Unsubscribe – THE WALDRONS

When I went in for my annual physical exam with Dr Kaplan this past winter, I was asked to complete a depression questionnaire, a PHQ-10. I already knew the score before I walked in and was already prepared to have the conversation.

I had been feeling really low for a few months and things were not getting better. I am familiar with the PHQ, and my baseline misanthropic nihilism keeps me between a 1-3 most of the time. Things were feeling worse than they had in a while, though, and I was planning to ask for help. This was the worst that I had felt since my thyroid condition and something needed to change.

I wasn’t scared this time, though. The thyroid-thing was really, really scary. Back then, I was having thoughts that I really didn’t want to have. The darkest of thoughts. This time, I was just feeling painfully low. Nothing in life was giving me any joy and the glass was never half-full because it always felt completely empty. Dr Kaplan, being the good man he is, looked at my questionnaire form, turned to me and asked, “Why do you choose to suffer?”

As a student of interviewing, I loved this question. When someone is depressed, they feel like they don’t have control of how they feel. They are often fatalistic. Their depression becomes their identity. To the depressed, depression is a predetermined outcome. It is a character trait. It defines the individual. But that question … right from the start, it re-frames the situation in a manner that shifts the focus toward (1) control (choice) and (2) the downstream effects of the depression (suffering) rather than the depression itself. It was a wonderful tact.

As I said, though, this was a conversation that I had already committed to having. I had already started looking around online for therapists in the area and I was likely going to ask for a Prozac prescription, even though I wasn’t eager for the weight gain that would almost certainly accompany its introduction. You see, I have been through this before.

I have been coping with (mostly) functional anxiety/depression since I was a teen. When I was in high school, I had panic attacks that persisted into my college years. The panic attacks were a symptom of anxiety (more than depression) that was omnipresent through my late twenties when I tried a few different medicines (Buspar, Klonopin, Xanax, Paxil) before landing on Prozac for a few years. Things remained manageable until the thyroid condition, which responded to intervention, but never fully, I think. I don’t recall having the same level of baseline depression pre-thyroiditis as I had post, but I can’t be certain.

Anyway, the moral of the story is that this wasn’t something that was new to me, I knew what I was planning to ask for, and I knew what I was getting myself into. As is usually the case, I had a plan of how things were going to progress, but things Dr Kaplan had another idea: genetic testing.

Dr Kaplan wanted me to setup an appointment to consult with both him and his colleague, Ginnie; she had been using genetic testing for other patients with depression with good success identifying prescription medications with the best likelihood of benefit or avoidance of harm. I agreed to return in a couple of weeks and researched a bit on my own in the intermediate time; there seemed to be a strong case to be made for prior plausibility and there was some evidence that this might be an effective tool.

In the meantime, I had already been researching therapists online. I needed someone who provided telehealth (I would need to do it from home/work depending on my schedule), had their PhD (it is the rare social worker who I relate to at the level required for me to establish a therapeutic alliance), and who focused on Cognitive Behavioral Therapy (CBT, which I am familiar with and has a strong evidence base). Ultimately, I landed with Laura.

When I went into therapy, I thought that I knew what was going on. Much like previous instances of therapy, I was wrong. In this instance, I had not recognized the power that my anxiety wielded and strongly drove of my depression. With Laura’s help, I would learn to recognize that the anxiety that I had experienced throughout the first half of my life was still present and I needed to work to get that under better control.

Flashback

I can’t imagine that any friend from the 1990s would be surprised if I were to them that I was anxious in 2023. My hypochondria and medical student anxiety was not easily guised. I thought I was dying of cancer or a variety of neurological conditions on numerous occasions. Those thoughts/feelings would lead to multiple trips to the hospital with full-on panic attacks, and I was prescription medications to help keep my symptoms at bay. What would surprise those same friends is learning that much of my anxiety was rooted in poor self-confidence.

When I was younger, I wasn’t the ideal/conventional male that the girls in high school were interested in. I was thin, marginally athletic, and not at all adventurous. In short, I was a great guy to be friends with, but not exactly ‘boyfriend material’. I was, however, smart with a quick wit, a strong student, active in the community, and good with kids. Looking ahead, I knew I was confident in my ability to offer a lot to my community and (if I were lucky) a romantic partner.

