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Wise Habits Reminders

Anxiety & Depression

A collection of The One You Feed episodes that discuss handling anxiety and depression.

From Avoidance to Acceptance: A New Way to Live with Anxiety with Kelly Wilson

October 31, 2025 1 Comment

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In this episode, Kelly Wilson explains how to move from avoidance to acceptance: a new way to live with anxiety. He delves into how our vulnerabilities show us what matters to us, and that the goal isn’t to win a war inside. It’s to keep coming back to the next honest action that moves you towards what matters. That is at the core of acceptance and commitment therapy. Not chasing perfect feelings, but choosing the next right move towards your values, again and again.

Exciting News!!!Coming in March, 2026, my new book, How a Little Becomes a Lot: The Art of Small Changes for a More Meaningful Life is now available for pre-orders!

Key Takeaways:

  • Exploration of psychological struggles, particularly anxiety, and their impact on life.
  • Introduction to Acceptance and Commitment Therapy (ACT) and its core principles.
  • Discussion of the six core processes of ACT: present moment awareness, cognitive defusion, acceptance, values, committed action, and self as context.
  • Examination of the relationship between vulnerability and personal growth.
  • Critique of traditional diagnostic labels and their limitations in understanding psychological experiences.
  • Emphasis on the importance of values in guiding meaningful actions and decisions.
  • Insights into the nature of human suffering and the commonality of psychological pain.
  • The concept of redemption and its role in personal development and therapy.
  • Reframing commitment as a moment-to-moment process rather than a rigid promise.
  • Encouragement of compassion and understanding in the face of psychological challenges.d understanding.

Kelly Wilson, Ph.D., is a Professor of Psychology at the University of Mississippi. He is Past President of the Association for Contextual Behavioral Science and has won the University of Mississipi’s prestigious Elsie M. Hood Outstanding Teacher Award.  Dr. Wilson is one of the co-developers of Acceptance and Commitment Therapy (ACT) and has written several books, including Things Might Go Terribly, Horribly Wrong:  A Guide to Life Liberated from Anxiety.

Connect with Kelly Wilson: Website | Instagram

If you enjoyed this conversation with Kelly Wilson, check out these other episodes:

Steven C. Hayes

Russ Harris (Part 1)

Russ Harris (Part 2)

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Episode Transcript:

Kelly Wilson 00:00:00  My vulnerability seemed to me to be the enemy, and I tried ever so hard to make it go away. And when I made peace with it, it ended up being the center of my career.

Chris Forbes 00:00:20  Welcome to the one you feed. Throughout time, great thinkers have recognized the importance of the thoughts. We have quotes like garbage in, garbage out or you are what you think ring true. And yet for many of us, our thoughts don’t strengthen or empower us. We tend toward negativity, self-pity, jealousy, or fear. We see what we don’t have instead of what we do. We think things that hold us back and dampen our spirit. But it’s not just about thinking our actions matter. It takes conscious, consistent, and creative effort to make a life worth living. This podcast is about how other people keep themselves moving in the right direction, how they feed their good wolf.

Eric Zimmer 00:01:05  When I was younger, I thought my weakest traits were the enemy. Maybe you felt that way, too. The tenderness that makes you easy to hurt.

Eric Zimmer 00:01:13  The anxiety that won’t let go. Kelly Wilson, co-developer of Acceptance and commitment therapy, said something in our conversation that I think about often our values and our vulnerabilities are poured from the same vessel. Our vulnerabilities show us what matters to us, and the goal isn’t to win a war inside. It’s to keep coming back to the next honest action that moves you towards what matters. And that’s the spirit of acceptance and commitment therapy. Not chasing perfect feelings, but choosing the next right move towards your values. Again and again I’m Eric Zimmer and this is the one you feed. Hi Kelly. Welcome to the show.

Kelly Wilson 00:01:54  Well, it’s good to be here.

Eric Zimmer 00:01:55  I am glad to have you on. We’re going to talk a little bit about your book, which I love. The title of called Things Might Go Terribly, Horribly Wrong A Guide to Life Liberated from Anxiety. And we certainly will be spending a fair amount of time talking about acceptance and commitment therapy, also known as Act, for which you are a significant contributor.

Eric Zimmer 00:02:16  But we’ll start, like we always do, with a parable. There is a grandfather who’s talking with his grandson. He says, in life there are two wolves inside of us that are always a battle. One is a good wolf, which represents things like kindness and bravery and love, and the other is a bad wolf, which represents things like greed and hatred and fear. And the grandson stops and he thinks about this for a second. He looks up at his grandfather. He says, well, grandfather, which one wins? And the grandfather says, the one you feed. So I’d like to start off by asking you what that parable means to you in your life and in the work that you do.

Kelly Wilson 00:02:52  I’m not personally a super enamored of the idea of a war inside, although it’s not incomprehensible to me. You know, I know what it is like, you know, to feel as though I have a war inside of me. And I certainly remember a time in my own life when I was sure that, you know, the worst of the players were winning.

Kelly Wilson 00:03:15  You know, for me, I got peace, a measure of it when I let go of the war. I do know the piece of that parable that strikes me is that we’re always practicing in life, and what we practice gets stronger, and I practice running away for a very, very, very long time and have been practicing sitting still and moving towards things. And, and it’s gotten stronger, you know, so I suppose that that is what it means to me.

Eric Zimmer 00:03:42  Excellent. Well, I agree with you that the parable has its value and certainly its limitations. Let’s talk a little bit about problems in life. And so you say that through the lens of of act problems in life, such as anxiety. Look a little different than we might be used to. Instead of seeing a problem like anxiety is something we have. Like a virus or a broken bone. Act describes these problems in terms of our ability to function in six process areas. So before we go into the process areas, let’s talk about that view as a whole.

Eric Zimmer 00:04:19  Not that I have anxiety, but that some certain ways of functioning, let’s say mentally or psychologically, I may need a little tweak in a couple areas versus having, like you said, like a virus.

Kelly Wilson 00:04:33  You know, I suppose the idea that people with psychological struggles, in order to be legitimately understood as having struggles, you know, have to have some kind of disease label that troubles me. You know, kind of it starts with this sort of metaphor that, you know, your problem in life is that you’re somehow broken inside. I don’t mean at all to discount That human experience is extraordinarily varied, and you know that we don’t all carry certain kinds of vulnerabilities, some of which are very hard to carry, very poorly understood by people around us. And it’s very easy to make an enemy of them. That is the piece that I object to. In all of that.

Eric Zimmer 00:05:12  I think this is an interesting topic because sometimes a diagnosis can be liberating, right? A diagnosis can be liberating, like, oh, okay, there’s this thing and it provides me some context and it gives me a frame of reference.

Eric Zimmer 00:05:27  And maybe now that we know what the problem is, we can work on it. And yet diagnoses are ultimately then depending on how they’re interpreted, become limiting.

Kelly Wilson 00:05:38  I wouldn’t take anything away from that. And I know that there are communities out there like my good friend Lisa Coyne does work and, OCD. And there’s a whole kind of community around people supporting one another. You know, when I look at when people get a diagnosis and they get it kind of an experience of relief, usually, you know, what I hear in that is I’m not alone. Yes. It’s not just me. Yes. And, you know, I want to say to people like, say, you’re somebody who’s suffering, but you don’t have a diagnosable disorder. Well, you’re also not alone. Like a diagnosis can be an instrument. It can be sometimes use usefully engaged in people do community building around. I don’t have a problem with that. And more and more people, I think, are thinking of this kind of more in terms of things like neurodiversity and that kind of language, which I’m much more at home, you know, I’m much more at home with.

Kelly Wilson 00:06:39  Yeah, yeah, like me, I’m not the anxious sort. You know, I always sort of half joke with people that, you know, I’m the more moody, depressive sort of myself. Me too anxious or afraid? Bad things are going to happen. You know, people like me. You know, they’ve already happened, you know.

Eric Zimmer 00:06:57  And. And even if they do. Who cares? You know. Well.

Kelly Wilson 00:07:02  You know, I know for myself that, I’m like. I’m extraordinarily easy to hurt. I mean, especially, like, in a social exchange. You can send me to tears with a word, you know? And as a boy growing up in the, you know, 1950s and 1960s. Oh my goodness. I, I’m small. I got a girl’s name and I cry, you know, at the drop of a hat. You know, my vulnerability seemed to me to be the enemy. And I tried ever so hard to make it go away. And when I made peace with it, it ended up being the center of my career.

Kelly Wilson 00:07:46  Yeah.

Eric Zimmer 00:07:47  Yeah. You say this in the book. You say that when we look at problems with living this way, we start to see that there’s actually some really common threads that run through the whole cloth of human suffering, of human experience on the whole. And I think there’s a couple of values there. Right? What I find interesting about that, I agree, I see that too, and I find it so interesting that we will say that one potential intervention, let’s just take exercise, right. Exercise helps like a ton of different things, which tells you there’s some degree of commonality running around here. The other thing that you said there that I really relate with is, you know, I’m a recovering alcoholic and heroin addict. I don’t really go to 12 step a whole lot. It saved my life and it meant so much to me. But I eventually got tired of dividing the world into us. And then what they used to say all the time, normies and I went. I think that’s a false distinction.

Eric Zimmer 00:08:42  I think the problems that plague me as an alcoholic, whether they be over sensitivity or selfishness or various things. They plague everyone, and I think it helped me to feel more a part of the human community when I saw that. And one of the things you do in the book so well is you paint the idea without being gloomy. How ubiquitous human suffering is, and how that by certain measures, one out of every two people will have suffered some degree of deep psychological pain at some point. And that’s a really interesting way. You have an exercise in the book you like, just go out to the next party, be like one, two, one, two, one, two, and you all of a sudden realize that, like these barriers that we put up to distinguish ourselves from different people. Oh, I have anxiety. Oh, I have depression. Oh, I have alcoholism. These things start to break down a little bit. Yeah. I just find it a helpful way to look at life.

Kelly Wilson 00:09:41  They’re useful when and where they’re useful. Yeah. I mean, alcoholism and heroin addiction. Like Jack. Jack. I’m there, you know. One of the things that I’ve heard people talk about coming out of 12 step meetings sometimes and they’ll say, well, you know, that’s alcoholic thinking or that’s addictive thinking. And I have a theory on why people think that it’s because they go into these rooms and the people in the meetings, they say the stuff that’s going through their heads, you know, and people hear it and they think, oh, man, that’s how I think, you know. And then they leave the meeting and nobody’s talking about that.

Eric Zimmer 00:10:20  Yes.

Kelly Wilson 00:10:21  In their out loud voice. And they assume that it’s only those people in those meetings. Yes. You know, it wasn’t, you know, until I’d spent a few years in clinical psychology when I, you know, and I started to listen to people who were, you know, not addicts, but they were depressed or they were anxious or they were whatever they were.

Kelly Wilson 00:10:39  And it’s sort of like, oh, no. And you know, that number you pointed to? Kirk Strassel cites in his book on suicidality years back, where he talked about, in some community samples, something like 40 to 50% of the people surveyed at some point in their life experience such a level of just hopelessness that they seriously considered ending their own life not as a fleeting thing, but spent a couple of weeks where they thought about it. Maybe with a plan, maybe not, but serious. And that’s where that exercise, that one, two and I have literally sat with clients on a bench in a public place and just said, you know, leaned over and said, you know, like, look into these people’s faces, you know, and like, which one, you know, one, two, one, two, one, two, that one. And it changes you, you know, you sit on a park bench and you count those faces and you just wonder what the flavor of that hardship that they’ve known and they won’t show it.

Kelly Wilson 00:11:42  I’ve asked people that in big, big workshops, you know, and I asked him, how many people did you tell? And far and away, the most common number of people that anyone has told about their own suicidality is zero.

Eric Zimmer 00:11:58  That’s a really great point about AA. And that’s one of the beautiful things about 12 step programs, is that you walk in and you’re like, Holy mackerel. Like people are talking about the real stuff, you know? And your point is exactly right, because you go back out into the world and nobody’s talking about it and you. And then it’s easy to assume, like, well, it’s only the people in there that, that, that have that. And but I think that in a way of feeling less alone in the world and of having greater compassion in the world, it’s important to broaden beyond our diagnosis. I think, again, our diagnosis can help build community. It can help join us together. It can help us not feel so alone. But in the longer run, I find it more empowering to realize most people suffer to some degree or other.

Eric Zimmer 00:12:42  Life is life. It just delivers the blows.

Kelly Wilson 00:12:44  You know, many years ago I worked in a place for intellectual disabilities, and there was a guy there who was part of an organization called People First, and it was an organization for folks with intellectual disabilities. And I remember him explaining it to me. You know, it was just this plaintive kind of were people first. And to bring home that the people in this group were more like you than, we’re not like you. And I remember at the time, and still it moved me that these labels can sometimes stand in for people, and they don’t tell us how rich those people are. You know, sometimes the label almost obscures the person.

Eric Zimmer 00:13:49  I don’t know if we’ll get through all of them, but I’d like to explore the six process areas that make up acceptance and commitment therapy, and I’m just going to read what they are. Real quick just to put them all out there. And then we’ll just kind of see how our discussion goes. One of the things that’s important to know is, you know, you guys just say that, you know, each of these process areas is sort of like the facets of a gem.

Eric Zimmer 00:14:11  If you peer in through one, you’ll see the other five reflected. So it’s not like we’re going to go in order because they’re not in order, and we’re just going to see as we start talking about one, it’s going to lead us into the other. And and who knows where that will take us. But at least I’ll get them out there and then we’ll go from there. So the first one is just contact with the present moment. The other one is diffusion. And we’ve talked about diffusion on this show. But the ability to get a little bit of distance from our thoughts. The third is acceptance, the ability to sort of accept the aspects of our life as they are. The fourth is values being able to choose what matters and what’s important to us. The fifth is committed action, the ability to actually take positive action towards what our values are. And then the six, which is perhaps the most mysterious is self as context, the ability to see ourselves as a dynamic and evolving setting in which our life unfolds.

Eric Zimmer 00:15:05  So we’ll go into those. But I’d like to start with something that act often talks about, and it’s something that I agree with 100% when I hear it in principle, and then when I look at it in my own life and I look at it in others lives, I go, I don’t know, right? And it’s this idea that the goal isn’t symptom reduction the goal or so in this case. The goal is not the overcoming of anxiety. The purpose of this work is to make more room in which to live a life that matters to you. And I get that at a basic level. Right? And I get the idea that the goal is that I decide what’s important to me, and I live that way, and that these symptoms don’t stop me from doing that. So, for example, if anxiety is the thing I’m mostly concerned with, right? My anxiety doesn’t stand in the way of me doing things that matter to me, like going to spend time with family, or getting on a plane to go to an event that I love.

Eric Zimmer 00:16:04  We don’t go into experiential avoidance, we don’t avoid things. So again, in principle, I’m 100% on board. What I’ve seen in practice is yes. And boy, when we’re deep in symptoms like I’ve got a client, you know, God bless him, he works hard and he does not let his issues stop him from going. So he’ll describe it like, I got myself to jiu jitsu class and then the entire time I was there, I was so anxious and miserable that, like, I might as well not have gone. So I just be interested. Your initial thoughts on that little riff I did there.

Kelly Wilson 00:16:41  One thing is that, you know, like the word acceptance, I don’t even use the word acceptance with people until they really, really get to know me, you know? Because when I say acceptance, what they hear is not what I mean. It’s just not, you know, and I mean, even graduate students, it probably takes them a couple of years before they, you know, before it sort of penetrates what I mean by acceptance, you know, because they think acceptance means, you know, thoughts of acceptance or feelings of acceptance or something like that.

Kelly Wilson 00:17:11  And of course, that is not at all what I mean. You know, if we say things like, like the way that you describe that, I don’t know that it’s inaccurate. But if I sit in here and like in the middle of the deep, dark depression and you say that to me, it’s just going to feel invalidated, right? You know, I’m just going to like, say, you know, if you know what, I know, you would not say that shit to me, you know.

Eric Zimmer 00:17:37  Make me feel better. Yeah, make me feel better.

Kelly Wilson 00:17:41  Like, here’s the thing. Some kinds of things are really amenable to direct action and to try and harder, you know, like, you know, you choose the action, you try harder. And that forwards the action. And some things just aren’t like that. And I think most people can understand that, you know, usually like like I’ll ask people like, do you dance? You know, and if they dance, then I’ll ask them, what happens when you’re dancing and you start thinking about, you know, which foot you move next, and you know, you start thinking about each dance step.

Kelly Wilson 00:18:21  And and what happens is you start to look like me when I’m dancing, you know, ask like, like a guitar player or something like that. Who is playing? They cannot think about each note, because if they think about each note node and, you know, the picking pattern or something like that. You can’t do it and think about it at the same time, and you can try harder. But I had a traumatic baseball history from when I was a kid. I played a little league baseball for four years, and I hit the ball one time in four years, you know, and I asked my dad about it because he was our coach, you know, he was a good guy. And I said, you know, dad, I tell people this story that I hit the ball only once in four years. But it was a long time ago, and I’m not sure if that’s right. You know, and, and he says to me one time he says, yeah, that’s about, you know, plus or minus one.

Kelly Wilson 00:19:17  And it was because, you know, like, I’m up there and I want to hit the ball and I’m thinking, keep the bat up off your shoulder, you know, step into it. Don’t step in the bucket. Keep your eye on them. And all these rules are buzzing around in my head and the ball just goes whizzing by, you know? So some things just don’t seem to respond very well to that. People can also understand the idea of openness to experience better when you ask them questions about what they care about, what matters to them, and like in a world where they could move ahead in their life, what would they move towards? What swells their heart? See, I want to ask people those kinds of questions. People can understand sacrifice for something valuable. People can understand pain in the service of valued action. So I want to have a conversation, you know, before I ever start talking about acceptance, I want to talk to people about what they lay their life down for and from that place.

Kelly Wilson 00:20:21  Then I want to have a conversation with them about practices that we can cultivate, that we can try and see if those practices don’t make movement possible. There’s a certain informed consent at the front end of a therapy that you have to do. And so, you know, I’ll just tell people they come in. I’ve had this buzzing with difficult thoughts, and they’re buzzing with all the difficult emotions. And I’ll tell them, there are some people who do types of therapy that directly target the reduction of these. That’s not the kind of work that I do. If you want someone who does that, I know people who do that and I can make a referral. There’s another approach to therapy, and it has to do with what do you love? What do you love? How would your life move in a world you know, where you could choose a direction for it? And then we start to practice and engage with all of the different parts of you. Here’s what I found in my own life. And I’ve told a thousand clients this, that the thing that I thought was the enemy, and that drove me to all kinds of action and inaction that were incredibly destructive to me and people around me, that some of those very same things that I thought were the enemy are now a central part of my ability to hear the suffering of others.

Kelly Wilson 00:21:42  Like, what if there’s something in some of your experiences that are not refuse? Like, yes, they hurt, but maybe there’s something else in there. Maybe it’s how you’re carrying it. You know, like if I took a piece of a cactus and I’d cradled it in my hands, you know, just real gentle. Like I could roll it around. I could feel those spines, but they wouldn’t cause any damage. But if I grabbed a hold of it tight, you know, and squeezed my hands, you know, maybe some of what you’re feeling, maybe some of the suffering that you’re experiencing has to do with how it’s being carried, not that it’s being carried.

Eric Zimmer 00:22:24  I think that points to a phrase that you use a couple of times in the book that I really love, which is that our values and Vulnerabilities are poured from the same vessel. I think that’s a beautiful phrase that really says that the things that we care about the most are also the places that we can suffer the most.

Eric Zimmer 00:22:42  But I think it’s it’s helpful when we’re suffering to see that. And a lot of what you’re talking about strikes me. I often say on this show, I don’t know where this phrase came from, but that people don’t become great in spite of their difficulties, but because of them. And just like you, a lot of the things about me that caused me so much trouble turn out to be great gifts in a context of a different way of living.

Kelly Wilson 00:23:07  Yeah, yeah, no doubt about it. I’ll often ask people, you know, when I’m out teaching and to think about the people in their life who they most admire, you know, people in their own families, friends, public figures who they most admire and try to look are those people who have not had a drop of rainfall in their life. It’s never true, right? They’re always people who, in fact have suffered tremendously and and persevered, you know, and persevered with purpose. That’s why we admire them. Yeah. It’s not very admirable.

Kelly Wilson 00:23:42  You know, if at all, you know, just came easily. Well, it’s sort of like, well, great for you.

Eric Zimmer 00:23:49  Yeah.

Kelly Wilson 00:23:49  I think your album tells a story about two soldiers, and I think it’s World War one. And the Jewish guy is, you know, down in the trench and the bombs are flying. And the German general says this proves the superiority of the German aristocracy. Look how brave I am. And the other guy goes, no, no, it proves our superiority. Because if you were half as afraid as me, you would have run away long ago. It is in the face of these things that we understand what courage and sacrifice looks like.

Eric Zimmer 00:24:51  Check in for a moment. Is your jaw tight? Breath shallow? Are your shoulders creeping up? Those little signals are invitations to slow down and listen. Every Wednesday, I send weekly bites of wisdom. A short email that turns the big ideas we explore here in each show. Things like mental health, anxiety, relationships, purpose into bite size practices you can use the same day it’s free.

Eric Zimmer 00:25:20  It takes about a minute to read and thousands already swear by it. If you’d like extra fuel for the weekend, you also get a weekend podcast playlist. Join us at One Coffee Letter. That’s one you get letter and start receiving your next bite of wisdom. All right. Back to the show. It sounds like you like to start. Or at least an initial place to focus is with values. What do we value?

Kelly Wilson 00:25:51  Yeah, I mean, I am facile with the model and so I can start anywhere in the model, but I’m kind of known in act circles. I’m the one who wrote the original values, protocols and the 99 book. I wrote them back when I was a graduate student. I am kind of known as the guy who starts with values. When I start a therapy, it’s the values and vulnerabilities that interest me. So people will very often present their vulnerability. And I want to hear, you know, what is the other side of that? You know, where they would move if they could.

Kelly Wilson 00:26:25  When I start to teach, including sometimes in therapy, I start with my own vulnerability. Like, I just take my heart out and I lay it on the table and they know this is going to be like one of those places. So I like to start with values with a sort of light hand. You know, I don’t want to force people to it, but, you know, I mean, you know, what I’ll say to people? It’s like, look, we’re going to do hard things in here. That’s no surprise to you that therapy is hard work. But I want to make sure that we don’t do any hard work that isn’t in the direction of something you care about, and it will help me to be helpful to you if you can kind of give me the taste of, you know, what would just make the hardest thing worthwhile? I want to hear it not just like a checked box, but sort of like if I were to tell you I had a conversation with my daughter this morning who has made this sort of move where she’s letting go of a very certain job and kind of stepping off into uncertainty for the next thing that she’s going to do.

Kelly Wilson 00:27:30  And she’s done it in the most extraordinarily adult way. And I admire her so deeply for why she’s 25 years old. My goodness. You know, see, I want to hear it like that. Like, my guess is you’re just hearing that from me. Like, you can hear how important, you know, being a father is to her. I love to have a client or a student if they can sort of ring that bell for me so that I can hear it, you know, just as a clear tone, like what they love. Now, sometimes people don’t know. They don’t know. They’ve been so upside down for so long. And there were times in my own life when I would have said, I believe in nothing, I believe in nothing. I want nothing but oblivion. But then I’ll ask them, would you like to know? Did you know once you know. Tell me what that was.

Eric Zimmer 00:28:22  Yeah. So let’s talk about this process of digging into values, because I know that in the work that I do with coaching clients, I often simplify the work we’re doing.

Eric Zimmer 00:28:33  This is a vast oversimplification, but to be to think about what matters to us and then be able to bring that into the world, like if we can do those two things, we’ve got a pretty good life, right? And so I’m interested in the ways in which you lead people into that work, because I know a lot of our listeners, they hear it and they really resonate. They go, yes, I want to start with my values, you know? And so I’d like to explore in general ways of doing that. And then I think it’s also helpful to maybe talk a little bit about what you just said, which is that people that go, well, I don’t know, I’m not sure how do I explore this topic in a useful way?

Kelly Wilson 00:29:11  Somewhat paradoxically, I suppose, you know, I said mindfulness for two and in wisdom a couple of places. I’ve said that values and vulnerabilities are poured from the same vessel when people don’t know or they know and say, you know when I say.

Kelly Wilson 00:29:28  You know, tell me what’s really important to you. And you get like a not very engaged answer to that. Like it might be kind of, you know, like textbook. True. But not, you know, a witnessed, felt, experienced, connection to a value. I’ll ask them where they hurt. I’ll ask them about their vulnerability like I asked him about. Tell me when it hurts. And and they’ll usually give me abstract things about how they hurt. And then I’ll ask them if they can tell me a specific moment. You know, that they can remember, you know, carry in that weight kind of slow motion, like a meditation. Help me see the inside of that particular moment. You know, if they can carry me into that, and then I can start to ask a question like, and if this burden could be lifted in some way, what would you move towards? You know, what would you allow? What second chance would you give yourself? People can understand that.

