There’s an increasing drift between how they get used colloquially in everyday language and the commonly accepted definitions among psychologists. There’s a sense in which the lay usage is “wrong” (in that it doesn’t match more scientific, precise, or technical usage), but of course, language has always been and always will be in flux. At the end of the day, a word does mean what people widely use it to mean. So I think it’s useful to be aware of both definitions for psychological concepts. The everyday concept helps us understand others, whereas the more technical definition is usually more helpful for helping us understand the way the world works. Here’s a list of examples:

1) Gaslighting

Everyday usage: Someone invalidating your perspective or lying to you in order to manipulate you

Precise usage: Manipulation that specifically causes someone to doubt their own senses or their ability to reason

2) Negative reinforcement

Everyday usage: Something bad happens when you do a behavior, so you do it less

Precise usage: Removal of an aversive stimulus after a behavior is engaged in, causing that behavior to increase (not a form of punishment). This is in contact with positive reinforcement, which adds a desirable stimulus after a behavior (which is a different way to get a behavior to increase).

3) OCD

Everyday usage: being a neat freak or someone who needs things done in a specific way

Precise usage: A disorder involving repetitive, intrusive obsessions and/or compulsions (behaviors performed to reduce anxiety) that are time‑consuming or impair function.

4) Depression

Everyday usage: feeling sad a lot

Precise usage: an ongoing near-daily pervasive depressed mood (sadness, emptiness, and/or hopelessness) or loss of interest or pleasure, that coincides with symptoms like fatigue, suicidality, poor concentration, weight change, or feelings of worthlessness.

5) Antisocial

Everyday usage: a desire to avoid being around other people

Precise usage: a personality disorder (ASPD) involving pervasive disregard for or violation of the rights of others, typically involving deceit, manipulativeness, aggression, and a lack of empathy/remorse.

6) Narcissist

Everyday usage: someone who is self-centered or very vain

Precise usage: a personality disorder (NPD) involving a grandiose sense of self-importance and superiority, need for admiration, and reduced empathy.

7) Trauma

Everyday usage: A very upsetting experience

Precise usage: Exposure to someone dying, serious injury, or sexual violence (DSM), or another extremely threatening or horrific event that has a long-lasting negative impact on a person’s mental function.

While there’s a time for going with the flow of culture, and using words however people casually use them, there’s an important role for more technically precise terminology as well. In the cases above, I believe the technical versions of these words are worth knowing about and understanding.

This piece was first written on November 7, 2025, and first appeared on my website on December 11, 2025.

There’s an increasing drift between how they get used colloquially in everyday language and the commonly accepted definitions among psychologists. There’s a sense in which the lay usage is “wrong” (in that it doesn’t match more scientific, precise, or technical usage), but of course, language has always been and always will be in flux. At the end of the day, a word does mean what people widely use it to mean. So I think it’s useful to be aware of both definitions for psychological concepts. The everyday concept helps us understand others, whereas the more technical definition is usually more helpful for helping us understand the way the world works. Here’s a list of examples:

1) Gaslighting

Everyday usage: Someone invalidating your perspective or lying to you in order to manipulate you

Precise usage: Manipulation that specifically causes someone to doubt their own senses or their ability to reason

2) Negative reinforcement

Everyday usage: Something bad happens when you do a behavior, so you do it less

Precise usage: Removal of an aversive stimulus after a behavior is engaged in, causing that behavior to increase (not a form of punishment). This is in contact with positive reinforcement, which adds a desirable stimulus after a behavior (which is a different way to get a behavior to increase).

3) OCD

Everyday usage: being a neat freak or someone who needs things done in a specific way

Precise usage: A disorder involving repetitive, intrusive obsessions and/or compulsions (behaviors performed to reduce anxiety) that are time‑consuming or impair function

4) Depression

Every day usage: feeling sad a lot

Precise usage: an ongoing near-daily pervasive depressed mood (sadness, emptiness, and/or hopelessness) or loss of interest or pleasure, that coincides with symptoms like fatigue, suicidality, poor concentration, weight change, or feelings of worthlessness.

5) Antisocial

Everyday usage: a desire to avoid being around other people

Precise usage: a personality disorder (ASPD) involving pervasive disregard for or violation of the rights of others, typically involving deceit, manipulativeness, aggression, and a lack of empathy/remorse.

6) Narcissist

Everyday usage: someone who is self-centered or very vain

Precise usage: a personality disorder (NPD) involving a grandiose sense of self-importance and superiority, need for admiration, and reduced empathy.

7) Trauma

Everyday usage: A very upsetting experience

Precise usage: Exposure to someone dying, serious injury, or sexual violence (DSM), or another extremely threatening or horrific event that has a long-lasting negative impact on a person’s mental function

While there’s a time for going with the flow of culture, and using words however people casually use them, there’s an important role for more technically precise terminology as well. In the cases above, I believe the technical versions of these words are worth knowing about and understanding.

