Latest / The Lila Rose Show / E9: Healing Depression with Dr. Aaron Kheriaty

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E9: Healing Depression with Dr. Aaron Kheriaty · The Lila Rose Show

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Welcome to the Lila Rose show. This is Lila Rose.
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I'm delighted that you're listening.
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Today we're going to deep dive the topic of depression,
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something that impacts millions of people, people that we might
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know, maybe even ourselves. And we're going to be asking the
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question, what is it? How can we heal?
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How can we help those that we love?
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And joining me today will be Doctor Aaron Kariati.
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He's a an associate professor of psychiatry and the director of
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bioethics at the University of California, Irvine, so UC
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Irvine. He's also a prolific author.
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He has written for Washington Post, Wall Street Journal and
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has also written the book, which I personally love called A
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Catholic Guide to Depression. Doctor Cariotti, thanks so much
0:45
for joining me. Thanks, Lila.
0:46
It's great to be with you. This is something, when I
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announced it on social media, so I did an Instagram story saying
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I would be interviewing you and asked what other people's
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questions were for a psychiatrist just on the issue
1:00
of depression. I started getting dozens.
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I think we're well past 100 responses in just a couple hours
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from people direct messaging me with their questions.
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So this is something that affects A tremendous amount of
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people, whether themselves personally or their friends or
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family or loved ones. And I think this will be really
1:18
good just to do an overview on depression and also to really
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what we can do, whether it's something we may be struggling
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with or people that we know that we love may be struggling.
1:29
Yeah, I agree. And this is also a condition and
1:34
illness that. Is often not talked.
1:36
About publicly, even though it is so common and impacts so many
1:40
people, there is this, unfortunately this continued
1:45
kind of stigma or silence around mental health challenges or
1:50
around, you know, behavioral disorders that causes us to sort
1:55
of think that we have to contend with them on our own.
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It makes it harder for maybe people that haven't gone through
2:02
these things personally to understand what someone might be
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dealing with if they're struggling with depression.
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So I'm very pleased that we're having this conversation.
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And I'm not surprised that so many of the folks that follow
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you have responded already to the suggestion that we're going
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to talk about this topic, because that's been my
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experience as well, going around and talking to folks about
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depression. Well, I think a good place to
2:29
start is really defining depression because I think
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everybody experiences mood disruption at some point.
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You know, you have a bad day or even a slew of bad days, You
2:40
feel like you're in a funk. And then there's severe
2:43
depression. There's, there's, there's
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clinical depression. So can you start by just walking
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us through how you define depression, maybe the different
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types? And and then I'm going to ask
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you what what, what if somebody thinks that they might be
2:56
depressed? And we can even just answer this
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with somebody thinks they might be depressed.
3:00
What are some of the telltale signs of depression?
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Sure. And you're right, Depression is
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one of those words that we use in casual conversation to
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describe, as you said, hitting a rough patch, having a bad day or
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a bad, maybe a bad couple of days, feeling down, low mood.
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All of us have that. All of us have that experience.
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And very often we describe it using this word.
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But when psychiatrists or physicians or mental health
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professionals talk about depression, we're talking about
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a clinical, A clinical condition that is in some ways maybe
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analogous to what all of us have experienced, but in other ways
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is much more profound, much more sustained, and affects us in in
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much more serious ways. And I think it's important for
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folks to understand what we mean when we talk about clinical
3:57
depression or what psychiatrist described as major depression.
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So we'll start with maybe major depressive disorder, which is
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one of the more serious types of depression.
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And depression is not an illness that affects just our emotional
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state. That's part of it.
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The low mood, perhaps feelings of sadness, sometimes anger and
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irritability can be a feature of it as well.
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So even even the emotional state itself can be complicated and
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not just reducible to feeling sad or blue.
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But beyond that, depression effects us on the biological
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level, on the psychological level, it affects our social
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relationships and it can impact our spiritual life in pretty
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profound ways that we can talk about maybe later in the show.
4:46
So we can look just at the basic level of a person's biological
4:50
functioning and see the depression effects.
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Things like sleep, our normal sleep wake cycle with doctors
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call the circadian rhythm, usually gets pretty seriously
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thrown off with sustained depression.
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Most people experience that as difficulty falling asleep,
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difficulty staying asleep. So insomnia can be a key feature
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of depression. Sometimes you have a typical
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forms of depression where the opposite happens where you're
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sleeping in excess. You're in bed 18 hours a day,
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maybe sleeping 1415 of those hours.
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And even though you're sleeping maybe twice as much as as you're
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as you typically would need, if you're healthy, you still feel
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exhausted. OK, the same thing can happen
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with our appetite. So most people with depression
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experience a diminished appetite that can sometimes result in
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significant weight loss that can impact your physical health.
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But again, there are a typical forms of depression where things
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go in the opposite direction and people have an increased
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appetite, they have weight gain problems, so sleep and appetite
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are affected. Just our level of physical
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energy can be profoundly impacted.
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So it's important for people that are depressed and feeling
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literally maybe like they can't get out of bed, feeling
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exhausted all the time to get a good medical evaluation because
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this might be depression or it might be another medical
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condition that can mimic some of the symptoms of depression.
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So to, you know, get a get a full examination and some lab
6:30
tests to rule out the possibility that you have low
6:33
thyroid hormones. So hypothyroidism is a General
6:37
Medical condition that can look a lot like depression, but it
6:41
has a straightforward hormonal 'cause that can be interacted
6:45
with with medical treatments. Anemia can be another condition
6:49
where you're you're feeling exhausted all the time for no
6:52
apparent reason. So it, depression clearly
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affects us on the just sort of straightforward biological level
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and not just in the brain, but throughout all of the systems in
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our body. Obviously our mood is impacted,
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our ability to concentrate and focus.
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So now we're getting into some of the cognitive symptoms of
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depression. So people that are depressed
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might have the experience of of trying to read a page of a book
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that's ordinarily not too difficult for them, but they
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find that they're not retaining any of the information.