I really knew it. By the time I was in college, I was very confident in who I was and who I was going to be. I had found my niche and I owned it. I knew how to lean into my strengths and I had found a way to self-select a peer group in college that valued those strengths. If I had chosen to be a PE teacher and attended a state college, perhaps things would have been different, but to be an aspiring pediatric PT in a private college with a service/liberal arts focus, my confidence only grew.

So … what, you may ask, does this have to do with my current plight? This part of the story is for context; we can only fully appreciate where we stand today by knowing how we arrived there. The rest of the story, however … I am sharing that part, the larger part, for the sake of transparent humility, to continue to be true to who I am and who I aim to be, and to move in the direction of progress, not regress. But, most importantly, I am trying my damnedest to not be a hypocrite.

You see, at around the same time that I was coping with my own depression/anxiety, it came to light that Victoria was dealing with some things of her own too. And while this story isn’t and can’t be about her, the path I chose was most definitely for her. My path of intellectual and emotional humility through therapeutic intervention and self reflection is available to her to serve as a model. No, my path can’t be hers, but I can show her how it is possible to forge a healthy path forward. I can show her how my feelings are not my identity. I can illustrate that we are capable of shaping our thoughts and our feelings in a manner that doesn’t change who we are, but embraces who we aim to be. I didn’t want to hurt anymore and I made a choice to do something about it because I could. Anyone can, so long as they have the desire and the support. I had both. One day, I hope she does too.

But I digress …

I often think about that (over)confidence that I had in my late adolescence and early adulthood and I wonder how much of it was authentic. It felt authentic at the time, but I wonder now how much was a cloak that I wore to shroud others and myself from my insecurities. I wonder how much I was stacking the deck and forcing a play. If my confidence was indeed authentic, I wonder how much of it was fruit from a tree that I planted, by exercising control and choosing a profession, school, and peer group that suited me. Looking back, I can’t be certain, but I recognize that even my greatest confidence was never able to guise the frailty of all things.

Meaning from Meaninglessness

Everyone knows that life is frail; we can kiss our loved ones on the forehead, make plans for dinner later in the day, exit the home, get in the car, drive away, and be fatally struck by a distracted driver who crosses into oncoming traffic while haphazardly scrolling their Instagram-feed. Life is bigger than that, though. We know that we might get in an accident, but most people don’t think about what might happen if their partner gets in that accident. Or if their kids are standing on the sidewalk when a different car veers in the wrong direction. Or if their lover meets someone new/exciting. Or if we step down from stairs awkwardly and develop chronic and disabling pain. Or … well, you get the point. Our lives are all so very, very frail because they rely on circumstance in more ways than we can possibly understand or comprehend.

When my thyroid was under attack, I was struggling with the same thing that most self-reflective atheists eventually struggle with: absurdity. We are creatures seeking purpose in a world without any. But still, we need a reason to get up out of bed in the morning, so we need to think. Ponder. Contemplate. We know that our lives are nearly meaningless, because we see evidence of it every day. If you pull back far enough and view the workings of the world through a wide enough lens, the meaninglessness is stark. But alas, much like the science of physics, we still have an opportunities for meaning, if we zoom in and look close enough.

You see, in physics there are laws that work at different levels of explanation. There are Newtonian mechanics, which are valid, and there quantum mechanics, which are also simultaneously valid. Newtonian physics works on particles larger than the subatomic while quantum mechanics work on a much smaller scale. The same can be true for meaning: what is true for humanity writ large (meaninglessness) needn’t be true for the individual (meaningful). It is a matter of scale. It is my view that I can only derive meaning from the smallest hyperlocal interactions, and even then, the meaning that I derive from acting in any given space may be disproportionate to the meaning perceived by other actors in the same space.

Of course, complex social interactions of complex social creatures will never yield predictable results … we never know what may or may not result from the choices that we make. We never know how underwhelming or oversized any consequence might be. We only know that if there is a chance that we can make a difference and exert our will in the direction of meaning, it must necessarily be at a hyperlocal and interpersonal level. It is the only chance that we have, if there is any chance at all.

Seeking perspective

So what does this have to do with depression/anxiety? I don’t know for certain, but I think it has something to do with distortions. You see, when I take my camera out for a walk in the woods, I bring a variety of lenses in my bag. At minimum, I typically travel with telephoto, macro, and wideangle lenses. Each has its own strength and each has its own weaknesses. Telephoto lenses help us photograph things far away, but usually at the expense of surrounding context. A macro lens allows the photographer to see tremendous detail, but without any focused depth. The wide angle lens, like we have on most cell phone devices, allow us to capture an entire scene with detail, but not without a distortion and a loss of resolution and subject separation.

