Something I talk about often on this show is how wellness is about the whole body, not just one system.
And magnesium is a really great example of that.
It touches nearly everything, from your muscles and bones to your heart, to even the quality of your sleep.
That's why I recommend Magnesium Breakthrough.
It's a complete blend of all seven types of magnesium your body needs, plus vitamin B6 and humic and fulvic acid.
This one formula makes my whole body feel like it has what it needs to function at its best.
So get yours today.
Go to buyoptimizerscom forward, slash headspace and use the code headspace to get 10 off your purchase.
Thanks so much for listening.
DSW designer shoe warehouse is the one stop shop for all your footwear needs, with sneakers, boots and everything in between for every style, mood and occasion.
You'll definitely find shoes that get you at prices that get your budget.
DSW has what you need, but more importantly, they have what you didn't even know you wanted.
You never know what you'll find at DSW.
Find the shoes that get you at prices that get your budget at DSW stores or DSW.com.
There are people who walk around with symptoms of depression, who are coping by functioning, but they're struggling in silence.
Hi, everyone.
It's Rosie here.
Welcome back to Radio Headspace.
My guest today is Dr Judith Joseph psychiatrist, professor and expert on high functioning depression, a type of depression where everything seems normal on the outside, but inside you're struggling deeply, which I think many of us can relate to.
This is such an important and timely conversation and one I think you'll really enjoy.
Dr. Judith, I am so excited to be chatting with you today.
I've been looking forward to this conversation for a really, really long time.
I've done some pretty extensive research on you and your background and what you're doing.
So thank you so much for joining us today.
Thank you for having me.
I'm excited to speak with you as well.
Well, I see that you're wearing your lab coat.
I'm going to assume you're at your office.
Yes, I'm in my research lab.
I see a mixture of research patients and therapy patients throughout the day.
It's really interesting because one of the things that I wanted to talk to you about I recently started well, not recently, it's been a year and I'm in the graduate program for clinical psychology currently.
And I am at this crossroads right now where I'm trying to figure out exactly like where I want to go from from here, because I don't know that I am going to go the therapy route.
I'm really interested in the world of research.
And I know that part of what has led you to the path that you're on now is also that you have this drive and passion for learning and doing research, and that's why you started the Happiness Lab right.
It's called Manhattan Behavioral Medicine, but I have a section of it called the Happiness Lab.
So excited.
So what got you into this field of work?
Well, I started off as an anesthesiology resident and two years into anesthesiology I found myself just like not really enjoying it.
You know, 90 of the time it's pretty smooth sailing and you're putting a patient on anesthesia and then they're going through surgery.
Then you take out the tube and you wake them up and then they go about their way.
You never see them again.
And I just found that very unfulfilling because I like to talk to people.
I'm a very social person.
And I remembered my psychiatry rotation when I was a medical student, really enjoying some of those electives.
I did one in South Africa with these orphans and we did trauma focused therapies.
And I just found that so fulfilling and it just, it really stuck with me, that memory.
So I was fortunate and I got a spot at Columbia and I got an interview for this spot and I got it and I never looked back.
And my way of like continuing to use my hands in psychiatry is by doing clinical research.
So I have a team and we enroll patients into clinical studies and We're doing a lot of exciting work anything from psilocybin to ADHD medications to antipsychotics for schizophrenia.
We're doing all of that research here.
So I get to do the therapy and have patients in my private practice, but then I also get to see patients in the research lab and be a part of a lot of groundbreaking treatments and research.
Yeah.
I heard one of your interviews that you did recently and You know we're talking about this sort of pathway, right.
What led you to get on this path?
And I was really curious to ask you, especially now with the topic of depression, right?
Like so many people are struggling with depression.
We often hear that, you know, depression can show up in different ways, right?
Like there's people that have high functioning depression.
There's people that you know have depression, major depressive disorder, like there are key differences.
So I was.
I was hoping, if you wouldn't mind, just kind of telling us the the differences and perhaps maybe some some treatments or methods that you've used, that you've seen work to help people navigate, that.
Yeah, so the fun thing about my job is that I have a very, very like rigid research job where I have to use something called the DSM-5.
It's a diagnostic and statistical manual for how we classify conditions.
So in my research practice the assessments are taped, some of them audio, some of them visual, some both, and we have to go by the guidelines.
So if a patient sits down in front of me and I'm doing an evaluation for major depression or major depressive disorder, I'll go through the checklist.
So I'll ask things like you know Are you experiencing guilt or hopelessness, or changes in energy, changes in your sleep, changes in your appetite?
