relinquishing any responsibility for making it happen. Resignedly, you could be giving yourself the message that you can’t do anything about the situation when, quite possibly, you actually could. Once you give something over to an external force, then, practically, you’re “surrendering” to it.

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So far as I could determine, this hypothesis has yet to be researched, but it’s reasonable to assume that the motivation to give one’s all to an upcoming challenge would be diminished by that person’s looking for some deus ex machina to almost magically intervene on their behalf. Too often, hope is susceptible to drift—or degenerate—into mere wishful thinking.

The Earth Blog author cited in #4 succinctly characterizes such hope as a “dereliction of responsibility.” And he notes that this breach in the populace’s handing over to various authorities what, finally, they must each take responsibility for refers not only to religious leaders but also to politicians, heads of corporations, and even environmental organizations. Such a regrettable phenomenon represents for him nothing less than “a mass [my emphasis] dereliction of responsibility.”

And the author closes his critical piece with this wonderfully suggestive quote: “When hope dies, action begins” (from Derrick Jensen, Endgame ).

Hope/Pixabay Free Image
Source: Hope/Pixabay Free Image

6. Hope can be a tool of self-deception.

False hope is a hope that has no meaningful basis in reality. It’s self-deluding, and eventually it will probably end up sabotaging or defeating you. So you need to ask yourself whether what you’re hoping for makes any legitimate sense, or whether it simply makes you more gullible. For when hope literally runs away with you, your ability to see things clearly—and with just the right degree of skepticism—is seriously undermined.

Consider, for instance, hoping that you’ll win the lottery (after all, someone’s got to win!) or, more generally, standing up to forces far more powerful than you and with the law on their side. Such excessively aspirational hope isn’t only irrational, it’s also imprudent and can at times be dangerous. For it can increase the risk that you’ll get into more trouble than you might already be in. What is it but hope that creates our most wondrous, but farfetched, fantasies. But, enjoyable as they may be, to the extent that they’re over-the-top, it’s wise to maintain them as fantasies only.

7. Hope can set us up for hopelessness.

When hope is defeated, and possibly repeatedly defeated, it’s vulnerable to be replaced by hopelessness—or downright despair (which means the complete absence of hope). And once hope weakens or vanishes, it’s all the harder to take action that could be effective in helping you reach your goals.

On the contrary, if you proceed in your endeavors without hope, independently striving to accomplish whatever objectives you’ve set for yourself, you’ll be taking full responsibility for your future. And regardless of whether you succeed or fail, you’ll be able to attest to—and maybe even congratulate yourself for—all the industry, zeal, and perseverance you put into your attempts. That’s finally far more affirmative than “helplessly” depending on providence to enable you to overcome personal obstacles. Though putting your trust in hope can be extremely tempting, diligently applying yourself to what you most care about is a much more reliable way to prosper in life.

Speaking of the Greek philosophy of Stoicism, Darrell Arnold, Ph.D., discusses how Stoics saw inner peace as linked to eliminating hope, because hopes are eventually dashed. Moreover, the Stoics saw the emotion of anger as originating from

misplaced hopes smash[ing] into unforeseen reality. We get mad, not at every bad thing, but at bad, unexpected things. So we should expect bad things . . . and then we won’t be angry when things go wrong. Wisdom is reaching a state where no expected or unexpected tragedy disturbs our inner peace, so again we do best without hope” (from “Is Hope Bad?” Reason and Meaning, 3/14/17).

Better, that is, to accept the world as unfair and then focus on what, nonetheless, might be possible for you to change.

To conclude, it’s not bad to hope—if, that is, you hope wisely. Still, if you earnestly dedicate yourself to what you want to happen, not really trusting in hope but (self-confidently) in your own tactical and prudent efforts, then hope may become redundant—and even be an impediment. As already indicated, when your hopes are false or unrealistic, you can end up feeling not simply frustrated and disappointed but also angry and resentful . . . and possibly embittered as well.

So, if you wish, go ahead and hope. But do so judiciously.

© 2018 Leon F. Seltzer, Ph.D. All Rights Reserved.

About the Author

Leon F. Seltzer, Ph.D., is the author of Paradoxical Strategies in Psychotherapy and The Vision of Melville and Conrad. He holds doctorates in English and Psychology. His posts have received over 45 million views.

We Need to Hang Out: A Memoir of Making Friends

           Addressing the Male Depression and Loneliness crisis that is ongoing.



In this comic adventure through the loneliness epidemic, a middle-aged everyman looks around one day and realizes that he seems to have misplaced his friends, inspiring him to set out on a hilarious and ultimately moving quest to revive old tribes and build new ones, in his own ridiculous way.

At the age of forty, having settled into his busy career and active family life, Billy Baker discovers that he’s lost something crucial along the way: his friends. Other priorities always seemed to come first, until all his close friendships had lapsed into distant memories. When he takes an assignment to write an article about the modern loneliness epidemic, he realizes just how common it is to be a middle-aged loner: almost fifty million Americans over the age of forty-five, especially men, suffer from chronic loneliness, which the surgeon general has declared one of the nation’s “greatest pathologies,” worse than smoking, obesity, or heart disease in increasing a person’s risk for premature death. Determined to defy these odds, Baker vows to salvage his lost friendships and blaze a path for men (and women) everywhere to improve their relationships old and new.

In We Need to Hang Out, Baker embarks on an entertaining and relatable quest to reprioritize his ties with his buddies and forge more connections, all while balancing work, marriage, and kids. From leading a buried treasure hunt with his old college crew to organizing an impromptu “ditch day” for dozens of his former high school classmates to essentially starting a frat house for middle-aged guys in his neighborhood, he experiments with ways to keep in touch with his friends no matter how hectic their lives are—with surprising and deeply satisfying results.

Along the way, Baker talks to experts in sociology and psychology to investigate how such naturally social creatures as humans could become so profoundly isolated today. And he turns to real-life experts in lasting friendship, bravely joining a cruise packed entirely with crowds of female BFFs and learning the secrets of male bonding from a group of older dudes who faithfully meet up on the same night every week. Bursting with humor, candor, and charm, We Need to Hang Out is a celebration of companionship and a call to action in this age of alone.

Job Burnout: How to spot it and take action


Feeling burned out at work? Find out what you can do when your job affects your health.

By Mayo Clinic Staff

Job burnout is a special type of work-related stress — a state of physical or emotional exhaustion that also involves a sense of reduced accomplishment and loss of personal identity.

“Burnout” isn’t a medical diagnosis. Some experts think that other conditions, such as depression, are behind burnout. Some research suggests that many people who experience symptoms of job burnout don’t believe their jobs are the main cause. Whatever the cause, job burnout can affect your physical and mental health. Consider how to know if you’ve got job burnout and what you can do about it.

Job burnout symptoms

Ask yourself:

  • Have you become cynical or critical at work?
  • Do you drag yourself to work and have trouble getting started?
  • Have you become irritable or impatient with co-workers, customers or clients?
  • Do you lack the energy to be consistently productive?
  • Do you find it hard to concentrate?
  • Do you lack satisfaction from your achievements?
  • Do you feel disillusioned about your job?
  • Are you using food, drugs or alcohol to feel better or to simply not feel?
  • Have your sleep habits changed?
  • Are you troubled by unexplained headaches, stomach or bowel problems, or other physical complaints?

If you answered yes to any of these questions, you might be experiencing job burnout. Consider talking to a doctor or a mental health provider because these symptoms can also be related to health conditions, such as depression.

Possible causes of job burnout

Job burnout can result from various factors, including:

  • Lack of control. An inability to influence decisions that affect your job — such as your schedule, assignments or workload — could lead to job burnout. So could a lack of the resources you need to do your work.
  • Unclear job expectations. If you’re unclear about the degree of authority you have or what your supervisor or others expect from you, you’re not likely to feel comfortable at work.
  • Dysfunctional workplace dynamics. Perhaps you work with an office bully, or you feel undermined by colleagues or your boss micromanages your work. This can contribute to job stress.
  • Extremes of activity. When a job is monotonous or chaotic, you need constant energy to remain focused — which can lead to fatigue and job burnout.
  • Lack of social support. If you feel isolated at work and in your personal life, you might feel more stressed.
  • Work-life imbalance. If your work takes up so much of your time and effort that you don’t have the energy to spend time with your family and friends, you might burn out quickly.

