Battling Depression from the C-Suite

Talking about Self-Awareness and Anxiety (with Hello Monday’s Jessi Hempel)


MORRA AARONS-MELE: I’m Morra Aarons-Mele, and this is The Anxious Achiever. Each episode, we look at stories from business leaders who have dealt with anxiety, depression, or other mental health challenges, how they fell down, how they picked themselves up, and how they hope workplaces can change in the future.

If I told you you’re about to hear from someone, who first tried to take his own life at age 13, has spent a lifetime burdened by clinical depression and suicidal impulses, and who finally found solace after electroshock therapy, you might expect to hear from someone who sounds a little bit like his mouth is filled with cement, whose sadness, malaise, and trauma just oozes through the airwaves.

But on the contrary, you’re about to hear Paul Greenberg, who sounds exactly like what he used to be, a charismatic radio sports announcer. Despite living through deep and chronic depression for decades, Paul built an incredibly successful career as a media executive and CEO, as CEO of CollegeHumor, Digital President of Time Inc.’s Lifestyle brands, EVP and GM of TV Guide Digital, and VP of Business Operations at MTV.com. And today, he runs his own fast-growing company, Butter Works.

I think you’ll really enjoy the conversation with Paul and me, learn a lot, and be surprised by his positive attitude in the midst of severe mental illness, but we do talk about suicide and suicidal thinking. If this is an issue that will trigger you or upset you, I wanted to let you know that we do talk about that.

So, Paul, you wrote, “I worked nearly three decades of 10-hour days, during which none of my colleagues knew that I was struggling.” How is that possible?

PAUL GREENBERG: I honestly wish I could tell you. It was brutal, but there was some ability I had to parcel out the work that needed to happen and containerize, if you will, the issues of how I felt and what I needed to get done. Sometimes the work was a solace, where I could focus on something else besides the depression. Often, however, it was a slog really working hard to get through it.

I talked to my doctors. Some of the treatments that I’ve had, which I know we’ll discuss, have been quite aggressive, and I’ve had very few side effects, but they theorize that maybe the reason I had few side effects is that I exercise quite a bit. So, maybe there’s good blood flow to my brain, which they also theorized might have been one of the reasons why I was able to tolerate the depression in the first place.

MORRA AARONS-MELE: Talk us through a day that felt like a slog. You were in leadership positions. I assume you were dealing with other people’s problems as a manager, leading meetings. What did those slog days feel like?

PAUL GREENBERG: Exhausting, Sisyphean. I would get up in the morning. I was fortunate not to have the kind of depression that made me unable to get out of bed, but I would get up and think, “Okay, I just need to get through this day. Whatever I have to do, I’m just going to keep pushing the rock up the hill.” Every day or every minute, I would have almost constant suicidal thoughts of, “I want to kill myself. You need to kill yourself.” I wasn’t visualizing actually killing myself. I just kept hearing those thoughts, and that was exhausting enough.

But then there was this weight, this heaviness that depression gives you of this physical pit in your stomach in addition to the other things that depression does to you, which is to catastrophize everything, so, “Nothing will ever work out. We’ll never get through this. I’m going to lose my job and be homeless, and everything will fall apart forever.” So, all of that on top of everything else.

But I would go through my day, and I would get to work and focus as hard as I could on the people around me, trying to feel needed, and trying to understand and be as empathetic as possible to what I could do for them and how I could help them. Somehow, that made it a little easier to get through the day – to feel like I was part of something and I was part of something bigger. I had a mission that connected me to other human beings, and I had a responsibility to these people that I had to lead them, not in a power-hungry, obnoxious way, but that was my job.

But as soon as I had any downtime, I wasn’t in a meeting, or I was just eating my salad at my desk, the depression would rush back, and I would feel hopeless, and anxious, and angry, and frustrated. Then as soon as I had to go to my next meeting, I would shake it off and push through. It was one of the hardest things I’ve ever done, but it almost felt like I didn’t have an option. I really just felt that if I stopped and succumbed in any way, it would take me over, and I would never be able to get out of it. So, it almost just felt like I had to keep the inertia on my side.

