During my sophomore year at Middlebury College, I took notoriously tricky course called Introduction to Modern Logic. An early requirement for philosophy majors (one of the many declarative detours I flirted with before landing on the equally useless History degree), it focused on good reasoning and the technical breakdown of arguments.

A basic example:

If Bellaroo is napping on her dog bed, then Bellaroo is not taking a walk.

Bellaroo is napping on her dog bed.

Therefore, Bellaroo is not taking a walk.

The statement is true in all circumstances, regardless of time, interpretation, or the laws of physics. If Bellaroo is napping on her bed, she is irrefutably not taking a walk.

The point of this course is to help students identify patterns of good reasoning and patterns of bad reasoning, so they have a better idea of what to follow and what to avoid. The tricky part occurs when a statement seems true at first glance, but breaks down when logic is applied. These are called logical fallacies, and they are everywhere.

A few examples:

The Appeal to Ignorance, where we assert a claim because no one can prove otherwise.

People have been praying to God for years. No one can prove He doesn’t exist. Therefore, He exists.

The Bandwagon, where we assume something to be true or good just because many others believe it to be true or good.

Everyone at the gym is wearing Lululemon. I need to buy their yoga pants.

The Red Herring, were we use irrelevant information to distract from an argument.

There are starving children in Africa. Eat your broccoli.

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Psychiatry, more than any other branch of medicine, is saturated with logical fallacies. Hell, we can apply all three of the above examples to cultural rationale within the world of psychiatry and mental health:

The most pervasive logical fallacy in psychiatry and mental health diagnoses, though, is circular reasoning, which is an argument that uses the same statement as both the premise and the conclusion.

The reason why circular reasoning is so pervasive in psychiatry compared to other specialties is because psychiatry doesn’t have any form of objective boundaries. The rest of medicine, generally, agrees on parameters that define a pathological disease. Diabetes in the United States is only diagnosed as diabetes when two fasting A1C blood sugar tests read 6.5% or higher. Doctors—and even different countries—debate 6.5% as the cutoff, but all agree that at a certain point, high blood sugar levels indicate disease.

But psychiatric criteria cannot explain behaviors or experiences through any means beyond subjective opinion. Furthermore, as we’ve been exploring throughout the last few issues, these subjective opinions are rooted in norms and meaning. They can’t be measured independently, and they are not necessarily true across time and culture.

And yet, the flywheel of circular reasoning continues to spin, flinging the world of mental and emotional health further away from the solution. As British child psychiatrist Sammy Tammi said in his open letter on the diagnostic model of psychiatry to the Society of Humanistic Psychology, “The result of this basic [logic] error is that medical scientific knowledge in the area of mental health is at a standstill. No chemical imbalances, consistent neurological differences, genetic abnormalities or markers found. None. Billions of dollars of wasted money on wasted biological research that leads nowhere…higher levels of reported stress and anxiety, higher numbers of people disabled due to a mental health condition and rates of significant improvement from those attending mainstream services hovering at around a quarter to a third of those they see. These are not the outcomes you would expect to see from an effective model of clinical care.”

“When humans do not assume they have rather complete control of their experience, they do not so deeply fear those who have appeared to have lost it.”

—Juli McGruder, anthropologist

As of late, I’ve been learning about the different expressions of perceived mental illness around the world. I use “perceived” in this context because the more I learn, the more I understand that symptoms of mental/emotional distress are tied to cultural expectations. (See the TikTok tics from issue 105.) Said another way, the lifecycle of mental illness is influenced by the macro and micro-level beliefs that surround it. What’s considered crazy in one culture is accepted in another.

On a macro level, the prevalence and intensity of schizophrenia vary from place to place. Men living in urban areas of Sweden, for example, are at a 68% higher risk of being admitted for psychosis than those who live in the countryside. This is also true for urban settings in the United States and Europe, and it remains constant even when migration, drug use, and poverty are taken out of the equation.

Furthermore, a 25 year study conducted by the World Health Organization that began in the 1960s found that people diagnosed with schizophrenia in developing countries have better outcomes, longer periods of remission, and higher levels of social functioning than those in industrialized nations. Known as the International Pilot Study of Schizophrenia, the data showed that over time, 40% of schizophrenics in countries like the United States, Denmark, and Taiwan were considered “severely impaired” compared to 24% of people in countries like India, Nigeria, and Columbia.

Of course, these findings ignited a hot debate because the results are counterintuitive. You’d think all the money, research, and resources would lead to better outcomes. But alas, the data showed the opposite to be true.

(Side note, half a century later, our use of psychotropic medicine continues to reflect what we knew in the 1960s and 1970s. Are poor nations tragically underserved by psychiatry? Or have they avoided the crosshairs?)

This debate is the heart of cross-cultural psychiatry research. While it’s interesting in its own right and the conclusions are, to me, dead obvious, I find the micro influences to be even more interesting. It’s not just about the culture we live in. But the roof we live under.

Expressed emotion (EE) is a term used to describe the way that family members and caregivers interact with a person. High EE is characterized by critical, hostile, and emotionally overinvolved behaviors. Low EE is characterized by warm, supportive, and accepting behaviors. While expressed emotion is not the cause of distress, it can influence the course and outcome in an individual.

We all know that when our actions are met with criticism or hostility, we don’t fare as well. But emotional over-involvement requires more explanation.

Emotional over-involvment is characterized as a range of dramatic behaviors ranging from self-sacrifice, extreme devotion, overprotectiveness, or intrusiveness over a person’s life. Control, essentially.

Ethan Watters uses an example in his book, Crazy Like Us, that describes a mother who was so emotionally over involved with her son’s schizophrenia that she “dropped all other interests from her life. Her sole activity, she reported, was to take care of him and protect him, ‘like a pearl of a diamond.’ This same mother said that she often became so distraught over her son’s plight that she considered committing suicide by throwing herself down the family staircase.”

In addition to raising stress levels in the sufferer—which in this case, could trigger schizophrenic episodes—this maligned strategy is a constant reminder to the person suffering that those around him perceive him to be ill, which in turn, reinforces the idea that something is wrong.

Watters gives a contrasting example of a family in Zanzibar with a schizophrenic daughter, Kimwana, who overdosed her medication and nearly died. Juli McGruder, an anthropologist who witnessed the scene said, “There was no noisy woe-is-me talk or dramatic wringing of hands. [The family] seemed to take it in stride like everything else…When I asked what I could do, [the mother] told me I could take a carton of milk to Kimwana in the hospital.”

The ability for the family unit to keep calm and carry on benefitted Kimwana. The family’s perspective, in part because of Zanzibarian beliefs include spiritual possession, allowed everyone to embrace the idea that difficulties—and even voices in the head—are a natural part of life. Therefore, disruptive behavior as a result of these difficulties was more understandable and forgivable. Kimwana wasn’t viewed as other, or as someone to be feared. She was viewed as a strong expression of what we all have inside of us. This kept her within the social group.

Anglo-Americans have the highest level of expressed emotion compared to different groups around the world. Given that we no longer let our kids have sleepovers, have unsupervised play, or breathe without parental supervision, this shouldn’t be surprising. According to researcher Jill Hooley, Anglo-Americans have a strong “locus of control,” which means they believe a person can be master of their own fate and control their own issues through force of will. The critical, hostile, and emotionally over involved actions stemming from this locus of control aren’t necessarily cruel in intent, but are instead an expression of assumed (and flawed) human nature.

