Why It's Getting Harder To Treat Existential Depression

Med keddar, Picklade rödlök och en legendarisk orjö. Bjuder i maxappen. Kanske med saftigt svenskt nötkött. Leverera direkt i bil. Välkommen till Max. Hey y'all, just a reminder that in addition to these awesome videos, we have a ton of tools and resources to help you grow and overcome the challenges that you face.

We've got things like Dr. K's Guide to Mental Health, personalized coaching programs, and things like free community events and other sorts of tools to help you no matter where you are on your mental health journey. So check out the link in the description below and back to the video.

Hey chat, welcome to the Healthy Gamer GG podcast. I'm Dr. Ola Kanojo, but you can call me Dr. K. I'm a psychiatrist, gamer, and co-founder of Healthy Gamer. On this podcast, we explore mental health and life in the digital age, breaking down big ideas to help you better understand yourself and the world around you. So let's dive right in. So this is becoming a huge problem because we're seeing an increase in the rates of diagnosis of things like mood disorders, like major depressive disorder.

But we're also seeing a spike in symptom severity. So not only are more people depressed than they've ever been that we're aware of. But the severity of depression seems to be on the rise.

The bigger problem though is that our treatments for depression don't appear to be working. And that's what today's video is about. Understanding that not all kinds of depression are the same. And furthermore, we're gonna dive into this concept of existential depression, which is really, really scary in a lot of ways because it doesn't fit the mold of what we think of as depression.

So let's start by like understanding a couple of evolutions recently that we've discovered in psychiatry. So a lot of people think that depression is caused by a a chemical imbalance of serotonin. And if we improve the someone's serotonin transmission by giving people antidepressants. It'll work great, right? So we'll basically be able to treat it. But there was a really interesting um paper that came out in 2022 that basically found

The main areas of serotonin research provide no consistent evidence of there being an association between serotonin and depression and no support for the hypothesis that depression is caused by lower serotonin activity or concentrations. Okay.

So this is still somewhat up for debate. I think that a lot of treatments um involving serotonin do help people with depression. But I think that this idea that there's like depression is caused by just a chemical imbalance, that if we correct the chemical imbalance, everything will be fine. That's not entirely true. So in my experience as a psychiatrist, about one third of patients who are depressed will benefit substantially for f uh from an antidepressant medication.

The problem is that for those other two-thirds of people, it won't help very much because the origin of their depression is a little bit different. And this is sort of where we're going to dive into existential depression.

So this is what I want you all to think about. There are two reasons that you could be depressed. One is that your life is pretty good. Okay. But you have a cognitive distortion or you have something like a chemical imbalance. And if you have a cognitive distortion, if your brain isn't working right and that causes your depression, that is something that we can potentially fix.

with a medication to restore your serotonin levels, or we can use something like cognitive behavioral therapy to correct your cognitive distortions. There's basically a problem with the way that your brain is functioning, the way that you're seeing the world, which is why you're depressed. Things are not actually that bad. It's just your brain is messed up, so you can't see how good things are. Okay.

That's option number one. And that's what a lot of our psychiatric treatment is oriented towards. But there's a second possibility. Which is that the world is becoming increasingly uncertain. You genuinely look into the future and don't know what to do. You don't see a whole lot of hope. And this is not like a you're hopeless because your brain is messed up. This is like a genuine objective assessment of your future.

and discovering that like basically things are not hopeful from like a logical sense. And if you have this kind of depression, which by the way is skyrocketing, right? So we see existential depression increasing so much because the world is becoming a worse place. There's a lot of uncertainty around careers. Like is AI gonna replace your job? People are buying houses later. People can't afford houses. In the US, a lot of people have crushing amounts of student debt.

We don't know what the hell is going on with dating, right? So we don't know what's going on with the climate. We don't know what's going on with the environment. There's a lot of political unrest. There are wars. So as you like look out into the world, is the future a hopeful place? And for a lot of people, the answer is no.

The bigger problem is that the standard treatments that we use don't really work well for people with existential depression. This is the second kind of depression, which is Almost like a logical reaction to the world becoming a worse place.

Because this idea that depression is caused by a serotonin imbalance, I think is partially true. It's true in some cases, but not true for everybody. If y'all want more info on existential depression, we've put together an awesome page that has free resources.

links to other relevant videos and some info on our coaching program. Check out the link in the description below and back to the video. Now the the second problem is that if we look at the other sort of gold standard of treatment for depression, it's something called cognitive behavioral therapy. But I've worked with a ton of patients who have this existential depression.

for whom cognitive behavioral therapy doesn't work. So let's take a look at that. So this is a great paper by a a guy named Asir Gami, fantastic researcher on mood disorders, depressive realism, and existential psychotherapy. So we'll get to that in a second.