MORRA AARONS-MELE: It’s interesting first that you express such empathy as a depressive. Normally, we don’t think of people in clinical depression as having empathy for other people because that’s one of the things that depression does. It makes you very, very focused on your own misery and catastrophe. What do you think that having the empathy did for you? Was it something that you cultivated, or do you think it’s just who you are, relying on other people and getting drawn out of your head by other people?

PAUL GREENBERG: I’m a very social person. I’m, I guess, definitionally an extrovert, where I get energy from being around other people, but I also think, not to pathologize my depression too much, that my depression, honestly, could have gone one of two ways in terms of how it came to be based on events in my life. I could have turned it outwards in terms of getting angry at everybody else and feeling like it was everybody else’s fault, or I could have turned it inward, beaten myself up, and thought that I was a horrible person and useless, which is what happened.

I think that, in a way, made me more sensitive. Again, I don’t mean to self-aggrandize, but I do feel like somehow that made me more in tune with what I was feeling, the pain I was feeling, and then the pain that other people might be feeling. So, in a weird way, I felt almost more sensitive because I was depressed.

MORRA AARONS-MELE: I think that’s true. I absolutely … I think that people who are in the state of depression or anxiety and know it so well that it is their life – if they can understand it at some level – are able to see in others the things that a lot of others can’t see. It’s a horrible gift in a way, but it’s a gift nonetheless.

PAUL GREENBERG: Well, but I also think that I’ve been in therapy most of my life since I was 13, some more successful than others, but when you spend that much time looking at yourself, looking for causes and effects of human emotion, transference, and unconscious feelings, you do begin to understand there’s a lot more going on below the surface for all human beings.

MORRA AARONS-MELE: How does your depression manifest itself? You said that you take it inward?

PAUL GREENBERG: Yes.

MORRA AARONS-MELE: Is it a script? Is it the suicidal thoughts? Is it always the same every episode?

PAUL GREENBERG: It’s a good question. Yes, I think it is. For a while, it was one long episode. Literally, I tried to kill myself when I was 13, and from then until I was in my mid-40s when I had ECT, I was depressed basically consistently. It wasn’t up and down. It was just there all the time, just living with me, and so, that script was constant.

Since the ECT, I’ve had a couple of down episodes. Recently, I had a very down episode, which was the first time since ECT six years ago that I’ve felt as bad as I felt before I had ECT.

MORRA AARONS-MELE: That must have been scary, really scary.

PAUL GREENBERG: It was less scary, but it was certainly … it made me feel hopeless because it made me feel again, which is what depression does to you. But it was also a characteristic of my depression, that is, “This will never get better, and everything will be terrible, and no one will ever love me, and I will never be able to succeed, and my business is going to fail, and I’m going to end up living on a box on the street, and I’ll fail my family, and my kids will starve.” It went on and on and on, and, “Oh, by the way, on top of that, I’m a horrible person, and there’s nothing about me that’s lovable.” That is consistent throughout my life.

Then you add on top of that, “And I should kill myself. I want to kill myself.” Some of the suicidality is, “I want to end this suffering,” but for me, it was slightly parallel to the depression, where it just felt like an add-on, in the sense of, “It’s important that I think about this. I need to. I’m such a bad person that I need to kill myself.” It was almost, again, turning it inward on myself. “I need to hurt myself or punish myself for being such a bad person to the point where I deserve the death penalty at my own hands.”

MORRA AARONS-MELE: Oh, my god.

PAUL GREENBERG: Sorry.

MORRA AARONS-MELE: No, that’s okay.

PAUL GREENBERG: Other people, I think for them, suicidality is, “I just need to end this pain.” For me, it really was more, like I said, pathologized of, “I hate myself so much, I deserve to murder myself.”

MORRA AARONS-MELE: Now, I think that you’re a dad and you’re a breadwinner. Yes?

PAUL GREENBERG: That’s correct.