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They go back and read the same paragraph four times in a row
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and that they're that they can't focus on it.
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They're having a conversation with someone and what the other
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person is saying is going right past them.
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They just can't take it in and process it.
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So depression also effects our ability to focus, to pay
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attention to process information.
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When you think about that aspect of depression, it's very easy to
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see how even if you don't have a job that requires physical labor
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or a lot of physical energy, you're not doing, I don't know,
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manual labor or something like that.
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You have a job that requires, you know, intellectual labor or
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focus and attention that depression is is potentially
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going to profoundly impact. Your ability to work.
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Right. And what's what is, I mean, all
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of those things. So whether it's your sleep or
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your appetite or your focus or your, your just your feelings of
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sadness and loss, what is behind all of that?
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I mean, we're here. We're talking about something
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that you, you, you, you do the work to meet with a doctor, you
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determine this is not my thyroid or this is not my, you know,
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this is not caused by another ailment that's Co occurring, but
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this is something that is a result of depression.
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So is that, I mean, what's happening in your brain
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chemistry or what are the the factors that are are that are
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actually causing all of these painful symptoms?
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Sure. So we know that certain people
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have genetic predispositions to depression.
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Depression has a strong component of what?
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We call heritability. OK, so some people come into the
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world just primed to be more disposed to having depression.
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That doesn't mean that if you had a parent with depression, or
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even 2 parents with depression, you're automatically going to
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get it. It's not that straightforward.
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Genes are only part of the story.
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But some people react to stress by getting headaches.
9:22
Some people react to stress by getting gastrointestinal
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symptoms, you know, upset stomach.
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Other people might respond to stress with depression.
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There are other factors, sometimes early life experience
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factors, that can contribute to depression, but we know that
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early childhood loss or early childhood trauma significantly
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increases a person's risk for depression, not only in
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childhood but also later in life.
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There are certainly other psychological and social factors
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that can play a role in a person developing depression, physical
10:03
stress, emotional stress. So the story usually with
10:08
depression is complex. We know that there are changes
10:12
in the brain, that's clear. But those changes in the brain
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can be downstream of all kinds of other causes, right?
10:20
So just because there's sort of something going on in your brain
10:23
biologically doesn't mean that external stress or even
10:27
relationships are not contributing to the depression.
10:30
We know that relationships change the brain.
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It's very interesting that, you know, the brain is not sort of
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locked in our skull in a kind of black box.
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It's, it's, it's a central processing source, you could say
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that interacts with our entire body, but also with the external
10:51
world and all kinds of complicated ways.
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So, so we know that medications have an effect on the brain.
10:57
Antidepressant medications can cause certain changes when they
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treat depression that that are moving things hopefully in a
11:03
positive direction. But we know also that
11:06
psychotherapy, talk therapy can induce some of the same kinds of
11:10
changes, even permanent changes in the brain that medications
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cause. So it's very interesting even
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even relationships in our life, important relationships and
11:22
attachments and experiences have profound effects on our brain.
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So depression is, I want to say it's an interesting illness and
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that's. Not to make it sound like a
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good. Thing, But from a scientific
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perspective, it's to me it's very interesting because it
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can't be sort of boiled down to just one simple problem in the
11:45
body or problem in the brain, even though those those pieces
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are certainly at work. It can't be boiled down just to
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genetics or just to environment and experience.
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All of the above, all of these things play a role.
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And so when we get someone who's dealing with depression, it's
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very important for us to take a comprehensive and whole person
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look at what's happening and evaluate it on all of these
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different levels and from these different perspectives.
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Biological, the psychological, the social and the spiritual
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because the causes are complex and likewise the remedies, the
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treatment treatments in the interventions might also be
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complex. We know that medications are
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helpful. We know that psychotherapy is
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helpful when you put the two of those together doesn't have to
12:32
be an either or. We know that both together are
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more helpful than one or another alone.
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The medications can actually make the psychotherapeutic work
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more fruitful. They can, they can help you
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enough that you can engage more meaningfully in the work that
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you might have to do with cognitive therapy or with
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behavioral therapy or with therapy that maybe looks at some
12:54
of the difficulties or challenges or traumas of your
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past. It's interesting because I, I
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have gotten a lot of, and in conversations with friends and
13:04
family, you know, depression runs in my family, for example.
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So there is that biological maybe frailty for some of us.
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You know, I'm one of eight kids. I have a large extended family.
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And you know, one thing that I, there's kind of this ongoing
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debate about therapy for depression, which include, well,
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what about medication? You know, some, some would say
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medication makes it worse. There's, there are horror
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stories and bad stories of medication gone wrong.
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There are, you know, consequences to medication or
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there's the, you know, side effects that are negative and
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but then also there are success stories.
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And I know that person, you know, from personal experience
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and in my family, that can maybe be another episode for another
13:47
day. But how medication can be part
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of the healing process. So what's your kind?
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What's your perspective as a psychiatrist on these kind of
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competing different treatment plans?
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And it sounds like all of the above, you know, can work
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together. But if someone's, you know,
14:04
concerned about just being prescribed medication, because
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that does happen, I, you know, that does happen in in our
14:09
healthcare system today where you go, you can go to a doctor
14:12
and you're just prescribed medication.
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That's just, you know, kind of an easy, direct answer to, OK,
14:17
you're struggling. Here's some here are some pills.
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What would be some of your thoughts on on kind of the
14:23
status of our even our medical system today and, and the role
14:27
of medication? Sure.
14:29
So great, great set of questions here.
