Dave Stahoviak (4:35)

You paint a distinction in the book between low functioning depression, which is what we often think of when we think of the word depression, and high functioning depression. What does that distinction look like?

Judith Joseph (4:47)

Many people when they think of depression, they think of someone in bed crying, not doing things that they're supposed to do, but they don't think about the person who doesn't tap into those emotions that has past pain, past trauma, that they're trying to outrun by busying themselves to avoid dealing with this pain. And depression has many faces. You know, the depression 50 years ago that your grandma knew about was a depression that, you know, people look like they were not functioning, they were not getting out of bed. They were not getting things done, they were crying. But these days, we push through our pain all the time. We show up for others. We can't afford to stop. The world that we live in today does not allow many of us to have the ability to slow down, to reflect. And many of us have these symptoms of depression, especially one that I talk about frequently called anhedonia, a lack of pleasure and joy feeling, meh or blah. And we're, we don't even know what this is. We just think that this is life. And I beg to differ, you know, as someone who researches happiness and joy, because you can't study depression without understanding the opposite, which is joy. I know that we all have the DNA for joy. We all are built with that as human beings. It's our birthright. So if you're walking around this earth and you're not accessing joy and you have symptoms of depression, but you're masking it behind pathological productivity. I'm telling you that you don't have to live a joyless, empty life if you're someone who sits and can't feel calm because you have to be busy, who feels empty when you're not working, who feels restless when you're not busying yourself. This book is for you. You don't have to cope by avoiding your pain. You can access joy. And I have the tools to help you to slow down.

Dave Stahoviak (6:42)

Indeed. And you write, people with high functioning depression think of success as the only path to happiness. Healing can help a person realize they're worthy of joy in life just as they are. And I was thinking about that word success, because so many people define that word differently. When you say success, how's that defined in the context of thinking about this?

Judith Joseph (7:09)

Well, I have a private practice where I see therapy patients and then I have a research lab. And when people come to my private practice, they'll say, Dr. Judith, I just want to be happy. And then I'll ask them, well, what does happiness mean to you? And many times they will paint a picture of what they define as success. So that could be success in finding a romantic partner or a soulmate. That could be success in paying off debt. That could be success in your career, like finally getting that big job, finally having that home, that family. It's always a thing. It's always a check checkpoint. But what the research shows us is that even when you get those things, even when you achieve those accolades, those markers of success, you're still not happy. And I don't think a lot of people Know this, they don't know about this research, they don't know about the science of your happiness research. But in the research lab, when I'm trying to figure out if someone is becoming happier or they're becoming less happy, I'm adding up points of joy. So when you think about it, happiness is this idea or this event that people hold their breath for. Joy is the experience. So for example, when we're adding up the points of joy in research, we're adding up things such as when you're tired and you took a rest, do you feel replenished? When you were hungry and you ate, did you, did you savor? Was it satisfying? When you were lonely and you reached out to a loved one, did you feel nurtured and connected? Did you feel loved? When you were stressed and overwhelmed, were you able to relax and self soothe? That's a point that I think a lot of people don't realize. It's really hard to access joy when you're stressed out and anxious, you know. So when we add up all of these points of joy, this is how in research we define happiness. But in the real world, people are holding their breaths for an event, for an idea. So it's a real shift to help patients to see that you are leaving your points on the table. When you are rushing through your meal at lunch and you're not chewing and you're not savoring, that's a point you left on the table. When you are not looking at your loved one at home or your pet and you're too busy on your phone, that's a point you're leaving on the table. When you're doom scrolling at night and you're not getting that good yummy rest, you are leaving those points on the table. And those points of joy are what make life worth living. You know, human beings were designed to access joy and these pleasurable, basic human experiences. But we forget this as we get busy in life, as we try to outrun our pain and our trauma. And in my research, because I've conducted the first study in the world on high functioning depression, there was a high correlation between trauma and painful past experiences and high functioning depression. And the theory is that in the way that, let's say a combat veteran wants to avoid being triggered by a person, a place or a situation that reminds them of their pain. Folks with high functioning depression try to avoid dealing with their pain by busying themselves. That's their form of avoidance. So they over commit and they overwhelm themselves so they don't have time to even think about the pain and the struggles. And it's different than burnout. Burnout is a workplace phenomenon. By definition, burnout is when the workplace is causing these symptoms of fatigue, exhaustion, irritability, lack of motivation. But technically, if you remove that person from the workplace, their burnout should improve. Folks with high functioning depression, you remove them from the workplace and they're still busy, they'll take on a side project, they'll clean their homes on the weekend, they'll take on other people's problems, or they'll get super involved in hobbies that are a bit excessive. You know, they're, they cannot sit still when they are still, they feel empty. When they are not busying themselves, they feel restless. And I want people to understand that there's another way to live. You can access joy. It is your birthright as a human being.

