Hi friends,
Welcome to the second dispatch of How Humans Flourish, a research-informed newsletter on how humans thrive.
I’ve so enjoyed the responses many of you sent after reading last week’s newsletter and I hope you’ll continue to let me know when the research resonates with you.
Published over a decade ago, it’s the perfect book to begin our descent down the wellness rabbit hole as it lays the groundwork for what flourishing is and what it is not. In particular, I appreciate the focus on how we can flourish even with complicated mental health as the mind is a particularly powerful driver in enacting behavioral change.
I also want to start in and with the mind, because over the last few years it seems we’ve turned an ideological corner in mainstream, popular culture where seeking help and leaning into vulnerability is heralded as a true strength. I am an avid drinker of the Kool-Aid, but as much as I appreciate a
Brené Brown talk, it’s still important to ask– get help to bring about what, exactly?
In a powerful chapter of his book called The Dirty Little Secret of Drugs and Therapy, Dr. Seligman writes, “According to the World Health Organization (WHO), depression is the most costly disease in the world, and the treatments of choice are drugs and psychotherapy.” (pg. 57) He makes a very critical distinction on efficacy: drugs and psychotherapy are not cures for depression (there is no cure), but they are the most widely recommended and insured short-term, cosmetic interventions.
He shares, the traditional goal of psychiatry has always been to relieve human suffering, and somehow along the way, many also assumed that the eradication of suffering would automatically and inversely lead to an increase in happiness.
However, in recounting over three decades of treating patients struggling with anger, anxiety, and/or depression, on those rare occasions when patients would actually get rid of their overwhelming negative emotions, for some reason these patients didn’t suddenly have the kind of irrepressible happiness poet
Walt Whitman describes as a joy of spirit, uncaged, darting like lightning.
No, not at all.
Instead, Dr. Seligman’s patients would report feeling… empty… like something was missing. The anger was gone, sure, but positive emotions did not suddenly flood the emotional riverbank.
This fueled Dr. Seligman’s quest to understand how to not just remove negative feelings, but how to cultivate good ones. But of course, this is complicated as there is no cure for depression and much of our relationship to negative emotions is biological. There’s the genetics of it, where
depression heritability is 50% (and most likely even higher for severe depression). And then there’s general affliction– whether physical or psychological– that accounts for the other 50%.
And globally,
young people are far more depressed than anyone over the age of 26. By some estimates, depression amongst young people is about ten times more common than it was fifty years ago. Fifty years ago, the average age of first onset depression was about thirty. Now it is below age fifteen.
And unfortunately our most widely recommended interventions aren’t as efficacious as we’d like.
Dr. Seligman writes, “Consider two treatments that are certified by vast literatures to “work”: cognitive therapy for depression (which changes how you think about bad events) and selective serotonin reuptake inhibitors (SSRIs, such as Prozac, Zoloft, Lexapro, etc.). Taking an average over the entire huge literature, for each you get a 65% relief rate, accompanied by a placebo effect that ranges from 45% to 55%. So high is the placebo response that in half the studies on which the U.S. Food and Drug Administration (FDA) based its official approval of the antidepressant drugs, there was no difference between placebo and drug.”
Almost always, he writes, the effects of psychotherapy and drugs are “small.”
He continues, “a prestigious consortium of psychologists and psychiatrists took the data from all 718 patients together from the six best-done studies of drug versus placebo, dividing the patients by severity of depression. For very severe depression, the drugs showed reliable effects, but for moderate or mild depression, the effects were nonexistent. The vast majority of prescriptions for antidepressants of drugs unfortunately are written for just these patients– moderate and mild depressives. So a 20% drug edge over placebo would be a generous, maximum estimate of their benefit.”
And for talk therapy he writes, “most forms of psychotherapies are not self-reinforcing, and so the benefits fade over time… and similar is true for drugs… every single drug has exactly the same property: once you stop taking it you are back to square one, and recurrence and relapse are standard.” (pg. 65)
This can be disheartening to read, but I’m an eternal optimist, and believe this is where empathy-driven technology shines.
There is immense opportunity for mobile and AI applications to service those dealing with moderate to mild depression without the often numbing consequences of drugs and the expensive, often inaccessible costs of therapy.
While we still have a lot of longitudinal testing to do with these innovations, there are breadcrumbs we can look for, specifically around resiliency building and habit formation.
Resiliency:
Solutions that build with a resiliency component are primed to provide longer lasting results that don’t just feel good, but allow users to develop a sense of perspective and appreciation for the hardships they encounter. Essentially, building mental toughness.
In my own startup break*through (launching in just 2 weeks!), we’ve built customizable AI companions that take cohorts of like-minded groups through fun challenges and exercises centered around holistic wellness.
Kaizen, the Japanese approach of creating continuous improvement through small, ongoing positive changes, is built into every curriculum allowing for positive mindset changes that turn into lifestyle habits. There is no grand, quick-fix to learning how to deal with life, but at least we can make developing
grit fun.
Habit Formation:
Habit formation and skill-building is critical, because as we’ve noted relapses are to be expected when most mental health treatments end. Dr. Seligman shares, “we need to tell patients, ‘Look, the truth is that many days– no matter how successful we are in therapy– you will wake up feeling blue and thinking life is hopeless. Your job is not only to fight these feelings, but also to live heroically: functioning well even when you are very sad.’” (pg. 65)
How do we do this? By learning skills in relation to improving the five core pillars of human flourishing: life satisfaction and happiness, close social relationships, meaning and purpose, character and virtue, physical and mental health. An example I’m excited about is
Meeno, an AI personal relationship mentor for all the relationships in one's life. Founded by the
former CEO of Tinder, Meeno teaches younger generations skills that increase the depth and profundity of their relationships (and also…nothing like working at
Tinder to realize how inefficient many can be at cultivating relationships, right?).
Oh my… I’m a little over 1000 words with this newsletter, but there was a lot to cover.
Tell me, what do you think of all of this? Feel free to respond to this email with your thoughts on whether empathy-driven technology can truly offer a new pathway for mental health interventions. Passionate disagreements welcome!
With gratitude,