Kelly Wilson 00:30:36  It’s not technical language. Sometimes I’ll use, you know, figures and things like that that have things like family. Which ones of these, you know, matter to you, and then not just like, oh, family matters or, you know, parenting matters or, you know, work matters with each one of those things that I ask them about that they value, then I want that same kind of thing, you know, like Eric, are you a brother or do you have siblings? And does being a a brother is not an important thing to you? I see, I might ask you, can you think of a moment when you, like, knew yourself as the brother that you want to be like a time in your history with your sibs when it was like. That’s it. That moment I was the brother I want to be. See? And then I want you that same process. I want you to help me see it. Like. Like, let’s close our eyes for a minute and tell me who you’re seeing there.

Kelly Wilson 00:31:36  And tell me what the. You know, describe the context. And then. And then like that moment, you know, watch slow walk up to the moment, you know, when you behave like the brother that you would be. Now, see if you can help me connect with those things. Now we have something we can kind of put our hand on. So when we approach suffering, we can put our hand on that value and remember, okay, what are we doing here? What is this about? You know, it’s about being that brother. Remember that day, you know, and I’ll I’ll get a few of the details of it so that we can use it as a sort of a touchstone when things get hard. It’s such a great conversation. I love this conversation. Just working through the different areas of a person’s life. some of them, they’re they’re lost to them, but I still want to hear about it. I want to hear about them, because there may be a way that those values can live in their current life.

Kelly Wilson 00:32:34  Even though sometimes there are bells you can’t unring.

Eric Zimmer 00:32:37  And can you go in the other direction you went in from the positive? Tell me a moment that you remember being the brother you want to be. Tell me a moment where you didn’t. Sure. And what that brings up. Or a moment that you weren’t the partner you wanted to be?

Kelly Wilson 00:32:52  Yes, but not in the kind of ruminative, categorical kind of flavor. I want to see it moment by moment. I want to know the.

Eric Zimmer 00:33:01  The.

Kelly Wilson 00:33:01  Right grit and grain of that experience, the phenomenology of that experience.

Eric Zimmer 00:33:06  As a way to touch the emotion.

Kelly Wilson 00:33:08  Those conversations almost always spawn one another. You know, if I talk about you being a brother, you’ll also remember the times that you weren’t. And I don’t touch those as things to ruminate over. But like I myself, you were asking me when we were chatting before the show. If there are things that I’ve been thinking about and one and it’s a long time theme for me, I’m not a religious guy at all, but the concept of redemption is a marvelous and underexplored in psychology.

Kelly Wilson 00:33:39  A friend of mine, Pat Freeman, I saw a film that was done a documentary thing the other day, and he was talking to this roomful of brand new, fresh faced interns, you know, and Pat says, I have done bad things. I’ve done bad things, and so have you. And this work that we do is redemptive. You know, and I just thought I knew exactly what he was talking about because he’s right. I have done bad things. You know, I don’t mean it except in the most plain way, you know, like, if I mean to my wife. Well what next? What will I do now if I’ve broken things? You know, how might I mend those? Or at least act like someone who recognizes that they broke those things. I think people can understand those kinds of conversations. Not a lot of fancy language around it. It’s in some ways quite common sense.

Eric Zimmer 00:34:36  My siblings don’t listen to this show. Well, actually, one of them does.

Eric Zimmer 00:34:39  She does. She’ll probably hear this. the other one. I don’t think he does. If he does, give me a call. But, you know, she could probably pull up better than me. I’ve got a terrible memory. She could probably pull up for me some memory of me not being the brother I wanted to be. So go ahead, let me know. let’s say that that brings something up. And you said, you know, not in a ruminative way. Right. So rumination is not is not useful. You know, there’s a phrase that people use a lot. Like, don’t beat yourself up over that. Right. Which. Okay. And how do you balance that with, I’ll say, guilt in the useful sense of the word, which is when you act outside your values. You know, I think there’s lots of ways guilt gets twisted, but I think a useful use of guilt, at least in my own life, is I go, I feel guilty. Why? Oh, because I value this and I didn’t act that way.

Eric Zimmer 00:35:28  Okay. That leads me to want redemption of some sort. So how do we balance using this sort of thing in a useful way, but not a ruminative way? What’s the distinction to you there?

Kelly Wilson 00:35:42  To own a regret is different, you know, to to acknowledge and own a regret. Like like right now. Here’s a very contemporary example. We are watching our country in incredible turmoil in the midst of the Black Lives Matter protests. I was academic for a career in academia, and I think that I was, you know, what I would consider generally on the right side of, you know, history and this kind of thing. But at the same time, I’ve got students, you know, a whole bunch of them who were educating me, or they’re trying patiently to educate me over the years. And I’ve seen them write things, you know, on Facebook about, you know, like, if you see me and you don’t see color, you don’t really see me. And it caused me to sort of reflect on my own action and inaction, and it’s caused me to move into trying to best I can to understand that I have been a participant in a system, you know, because I have not demanded that it and I’ve complained about it, but I have not insisted, you know, that at the end.

Kelly Wilson 00:37:04  Now, here’s one thing I could do is I could sit around and feel bad about all of my inaction over the years. But, you know, how is the black community served by me sitting around feeling bad about myself or going over the times I said stupid, racist things, you know, and I’m old enough that, you know, pre quote, you know, Holy heavens, you know, I know where the bodies are buried. No one is served. No one is served by me. You know, sort of grinding over and over again all of the things that I didn’t do or that I did do. There is something valuable about me acknowledging those things for me to say, you know, I could have done more. Or my heavens, how did I not see that? So the ladder of how did I not see that? And what can I do this day? What is in my power to do this day? That’s a redemptive act in the way that I’m talking about. You know, it’s where I reclaim what I valued all along.

Kelly Wilson 00:38:08  You know, when it hit me is I have a graduate student. She’s got a daughter who’s nine years old. Who? That child was just stated in an Act seminar at my house. You know, she was my graduate student. And when she was a baby, there are all kinds of pictures of me out on Facebook. When she was a baby, there were pictures of me lecturing with her sitting on my lap. You know, in lectures. We took her to lab meetings. I mean, she was just, like, everywhere, all the time. You know, and her mama is an African American from Mississippi Delta, you know. And I was listening. And Nadia, my student, had pointed me to the numbers of, you know, there’s 38% of the of the population of Mississippi is African-American. Something like 70% of the deaths have been African American. And I listened to the governor of the state of Mississippi talking about it and the interviewer asked him a question about that. You know, just incredible disparity in mortality.

Kelly Wilson 00:39:17  And he says, that’s just the way it is. It was right before we went to bed, and I thought about this little girl who calls me grandpa, you know? And I thought, am I going to tell her that, you know, I’m going to go to Little Eight and I’m and say, well, that’s just how it is. No, no. You know, in that way I didn’t get it. And no amount of sitting around feeling guilty changes that for her. And that’s what’s important, how I feel. That is not the most important thing. Not even close.

Eric Zimmer 00:39:49  Yeah. Yeah, I love that. I love that idea of redemption, because redemption points to going back to our six process areas, right? The value, the guilt tells you what you value. Redemption is committed action towards that value. It’s now what’s the next thing that I do? And I always say, you know, when I look at guilt in my own life is like it’s useful to the extent it moves me back towards the value that I, for lack of a better word, transgressed against.

Eric Zimmer 00:40:20  When it doesn’t do that, it’s not a particularly useful emotion.

Kelly Wilson 00:40:24  You want to know what is the next right thing. No matter how small. Acknowledging where you’ve been wrong. If you’ve been, you know, in the business of denying it, it’s probably a good start, you know? Yeah. But, you know, and I’m talking about this in terms of systemic racism and white privilege and how we play a part in it. But I don’t think this is different than psychological difficulties like addiction or like anxiety or like depression. It’s not different. You know, we get oriented away from the things that we care about, that we value. And when we do, it makes us sick and it makes us hurt. Now moving back towards what we value that also hurts.

Eric Zimmer 00:41:08  Yeah. Yeah. And, we’re already out of time, but I don’t want to leave it there. I’m going to go a little bit long here. because you just said something I think is really important. And you said do the next right thing, the next little thing.

Eric Zimmer 00:41:22  And that’s one of my favorite phrases of all time that I got from AA, do the next right thing. And but I want to talk about committed action for a second because committed action sounds like, okay, I commit now and forever forth that I will act to stamp out systemic racism. Right? I’ve got I mean, you gave your story. I’ve got my own, right? I’ve got my own awakenings that come up where I go, well, no, I okay, I know more now. I didn’t do enough. I could have done more, need to do more. I think that and I see this happen a lot with coaching clients. And this is why I want to bring it up, because a lot of times when we think about committed action, we look at like, okay, I am I’m not going to do that again. Yeah. And so we cast ourselves and we look out into the future and we go, oh, boy. I’m not going to live up to that.

Eric Zimmer 00:42:13  Holy mackerel. I’m not going to live up to that. So I’m not sure I even want to start because I don’t think I can keep going. So let’s talk about what we mean by committed action in Act, because we don’t mean a commitment for now and forever.

Kelly Wilson 00:42:29  Commitment. People seem to think that it has something to do with the future. And there may be some definitions of the word commitment that have to do with the future. But in fact, I would say commitment has nothing to do with the future at all, zero to do with the future. The best way, I think, kind of common sense way to understand what committed action is, is take the metaphor of a breathing meditation. You sit down for a breathing meditation with the intention of putting your awareness on your rise and fall of breath. And if you’re like me, you can get about a breath and a half in and your mind starts wandering to the groceries and to all these other kinds of things. And then there’s a moment when you notice that you know you’re not on your breath.

Kelly Wilson 00:43:13  You know that you’re distracted. Maybe you’re browbeating yourself about what a lousy meditator you are or something, but you’re not on your breath. Right? And so there’s that moment, and then you can return to breath. It’s in that return, in the very return, not what comes later, but in that return. That’s where commitment lives in act. So if I have a value of like being a dad or being a husband or being a teacher, it’s not a matter of if, but when I find myself engaged in a patterned behavior that is off that, you know, I’m talking to my daughter and I find myself being sarcastic or something, and I stop and I think really, you know, is that the dad I want to be, you know. Does she need more sarcasm in her world? So there’s that moment of recognizing I’m off that value. and then, you know, there’s coming back and it’s in the return. So tell a story sometimes about the same daughter who is magnificent. when she was maybe 16, she came into the day room where I was working with a fella for just frustrated, and she says, can’t find my car keys.

Kelly Wilson 00:44:22  You know, I’m taking the spare keys to the Honda. And I says to her, I said, well, I won’t say anything about how if, you put him on the hook in the kitchen, you’d know exactly where they are. And she’s just like, thanks, dad. You know, you just did. And she storms out of the house, you know, and it was even kind of worse than that, my friend. I got a little laugh at her expense, you know, he was kind of like, oh, you know, kids, you know? And I just thought, God, really? Is that it? You know? And so I sent her this text message, you know, dear Sarah, God, you know, I don’t know what possessed me to speak to you in that way. Please give me another chance. You know, a couple of minutes later, I get a message back from her. That is. I love you to the moon and back.

Kelly Wilson 00:45:10  Now, it’s not the message I got back. It’s that I went from being off who I want to be as a dad. And in that moment when I came back, that’s where commitment lives. In fact, it’s in the next action that brings you back into the pattern. That’s where commitment lives. Each one there’s there is no such thing as an action that doesn’t count. It’s all about direction, not distance.

Eric Zimmer 00:45:37  Before you check out, pick one insight from today and ask, how will I practice this before bedtime? Need help turning ideas into action? My free weekly Bites of Wisdom email lands every Wednesday with simple practices, reflection and links to former guests who can guide you even on the tough stuff like anxiety, purpose and habit change. Feed your good wolf at one you feed. Net newsletter again. One you feed your net letter. I love the meditation example because in meditation we have generally the good sense. We do it a few times. We go. There’s no way I’m sticking with this breath, right? And so we just go when I forget I’m going to come back.

Eric Zimmer 00:46:20  Some of us do actually often give up because we think we can’t do it. But the people who succeed go, well. It’s the next breath that matters. And in life, sometimes what we do is I sometimes see this hesitancy to start because we’re like, well, I just know I won’t be successful. And I just love coming back to that’s why I love the next right thing. It’s not like the next six right things, it’s just the next one. And I think that’s so important. We’ve gone long here. You and I are going to spend a couple minutes in the post-show conversation talking about self as context, whether in acceptance and commitment therapy, selfies, context bears much resemblance to the idea of no self in Buddhism. So one of my favorite topics. So yeah, we’re going to wander around for a while and come up with no answers. But listeners, if you’re interested in the post-show conversation and they’re good and other benefits, like a mini episode with me, go to when you join and you can become a member and support the show.

Eric Zimmer 00:47:17  Kelly, thank you so much for taking the time to come on. I’ve really enjoyed talking with you.

Kelly Wilson 00:47:22  It’s my pleasure. Eric. Thank you.

Eric Zimmer 00:47:24  Thank you so much for listening to the show. If you found this conversation helpful, inspiring, or thought provoking, I’d love for you to share it with a friend. Share it from one person to another is the lifeblood of what we do. We don’t have a big budget, and I’m certainly not a celebrity. But we have something even better. And that’s you just hit the share button on your podcast app, or send a quick text with the episode link to someone who might enjoy it. Your support means the world, and together we can spread wisdom one episode at a time. Thank you for being part of the One You Feed community.

Filed Under: Anxiety & Depression, Featured, Podcast Episode

Beyond the Buzzwords: How to Talk About Mental Health Without Losing Its Meaning with Joe Nucci

October 28, 2025 Leave a Comment

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In this episode, Joe Nucci explores what it means to go beyond the buzzwords and how to talk about mental health without losing its meaning. He explains how mental health language has become less useful as it’s gained popularity, and how clinical terms meant for specific purposes have drifted into everyday speech until they describe everything, and therefore, nothing. The words we use create the world we see, and once you start viewing yourself through a diagnostic lens, it can be hard to see in any other way. One of the most powerful takeaways from this conversation is that the value of a psychological term lies not only in its accuracy, but in its usefulness, and sometimes the language we use builds a cage instead of offering clarity.

Exciting News!!!
Coming in March, 2026, my new book, How a Little Becomes a Lot: The Art of Small Changes for a More Meaningful Life is now available for pre-orders!

Key Takeaways:

  • The popularization of mental health language and concepts.
  • The phenomenon of “psychobabble” and its implications.
  • The concept of “concept creep” in mental health terminology.
  • The importance of accurate mental health diagnoses and their clinical usefulness.
  • The balance between clinical accuracy and practical application in mental health discussions.
  • The complexities of people pleasing and its underlying motivations.
  • The overuse and misapplication of the term “trauma” in contemporary discourse.
  • The distinction between normal emotional responses and clinical disorders.
  • The role of language in shaping perceptions of mental health.
  • The need for nuanced, context-sensitive approaches to mental health treatment and understanding.

Joe Nucci, LPC, is a psychotherapist and writer whose content contextualizes mental health misinformation, pop-psychology facts and fallacies, and culturally misconstrued ideas. Joe’s research and content focus on how someone without an advanced education in mental health can avoid the psychobabble rampant throughout the industry. You can find his writings in his newsletter, Mental State of the Union, his content at @joenuccitherapy, and his debut book, Psychobabble, is available wherever books are sold.

Connect with Joe Nucci: Website | Instagram

If you enjoyed this conversation with Joe Nucci, check out these other episodes:

How to Harness Brain Energy for Mental Health with Dr. Chris Palmer

Why We Need to Rethink Mental Health with Eric Maisel

Insights on Mental Health and Resilience with Andrew Solomon

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Episode Transcript:

Joe Nucci 00:00:00  What we give up. I think when we shirk the idea of diagnosis altogether or like these are just socially constructed or whatever people might say is we’re basically saying, okay, well then all of the evidence, all the scientific evidence, all the clinical wisdom that has gone into studying and treating these things quite successfully, a lot of the time, we’re just going to kind of throw it out the window. And I think that’s completely unfair.

Chris Forbes 00:00:27  Welcome to the one you feed. Throughout time, great thinkers have recognized the importance of the thoughts. We have quotes like garbage in, garbage out or you are what you think ring true. And yet for many of us, our thoughts don’t strengthen or empower us. We tend toward negativity, self-pity, jealousy, or fear. We see what we don’t have instead of what we do. We think things that hold us back and dampen our spirit. But it’s not just about thinking. Our actions matter. It takes conscious, consistent and creative effort to make a life worth living. This podcast is about how other people keep themselves moving in the right direction, how they feed their good wolf.

Eric Zimmer 00:01:11  I used to think that having precise clinical language for my internal experience would help me navigate it better. Turns out that’s only half true. Joe Nucci is a therapist who wrote psychobabble because he noticed something. As mental health language became more popular, it became less useful. Clinical terms used for specific purposes turned into everyday descriptions that ended up describing everything, which means that they describe nothing. Like if everyone has trauma, what does that word even mean? If we’re all depressed when we’re sad, what happens to people who are actually clinically depressed? The words we use create the world we see. Once you start viewing yourself through a diagnostic lens, it can be hard to see any other way. One of the most powerful takeaways for me was the idea that the value of a psychological term lies not just in its accuracy, but in its usefulness. And sometimes the language we use builds a cage instead of offering clarity. I’m Eric Zimmer, and this is the one you feed. Hi, Joe. Welcome to the show.

Joe Nucci 00:02:20  Hey, thanks so much for having me.

Eric Zimmer 00:02:21  I’m excited to talk to you. I really love your book, which is called Psychobabble Viral Mental Health Myths and the Truth to Set You Free. But before we get into that, we’ll start like we always do with the parable. And in the parable, there’s a grandparent who’s talking with their grandchild, and they say, in life there are two wolves inside of us that are always at battle. One is a good wolf, which represents things like kindness and bravery and love, and the other is a bad wolf, which represents things like greed and hatred and fear. And the grandchild stops. They think about it for a second. They look up at their grandparent and they say, well, which one wins? And the grandparent says, the one you feed. So I’d like to start off by asking you what that parable means to you in your life and in the work that you do.

Joe Nucci 00:03:06  To me, the parable is highlighting something that I think is fundamentally true about human beings, that I do think we have good and bad in all of us. And I don’t think that that’s a belief that necessarily everybody buys into. I think it’s much more comfortable to think that, you know, everyone is good and that it is, you know, our, our pasts or our childhoods or the, the culture that that brings bad out of us. But I think that’s a little oversimplified. I think it’s a little bit more nuanced than that from a psychological perspective. We’re pretty actually bad in a lot of ways at perceiving our reality in the sense that there’s just too much data. Like even in this moment, like talking to you like I see you, but then I can’t actually see the high resolution version of, like, your total biology, your total history. Like the context that it’s just it’s too much data. And so what? What different psychological scientists have essentially figured out is that you filter it through your assumptions and projections and beliefs.

Joe Nucci 00:04:05  It’s from about what’s in here. And if you’re feeding that bad wolf, right, that is how you’re going to fill in the gaps as you’re trying to make sense of all the data around you. And if you’re feeding the good wolf, that is also going to be the same. And there’s there’s lots of studies to just validate that idea around, like self-fulfilling prophecies. And if you approach someone with aggression, they’re going to be aggressive to you versus if you approach someone with reciprocity. And so that’s what I think it means to me. I think it’s not just ancient wisdom, but I think that there’s some pretty cool evidence for it.

Eric Zimmer 00:04:33  Right, right. I mean, I think that is such a fundamental reality of life, which is that we are always seeing it from some point of view that is concocted out of all of our experiences up till now. And I almost think you can’t turn it off, but you can be aware that that it’s happening and you can begin to question it and say, hey, well, what about this? Or what might it look like, you know? And I think one of the things that you do a really nice job of in this book and in your work is you don’t tend to let people get too fixed into one spot.

Eric Zimmer 00:05:09  I’ll give you an example. So in your book, you’ve got a myth about how evil isn’t really there and that, you know, people, everything people do is a mental health issue. Like all the bad that happens is a mental health issue. And you’re like, I think that’s an oversimplification. I think that’s missing some things. And sometimes people should be judged based on what they do. And then you have a talk recently I heard about masculinity, where you encourage people to look at sort of bro culture and wonder what happened to those people to make them that way. And on one hand, I could point to that and go, well, that’s contradictory, Joe, but I actually don’t think it is, because what you’re saying is you’ve got to look at things from different points of view in order to triangulate into the most useful strategy.

Joe Nucci 00:06:02  Absolutely. In in dialectical behavioural therapy, there’s this idea that one of the most essential psychological skills you can learn is being able to sit in paradox. And so being able to sit like with on one hand, like make one claim and on the other hand make the other claim and have it be like, okay, you know, within yourself, but also in just like in how you’re relating to reality, I think is very important.

Joe Nucci 00:06:26  And it doesn’t necessarily have to be with something, you know, super deep or kind of like cultural like you mentioned, a very basic example might be, well, when you let yourself feel your feelings, right, they will go away. They won’t have as much power over you. Like there’s something very paradoxical about that, because in the moment it feels very, very hard. But clinical psychology and mental health is just littered with paradoxes like that.

Eric Zimmer 00:06:51  Yeah, absolutely. So let’s start kind of at the top with the book. And you say the speed at which talking about mental health has gone from taboo to commonplace is unprecedented. And as someone who’s been in this space more or less for 11 years now, I couldn’t agree more. I mean, the way that we as a culture talk about mental health and the amount of content and material on it in even a decade is staggeringly different, right? It is staggeringly different. And while in some ways I think that’s a really good thing. I think there are other ways in which it’s not such a good thing. So tell me, from your perspective, sort of the downside to to what has happened with mental health becoming almost a cultural phenomenon in a way?

Joe Nucci 00:07:41  Well, like you said, there’s lots of good things about it. I believe in mental health. I believe in the project of it and the vision of it. But I think that in the popularization of it, because it’s not just that we’ve destigmatized it, it’s that it’s almost become popular. People talk about, you know, their therapy journey and their dating apps on people or building whole careers out of it, you know, even like myself included. Like, I also talk about, like, mental health in the public space. And so when that happens, there’s a few things that are coming up that I do find to be very significantly concerning. One is this danger of just pathologizing everyday life, using these terms and concepts not just from psychology, but specifically the mental health part of psychology specifically like clinical psychology science, to then explain everyday life and experiences.

Joe Nucci 00:08:29  I think it can lead to a whole bunch of things. I think it can lead to people unnecessarily labeling themselves and others. I think it can lead to certain kinds of social contagion, but I also think that oftentimes it’s just not that helpful. One thing I write about in the book just is a basic good example. Like mindfulness, mindfulness is a wonderful tool. Many people can benefit from it. But there was this really big study done where they brought in basically like mindfulness through like social emotional learning classes to high schoolers. I want to say that it was like adolescents, and what they found was their depression and anxiety scores were worse after. Why? Well, it’s because if you’re a teenager and you need to let say, speak in front of your class for the first time and you’re really nervous, now might not actually be the time to be mindful. Like you’re in puberty. You’re hormones are raging. You’ve never done this before. Like like you’re you’re feeling things so deeply. Like maybe now it’s not the time to do, like breathing and just feel your anxiety all the way through.

Joe Nucci 00:09:28  The reason why therapists love mindfulness is because anxiety, depression, a bunch of different mental health concerns are correlated with emotional suppression. And I see it all the time. Someone’s depressed, they learn to feel their feelings, the depression goes away. But for that teenager, what they need to learn to do, it’s called adaptive avoidance. They need to actually suppress in a healthy way, get up on stage, realize they can do it, and build some confidence. And we’re not in the desire to make everyone mentally healthy. It kind of seems like we’re we’re tripping up on things like that. I have so many examples of that, and it doesn’t really seem like despite all that, we’re investing in it and how much we’re branding and talking about it, it doesn’t feel like we’re just all so mentally well, like, you know.

Eric Zimmer 00:10:08  Yeah, I agree. I mean, I think that the problem is really that different people need different things at different times. If we start from that as a truth or an assumption, then you realize that any one intervention aimed at a big group of people is going to help.

Eric Zimmer 00:10:28  Some of them is going to probably do nothing for some of them, and some of them it may not even be helpful for. And that’s the problem with one size fits all advice of any sort. We’re not all the same size and we change size even month to month. Year to year. The things that helped me when I was 26. Getting over addiction. Don’t help me now. I need different things, you know? And I think there’s just a subtlety to all that that gets lost in TikTok, Instagram, you know, clips about mental health. And I also think it is really interesting. I’ve watched it also, like you said, kind of the way in which I see people arguing for their diagnoses and making like it’s an identity in a positive way. And I sort of understand that. Right. I was a homeless heroin addict at 25 and for a few years, and identity as a recovering person, like, was really helpful. I needed that because I had to put so much focus in one direction in order to get well at that time.