In this metaphor, I have come to see depression as realism unknowingly viewed exclusively through a broken zoom lens. Humans evolved over hundreds of thousands of years by being able to shift from one view to another, but always through a narrow field of view. The focus had to be narrow and local: kin and clan, here and now. Sure, there was some planning from season to season, but there was no consideration of societal progress on a grand scale. And while humans evolved with a telephoto view of the world, it is only in recent history that humans have begun to try to deploy new lenses with varying degrees of success.

The success of science, for instance, is a direct result of a reductive approach to problems through a macro perspective. To date, the goal of science is to look at small things with increasing fidelity until they reveal their truths to us as observers. And while this reductive approach has increased our life expectancy and improved our quality of life, it has its limits when it bumps headlong into complex problems that seem to simultaneously require placing a macro lens over one eye and a wide-angle lens over the other. We never evolved to see such problems from such perspectives. Perhaps one day humans will be better equipped to address the challenges that they face, but today we are woefully inadequate.

And herein lies the problem for me. My depression stealthily forces me to view the world through a fixed lens that clouds judgement, because it only allows me to to see the world through a very narrow perspective. Depression prevents me from zooming out enough to see context. In this manner, the difference between the photographer and the depressive is that the photographer can take his eye away from the camera to see the world for what it is while the depressive struggles to ever look through any other lens, any other length, or any other field of view. The depressive-lens necessarily forces perspective on the viewer. It forces me to see the world from a singular and interpersonally ineffectual level. I am forced to live with a view that is zoomed in too far to see that I can (do!) matter.

Orders of operation

Humans like to think that we are rational, but it is more a story that we tell ourselves than it is a reality. What we fail to recognize is that we have the tools for reason, but we do it wrong. More importantly, we can never do it right. Not perfectly anyway. You see, we know the basic facts, but we are incapable of knowing how or when to apply them.

Consider for a moment this simple problem:

3×4-8/2+5= Y

Obviously, in the world of mathematics, the answer (Y) is 13. In the world of reason or rationality, the answer (Y) would almost certainly be 7. Why would that be?

From late elementary school forward, students are taught that there is a sequence to how they are to complete the operations of a problem: multiplication and division then addition and subtraction. In the above example, we multiply 3×4 (12) and then divide 8/2 (4) before subtracting 4 from 12 and adding 5. That is NOT how rationality works.

Reason and rationality, unfortunately, is employed out of sequence. We do our thinking out of order, because most of our thinking is done out of view, subconsciously. We reason on top of emotions. We reason on top of perception. We can only be truly rational if we account for the fallibility of perception first, reason next, then emote after. To reason on top of emotional output and misperceptions is futile if rationality is our goal. It might (and often does) yield the best possible result, but an almost always imperfect one. Without processing our thoughts and ideas in the optimal sequence, we necessarily multiply 3×4 (12), then subtract 8 (4), then divide by 2 (2), and add 5. 7 is close, but it often isn’t good enough.

Hijacking

So, in my telling of the story of my depression, I am viewing the world in manner that I don’t see my impact/meaning in, and then I am left to reason on top of a distorted view of that same world. But why does that lead to sadness and anxiety?

As I understand it, it has something to do with evolution and the sympathetic nervous system, better known as the “fight or flight” system. The oft used example is of our very distant and pre-homo sapiens ancestors, hunting or moving through the prairie or jungle. These very, very distant relatives were NOT alpha predators. They were often too slow to outrun or too weak to outfight their predators, but some still managed to survive. The creatures that had the most “fitness” were the ones who procreated and the species slowly evolved over hundreds of thousands of years to eventually result in what and who we see in the mirror today.

Today, we needn’t be as vigilant when we are walking on the sidewalks or sitting at our desks as when our distant ancestors walked the plains or settled down to rest in the forest. Our ancestors had to be on alert all the time. Their eyes had to be open. They had to listen carefully. The needed to sense when things weren’t right, even if they couldn’t know exactly what it was that made them feel uneasy. They had to be ready to run or fight in a moment’s notice. Their sympathetic nervous system needed to be well tuned, primed, and ready to go.

