When Depression Doesn't Look Like Depression

0:00All right, picture this. You've just cooked your kid dinner. It's nutritious. It smells amazing to you. And then your kid goes, oh, gross. Okay, we've all been there. I definitely have. And then you feel rejected by your kid. And on top of it, you're feeling anxious that your kid isn't getting enough nutrients. And when this inevitably sends you on a walk down the vitamin aisle, you end up thinking, all right, but will my kid even like any of these? Which one has what my kid actually needs? That's when you can turn to Smarty Pants Vitamins. Smarty Pants Kids Plus Multi and Omegas delivers 33 % more nutrients than the next leading product and includes omega-3s.

0:38That's part of why it's the number one best-selling kids gummy multivitamin. You can shop Smarty Pants Vitamins at Target, Walmart, or Amazon today. After 10, 12 hours of work, I would start to think, okay, well, what's going on at home? Is it going to be chaos when I get home? And inevitably, I would have to take the long way home. And that would involve twisty, curvy roads. I have a old manual transmission car that can go fast and do dangerous things. And man, I was in it. And so for those four or five seconds where you were going so fast and turning so hard that you couldn't help but be immersed in that, there was this, like, release.

1:20But inevitably, the curve straightens, and your focus turns back to what you're going to find at home. So, on the surface, this is an episode about a dad who experienced depression in the months after his daughters arrived. But honestly, I want you to hear this in such a broader context. the more we understand about how our minds work, the more we understand about what's actually going on underneath behavior, whether it's for us or a partner or someone in our life we really care about, the more behavior starts to make sense and not make sense like it's okay, but make sense in that we actually understand what's going on and then we can actually intervene in a way to make things better.

2:07And I just know by the end of today's conversation, you're going to have that new framework. It's like you're going to have a new set of glasses. You're going to see things differently, and you're going to feel so much more empowered. Today, I'm talking to Chris Joukalis. He's a physician. He treats patients at an ICU at UCSF, and he's a dad who experienced this form of depression. Now, this form of depression doesn't just happen in men. It can happen in women as well, And it is eye-opening to hear him talk about all the different things that actually were part of his depressive cycle that were massively impacting his partnership and his relationship or his struggle to really form a strong relationship with his daughters.

2:52And I have a feeling it's going to help you just to understand that this exists, that it's real, and that it can get help. I'm Dr. Becky. This is Good Inside. So it's six months after your daughters are born. What's life like in your house? Well, six months with twins, you can imagine there's a lot of chaos. But the truth of the matter is the chaos started even before that point when the girls were born. You know, we're in the middle of COVID, pre-vaccine. I'm an intensive care physician at the University of California. And so I'm seeing some horrific things every day at work. And then on top of that, there are wildfires making the sky gray and orange and black and even the scent infiltrating the hospital as the girls were born.

3:44Lindsay is recovering from her emergency surgery, her harrowing near-death bleeding event. And I'm just kind of holding on. I don't think I know at the time what's happening. I'm just trying to be there and be present as much as I can. Just show up, survive, function, keep the day moving forward? Or how would you term it? Well, you know, I'm an earnest Midwestern Scandinavian. And our job is to keep the train moving. And so, and again, as you can imagine, there's a lot to do. So I am shuttling the girls back and forth between the nursery and the ICU where Lindsay's being cared for, trying to help with the feeding.

4:24They even have me carry these little swabs of colostrum from the ICU down to the babies to pretend that I'm doing something that's helpful. And give a little bit more color about, you know, about Lindsay's birth story. Well, you know, we spent five years trying to get pregnant. And for anybody who's been through IVF, you know, it's a lot of poking and prodding and tests. And because the pregnancy was so medicalized or the conception was so medicalized, she felt very strongly that the pregnancy and the birth would not be. We're in Marin County. There's a lot of home births. There's a lot of sort of non-traditional medicine practices there.

5:06And yet here I am trying to make sure that everything, quote unquote, goes okay. So I want every test, every ultrasound. And Lindsay did not. So we got to 39 and plus weeks with twins, which is... Far long. Far long. Yeah. And so when we finally went into the hospital, hours of failed induction strategies, ultimately a C-section, during which as the babies are coming out, I'm realizing that Lindsay's blood pressure is dangerously low. And the cognitive disconnect between being an anesthesiologist who does care like this routinely, holding two babies that I've never, I mean, I don't know that I've ever held a baby in my life before that moment.

