A Clinician’s Unique View to Feeling Down- With Dr. Pete Kelly

In this very detailed conversation with the most passionate, wonderful Dr. Pete Kelly, we discussed a wide variety to subjects that has to do with mental health and some of the latest research in the field. 

 In this conversation, we discussed

— Pete’s unique persepctive on depression based on his experience

— His observation of people who are attracted to the mental health profession, and what they tend to do

— How he works with depression and what he has found to be effective

—What has our souls got to do with depression

— The relationship between repressed anger, perfectionism and depression. 

Dr. Pete Kelly is one of the most passionate clinicians I have ever met. I hope you enjoy this one— 

 

 

 

Trigger Warning: This episode may cover sensitive topics including but not limited to suicide, abuse, violence, severe mental illnesses, relationship challenges, sex, drugs, alcohol addiction, psychedelics, and the use of plant medicines. You are advised to refrain from watching or listening to the YouTube Channel or Podcast if you are likely to be offended or adversely impacted by any of these topics.

Disclaimer: The content provided is for informational purposes only. Please do not consider any of the content clinical or professional advice. None of the content can substitute professional consultation, psychotherapy, diagnosis, or any mental health intervention.  Opinions and views expressed by the host and the guests are personal views and they reserve the right to change their opinions. We also cannot guarantee that everything mentioned is factual and completely accurate. Any action you take based on the information in this episode is taken strictly at your own risk.  For a full disclaimer, please refer to: https://www.eggshelltherapy.com/disclaimers/

 

FULL TRANSCRIPT:

 

Imi Lo: Hi Dr. Pete Kelly, welcome. Welcome so much to Eggshell Transformations podcast.

Dr. Pete Kelly: Thanks so much for having me, Imi, I’m delighted to be here. It’s so nice to be the guest as opposed to the host for once, this is awesome.

Imi Lo: Absolutely. So we did the previous interview together and then realized we have quite a bit of discuss, so this is my chance to pick your brain.

Dr. Pete Kelly: Excellent, I’m looking forward to it.

INTRODUCING DR PETE KELLY

Imi Lo: Okay. So before we start, I would like you to just briefly introduce yourself to the audience, tell us who you are, what are some of your professional and personal experiences, that would be great.

Dr. Pete Kelly: Sure thing. So currently am a clinical psychologist in Ottawa, Canada. I’m also the executive director of innovation at the Ottawa Institute of Cognitive Behavioural Therapy. I also host the podcast Thoughts on Record, which is the podcast of the practice that I’m at. I do a lot of supervision for students of the University of Ottawa as well as clinicians in the community. I’ve taught previously, although I’m doing that less so now because I’m so busy with the podcast. And what else do I do? I see clients individually as well as in group, I also do a lot of assessments. I’ve had sort of a little bit of a different trajectory into clinical psychology, I can maybe speak about that for a moment and how that has informed my identity as a clinician.

Imi Lo: I mean, why have you chosen to do what you do?

Dr. Pete Kelly: Well, obviously to help people. I felt a little bit sort of trapped on the research side where it wasn’t clear to me that what we were doing was translating into sort of actionable clinical interventions or things like that, so of course to help people. And from my own perspective, I’ve always having been really drawn to the complexity of human beings, both on their own and in the context of relationships, especially I find it really fascinating on how humans function in groups. I think all also too, being informed by confusion around my own complexity and intensity and trying to figure out how I work. So yeah, I think if you put it all together that’s how I’ve ended up being a clinical psychologist. I love the detective work of figuring out what’s going on for a client, helping them to understand that complexity and then translating it into interventions that are actually going to make a difference, I hope in their lives.

Imi Lo: What do you think is the bigger driver? The need to help or the intellectual analytic work?

Dr. Pete Kelly: You know what? I really looked deeply at this question for myself and I think both have to be there. It’s really important to me, of course, that the work feel mean meaningful for the client and that it resonate with them and that they perceive that it is helping them. I’ve also found that it has to feel meaningful for me as well. There has to be a certain level of engagement and passion and complexity that’s there to get me really engaged in the way that I want to be engaged and to keep it feeling sustainable. As I often say to my trainees, I feel that boredom in therapy is far bigger a contributor to burnout than is the complexity or difficulty of a case. Sitting there in the midst of work that doesn’t feel meaningful or feels like it’s soul crushing or again, not aligned with what the client actually truly needs, it can be very stifling to sit in a process like that.

PERSONALITIES OF CLINICIANS?

Imi Lo: Yeah. Because in your work, you do interact with a lot of clinicians. What do you see as a pattern? What people are drawn to this profession in your experience?

Dr. Pete Kelly: Yeah, that’s such an interesting question. I mean, with a very broad stroke I would say, I’m almost tempted to put this in big five sort of language, but I would have to think about it.

Imi Lo: Yeah, absolutely. I think some of our audience are in the familiar with the big five, so. And I’m not holding you to this, I know we haven’t done proper research, but what do you think?

Dr. Pete Kelly: Yeah. So staunchly in the realm of the anecdotal, I would say clinicians that I work with are generally higher than average in terms of openness, being open to ideas, creativity, things like that, tend to be very conscientious, I would say overly conscientious. There’s some sort of tipping point where that virtue of conscientiousness turns into a vice and it leads to rigidity, perfectionism, pleasing, things like that. Extra version… So yeah, go ahead.

Imi Lo: So what does it look like for someone who is not familiar with the clinical language? What would it look like in the room?

Dr. Pete Kelly: So someone who’s really conscientious?

Imi Lo: Yeah, overly so.