This piece was first written on November 7, 2025, and first appeared on my website on November 18, 2025.

• “Depression is anger turned inward.”
• “Anger is sadness’s bodyguard.”
• “Anger is just a manifestation of sadness.”
• “There is an anger iceberg (anger on top, with sadness, fear, or shame beneath).”
• “In men, sadness and depression show up as anger.”

While there is debate about these ideas among people in the field, my opinion is that these statements are misleading and, in some cases, wrong. I think these statements can promote misunderstandings about the nature of anger, depression, and sadness, as well as what their connection to each other actually is.

In my view:

• Anger is the emotion we experience when we believe that someone is purposely or negligently destroying (or trying to prevent us from getting) something we value. As an example, if someone were trying to hurt our pet, most of us would feel angry.
• Sadness is the emotion we experience when we believe something we value has been lost. For example, if our much-loved pet died, we’d likely feel sadness.
• Depression is the emotion we experience when we believe that we ourselves, or our future, contains nothing of value (e.g., because we think there is no action we can take to produce states we deem valuable). For example, if our pet were the only source of value in our life, and our pet died, we’d likely feel depression. Note: Many people, including many researchers, do not see depression as an emotion at all – only as a syndrome or disorder. I believe depression is also a distinct emotion that we can experience (though I could be mistaken on this point) – much the way that anxiety is an emotion, but there are also disorders of anxiety (like generalized anxiety disorder).

If I’m largely right about the points above, what then is the connection (if any) between anger and sadness and between anger and depression?

Well, some things can generate a mix of anger and other emotions.

We’d likely feel both anger and sadness if we believed that someone had permanently destroyed something we really value. For instance, if we believed that someone had purposely burned down our beloved home.

We’d likely feel both anger and depression if we felt that someone (or something) had rendered our future devoid of value. For instance, if we believed that someone had sabotaged our career prospects.

Additionally, emotions are not all equally available or comfortable to talk about. When we feel anger and sadness at the same time, we may be more aware of one of the two emotions, or more willing to express one of the two emotions to others, which can make it seem like one of them is hidden “beneath” the other.

But can other anger take the place of other emotions? Well, as one example, in some situations where we find it too emotionally difficult to blame ourselves for something bad that happened (that we, in fact, caused), we may blame others as a self-protective mechanism, which may mean we experience anger (towards these others), whereas if we accepted responsibility, we may feel depression rather than anger (e.g., due to viewing ourselves as worthless due to having caused the bad event).

On the flip side, our sadness or depression might suddenly turn to anger if we switched from believing that we had caused a great loss of something we value, to believing that someone else had been the cause of the loss.

Another way that anger can connect to sadness or depression is that if a person feels ashamed of being sad or depressed, and someone tries to get them to talk about their sadness or depression, they may respond with anger, for example, due to feeling pressured or judged.

So yes, anger can be connected to sadness or depression, though it isn’t always. And no, depression is not anger turned inward (they are distinct feelings), anger is usually not sadness’s bodyguard (though sometimes we can cast blame at others, leading to anger, to protect against blaming ourselves), and anger is not necessarily an iceberg (though we can have multiple emotions at a time, and some can be easier to notice or talk about).

This piece was first written on September 29, 2025, and first appeared on my website on November 3, 2025.

This is the fifth and final part in my sequence of essays about my life philosophy, Valuism – here are the first, second, third, and fourth parts.

In previous posts, I’ve described Valuism – my life philosophy. I’ve also discussed how it could serve as a life philosophy for others. In this post, I discuss how a Valuist lens can help shed light on various fields and areas of inquiry.

Valuism and Effective Altruism

Effective Altruism is a community and social movement about “using evidence and reason to figure out how to benefit others as much as possible, and taking action on that basis.”

Effective Altruists often operate from a hedonic utilitarian framework (trying to increase happiness and reduce suffering for all conscious beings). But Effective Altruism can alternatively be approached from a Valuist framework.

You can think of Valuist Effective Altruism as addressing the question of how to effectively increase the production of one’s altruistic intrinsic values within the time, effort, and focus you give to those values (as opposed to your other intrinsic values). If you’re an Effective Altruist, chances are two of your strongest intrinsic values are related to reducing suffering (or increasing happiness) and seeking truth.

For people with certain intrinsic values, Effective Altruism is a natural consequence of Valuism. To see this, consider a Valuist whose two strongest values are the happiness (and/or lack of suffering) of conscious beings and truth-seeking. Such a Valuist would naturally want to increase global happiness (and/or reduce global suffering) in highly effective ways while seeing the world impartially (e.g., by using reason and evidence to guide their understanding). This is extremely aligned with (and similar to) the mission of Effective Altruism.

For more on the relationship between Effective Altruism and Valuism, see this post.