Eric Zimmer 00:11:31  And I had a serious, serious problem. But over time, loosening that identity has been really important, and I kind of am curious to see that journey for some of these people who are very early in the process, because nobody’s more evangelical than somebody who’s like a year from being significantly helped, in my opinion. Right, right. That’s about when you’re like, Holy crap, this actually worked. I feel better right now. Everybody needs to do it.

Joe Nucci 00:11:58  Totally. Something that I like to remind people of is the spirit of this book and my content. And what I’m up to in the world is not this, like, finger wagging, like, this is the incorrect definition like of this term or that term. It’s kind of like you think I wasn’t the number one offender of psychobabble when I was like in grad school, like semester one, like, of course, like every psych student is like, of course they are. But the difference is we keep learning and we’re able to get into that nuance and context, and it kind of feels like culture.

Joe Nucci 00:12:27  It’s like we’ve taken psych 101, and I’m here with my content in my book, and I’m like, okay, but here’s psych 102. Like, here’s like actually like what you like, need to know. You know.

Eric Zimmer 00:12:36  That’s a really great analogy. So so let’s get into it. I don’t I don’t want to spend all our time sort of criticizing what’s out there. Generally, I want to get into some of the specifics that you do a lot, but I think it’s important that we start with an idea of the way that we use certain words: depression, anxiety, trauma, ADHD. Pick your sort of phrase. You introduce an idea in the book of concept creep, and you talk about it in context of trauma, but I think it applies to all of these terms. So walk me through what concept creep is and how it applies to sort of these vague mental health term.

Joe Nucci 00:13:16  Yeah. So concept creep is a term studied and coined by Doctor Nicholas Haslam. He’s based out of Australia. Really wonderful researcher.

Joe Nucci 00:13:27  He applies it to so many terms, not just mental health but stuff like bullying, harm, violence. This is happening culture right now. Like is speech violence Right. Is exclusion like not getting invited to the birthday party in middle school? Is that bullying? You know, like like, like ten, 20, 30 years ago, it wasn’t. But now there’s kind of this question. So these terms are creeping over time. He’s noticed that it almost exclusively happens to harm based terms, it seems. And when it comes to mental health, it I think it may happen to to other ones too. But that’s the focus of his research. And that seems to be where it happens more by my anecdotal observation as well, when it comes to mental health terms, what him and his team found was that if you look at the words of depression and anxiety, it’s not just that over time they are used interchangeably with sadness, apathy, nervousness, you know, anticipation. It’s that these terms have actually started to become what these words mean.

Joe Nucci 00:14:24  Like, like the semantic definition has expanded and they looked at like millions of data points, like the way people can do research now with like, language processing models allowed them to really see it over long term. And so what does that mean? It means that, well, I don’t feel sad anymore. I’m depressed. It means that I’m not nervous or self-conscious, like I’m anxious or I have anxiety. And the issue with that, I think, is that everyone gets sad. Everyone can get apathetic and bored. Everyone can feel nervous and self-conscious. I know for myself, I get nervous like before. I like come on a podcast or before I post a video. You know, almost every single time I do it anyways. And that’s what’s given me like a lot of my resilience and resolve. But I think that the issue is that people can. You were talking about identity earlier and this stuff and diagnosis. It’s kind of like the doorway. It’s not the destination is how I like to think about it.

Joe Nucci 00:15:18  And so it’s really important at the beginning, and it’s okay to identify with an accurate diagnosis. You will be very easily able to identify with it. But the goal of therapy is to help you move through those things. And the truth is, therapy can’t fix sadness. It can’t fix you from never being nervous about things that actually matter to you, or things that are nerve wracking. It can fix anxiety and depression. Like for sure. Like, you know, like that is right. We know how to do that. But but but they’re different.

Eric Zimmer 00:16:17  I think about this a lot and I talk about it on the show a lot. Listeners will have heard me talk about this, about depression as a word. You know, a couple years after I got sober in my 20s, I had clinical depression. It was seriously impacting my ability to function. And I had it. And I’ve treated it for a long time. And it and it recurs never quite to that severity, but it recurs. But I’ve been spending a lot of time over the last, I mean probably 4 or 5 years thinking about that term.

Eric Zimmer 00:16:47  And is it accurate to describe what I have or I don’t want to say what I have, what I experience, that’s a better way to say it. And how much of that might just be temperament, right? I may just have a slightly more melancholy temperament than the average bear.

Joe Nucci 00:17:06  Maybe.

Eric Zimmer 00:17:07  I’ve also started to realize the number of times that tiredness I label as depression. And so it’s just this question of really, to your point, concept creep, you know, of where this term begins to encompass a whole lot of things that, if I’m not paying really close attention to, I miss.

Joe Nucci 00:17:24  Definitely tell me because because you’re not a clinician, I am. So I wonder how much of that color is my experience, but in my day to day life, if I’m with a friend and they let me know that they’re nervous about something, like they’re nervous to go approach someone at a party that they think is attractive or nervous to to leave their job and to, you know, go chase their dream like whatever it is.

Joe Nucci 00:17:47  When someone lets me know how they’re feeling like that, like I’m nervous. Like I don’t know if like if I can do it. I feel pulled in to one. Like, comfort them and encourage them as a friend. But when if they describe it as like, it’s like, well, I have anxiety about that. There’s something like that. Kind of like almost like deters me even as a licensed clinician, because then it’s kind of it’s like, oh, well, this is like it elevates it to this level that is like beyond that is just beyond the basic encouragement. And so I think it’s I don’t know, I just it’s just coming up for me right now. But I think that that’s something that’s kind of a bummer about all the psychobabble as well, you know, because when you let people how you’re feeling, you’re telling them that you trust them and you invite them in. But when you’re like using like an authoritative, like psychological jargon. You know, there’s something that feels just more definitive about it, and maybe that’s why people use it.

Joe Nucci 00:18:35  But my sense is that people use it because they want people to take their feelings seriously. But maybe it paradoxically has the opposite effect.

Eric Zimmer 00:18:43  Interesting. Yeah, that is really interesting. Let’s talk about diagnosis for a second, because you’ve got several myths around diagnosis. You know, one is receiving a diagnosis is terrible. But I’d really like to talk more about this one, which is mental health diagnoses are just made up. I think about this one a lot. And I’ve talked to a lot of different people with a lot of different opinions on this. Walk us through your thinking on this.

Joe Nucci 00:19:08  So what you will sometimes hear on social media and in culture is, you know, a bunch of psychiatrists at the American Psychiatric Association that comes out with the DSM, the Diagnostic and Statistical Manual of Mental Disorders, basically kind of sat in a room and they just kind of were like, okay, well, if you’re experiencing like nine of these 14 criteria, then that means you have depression or that means you have borderline personality disorder.

Joe Nucci 00:19:33  If it’s within these different parameters like how long you’ve been experiencing it, the severity of the symptoms, and so on and so forth. And that leads people to then say it’s like, well, diagnoses are just like made up. Like they’re not they’re not like reflecting anything like, real. Now, one argument for this myth is that you learn about these different diagnoses. And then when these different diagnoses and the treatment of them are studied, they are studied on people that fit this fixed criteria. But then as a therapist, people walk into your office and they don’t necessarily fit these neat little boxes. They might have something resembling more than one or like whatever it is. And so I think about that and I think it’s a pretty good argument. But then I, I realized that the point of this field is not that we’re when we talk about categories, we’re not talking about them like we’re chemists or. Like like like a like a category of a triangle as three sides and three angles. And they equal 180 degrees.

Joe Nucci 00:20:30  And it’s not that it’s not a triangle, but someone that has major depression. They can look like, you know, five different combinations or more of depression. And so I like to think of it as well. Diagnoses are helpful, and they’re not just made up in the sense that if I say the color blue, this is a different kind of category. There’s lots of different kinds of blue. It’s still helpful as a category. It’s helpful for me to talk about if I need to go research it, if I need to go read books about it, if I have to talk to a colleague about it, what we give up. I think when we shirk the idea of diagnosis altogether or like these are just socially constructed or whatever people might say is we’re basically saying, okay, well then all of the evidence, all the scientific evidence, all the clinical wisdom that has gone into studying and treating these things quite successfully, a lot of the time, we’re just going to kind of throw it out the window.

Joe Nucci 00:21:17  And I think that’s completely unfair. Therapy is like medicine in the sense that it’s a craft. It takes evidence in science and knowledge, but then it takes practice applying it. And it seems like in that move, when you leave the ivory tower and then go into helping that person in front of you, people like to say like, well, this is just made up anyways. And my argument is, no, it’s not. This is something like this is seen across cultures, across gender, across time. The last thing I’ll say and I’d love to know like what you’re thinking about all of this, is that one way to understand what mental illness is, is under sufficient stressful circumstances, your nervous system will cope by kind of manifesting what we call a mental disorder. And some people, they get depressed, some people get anxious, some people their OCD comes out. Some people they start eating kind of funny. It becomes disordered eating, maybe eating, eating, eating disorder. And so learning how your nervous system works like that is a great way to keep your mental health in check.

Joe Nucci 00:22:13  Does that make any of this made up I would argue. No, I actually think that this has been studied. These concepts have been narrowed down for a reason because there are patterns that we see just in people.

Eric Zimmer 00:22:25  Yeah. I think an important thing that you say in the book that jumped out at me was that diagnoses are there to inform treatment. That’s the point. Nothing else. Right. And I think that is a useful way to think of it. I tend to be I think like you, just from what I’ve read, and I’m making an assumption about you, I tend to be a middle of the road kind of guy. Right. Like, I avoid extremists on both sides. Right. Somebody says that the DSM is completely pointless. I think is missing the boat. Somebody who says that it’s got everything right is also probably missing the boat. I think that what is hard and the criticism that I actually take seriously, and I think is worth thinking about is, given the nature of the fact that you described like five depressed people could show up with looking kind of differently with different symptom clusters, and that that same person is more likely to get multiple diagnoses.

Eric Zimmer 00:23:17  The question that I think that is right or important is have we missed something in our categorization? Do we have the wrong categories here? You know, because we sort of slotted things into these boxes, which is helpful. But it’s sort of like the four humours in medicine. I don’t remember what they were like. Bile.

Joe Nucci 00:23:34  Oh, really?

Eric Zimmer 00:23:35  Yeah. Right. And so you had a category of things, but but now we know, like, okay, those categorizations were wrong. And I think that’s the meaningful critique of the DSM that I think is worth looking at for people. Or this is what people smarter than me, like you that are in the field are, you know, thinking about is is there something underlying here that we’re missing? So I had a guy on the show, I don’t know if you come across him. His name’s Christopher Palmer, and he’s got a theory of like, the brain energy theory of mental disorders. And he basically, you know, talks a lot about this sort of heterogeneity and comorbidity of these things that, you know, one person has lots of different symptoms or different from each other, and you get multiple diagnoses pointing to something that is lower level underlying it.

Eric Zimmer 00:24:23  Now he eventually takes it to metabolism, which to me is sort of a way of saying like, well, it’s everything, right? Metabolism. Metabolism drives everything. Of course, it’s all metabolism related on some level, in the same way that it’s all atom related at some level. I don’t know that that’s particularly helpful. Right. And so I think as we abstract up into the diagnoses we have, I do think they can be enormously helpful. Right. I do think it was really helpful for me to recognize depression as a condition that I had. You make the point that, you know, it’s useful to have a category for blue, even though there’s hundreds of shades of blue. But if I walk into a paint store, it’s helpful for me to be able to say, I could use some blue and somebody goes, oh, blue’s over there. And I think the same thing is true for, say, depression We may not know exactly what I need, but we go. You’re in that section.

Eric Zimmer 00:25:19  Go over there. There’s where the depression stuff is. There’s. There may be different opinions on how to treat it and what to do, but you’re in the right section. And I think your analogy is actually one that I found really useful.

Joe Nucci 00:25:30  So here’s the slight pushback I would have on what you’re saying. I’m not sure that it’s it’s that the categories are wrong because like I said, if you compare it to something like paint colors, they’re they’re useful enough. And for those who are interested, this is like called family resemblance categories versus something like a shape. It’s a classical category. There’s not as much like wiggle room. I think that the issue is not so much that the categories are wrong, but what’s complex is that there’s what’s called multiple possible etiologies or origins of the quote unquote, illness. So for an example, someone might come in presenting with something on the bipolar spectrum. I’m Chris Palmer and I am moderately familiar with his work, and I think it’s exciting work. I think it’s very innovative and I’m excited to see, you know, what comes out is very true and useful and what is maybe a little bit more anecdotal for him, but I think that, you know, if changing someone’s diet can help the the energy swings of someone with bipolar, like, I think that’s awesome.

Joe Nucci 00:26:33  and I know that sometimes people have come in with a pre-existing bipolar diagnosis. I do further assessment. I refer them out to a a testing psychologist I trust, and it comes back and it’s like, you know what? I think this person has had PTSD for years. They are super, super dysregulated. And we don’t we actually think this is a misdiagnosis. We actually think that they need like, you know, this medication, not this medication. This is the kind of treatment we need to really call on their nervous system down. It’s been on fire and burning out and catching fire and burning out. And it looks like bipolar, but it’s not. I have been diagnosed with ADHD. I sometimes struggle with, you know, a busy mind and impulsivity and you know who also struggles with that, or people who are on the borderline spectrum and people who are bipolar. But the way I treat my ADHD super different. And that’s why even though they share symptoms, but they’re still different categories and for good reason.

Eric Zimmer 00:27:31  I like that idea of different etiologies because I think of addiction often. You know, I was an addict. I got into recovery at 25. I’ve been in that world 30 years now, amazingly so. I’ve thought a lot about this. And, you know, there’s this idea of alcoholism as a disease, which I think is interesting. I don’t think it’s quite correct, but I do think to think of addiction as a, I like the word syndrome, for lack of a better word. And I know now we say, you know, people are on a scale of addiction, a spectrum of addiction, not, you know, you’ve got like there’s a hard line between somebody and the other. But I do think that what makes addiction interesting is the way people get to it? Because there’s a lot of different things that that drive somebody towards being an addict. Right. And so it’s why something like a 12 step program is a miracle for a lot of people, like it was for me. And it doesn’t work at all for other people.

Eric Zimmer 00:28:31  And it’s because, like you said, the underlying causes can be very different. I think the thing that’s worrisome and your book sort of even reinforced it for me a little bit, is the fear of the wrong diagnosis, because you could take a certain person that’s got sort of a confusing thing and trot them out to three different clinicians, and you might get three different diagnoses. That’s concerning, because those diagnoses then very often are driving a medical treatment right, of some sort, which is then starting to change the brain in different ways. So I love the fact that you talk about you. For difficult cases, you send it out to someone who’s even more specialized in this. Tell us about that.

Joe Nucci 00:29:18  Yeah. So if diagnosis informs a treatment plan, then the proof in my thinking is that the proof that the diagnosis is accurate is that the treatment plan works. Now, the caveat is that there are often more than one ways to treat a given diagnosis. And so you could recontextualize like your treatment modality and kind of to your point, like if you’re treating addiction or substance misuse, it’s like, well, I was treating the underneath that I thought was this, but maybe it’s this, you know, and so the, the, the diagnosis is still accurate, but it’s like how we’re getting at it might take like, you know, a couple a couple of tries I’m thinking of and I write about this in the book.

Joe Nucci 00:29:55  I’ve had more than one case in which someone comes in and they’re they’re picking at their skin or they’re pulling their hair. It’s traditionally seen in OCD, trichotillomania or excoriation disorder And the way you traditionally treat someone with OCD. And it’s pretty evidence based, is it’s through a lot of like exposure therapy and helping them kind of rewire those patterns in the brain. But I’ve had cases where people come in either looking for exposure therapy or that’s what we try, and then it just doesn’t work. And then it’s like, okay, like why I found that. Well, sometimes the picking behavior is from like an OCD related diagnosis where there’s these like obsessive thoughts and then the compulsive behaviors are keeping those thoughts at bay. But sometimes people are picking because they are trying to emotionally self soothe. There’s there’s these emotions that are just like very big. And maybe that’s because it’s an anxiety disorder, or maybe they’re just they’re just really sensitive. Like it’s not even a diagnosis, but they just feel very, very deeply. And you have to help them with that.

Joe Nucci 00:30:57  It’s completely different treatment.

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Joe Nucci 00:32:16  It’s funny to be, you know, talking to you and so many wonderful people like about diagnosis and why it’s important and what its limitations are. Because in my practice, I just don’t actually diagnose that often because, well, one, I don’t accept insurance. And so that’s important for people to know, right? You you are if you’re going through insurance, you’re getting diagnosed with something.

Joe Nucci 00:32:32  It’s probably not anything bad. They’re actually diagnoses that are for, you know, very like mild cases of like quote unquote nothing. But they just have to put something on your billing, you know, like an adjustment disorder. Like if you read the criteria, it’s like, oh, experiencing heightened stress or anxiety due to a life transition. It’s like, well, that’s like everybody at any given point in life, you know, but.

Eric Zimmer 00:32:55  We need an ICD code for a mild case of nothing. That’s beautiful.

Joe Nucci 00:33:00  Totally. Oh my God. Yeah. Clip it. I bring that up to say that it’s like I will if it’s, you know, clinically appropriate and ethical. But a lot of times for me, like my focus in my practice is like, but how do I help you? And so like, yes, maybe the OCD treatment doesn’t work. So I’m going to shift to this. And that’s where you start to see the different diagnoses. And that’s I think one of the limitations of the diagnosis.

Joe Nucci 00:33:21  Right. I think the treatment plan that follows is way more important than the label. and one of the things I tell patients in my practice is I say, listen, I want you to think of your diagnoses a little bit, kind of like an astrology constellation. And I know it’s funny because I’m like, I’m like, speaking out, you know, for, like, you know, like, like the evidence matters. Like in psychology, we have to, like, keep these terms. And then astrology is like, you know, like, so different, but but you know, different astrological signs will share the same star, right? So it’s like someone with ADHD is impulsive, but so is someone with borderline personality disorder. So is someone with psychopathy. So is someone with bipolar. So is someone with who is like a conductor. Sort of like. But they all share this one star. And so what I tell them is like, look, I’m more concerned about the details. I’m more concerned about which stars fit you than I am.

Joe Nucci 00:34:10  The constellation that it looks most like. I’ll tell you, like, you know what the constellation it looks most like is. But just like you would never say that, you know, an Aquarius describes everything about who you are. We think we have to approach diagnoses with a similar lens. One of my favorite chapters in the book is that personality frameworks are reductive and unhelpful. My argument is actually like, but don’t criticize these frameworks like diagnosis, or like the Enneagram or Myers-Briggs or astrology, even for being inaccurate. It’s not what they’re for. It’s a little bit like criticizing a restaurant’s menu for not being the cookbook that the chef uses. It’s it’s to communicate something effectively and quickly and not for necessarily scientific accuracy in the same way.

Eric Zimmer 00:34:55  Yeah, I loved that chapter too, because I used to be a personality test enthusiast. And now now I am a personality test avoider. I’m not saying that everybody should do that. I’m saying for me, I don’t want it right, because I don’t want to think of myself through a certain category.

Eric Zimmer 00:35:18  Right. You talk in that chapter about something really interesting called terministic screen. Tell us what that is.

Joe Nucci 00:35:24  So Dave Logan at the University of Southern California I believe coined this term. It was his papers that I first encountered it. And the idea is that words create your world. Like I was saying at the beginning of our conversation, it’s really difficult for us to take in all the data at high resolution from our surroundings, from like, what we see and what we know and what we’re hearing and smelling. It would it would overwhelm our nervous system. So we have to filter it. And one of the ways we filter it or through something called terministic screens. So terministic screens is when you learn enough of a jargon about something, there becomes this moment where something clicks and now you see the world in a completely different way, through a lens, through a deterministic screen, that unless someone else has learned all those words and distinctions and jargon, they can’t see it. And so what Dave Logan writes about is he he’s at the business school, I believe.

Joe Nucci 00:36:16  So he writes a lot about like, leadership and how part of building a really effective company culture is making sure you all have the same vocabulary and language. But I think when it comes to different subjects, like me as a psychotherapist, I have words for human emotion and human behavior and distinctions that people who haven’t been trained as a clinician, they just don’t have. And so if I’m out with a friend of mine who’s a therapist and something like happens, like, we might give each other a little look, it’s like, did you notice that? You know, and it’s not it’s not anything good or bad, right or wrong. It’s just we’re seeing something that other people aren’t going to just like, you know, I have friends, I live in New York, so I have friends who work, like in fashion and beauty And we’re at brunch and they’re like, oh my gosh. And then they’re like pointing to someone and they’re all immediately seeing something special about the person’s outfit or hair or makeup.

Joe Nucci 00:37:05  And I’m just like, I don’t know. I mean, they look good. Like, that’s that’s as deep as I’m getting with it. Exactly. You know, so that’s how it works. It can be for any subject.

Eric Zimmer 00:37:13  Right. And I think that idea of terministic screens is why I don’t like personality tests for me anymore. I don’t want to see any aspect of me through a terministic screen. I sometimes get frustrated by personality tests, like, I have people in my life who are very enneagram focused, right? And I’ve taken the Enneagram. I think I kind of know what I am, all that, but they’re always describing what I do through the lens of being a nine Enneagram, which is a useful lens, but it’s not the only lens. Right. And I think maybe, maybe people like me who like, I guess, here to here to validate a nine, right? A nine has a little bit of everything in it. True. I always feel like when I take any personality test, I fall right down the middle.

Eric Zimmer 00:38:02  I get driven crazy by questions like, do you feel energized and stimulated by being around people and social activities? And I’m like, well, who are the people? What’s the activity after work first thing in the morning? Like, you know, same thing. Do you like to work in groups or collaborate with others? What are we working on? Who are the other people? I feel like for me, context is so important in the way I react to anything that when I, I feel like, you know, these questions sort of today I feel boxed in by them. And again, I’m not saying that’s right or anybody else should feel that way. It’s the same reason I won’t go get like a psychic reading, even though I don’t really believe in it. I don’t want it in my head.

Joe Nucci 00:38:42  Right?

Eric Zimmer 00:38:42  I have enough stories in my head about the way why things are the way they are.

Joe Nucci 00:38:47  Totally.

Eric Zimmer 00:38:48  I’m working on getting rid of them. I don’t need to introduce more, you know. So again, that’s just me where I’m at today.

Joe Nucci 00:38:54  I’ve had phases like that where I’m like, not really like thinking in terms of the personality frameworks or whatever it is. But my the thing I would offer you is that maybe the solution isn’t to to turn away from them, it’s just to add more screens and stack on top of each other, and then you get to decide like, what are those like? What are those like glasses that like, I guess, like doctors or like mad scientists? You swear where it’s like you, there’s like multiple lenses that you could, like, flip down, you know, optometrists.

Eric Zimmer 00:39:21  Yeah.

Joe Nucci 00:39:21  They kind of like, look it up.

Eric Zimmer 00:39:23  They just. They do that. Yeah.

Joe Nucci 00:39:25  Exactly. Right. Yeah, exactly. So it’s like like is it one or is it two, is it three or is it four? I kind of like to think of it like that because there are moments where, like, intuitively, I’m like, well, the Enneagram could actually help me right now, understand maybe what’s happening here, having some empathy for this person that’s different from me.

Joe Nucci 00:39:40  But then there’s other times where I’m like, actually, I don’t want to, like, you think about psychology at all. Like I want to think about like I want to look at it through this subject or through this lens. Yeah.

Eric Zimmer 00:39:49  Exactly. I think this kind of goes back to where we started the conversation to a certain degree, which is or maybe we even talked about this in the pre-show before we even hit record. But this ability to to know that you’re always looking through some lens and to be willing to say, well, let me try a different lens and okay, what if I look at it, this lens, right. I just think all that’s good. So let’s let’s take people pleasing as an example. You’ve got a chapter in there about people pleasing. So I’ll let you set it up and then maybe we can we can kind of go into it.

Joe Nucci 00:40:19  Right. So this true of people pleasing is one that’s certainly popular on social media and has trickled its way into culture, where it has seemed to become like an identity that people will will claim.

Joe Nucci 00:40:32  And it’s like, well, you know, I, I’m a people pleaser because of this or because of this. And for me, my pushback is not so much that people pleasing isn’t real, but it’s it’s so broad. It’s such an umbrella term that I find it to be inherently unusable. I’m much more interested in the because. Yeah. So if you say I’m a people pleaser because I’m afraid of conflict, my thinking is skip the people pleasing part. Just say it. Say it with me. Like I’m afraid of conflict. How does that fit you? What does that. What does that mean for you? I know exactly well, if you come in to see me. And I think I would argue if you go to see any therapist that’s worth their salt, that’s going to be their first curiosity. Is it? Does it mean you’re a martyr? Does it mean that you’re so agreeable just in your personality, speaking to personality frameworks that you’re so agreeable that sometimes you don’t even know what you want because you’re so cooperative and you’re so go with the flow and you’re.