Do you have a low mood or sadness, or do you have anhedonia, which is a lack of interest and pleasure in things?
So to meet criteria for depression, clinical depression or major depressive disorder, you have to have either low mood or anhedonia, and then those symptoms of depression.
And at the very bottom of that checklist you have to check off the box that says that you've have an impairment in your functioning due to your symptoms or the symptoms are causing distress.
But what I was finding was a lot of people were coming in and they were checking those boxes up until they got to the bottom.
They weren't lacking functioning and they weren't acutely in distress.
So then we would just say, well, okay, well, you don't meet criteria, come back when you break down.
I just felt like, wait, after doing this for so many years, I'm like, why is psychiatry like this?
Why do we wait? until people break down.
Why isn't every other field in medicine like this?
If a cancer doctor told you, come back when this cancer is at stage four, you'd be like, what?
Where do you get your medical degree, right?
We'd be like, no, we should be teaching people about preventing cancer or catching it early.
If a cardiologist said to you, come back when you have a heart attack, we'd be like no, you're supposed to be preventing the heart attack.
What are the risk factors?
But in mental health we're kind of like in these like dark ages where we wait for people to break down or they're in crisis and then we react.
And if we continue down this path, we're just going to have this really large body of people who are not getting help in crisis or in queue to break down.
So let's teach patients about the symptoms.
Let's prevent the breakdowns.
And let's also decrease the stigma around depression.
There are people who walk around with symptoms of depression who are coping by functioning.
They're showing up.
They're busying themselves.
You know, they are the rock, but they just, others depend on them.
But they're struggling in silence.
And that's why we often see these high-profile cases of people who looked great on the outside and they were functioning.
You know, they were doing their jobs, but then they gave up, right?
They were suffering in silence.
So I wanted to change that conversation so that we don't lose people, so that we empower people to identify signs when they're struggling, so we can actually all do something about this mental health crisis, not just wait for people to break down and then the mental health care professionals to rescue them.
Right.
And so just for clarity, can you give us a definition of anhedonia?
Yes.
So anhedonia is a really old term in psychiatry.
It's been around since the 1800s.
And it literally means a lack of interest and pleasure and things that you once enjoyed.
And when you think about depression, I often say depression is like two sisters, right?
They're twins, but they're not identical.
One sister is depressed and sad and crying and gets all the attention because she's not getting out of bed.
The other sister is showing up, going to work, but she feels no joy.
And it's not considered a crisis because you can't see the pain, right?
Yeah.
Anhedonia is a symptom that many people experience.
They just don't know that there's a name for it, this lack of joy.
A lot of people say blah or meh, but a lack of joy and interest and pleasure in things is possibly a red flag that something else is happening.
We are all built with the DNA for joy.
We're all built with that, but many of us lose track or lose access or lose capability to access that joy and somewhere along the way and it could be due to past trauma, it could be due to other factors, but we're supposed to all experience joy.
You know, you don't have to teach a child how to be joyful.
You see it, when they drink their milk, they're just like yeah, you know, lapping it up, because joy is built into our dna so that we can't survive.
Yeah i, i think this is.
It's such a great uh, it's such a great observation And such a great sort of like framework to give people so that they can, you know, begin to examine, because I'm curious what you think, or if we can see what the signs are right.
Can you see it in yourself or can you see it in somebody else?
Especially if, you know, they're high functioning.
So how do you see that?
I get asked this all the time.
And I make a really clear distinction between burnout and high functioning depression, because Burnout by definition is a workplace phenomenon.
So the workplace causes this stress that leads to this fatigue, lack of motivation, lack of focus.
But when you remove the person from the workplace, they get better, right?
High-functioning depression is different.
There's something internal that's not resolved.
That's the root of it.
That's why it doesn't matter what setting they're in.
The problems are persisting.
Also, what I found with high-functioning depression is that when I ask my patients, how do you feel when you're not, you're not busy, you know a lot of times they'll be like i feel restless, like i can't sit still.
Or, you know, if you're not working, how do you feel?
I feel empty.
And so i really want them to understand that what is it that is causing this restlessness?
What is it?
And a lot of times we'll work together and we, we unpack things from the past, and in my clinical study that i did the first ever peer-reviewed studying high function depression i found a correlation between trauma and high function depression and i thought well, that's interesting.
I wonder If you know how, in trauma, we typically see people avoiding people, places or situations.
But with high-functioning depression.