So the second gold standard of treatment for mood disorders and depression is CBT, right? So this is the cognitive behavioral model. A lot of people have heard of cognitive behavioral therapy. It holds that a major psychological mechanism behind clinical depression Is the tendency of patients to distort reality through inaccurate cognitive mindset? Okay, so basically the idea behind CBT is that your brain or your mind's ability to see reality is distorted by cognitive bias.

Things are not actually as bad as you thought they were. And if we can correct those cognitive distortions then your depression will go away. And CBT works well for many people. But there are more and more patients who I've worked with. A lot of these people end up in my office because they're looking for a different sort of approach because CBT doesn't work for them. Their cognitive distortions, they don't have a whole lot of cognitive distortions.

Uh in fact, what is going on is actually way scarier, which is something called the depressive realism model. Uh, many clinicians are unaware of the presence of a completely opposite of model, a model of depression, called depressive realism. What depressive realism basically shows is that those who had some depressive symptoms.

based on self report rating scales were more accurate than those without depressive symptoms, and correctly attributing errors to themselves as opposed to random errors beyond their control. Conversely, the normal non-depressed sub subjects had a sense of greater control than they actually possessed.

Okay. So what does this mean? So if you look at studies and we have a great uh whole video about logic in depression, if you look at uh studies on people who are depressed, it turns out that on the one hand, there are some people who have cognitive distortions. But on the other hand, people who are depressed are actually more accurate judges of reality than non-depressed people.

The default state of existence if you're a human is to be cognitively biased in your own favor. This is why people do things like buy lottery tickets, right? So their ability to actually assess. how what their odds of winning are are really, really poor. Like everyone thinks they're better than average. You know what there's this group of people who are depressive realists. Who are better accurate judges of reality. So now here's the situation.

You're depressed. Now you may be looking out into the future and there are a couple of different options. So you see the world as bleak in front of you, okay? So option number one is that you have a chemical imbalance in your brain. You can start an antidepressant, take an SSRI, boost your serotonin levels, and I'd say one out of three people benefits a lot from that.

Okay. Second uh option that you've got is you can do cognitive behavioral therapy, but maybe your brain isn't actually like messed up. Maybe you're not actually having cognitive distortions. Maybe you are an accurate judge of your bleak future.

And you are depressed as a result of that. And so what we tend to see in cognitive behavioral therapy is that it doesn't work for everyone. And so if you don't have a chemical imbalance and if you don't have a whole lot of cognitive distortions, then what do you do?

This is where we enter into a discussion of existential depression. Now, today's video is gonna be a little bit more detailed and a little bit more abstract, where if you have existential depression, you're probably a little bit philosophical. So hopefully you'll appreciate this, but this is actually what we really need to look at, right? So we need to take this sort of philosophical approach to understanding what is life.

Who are you? How do these two things relate to each other? And once we understand how those two things connect, hopefully it will equip you for a way of like living and existing in the world. That allows you to like be happier. I know it sounds kind of weird. I don't know how to say it, but like basically if you're existentially depressed, you need an existential solution. And an existential solution isn't gonna come from cognitive behavioral therapy or an SSRI.

It's gonna come from fucking like philosophically sitting down and looking at your life and really trying to understand like what the hell is going on here. And oh the cool thing is if we understand a couple of principles, then we'll sort of help ourselves move in the right direction, okay? So if you fall into this third camp, this camp where you're looking into the future and things are genuinely bleak, how do we approach it?

So we're gonna approach it a little bit like philosophically, right? So you're existentially depressed. Which means that like you're a thinker and you think about life and you think about the meaning of life and you think, oh, there's like no meaning in life and like fair enough, okay? So we're gonna like approach things from that angle. This isn't s as simple as neurotransmitters and serotonin and things like that.

But the good news is that there's been a lot of work that's a little bit older that's been done. So this is what I thought was really interesting. So in the explosion of neuroscience, We've sort of lost sight of these like big picture philosophical approaches to the meaning of life and how to exist as a human. And and so it's really interesting because the more that I try to help people with existential depression, I find that some of these

Older approaches where human beings were grappling with this stuff in the 40s before science was very sophisticated. There's a lot of really great stuff there. And as we dig into that stuff, hopefully it will give y'all a road forward, not just in a big picture sense, but also a couple of really specific things that you can do to sort of change your perspective on life.

So let's take a look at what existential depression looks like. What is blocked or interrupted for the depressive is not the future, but contingency, spontaneity, or openness. As I see it, the problem with such a patient is not that the future is blocked. But that it is frozen or determined, that in losing its rhythmical flow and pause, in effect it has achieved a state of disordered perfection or completeness.

a situation intolerable in the healthy. Such an individual with a fixed or frozen future has become an object among objects or thing among things. His loss of the sense of the rhythm of the world and of his life demands that he attempt to reconstitute this sense of interrupted or disordered pause and flow.

