SPENCER: Elizabeth, welcome.

ELIZABETH: Thanks for having me.

SPENCER: Do you think that storytelling is an important part of most efforts to improve the world?

ELIZABETH: Yeah, I do, and the reason for that is that in order to make progress on important issues, they have to first be in the public consciousness and the water supply of ideas that people are talking about. I think storytelling is the primary mechanism for getting things there in the first place. With that being said, storytelling, I think, like any tool or technology, isn't inherently good or bad. There are a lot of examples of the impact of stories, but that impact can be positive or negative, so it matters a lot which stories are told and how they're told. Again, as with anything, any tool or technology, I think the risk of unintended consequences can be mitigated, but not necessarily eliminated completely.

SPENCER: I struggle with this because I'm really not a natural storyteller. My essays often read like just a list of ideas or thoughts, or even a bulleted list sometimes, and I have to kind of make an effort to be like, "Okay, how do I make this a little bit more of a story?" Because I know that, fundamentally, people want stories. Would you agree with that?

ELIZABETH: Yeah, I would. But I would also take a pretty broad definition of storytelling. I think it's possible that some of the efforts you don't see as stories might be more story-like than you think.

SPENCER: Interesting. I kind of think of a story as having characters, some kind of development — usually conflict — some kind of narrative arc for the characters in it. What kind of definition of story would you use?

ELIZABETH: I like the one that has a beginning, middle, and end, but not necessarily in that order. Personally, I think when I'm trying to identify what's compelling about an idea, or find the story, I am looking for what feels like the closest thing to a universally relatable truth in it, or the reason that someone who knows nothing about a topic or has no reason to be interested in it should be interested in it. So that is sort of the most fundamental unit of story, as I think of it.

SPENCER: I like that idea, but that also just sounds like something being interesting. How does that make it a story, rather than just part of something being interesting or universally appealing?

ELIZABETH: Yeah. I think that when thinking of something being interesting, first of all, it's easy to get stuck in the frame of what you individually find interesting. When I'm looking for the universal in it, it's usually related to a common experience or emotion or worry about the world, so relating whatever the cool facts about something are to those experiences or common grounds.

SPENCER: I see. So you think of storytelling as involving getting the reader to connect to what's happening, being able to identify with it.

ELIZABETH: Yes.

SPENCER: Interesting. I wouldn't have thought of that as a fundamental part of storytelling, but what do I know [laughs]? But I could imagine you feeling a story is really interesting because of unusual or surprising things you can't relate to at all happening. A story about people that are completely different from yourself. I love watching documentaries about subcultures that I would never normally encounter, for example.

ELIZABETH: Yeah, totally. But I think part of what makes those documentaries compelling is the effort. It's not just, "Here is this subculture. Here's what they're doing." It's understanding why they do it, and in some cases, being disturbingly relatable, even though you can never imagine yourself reaching that end point. I think that's a lot of the time what the filmmakers are trying to do: uncover the motivations for something that seems really out there that other people will identify as something they could experience a version of themselves.

SPENCER: When talking about storytelling, the monomyth or hero's journey often comes up, and people often use that as sort of the archetype of a story. You have a character who's living in an ordinary or mundane life, and then there's some kind of call to action, some crazy thing occurs, a portal opens up, and an alien comes through, or whatever it is, some incident that opens things up. Then, the character has to decide whether to take the call to action. Often they first reject it, and then they eventually take it. There are characters that help them on their journey, kind of their guides, etc. How fundamental do you think that is to storytelling? Is that just one very specific version of storytelling, or is that fundamental to a lot of storytelling?

ELIZABETH: There are a lot of different variations on the hero's journey, and I think it is useful for fiction stories, particularly things that need a higher degree of structure, like screenplays, as opposed to novels, for example. I think it's very valuable in terms of learning story craft, which I think is a craft to the same degree and the same level of complexity as writing or drawing or any other creative pursuit. I think writers, especially starting out, tend to think of writing as the craft, but story craft is the additional, separate, equally important part of writing. That's a journey a lot of people go through. Understanding the structural components of the hero's journey is an important part of wrapping your head around that a lot of stories that adhere to this basic structure really work, and there's a reason for that. But I think maybe more important than the exact format of the hero's journey is what it's getting at, which is understanding a character's motivations, desires, and fears, and having a meaningful change from beginning to end, like a goal they're trying to achieve, why they can or can't, and what they learn through that process. There are many versions of the hero's journey. There's the classic 12-step one, there's the three-act structure, or four-act structure, the story circle. These are all variations on the hero's journey. I see that as sort of the biggest meta lesson about storytelling, takeaway from it.

SPENCER: So do you think someone could tell a great story that's not at all relatable, where you are fascinated by how weird the characters are, or how this is so different from what you would ever do?

ELIZABETH: Yeah, totally, but I think there's a little bit of self-delusion in that. I think most gifted storytellers have a grain of relatability in there somewhere, which the reader or viewer might not be willing to acknowledge, but that is often there in making things compelling.

SPENCER: Emerson Spartz once pointed something out to me, which I think is true. He said that the number one most popular thing to do for entertainment is to consume stories, and we do it in many different forms. YouTube videos are often stories. Podcasts are often stories. Reading is often stories, etc., and games are often stories. So if you think of it broadly like that, people spend just an insanely large percent of their time consuming stories. Even news, you could say, is just stories, fundamentally.

ELIZABETH: Oh yeah, absolutely. Memories are stories.

SPENCER: Yeah, good point. Memories are stories. And it kind of suggests that stories might be something fundamental to the architecture of human minds. It's the natural thing our minds speak in rather than data or lists of facts or predictions.

ELIZABETH: Yeah, I would agree with that.

SPENCER: It's a bit sad to me, because you might think, "Well, I have a really good set of arguments and really good evidence that something's true and important, I could just present that evidence." But no, people just ignore it. They'll be bored by it. They won't share it. They won't consume it. You might have to actually package it into a story in order to get the word out or even to get to people who believe it.