Job burnout risk factors

You might be more likely to experience job burnout if:

  • You identify so strongly with work that you lack balance between your work life and your personal life
  • You have a high workload, including overtime work
  • You try to be everything to everyone
  • You work in a helping profession, such as health care
  • You feel you have little or no control over your work
  • Your job is monotonous

Consequences of job burnout

Ignored or unaddressed job burnout can have significant consequences, including:

  • Excessive stress
  • Fatigue
  • Insomnia
  • Sadness, anger or irritability
  • Alcohol or substance misuse
  • Heart disease
  • High blood pressure
  • Type 2 diabetes
  • Vulnerability to illnesses

Handling job burnout

Try to take action. To get started:

  • Evaluate your options. Discuss specific concerns with your supervisor. Maybe you can work together to change expectations or reach compromises or solutions. Try to set goals for what must get done and what can wait.
  • Seek support. Whether you reach out to co-workers, friends or loved ones, support and collaboration might help you cope. If you have access to an employee assistance program, take advantage of relevant services.
  • Try a relaxing activity. Explore programs that can help with stress such as yoga, meditation or tai chi.
  • Get some exercise. Regular physical activity can help you to better deal with stress. It can also take your mind off work.
  • Get some sleep. Sleep restores well-being and helps protect your health.
  • Mindfulness. Mindfulness is the act of focusing on your breath flow and being intensely aware of what you’re sensing and feeling at every moment, without interpretation or judgment. In a job setting, this practice involves facing situations with openness and patience, and without judgment.

Keep an open mind as you consider the options. Try not to let a demanding or unrewarding job undermine your health.

‘We Need To Hang Out’


‘We Need To Hang Out’ Aims To Remedy Struggles Some People Have To Connect

Studies have shown men have trouble maintaining close friendships, and that has detrimental effects. NPR’s Rachel Martin talks to Boston Globe reporter Billy Baker about his book: We Need to Hang Out.


How many friends do you have? I’m talking about really good friends. Now think about how long it’s been since you spent time with them. When Boston Globe reporter Billy Baker’s editor assigned him to write a story about friends back in 2017, he discovered that he had lost touch with nearly all of his. And like many men around his age – he was about 40 at the time – he found himself pretty lonely. Researchers told him that even before the pandemic hit, Americans were becoming increasingly isolated from their friends. And men are doing way worse than women. So in his new book, Billy Baker writes about his attempts to reconnect with his friends. The book is called “We Need To Hang Out.”

BILLY BAKER: I’d be perfectly happy if nobody gets more than five pages into this book and they’re like, I know what I need to do. I need to hang out with my friends.

MARTIN: And if you do keep reading, you’ll realize it can be more complicated than that – and more dire. Responsible for many ailments, both mental and physical, loneliness is killing us.

BAKER: Isolation, even living alone – all these, like, little things, can make you more susceptible to basically everything you don’t want. When I wrote this article, people wrote to me – and emails came by the thousands, these really confessional emails. They weren’t so much interested in the information about the cancer. They wanted to know about the cure. I wanted to know about the cure for myself, you know? I wanted to know how to be friends with my friends in this period in life – you know, this broad period we call middle age – where there’s so many other things begging for your attention that friends, you know, wasn’t one of the priorities when I woke up every morning.

MARTIN: Your friend Rory, for example, had up and moved to Vienna, Austria, and never told you about (laughter).

BAKER: Never mentioned it. I write this article. I send it to him. I’d mentioned him in the article. And it was like, oh, this – you’re not going to be happy to hear this. But I forgot to tell you, I moved to Vienna. And this was a guy I would have considered my best friend in the world. And so – you know, I did a lot of things on this journey. And the first thing I did was chase him to Vienna. It felt very…

MARTIN: This is so dramatic, Billy, though. Like, you could have started with a FaceTime call.

BAKER: I mean, I guess. But I was just still in shock at the whole thing. And – plus, you know, I’ve never been to Vienna. So you know, like, I hop on a plane. It felt very, like, romantic comedy scene as I’m, like, dashing to the airport and like, what am I doing? I’m getting on this plane to save a relationship with a guy. Like, this is new territory for me. But you know what? Like, that was the beginning of a pattern that held throughout this entire journey, where just showing intent and showing a teeny little bit of vulnerability, like not a cool-guy move, it always led to the best places. And he will never move to another country without telling me again.


MARTIN: Can we talk a little bit about that cool-guy thing and what’s embedded in that? While you don’t use these words in the book, you do seem to suggest that some of that bias against intimacy is a bias against behaviors that are seen as feminine. Is that fair to say?

BAKER: I think it is fair to say. One of the things that I kept hearing right from the beginning of this is how women are so much better than men, and all the data seem to support it. Women are better at friendship than men. And it was like, OK. Like, why? Like, what is it that they do? And women are more willing to touch. They’re more willing to call each other when they’re feeling down. They’re able to keep up relationships over the phone in ways that men are not.

So it’s actually a very interesting, fundamental difference in the way men interact versus the way women interact. Men talk shoulder-to-shoulder, and women talk face-to-face. So immediately, like, male friendships are built – usually built around activity. You know, we’re doing something together. Like, a friend of mine referred to golf as his way of finding something to do with his hands while he talks to his friend about, you know, what’s going on at home.

MARTIN: Through the book, it’s you setting this intention to cultivate friendships – trying to nurture old ones, also start new ones. You start sort of an unofficial fraternity with a wider group of guys. Some of them you know really well, some you don’t. Can you talk about that moment when you’ve invited this group – what is it, 12 guys? – very intentional number…


MARTIN: …To this place, this barn you’ve secured to begin this regular hangout thing. How did you explain what you were doing there when you got up in the barn and said, welcome…

BAKER: (Laughter).

MARTIN: …Dudes?

BAKER: Well, I mean, the idea was, all right, I’m going to try and build a new tribe. I’m going to try and connect these guys that I’ve met. You know, maybe they’re through my kids, maybe wherever and I felt a little bit of a spark. Like, OK, we could be friends. So I brought them all together. Maybe it didn’t have to be this dramatic, but I invited them all. I sent them all sort of invitations, didn’t tell them what was up. I kind of laid out this whole journey I was on. The energy in that room was that like, yeah, we could also use someone to hang out with on a Wednesday night. It wasn’t a slight on our friendships of the past to say we need a better daily friend life in the present.

MARTIN: But you do ponder whether just the hangout is sufficient. You go through this part of the book where you think you need a purpose, a task – that it’s not enough to just sit around and, you know, shoot the bull, so to speak. You have to be physically doing something – shoulder-to-shoulder, right?

BAKER: Yeah. For a while, this Wednesday night crew was going gangbusters. And then it just – it was like, what are – we’re just going to get together in this barn and do what – like, talk about our feelings? I use this phrase in the book, velvet hooks. There are these things that connect people. And they’re soft. You’re not locked in iron – the weekly golf game, the fantasy football, the bar trivia, the book clubs, the sports teams, whatever it is, you know. They’re the excuse to get together. And then, you know, while that activity is going on, maybe that’s where the magic happens.

And it’s funny. What really brought everyone together – a guy came up with the idea, let’s build, like, a dirt BMX track like every little kid’s dream. By simply agreeing that that’s what we were going to do, it gave the group a purpose. And we haven’t done it. But we do get together…

MARTIN: (Laughter).

BAKER: We do talk about how we’re going to do it. And then, you know, we…

MARTIN: That’s so interesting, though. The dream is enough. The dream is the velvet hook.

BAKER: But it works. It works for us. And at this point, we have become good enough friends where the awkwardness is gone. And I love it. I live for it.

MARTIN: Billy Baker – his new memoir is called “We Need To Hang Out.” Billy, thanks so much for talking with us.

BAKER: Thank you, Rachel. I enjoyed it.


WAR: (Singing) Ooh, ooh, ooh…

Evolution Could Explain Why Psychotherapy May Work for Depression – Scientific American

Source: Evolution Could Explain Why Psychotherapy May Work for Depression – Scientific American

Persistent rumination may be an attribute that lets us think our way out of despair—a process enhanced through talk therapy

Evolution Could Explain Why Psychotherapy May Work for Depression
Credit: Malte Mueller Getty Images

A consensus has emerged in recent years that psychotherapies—in particular, cognitive behavioral therapy (CBT)—rate comparably to medications such as Prozac and Lexapro as treatments for depression. Either option, or the two together, may at times alleviate the mood disorder. In looking more closely at both treatments, CBT—which delves into dysfunctional thinking patterns—may have a benefit that could make it the better choice for a patient.

The reason may be rooted in our deep evolutionary past. Scholars suggest humans may become depressed to help us focus attention on a problem that might cause someone to fall out of step with family, friends, clan or the larger society—an outcast status that, especially in Paleolithic times, would have meant an all-but-certain tragic fate. Depression, by this account, came about as a mood state to make us think long and hard about behaviors that may have caused us to become despondent because some issue in our lives is socially problematic.

A recent article in American Psychologist, the flagship publication of the American Psychological Association, weighs what the possible evolutionary origins of depression might mean for arguments about the merits of psychotherapy versus antidepressants. In the article, Steven D. Hollon, a professor of psychology at Vanderbilt University, explores the implications of helping a patient come to grips with the underlying causes of a depression—which is the goal of CBT, and is also in line with an evolutionary explanation. The anodyne effects of an antidepressant, by contrast, may divert a patient from engaging in the reflective process for which depression evolved—a reason perhaps that psychotherapy appears to produce a more enduring effect than antidepressants.  Scientific American spoke with Hollon about his ideas on the topic.