Cultures with more fatalistic or spiritual values place less focus and/or blame on those with mental and emotional distress. Conversely, in cultures that value personal accountability and individualism, highly emotionally involved relatives are actually more hopeful about the disease because they are convinced recovery is a matter of will—both on their part and the part of the sufferer.

But as they say in football (soccer), “It’s the hope that kills you.”

Watters says, “One typical father described his reaction to the schizophrenic break of his son: ‘I went to the library and began reading books about mental illness…I thought: “No, I’m going to fix this.” That is your first instinct as a parent. You’re going to fix it. I thought, “I can get him help. I can get him cured.”…That intense focus, even when it springs from a hopeful engagement of the problem, might be the very thing that exacerbates the illness.”

Furthermore, our obsession with the biomedical model of mental illness only exacerbates emotional over involvement. Take the following Euro-American norms:

By applying these norms to an individual, we separate them from the group by labeling them as Other, all while promoting the idea that recovery is never really possible. How could it be, if mental illness is nothing more than a stroke of bad luck and questionable genetics?

In 1997, Sheila Mehta of Auburn University got curious about whether or not the “brain disease” narrative of mental illness actually reduced stigma, as promised.

In her experiment, she paired up people for what test subjects thought was a simple learning experiment. Unbeknownst to the test subjects in the study, their partners were actors and were instructed to inform the test subjects during the get-to-know-you phase that they suffered from mental illness.

The actor told the test subject that the distress occurred because of the “things that happened to me when I was a kid or that they had “a disease just like any other, which affected my biochemistry.”

In the experiment, the test subject was assigned to teach the actor a pattern of button presses. When the actor got the pattern wrong, the test subject was told to give the actor a “barely discernible” to “somewhat painful” electric shock.

Test subjects who believed their partner had a “disease like any other” increased the severity of shocks at a faster rate than those paired with the actor whose issues were caused by childhood events.

Mehta said, “The results of the study suggest that we may actually treat people more harshly when their problem is described in disease terms. Viewing those with mental disorders as diseased sets them apart and may lead to our perceiving them as physically distinct. Biochemical aberrations make them almost a different species.“

And what is our instinct when we encounter Other? Critical, hostile, and emotionally over-involved behaviors.

So it goes.

As of late, I’ve become fascinated with the idea that mental illness is contagious.

The fascination started with a New York Times article about a wave of thousands of female and gender-nonbinary teens who developed Tourette’s-like tics during the pandemic—because of TikTok.

Arriving in the zeitgeist when people were forced to stay home, TikTok exploded during the pandemic. Videos of people claiming to have Tourettes multiplied on the platform, and because TikTok’s algorithm is built on showing users a wide variety of content—regardless of the user’s preferred interests—Tourette’s videos began popping up on people’s feeds. As of this writing, #Tourettes on TikTok has 8.7 billion views.

Like mental illness, there aren’t any scans or biological markers to diagnose or identify Tourettes. However, Tourettes is categorized as a movement and neurological disorder marked by uncontrolled physical or verbal tics, not a mental illness. It typically presents in males and first appears in childhood, with waxing and waning symptoms.

For the girls with “TikTok Tics,” however, the Tourettes-like symptoms arrived suddenly, with a wave of new cases popping up all over the world. Notably, though, when life began to regain some normalcy and the stress of the pandemic waned, the wave of TikTok Tics receded as well. Thus, it is hypothesized that the unique stress of the pandemic + the unique vulnerability of teenage girls created a tinderbox of stress that manifested in psychologically contagious tics.

This isn’t the first time we’ve observed psychological contagion. This phenomenon repeats itself across both time and cultures. In the Middle Ages, it was believed that humans could be possessed by the spirits of demonic animals, leading a group of nuns at a French convent to meow like cats.

In the 1800s, “hysteria” was a known psychological diagnosis that afflicted women. It included a diverse range of symptoms, including paralysis, stomach pain, amnesia, and day blindness. Hysteria was almost worshiped and certainly fetishized by popular magazines, newspapers, and even public hygiene literature. Much like today, male doctors and scholars of the time filled lecture halls and pontificated on the “quintessential illness of womanhood,” as Ethan Watters said in his book, Crazy Like Us. But by the time the 20th century rolled around, hysteria had largely evaporated from the collective consciousness. Women stopped reporting paralysis and leg weakness, and the symptoms of psychosomatic illness moved on to other expressions.

Even the human reaction to war is tied to the cultural temperature. Medical records of war veterans show that the psychological and even physical effects of war are a reflection of time and place. For British soldiers in the Boer War, the psychological trauma manifested as muscle weakness and joint pain, while American soldiers during the Civil War complained of a weak heartbeat and an aching in the left side of the chest. During World War I, both British and American soldiers experienced “shell shock,” with symptoms that included tremors, ticks, and sensory disturbances. Today, addiction affects veterans of modern war.

As Watters explains, “Although the potential psychic damage of war is indisputable, the process by which that damage becomes an outward symptom is a reflection of the cultural beliefs in a particular time and place.”

Said another way, whether as a PTSD response to war or TikTok, people will unconsciously produce symptoms that reflect the culture’s prevailing cultural diagnosis of the time. The TikTok Tics were not so much a measurable illness, but a subconscious yearning for recognition of internal distress.

The implications of viewing mental illness through this lens, in my opinion, destabilize the entire foundation of psychiatry and psychology. I know, for example, that as a young ballet dancer, the eating disorders I experienced as a teenager were created through community. Anorexia is rampant in ballet not just because thinness is an aesthetic ideal, but because everyone else is doing it. Toss in the death of my father and the emergence of the internet in the early 2000s, and the fixation on thinness festered as a direct result in order to satisfy a need to belong to something while expressing suffering. There wasn’t ever anything wrong with my brain. If anything, it was a sign that my psyche was doing exactly what it should be expected to do in times of great stress. I was simply exhibiting symptoms consistent with the time—no different than if I had started meowing with nuns in the Middle Ages.

For an affliction to be pathological, it seems to me that it should ring true across both time and culture. A cancerous mass viewed under a modern microscope looks the same in Taiwan as it does in the United States. But if mental illness and psychological distress cannot be separated from the culture in which it is experienced, how is a blanket biomedical response ever going to be the answer?

Welcome to Science Corner by Happiness Is A Skill, where I take a few minutes to teach you about the relevant neuroscience of antidepressants and antidepressant withdrawal. No more half assed assumptions without evidentiary support, like the whole chemical imbalance theory of mental illness. The idea that “too little” serotonin causes depression? Or that “too little” dopamine causes ADHD? Obsolete, oversimplified, hogwash conveniently packaged by marketing departments of pharmaceutical companies in order to convince you to “talk to your doctor about Zoloft, because when you know more about what’s wrong, you can help make it right.”

That’s the actual tagline for Zoloft by the way, from 2001. Brilliant, isn’t it? Here’s a very simple explanation for your distress. It has nothing to do with your life or your choices or the bad things that happened to you, but instead has to do with some chemicals in your brain you can’t control. So take this pill and the sun will shine and flowers will bloom and scary thoughts will go away and we’ll all be content. Right? Right? 

If one could die of bullshit overload, I would long be gone.

Instead, let’s talk serotonin transporter (SERT) occupancy, something researchers have actually measured and analyzed in labs.