ELIZABETH: Yeah. I have definitely experienced that frustration, but I do wonder if we're working from slightly different definitions of what a story is here, because I consider evidence on its own to be a story. Or maybe I'm just anthropomorphizing everything, but this evidence is telling me something, and that something is what I would call a story. So I'm not sure how helpful all this definitional stuff about stories is in terms of getting to a clearer idea of what they are, because I think they're almost every way humans exchange information.

SPENCER: So you've got raw data, you have a spreadsheet of data. To me, that's not a story. A story happens when you go in and interpret it in some way, and you say, "Ah, look what we're seeing. We're seeing there's this trend where allergies go up in the summer months," or whatever. So to me, a story is saying you overlay on the data, and similarly, you have a bunch of facts. You have a list of facts about a topic, facts about malaria. To me, that's not a story. To make it into a story, you have to put the facts in a certain order. You've got to omit some of the facts because there are too many to say all of them. You've got to create some unifying thread through the facts that makes the whole thing make sense together. And then, okay, now you have a story.

ELIZABETH: Yeah. So I think maybe what I'm brushing up against here is that I may define a story differently as the person who's telling stories than I do as the audience for a story or the observer of a story that I did not construct. Because I think what you're saying is totally right. But also, if I was looking at that spreadsheet or those facts, I would be thinking of it in terms of, again, and this sounds a little nutty when I put it this way, but the story they're trying to tell me and trying to identify what that is.

SPENCER: And, well, I guess, as someone who works with data a lot, I know that there are many stories that could be told from any single set of data. Yeah. So it's very much not a unique mapping from data to story. There could be 100 stories you tell, and some of those stories are more true to the data. Some are less true to the data. Some are longer, some are shorter. Some compress information more. Some selectively omit facts to actually trick their audience. And some get to the core of what's most important about the data, etc.

ELIZABETH: Yeah, they're practically infinite — how thrilling and scary.

SPENCER: Yeah, but then I think it creates this question of, "Okay, you want to change the world, you want to make an impact, you want to get the word out about something. You've got a set of facts, you've got some data, or whatever it is, your raw materials. How do you turn that into a compelling story that is both true to the data or facts but also actually gets people to share it, gets people excited, gets people motivated, and causes change in the world?"

ELIZABETH: Personally, in all my work, I try to build in an exuberant spirit of inquiry and model a willingness to engage with unfamiliar or even off-putting questions, and be open to reaching unexpected conclusions and actually engage with them and see where that can lead you. So I think if I'm telling a story about a set of facts, or a story that's intended to persuade people of the importance of something, or intended to contribute to improving the world, I always want that to be built in. Because there's always a possibility that I haven't gotten it right. And also, nothing's future-proof. In order to convey the importance of something, that's going to change, and it's not going to stay static from whatever it was when you first expressed it. So I really do think that, and this is obviously not a foolproof thing, but I think including that sort of willingness to engage.

SPENCER: What's an example of that? How do you actually do that?

ELIZABETH: Yeah, so, for example, in Ada, the animated series I just finished, I think when I was at the pitching phase of it, a lot of people wanted to frame it as optimistic futurism, or optimism about transformative technologies. And it's really not that, but it's not pessimistic either. I tried to make each of the stories take this sort of journey through posing questions, engaging with them, pivoting in another direction. It's very much built into the main character's personality. This sort of willingness to engage and enthusiasm for weird questions. One of the episodes is about gene drives. It starts with the possibility of eliminating malaria-carrying mosquitoes, and then gets broader to talk about other species. I think the sort of weird, uncomfortable question that I wanted to engage with in that one is the thematic question of that episode, which is, "Is it ever okay to play God?" But I wanted to push it a step further to be like, "Do we ever have a moral obligation to play God?" That is pushing it to the level of weirdness or potential discomfort, and just going there and engaging and seeing that through to its possible conclusions for that particular case.

SPENCER: I love that question: do I have a moral obligation to play God? That's fascinating.

ELIZABETH: But that's not the first question, right? The first question is, "Is it ever okay to play God?" And then you kind of have to engage further and push it.

SPENCER: Yeah, but it sounds like you're building into your work this sort of acknowledgment of the difficulty of the questions and uncertainty. But very few storytellers do that. Storytelling is almost always overconfident in a certain sense, where it's just sort of accepting its narrative as the narrative, if you will.

ELIZABETH: Yeah, I'm not sure I would agree that very few storytellers do that. I think possibly my favorite theme is unintended consequences, and particularly the unintended consequences of choices people don't realize they're making. But I think I'm far from the only person who has that interest, and there are definitely plenty of examples of that in both fiction and nonfiction, but I do take your point; definitely, it is not a given of a lot of storytelling.

SPENCER: Yeah, to me, a great documentary is one where the documentarian's perspective on the subject is not apparent. There are so many documentaries I've watched that hit you over the head with a one-sided view, and you can tell they are purposely omitting evidence over and over again to persuade you of something, which I find very aggravating.

ELIZABETH: Yeah, for sure. I also think there are some growing pains in storytelling and media right now. There is this exciting trend where many formats are mutating and combining. The flip side of that, and the growing pain, is that the rules of different formats are perhaps less clearly delineated than they used to be. For example, you have a lot of YouTube channels that are video journalists, but some of their videos are effectively sponsored content, which is not really journalism. I think what you're talking about with documentaries is somewhat related to this. Up until quite recently, documentaries were not big money makers. Now they are, and a lot of them are higher budget, more risk-averse, and very curated from the start, going in with a point they want to make rather than the goal of exploration as before. So, I think part of what you're identifying is the moment we're living in. There are things that are exciting about that moment, but there are also growing pains, and that's perhaps one of them.

SPENCER: That's interesting. Maybe it has gotten worse, but I think I've always felt this way about documentaries for 20 years, that most of them are polemical and not true explorations of the topic.

ELIZABETH: Yeah, totally. Not to be too cynical, but I think a lot of work in any field is not the best, sort of by definition. That's definitely true of storytelling, too.