Dave Stahoviak (11:23)

And I, I'd love to loop back on this word trauma because I think this is something sometimes that we miss because we think about a ward like trauma and we think a lot of us, oh, I've never been in a life or death situation. I haven't been in a war zone. I, I haven't, I haven't gone through a horrible assault. And we think like, oh, we don't have trauma as a result. But that's only one kind of trauma, right?

Judith Joseph (11:57)

That is, that's only one kind of trauma. When we think of trauma, there are many instances where there are events that happen in our life that shape us and they shape the way that we view ourselves, the way that we view the world. And they're significant, you know, in the very clear textbook definition of a trauma required to meet criteria for post traumatic stress disorder. The dsm, which is the bible of psychiatry, will tell you that you have to have a life threatening or an assault or something very severe happen. But what we found in trauma research is that there are smaller traumas that are not as intense as like an assault or life threatening event, such as not having resources, not having money to eat a proper meal. Going through things like divorces can be highly traumatizing. Having a significant other emotionally and psychologically break you down, right, it's not life threatening and it's not a physical assault, but it is painful and it shapes the way that you view yourself and the way that you see yourself in the world. And people rejecting you because of your race, religion or the way you look, those are all things that are highly influential and significant in your, in your emotional and psychological well being and they shape you so I wanted to encapsulate all of these types of experiences, including collective traumas. You know, by definition, a collective trauma is what we went through in 2020. But according to the very strict and rigid guidelines of PTSD literature, that would not count as a trauma. So I wanted to include things that are significant in terms of how they emotionally and psychologically shape us and impact us into this trauma inventory. And in my research and when I submitted this research to the research board that oversees these type of studies, I wanted to make sure that I was including these significant events. Now, some of us go through loss and we don't have the repercussions of trauma, but others of us do. So just because something bad happens to you doesn't mean it's a trauma. But if it happens to you and it shapes you and significantly impacts the way that you interact in the world and how you view yourself, if it causes you to feel low self worth and shame and blame, and it impacts the way that you interact with others and you bend over backwards and you engage in people pleasing that is detrimental to your own personal joy, then that's something that I would consider a personal trauma. And then when you understand this and when you acknowledge that this has happened to you and how it impacts the way that you behave and you go through this life and how it may or may not get in the way of your joy, then you can start that process of healing. Once you've done the process of self.

Dave Stahoviak (14:45)

Discovery, there's two words that you highlight pretty extensively, especially at the first part of the book, on how this tends to show up those who are experiencing high functioning depression. You've said one of them in this conversation already a couple of times, anhedonia. And you point out that this is a word like we don't know very well. In fact, I had to look up the pronunciation, I mean, just to reinforce, like, how this is like a foreign word to so many of us. Could you share what, what is the first of all the definition of the word? But like, how does this show up in the context of high functioning depression?

Judith Joseph (15:21)

Well, anhedonia is the lack of pleasure and interest in things that once used to bring joy. And when you think about depression, it's sometimes helpful to think of depression as being twin sisters, right? One sister has low mood and is crying and the other sister feels nothing. The sister that tends to get most of the attention is the one who's crying because you can see the symptoms. It's very visible. You see her not getting things done, but the other sister who's quiet and pushes down her emotions and doesn't seem to enjoy life and is feeling meh blah. She doesn't seem to be in a crisis, right? One is a crisis of functioning, which is the depressed sister who's crying. The other is a crisis that's an existential crisis, a lack of joy, but doesn't look like it's serious, doesn't look like it's a emergency, so she gets ignored. And what I want people to realize is that a lack of joy may not be something that is immediately life threatening, but over time, lacking joy in life leads to negative health outcomes, it leads to poor relationships, it leads to earning less. So overall it is impacting your livelihood, although it may not appear to be an immediate threat or an immediate emergency. And anhedonia is that lack of joy.