Joe Nucci 00:41:25  And you’re so like to quote unquote, please people. Is there anything even necessarily wrong with that? I think that’s far more useful data than just the I’m the people pleaser. There’s the identity piece, which we’ve all already covered. It’s like, don’t box yourself in to the identity. But there’s also, you know, if you the promise of therapy, I believe, is not identity. It’s not just understanding yourself, it’s learning the tools to transform yourself, or at the very least correct for your downsides. So if it’s just that you have a very agreeable personality, well, do you know how to negotiate? Like, do you know how to navigate conflict with someone who is very disagreeable? Because if you don’t, I got news for you. The disagreeable people are gonna walk and run right all over you because they’re they are not depleted by conflict. They are energized by it, and they like it. And, you know, that’s how they’re wired.

Eric Zimmer 00:42:14  I have a whole previous marriage that sort of follows exactly what you described a extraordinarily agreeable person like me, and conflict avoidance with somebody who has very strong opinions about everything and is energized by contract.

Eric Zimmer 00:42:30  And I’m not saying one’s better than the other, I’m just saying you put the two together, it can be problematic. It was in our case. But I like that people pleasing peace because again, we’ve talked about this. You know, one of the risks of mental health culture is that we apologize. Normal behavior. I also feel like we, you know, people swing too. We swing too far. I am a people pleaser by the general definition of it, but I don’t always think that’s bad. And you make that case in your book. Like compromising in order to make other people happy is not a bad thing. Sacrificing in the spirit of the relationship is not necessarily bad for me. What I have to spend a lot of time looking at and it’s murky is when is that? My general agreeableness? I think I probably am very high on agreeableness as a personality trait. Where is that? My belief in kindness and compassion, and I do best when I’m caring about other people. Where does that cross into what we might say more earlier mental health issues that came from fear of conflict, you know, avoidance, all that.

Eric Zimmer 00:43:39  And and it’s a murky sort of soup down there to sort out. Even today I was going through that with something in my life. I was like, okay, well, what’s behind this? You know, what’s what’s driving this? Is it just kindness? There’s a there’s a concept in Buddhism that I love about near and far enemies. And I think it’s interesting. I don’t know if you’re familiar with it.

Joe Nucci 00:43:58  I don’t think I am.

Eric Zimmer 00:43:59  So it says that take a trait like compassion. It has a near and afar enemy. The far enemy of compassion would be like meanness or hatred or whatever. You know, whatever term we want to throw up, the near enemy of compassion might be something like indifference, right? It looks similar, you know, or indifference would be a better near enemy for a trait like equanimity. Is it equanimity or is it indifference? They look similar, and I feel like in my life I’ve had to spend a lot more time as I’ve gone from grosser forms of suffering like addiction or clinical depression, to just more day to day stuff.

Eric Zimmer 00:44:37  There’s a lot of that getting in there and trying to to discern that. How do you help clients think through like the kind of thing I’m describing?

Joe Nucci 00:44:45  So is it is a potential near enemy of compassion, maybe something like enabling or coddling.

Eric Zimmer 00:44:53  Yeah, yeah. Or pathological kindness.

Joe Nucci 00:44:55  Okay. Right. Yeah, yeah, yeah. Well, listen, without even knowing the specifics of what you’re going through today, when it comes through, when it comes to stuff like this, I think this is actually very cool. It’s been on my mind a lot. So in every chapter of the DSM, every single mental health concern, there’s always a specification. And the specification is and it’s causing emotional, psychological or social and relational dysfunction. Right. And I’ve been thinking a lot about that social dysfunction piece. And I’ve been thinking a lot about what it means because you hear therapists talk about, well, that’s adaptive or that’s maladaptive. And what we mean by adaptive or maladaptive is is it in harmony with your social relationships that sustainable, you know, in the long term or is it maladaptive? Is it causing unnecessary conflict? And so I think about something like people pleasing or having a very compassionate personality.

Joe Nucci 00:45:47  I’m a very compassionate person by temperament, and everything has like the the light side and the dark side. So I believe it’s it’s funders. First law of personality is there is no weakness without a strength and vice versa. When I’m talking to patients about it, I sometimes bring up Pokemon. You know, the water Pokemon is great, but it has weaknesses, you know?

Speaker 5 00:46:09  Oh, is that funder?

Joe Nucci 00:46:11  I’m funder. He’s a personality researcher.

Eric Zimmer 00:46:15  Okay, I’m not familiar, but boy, do I love that. That statement. I couldn’t agree more. Yeah, similar to Aristotle’s idea of virtue, like any quality has, you know, you take it too far. It’s problematic. Right? Courage. You know, if you have too much of it, you become rash and foolish. If you don’t have enough of it, you become a coward. Or another way of saying it is like you need to use the right tool for the right job?

Joe Nucci 00:46:38  Yeah, totally. So when it comes to something like someone who’s people pleasing, maybe because they’re very compassionate, you have to ask yourself, well, is this in this moment, in this contextual moment? And it can change.

Joe Nucci 00:46:49  The answer can change as a relationship progresses or even as a conversation progresses. Maybe the thing to do is to be compassionate, be allowing to give space to, you know, have some sort of allowance for where someone is. But there comes a point right where that spills over into the enabling, into the coddling, into the being permissive for things that you don’t actually agree with or aren’t good for them. So there’s one trait all of a sudden becomes something very, very dark. That’s the shift, right? Someone has PTSD, they’re hypervigilant. They’re scanning for danger everywhere. Well, they didn’t actually fit the criteria for PTSD when they were in the war because there was danger everywhere. They didn’t want to get shot and die.

Eric Zimmer 00:47:29  It was adaptive behavior.

Joe Nucci 00:47:31  Then it was adaptive. Exactly, exactly. And so now they’re they’re back. They’re a civilian again, and they think that every loud noise is a is a gun or a bomb. It’s not adaptive anymore. Very interesting. The there was a study done.

Joe Nucci 00:47:44  I read this book. If you haven’t read it I would I think you’d love it. It’s called Tribe by Sebastian Junger or Junger.

Eric Zimmer 00:47:50  I’m familiar with it, but I’ve not read it.

Joe Nucci 00:47:52  So he talks about how in it’s actually in Israel, there’s some really, really low rates of PTSD, despite that country having military conflicts with people, you know, pretty constantly throughout the ages. Why? Well, it’s because if you have a touch of hypervigilance, but you live in Israel and there’s always rockets going off and stuff that it’s adaptive, you know, versus you come and live in a different country or you move from like the, you know, you move to like a small town in like middle America. Right. That’s not going to be adaptive anymore. And so a lot of what we talk about is mental health concerns. I think there’s there’s a relational piece that I think cannot be overstated. I don’t think people think about it enough.

Eric Zimmer 00:48:33  All right. Let’s move to trauma besides mindfulness.

Eric Zimmer 00:48:36  If there’s been one word that has exploded in the culture over the last decade, and particularly in mental health, whether it be, you know, true mental health, like what you do or, you know, talking about it like me, sort of with experience and trying to ask people who know more than I trauma is everywhere. I mean, I have a good view on this because I get submissions for all the books that are written in the world, right? All the publishers know us at this point, so we’re on that list. And I could tell you the number of books that have trauma in them over the last 3 or 4 years is ten x what it was eight years ago. So talk to me about the overuse of trauma and maybe how we define that word.

Joe Nucci 00:49:20  So I have a very bold and sincere belief that in the coming decades, we will look back on this moment as the mental health community, and we’re going to cringe a little bit, and how often we used this word because it to be clear, it’s not just the mental health influencers on social media, it’s it’s clinicians and other researchers.

Joe Nucci 00:49:41  And I, a lot of people agree with me. A lot of people don’t with what I’m about to say. This idea that everything that bad that happens to us is a trauma, right? Or we all have trauma symptoms or develop trauma responses from things in our past. I think it’s a very dangerous story to tell. And I think it’s inaccurate. It’s inaccurate because we know two people can get in the same car accident and one will walk away a little shaken up, but fine, and the other one will develop full blown PTSD. You know why? There’s all sorts of reasons why there’s temperamental, different temperamental differences, like in personality, that can predict getting PTSD or developing trauma symptoms. There’s also like if you had a lot of tragic events that resulted in trauma, responses happen before, do they stack onto each other? All sorts of things can predict why or why not. Someone might develop PTSD, but I’m much, much more interested in the person that doesn’t develop PTSD. George Bonanno, I believe, is how you pronounce his last name, is a scientist and researcher at Columbia.

Joe Nucci 00:50:43  He studied first responders after 9/11, and he found that trauma was actually the exception. It wasn’t the norm. Resilience was the norm. If you give people a window to have their emotional normal responses, some of which can mimic what we might classify as trauma responses. But for most people, they fade very quickly without intervention, without treatment, because it’s normal, right? Like if you witness a disaster or something scary like you’ll think about it more is that having flashbacks and being unable to focus, right? Or is that actually the normal response? It’s very confusing because as trauma research progressed, there was this idea introduced of like little T traumas. And I want to be very clear for anyone listening or watching. I believe in little traumas. I believe that something more minor can happen to you, and it can affect your nervous system in a way that you develop a full blown trauma response. But that doesn’t mean that everybody has them, and it certainly doesn’t mean that every response you have to hardship or a tragic event is going to result in something like trauma.

Joe Nucci 00:51:50  I’m very fond of what Doctor Alan Francis says. He wrote this book, Saving Normal its, about the pathologies of everyday life. He says most things that you go through in life will get resolved with the healing powers of time, you know, and support from your loved ones. I’m paraphrasing, but it’s something like that. He goes, A mental disorder will not get better with time. It will get worse. And the longer you delay treatment, the harder the treatment is going to be. I’m thinking of some of people in my practice who have come in with PTSD, and by the time they come to see me, they have agoraphobia. They’re not leaving their house. Now, in their nervous system’s defense. Never leaving the house is a great way to make sure the thing that happened to them never happened again. But that’s not adaptive, right? And so, yeah, I’m curious to know how you see all of this for your perspective. The last thing I’ll say is, you know, in the book I read about losing my dad when I was 11, and I certainly developed trauma responses from that.

Joe Nucci 00:52:44  And I think it’s completely distinct from grief. I think that grief is something that will be with me all my life. And I think grief, I think grief touches all of us. But I think that’s so different from this idea that I’m traumatized. I have this wound, and I have this wound that cannot be healed without some sort of clinical attention.

Eric Zimmer 00:53:04  Yeah, I in general think that the word and you say this in your book, a couple different places, which I agree with when a word is used to describe everything that ultimately ends up describing nothing if everybody has trauma, what are you saying? Everybody’s a human being. Well, I knew that, right?

Eric Zimmer 00:53:20  That that isn’t exactly helpful. And so I do think it’s become an overused term. I have some questions for you, though I’d like to go a little deeper on, because my thinking is always sort of in flux on this. Let’s just take let’s just take me for an example. Sure. You know, I was a homeless heroin addict at 25.

Eric Zimmer 00:53:37  I had clinical depression coming out of that. I was a kleptomaniac at age ten. Like, I was never really doing well. So I developed some very maladaptive strategies, we might say, to coping with things going on inside of me. And I don’t think I fully understand the difference between like a trauma response and just a normal, maladaptive response.

Eric Zimmer 00:53:59  Because I don’t think I could point to in my childhood. Now, I’ve had therapists tell me there’s something you don’t remember, which that’s a whole nother subject I don’t want to even go into, but I can look at my slightly older life. I can look at my parents, I can see the way they kind of are. I can see the way I am. I can see why as a young child, like, okay, that that was not a good environment for me, but I don’t know if I’d call it traumatic. I, you know, I don’t know what to say about it.

Joe Nucci 00:54:23  Well, I think the reason why you’re confused is because I think the field is confused.

Joe Nucci 00:54:27  And I think they’re confused because this is a super difficult thing to measure scientifically. And the reason it’s difficult, if not impossible to decide scientifically is because I think we’ve left, you know, clinical research and we now have a foot in philosophy or theology or spirituality.

Joe Nucci 00:54:43  You know, and so I think for me, this idea that everyone has trauma, it’s it’s a pretty tragic view of human nature. And not in like, the small C conservative sense. It’s it seems to be like it’s like it’s it’s almost worse than that because they’re saying not only do the bad things that happen to you cause trauma, but you need like the attention of a professional that is trained, that is trauma informed. And to me that’s that’s giving like capitalism, like that’s giving like mental health industrial complex. But that’s a whole other conversation. I think for me, the way I differentiate it is a trauma response is one in which your nervous system over corrects, over being the key part of that, over corrects so that you do not have to experience what happened to you again.

Joe Nucci 00:55:32  So I can give you a personal example that I’ve been open about. I lose my dad unexpectedly at age 11. Throughout high school and even into college, I became aware of a pattern where I was just like distant with with men in my life. I always thought it was because I was gay and like, gay dudes stereotypically like, have lots of friends with lots of have lots of girlfriends and and stuff. But over time, what I, what I realized is my nervous system was saying, well, well, don’t get too close to these guys because you might actually end up really liking the friendship and like valuing it and like, and what happens what happens if they go away unexpectedly? Like, you don’t want to go through that again like you did. And, and in my nervous systems defense. Fair enough. You know what I mean? right. But it wasn’t adaptive. You know, I wasn’t letting people get close to me. Like, I wasn’t fully putting myself out there and this.

Joe Nucci 00:56:21  And for people listening, take sexuality out for a second. I’m just talking about like, platonic friendship. Yeah. You know, because this is really where it was showing up. And so I think that that is I think that is properly classified as a trauma response. I was over correcting. Right. And I had all these sorts of rationalizations or beliefs in my day to day life about why I was conducting myself like the way that I did, but like, ultimately not adaptive, not what I needed for me. I think that that is the trauma, right? You can point to the behavior. You can even point to the underlying beliefs. I think if you want to look at like the grief perspective, well, how might his death like affect me over the long term? Because this was a meaningful event that happened in my past. Well, it’s probably going to mean that, relationships of all kind male relationships especially are very important to me, right? Maybe even to a great degree. It totally maybe even to a degree that, that there that other people aren’t necessarily putting the same kind of like psychological or emotional capital or energy into them.

Joe Nucci 00:57:20  Is that maladaptive? I mean, if it is, if I’m not aware of it. Right? But I don’t think the solution is for me to be like, well, no, I can’t feel this way or I can’t conduct this way because this is part of my anatomy. It’s not necessarily causing problems, you know?

Eric Zimmer 00:57:36  Yeah, I agree with so much of what you’re saying. I think I’ve been informed by Buddhism to a large degree. And Buddhism, I mean, a core concept is that you are the result of a whole bunch of causes and conditions. Everyone is. We all are. That’s what’s happening, right? You are conditioned by what happens to you, I believe, to a large degree. But to label all of that, I think, as trauma can be challenging. It’s a term for me that I’ve just, I don’t know what to do with. And I and I appreciate your sensitivity on it because you’re actually willing to call it into question, which you probably get all sorts of grief for.

Joe Nucci 00:58:17  A little bit.

Eric Zimmer 00:58:18  But, I do think it’s a question that’s worth asking, right? Because it’s a real thing. But if we use it in ways that aren’t helpful, then it lessens its ability. I want to finish with what you just said there, because I want to get back to this underlying idea that you bring up again and again, which is usefulness. Talk to me about usefulness as a way of approaching all of this.

Joe Nucci 00:58:44  Yeah, absolutely. I’m a super practical guy, you know? So if it comes to the DSM and diagnosis, I’m kind of like, well, how can I use this for the benefit of my patient or whoever’s in my care or for myself when it comes to this term? It’s like, well, where is it useful? Where is it not? Sometimes people are surprised to hear, you know, I’m very pro coach. I’m pro spirituality. Not that there aren’t problems with coaching or certain spiritual circles can obviously generate a good amount of pathology. But like sometimes the spiritual phrasing of something is just super practical and useful, and people just like, get it? You know what I mean? And so for me as a practitioner and as a person, I think I’m always really curious on how can we use this tool.

Joe Nucci 00:59:29  You know, if you have a toolbox, you know, the hammer and the saw are very different, but they both have pretty valuable applications. And, you know, if you can, if you can do something about it, then then I say to it, if you could use the tool. My belief is that the more tools you have, the better. There is this wonderful study done on emotional granularity. Basically, the more words you have for your feelings, the more resilient you’re going to be. There’s a related study that found that people with PTSD will often use limited words to describe their negative emotional experiences. And so part of treatment and part of instilling resilience is like, let’s give ourselves more words and more tools. And I think that’s that’s the issue with psychobabble. The issue is, well, if everything is trauma and everyone bad is a narcissist, you know, and everyone else is a people pleaser, right? We’re really boiling down our worlds where we only have like 3 or 4 constructs or 3 or 4 tools, and that’s not going to be helpful.   It’s not gonna be useful in the long run.

Eric Zimmer 01:00:28  Before you check out. Pick one insight from today and ask, how will I practice this before bedtime? Need help turning ideas into action? My free weekly Bites of Wisdom email lands every Wednesday with simple practices, reflection and links to former guests who can guide you even on the tough stuff like anxiety, purpose and habit change. Feed your good wolf at one you feed.net/newsletter again oneyoufeed.net/newsletter. 

You and I are going to continue in the post-show conversation because I could talk to you for about another six hours, but I want to talk about this idea of expressing your feelings is valid, and analyzing your thoughts is always good for you. So in the post-show conversation, we’re going to dive into that. Listeners, if you’d like access to that as well as ad free episodes, a special episode I record each week specially for you. And most importantly, if you would like to support what we’re doing here. If you believe in what we’re doing, we could use your support and you can go to oneyoufeed.net/join.

Eric Zimmer 01:01:32  Joe, thanks so much for coming on the show. I’ve really enjoyed it.

Joe Nucci 01:01:35  Thank you for having me.

Eric Zimmer 01:01:36  Thank you so much for listening to the show. If you found this conversation helpful, inspiring, or thought provoking, I’d love for you to share it with a friend. Share it from one person to another is the lifeblood of what we do. We don’t have a big budget, and I’m certainly not a celebrity, but we have something even better. And that’s you just hit the share button on your podcast app, or send a quick text with the episode link to someone who might enjoy it. Your support means the world, and together we can spread wisdom one episode at a time. Thank you for being part of the one You Feed community.

Filed Under: Anxiety & Depression, Featured, Podcast Episode

When Success Hides Suffering: Understanding High Functioning Depression with Dr. Judith Joseph

August 12, 2025 Leave a Comment

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In this episode, Dr. Judith Joseph explains what happens success hides suffering, and the importance of understanding high-functioning depression. She explores why many people who look fine on the outside are quietly suffering on the inside with something we rarely talk about: anhedonia, the loss of joy, or the loss of ability to feel pleasure. This is an important conversation that highlights this often overlooked and underplayed challenge of high-functioning depression that so many of us deal with, and most importantly, how to overcome it.

Key Takeaways:

  • Concept of high-functioning depression and its characteristics
  • Symptoms of anhedonia and their impact on daily life
  • Limitations of current diagnostic criteria for depression
  • Importance of early recognition and intervention for mental health issues
  • Biopsychosocial model for understanding mental health
  • Role of personal agency and choice in managing mental health
  • Strategies for emotional validation and expression
  • The significance of reconnecting with personal values for joy
  • Impact of technology and social connections on mental well-being
  • Importance of celebrating small wins and planning for future joy

Dr. Judith Joseph MD MBA is a board-certified psychiatrist, researcher and award-winning content creator who specializes in mental health and trauma. She is chair of the women in medicine initiative at Columbia University Vagelos College of Physicians and Surgeons, clinical assistant professor in child and adolescent psychiatry at NYU Grossman School of Medicine and Principal Investigator at Manhattan Behavioral Medicine, New York City’s Premier Clinical Research Site. She was one of the experts featured in Oprah Daily’s 2023 The Menopause Special and “The Magic of Menopause” Masterclass alongside Halle Berry and other experts. She is a board member of the national non-profit Let’s Talk Menopause. Dr. Judith was awarded by the US House of Representatives with a 2023 Congress Proclamation Award for her social media advocacy and mental health research. In 2024 she was named a top 6 NAACP Mental Health Champion and a VeryWell Mind top 25 Thought leader. In 2024 she taught a Workplace Mental Health Course to The Executive Office Of The President of The United States of America. In May 2025 she gave a Mental Health Google Talk at Google’s Playa Vista Headquarters and also became a Google official YouTube THE-IQ Creator in partnership with Harvard School of Public Health. In 2025 she became an official LinkedIn Top Voice and a LinkedIn Course Instructor. She gave the first US House of Representatives Congressional Recording Studio Filmed Special on Caribbean American Mental Health. In addition to being a notable public speaker at prestigious institutions, such as Columbia University, Concordia and United Nations UNGA events, Dr. Judith is a sought-after on-air expert. Her National Bestselling book, “High Functioning” is based on the first peer-reviewed published clinical study on high functioning depression which she conducted in her all-women research lab in New York City. Dr. Judith uses her platform of over 1 million followers to educate her community about mental health topics and she trains doctors at NYU about how to use various forms of media to educate the public about mental health issues.

Connect with Dr. Judith Joseph:  Website | Instagram | Facebook | LinkedIn

If you enjoyed this conversation with Dr. Judith Joseph, check out these other episodes:

How Identity Can Affect How You Deal with Depression with Kimi Culp

Emerging Perspectives on Depression with Alex Riley

Strategies for Depression with Therese Borchard

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Episode Transcript:

Dr. Judith Joseph 00:00:00  In the real world, we think happiness is this like grand destination, and that when we get there, we should be okay. But we’re learning that that’s not it. It’s these plethora of these sensations.

Chris Forbes 00:00:17  Welcome to the one you feed. Throughout time, great thinkers have recognized the importance of the thoughts we have. Quotes like garbage in, garbage out or you are what you think ring true. And yet, for many of us, our thoughts don’t strengthen or empower us. We tend toward negativity, self-pity, jealousy, or fear. We see what we don’t have instead of what we do. We think things that hold us back and dampen our spirit. But it’s not just about thinking. Our actions matter. It takes conscious, consistent, and creative effort to make a life worth living. This podcast is about how other people keep themselves moving in the right direction. How they feed their good Wolf.

Eric Zimmer 00:01:02  You’ve got the job. The house? Maybe even the partner. You’ve checked the boxes. So why do you still feel flat? That question is at the heart of today’s conversation with psychiatrist and researcher Doctor Judith Joseph in her new book, High Functioning Overcome Your Hidden Depression and Reclaim Your Joy.

Eric Zimmer 00:01:21  She explores why many people who look fine on the outside are quietly suffering on the inside with something we rarely talk about anhedonia, the loss of joy, or the loss of ability to feel pleasure. I felt this myself many times. Moments where everything should feel good but nothing really lands. This episode resonated personally for me. As someone who’s learned that sometimes the very tools I use to succeed can become the barriers to actually feeling alive. I’m Erich Zimmer and this is the one you feed. Hi, doctor. Judith, welcome to the show.

Dr. Judith Joseph 00:01:56  Hello. Thank you for having me.

Eric Zimmer 00:01:58  I’m excited to have you on. We’re going to be discussing your book, which is called High Functioning Overcome Your Hidden Depression and Reclaim Your Joy. But before we get to that, we’ll start like we always do with the parable. And in the parable, there’s a grandparent who’s talking to their grandchild, and they say, in life there are two wolves inside of us that are always at battle. One is a good wolf, which represents things like kindness and bravery and love, and the other is a bad wolf, which represents things like greed and hatred and fear.

Eric Zimmer 00:02:28  The grandchild stops and they think about it for a second. They look up at their grandparent and they say, well, which one wins? And the grandparent says, the one you feed. So I’d like to start off by asking you what that parable means to you in your life and in the work that you do.

Dr. Judith Joseph 00:02:45  Well, you know, it’s interesting because wolves are carnivorous and you often think of them as, you know, these predators that are robbing you of something. But, you know, the interesting thing about this parable is that it allows people to realize that you can only let someone rob you of something. If you put yourself in certain situations, for that to happen. And so, you know, in many of these parables that we learn about as children, there’s almost like this, a victim mentality to it, like things are out of your control. There’s a big bad wolf who’s coming to get you. But if you look at it from a different perspective, there is a certain amount of agency involved.

Dr. Judith Joseph 00:03:33  You know, you can choose to give your joy. You can choose to give your power away. and yes, there are bad people in the world. There are situations beyond our control. But there’s always a choice, right? You always have a choice. So that’s the takeaway that I get from this parable.

Eric Zimmer 00:03:51  Beautiful. And that really is kind of to me, what it ultimately boils down to is that we. We have a choice. We are going to be faced with difficult situations. We’re going to be faced with situations where we’re not sure what the right thing to do is, but we have a choice in what we do in those choices really matter. You’ve got a term in the book. High functioning depression. Walk us through what that means.