SPENCER: What are some examples that you think illustrate the power of storytelling to change the world?

ELIZABETH: I think climate change as an issue is very useful to look at here, because it's gone through this life cycle of being totally fringe and weird to being something absolutely everyone knows about. If we're talking about documentaries, the clearest example in climate change is An Inconvenient Truth, and there have been a lot of studies on the impact of An Inconvenient Truth and how it expanded public awareness of climate change. I think that's an interesting example. Also, in the environmental space, a much earlier example is a creative nonfiction book by Rachel Carson called Silent Spring, which led semi-directly to the EPA being founded, which is pretty cool, but was basically raising awareness of the negative impacts of pesticides used in agriculture at a time when the public was pretty much completely unaware of that. So that's in the early 60s. Those are two interesting examples from the topic of climate change that I think are kind of illustrative for other efforts to bring new ideas into the public consciousness through storytelling.

SPENCER: What do you think made those so effective? Why did those two pieces of work have such a huge effect when there have probably been hundreds of other attempts to raise consciousness about environmentalism?

ELIZABETH: That's a good question. I think it's not entirely something we can answer. In the case of Silent Spring, the writing itself, the lyricism, the appreciation of nature, and the accessibility of the prose is what made that book a hit. Rachel Carson was not a celebrity beforehand, and she wasn't after either. She was just a quiet, private person. That was very much down to the way in which the book was written and the way it treated its subject, basically not being dry, which doesn't sound revolutionary now, but that was much more unusual at the time. With An Inconvenient Truth, a couple of things helped. Al Gore was already very well known, which helps a ton. It's interesting that it helped the film circulate even among people who were not necessarily interested in him. I was shown that film in school, and I thought, "Oh, this guy's kind of a tool." But that was my first big exposure to the idea of climate change, or global warming, as it's called in the film. That stuck with me forever, even though I didn't particularly like the film or him. I think his career and existing public profile were one of the reasons for that.

SPENCER: One thing I find disturbing about storytelling is that it's often as easy to tell a false story, a misleading story, as a true story. And so we take something like Silent Spring, and I think there was, as far as I know, a lot of truth in that book about DDT and its effects. But on the other hand, some people have criticized it, saying DDT was actually a really important way to fight malaria, and that book may have actually caused people to underuse DDT after that, which may have caused a huge human death toll. So, I don't know enough to get into the details of the debate about how responsible Carson is for that, or to make sense of that, but it's a little bit scary. She tells a really great story, but whether that story is true is a completely separate question. Or does that story make the world better, or does it make the world worse?

ELIZABETH: I think that's something that's true of almost every effort to make the world better. It's really hard to play out all the long-range and unintended consequences of any particular action. At the time that Silent Spring was published, information was being suppressed by the USDA and all the big agriculture players about the harms to both humans and wildlife from DDT. So it's definitely, I agree that it is. There's a reason stories are used as propaganda too. They can be used for good or bad purposes or with good intentions that end up not having good results. But again, I don't really see that as a difference from most things.

SPENCER: I think climate change is an interesting example where there seems to be a strong incentive to exaggerate. Personally, I think climate change is a really important issue. I think the world should work hard on it. But I also think you often see scare tactics used that are generally false, like, "Oh, in X years, the world's gonna end." In fact, in Union Square in Manhattan, they had these numbers that people thought were the national debt, but they weren't actually there at the time, and people were very confused about it. Eventually, they changed it, and now it's this countdown timer to something. I was trying to figure out what on earth this countdown was for, and what it's counting down to is when the world will end from climate change. I was wondering, "Where did they get that calculation?" And I looked it up. It turned out it was just the artist's opinion of how the world is gonna end or something. Maybe they heard it from some environmental activists, but it's really based on nothing, and it's extremely scary. "Oh my god, we have this many days until the world ends."

ELIZABETH: I think it's worth noting that stuff doesn't really work. The scare tactic stories about climate change shut people down and make them not want to engage on a more productive level.

SPENCER: I think that those efforts to tell people the world's going to end in the next number of days or years are false. But you think that they're actually kind of productive as well for the environmental movement. You don't think they motivate action to say, "Look, this is how long we have and disasters [unclear]."

ELIZABETH: I don't think they motivate action, no. In fact, I've done deep dives around the framing and angles of climate change content and what people respond to and engage with more, and the fearmongering and scare tactics just don't drive engagement.

SPENCER: It seems to freak people out a lot. I've met quite a few people who are freaked out about this [laughs]. But you just think they don't take action to the thing, when they're freaked out?

ELIZABETH: In fact, I think it makes them less likely to engage because it just seems too much.

SPENCER: It's strange to me, because imagine you live during the time of World War II, and you found out, "Oh my gosh, there are armies marching and they're going to come attack us." That would be extremely motivating. Everyone would get motivated to do something. This concrete enemy is coming, and we know they're going to be here in a certain amount of time. So what do you think it is about fear mongering around climate change that doesn't have like, "We need to take action immediately," kind of effect?

ELIZABETH: There's probably something to the fact that, historically, and there have been shifts in this in recent years, but a lot of the calls to action around climate change have to do with changing individual behaviors, which is fundamentally different from an army approaching. Something that's very intense and fear mongering about that can feel like you are being scolded, where there's no way of interpreting, "The army coming this way is my fault. I need to take action on it because it's very scary."

SPENCER: So there's a guilt aspect to it, maybe also just the feeling of helplessness. It's like, "What am I going to do?" Climate change is the whole world doing stuff.

ELIZABETH: Yeah, it's part of that feeling of being scolded. I think the other thing about climate change is it's something that requires sustained effort over time. It has, not a long time scale by some standards, but we're talking about years and decades. So it's not like the other example you gave of an enemy army marching now. It requires sustained effort over an unclear amount of time, but definitely what feels to most people, like a long time. I think that contributes to the fear mongering shutting people down because it's constantly urgent, which it is, but because it's urgent over a long time, that annoys people or makes them feel scolded.