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And first of all, let me agree with you that unfortunately, so
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much of our current healthcare system, either in primary care
14:39
where you may be getting antidepressant medications or
14:43
even seeing a psychiatrist, the specialist to get those
14:46
medications. There are so many pressures on
14:49
the system and so many pressures on doctors that that
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unfortunately, many of them have moved to short visits where
14:54
they're sort of going through checklist of symptoms and then
14:57
prescribing medications or simply adjusting the dose of
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medications. And to me, that's not the best
15:04
model, the Sonic really good model for delivering adequate
15:09
mental health care to people or or for dealing with a complex
15:13
condition like depression. With that said, medications can
15:19
and often do have an important role in treating this illness.
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And so we don't want to dismiss them.
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We don't want to sort of throw out the baby with the bathwater.
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I think in most cases, depression should be part of a
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more holistic and comprehend antidepressant medication should
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be part of a more holistic and comprehensive treatment program
15:40
that even if you're not engaged in, let's say psychotherapy or
15:43
some other therapeutic intervention, the very least you
15:46
should be looking at things like exercise, right?
15:49
Four days a week, 30 to 40 minutes a day can be as as
15:54
effective as medications for mild depression, moderate to
15:57
severe depression. You're you're probably also
16:01
going to need antidepressant medications.
16:03
But again, exercise plus medications is going to work
16:07
better than one or another alone.
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In some cases, you're so depressed that you literally
16:12
can't get out of bed and exercises just a pipe dream.
16:15
So the antidepressants maybe bring you up to the to, you
16:19
know, to the point where you're more meaningfully able to engage
16:24
in an exercise regimen and put that second piece of the puzzle
16:27
in place to start proving, you know, some of the biological and
16:31
psychological psychological components of this illness.
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So I, I tend to be a both and rather than an either or.
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And it makes, it makes sense. It makes sense.
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And I, I think, you know, even in my personal experience with
16:45
loved ones and family that it's, it's, it has to be a holistic.
16:50
And I think that is, you know, back to problems in the medical
16:53
system, like you said, I think there is sometimes if they're
16:56
not, if you're not getting more specialized care, it can just be
16:59
OK, you know, here's a prescription, right?
17:02
But including, you know, diet and exercise and relationships
17:07
and maybe talk therapy or, you know, different kinds times of
17:10
if you're dealing with trauma or different experiences from your
17:13
childhood or whatever it is working through, doing the work
17:17
to work through that can all be important factors.
17:21
One, one other element of this, which I've gotten a lot of
17:25
questions about and I hear as a kind of an ongoing debate as
17:28
well, alongside the medication debate is the spiritual side.
17:32
And I know this is something that you've investigated
17:35
thoroughly, you know, as a Catholic psychiatrist and
17:38
someone who's written the Catholic Guide to Depression
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that, you know, in whether it's the evangelical community, the
17:45
Catholic community, sometimes there's a sense of, OK, if
17:47
you're struggling, if you're depressed, you know, fake it
17:49
till you make it, you know, grin and bear it.
17:51
Maybe this is just a problem with your faith.
17:53
You're not strong enough in your faith.
17:56
What would you say to those people?
17:58
And into that argument about depression, that it's a, it's a
18:01
lack of faith. It's you're not, you're not,
18:03
you're not, You're not fighting the good fight enough.
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So the first thing that I would say is.
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It's important for people to understand that depression is
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not a character flaw. It's not a sign of character
18:18
weakness. It's not a sign of a lack of
18:20
virtue. It's not a sign of a.
18:22
Lack of faith. And one of the things I talk
18:24
about in my book is that we have in our, in our Catholic
18:28
tradition, I'm sure you can find the same thing in Protestant
18:30
Orthodox traditions. In the Jewish tradition, we have
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Saints, people that we hold up as models of holiness, models of
18:40
virtue that have suffered from and struggled with depression
18:44
and even even more serious mental illnesses.
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I talk about Saint Benedict Joseph Labre in my book, Little
18:52
known 19th century St. in Rome, who likely had schizophrenia or
18:58
another psychotic disorder. This was a man with a severe
19:01
mental illness who achieved great heights of sanctity.
19:05
Canonized. That's right.
19:06
That's amazing. And the treatment plans back
19:08
then, I'm just going to guess, weren't as good as they are
19:10
today. That's right.
19:12
He suffered from this his whole life.
19:13
God did not take this enormous cross away from him.
19:16
And in fact, in some ways it was.
19:19
It was the vehicle for his sanctity.
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You might argue so. So the first thing to that needs
19:26
to be said is while it's clear that depression can impact your
19:31
spiritual life, and in some cases people's spiritual life or
19:34
their spiritual struggle may be impacting their depression too,
19:37
I'm not. I'm not suggesting that these
19:41
two things are entirely unrelated, but to to go with
19:46
this simplistic narrative or the simplistic interpretation that
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I'm depressed and so I just need to If I only had I had more
19:56
faith. If only I read the Bible more,
19:59
or I received the sacraments more frequently, or I was more
20:03
devoted. Then I wouldn't be struggling
20:05
with this thing. I think that ignores what we
20:08
know about depression. I think that ignores the
20:10
important insights from our own spiritual tradition.
20:14
And you know, with the with the fathers of the Church and the
20:17
Saints sort of understood about the fact that we're embodied
20:21
creatures, right? Our body and our brain and our
20:24
our mind, some sometimes needs, needs help, right.
20:30
Yeah. And in a way, I mean depression.
20:31
It's interesting because part of depression is the accusations in
20:36
your own head that life is hopeless, that you're no good,
20:39
you're worthless. So I think folks struggling with
20:42
depression, and I can speak again from personal experience,
20:45
which is a whole other conversation we could have, but
20:49
that whole personal experience of someone being depressed is
20:53
that they are not wanted, that love, their life isn't
20:56
worthwhile. I mean, there's so many negative
20:58
thoughts that they can be thinking as part of depression
21:00
or just feeling numb. And so I can see why it's easy
21:04
as a depressed person to think, oh, this is this is my fault.
21:07
You know, I'm just not, I'm just not a strong enough Christian
21:10
and This is why I'm depressed. I see that.
21:13
Unfortunately, I see that all the time.