Since he feels very foreclosed in terms of the viable future, he feels he must reinstitute, even if by pathologic devices, the disruption of the painful, monadic, unitary, closed state he has achieved. Now, you are probably wondering, what the hell does that mean? So let's explain. So here's what Dr. Scher noticed. If you are a human being, you have a lot of stuff in the past that brings you to the present. Okay? And then the future is a set of possibilities.

Right. So if we kinda think about like what's gonna happen in the future, this thing could happen over here or this thing could happen over here. There's all kinds of possibilities. What are you gonna do with your life? Oh, I could do anything. I could study this, I could study this, I could move here, I could go over here. There's a lot of possibility. in life. So what happens in existential depression is that the future becomes frozen or determined.

Right. It becomes a disordered perfection or completeness. So this is kind of what what I see when I when I work with people who are depressed, right? What I sit with is someone who there's no fut there's no possibility of the future. The future actually collapses. Down to one thing. There's no more possibility. No matter which road we start walking, we are gonna end up In the same spot.

There's no there's no point in effort because the future is foreclosed. The future is predetermined. That's where the hopelessness comes from. So a good example of this is, you know, I I work with a lot of people who struggle a lot with like dating and loneliness. And there's a camp of people who uh call themselves Forever Alone. So if you think about forever alone, what does that mean? It means that no matter what you do.

The future is fixed. And when the future becomes fixed like that, it induces this sense of existential depression. There's no point in life. What's the point in life if no matter what I do? Everything is gonna fall apart anyway. There's no there's no point in investing in a career because my job is gonna be replaced by AI.

Right. So no matter what I do, I become powerless because my efforts, whether I go do this on a a Monday or this or whether I procrastinate on a Monday or I don't procrastinate makes no difference. My job is gonna get replaced by AI. Whether I go to the gym, whether I get my hair done, whether I work with a stylist,

Whether I go to this pick up artist camp, doesn't matter because I'm gonna be alone no matter what what happens. So there is a fixed or frozen future. And when there is a fric fixed or frozen future, what is the point of acting? Right? What's the point? This is why people with existential depression

Struggle day in and day out to find a meaning, to find a purpose, to find a point. It's like I go on existing in this world. I become an object among objects, a thing among things. Life has no zest, it has no possibility, it has no excitement. As the depressive initiates his descent to Avernus, he begins by feeling bad, that is dysrhythmic, out of phase, and anxious.

By degrees the depressive reduces his participation in the world of events of social, personal, and even family contacts. They start to withdraw. His future consolidates, his present constricts, and his past may not become the center of repetitious and blocked focus. As he closes linearly or frontally, he seems to open laterally. So what does this mean? So the future is full of possibilities.

Right? In a normal person. But as you become depressed, right, your future consolidates. No matter what you do, you end up in the same spot. There's no point. So now if there's no point to you doing anything, you stop moving in this direction, right? This is a forward, if we look at this as the x-axis, and this is progress. So what ends up happening with people who are existentially depressed is that they move laterally. They start moving in this direction. Now what does lateral movement mean?

That means that after you act, here's you, here's action, you end up in the same place that you were before. Right? There's no there's no sense of progress in your actions. So what does this look like? Well, G I wonder can y'all envision anything that a lot of people are doing in the world today that constitutes lateral movement? Can y'all envision anything that people are doing where at the end of the day, when they've spent a whole day doing this,

They have not moved forward a single step in life. Wow. Yeah, that's right. It's this. It's technology, it's drugs, it's video games, it's porn, it's social media, it's doom scrolling. All of these are lateral movements, right? At the end of the day, if you spend a day, a week, or a month doing this, you have not moved forward at all.

Now a lot of people think, okay, so that's why we just need to stop. And this is where a lot of people make a huge mistake. See, stopping technology usage isn't gonna work. If you are trying to move laterally, you will just replace video games with something else that's useless. You'll sort of force yourself.

into trying to learn a new skill. Let me just like try to grow by playing guitar and then like at least I'll have a skill at the end of it. But there's no actual passion or joy or anything like that in driving the guitar, so you won't stick with it. The lateral movement is a consequence of an absence of forward movement, right? So the real thing, if you really want to give up technology, there's a bunch of research that shows this, you have to have a reason to quit.

Otherwise, you'll just replace it with something else. So one other thing that I want to talk about in terms of existential depression, which is this sense of profound desperation. When I sit with my patients, I don't know if this kind of makes sense, but they're like, Like this is some sometimes where their suicidality comes in, where they're like I don't care. I just can't live in this fucking life anymore. Like

I just don't want it's the same damn day over and over and over again. I've been doing this for years. I can't do this for thirty years. I can't do this for forty years. So sometimes it manifests as suicidality, but sometimes it manifests is like highly reckless behavior. I just want a YOLO. It's not that my patients are oftentimes suicidal. It's that they long for like I want to become something or nothing at all. Like I'm going to put I want to go all in on something in life.