SPENCER: If the army was always marching to you, then maybe you would eventually kind of burn out and be like, "I'm not going to do anything." You've said this; you've been saying this for months or years. It's funny, this reminds me of a time when I was a very intense animal activist. Someone tried to convince me that I wasn't sufficiently an animal activist and basically berated me and told me I was immoral. I was just so confused about how he thought that was a good way to change people's behavior. I was just like, "I don't understand your training. You think just telling people that they're bad and trying to guilt-monger them is effective?" But I don't know. I guess there's still a lot of people that believe that does work.

ELIZABETH: Well, it doesn't.

SPENCER: Yeah. So, what do you think is effective? In your deep dive, what kinds of stories get people activated to do something, like work on climate change?

ELIZABETH: Yeah. So I will say that I like to look to climate change as a source of examples for how stories can change the world because there's sort of a longish track record of evidence on that compared to some of the other topics I'm interested in. But it's actually not something that I'm personally interested in working on as much. Part of that is just personal fit, but it's also because so many people are working on it and telling stories about it. But I do think that finding something that is relatable or that someone should care about, even if they don't think they care about whatever the main topic of the story is, is sort of crucial to getting people engaged.

SPENCER: You mentioned a couple of climate change examples that you think were effective storytelling. Do you have another example from a different topic that you think does a really good job of illustrating how storytelling could change the world?

ELIZABETH: So my favorite example from journalism is the Red Record, which was published in 1895 by Ida B. Wells. It was an investigative report on lynching in the American South. Basically, what prompted her to do this was that several of her friends who were grocery store owners in Memphis were murdered for being successful. She wanted to expose the truth of what had happened, which was not widely known in the US, but also definitely not widely known abroad. Her work raised awareness of lynching in Europe and internationally, and facilitated her speaking tours abroad where she discussed this, which in turn put pressure on the US government and the American public to recognize and address some of the issues she was talking about. So that was a really clear, specific example. I think another interesting aspect of her was that she had ideas that would now not seem radical about civil rights and feminism, but at the time were very radical. She died in 1931, so this was pretty early on in both those movements. She was ostracized by both civil rights leaders and feminist leaders, even though she was completely correct. Ultimately, her ideas are foundational to how we think today, but she was seen as a liability for being unwilling to compromise on her visions of equality for both women and Black people. This came at a high personal cost for her; it probably prevented her from having as much of a legacy as she might have and made it difficult for her to find a place within the movements that supported her biggest ideas. Ultimately, it illustrates how the right ideas also have to come at the right time.

SPENCER: So what was her approach to this storytelling, and why do you think it was so effective in particular?

ELIZABETH: I think part of it was her skill as an orator. She was a really good speaker. This is true of many powerful stories. It's not just the original piece of work, the Red Record itself or her follow-up pieces, but the opportunities she had to talk about that work and reinforce those ideas in other mediums, formats, and contexts. I think that is often a part of what makes the most impactful stories effective: the opportunities they create for their creators to repeat the idea in other contexts and to other audiences, just by existing.

SPENCER: And how did she report on the bad things happening? Was it telling personal stories? Or what was the approach?

ELIZABETH: It started with the personal story of investigating her two friends' murders. I think it very much helps to have that as both a motivation and a connection point for the audience, to have that kind of entry point, but she expanded it to include many other cases. While she was doing this work, she actually received tons of credible death threats and had to leave Memphis. I think the entry point of a story of people she had known in a community she'd known also helped gain access as the person investigating it, which was really important to making this resonate. Having witnessed, not with her eyes, but in her community, similar crimes and the way they were treated gave her the argument she needed to make, which was just that these are hate crimes. These are not retaliations for wrongdoing. I think that sounds like a very basic known truth to us now, but that was what was not being said or reported in newspapers or on any kind of national or international scale.

SPENCER: Sometimes, to improve the world, it seems like we have to not just tell powerful stories, but actually combat powerful stories. An example of this comes to mind for me is nuclear power, where it seems like it was substantially set back by stories about the danger of it, the unnaturalness of it, et cetera. Not to say that those stories were completely untrue; obviously, there were nuclear meltdowns and so on, but they seemed way exaggerated. I'm curious if you have thoughts about combating stories. Is there a specific approach to that that you think we should take?

ELIZABETH: There are a few schools of thought on this. To combat a powerful story, you can either address it directly, but that also has the effect of giving it more oxygen. To address it directly, you have to repeat it. I don't think there's one solution here. I don't think we have successfully counteracted the nuclear power stories, so I'm not quite sure what to do with that one.

SPENCER: One attempt I've seen to combat misinformation or negative stories that may be making the world worse is to try to make the alternative story cool. A really interesting example is Isodope. Isodope is an influencer doing stuff totally unrelated to this but decided to take on this as a challenge. So Isodope is a whole personality she's constructed around promoting nuclear power and getting the word out about it being a good solution. For example, the other day, she posted a picture of her kissing a nuclear storage containment unit, which kind of went a little bit viral. So I'm curious, I don't know if you've seen efforts like that that are able to sort of essentially rebrand a particular side of a story.

ELIZABETH: I mean, do we know if that's working?

SPENCER: I don't know. It's a good question. It's certainly getting attention. I don't know if it's working.

ELIZABETH: So I think probably one of the best ways to combat bad stories is to be a little bit patient and keep pushing good stories. I'm a little bit leery of attempts to make things cool because those can so easily backfire. Almost by definition, trying to be cool makes something less cool. But I do think that this is not just my thought; there's plenty of evidence to suggest this. The more times people are exposed to an idea, the less weird it will seem, the less likely they are to reject it, and the more likely they are to accept it, even if it starts out totally novel. So when it comes to the bad stories about nuclear power, I think just putting out the different story and continuing to put it out in different formats and in different versions has the chance of accumulating over time to shift opinion. But again, there's not a silver bullet for destroying the bad stories with a good story.

SPENCER: Another topic I want to discuss with you, totally unrelated, or maybe related in subtle ways, is the topic of understanding depression. How did you get interested in this?