5:53And then simultaneously looking over my right shoulder at the monitor and realizing that something seems wrong and yet they have not taken these babies from me and shuttled me out of the room, which is the first thing you do when something is going wrong in a C-section. And so after what felt like hours of just living through that sort of bewildering confusion, I sort of looked up over the drapes and realized what was really going on. That her uterus was bleeding from uterine atony. That the anesthesiologist and the surgeon were calling all of these plays to try to rescue her. Massive transfusion protocols.

6:28The machine that pumps and heats gallons of blood at a time to transfuse to her. Extra IVs being put in. And that's when I kind of snapped to and realized I need to give them these babies and I need to get out of here because I cannot help. Yeah. So that was, that's the start of your, your fatherhood journey. The start of my fatherhood journey. Wow. And then, okay. So she gets out of the hospital after how long? So we were there seven days. Okay. You're home. And then, I guess, give me what Lindsay's point of view would have been on your behavior kind of day to day.

7:15Well, growing up the way that I did, I felt as though I had to control everything. And when my anxiety and panic would creep in, I wouldn't necessarily have labeled it that at the time. but it caused me to have this overdeveloped need to control things. And nothing more singular than the sleep routine, which for parents of young children, you know, is an area that's just begging to have people try to control it. So she would say, I would say, I was trying to keep the trains coming on time because if the girls weren't sleeping, I couldn't breathe. she would say that i was sapping every last bit of joy out of being a parent which is really just all she ever wanted and so it created this tension between the two of us that that just began to boil over month after month and just to give it a flavor so someone here can someone listening can recognize it like the babies have to go down now or that nap wasn't long enough or we messed that up or what would it sound like?

8:22Yes, yes, yes, yes. And worse than that. I mean, imagine again, and it's COVID and so stores aren't really open and people aren't really going or people certainly aren't coming to visit us. Right. And so our only way to experience joy with these children is to go for a walk in the park, maybe get a bag of potato chips and a beer at the one place that has outdoor tables in the neighborhood. Okay. But you know that the babies have to go down at such and such a time in order for that to happen, you have to feed them and change them at such and such a time. In order to do that, you have to get home at such and such a time.

8:54Well, then you have to leave this place at a certain time. I mean, it just goes on and on and on and it never stopped. And so if, if the precision of sleep, you're saying kind of became like the operating focus, everything was about optimizing for that. Everything was about just building this, this stack of spinning plates around making that perfect. And what's interesting to me, because I see echoes of this in my own life. I don't have babies anymore. Right. But just tell me if this makes sense to you where each individual factor makes sense in a vacuum. OK, yeah. Sleep is good. A schedule is good.

9:33And so that's true. You have to feed them at a certain time. That's true. You have to kind of change their diapers at a certain time. Like all of these things are individually logical, but it sounds like somehow the accumulation of all of them was kind of joyless and more stressful than it was stress reducing. Oh, absolutely. Okay. Absolutely. For her. Yeah. And then I think the tension, the fact that she wouldn't sort of play ball on this stuff made it very difficult to relate and to co-parent because here I was trying to make everything better. And when she would kind of refuse, no, no, we're going to stay out longer.

10:07We're actually going to do another lap. I would then become kind of a jerk. Yeah. What, and we'll get to that. You guys had different worldviews. I feel like you were optimizing for different things. She was optimizing for, let me have another lap. This is enjoyable. Sleep will, I don't know, figure itself out. We'll be off schedule. We'll be on schedule. But I'm kind of trying to enjoy a moment. You were optimizing for controlling it in this way. So that I could. breathe so that I could stave the sharp, jarring electrical jolts of energy that would go through my chest and my belly when I would have these sensations.