Dr. Pete Kelly: Yeah. So I think someone who’s really perfectionistic, overly rigid, tied to a particular process as opposed to maybe what’s happening right in front of them, overly concerned about results, might be seeking a lot of reassurance. Is this feeling okay for you? Is this going okay? Do you like this, right? All of which ultimately might serve to undermine their confidence rather than bolster confidence, right? So I think there’s an anxiety under that as well. So that conscientiousness reflects an overcompensation of some kind, right? It’s like, “I’m defective in some way, I’ve really got to be perfect otherwise a bad thing’s going to happen.” And I think that’s actually quite common among clinicians. There’s a deep underlying insecurity that they may bring to the job both consciously and unconsciously. And it can show up a lot internally, unfortunately it can also show up in the work as well. So I think clinicians have an extra burden of really sorting themselves out from that perspective.

Imi Lo: Sure. Well, you say it’s a burden, but I can also see a lot of people benefiting from the work that they have been pushed to do.

Dr. Pete Kelly: Oh 100%, I couldn’t agree more.

DEPRESSION

Imi Lo: So I know that you specialize in working with depression and anxiety and you have a unique perspective on this that I would like to talk to you about. So in your definition or in your experience what is depression? Maybe tell our audience, what are the clinical definitions and what’s yours?

Dr. Pete Kelly: For sure. So I would say generally speaking, I do align myself with, let’s say the standard DSM five version of depression, which basically there’s two main symptoms, depressed mood, feeling sad or down most of the day, nearly every day for at least two weeks, and then anhedonia, which is the inability to access or experience pleasure around things that would typically bring a sense of pleasure or motivation or joy. And again, most of the day, nearly every day for at least a couple weeks. And we can talk about the arbitrariness of those two weeks in some senses, but there would also typically be challenges with sleep, either sleeping too much or sleeping too little, changes in appetite. Again same thing, eating too much, eating too little, challenges with concentration, making decisions, feeling fatigue, what we call psychomotor agitation, whereas a sense of restlessness or feeling agitated. Can go the other way too, psychomotor retardation where people feel slowed down like they’re walking in molasses, like their bodies are made of lead, very heavy.

Dr. Pete Kelly: And of course there’s thoughts of suicide or death. And in order for someone to be diagnosed with depression they don’t need to have all of those symptoms. They need to have at least one of depressed mood or what we call anhedonia, and they need certain number of those other symptoms. But because there’s so many symptoms and there’s so many ways they can be combined, depression can look so different depending on who you’re meeting with. So it’s not a disorder with one face, there are many faces that depression can have. And I would also say too, it’s not one of the diagnostic features of it, but very often depression is accompanied by an anxious mood. And we often perceived by a lot of anxiety, and it’s a risk factor for developing depression. And I might just add two other things real quick. I do think that the standard definition of depression is a little bit gendered in the sense that men tend to present more with perhaps grandiosity, anger, irritability.

Imi Lo: Oh interesting, so it looks different.

Dr. Pete Kelly: It looks very different, or it can look very different, I should say, right? So yeah, so men you have to be on the look out for they may not map onto those standard criteria but they’re presenting in other ways. And again, like grandiosity, anger, irritability, substance use, and then there’s a cultural layer to it as well, right? Where certain cultures are going to be more prone to talk about depression in sematic terms, right? Describing it as a bodily experience as opposed to something more cognitive in nature.

Imi Lo: Mm-hmm (affirmative), interesting. Well, can you give us some examples of this cultural differences?

Dr. Pete Kelly: Well, for instance, we know Asian cultures, and again, that’s a very broad stroke are more prone to describing depression in terms of the sematic experience. And that could be for a number of different reasons, right? It could be what’s the cultural appropriateness of talking about certain kinds of symptoms. We know that emotions are constructed as part of a broader culture narrative, so what does the culture have to say about what the expression of a low mood is? Maybe it might be more of feeling in the stomach, or I once had a client describe that their heart felt cold, right? And that’s not language that you would typically hear your average westerner describe depression in, they would describe it in terms of, “I don’t have any motivation, I hate myself, I’m having these ruminations all the time.”

Dr. Pete Kelly: So yeah, I think there’s different ways in which depression can be described because there is no… If anyone’s interested in checking out the work of Lisa Feldman Barrett, she’s a very renowned-

Imi Lo: Can you spell that?

Dr. Pete Kelly: Sure. So Lisa, and then her middle name Feldman, F-E-L-D-M-A-N, and then Barrett, B-A-R-R-E-T-T. Lisa Feldman Barrett, she’s a neuroscientist, and she has really demonstrated that there’s no universal experience of emotions. They’re highly nested and informed by the culture in which the person finds themselves.

Imi Lo: And yeah, it sounds like you really resonate with this idea and have adopted it in your own practice.

Dr. Pete Kelly: I do. So a point I try to make to clients all the time is that, the brain is not detecting reality, it’s predicting reality. And largely what you are doing is experiencing predictions, and then your brain will go about sort of cross-checking those after the fact just to see if there’s a discrepancy. And so you can ask yourself, “Where do those predictions come from?” Well, they come from experiences growing up, they come from the culture around us. So there’s I think a great saying, “You curate your past so that you can make better predictions about your future.” And when we talked about clinical interventions and stuff like that, I can maybe speak about the role that experience I feel plays in the efficacy of treatment. But yeah, I do really believe that we are dealing with constructed experiences. And because of that, it’s really important to understand how those experiences ultimately become constructed.

Imi Lo: I hear you. So based on that idea, how do you help someone with depression?

