Is depression as bad as people think? The short answer is, YES it is!
Yes depression is as bad as people think. However, it is a complicated issue and generally misunderstood.
Clinical depression or Major Depressive Disorder (as defined by the Diagnostic and Statistical Manual of Mental Disorders-5th edition: DSM-V) is very serious.
The reality we must face, however, is that diagnosis is intuitive rather than precise.
Many people will be labeled “depressed”, or will label themselves depressed, when in fact they are experience a normal range of human emotions. Affect within normal range (ie..you are sad because you should be sad).
The individual must be experiencing five or more symptoms during the same 2-week period and at least one of the symptoms should be either – (1) depressed mood or (2) loss of interest or pleasure.
Depressed mood most of the day, nearly every day.
Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day.
Significant weight loss when not dieting or weight gain, or decrease or increase in appetite nearly every day.
A slowing down of thought and a reduction of physical movement (observable by others, not merely subjective feelings of restlessness or being slowed down).
Fatigue or loss of energy nearly every day.
Feelings of worthlessness or excessive or inappropriate guilt nearly every day.
Diminished ability to think or concentrate, or indecisiveness, nearly every day.
Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.
Distress or Impairment
To receive a diagnosis of depression, these symptoms must cause the individual clinically significant distress or impairment in social, occupational, or other important areas of functioning.
There are other conditions which reach clinically significant levels.
The most common being Persistent Depressive Disorder (used to be called Dysthymia). The condition is not as “deep” or “severe” as MDD. However, PDD has its own unique set of challenges.
Criteria From The DSM-V:
A. Depressed mood for most of the day, for more days than not, as indicated by either subjective account or observation by others, for at least 2 years. Note: In children and adolescents, mood can be irritable and duration must be at least 1 year.
B. Presence, while depressed, of two (or more) of the following:
Poor appetite or overeating
2. Insomnia or hypersomnia
3. Low energy or fatigue
4. Low self-esteem
5. Poor concentration or difficulty making decisions
6. Feelings of hopelessness.
C. During the 2-year period (1 year for children or adolescents) of the disturbance, the individual has never been without the symptoms in Criteria A and B for more than 2 months at a time.
D. Criteria for a major depressive disorder may be continuously present for 2 years.
F. The disturbance is not better explained by a persistent schizoaffective disorder, schizophrenia, delusional disorder, or other specified or unspecified schizophrenia spectrum and other psychotic disorder.
G. The symptoms are not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hypothyroidism).
H. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
Note: Because the criteria for a major depressive episode include four symptoms that are absent from the symptom list for persistent depressive disorder (dysthymia), a very limited number of individuals will have depressive symptoms that have persisted longer than 2 years but will not meet criteria for persistent depressive disorder.
Treatment Is Required
If full criteria for a major depressive episode have been met at some point during the current episode of illness, they should be given a diagnosis of major depressive disorder. Otherwise, a diagnosis of other specified depressive disorder or unspecified depressive disorder is warranted
Depression, when at the clinically significant/diagnostic level, is “that bad”.
It impacts people on a biological, psychological, and behavioral level.
Treatment of depression requires psychiatric support and talk therapy.
Medicine is available that can help. People should seek professional support as soon as possible.
However sadness is part of life, and the sooner we “jump on” the negative feelings the easier the fix. We need to be careful to not characterize all “low moods” as depression.
Therapist For 15 Plus Yrs
I have been in practice as therapist for 15 plus years. So clearly, I believe in therapy and I believe that depression is real.
As I said above, it is serious and it requires professional intervention and support. But people can also improve their lives without a therapist and feeling down does not automatically equal depression.
People have always struggled with emotional issues and mental health. This is not a modern phenomenon. It’s well documented.
Anxiety, depression, substance misuse have been part of the human condition across history. People found a way through.
Seeking the perfect therapist, or the perfect “program” or
perfect treatment center or perfect combination of medication is an exercise in
frustration. Don’t wait for that perfect solution.
Warning!!!
Stay away from incompetent therapists and providers that suck.
There are a fair number out there. But otherwise, accept support and try to take action.
The action does not have to be perfect and you won’t immediately solve the problem. The “action” can be as simple as evaluating your current behavior in an honest and open manner.
Talk to someone about your struggle. But do so with full investment and vulnerability. Get more information on depression. Try on different ideas.