ELIZABETH: So I'll start by saying that this is a lifelong area of interest for me, and the reason I'm returning to it now after not doing work related to it for a few years is because I think it's a good fit for the approach to storytelling I was describing, where an emphasis on the joy and inspiration of engaging with uncertainty is built in, and that's part of what makes the story exciting, and part of what we hope will generate positive impact. There's been just an absolute explosion of online content about depression and other topics related to mental health in the last decade, but I think increasingly in more recent years. And while I was producing videos related to mental health, I was kind of keeping up with what else was out there, and a lot of it has this flavor of advocacy, which is where the clearer and often explicit aim is to destigmatize depression. And while there's a lot of misinformation and not necessarily the most informed people creating some of this content, there's also a clear benefit to this flavor of storytelling. I think depression and seeking treatment for depression is less stigmatized now than ever before. So now, having just finished a multi-year project, I'm thinking about what to do next, and I'm really interested in returning to this subject and filling the gap I see for stories about depression and mental health more broadly that don't flatten out that nuance, and in particular emphasize some of the scientific mysteries that remain unsolved and delve into some of the shortcomings of even the most effective treatments for depression that we have today. Because I think those stories can, most importantly, inspire people who might be interested in helping to solve them.

SPENCER: So when I was younger, high school, college, I had some depression, quite significant at times. Thankfully, I haven't since then. I'm more of a worrier type person than a depressive type person, so generally worry is definitely much more the way my brain works than depression. But when I was in the throes of depression, in high school and college, it has this sort of incredible quality of sapping meaning from everything where you wake up and you're like, "Why should I do anything? Everything is just totally pointless to do." And to me, that was just the most horrendous aspect of it, where nothing felt worth doing. I think if you haven't had that experience, it's really hard to imagine that, and actually how horrible that is.

ELIZABETH: Yeah, totally.

SPENCER: Not to say the average depressed person feels the same way, but I think that is a fair, at least a fairly common feeling when you're really depressed.

ELIZABETH: Yeah, and I think there was a book that, when I read it, it really resonated with me. It was published in 2007, and I read it in maybe 2012. It's called The Loss of Sadness. It was reacting to the 1990s uptick in people being treated for depression, primarily with medication. The primary argument of the book was making a distinction between normal and disordered sadness, and making the case that the distinction wasn't the degree of feelings of despair or sadness, but whether they were in or out of proportion to the events in a person's life. At the time, that idea and the argument that it was a public disservice to treat so-called normal sadness, even if it was very extreme, like grief, as an illness with medication made a lot of sense to me. But since then, I've kind of come around on that again. I'm like, "Well, if we can treat someone with something that makes them feel better, why does it matter what the source of the badness is?" I'm not actually sure that is important, but it was definitely a helpful way for me at the time of conceptualizing it.

SPENCER: My understanding is that there have been experiments where they tried to treat people's depression right after a really bad thing occurred, like when someone's family member dies and they're feeling depressed, and they'll treat them with therapy. They actually found that not only is it not helpful, but it can backfire in that period. There has been an increasing feeling that you don't want to treat it in those cases, and it's better to wait. If it becomes something where the person still feels depressed six months later, then it might be more helpful to treat it. There are experiments that back this up, and I think the reasoning is something like it's very normal and natural to feel really bad when something really bad happens. Most people go through this natural healing process, and for some small fraction of people, something goes wrong in that natural restorative process, and they get stuck. That's when therapy becomes useful.

ELIZABETH: All of these overarching frameworks for thinking about depression are less useful than they could be because they're kind of dancing around the point that depression probably isn't one thing, and we still don't really know what it is. I definitely found this when I was producing videos about various mental health issues. I was always looking for an angle or through line, "What aspect of this should I focus on?" It always ended up on an angle of, "What is this thing? I want to understand what this is." Eventually, that led to an acceptance that there isn't one thing that we understand with certainty. All the ways of treating depression can be described as, "This seems to work. This is true of medications, talk therapies, CBT, and mindfulness." There are many variations of this. No single one is across the board way better than the others. Generally, it seems to work, but we don't know why, and we can't really predict which specific variants will work for any given person. Very often, what works for one person won't work for another. That just points to the underlying thing that we're calling depression or anxiety or whatever. It's not a single identifiable condition. It's not like, "Okay, this is a staph infection, this is a broken leg." I think that was just helpful in reconciling the decades of beating my head against wanting to understand what this is.

SPENCER: To your point, it's really shocking how many different things have been linked to depression. I actually wrote an essay about this called The Many Models for Depression. You've got the neurological chemical imbalance theory, which is a lot of the chemical imbalance theory that, like, "Oh, it's just a chemical imbalance." Many of the specific theories there have been debunked, but I think a lot of people still believe that general idea that there's something going on with neurotransmitters, even if it's not very clear what, and that explains why many people feel better when they get SSRIs. There are belief-based theories, like in cognitive therapy, where they tackle beliefs about yourself and others. Then there are sleep-related issues. We know that depressed people tend to have sleep issues, and bizarrely, studies find that actually interfering with sleep, where you get depressed people to sleep less, causes temporary remission of depression for many people, which is bizarre. Then there are relationship-related views of depression. In fact, there's a treatment, interpersonal therapy, that just focuses on relationships. It's crazy that there's evidence that that works when it's just ignoring all this other stuff. There are also claims about links to nutrition. Societies seem to produce depression at different rates, potentially suggesting lifestyle. There are just so many different lenses on it. In many cases, when there are so many lenses, you'd think, "Oh no, just a bunch of them must be wrong." The bizarre thing is that all these lenses have evidence behind them, significant evidence suggesting that somehow it's this giant web of factors that are all coming together.