21:15
That's one of the things I very often have to work through with
21:17
people in therapy. And again, once you accept that
21:24
there are things that are happening sort of on the
21:25
biological and psychological level that we can attend to,
21:28
then you can attend to the spiritual life because there are
21:33
things that can be done in the spiritual life to help you
21:35
recover and to lower your risk of relapse.
21:39
Those, there's not replacements for medications or the, or the
21:43
other interventions that need to be done, but they, they can't
21:46
help. So we don't want to ignore the
21:48
spiritual. Life.
21:49
But there I do see this tendency among among Christians all the
21:53
time of sort of over spiritualizing or prematurely
21:57
spiritualizing a complex problem like this and suffering more and
22:04
longer than they need to in in exactly the way that you
22:08
describe this self blame. Not only am I suffering from
22:11
this sort of terrible condition, it's really important to
22:14
emphasize just how. Awful.
22:16
Depression is I've I've struggled personally with
22:20
chronic pain from a spine injury for almost three years now.
22:24
At times, very serious pain and, and depression and chronic pain
22:27
tend to go hand in hand. So there have been times where I
22:30
struggled with at least mild depression, not the more severe
22:32
forms that I've seen in my clinical practice, but even that
22:35
mild depression was enough to to convince me that if I had to
22:39
pick between the chronic pain and, and, and depression, I
22:42
would pick the chronic pain. I mean, it's just, they're just
22:45
there's, there's, there's nothing worse than than than
22:49
suffering the the, the kind of suffering that can come from
22:54
depression and and other, other mental illnesses.
22:58
And what has, what has that been like for you, Doctor Kariati?
23:01
I mean, that is something that I know you've been sharing more
23:04
and more about publicly, your battle, personal battle with
23:07
chronic pain, which I understand is just a recent one, just the
23:11
last three years. Can you share about that?
23:13
And then also how that has impacted your, your work dealing
23:18
with mental illness, dealing with people that are also
23:20
suffering. Sure, sure.
23:22
So the first thing that's happened for me is just a better
23:31
understanding of challenge, the challenges of navigating the
23:34
medical system with with a chronic problem, right?
23:38
The healthcare system itself. And I've got good health
23:41
insurance and I've got good doctors available and I've got
23:43
second opinions. I've got everything that you
23:45
would want in the United States. And even then you have to sort
23:48
of advocate for yourself and it's.
23:50
And for you, for you it's it's, is it chronic back pain?
23:54
Is it a spinal injury? Or yeah, it started out, it was
23:57
a spinal injury and I had back pain initially, but it damaged a
24:01
nerve route, my L5 nerve route that goes down my leg and my
24:04
foot. So my pain, funny enough now is,
24:07
is experienced in my leg and foot, even though the injury to
24:11
the nerve and the scar tissue that's kind of tethering the
24:13
nerve that's causing all of this is in my back.
24:16
So it's a back injury that causes leg pain for me.
24:20
So yeah, just the perspective of being a patient has been good.
24:24
The perspective of. Having something that, that
24:27
disables me it in many ways. I mean, I still work, work full
24:31
time and I can do some of the things that I used to do, but
24:34
many of the physical activities I used to do I I can't do and,
24:38
and, and yet I look normal. I look like a normal, healthy
24:42
sort of 42 year old guy from the outside.
24:45
And so the experience of having a condition that's not
24:49
immediately visible and doesn't sort of immediately elicit
24:53
sympathy from other people, like if I'm, you know, walking around
24:55
on crutches or some kind of injury, that's obvious.
24:59
Well, the same. Thing happens.
25:00
I think something some of these happens is somebody who's
25:02
suffering from depression. It's hard for people, you know,
25:06
on the outside to understand why is it so hard for you to brush
25:08
your teeth? Why is it so hard for you to get
25:10
going? Why is, you know, why is
25:12
everything so difficult when you look fine from the outside and
25:16
you don't have cancer and you don't have diabetes, you don't
25:18
have an, you know? A.
25:21
A clear, clean, physical 'cause that we can sort of pinpoint and
25:25
put under the microscope. And yet ordinary, ordinary
25:31
activities of daily living seem so tough for you.
25:34
I think in, in, in many respects, depression and chronic
25:37
pain are obviously different, but at least in that respect,
25:40
they're they're analogous. They sort of overlap and that
25:43
they're hidden from most people on the outside, but they're very
25:48
much experienced interiorly. Sort of all the time.
25:51
Or almost all the time. And so I think they're both
25:56
conditions that can cause a certain sense of loneliness, a
26:00
certain sense that maybe other people don't understand what I'm
26:03
experiencing. It's hard to even even my loved
26:05
1 ones it's. Hard.
26:07
For them to connect with what I'm going through and that can
26:11
be a real challenge of dealing with an illness like this.
26:15
It's feeling like, you know, there's no one around who
26:17
understands. I think that's one of the
26:19
reasons it's valuable to be able to have, whether it's a support
26:22
group or, or even a conversation like this that you listen to via
26:25
podcast of connecting with other people that have gone through
26:29
depression or gone through chronic pain.
26:31
So that you feel like I'm not the only one in the world who's
26:34
contending with this. There's someone there who gets
26:37
it. There's someone there who
26:37
understands, Does that take away my depression?
26:40
No. Does that take away my pain?
26:41
No. But there is some kind of
26:43
there's, there's, there's a real consolation in that that I
26:46
personally have found, have found helpful in a connection to
26:49
other people that are struggling with chronic pain that I've,
26:52
I've found helpful. And just knowing that, you know,
26:54
I'm praying for them. They're praying for me.
26:57
There's some solidarity in this is, is, is controlling.
27:01
We need, we need connections to other people so, so desperately.
27:05
And one of the things that's causing rising rates of is
27:08
depression in our country and so-called deaths of despair, you
27:12
know, the opioid overdose, the suicide epidemic is, is that
27:18
we're becoming more fragmented and fractured as a society and,
27:22
and more lonely people have fewer real face to face
27:25
connections than they did a generation ago.