Valuism and existential risk

Potential existential risks (such as threats from nuclear war, bioterrorism, and advanced A.I.) are a major area of focus for many Effective Altruists. According to most people’s intrinsic values, existential risk is also incredibly bad. Existential risks threaten many of the things that humans value (happiness, pleasure, learning, achievement, freedom, longevity, legacy, virtue, and so on). So for most people’s intrinsic values, Valuism is compatible with caring about existential risk reduction (depending on one’s estimates of the relevant probabilities).

Valuism and utopias

Utopias are hard to construct. Sure, we pretty much all want a world without poverty and disease, but it’s hard to agree on the specific details beyond avoiding bad things. If we go all-in on one intrinsic value, we end up with a world that seems like a dystopia to many. For instance, a utopia, according to hedonic utilitarianism, might look like attaching each of our brains to a bliss-generating machine while we do nothing for the rest of our lives, or it might look like or filling the universe with tiny algorithms that experience maximal bliss per unit of energy. Of course, these are horrifying outcomes for many people.

If we maximize utopia according to one or a small set of intrinsic values, it will very likely seem like a dystopia according to someone with other intrinsic values. To construct a utopia that is not a dystopia to many, we should make sure that it includes high levels of a wide range of intrinsic values, keeping these in balance rather than going all-in on a small set of values.

Put another way, if we preserve a wide range of different intrinsic values in our construction of potential utopias, we protect ourselves against various failure modes. For instance:

• The intrinsic value of avoidance of suffering protects us from a world where there is a lot of pain and suffering.
• The intrinsic value of freedom helps protect us from a failure mode of a world of forced wireheading. 
• An intrinsic value of truth helps protect us from a failure mode where we’re all unknowingly in the matrix (e.g., being used for a purpose unknown to us) or living under an authoritarian world government that tries to keep the populace happy through delusion.

Valuism and worldviews

Worldviews usually come with a set of shared intrinsic values. These are the strong intrinsic values that most (though not all) people with that worldview have in common. Of course, in most cases, in addition to these shared intrinsic values, each individual will also have other intrinsic values that are not shared by most people with their worldview. You can learn more about the interface between worldviews and intrinsic values in our essay on worldviews here.

Valuism and mental health 

Mental health may have interesting connections to intrinsic values. For instance, here’s an oversimplified model of anxiety and depression that I find usefully predictive (I developed this in collaboration with my colleague Amanda Metskas):

Anxiety occurs when you think there is a chance that something you intrinsically value may be lost. Anxiety tends to be worse when you perceive the chance of this happening as higher, when you perceive the intrinsic values as more important, or when the potential loss is nearer in time.

Depression occurs when you’re convinced you can’t create sufficient intrinsic value in your future. This could be because you think the things you value most are lost forever, because you see yourself as useless at achieving what you value, or for other reasons.

Valuism and animals

What do animals care about? While some animals (e.g., some insects) may not be conscious (i.e., they may lack something that it’s like to be them), and therefore it may not matter what they care about, for conscious animals, it may be important to understand what they intrinsically value so we know how to treat them ethically.

An intrinsic value perspective on animal ethics is that we should not deprive animals of the things they intrinsically value (and we should help them get the things they intrinsically value, at least when they are easy to provide). So, for instance, we can ask how much a chicken that lives almost its whole life in a small cage (as many chickens raised for food in the U.S. do) is able to have its intrinsic values met. The answer is probably very little.

But what are the sorts of things that animals may intrinsically value? I suspect there are a wide variety of animal intrinsic values and that they depend on species, but here are a few that may be especially common in mammals:

• Pleasure
• Not suffering
• Not experiencing large amounts of fear, stress, and anxiety
• Surviving
• Agency (e.g., the ability to choose)
• Bonding with other animals
• Protection of their offspring

Valuism and economics

Economics often operates under the assumption that each person has a “utility function”: i.e., a function that maps states of the world into how good or bad the person thinks those states are and that describes the choices people make. According to this frame, if a person chooses A over B, that means that their utility function assigns a higher value to A than B. For example, if I buy a Mac rather than a PC, and they are the same price, this must mean that I predict the Mac gives me more utility (according to my utility function). 

Valuism, on the other hand, says that when A is more intrinsically valuable to us than B (and equivalent along other dimensions such as price), we often will choose A over B because A produces more of what we intrinsically value; however, sometimes we choose B over A instead because we confuse instrumental value with intrinsic value, or we have a habit of doing B, we feel social pressure to do B, etc.

In other words, choosing something is not the same as intrinsically valuing something, and ideally, we want to construct a society where people get more of what they intrinsically value, not merely giving people more of what they would choose. 

A classic example where intrinsic value and choice come apart is addictive products like cigarettes or video games with upsells: people sometimes choose to pay for them and use them way past the point of benefit, according to their own intrinsic values.