Dave Stahoviak (16:46)

One of the paragraphs that probably landed with me in the book more than any other is this one you write. Anecdotally, I've noticed that people with high functioning depression often have a superpower that can both be a blessing and a curse. They might have an enormous capacity for love, but the amount of care they give to others drains them of energy. Or they have a tremendous tolerance for pain and can tolerate really difficult situations, so they put themselves in the line of fire too often. Or perhaps they're so extraordinarily patient that they delay gratification or even resign themselves to no gratification at all. And the reason I highlighted and thought about that paragraph so much is so many of those things we think of as on their face, strengths, a high capacity for love, being able to handle difficult situations, not needing to rely on others for, or not thinking of gratification for oneself. Like societally, we think of those things as strengths. And on its face it's like, wow, someone who's able to do that consistently is someone who's a great human being, a strong leader. And yet, like, we don't think of the other side of those often, do we?

Judith Joseph (18:02)

We don't. We often don't. Society does tend to reward our people pleasing. You know, in certain cultures like the uk, people are rewarded for letting others benefit from their sacrifices. And it's seen as something that you put your head down and you keep going. In certain parts of Asia, certain groups of people, such as girls and women, are told to be subservient and that this is rewarded, this is something that's a positive thing, even though they are being cheated out of their own personal joy. Even in certain healthcare fields, you know, when doctors have to Work through long shifts and see so much trauma and pain. They're rewarded by the administration in the hospital that says this is what a good doctor is. Even though this doctor has poor health, poor sleep, poor family life, is suffering from high functioning depression, they're rewarded. So we're getting a lot of messages from the outside telling us to sacrifice our joy. But we know that something is off because on the inside we are struggling, we are feeling empty, we are feeling a lack of pleasure and interest in things that used to light us up. And what I say to people is to listen to that inner voice. The fact that you are joyless is not okay. It may not be a crisis today, but in the long run it's going to impact your health, it's going to impact your relationships, it's going to impact your productivity and everything that you value currently. So don't ignore it. We were known, we were created as human beings to be able to pick up on this lack of joy. That's why we know something is off. And instinctually we know that we're supposed to have pleasure, we're supposed to get the most out of life and that if we're feeling meh or blah and we identify this, don't ignore it. We have that instinct for a reason.

Dave Stahoviak (20:02)

For folks who are hearing our conversation and thinking like this sounds a little bit like me. One of the things I so appreciate in the book is there's several videos, very quick assessments. I mean, they take 60 seconds or so. It really gives you a starting point for thinking like, okay, am I running into this? Is this something maybe I need to look at? And then of course you have a number of invitations on where we can start. And there's five Vs you talk about in the book. And the first one and the starting point you say is validation. And could you say a little bit about what's so significant about validation when it comes to this?

Judith Joseph (20:44)

Yes. Validation tends to be the hardest V for people with high functioning depression. Because if your coping skill was too busy and avoid, then acknowledging and accepting emotions is going to be difficult for you because this is a relatively new way of thinking. But validation and acknowledging and accepting your emotions and your experiences is so important. And there's a term in psychology called affect labeling. So the very idea, the very notion that labeling and naming an emotion and an experience is so powerful that it is a therapeutic intervention. And so I use the analogy of if you were in a dark room and you couldn't see anything and you heard a very loud crash, some of us would start running, some of us would start swinging, some of us would start crying or screaming. But if you turn the light on and you could see what it was, and you saw it was an inanimate object that fell and you were in, you were nowhere in danger, then you'd automatically feel calm. And that's because the human brain struggles with uncertainty. We all know that this uncertainty of 2020 really mess with a lot of our heads, right?

Dave Stahoviak (22:00)

Yeah.