Maintain Perspective
Bearing the emotional pain of a seriously troubling
circumstance can be “depressing”. This state may not be representative of
depression in the diagnostic or clinical sense. However, it could be the
catalyst for clinical depression.
Address this before it transitions to more serious stage.
Some Suggestions:
A) Get moving (or keep moving). Imperfectly execute on your life and responsibilities. Seek out the presence of other Homo sapiens. Preferably nice ones… with pleasant demeanor and positive attitudes.
B) Perspective taking. Write in your journal. Journal and write about a major difficulty/problem you have gone through in the past where the long term impact/result was not as bad as you anticipated (ie…it all worked out in the end) Write about the outcomes and how it worked out and how you made it through.
C) Engage the free three: 1) listen to upbeat music, 2) laugh, 3) go outside.
D) Identify your preferred thinking error. Mine is catastrophizing. Be on the look out for those type of thoughts (call them ants). Know the ants are coming. Act swiftly and decisively to crush these ants.
E) Have a “go to person”. One on one to talk it out. Obviously a therapist is one option. Also coach, mentor, appropriate family/friends.
F) Tell yourself: “It is possible that I will feel better in the future”… “It is possible that I can be happy again”… etc.
It is important to focus on light at the end of the tunnel. All things pass and if you can hold on you will likely feel better. Watch this video.
I was vaguely aware of what “addiction” was. My job exposed me to the mental health world as I worked within a healthcare system. I was not a clinician so my knowledge remained on a superficial level. However, I was aware that the Diagnostic and Statistical Manual (DSM) was the “book” used to diagnose both mental health and substance use disorders.
I had access to these manuals via my “psychiatrist co-workers” in the health system.
On many occasions, I found myself looking over the criteria for substance abuse and dependency-as it was called at that time; 1998…
I would read the criteria and read it over and over again. I would dissect the words and see if it applied to me. I was not living under a bridge or eating out of a dumpster. I had not been to jail. I was losing my family…but I had not lost my family.
Most of my consequences were internal. There were consequences:
I was never able to sleep.
I was “dope-sick”/experiencing withdrawal on most days but didn’t really know what was happening to me.
I was using opioid base pain pills that I was getting prescribed (from several doctors).
I never bought it off the street. This allowed me to buy into the concept that “it was from a doctor and couldn’t be that bad”.
I was always running out early.
I was always terrified of running out early.
I had suicidal thoughts.
But no one really knew what was going on with me. Not even my family. I was in an internal hell. But it wasn’t dramatic and I wasn’t a “scum-bag, liar, cheater, and thief”.
I was a pretty high functioning person who was quietly, yet desperately, dependent on substances to get through the day. Oh…on a side note: alcohol was ever present and I was probably more dependent on alcohol than any other substance. It was just socially acceptable and therefore I didn’t identify it as the main problem.
Man… I would look at that Diagnostic Manual. I would play with the criteria in my mind.
The manual said “inability to control use” was a symptom.
I would tell myself that really didn’t apply to me because “it wasn’t lack of control. I actually wanted to drink 24 beers and eat 10 Percocet… so I was in control…it was my choice”.
The manual said “can’t cut down” was a symptom.
I would tell myself that I really could cut down if I wanted “I just haven’t decided to yet”…
The manual said “interpersonal problems due to using”.
I told myself that it was “my wife that had an attitude problem” and it really wasn’t on me…
And I looked at this manual over and over…and as time went by I had more and more trouble explaining away the symptoms. But I was always able to do so. Because I was NEVER TALKING TO ANYONE ABOUT THIS.
My mom, my wife, told me to see counselors or “go to AA” and I flat out refused. I was clueless as to what was happening to me…
I turned the book upside down to see if it made more sense from a different angle. I couldn’t figure it out.
Once I went to an EAP counselor and I was just waiting for her to ask me about my use and give me some answers. But all we talked about was “stress” and “career planning”. You see…she wasn’t a drug and alcohol “specialist”. So we didn’t go there.
I just simply never discussed my substance use with anyone despite the fact that it was destroying my life. And it got worse. I did temporarily lose my mind and my family and my sense of purpose and my future….
Why did it have to roll on so long?
Did I have to “hit bottom”?
Did I have to “become ready”?