10:51And again, I think for anyone listening, we all have a mindset that feels like it makes sense to us. It gives us relief sometimes. Sometimes. Sometimes, right? Sometimes the relief becomes part of the cycle that makes the anxiety worse. Of course it does. You're a psychologist. That's how anxiety works, unfortunately. Solutions sometimes become tomorrow's problem, but it works for today. But I think the shift starts to happen, at least in the marriage, when you kind of realize we have kind of these different worldviews. One's not inherently morally superior than the other, but we're probably not just talking about the sleep schedule, probably not just talking about the sitting on the couch.

11:28We're talking about how each of our bodies kind of process stress and uncertainty. Well, if you go even farther back before the birth, all of the conflict between the medicalization of the pregnancy created tension, too. And you could argue that it was the same underlying principle, right? Like, I needed to have all of the tests and the ultrasounds and all of the things so that I could feel as though, A, I was doing everything that I could do to shepherd these babies into the world as a physician. and it was kind of that same irritation earlier as after the girls were born of this sort of faux casualness that she would exhibit.

12:10And I haven't articulated this out loud before, so I may not get it just right, but I'm trying to put the puzzle together and she's not even willing to sit at the table and look at the pieces. Yeah. And so I think the sleep issues, you know, after they were born were just a stronger version of the stuff from before they were born. So coming back to your story, your wife comes home one day and she diagnoses you kind of in some ways. Or she, maybe that's the wrong way of saying it, but she has a framework. Tell me what happened. Well, that was a very difficult day for me. And it was a beautiful day for her.

12:57She had been out on this run with a friend of hers through a gorgeous valley just north of the Golden Gate Bridge and inevitably complaining to her friend about me, about all the things that I was doing to make her life miserable. And her friend said, God, it sounds like he's got postpartum depression, but as a man. And my wife said to her, men can get that. And I think the way she responded was like, sure, why not? And so they get back to the parking lot. They finally get some cell reception and she's Googling this. And she comes up with this list of symptoms. And it's not the things that you think of with depression in general or maternal postpartum depression with the sadness and the guilt and the shame.

13:37It's anger and irritability and conflict. drug seeking, risk taking. And she thought to herself, he has got all of these. So she comes home ready to have a talk about this as if she is now saving me. Runs up the stairs. I think I know what's wrong with you. And I'm thinking to myself, why does there now have to be something wrong with me? Why can't this just be terrible? Why can't it be that I'm right about the sleep and you just need to toe the line and get on board so that we can have a peaceful life. But I eventually came around to the idea that at the very least, if I go talk to a therapist, I will be able to unload that to them and that will make me feel better.

14:29And between this day and when I could finally get an appointment with someone, because again, this was COVID and it was a mental health crisis in the making. And it was not necessarily easy to find someone that had time in their schedule, but I did. And during that time frame, I think I came to realize, and part of it was my physician mind, like if there is a name to this, if there is something that I have, then maybe it can get better. Maybe I'm not just a terrible father. Maybe I'm not just a selfish spouse. Maybe I'm not just an out of control lunatic. Maybe I caught something. And if I caught something, maybe it can get better.

15:15Okay. You just said something, you know, that I always think when we're in a marital argument, we're kind of just saying I'm right. And if you just saw it my way, it would all be fine. If everybody thought like I did. Right. What a place the world would be. Turns out it doesn't help things get better, but it is, we all have that wish. so what I want to do with you right now because I want to go through this list of symptoms and I'd love for you to tell me with each one like check did you have it or like no not that one but then I want you to tell me a little bit in your day-to-day how it actually looked because I think sometimes there's a gap with what we think something will look like and then what it actually looks like honestly that's such a great exercise anxiety anxiety was thing number one.

16:00And I didn't, I wouldn't have labeled it as such. I would have just labeled it as I'm being a responsible parent, but I would be up at night. I described those physical jolts of electricity. I was even having palpitations and had to see a cardiologist. Like, why do I have this irregular heartbeat? And so anxiety, absolutely. And just to go further on that, I mean, anxiety gets such a bad reputation, right? Like anxiety is trying to be helpful just to say, you know, everyone here, anxiety is trying to be helpful. Anxiety increases our alertness because our body thinks there's something in our environment that requires extra attention, which by the way, when you have a baby, this is true.