A similar issue comes up when people slip into treating every dollar of GDP or each unit reduction of “deadweight loss” as though they are equally valuable. Imagine that an influencer gets all the hottest celebrities to start wearing the hair of a rare species of sloth and that buzz convinces millions of people that it’s really cool, so consumers spend billions of dollars buying these sloth hair pieces. Unfortunately, the sloth hair is really aesthetically ugly, uncomfortable, and expensive, and making clothes out of it requires torturing the sloths. This will probably increase GDP, yet (on net) intrinsic value will almost certainly have been destroyed. There is no good reason to care about GDP for its own sake, but intrinsic values are precisely the things we care about for their own sake. While increasing GDP may often be aligned with producing more of what people intrinsically value (both now and potentially in the future), in cases when GDP and the long-term production of intrinsic values are out of alignment, I would argue that GDP is no longer a good measure of societal benefit.

Going back to the sloth hair example, having a free market for this sloth hair would, according to simple economic theory, reduce “deadweight loss” (relative to having restrictions on their sale). And yet, the production of this sloth hair will likely be net destructive to what people intrinsically value. We can imagine a multi-faceted accounting of how society is doing that takes into account productivity and wealth but goes beyond it to consider the extent to which people are creating their intrinsic values; productivity and wealth would be viewed as being in the service of intrinsic value production.

As a complement to GDP, we can think about measuring how well the people of a society get the things that they intrinsic value. For instance, attempting to measure:

• How happy are they? 
• To what extent are they accomplishing their goals? 
• How free are they?
• How meaningful are their relationships? 
• How much are they suffering?

This is related to the Human Development Index, though that index includes items that are not intrinsic values, and it doesn’t cover all intrinsic values.

If we had such an accounting, different people would naturally rank societies differently (in terms of how good they are overall) because they value these intrinsic values to different extents.

As you can see in this post, a Valuist perspective may have something to say about many other topic areas, giving us a different way to look at topics like Effective Altruism, utopia, animal ethics, worldviews, mental health, and economics.

You’ve just finished the fifth and final part in my sequence of essays on my life philosophy, Valuism – here are the first, second, third, and fourth parts.

I’ve noticed that it’s quite common for people to struggle to know what they should do to support friends or family members going through a mental health challenge, and it’s also quite common to say counterproductive things in such situations.

With the aim of helping you better help those people in your life who are struggling, here’s a list of five things that are usually a *bad* idea to say to someone who is dealing with a mental health challenge, along with seven things it usually is a *good* idea to do in such cases.

Part 1: things that are usually a *bad* idea to say to someone who is going through a mental health challenge

1. “Just think positively.”

For most mental health challenges, the problem is not a lack of positive thinking, and even if it were, being told to “think positively” would not enable them to actually be able to do so. This advice also trivializes people’s problems and so can come across as quite annoying or condescending.

2. “Focus on everything you have to be grateful for. Other people don’t even have enough food to eat!”

While it may be true that their life objectively has a lot of good things in it, their mental health challenge is not going to go away just by observing that. Gratitude can be a very useful mindset, but it is not a solution to mental health challenges, and being told to be grateful for what you have can lead to feelings of guilt (e.g., “I’m such a screw-up that I can’t even be happy when I have all these good things!”)

3. “You have to choose to be happy.”

It’s extremely rare that people choose to have a mental health challenge, and very few people, if any, know how to take the ongoing action of “choosing” to be happy. This framing of “choice” can also come across as though you are blaming the person for their mental health challenge, which is likely to be counterproductive.

4. “Today is the first day of your new life!”

This assumes that they can suddenly break out of their old patterns by reframing their life as starting anew, but this is a very unrealistic assumption. 

5. You should read “The Secret”/”The Power Of Positive Thinking” (or similar books)

These are in a genre of books that tell you that your problems are the result of not thinking the right way and that if you just start to think differently (e.g., imagine yourself succeeding and believe it with certainty), you will suddenly start to have the life you want. These techniques usually do not work for people with mental health challenges and can leave the reader feeling blamed for how they feel.

Part 2: things that usually *ARE* helpful to do with someone who is struggling with their mental health:

1. Ask open-ended questions about how they’re feeling and what they’re experiencing, without pushing them to reveal more than they’re comfortable with. Listen carefully. Try to really understand what they are going through.

2. Learn about the condition. Reading a book or two about the condition they are struggling with, or talking to an expert about it, can help you better understand what the other person is dealing with and can improve your ability to support them in helpful ways. Keep in mind, however, that their manifestation of the condition may differ from the typical manifestation, so be careful about jumping to conclusions about what they must be experiencing.

3. Empathize with them and show compassion. Don’t blame them for what they’re experiencing. And don’t use their struggles as an excuse to spend a lot of time talking about your own struggles. Though if you have been through similar challenges, they may appreciate knowing that.

4. Encourage them (with gentleness and compassion) to seek professional help (e.g., an excellent psychologist or psychiatrist). If they’re struggling to get started, ask permission to assist, and if they agree, reduce the effort for them (for instance, by trying to track down an excellent professional and provide them with the contact info). Thankfully, most people will improve when they are given evidence-based treatment that is carried out by a competent mental health professional (though it may take a few tries and failures to find a treatment that works well).