Let’s start with some background information. The serotonin transporter is a protein in the brain that helps regulate levels of serotonin. When someone takes an antidepressant, the drug binds to the SERT protein and blocks it from transporting serotonin out of the brain, disturbing the brain’s longstanding homeostasis by increasing the amount of serotonin available. When early test subjects reported an elevated mood after taking antidepressants in clinical trials, the assumption was that the increase in serotonin was responsible for this relief, therefore thus forming the basis of the serotonin theory of depression. If more serotonin = happier people, then less serotonin = sad people. And that’s how Prozac was born!

Too bad it was all a pipe dream.

Over time, the brain adapts to the presence of the drug and learns to produce less serotonin on its own. The body is always trying to get back to homeostasis, remember. The pharmaceutical industry spends billions of dollars trying to convince you that they can override hundreds of thousands of years of evolutionary physiology, but the bottom line is the body has to remain in equilibrium to stay alive. If you’re hot, you sweat to cool down. If you’re cold, you shiver to warm up. If either of those systems don’t work like they should, you die.

So let’s say you’ve been on 20mg Prozac (fluoxetine) for ten years and you decide it’s time to come off. Your doctor drops you to 10mg for a few weeks and you tolerate it. Maybe you’re a little emotional and antsy but you can handle it. Your doctor has heard about all this withdrawal stuff so he thinks he’s got it all figured out and tells you not to drop from 10mg to 0, but to instead cut the capsule in half and take 5mg for a week or two. You don’t feel great and wonder if it’s the depression coming back. But you figure you’ll drop to zero and give it a few weeks to know for sure. After all, 5mg is miniscule. Smaller than the smallest dose on the market! They give 5mg of Prozac to six year olds!

You drop to zero and all hell breaks loose—akathisia, huge emotional swings, paranoia, brain fog, gut issues. Back to the doctor you go, because clearly you’re sick and how stupid you were to think that you could operate without the Prozac. So you go back on 20mg. Hell, make it 40mg this time. Clearly, you need it. Your doctor suggests an antipsychotic as well because the paranoia suggests an emergence of Bipolar Disorder. Life, now, is all about managing symptoms.

Where did everyone go wrong? A fundamental misunderstanding of SERT occupancy.

Let’s look at the following graphs, courtesy of researcher Mark Horowitz:

The black curve is the measure of SERT occupancy as determined through brain-imaging techniques called PET scans that allow researchers to see the biological workings of the body. As you can see, at 25mg of fluoxetine, 80% of the serotonin transporters are occupied.

Figure (a) is a representative of the conventional line of thinking for linear tapering of antidepressants. Rather, the idea of lowering dosages by equal, measured steps—5mg, in the case of this graph. The problem is that if you lower the dose of Prozac from 20mg to 5mg—a 75% reduction—SERT occupancy only reduces by 20%. This means that not only are there fewer operating receptors, there is also less serotonin in the brain because the body long ago lowered its production. It is likely that withdrawal occurs at least in part because of this chemical imbalance created through linear tapering. And yes, it is ironic that this time, a true chemical imbalance is responsible.

Due to the hyperbolic nature of SERT occupancy, this dissonance is even more extreme at lower dosages, as seen in Figure (b). At 2.5mg of Prozac—20% of the lowest dose available on the market—SERT occupancy is 40%, just half of what it is at a robust dose of 25mg. This explains why it can be more difficult for people taper as they get closer and closer to zero.

Though SERT occupancy occurs with all antidepressants, the levels of SERT occupancy vary from drug to drug, as shown by this systematic analysis of 10 different psychiatric drugs, done by Anders Sorenson, et al.

The reason why you need to know about this is because it’s likely your prescriber is completely unaware. More understanding of SERT occupancy, as well as more robust research (especially when multiple drugs are involved), would lead to better de-prescribing practices that will likely lessen or eliminate severe withdrawal effects.

In the fictional example I gave above, our now “bipolar” patient needed a much slower taper that followed the hyperbolic curve and was adjusted only once she stabilized from the previous dose reduction. Had she tolerated a 10% reduction—from 10mg to 9mg to 8.1mg to 7.29mg and so on to 0—her brain likely would have had much more time to fire up dormant receptors and naturally ramp up serotonin production, leading to a more gentle, symptom-free re-introduction into a world without SSRIs.

Instead, when she was pulled off too quickly, her system went haywire because neurotransmitters are responsible for regulating the entire body. Instead of recognizing this as withdrawal, both she and her doctor assumed it was mental illness and plunked her back in the system with a shiny new diagnosis. This happens all the time. All. The. Time.

I hope you’ve enjoyed this Science Corner issue of Happiness Is A Skill. Please keep in mind that we are very much in the infancy of antidepressant withdrawal research, and that no single piece of information is the whole answer. But as they say on NBC, the more you know! Ding ding dong!

In the midst of the pandemic, a 35 year old man I’ll call Sav, began shooting hoops in his hometown in Italy. First, he shot from the three point line. Then, he turned around and shot backward, sinking the basketball into the net. A few weeks later, he did it blindfolded. Then backward, blindfolded, and while jumping on a trampoline. 

The trick shot obsession grew to kicking ping pong balls into narrow-mouthed water jugs and launching soccer balls into basketball hoops with a golf club. In less than a year, he amassed millions of followers and cashed fat checks from merch and ad sales. 

Then, in the summer of 2022, Sav went dark. 

As it turns out, the followers, the money, the trick shots—all of it was a result of psychiatric drug withdrawal-induced akathisia, a constant state of tortuous restlessness and burning agitation that Sav described as “dishumane.” Unable to sleep or stop moving, Sav channeled his distress into intricate human tricks.

The circus nature of it all kept him occupied in between months long hospitalizations over 30 sessions of controversial electroconvulsive therapy (ECT). He spoke to every known doctor, expert, and advocate on the subject of withdrawal—including me—in hopes that someone could stop the pain. Nothing helped. Most suggestions just made things worse.

Today, Sav is in the process of ending his life through an assisted suicide organization in Switzerland. 

There is an aphorism in medicine, coined by former Dean of Medicine at Harvard Dr. Charles Sidney Burwell that says, “Half of what we are going to teach you is wrong, and half of it is right. Our problem is that we don’t know which half is which.”

I think about this quote constantly, both in the context of my own health and when people like Sav reach out to me for help. I can’t give medical advice since I’m not a doctor, but I can talk about my experience and share resources. Even when I’m passing along research done by other people, it’s a paralyzing to know how much we don’t know, how much I don’t know. What works for one person causes havoc in another. That’s all well and good if the body is strong enough to recover from all the self experimentation. But in a case like Sav’s, any little change seems to set off a cascade of irreversible negative effects.

So much of medicine, and especially a new field like psychiatric drug withdrawal, is focused on the how, not the why. The why is too expensive, requiring oodles of money and serious research. Sav’s case is the perfect example. He followed the leading theory of tapering off psychiatric drugs—hyperbolic tapering—a strategy that encourages small dose reductions, each one smaller than the one before, over a long period of time. Research shows that generally, this method lessens or eliminates withdrawal symptoms by allowing the brain and body to adjust without getting overwhelmed by the sudden lack of drug presence.

But there is a subset of people like Sav who don’t seem to tolerate this method. Instead, it’s like their body hits a limit with how much of the drug they can process, and these long tapers basically become prolonged poisoning. Sav told his doctors over and over again that he thought the taper was hurting him. He was dismissed and told to stay the course. Not knowing what else to do, he followed their advice. And he’s now going to Switzerland because of it.