Dr. Pete Kelly: Right. So when someone comes and they talk about feeling depressed, the first thing I’m going to do is a really thorough assessment of why it is that the depression might be there. And there’s four buckets that I’m looking for in terms of where the depression could be living. And of course there could be overlap, right? It could be an all four. But basically, so the first thing I’m trying to look at is, is there a strong possibility that the depression is organic or brain-based in some way, right? And typically, this will show up through really severe symptoms, like a melancholic depression tends to be worse in the morning, the person sort of can’t get out of bed, they’ll often describe that depression as not even feeling sad, it’s almost more just like feeling nothing, in abyss of some kind.

Imi Lo: Numbness.

Dr. Pete Kelly: Numbness exactly, right? So those are some… Do they have a family history? Has it responded to medication in the past? Of the top of my head, those are some of the ways that I would start to get a sense of, “Okay, is there something biological going on here? Do they have an underlying medical condition that might be precipitating this?” But then typically, often I’ll transition to looking at the three other buckets. And so the first bucket that I look at is, does the person have some sort of unresolved traumatic loss that are living with? Death of a loved one, a trauma history that hasn’t been adequately processed, something terrible that’s happened to them in their life that reflects a loss or a betrayal or an upsetting of all their beliefs about the self, world and other people, that’s a real common source of depression.

Dr. Pete Kelly: The second one would be something akin to failure to give up on an unachievable goal of some kind. An example of this would be someone has experienced the ending of a romantic relationship and it’s been two years and they are harboring hope that this relationship will rekindle itself somehow, and they haven’t sort of accepted it and moved on. Another example of this would be maybe complicated grief, where someone has had someone pass away in many months or even years, they’re still setting the table for this person, they haven’t brought any of their clothes to Goodwill or something to that effect.

Imi Lo: Yeah. When speaking of grief, I do want to jump in and say something that many people are not aware of, there’s such a thing called disenfranchised grief. Where grief topics that many people are not aware of or wouldn’t recognize. For example, death of a therapist, or even not death, just ending a relationship or maybe a pet, or maybe one of your parents having dementia where they’re no longer the same. Other people don’t recognize these forms of grief, and the person is left in isolation to deal with their emotions.

Dr. Pete Kelly: Couldn’t agree more. And if I could add one more to that list, I believe it would be something like a pregnancy that ends unexpectedly or a miscarriage, right? I mean, the number of cruel things that I’ve heard mothers or women tell me about those experiences, it’s just unbelievable. It’s not regarded as a real loss, it’s like, “Oh, it wasn’t meant to be, or that was nature just sort of running its course.” It’s like yeah, there might be a truth to that, but it also reflects an extremely traumatic loss for that person.

Imi Lo: Yeah. Okay. So I thought you were on the second. So to sum up, basically there are four roots to depression potentially. The first one is organic and chemical imbalances, which I’m guessing could be fixed through medication. And the second is traumatic loss, and then there are three and the forth.

Dr. Pete Kelly: That’s right. So failure to give up on an unachievable goal. And again, that would be that example of a relationship that you want to keep continue or reestablish and there’s just no possibility of that. And then the last one is continually assuming a submissive position within a relationship of some kind. And-

Imi Lo: Okay. Expand on that please, and give us some examples if possible.

Dr. Pete Kelly: For sure. This is a really common one. So the example that I always use is, imagine you have an employee who’s really sharp, really clever, a real go-getter, and then they have to report to a boss who’s perhaps not blessed with the same attributes. They’re not that intelligent or they’re disorganized, or they just haven’t got it together in the way this employee does. What’s typically going to happen is that as this employee sort of starts to outshine their boss, the boss is going to perceive this person as a threat and start to retaliate against them by marginalizing them or putting them down or denying them of opportunities because they don’t want to be [inaudible 00:16:36] by this person. And so what happens is that when you are being dominated and subjugated every single day, you either fight back against it, and in many instances the circumstances will dictate that you will not be successful maybe structurally or from a power structure perspective, but then also you end up internalizing that idea, right?

Dr. Pete Kelly: It’s like, “Oh, man…” Because it’s too dissonant to be trying to be fight and be assertive all the time and then getting put down. So you end up internalizing what’s going on through a depressed mood. It’s also from a common sense perspective, it’s a way of not getting attacked. So there’s adaptive value of putting your head down, putting your tail between your legs and just going about your business and being dominated by this person. It insulates you from further attacks, and not only does this happen in the workplace, it also happens in the context of romantic relationships, basically anywhere where two or more humans are interacting and one has to structurally assume a submissive position. You can be pretty sure that some decrease in affect or low mood is going follow.

Imi Lo: It’s so common, we see it so commonly. And a pattern can be so set that people don’t realize that it’s a problem and it’s ridiculously difficult to change. Why have people adopted an ongoing submissive poster in relationships, do you think?

Dr. Pete Kelly: Yeah, it’s a great question, I think it’s really complicated. I think the most obvious low hanging fruit around that one is that they learned to do that within their family of origin, right? So they may have learned that to keep mom or dad from getting irritated or when you spilled the milk or whatnot, to keep conflict at a minimum you just assume-

Imi Lo: Talked about that last time, didn’t way?

Dr. Pete Kelly: I think so, yeah. So you basically learn that that’s a way of solving that problem within the family, right? You keep your head down, you say you’re sorry even if it’s not your fault and you just keep carrying on. And I think what ends up happening is that, that pattern, because it works, of course it gets reinforced and then people carry that into adolescence and their adulthood and it still works. So people never really have the chance to undo it necessarily, they haven’t maybe developed other ways of coping with that. It’s getting reinforced, it’s affording them a sense of safety and who doesn’t want that? But what we find in the background is that people’s mood ends up going down and down and down and down.