I think a lot of people avoid dealing with their pain by working, by busying themselves, by taking on more projects.
They just can't sit still.
When they sit still, they feel restless.
And I explain to my patients that restlessness.
It's something we call psychomotor agitation in the DSM criteria.
It's like that you can't sit still.
And so what do you do?
You just, you just work to fill that void, or you take on all these projects or do all these things to fill the void.
Let's actually start processing that trauma.
Let's start processing those emotions.
Let's, let's see what happens when you sit still.
Sometimes people say, I don't want to, I don't want to, I'm afraid.
I don't want to deal with this.
But we, a lot of the work is is in slowing down And unpacking what's happening and processing it so that you can start to feel again.
And sometimes you do cry.
Sometimes you feel a lot of emotions.
Sometimes you feel not so great.
But the great thing about going through that is that eventually you'll start to feel joy again when you allow yourself to feel again.
So the feelings are something a lot of people try to run from.
And working and busying themselves is the only way that they can do that.
Yeah, there was somebody, a mentor of mine years ago, said to me one time emotion can't hit a moving target.
And so that's all I'm thinking about as you're saying that, because I think oftentimes the visual that we have of depression is inertia stagnation, this sort of lack of desire of doing anything, where I think, now framing it in this way, it may explain so much for so many people when they don't feel the joy or they're having those anhedonia symptoms right.
Where they're still doing what they do, but they're not feeling, you know, like the way that they would normally feel when experiencing their life.
It's so true.
I love that saying.
What was it you said you can't emotions, emotion can't hit a moving target.
Oh, I love that.
I'm gonna have to put that on a little poster.
Do it.
I actually I loved it so much.
I, I wrote a book a couple years ago, and I put it in there because I was like this.
And it's not mine, obviously.
And I don't know where this mentor of mine got that from.
She was heavily in the world of recovery.
So I'm imagining it's it's from some sort of recovery group, you know, They always have such great little anecdotes.
But I'm curious, since we're on this topic how do we approach treatment for somebody like this, with high-functioning depression?
Yeah, a lot of times it's reminding patients and this is a saying I haven't, I did not write this, but I love it and I use it a lot that you know I say are you a human being or a human doing?
And that'll hit people a lot.
It's like, oof.
You know, like they're like, Dr. J, did you have to do me like that?
Right.
But it's true, though.
Like we sometimes we are so busy.
Right.
And so the first step for me, for my patients, is I want you to slow down, not stop, because a lot of times you have all or nothing thinking.
Right.
You tell someone with high functioning, slow down.
They're like, I can't stop.
Everyone depends on me.
And I'm like, didn't say that.
I said, slow down.
Not the same as stopping.
Right. but let's start to actually feel.
And a lot of the work and the tools are in grounding techniques.
We're literally sitting there and we're trying to get back into our bodies and validate how we feel.
And it sounds very, very basic and very primitive, but I think a lot of times folks who are on the go, they don't validate how they feel.
They don't accept it, they don't acknowledge it.
They'll go through a whole day and not use the bathroom.
They'll go through a whole day and not eat or drink water.
They're not listening to their bodies.
They're just so focused on this idea of happiness that they're missing out on the experience of joy.
And when we slow down, we do these grounding tools.
One of them that I use frequently is the 5-4-3-2-1, where we just try to stay present in the moment and feel the feels.
So the first step of my 5E methodology is actually validation.
It's acknowledging and accepting how you feel.
And it's so important?
Because if the human brain doesn't know how it feels, if there's that uncertainty, there's fear.
And I liken it to being in like a really dark room and you hear a loud noise.
Some of us would start screaming.
Some of us would start running.
Some would start swinging.
But if you turn the light on, And you saw, oh, something fell.
You know, it was just an inanimate object.
I'm safe.
Then you feel calm, right?
So knowing and naming how you feel is calming for you.
You know what you're dealing with.
There are so many beautiful feelings out there, right?
And in my book, I actually put them in a very concrete way.
And I have faces that people can start to access these different emotions and be a little nuanced with it, you know.
But naming and accepting how you feel is so important because it's like turning that light on and it decreases the uncertainty.
Yeah, I love that.
Well, you said one V. Can you take us through the others?
The second V is venting.
So venting in physics is literally meaning like letting out the air to decrease the pressure.
So in my lab I'll have people come in and I'll blow up this red balloon and I'll have them take turns trying to dunk it underwater.
And 100% of the time, that balloon will pop up.
Why?
You can't out-math physics.
The numbers never lie.