We are equipped with the same protective mechanisms today, and they are sometimes useful, especially in emergencies and violent environments. But those same mechanisms can be co-opted and reallocated for use in today’s more peaceful and safe environments as well. When I am only seeing the world through a cloudy fixed lens, I am inundated with scenes and stories of inadequacy, ineptitude, and apathy, it feels threatening and overwhelming. My hypothesis is that I begin to feel anxious as my sympathetic nervous system deploys the same innate defense mechanisms against my insecurities as it would if I were threatened by a large predator on the Savannah. My anxieties begin to exhaust me as there is never any hope in sight and (eventually) nihilism, emotional isolation, and depression begin to settle in as I perceive no way out of the the perceptual cycle of emotional angst that I experience every day. I feel powerless while my point of view feels nothing shy of well-reasoned and justifiable.

Goals

If we recognize that depression/anxiety is an understandable and ultimately predictable failure of our ability to reason, then the only reasonable and rational way to overcome our depressive symptoms is to somehow account for the weaknesses, preconceived notions, and confirmation biases that lead us to arrive at false conclusions. How do we accomplish such a feat? We follow the example set by Albert Einstein.

What does Einstein have to do with depression? Nothing that I am aware of, actually, or at least not directly. But then again, neither does order of operation in mathematics, camera lenses, or Newtonian physics, but somehow I am weaving it all together. My mention of Einstein should be no different. But seriously, there is a small lessen to be learned.

You see, when Einstein was trying to develop a mathematical formula to explain the expanse of the universe, the math wasn’t working out: no matter what, the math wasn’t allowing for a static universe. Instead, his math showed that the universe was actually expanding. Convinced that the universe was indeed static, Einstein would introduce to his equation the “cosmological constant coefficient”, a multiplier in his formula that brought his results into an acceptable and stable range.

Of course, since then, scientists have learned that Einstein’s math didn’t need the cosmological constant coefficient after all; the universe is actually expanding. But the current standard model of cosmology continues to require a cosmological constant to account for dark energy, which is postulated to comprise 68% of the mass density of the universe. In short, the scientists know that their math is somehow off (even if they don’t yet know exactly how), so they add a variable to offset some errors in the measurements.

We need do the same thing with the treatment of depression. We need to introduce new cognitive or perceptual variables to achieve a more reasonable outcome. We need a cognitive coefficient to balance against those weaknesses, preconceived notions, and confirmation biases that we are growing increasingly aware of.

Variable #1 – Medication

Medications work. Not every medication works for every person. And not every person has the same physiologic response to every medicine (or class of mediation, for that matter), but still … if a patient is willing to work collaboratively with their provider, medications can have a significant and positive impact once the appropriate dose of the appropriate medication in place.

When my genetic tests came back, it was clear that there wouldn’t be a magic bullet. To the contrary, my results revealed that I have some genetic alleles that poorly correlate with the adequate uptake of the therapeutic ingredients of nearly all anti-depressants. In short, I am unlikely to adequately metabolize most anti-depressive medications. Without proper metabolization/breakdown of the medications, they are prone to remain in my bloodstream longer and at higher concentrations, simultaneously increasing the risk of side effects while reducing clinical effectiveness. In hindsight, perhaps this little bit of knowledge explains my poor response to medications when I first tried them nearly 20 years ago.

But this time I had more knowledge than before and I elected to start with a low dose of Bupropion (Wellbutrin). I selected Bupropion because it is not an SSRI (Selective Seratonin Reuptake Inhibitor, a particular class of anti-depressants that I had previous experience with) so I would be less likely to experience side effects, and I wouldn’t have to be as concerned about weaning myself off of the medication if I didn’t like it.

Within 5 days, I was beginning to feel different. My mood wasn’t necessarily better, but I had a sense of having more energy. I wanted to get up and do something, even if I didn’t know exactly what I wanted to do. I still had the same thoughts as ever but they just seemed a bit lighter. Or maybe my heavy thoughts didn’t feel lighter so much as there was a new fuel that was lent to some of my less depressed thoughts/feelings. Either way, I felt a bit more balanced and my mood felt buoyed.