I’ve heard similar stories from enough people to know that Sav’s story is not a one off. For these folks, there’s something going on physiologically that’s outside of the norm. My hunch is that it has something to do with the genetic component of their body’s CYP system, a complex bodily function involved in the metabolism of drugs, chemicals, hormones, and neurotransmitters. But until someone designs a study for people in withdrawal that analyzes genetic variants in the CYP system, it’s all just a guess. And I’m sure it’s not that simple. I’d also like to see fMRIs, qEEG, hormone panels, and VO2 max tests for people in withdrawal. Until that actually happens (if it ever happens), people like Sav are going to suffer thanks to well intended but myopic views.

Personally, I don’t know know how to deal with this. I’m heartbroken over Sav. I feel like the community failed him. It’s an impossible position for everyone. What percentage of people are sacrificial lambs on the path to truth and understanding? How do you instill hope in the hopeless? How do you help when sometimes the help is poison?

If there is any silver lining to this story, it is this: Sav told me he does not want to go quietly. He wants the world to know his story. We have a little bit of time. The checks and balances in Switzerland are many, for good reason, and he does not yet have a date.

Of course, I hope that between now and then some miracle shows up and he finds some relief. If not, I have to assume that he is a player in a bigger game. That somehow, his suffering won’t be in vain because it will lead to more awareness and education. He is, after all, a bit of a showman. Every trick shot sunk not just to distract himself, but to prove that nothing is impossible.

I will share his real name when he is ready to fully go public. In the meantime, he has given me permission to share his story. Thank you for reading.

In the year before and months after MAY CAUSE SIDE EFFECTS released, I didn’t read a single book. I’d just finished writing one, and reading other people’s work did nothing but invite comparison and insecurity. But something shifted when we flipped the page to 2023, and I’m back to devouring books at all hours of the day.

Among the stack I’ve recently finished is Dr. Ellen Vora’s The Anatomy of Anxiety: Understanding and Overcoming the Body’s Fear Response.

Ellen is a Yale and Columbia University educated, board-certified psychiatrist who speaks openly about antidepressant withdrawal and the overprescription epidemic. Though Ellen and I haven’t ever met, we’re in occasional contact since she’s one of the few working psychiatrists with the balls to speak out about the pill for every ill “strategy” that seems to be doing more harm than good. Also an acupuncturist and yoga teacher, she practices from a functional-medicine foundation, meaning she believes most (if not all) mental health issues are caused not by disease or a chemical imbalance but by everything from unresolved trauma to lifestyle choices to blood sugar crashes.

The perk of this approach is that unresolved trauma, lifestyle choices, and blood sugar crashes are all things we have the power to fix. What a concept!

The conventional theory of anxiety is that it exists in the head and causes downstream, emotional and physical effects. In The Anatomy of Anxiety, Ellen argues that anxiety begins in the body, and that it’s the physiological stress response that causes mental anguish. Said another way, our brain chemistry changes as a result of an imbalance in the body, not the other way around. This is good news, she says, because this anxiety is both preventable and responsive to basic adjustments to habits, diet, and lifestyle.

Just as I did with Johann Hari’s Stolen Focus, I’ve compiled what I think are the 10 most important and interesting ideas from Ellen’s book. One caveat: The Anatomy of Anxiety is an outstanding starting point for those beginning to explore the mind-body connection and the basic science of anxiety. For those of you who spend a lot of time in this space, you’ll likely recognize much of the content. I worry that my familiarity with the topic means I’ve skimmed over obvious lightbulb moments. Thus, if you’re someone who struggles with anxiety and you don’t spend your free time nerding out over the science like I do, I highly recommend you take my word for it and get a copy for yourself. Understanding how your body works and why it reacts the way it does is a key first step in managing and healing anxiety.

Onward to the good stuff! (Bold emphasis mine.)

Ellen likes to differentiate from “true anxiety” and “false anxiety” in order to help her patients understand what is anxiety they can control (false), and what is anxiety that’s baked into human existence (true)

“False anxiety is the body communicating that there is a physiological imbalance, usually through a stress response, whereas true anxiety is the body communicating an essential message about our lives. In false anxiety, the stress response transmits signals up to our brain telling us, something is not right. And our brain, in turn, offers a narrative for why we feel uneasy…this type of anxiety is not here to tell you something meaningful about your deeper self; rather, it’s offering a more fundamental message about your body. When we recognize that we are experiencing anxiety precipitated by a physiological stress response, we can address the problem at the level of the body, by altering our diet or getting more sunshine or sleep. In other words, false anxiety is common, it causes immense suffering, and it’s mostly avoidable.”

True anxiety arises from having strayed from a vital sense of purpose and meaning. This anxiety is what it means to be human—to know the inherent vulnerability of walking this earth, that we can lose the people we love and that we too, will one day die…it is essentially a guide for how to make our lives as full as they can be.

Between 2019 and 2021, the Kaiser Family Foundation estimated that rates of anxiety and depression skyrocketed by 270 percent.

Genes simply don’t adapt that quickly, which punctures quite the hole in the theory of anxiety as a genetic disorder. (Never mind the fact that an “anxiety gene” has never been identified.”

Ellen says: “These rates would not have risen so precipitously if these disorders had a predominantly genetic basis—which was our presiding understanding over the last several decades. Our genes cannot adapt so quickly as to account for our recent catapult into anxiety. It stands to reason that we are increasingly anxious because of the new pressures and exposures of modern life—such as chronic stress, inflammation, and social isolation. So, odd as it may sound, this recent acceleration is actually good news because it means there are straightforward changes we can make.”

Though we have the same stress response as we did thousands of years ago—when stress meant running from a saber-tooth tiger or finding consistent food supply—modern life gives us a very different set of circumstances to cope with. Rarely are we in life or death situations and instead experience regular, low-grade stressors like a bloated email inbox or road rage.

Still, “with our modern diets and habits—which frequently trigger stress responses in our bodies—many of us live in a near constant state of feeling under siege. Your blood sugar is crashing after eating something sweet? The body interprets this as a mild threat to survival. You stay dup too late doom scrolling on your phone? The body feels surrounded by danger. Sleep deprivation, chronic inflammation from eating foods you don’t tolerate, and the comment section on Twitter—these are all, from your body’s perspective, indications that your environment is not safe. So, the body releases stress hormones into your bloodstream, and this invisible chemical cascade manifests as the feelings and sensations of false anxiety.”

Because false anxiety is often caused by outside stressors, it’s also manageable if you know what to look for. The book goes into the science behind each of these bullet points, but as a starting point, here are Ellen’s recommendations for “pausing in the midst of turmoil” in order to understand the particular false anxiety that’s occurring as well as how to address it:

“I’m anxious, and I’m not sure why. Am I…

• Hungry? (eat something)
• Sugar-crashing or having a chemical comedown? (Did I just eat something sweet, processed, or laden with food coloring or preservatives? Have a snack and focus on making different choices next time.
• Overcaffeinated? (Perhaps this jittery anxiety is really caffeine sensitivity; tomorrow, drink less caffeine.)
• Undercaffeinated? (I drank less caffeine today than usual; dose up and aim for consistent daily caffeine consumption going forward)
• Tired? (Take a nap; prioritize an earlier bedtime tonight.)
• Dehydrated? (Drink some water.)
• Feeling sluggish? (Take a quick walk outside; dance.)
• Dysregulated? (Did I just engage in an internet rabbit hole or social media binge? Dance or go outside to rest the nervous system.)
• Drunk or hungover? (File this away to help inform future choices around alcohol.)
• Due for a dose of psychiatric medication? (Right before the next dose, I’m at the pharmacological nadir—or the point where the level of medication in my bloodstream is at its lowest, and this can affect mood. Time to take meds.)