There's this this this fascination and love for YOLO, right? Like you only live once. I want to fucking live, even if it comes with negative consequences. And I think Dr. Scher described this incredibly well. The dis depressive desperately wishes to break the sense of hyperstructuring, the preordination toward inevitable catastrophe that gives the sense uh or actual loss of self. His problem is how to stop this inexorable, ineluctant flow. He feels encased in amber and he must break out.

In his lateralizing, he attempts by unclochuring, namely by breaking the rhythmic flow coherently in some magical way, unfix, defreeze his linear progression. So I know that that's quite verbose, so I'm gonna try to illustrate that too, okay? So this is what happens. Here's you. And no matter what you do, you end up in the same place. So what do you need to do? You're encased in amber, right? So the main thing is you have to break out of this.

You need to shatter this pattern. You need to do something drastic because right now you're not really moving anywhere. You're just lateralizing. Forward momentum ends up in in somewhere that you can't really control. So you just need to shake it up, right? And this is what I I see so much when I work with people. They have this very, very intense sense of like, I just wanna leave it all and go to an ashram and find myself. I wanna go to some boot camp. I wanna read I I just can't tolerate

this staticness of life. This is what existential depression is. In order to have meaning in life, what we need is we need a past To come into our present. And then we need our present actions to help us build a future. And the future should be full of possibilities. This is why people get addicted to video games and all of these like apps now have gamification. Why? Because we are so empty with our sense of progress and forward momentum in life.

That all of these apps have figured out if we give someone XP and leveling up and if we give them some sense of grinding towards something. Then that scratches that itch of existential depression. In existential depression, you want to be moving forward, but you don't know how to move forward. That's why we will grind video games for 10,000 hours. I want y'all to think about this for a second. Every day you play a video game, it's not even that much fun.

Why do you grind so hard for meaningless things? It's because you have a meaningless life. And the illusion of meaning from something like a video game, the illusion of progress.

So now the question becomes okay, if this is the case, what do we do about it, right? Because cognitive behavioral therapy may not work, antidepressants may not work. How do we tackle this problem? So the first thing I'm gonna do, I'm we're gonna go back to Sure, and we're gonna sort of give you all a picture of what the goal looks like. So the unself conscious man, that is existential man, moves through the space of his world or worlds pulled upon or altered by the tribe blah blah blah.

He's deeply involved in a future oriented apprehending of the particulars of existence. He participates, he takes in, he gives out, and in all of this, he maintains a certain pace, a certain rhythm, a certain flow. There is a flow to life, a movement to it, which is interrupted in its timing or in its direction. So this is the key thing. I know that Dr. Sher likes to use a lot of complex words, but here's the key thing.

So if we look at life, life has a flow to it, it has a rhythm, it has an exchange. Right? So I I have good days and I have bad. Good days all the time will lead to depression. Bad days all the time will lead to depression. It is good days and bad days that make a good life. If we think about movies You know, what makes an exciting movie or narrative?

When the good guy is just dumpstering all of the enemies with like one attack, like one punch man. I mean, one punch man is pretty good, but whatever. You know, most of the time, like in order for a like a a game to be fun or a movie to be entertaining. The good guy has to lose and then he has to win at the end, right? There has to be some sense of tension. There has to be some degree of uncertainty in life.

So that is what we're gonna try to recreate. And now what we're gonna do is understand a couple of basic patterns that allow us to recreate this kind of sinusoidal flow, this this sort of, you know, life is like oscillating, right? And this is the problem in depression is that it feels every we feel encased in amber. So how do we create that sense of flow again?

So this is where the first thing that we're gonna do, it's really interesting because Sher talked about this too. So Beck mentioned that we have a relationship between three things. Affect or emotions? Thoughts and actions. Okay. So as a human being, like there are three fundamental pieces of your existence. Now, what we notice about people who are existentially depressed is that there is an imbalance between these. So I'll give you all an example. So if I am a thinker.

What I'll find is that I don't feel very much and I don't do very much. So this person is not going to be happy. All they do, and we we have this great video on thinkers versus doers. And all they do is like think, think, think, think, think, think, think. They don't even feel very much. Maybe there's depression, maybe there's sadness, maybe there's some degree of shame or anger. But generally speaking, they're so hyper cognitive.

And when someone is hypercognitive, it doesn't work, right? So b in order to feel the joy of life, you can't just sit there and think all the time. You gotta go out and like experience things, do things. Go and and you know, ask someone out on a date. Go swimming at the beach. Like you have to do stuff. The other thing about life is that life requires emotion to be interesting.