27:28
That's a, that's a real social, socially studied fact that's
27:34
been confirmed over and over by, by social science and by
27:38
research. And into my mind, that's, that's
27:41
one of the key causes of our rising rates of depression.
27:45
So anything we can do to reverse that trend and help people
27:50
connect with one another is going to is going to mitigate
27:54
the suffering that's caused by these kinds of problems.
27:57
There, that is a an interesting point you bring up because when
28:01
the research I've been doing on depression and mental health, I
28:03
mean everything is spiking, the suicide rate spiking, depression
28:07
itself is spiking. I was reading one study from
28:09
Blue Cross Blue Shield just about medical claims made
28:13
through the insurance company and it said that the diagnosis
28:17
for major depression swelled by 33% in a three-year period.
28:22
And it for teens, it jumped 63% and millennials 47%.
28:27
Do you think that so, I mean, is that social media?
28:30
I mean, why are we so depressed? What, what is you mentioned
28:33
isolation. What is that?
28:36
Is that is that that we're on our phones all day?
28:39
That's a yeah, great question. It's a long conversation.
28:42
That's a whole other podcast. Let me give you the the
28:45
two-minute answer to that I think is for young people, yes,
28:49
that we have a growing body of social science research that is
28:54
showing that screen time is bad for the mental health of
28:59
adolescents. And there's a pretty direct
29:02
linear correlation between the amount of screen time and the
29:06
severity of the poor mental health outcomes.
29:10
Jean Twenge at UC San Diego has done a lot of work on this and
29:15
published on this. That.
29:20
So what's happening with what's happening with young people and
29:23
social media? Again, that's a long story.
29:26
That's a complex story, but one of the pieces of it Lila is on
29:32
social media, especially the kind of social media that that
29:36
young people are engaged with and and sort of consuming pretty
29:41
pretty constantly is a kind of status in comparison game where
29:49
most people are going to feel like they're not measuring up.
29:54
Even people that by objective measures are, are thriving as
29:59
compared to their peers. You know, they're they're going
30:03
to hit rough patches. They're going to have, they're
30:05
going to have snafus, they're going to, they're going to get
30:08
AC on a test from time to time, whatever.
30:11
Those are not the kinds of things that people post on
30:14
social media. You know, they take their best
30:16
picture and then they touch it up a little bit and then they,
30:18
you know, and then they. So when you're looking around at
30:21
the people around you, it always seems like everyone's life is
30:25
pretty awesome. Yeah, everyone looks perfect,
30:27
Yeah. As compared to mine, because
30:29
people are always putting their best foot forward and then even
30:33
even airbrushing it up a little bit, you know, from there.
30:37
And so there's this kind of standard up there that is
30:40
impossible for anyone to measure, measure up to even the
30:44
most even the person who's most successful or whatever, by
30:47
whatever standard you're using, you know, physical appearance or
30:51
academic performance or athletics or what college they
30:54
got into. And this, this comparison game
30:58
is, is really, you know, aside from the outright kind of
31:05
bullying and doxing and kind of the really nasty stuff that all
31:09
of us know about, you know, the comments, threads and so forth
31:12
that it can really, really bruise your ego.
31:15
And for someone who's vulnerable can actually push them toward,
31:19
toward suicide, you know, social humiliation is, is a real threat
31:24
for all adolescents today in a way, in ways that it wasn't when
31:27
I was growing up not that long ago.
31:30
And so is a solution that I mean, just limit your screen
31:33
time. I mean, it sounds like it's a
31:34
pretty, if it's such a direct correlation, it's find friends
31:38
or people that you can do real life with that are not digital,
31:43
you know, that are not on your screen.
31:46
That's the most straightforward solution.
31:48
It's, it's obviously it's easier said than done, right?
31:51
Of course. But there have been a movement
31:53
toward, you know, archaic flip phones.
31:55
You know, some people have just decided the smartphone in my
31:58
pocket is not good for me. It's not smart.
32:01
It's not, it's not smart, it's not helping me and I don't feel
32:03
good when I use it. And there's the what what some
32:06
people have called, what is it? FOMO, fear of missing out,
32:09
right? If I'm not dialed in and
32:10
connect, connected in this way that I'm, I'm not going to be
32:13
invited to the party. I'm not going to notice
32:14
something that I ought to know about.
32:17
So that drives a lot of people to consume more of this than
32:20
they need to. But in my experience with
32:22
younger people and adolescents have moved away from this when
32:25
they've, when they've left the phone at home or when they've,
32:28
yeah, they've gotten a flip phone that they can make phone
32:31
calls on or, or do a text message, but it takes 10 minutes
32:34
to type it up. They're, they're happier.
32:37
They call their friends more, they get together with their
32:39
friends more. They meet more face to face.
32:41
And you know, they, they don't become socially ostracized or,
32:46
you know, sort of social pariah or an outcast.
32:50
Things work out much better than they may have feared.
32:53
And actually, so yeah, taking a once a week Sabbath from the
32:57
smartphone, taking a month long Sabbath or break from the
33:02
smartphone once a year. And you know, if you find that
33:06
you're happier, try it. And if you find that it works,
33:08
maybe maybe it's time to to downsize, or maybe it's time to,
33:13
you know, close some of the social media accounts and
33:15
consume screen time in a different way.
33:20
Doctor Cariade, I want to get to the role of faith and then also
33:24
resources, which I know you have lots of recommendations for
33:28
that. That's your professional work.
33:29
I do want to understand though, I mean, especially here you are
33:33
battling chronic pain daily. You're, you're working full
33:36
time, you're still writing, speaking, obviously working at
33:39
University of California, Irvine as a psychiatrist.
33:42
What, what got you passionate about mental health?
33:46
Why is this something that you've really dedicated your
33:49
life to? So I went to medical school and
33:54
you know, psychiatry is a specialty of medicines.