(A note from Brooke in bold: I’d argue that the last bullet point could also include, “Time to take meds or if coming off meds, recognize this as a sign of psychiatric drug withdrawal and be kind to yourself.” )

True anxiety serves a purpose in society, as demonstrated by this fascinating 1980s study of primates:

“Studies of primates show that some members of the tribe are more anxious than others—these are the ones that tend to hang back, gathering the peripheries of the main group. In the 1980s, the late zoologist Dian Fossey decided to remove these more sensitive members of one group of chimpanzees to see how it would affect the rest of the community. Six months later, all the chimps were dead. ‘It was suggested that the anxious chimps were pivotal for survival,’ Sarah Wilson writes compellingly of this experiment in her book First, We Make the Beast Beautiful. ‘Outsiders, they were the ones who were sleeping in the trees on the edge, on the border, on the boundary of the community. Hyper-sensitive and vigilant, the smallest noise freaked them out and disturbed them, so they were awake much of the night anyway. We label such symptoms anxiety, but back when we were in trees, they were the early warning system for the troop. They were the first to scream, “Look out! Look out!”’”

(Side note, I’ve never used that many quotation marks before. My 10th grade English teacher Mrs. Utter would be proud.)

Though this study was on monkeys, the same can be said about more sensitive and anxious folks in the world. They alert everyone else to potential problems and dangers. (I.E., climate activists.)

The most positive (and counterintuitive) change I ever made to my sleep hygiene was when I started eating a hefty portion of starchy carbs at dinner.

Prior to this directive—which came from a high performance nutritionist and professor of muscle science at Cal Fullerton—I’d often skimp on starchy carbs at dinner in order to rationalize dessert, or go low-carb all together in a misguided attempt to cut calories and stay lean. My shitty sleep, I assumed, was unrelated.

As it turned out, this strategy was causing blood sugar spikes and crashes (with dessert) or causing overall low blood sugar (low-carb) that disturbed my sleep. When I added about a cup of cooked white rice or potatoes to the meal, my sleep issues evaporated. What happened?

Ellen explains: “If you typically get ‘hangry’—angry and irritable when you’re hungry—at 3pm, the overnight equivalent is waking up at 3am with racing thoughts, unable to fall back asleep. This typically happens when your blood sugar crashes overnight and your body counters with a stress response…a stress response can make your sleep more superficial, shunting you out of the deeper stages of sleep and making it more likely you’ll be jolted awake.”

The solution is to stabilize blood sugar throughout the night. I do this with a big, starchy carb heavy (but low sugar) meal. Ellen likes to eat a spoonful of almond butter before bed, and eats another spoonful if she wakes up jittery and anxious.

“Our bodies are increasingly bombarded with unrecognizable chemicals and food—ranging from pesticides to phthalates to Pop-Tarts (essentially, foreign agents our bodies didn’t evolve to deal with)—that provoke the immune system in much the same way a genuine infection would. A daily ingestion of Doritos, for instance, leaves the immune system belligerent and confused. It keeps fighting, thinking it stands a chance at killing off the ‘infection’ of Doritos, but our immune system isn’t build to defeat chips—not to mention that we get ‘reinfected’ with every snack. Over time, a consistently inflammatory diet can result in a dysregulated, hyper-vigilant immune system, an inflamed body, and sustained feelings of depression or anxiety.”

“The body is hardwired for survival,” Ellen says, “not for feeling calm.”

She’s says this in the chapter about psychiatric drug withdrawal, specifically in relation to benzodiazepines. But what I find most interesting about the statement is that we’re all walking around under the assumption that calm should be the norm and anxiety a pathogen to eradicate.

In reality, a part of our body is always looking out for dangers. It’s why we startle when we hear an unfamiliar thunk. Debilitating anxiety needs to be dealt with, of course, but bouts of it is just the body doing its job of trying to stay alive.

“We’re taught from a young age that when something is difficult, it is necessary to distract ourselves. When a child has a tantrum, we think, How can I make the crying stop? We know that if we hand the kid some sugar or a screen, they’ll probably be satisfied. Problem solved, right? Well, actually, now we’ve taught the kid: I can’t handle your big emotions, you can’t handle your big emotions, and should ever feel big emotions in your future life, quickly find something that will distract you, offer you a hit of dopamine, or numb you out. It’s no wonder even we adults turn to our phones or emotional eating when in fact we just need to feel our feelings and let our tantrums run their course.”

This is where true anxiety comes into play. Safety is an illusion. All our effort put into keeping our kids “safe,” building equity, or eating clean could be undone in a matter of moments. We do these things to bring a sense of order into our lives, but trying to white-knuckle our way to control often creates the exact anxiety we’re trying to prevent.

“We are anxious and exhausted because wee are fighting with reality, beliving things are supposed to go a certain way. Instead of showing us where we need more control, anxiety actually alerts us to where we need to let go; when we need to take a breath and patiently, courageously see where our particular path will take us.”

Last weekend, I was invited to sign copies of MAY CAUSE SIDE EFFECTS at a new bookstore in Santa Monica called Zibby’s Bookshop. A dozen or so other authors, including my writing mentor, were signing at the event as well. Afterwards, we all gathered in the lobby of a fancy hotel to drink wine, eat cheese, and bitch about the disaster that is publishing books. Everyone had a horror story, from “my Gen Z publicist will no longer talk on the phone because she says the phone is too stressful” to “my book came out two days before Covid shut the world down” to “my former agent stole my royalties and fled town in a Winnebago.” (I get to take credit for that last one.)

As nurturing and fulfilling as the evening was, I was exhausted from the intensity of it all. As a few of the ladies were transitioning from the party to the after party, I declined, instead deciding it was time to head back to my AirBnB.

“Brooke’s got strong boundaries,” my mentor said, her eyes scanning me like I was some sort of curious, alien species. “I need to work on that.”

This observation stuck with me because it butted up against a series of recent encounters where my “boundaries” caused confusion, discontent, or outright pain in other people. I put boundaries in quotes because to me, it doesn’t feel like a boundary. It feels like the most obvious thing in the world. By doing what’s best for me—in this case, getting a good night’s sleep—I guarantee that I won’t be exhausted in the morning. I’m nicer and more patient when I’m rested, which leads to more pleasant encounters with others, which means my day and everyone else’s is going to be easier. A win for me, a win for the world.

This is called egotistical utilitarianism, a phrase I first heard coined by Matthew McConaghy in an interview with Tim Ferris.

It’s a counterintuitive concept. An egoist does whatever is best for them. A utilitarian does whatever is best for others. How can such opposition fit together?

Because when we take action based on what benefits us the most, it also benefits those around us.

As McConaghy put it, “The decisions we make for the I, for ourselves, the selfish decisions are actually what’s best for the most amount of people — utilitarian — they are where the ‘I’ meets the ‘we’, where the selfish is the selfless.”

Don’t get confused by the “egotistical” part of this. Our negative connotation of the word, in the sense that people who are egotistical operate as if they’re the only mattering person on Earth, disappears when egotistical utilitarianism is fully understood. In this sense, it is about the reason for the action, not the action itself.

