B (3:01)

Hi, I'm Dan Buettner and today my guest has been pulling back the curtain on a silent epidemic sweeping through our high achieving society. Dr. Judith Joseph is a board certified psychiatrist, researcher and the founder of the Manhattan Mind Health and Wellness Center. She became a pioneer in her field when she published the first ever study on a phenomenon many may be living through right now, high functioning depression.

C (3:33)

Dr. Judith, founder of the Manhattan Mind Health and Wellness Center, Board certified psychiatrist. What a journey. And you got your start in Trinidad. Tell us about how you ended up.

B (3:44)

Becoming this psychiatrist and identifying this high functioning depression.

C (3:49)

Something I didn't even realize we had.

D (3:51)

Well, you and I were chatting about how when you're raised by Caribbean parents who are very traditional, you either become a lawyer, a doctor, an engineer, or an accountant. My parents had four children and that's exactly what we are.

C (4:06)

That's a good portfolio.

D (4:08)

In fact, when I was younger, I wanted to be a writer and to write poetry. And I remember my parents are like.

C (4:15)

Mm, well, it sounds like you've become.

B (4:18)

A writer as well.

D (4:19)

Eventually. It took a couple of years.

C (4:22)

High functioning.

D (4:23)

But I think a lot of people with similar backgrounds where you're the first, you know, child to go to college, graduate college, become a doctor, there's this expectation that you delay happiness. And for me, it was really having all of the things on the outside that, you know, check the boxes and I should be happy and I wasn't. And that led me to this research on high functioning depression. Because I'm a board certified psychiatrist, I research depression for a living. And I wasn't even aware when it snuck upon me. I was shocked, you know, just to.

C (5:00)

Sort of connect the dots between this podcast, DAN Buenter podcast and blue zones. In these blue zones, where people are living a long time, they have very low rates of depression. I happen to know for Icaria, it's about a quarter of the rate of depression as we have in the United States. And there seems, seems to be a very clear connection or correlation between depression and life expectancy. So A, recognizing depression and B, treating it early and treating it thoroughly is probably better than any supplement when it comes to raising your life expectancy or living longer. So how did you come, you know, as a psychiatrist, there's lots of different sort of channels that you could explore, but you ended up with depression and Specifically high functioning depression. So how did you get there specifically in your profession?

D (5:51)

Well, high functioning depression is not recognized by the medical literature. In fact, in my lab, when we're doing depression studies, we're using these inventories and their checklists based on the Diagnostic Statistical Manual for Psychiatry. So you go down a checklist of all of these symptoms of depression.

C (6:10)

So for the audience, just what are some of the questions that you asked to diagnose depression?

D (6:15)

Things like low concentration, low energy, symptoms like lack of appetite or changes in appetite, changes in your sleep, feeling guilty or hopeless. You have to meet criteria for one of these two. Either depressed mood, which is sadness, or anhedonia, which is a fancy way of saying a lack of joy and interest and pleasure in things. And your symptoms have to cause significant distress or they have to cause significant impairment. Well, I didn't feel in distress and I wasn't impaired. In fact, I was over functioning. But I was having all of these symptoms, especially anhedonia. And I remember the exact moment. I was sitting at my desk in 2020 and when you come to my office, you'll see awards wall to wall.

C (7:06)

All these make your parents proud, right?

D (7:10)

Sitting at my desk giving a talk to a large hospital system. And at that time, you know, there was a lot of uncertainty. They were in the midst of the pandemic. And I was asked to give this talk to help these healthcare professionals get through this tough time. And about halfway through that talk, like, it hit me. I was like, I feel empty, I feel meh, blah. I feel lack of joy. But on the outside, I was getting booked, getting awards.

C (7:34)

Yeah, yeah.

D (7:35)

But no one knew that I was struggling. Even I didn't know. It just snuck up on me. I call anhedonia the joy thief. It robs you of your joy, kind of like in the middle of the night, right? Sneaks up on you. So initially when I felt this way, finished the talk and everything, I just sat in my office and I just thought, well, how did this happen to me? The initial feeling was guilt and shame. Like, how did I not know this? I should know this. I treat this, I study this for a living. But then I realized, well, if this could happen to me, it can happen to anyone if I'm a board certified psychiatrist and researcher. And it happened to me. What about everyone else out there? What about those who others depend on them. They're the rocks, they're the caregivers, they're the entrepreneurs. Right. This must be happening to other people too.

C (8:19)

Just to clarify, high functioning depression from normal depression. So Would somebody with high functioning depression be checking off these boxes on this checklist? Would they feel low energy and inability to feel joy, but yet outwardly they seem fine? So what exactly is the difference between high functioning depression and garden variety depression?