33:57
You do 4 years of medical school and then you choose a residency
34:00
training program based on your specialty.
34:02
And I didn't know I wanted to be a psychiatrist when I went to
34:05
medical school. I knew I wanted to be a
34:06
physician, but I wasn't sure what kind.
34:09
And when I did my required psychiatry rotation in my third
34:12
year, I just, I just found the, the illnesses that I was
34:16
treating fascinating. I found the patients
34:17
fascinating. I was really attracted to the
34:20
idea of being able to spend more time with patients, not be so
34:23
rushed. So I'm, I'm still an old
34:25
fashioned psychiatrist in the sense that I, you know, I spent
34:28
an hour with my patients rather than 15 minutes, even if I'm
34:32
seeing them just for a routine follow up.
34:34
And I really enjoy that about psychiatry, being able to
34:37
accompany people, you know, long term and really get into what's
34:41
happening in their lives beyond just a sort of sort of a
34:44
superficial checklist of symptoms or an acute problem
34:48
that I solve. And then and then that's it.
34:50
So psychiatry snuck up on me. But now that I've done it, in
34:54
retrospect, I can see also there were some personal experiences
34:57
that also pushed me in this direction. 1 was that I lost a
35:01
very close friend, a high school friend to suicide.
35:05
He had he was diagnosed with bipolar disorder, which is a
35:09
mood disorder like depression, but that also has a time severe
35:14
manic episodes, which we can make talk about on another show,
35:17
another day. But but Matt struggled with
35:20
bipolar starting when he was starting, when he was at the Air
35:26
Force Academy. And he was very successful
35:31
student, got into this highly competitive Military Academy,
35:34
ran NC 2A Division One track. He was an all American kid, just
35:39
a terrific, terrific young man. But this illness, this illness
35:44
was was severe, severe disruption on his life.
35:52
And he ended up, he ended up dying by suicide when I was a
35:54
first year medical student. And so I had a deep desire to
35:58
understand what happened, you know, with Matt and how I lost
36:02
him. And I could see how it impacted
36:04
his family. I could see how it impacted his
36:06
friends. And so I think my personal
36:08
experience with a close friend and, and his family that was
36:13
impacted in this way also played a role in leading me in this, in
36:18
this direction. And.
36:21
Yeah. And I I think.
36:22
You asked about resources. I didn't.
36:24
I don't want to jump. No, I, I want to go to that
36:26
because I mean, I think and a lot of folks listening,
36:29
including you, including myself, have loved ones or even have
36:33
lost loved ones or maybe people listening themselves, like you
36:37
said yourself, dealing with chronic pain when I was a teen,
36:40
I dealt with depression. That's something that I had to
36:44
go through. So there's so many out there
36:46
struggling with this. So first question as far as
36:49
resources, what can friends and family do to help loved ones who
36:53
may be struggling with depression?
36:54
And specifically, I think there's this fear of
36:56
overstepping or not being involved enough, you know, in
37:00
supporting that friend or that loved one.
37:02
It's challenging. You have to walk a fine line
37:05
between being helpful and offering assistance and
37:09
resources to a loved one to help, but not trying to be the
37:13
one that fixes it, which you most likely will not be able to
37:18
fix it. So the first thing that I would
37:19
say, and it sounds really simplistic and almost tried, but
37:23
at the same time it can be really difficult, is just simply
37:27
listening. Listening not in order.
37:30
To get a handle on it so that you can offer the advice that
37:33
they need and fix it for them. But listening simply to be
37:37
present to them and to try to understand what it is that
37:40
they're going through. And maybe they.
37:42
Want to talk about it? Maybe they don't want to talk
37:43
about it, but you can. You can crack that door open and
37:47
let them know that I'm I'm here and I'm interested in, you know,
37:51
what you've been going through and what is this been?
37:53
Like for you and tell me more about that if, if you'd like to,
37:58
that ministry of presence is in itself enormously healing
38:05
because again, the person who's depressed is very often isolated
38:08
in that depression and having someone who even if they can't
38:11
fully understand, wants to understand and and wants to.
38:16
It doesn't get scared and run away from it, which is what we
38:19
often do. It's one of the reasons we rush
38:22
to a solution Lila and jump in and try to be a fixer.
38:25
Is that it's? Painful to be with someone who's
38:28
who's depressed It can you know, these emotions can have a kind
38:32
of. Contagion effect.
38:33
And if you sit with someone long enough who's depressed and
38:36
listen to them, you can start to feel kind of heavy and you know,
38:39
your heart feels weighted down. And that's not always, that's
38:43
not always fun. So.
38:44
So that's the first. Thing that I would say is just
38:46
be willing to listen without trying to fix, be willing to
38:52
suggest resources in the simplest resource is to get a
38:56
consultation with a physician, right.
38:59
And maybe that's just a primary care physician.
39:01
They don't want to go see the psychiatrist.
39:03
No, I, I'm not crazy. I don't need to see the head
39:05
shrink. And they sort of those, those,
39:07
those defenses go up at the stigma sort of comes out there.
39:12
OK, fine. But would you be willing to see
39:15
the internist or the family physician?
39:18
The psychiatrist would be better, but most primary care
39:22
physicians can at least offer some initial advice on dealing
39:26
with depression or anxiety or other common psychiatric
39:30
disorder. So that would be a place to
39:32
start. Getting a consultation with a
39:34
psychiatrist is, I think, important, especially if the.
39:39
Depression is really impairing your ability to function.
39:42
So if it start starting to affection affect your ability to
39:46
succeed in school or your ability to succeed at work or
39:52
it's really impacting. Your family's life.
39:54
It's time to go see a psychiatrist, or if the
39:56
psychiatrist is not available, to go see a psychologist who can
40:00
then refer you to to a physician if medications might be
40:04
warranted. So, you know, try to get over
40:07
that hump of of not wanting to ask for help or wanting to fix
40:12
it on your own. It's not a sign of weakness to
40:16
seek help. If you had a medical condition,
40:19
get an infection that required antibiotics, you wouldn't try to
40:22
fix it on your own. You would be sensible.