If they aren’t willing to see a therapist, you can ask if they would be up for reading a book that is specifically designed to help people who have mental health challenges. If they agree, you can research what the best book is on the topic and buy it for them.

For instance, many people have benefited from the David Burns books Feeling Good (for depression) and When Panic Attacks (for intense fears, such as social anxiety and phobias). Chronic worriers may benefit from The Worry Cure by Robert Leahy. For people who are mean to themselves (e.g., engaging in negative self-talk), the book Self-Compassion (by Kristin Neff) may be useful. For people who have very intense emotions or who have Borderline Personality Disorder, The Dialectical Behavior Therapy Skills Workbook by Matthew McKay may be useful.

If the person expresses openness to it, you may also want to encourage them to engage in other healthy behaviors that may be beneficial (such as eating healthy food, walking outside daily, and getting regular exercise at the gym). It’s ideal if you can make these behaviors easier for them, such as by offering to go to the gym with them three times per week or by buying them a healthy meal delivery plan as a gift (with their permission, of course).

5. Avoid advice until they are ready to hear it. In an attempt to be helpful, people are often much too quick to give advice, which can be very frustrating to the receiver (especially when the advice-giver doesn’t really understand the circumstances well). The time to give advice is after you have done a lot of listening and when the other person has indicated that they would like your advice. If you aren’t sure if they want advice, you may want to ask something like, “Would it be helpful if I gave you some suggestions now for how to do X, or would that not be useful at the moment?” Of course, once they are ready for advice, you should absolutely give it. When you do give advice, try to make it clear when you are confident in what you’re saying versus when you aren’t as sure (and they may want to consult someone else, such as a mental health professional).

6. Do nice things for them that you know (based on past experience with the person) they’re likely to appreciate – whether it’s spending more time together, sending a random compliment, reminding them you love them, giving an extra hug, planning a fun activity for the two of you (that they feel well enough to enjoy), or offering to help them clean their apartment. What matters, of course, is what they would actually appreciate in their current state, not what you would appreciate if you were them, and not what they would appreciate if they weren’t in their current condition.

7. Make your help sustainable. Remember that it is not your job to “fix” this person’s mental health, nor will you be able to do so. Mostly, you can only help someone when they WANT to be helped and only in ways they are WILLING to be helped. It’s also important that you take care of yourself in the process. This person may have a mental health challenge for a long time, so (other than in cases of acute crises where extra action is needed), it’s not a good idea to extend yourself in a way that will not be sustainable. Don’t jeopardize your relationship with this person by taking on more than you can realistically handle, which could lead you to experience burnout or resentment. Just because someone is experiencing a mental health challenge does not mean you should let them violate your boundaries. If the person is acting in a way that is harmful to you, it’s important that you clearly assert your boundaries to prevent yourself from being harmed (while you continue to help in whatever ways you can, without giving up on those boundaries).

Conclusion

Everyone is different, so it’s always possible someone would benefit from items in the “bad” list above or dislike items in the “good” list. But I believe that following these guidelines will, more often than not, make you more effective at helping the people you love.

In summary, as a friend/family member, your job is to provide love, empathy, and the level of support that you can sustainably manage. Avoid giving shallow suggestions such as to “think positively.” Instead:

• ask open-ended questions

• learn about their condition

• empathize with their experience

• encourage the person to get high-quality professional help

• avoid giving advice (until they want it)

• do nice things

• make your help sustainable

This piece was first written on January 8, 2023, and first appeared on this site on May 28, 2023.

It’s common to try to explain things as either due to nature OR nurture.

Or, at best, we say: some percentage of the variation in outcome is due to genes, and some percentage is due to the environment. It’s important to remember, though, that outcomes can be a complex interaction between the two.

Consider this:

Our genetically-influenced traits impact what environments we seek out and find ourselves in.

For instance, risk-taking seems to have moderate heritability, and it influences career and life choices that change our environment.

A risk-taker is more likely to seek out riskier environments. And this choice of environment might itself depend on the opportunity set (i.e., current environment). In one environment, risk-taking might mean a greater likelihood of entrepreneurship; in another, it might mean crypto trading, and in a third, drug dealing.

Genetic propensities and the environment we are in can become intertwined.

Consider depression:

Depression seems to have a heritability in the 20%-60% range.

Some are unusually susceptible to it, others less so. Yet whether someone has a depressive episode or not may depend a lot on what environment they happen to be in.

With meaningful work, supportive friends, a robust exercise routine, and effective self-regulation strategies, even with a high propensity toward depression, you may be able to avoid it. On the other hand, if you’re unemployed, lonely, and without helpful routines, even with a low propensity toward depression, you may still become depressed.