As an example, a fireman spends hours at the gym lifting weights, running on the treadmill, and staring at himself in the mirror. His friends and family are chuffy because he isn’t around that much or comes off too rigid in his adherence to the gym schedule. They want him to spend time with them. To tend to their emotional needs. But what’s really happening is the fireman’s inner drive to be in the best shape possible also allows him to have the physical ability and confidence to carry heavy firehoses, pull people out of burning buildings, and trust in his body’s carbon dioxide capacity. His usefulness as an individual, in this specific area where he excels, benefits the collective every time he goes out on a call. And when he is able to do his job to the best of his ability, he is more fulfilled in his life. The more fulfilled his life, the better and more present he can be with the people around him during the time he makes for them.

In my life, it plays out like this:

My work on antidepressant withdrawal is my priority. Full stop. It takes a tremendous amount of energetic effort to navigate a topic this heavy, leaving little energy in the tank to manage the needs of other people. It’s why I’m not married and don’t have kids. I simply don’t have the bandwidth.

As a result, most of my day to day choices are based on what’s best for me and my energy conservation. That means I’m often non-committal, have zero issues cancelling social plans, and don’t express a natural interest in other people’s lives. This comes off as flaky and uncaring, especially to the people in my inner circle who feel they deserve to be put ahead.

But the reality is I can’t do this work and impact the collective if I’m constantly shifting my focus because someone wants attention or pat on the back. If they’re dying or in a real crisis, then of course I’ll drop everything and show up. And I make a conscious effort to speak their love language and spend time with them when I do have the bandwidth. The folks who understand this balance—and more importantly, practice it themselves and manage their own feelings around it—are the people who have staying power.

To harness our drive and use it for the good of the whole is a powerful strategy for both individual and collective happiness. It’s doesn’t mean there won’t be times where you are called to perform an entirely selfless or selfish act, or where obligations and ethics won’t trump individual wants. But it’s worth exploring what exactly is best for you, and to watch what happens around you when to act upon it.

Today, I’d like to share with you an essay by Dr. Bonnie Burstow, a professor and psychotherapist who spent most of her career at the University of Toronto’s Ontario Institute for Studies in Education.

The essay, published in the academic journal Ethical Human Psychology and Psychiatry in 2017, is the sort of work that burrows into your psyche. The core idea presented—that psychiatric drugging of children (including with ADHD drugs) is a form of child abuse—seems radical at first glance. But the deeper you get into the paper, the more difficult it is to argue with the claim.

I am going to refrain from injecting my own thoughts on the essay and instead leave you to process it on your own. However, the paper is quite dense and the language has an academic bent that can make it difficult to understand if you don’t speak academic-ese. Thus, I have pulled key highlights from the work and added them below. Everything blow is a direct quote from the essay. All emphasis (in bold) is my own.

I have also linked to the full paper through a public Google document. I encourage you to read the full piece and share it with your friends and family.

To learn more about Dr. Bonnie Burstow, who died on January 4, 2020, in this New York Times profile.

“Abuse is any behaviour that is used to gain and/or maintain power and control over another person” (Kelowna Women’s Shelter)

“Child abuse refers to any form of physical, psychological, social, emotional, or sexual maltreat- ment of a child whereby the survival, safety, self-esteem, growth, and development of the child are endangered. There are four main types of child abuse: neglect, emotional, physical, and sexual. (Royal Canadian Mountain Police, 2012)”

The United Nations Convention on the Rights of the Child, Article 6:

1. State parties recognize that every child has the inherent right to life

2. State parties shall ensure to the maximum extent possible the survival and the development of the child (UNCRC, Article 6).

The United Nations Convention on the Rights of the Child, Article 37:

1. No child shall be subjected to torture or other cruel or unusual punishment.

2. No child shall be deprived of his or her liberty unlawfully or arbitrarily (UNCRC, Article 37).

If something constitutes abuse, it is not in the best interests of the person being subjected to it—not with women being battered, not with children being assaulted with harmful drugs.

There are, of course, people who would argue that a definition like this cannot cover the area of child abuse because, irrespective of other considerations, it is always critical to do what is in the best interests of the child. (Don’t claims like this frequently underlie oppression?)

Well folks, it’s happened. After a year that I will henceforth refer to as, “The Year That Changed Everything,” I have completely, utterly, all the overused adverbs in the world-ly, hit a wall of systemic exhaustion. 

Not that I can stop. 

I’ve got four trips planned in the next eight weeks, all for work or book-related endeavors. Los Angeles —> Las Vegas (lord help me) —> San Francisco —> Virginia Beach. 

I’ve put myself on a work embargo in between trips, which means after I write this, I’m going skiing. (That’s how embargoes work, right? They’re conditional upon finishing work, right? RIGHT?)

Burnout is a manifestation of chronic, unmitigated stress. Or, as the World Health Organization defines it, an “occupational phenomena” characterized by “feelings of energy depletion or exhaustion; increased mental distance from one’s job, or feelings of negativism or cynicism related to one’s job; and reduced professional efficacy.”

One google of “burnout” provides a whole host of solutions, but frankly, I’m too burned out to even look through it and throw some research at you. Instead, I’ll share my unscientific philosophy on the matter: the BBC.

Boundaries

Bordem

Creativity

The thing about publishing memoir is that everyone wants to talk to you about it. If you’re trying to sell as many books as possible, which I am, this means taking every opportunity to chat. MAY CAUSE SIDE EFFECTS is gaining traction and the bigger the opportunity, the more focused I need to be. 

Thus, for the next eight weeks, I’m postponing, cancelling, or avoiding any work that’s not directly MCSE related. No more bullshit meetings. No more “picking my brain.” The same goes for social obligations. If I don’t fully want to be in an experience or around a group of people, it’s just not happening. I don’t have the bandwidth. 

The only cure I’ve ever found for burnout is boredom followed by creativity. Not standing-in-line-at-the-grocery-store-boredom, but true boredom. Like pandemic levels of boredom. The kind of boredom that transitions from agitation to openness, where the brain shuts down and the instinct to pick up a paintbrush, go for a walk, or play an instrument kicks in. 

In my experience, true rest only occurs in this state. And it’s why vegging out in front of the TV for an hour isn’t all that rejuvenating. What the mind and body needs is primal rest, the sort that occurs in nature or in the nurturing presence of close friends or family. 

It’s a cumulative process, too. One that isn’t all that compatible to modern life. But there are little things we can do to facilitate boredom, like leaving your phone at home when you go for a walk or taking a social media break. One of the more amusing strategies I heard involved locking yourself in your bathroom with nothing but a pen and paper, setting an hour-long timer, and not allowing yourself to do anything but scribble or doodle while you’re in there. No reading lotion labels, no organizing the makeup drawer. No bubble baths. Just pure, private, glorious boredom. 

The great tragedy of the digital world is that fewer people—kids, especially—get bored enough to pick up a pen, eliminating countless writers and artists who might be filled with talent but are instead wasting away playing Fortnite.

I don’t think it’s an accident that our abhorrent collective mental health coincides with the massacre of arts funding in schools. As the beloved author Kurt Vonnegut said, “The arts are not a way to make a living. They are a very human way of making life more bearable. Practicing an art, no matter how well or badly, is a way to make your soul grow, for heaven’s sake.”

