Podcast Summary
Making Space with Hoda Kotb
Episode: Dr. Judith Joseph on the Cost of Holding It All Together (May 2025)
Release Date: April 8, 2026
Guest: Dr. Judith Joseph, Psychiatrist and Author

Episode Overview

This episode features board-certified psychiatrist Dr. Judith Joseph, who opens up about her journey through high academic and professional achievement—and the hidden cost of keeping it all together. Dr. Joseph discusses "high functioning depression" (HFD), how it can go unnoticed in driven individuals, and the path she found back to joy. The conversation is candid, empathetic, and rich with both clinical insights and personal anecdotes, offering concrete steps and hope for anyone who feels “meh,” empty, or stuck in a cycle of relentless productivity.

Key Discussion Points and Insights

Dr. Judith Joseph's Early Life and Scarcity Trauma

• Caribbean roots and early community:
  • Dr. Joseph grew up in Trinidad within a supportive, communal environment before immigrating to the U.S. at age four (04:22).
  • “In Trinidad, we'd go to the beach every weekend... you had community. Things were slower, you know… you take your time, you do things right.” (04:33, Dr. Joseph)
• Adjustment to scarcity in America:
  • Her family faced financial hardship upon immigrating—sometimes without food or electricity (05:03).
  • Early stress presented as tension headaches and anxiety about grades and bills (05:22).
• Coping as a child:
  • Coping strategy was to become “pathologically productive” and “high functioning,” using academic and extracurricular overachievement to manage internalized shame and trauma (05:47).

The Drive for Perfection and Its Hidden Toll

• Childhood pressures:
  • Felt a strong obligation to succeed as an immigrant: “You have to do well because you have opportunities that others don’t.” (07:34, Dr. Joseph)
• Trade-off of high achievement:
  • Enjoyment of learning eroded over time; academic pursuits were no longer joyful but driven by fear of failure (09:34).
  • “Over time, if you push down the ability to feel that pain, you also push down the ability to feel the joy.” (08:40, Dr. Joseph)
• Imposter syndrome:
  • Despite acceptance to top schools (Duke, Columbia), struggled with feeling like a fraud (11:55).
  • “I remember looking at that pamphlet and being like, this is a mistake...I’m gonna ride with it.” (11:57, Dr. Joseph)

High Functioning Depression (HFD) and Anhedonia

• Defining HFD:
  • Dr. Joseph describes HFD as experiencing classic depression symptoms (fatigue, poor concentration, guilt, restlessness) but without outwardly visible distress—often masked by continued achievement (00:30).
• Anhedonia explained:
  • “It’s a lack of pleasure and interest in things that you once enjoyed.” (03:54, Dr. Joseph)
  • Subtle symptoms like not enjoying time with loved ones, food, or rest (20:27).
• Personal tipping point:
  • Realized her own anhedonia during the COVID-19 pandemic, while externally she appeared highly successful: “I just felt so muted...Oh my gosh, I think I’m depressed.” (19:59, Dr. Joseph)

The Power of “Points of Joy”

• Joy is cumulative:
  • True happiness isn’t found in future achievements but in “points of joy” throughout the day—small pleasures (22:01).
  • “If you had pain and you got relief, that’s joy…If you’re thirsty and you quench that thirst, you got a point.” (22:01, Dr. Joseph)
• Practical recentering:
  • Encourages listeners to abandon the elusive chase for happiness “out there” and instead seek and savor daily moments (23:54).
• Acknowledge and value small wins:
  • Reframe: If you didn't get a point of joy today, there’s hope you can tomorrow (23:55).