So while it can be useful to think about the heritability of a trait, it is important to remember that heritable traits can influence what environment we end up in and that the interplay between genes, environment, and our habits/skills/strategies are what leads to outcomes.

So while it’s common to think in terms of:

(1) nature OR nurture

…or, at best… 

(2) an additive model: outcome = w * nature + (1-w) * nurture…

…Sometimes, a better model has an interaction term:

outcome = w1 * nature + w2* nurture + w3 * nature * nurture.

This was first written on April 28, 2021, and first appeared on this site on December 9, 2022.

Additionally, many studies have found that SSRIs (and other medications) help people with both depression and anxiety, as do certain therapeutic modalities such as Cognitive Behavioral Therapy, suggesting further linkage.

Findings like these lead some to conclude that the two diseases are just one and the same, or part of the “same thing.” I don’t agree. The main reasons I don’t agree are because:

A. Anxiety and depression feel different internally (i.e., they have different “qualia” for most people). This is a major part of how we can tell which one we’re experiencing at a given moment. For instance, for me, I am more likely to experience anxious feelings in my upper chest, with depressive feelings being more like an “emptiness.”

B. Some events cause anxiety but not depression (e.g., worrying that there is a tiger hiding by the watering hole because you saw a tiger there at another time); others cause depression but without necessarily causing anxiety (e.g., having trouble getting over the death of a beloved friend a year after the event).

C. The behavioral changes they cause tend to be different since anxiety tends to cause avoidance of the things you fear, whereas depression tends to produce a lack of motivation.

D. There are some personal factors that are strongly linked to one but not the other. For instance, in our research, we found that negative self-talk is strongly linked to depression, but it is not linked to anxiety (once you control for depression).

Clearly, though, anxiety and depression ARE very connected.

So, how ARE they linked?

Here’s what I think the main links between anxiety and depression are:

1. Anxiety sometimes causes depression since anxiety at high levels leads people to avoid important things of value out of fear and (in some cases) out of exhaustion. Missing out on the things they value has a tendency to make people depressed. And feeling trapped by your anxiety can also give a sense of hopelessness, leading to depression.

2. Depression sometimes causes anxiety since feeling that “nothing really matters,” or that there is “no point in trying,” or that “I’m worthless” can lead to difficulty with motivation, exhaustion, and giving up, which can cause a snowballing set of anxiety-inducing life problems (e.g., fear of losing one’s job, or fear of losing friendships, or a piling up of life chores that go undone, with increasingly large consequences).

3. There are factors that increase one’s chances of getting both depression AND anxiety, such as early life trauma, negative life events (like losing a job), and poverty.

Therefore I see the links this way:

Depression sometimes causes anxiety.

so: D -> A

Anxiety sometimes causes depression.

so: A -> D

A negative spiral can occur, with anxiety causing depression, which causes anxiety, which causes depression, and so on, in a feedback loop.

so: A -> D -> A -> D -> …

And difficult life situations and events can cause BOTH simultaneously.

so: X, Y, Z -> A & D

So yes, depression and anxiety are highly related, but they don’t, by any means, seem to be “the same thing.”

This piece was first written on January 10, 2021, and first appeared on this site on December 23, 2022.

Much of what happens in our brains is chemical, why would depression not be? If by “imbalance” we happen to mean “a state of brain chemicals that the patient doesn’t want”, as opposed to, say, some specific theory that is now discredited like “not enough serotonin” (i.e., the low serotonin myth), then depression can reasonably be thought of as a “chemical imbalance”.

Disagreement about whether depression is a chemical imbalance may stem from confusion about what it means for something to be a “model” for something else. For instance, “chemical imbalance” is a model for depression. But it’s just one model, and it is often not the most useful one. Here are all the models I’ve seen people use for depression:

(1) Neurology – caused by a chemical imbalance of neurotransmitters in your brain; that’s why anti-depressants are effective for many people.

(2) Beliefs – caused by unhelpful perceptions of yourself, your future, or the world; that’s why cognitive therapy is helpful for many people.

(3) Circadian rhythm/sleep – that’s why some people may find chronotherapy (involving sleep and light) or sleep apnea treatment effective.

(4) Relationships – that’s why socially isolated people often feel depressed and why Interpersonal Therapy may be effective.

(5) Nutrition – that’s why people with depression are sometimes found to have vitamin deficiencies or harmful diets and may feel better if these are corrected.

(6) Society – that’s why groups of people who are oppressed, shunned, or in poverty are more likely to be depressed, and improving these social problems may resolve the depression.

(7) Behavior – that’s why depressed people are sometimes found stuck in harmful behavioral feedback loops and why Behavioral Activation for depression is helpful.

(8) Trauma – that’s why people who were unloved or abused as children may be more likely to be depressed, and why people often show depressive symptoms for a while after a loved one dies.

(9) Meaning – that’s why depressed people sometimes feel that nothing matters, and why techniques from the ACT approach that get you to take action towards what you value may be useful.