Or would I have benefited from a conversation.
As you can probably assume…I eventually found recovery and went back to school. I got a graduate degree in Sociology with concentration in Addiction studies, became a therapist, went back and got an MBA with a concentration in healthcare management.
I jumped through a bunch of hoops and got licenses and certifications. Started working in the field in 2001—basically as soon as I entered recovery. And I’ve learned a lot. Both personally and professionally.
Based on all this…What do I believe people need to know:
1). Substance use disorder. – It is a real problem. It’s a brain issue. It’s not bad behavior or just a bad habit. It will get worse and it will not just go away on its own.
2). That said…it takes on many different variations. – Just like other diseases there are different stages or different “species” of addiction. There is no such thing as a garden variety drug addict—as you so often hear people say. The word addict is demeaning and people say addicts are scumbags and liars and cheaters and thieves. That doesn’t help and it’s not accurate. It’s an individualized experience. Don’t buy into the hype.
3). Following logically behind premise number 2. – There are multiple ways to “get better”. There is no one prescribed way to recover. It is an individualized experience
4). I wish someone would have engaged my family in the process. – Families are profoundly impacted and deserve information. Families should be included not removed from the process. Unless their involvement is dangerous for the person needing recovery or for the family members.
5). You are allowed to talk to someone, without making a commitment to quit everything all together and “never take another drink”. This would have been the most beneficial piece of information for me when I was “out there”. I stayed away from “addiction counselors” for years because I wasn’t going to “quit everything”.
6). You don’t automatically need to go to rehab. – There is actually a clinical assessment process that indicates level of care. You would never know that based on the media and based on the behavior of some rehab marketers. But rehab is not always necessary.
7). There are many people in recovery who did not go to jail and/or eat out of a dumpster. – We have allowed ourselves to become caricatures and we promote stereotypes of the scumbag drug addict. I’m sure this chases many people away from recovery. Don’t buy into that… it’s a very diverse crowd.
8). There is medicine available that can support recovery.- Staying alive is first on the agenda. Don’t let uneducated and uniformed people tell you otherwise. It’s not the only option. But it is an option.
9). It may be hard to find people who are willing to “meet you where you are at” in the process of change. – Keep looking. Professionals are wrong when they blindly confront you and prescribe one size fits all solutions. Don’t quit the process based on a bad experience. Find another meeting or another therapist or another program. Be your own advocate.
10). If you are using heroin or “pills from the street” (or apparently cocaine) – In today’s world of carfentanil and fentanyl please understand you are playing Russian roulette every time you use. It is better to seek help even if you are “not sure you are ready for recovery” and let a professional help you figure out options…than it is to continue on until you “hit bottom”. Hitting bottom today means death…too often.
11). YOU CAN GET BETTER…LIFE CAN BE BETTER.
12). YOU WILL BE ABLE TO SLEEP AGAIN…
13). YOU WILL BE ABLE TO LOOK AT YOURSELF IN THE MIRROR AGAIN.
14). YOU HAVE NOTHING TO BE ASHAMED OF. EVERY PERSON ON THIS PLANET HAS A SKELETON IN THE CLOSET. AN ISSUE THEY ARE ASHAMED OF. AN ISSUE THEY STRUGGLE WITH… THIS IS OURS.
Many times, I write a blog post to “scratch my own itch”; meaning I need to solve a problem or address a personal issue with which I am struggling. As I work this issue out for my own benefit, I share it with you. The hope is you will also gain from this process.
What’s bothering me?
BEFORE YOU YELL AT ME FOR INSENSITIVITY: I HAVE GREAT RESPECT FOR THE LEGITIMATE DIAGNOSIS AND TREATMENT OF MENTAL HEALTH ISSUES. I AM NOT MINIMIZING ANYONE’S EXPERIENCE IN COPING WITH MENTAL HEALTH. I AM MERELY POINTING OUT THE OVERWHELMING PROCESS OF “UNDERSTANDING” WHAT AILS US…
Identifying what is bothering me is easier said than done. I decided to google it and begin some research. I typed in my symptoms (restlessness, distractibility, low grade worry, dysphoric mood, a bit of anhedonia, pre-occupation with work, difficulty making career decisions)
The diagnostic and statistical manual 5th edition (DSM-V) has nearly 300 different disorders in it. So far, if I base it strictly on the criteria in this book, I may have the following disorders:
Adjustment Disorder with mixed disturbance of emotions and conduct
Unspecified Anxiety Disorder
Unspecified Trauma and stressor-related disorder
Or if I want to stay away from a medical diagnosis perhaps I am suffering from:
Mid-life crisis (what the hell?)