[An edited transcript of the interview follows].

You described in your recent article the idea that humans evolved a propensity toward depression as a means to restore emotional and psychological equilibrium. That allows people to stay well integrated within their social milieus. So, can you explain how depression may be a product of evolution that can actually protect us?

In the late 2000s, I read a paper by the evolutionary biologist Paul Andrews. It was masterful, very thoughtful—and I totally disagreed with it. The main premise was that depression was an evolved adaptation that serves to make people ruminate.

Why did you disagree?

For clinicians, we think of rumination as a terrible thing that at best is a symptom of depression and at worst leads to something that deepens the depression. We’ve always thought of it as a kind of exhaust out the tailpipe that is not really helpful.

But the work of Andrews and his colleague J. Andrew (Andy) Thomson recounted that in our evolutionary past, what got you depressed was some kind of major problem—probably a social problem—that might get you excluded from the tribe. And what you had to do is sit down and think about things.

Most of us can think of anxiety as being a useful function, because anxiety takes us away from danger. It’s quick, it’s rapid, the reaction that occurs after stepping on a snake that might be poisonous when you’re out in the woods. But most folks don’t think of depression as having any function. It’s just something unpleasant. The trick is to figure out what the purpose of depression is—and when Andrews and Thomson looked at what goes on when you get depressed, they found that a lot of energy went to the brain.

And the reason for that is to help us to think more carefully about the things that are going wrong, and first to understand what’s the cause. That answers the question: How come I’m feeling so bad? And the second thing is: How can I do a good job of figuring out a solution to a problem?

So, you don’t have to move rapidly in depression; the bad thing has already happened. You don’t have to get out of the way of a poisonous snake or a leopard. But you do have to solve some kind of complex social problem, and rumination is what gets you there. So as opposed to being an unpleasant byproduct of being depressed, rumination is actually the reason why depression evolved. And it helps you solve complex social problems.

You seem to now be giving some credence to the ideas of Andrews and Thomson. How does this line of thinking actually play out in people’s lives? At what point does depression and the social problems that need to be ruminated upon begin?

These complex social problems often gear up in adolescence when young people start to ask: Am I going to have a boyfriend and girlfriend? How do I get a boy or girl to like me? Am I going to do okay in school? Are my parents happy with me? Am I going to get to go to college? Will I be able to find a job?

How does your expertise in psychotherapy—and specifically cognitive behavioral therapy—jibe with the evolutionary theory of depression?

Cognitive therapy in this context becomes a bit of a natural. It teaches people how to ruminate more effectively. Cognitive theory holds that people got depressed because they hold inaccurate beliefs about themselves. This can be combined with the additional notion that people can get stuck. For example, if something bad happens, you start thinking that you’re a failure, you’re a loser. For most people, depression motivates them to think more deliberately about the causes of their problems and the solutions they can apply. In most instances in our ancestral past this worked well enough; most depressions remit spontaneously even in the absence of treatment. Cognitive therapy, at the least, hurries the process along and, at the most, helps unstick that subset of individuals who get stuck making negative ascriptions about themselves, typically about personal competence or lovability.

The solution is to essentially teach them the scientific method so they get unstuck. We ask a patient to ask themselves: what do you think is the cause of the problem? What other explanations could there be? What’s the evidence supporting one or the other? And especially we encourage patients who get stuck to pit what are called their stable trait theories—“I am incompetent” or “I am unlovable”— against a more behavioral explanation: “I chose the wrong strategies.”

One area that you’ve worked on is whether CBT has a more enduring effect than drugs, and you’re interested in how that might provide evidence for the evolutionary basis for depression.

Basically, we have good clinical evidence that cognitive therapy is at least as effective as medications in the short run, and more enduring in the long run. CBT may get people thinking carefully about their problems in a way that facilitates coming to a resolution, whereas medications may just anesthetize the stress that underlies a depression.

Are you going to test that idea in some way?

I’ve got colleagues in Vietnam, where they’re quite interested in a study we want to do in which we compare folks treated to recovery with CBT versus folks treated to recovery with medication—and compare those against a control that uses Chinese herbal medicine, which is widely believed there to be effective. And if it’s really the case that antidepressant medications suppress symptoms in a way that worsens the underlying course of depression, then those patients should be more likely to have recurrences when we take them off the medications than when we take them off the Chinese herbal medicine. If it’s really true that CBT truly has an enduring effect that protects against depression, then patients treated to recovery should be less likely to recur following treatment termination than patients who recover on Chinese herbal medicine. In essence, the Chinese herbal medicine serves as an ideal nonspecific control because it provides neither the coping skills taught in cognitive therapy nor the pharmacologically active serotonin-related ingredient provided by antidepressant medications. We have a trial that we want to do that should answer the question, but it hasn’t yet been done.

Doesn’t some evidence exist along these lines already, though?

There are over half a dozen studies that indicate that patients treated to remission with cognitive therapy are less likely to relapse following treatment termination than patients treated to remission with antidepressant medications—and a pair of studies that suggest that this enduring effect may extend to the prevention of recurrence. What we do not know is where all this fits within the proposed evolutionary context: whether cognitive therapy has an enduring effect, or antidepressant medications may be detrimental in terms of prolonging the life of the underlying episode—as evolutionary theory suggests. What is needed is a nonspecific control that neither has enduring effects or the anesthetizing effects caused by the medication. Whether cognitive therapy truly has an enduring effect, or antidepressant medications have a detrimental effect, remains to be determined. The comparison of each to a nonspecific control like Chinese herbal medicine should allow us to determine in absolute terms which is which.

You’ve talked about the difficulties in trying to measure whether there really are enduring effects in this type of trial.

It also is possible that the enduring effects observed for cognitive therapy (relative to antidepressant medications) have to do with changes that occur during the course of a clinical trial. Although we randomize patients to cognitive therapy versus antidepressant medications at the outset of the trial, we typically lose about 15 percent of the sample because of attrition, and another 25 percent as a nonresponse to either intervention. That means that only about 60 percent of the sample initially randomized makes it into the comparison of subsequent rates of relapse. If different kinds of patients remit to cognitive therapy than to antidepressant medications, that could bias any subsequent comparisons.

Do you think that these insights about CBT could have an impact for severe depression?

I don’t know, and wouldn’t necessarily assume that they would. For psychotic depression, you’d go to electroconvulsive therapy first. I’m not sure that the analytical rumination hypothesis will apply to psychotic depressions, or that it needs to. For every evolved adaptation there are instances in which the mechanism evolved breaks down and the condition can be considered to be an actual disease or disorder.


We’ve Got Depression All Wrong. It’s Trying to Save Us. | Psychology Today Canada

I really like this vision of depression.


Source: We’ve Got Depression All Wrong. It’s Trying to Save Us. | Psychology Today Canada

New theories recognize depression as part of a biological survival strategy.

Posted Dec 22, 2020

For generations, we have seen depression as an illness, an unnecessary deviation from normal functioning. It’s an idea that makes sense because depression causes suffering and even death. But what if we’ve got it all wrong? What if depression is not an aberration at all, but an important part of our biological defense system?

Depression is a courageous biological strategy to help us survive.
Source: ActionVance/Unsplash

More and more researchers across specialties are questioning our current definitions of depression. Biological anthropologists have argued that depression is an adaptive response to adversity and not a mental disorder. In October, the British Psychological Society published a new report on depression, stating that “depression is best thought of as an experience, or set of experiences, rather than as a disease.” And neuroscientists are focusing on the role of the autonomic nervous system (ANS) in depression. According to the Polyvagal Theory of the ANS, depression is part of a biological defense strategy meant to help us survive.

The common wisdom is that depression starts in the mind with distorted thinking. That leads to “psychosomatic” symptoms like headaches, stomachaches, or fatigue. Now, models like the Polyvagal Theory suggest that we’ve got it backward. It’s the body that detects danger and initiates a defense strategy meant to help us survive. That biological strategy is called immobilization, and it manifests in the mind and the body with a set of symptoms we call depression.

When we think of depression as irrational and unnecessary suffering, we stigmatize people and rob them of hope. But when we begin to understand that depression, at least initially, happens for a good reason we lift the shame. People with depression are courageous survivors, not damaged invalids.

Laura believes that depression saved her life. Most of the time her father only hurt her with words, but it was when she stood up to him that Laura’s dad got dangerous. That’s when he’d get that vicious look in his eyes. More than once his violence had put Laura’s life at risk.

Laura’s father was so perceptive, that he could tell when she felt rebellious on the inside even when she was hiding it. And he punished her for those feelings.