ELIZABETH: I think that is the story. For so long, we've been trying to come up with a coherent narrative that will make people feel better about having depression or judge people who do less. The real story is that there is this huge web of mysteries, and that is exciting. It's very frustrating, but that is the excitement and the opportunity. It's also interesting to me, the relationships between what are classified as different mental health issues. In the past few years, it's become a lot more common to treat anxiety with antidepressants, primarily with SSRIs, but also with some other medications that are traditionally prescribed as antidepressants. That is super interesting to me. It also makes sense because how can you experience extreme anxiety without accompanying feelings of hopelessness? What I come back to is this thought that we see them as explanations, whether on a scientific level or a diagnostic or descriptive level. We see low levels of serotonin, for example, as an explanation of depression, or low mood and disruptions to sleep as an explanation of depression. But really, these are just descriptions of things that are going on. These are not definitions of a cause or a disease that is this thing we call depression. A lot of people definitely don't think of it that way, but there is no one thing that is depression, no one thing that is anxiety, and all of these. It's easy to fall into this mode of, "Oh, does X, Y, or Z approach to treatment actually work?" When they all seem to be working in a way. I think the question here is not whether this particular evidence is wrong, but whether whatever thing we've been circling as depression is not a single thing or has a different nature than maybe we're thinking of.

SPENCER: So I'm going to say something that almost certainly you're going to disagree with. But in my view, and this is controversial, I think there is a kind of core thing to depression, and most people don't agree with me. This is a theory that I developed with my colleagues. It very well could be wrong, but I do have evidence for it. I think the core of depression is the feeling that you can't produce anything of value. My thinking on why it's connected to so many things is that there are actually a lot of different reasons why you could have trouble creating anything of value according to your own value system. I use a metaphor for this: imagine that you're exploring a cave, the cave entrance collapses, and you're trapped in the cave. You try to escape, but there's no way to escape. Imagine that state you'd be in, day after day. Maybe you have enough water, so you're going to survive a long time. Maybe you have enough food even, but you're just trapped in the cave. There's literally nothing you can do of value. That's the depressed state, and you become very low energy; it's like a conserve energy mode. You have an extreme sense of hopelessness. You probably will question your behaviors, like, "Why did I go in this cave? I'm such a moron." So that's my metaphor for depression. I think this helps explain a bunch of things about depression, but I'm curious to hear your reaction.

ELIZABETH: Yeah, I actually don't disagree with that, and correct me if this is not how you meant it, but to me, that sounds sort of like a unifying theory or explanation, rather than "I have identified the cause of depression, and this is what it is."

SPENCER: Yeah, right. That's kind of what I'm saying: there are many causes of that.

ELIZABETH: Exactly. You're sort of acknowledging that there's not one disease, but this is the framework that encompasses it all and is most productive to think about it through.

SPENCER: That's what I think. But then I think one thing that people often mistake for depression is sadness. They think, "Oh depression is the same as sadness." I think they think that because depressed people often feel sad, but I think there are also some depressed people that don't feel sad. Why would a depressed person not feel sad? My view on this — and again, this is somewhat speculative — is because sadness is what you experience when you feel there's a loss. Some depression is linked to feeling there's a loss. Let's say you feel like you screwed up your life. You had a great life and you screwed it up. You're likely going to feel depressed and you're going to feel sad. But let's say you just felt like you were always worthless and you didn't lose anything. Then you might feel depressed, but with no sadness, because there was nothing to lose according to your own sense.

ELIZABETH: I will say it is very weird to experience extreme sadness without the element of mental illness. Having experienced depression in the past, I think, "Oh, whoa. This is weird. I'm extremely sad, but this is nowhere near as bad." That's kind of depressing in the colloquial sense in its own way. It's like, "Man, this intense sadness with a cause in my actual life feels just nowhere near as bad as the free-floating thing."

SPENCER: Well, I think it's like sadness when your cat dies or a loved one dies, there's a sense it feels bad, right? In a sense, but there's also a feeling of would I not want to be feeling sad if my cat dies? Of course, I want to feel sad if my cat dies. There's a feeling of things being right and good, not that your cat died, but that you're feeling the way you are. Whereas with depression, it felt to me like this black hole inside of me, like something is horribly wrong here.

ELIZABETH: Yeah. Totally.

SPENCER: Another thing that I think is sort of shocking about depression is how linked it is to anxiety. We actually ran a study on this. We found a 0.84 correlation or 0.83 correlation between our anxiety measure and our depression measure, which is kind of mind-blowingly high. Almost nothing is that correlated. It's actually caused some people to say, "Well, maybe they're not even different things. Maybe depression and anxiety are just one thing," and there are actually a bunch of people pushing for that. I'm curious here what you think. My view is actually they are fundamentally different things. They tend to cause each other; depression tends to cause anxiety, and anxiety tends to cause depression. They end up being very linked for many people, but not everyone.

ELIZABETH: Yeah, that is pretty much exactly what I was going to say. I think being in a state of persistent high anxiety, it's hard to imagine how that couldn't leave you with a persistent feeling of hopelessness and just despair and sort of existential exhaustion. I agree with you that they are different things, but they cause each other.

SPENCER: Because imagine you have really bad anxiety. Some people might be able to push through that and do the valuable things anyway. But for many people, the bad anxiety will actually stop them from doing the things that they value in their life. Let's say someone has really bad social anxiety. They might stop socially interacting. Maybe they move to a new city and they never make new friends, and now they stop doing any kind of social interaction. Then you start to see, "Well, of course, that makes them depressed. How does that not make you depressed for most people, right? Because these fundamental needs are no longer being met."

ELIZABETH: Yeah.

SPENCER: If they are a sort of hermit type personality, fine, but if they're like most people and they really deeply value human connection as one of their fundamental values, now they're just not getting that value anymore.