Entrepreneurial depression and mood swings!
An existential crisis!
A theological crisis!
According to the Big Book it’s a spiritual malady. Irritable, restless and discontent!
According to others in recovery it’s a lack of self-acceptance.
Or maybe I have not worked the steps?
Or maybe I have not worked on core issues?
According to time management gurus I have too many open loops and uncategorized projects.
Or maybe I a human being…being human.
This is my dilemma, I’m human
I do not have a diagnosis or a “condition”. I have not missed the boat on some type of spiritual conversion. There is no magic answer to be found in any time management system and I don’t need any medication. My condition is serious enough to be a nuisance but not serious enough to warrant drastic measures. I have diagnosed myself and the condition I am suffering from is:
HUMAN BEING DISORDER – NOT OTHERWISE SPECIFIED
That being said, I definitely need to make some changes. The symptoms I listed above are real. I can be overwhelmed with life from time to time. I don’t want to just survive. I want to THRIVE. Therefore, I need to choose how to attack these issues. For me it comes down to 4 essential factors:
What’s happening to me physically? Am I eating right, am I getting sleep? Am I exercising and if so am I pushing myself beyond my comfort zone? Am I sick or suffering from another allergy attack? It is impossible for me to separate the way I feel physically from my mental state.
What happening in my “circumstances”? The serenity prayer nails it with the line “the courage to change the things I can”. If am living with a situation that is unacceptable and IT CAN BE CHANGED, I have an obligation to change it. And, as the serenity prayer states, if it can’t be changed I must accept it. This simple prayer is a mantra for many in the world. However, I would argue few take these wise words to heart.
What’s happening to my mindset? Am I in a growth mindset? What new things am I learning? I cannot stand still. Just like physical well-being I need to push myself beyond my comfort zone intellectually and mentally. I need to find new things, start new projects and fully embrace the mission. With a why I can do anything. Without a purpose, I will stumble through life.
What’s happening with my thinking? I need to stay mindful of my past and how it influences my core issues. I need to be willing to acknowledge the traumas of my past, identify the schema associated with these experiences and explore ways to work through these issues in the present.
These are areas within my control and they influence the other important areas of life. Relationships, work and finances are all positively impacted when I’m on my game in these 4 categories. Conversely, when I struggle in these areas my relationships and my work and all areas of my life suffer.
THE BIG FOUR
1) Physically
I have not been doing well in this area lately. I have 4 businesses that I currently work in. I work about 70 hours a week. I also have 4 children 10 and under at home. It can be very easy for me to get run down if I don’t take care of myself. This category is frequently related to eliminating bad stuff (cigarettes for example) and adding good (exercise). For me it’s about behavior change on the elimination side. I am doing relatively well with exercise and better with sleep. I can’t control my ever-present allergy issues unless I move to Arizona. I need to manage this on an ongoing basis. But there is at least one major problem in relation to physical issues:
It all starts with sugar. Sugar is addictive. This is a known fact.
At FAVOR Greenville, we have a serious sugar problem. Candy everywhere, donuts everywhere. Sugary snacks that are yet to be identified. I have not imposed my will on the masses at FAVOR by banning candy and donuts. It’s an interesting phenomenon. I can abstain during the morning and into the early afternoon. However, around 3 pm it’s all over. I give in.
Here is my plan:
More important than anything, I need to assess where I am in the stages of change? Am I sure I want to make this change?
Do the benefits of giving up sugar (healthy etc…) outweigh the payoff (it tastes really good; I get a sugar buzz). I cannot take motivation for granted.
Maybe I should write this down. There are normal and predictable stages that people go through when it comes to making a change.
Announce my intention to change to people who are important to me. Publicly proclaiming my plans increases likelihood of follow through. I just announced my plans!!!
Bring more healthy food to eat during the day. This capitalizes on the principle of replacement behavior. (I will need to beg my wife to help me with this.)
Which brings me to an important point. Having someone in your corner to support you through these changes is very important.