So what when you know, one of the side effects of things like SSRI medication is that it numbs people out and they don't like it. Like I've had so many patients who will You know, they'll they'll prefer I'd rather have the sadness because it gives me access to the joy. I just don't want to be like, you know, numbed out. That happens a lot in bipolar disorder with mood destabilizers, so

Key point here is that we have to have a balance of these three things. Now, I've also worked with people who are you know, they're in a different way, where they feel too much. So good examples of this are people with um, you know, maybe some something like borderline personality disorder or emotional dysregulation with ADHD. There are a lot of people who just their life is just so full of intense feelings. And their feelings are so intense that they're paralyzing.

So my my you know anger is so profound that I can't make up with this person at work. I therefore I'm never gonna get promoted. Like my sadness is so profound that I can't get out of bed. So this is where when we're feeling too much. Or even it's not even just negative feelings, it's even like positive feelings, like excitement. I get so excited about starting this company that I don't bother to think through whether is it is a good idea.

So my life becomes a series of spurts of motivation, followed by a lack of mo follow through. And over time, once again, what happens? The future constricts. Because I'm not actually building towards everything. Everything is a project that is half completed. Now y'all may say, but Doctor K, what about people who act a lot, right? Aren't they really happy? Let's say they think this much and they feel this much. So this is a great example.

of my classic high performing patient. This is your Fang engineer. This is your second year surgery resident at the Harvard Medical School in Massachusetts General Hospital. This is your startup CEO who is Starting the third company and they have a hundred million dollars. All they are is action, action, action, action.

And lots of us, we, we love these people, right? We we elevate these people. We think, oh, I want to be like this. Those fucking people wind up in my office too. These are the people who are burnt out. These are the people who will also have imposter syndrome. These are the people who despite

Sweat and toil and they work really hard. And if you guys look in the world today, you may notice that some very, very wealthy and successful people do not appear to be happy, content, or decent human beings. Right? Shocking. So this is where one of the key things that we have to understand is if you wanna break out of existential depression, you need to have some balance between action

Feeling and thinking. Okay. And I know it sounds you're y'all are gonna say, but how do I do that? So this is just big principle, big picture. We're gonna get to little things later. So the first thing that I would say is just look at your life. Do you spend a lot of time thinking?

Do you spend a lot of time feeling? Do you spend a lot of time doing? And whichever one of these is out of balance is something that you should lean into. Right. So if you spend all of your time thinking, and this is where people get really paralyzed. They think, oh, like you need to do more. Now here's the problem that happens if you're a thinker. If I tell you you need to do more, you wanna find the right thing to do. What is the right thing to do?

It doesn't matter. This is what we learn from these explorations of existential depression. See, what we need to do is activate your body. Like we just need to do anything. It doesn't matter what you do. I mean, I guess it's matters some, but you do you don't need to find the right thing. As you start acting more, there will be a genuine balancing of like the crap that is going on inside you and things will get better. So just to give y'all a simple example of this.

If you are physically unhealthy and you're like, what kind of exercise should I do? the answer is it doesn't matter. The answer is you should do some kind of exercise. Sure, there's certain ways to optimize the exercise that you do, but generally speaking Сам акшен ені акшен. far outweighs I mean that's where the real money is. And then later on you can refine what you do. So this is where if you're not feeling enough, what should you feel doesn't fucking matter.

If you're not thinking enough, if you're just a bot who is grinding at life, you should stop and think, right? Think about your life. Think about what you're doing. Think about where you're going. It is these actions that will actually move you in the right direction.

Okay, so the first is a balance between thinking, feeling, and doing. Next, there are three ways That human beings feel good about themselves. One is self-fulfillment. satisfying others or worldly fulfillment. And the third is transcendental fulfillment. Now what does this mean? Generally speaking, the other observation that they made is that if you sort of look at human beings, happiness in life comes from three things. Either I satisfy myself or I satisfy other people.

Or there's some weird dimension of God and spirituality. That's basically what they found. Right. So I want you all to think about this balance. So I've worked with a ton of people who are depressed because they spend their whole life making the rest of the world happy.

They achieve things, they accomplish things, they do, you know, they're the perfect husband, the perfect wife, the perfect boyfriend, the perfect girlfriend, the perfect son, the perfect daughter, the perfect employee, the perfect boss. All of their identity is Invested in making the rest of the world happy. This is going to lead to existential depression because you're sort of sitting there, you're living your whole life.

for the sake of other people. You wake up one day and you're we're forty. This is where a midlife crisis comes from. What the hell am I doing on this planet? I've done everything that I'm supposed to do. I've made everyone happy. I got promoted. I accomplished a lot, but I wake up and I'm unhappy. The second version Prioritizing self fulfillment. They're they're very selfish.

Or they just spend all their time playing video games, getting high, whatever. They're engaged in a lot of lateral movement, right? They're not fulfilling any of their world r worldly responsibilities. So they're not respected. They're not accomplished. They don't do they don't get positive feedback from the world, right? This leads to existential depression as well. And the third dimension is a little bit trickier. We're not gonna talk too much about that today.