D (8:40)

Right. Well, in the research protocol, the first ever peer reviewed, published research study on high functioning depression in the world, the one that we conducted, you have to have criteria for all of these symptoms of depression, right? Five or more, but not meet criteria for the last two, which is impaired functioning and being in distress.

C (9:03)

Okay.

D (9:04)

And these are folks who are actually, you know, we interviewed several, over 100 people. You still have to be functioning like or over functioning. Right.

C (9:14)

So you're still showing up to work, you're still being a mom or a dad. In the case of a father, you're still. Your friends might not even necessarily know that you're depressed, but behind the eyes you're feeling little or no joy.

D (9:29)

Correct. Anhedonia was high.

C (9:32)

It sounds like, you know, stedford wives or something. It sounds horrible.

D (9:36)

The interesting thing is that that lack of joy, a lot of people don't even identify it. They're like meh or bleh and they don't even know that there's a term for it. When I first started talking about anhedonia, I remember the first media appearance that I did and I talked about and I talked about my rating scale for anhedonia. My website crashed. 10,000 people filled it out and my IT guys, they were like, what's going on here? People wanted a term for what they were feeling. They just didn't know that word even existed. So it was validating for them.

C (10:10)

And what is it about our environment that is producing this high functioning depression? Is it indeed a symptom of living in 2025, or did our parents and grandparents also suffer from high functioning depression, as far as you can tell?

D (10:30)

Well, I think overall people are becoming unhappier. You know, when you look at reports, Gallup polls and the World Happiness Report.

C (10:38)

Yes.

D (10:38)

You see usually typically what you'd see is this U shaped curve. Right.

C (10:42)

With age.

D (10:43)

With age, Right. So in the younger generations, they'd be happier than, let's say when you go to midlife. That's that.

C (10:49)

Yeah, that's the worst part.

D (10:50)

Right. And then you get to the top at the end and the older.

C (10:54)

So my blue zone centenarians are just. Yes, finally.

D (10:58)

But what we're seeing now is that this protected younger group is no longer protected. They're experiencing unhappiness. And overall people are saying that they're unhappy. So this lack of.

C (11:09)

Wait, how do you explain that?

D (11:11)

I think that this lack of joy has to do with multiple things. I think in this age where we have access to technology at all times, I think we're less present. We have access to bad news, even though we want to hear it or not. We can't disconnect from work. You could be on a beach, a remote beach in Bali and still have your outlook open. You know, 30, 40 years ago, that was not even a possibility. I think that's one factor.

C (11:37)

Yes.

D (11:38)

The other thing is I think our foods are just not as nourishing or nutritious as they used to be. A lot of the foods are processed, so our brain isn't getting that those natural nutrients that used to build up our neurons, our brain cells, to talk to each other better. I think also we're probably not getting as much movement because we're in this capitalist society where we constantly moving, hustling, trying to make money, so we're at our desks. But also we're not connecting with others the way that we used to, you know, and also, I think we can't not mention that we all went through this collective trauma. Like, what are the chances of us as a planet going through a trauma at the same time? COVID 19 a pandemic.

C (12:23)

Oh, yeah.

D (12:24)

You know, so that unprocessed. If you haven't processed that trauma, you know, and if you're constantly in this fight or flight or restlessness and things haven't really healed since then, there are all these accumulations of things that I think lead to this lack of joy. And if you're listening, you're probably thinking, well, joy was nice to have. But we know from the research that joy is important. It's not something that's nice to have. It's not a luxury. It's essential. Because joyful people are physically healthier, they're more likely to have better relationships, they're better at work, they're more likely to give back to communities. Right. It used to be thought that disgruntled, angry people are the ones that go out and change the world. No, it's people who are joyful. So we need to invest in this.

C (13:08)

I can add a statistic from that. If you can manage to achieve the top 10% of happiness or subjective well being, it's worth about six years of extra life expectancy compared with being in the bottom 10%. So happiness and longevity, you can't pull them apart. They're one of the same.

D (13:29)

Yeah. In Medicine, we don't talk about it.

C (13:31)

You know, just to connect the dots. And one thing, we have another guest on the Dan Buettner podcast named Tim Spector, who works on, works with facility, but specifically on gut health. And his research finds that most of the precursors to the hormones that make us feel good, like oxytocin and serotonin, are actually made in our gut. And the building blocks in our gut for those feel good hormones is fiber. And about 90% of Americans don't get enough fiber. So to your point, there's this clear connection between what we eat or what we don't eat and this depression, and as you call it, this high functioning depression.