Move the freaking candy bowl off the front desk. Clearly environmental triggers are the easiest to control. Putting a barrier between you and the behavior you are trying to eliminate increases the likelihood of success.
Beware of the Abstinence Violation Effect (AVE). The AVE is the very natural human tendency to throw the towel in when we make a mistake. When we try and make a change and “fail” we tend to give up.
Develop the mental awareness and toughness to simply refocus and re-engage in the change process.Track my behavior. There is universal agreement. When you track something you improve by virtue of the tracking.
I will use a program on my iPad to chart my behavior daily. Including food.
How are you doing with your physical well-being? What is the issue you need to address? Is it a matter of eliminating a bad habit or adding a good habit, or both.
Once you identify the change then get together an action plan.
These principles are universal.
2) Circumstances
Believe it or not the discipline of positive psychology has identified a happiness formula.
Our circumstances clearly influence or happiness. However, at a surprisingly low level of influence. At 10%, our circumstances are not going to make or break our subjective well-being.
I have much to be grateful for and, truth be told, I have already made significant changes to my circumstances. This was mostly related to work and career and involved a great deal of risk.
In order to identify additional changes, I need to spend some time in silence and actively reflect on my situation. I cannot expect to come to some understanding without meditating and reflecting on what needs to change. For me, simply saying the serenity prayer will have little impact. Therefore, my action plan will include the following:
Journaling for 7 consecutive days on the following subjects:
Work/Business: I have MANY opportunities and that is great. However, I need to get clear and make some difficult decisions. I also need to be honest about what holds me back on these decisions. In my case it is the difficult/uncomfortable conversations that are sure to follow some of these decisions.
Family: Directly related to business; I need to clarify work/life balance and make changes or come to some level of acceptance. I need to focus on the long view and compartmentalize better. I need to maximize time off and think in terms of decades rather than day to day or week to week.
Financial: How much money do I want to make? Write it down and don’t be vague about it. Our relationship with money can be strange. Especially in the “nonprofit” human services field. We seem to believe we must be martyrs. Visualize what you want. Visualize your ideal life.
Work on acceptance:
Acceptance is a very unusual concept. Similar to forgiveness or “letting go and letting God”. How does one “accept”. I believe it is an active process of repetitively identifying “lack of acceptance” and redirecting thinking. It also involves setting an intention and focusing on one area at a time.
For example, if I need to accept my relationship with my parents I must set that intention every morning and then actively redirect that thinking through the course of the day. Remember our thoughts are mostly automatic and we will need to bring effort in order to reprogram our thinking:
Do you have any circumstances in your life that need to be reevaluated? You need to be honest with yourself and take some time to examine your life. Maybe it’s a relationship or perhaps a work situation. Living mindful and intentionally requires time and effort. However, it is well worth it. Then challenge yourself to have the courage to change the circumstances that need changed. Have the difficult conversations and take the necessary risk to live your life. Not someone else’s life.
NOTE: Many of us deal with very serious issues related to addiction. Either our own recovery or the recovery and struggles of a loved one. Some may have even lost someone to this deadly disease. Recognizing your circumstances and exploring ways to improve the situation and/or cope with the outcome is essential to your well-being. Of course, there are very specific ways to get support surrounding addiction. Not the least of which is staying tuned to the cartel.
How we can learn to fulfill our potential”, has brought the term “mindset” into the mainstream.
I am certainly a proponent of the growth over fixed mindset, however, my thoughts on mindset include some additional principles. For me Dweck’s growth mindset is absolutely essential to my well-being.
Dweck’s thesis, in VERY brief summary form, is that people develop a growth mindset (“I can learn and grow and become more”) or a fixed mindset (“I am born a certain way and that is all I can expect from life”).
I know this is a fact and I know that our educational system is set up to differentiate “smart kids” from “average” or “below average” kids and most of us spend our lives living up to, or down to, these expectations.
We must throw off these expectations and not live our life according to this limiting dogma. We must realize that the world was created by people no smarter than we are, they just did not buy into the conventional wisdom of the day.
Never stop learning and growing. For me this means I need to read more books this year than I did last year (at least 23). I am behind pace at only 8 to this point but I intend to have a good second half of the year.
I must also continuously challenge myself professionally.