40:25
You would go see the doctor. Well, this illness is no less
40:29
real and no less medical, you could say, than any other
40:33
illness like an infection. And so be sensible about it.
40:37
Be willing to go see the doctor and get some help.
40:40
Be open to the idea of medications.
40:42
Maybe medications aren't going to work for you.
40:45
Maybe maybe you just are opposed to medications so you don't want
40:49
to try them. Fine, there are other ways of,
40:52
of treating this, this problem, but try to be open to the idea
40:56
of at least hearing about the medications and going through
40:59
some of the details about the risks and benefits of, of
41:02
medications as a family member. I think you can suggest these
41:08
resources. It's hard, it's hard to see a
41:14
family member struggle and suffer when they might be able
41:17
to get help and they don't want to get help.
41:19
So when do you get to the point where you try to kind of really
41:24
maybe use more, yeah, strong measures, interventions to try
41:31
to get them help? Certainly if you're worried
41:35
about their safety, certainly if you're worried about someone
41:37
else's safety, their ability to care for their child.
41:41
If you're worried about the possibility of suicide, if
41:46
someone makes remarks about suicide and they're unwilling to
41:49
go get help about it, you can always call 911 and they'll send
41:54
a mental health team or in some cases, if that's not available,
41:57
a police officer to evaluate the person and see if they need to
42:01
be placed on, on a legal hold in order to be taken to a
42:07
psychiatric hospital for evaluation.
42:10
Right? Because this could be, it could
42:11
be life and death. And I think that's right.
42:14
And that's why this is not a matter where we just sit by.
42:18
But at the same time, like you're saying it, if there are
42:21
warning signs that there's, you know, suicidal ideation, they're
42:23
considering suicide or they can no longer care for themselves or
42:27
their own child or their own loved one, their own family,
42:31
that's where maybe our reaction can get stronger.
42:34
Our response can get stronger. What, what would you say for
42:38
those that you mentioned the importance of going to see a
42:40
good doctor? And, you know, I think a lot of
42:43
people, like you said, they there's stigma attached to it,
42:46
which is so sad because there's zero shame in having an illness
42:49
or a struggle, a mental health struggle.
42:51
I mean, it's something I've struggled with.
42:52
It's something many members of my loved ones and family have
42:55
struggled with. You're taught you, you even
42:57
shared in your chronic pain journey.
42:59
It's something you've had to battle with.
43:01
What, what do we do, especially for those that are listening
43:04
that are Catholics or Christian, you know, Catholic Christians or
43:07
evangelicals, Protestants that are a little bit suspicious, you
43:11
know, they're the psychiat. They're concerned the
43:13
psychiatrist won't pay attention to the spiritual side.
43:16
They are, they're not sure if this is someone that has their
43:20
values. What?
43:21
What are some resources you would recommend for that person?
43:24
Sure. So very often you can reach out
43:27
to a pastor, your priest or the local diocese if you're a
43:31
Catholic, and often they will have mental health resources
43:35
that they can refer you to. I completely understand the
43:39
desire of many patients, many people, to see a mental health
43:44
professional who. Shares their religious
43:46
convictions, right? Because if that's an important
43:51
part of your life, if that's central to your identity, you
43:53
want someone who's who's going to be respectful of that, who's
43:56
going to have regard for that. Maybe see that as a potential
43:59
resource to help you heal when that's available.
44:04
Terrific. If that's not available, I think
44:07
you should still be open to the idea of getting help from a
44:11
mental health professional. You can try someone out right If
44:14
if you feel like I didn't connect with this person, this
44:16
is not the right therapist for me.
44:18
They were. They were not understanding
44:20
where I'm coming from in terms of faith and morals.
44:23
Fine, go look for someone else. But I know many, many really
44:27
skilled psychiatrists that have trained with us, good mental
44:30
health professionals that are not Catholic, Christian, Jewish,
44:35
what have you, but have regard and respect for their patients,
44:39
religious convictions and are sensitive to not not sort of
44:45
travelling over those and and see those also as a potential
44:48
resource for healing. So fine, when when the ideal is
44:52
not available, you can still find that kind of person, right?
44:56
And that certainly is going to be better than nothing.
44:59
That's going to be better than forgoing help.
45:02
Because, you know, I didn't, I didn't find the ideal whatever
45:05
Catholic psychiatrist. So that's the first thing that
45:09
that I would say. And there there are good
45:11
resources out there. You mention my book.
45:13
Thank you for the plug. The the bishops of California a
45:18
couple of years ago published a really nice document called Hope
45:22
and healing. It was a pastoral letter on
45:25
mental illness. And, you know, perhaps we can
45:27
link this to your, your podcast page.
45:29
That's a resource that you can find on the Internet.
45:32
You know, just search for California bishops mental health
45:35
letter or California bishops hope and healing whatever you'll
45:39
you'll run across it. And it does a really good job of
45:43
explaining the need for people of faith, Christians, Catholics
45:47
especially, to attend to this in our communities and to start
45:54
talking about this and to offer support to people that are
45:57
struggling with mental illness, people, people who have a family
46:01
member who are struggling with depression or bipolar or
46:04
schizophrenia or an addiction. That there is no shame in this.
46:08
There's no stigma that needs to be attached to this.
46:12
This is something that, out of love of neighbor and solidarity
46:16
with one another, we need to start attending to in our own
46:19
faith communities. Yes, so, so true and and talk
46:23
about it, make it a regular part of our conversation, like you
46:26
say in our faith communities. One one last question for you,
46:31
Doctor Curiati, This is so good and there's so much here to go
46:35
even deeper. And and so I look afford to
46:37
having you back on to continue this conversation.