Making art for art’s sake is the only thing that rejuvenates my brain during times of burnout. But purposeless creativity does not exist without boredom, which is why the two need to go together. The second moneymaking is involved, it moves into the realm of adding to burnout rather than removing it. 

Of course, I don’t have kids or an elderly parent to care for. Caregiving burnout is its own beast; one that trickier to address. So I’m not even going to try. But if you’re burned out keeping other humans alive, consider yourself hugged. You’re doing a hard thing. 

With that, I’m going skiing. Without my phone. If I have time left in the day while it’s still light out, I’ll paint something. And then in 36 hours I’ll get on a plane. Rinse and repeat.

Last weekend, I did something I rarely do: I went out. Like out out. I put on heels, wore makeup, and made chitchat with strangers at a fundraiser for a local museum. 

I was invited as a date for a friend whose husband went on a last minute business trip, leaving her as the lone stag in a group of eight couples. My butt did a great job of filling the seat, but a table of familiar faces brought not a sense of inclusion, but the sting of loneliness. 

The experience highlighted a nagging feeling I’ve had since MAY CAUSE SIDE EFFECTS was published in September. The book was, in many ways, my best friend. A constant, intimate presence, it persisted through the ebbs and flows of my life, the work often reflecting my reality. It gave me a sense of purpose, never wavered in its dedication, and showed up when I needed it. When it hit bookshelves, it’s like it moved away. It isn’t mine any more. It belongs to other people now, influencing their lives while I scramble to fill the void. 

Though the loss has gifted me oodles time, it also illuminates neglect. All of my relationships have suffered over the past five years, particularly my friendships. As a single person with no kids and a minuscule family unit—it’s just me and my mom, no siblings or notable extended family—I’ve always kept a mental running list of friends who would step up in a crisis, no questions asked. 

I don’t know if there’s anyone on that list anymore. 

Years ago I might have blamed this development on the failure of the parties involved, assuming we just didn’t try hard enough. Now, I understand that biology and social psychology is at play, and that itinerant life I’ve led isn’t conducive to creating and maintaining intimate friendships.

The number and quality of friendships is the single most important indicator of longevity and happiness and as we age, friendships become more important for health than family. 

But in 2021, 12 percent of American adults said they had no close friends, contributing to the loneliness crisis that began well before, but was exacerbated by, the pandemic. 

So how do we make friends as adults? More importantly, how do we create meaningful friendships that increase happiness? I dove into the research of evolutionary psychologist and friendship expert Robin Dunbar to find out.

Robin Dunbar is best known for Dunbar’s Number, which he defines as the number of relationships people are able to cognitively able to manage and maintain at once. He puts this number at 150, which unsurprisingly, is just about the size of the average American wedding guest list. 

These 150 people are made up both friends and family and sorted into a sort of circular hierarchy. The closer the ring of people around you, the fewer the people in the ring. 

In the bullseye with you is an spouse or intimate partner, followed by three to five people who make up the first ring, usually family members and a close friend or two. The next ring expands and holds secondary characters. Grandma, perhaps. Friends you know very well but maybe not the one you call in a crisis. From there, we expand through the rings of fair weather friends, colleagues, extended family, old friends who live in different places, and so on through the target.

Meaningful friendship is woven by shared experience and regular exposure. Therefore, the best way to make new friends is to engage in a consistent, social activity like a weekly meetup group. 

When we’re kids, this is automatic. We go to school or an after school activity, see the same people every day, and become friends. As adults, we lose opportunities for that natural interaction. Some people get it through work, but for someone like me who works alone and at home, I have to create it. It’s no surprise, then, that the people in my “close” and “best” friend circles over the years have come from going to the same CrossFit class, at the same time, five days a week for years. 

It’s also not surprising that over the past six years, when I was either traveling internationally or splitting my time between Canada and the US, my friendships suffered. I’d be in town for three weeks and leave for two months. People had babies in the time I was away. 

In my head, they still remained in the “close” or “best” category because I didn’t stay in one place long enough to forge a friendship strong enough to fill the space. But while I was away, my place in their hierarchy shifted, knocking me to outer circles. 

Where people stand in the hierarchy is constantly shifting. When you see less of someone because you see more of somebody else, it pushes people in and out of different circles. We see this happen all the time when people enter new relationships. In an interview with Dan Harris on the Ten Percent Happier Podcast, Dunbar said that falling in love can actually take the place of two close relationships, because the mental energy and attention devoted to the new person inevitably boots two people out of the ring. This explains why people disappear when they get into a relationship. It’s not because they don’t care or are blinded by love. It’s because we have limited capacity.

When life separates “close” and “best” friends, the instinct is to hold those people in their circles by keeping in touch through social media or phone calls. Though social media has a reputation for, you know, toppling democracy and obliterating societal mental health, it’s actually supports relationship intimacy. But with limited energy to devote to friendships, time spent on Facebook eats into opportunities for in-person connection. 

For relationships in the outer rings, this isn’t a big deal. But at the inner rings, intention is crucial. As Dunbar says, people might be “better off finding a new shoulder to cry on just round the corner, so when the world does fall apart, they can walk around the block, knock on their door and get a hug.”

Said another way by the lyricist Stephen Stills: “If you can’t be with the one you love, love the one you’re with.” 

The hardest part of making friends—especially in a new place—is the beginning. But once you engage in a community and show up consistently, proximity will eventually lead to connection. Once those connections are made, the circles naturally expand as people get introduced to one another, creating a flywheel affect that ultimately leads to the sort of event I found myself at last weekend. 

As I felt sorry for myself at the table, envious that these sixteen (!) adults had so much support for one another, I wondered what it was about me that made me feel so separate. 

The answer is that while I was off in Cambodia or Croatia for a month at a time, they were all moving back to Reno and starting their families. All of them have kids around the same age. They get together for play dates and PTA meetings. When the kids aren’t around, they share the common ground gained from so many years of similar experience, often within walking distance of one another. 

It’s a barrier I’m just not going to be able to crack. But that’s okay. There’s plenty of room for them in my “good friends” category, and now I won’t beat myself up wondering why I can’t bring them closer.

When I began Happiness Is A Skill early in the pandemic, I imagined it as a space where I could freely share my tips and strategies for recovering from depression and antidepressant withdrawal. Sixty-eight issues later, I’ve decided it’s time to bring in other voices. As much as I’d love to pretend I have all the answers for everyone on the planet, the truth is that the first step to becoming a great teacher is being a great learner.

Happiness isn’t like riding a bike. You don’t learn it once and know it forever. It requires maintenance, and without practice, can slip away. When you return to it, weeks or years later, it can feel like you never learned it at all. I am deeply curious about how other people learned happiness, what techniques they’ve developed to keep themselves on track, and how they know they’re sliding off track in the first place.

I’ve reached out to a slew of people from all sorts of backgrounds. Even though we’re all in different situations, at the heart of it, I believe that depression and anxiety feels roughly the same for each individual, with varying degrees. If you’ve experienced either one, you know what it’s like to feel like your body is made of lead or for your heart to jump into your throat. You know what it’s like to lack motivation and curiosity, for the world to literally lose its color. You may not know how to recognize early patterns that signal an incoming bout of mania or melancholy, but learning to recognize those signals early is part of the practice.