Judith Joseph (22:00)

So if we can decrease the amount of uncertainty by naming an emotion, that in itself is a powerful intervention. But many folks with high functioning depression, we don't acknowledge and we don't accept our emotions. So validating this is an uphill battle for us. So we have to be very careful in doing this. And I would say even before you start to validate how you feel, understand the science of your happiness. The 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. So knowing that there's only one you, it's important to understand the science of your happiness. And I put a tool early on in the book called the biopsychosocial model. Because in the same way that we all have our, our own fingerprints, we all have our unique biopsychosocial. So just as we all have a, a fingerprint, we all have a biopsychosocial that is unique to ourselves because there's only one you. So understand what the biological risk factors are in your depression. Are you someone who is a woman in midlife? If you're a woman in midlife, biologically you probably have hormonal fluctuations that are impacting your mood and contributing to losing some points of joy because it's making it very difficult to sleep or to even cope during the day. If you're a man in midlife, you know, think about your testosterone levels. But if you have medical conditions and let's say you have an autoimmune condition that will pull on your points of joy biologically, do you have a family history of any medical conditions like thyroid disease? These are things that can impact your personal well being. And then the second part of the biopsychosocial is the psychological part. So what is your past trauma? Some of us have attachment traumas. We had really difficult parental figures that made it difficult to attach. So we have very contentious relationships as adults because we haven't healed that trauma. Some of us have personal real trauma from past painful and violent experiences. Others like myself, have scarcity trauma. Where I came to this country with very little. So a lot of my busying and over functioning stems from a fear of losing it all, a fear of lack of resources. Some of us may have family members, grandparents who came to this country with very little, but a lot of that generational scarcity has trickled down to us. So there's never enough work. And that's what drives our busyness. And then the social part of the biopsychosocial is what's happening around us in our daily lives, what's happening in our environments? Do we have access to nature? Are we in a big city? Are we in a job that's toxic? Are we in a job that's supportive? Are we in relationships that are toxic? Are we in relationships that are supportive? Do we engage in unhealthy behaviors like excessive drinking or smoking? Are we getting foods that are highly processed with additives, or are we getting fresh, nutritious foods? You know, these are things in our social environments, are we exposed to too much technology? So when you understand your biopsychosocial and you draw it out and you make it your own, you understand where you're losing your points of joy, so you understand where you can add back the points of joy. And I say that do this before you start validating. Because without understanding the science of your happiness, you may be using tools or reading books that don't even apply to you because you don't even understand. You, you haven't even understand, you don't even understand what makes you so different than the person next to you. But when you start to acknowledge and accept and validate what makes you so unique and the fact that you existing in this world, the chances of you being here are so small, that you are here for a reason, then you start to acknowledge, okay, these are the things that make me different. These are things that have happened to me. So you start to accept and acknowledge all of the ways that you're so different and unique. And then you can start acknowledging and accepting your day to day emotions. Like just this morning when I woke up, I said, wow, I am really fatigued, I'm really tired and exhausted. But that's because I was able to acknowledge that last week was a very busy week for me and I don't have to feel ashamed and have low self worth and undeserving abreast. So when I come home today, I'm going to go and get some good rest and not finish a project. And I'm going to be okay with that because I've acknowledged and accepted that I'm tired. You know, it's a really difficult thing for busy people to. To accept. I recently taught a large conference, and There were about 300 working women there, and there were busy and highly successful people. And I asked them, I said, how many of you in this room have invalidated your bodily functions? Like, you knew you had to go to the bathroom, but you sat through all these zoom meetings, and you didn't even have a bathroom break once in a day. And they all started laughing because it was such a common experience we worked through. We pushed through a day without even relieving ourselves to go to the bathroom. But it's really difficult to access joy when you have pelvic pain because you haven't relieved yourself. So the little things that we do in a day invalidate us. So I want people to start small and not. You don't need to have a big moment of, let me deep dive into my childhood and try to heal all my trauma. Just start slowly accepting and acknowledging how you feel at points throughout the day. And that is really the first start. But I think it's really hard to do that if you haven't understood the science of your happiness and what makes.

Dave Stahoviak (27:36)

You so unique indeed, and how unique all of us are. Right. And it reminds me of something you mention in the book that you often give as a homework assignment to patients who are at this point, is you suggest that they find a movie or book or a musical or something that reflects their life. And what is it about that that is helpful?

Judith Joseph (28:00)

Many people have a hard time doing this work, and it has to be fun. And if. If you take a look at my social media, I talk about very serious things in a very fun and entertaining way. What we found in medicine and medical education lately is that people want to learn. They're curious.