ELIZABETH: Another thing I think is sort of interesting and a bit tragic is that another thing that all the treatments have in common, besides it being sort of unclear why they work or why some variants work better on certain people than others, is that basically all have a pretty high chance of making people feel worse before they feel better. So there's this vulnerability of seeking treatment; starting treatment is a very dangerous place to be because people are feeling really bad. For medications, it's an adjustment period where it's fairly common for people to have sort of weird or disorienting psychological symptoms during that time or feel in some way worse before they feel better. I think perhaps less discussed, the same is true of therapy. Whether it's variations on talk therapy, oftentimes when people start, they feel really overwhelmed and a bunch of stuff sort of unfurls and multiplies at once, or that's what it feels like from the inside. This is a case where I especially don't think losing nuance is worth encouraging people to seek treatment for depression. I think people need to be prepared for the possibility of a bumpy start and also know that it doesn't mean the treatment isn't working. I think talking more about this particular aspect of treatment could be exciting and motivating to people who might want to work on improving it and making better treatments for depression than we have right now. In the efforts to increase understanding or destigmatize, we kind of have to ignore the unknowns and the complexity. I think that's a shame because, again, I think the interesting story here is the remaining unknowns and the mystery.

SPENCER: When it comes to exploring your feelings of depression, often that does bring up difficult thoughts. A really common thought that people who are depressed have is a thought like, "I can't do anything, or I'm not good enough." Going into therapy and actually talking about that, instead of just trying to put that out of your mind. There's a phase where you have to grapple with, "Why do I feel like I'm not good enough? Or why do I feel like I suck?" That's going to bring up lots of bad memories of times when you messed up or you felt like you didn't do the right thing, etc. I think it's a bit of a rocky road, but ultimately, much more happiness generating than the alternative of just trying to block those thoughts out.

ELIZABETH: Yeah, totally. It sucks that, and I'm not proposing a solution for this, just kind of acknowledging the suck of it that, okay, you're already sort of feeling like, "Oh, God, can things get any worse?" In order to make them better, we do have to make them a bit worse. It's kind of alarming. I also think this is maybe a bad story that's been perpetuated through films and books. A lot of people sort of fear losing something inherent to themselves, whether it's their creativity or uniqueness or something else about themselves, by treating this debilitating thing. There's an idea that it's tied to your creativity or individuality. First of all, who knows? There have been attempts to study this. I have not really seen anything that compels me in one way or another, but if you can't function, what does it matter if you are your sort of perfect, complete self, or you have all your creativity or whatever? I think that's another weird, harmful roadblock that people grapple with.

SPENCER: I think especially if you've been depressed for a long time, you might view it as part of your identity, but you also have the stereotypes of the brooding artist, the depressed comedian, or the rock band where everyone wants to die and they think about it. It seems like dark feelings generate a lot of art. On the other hand, I suspect on average, if those people felt better, their art, overall, would not suffer so much. They may make up for the broodiness with much greater productivity and effectiveness.

ELIZABETH: I think maybe that's something that's sort of easier for people to let go of as they age. You take the lumps of life in various ways, and you're not clinging to your perfect, complete identity in whatever its original state was anyway, so you might as well feel better. I think another thing is that confronting your own suffering or a loved one's suffering kind of makes it more real, in a sense. So I think that's another roadblock.

SPENCER: Before we wrap up, there was one final topic I wanted to bring up with you, which is one we very rarely hear about. I've maybe read one or two articles ever about it, which is the topic of artificial wombs. Can you tell us about that?

ELIZABETH: Yeah. So this was the subject of one of the episodes of the animated series I recently finished, and it sort of unexpectedly became the most compelling episode to me, and kind of the topic I'm most interested in doing further work on. You're right that we rarely hear about it, and actually, in the process of researching it, I talked to or read the work of just about everyone who's ever worked on it, which is kind of astonishing to me. But basically, through that process, I kind of came to think that given the amount of good that true artificial wombs — devices that can complete the process of pregnancy from start to finish outside the human body — could do, it's just amazing to me that they aren't talked about more. In the rare occasions that they are covered, it's in a way that feels reactionary. It's like these are a long way off. There are a lot of obstacles. It feels like a reaction to overzealous support for artificial wombs, which has never happened. It feels like a different treatment than other speculative technologies that do get more serious investment in research. So that's kind of interesting to me. I basically think they would be great, and we should have them.

SPENCER: What comes to mind for me is one benefit, obviously, would be very premature babies that maybe wouldn't survive otherwise if we had better artificial wombs. Another one is it could alleviate some, or maybe some point in the future, all of the difficulties of being pregnant for those that don't want to actually have to carry the baby themselves. Are there other benefits that you'd point to?

ELIZABETH: I think eliminating the burden of pregnancy is far and away the largest benefit. This is something that a lot of people have a very knee-jerk negative reaction to, but I think it's just sort of weird that we accept the status quo. Why is it more acceptable to talk about technologies to eliminate death than it is to talk about technologies to eliminate birth? I don't get it.

SPENCER: Even the death one is pretty taboo, I would say, but a lot less so. It seems to me that a lot of people are attached to natural things, and anything you're proposing that has never really been done and feels "unnatural or messing with nature." there's some group of people that will oppose that just on those grounds. It feels like there's another thing going on, and I'm curious to hear your thoughts on this. If you're a woman who's had to go through a bunch of pregnancies, there probably are some positive aspects to it, and it's probably going to be pretty appealing to try to focus on those positive aspects as you went through this really difficult thing to create your baby. I imagine that might also play into the feelings you have about pregnancy.

ELIZABETH: Yeah, sure. But I also don't really think that makes sense as a reason not to pursue this. I kind of think maybe there's a sense in which I'm not saying there should be no pregnancy. People should still be able to opt in or make the choice or whatever, but I do wonder if there's a sense in which we'll look back on just acceptance of pregnancy as the status quo and the way things have to be as somewhat akin to attitudes about smoking in the mid-20th century, where people were like, "How can you say smoking causes cancer? Everyone smokes. How would we know?" I think women have longer lives but higher levels of chronic illness and disability than men. There's some evidence tying various aspects of that to pregnancy and childbirth, but I wouldn't be surprised if the health burdens and even the pain burdens and sort of the acute things are way bigger than anyone is really recognizing now.

SPENCER: It does take quite an amazingly challenging toll on the body. I definitely had multiple friends who, post-pregnancy, felt like their bodies were wrecked for quite some time. It took a long time to get back to where they felt fully themselves.