Dr. Judith Joseph 00:04:13  Well, I’m sitting here in my research lab. I’ve had this clinical research lab, for over ten years now. And I use a diagnostic tool that I’m sure you’re familiar with as a therapist. it’s called the mini and the skid, and it’s used for just about every single behavioral health clinical research study.

Dr. Judith Joseph 00:04:34  you have to use the criteria based on the Diagnostic and Statistical Manual for Psychiatric Condition in the section on major depressive disorder, which most people think about as clinical depression. You have to have these symptoms, and they’re laid out in the, you know, Bible of psychiatry, this DSM five, that’s manual ized into these, tools that we use. And you have to have these symptoms of depression at the very end of the checklist. If you don’t meet criteria for having your symptoms impairing your functioning or causing significant distress, you don’t check the box. You know, we say, well, you don’t meet criteria come back when you break down. And throughout the pandemic, running these clinical studies and seeing all these people coming in who were actually over functioning, they didn’t they weren’t breaking down. They were coping with their pain by taking on more work, taking on more projects, creating a side hustle or to busying themselves. I say that they are humans doing instead of human beings. This was how they were coping and they kept saying, something is off, something’s off.

Dr. Judith Joseph 00:05:41  But I’m not meeting criteria. Every therapist is turning me away. And I was also experiencing this. I had this very successful research lab, you know, when every other office in the building had shut down. I was still going because I have these clinical research studies that have to continue, you know, via the FDA mandates. You can’t you can’t yank people off their meds, you know. Right, right. The research continues through crisis, at least it did back then. But, you know, I was seeing these people who were like myself functioning over functioning, showing up. They were the rocks, you know, but they had this lack of joy. They had this inner struggle, and they were coping with their pain by busying themselves. And I thought, why aren’t we focusing on these folks, too? Yes. It’s important to address people who have broken down, you know. Yes, it is important to address crises. But what if we thought about things differently? And what if we were preventative? What if we prevented the breakdown? Why aren’t we thinking like this in mental health? And I just thought, well, you know, look at all these other fields of healthcare.

Dr. Judith Joseph 00:06:45  When you look at longevity science, you don’t see doctors saying, let’s wait until stage for cancer to do something. We say, let’s educate patients about the risk of cancer and let’s prevent it. Yep. In the menopause space, where I do a lot of work in terms of mental health and menopause, we’re not saying, let’s break the let’s wait for the hip fracture. We’re saying, let’s prevent the osteoporosis by educating patients about things they can do, like, you know, using hormone therapies and weight bearing therapies and so forth. But why in mental health do we wait for people to break down? So I set out to conduct the first clinical research study in high functioning depression. And so in the study we enrolled 120 patients. We interviewed them. We didn’t do questionnaires because we found that that is not effective. You know, talking to people and getting their symptoms is more effective in terms of like collecting real data. And we found that there are these people who have these symptoms of depression, but they don’t break down.

Dr. Judith Joseph 00:07:44  So they wouldn’t meet criteria according to any diagnostic criteria that we currently have in the medical field. But in our new criteria for depression, we’re seeing them having these symptoms. But they’re not breaking down. They’re over functioning. And we’re seeing something called anhedonia, which is a scientific term meaning a lack of joy and interest and things that they want to enjoy. And many of these patients were experiencing this. They just didn’t know there was a name for it. And I wish I could take the credit for inventing the term anhedonia, but it’s been around since 1800s. Yeah, but most people have never heard of it. You know, people experience anhedonia all the time. They just don’t even know what it’s called. Many times they’ll say, well, that’s just life. That’s just being a mom. That’s just being busy. Yeah, but Anna Donia literally means a lack of joy and interest and pleasure. And I was also surprised that most people don’t know that in order to meet criteria for depression, you don’t have to be sad.

Dr. Judith Joseph 00:08:40  You don’t have to have a low mood having anhedonia, you know, according to the clinical, traditional sense of depression is enough without a low mood. And, you know, you have to have all the other symptoms. So. Yeah. When I started talking about anhedonia and high functioning depression, I thought maybe, maybe a hundred people would respond. But I was just astounded. Like, millions of people reached out saying, this is me, you know? Can I have more information about it? So, you know, it was validating because, you know, when I did the research, many of my colleagues were saying, well, oh, you know, well, we should be focusing on clinical depression. And but then the same colleagues after, you know, the work was done, said, I think my patient has that. Can I learn more about this? We need to think about this differently. You’re right. We shouldn’t be waiting for people to break down because, I mean, there are just not enough of us.

Dr. Judith Joseph 00:09:30  There are just not enough of the mental health professionals to address the growing demand. So we need to educate patients, allow them to have that access to knowledge so that they can identify when things aren’t right before they break down. And so this preventative health, you know, measure I think is crucial, Sure. Especially now.

Eric Zimmer 00:10:08  Listeners will know this, but I’m a recovering heroin addict, and after I got sober for a few years, I had clinical depression in the sense of like, not functioning very well kind of thing. The classic depression. And I went on anti depressants and I have, you know, in all the intervening years I have learned how to take care of myself physically, socially, spiritually, psychologically. And I find myself in this place where I don’t know what I don’t want to say, what I have, whether I have anything, and let me explain that. So I’m high functioning and I sometimes have Of Anatolia. But I don’t know, like I can tell it it for me, it seems clear when it comes.

Eric Zimmer 00:10:54  It’s all of a sudden there’s no books I want to read. There’s no songs I want to listen to. but that passes in in a day or two often about that time range. I have some of the other symptoms of irritability. And my question is this. And I this is something I think about a lot in regards to myself. At what point is good enough? Good enough meaning do we risk pathology using normal human experience? And when I hear questions about do you, you know, have enough joy or do you have joy? My question is like, well, how much like as a former heroin addict, I’m like, well, joy is way up here, right? You know, when I hear people say, well, low energy, I’m like, well, how much energy? So I kind of just am curious how you think about this sort of question of capable of always thinking of how things could be better, a standard of normal. It’s not even a question, but I’ll let you respond.

Dr. Judith Joseph 00:11:51  Well, in our clinical research protocol, the symptoms had to be present for at least two weeks or more. In research, you have to have clearly defined periods when you submit a protocol to the IRB, which is the review board that really oversees human research. And so what you’re describing are, you know, dips and flows in a day. Right. periods of fluctuation, which are not typically categorized in research or in the medical field. Yeah. so that’s different. usually when we look at mental health conditions, there’s a fixed period of time. It’s a persistent state. it’s not like, oh, I have a bad day today. Oh, tomorrow I’m better. That’s not what is typically used to classify. But in the folks that we did end up interviewing, we talked about a clearly defined period. And we also asked if it was persistent. We also, you know, wanted to know a bit more about their past. They had to do extensive trauma inventory. So we wanted to understand, you know, what it is that possibly could be the root of what was happening.

Dr. Judith Joseph 00:12:53  Many times during these interviews, we’d go through these really extensive questionnaires, and I would encourage people to take a look. We’ve made them available online on the website, but we go through these questionnaires, and then they’d be surprised that that was a painful experience and never acknowledged it. And you’re right, I just pushed it down. I actually just never even thought about it. And that is traumatizing. What we found was that we also do PTSD, like the traditional PTSD studies here. We found that people who fit the profile of high functioning, what they ended up doing was not avoiding people, places and situations in order to not feel triggered. What they ended up doing was they ended up diving into work, diving into projects to avoid processing their pain. So it’s a very different picture, you know, like from what we typically saw in our PTSD studies. you know, we use. We use these tools called the Capps five. It’s it’s a gold standard tool. It was developed in the VA hospitals for combat veterans.

Dr. Judith Joseph 00:13:52  But we actually used this in PTSD research. And usually using these tools, people avoid, you know, places, situations, people that trigger them but are high functioning folks. They were avoiding dealing with the pain by just busying themselves. They were afraid that if they slowed down, something catastrophic would happen. Either they’d break apart, they cried. They tapped into something that they couldn’t control. They weren’t even aware that they were doing this numbing to avoid dealing with the pain. But the problem with that is that when they were numbing, you know, these sensations, they were also possibly numbing their ability to feel that joy. Right? And it wasn’t just a blip. It was like a persistent. Yep. and hedonic a thing that they were going through. But to speak to your experience, Anna Donia, is not something that is just specific to depression. Anna Donia, as you’re well aware, is very prominent in substance conditions. Right. And with people who’ve used substances in the past, because, you know, the theory is that, you know, your brain gets somewhat, you know, changed in a way that you don’t access pleasure as much.

Dr. Judith Joseph 00:14:58  Right? Right. Antidote is also really prominent in conditions like dementia and schizophrenia. You know, schizophrenia is one of those mental health conditions where you have like the positive. And I, I really don’t like the term positive and negative, but that’s what they call it in science. Yeah. It makes sense in the science world. But in the regular world people are like, what? Is it good. But the positive symptoms of schizophrenia are like hallucinations, delusions, bizarre kind of behaviors. Right. Positive meaning? Not good, but positive meaning. You can see them. Yes. And the negative symptoms in schizophrenia not mean that they’re bad, but, you know, are the depressed depression, the anhedonia, the, the concrete thinking, the flat affect you know and so and disorganized thinking at times. So you know anecdote is something that is throughout multiple mental health conditions. So it’s not just specific to depression, but you know, as you’re aware, you know, when you have recovery from substances and so forth, you can have comorbid or co-occurring depression, co-occurring anxiety, you know, insomnia, all of these things that are part of the healing journey after, you know, you’ve made that change in your life.

Eric Zimmer 00:16:12  I totally agree, I’m a long way off from that experience. That was in my early 20s. And one other thing I think you said at one point, like, that I might know as a therapist, I want to be clear. I’m not a I’m not a therapist. I have talked to hundreds of them on this show and paid a dozen others a fair amount of money over the years to help me, but I’m not one my myself, so.

Dr. Judith Joseph 00:16:35  I’m sorry about that. Please edit that out. Yeah, no. That’s fine. Therapist.

Eric Zimmer 00:16:38  I just wanted you to know, as you as you talk to me. Yeah, exactly. So people who fall into this category of high functioning depression. Do they know something is wrong? They just can’t put their finger on it. Is that what we’re talking about? They. You know, this is not the person who just says, well, I’m kind of busy. I’m a little bit overwhelmed. Sometimes I feel this is somebody who has a sense that something is off.

Eric Zimmer 00:17:04  They don’t know what, though. Is that accurate?

Dr. Judith Joseph 00:17:06  Yeah, they they don’t necessarily come into my office saying I’m depressed. They come in and they say something’s off and usually it’s Antonia, you know, it’s different than when you’re like doing well. You’re, you’re you’re engaging in your work and you’re, you’re busy. But it’s not pathological productivity. You’re actually enjoying the work. You’re looking forward to it. You’re excited about it. That’s very different than doing these things. Busy yourself and actually not enjoying it at all, and not understanding why you can’t slow down two different experiences, you know, and it’s possible that at one point you did enjoy things. Maybe you did get excited. You you did know why you were doing things. You had purpose. And then you you find yourself no longer feeling purposeful, no longer enjoying it, feeling numb and just not knowing how to stop. You don’t even know why you’re doing it anymore. That’s typically what I see. Yeah. and, you know, I’m located in a very busy intensity in Manhattan.

Dr. Judith Joseph 00:18:05  Yeah. And so I see this a lot. And people are like, well, I, I know something’s off. I don’t know what it is. And you’re like, you’re a top psychiatrist, so you can figure it out. Please help me. And that’s usually what happens, you know. And that’s why it’s so powerful to have that term anhedonia. Because many times people will have a lot of guilt. They’ll say, I don’t know why I’m not happy and why am I here spending all this money? I have a great life. I have all these things going for me. I, I, you know, I survived all these bad things and yet I’m still feeling this way. I thought I would be happy, And I explain that, you know, for many of us, you know, we drank the Kool-Aid. We thought if I, you know, do all these things in life and I do the right things, I will be happy. But we’re learning in the science of happiness that when we have that mindset of when I finally get, you know, the partner, when I finally get the job, when I finally graduate school, I will be happy.

Dr. Judith Joseph 00:19:00  We’re learning that that delayed model of happiness actually makes us unhappy. We avoid the actual joys in life because we’re so busy chasing this idea of happiness that we don’t even realize we’re actually outrunning some past pain. And if we just slow down a bit and we tapped into our senses and we literally smell the roses, we would actually feel more joyful. Doesn’t mean that the problems are going to be solved, but by accessing these tiny points of joy along the way, you can actually become happier. And I say points of joy because in the research that I do, when we are adding up to see if someone’s actually becoming happy. We’re literally adding up points. We are asking them. You know, when you took a nap. Did you feel refreshed? We’re asking them when you were feeling lonely and you reached out to your loved one. Did you feel connected? We’re asking them when you were stressed. Were you able to self soothe all of these? Are these little points that we literally add up? To determine if someone’s becoming happier.

Dr. Judith Joseph 00:20:03  But in the real world, we think happiness is this like grand destination, and that when we get there, we should be okay. But we’re learning that that’s not it. It’s these plethora of these sensations, even in the in the suicide research that we’re doing. We’re reframing it for patients because if we if they have this idea that I will be happy one day, they may never get that. But we’re teaching them that actually, you know, it’s slowing down. It’s eating your food, savoring it. It’s going for that walk and noticing that beautiful tree and feeling that wind on your face. Right. Like all of these sensations are really what it is to experience joy, and that’s how you actually become happier in life, not this grand destination that even when you get there, the science shows us that you’re still not happy.

Eric Zimmer 00:20:48  Yeah, I love that. I mean, that accords with one of my core foundational ideas is that little by little, a little becomes a lot, right? Like, that’s how.

Eric Zimmer 00:20:56  That’s how we change. You know, and little moments accumulate over time. Little moments of goodness accumulate. And over time you start to at least my experience is over time that starts to change the overall climate inside. I have a question I want to ask though, about happiness, because happiness is one of those things that we can get fairly obsessed with. You know, I’m going to be happy. Am I happy enough? All of that? And the the science for a while, and I don’t know if it’s changed, which is kind of why I’m asking you, was that there was a certain genetic set point of happiness for people. And you could you could move it some. There’s portions of it that you could move, but that people would have sort of a set point that they would sort of settle back to something bad happens. They’re going to eventually come back to that, that point, something good happens. They’re going to feel good for a little while. They’re going to kind of come back to that point.

Eric Zimmer 00:21:56  How do you think about that in terms of the work that you do?

Dr. Judith Joseph 00:22:01  Well, there’s a field called epigenetics, and we know that things in the environment can change the way that genes are expressed. And it’s just fascinating. When I was in college I never heard of it. Right. You know, we’re learning that, you know, things in your environment can literally modify the way that your genes are expressed. And there used to be this idea that, you know, you can’t do anything about it. You’re just born this way. You know, genetics are important, but they’re not everything. Yes, In my book, I talk about a tool that most people have probably never heard of, but everyone in healthcare uses, and it’s called the biopsychosocial model. And the way that I break down the biopsychosocial system doesn’t seem too large and too like lofty is that everyone has a fingerprint. We all have our own fingerprint, but all of our fingerprints are unique. Everyone has a biopsychosocial. There are no two biopsychosocial that are identical.

Dr. Judith Joseph 00:23:05  And so when you use this model and you imagine it, imagine like this Venn diagram, these three circles that overlap. Think about yourself. You know there’s only one. You there will only ever be one you. So really take the time to understand the science of your happiness. And what I mean by that is draw this biopsychosocial. Look at your biological risk factors. Where are you losing your points of joy? Biologically, I use myself as an example, I. I have a low thyroid, so my endocrinologist has to be on top of my thyroid. If I get to high functioning and don’t go to my appointments. You know, like I’m not going to be able to have as much joy, right?

Eric Zimmer 00:23:48  Is it manifest as low energy that then translates into lack of joy? Is that kind of the mechanism or is it something different.

Dr. Judith Joseph 00:23:55  For my thyroid? Yeah. Low energy could be changes in sleep can be irritability. Yeah. You know, but other people have other medical conditions. Some people have autoimmune conditions where their bodies in this high state of inflammation.

Dr. Judith Joseph 00:24:09  Right. some people have other health issues. You know, whatever it is, where you’re losing your joy. Think about biologically what makes you different. Psychologically, that’s the other bubble in the Venn diagram. What is your past look like. What is your past trauma. What are your attachment styles. You know when I say past trauma you know people often think okay well I didn’t have anything bad happen, but maybe there were other traumas, you know? Maybe you had a divorce, or maybe you went bankrupt. Or maybe you didn’t grow up with much in life. You know, these are things that we traditionally don’t think about as being traumas. When we think trauma, we think, oh, combat near life, near-death experiences, attacks and things like. But other things can be painful, and they can shape the way that you view yourself or the way that you interact in the world. But if you don’t process it and acknowledge it, then you just don’t deal with it. And attachment styles.

Dr. Judith Joseph 00:25:03  You know, it’s another thing that we don’t often think about who is in our life, how do we interact with others? And then, you know, what are our comorbid conditions? What are our other things that we deal with every day? Some of us have ADHD. Some of us are neurodivergent. That’s all in the psychology, right? And then in the social bucket of the Venn diagram, what are the things in our day to day life? Are we getting good nutrition? You know. Are we eating foods that build up our brain? Or are we eating processed foods that are increasing inflammation in our brain? You know, all of these things interact with our genetics. What are we putting into our body? Do we have access to nature or are we in a toxic environment in terms of pollution? you know, are we around healthy individuals or are we around people that are bringing us down and increasing our stress levels? Are we getting the movement that we need so that our body is relieving stress, or are we sedentary and not, you know, living the healthiest lifestyle in terms of how much movement we’re getting? All of these things are the social things.

Dr. Judith Joseph 00:26:08  So that’s why it’s important to look at your unique biopsychosocial, because that is your fingerprint. That is your fingerprint for what you are experiencing in life and where you are losing your points of joy. And this is important because let’s say you’re someone who’s biological, you know, that part of your biopsychosocial that’s dominating where you’re really losing your points of joy. Then you’re going to focus your efforts there. You’re going to say, okay, my medical issues are getting in the way of my joy. They’re causing me all this pain and all this physical stuff. Let me prioritize there and let’s see if my life becomes a bit more easier to deal with, right? Less stressful. Yeah. But for others who are, let’s say they’re physically healthy, maybe it’s the past, maybe they’re past traumas or things that they haven’t resolved. Maybe that’s what’s blocking their joy because they’re constantly revved up in fight or flight. They can’t access joy. And for others, it’d be social. You know, it’s what’s happening in their day to day lives.

Dr. Judith Joseph 00:27:04  That’s where they’re having a loss of their points of joy. And that’s why I like this model, because it reminds people that there’s only one you, and there will only ever be one use. You got to really take the time to understand the science of your happiness, so that you can be strategic about where you want to focus your efforts to reclaim your joy.

Eric Zimmer 00:27:23  I really love that you said that, because that is a belief I’ve grown more and more into over the years that we are all different, and there are some principles that are can be helpful about being happier, about healing, and about all living a better life. All of these things. But what each of us need could be very, very different. And that’s why when we hear one size fits all mental health advice or one size fits all like life coaching advice or one size fits all diet advice like this is the right diet. I’m just I just as somebody who really sees the nuance and everything, I kind of bristle and I’m like, well, people are really different, you know, different.

Eric Zimmer 00:28:07  And I did a lot of coaching for a number of years, and I’ve started doing some again. And that’s one of the big things I learned over the years that I got better at understanding is like, oh, hang on a second. We need to understand this person more before we start thinking about what they should do. You know, you can have this bag of tools, but I think a lot of the art comes in. Like, what tool do you actually pull out to help?

Dr. Judith Joseph 00:28:29  Absolutely. I mean, in your work, you’ve seen so many different people and you would you would never just take one cookie cutter plan and apply it to one person and then use that same one. You take the time to understand what makes one person’s journey so unique. You know, what were their unique struggles because their challenges are going to be different compared to someone else, even though from like a far view, let’s say you’re like, oh, they have similar, you know, life histories. When you zoom in, you see how unique they are.

Dr. Judith Joseph 00:29:06  I think that that’s very validating. You know, like, I think when you can show someone like, this is what makes you you, right. And this is why when you read that book, when you listen to that podcast, when you when your friend sent you that meme, it didn’t work for you. It wasn’t. Yeah. That it was. You were the problem. It’s just that you didn’t understand the science of your own happiness. So you’re trying to apply someone else’s happiness to you? Yeah, it’s not going to work. And it’s very, I think, validating when I bring people into my lab and they do this tool, they just sometimes they literally break down crying and they’re like, well, I finally get it. Like, I wish I had this sooner. And it’s a tool we all use in healthcare, but most people don’t know about it. I’m really trying to change that, to make it available to everyone, so that you have the tools that you need based on the science of your happiness.

Eric Zimmer 00:30:08  Check in for a moment. Is your jaw tight, breath shallow? Are your shoulders creeping up? Those little signals are invitations to slow down and listen. Every Wednesday I send weekly bites of wisdom. A short email that turns the big ideas we explore here in each show. Things like mental health. Anxiety. Relationships. Purpose. Into bite sized practices you can use the same day. It’s free. It takes about a minute to read and thousands already swear by it. If you’d like extra fuel for the weekend, you also get a weekend podcast playlist. Join us at one you feed. That’s one you feed. Net newsletter and start receiving your next bite of wisdom. All right, back to the show. I love the biopsychosocial model also, because if we go back to me in dealing with recovery from substance abuse, which then, you know, sort of was co-morbid with depression and dealing with that, for me, it was it was all of those things were critical. You know, antidepressants were part of that for me.

Eric Zimmer 00:31:19  The food that I eat is part of that. For me. The exercise that I do, the people I, I talk to, the everything I used to say, like I just kind of thrown the kitchen sink at this, which is another way of saying biopsychosocial, right? It’s got to you’ve got to look at all aspects and, and but I love your way of prioritizing also of picking a place to start because that’s often the hard thing is to figure out where to start. And over time, little by little, we can start to layer more things on.

Dr. Judith Joseph 00:31:50  Absolutely. You know, the way you described your journey, it sounds like there are so many different avenues to gaining points of joy, right? Because when you get stuck and you’re like, well, this is the one thing you try medication, it doesn’t work, which is actually quite common in psychiatry, like so common. And but many people will start it and they’ll be like, oh my gosh, it didn’t work for me.

Dr. Judith Joseph 00:32:13  I feel hopeless versus all of these different avenues to joy. If I you maybe walked a block more a day, or if I changed my eating habits, ate Eat more leafy greens or more fish, or whatever it is that you choose to modify. You know, if I connect it with loved ones, if I tweak the medication, you know, all of these are different avenues to joy. But if we only think there’s one path, and that one path doesn’t work, we can feel so deflated, so hopeless. But learning that there are all these different paths to joy, I think provides so much more hope and opportunities for people.

Eric Zimmer 00:32:48  I love that idea and that hope idea because it can be really deflating. And that’s why I think when we think something is the answer, we’re setting ourselves up, right? Or more often we’re being set up by someone and we’re going to be disappointed, usually because life isn’t that easy. And for me, all of the different things, as they come together, they also amplify each other.

Eric Zimmer 00:33:15  It’s a cliche, right? But they come. They become more than just the sum of their parts for me in some way. And had I only done medicine, I would have had some help in the same way. Like some people only give up alcohol or drugs, which is a great step. I mean, if you if you just do that, that is a huge step really, really hard for most people to do. But my experience was I would have missed out on a whole lot that made life rich and rewarding by actually going into recovery. And I’d love to transition this conversation in that direction now, because you do have, the five V’s you talk about, which are ways of working with this high functioning depression. And so I’d love we’ve kind of talked about what the what the problem looks like. Now, I’d love to move towards some of what you think the solution is. And I’d like to start with the first V, which is validation. And you say that it’s in essence both the hardest and the most foundational of all of the other ones.

Eric Zimmer 00:34:17  So talk to me about what we mean by validation.

Dr. Judith Joseph 00:34:19  Validation is the hardest. And when I explain validation, I like to use this analogy of imagine you’re in a very dark room and you can’t see anything pitch black, and you hear a loud crash. Some of us would start screaming, some would start swinging, some would start running. But if you turn the light on and you saw, oh, it’s nothing. It’s just an inanimate object that fell. I’m safe. That is what validation is. It is turning the light on and understanding and acknowledging what you’re dealing with emotionally, what you’re experiencing. Good or bad, we’re not putting any judgment on it. Many of us, we don’t acknowledge how we feel. We invalidate ourselves all day long. We will work through lunch and ignore that hunger pain in our belly. We’ll go through a day and not use the bathroom and invalidate that, you know, sensation in our pelvis. It’s like you need to go to the bathroom. You know we will.