And we talk a a bunch about spirituality on the channel. But the third thing that they sort of acknowledged, right? So these people who were focused on existential depression was that, you know, there's a third category of like Like something about meaning comes from a dimension that is not you and not the outside world. The outside world. They just acknowledge that these two dimensions.

seem to be insufficient to describe the total amount of meaning. And so what they observed, I'm not saying this is I think it's right. So not that God is real or anything like that. But what they observed is that some human beings derive meaning or purpose. from like a religious perspective or a spiritual perspective, right? Some people it's like I'm gonna do I'm gonna do right by my family, I'm gonna have some fun and I'm gonna like live a pious and not sinful life.

And that will give my my I'm striving for heaven and it gives their life purpose. This is just an observation. It's not saying that it's right or wrong, but I think what is it indisputable, or maybe I'm sure it's disputable, but What I think is a fair observation is that a lot of human beings in the history of humanity have derived some sense of meaning and direction from a religious or a spiritual pursuit. Now I'm a huge fan of this pursuit.

So I that's why we sort of advocate for things like meditation. And I think once you start meditating a lot, you will start to discover meaning and purpose in life in ways that you may not have otherwise realized. So the next question becomes, do you have a balance of these three things? If you spend too much time making the rest of the world happy, make yourself happy. If you spend too much time making yourself happy, then start being in service to the world.

So there's a a couple of fascinating studies on depression that show that see when we're depressed, we sort of get help from other people. But one of the best treatments or one of the best ways to improve your depression is to actually be of service to other people. When you do something kind for other human beings, when you start volunteering and taking care of animals, it helps your depression immensely.

Okay, lots of studies show this. So that's the second dimension. Now the third thing that we're gonna talk about.

is a lack of lateralization. So this is the key thing to understand. If y'all are wasting all of your energy in a non-forward direction and you are just lateralizing all of your effort. There's no way to move forward. Now the the challenge here is that if you are lateralizing, chances are you are looking into the future and you're saying, there is no point in doing this.

And that's where you should do it anyway. So, one of the key things I found when working with people who are existentially depressed is we want to increase their suite of experience. Right, we want to give them more data. We wanna expand their horizons, try something new. What is gonna be the result of it? I don't know. Will it fix your future? Or who knows? Do it anyway.

Because this is what's really interesting. When we think about the conclusions that the brain makes, I couldn't resist it. We're going into neuroscience. When we look at the conclusions that the brain makes, what you have to understand is that if you're projecting out your future, the calculation is made by your current knowledge, right?

So our brain is making a calculation based on other centers of the brain. Our hippocampus has a bunch of memories. Our association cortices have a lot of good knowledge packed in there. So we we sort of have this projection of the future that is based on our current data set. Logically altering that data set, thinking through. Certain problems can help some, but the best way for your brain to learn and change its calculation is to give it new experience.

So I I'm sure this has happened to you where you're like, oh, like I thought this thing was gonna be really bad. And it turns out it wasn't that bad. So I can logically explain to you, oh, uh uh, you know, an injection isn't going to hurt, but it is only through experience that your actual perspective towards it will change.

And what I see in the world today is lateralizing our efforts has become so easy that we've stopped experiencing. Right. So many of the problems that I see are gonna be people posting about like Are all women women this way or all men this way? And what they're referring to is not real life interactions. They are like ingesting information from the internet.

So we need to really reduce our lateral movements, right? So think about all the things that you do over the course of a day that will lead to nothing and instead shift your work towards anything that leads to anywhere. And experience more. There are two or three other simple techniques that we can talk about because y'all may be listening to this and be like, oh, is this really going to change things? It really is. So here's the key thing to understand.

The all of these techniques work by restoring the sinusoidal rhythm of life. So this is what life is supposed to be like. There are downs and there are ups and there's stuff in the middle. There's up, there's down, there's up. You'll notice that the width of the peaks is different. We have some peaks that are very narrow and some peaks that are very wide. This is what normal life is like. Now in reactive depression.

What what tends to happen is we have a prolonged, there's less sinusoidal rhythm, right? So there's more variance here. Whereas in reactive depression, something bad happens and then we're locked into this pattern for a while. We're locked into this pat pattern for a while. And then we have Endogenous depression, which is way more constant than even reactive depression. So the key thing, and this is what's pretty cool about this.

The key thing is we just want to restore this normal fluctuation. Doesn't matter what you do. The important thing is the variety. If you've been sitting on your ass for eight hours a day, it doesn't matter what kind of movement you do. You can do yoga, you can do stretching, you can go for a walk, you can take a bath, you can even just get up and do this.