ELIZABETH: For sure. I think the most credible objection people have to artificial wombs is related to reproductive rights. It's true that at times when they've been proposed, people have embraced them as a possible way to end abortion, which is obviously alarming. First of all, that doesn't really make sense for a number of reasons. One of them is sheer numbers. People are really worried about the implications that advanced artificial wombs could have for reproductive rights in the sense of redefining the moral status of an embryo or fetus. Having spent a lot of time talking to people who research this and looking into it myself, I don't think all of those scary questions mean we already have to grapple with now, with the reproductive technologies we have, whether it's IVF or whatever. I don't think artificial wombs introduce something fundamentally new. I also think that's not a reason not to do something that could make so many people's lives better. So, in my mind, that is the most credible hesitation for developing artificial wombs.

SPENCER: What do you chalk up the rest of the negative feelings about it to? Is it just that it's not natural, or there's more to it than that?

ELIZABETH: I think it's super weird. A lot of speculative or transformative technologies come to us first from science fiction, and it hasn't even been mentioned much there, and even less so in a positive way. It sounds super weird. The bias towards the natural, especially as it pertains to pregnancy and birth, and maybe a desire to rationalize the suffering of it when it seems unavoidable, plays a big part. A lot of it is just more exposure to the idea. I guess that's a theme in what I think the value of stories is. There are some schools of thought that suggest we have to work sort of backwards from birth and forwards from conception, bit by bit, and by the time we get there, it'll be acceptable to people. I don't buy that as a strategy for bringing artificial wombs into the public consciousness in a positive way. I think they should be talked about explicitly. Exposing people to ideas repeatedly makes them more likely to embrace them. Being explicit about what the idea is and why it's good is important. In general, people don't like feeling misled, so those incremental strategies can backfire. Obviously, the way to get to the technology is to work slowly towards it, but in terms of the stories told around artificial wombs, it's important to have explicit discussions about what the full potential and end goal of this could be.

SPENCER: Is there anyone today working on trying to make this a reality?

ELIZABETH: There are two main initiatives. They're called EVE and EXTEND. Both are working backwards, basically making incubators for increasingly premature infants. Those are targeting infants around 21 to 23 weeks. At 22 weeks, a premature baby has a 10% chance of survival. That's a class of newborns that could really benefit from this technology. However, there are limits to working in that direction because those are sort of like advanced ventilators and incubators, and they rely on connecting to the veins, which get too small. Before that, the bigger scientific obstacle is the first half of pregnancy. Right now, in vitro research on human embryos has an international ethical standard that doesn't allow going beyond 14 days. Since 2021, that has been gradually updated, and a few countries now have 28-day limits, but no research has actually been approved to go to that limit yet. So, that two weeks to 20 weeks is the big scientific black box, and nobody's been working on it yet because no one is able to get the funding and ethical permissions for it. That is the legacy of regulations put in place after IVF as a reaction to people's concerns about the process of developing IVF. When IVF was created, there weren't many standards in place around the ethics of research on human embryos. The 14-day rule was a semi-random compromise; at that point, no one could get an embryo anywhere near 14 days of development in vitro anyway, so it was, in a way, kicking the can down the road. Now scientists have gotten up to 13 days and think they could go further but had to stop. For the first half of pregnancy, that's when all of the organs and tissues are differentiating. The reason that seems like a huge scientific obstacle is that a lot of that is thought to be driven by interactions between the placenta and the embryo, involving really complex biochemical signaling. Some researchers who've gotten embryos to develop in vitro up to 13 days have been surprised by how self-guided, based on internal signaling to the embryo, the differentiation is up to that point. There's reason to believe that might continue a bit past that point. Again, this is very speculative because no one has been able to do that yet, and that first half of pregnancy might still be a huge task. But maybe it's not quite so complicated to replicate as we think. It's a huge black box we've never tried to enter. Historically, when people really throw themselves behind a scientific or technological task, we can make progress quicker than we think. Sometimes not, but sometimes yes. So anyway, it's interesting.

SPENCER: A general class of concern for any kind of new technology dealing with something really important is the fear that we'll have a half-baked solution that will cause a lot of harm. What if we have these technologies, but they're not that great, and we end up with a bunch of babies that are deeply harmed from it? Or we may not even realize it for years. It's a difficult thing to address because it obviously depends on the development of technology and how carefully we proceed, but I do think it's important to keep in mind when dealing with the fate of a human.

ELIZABETH: But again, I don't really see that as a reason not to try. I think both with working backward and working forward, there are many cases of newborns who wouldn't survive or embryos and fetuses that would be miscarried that this research benefits before it gets to the stage of becoming purely for the purpose of avoiding the suffering of pregnancy and birth through artificial gestation.

SPENCER: I guess that creates a complicated issue, though, because some embryos that wouldn't survive putting them in an artificial womb that's half-baked, that doesn't work that well, that could actually turn out to be worse than them dying as an embryo.

ELIZABETH: Yeah, totally. But I think that's sort of not the next step, or even several steps in the current case. I think what's been proposed is that the research on days 14 to 28 could be used to prevent miscarriages, or I've seen some suggestions that the embryos or fetuses could then be re-implanted. But yeah, I'm definitely not proposing. I think it's going to have to be so incremental, both from an ethics and testing approval perspective and from a scientific perspective that I don't want to say that's not going to happen, because obviously it's a real concern. But I think the guardrails in place on this kind of research are more than sufficient to account for that. And again, it's not a unique problem to this. These kinds of questions are things we have to deal with in a lot of different new technologies, and I don't see it as a reason to not carefully pursue something that could prevent a lot of suffering.

SPENCER: Elizabeth, thank you so much for coming on. Where can people watch your new show, Ada, when it comes out in a few weeks?

ELIZABETH: The easiest place to watch it will be on TED-Ed's YouTube channel.

SPENCER: All right, fantastic. Thanks for the conversation.

ELIZABETH: Yeah. Thank you.