Dr. Pete Kelly: It can lead to a sense of helplessness and hopelessness about the future, and then people will show up in your office and they wonder where it all went wrong. And then you have to spend some time unpacking how people have arrived at this point through an ongoing pattern of submissiveness and subjugation. And there’s a temperament piece as well, right? Some of us are just born being more agreeable than others. And more agreeable people are more likely to go along with things and not push back and to be nice. And what I try to teach clients is, it’s not like being nice is the only virtue, we also have to learn how to be tough and to protect ourselves and to be assertive when someone is legitimately infringing upon our autonomy as a human being.

WHAT CAN WE DO?

Imi Lo: So what’s one small thing people can do if they realize, “Oh no, this is me?”

Dr. Pete Kelly: I think what I’ve always encouraged people to do, the first thing is to start to look out for it. So what I’ll often ask clients to do is say, “Just for a week, without even doing anything different I want you to note the number of times that you say no when you really mean yes, and you say yes when you really mean no.” Just something simple like that, just to start to watch it, to get a sense of-

Imi Lo: When you say yes when you really mean no, oh that’s a good one.

Dr. Pete Kelly: Yeah. And just watching it, or the number of times you want to speak up but then you find yourself not doing it. So getting a sense of the nature and the scope of the problem. And then the second step would be, I would ask people to start to do little experiments. Okay like, “Once a day I would like you to start saying no to something that you would normally say yes to. And start with something manageable, start with something that’s not going to overwhelm you and is within your proximal zone of development, right? There’s a reasonable chance that you’ll be able to manage what comes with this.”

Dr. Pete Kelly: And then we go on, and then you take on bigger and bigger challenges. Now there’s an interesting thing that happens here, I mean that I seen a lot is that, what I always warn clients is that you’re unleashing a monster a little bit, right? Once people realize that they’re able to say no to things, they tend to go on a no spree. Well, and they can lead to being angry and irritable, and basically they’re like, “I’m not taking this anymore.” There’s a realization that things can be different.

Imi Lo: I mean, I think that could be really useful and growthful. The only worry I would have is that their family is not used to it and they not react so kindly.

Dr. Pete Kelly: Exactly. So that’s the challenge, right? Is that a lot of people are in these relationships that have only worked based on the equilibrium that they’ve been able to establish through their pleasing or saying yes all the time or whatnot, saying no is going to now start to introduce a disruption to these relationships. It could even mean the end of those relationships depending on how pathological the pattern has been. So there’s almost an informed consent around this, is like, “Hey, as you walk down this road of growth and change and start to become more comfortable with conflict you have to be prepared that others are not going to be as excited about these changes as you are, and that it can lead to the disruptions of some pretty longstanding relationships that you may have.”

Imi Lo: But at the same time the fear that the relationships will be ruined is what keep people not standing up for themselves for a very long time. So it’s a really, really hard line to walk. I think a lot of people know that what they’re doing is probably not honoring themselves enough, but at the same time the message that they have received from childhood is that if they say no they would either be abandoned or rejected or things would break down.

Dr. Pete Kelly: 100%. There’s really good reasons why people have adopted these strategies, and I’m one of them. One of the great challenges of my professional development has been learning to become more comfortable with conflict and to assert myself and not to please and not to say yes and everything. So I say this with full empathy and knowing the anxiety that saying no brings about. It can feel like your existence is coming to an end and it can be incredibly anxiety provoking. And it also happens to be incredibly necessary to be a healthy human being in my observation. So I think we can both have a compassionate conceptualization of how someone’s arrived at that and make a really good case for change and how while difficult, there’s something so much more fulfilling. And I like the way you put that, honoring of themselves on the other side of changing that pattern.

Imi Lo: Absolutely. Wow, you’ve said it really clearly. And this whole thing with adopting a submissive position in the key relationships, I would imagine there are cultural differences too.

Dr. Pete Kelly: Yeah, absolutely. Now, I’m going to say I’m not familiar with any sort of specifics that I could give around that, I can speak with any authority around that, but absolutely. For sure, would culture inform the way that we are supposed to orient and relate to one another? Absolutely. And could that play out with respect to assuming a submissive position in a relationship? I would say 100%.

Imi Lo: I mean, I haven’t done a research on this, but I even wonder if in certain culture taking a submissive position is not unhealthy, but I don’t know.

Dr. Pete Kelly: I think we could definitely imagine scenario where that is the case, for sure. And I think even if it wasn’t culturally sanctioned let’s say in some way, I could even imagine in a lot of day-to-day scenarios where it actually makes sense. If you are in that scenario with the boss and you really don’t have a lateral move available to you, it might actually be the best play to stay in that submissive position might make all the sense in the world. And often I would find myself normalizing and validating that for the clients to say, “You know what? All the things considered it’s your best play for the moment, let’s try and make some moves to get out of that job, but for the indeterminate future this is the way to survive this situation.”

Imi Lo: Wow, I hear you. And I’m sure there are gender differences too, because our culture socialize one gender should be more submissive than the other. I have another question for you, which is, you come across more doctor as a medical and general practitioners than the standard therapist do, what do you think most medical professional or GP gets wrong about mental health?