It doesn't matter what kind of movement you do. The key thing is that you move in some way. Now, the last thing that we're going to talk about are two microscopic techniques. So these are actual techniques from something called logotherapy. So I don't know if y'all have heard of um a guy named Victor Frankel, right? So he wrote Man's uh Search for Meaning.

was a Holocaust survivor, became a doctor, was I think I guess a psychiatrist. I'm not sure if he was like neurologist or psychiatrist or what. But he developed this system of therapy which was specifically targeting existential depression. So here's just his characterization. Patients who fall into this diagnostic category usually complain of a sense of futility and meaningless or emptiness and void.

In logotherapy, this condition is termed the existential vacuum. The first thing that we're gonna talk about, he developed this technique called paradoxical intention. So here's what he said about it. In order to understand it, one must consider the phenomenon called anticipatory anxiety. By this I mean the response and reaction to an event in terms of the fearful expectation of the recurrence of the event.

However, fear tends to make come true precisely that which one is afraid of. And in the same vein, anticipatory anxiety triggers off what the patient so fearfully expects to happen. Thus a vicious circle is established. A symptom evokes a phobia and the phobia provokes the symptom.

The recurrence of the symptom then reinforces the phobia. I'm sitting here and I'm saying, look, you should go out and act more. But Frankel figured this out. When I say go out and act more, he discovered that there is something that's getting in the way of your acting. That is your anticipatory anxiety. So if I take someone who is forever alone and I tell them, go out and talk to people, this evokes.

Some anxiety. Things are not going to go well. People won't like me. And then if you push yourself and force yourself out into public, You will be so in your head and anxious. you will be sending off the wrong empathic energy so that people are gonna think you're an awkward you're awkward and you're a creep. So those social interactions that you force yourself into will become traumatic.

And as they become traumatic, then they will reinforce your anxiety. Right. So if I just tell you to go out and act, doesn't work. So if you're someone who is paralyzed by anxiety, right? I'm afraid to ask for a promotion, then when you go in and you ask for a promotion, you're stuttering, you're not confident, you don't really believe, you're afraid of what they're gonna think of you, so you don't project your confidence and then you don't end up getting promoted anyway.

This is the problem. When we are anxious about doing something and we try to do it, our anxiety sabotages our ability to do the thing. So there are two solutions to this. One is we can do an exposure therapy where we engage in the behavior over and over and over and over and over again until our anxiety gets numbed out, or we can do what Richter Frankel called paradoxical intention. To put it in a nutshell, the patient is thereby encouraged to do or wish to happen the very things he fears.

In other words, the pathogenic fear is replaced by a paradoxical wish. Now, what does this mean? This means that you should wish for the thing that you fear the most. This is Frankel we're talking about. Okay. So he's like, look, if you're afraid of something, just wish for it, right? Just be like and I think now in in the current

you know, society we talk about acceptance. So I think this is another version of that. So right, so from the spiritual tradition, like the Eastern karmic traditions, we talk about like the value of acceptance. And we kinda say like Look, life is gonna happen. It's gonna be your karma. There's no way to dodge your bad karma, so just accept it. Same kind of thing.

The key thing here is that what we're trying to do is disable the anxiety. Right. So if I if I o am thinking about asking someone out on a date or socializing, if I go into it and saying, look. I'm gonna go into this social situation. I'm gonna feel anxious. I'm it's gonna be terrible. So be it. Bring it on, right? Just because life sucks doesn't mean I'm gonna retreat from it. Let it happen. Like do your worst, bitch. Let's go. And this is the key thing that Frankel discovered.

Is that the attitude that we embody when we approach the difficulties of life will ultimately determine how we live our life. So if you adopt this attitude of, okay, this person, I'm gonna ask this person out on a date. They're gonna reject me. It's gonna hurt. Bring it on. So be it. But fuck me, I'm not gonna live encased in amber anymore. Like even if things go bad, so be it.

I'm gonna start living and I'm gonna shoot my shot and I'm gonna start taking chances in life. If the worst happens, let the worst happen. So be it. Now, this is the cool thing. When we adopt paradoxical atten uh uh intention, and there's a lot of studies on acceptance that show basically the same thing, it actually improves our chances, right? So like now what we've done is we've disabled the anxiety, and it's the anxiety itself that is really sabotaging the outcome.

So when we bring it when we have this bring it on kind of attitude, it really helps us to disable that anxiety, maybe disabled not work right away, but as you practice it, your brain will get better at it, and then you'll be able to take chances in life, and then something cool will happen. Things will start to go your way.

Right? You won't be quite as anxious. You ask someone out, turns out they're crushing on you two. They say yes, let's give it a shot. And now someone has said yes. Now your life is completely different. Now you're living life. Now life becomes sinusoidal. Now life has up. And we went on two dates. They said, hey, they don't really see me romantically. And it has a down. So now the question becomes, are you going to be anxious?

and paralyzed, or are you gonna live life again? Oh, another down, another down, and then an up, and then you end up dating someone for like a year. We've seen these kinds of progress in our community. People post about it all the time. It does work. I've seen it in my patient.