Dave Stahoviak (28:21)

Yeah.

Judith Joseph (28:22)

But they're so bombarded by all of these distractions that you have to make the information relatable and accessible and fun. And I teach a course at NYU. I've taught it for over 10 years now, developed it for doctors to teach doctors how to give press interviews. And it's since pivoted to teaching doctors how to use social media, because that's where most people get their information these days. And what we've learned through this course is that you have to allow people to learn information about their past psychology, about psychological terms in entertaining ways. So one of the lessons that I put in my book that has to do with finding a character that you feel has a similar tale to yours. So if you're someone who went through a very difficult childhood. Divorce. And you found that you. You never really talked about it because everyone says divorce is so common. Like, it's. There's nothing important about that. But you know that after your parents divorced, you kind of lost interest in things. Let's say you used to really be interested in nature, and maybe that was because your parents used to camp together. And after that divorce, you guys stopped camping. And maybe you haven't really enjoyed nature since then as much as you did. So that's something that you may want to watch a movie that replicates that, like, marriage story or a movie where there was a child that was seeing their parents going through a divorce, and you identify with the character, and that's a slow way of validating that what you went through was painful. And a lot of these techniques, we actually use these on inpatient units because when patients stay on inpatient units, it's pretty boring. People think that you're doing therapy 24, 7. It's not the case. A lot of times you're on the inpatient unit so that people can just observe you and make sure that the medications that you're taking and the therapies that you're using are safe and that they're working so that it decreases your rate of returning to the inpatient unit. So a lot of the activities and the behavioral tools that we use in outpatient therapies are derived from these very entertaining type of skills that we try to infuse some fun pop culture into the work. Because you could do this test on your own. Try reading a research paper on your condition versus reading a more entertaining paper that has to do with movie themes. Which one are you going to pick as a patient? You're going to pick the one that has the movie themes because it's relatable. And in the course that I teach at nyu, we always start with a story, because what we found is that when doctors present to other doctors, they try to sound so important. They start with the data and the numbers, and then they feel good about their research, and then they. Then they go into the case. But when you present that same information to a patient, they want the story first. So you're going to start with, you know, I saw a patient and they were struggling with this, and this is what we did. And then the audience will be like, oh, I want to learn about this patient. Maybe it could help me. Right? It's just so different when you talk about this information with patients versus when you talk to other clinicians. So a Lot of the tools in my book are very practical and they're fun and they make learning the science of your happiness interesting. So you want to actually build on the principles, you want to learn more, you want to share it with others because you found value and it's so relatable.

Dave Stahoviak (32:00)

That is exactly my invitation I hope folks will take coming out of this conversation is if you've heard something from what Judith has shared and you think, hmm, is this me? Is this someone that I'm close to? Is this someone that I'm supporting? Boy, there's so much practical steps in this of like, what to do next and also to emphasize, like, story, the importance of story. You're so gracious of sharing so much of your own story and the story of patients that like. As I read through it, I thought, wow, this is like so relatable on so many levels and thinking about relationships and people in my life. So I hope folks will grab the book if this conversation has sparked your interest and begin to go down that journey of doing a bit of the assessment. We're going to link up all the resources on Judith's website so you can do that. And Judith, I have one last question for you. I often ask people what they've changed their minds on in their work. And I'm curious, as you have been on this journey, not only yourself, but obviously doing the research, teaching so many others, putting this book together now and bringing it out into the world. As you reflect on the last couple years of doing your work, what's something you've changed your mind on?

Judith Joseph (33:06)

Well, I came into this research thinking that high functioning depression was just high achievers, you know, like the doctor, the busy surgeon, the nurse. But what I found, and I was pleasantly surprised, was that the more that I did this research and the more that I worked with patients and gave these talks, is that high functioning depression does not discriminate. And what I found is that a lot of artists resonate with this. You know, people who are performance artists, they have to constantly wear a mask of happiness. They can't show that they're struggling because they won't get the gig. And what I also found was that a lot of people who, you know, are like working, are not working mothers, people who are caregivers, people at home who may not have the flashy, what you think is a successful job or title, you just think of, oh, well, that's, that's not real job. It's, it's actually a job. People who take care of children and they take care of elderly folks that is a full time 247 job and indeed. And they often don't think about their happiness. They're constantly showing up for others. So I thought I found that interesting.