Dr. Pete Kelly: I think it’s a great question. I think the biggest challenge is seeing depression as maybe automatically being a problem and automatically that we need to reach for the prescription pad and to get a medication going with respect to that person’s treatment plan. I’ve had many clients come in fresh on the heels of the divorce or being unemployed or some other major psychosocial stressor, they have a prescription in hand and they’re like, “I’ve just came from the family doc, he gave me a quick screener and he’s prescribed this medication.” And my typical response is, “Okay whoa, let’s just slow down here, and let’s get a sense of what’s really going on here. How long has it been going on for? What’s the impact? What’s the context?”

Dr. Pete Kelly: So I think automatically assuming that low mood is a problem, and let be clear, it can be a profound problem, can be a life ending problem unfortunately in some instances, so I do not want to downplay the seriousness of it, but nature’s really cheap. It’s going to edit out things in our body and in our mind, in our behavioral repertoire that don’t work because they cost a lot of energy, and energy is the key to survive, so.

Imi Lo: Nature is cheap. The first time I hear when someone say that. Well put.

Dr. Pete Kelly: And it is. And I think we can leverage that idea to think about the symptoms that come across that will happen in the context of mental illness. Where we can say like, “Listen, depression has been around for a very, very long time, why?” It must have some utility on some level, otherwise nature would have edited it out. So when someone comes in and they’re talking about low mood, we really want to understand the place that it’s coming from before labeling it a problem. Within that depressive episode there might be an opportunity to connect in a new and different way with a set of circumstances that are not to the person’s advantage and their body and mind are letting them know.

Imi Lo: Yeah, it’s a much more empowering perspective. I don’t want people to think we are saying we are against medication, but indeed a lot of people want to try different things before getting on medications.

Dr. Pete Kelly: Yes. I would whole heartedly endorse that I’ve seen medications be absolutely life changing for people. And in instances where someone’s safety is a question, certainly medication is something that we would want to explore fully. I mean, this brings in a bit of a broader question too. It’s like, what is mental illness, right? And the DSM has, I think, rightly so been accused of this diagnostic inflation, where we have started order to pathologize normal everyday features of our emotional life. And so I think, again, these are really complex questions and we’re not going to solve it in the next five minutes or even five hours if we-

Imi Lo: No, we’re not solving it, but we are talking about it.

Dr. Pete Kelly: Exactly. Eyes wide open with all the options available, all the risks openly discussed, all the benefits openly discussed, that’s the best case scenario. I mean, for what it’s worth for anyone listening, very quickly clients will often ask me like, “Hey, do you think I should try medication in my criteria?” My mind are very clear, number one, it’s got to have a really clear sort of benefit to cost ratio, it’s got to actually do something. And then number two, usually it’s like, if you can’t access the benefit of therapy and, or your functioning is so impaired that it’s disrupting your life in some really serious way like you can’t go to work or it’s causing performance problems or your relationships are flying apart, then absolutely, let’s go there and check out what benefit might be available.

Imi Lo: I love that you give us something concrete to go with.

Dr. Pete Kelly: I think that’s really important because clients want to know, I would want to know the same thing. I mean, it’s complicated, it’s scary to think about ingesting a compound potentially, it could have side effects. A lot of people rightly are concerned about sexual side effects or being numbed out, things like that. So yeah, it’s important to give people, I think, a clear decisional framework as clear as it can be so that they can feel like they are good stewards of their mental health and that they have a reasonable chance of making a good decision to help themselves.

ABOUT SOULS — BEYOND COGNITIVE BEHAVIOURAL STRATEGIES

Imi Lo: Yeah. Thank you, that’s useful. And so the last time we spoke, we spoke about the idea of souls, and we talked about James Hollis work. But in the mainstream psychiatry and psychotherapy it does seem that the more common approach to depression is the cognitive behavioral strategies. What are your take on this? And yeah, what are the differences and what are your thoughts?

Dr. Pete Kelly: Oh, so that’s such a great question and I really appreciate you asking me that, because it will allow me to maybe speak to a bunch of things that I feel really passionate about. So I guess for starters, I want to tell a little anecdote about some of the work that I used to do on the inpatient unit of a psychiatric hospital that I worked at during my residency. Would that be okay?

Imi Lo: Yes, absolutely.

Dr. Pete Kelly: So one of the exercises that we used to do with the clients who were there, and again, these are clients who have to be hospitalized owing to the seriousness of their symptoms, often we’re seeing them at the most challenging point in their life. And we used to do this exercise where I’d put up on the board a list of people’s values, like relationship, work, community, self care, recreation, friends, things like that, we’d just make a whole list of them. And then I’d get everybody to rate the importance of those values out of 100. And they don’t have to add up to 100, all of them could be 100. So relationship 100, maybe work’s 80%, maybe self care is a 70, whatever. And then what I ask people to do is to very simply put something to the effect of too much, too little, or just right with respect to what’s the amount of their behavior that is going into servicing those values within the course of the given week relative to the importance that you say.

Dr. Pete Kelly: So for example, someone says, “You know what? My relationship is 100 out of 100 important to me but putting too little of my behavior into servicing that value. I don’t go out of my way to compliment my partner, we don’t go on date nights, I don’t make the effort to speak to them,” so on and so forth. And what we always found is that people’s depression would live in the gaps between what they said was important to them and what their behavior was going into week over week. And where I see the tie in with the soul piece here is, if those values are perhaps maybe a rough analog for the desire of the soul or the psyche, and you’re not engaging in behaviors that feed those aspects of your soul or your psyche, your mood is going to step in and let you know.

Imi Lo: Yeah. But for many people it’s so hard to get reconnected to what the soul’s saying, this can seem so far away and so vague. And in fact, being told they’re not being connected to their souls could even be more disturbing than not being told that, because it’s like being told something they can’t do anything about.