So then, what we then do is we have them deflate the balloon, and then each of them can push it easily under the water.
If we don't express our emotions, if we don't let it out over time, it'll pop up in our health, it'll pop up in our relationships, it pops up in ways that we can't control and then we feel guilty.
Oh, why'd I have to blow up like this?
So learning to express your emotions It's so important.
And venting can be.
You know verbally venting.
You know talking to someone, not your therapist, but because your therapist is different.
You can tell your therapist everything.
But when you talk to another person who's not your therapist, you want to check in.
You want to say, is this an okay time?
You want to say, you know, you want to think about it.
Are you venting with intention?
You don't want a trauma dump.
You know, you want to think about who you're talking to.
Is it someone who's in a position of power or is it someone who's under your power, right?
Because That's important, because that person is going to listen out of obligation, but you're not going to get anything out of that interaction.
So that's verbal venting, but you can vent by writing in a journal.
Other people vent by prayer.
My dad's a pastor and we call him the prayer warrior, because when he prays it's like that angry prayer.
He'll never talk to a therapist, but that man will pray, right?
And that's okay.
Some people are faith-based, and that's okay.
Other people who are artists, you know they express how they feel through song, dance or their art forms, and some people cry, you know that's.
Yeah, I wish more people utilize that a bit more.
So those are all ways to express emotions.
Yeah, and I know that you've said to the younger people now express themselves or event posting on social media or expressing themselves in a public forum.
I think 55% of Gen Z or 57, some high number, they want to be content creators.
That's what they want as their career.
So I talk about that in my book because it's like, well, you got to learn how to vent healthily.
Because once it's out there, it's out there.
And I actually do work closely with a lot of platforms with regards to mental health and creators and so forth.
And we talk about ways to vent so that you're not trauma dumping on your on your community.
And so that you're not triggering them, because you may feel better shortly after but you may trigger someone else, and that you know the ripple effects are there.
So yes, you want to think about how to do that.
I talk about that in my book because 50, like 57%, you know, that's a huge number.
That's a, that's a large, substantial, it's more than half.
I don't know any other profession that's ever had those numbers.
You know like yeah no, that's so wild.
And so, okay.
And the final three, Yes.
So values.
I say that values are things that are priceless, not with the price tags.
So you see the degrees behind me.
I used to chase the accolades.
But before I chased the price tags, the accolades, I remember being a three-year-old kid who couldn't wait to go to school and couldn't wait to read.
And that's why I used to really just love knowledge.
And, you know, somewhere along the line, I lost sight of that.
It became more about well, you got to go to school so that you're not poor anymore, so that you never have to worry about food or resources.
So it became something that I did out of a scarcity trauma background.
But I think, you know, many of us have these values, these things that bring us meaning and purpose that we may have lost along the way.
And due to past pain or trauma or events, we just we don't tap into those anymore.
So I talk about ways to rediscover these values, these things that lit you up.
You know to be your own archaeologist, your own historian, and go in the past and find those things again.
It could be your faith.
It could be your family.
It could be community causes that you believe in.
But try to tap into those because that is really what it's about.
You know, on your deathbed, you're not going to say, I wish I had another purse or another degree.
You're going to say, I wish I spent more time in nature or with that loved one, you know.
And the fourth V is vital.
So we all have a body and brain.
And many of us are not kind to our bodies and brain.
Many of us, we talk badly about the way we look.
And rather than saying wow, look at my strong legs that take me here from point A to point B, we're like oh, I wish my legs were thin, or I wish they were bigger.
Be kind to your body.
And being kind to your body looks like eating foods that are not processed, that are not sugary, but actually full of nutrients that support your brain and your body and decrease inflammation, because an inflamed brain is not happy.
You know, getting movement versus just staying stuck at a desk.
You know.
Getting good sleep rather than doom scrolling at night.
Having healthy relationships, you know, because relationships are the number one predictor of our longevity.
So you could eat all the kale you want.
If you're with a toxic person, that kind of takes over, right?
And the last, non-traditional vital is our work-life balance, because that's an issue for people with high functioning.
But the fifth V is vision.
How do you plan joy in the future so that you don't get stuck in the past?
So you keep moving forward.
And how do you celebrate your wins?
And I have these wins that I celebrate, like If I get my kid to school on time, everybody knows I will sit in my living room.
I'll sip my Caribbean rum-flavored coffee.
It has no alcohol in it, but it's rum-flavored.
And I'm just like, wow, I did that.
I got this child to school on time.
Her hair is combed.
And I celebrate that.
And I look forward to that.