Dr. Judith Joseph 00:35:16  Not even the ability.

Eric Zimmer 00:35:17  To do that starts to cease when you get to be my age. It’s all of a sudden like you’re like, well, you know, I, I’m not sure I got a choice in the matter anymore.

Dr. Judith Joseph 00:35:26  That’s true. Our bodies will give eventually.

Eric Zimmer 00:35:28  Eventually.

Dr. Judith Joseph 00:35:29  We often we do. We often, you know, things happen to us and we just pass it off and say, well, this happens to everyone. But what is powerful in this exercise is that you’re actually saying this is happening. This is what I’m feeling. I’m going to acknowledge it. And it’s really useful, especially if you’ve been mis naming an experience your entire life. I have a lot of people who come in, especially men, and they’re like, I am so angry all the time. I’m so angry. And then we we actually unpack this anger and it’s actually anxiety. A lot of these, the men that I work with, they’re very, very nervous. They’re very, very anxious. They worry all the time.

Dr. Judith Joseph 00:36:09  But it was not a part of their culture to say that they worry. It just didn’t seem manly. It didn’t seem strong, but a lot of their anger would look like anger was actually rooted in anxiety. You know, they’d snap, they’d be irritable, they’d yell. But it wasn’t related to being internally angry. It was related to being internally anxious.

Eric Zimmer 00:36:31  They were afraid. And so that’s why.

Dr. Judith Joseph 00:36:33  They were afraid. Yes. Fear is not great for humans. Right. You know, it’s that. So we turn the light on and we name the emotion and we name what the worry is. And they’re no longer afraid. And so validation can sometimes be the hardest part. Many people don’t want to acknowledge how they feel. They’re afraid. They say, you know, Doctor Judith, if I name it, if I finally deal with what I. I’ve been avoiding, then maybe I’ll break down. Maybe I’ll. I’ll stop. But the opposite happens. It’s so freeing. Yeah. It is just.

Dr. Judith Joseph 00:37:02  It just releases so much tension. And you know how I said in in the happiness research, we add up those points. You know, one of the points of joy that we miss out on is that the point of stress. People used to think, oh, stress and anxiety. That’s one part of the brain. Depression’s the other side. We’re learning that. No, no, no, it’s not true. It’s really important to manage that stress and anxiety so you can access joy because you don’t know very I don’t know very many people who are stressed out and also joyful.

Eric Zimmer 00:37:29  It’s very hard to do.

Dr. Judith Joseph 00:37:30  Yeah. Being able to very, very difficult, very difficult when your body is revved up. So yeah, being able to name these emotions, identify them allows that calm, you know, what you’re dealing with in what you’re working with. And then you can choose the appropriate action.

Eric Zimmer 00:37:46  You talk about the cognitive triangle, which is a CBT concept that says, you know, an experience is really kind of thoughts, emotions and behaviors and thoughts are usually what we have at the top of the triangle.

Eric Zimmer 00:38:00  And I have spent a lot of time thinking about the relation between thoughts and emotions, and recognizing where cognitive approaches are really helpful, and then starting to learn where they’re not. And I love that you say we should pivot the triangle a little bit and put feelings at the top. I have realized for me that’s essential because one of my great strengths is a certain mental equanimity, a certain ability to see the whole picture or the certain, the ability to zoom out, the ability to have perspective. Right. Which is a great skill. And it can be a way of never letting myself feel anything because I talk myself out of it immediately. And so for me, it’s been useful to first go, oh, you’re feeling something? What are you feeling? Okay. Acknowledge that. Okay. It’s okay that you feel that way. And now I can think about, you know, okay, that’s being driven because I’m thinking about x, y and z and is x, y and Z actually true? Is it useful? But if I don’t flip it, as you say, I don’t allow myself ever to get too emotional because my cognitive is sort of a superpower that just takes over.

Eric Zimmer 00:39:16  But that’s not. That’s not good for an emotionally developed life.

Dr. Judith Joseph 00:39:20  It’s not an I used to be the same way, you know, before I became a psychiatrist, I was actually an anesthesiology resident. And I, you know, when people think about anesthesia, they think, oh, you’re putting someone asleep. But it is a highly traumatizing field. You know, 90% of the time it’s easy. You know, you’re just like, put intubated someone, you put the IVs in and you’re coasting, you’re just monitoring, and then you wake them up and then they go home. They never see you again. But 10% of the time you are literally saving someone’s life. And it could happen at any moment where things can go south. And so, you know, in healthcare you see a lot of death, you see a lot of pain, you see a lot of gory stuff, but you are conditioned to just focus on doing your job and showing up the next day and not complaining. And that’s just part of it.

Dr. Judith Joseph 00:40:13  You are in the trenches, similar to like military fields. You know, you just it’s part of the culture is just you see trauma all day long and that’s just part of it. That’s what you signed up for. And over time, many health care professionals, including myself, you just learn to just push it down. You don’t validate it. You don’t say, wow, that was tough seeing someone die. Oh, that was really hard. You know, doing a code and doing chest compressions like that was traumatizing. We don’t do that. You just show up the next day and you act like nothing happened. So that was my go to coping for a very long time when I was going through the pandemic. And, you know, this uncertainty of like, well, what’s going to happen to the world? What’s going to happen to my patients, what’s going to happen to my team? What’s going to happen to my family? I was just coping by like pushing it down. But it was when I started to realize that that wasn’t working and I was going through severe anhedonia.

Dr. Judith Joseph 00:41:04  I started to realize that I was avoiding my feelings. So now I regularly name my feelings. If I’m, like, feeling antsy, I’m like, well, why am I antsy? Oh, it’s because I didn’t sleep well. Why was I not sleeping well? Well, because I was worrying about this new study that I’m starting up and it’s not working the way that I want. You know, like, I’m able to actually verifies myself, whereas before I was pushing my feelings down. You know, that’s why it’s important to to name these feelings, not to avoid them and not to get so caught up in the thoughts. Right. And that CBT triangle, we scrutinize those thoughts way too much. And a lot of times we just need to start feeling our feelings.

Eric Zimmer 00:41:42  And it’s not that we just let the feelings run the show. One of the things I have thought a lot about is how this kind of, there’s this sort of an art, I think. And this gets back to knowing yourself.

Eric Zimmer 00:41:55  There’s an art I have found for, like, when when do I lean into the emotional? When do I lean into the cognitive? When do I lean into the behavioral. Right. Because one of my favorite sayings is sometimes you can’t think your way into right action. You have to act your way into right thinking, right? So when do I need to intervene behaviorally? And as you said, I think for most of us, the emotional is the piece. And one of the things I’ve started to do, because I can have a feeling and I can cognitively also be like, okay, that’s not really what’s happening here. I’ll give you a personal example. I like you about a year behind you on when my book comes out in April, but it’s about now that I start thinking about like, who’s going to help support me in launching this book? You know, of all the podcast guests I’ve had on who can I who can I talk to? Who could say like, oh, I help, or I’ll share it in my newsletter, which means you’re you’re reaching out and asking for something from all these people.

Eric Zimmer 00:42:49  And I have found it to be decidedly uncomfortable. And some of it is that I don’t like asking for help. But I think on a deeper level, what I identified is it feels a little bit like being in high school and going, well, will I get into the cool kids club? So I know that’s not what this is, right? I know that somebody’s choosing whether somebody does or doesn’t blurb my book or does or doesn’t share. It has an awful lot to do with a thousand factors, of which I am just a small part of. So I intellectually. But I’ll name that thing to my partner. I’ll say, this is what I’m feeling, even though I know the answer right. Cognitively, I want to name what I feel because that’s my history is to just ignore the feeling.

Dr. Judith Joseph 00:43:32  Yeah, it’s very powerful. Naming your feeling and acknowledging it and seeing it and turning light on it. You may still have that intense emotion, but it doesn’t linger as long as it used to, and it doesn’t interfere with everything else as much as it used to be.

Dr. Judith Joseph 00:43:50  Because you know what it is. Yeah, and it’s a way of not invalidating it, but living with it, living alongside it, letting it write itself out versus trying to push it down. And and that leads us into the next venting because people come into my lab. I’ll. I’ll have them take turns with this red balloon, and we’ll. They’ll try and dunk it into this tank of water. And 100% of the time, that balloon will pop right up. Right. Because you can’t out math the numbers. Can’t out math physics. But then when we take turns and we start to deflate that balloon, we can push that balloon so easily down into that tank of water. And for me, being able to say out loud, I’m anxious about this thing, it like, it just feels so much better. Like it just it’s almost it’s like that deflating that balloon and naming the feelings and acknowledging it and expressing it has been extremely powerful. And you know, when you vent and you express your emotions, you want to be intentional about who you’re venting to unless it’s your therapist.

Dr. Judith Joseph 00:45:01  Because with therapists you can vent. You’re paying them for that. That’s what they’re there for. If it is a family member, if it’s a partner, you want to be very careful. You want to vent with empathy. You want to say, is this a good time? Can I? Can I talk to you now? And you want to have an intention. You don’t want to just vent just to get it out. The intention should be either a resolution or something that you’ve thought through. And if you don’t have someone to talk to him, not everyone does. You can vent using a pen and paper. You can write in a journal. Journaling has been very effective for many of my clients. for for some of my faith based clients, prayer has been very powerful for them. You know, they talk to whoever they believe in about their emotions. They feel better. For my artist clients, singing, dancing, expressing it that way for my pediatric patients, they cry and I say, it’s okay to cry.

Dr. Judith Joseph 00:45:49  You know, a lot of the parents say, you know, my kid cry so much and I’m like, try this to tell your child when they’re crying, it’s okay to cry. You know, sometimes you feel sad and you cry. They stop crying. What do you tell a kid?

Speaker 4 00:46:03  100%.

Dr. Judith Joseph 00:46:04  They cry more.

Eric Zimmer 00:46:05  100%. That has been my experience. It was completely my experience raising my son when I was like, oh, you’re really sad. It’s okay that you’re sad. He would kind of go through it. It’d be a minute or two, and then he, you know, he’d be like, oh, look at that balloon over there and run off and start playing. But if I was trying to get him not to feel it, it just kept it was it became an episode. You know, it’s so funny the way that is. I used to have this thing written on my, you know, some of us stick things on our walls that we really need to remember.

Eric Zimmer 00:46:34  And mine said it helps to talk to people even when you know the answer. And what I meant by that was, I’ve done 800 of these podcasts. I’ve been in recovery for 30 plus years. I’ve I mean, I’ve read a thousand books on this stuff, right? Like, I generally know the answer, but that’s not what talking to somebody else is about. I mean, it can be about that person bringing perspective, but it’s often about talking about it. And I had to kind of remind myself that even when I was like, well, I know what I should do, I should do x, y, and Z. Okay, I’ll go do that. I had to remind myself. Talking helps even when. But I want to ask you a question about this. You’ve got a sentence that I loved, which is we should think of venting as complaining. Savvy older sister. And you talked about having an intention there. And I want to talk about how does venting become useful and not a case where I tell you how bad my life is.

Eric Zimmer 00:47:32  And you, you agree with me how bad my life is. And then I tell you, tell me how bad your life is, and I agree. You imagine two people complaining about their boss, right? And they just keep ample. It just amplifies, right? So how do we keep venting from becoming that?

Speaker 4 00:47:46  Well, what you describe.

Dr. Judith Joseph 00:47:47  That amplification was actually recently published in a study where they found that, when you vent in that manner, like it is like pouring gas onto a fire, you don’t feel better, you feel worse. Yeah. And so with with my clients, I suggest they start self eventing first. So first you start, you know, and even talking to yourself. People who talk to themselves out loud. It may look weird, but it works. It’s like they are trying to get through these emotions on their own. So what’s happening is that you’re actually de-escalating. You know, you may feel your emotions at 100%, and we don’t want to change your emotion.

Dr. Judith Joseph 00:48:27  We want you to validate it. But as you go through this process of self venting, maybe writing or talking to yourself, you actually start to get some more clarity. You start to understand what it is that you want and what’s the best way to go about doing that. And as you start to talk to yourself and your self venting and then you say, okay, now I want to talk to someone else, I’m going to check in with them. I’m going to be empathic. So that’s, you know, using that emotional consent, you know, is it okay to talk now and then that empathy. Right. Because you don’t want to just go and tromp it up on someone and they’re not ready to hear it. Maybe they have their own problems going on. Right. And you want to have a clear idea as to what you want. What is the outcome. Do you want to resolve this issue? You want to, you know, have more clarity. So when you go about venting that way, you’re going to feel better.

Dr. Judith Joseph 00:49:12  But if you go about venting in a way that you’re not even thinking about the person you’re talking to, maybe you’re talking to someone who’s in a position of power below you, like your child, who’s not going to say no. They’re going to listen because they want to feel attached to you, but they’re going to worry about you, or like to an employee who’s going to be like, well, I have to listen to the boss. And then they go home and they trauma up on their family. You know, you really want to be intentional about how you vent so that you actually have a resolution.

Eric Zimmer 00:49:38  I love the nuance in that. I’ve kind of commented on that a couple times in what I’ve seen in your work, because it’s not like venting is all good, and it’s not like you should keep everything to yourself. It’s like there’s a way to do this that’s more skillful.

Dr. Judith Joseph 00:49:53  Yes.

Eric Zimmer 00:49:54  So we’re not going to have time to go through the other three V’s, which are values, vitals and vision.

Eric Zimmer 00:50:00  But in the conclusion, you kind of walk through yourself practicing these five V’s in in a situation. I’m wondering if you could just maybe walk us through you using these in a real situation in your life.

Dr. Judith Joseph 00:50:13  Yeah. So the third V we’re landing right now was really important for me, the values. Because on the outside I got so much admiration for like being on these prestigious boards, having this research lab, everything looks so great. And again, I was experiencing anhedonia. And so I had to really go back into my past and be the archaeologist and dig up, like, where did I go wrong here? You know, I was chasing the values that the world says are important. The things with the price tags, you know, had the family, had the house, had the job, had the accolades, but feeling empty. And when I started to really look at my past and where I found meaning and purpose, you know, the things that have that don’t have price tags and things that are priceless.

Dr. Judith Joseph 00:51:04  That’s where I started to reclaim my joy. And growing up, I had very little. I came to this country from the Caribbean with very little resources, but we always, always helped out other people. You know, it wasn’t like, oh, like we don’t have much, so let’s just hoard our resources for ourselves. It was how do we help others? And that’s how my family found joy as a collective. My dad is a pastor. My mom’s very active in the church. And every weekend we would spend, giving back to the community. Either it was the YMCA or a dementia unit, you know, helping others to have some hope. And, you know, for me, getting the accolades, having the degrees, having the lab, I just I wasn’t helping others, like, I was helping people in the traditional sense of like, you’re a doctor, you help others. But there was no community outreach in the sense of, let’s just do something for the greater good. So when I started to tap back into that, you know, bringing youth into my lab to learn about Stem, creating content to educate others, just for, you know, the purpose of helping people to understand mental health.

Dr. Judith Joseph 00:52:14  I experienced this abundance of joy. And that’s for me is is what I value is connecting with people and and helping communities. But for others, it could be something else. You know, I write about in my book how clients forgot that they actually loved nature, and they were living in a big city and everything looked so successful, but they forgot that that’s what helped them to feel rooted and grounded. So we had to work together to get them back into a lifestyle where they were accessing nature. You know, so if anyone’s listening to this and they’re just like, I don’t know what I value anymore. Like, look, in your past, you know, go back to old pictures. What lit you up, you know? Was it tinkering? You know. Did you used to use your hand a lot and you don’t use your hands anymore. You’re in front of screens. Try and tap back into that, because there may be these pockets of joy that you’ve forgotten, because you’ve gotten so busy in life and things have changed around you.

Dr. Judith Joseph 00:53:10  And see if you can tap back into those aspects of your life.

Eric Zimmer 00:53:14  Before you check out, pick one insight from today and ask, how will I practice this before bedtime? Need help turning ideas into action? My free weekly Bites of Wisdom email lands every Wednesday with simple practices, reflection and links to former guests who can guide you even on the tough stuff like anxiety, purpose and habit change. Feed your good wolf at one you feed. Net newsletter again one you feed net newsletter excellent and so do you want to give me an example of applying a couple of the other V’s in your own life?

Dr. Judith Joseph 00:53:51  The fourth V is vitals. Vitals are anything that supports your body and brain. Because you only get one, you’re only going to get one body and brain in this life. And the traditional vital signs are things like, you know, getting movement, eating foods that are nutritious and fortifying for your brain and body, things like getting adequate sleep. But there are these non-traditional vital signs that I also highlight in my work.

Dr. Judith Joseph 00:54:20  One of those is our relationship with technology. You know, we we use so much technology these days. We’re on screens all the time. And I recently gave a talk about something called the auto phenomenon, where we’re looking at our faces too often and we’re instead of instead of, you know, looking at others and figuring out, is this person attaching to me? Are they, you know, are they a threat? Am I connecting with them? We’re looking at ourselves. We’re looking at our faces when we’re on these zoom calls all day long, when we’re on these, you know, face times, when we’re on our social media, we’re looking at ourselves too much. So what ends up happening is we’re not connecting with others and we’re scrutinizing ourselves. We’re judging ourselves. It’s creating a lack of confidence. It’s creating a lot of anxiety. And the autistic phenomenon is something we see in mental health, usually with people who have a psychotic illness or psychotic condition, like schizophrenia or bipolar disorder with psychosis.

Dr. Judith Joseph 00:55:17  Or it’s when they see themselves outside of their body, so they literally see themselves walking into a room, and it creates a lot of anxiety for them. Stress. We’re doing that to ourselves willingly by looking at ourselves all day long. So I really try to get my clients to develop boundaries with technology so that they are not living their lives on screens. And there was a recent study out of one of the University of Texas schools where they took adults, and they removed the smartphone capacity from their phones. And instead of being able to get online and be seamless, and, and access to, to socials all the time, they could just use their phones for communicating with text or phone calls. And what they found was that being away from that smartphone capacity for two weeks, they actually appeared to become less depressed. Right. The the amount of points that increase over two weeks. And these were not people who were depressed to begin with, but it looked as if they were being treated with an antidepressant.

Dr. Judith Joseph 00:56:13  So it’s just interesting because what they found was that these people were sleeping better. They were connecting more with others. They were in nature more. You know all those points that I said we add up in in the research, they were getting more of those points just by not being on their screen. So that relationship with technology is so crucial to examine our personal lives. And then another non-traditional vital sign that we’re learning is really important these days is our connections with others. So, you know, being in healthy relationships and not being paired and partnered and around people who literally drain us of our life force, that’s an area we need to work on. And you may not be able to just up and leave, right. But you can set boundaries so that you’re protecting your peace a bit more. And then the fifth vital, the fifth V is a vision. How do you celebrate your wins?

Speaker 5 00:57:07  I love this.

Dr. Judith Joseph 00:57:07  How do you plan joy in the future? Yes. As someone who used to, like, only celebrate the accolades.

Dr. Judith Joseph 00:57:14  Now I celebrate the small things. If I get my kid to school on time every day. I, like, give myself a pat on the back and I’m like, I’m going to sit in my living room and I’m going to enjoy my Caribbean coffee because I have this really delicious coffee from I got from Saint Martin that I love. And I’m just going to celebrate that one. And I’m going to plan joy in our lab whenever we finish a training. We celebrate it. You know, whenever there’s a birthday, we celebrate it. We acknowledge the small things. And it’s not just the big things. That is very powerful because it keeps us hopeful. It keeps us moving forward, and it keeps us from getting stuck in the past. So the wins. I think many of us don’t celebrate our wins enough, and it doesn’t have to be grand. It could be small, but it’s another point of joy that we tend to overlook.

Eric Zimmer 00:58:01  Wonderful. Well, we are out of time, but thank you so much for coming on.

Eric Zimmer 00:58:05  I enjoyed reading the book and I’ve really enjoyed this conversation, so thank you so much.

Dr. Judith Joseph 00:58:09  Thank you so much and I look forward to reading your book as well. Congratulations. Celebrate that one. It’s a big deal.

Eric Zimmer 00:58:16  Indeed indeed. Thank you so much for listening to the show. If you found this conversation helpful, inspiring, or thought provoking, I’d love for you to share it with a friend. Sharing from one person to another is the lifeblood of what we do. We don’t have a big budget, and I’m certainly not a celebrity. But we have something even better. And that’s you just hit the share button on your podcast app, or send a quick text with the episode link to someone who might enjoy it. Your support means the world, and together we can spread wisdom. One episode at a time. Thank you for being part of the one You Feed community.

Filed Under: Anxiety & Depression, Featured, Podcast Episode

Why We Need to Rethink Mental Illness with Sarah Fay

October 1, 2024 Leave a Comment

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In this episode, Sarah Fay brings a unique blend of personal experiences to the conversation around mental health recovery and explores why we need to rethink mental illness. Sarah’s journey of recovering from mental illness underscores the complexities and challenges individuals face in navigating mental health diagnoses. She delves into the limitations of the DSM and the influence of societal perceptions, as well as an ongoing dialogue that sheds light on the path to recovery with empathy and understanding.

In this episode, you will be able to:

  • Unravel the truth behind mental health misinformation on social media
  • Discover the risks of self-diagnosing mental health and how to avoid them
  • Uncover the impact of social media on mental health awareness and well-being
  • Understand how mental health diagnoses are determined and the challenges with such diagnoses
  • Embrace effective strategies for personal recovery from mental illness

Sarah Fay is an award-winning, bestselling author, educator, activist, and entrepreneur.

Her journalistic memoir Pathological: The True Story of Six Misdiagnoses was an Apple Best Books pick, hailed in The New York Times as a “fiery manifesto of a memoir,” and named by Parade Magazine as one of the sixteen best mental health memoirs to read. Her new memoir Cured, the sequel to Pathological, is a bestselling, Featured Publication on Substack. Her work has been featured on NPR, Oprah Daily, Salon, Forbes, The Los Angeles Times, and more. She writes for many publications, including The New York Times, The Atlantic, Time, and The Paris Review, where she was an advisory editor. Her essays have been chosen as a Notable Mention in Best American Essays and nominated for Pushcart Prizes. She’s the recipient of the Hopwood Award for Literature, as well as grants and fellowships from Yaddo, the Mellon Foundation, and the MacDowell Colony, among others.

Connect with Sarah Fay  Website | Sarah’s Substack

If you enjoyed this conversation with Sarah Fay, check out these other episodes:

Challenges of Mental Health Diagnoses with Sarah Fay

Rethinking Mental Health with Eric Maisel

Why We Need a Different Approach to Mental Health with Dr. Tom Insel

The Power of Mindfulness for Wellbeing with Ellen Langer

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Episode Transcript:

00:00:00 – Sarah Fay
There’s a part of mental health diagnoses that is really no different than horoscopes, right? They’re just introvert, extrovert, personality tests, same kind of thing. That’s how they’re being embraced today, right now. But the stakes are so high with psychiatric diagnoses.

00:00:22 – Chris Forbes
Welcome to the one you feed. Throughout time, great thinkers have recognized the importance of the thoughts. We have quotes like garbage in, garbage out, or you are what you think ring true. And yet, for many of us, our thoughts don’t strengthen or empower us. We tend toward negativity, self pity, jealousy, or fear. We see what we don’t have instead of what we do. We think things that hold us back and dampen our spirit. But it’s not just about thinking. Our actions matter. It takes conscious, consistent, and creative effort to make a life worth living. This podcast is about how other people keep themselves moving in the right direction. Direction how they feed their good. Wolf, thanks for joining us. Back on the show is Sarah Fay, an award winning author, educator, activist, and entrepreneur. Her work focuses on mental health advocacy and questioning society’s happiness formula and how to create your own. Her debut memoir was the true story of six misdiagnoses. Today, Sarah and Eric discussed the highly anticipated sequel called cured, which is a best selling featured publication on Substack.

00:01:47 – Eric Zimmer
Hi, Sarah. Welcome to the show.

00:01:48 – Sarah Fay
Thank you so much. I’m so happy to be here again. I feel very honored to be a double guest. It’s wonderful.

00:01:55 – Eric Zimmer
Yeah, I’m really happy to get to talk to you again. I think our first conversation was really about two years ago, around that timeframe, and it was around your book that was called pathological, and it was about the six diagnoses you had been given, you know, psychiatrically and where that is. And what we’re going to talk about today, mainly, is a new book you’ve written, although it’s not quite in a book form at the moment, but it’s been serialized on Substack, which is called cured. But before we get into any of that, we’ll start, like we always do, with a parable. In the parable, there’s a grandparent who’s talking with her grandchild, and they say in life there are two wolves inside of us that are always at battle. One is a good wolf, which represents things like kindness and bravery and love, and the other is a bad wolf, which represents things like greed and hatred and fear, and the grandchild stops. They think about it for a second, they look up at their grandparent and they say, well, which one wins? And the grandparent says, the one you feed. So I’d like to start off by asking you what that parable means to you in your life and in the work that you do.