Dr. Pete Kelly: I mean, I completely agree-

Imi Lo: Just playing devil’s advocate here.

Dr. Pete Kelly: No, I think it’s a great point, I completely agree. And indeed when someone’s depressed, so a very common phenomenon when you do this exercise with people is that people rate everything very low, right? Because it’s being filtered through the depressed lens at that particular moment. So relationships, “Ah, they don’t matter,” work, “Who cares,” self care, “Whatever,” they’re really being downplayed. So what we often have to do is invite people to travel back in time to when they were younger or a time that they can remember feeling maybe more fulfilled and aligned with themselves and answer the questions as if that person was answering it. Or another tip for managing that is to imagine the best case scenario, because sometimes, again, someone may be in a marriage of some kind that is not very healthy. So of course they’re going to rank the importance of that lower because it’s contaminated by their experience of that relationship as it stands in the present.

Dr. Pete Kelly: And so what I ask them to do is like, “Okay, I want you to answer that question relative to your idealized relationship. Imagining that this could be fixed, imagining that it could be as good as it could be, how would you then rank the importance of that relationship?” And those two exercises can help people to move towards maybe a more authentic connection with that. And Imi I would also say this, that it’s very difficult for people to do this work and it also happens to be incredibly necessary, right? It’s like that is the work I believe of getting out of depression is to connect with yourself, connect with your soul. I don’t see that we have another option, and certainly we can comfort and support people as they build the capacity to get there. But that is the work, and I’m down for whatever it takes for them to do that work ultimately.

Imi Lo: Sounds like you’ve got a mission.

Dr. Pete Kelly: Well, I feel really strongly about it because again, I think James Hollis talks about this, right? “You can either stay depressed and sort of stay asleep by way of a metaphor, or you can sort of awaken which will come with anxiety, but I think you’re upgrading your problem in that perspective.” So we’re always going to have the problems-

Imi Lo: That’s a good way of saying… Yeah. I think Carl Jung says that, “You either deal with the grief or the unhappiness that comes from you putting your thing off. We deal with the real thing and then it’s once and for all.”

Dr. Pete Kelly: That’s right. And I think there’s a really important… You asked me before about, “Okay, well how would you implement CBT being informed by this sort of soul-based or psyche-based model, right?” So whenever I used to be in the hospital setting I would see the clients doing maybe puzzles or arts and crafts and things like that. And what I was always struck by is like, “What if that’s not meaningful to that person? What if a crossword is not something that speaks to that person’s soul? It’s on the program for that day but it’s not necessarily going to align with what the person…” Basically give them a reason to stick around just to put it sort of maybe very straightforward terms, right? To live a life worth suffering for, what’s going on in that life to make it worth suffering for, right? So when we do our interventions-

Imi Lo: That’s really well said. Yeah. Sorry, go on. I don’t remember who says it, but then it’s a saying along the side of, “Everything in life is a shit sandwich and it just depends on which one you choose to have.” So either you wallow in the suffering of feeling purposeless or you go and struggle to achieve or to try and go for what you really want. And I just want to clarify, it doesn’t have to be some ambitious career goal, it can be something really simple as long as it’s true to you. It could be peace, it could be your highest value. People can do traveling to be with family, or yeah, something like save the world. It could be anything that is true to your soul.

Dr. Pete Kelly: That’s right. The beautiful part of that is that there’s no right answer. I think the challenge is finding out what the answer is and then implementing that. But the number of clients that I’ve seen pulled out of a major depression by a renewed love of photography or animal husbandry, or reconnecting with a relationship or Dungeons & Dragons, or whatever. It’s whatever speaks to your soul, if you’re not nourishing that, your soul will let you know, it will protest and withdraw support for you.

Imi Lo: Yeah. So really depression is a messenger.

Dr. Pete Kelly: That’s how I view it. And again, I think it’s important when we made this point off the top, but it’s worth making again. Sometimes there’s just something going on with the brain and we don’t yet have the understanding to completely be able to speak to this. But whether it be a genetic problem or something, or rather… So yes, there’s very definitely times where there’s something biological going on. But in my experience as a clinician in private practice, I have over 10,000 hours of sitting with clients at this point, the vast majority of the time what I’ve seen is that there’s some set of circumstances that have evolved in the client’s life that are unacceptable to some aspect of their being, and my goal is to help them realign themselves with themselves. And that can often help them move their mood along tremendously.

REPRESSED ANGER?

Imi Lo: Oh, you absolutely have the authority on that. Yes, and I agree with you. Okay. There’s something that I have been very interested in. Psychoanalysts have always said that depression is a sign of anger turned inward. And repressed anger is something that I have been investigating myself. What do you think of that idea of repressed anger causing depression? 

Dr. Pete Kelly: Okay. Imi, I think that it’s a really interesting model or conceptualization. And what I’m struck by is its alignment with some of the work that goes on with some of the intensive short-term dynamic therapy models that are out there, right? Where as a way of regulating emotions some of the activation is forwarded into first the striatal muscle, and if that doesn’t work then into the smooth muscles, and if that doesn’t work then you start to get more cognitive or confusional types of symptoms. So it’s definitely something that’s been on my radar, I’ve been thinking a lot about it a lot more. I wouldn’t say that emotions are stored in the body, I don’t think that’s accurate based on what we know, but I think they can be regulated-

Imi Lo: That’s really interesting, because a lot of people are saying that.

Dr. Pete Kelly: Yes, exactly.

Imi Lo: The whole idea of it’s storing in the body.