I will never again be part of the machine in the addiction treatment industry. It is my intention to disrupt the industry. It is my intention to remake the delivery of addiction recovery services from top to bottom.
I cannot live in a static, fixed mindset. What worked for my personal development in early recovery will not carry the day now. I would rather burnout than fade away.
Beyond growth versus fixed mindset: I need to go beyond growth versus fixed mindset. I must develop a mindset of mission and disciplined effort. If I work for the weekend or work for vacation I will not make it. If I think I’m going to cruise when I get home from work I will not make it. I must maintain the mindset that the merit is in the struggle. The journey is the reward not the destination. In order to do this I must get a better morning routine and set my intention for the day. I also must redirect my thinking when I drift into a victim mentality.
Three good things: A conscious effort at maintaining an attitude of gratitude can go a long way. Some people keep a gratitude list. For some gratitude comes very naturally. I am going to continue the practice of 3 good things. Each night, sometimes via posting on Facebook, I will write down 3 specific good things that happened during the day. This practice will condition my mind to pick up on the good rather than notice only the bad.
Peak performance: Similar to Dweck’s growth mindset, Anders Ericsson’s book, Peak, explores the limits of human performance. Through deliberate practice it is possible to become a true expert in a chosen area. I intend to apply deliberate practice to the art of staff development. People are the most important asset in my line of work and I intend to become the best in the world at supervising and developing a recovery workforce. This will help keep me in a growth mindset.
Mindset is essential to your growth and sense of purpose. What are your plans surrounding mindset? Maybe it’s as simple as reading Dweck or Ericsson. Or maybe you want to set specific goals around professional or personal development.
4) Core beliefs, past issues and present thinking.
Thoughts lead to feelings lead to actions lead to thoughts etc… Cognitive behavioral therapy. Rational emotive behavioral therapy. SMART recovery. Even the 12-step programs all rely on identifying thinking and challenging irrational thoughts. “Play the tape the whole way through” for example is all about challenging the euphoric recall and getting a realistic view on what it would be like to use again after some time in recovery.
I would like to go a little deeper than surface thoughts, however, and explore core beliefs and how our past influences our present.
As a certified EMDR trauma therapist I learned about “stuck” experiences and how unprocessed trauma can influence our behaviors. This was one of the most powerful experiences I have ever had. I had always heard this was the case, however, experiencing it first-hand changed my outlook.
Our past experiences contribute to core beliefs. For example: “I’m not worthy” or “I must be perfect”. This leads to us being hypersensitive to modern day experiences and “data” that supports this core belief.
For example, let’s say my core belief is “I am not smart enough” due to invalidating and emotionally abusive parenting I experienced. Maybe as an adult I go back to school and get a grade lower than desired.
This “failure” in school will fit nicely into my core belief. Conversely, when I do something well (pass a test for example) the data will not fit into my core belief.
It’s going to take substantial effort and time to pave new pathways and reprogram this core belief.
I have worked hard on identifying my core belief (“I’m not worthy”) that arose via growing up with an alcoholic father who could be violent. Now I need to work just as hard at identifying when I’m feeding into the core belief or discounting the positive data.
In the same vein, I am going to work on identifying the most common thinking errors that plague me day to day and track my responses to these errors.
The list below is a universal list that all human being cite as being present from time to time.
If I can establish a pattern for these thinking errors then I can self-correct. In time, due to neuro-plasticity my brain can rewire and I can respond differently to provocative situations.
What is the core belief that holds you back?
What are the most common thinking errors with which you struggle?
Awareness is the first step.
Obviously there is much more to life than these four areas. Spirituality, for example, is a big part of life and can go far in soothing the soul. However, I will leave those discussions for another time.
If you are progressing as you wish, if you are doing well then don’t bother with these suggestions. If it is not broke don’t fix it.
However, if you are looking for some new ideas then experiment with some of the things discussed in this post. Do a research project on yourself; n=1. See what works for you and what does not work for you.
More important than anything. Do not let life happen to you. Take as much from life as you can. You only live once. Many people don’t want us to thrive. They want us to assume our designated place in the machine. When you thrive and chase your dreams it makes them uncomfortable.
Our circumstances clearly influence or happiness. However, at a surprisingly low level of influence. At 10%, our circumstances are not going to make or break our subjective well-being.