MORRA AARONS-MELE: How did that relate to your keeping going? Do you think that if you hadn’t had the family, this would be a different story?

PAUL GREENBERG: No, I don’t think so. I just think that’s how I’m built. I want to succeed. I’m very ambitious. I like to succeed. It didn’t help the depression go away, my success. Although, I would say to some extent you’re right in the sense that I really had no safety net – if I can use the suicidality as a safety net. It was almost like saying, “Killing yourself isn’t an option because you’ve got two kids that you have to support, and you have a family you have to support.”

MORRA AARONS-MELE: Even though you’re a failure, and you’re going to go broke, and it’s all going to-

PAUL GREENBERG: Exactly. I never said I was logical.

MORRA AARONS-MELE: I know it well.

PAUL GREENBERG: Exactly, right? But I do think that there was something about it, in a weird way, that made me angry a lot. It drove me, but it also felt like, “Well these kids are making it so I can’t kill myself and end my pain. How dare they force me to stay alive,” which obviously on its face is absurd, but I think, in a good way, it did remove that option in reality.

I would say that until I had the ECT, which removed the wall of depression, therapy was really useless. I couldn’t get at the root of anything because I was so sick, mentally ill that I… Again, I see mental illness as the same as physical illness. You have a broken leg, and you can’t walk until it heals. Since I had a mental illness, I couldn’t feel happy until I was able to make it heal.

MORRA AARONS-MELE: Well, let’s talk about treatment. How many meds over your life do you think you’ve tried?

PAUL GREENBERG: Probably 75.

MORRA AARONS-MELE: Wow.

PAUL GREENBERG: And nothing worked.

MORRA AARONS-MELE: So, you tried electroshock therapy in 2013?

PAUL GREENBERG: 2014.

MORRA AARONS-MELE: 2014. How did you come to that, you and your medical treatment team? Was that the last straw? Were you scared to try it? What happened to get you there?

PAUL GREENBERG: It was the last straw. I was really down. I was worse than I had ever been. My psychopharmacologist, Dr. David Kahn, who’s just a genius … He is affiliated with Columbia University. He’d been working with me on the meds and trying different things, and nothing worked. Several times, he had said, “Okay, I think it’s time for ECT.” I thought, “I’ve seen One Flew Over the Cuckoo’s Nest. No way are you getting me strapped into that thing.”

And finally, they say, “When you’re in enough pain, you change,” I was in enough pain. I said, ‘Okay, I’ll do anything you suggest.” He got me into the ECT outpatient program at Columbia. It’s not anything like One Flew Over the Cuckoo’s Nest anymore. They give you a general anesthetic. They give you a muscle relaxant. So literally, you count backwards from 100, I got to 88, and then I woke up, and they said, “Do you want some apple juice?” And they had done the treatment.

One thing I was super fortunate about, which I alluded to before, is I had almost no side effects. ECT can cause short-term memory loss, nausea, and headaches. I woke up, and I went straight to work. I got to Columbia at eight in the morning. They took me right away. They did the treatment – the treatment itself, I don’t know if you want me to go into what it is. I’m happy to.

MORRA AARONS-MELE: Yeah.

PAUL GREENBERG: ECT stands for electroconvulsive therapy, and they are literally convulsing you. They are inducing a grand mal epileptic seizure, which is actually what they think heals your brain, not the electricity per se. They just need the electricity to create the seizure, and what’s weird is they don’t know why it works. They know that it does. It’s 85% effective with drug-resistant unipolar and bipolar depression, which is amazing, just off-the-charts amazing.

I went in. I had three days a week for four weeks. After the 12th treatment, it was Sunday morning. I was in the playground with my kids, and I suddenly felt happy for the first time in my adult life. I really didn’t know what was going on. I thought maybe I was having a heart attack, but it just … This albatross that had been around my neck for so long lifted, and I just felt physically lighter, emotionally lighter, and the sun looked different, and the kids looked different, and I just felt, “Wow, I am actually happy.”