It was the depression that helped Laura survive. Depression kept her head down, kept her from resisting, helped her accept the unacceptable. Depression numbed her rebellious feelings. Laura grew up at a time where there was no one to tell, nowhere for her to get help outside her home. Her only strategy was to survive in place. And she did.

Looking back, Laura does not regret her childhood depression. She values it. Going through her own healing process and working with her therapist helped her see how depression served her.

Laura’s story is stark. It’s ugly. And it helps us understand that even though depression may happen for a good reason, that does not make it a good thing. Laura suffered deeply and describes the pain of her hopelessness vividly. Her depression was a bad experience that started as the last resort of a good biological system.

Depression Starts with Immobilization

According to the Polyvagal Theory, discovered and articulated by neuroscientist Stephen Porges, our daily experience is based on a hierarchy of states in the autonomic nervous system. When the ANS feels safe, we experience a sense of well-being and social connection. That’s when we feel like ourselves.

But the autonomic nervous system is also constantly scanning our internal and external environment for signs of danger. If our ANS detects a threat or even a simple lack of safety, its next strategy is the fight or flight response which we often feel as anxiety.

Sometimes the threat is so bad or goes on for so long, that the nervous system decides there is no way to fight or to flee. At that point, there is only one option left: immobilization.

The immobilization response is the original biological defense in higher animals. This is the shutdown response we see in reptiles. Also known as the freeze or faint response, immobilization is mediated by the dorsal vagus nerve. It turns down the metabolism to a resting state, which often makes people feel faint or sluggish.

Owlie Harring/Unsplash
The immobilization response dulls pain.
Source: Owlie Harring/Unsplash

Immobilization has an important role. It dulls pain and makes us feel disconnected. Think of a rabbit hanging limply in the fox’s mouth: that rabbit is shutting down so it won’t suffer too badly when the fox eats it. And the immobilization response also has a metabolic effect, slowing the metabolism and switching the body to ketosis. Some doctors speculate that this metabolic state could help healing in severe illness.

In humans, people often describe feeling “out of their bodies” during traumatic events, which has a defensive effect of cushioning the emotional shock. This is important because some things are so terrible, we don’t want people to be fully present when they happen.

So the immobilization response is a key part of the biological defense, but it is ideally designed to be short term. Either the metabolic shut down preserves the organism, i.e. the rabbit gets away, or the organism dies and the fox eats the rabbit.

But if the threat continues indefinitely and there is no way to fight or flee, the immobilization response continues. And since the response also changes brain activity, it impacts how people’s emotions and their ability to solve problems. People feel like they can’t get moving physically or mentally, they feel hopeless and helpless. That’s depression.

Does Depression Have Value?

It’s easy to see why Laura’s childhood circumstances would set off the immobilization response, and even how it might have helped her survive. But why does it happen in people with less obvious adversity? Our culture tends to think of depression in the person who finds work too stressful as a sign of weakness. Self-help articles imply that they just need more mental toughness and they could lean in and solve it. Even some therapists tell them that their depression is a distorted perception of circumstances that aren’t so bad.

But that is not how the body sees it. The defense responses in the autonomic nervous system, whether fight/flight or immobilization are not about the actual nature of the trigger. They are about whether this body decides there is a threat. And that happens at a pre-conscious point. The biological threat response starts before we think about it, and then our higher-level brain makes up a story to explain it. We don’t get to choose this response; it happens before we even know it.

Studying anxiety has revealed that many modern circumstances can set off the fight or flight response. For instance, low rumbling noises from construction equipment sound to the nervous system like the growl of a large predator. Better run. Feeling like they are being evaluated at school removes kids’ sense of safety and triggers fight-or-flight. Better give the teacher attitude or avoid homework. And to most of us, fight-or=flight feels like anxiety.

Eventually, if these modern triggers last long enough, the body decides it can’t get away. Next comes immobilization which the body triggers to defend us. According to Porges, what we call depression is the cluster of emotional and cognitive symptoms that sits on top of a physiological platform in the immobilization response. It’s a strategy meant to help us survive; the body is trying to save us. Depression happens for a fundamentally good reason.

And that changes everything. When people who are depressed learn that they are not damaged, but have a good biological system that is trying to help them survive, they begin to see themselves differently. After all, depression is notorious for the feelings of hopelessness and helplessness. But if depression is an active defense strategy, people may recognize they are not quite so helpless as they thought.

Shifting Out of Immobilization

If depression is the emotional expression of the immobilization response, then the solution is to move out of that state of defense. Porges believes it is not enough to simply remove the threat. Rather, the nervous system has to detect robust signals of safety to bring the social state back online. The best way to do that? Social connection.

One of the symptoms of depression is shame, a sense of having let other people down or being unworthy to be with them. When people are told that depression is an aberration, we are telling them that they are not part of the tribe. They are not right, they don’t belong. That’s when their shame deepens and they avoid social connection. We have cut them off from the path that leads them out of depression.

It is time that we start honoring the courage and strength of depressed people. It is time we start valuing the incredible capacity of our biology to find a way in hard times. And it is time that we stop pretending depressed people are any different than anyone else.

Why self-compassion – not self-esteem – leads to success – BBC Worklife

Source: Why self-compassion – not self-esteem – leads to success – BBC Worklife

(Credit: Alamy)
By David Robson
13th January 2021
Talking about being kind to yourself may sound like something from a nursery classroom. But even cynics should care about self-compassion – especially if they want to be resilient.

Think back to the last time you failed or made an important mistake. Do you still blush with shame, and scold yourself for having been so stupid or selfish? Do you tend to feel alone in that failure, as if you were the only person to have erred? Or do you accept that error is a part of being human, and try to talk to yourself with care and tenderness?

For many people, the most harshly judgemental responses are the most natural. Indeed, we may even take pride in being hard on ourselves as a sign of our ambition and resolution to be our best possible self. But a wealth of research shows that self-criticism often backfires – badly. Besides increasing our unhappiness and stress levels, it can increase procrastination, and makes us even less able to achieve our goals in the future.

Instead of chastising ourselves, we should practice self-compassion: greater forgiveness of our mistakes, and a deliberate effort to take care of ourselves throughout times of disappointment or embarrassment. “Most of us have a good friend in our lives, who is kind of unconditionally supportive,” says Kristin Neff, an associate professor of educational psychology at the University of Texas at Austin, who has pioneered this research. “Self-compassion is learning to be that same warm, supportive friend to yourself.”

If you are a cynic, you may initially baulk at the idea. As the British comedian Ruby Wax wrote in her book on mindfulness: “When I hear of people being kind to themselves, I picture the types who light scented candles in their bathrooms and sink into a tub of Himalayan foetal yak milk.” Yet the scientific evidence suggests it can increase our emotional resilience and improve our health, wellbeing and productivity. Importantly, it also helps us to learn from the mistakes that caused our upset in the first place.
We all make errors, but self-compassion can help us forgive ourselves and take better care during disappointment and embarrassment (Credit: Alamy)

We all make errors, but self-compassion can help us forgive ourselves and take better care during disappointment and embarrassment (Credit: Alamy)

Relying on self-compassion, not self-esteem

Neff’s research was inspired by a personal crisis. In the late 90s, she was going through a painful divorce. “It was very messy, and I felt a lot of shame about some bad decisions I had made.” Looking for a way to cope with the stress, she signed up for meditation classes at a local Buddhist centre. The practice of mindfulness did indeed bring some relief, but it was their teachings about compassion – particularly, the need to direct that kindness toward ourselves – that brought the greatest comfort. “It just made an immediate difference,” she says.

Superficially, self-compassion may sound similar to the concept of ‘self-esteem’, which concerns how much we value ourselves, and whether we see ourselves positively. Questionnaires to measure self-esteem ask participants to rate statements such as, “I feel that I’m a person of worth, at least on an equal plane with others”.

Unfortunately, this often comes with a sense of competition, and it can easily result in a kind of fragile narcissism that crumbles under potential failure. “Self-esteem is contingent on success and people liking you, so it is not very stable – you could have it on a good day but lose it on a bad day,” says Neff. Many people with high self-esteem even resort to aggression and bullying when their confidence is under threat.

A wealth of research shows that self-criticism often backfires – badly

Cultivating self-compassion, Neff realised, might help you avoid those traps, so that you can pick yourself up when you feel hurt, embarrassed or ashamed – without taking down others along the way. So, she decided to design a psychological scale to measure the trait, in which participants had to rate a series of statements on a scale of 1 (almost never) to 5 (almost always), such as:

I try to be loving toward myself when I’m feeling emotional pain
I try to see my failings as part of the human condition
When something painful happens, I try to take a balanced view of the situation


I’m disapproving and judgmental about my own flaws and inadequacies
When I think about my inadequacies it tends to make me feel more separate and cut off from the rest of the world
When I’m feeling down, I tend to obsess and fixate on everything that’s wrong

The more you agree with the first set of statements, and the less you agree with the second set of statements, the higher your self-compassion.