(10) Genetics, that’s partly why depression tends to run in families and helps explain why one person gets depressed in a particular circumstance that another person doesn’t get depressed in.

These can’t all be true, can they? I believe they can, in the sense that each of these is partially correct, or to be more precise, each of these is a model for depression that is better than useless. What’s nice about this set of models is that they are complementary: they each capture some distinct aspect of depression, and each will be especially useful in certain circumstances. In particular, a number of these refer to different things that can cause or trigger depression. Not all of these causes will be in play in any particular case, so sometimes one model will apply more than other.

There are many ways to model any system. A good model typically is not one that fully explains every detail of a system but rather one that explains important aspects of the system in important cases of interest. It is not a contradiction to find that there are multiple good models for the same system that are very different from each other. They may each capture different important attributes of the system, or may each be accurate in different situations, or they may just represent similar information in very different seeming ways. Even if one model is much better than the others on average, there may be specific cases where the alternative models make better predictions. And realizing that may allow us to combine models to create an even better one.

Consider the game of Pac-Man as an example. One way to model the game is to think of the ghosts as sentient beings that are trying to touch you, which will cause you to die. This is the intuitive model that players often have of the game, and despite being completely untrue on one level (the ghosts are not sentient), it is quite a useful model that enables you to play the game effectively.

However, if you train a reinforcement learning algorithm to play Pac-Man, it will produce a very different model of the system (one that may well contain no direct notion of ghosts that are out to get you, and likely the model it produces will be one that you’ll have a hard time understanding). Yet, using this model, the software may play Pac-Man as well as you do or perhaps even better. So whose model is right, the intuitive human one or that of the reinforcement learning algorithm? Neither is “right”, and neither is “wrong”; they both capture important elements of the game in different ways.

A more complete model of Pac-Man than either the intuitive human one from a reinforcement learning algorithm’s is the computer code of Pac-Man, which determines the gameplay. From the point of view of you playing the game effectively, it MIGHT help to some extent to study the code in advance to learn potential quirks of the ghosts’ behavior, but mostly the code would not be useful while you play, and you’ll find it a lot easier to think of ghosts being out to get than to mentally reference the underlying algorithms. So your “ghosts are out to get me” model may be more helpful to you than the “source code of the game” model, despite the latter being a much more accurate description.
But even the source code is not the ultimate model of your Pac-Man experience, as the ULTIMATE model would include the hardware that code runs on (maybe the behavior of that code varies slightly on different hardware), and even the people around who might distract you during the game, and ultimately the laws of physics on which the behavior of the hardware and everything else depends.

As statistician George Box once wrote, “The most that can be expected from any model is that it can supply a useful approximation to reality: All models are wrong; some models are useful.”

So let’s stop asking if depression “is” a chemical imbalance. Instead, let’s ask: is it useful to sometimes model depression as a chemical imbalance? I think the answer there is yes; this is one model that should be used among other models in certain specific instances. It may sometimes be a useful model, but other times other models of depression will be much more useful. And, of course, much of what happens in our brains can be modeled as chemical changes. So the question is: when is this a useful way to think about what’s happening chemically in the brain? When does such a model give us insight?

If a depressed person responds well to anti-depressants, we can use our Neurology model of depression to try to understand this (though that still may be very tricky to do). On the other hand, if a person’s depression lifts after they stop believing that they are inherently worthless, we can use our Beliefs model to try to understand this. And if a person’s depression improves when they adjust their sleep patterns, we can use our Circadian rhythm model to try to explain this. And so on.

Ideally, we’d try to figure out the most effective model for a given person’s depression so that we can accurately model their specific depression, not merely depression in general.

happiness =

   social-acceptance
+ self-acceptance
+ meaning
+ hope
+ pleasure
+ efficacy
+ resilience
+ optimism

– physical-wants
– pain
– anxiety
– loss and depression

Positives

social-acceptance = human interaction with the sort of people you want to interact with in the form of warm and trusting relationships, and the gut-level feeling that this group accepts you, likes you, and respects you

Interventions: exposure therapy if you have social anxiety, avoiding mean people, social skills training, getting direct feedback on how to be a better friend, meeting a wide range of people in a wide variety of social circles, leaving a social circle that treats you badly

–

self-acceptance = believing you are not fundamentally bad or worthless, that you are worthy of love and respect, not feeling excessively guilty about your past actions, etc.

Interventions: self-compassion training

–

meaning = feeling on a gut level that your life has meaning or significance, that actions you take have the ability to influence what happens, and that the world in general is not meaningless

Interventions: working on a project that you find deeply important for a cause much bigger than yourself, cognitive behavioral therapy or antidepressants if you think you may be depressed and haven’t tried them yet

–

hope = feeling on a gut level that there will be good things in the future and that your future is not doomed

Interventions: mapping out plans for your future, applying problem solving techniques to problems that you feel are hopeless, life coaching

–

pleasure = for instance, eating delicious food, listening to beautiful music, play, doing work you find fun, etc.