Dr. Pete Kelly: Yes, exactly. So from Lisa Feldman Barrett’s perspective, there’s that book, The Body Keeps the Score is a very sort of famous trauma book, right? So it should be like, “It’s the brain that keeps the score and the body is the scorecard.” And it’s sort of a little bit hard to impact that without going into the full on sort of model. But I think the idea is that, our body and mind will leverage different systems in the body to regulate emotions differently depending on perhaps the safety of experiencing those emotions. So in that intensive short-term dynamic therapy model, what the clinician will do, and again, I’m hardly an expert, I’ve just had a couple guest in the podcast. What I’ve been fascinated by is that, when the client feels that muscle tension, when they feel that upset stomach, to invite them to connect with maybe the anxiety that’s there and create a safe environment for that cognitive anxiety to be experienced so that it does not have to be energized back down into the body, if that makes sense.

Imi Lo: Yeah, it does make sense to me.

Dr. Pete Kelly: Yeah. So long story short, the idea of depression being some sort of manifestation of internalized anger, I think there’s probably something to that. I don’t completely understand how or why that could happen, but I’m intrigued and fascinated by the idea. And that’s probably where I’ve been spending most of my time these days, is standing how emotions can be sort of experienced unconsciously if that makes sense, if that’s not too paradoxical.

Imi Lo: No, it makes sense to me. Does it make sense to you?

Dr. Pete Kelly: Well, it does because it’s hard, right? Because we might experience emotions unconsciously, or they might be influencing us unconsciously, but we can only experience one thing at a time, let’s say, right? And yet we have other factors that are influencing us in a way that is sort of unknown to us. So I’m really fascinated by what is going on underneath all our conscious experience and how it ultimately precipitates impacts on our consciously experience. I think it’s just so fascinating.

DEFAULT MODE NETWORK AND PSYCHEDELICS

Imi Lo: If you can do research in something, what would you choose to be doing it in?

Dr. Pete Kelly: I’m really interested right now about the impact that psychedelics could have with respect to ameliorating suffering flowing from mental illnesses. Because what’s real interesting is that a lot of the medications that we have right now, say the SSRIs, selective serotonin reuptake inhibitors, which most people would be familiar with. What they tend to do is to work on a part of their brain called the limbic system. They tend to sort of reduce that flight or freeze response or how strong physiological reactions are to things. And psychedelics seem to work in a very different way, where they work more in a top down and they tend to activate a different serotonin receptor that’s more found in the cortex.

Dr. Pete Kelly: It tends to decouple the brain from itself a little bit in the sense of, there’s what’s called a default mode network, which is where our sense of self is thought to reside, psychedelics will turn that off and allow people to get some distance from themselves and to see things without themselves so much in the way of that. And I think that’s just absolutely fascinating based on some of the evidence that’s emerging around this. So I think it’s so fascinating to me what these psychedelics could potentially offer in terms of understanding how consciousness works, how things like depression work and how we could treat it more effectively.

Imi Lo: You have a lot of confidence and passion when you speak of this.

Dr. Pete Kelly: Well, I just think that we can do better. The psychedelics have been used by many cultures over many millennia. These are not a new thing, they were shut down for largely political reasons in the ’60s and ’70s. There is thankfully a bit of a renaissance happening around this, and I think we’ve unduly deprived ourselves of a tool that’s, I would say at least worth exploring, right? Because mental health outcomes haven’t really improved over time, it strikes me that we could do better. I think that’s the lens from which I’m approaching this.

SENSITIVITY AND DEPRESSION

Imi Lo: Sure. So finally, I just realized we’ve been speaking for a long time. I work specifically with people who are sensitive and intense. What do you think you see that trait in people that you work with who tend to struggle more with depression, and what’s the relationship that you see?

Dr. Pete Kelly: Absolutely. I mean, I think clients who are intense and sensitive as those two adjectives would their internal experience is very intense. And I think at the same time their experience of their outside world is likewise very intense. So if we think about depression as being maybe a smoke alarm going off or an early warning sign that perhaps things aren’t going in the right direction, I think it stands to reason that someone who is a highly sensitive and intense the smoke alarm is going to go off sooner and the smoke alarm is going to be louder, right? So there’s going to be just a lot more activation, I would say. And from a resilience perspective, I think highly intensive people bring a really, really important lens to say like a group, right?

Dr. Pete Kelly: Say there’s a group of four or five people, they’re going to be really apt, I think, to detect dysfunction within that group where the group context or the environment much earlier than others are going to, and then are able to perhaps react or make a suggestion or put some coping in place. The burden of that of course is feeling activated a lot more of the time. And the more activated one is feeling more of the time, the more one is going to potentially cycle through coping resources, both biological and behavioral. When those get depleted, then we know depression is more likely to evolve. So I would say, in plain language it’s like running really hot, and that’s really good in some context, but it can also lead to the evolution of symptoms when those resources have been run through all the way to their end.

PERFECTIONISM AND DEPRESSION

Imi Lo: Thank you. Are there questions that you would like me to ask that I haven’t asked you?

Dr. Pete Kelly: Maybe about perfectionist, overachievers and pleasers.

Imi Lo: Oh, yes.

Dr. Pete Kelly: I’d love to speak to those folks.

Imi Lo: Please do. So what’s the link between perfectionism, overachiever or people pleaser? What’s the relationship between those traits with depression?

Dr. Pete Kelly: I think it’s such a great question, and thank you so much for asking me, because it’s something that I feel very passionately about. I think a lot of clients who have felt sense of effectiveness or core belief around effectiveness or failure they will end up overcompensating for that by becoming perfectionists or overachiever or pleasers. And I want to be very clear, I have no problem with people with excellence or people achieving their life’s dream or goal of some kind. But I must say, I have learned over time to be wary of really high functioning clients when they come in or when I meet them in everyday life. I’m like, “Okay, what’s the wound that’s being tended to here, right?” Especially if it’s extreme in some kind with respect to the engagement in a project or achieving or pleasing or things like that.