Neff’s first studies examined how self-compassion related to people’s overall mental health and wellbeing. Questioning hundreds of undergraduate students, she found the trait was negatively correlated with reports of depression and anxiety, and positively correlated with general life satisfaction. Importantly, this study also confirmed that self-compassion was distinct from measures of self-esteem. In other words, you could have someone with a general sense of superiority, who nevertheless finds it very difficult to forgive themselves for perceived failures – a far from ideal combination.
Many think of ‘self-compassion’ as lighting candles, meditating or other notions of ‘self-care’, but self-compassion runs deeper – and even cynics should care (Credit: Alamy)

Many think of ‘self-compassion’ as lighting candles, meditating or other notions of ‘self-care’, but self-compassion runs deeper – and even cynics should care (Credit: Alamy)

Blossoming field

Later research confirmed these discoveries in more diverse samples, from high-school students to US veterans at risk of suicide, all of which showed that self-compassion increases psychological resilience. Indeed, self-compassion has now become a blossoming field of research, attracting interest from many other researchers.

Some of the most intriguing results concern people’s physical health, with a recent study showing that people with high self-compassion are less likely to report a range of different ailments – such as back pain, headache, nausea and respiratory problems. One explanation could be a muted stress response, with previous studies revealing that self-compassion reduces the inflammation that normally comes with mental anguish, and which can damage our tissues in the long term. But the health benefits may also be due to behavioural differences, with evidence that people with higher self-compassion take better care of their bodies through diet and exercise.

People who have higher levels of self-compassion are generally more proactive – Sara Dunne

“People who have higher levels of self-compassion are generally more proactive,” says Sara Dunne, a psychologist who studied the link between self-compassion and healthy behaviours at the University of Derby, UK. She compares it to the advice of a well-meaning parent. “They would tell you that you need to go to bed, get up early and then tackle your problems,” she says. Similarly, someone with high self-compassion knows that they can treat themselves kindly – without overly judgemental criticism – while also recognising what is best for them in the long-term.

This is an important point, says Neff, since some early critics of her work had wondered whether self-compassion would simply lead to lazy behaviour and low willpower. In their view, we need self-criticism to motivate us to make importance changes in our lives. As evidence against this idea, she points to research from 2012, which had found that people with high self-compassion show greater motivation to correct their errors. They tended to work harder after failing an important test, for instance, and were more determined to make up for a perceived moral transgression, such as betraying a friend’s trust. Self-compassion, it seems, can create a sense of safety that allows us to confront our weaknesses and make positive changes in our lives, rather than becoming overly self-defensive or wallowing in a sense of hopelessness.
After making mistakes, many jump to highly self-critical responses, but research shows that cutting yourself a little slack can be the key to resilience (Credit: Alamy)

After making mistakes, many jump to highly self-critical responses, but research shows that cutting yourself a little slack can be the key to resilience (Credit: Alamy)

Rapid interventions

If you would like to gain some of these benefits, there is now abundant evidence – from Neff’s research group and many others – that self-compassion can be trained. Popular interventions include “loving-kindness meditation”, which guides you to focus on feelings of forgiveness and warmth to yourself and others.

In one recent trial, Tobias Krieger and colleagues at the University of Bern in Switzerland designed an online course to teach this exercise alongside more theoretical lessons about the causes of self-criticism and its consequences. After seven sessions, they found significant increases in the participants’ self-compassion scores, along with reduced stress, anxiety and depressive feelings. “We measured a lot of outcomes,” says Krieger, “and they all went in the expected direction.”

There are also written interventions, such as composing a letter from the perspective of a loving friend, that can provide a significant boost, says Neff. For most people, the habit of self-criticism does not seem to be so deeply ingrained that it is beyond repair. (Neff’s website includes more detailed guidelines on the ways to put this and the loving-kindness meditation into practice.)

Neff says that she has seen an increased interest in these techniques during the pandemic. For many of us, the struggles of isolation, remote working and caring for the people we love have provided the perfect breeding ground for self-criticism and doubt. While we cannot eliminate those stresses, we can at least change the ways we view ourselves, giving us the resilience to face the challenges head on.

More than ever, we need to stop seeing self-compassion and self-care as a sign of weakness, says Neff. “The research is really overwhelming at this point, showing that when life gets tough, you want to be self-compassionate. It’s going to make you stronger.”

David Robson is the is author of The Intelligence Trap: Revolutionise Your Thinking and Make Wiser Decisions (Hodder & Stoughton/WW Norton). He is @d_a_robson on Twitter.

BounceBack Ontario – Canadian Mental Health Association, Ontario

Source: BounceBack Ontario – Canadian Mental Health Association, Ontario

Mood and Anxiety | The Royal

Source: Mood and Anxiety | The Royal

The Royal’s Mood and Anxiety Program cares for people with complex and persistent mood and anxiety disorders. This may include:

  • depression (depressive disorders),
  • bipolar disorder and related disorders,
  • anxiety disorders,
  • obsessive-compulsive disorder (OCD) and related disorders,
  • or trauma-and stressor-related disorders.

We treat patients whose mood and anxiety disorders require highly specialized services. We also support community-based mental health care providers through consultation.

The Mood and Anxiety Program specializes in treating patients who do not respond to conventional treatment. This means that the patients we typically see have recurrent or chronic symptoms and have tried multiple treatment options that haven’t worked for them.

Our services

Short-term follow up

Most people who are seen in our program are here for short-term follow up. This usually means specialized mental health professionals at The Royal help clarify a person’s diagnosis and/or provide treatment recommendations. Some people proceed to receive allied health services in the Mood and Anxiety Program, but for most, ongoing care will be provided by their health care providers (i.e. family doctors) outside of The Royal.

Inpatient and outpatient units

For those who need the most specialized care, we provide more intensive treatment options, including outpatient and inpatient services. Our inpatient service is for patients who require intensive and prolonged care.

The outpatient unit works with patients to develop individualized care plans to help them better manage their difficulties, prevent relapse, and ensure they receive proper ongoing care after discharge.

Our philosophy is to approach care as a respectful partnership between the patient and staff, looking at a wide view of the patient’s situation. This translates into treatment that takes in to account your personal story, ideas and feedback.

Our team of professionals has specialized knowledge and expertise in both the medical and psychological aspects of mood and anxiety disorders, as well as social and vocational rehabilitation. Our program also works with family physicians and community mental health agencies as required to make sure that patients receive the best ongoing care.

Our outpatient services may also support patients referred by other hospitals or directly by community psychiatrists or family physicians. The clinic would work as a complement to the patient’s other mental health care provider to help prevent relapse and recurrence.


Referrals to this program need to be completed by a physician or nurse practitioner.

If you are interested in a referral for yourself or a loved one, please contact your physician or nurse practitioner.

If you are a physician or nurse practitioner looking to refer a patient, please visit our referral page to learn more about our inclusion criteria and to access our central intake forms. If you require assistance submitting your referral, please call +1 (613) 722-6521 ext. 6211.

Note to referring physicians and nurse practitioners: Referrals to The Royal’s Mood and Anxiety Program can be submitted electronically directly from your EMR if you have been set up with Ocean eReferral. Ocean eReferral is a regional program that offers an integrated solution at no cost for all primary care providers in Champlain with compatible EMRs (Telus PSS, QHR Accuro, and certain versions of OSCAR). Once set up, referrals can be initiated directly from the patient’s chart in your EMR, launching the appropriate electronic referral form and automatically populating it with much of the appropriate information for the patient and referring clinician. For more information about eReferral, please email: Champlain_eReferral_Team@lhins.on.ca

When Depression Is a Symptom of Buried Anger | Psychology Today

This is a great technique for depresssion through releasing the energy of anger to free the vital self!



Source: When Depression Is a Symptom of Buried Anger | Psychology Today

Trauma was always a word I associated with a catastrophic event: a car accident, a war experience, child abuse, or being a victim of crime. So, it was an “aha” moment to learn that symptoms of trauma, like depression, could be caused by repeated instances of emotional disregard. Childhood emotional neglect comes in many forms and is more common than one would hope.

Below are a few examples of emotional disregard:

  • Rachel, 8 years old, was scared to go to school. Her father repeatedly told her there was nothing to be afraid of and that she shouldn’t be a “scaredy cat.” Dad didn’t ask what she feared or spend any time trying to understand Rachel’s fear from her point of view.
  • Johnny told his mother he hated his little brother and was sorry he was born. The next moment, a hard slap across the face stunned him. Johnny was told never to speak in such a hateful way again.
  • Barb, age 12, kicked the winning goal in soccer. She got in the car riding high with emotions like excitement, joy, and pride in herself for playing a great game. Her mother, instead of matching her enthusiasm with a big proud smile, immediately pointed out the “ugly” red juice stain on her shirt. She was devastated.