Root Causes: Unprocessed Pain and Trauma

• Origin of over-busyness:
  • Hypothesis: Many high-functioning individuals are coping with unprocessed traumas—what Dr. Joseph calls “scarcity trauma” or “little t traumas” (26:07).
• Shame and internal narratives:
  • Shame statements—core negative beliefs (e.g., “I’m a mistake”)—shape experience and behavior, whether remembered clearly or buried (27:16).
  • “One of the symptoms of trauma is burying memories that are painful.” (27:34, Dr. Joseph)

The 5 V’s Method for Healing

Dr. Joseph outlines a stepwise approach for breaking the cycle of high functioning depression:

1. Validation (29:24):
   • “Acknowledge how you feel… if you can pinpoint what it is, then you feel less anxious.”
2. Venting (30:07):
   • Express feelings safely—verbally (with emotional consent), through journaling, or creative outlets.
3. Values (31:09):
   • Rediscover what is truly meaningful, outside external accolades (e.g., knowledge, curiosity, connection).
   • “My values got muddied with achievements and titles, and I had to find my way back.” (31:35, Dr. Joseph)
4. Vitals (31:49):
   • Care for your body (sleep, nutrition, movement), maintain healthy relationships and set boundaries with technology and work-life balance.
   • “There will only ever be one Hoda, ever in the history of the universe…We have to take care of ourselves.” (32:03, Dr. Joseph)
5. Vision (32:53):
   • Plan enjoyable moments or events, even small ones, to look forward to: “Celebrate your wins…have something to look forward to.” (33:03, Dr. Joseph)

Nature vs. Nurture in Positivity

• Are some people just “born happy”?:
  • Some are genetically predisposed to optimism, but learned habits and environment—especially from caregivers—also play a significant role (33:42).
• Dr. Joseph’s mother as a model:
  • Despite hardships, her mother exemplified generosity, joy, and connection: “She had no reason to be as joyful as she was…[but] she was always optimistic.” (34:05, Dr. Joseph)
• Connection as a cornerstone:
  • “Loneliness is a choice. You can always ask for help.” (Dr. Joseph’s mother quoted, 34:52)

Notable Quotes & Memorable Moments

• “If you push down the ability to feel that pain, you also push down the ability to feel the joy.”
  —Dr. Judith Joseph (08:40)
• “You don’t have to teach a three year old how to be joyful.”
  —Dr. Judith Joseph (21:26)
• “My way of coping and dealing with the trauma was not dealing with it and avoiding it by busying myself.”
  —Dr. Judith Joseph (05:47)
• “Imposter syndrome is not even a clinical diagnosis. But... none of us, especially as women, would say it doesn’t exist.”
  —Dr. Judith Joseph (15:03)
• “The happiest moments in my life were times when I felt connected.”
  —Dr. Judith Joseph (37:12)
• “She managed to raise four kids who get along...we had this group text. And I think it’s because she just sees the potential in every person.”
  —Dr. Judith Joseph (35:30)
• “Now, I feel like sharing my pain is my way of processing it. And I’m helping others.”
  —Dr. Judith Joseph (36:16)

Timestamps for Key Segments

• Early life & scarcity trauma: 04:22–06:54
• Academic pressure & shame: 07:34–09:34
• Imposter syndrome and feeling “meh”: 11:55–15:03; 19:44–20:24
• Anhedonia explained: 20:27–21:26
• The “points of joy” concept: 22:01–23:55
• Social media and the HFD viral moment: 24:21–25:50
• Explaining the “5 V’s”: 29:21–33:29
• Genetics, role models, and the importance of connection: 33:42–35:30
• Vision and embracing connection: 35:47–37:12

Conclusion & Takeaways

Dr. Judith Joseph’s journey and research shine a light on the invisible emotional burdens many overachievers carry. By validating difficult feelings, expressing them safely, reconnecting with personal values, caring for one’s “vitals,” and creating a hopeful vision, it’s possible to heal from high functioning depression and reclaim a richer, more joyful life. Ultimately, consistent small joys and nurturing connections—not relentless achievement—anchor well-being.

Recommended for:
Any listener who feels chronically busy but unfulfilled, those curious about high functioning depression, or anyone seeking a compassionate, practical roadmap back to themselves.