00:03:02 – Sarah Fay
I love this parable, and I’ve been thinking so much about it for the last couple of days because it was a spoiler. I already knew you were going to ask me, and so. But really, I never could have predicted when we talked the last time, because we talked right before pathological came out, I never could have predicted what was going to happen with psychiatric diagnoses in the last two years. And so what I mean by that is, to me, the good wolf is when diagnoses are used by trained professionals to get people in emotional and mental distress help. And the bad wolf is when diagnoses are used by the public who don’t have that training, often by teenagers and even children diagnosing themselves on social media like they’re doing right now. And social media influencers with no training spreading misinformation. So you’ve got, you know, the good wolf is kind of diagnoses being used in the right way, even though they’re flawed. And then the bad wolf is diagnoses being used by the public who really don’t know enough about them. And I wrote pathological to prevent that. But now what we’ve seen is that we’ve been feeding the bad wolf, and that has really created a new kind of crisis. Instead of feeding the good wolf, which it was meant to do, right, mental health awareness was meant to do that. And instead, basically, you’ve got people who really don’t understand the diagnoses, which is why I wrote pathological about the DSM, to educate people, especially parents. And just over the last two years, I’ve seen how young people on TikTok and Instagram are really diagnosing themselves. There’s this idea that you can be undiagnosed, autistic or borderline personality disorder or whatever it is, and then the statistics of how damaging that can be. And it really has saddened me in some ways. But I wrote cured, hopefully, as a remedy to that or an alternative to that.

00:05:00 – Eric Zimmer
It is sort of fascinating. I’m not really on social media, so I’m talking secondhand here, broadly. But you quote a study that found that 83% of the mental health advice on TikTok is misleading. And we’re not talking about, like, a few people are seeing this. It is huge on TikTok. I can’t remember the impression numbers I was seeing, but they were huge numbers.

00:05:22 – Sarah Fay
24 million people.

00:05:24 – Eric Zimmer
Yeah, yeah, yeah. I mean, that’s a lot of people. And so diagnosing ourselves is a risky sort of thing. And I think the other thing that’s just fascinating to me is that people seem to almost want these diagnoses. And I understand that on some level, because if you’re suffering for me at least, and I think I’ve heard enough people report this initially, some sort of diagnosis feels good. Like, if I’ve got some unknown pain and I don’t know what’s going on, and I go to the doctor and they’re like, oh, you’ve got a strained right quadricep. I’m like, oh, great, okay, we know what this is, and ideally we’re going to be able to do something about it. So these diagnoses, I get why they can be helpful, but it’s so strange for them to be almost a status symbol in some ways. And I agree with you that I think our desire to make mental health awareness go up is backfiring in some ways.

00:06:19 – Sarah Fay
It really has, and in the scariest, scariest way. And this was true of me in pathological. I really show my trajectory from being someone who. I got six different diagnoses. I took each one on as a label and they became self fulfilling prophecies. And I should say mental illness is very real. I had a severe mental illness for 25 years. I know what it’s like. There was something wrong. So I’m not doubting that these young people or whoever aren’t in mental and emotional pain and some of them may have serious mental illness. So I’m not at all saying that. It’s just that when you don’t understand, and this was true for me, that DSM diagnoses, they’re subjective, they have racial and gender biases, they’re scientifically invalid. There’s no test we can use to prove them they’re unreliable. So two mental health professionals can see the same person at the same time and give them two different diagnoses, and then there’s all this influence with big pharma in their creation. So what the DSM is, it’d be very different if the public was educated on that and parents knew and everyone knew and was very aware and we had all the information. Christina. Karen at the New York Times did a wonderful piece about how people are now going into therapist’s office and psychiatrist’s office and demanding diagnoses, like saying, I know I have this. And so really almost putting the professional out of the equation in many ways. So there’s nothing wrong with even identifying and labeling yourself if it brings you some relief. But in some ways, there’s a part of mental health diagnoses that is really no different than horoscopes. Right. They’re just introvert, extrovert, personality tests, same kind of thing. That’s how they’re being embraced today right now. But the stakes are so high with psychiatric diagnoses.

00:08:03 – Eric Zimmer
Right.

00:08:04 – Sarah Fay
You know, they can be, you know, in terms of looking at it as a medical disease, as something that I need a medication for, or I’m gonna limit my life by. And medications can be so helpful and so not helpful. So. And I’m not laughing at that, but in many ways, they were a godsend for me, and they have been very, very unhelpful, both for me and others. So that’s not to discount medication. But again, that study was unbelievable. So 83% of people on social media giving advice, particularly TikTok, in this study, 91% had no mental health training. 14% of the videos were potentially damaging content. And then what was so fascinating to me, because it feels like everyone is saying they have ADHD, is 100% of the videos in their study on ADHD were misleading. I mean, that’s just what. What are we doing? And then the algorithm puts you in a silo of misinformation, and so it just gets reinforced. But going back to what you were saying about some of them are cool. There are cool diagnoses, and then there are uncool diagnoses. And there was a study on stigma and mental health awareness, and what they found was the stigma for certain diagnoses, anxiety, depression, ADHD, and in some ways, very high functioning autism. If you are one of these exceptional people, the stigma for those went down. If you’re calling yourself neurodivergent. So these are not like the people with autism and the young people that I worked with in the New York City public schools who are non verbal, who are extremely low functioning. That is in the uncool category. So also anything with psychosis, the stigma against those has gone way up, which is really fascinating. So we’re just in a very weird, scary position. I interviewed Martin Rafferty, who’s with youth era, which is an exceptional organization in Oregon where they really help youth. And he said something really, really scary to me, which is I asked him about recovery, because if you are over identifying with these diagnoses in a mental health system that does not mention recovery, you are just given the diagnosis and sent on your way. Like, there is no such thing as recovery. In 25 years, I never heard the word recovery. But he said that young people who he works with and he’s very tapped into, they have disavowed recovery. They don’t even want to recover. So they really do embrace their diagnoses. They refuse it, and they want the negative symptoms, they want the positive symptoms. And some of that can be good because being a human means that, you know, there’s mental and emotional suffering. We don’t get to escape that, but they’re pathologizing it, and that can be very damaging.

00:10:47 – Eric Zimmer
You and I talked about, and I’ve talked about with lots of people on this show, this idea of diagnoses and labels and all of that, and I think they are useful until they’re not. And that’s my framework for so many things, is like, is this useful? And I think that’s the lens to look through these things because to your point, the DSM is the diagnostic statistical manual. It’s the way that psychiatrists and psychologists look at and say, oh, you know, you have these symptoms. That means you have this thing, or you have these symptoms for three months, then you have this thing, right? That’s for people who are wondering what DSM. That’s what it is. It’s the guidebook. And the point that you made, which is good, is that it’s a highly unreliable guide. Meaning, like you said, there’s no scientific validity to it. There’s no, like, I can give you a test and find out that you’re bipolar, too. And so I could describe my symptoms and you said this to one psychologist, and they could be like, you have bipolar, and I could describe it to another psychologist who could be like, you have depression, and another one who might say, you have ADHD. Right? And according to the DSM, they would all sort of be correct in their own way because these symptoms, they just cross over in so many different ways. And so taking on these labels or diagnoses, getting back to where I started, can be helpful, like I said, until they’re not, because you’re taking on an identity that in some ways doesn’t even really exist. We don’t know what mental illness is at this point. I mean, it’s sort of frightening to say, but we just don’t. We don’t understand the cluster of symptoms that seem to show up. The models that make the most sense to me are sort of the biopsychosocial models, which are saying, like, this is some combination of biology, psychology and culture. And the people you’re around. I think that’s the best model for addiction, too, which is the thing I’m most familiar with. And so we don’t know what it is. And what you’re doing so well, you did in Pathological, and you’re doing here is trying, I think, to get us to loosen our grip on believing things about ourselves that may or may not be true and being open to the fact that this is more fluid than we think it is. And the important thing that you’re talking about is this idea of recovery.

00:13:15 – Sarah Fay
Yeah.

00:13:15 – Eric Zimmer
Say more about recovery from mental illness.

00:13:19 – Sarah Fay
I just wanted to stop. I realized I just launched into the DSM. So maybe I’ll define the DSM. Okay. So that we can put that back in. So I don’t just launch into this. But the DSM is the Diagnostic and Statistical Manual of Mental Disorders. It started in 1952, and it was started by a small group of psychiatrists who at the time, unsurprisingly, were white, heterosexual men. And they came up with about. Close to about 90 diagnoses. And it was a way to try to order and categorize and take mental and emotional pain and give, essentially, a language for doctors to talk to other doctors about patients. It was never meant to be in the hands of patients, ever. So until the 1980s, patients never knew their diagnoses. You just got therapy. You never needed to know it. And then in 1980, they did a revision of the DSM that was really monumental, and it created a checklist of symptoms for diagnoses. And so basically, you could go through and say, yes, insomnia, yes, anhedonia, which is a loss of interest in things. Yes, eating too much. But note, these are symptoms of depression in the DSM. But note that it’s also sleeping too much, sleeping too little. It’s eating too much, eating too little. And you’re like, well, I’m gonna fit one of those.

00:14:41 – Eric Zimmer
Yeah, exactly.

00:14:42 – Sarah Fay
Yeah. They turned it into a checklist, and they, you know, kind of the criticism was it’s this restaurant menu of diagnoses, and that it was very reductive and it wasn’t helpful. This was from mental health professionals. Now, the twists that happened in this sort of plot of how diagnoses have come into the culture is that the DSM became a bestseller. It went on the bestseller list, and it became the American Psychiatric Association’s primary income stream. I mean, that’s just phenomenal. Besides big pharma. So suddenly it was in the hands of all kinds of people. So it got into the public, and then more and more and more. And they expanded the diagnostic criteria and added diagnoses so that we now have over 300 different psychiatric diagnoses. So it’s very hard not to find yourself in the DSM. I mean, we all have been there, and especially when we’re not well. And again, it’s very different when you’re dysfunctional. I was to the point that I could no longer live independently. They were basically telling me that I would most likely die by suicide and I would never hold a full time job, etcetera. So I was really given this very, very dismal prognosis. So that’s the DSM.  

In terms of recovery, recovery is another well kept secret, for some reason, in the mental health field. Part of that is because there is no recovery in the DSM. There’s no page on recovery. I think it’s mentioned once. And so, really, we have mental health professionals right now who have no training in recovery. That’s phenomenal. Can you imagine if all of our doctors knew nothing of recovery from broken bones and Afib and stroke or whatever? I mean, that’s what we’re living in right now. And so if you went into a doctor’s office and he told you you have Afib, see you. Like, have a good day, you know, here’s some medication. You will never recover. And, you know, Afib is hard. You know, there are certainly physical diagnoses that we don’t recover from, and not everyone will recover from mental illness. But my feeling was that I was not given the chance, and everyone should be given the chance. I had a psychiatrist who also really alerted me to the DSM and the realities of the diagnoses that we receive. And he’s wonderful. He’s a serious biopsychiatrist. I mean, he believes in psychiatry wholeheartedly. He’s not even a critic of it. But he was very honest with me, and he said, you know, these are flawed. These are just really flawed diagnoses. And that really opened my mind, and that’s why I wrote pathological, to bring that information to other people. And then he also told me a story, and we were talking about something. It was apropos of nothing. And he told me about a patient of his who had schizoaffective disorder. So that is a combination of schizophrenia with bipolar features. And so it’s a very, very grave prognosis. And really, I mean, the idea that you could recover is just not there. He never mentioned the word recovery, but he said she came from a wealthy family, and he treated her so they had everything at their disposal. That’s important because recovery, we don’t have a mental health system that supports it either. They had everything at their disposal and he said that he treated her and he wasn’t boasting in this way, but they worked together off all medications and became an executive at Google. And I was like, what? First of all, you don’t recover from mental illness. And two, you do not become an executive at Google. Now, I do not want to be an executive at Google, but it seemed to, like, embody health and productivity and wellness and all this kind of for better or worse, like, it seemed like, oh, that’s it. And I couldn’t believe someone had healed.

00:18:24 – Eric Zimmer
Yeah, I think it’s interesting, this idea of recovery, because, I mean, I was in recovery from addiction. I mean, that’s what we call it when you go to a meeting. I was in twelve steps, we call it recovery. And the idea is there is recovery. So it’s interesting, when I got my first sort of psychiatric diagnosis of depression, I think that I didn’t take it on in the way that you did because everything in my mind was in the context of recovery. I also had hepatitis C from my needle use and was treated for that. And I was one of the lucky few back then. It’s a lot more common now where it kind of just went away. So it was this weird sort of thing because the doctors didn’t know what to call it, because if you test me, you’ll detect that there is some degree of viral load of that. But it is so low that it hasn’t done anything and infected my liver in all these years. And so I’ve never known what to call it. Do I call myself cured? I’m not. I mean, kind of. It’s interesting to me that my view into mental illness was always one of that. There’s some ability to get better. I don’t know how much better. But it’s interesting to me that you took them on and the way they were presented to you as basically life sentences and very predictive of your future capability and capacity.

00:19:49 – Sarah Fay
Yes. And I did what a lot of young people are doing. I made it my identity then you are locked into it. You can’t recover. You don’t want to recover. It’s your identity. And if someone had told me what I’m talking about right now, and I’ve spoken to so many young people who are very resistant to this, I tell them I would have been too. It was my identity I didn’t want to lose that? Who wants to do that? But your analogy with hepatitis C, that is it. Because we’re never going to be without depression. We’re never going to be without anxiety. Psychosis is probably the most extreme example of a symptom that not everyone experiences. But distraction, irritability, insomnia, sleeping too much, eating too much, all of these symptoms are part of the human experience. So I think what you said is sometimes there’s a viral load there. It will always be present, but do we have it anymore? And people say to me, do you still have a diagnosis? And my psychiatrist did give me one. He had never told me. When I first went to see him, he said to me, I don’t know what you have. And that’s what kind of changed my whole view of diagnoses. And then after, when we were on the road to recovery, he’s since declared me cured. But here’s the confusing part. I am still on medication. I’ve been on it for ten years. It’s going to take me about ten years to go off of it safely. And so he and I are really working toward that, and it’s very hard to go off these medications. So anyone listening to this, please do not do it without medical supervision. I tell you, I’m on the ten year plan, and that’s okay with me. But so, wait, I’m taking a medication. Doesn’t that mean I’m still sick? And so, on his records, I still have a diagnosis, because that’s how you get medication. So it is very confusing. But I know for myself, well, first of all, I’m thriving in my life, and that is part of it. But I have terrible anxiety. I mean, just crippling my neck right now. So terrible because of things going on in my life. And that’s okay. It’s very different than it being a pathological condition. And I see the difference. I know the difference.

00:21:56 – Eric Zimmer
Yeah. I have not known for several years now how to talk about depression in myself. I don’t know what to say. I don’t know whether to say I still have it. I don’t have it. I’m prone to low moods. I’m prone to anhedonia, but not to the degree I used to be. And what’s a normal amount and what’s in the amount? That’s just my temperament, my personality, my makeup. And so I don’t know what to say about it. Like, I literally get sort of like, uh. I don’t know. I battled with, I struggled with. I had. I have. I don’t know what to say about that, because exactly to your point, with alcohol and drugs, I don’t really use the word recovered. We’ll get into that in a second. But it’s pretty easy for me to say I’m in recovery very heavily because it’s just gone. I just don’t do those things. And I haven’t for 15 years this time. These other things, as you said, are a lot harder because we all have anxiety at times, we all have low moods at times. We all have a feeling of disconnection at times. And so what degree of it becomes a diagnosis of something you have? And obviously there’s no right answer. And I think we’ve learned the same thing with alcoholism and addiction. They give you some strange twelve question test, and if you answered seven of them, you were an alcoholic. And now we know, like, it’s a lot more nuanced than that, right. All this stuff is on a spectrum. And so we talk about alcohol use disorder, and they’ll plot you somewhere on this line right between no problem to serious alcohol. I don’t know the exact terms, but we don’t talk about psychiatric diagnoses in that way, that you’re on some sort of spectrum. Right. It’s this idea that you cross this line and now you have this thing. Ellen Langer, who’s a professor at, I believe, Harvard, and she wrote a lot about mindfulness, but she also has written very compellingly about something she calls, I think she called them border conditions. And what she was talking about was there’s been a number of studies done. Let’s take somebody who is right on the line of diabetes or non diabetes. If you’re at a blood sugar of x, you are non diabetic, and a blood sugar of x plus one, you are diabetic. And this is a test where they’re actually measuring something, unlike psychiatric diagnosis, which are even farther off. But statistically, there’s no big difference in one point of blood sugar. But what she has found and others have found is that it makes a tremendous difference in the outcomes of those people. And you might think that getting the diabetes diagnosis is positive because now you get treated for it, but they find almost exactly the opposite. They find that the minute you are now in that category, you are treated differently and you do things differently. And they’ve seen the same thing in like children with, like IQ. Like if you’re like one point above, you’re in normal classes, and if you’re one point below, you’re in special ed classes and your outcomes are dramatically different. And it’s not because you had a one point difference. It’s because of what happened after that and what you internalized about yourself. And so even in these things, where we’re measuring something a little bit more than we are in psychiatric diagnoses, this labeling has profound implications.

00:25:25 – Sarah Fay
What you just said is so resonant and so important, and that’s what I found in my life, is that even if I hadn’t thought it was, you know, a death sentence, it still limited me so much, and it definitely dictated my path, no question. Now that I’ve recovered, there is a lot of regret. You know, I feel like I lost 25 years of my life to the DSM in some ways. And, you know, that’s not fair to put on a book, but it really does. It does feel that way sometimes. I think, what would I have done? Where would I be right now if I hadn’t been pigeonholed or said, you know, sort of slap with this label and thought that I was limited in any way. But it’s interesting. What you’re talking about, too, is, what is the measurement, and how do we do that? And I write about this in Cured. I didn’t want to tell anyone. And actually, the first time I was on with you, I thought, wait, I think I’m better. I thought, I think I’m really better. And I didn’t want to say anything. In our first interview, I didn’t feel like I could tell anyone. It was like a big secret, because I thought someone would say, one, no, you haven’t, and you can’t. And two, I just thought it wasn’t possible. I had not heard of the recovery movement. I had no idea that people had been recovering from mental illness since the 16th century and that this was a thing and that there were all these people out there advocating for it. I just had never come across it. And so I’d not told my psychiatrist at that time. But I went to lunch with my father, and I decided, okay, I’m gonna take a chance. And I said, dad, you know, I think I’m better. I think I’m well. And he looked at me and he said, I know you are. I know you are. And it was like, I get chills. Cause it was the best day of my life, and especially cause I’d had such a fraught relationship with my father. And now we are very close and just feeling like, oh, wait, he sees it. And we’ve talked about, and he said, I’ve never seen anything so complete. I’ve never seen such a complete, massive change. And so much of it came from believing I could. I mean, that’s it. So much of it was that. I mean, there were a lot of other things, and I really detailed them and cured. Learning how to manage my mind, learning my emotions. I had a panic attack last night. I knew now, okay, there isn’t something pathologically wrong with me. You’re having a panic attack. And sometimes we can’t do that for ourselves. But I really have learned to talk to myself. And then, of course, diet. I have a very extreme diet, and I don’t eat any sugar. I don’t eat any white flour. There are things I had to do, and these are things that we have seen really help. I drink no caffeine. I don’t drink alcohol. I obviously take no drugs besides psychiatric drugs. And, you know, I have two cats that I give my life to, so we know that’s very healthy. I go to bed at the same time, I wake up at the same time. There’s just a lot there that goes into recovery, that a lot of people are in a place where that would be very, very difficult. And then just going to. The term recovery is so interesting. So for cured, because I serialized it on a platform called Substack. So Substack is essentially, we could call it. It’s my own personal media magazine. So it is a newsletter. If you sign up for it, you will receive emails from me. But it’s also a blog. So basically, it is on the Internet, and you can go on there, and it would be like visiting a website. And so what I did was part of my dissertation. So I do have a PhD in literature, and part of my dissertation was on serialization in the 19th century. And I love it. It’s just so amazing. So all of Dickens’s novels came to people chapter by chapter. It was portioned out. We didn’t have single volume novels at that time, so in the 19th century. And so that was how storytelling really came to be. It was not.  here’s a book. So you can imagine television pre netflix versus television. Now, you couldn’t binge on a novel. And I’ve always loved that form. And so, I mean, Agatha Christie serialized, and F. Scott Fitzgerald. So it did move into the 20th century. And so I decided we went to my publisher with Cured, which was the sequel to Pathological. They had optioned my second book, and they passed. And part of the reason that they passed was that it’s not the book. And they said that it’s just that pathological came out at a time when, again, people just wanted their diagnoses. They didn’t want to be questioned, they didn’t want to be educated. And that has shifted so much. And there’s so much publicity now happening about the need for not getting rid of diagnoses. I, in no way, I don’t have a system to replace it, so I can’t do that. But it is about knowing the truth and empowering patients and empowering parents to know, okay, this is what this diagnosis is. It’s useful here. It’s not useful to this degree. And maybe I can help my child understand that and myself. So we went to them, but I spoke with my editor and my agent and they said, why don’t you serialize it on Substack and why don’t you bring it to people? Partly because I really wanted to enact social change. And my agent said the most phenomenal thing to me. She said, Sarah, books don’t incite change. They reflect on change, they reflect on social movement. And that may or may not be true across the board, but I think generally she’s right.

00:30:42 – Eric Zimmer
That’s an interesting idea. Yeah.

00:30:43 – Sarah Fay
Yeah. By bringing it to people and then I was able to record it. So there’s an audiobook. But what I was able to do as part of that, it’s this living thing on Substack. So I was able to interview other people who’ve recovered, so it isn’t just me to kind of give evidence of that. And their stories and their trajectory is so different from mine.

00:31:03 – Eric Zimmer
Right.

00:31:03 – Sarah Fay
Some of them still embrace a diagnosis, some of them don’t. Some of them, you know, are transgender and had addiction issues. And so there’s so many different dimensions to this. And then I was also able to interview so many people in the mental health field, those who do agree that recovery is possible and those who don’t. And that was also really phenomenal. So it became this other thing. I was able to interview Larry Davidson, who runs SAmHSA’s office of recovery. We do have an office, my friends. So there is an office in the us government that we have for recovery. So the US government has acknowledged it. It was early two thousands that they first acknowledged that mental health recovery was possible. And so the government has been trying to bring it to people for two decades, but because of big pharma, because of other things, it just has not gone. And because of people wanting their diagnoses, not listening to this idea of recovery, it’s just not gotten into the media mainstream. So it hasn’t reached people. Larry Davidson, who also is at Yale, which has an amazing center for recovery, mental health recovery, and they’re doing really the preeminent research on it. But what he said to me was recovery. The name of it is problematic because it is so associated with addiction and so it just was used and they haven’t come up with another one. And I use the term cured ironically, right. There isn’t a cure, right single, there’s no magic bullet. But can we cure? The verb? Can it be an ongoing process in our lives of living more well, whatever that means to that person?

00:32:56 – Eric Zimmer
Let’s talk about this idea. Recovery is the word that’s being used, so let’s stick with it for now. What is recovery from mental illness?

00:33:05 – Sarah Fay
So I asked my psychiatrist this when he declared me well, and for him he said it was that you have not had an episode in a year, so you have not had some sort of crisis in one year. Now that was him. So there is no overall definition of it, but there are two models. So there’s clinical recovery and then there’s personal recovery. And so clinical recovery is what we went by for a very long time. And that means that your psychiatrist declares you cured, well recovered, and it is purely their decision and they decide your trajectory. Now, the problem is with this, they call it the clinician’s illusion. And when you are in the mental health system, psychiatrists, mental health professionals, they see people who are not well. So their view is no one can recover, not all of them. But it’s understandable why they think that, because they’re only seeing us. But the minute we’re, well, we’re out of their office, we’re not seeing them anymore.

00:34:05 – Eric Zimmer
Twelve step programs have the same thing, right? What they see is the people who go out and come back. The idea then is if you go back out there and drink, you come back, because that’s all that we see. We don’t see the people who just disappear and either decide they don’t need twelve step help anymore or go back to some form of drinking that doesn’t get them to the same point. Right. And it is an illusion because you’re only seeing part of what’s happening and there are more scenarios out there occurring than what they’re seeing. So I understand why clinicians would have be the same way. Right. They see the people who are still suffering, right.