When our emotions are invalidated, we experience a crushing insult. And, it evokes anger and even rage, depending on how young we were when the emotional neglect began plus how often it occurred.

David, a former client of mine, grew up with parents who bristled at emotional displays. As a child, when David cried, he was told he had nothing to be sad about or to “chin up!” When David was scared, he was told to stop being such a baby. When he was excited, he was told to cool it. When he was angry at his parents, they got insulted and left him alone. They never asked What’s the matter? How do you feel? or, Are you ok?

David, now 30, showed up in therapy with depression. Blaming himself for his anguish, he described a privileged upbringing with parents who provided well for him. Attending private schools and being given a generous allowance, he was truly grateful to his parents for their gifts.

We soon discovered that part of what led to his depression was the conflict between positive and negative feelings for his parents. He found it hard to validate his emotions. Guilt, an inhibitory emotion on the Change Triangle, left his anger, a core emotion, buried and festering. Most people don’t realize that we can be grateful to our parents for giving us life, financial security, and for making sacrifices, and, at the exact same time, feel angry at them for not meeting our emotional needs. This understanding helps us embrace our complex and conflicting emotional worlds.

As David grew from a teenager to a young adult, his depression got worse. This makes sense because his anger was still suppressed. To squash anger down, the mind enlists inhibitory emotions like anxiety, guilt, and shame, which are effective at keeping anger out of conscious awareness. But they also feel awful and undermine confidence and well-being. Furthermore, the cost of chronically suppressing anger is depression. The energy needed for vital living and outside engagement gets diverted to keeping rage pushed down so that we don’t lose control or lash out.

Healing Depression by Releasing Rage

One effective way to ease and even heal depression is by releasing the enormous burden of our visceral rage. How is this done?

Anger portrayals, a technique common in accelerated experiential dynamic psychotherapy (AEDP), are extremely therapeutic. In a nutshell, anger portrayals guide a person in identifying anger in their body. Anger typically is felt as heat, energy, and tension. Then, by noticing and staying with the physical sensations inherent in the core emotion of anger, impulses and images emerge, like a movie. Allowing the movie to unfold in real time, the person gives themself permission to envision exactly what the anger wants to do to those who hurt them. In this way, anger comes up and out, and symptoms of depression remit.

Sometimes guilty feelings make it hard to validate and fully experience anger. In the beginning, when David first started to connect with his inner rage, another guilty part of him would leap up and stop the anger from coming up: “But they did so much for me. I’m so grateful for all the good things they did.”

There’s so much emphasis on gratitude these days that it is important to know that we can hold opposite and conflicting truths at the same time. “David,” I said during one session, “let’s fully validate the gratitude and love you have for your parents, and, for just right now, can we ask for the gratitude, love, and any other feelings you have to step back while we tend to the anger inside?”

Rage portrayals work because, as research shows, when it comes to processing emotions, the brain doesn’t really know the difference between fantasy and reality. Imagining what our rage wants to do and then carrying that out in fantasy allows the energy of the rage to come up and out. No longer are forces required to hold down that anger, so energy becomes available again for vital living. The best part about anger portrayals is that no one gets hurt because it’s all happening in imagination.

Depression is the beginning of a story, not the end. It is a symptom that tells us that something deep inside needs tending, be it anger, fear, sadness, or more. And when we tend to ourselves and our deepest truths, we recover stronger and wiser. We no longer need to fear our emotions but can use them along with our logic and reason to meet life’s challenges in the direction of our deepest wants and needs.

Patient details have been changed to protect confidentiality.

The Epidemic of Covert Male Depression | Psychology Today Canada

Source: The Epidemic of Covert Male Depression | Psychology Today Canada

Show me a mad guy, and I’ll show you a sad guy…

For the most part, men have two speeds — neutral and pissed. Experience demonstrates that the state of rage that plagues the majority of the male population is driven less by genuine anger and more by what might be characterize as covert depression manifesting as anger.

Covert depression doesn’t look like the depression with which we are generally familiar, especially to the people around a man who is in the throes of this particular emotional upheaval. Instead, what the people around us tend to witness is subtle irritation, road rage, explosive arguments, passive-aggression, slovenliness, self-sabotage supported by a failure to follow through and/or a faint sense of insecurity that leads to all kinds of shortcomings in performance — at work, at home, within society at large or even in the bedroom.

“Why anger”, you ask? I like to call anger the First Feeling because it goes straight to the root of the aggression that drives our instinct for survival. Because men are not great at filtering and expressing emotions or feelings, we typically express, or more properly act out, our experience of emotion as anger. The whole male dynamic of emotional experience–feeling, reaction and anger–occurs at a very primal and instinctual level. Men are, in some ways, hardwired for rage – it keeps us sharp. Problem …there are no more saber-toothed tigers with which to contend; the mechanism is obsolete.

For men, the key to deflecting this circumstance is recognizing and acknowledging our emotions. We do this by dissecting rage. Here’s an example: when you get cut off on the highway, you become angry. The reason that you become angry is because someone, in your mind (read: feelings), has compromised your safety, or crossed your boundaries. On the other hand, when your boss chews you out you become angry because you may feel his accusations are unfounded, or you feel disrespected or unappreciated, or you’re anxious about losing your job.

In both situations detailed above you experience anger, but the motivation for that anger is different in each situation. Learning to look at the experience of anger and recognize the underlying feelings and emotions, then expressing those emotions and feelings in a productive manner, diffuses the anger.

As this diffusion begins to happen, the covert depression that ultimately drives our general sense of anger and annoyance starts to take shape as a lack of fulfillment, or disappointment over broken dreams, or anxiety about being able to provide for our family, or performance at work or being a good husband or partner.

It’s not really necessary to understand the why or the how of our human condition or our social circumstances. It’s more important, once we’ve recognized what that circumstance is, to ask the question, “What next?”. I was in an airport a few months ago and saw an advertisement for what I believe was an investment firm. It was a picture of Tiger Woods standing in the rough and tall grass up to his knees. Hand drawn into the picture was a vertical arrow with a break in the line; the small piece at the bottom had a label that said, “10% what you did” — at the top, the label said, “90% what you do”.

In the case of covert depression, emotional success does not rely on the why and how, but more upon what we do next. Tiger Woods lifting the ball out of the rough and onto the green is a metaphor for men lifting ourselves out of our covert depression by both finding and feeling our feelings.

Deconstructing our state of rage leads us to a place where we can drill down into that underlying covert depression that is driven by the subtle sense of “less than” that is visited upon us. This leads to a deconstruction of the depression, and that provides a context for working through the issues that are driving the depression in the first place.

© 2008 Michael J. Formica, All Rights Reserved

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10 Signs of Walking Depression


This is Part 1 in a series on depression in creatives.

Part 2: 10 Ways to Walk Away from Depression
Part 3: When Medication Isn’t Enough: Rethinking Depression with Eric Maisel

Note: I wrote this article to raise awareness of low-grade depression, which many people don’t recognize in themselves. I am an author and creativity coach, so I wrote it particularly for writers and artists, but these signs could apply to anyone ~ I believe we are all creative in one way or another.

There are many causes of depression; in my work I focus on people’s needs to create art and to make meaning, and on how to deal with the depression that arises when those needs go unmet for whatever reason.

Let’s play a little word association.

When I say someone is DEPRESSED, what comes to mind?

You might think of someone who:

  • Looks or acts sad most of the time
  • Cries often
  • Can’t feel any emotions (positive or negative)
  • Can’t get out of bed or leave the house
  • Can’t work
  • Can’t take care of themselves or others
  • Thinks or talks about suicide

That’s what severe depression can look like, and it’s a terrible and potentially deadly illness. Most people would notice those signs, realize something was wrong, and hopefully get some help.

But depression has many different faces and manifestations.

I was one of the walking depressed. Some of my clients are too.

We have many of the symptoms of clinical depression, but we are still functioning.

On the surface, people might not know anything is wrong. We keep working, keep going to school, keep looking after our families.

But we’re doing it all while profoundly unhappy. Depression is negatively impacting our lives and relationships and impairing our abilities.

Our depression may not be completely disabling, but it’s real.

10 Signs of Walking Depression

“I once read that succumbing to depression doesn’t mean you are weak, but that you have been trying to be strong for too long, which is maybe a form of denial. So much of life happens somewhere in between being okay and complete breakdown—that’s where many of us live, and doing so requires strength.” ~ novelist Matthew Quick

Walking depression can be hard to recognize because it doesn’t fit the more common picture of severe depression. But it can be just as dangerous to our well-being when left unacknowledged.

This list isn’t meant to be exhaustive or to diagnose anyone. But these are some of the signs I’ve observed in myself and those I’ve coached:

Nothing is fun. You root around for something to look forward to and come up empty.

You can’t find flow. Working on your creative projects feels like a grind, but you keep plodding away. There is research that shows that neuroticism (the tendency toward negative moods) is associated with lower rates of flow.