46:41
But for those you mentioned some resources and for those who are
46:45
again, people who are listening are Catholics or who are
46:48
Protestants, people of faith. And they want to really make
46:52
that part of their their healing because we know we serve an all
46:55
powerful God who heals, right, Who, who created medicine, who
46:58
created the sciences, who created everything on earth.
47:02
And so we can use these tools. Psychiatry obviously is so
47:05
important and powerful. What are some things, and maybe
47:08
you can even speak to this personally, as someone who has
47:10
has had your own recent bout with chronic pain, What would
47:14
you recommend for someone who is listening, who wants to be
47:19
holistic in their approach? Maybe they're pursuing, you
47:21
know, they're meeting with psychiatrist, therapist, They're
47:24
maybe they're doing medication from the spiritual perspective.
47:27
What are some thoughts that you might have for how we can really
47:32
unite our suffering to Christ and and deepen our faith even as
47:37
we go through or we are with loved ones who are going through
47:40
hard times? Great question and I wish we
47:44
could spend another hour on it. Let.
47:47
Me just throw out a couple of quick suggestions in that regard
47:52
and shameless self promotion here.
47:55
You can read more in in in my book on on depression, but.
47:59
It's a great book. A Catholic.
48:00
It's a Catholic's guide to depression.
48:03
A few ideas. 1 is OK. If you're in the midst of a
48:06
profound depressive episode, it can be hard to engage in
48:12
spiritual practices that maybe you were doing before.
48:15
OK, so it's OK to acknowledge that and you know, I used to
48:21
read the Bible for 20 minutes every day and now I'm only doing
48:24
5 minutes That's fine but keep doing those 5 minutes, right?
48:28
Maybe, maybe meditate on the passion, right?
48:32
Think about the fact that our Lord in Gethsemane and on the
48:36
cross suffered not only our. Our physical pain, clearly, but
48:43
our our. Emotional and mental anguish as
48:46
well, right? He had that loss.
48:48
He was betrayed by one of his closest friends.
48:52
He felt the weight of of our sins.
48:55
Think about our Lord weeping over Jerusalem in the the tender
48:59
words that he said there. So, so Christ has a human heart,
49:02
right? He's he's a man of flesh and
49:04
blood. He has a he's a heart that's
49:06
fully human and fully divine and and meditate on the humanity of
49:11
Christ. Meditate on his passion.
49:15
Think about his passion in relation to your own suffering,
49:20
because your suffering can be part of his.
49:22
It can be a way like Simon of Cyrene that you help him carry
49:28
the cross, right. Continue engaging in communal.
49:34
Spiritual. Practices go to Mass, go to your
49:38
Bible study, go to your prayer service.
49:40
You, you One of the behavioral tendencies of depression is to
49:44
withdraw. I have so little energy that I,
49:47
I have to conserve it. I, I can't push myself.
49:50
Well, paradoxically, you know, he who loses his life will find
49:54
it. And with depression, it's kind
49:55
of like that. You have to expend energy, the
49:57
little energy that you have to try to get out, to try to
50:00
connect with other people in order to get that energy
50:03
replenished. And that can be part of the
50:05
healing. My friend at at Harvard, a
50:09
public health researcher named Tyler Vanderweil, published a
50:12
very interesting study in the Journal of the American Medical
50:14
Association last year showing that he this was looking at
50:19
suicide rates and suicide rates for people that went to church
50:25
services. Once a week were five times
50:28
lower than suicide rates of the general population and this was
50:33
a study of women. It was from women's nursing
50:38
study, population based study of nurses.
50:39
Around the country, but. I think these results apply to
50:44
men as well because there's been a lot of other research that
50:46
found the same results, but for women that went to Catholic
50:50
women that went to mass more than once a week, so daily mass.
50:55
There were no cases of suicide in this study of like 70,000
51:00
people. So, so we know that religious
51:04
practice, and that's not to say that religious practice
51:07
prevents, absolutely prevents suicide.
51:09
It doesn't. But it's significantly lowers
51:11
our risk of suicide because it helps us connect with other
51:14
people. It gives us a source of hope in
51:18
the midst of suffering, and those things can be very helpful
51:25
in healing and recovery. So continue receiving the
51:30
sacraments as frequently as you can.
51:33
Give yourself permission. You know, to dial back on your
51:36
spiritual practices if if, if you can't manage them, if they
51:40
are becoming a source of stress. I used to pray the rosary every
51:43
day and I just can't feel like I can get through it.
51:46
My my focus and my concentration, my attention is
51:48
too impaired by this illness. That's fine.
51:51
Just pray one decade of it. I just just that's OK.
51:55
But but don't give it up entirely, right?
51:58
And know that our Lord understands your challenges and
52:01
your difficulties right now. And he's, he's happy with
52:04
whatever you can give him in this regard.
52:08
So, so my advice is give yourself permission to
52:13
understand that you're going to have impairments now that you
52:15
wouldn't ordinarily have and that's OK.
52:19
But also don't take that to the extreme where you withdraw
52:22
entirely from your religious and spiritual practices, whether
52:27
they're they're individual prayer or or liturgical or
52:32
communal prayer that happened with other people.
52:34
Continue engaging in both of those things because we have, we
52:38
have a growing body of scientific research now, Lila,
52:41
that actually shows that while these things alone are not
52:44
curative, they are helpful in recovering from depression and
52:48
lowering anxiety and helping lower the risk of relapse for a
52:53
person who's vulnerable to depression.
52:55
Thank you so much, Doctor Cariotti, for taking the time to
52:58
talk about this today and for the healing that you do every
53:02
day in your practice and for sharing more about how healing
53:05
is possible. Thank you, Lila.
53:07
It's been a pleasure. And that's the message I want to
53:10
leave with anybody listening right now is that healing is
53:12
possible. There are resources out there
53:15
that there is hope for anybody who is suffering.
53:19
Thanks for joining for this episode of The Lila Rose Show.
53:22
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53:53
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