MORRA AARONS-MELE: Did you know that this feeling was happiness? Did it take you-

PAUL GREENBERG: No, I didn’t know. I never felt it before. I knew it was better. I knew that the pain had diminished, so that was great. Then we started tapering, so I did it twice a week, once a week, once every two weeks, et cetera, et cetera, for another eight months and have not had to do it again. It was a medical miracle, and it is…

And the thing is that I would sit in the waiting room, the outpatient waiting room, and there were a number of people there every day, a fair number of people. This isn’t like I’m the only person who gets ECT these days. It’s just something people don’t talk about because it’s got this terrible stigma.

MORRA AARONS-MELE: Take us through to the present day. You had the ECT in 2014. It’s 2019.

PAUL GREENBERG: An ECT, yeah … so I was doing okay for a long time. A few, like I said, downs, but I actually went back to see Dr. Kahn and said, “Do I need a touch up of ECT?” which they say you can go back for if your depression comes back. He said, “I don’t think so. It sounds like you’re just not feeling great,” and he was right. It passed after a couple of weeks.

This year, I had a huge new… I was actually … because as I mentioned before, the ECT allowed me to do real therapy. I actually came to a lot of realizations in the last few years that I never was able to, that I probably should have had in my 20s if the depression hadn’t been this big wall in my way. So, I finally came to some of these realizations, which are incredibly painful, about my childhood, and my life, and what’s going on. That sent me back into more of a depression, and it got better, and it got worse, and it got better, and it got worse.

Then actually about a month ago, it got really bad, and it got as bad as it was before ECT, where I was depressed all the time, terribly suicidal, very upset. Dr. Kahn, God bless him, pulled another magic trick out of his pocket and said, “Okay, it’s time to try ketamine.” I thought, “Okay, I’ve heard of ketamine. I know it was a club drug-”

MORRA AARONS-MELE: It was a club drug in the early 2000s that I-

PAUL GREENBERG: Okay, exactly. Actually, ketamine was invented in 1962 as an anesthetic to be used medically. Then in the late 90s, it started to thaw – the academic climate – and they started looking at ketamine for depression. In 2000, a couple of people at Yale had great success with it. In fact, this year, Johnson and Johnson had a ketamine nasal spray approved for depression by the FDA. It’s now being sold. And so, it’s … in a way, it’s been validated. It’s actually … interestingly enough, it’s a slightly different variant. What Johnson and Johnson got approved was a portion of what the full ketamine drug is.

But the way I get ketamine is intravenously, and it’s actually ketamine. It’s not the Johnson and Johnson variant. You go for 40 minutes, and you get ketamine intravenously. I felt loopy and a little spacey for 25 minutes. Then you come out of it. It works really, really fast. Within four to five hours, they say your suicidal thoughts go away, your depression goes away. Those effects aren’t lasting unless you do it several times.

MORRA AARONS-MELE: I was going to say, do you have to go every week? Is it like a course of chemo? It sounds a little bit like a course of chemo.

PAUL GREENBERG: I went Monday and Friday for the last three weeks. Yesterday was my sixth treatment. This depression that I was talking about is totally gone. My suicidal thoughts are totally gone. Now, I’m just going back to taper and maintain. It’s new, so they don’t know a lot about how to maintain, but ultimately what you’re getting is a relatively small dose, so it’s not addictive. I just read that a psychiatrist called it, ketamine specifically, the most incredible advance in psychiatry in the last 50 years.

MORRA AARONS-MELE: Actually, I would like to shift a little bit to leadership and management because of your extraordinary success. You’re talking about this with me. When did you go public with your depression, and why? Why at that moment did you decide? I’ve read about you in The Hollywood Reporter of all places.

PAUL GREENBERG: Yeah, that was the first time I went truly public. I wrote about my depression right after Robin Williams committed suicide, which was shortly after I finished ECT. I thought, “Robin Williams, if he wanted to commit suicide…” I know there were some extenuating circumstances, but I just thought, “If he wanted to commit suicide, it could affect anybody.”