So that is paradoxical intention. Bring it on. The second technique that we're gonna talk about is called dereflection. So Frankel noticed that when he worked with people who are existentially depressed. They tend to be hyper focused on a particular problem and its implications. So let's say that someone gets dumped or someone fails attack. We tend to focus fully on this thing. Our eyes kind of tunnel down into this thing and the impact in our lives. Now that I failed this test.

I'm not gonna get a four point oh GPA. If I won't get a four point oh GPA, I won't get in college. If I don't get in or med school. If I don't get into med school, then I won't make my parents proud and I won't ever get married and like all these things happen, right? So we we look at this one thing in life, whether we get dumped or we get a bad grade or whatever, we become hyper focused on it. So instead What d reflection is is taking a step back and looking at how even this setback

Which existential psychotherapy does a great job of this. Existential psychotherapy says that life is full of suffering, right? So suffering there's uh some amount of unavoidable suffering. Can't Buddha said the same thing. The key thing is how we respond to it. So when we have these setbacks, what dereflection encourages us to do is pivot towards something called a transcendental value.

So pivot towards something that matters to you that is greater than this problem. So I'll give you all a couple of examples of how I do this with patients. So let's say you fail a class, okay? And now you're catastrophizing. So when I work with people, what I'll do is I'll ask them, Okay, like so sure you failed, but let's think about this for a second. How useful do you think it is to be someone? Who is capable of bouncing back from failure? Is that important to you?

is picking yourself up when you face the setback an important thing for you in life? Would you want to acquire that skill, right? And so now what we're doing is we're taking this setback, which is absolutely a setback, and we're sort of recognizing that, okay, this is a chance for me to level up my damage control skill.

This is a chance for me to acknowledge that even though I got dumped by this person, that I want to be someone who is capable of being dumped and still living a good life, putting myself out there, meeting someone else. In the grand scheme of things, there is something that is more important to me than this particular thing. So this requires some work, right, for you to really sit down and think about what are your transcendental values? What are the things that you want to become?

And for the setbacks in in life, what you want to do with D-Reflection is think about the setback and think about how can you turn this lemon into lemonade. Right. How can I take this negative thing that has happened to me? and turn it into something that I care about and is positive in life. This is where the thinking comes in. So I do this all the time, right? So I failed out of college basically and like, you know, ended up

being a Harvard trained psychiatrist and like that's become an important part of my story. Like I went through this process myself in terms of growth and it's been like awesome. Now I feel like I have meaning and purpose and like y'all should do it too. It doesn't mean that I'm magical or I'm special or I'm like unique in some way.

It just means that I sort of went through more of an eastern path, but like Frankel literally laid this stuff out. So not only did I go through this stuff, what I saw as a psychiatrist in like 2018. was that this kind of problem is increasing. People are struggling to find meaning in life. This is one of the reasons that, you know, I had a choice between opening a clinic or developing a coaching program.

Reason I chose the coaching program, so in our pilot study of our coaching program, fourteen I think one thousand four hundred and ninety-three people, maybe thirty nine, I could be a little bit off. That was our pilot study on almost fifteen hundred people. We found a 58% increase in purpose and direction in life. This is the variable that we were going for, right? We want to help people find their meaning in their direction. So our pilot study was also looking at unhealthy technology use.

And what we found is that it improved like depression and anxiety by twenty to thirty percent. But that's not what we were trying to do. We developed a program to help people find meaning and direction in life. And once you have meaning and direction in life, the technology use and the lateralizing behavior goes down on its own. So in today's video, we've equipped you with some of the big picture concepts. A balance between actions, thoughts, and feelings, a sinusoidal rhythm in life.

Dereflection, paradoxical intention, right? This is how to solve existential depression, or this is what the data suggest, or the these are what some of these people suggest, right? That's what works. I've seen it as a clinician. Hopefully it'll work for you.

Other thing is that y'all can absolutely work with our coaches. That's why we developed this, right? So the coaching program was developed because I saw that there are like certain problems that are called these trans diagnostic factors, like perfectionism, right? Ego. identity issues, purpose, meaning. These are things that as psychiatrists, we're not there's no medication for that. That's not what our training is in. Our training is not about building purpose. It is about healing pathology.

So if y'all are struggling with that and you really want someone to help you through that, so you've made significant progress in eight to twelve weeks, definitely check it out. And for those of y'all that aren't interested in that, that's why we make these videos. That's why we explain things mechanistically. And hopefully we've given y'all some big picture abstract stuff to focus on, as well as two very concrete techniques to apply in your own life.

Thanks for joining us today. We're here to help you understand your mind and live a better life. If you enjoyed the conversation, be sure to subscribe. Until next time, take care of yourselves and each other.