Dr. Pete Kelly: And I think it’s doubly hard for these clients in some senses because the perfectionism, the overachieving and the pleasing is being reinforced by others. They’re being rewarded for this either monetarily or through the praise of others or being assigned more work. Although the joke that I always say with these clients is, the reward for doing good work is you just get more work, right? So you have to be careful that you’re not one of those 10% of people in an organization doing 90% of the work. But anyway, so really with these clients it’s to start to deconstruct those patterns so that they can start to see them for what they are. And to see that, “Yes, there are some benefits that are conferred by these patterns, but it is, you are tending to a wound that needs to be healed in another way, right?”

Dr. Pete Kelly: For a lot of clients, they’ve almost run out of achievement, right? It’s like, “If achievement was going to fix this problem for you, you would’ve fixed it by now because you’ve achieved so much already.” It’s like, “What are you waiting for in a sense to come onto your plate from an achievement perspective to feel better?” That’s not the challenge here, right? So it’s helping them to reorient to, what do you really need to feel whole? What do you really need to have on board to have an internalized sense of safety about yourself? It’s not achieving or being perfect, it’s some other thing that’s missing. And then we go about the work of trying to fill the hole in the soul in some other way beyond those things. I could go on and on, but in a nutshell that’s how I conceptualize that challenge.

RESOURCES

Imi Lo: Perfect. Thank you. I’ve already asked you what can people do, but if people want to know more about these subjects that you’ve spoken about where can they go? You’ve mentioned a few resources. Are there any books or resources that you can recommend?

Dr. Pete Kelly: For sure. The two books that I find myself recommending the most for clients who resonate with this content is, the first is a book called When Perfect isn’t Good Enough by Dr. Martin Anthony.

Imi Lo: Well, what a nice book title.

Dr. Pete Kelly: It’s wonderful, and it’s a great book on top of that. Dr. Martin Anthony is a very prominent Canadian psychologist. He’s written just an insane amount of books, that happens to be one of them. And the other book, and Imi perhaps you’ve read this one already is Reinventing your Life.

Imi Lo: Oh God, yeah. I have it on the west side and recommend it to so many people. I hate the book title, but it’s got such good content.

Dr. Pete Kelly: I really feel like that book should be handed out at the corner of every street and, or given out to people when they’re 18 or 19-

Imi Lo: And maybe giving out to children, most children, but then young abouts.

Dr. Pete Kelly: Yeah. I often wonder like, what would the world look like if everyone did a sort of mini course of schema therapy? But I think some of the themes that we’ve talked about today will show up in that book. And again, it’s a little bit more tangential to some of the stuff I’ve spoken about today, but really anything by James Hollis, I think it’s hard to go wrong. It’s not for the faint of heart on some level, it’s a bit of a deep dive to read his material but can be utterly life changing if you’re open to what he has to say.

Imi Lo: He has these really commercialized mass market targeting books, like The Second Half of Life. But when you dig deeper on am Amazon, you can find his earlier works that are on… They’re these thin titles, they are written in much more academic tone, but those are gems. So yeah, if you can handle and not so simplified version of the theory, I would suggest you to go for that.

Dr. Pete Kelly: No, couldn’t agree more. And yeah, I think those are the top two books that to me would be germane to this. There’s also a really nice book called Good Reasons for Bad Feelings, is by an evolution psychologist.

Imi Lo: I’ve never heard of that.

Dr. Pete Kelly: Yeah, it’s a wonderful book by Dr. Randolph Neese. I’ve had him on the podcast as well, so you could direct people to that episode as well. I’m not sure what episode number it is, but a quick Google search will get you there, no problem. Really fascinating take on mental illness and mental health resilience, and how it is we’ve come to think about mental illness and health the way that we have.

Imi Lo: Thank you, that’s a lot of gems. Do you want people to find you? Where can people find you? I know you’re rather busy that’s why I said that.

Dr. Pete Kelly: The only social media presence I have is very indirectly through the Ottawa Institute of Cognitive Behavioral Therapy’s Twitter Feed. I basically just will tweet out the episodes but I’m not actively monitoring it in any way. I’ve been giving social media a lot of thought. I have sort of a difficult relationship with it, in the sense that it feels like it’s not always a force for good in the world, but I also appreciate that it can do a lot of good in the right hand. So I’ve been sort of working my way through that, but anyway, long story short, I think the best way for people to access more content if they like what they’ve heard today is through the podcast. That’s really my voice in the world, people can-

Imi Lo: What is it called?

Dr. Pete Kelly: It’s called Thoughts on Record. It’s available on Apple Podcast, Spotify, basically anywhere you’d find a podcast, you’d be able to find Thoughts on Record.

Imi Lo: Perfect, thank you so much. Thank you so much for talking to us about your expertise, your unique perspective on depression and all the resources that you have recommended. Lots of food for thoughts.

Dr. Pete Kelly: Well, thanks so much for having me, Imi, it was so nice to be the guest. I’ve often compared the experience of hosting and being the guest, I’m not sure which I prefer more, but it was so delightful to be able to have the chance to speak about some of the stuff that’s been in my mind. So thanks for having me, I really appreciate it.

Imi Lo: Yay, thank you. Have a lovely, lovely day.

Dr. Pete Kelly: You too. Take good care.