I wrote what you basically read, but I shared it only with friends. Within a week of each other, Kate Spade and Anthony Bourdain committed suicide in 2018. I just thought, “This is an epidemic that I have to speak out against. I have to de-stigmatize this. I have to share my experience.”

And to your point, I’m a normal looking “successful guy,” who’s got a family, and has run businesses, and blah, blah, blah. So, if it can affect me, it can affect anybody. And I don’t mean “affect anybody” in that you have to be depressed, but you know somebody who’s depressed, or it’s in your family, or you’re living with somebody who’s depressed, or you’re whatever, but it is absolutely stigmatized.

I said this to Dr. Kahn when he said, “Get ECT.” I said, “Well, what am I…” He said, “You may have to skip work for a month.” I said, “I can’t. What am I going to tell them?” He said, “Well, let me ask you a question. If you had to get a stent put in your heart because you were having a heart attack, would you stop going to work and go to the hospital?” And I said, “Of course.” He said, “This is the same thing. This is a medical illness. It just happens to be in your brain as opposed to another part of your body.”

And so until we’re able to see that, people are not going to get the help they need, and so I just felt… They both, Kate Spade and Anthony Bourdain, had kids near my age. I thought, “This is an epidemic of monstrous proportions. 25% of the people in the country are affected somehow by depression, and yet it’s humiliating.”

MORRA AARONS-MELE: The veil of shame is so intense. But I will ask you when you went public, were you working for yourself at that time, or were you still-?

PAUL GREENBERG: Yes, I was, so I was-

MORRA AARONS-MELE: Do you think that made a difference, honestly?

PAUL GREENBERG: I think it made it easier because I didn’t have to check with HR and the press department, and I didn’t have to go to the CEO and say, “Hey, this may affect the stock price.” It was really my decision. But I think even if I had been working at a big company at that point, I would have pushed. Unless they just said, “You absolutely can’t do it,” for whatever reason, I would have said, “Okay, now’s the time to tell my story,” because it just got to… I don’t know. Those two suicides, obviously, I didn’t know them personally, but-

MORRA AARONS-MELE: We felt like we did though, didn’t we?

PAUL GREENBERG: It did.

MORRA AARONS-MELE: Especially people, our age, who grew up. When I graduated college, my mother gave me, for my present, a Kate Spade bag. That was all I wanted as my coming-out into the world.

PAUL GREENBERG: You watch these Anthony Bourdain shows, and he’s our John Wayne. He’s rough and rugged, and he goes out, and he sees these cool cultures, and does all these amazing things, and is so miserable, he had to commit suicide. You’re just thinking, “Well, the disconnect, the dichotomy is so great.”

But I know that dichotomy of being in constant pain, and yet pretending you’re not, and pushing through, so why not tell everybody else who’s in that pain, “There is help. You have to work hard to find it.” I went through 75 drugs to find it and finally found it somewhere else.

But giving up is brutal, and too many people give up, partly because that’s what depression does to you. It makes you feel hopeless in addition to being depressed, but I was hoping that I could tell my story and de-stigmatize it to some extent and let people know there’s an opportunity to get healthy.

MORRA AARONS-MELE: Well, so too, you have a culture to create at your own company. How does your life story inform the culture that you’ve created?

PAUL GREENBERG: I’m very honest. My team knew I was going for ketamine treatments. I said, “I’m sorry, I can’t come to this meeting. I’m going to be in ketamine treatments, and I may be a little loopy the rest of the afternoon, so I can’t do it.” It wasn’t saying, “I have a doctor’s appointment, I’ll be busy.” I just was very open about it.

You begin to de-stigmatize it by talking about it as if it were normal, which it should be. It’s like, “Oh, I’m sorry. I have to take my car in for a tune-up.” If you say it as casually as that, people look at you funny for a second, but then if you just say it like, “Oh, you know what, I can’t be here today. I have my therapy appointment this afternoon.” They start to use it as the vernacular of normal conversation.