That's a point of joy for me.
And other things could be.
As a team, you know at work, you know if you finish a project together, don't just be like OK, on to the next, like celebrate it.
You know, you did something.
All of these things are really important because in the science, when we are measuring happiness, we're adding up points.
You know, for example, if you're tired and you get rest and you feel refreshed, that's a point.
If you're lonely and you reach out to a loved one and you feel seen and heard, that's a point.
If you're hungry and you savor it and it's yummy. and your food, that's a point, right?
But in the real world, when we think about happiness, we think about oh, when I get this job, I'll be happy.
When I get this partner, I'll be happy.
But the research shows us when we get those things, we're still not happy.
So it's all about savoring those points of joy, those experiences, and really planning them instead of rushing through them.
So Instead of eating your lunch in front of your computer, like closing the computer and making it a habit every day, I'm going to plan my joy.
I'm going to sit here.
I'm going to taste this food.
I'm going to pay attention to the ingredients.
I'm going to savor it.
Little things like that are so important.
It sends a message that you are a human being, not a human doing.
So planning joy doesn't have to be grand.
It could be small, those little points.
Yes.
Oh, I love that.
So the five Vs. Validate.
Vent. values, vital and vision.
This is such a great framework.
I think it's brilliant.
Thank you so much for explaining it all.
And for the people that are listening right now and maybe they're in the middle of a really tough moment.
And they're in this high functioning depression.
What is the first thing that you think they should do?
Or like what helps them in that moment?
Say they're listening to this right now.
Well, you know, the reason that I picked the number five is because I've traveled the world looking at health and mental health.
And I thought about five because it's a number that comes up in so many cultures, right?
And I think it's because most of us have five fingers.
So I'll often say like, look at your hand and you know, tell yourself that you were built with the DNA for joy.
You just forgot how to access it, you know?
And try to tap into one of those five Vs.
And I also say, you know, before you start trying something to try to become happy, you know, do you even understand the science of your happiness?
You know like there is only one you and there will only ever be one you in the history of the universe and in the future of the universe.
You know, when I think about those numbers, I'm like wow, the chances of us existing are so small that we are here for a reason.
So, rather than trying something that works for someone else, Try to understand the science of your happiness.
And what I mean by that is how can you be happy if you don't understand the things that are making you unhappy?
You know.
So we're so busy chasing happiness, but we don't even understand the areas where we're losing joy.
So biologically, where are you losing your joy?
You know, do you have a medical condition like an autoimmune condition that's making it really hard for your brain to be happy because it's inflamed?
Or do you have a psychological condition, right?
Do you have past trauma and you're constantly in fight or flight?
So you're so restless that you can't access joy in any moment?
Or socially, are you surrounded by people who are negative?
And no matter what you do, they're bringing you down.
Or substances, right, that are chemically getting in the way.
Or an environment that's toxic and unhealthy.
So you're someone who has that biological condition.
Because you have so many medical problems going on, maybe that's where you want to start.
But if you're someone who's psychologically so triggered that you can't even access joy in the real world, then maybe that's where you want to start.
Or socially.
If you're in these relationships that are bringing you down, maybe that's where you want to start.
Understand the science of your unhappiness that you understand the science of your happiness.
Because there's only one you.
There will only ever be one you.
So take the time to get to know yourself.
Dr. Judith, thank you so, so much.
This has been so insightful and enlightening and I'm, I'm just, I'm so grateful for you and the work that you're putting out in the world.
Thank you so, so much.
Where can everybody go to learn more about you?
Thank you.
It was such a pleasure speaking with you and talking about the science of happiness.
I hope that everyone listening thanks themselves because they didn't have to be here, but they took the time to be curious about themselves.
And um.
You can find me at Dr Judith Joseph on all the socials, drjudithjosephcom.
And by my book High Functioning.
We will put the links to Dr Judith Joseph in the show notes or, if you're watching this on YouTube, it'll be in the description.
Thank you again, Dr. Judith, so much for being here.
And thank you all so much for listening.
Doug.
Here we have the Lemu Emu in its natural habitat, helping people customize their car insurance and save hundreds with Liberty Mutual.
Fascinating.
It's accompanied by his natural ally, Doug.
Uh, Lemu, is that guy with the binoculars watching us?
Cut the camera.
They see us.
Only pay for what you need at libertymutual.com.
Liberty, Liberty, Liberty, Liberty.
Savings vary.
Underwritten by Liberty Mutual Insurance Company and affiliates excludes Massachusetts.