Interventions: spending money on pleasurable experiences rather than things, engaging in pleasurable experiences at the maximal rate you can afford without them getting dull or routine, trying a wide variety of activities to see which you most enjoy

–

efficacy = the belief that you have the capability to achieve the things that you want to achieve, and the feeling that you are actively achieving worthwhile things (whether in work, in hobbies, or in your social life)

Interventions: if possible, choosing work where you get a consistent feeling of accomplishment, taking on side projects or hobbies that give you a feeling of accomplishment, training each week at a skill that you can watch yourself improving at, looking for small achievements that you can hit easily and then building up slowly to more and more difficult ones

–

resilience = the ability to recover quickly from setbacks, failures, and bad conditions

–

optimism = a mindset where you see the best in things, interpret ambiguous events positively, see the silver lining in bad things, etc.

Negatives

physical-wants = hunger, thirst, sleep deprivation, the need for warmth, etc.

–

pain = injuries, illnesses, physical environments, or social treatment that causes consistent substantial pain

Interventions: avoiding repetitive stress injury by using good typing practices, avoiding chronic back pain by learning to have good sitting posture, leaving abusive relationships

–

anxiety = constantly worrying about, or ruminating or obsessing over what will happen or did happen (e.g., from uncertainty about basic security like clean water, nourishing food, reliable shelter, or safety from physical danger, or worrying about social rejection or fear of failure), or regular triggers of intense fear

Interventions: regularly doing intense exercise, cognitive behavioral therapy or antidepressants if you think you may have an anxiety disorder, Exposure and Response Prevention if you think you may have obsessive compulsive disorder (OCD), Prolonged Exposure Therapy if you think you might have post-traumatic stress disorder (PTSD)

–

loss and depression = having something you value taken away from you, or knowing that you will lose something you value in the near future

Please note: if you have been feeling a lot of sadness, or you worry that you might be depressed, I recommend seeing a professional and checking out our app UpLift.

If you like this essay, you may also like The Fourier transform of happiness and Ten theories for how to achieve true happiness (and useful resources for you to try them out).

The results of the predictive model surprised me! 

Before scrolling down, take a moment now to try to guess the top 5 variables that you think would be useful in predicting the severity of a person’s depression! I tried to include a very broad range of demographic and personality variables in the model – testing 91 in total.

Important note: these variables are predictive, not necessarily causal. In each case, we aren’t certain whether a higher incidence of that variable leads to worse depression, whether more severe depression causes a higher incidence of that variable, or if some outside factor happens to cause both depression and that variable. Also note that the variables shown below those that were most predictive of depression when controlling for all the other 90 variables. That means that a one standard deviation increase in each of these variables was associated with a greater increase in PHQ9 scores than any of the other variables (when training a model with all the variables at once). But all but of these variables are all associated with depression in the same direction on there own (when not controlling for other variables) except for one exception that is mentioned.

Variables That Most Strongly Predicted Depression

(1) Introversion (related to the Big 5 personality trait of Extroversion), as measured by the statements: “I see myself as extraverted, enthusiastic” or “I see myself as reserved, quiet”

(2) Feeling Poorly Rested after sleeping their ideal number of hours, as measured by the question: “Typically, how rested do you feel upon waking when you’ve just slept your ideal number of hours?”

(3) Under-sleeping, that is, the amount of time lower than their ideal hours of sleep that they sleep per night, calculated by subtracting actual average hours of sleep from reported ideal hours.

(4) Poor Treatment From Caregivers in childhood, as measured by the question: “Overall, how well were you treated by the people who raised you (while you were growing up)?”

(5) Spirituality, as measured by the question “How spiritual do you consider yourself to be?” Interestingly enough, the correlation of this variable with the PHQ9 depression score was VERY weak (r=0.02) in itself, it became strong only when controlling for the others. This is a weird exception, as all the other variables mentioned here have strong correlations with depression, whether measured on their own, or among controlled variables. 

(6) Low Levels of Conscientiousness, as measured by these two statements: “I see myself as disorganized, careless” or “I see myself as dependable, self-disciplined.”

NOTE: I did not include the Big 5 trait “emotional stability” a.k.a. “neuroticism” in the regression, since it contains aspects of depression already in its questions.

So this suggests that depression is linked to introversion, poor sleep quality, under-sleeping, poor treatment from caregivers growing up, spirituality, and low conscientiousness. Remember though that in each case it could be that it causes depression, is caused by depression, or is caused by something that also causes depression.

The predictive model I used was Lasso regression, with cross-validation, since I expected many of the variables to have almost no relationship to depression (i.e., the results would be sparse). The training set had 696 points, and the test set had 174 points. The training set error was: 54.7% of variance remaining, and the test set (i.e., out of sample error on new data) was 57.5% of variance remaining, so the results appear to be statistically robust (i.e., there appears to be very little overfitting).