But it wasn’t without it’s side effects and – ultimately – they proved to be more than I was willing to cope with. In particular, I experienced symptoms of what I self diagnosed as tardive dyskinesia. I have seen dyskinesia in patients with schizophrenia; it is a known side effect of anti-psychotic medications and not unheard of with people taking Buproprion. I have worked with folks whose symptoms are so severe that they are challenged to feed themselves or walk. My issues were minuscule in comparison, but – in my assessment – I wasn’t getting enough benefit from the medication to make the side effects worthwhile.

That doesn’t mean I wasn’t starting to feel better, though. I just didn’t think that the medicine was the primary intervention of benefit.

Variable #2 – Cognitive Behavioral Therapy (CBT)

I had actually started CBT before I had completed all the testing and appointments to figure out what medicine I wanted to trial.

Fortunately, buying into CBT was easy for me. I already knew it to have a strong evidence base, I have used principles of CBT in patient interactions in my role as a physical therapist, and I found a therapist who was a great fit for my needs and expectations. Laura had her PhD and told me from day one that treatment would be patient centered, goal directed, and very finite. If I was just looking for someone to talk to for years and years, she encouraged me to take my business elsewhere. This was music to my ears, and I quickly learned how irrational I am.

Cognitive Distortions

Early on, I learned about cognitive distortions and how to identify them. In moments of argumentation, I am able to point out such fallacious thinking in other people’s arguments, but I was failing to recognize the same flaws in my own judgements. I learned how susceptible I was to these distortions (some more than others, of course), especially when they were centered around topics that were particularly powerful in provoking my anxiety about meaninglessness in the world. Some common distortions include:

Filtering: draining and straining all positives in a situation and, instead, dwelling on its negatives
Dichotomous (all or nothing) thinking: engaging in thoughts of A/B or black/white thinking, without any shades of gray
Blowing things up: making a really big deal out of something small, or making something a little bit bad seem like the worst thing ever
Overgeneralization: taking an isolated negative event and turning it into a neverending pattern of loss and defeat; words like “always,” “never,” “everything,” and “nothing” are frequent in our train of thought
Discounting the positive: similar to mental filtering, the main difference is that we dismiss the positive as something of no value when we do think of positive aspects/things
Jumping to conclusions (mind reading): interpreting an event or situation negatively without evidence supporting such a conclusion; it is often in response to a persistent thought or concern of ours
Catastrophizing: jumping to the worst possible conclusion in every scenario, no matter how improbable it is. This cognitive distortion often comes with “what if” questions
Personalization: leads we to believe that you’re responsible for events that, in reality, are completely or partially out of our control; we feel guilty or assign blame without contemplating all factors involved
Control fallacies: feeling responsible or in control of everything in ours and other people’s lives, or feeling as if we have no control at all over anything in our life
Fallacy of fairness: believing we know what’s fair and what isn’t; it is upsetting when other people disagree with us
Blaming: holding/making others responsible for how we feel; this distortion comes from believing that others have the power to affect our life, even more so than ourselves (e.g. “You made me feel bad.”)
Shoulds: subjective ironclad rules we set for ourselves and others without considering the specifics of a circumstance
Emotional reasoning: leads us to believe that the way we feel is a reflection of reality (e.g. “I feel this way about this situation, hence it must be a fact.”)
Fallacy of change: expecting other people will change their ways to suit our expectations or needs, particularly when we pressure them enough
Global labeling: an extreme form of overgeneralization that leads us to judge an action without taking the context into account. This, in turn, leads us to see ourselves and others in ways that might not be accurate
Always being right: we see our own opinions as facts of life, explaining why we will go to great lengths to prove we’re right

Laura helped me realize my anxieties surrounding the fraility of meaning and purposefulness were constant and smoldering, always waiting for my cognitive distortions to refuel yet another anxious flame. And these distortions, they are insidious. The conclusions feel so right in the moment, obvious even. But they are neither.

Have you ever felt like the rest of the world must be mad? That you are the only one who seeing something for what it really is and everyone else is blind to an obvious reality that only you can see? That might very well be true, but – odds are – you are experiencing a cognitive distortion and it is time to step back and consider how rational you are being. It is time to try to identify distortions and reassess not just how you are thinking, but what you are feeling and why.

Pushing Back

We can explore how we are thinking by asking ourselves disputing questions. A few examples might include:

Do I know for certain _______?
Am I 100% sure that _______?
What evidence do I have for _______? … and … What evidence do I have that the opposite might be true?
What is the worst that could happen? How bad is that? How can I cope with that?
Do I have a crystal ball?
Is there another explanation for _______?
Does _______ necessarily have to lead to or equal to _______?
Is there another point of view?
Is focusing on this helping me?