Dave Stahoviak (34:17)

Judith Joseph is the author of High Overcome youe Hidden Depression and Reclaim youm Joy. Judith, thank you so much for your time and for your work.

Judith Joseph (34:27)

Thank you so much for having me.

Dave Stahoviak (34:34)

If this conversation was helpful to you three related episodes I'd recommend one of them is episode 438, what to do with your feelings. Lori Gottlieb was my guest on that episode and we talked about the reality of leadership, which of course is it brings up a lot of feelings every single day for many, many of us. And we often think a lot about the feelings of the people around us, the people we're leading, our peers, our managers, and we sometimes don't spend enough time thinking about handling our own feelings and how do we respond to them. And that conversation Lori and I talk about what are some of the proactive things we can do and also what are some of the resources that we should reach out to when our feelings are taking control of us a bit too much. Episode 438 for that also recommended episode 608 the mindset leaders need to address burnout Christina Maslach was my guest on that episode and we talked about burnout and what is it and how is it different from other things. It is different of course, than depression and it's an important concept for all of us to know about because oftentimes when burnout happens, we think about that as an issue with a person and we miss the organizational stressors and culture and climate that are causing the burnout to happen in the first place. In that episode, Christina really invites us to think about the big picture, the organizational dynamics and how if burnout's happening, what we may do as leaders to be able to prevent that at a systemic level. Episode 608 for that also recommended episode 692 transcend leadership struggles through your strengths Lisa Cummings, my friend who's so such an extraordinary Expert on the CliftonStrengths assessment or strengths Finder, helps us to really think about how we work through things using our strengths. So many of us have been taught that we should improve upon our weaknesses and yes, of course there are things that we all need to do in order to get better at the things we're not good at. And we also should be indexing on our strengths as much as possible and leaning into that. So much of our work in the Academy is helping our members to lean in more on their strengths and to find the strengths of others and help to leverage those strengths in extraordinary ways for the team and the organization. Episode 692 A Great Reminder from Lisa on how to think about and utilize our strengths well and the strengths of others. All of those conversations you can find on the coaching4leaders.com website and I'm inviting you today to set up your free membership@coaching4leaders.com because when you do, you'll have full access to the entire library of episodes I've aired since 2011 and and the ability to search by topic. So if you are looking for something under the topic of personal leadership as today's episodes filed under so many conversations that we've had over the years in relation to that, as well as dozens and dozens of other topics, whatever you are searching for right now, maybe it's leading better meetings or handling a conflict in your organization or developing employees. All of those are just a few of the many topics inside of the free membership. Go over to coaching4leaders.com set up your free membership. You'll be able to access access everything in there, including many of the other benefits, including my book and interview notes. Every episode, or just about every episode, I post a link with all of my notes from the interview, things we talked about, but also some of the things we didn't get to, as well as the highlights that I think are most critical from the guest experts and their books and their articles. And all of those are included inside of the free membership as they are for today's conversation with Judith. Set up your free membership by going over to coaching4leaders.com and if you're looking for a bit more, I'd encourage you to go over to coaching 4 leaders plus. There I have provided a whole bunch of additional benefits that are part of Coaching for Leaders plus and available to you if you are seeking more. And one of those benefits is a weekly journal entry from me that comes right to your inbox with a reflection on more that I think will help you as a leader. And one of the recent journal entries that I explored, lord is how do you find what's missing? So often we miss what's right in front of us and I invite our members, when they're working with me in the academy, to consider three key questions in advance of conversations so that it's easier to find what's missing. In a recent entry I talked about those three questions, why they're important, how we use them, and how you can use them as well to begin to find what's missing in the situations you're dealing with. For details on how to get access to that, go over to Coaching four Leaders plus Coaching for Leaders is edited by Andrew Kroger. Production support is provided by Sierra Priest. Next Monday, I'm glad to welcome Wes Adams to the show. We're going to be talking about how we can do a better job as leaders to help people connect at work. Join me for that comment conversation with Wes and see you back on Monday.