This week, Jenny Blake (@jenny_blake), international keynote speaker and author shares her strategy for managing overwhelm—a feeling she is all too familiar with. After launching in 2016 as the top career pick by Axiom Best Business Books, Pivot: The Only Move That Matters Is Your Next One, by Jenny is now the go-to career development framework for forward-thinking organizations, pivoters, and entrepreneurs. Her next book, Free Time: Lose The Busywork, Love Your Business, tackles all that creates overwhelm in work and life: hustle culture, busywork, and overly-complicated systems.When asked to share a strategy to manage difficult or stressful times, Jenny said:

“As a highly sensitive introvert, sometimes the basics of family life—on top of running my own business—overwhelm me. I check my energy gauge to see if I feel like I’m drowning (as I did recently), treading water, or gliding and in flow. As much as I wish I could consistently be a good partner to my husband and dog mama to my two-year-old German shepherd within the constraints of my day-to-day and our WFH-household, sometimes I just need an escape. Booking a 3-night “staycation” or “workcation” in the city (I live in Manhattan) recharges me like nothing else. I know it’s not always financially feasible for everyone, and it can certainly feel like an excessive luxury (at first) to spend on room-and-board in one’s own city. But if I go into the trip with clear intentions (either deep rest, or deep work), I always come out with a renewed sense of self, feeling like it was a priceless investment.I got this idea from Cheryl Strayed and Maya Angelou, who said it was integral to their writing process.”

Two things stick out to me. First, Jenny stops to check in with herself before making any decision. Is she drowning, treading water, or gliding in the flow? Drowning signals a need to escape. Treading water is manageable, but it could also be a warning that an escape may be needed in the future. Gliding in the flow is calm, easy. All is well.

If she decides she’s drowning, she books a staycation and sets an intention. It’s not enough to mindlessly book a hotel and hope it works out. She creates a plan and sticks to it. After all, we can’t know if we’ve succeeded unless we’ve created parameters for success.

How could you take Jenny’s strategy and apply it to your own life? If a staycation isn’t on the menu, how about a solo hike or an overnight camping trip? Perhaps it’s about asking those around you for an hour a day, away from the kids. Or hiring someone to help you complete a project that’s been weighing on you, like cleaning the house or organizing the garage. Maybe the first step is simply asking for help.

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Related resources: 

After a marathon few months, I’m headed into a much needed hiatus from all things work. Until then, I wanted to leave you with a selection of books to help you mentally settle into these unsettling times. I ingest the wise words of others during troubled times always helps me re-center.

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I recommend this book all the time, including in recent issues of HIAS. If you are depressed or have a depressed family member, this is the one book I’d recommend over all others.

“There was a mystery haunting award-winning investigative journalist Johann Hari. He was thirty-nine years old, and almost every year he had been alive, depression and anxiety had increased in Britain and across the Western world. Why?

He had a very personal reason to ask this question. When he was a teenager, he had gone to his doctor and explained that he felt like pain was leaking out of him, and he couldn’t control it or understand it. Some of the solutions his doctor offered had given him some relief-but he remained in deep pain.

So, as an adult, he went on a forty-thousand-mile journey across the world to interview the leading experts about what causes depression and anxiety, and what solves them. He learned there is scientific evidence for nine different causes of depression and anxiety-and that this knowledge leads to a very different set of solutions: ones that offer real hope.”

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Biology of Belief was one of the first books to bring the world of epigenetics and the power of thought to the mainstream.

“The implications of this research radically change our understanding of life, showing that genes and DNA do not control our biology; instead, DNA is controlled by signals from outside the cell, including the energetic messages emanating from our positive and negative thoughts.

This profoundly hopeful synthesis of the latest and best research in cell biology and quantum physics has been hailed as a major breakthrough, showing that our bodies can be changed as we retrain our thinking.”

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“Do antidepressants work? Of course — everyone knows it. Like his colleagues, Irving Kirsch, a researcher and clinical psychologist, for years referred patients to psychiatrists to have their depression treated with drugs before deciding to investigate for himself just how effective the drugs actually were. Over the course of the past fifteen years, however, Kirsch’s research — a thorough analysis of decades of Food and Drug Administration data — has demonstrated that what everyone knew about antidepressants was wrong. Instead of treating depression with drugs, we’ve been treating it with suggestion.

The Emperor’s New Drugs makes an overwhelming case that what had seemed a cornerstone of psychiatric treatment is little more than a faulty consensus. But Kirsch does more than just criticize: he offers a path society can follow so that we stop popping pills and start proper treatment for depression.”

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“In this astonishing and startling book, award-winning science and history writer Robert Whitaker investigates a medical mystery: Why has the number of disabled mentally ill in the United States tripled over the past two decades?

Interwoven with Whitaker’s groundbreaking analysis of the merits of psychiatric medications are the personal stories of children and adults swept up in this epidemic. As Anatomy of an Epidemic reveals, other societies have begun to alter their use of psychiatric medications and are now reporting much improved outcomes . . . so why can’t such change happen here in the United States? Why have the results from these long-term studies—all of which point to the same startling conclusion—been kept from the public?”

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This book has changed the way I approach decision making and helped understand what is truly essential, as opposed to a shiny distraction.

“Essentialism is more than a time-management strategy or a productivity technique. It is a systematic discipline for discerning what is absolutely essential, then eliminating everything that is not, so we can make the highest possible contribution toward the things that really matter.

By forcing us to apply more selective criteria for what is Essential, the disciplined pursuit of less empowers us to reclaim control of our own choices about where to spend our precious time and energy—instead of giving others the implicit permission to choose for us.”

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A more practical application of epigenetics (whereas Biology of Belief focuses on the science), It Didn’t Start With You explores how the traumas suffered by your family have a direct affect on you.

“The latest scientific research, now making headlines, supports what many have long intuited—that traumatic experience can be passed down through generations. It Didn’t Start with You builds on the work of leading experts in post-traumatic stress, including Mount Sinai School of Medicine neuroscientist Rachel Yehuda and psychiatrist Bessel van der Kolk, author of The Body Keeps the Score.”

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The Power of Now was the final piece in my puzzle of healing. I read it when I was in Prague, in January of 2017, and felt the shift occur as I read the book. It is one of those books that will be over the head of those who aren’t ready, but for those who are, it is transformational.

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I believe this book should be required reading. It is astounding—for those who are ready to receive its message.

“At the age of sixteen, Edith Eger was sent to Auschwitz. Hours after her parents were killed, Nazi officer Dr. Josef Mengele, forced Edie to dance for his amusement and her survival. Edie was pulled from a pile of corpses when the American troops liberated the camps in 1945.

Edie spent decades struggling with flashbacks and survivor’s guilt, determined to stay silent and hide from the past. Thirty-five years after the war ended, she returned to Auschwitz and was finally able to fully heal and forgive the one person she’d been unable to forgive—herself.”

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“‘Believing that something is wrong with us is a deep and tenacious suffering,’ says Tara Brach at the start of this illuminating book. This suffering emerges in crippling self-judgments and conflicts in our relationships, in addictions and perfectionism, in loneliness and overwork—all the forces that keep our lives constricted and unfulfilled. Radical Acceptance offers a path to freedom, including the day-to-day practical guidance developed over Dr. Brach’s twenty years of work with therapy clients and Buddhist students.”

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Money is one of the great causes of mental anguish, and yet few people are willing to pick up a book and learn how to get out of debt, invest, and change the invisible scripts that run your monetary life. Whether you don’t think you have the income to save an extra $50/month or you don’t know what to do with your riches, I Will Teach You To Be Rich is as educational as it is entertaining.