Your energy is low. Maybe you’re not getting enough rest because you’re too anxious to sleep, or you’re trying to cram too many tasks into a day, or you’re punishing yourself by staying up. Whatever the reason, you are effin’ tired.

You feel worse in the morning and better at night. I remember explaining this to a friend, who found it mystifying. In the morning I felt the crushing weight of all the things I had to do that day. In the evening I was temporarily free from expectations and could enjoy a moment’s respite.

You have simmering resentment toward others. Sure, you’re still doing what everybody asks of you, but you stew in anger the whole time. You are jealous of and bitter toward people who look happier than you feel.

Your self-talk gets caustic. You say nasty things in an effort to shock yourself into action. You use shame as a motivator.

You feel distanced from people around you. It’s hard to have genuine, intimate conversations because you have to keep up this front that you are alright.

You deprive yourself of creative work time (the artist as sadomasochist). This helps you exert some control and stirs up feelings of suffering that are perversely pleasurable. Also, taking on new projects that prevent you from writing or making art lets you prove to yourself that you’re still strong and capable.

Jen Lee has coined the term Dutiful Creatives to describe those who are inclined to take care of their responsibilities before anything else.

“If life were a meal, you’d consider your creativity as the dessert, and always strive to eat your vegetables first. Pacing and knowing how to say No are your strengths, but your creativity is more essential to your well-being than you realize.” from Jen Lee’s Quiz: What Kind of Creative Are You

You notice a significant mood change when you have caffeine or alcohol. A cup of coffee might make you feel a lot more revved-up and optimistic. A glass of wine might make you feel really mellow and even ~ gasp! ~ happy. (That’s how I finally realized that I was depressed.)

You feel like you’re wasting your life. Some people have a high sensitivity to the inherent meaning in what we do. Creativity coach Eric Maisel calls this our “existential intelligence.” If our daily activities don’t carry enough significance ~ if they don’t feel like a worthwhile use of our talents and passions ~ then soon we are asking ourselves, “What’s the point? Why should I keep going?”

(Eric Maisel has published a book called Rethinking Depression, which I talk to him about in this post, When Medication Isn’t Enough.)

Why is it hard to admit that you have walking depression?

You may recognize many of these signs in your life but still be slow to admit that you are depressed. Why is that?

Because it feels presumptuous to put yourself in that category when you’re still getting by. You feel like it would be insulting to those who are much worse off than you. You may feel like you have no real reason to be depressed.

Because your pride and your identity take a hit. You have to admit vulnerability and allow that you are not the all-conquering superhero you thought you were.

Because you realize that you and your life need to change, which feels like more work piled on your plate.

Because you are admitting your own responsibility for your unhappiness and that can trigger self-judgment.

Because you might uncover grief or anger at those around you for not seeing and taking better care of you.

What to do, what to do?

I’ve posted another entry about how creatives heal from walking depression, and here are the highlights:

  • Rest.
  • Make use of medication and other physical treatments.
  • Do therapy.
  • Practice gratitude.
  • Make connections.
  • Reduce your responsibilities.
  • Spend time creating.
  • Change your thoughts.
  • Develop a meaning practice.
  • Change your life.

These steps are simple to say, not easy to do, so make sure you get as much support as you can.

Important: If you are in dire straits, please contact your doctor or visit the International Suicide Prevention Wiki to find a hotline near you.

11 Things Only Someone On Antidepressants Understands | Prevention

It’s time to stop treating antidepressants differently than medication for physical ailments.

Source: 11 Things Only Someone On Antidepressants Understands | Prevention

  November 30, 2015

facts about antidepressants
Linda Braucht/Getty
There’s a spin class I like here in New York City, and the instructor happens to have diabetes. Periodically in the middle of class—sometimes barely even slowing her pedaling feet—she’ll check her blood sugar with a quick prick of her fingertip. Occasionally she’ll explain herself before or after class. Other times, no explanation necessary. I’m sure others like me who have worked out with her more than a few times hardly notice anymore.
Therapists and doctors and writers like to draw an analogy between the constant vigilance required of people with diabetes and that of people with depression. A person might need to be on insulin for the rest of her life, and there’s no shame in that. Depression, too, the thinking goes, can require lifelong treatment—why should our perception of that medication be any different?

Still, I can’t imagine this spin instructor popping off the cap of a bottle of Zoloft in front of 30 sweaty strangers.

It’s not a perfect analogy: We now know that depression is perhaps infinitely more complicated than the comparatively well understood fix for type 1 diabetes of replacing missing insulin. But it still makes the point so clear it nearly punches you in the stomach: We wouldn’t judge someone for treating a physical illness with medication, so why do we judge someone for doing the same for a mental illness? Diagnosing depression can be just as challenging as treating it. (Do you experience any of these nine surprising depression symptoms?)

I’m confident we’re (slowly) moving away from this stigma, but we’re not quite there yet. Whether it’s because a person on antidepressants doesn’t necessarily “look” sick or because we simply don’t understand the benefits antidepressants have to offer, it’s obvious we need more honest discussion of these meds and whom they work for and how. Considering the most recent data available suggests 11% of Americans over the age of 12 take an antidepressant—and that was in 2008!—we owe them a little more compassion and understanding.

In an attempt to help make things clearer and help us all be even just a little more accepting, here are a few things only people taking antidepressants truly understand.

Antidepressants are not a cure.
Depression is thought to be a noxious combination of genetic, environmental, and psychological factors that leads to profound feelings of sadness, hopelessness, pessimism, irritability, and fatigue, among many other possible symptoms. Antidepressants, the medications most commonly used to treat depression, affect a number of brain chemicals called neurotransmitters, which are thought to be involved in regulating our mood. While meds can make a drastic, sometimes lifesaving improvement in how a person is feeling, antidepressants don’t always mean the end of bad days—or even meh days, for that matter.

Freelance writer Lynn Shattuck, 41, likens antidepressants to her contacts. “I’m super-nearsighted; I need contact lenses to see,” she says. “Antidepressants aren’t a happy pill; they just clear the fog for me. They help clear my vision and enable me to be able to see a little more.”

She’s been on and off meds to help manage depression and anxiety for 2 decades. “My antidepressants are just one tool in my toolbox,” she says. “I don’t think any one thing for someone with depression is necessarily the answer.”

For Rob O’Hare, 34, an actor, comedian, and web producer who also happens to be my dear friend, antidepressants haven’t made negative thoughts vanish, but they’ve helped speed them along. “Without medication, I might feel devastated,” he says, “but with medication, I won’t feel awful, and then the feelings will pass—and that’s actually a drastic improvement!” He was first diagnosed with depression in 2003, and while he recognizes that he still harbors negative thinking patterns, “they have a chance to get better now with medication.”

You don’t have to be on them forever (but you might be).

 It can be tempting to take antidepressants for a month or two, feel like you’ve improved leaps and bounds, and figure you no longer need meds, says psychiatrist Michelle Tricamo, MD, an assistant professor of psychiatry at Weill Cornell Medical College in New York. “That’s not something we want to see,” she cautions. “Just like you want someone to finish the whole course of antibiotics to prevent relapse, we don’t want anyone to prematurely discontinue antidepressants, either.”

Typically, Tricamo says, your doc will want you to be relatively symptom-free for about a year before you talk about stopping the meds, she says, to make sure the changes in how you’re feeing are going to stick. What’s even more important than how long you’ve been on antidepressants is that you don’t try to go off them alone. A doctor can help you expertly taper your dose to wean you off with as few withdrawal effects as possible (we’ll get to more on withdrawal later).

After that weaning period, some people might carry on drug-free. Antidepressants can function like that ever-illusive perfect face wash that clears up your acne after a few weeks and you’re set, O’Hare imagines. “But for someone like me, depression is chronic,” he says. “I just have to manage it.”

If you do stay on them forever, it’s not because you’re addicted.
Shattuck says she was constantly establishing timelines in her head for when she’d be able to ditch antidepressants. It took years for her to come to terms with the fact that she might take them for the rest of her life. “I believe this is part of my genetic makeup and something I need,” she says.

Her attitude is key in understanding long-term antidepressant use: People who benefit from the meds are taking them because they still provide those benefits. There’s no high, and there are no cravings, Tricamo says. Antidepressants can cause withdrawal, which is probably where this misconception came from, she says, but it in no way means you can’t stop using them.

It’s not always an easy decision to start taking them to begin with.

There are critics out there who say antidepressants (and heck, countless other meds) are simply overprescribed. But the process of beginning antidepressants doesn’t start with some haphazardly written prescription. Docs frequently recommend therapy first, Tricamo says, which can result in significant improvements for many people with mild to moderate depression.

When she’s considering who might benefit from meds, Tricamo evaluates how much depression interferes with a person’s daily life. “If adults are unable to get to their jobs or leave their homes or can’t support themselves, these might be times to use a medication,” she says.