Let’s use a common notion/thought that often impacts many folks with depression: they believe that they are unlovable. The above questions, if asked earnestly, can be disarming.

Do I know for certain that I am unlovable?
Am I 100% sure that I no one loves me?
What evidence do I have for my being unlovable? … and … What evidence do I have that might be lovable?
Is there another explanation for why I was ignored by someone I love this morning?
Does (in my case) my balding necessarily have to lead to or equal people not loving me?
Is there another point of view?
Is perpetually focusing on why people shouldn’t love me really helping me?

Of course, these questions are designed to point out or illuminate cognitive distortions. They are intended to encourage us to swap lenses, to zoom out, and to change perspective. They have the ability to help us see things from a bit more of a balanced point of view. As an extreme example, I recognize that I don’t have the face of Brad Pitt, the body of Channing Tatum, the intelligence of Neil deGrasse Tyson, the charisma of Barack Obama, the wit of Conan O’Brien, or the money of … well, a lot of people. If I were to focus on all the things that I am not, it can begin to weigh on me. Not handsome enough, not strong enough, not smart enough, not appealing enough, not funny enough, not rich enough … and on, and on, and on.

Of course, no single person checks all those boxes and if my best friend told me that they were feeling down because they weren’t meeting all those standards, I would proceed to tell them how crazy they are. I would tell them that the world is just too big for us now and that is okay.

You see, when people used to exist in small communities or tribes, they were able to see their relative value and contributions on a smaller scale and the proverbial bar that we would set for ourselves didn’t need to be set so high. But now? Information about the entire world is in the palm of our hand and we are inundated by culture, media, and advertising that informs us of our inadequacies in order to sell us products and experiences to fill the same holes that they drill out of us. The most attractive person in town? Relatively ugly. The strongest? Relatively weak. The smartest? Relatively stupid. The most charismatic? Relatively boring. The funniest? Sorta tragic. The richest? Probably just middle class. I would remind my friend of how much I love them, and – unless they think I am a liar or a terrible judge of character – my love alone is evidence that they are made of so much more than they can see or acknowledge themselves. When done right, that is what CBT accomplishes.

Depression or anxiety … they are the proverbial devil on our left shoulder, ceaselessly whispering and constantly reminding us of all of our inadequacies and insecurities. CBT gives us another voice to listen to. CBT’s voice that is also internally driven, but it differs, because it is purposefully tapping into reason and rationality rather than fear and emotion. CBT doesn’t mute the devil on the left shoulder, but it does offer a different perspective that we can listen to in order to give ourselves more balance in our thinking, which in turn affects how we feel, behave, think, feel, behave, think, et cetera, etc., etc. In this manner we become our own best friends, walking ourselves back from those moments when we are most fraught.

Cognitive Restructuring

In my mind, there were two character traits that have helped me get this far, and I want to take a moment to mention them, because I consider them to be prerequisites for success with CBT: humility and curiosity. If we falsely know ourselves and our experiences to necessarily be righteous and true, the process will take much longer. But if we are already aware of our fallibility from the start and are curious why and how to be better, the first half of the battle is already won. Strangely enough, much of the philosophy, neuroscience, and psychology that often weighs on me existentially simultaneously offers me the perspective that I need to bring balance to my thinking. It turns out that I was (unknowingly) consuming and contemplating asymmetrically, but – in therapy – I was learning to use thought exercises to become more equanimous, a word very much consistent with my readings of stoic philosophy, something I will revisit shortly.

The most effective way for me to look at things more reasonably was to identify moments in the day when I was feeling something very intensely, recognize that it was becoming overwhelming, distracting and/or anxiety-provoking, and then proceed to take myself through a comprehensive thought-exercise. For instance, revisiting the notion of feeling of being unlovable, I might need to zoom out and ask myself some questions:

What is happening right now? nothing especially interesting/different, just life
How am I feeling right now? unlovable
How intensely do I believe it? 80-90%
What thoughts do I have surrounding that feeling, and how strongly do I believe them? Not good enough (100%), not attractive enough (100%), not funny enough (100%), not fit enough (100%)
What evidence is there for those thoughts? There people who are funnier than me, people who are more attractive than me, people who are fitter than me.
What evidence is there against those thoughts? There people who are not as funny than me, people who are less attractive than me, people who not as fit as me.
A balanced, alternative, more helpful, and accurate thought based on the evidence for and against my initial thoughts might be: The bar for what is or isn’t “enough” is arbitrary and creates a false dichotomy. My depression has a way of placing me on the wrong side of a perceptual threshold while ignoring the likelihoods that any and all personal attributes lie on a continuum and any evidence to the contrary