16:44Okay. So if someone said my anxiety level before I had twins and my anxiety level after I had twins, straight line, I'd be, that's a little concerning. Like, you know, but you know, every time I would be confronted with something that I didn't like in this process, that burning and that paying of, of, of sensation, that's not normal. Well, I think that's, that this is exactly kind of some of the nuance. So do I wake up sometimes thinking, Oh, have I fed my baby recently? That's yeah. You want to wonder that. You don't want to sleep through the night and miss setting, you know, your alarm or responding to their cries.

17:28Right. But what you're differentiating also is things felt like a 10 alarm fire. Every time. Every time. Every time. And then your body just kind of probably gets short circuited into that more and more often. And the more tired you get, the more often it happens. And then it generalizes to lots of other things that are not threats. If you want to think of it that way. That's exactly right. Okay. Panic attacks. I have those and they would manifest in the form of the rapid fire cycling of if this, then that, then this, then that. And if not this, then not that. And to the point where I just couldn't even stand up.

18:12was a big feature of it, how rapidly things, the spinning. And the connecting one thing to the other, the certainty that this was going to happen and then that was going to cause this other thing. And an endless parade of problems borrowed from the future. Yep. Okay. Inability to bond. I think so. I definitely spent time alone with the girls and I would have thought that I was loving them. My wife will send me videos occasionally. And there's this one with Pia who still at six, just can't not sit in my lap. And there's this great video of her climbing. I'm sitting on the floor. I've got my arms behind me and she's climbing.

19:00She just cannot help herself, even at whatever she was, six months, eight months, 10 months. And she's looking at me and I don't even move my hands. I'm like leaning back on my hands and kind of looking around and we're having a conversation and she's just like right there, you know, just looking up at me. So I clearly wasn't. And what do you think now she was looking for? I think probably to mirror back to her like what she was giving me. Yeah. And your mind was elsewhere? I guess it was. Yeah. And I just want to name, I think this again is, if your body is in hypervigilance mode all the time, You really think about if I'm in the forest and there are enemies all around me trying to potentially hurt my child, it would make sense that bonding with your child wouldn't be top of your list.

19:51You'd be like, I'm sorry, I'm protecting my child from threats. I'm not like playing peekaboo, which would be smart. Like if you're playing peekaboo and there's bears coming at you, someone would be like, dude, stop. A very real threat in Northern California. Right, exactly. Exactly. And so, again, that makes sense. What probably, quote, doesn't make sense is there weren't bears, there were no bow and arrows at the time. But it explains why, like, bonding comes after assurance of safety of the most vulnerable, you know. That makes perfect sense now. And so a protector is constantly scanning out to protect.

20:29Right. Like, right. And so I just, I think it's so easy for all of us. We're so hard on ourselves. And that's not to say it's an excuse. It's not about excuse. It's an explanation that helps us understand something, which to me usually unlocks change. So you were in hypervigilant scanning mode, you know. All the time. All the time. Anger. Absolutely. Absolutely. So it was mostly at Lindsay, at my wife, and it was over the disconnect between what I thought was important and what she thought was important. And it all comes back to, we need to have a regimented orderly situation so that they can sleep, so that I can breathe.

21:11The only time I was free of those physical feelings was when they would be asleep. And I had to know they were asleep. And by the way, she also would not let us get a baby monitor. So I often didn't know if they were really asleep or not. I'd have to tiptoe around and kind of peek through the cracks in the door. Yeah. You guys were pretty far apart. And these kind of, you were like, I would like to know they're asleep at all times. She's like, ah, monitor, monitor. Right. And so. Well, and it's funny because we later spent some time at a friend's home that had, she had young grandchildren. And so she had a few rooms set up for them to sleep.

21:46And we were all enjoying time at the pool. And they had a baby monitor that was in use in the room where our girls were napping. And the way that you stare at one of these things is insane. I mean, even Lindsay was like, see, this is why I didn't want one of these things. And by then I was far enough along. I could be like, yeah, I kind of get it. Like, you cannot stop looking at this thing. You know what? Any screen with endless information is an addicting thing for the human brain. I guess that's right. Right? And I think one of the things in the anger cycle that can happen is when we're in that hypervigilant mode and we think we have to do all these things just to assure safety, even someone you love, like, think about you operating as if your baby's behind you, your six-year-old, whoever's behind you, and you think there's an army coming.