Some people still have hangups about starting meds, even if therapy hasn’t helped. “The biggest internal battle was the idea that I should be able to feel better by myself,” Shattuck says. “If I just did enough therapy or herbs or whatever, I could treat myself naturally.” Such defeating self-talk, she says, is a nonstarter because “depression is, in and of itself, a distorted way of thinking,” she says. “It makes it really, really challenging to get yourself out of that on your own.” We wouldn’t suggest that a person with a broken leg should simply pull herself up by her bootstraps.

Tricamo emphasizes the importance of working through these concerns and making the decision to try antidepressants a collaborative one. “They’re the ones taking the medication, after all,” she says of her patients. “You can’t force them, and since you’re not there to give it to them every day, you might not even know if they’re taking it.” Thoroughly explaining the risks and benefits can help a person understand why meds are important and how they might help. “If you don’t get them to buy in to treatment, treatment is going to fail,” she says.

Side effects can be harmless or hellish.

Anyone who has seen one of those horribly cliché staring-out-a-window-while-it’s-raining TV commercials for antidepressants knows that the accompanying long list of potential side effects is equally horrible. Many of them, like weight gain, insomnia, nausea, low libido, delayed or vanished orgasm, and diarrhea, to name just a few, sound entirely unpleasant.

Certain meds come to have a reputation for one side effect or another, but there’s no real way of knowing what you might feel when you start one or how long the side effects will last. Nausea, headaches, or a jittery feeling usually vanish within the first couple of weeks, Tricamo says, but weight gain or a dampened sex drive might be harder to cope with. “Unfortunately, it’s something we can’t really predict.” Side effects aren’t based on the dose of the med or really anything else measurable or adjustable, she says, although they are likely to be worsened by drugs or alcohol. While the unpredictability is certainly frustrating, it shouldn’t be prohibitive. “We can switch antidepressants, and we usually do find one that isn’t so harmful in these ways,” she says.

“It’s kind of a guessing game,” O’Hare says. He ended up in the emergency room after what was likely an allergic reaction to Lexapro when he first tried it in 2003. He’s since tried a handful of others with varying rates of success: Cymbalta and Wellbutrin both made his depressive symptoms worse, he says. Effexor made him feel something he can only explain as “medicated.” He gained weight on Remeron, but describes the experience as feeling like his body was no longer his own. He’s currently feeling some improvements on Prozac and is about to visit his psychiatrist for the first time in a month.

He’s stayed away from any antidepressants thought to mess with libido. He guesses everyone has their own threshold for tolerating different side effects. Some weight gain might not bother one person while it’s a deal-breaker for others, for example. “If a drug was going to diminish my libido, then I just wasn’t going to deal with that,” he says. “Among the drugs I haven’t taken are some I haven’t taken for that reason.”

But you’re not about to become a zombie.
The idea that antidepressants totally change your personality is understandable, Tricamo says, since they are tinkering with your brain. The persistent “I won’t feel anything” fear, however, is unwarranted. “Antidepressants are designed to help you return to your former demeanor,” she says, not transform you into some always-up or totally-out-of-it new you.

MORE: American Women Run On Prozac

“There’s some need to preserve a sense of your own identity or some kind of self-integrity or a version of yourself that being medicated might alter,” O’Hare says of this hesitance some people have to taking antidepressants. Of course, if you do feel like meds are “flattening” you, talk to your doctor, who can likely suggest another option.

There’s usually some trial and error involved before you find the right one.
When Shattuck first started medication, she went on Paxil and had horrible nightmares. Zoloft gave her heart palpitations and sent her anxiety through the roof. But just because one antidepressant makes you, say, sweat profusely, doesn’t mean they all will; it’s worth giving a few a try if nothing feels quite right at first, Tricamo says.

Even if you try one and feel nothing—no uncomfortable or dangerous side effects, but no real improvement either—don’t give up. With dozens on the market, odds are the first one isn’t the right one, O’Hare says, and frankly, it could take years to find one that helps. He was so frustrated by his experience with one drug in 2014 that he decided he wouldn’t try anything for a while. “I didn’t want to go through that hunt,” he says.

The process of starting a new antidepressant over and over again isn’t ideal, but it’s worth it to him. “It’s hard, but when you have major depression, after a while it’s just not worth being unmedicated or untreated anymore,” he says. “It’s so worth it to not feel the way you do when you’re suffering through major depression.”

Stopping or switching can be a Process with a capital P.
If only it were as simple as filling a new prescription. To avoid those aforementioned withdrawal symptoms—which can include anxiety, irritability, dizziness, headaches, muscle aches, and chills—doctors carefully and methodically wean patients off antidepressants when it’s time to stop or change meds. Shattuck says the last time took about a month to gradually taper her dose with her doctor. She felt flu-like fatigue, was more tearful than usual, and had what’s come to be called “brain zaps,” a feeling likened to an electrical current momentarily pulsing through the brain. Some people notice the effects of tapering almost immediately, Tricamo says. Some lucky others have no problems whatsoever.

Yes, yoga, meditation, and getting more sleep can help. That doesn’t mean antidepressants don’t.

Tricamo has a patient whose mother continually tells her she should quit the meds and take up yoga and meditation instead. There’s (probably) nothing wrong with any of the lifestyle tips offered up by your neighbor, your uncle, or that blogger you follow on Pinterest—but that doesn’t mean antidepressants are out. “Maybe she should be doing yoga and meditation, but that doesn’t mean she shouldn’t also be taking Zoloft and going to therapy every week,” Tricamo says. In fact, all these tools might work better together, if antidepressants are the “contact lenses” that clear the fog so you can actually get yourself to the yoga class.

MORE: 7 Reasons You’re Tired All The Time

Even if people mean well, this “just try yoga instead!” mentality is rooted in stigma, Tricamo says, against both psychiatric illness and its medical treatments. As long as there’s reason to believe there is a biological basis for mental illness, however, there’s reason to believe there is a biological treatment to go along with it. “If you have asthma and you can’t breathe, are you going to try to just meditate through it?” she asks.

O’Hare does his best to tolerate this kind of advice because he knows his friends mean well. “I’m not about to criticize my friends for whatever bits of helpfulness they’ve thrown my way,” he says. “I’m grateful for any and all of it, even when it is repetitive or bullshit.”

You can maybe even safely take them while pregnant.

Starting or growing a family can be a tricky decision for anyone, but women who use antidepressants have an extra layer of complication to decode. Questions about how antidepressants might affect a developing fetus have long been up for debate, and the most recent news is the meds don’t seem to have lasting cognitive or behavioral effects on children born to moms who use them.

Know what does leave a lasting impact on the lil guys? Moms who are depressed. “My midwives kept saying it’s not just the safety of my unborn baby that we had to consider but my safety and mental health,” Shattuck says. She stayed on antidepressants during both her pregnancies, a decision she calls “the most difficult part of my journey” with depression. Her son, now 6, and her daughter, almost 4, are both healthy. “They didn’t go through any of the scary things you find if you Google ‘antidepressants during pregnancy,’ ” she says with a chuckle. She was wracked with guilt, though, a feeling she doesn’t imagine she would have had if she had needed meds for, says, diabetes at the time. “A lot of people have to take medication during pregnancy for physical ailments,” she says. “I don’t know if I would be as hard on myself as I was about antidepressants.”

Sure, there’s a lot we don’t entirely understand about how they work. But they work.
You’ve likely heard the relatively straightforward theory that depression is caused by an imbalance of the neurotransmitter serotonin in the brain. If that were the case, drugs called selective serotonin reuptake inhibitors (SSRIs), which work by keeping more serotonin available in the brain, would obviously be an easy solution.

Unfortunately, it’s pretty clear today that depression is a much more complicated story than that: Serotonin’s not the only neurotransmitter involved, for starters, and we still don’t entirely know how antidepressants actually work. We know depressed people’s brains look different on imaging tests, but “we don’t necessarily have all the answers from science yet,” Tricamo says.

Whether we prescribe the meds, take them, or know someone who does, we’d probably all be more comfortable if we did have more answers. Antidepressant-bashing critiques range from there are too many people on them who don’t need them to they don’t work at all and patients only benefit from a placebo effect. “There are significant questions we should be asking about who needs antidepressants, why doctors prescribe them, and how the insurance industry approaches mental illness,” Maura Kelly wrote in the Atlantic in 2012. “But that, of course, doesn’t mean that antidepressants are dummy pills that have no real effect; and it’s crucial that depressives—many of whom are suspicious of medication—realize that.”

Shattuck is just glad they’re even an option. “Until really recent history, people didn’t have access to medication that could help them if they had depression,” she says. “I’ve come a long way from thinking, ‘Why can’t I do this on my own?’ to a place where I’m thankful I live in a time where it’s not quite as stigmatized and there’s access to help.”