Then it is time to reassess: after exploring the thoughts that I am having surrounding a feeling, examining the evidence for and against those thoughts, and crafting a balanced and more accurate thought based on a less selective and more purposeful review of all the information available to me, I ask myself: How strongly do now I feel that initial feeling? More often than not, much like talking to a friend, I feel better. I still might not like how I look, or I might wish I were funnier or smarter, but I will also remember what it was like the last time I sat in a public park and took in all that surrounded me. I will remember that no one looked like Brad Pitt. No one had the physique or jawline of Channing Tatum. And, no, not a single person walked and wowed with me with oversized intelligence, charisma, or comedic wit. I remember that while I might not be perfect, no one else is, but almost everyone – in one way or another – is enough. I probably am too.

That is the process. It is harder than taking a pill, but it has a much, much longer half-life. And the more and more that I learn how to flex those cognitive muscles, or use those neurological pathways, the easier it becomes. I more readily recognize unhelpful feelings and remind myself that I’ve already considered them in the past. I more easily recognize when I am starting to spiral and can stop for a moment to consider how much I believe what I am feeling and then explore why. I am able to zoom out and look at the world from above.

Stoic Meditations

For the last few years, I have explored the notion of Stoic philosophy. Offering me the most practical of my philosophical readings, the Stoics aimed to provide a framework for living a eudamonic life. In contrast to the hedonists (who sought pleasure and enjoyment that comes from peak moments of positive experiences, deriving satisfaction from their desires and needs), the stoics aimed to live in accordance with virtue, thereby living a life of happiness and flourishing (eudamonia). In this manner, happiness is achieved only through the development of our internal state and our character. To the Stoics, one must first learn to understand the universe we live in, then learn to accept it as it is, rather than resist and attempt to change what cannot be changed.

To fully explore the pillars of Stoicism would be too large an undertaking for the sake of this posting, but it is important to note that CBT and the Stoics have a lot in common. Both acknowledge that feelings are very important and shouldn’t be ignored or repressed. Both approaches aim to see the world as it is, not how it feels. And as importantly, both approaches offer the individual a means of stepping outside oneself while encouraging us to obtain a third person account of our world. In CBT, we look for external evidence for and against our thoughts and reshape our thinking in accordance with that evidence. The stoics too give us a similar “view from above”.

“Think of substance in its entirety, of which you have the smallest of shares; and of time in its entirety, of which a brief and momentary span has been assigned to you; and of the works of destiny, and how very small is your part in them.”
Marcus Aurelius

The “View from Above” thought exercise/meditation, encourages us to look at ourselves from a third person perspective to help us see ourselves and our concerns more objectively. In doing so, we hope to distance ourselves from our worries, anxieties, and problems so that we can see them more clearly, less emotionally, and have a better chance of understanding their causes and solutions. Sound familiar? The closer we are to our problems, the more difficult they can be to see clearly and objectively, but if we are able zoom out and look at the wider picture of our lives, it becomes easier to see things in context. To do this, we start at a small scale, considering just ourselves and out immediate surroundings, our first-person experience. Then it is time to start to zoom out.

Imagine yourself leaving your physical body and hovering above your household and the people you live with. Think about what they feel, how they relate to one another, what problems, hopes, and fears they might have. Consider for a moment how their feelings, problems, hopes, and fears influence their behaviors, how their behaviors interact with yours, and how their feelings, problems, hope, and fears become inexplicably intertwined with your own. Appreciate the complexity of that interaction … then zoom out.

Now you are viewing your town or city, and how everyone who lives around us has a unique life that you know nothing about. They too have hopes, dreams and fears just like us. We pass them in the street or in shops, however we rarely think about who they are as people. Think about all those lives, perspectives, and experiences and then, when you are ready, zoom out to your county, then zoom out to your state, then zoom out to see your country, then zoom out to see all of planet Earth.