And so, trying to create that culture of like… And then people started to ask me about it, and then they felt like they were intruding. But if I was able to say, “No, please, I want to talk about it. Yeah, so I was on ketamine, and this is what it was like, and this is what happened. These are the doctors.”

It’s unbelievable how many people have come up to me now and said, “Oh can you make a recommendation for a doctor for me?” You do have to look for lots of different ways to get better. There’s not just one-

MORRA AARONS-MELE: It takes a village, doesn’t it though, too? It’s like, you have your care team.

PAUL GREENBERG: Right, you have your care team, but it takes persistence to try lots of different things because not everything’s going to work. Some things work better in conjunction with other things.

MORRA AARONS-MELE: Do you think that if you saw a young person at your organization, or in the course of your professional life, who’s not the boss, who can’t stand up and say, “I’m going for my ketamine,” because they may feel that would hurt their future … What’s your advice for them and how can the boss support that person in the right way? That’s a two-part question. What would you say to your younger self about asking for help? And then, what would you say out there to people in management positions who want to help?

PAUL GREENBERG: I would say the old cliché of, “If you don’t have your health, you don’t have anything,” applies. Therefore, do everything you need to do, 28-year-old self, to get the help you need. You don’t have to tell everybody because you don’t want to overshare either. You don’t want to overshare about other things that are going on in your life, but tell the people you need to tell. And honestly, if they don’t support that, get out, because it’s not a culture in which you want to build a career or spend another minute of your life. It’s just … it’s toxic.

If people don’t understand and have the empathy for somebody who’s literally… Where at the same time, they would say to somebody who needed a stent, “Oh, of course, go ahead, but you, you have mental problems. No way. You’re nuts.” That’s just crazy, and so again, no pun intended. If you’re not finding that in the atmosphere you’re in, go somewhere else that will support that because it’s just too important.

I would say to managers, “Don’t overdo it, but de-stigmatize it. Talk about it in normal terms.” Don’t reveal confidences of people, but I would say, again, if that manager is in therapy, mention it, but be sensitive, and explain to your team, “Listen, we’re all in this together. Please come to me with anything you need personally that will help you.”

At the end of the day, it’s a business. The manager wants that person to be as productive as possible. Creating an environment where somebody can come and talk to them and say, “I’m not doing so well today,” it’s really interesting. If you have a meeting and somebody, your head data scientist, is miserably depressed, she’s not really going to contribute much to your meeting. So, give her the space to come to you and say, “I’m just feeling horrible today. I’m just not there for whatever reason,” or, “I need to do this treatment.”

Again, you don’t want to make her feel like she has to spill her guts but be able to say, “I’m just not fully there today.” It’s good to know, as a manager … to know which of your team members is there and is not on certain days, and who can contribute and who can’t, but it’s also the right thing to do just as an empathetic human being.

MORRA AARONS-MELE: Well, Paul Greenberg, I just really want to thank you. I want to wish you good moods and good health. Thank you.

PAUL GREENBERG: Thank you so much.

MORRA AARONS-MELE: I also want to offer the number for the Suicide Prevention Hotline in the U.S., which is 1-800-273-8255, or you can visit the National Suicide Prevention Lifeline at suicidepreventionlifeline.org. If there’s a young person in your life who you’re concerned about, I’d like to recommend the Jed Foundation, which is Jedfoundation.org, and that’s Jed with a J, J-E-D. You can also always reach out to the crisistextline.org for support, and that’s at crisistextline.org.

That’s it for this week’s show. If you like what you’ve heard, be sure to subscribe, and submit a review in Apple podcasts or wherever you get your shows. If you have an idea for the show, or you want to tell us your story, drop me a note at anxiousachiever@gmail.com, or you can tweet me @morraam. That’s M-O-R-R-A-A-M. Special thanks to the team at Harvard Business Review, my producer, Mary Dooe, the team at Podcast Garage, and all of our guests, who are telling us their stories from the heart. From the HBR Presents Network, I’m Morra Aarons-Mele, and this is The Anxious Achiever.



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