00:34:44 – Sarah Fay
And so it makes total sense. But because that’s not even in the conversation, it’s unlikely that a clinician’s going to say, you know, I think you’re well, and I think we can go for this. So there’s something called personal recovery, and that is when you and the clinician decide together that you are well. And that is why I think right now, as long as medical schools are not teaching recovery and as long as recovery is not a part of the DSM, the way it should be, what we need to do is really empower people to be saying, can we have this conversation about recovery? Can we talk about what is my path to recovery? What would that look like? And decide together when I’ve gotten there. Now, that doesn’t mean you stop seeing a therapist. I still see my psychiatrist because, as I said, it’s going to take me a very long time to get off medications. And I could have chosen to stay on medications. I mean, in some ways my body is fully dependent on them. If it turns out that I cannot get off them because the withdrawal symptoms are so bad, that’s fine with me. There are long term side effects I’d like to avoid, but if I can get it as low as possible, that’s great, I’m good, you know, so again, I don’t want people to feel this pressure of. Okay, then I have to be this normal person.

00:35:58 – Eric Zimmer
Yep.

00:35:58 – Sarah Fay
I’m so not normal. My life is so not normal. I cannot tell you, but it’s works for me.

00:36:04 – Eric Zimmer
Yeah. It’s interesting because you’re saying that you’re borrowing from the recovery movement, but there’s a couple different definitions. And one here is from the Depression and bipolar support alliance, where they say recovery is the process of gaining control over one’s life and the direction one wants that life to go on the other side of a psychiatric diagnosis and all the losses usually associated with that diagnosis. And I think the other thing you’re saying here, and you had misconceptions about what recovering might be, right. You thought it would mean you’re off all medicines, you thought it would mean you’re not in therapy. And I think, again, if we go back to the recovery from alcoholism, that’s primarily out there, which is twelve step recovery, that we see people are in recovery or recovered doesn’t mean that they don’t go to meetings anymore. Right. So it’s the same sort of idea. But you are having panic attacks. Right. Or had a panic attack. So talk to me about how that fits into the concept of being cured or recovered.

00:37:08 – Sarah Fay
We’re not going to be able to escape depression, anxiety, all these distractibility, irritability. Those things are still part of me. The difference in why it’s just a whole different world. And why my mind is so different is because I don’t think there’s anything wrong when those things happen. I don’t think it’s a sign that something’s gone horribly wrong. And before I did, it was an episode. Now, there are points where I was at in total dysfunction. And what I want to also emphasize is that, you know, I suffered from suicidality for five years. Chronic suicidality, that’s a very different situation. You know, again, those are extremes. That is not something that should be dismissed or, you know, or said, oh, this is just part of the experience, although some people argue that is part of the human experience and that we shame people for it in a way that we shouldn’t. And I believe that, too. I don’t think it’s, you know, definitely get help, but I think that also we tend to shame people. It’s got a lot of stigma suicidality does in a way that I wish it didn’t. So I don’t think that anything has gone wrong. I don’t rush to my psychiatrist. I do not change medication dosages in any way. And again, that doesn’t mean that someone who isn’t in crisis wouldn’t do that. But that’s the difference. I don’t need to do that. And it does change with time. But I’m also going through a lot right now. I run a business on Substack. I am a full time. I’m a writer. I teach at Northwestern. I mean, I have a very full life. So it’s not surprising to me that I have anxiety, and it’s not surprising to me that I have these lows because my life is so up. You know, it’s like so many things going on that when actually the weekend comes or I have a day off, I’ll find that I get kind of depressed. I get a little low because I’m going at this rate, you know, and.

00:38:59 – Eric Zimmer
That’S just very different.

00:39:00 – Sarah Fay
But the emotions are so uncomfortable and they’re so awful that I want to run from them, too. I want to say there’s something terribly wrong with me when I feel these. Lisa Feldman Barrett, she’s at MIT, I think, but she has a wonderful book on emotions. And when I read her book, that really helped me realize I didn’t even know what an emotion was. I didn’t know that an emotion was a sensation in my body. I had no emotion education. I was emotionally illiterate, you know, illiterate about emotions. And what I did was I really studied what they are. And I could say I didn’t know what anxiety felt like in my body. It just was terrible.

00:39:39 – Eric Zimmer
Right

00:39:39 – Sarah Fay
And now I’m thinking, oh, okay, wow, my chest feels like it’s about to collapse, and it’s just awful. And I feel like I’m jumping out of my skin, and all I want to do is stop this. Oh, I’m having anxiety. This is normal. This is a part of the human experience. One thing that’s really helped me is evolutionary psychiatry and psychology has been very helpful. So understanding that we are programmed for these emotions. Anxiety is a very helpful emotion when you are living on the savannah and you have to go hunt for your food and you’re being chased by lions. But when I open my email, I am not being chased by lions. And yet my body is designed to react that way. And so that makes me really understand, okay, this is just how I’m programmed now. I can understand it on an intellectual level. I can stop. I can just sit for a second, feel the terrible, allow the terrible emotion, not enjoy it, but accept it. And sometimes it goes away and sometimes it doesn’t. And then I live with it and I work, I go through my day, and, you know, that’s just how I’ve learned to really adjust.

00:40:46 – Eric Zimmer
Yeah. And that’s a really helpful way of explaining it. They also talk about recovery centering on three basic principles, improving health, living a self directed life, and striving to reach our potential. And again, I think the point you’re making is that personal recovery does not mean you’re free of symptoms. And that’s what clinical recovery would say. Clinical recovery is. You’re free of symptoms. And as we’ve said, some of these things, like depression is part of the human condition, or at least low moods. Right, right. So you’re not going to be completely asymptomatic. And so I think the question is, when is it bad enough that you feel like you want or need more help than you’re getting?

00:41:28 – Sarah Fay
I was just going to say that is why it is so important for patients and people to be empowered with, with all of this information. Right now, we’re just blind in this mental health system, and I don’t think the mental health system is bad. When pathological came out, I thought my editor and I and HarperCollins thought, we’re gonna get so much pushback on this from psychiatry. I was on NPR with the head of the steering committee, Paul Applebaum for the DSM with Thomas Insull, who was former head of the National Institute for Mental Health, both biopsychiatrists and both said, you’re right. The public deserves to know.  Psychiatry, the mental health system is not resistant to these things. It’s the public that is, and that is phenomenal. And they’re the ones who need that empowerment. And I think that we could all work together beautifully, beautifully, if people understood the information that I have in pathological and what’s in cured, and then again, talked to other people and spoke to others. And Thomas insull has a wonderful book on recovery as well. So really going toward that. But you’re so right that where it comes down to is it will be in the individual. Like, when is this a problem for me in my life? When am I not seeing it being a problem? But we also have to get to a place where mental and emotional pain isn’t necessarily a problem.

00:42:51 – Eric Zimmer
Right?

00:42:51 – Sarah Fay
That is what we think we have this happiness addiction, you know, in some ways, I don’t mean to use the word addiction flippantly, but, like, this happiness obsession, let’s put it that way. This kind of cult of happiness where we think we’re all supposed to be these happy, instagram y individuals, and it’s just not what life is. That’s not what it’s actually supposed to be like, and that’s not the full human experience.

00:43:12 – Eric Zimmer
It’s really tricky to know what is acceptable level of suffering. And acceptable is maybe the wrong word, but it’s the one that’s coming to mind. And I think about this a lot, right? I still have low mood. I have anhedonia, right? And these things will happen. And the nature of it when I’m in it, is to believe that it’s always this way, that always has been this way, and it always will be this way, and that is not true. And yet the question for me is, is it worth increasing my medication dose when I’m in the middle of one of those? And I don’t know. And the answer for me for years now has been, no, I don’t. I’m on a very low dose, and I’ve stayed on a very low dose largely for the reasons that you have described, which is our brains become dependent on them. It’s fascinating to me that you’re on a ten year plan. I thought I was doing really good to be on a one year plan in the past, which still seemed like an incredibly long time anyway, maybe we’ll talk more about that in the post show conversation, but it’s just difficult to know but what I like about this idea of personal recovery so much is that we become responsible for our mental health, and a doctor or a clinician is part of that, but it’s not all of it. And there’s all these other elements that you talked about. You’ve talked about diet, you’ve talked about sleep patterns. Right. And I’ve said for years, like, I throw the kitchen sink at my depression. Right.

00:44:47 – Sarah Fay
Yeah.

00:44:47 – Eric Zimmer
Like, it has been a lifestyle overhaul that has allowed me to be, I would say, very high functioning, but it’s been diet, it’s been exercise, it’s been sleep, it’s been talking to other people. It’s been doing things that I like. It’s been playing music, it’s reading books. It’s all of it. And I don’t want to position that as an ongoing struggle because the things that tend to make me better in that regard are also many of the wonderful things in life. And so I love this idea of recovery. I’m curious about recovery versus recovered, and this is a debate that has happened in twelve step programs forever. There is a phrase in the aa big book, we are people who have recovered. And so there are people who use that phrase, and there are other people that say that’s not accurate. Like, we’re in recovery. And I’ve always sort of, I think of myself as in recovery, not recovered. But again, we’ve sort of ascertained that my working with labels is fairly fluid, so I haven’t gotten too hung up in the debate. But is there a similar debate in the recovery movement in mental illness?

00:46:02 – Sarah Fay
We’re not even at that point yet.

00:46:04 – Eric Zimmer
Okay.

00:46:05 – Sarah Fay
I wish we were. That’s where we have to get. And I think that’s so, so smart and such a wonderful way to look at it, which is that maybe there isn’t an answer. Maybe it doesn’t have to be one or the other, that maybe what that indicates is a level of care that you need at that point or a level of support. Right. So if I feel like, because I’ve interviewed so many people who consider themselves either in recovery or recovered from serious mental illness often. So we’re not talking about what SAmHSA defines as any mental illness, which is high functioning. We’re talking about people who really went into a low functioning period of their lives, and some of them felt, no, I still have this diagnosis. I still very much identify with it. This is who I am and this is where I am. But I’m in recovery. I’m not sick anymore, whereas I have absolutely no interest in that, because I know how powerful my brain is. And that self fulfilling prophecy. I did it for so long that I don’t even want to know what’s on my medical records because I will adopt it. I don’t go by horoscopes. I don’t go by, I’m an introvert. I’m an extrovert. I don’t like because it just makes me into something, and I don’t want to be something.

00:47:14 – Eric Zimmer
I tend to agree. I take all those things, Myers Briggs or enneagram tests or all of that stuff with a huge grain of salt, you know, because I always find even answering the questions hard, because I’m like, well, you know, would you rather go to a party or stay home and read a book? And I’m like, well, what’s the party? What’s the book? You know, how much did I sleep last night? You know, like, what else? I mean, like, I can’t answer that. I’m going to need a. A whole lot more information to answer this question. And so, again, I find them sort of mildly interesting. But like you said, I will not go see a psychic. Even if I’m walking by, like, a free psychic. I’m like, no, I don’t want whatever you say, even the little bit that will get caught in my mind. I don’t want it there, good or bad, because I worry, like you, that, like, it will linger there in some way and in many ways. And you talk about this near the end, cured. Is that what we’re talking about here, to a large degree, is, what is the story we’re telling ourselves about our mental illness or whatever. And stories are extraordinarily powerful. The story we tell ourselves about it is really important. And you’ve chosen to tell yourself a story of, I am recovering. I am recovered. And that. That has been really important for you in getting to a place where you’re much better than you used to be, if that’s a phrase you’re comfortable using.

00:48:42 – Sarah Fay
Yes, 100%. I mean, I consider myself well, and I don’t have a diagnosis, all of that. And yet, if someone else wanted to say, no, I have a diagnosis. I’m in recovery, and I am living. What you just said, which is the definition of it is striving to reach my full potential. That is so important. And some people might condemn that and say, it’s so capitalist, and, you know, all of this probably, but striving to reach your full potential could be being a great mother to my cats.

00:49:15 – Eric Zimmer
I have absolutely right.

00:49:16 – Sarah Fay
I mean, it means that I am gardening. Yeah. I’m gardening every day, and I am making sure I carve out that time for myself. I am sleeping well. Right? Striving to reach my full potential does not mean I’m an executive at Google. I don’t want anyone to go work at Google. You’re fine. 

00:49:54 – Eric Zimmer
Part of your book that made me laugh cured, which is not a book yet. It’s a serialized Substack. And your Substack is wonderful. We’ll have links in the show notes to it. But you talk for a little bit about Jaco Wilnick, who, for people who don’t know, he is like, an ex military podcaster, but he is all about, like, you know, you go get it, you kill it, you crush it. Like, discipline, mental fortitude, toughness. Right. And you compare him, maybe even in the same sub stack, with people like Brene Brown and Kristen Neff.

00:50:28 – Sarah Fay
Yep.

00:50:28 – Eric Zimmer
That cracked me up. I just thought of, like, the jocko Willnick Kristen Neff cage match, and that just made me. Made me happy and made me laugh. I’ve interviewed Kristen a couple times, and she’s wonderful. But I think about this also, and I think about it in this way, that there is a place for a jocko will nick type approach. I think with my thoughts, where I sort of say, like, enough. No more. I’m not thinking this anymore. And I may have to do that 500 times, and at the same exact time, there is a place for. Okay, I can’t seem to fight you. Like, I’m just gonna let you be here.

00:51:07 – Sarah Fay
Yeah, right.

00:51:08 – Eric Zimmer
Knowing when to do which of those things I’m painting with very broad strokes, but when to sort of fight and adjust and when to allow and accept when it comes to the contents of our own brain is so nuanced. And so I just loved putting those two in the same sort of sentence group because it defines for me very well that struggle or what that challenge is. And it’s one that I talk about on this show all the time, trying to figure that out, that nuance.

00:51:41 – Sarah Fay
Yeah.

00:51:42 – Eric Zimmer
Where have you landed with it?

00:51:43 – Sarah Fay
Well, it’s funny because that was a period of time I was in the cult of Jaco. As I say, there’s just this cult around him. He loves jiu jitsu, and he’s like, do 100 burpees and tell me if you feel bad. You know, that’s kind of like what he said. And so I was like, okay, I’ll do 100 burpees and see if I feel bad.

00:52:00 – Eric Zimmer
The answer is yes, I do feel bad.

00:52:02 – Sarah Fay
I feel worse. Yeah.

00:52:03 – Eric Zimmer
At least for 75 to 85 of those burpees. I’m feeling worse. 

00:52:08 – Sarah Fay
But when I was in partial hospitalization programs, it was the cult of Brene Brown. It was the cult of Kristin Neff, who. Brene Brown. I feel like with vulnerability and the sort of cult of vulnerability that can be very hard people from marginalized communities, it can be very difficult from people who’ve had suffered from mental illness. We are already vulnerable, like a white woman with a great job and, you know, upper middle class. And, you know, to make yourself vulnerable is very different than someone who is in a psychiatric hospital. You know, doing that, it’s, you know, it’s just so, so different. So, you know, I understood that. But at some point, what I had to do for my recovery was to be hard on myself. I just did. And I just had to say no. And I did end up having a life coach, being in a life coach’s program. And one thing she said that stayed with me is that your brain is like a toddler running around with a knife. Your brain is just wild. I think of it as, and this is, again, evolutionary psychiatry and psychology. Our brains are evolutionarily designed to keep us alive. That is it. They are not designed to make us happy. They are not designed to give us what we want to make us. They are designed for us to stay alive, seek pleasure, and avoid pain, and that is it. And so when I’m negative, that’s what my brain is designed to do. So I just say, I get it, Brain. You’re looking for danger. You’re looking for everything to be terrible so that you keep me alive. And I always say, thank you. Thank you, Brain. You’re doing a great job, and you’re awful. So I’ve learned to really talk to myself in a very sweet way and get to know my brain and have a really good relationship with it and just get that it is just very, very mistaken most of the time. Now, sometimes there are dangers, and that’s real. So I also don’t want to discount it. So sometimes I sit down, and I’ll just write down my thoughts and look at which of these are facts. Okay? So, basically, and this is, again, something a life coach taught me, which is so if I write them all down, you know, she’s horrible. My cats hate me. Whatever it is, none of those are facts right now, right? So if it’s not a fact, it’s not necessarily a danger. And so then I can kind of piece it out and say, okay. Until it’s a fact that can be proven in a court of law. Law. And we could get into whether or not they’re really facts and all of that. But then I say, if it is a fact, though, you know, like, my business is failing, right. I get more specific. I’m losing subscribers or something. I’m not. But, like, if that were happening, that’s real. And as a business owner, I should look at that and say, okay, but that’s a business problem. That’s a math problem. That isn’t something, you know, terribly wrong with me. So being able to distinguish between what, what is fact and what is just my brain trying to take care of me and a thought of, we’re in danger, you know, it’s always on high alert.

00:54:59 – Eric Zimmer
I think that you sort of hit on where I land generally with this, which is, I am extremely kind to myself and I don’t let my brain just run wild. And I think Kristin Neff actually does a decent job of describing this when she talks about what self compassion is. Right. Because she says, like, think about a good parent, right. A good parent is not going to let the child eat all the ice cream. Yeah, but they’re also not going to be like, you pig, why would you want to eat all that ice cream? Right. They’re simply going to say, like, sweetheart, hey, look, you can’t have that ice cream. I know you really want it. But, and they maybe if the context is there, explain, you know, here’s why. You’ll get a stomach ache and blah, blah, blah. So I think that that seems to be the answer. But people, I think, often think that being, being kind to ourselves means we’re not accountable to ourselves. And so I’m often sort of trying to strike that balance now in my mind of Jocko and Kristin Neff. I wanted to ask you about writing down your thoughts because you talk about this a fair amount in cured, and I’m curious your process for it and when you do it, because thoughts are, they’re just constant. Right. If I was to write down every thought I had, I would just simply sit here and just be writing all day long. Thought, and this thought, that thought, this thought. So when are you doing it and what are you doing?

00:56:27 – Sarah Fay
Yeah.

00:56:29 – Eric Zimmer
What’s working for you? Yeah.

00:56:30 – Sarah Fay
Writing down all my thoughts would be frightening.

00:56:32 – Eric Zimmer
It’d be like a Jack Kerouac novel. You’d be like, all right, this is not, you know, so when I first.

00:56:36 – Sarah Fay
Started doing it, I would do what the life coach I worked with called a thought download. And I did it every morning.

00:56:42 – Eric Zimmer
Okay.

00:56:43 – Sarah Fay
Some people might think, oh, morning pages or something like that. No, it’s not quite morning pages, but it’s a similar idea, which is. So I would just write them in a line. So it’s not a journal. It’s just one line thought. One line thought, one line thought. And I would just do it.

00:56:57 – Sarah Fay
At first, I didn’t want to do this because I’m a writer. I feel like writing things down are very powerful, and if I wrote down my garbage thoughts and my negative thoughts, it would kind of make them more real or a little bit like, imprint on me. But so far, I’ve found that does not happen. And then what I would do would. Was pick out just one thought that was troubling. And then I would look at it, as we said, from this more educated point of view, which was another person that I’ve learned a lot from, calls it the four ends. How can I normalize this? Why would it be normal that I’m thinking this extreme thought, like, she hates me? Well, that’s because we got into an argument. Of course I think that. But is it true? So I used to do a process of looking at what’s the circumstance? And this is, again, from a life coach named Brooke Castillo. So I want to give credit where it’s due. She didn’t make it up, but she just does it in a way that people will probably recognize this. But you kind of look at the circumstance, and then you put your thought in, and then how does that make you feel and what actions do you take and what’s the result, and then how would you want it to be different? So I did that every single morning and night while I was recovering. I mean, every single morning and night. And I would do it during the day, too. So when I would have very crippling anxiety, I would do it, things like that. But then after a while, since I’ve now, you know, I don’t need to do it as much. I can kind of coach myself. I can basically talk myself out of things in some ways, but I’ll still do it. As you were asking, I probably should have done it last night when I was having my panic attack. It did go away. But whenever it’s interrupting my life, basically, when my mind has stopped me from going about my day. So what does that mean? Well, I do write down what I’m going to do every day. I don’t give myself this empty space. I know some people love that, and it’s considered freedom. I find a lot of freedom in. I know what I’m doing each day, because then it allows me to say, okay, wait, no, I’m not really doing what I want to do. So, again, going to these measurements, is this problematic? I just have ways of kind of measuring it, and that’s just been really helpful for me.

00:59:13 – Eric Zimmer
Yeah. I don’t know who said it, but the phrase structure liberates for some of us is really true. I think for some of us, structure is actually very freeing. It’s not that way for everybody, but for some of us, the key being, of course, that we get to decide the structure. Structure imposed upon us is not liberating, but structure that we decide that we’re going to put in place tends to be.

00:59:34 – Sarah Fay
I was just going to say, the other thing that was really helpful for me was Ethan Cross, who you interviewed, has a book called Chatter, where he talks about self talk and just how we speak to ourselves. And I spoke to myself horribly. I always said it was like a mean fifth grade girl on the playground. Just so mean and so really learning how to monitor that and just say, like you were saying. Say to myself, like, no, we don’t talk to ourselves like that anymore.

01:00:01 – Eric Zimmer
Yeah, there’s another great book out there. We interviewed him. His name’s john Acuff, and it’s called Soundtracks, and it’s about a similar idea. We are at the end of our time. You and I are going to continue in the post show conversation, talking all things about this, but we might be talking about medication. We’ll see. I don’t know exactly, but listeners, if you’d like access to this poorly defined post show conversation or all ad free episodes, and to be part of our wonderful community, we’d love to have you. Oneyoufeed.net join. Sarah, thanks so much. Such a pleasure to get to see you again and talk with you again.

01:00:40 – Sarah Fay
So great to be here. Thank you. Eric

01:00:57 – Chris Forbes
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Filed Under: Anxiety & Depression, Featured, Podcast Episode

How to Find Peace and Balance in Managing Anxiety with Sarah Wilson

December 15, 2023 Leave a Comment

In this episode, Sarah Wilson expounds on how we can learn to create space, go slow, and appreciate the beauty of one’s struggles, rather than aiming for a quick fix. Coupled with the proper use of medication and therapy, these strategies can offer a comprehensive approach to learning how to find peace and balance in managing anxiety.

In this episode, you will be able to:

  • Understand the impact of anxiety on mental health and well-being
  • Learn about the benefits and limitations of medication and therapy in managing mental health challenges
  • Engage in a nuanced conversation about mental health, exploring its complexities and varied experiences
  • Take responsibility for anxiety by exploring practical strategies such as slowing down
  • Create space in anxiety management by discovering techniques for finding peace and balance in everyday life

Sarah Wilson is a New York Times Bestselling author, journalist and founder of iquitsugar.com. She has published 15 I Quit Sugar books in 46 countries and in 2017 and 2018, she was ranked as one of the Top 200 Most Influential Authors In The World. At 29, Sarah was the Editor and Chief of Cosmopolitan Magazine Australia and she has also been the host of Master Chef Australia. Her newest book is, First, We Make the Beast Beautiful: A New Journey Through Anxiety and it is this that she and Eric discuss in this episode. 

Connect with Sarah Wilson: Website | Instagram | Facebook | Twitter

If you enjoyed this conversation with Sarah Wilson, check out these other episodes:

Why Anxiety is Good For You with Tracy Dennis-Tiwary

Being Liberated from Anxiety with Kelly Wilson

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Filed Under: Anxiety & Depression, Featured, Podcast Episode

Insights on Mental Health and Resilience with Andrew Solomon

August 29, 2023 Leave a Comment

In this conversation, mental health advocate Andrew Solomon challenges societal norms and explores the complex relationship between depression and identity. Andrew also strives to uncover the delicate balance between suffering and growth in his thought-provoking exploration of the complexities of mental health.

In this episode, you’ll be able to:

  • Uncover why resilience and personal control are integral to overcoming adversities
  • Gain an understanding of the multifaceted nature of depression as both a medical condition and a way of self-perception
  • Understand the profound implications of social media on the mental wellness of today’s younger generation
  • Learn the necessity of a broader vocabulary to accurately represent non-traditional family dynamics
  • Discern the interconnected impacts of neglect, poverty, and foster care on mental health

Andrew Solomon, Ph.D. is a Professor of Clinical Psychology at Columbia University Medical Center, and past President of PEN American Center. He is a writer and lecturer on psychology, politics, and the arts and an activist in LGBT rights, mental health, and the arts. Andrew writes regularly for The New Yorker and the New York Times. His 2012 book, Far from the Tree: Parents, Children, and the Search for Identitywon the National Book Critics Circle Award for Nonfiction and was chosen as one of the New York Times Ten Best Books of 2012. His subsequent book, Far and Away: How Travel Can Change the World, was published in 2016 and has been named a New York Times Notable Book. He previously wrote The Noonday Demon: An Atlas of Depression, which won the 2001 National Book Award and was a finalist for the 2002 Pulitzer Prize. Most recently, he made an award-winning film of Far from the Tree, available on Hulu, and an audiobook called New Family Values. 

Connect with Andrew Solomon: Website | Twitter | Facebook

If you enjoyed this conversation with Andrew Solomon, check out these other episodes:

Andrew Solomon (Interview from 2014)

How Identity Can Affect How You Deal with Depression with Kimi Culp

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