22:31And she's letting the bears in. And worse, Lindsay's like blocking your view. Like, hey, honey. And you're like, get out of my way. You know, and someone would say like, geez, your wife is like really, you know, like being annoying there. Right. And obviously there's no army. There's no bears. But I think everybody loves her. It's just like the life of the party. She sounds very likable. She is. She's not worried about the puzzle. Not worried about the puzzle or the bears or the army. But I think, again, that anger, when we are solely focused as if everything is a threat, anybody who we experience as getting in our way of having the full view of all the threats, we experience them as a threat.

23:11Absolutely. And that anger kind of comes out.

23:16you know that time in summer when it's about 4 p.m you've been with your kids all day you're drained because you're driving them everywhere you've made snacks 15 times and honestly you want something around them that just feels like yours now this is the part that gets a little serious but stay with me that's often a moment when a lot of parents reach for a glass of wine and this is not a referendum on wine but so many parents i know tell me i don't even want to have it. I don't like the way it makes me feel in the moment or the next day. But I think what the real need is, is that we are looking for something adult.

23:50We are looking to hold something that tells us I am not just a caregiver setting up a slip and slide and making my 19th meal of the day. And honestly, that's one of my favorite reasons for Element. See, you can use Element as your adult summer drink. It can be just yours, not for the kids. And then it's 4 p.m. And what you might be looking for isn't necessarily alcohol. You might be looking for something that just reminds you of you, that you're an adult, you're not only a caregiver, and you're allowed to have something of your own. Plus the fact that it's healthy, no sugar, and actually hydrates you is going to take you through the rest of the day and help you stay calmer while it still meets that need.

24:33You can check out Element at drinkelement.com slash goodinside. That's drinkelement.com slash goodinside. How do I raise a kid who actually trusts herself? This is one of the questions I hear most from parents because we all want our kids to have a strong sense of self. It's why I'm so excited to partner with Girl Scouts. Girl Scouts gives girls a space that's theirs, where they can start community service projects, learn to navigate the outdoors, challenge themselves, and make new friends. Girl Scouts meets girls where they are and helps them grow into who they're becoming. And here's what I love as a parent.

25:09It's girl-led. Adults are there to support, not run the show. So girls make the decisions, solve the problems, and build confidence along the way. In a world that puts a lot of pressure on girls, Girl Scouts is a space where girls can feel joyful and empowered. If you have a daughter in kindergarten through 12th grade, you can visit GirlScouts.org to learn more. That's GirlScouts.org to learn more.

25:42Okay. Drug use. Well, you know, it was COVID and everybody was drinking more and we would have wine with dinner. That's how I would say it, right? But were people having wine with dinner every night? And we were, I was, were people having a half a bottle, sometimes more, were people out on the back stoop huffing cigarettes. What's your understanding now of what first, what was that doing for you? What was your understanding of, what's your understanding of that now? Well, the alcohol absolutely softened the feelings I was having. Because, I mean, let's face it, you get a little bit drunk and you care about stuff less.

26:22And so in the short term, I think that was great. And I like wine. And we would have these meals, you know, Lindsay's sister at this point was living with us. And so we had enough bandwidth to have nice dinners after the girls would go to sleep. And so it was lovely, but I would drink too much every night. Yeah. And I think the cigarettes were just a way. I mean, everyone knows tobacco and nicotine aren't a depression. I mean, they don't relax you, not really, but I think it's just the artifice, the ritual. Yeah. Something I could control. Something that could get me out of the house. Yeah. Yeah.

26:59Okay. Irritability. Constant. Constant. Yeah. Because of the conflict. Yes. Absolutely. And because of the threat and the threat mode. I think so. I think, yeah. I mean, when you're in constant hypervigilant threat mode, again, I just think about someone who's saying, I'm going to stand guard, Becky, and guard you 24 hours a day. And I've been doing this for five weeks. I feel like they'd be pretty irritable, you know? Okay. And then risk-taking and impulsivity. Tell me about that one. So for me, that was related to driving. So I would go to work. So after, I don't know, four or five months of leave, I was back to work and I was taking care of patients in the operating room and in the intensive care units.