Earth. We begin to think about all the people on the planet, all of the lives spread across countries, social classes, races, cultures. We think about what hardships some of the worse off people are going through. Not only that, but the system as a whole is interconnected, one action leads to another, leads to another, leads to another in web of causality. We think about the rivers and the mountains, the wildlife, the wind and rain, the heat of the sun and the cold of night. We view everything having an impact on some other thing, and life is seen as an extremely complex series of impacts. But that is only one measly planet. Zoom out more.

The solar system. We seem small now, our place in the universe is tiny in comparison with the planets and the stars, until – of course – we zoom again to see the universe and all of existence. Our place in the universe seems impossibly small in comparison to all of space. It’s humbling. Time is vast, the scale of space is incomprehensible. We exist for just the tiniest sliver of time on what Carl Sagan beautifully coined “the pale blue dot” when viewing Earth at a distance, from images captured from Voyager 1. He wrote:

That’s home. That’s us. On it everyone you love, everyone you know, everyone you ever heard of, every human being who ever was, lived out their lives. The aggregate of our joy and suffering, thousands of confident religions, ideologies, and economic doctrines, every hunter and forager, every hero and coward, every creator and destroyer of civilization, every king and peasant, every young couple in love, every mother and father, hopeful child, inventor and explorer, every teacher of morals, every corrupt politician, every “superstar,” every “supreme leader,” every saint and sinner in the history of our species lived there-on a mote of dust suspended in a sunbeam.

The Earth is a very small stage in a vast cosmic arena. Think of the endless cruelties visited by the inhabitants of one corner of this pixel on the scarcely distinguishable inhabitants of some other corner, how frequent their misunderstandings, how eager they are to kill one another, how fervent their hatreds. Think of the rivers of blood spilled by all those generals and emperors so that, in glory and triumph, they could become the momentary masters of a fraction of a dot.

Our posturings, our imagined self-importance, the delusion that we have some privileged position in the Universe, are challenged by this point of pale light. Our planet is a lonely speck in the great enveloping cosmic dark. In our obscurity, in all this vastness, there is no hint that help will come from elsewhere to save us from ourselves.

The Stoics believed that by using the view from above, we can find ourselves closer to happiness. It seemed reasonable to them that if we are able to change how we look at our environment and our place in, we can reduce the effects of fear, anger and frustration. When we zoom out to see the world as a whole, bickering and minor disagreements seem downright silly, and many of our problems dissolve when we hold them up to the problems of others, or the vastness of space. Meanwhile, at the same time, we increase our capacity for compassion, understanding and objectivity, because we have started to develop the capacity to view other lives as part of the system we live in.

The view from above demands that we think not just about ourselves, but about other people, and other creatures that share the universe with us. We are instructed to raise our awareness outside of just ourselves and encompass the people around us so that we think about:

the fears, passions, experiences, perceptions, anxieties, insecurities and dreams they might have
what they do, how they act, what they feel, and the causes for all of those things
the people around them, the environment they’re in, and how those things form them as people

The more we perform this type of exercise, the more we empathize. We begin to understand the people around us, and why they do what they do. Everyone is trying to do the best with what they’ve got, and it becomes clear that even the most destructive behaviors are typically the understandable result of poor or misinformed beliefs, values, and experiences. In this manner, the stoic view from above can help us understand others, and in doing so, it can help us understand ourselves.

Bulk Select

When I was meeting with Laura, she used a simple analogy that seemed fitting. She said that my depression/anxiety was sorta like being auto-enrolled to an email newsletter that I never asked for and therapy could afford me the opportunity to unsubscribe. I wish that were true, but it isn’t. Neither medications, therapy, or philosophical meditations can stop my depression. Nor can they stop my anxiety. I can’t even manage to filter them to spam. No … those feelings land in my metaphorical inbox numerous times every day, after day, after day, and they don’t ever stop, but that is okay.

While therapy and stoicism didn’t teach me how to unsubscribe, they did help me learn that I don’t necessarily need to read the newsletter, either. If I’ve read one, I’ve read them all. The content is uninformative and misleading propaganda. It is trying to sell me something that I don’t want to buy. It is unhealthy. It isn’t at all helpful. It is mindless drivel, composed by the most insecure parts of me.

So what do I do? I receive metaphorical newsletters every day that remind me of my depression, anxiety and insecurities, I acknowledge that they are there, and then I make a concentrated effort to spend a little time every day to select all of those newsletters all at once … and send them to trash.