D (14:14)

Well, yet there are serotonin receptors everywhere. There are different types of serotonin receptors. There's ones in the brain, ones in the, several in the gut. But it's not just serotonin. You know, actual vitamin deficiencies can lead to less joyful brains. When I was an anesthesiology resident before I switched to a psychiatry residency.

C (14:36)

You're a real underachiever.

D (14:38)

And you know, I remember when people would have these severe vitamin deficiencies. They'd feel as if they were in this withdrawal state, they were unhappy, they were had tremors and so forth. So we'd infuse them with these vitamins to get them saturated faster rather than having oral vitamins taken. And then they felt less anxious. So it's even in the foods that we get that if you're not getting foods that are rich in vitamins and you're deficient, you can have unhappiness. It's not just serotonin. There are things like vitamin D, magnesium, you know, all of these omega 3 fatty acids. If you're not getting enough of that in your diet, your brain, the neurons aren't connecting enough, you know, and so thinking about what you put into your body is not just something just to feel healthy. It's actually important for feeling happier too.

C (15:29)

And do you have, you know, at the Dan Buettner podcast here, we really like to give the audience actionable advice. So can you articulate the diet of Joy? I mean, what exactly should we be eating if we want to. Want to avoid this high functioning depression?

D (15:47)

Well, there are studies in nutritional psychiatry that show you what a happiness diet looks like. There are things like leafy greens, spinach, kale. Everybody knows that, right? Blueberries, berries are really great for, you know, that antioxidant properties, fatty fish, salmon, mackerel even, must be.

C (16:08)

How about beans?

D (16:09)

Beans, yes, fiber. I mean, the diet that is most well studied and recommended in medicine. Mediterranean diet. But it's not just the Mediterranean area. You see this type of diet reflected across the world. So if you're not getting this natural way of building up your brain, then you may be ingesting foods that are so processed that your brain is inflamed, you have high levels of inflammation, and it's hard for an inflamed brain to feel joyous. So really thinking about what you put into your body is important.

C (16:44)

So diet's important. You talk about the seven signs of highly functioning depression. I'm not gonna make you tick off all of them, but what are some of the. Some of the big ones that I.

D (16:54)

Think, you know, if you're doing what you love, you're working hard, you're productive, and you're feeling joy, that's great. This is not for you or about you. But, you know, a lot of us, we do so much. You know, we're humans doing. We're not human beings, so we're doing all these things, but we're not accessing joy. And when you feel that way, and that's why people end up in my therapy office, they're like, you know, something's off, you know, I just don't feel like myself. And then when I administer this anhedonia rating scale, they're not getting these points of joy. And it's different than what most people think about is happiness. Right. I have this therapy practice, I have this research practice. In the therapy practice, people come in and they'll be like, Dr. Judith, I just want to be happy. And then I'll ask, well, what is happiness for you? And it's often something like when I pay off my debt, or when I have. I find the love of my life, or I finally have a family or have this dream career, it's always something external. But in the research practice, when we're literally adding up points of joy and talking to patients, we'll ask things like, when you ate your food, was it yummy? Did you have an appetite? Because that's a point of joy. It's that pleasurable experience eating. When you were lonely and you reached out to your loved one, did you feel connected? Did you feel seen, heard? When you were tired and you took a nap, did you feel refreshed? When you were stressed, were you able to self soothe? So those are all the points we're measuring, this plethora of human experiences that are joyful. But in the real world, people are like, well, I just want to be happy. When X, Y, Z happens on the external. So I often say that the external things, that idea of happiness, that's not what we're looking for. It's the internal experiences of joy that you're able to be intentional about and to access. So anhedonia, I think is the number one sign. And many people, most have never even heard of that term. The other symptoms, you know, things like when you're feeling a lack of energy, lack of motivation, guilt is something that a lot of folks, I think, with high functioning depression deal with. They don't want to burden others so they won't ask for help, Something's off, but they just don't want to be that person that brings others down. In fact, their whole identity, their, their whole role is the person that people turn to, so they don't want to ask others for help. And also things like those basic experiences of enjoying a nice yummy sleep. You know, like if you're going to bed and you're waking up and you're still feeling really exhausted, that's not yummy sleep, right? No, it's yucky sleep.

C (19:35)

It is, to use the technical term.

D (19:38)

And I was recently on this panel at Columbia with one of the top suicide researchers and she was saying we used to think about happiness in one way, right? This emoji smile. But if patients can shift the way they think about happiness to engaging in these pleasurable sensations, like when you walk through a park, when you walk through Central park and you feel that breeze on your face and you hear the birds chirping and you're like, oh, wow. Like that sense of awe from nature, like, I'm lucky to be alive. That's a point of joy. We often don't think about all of these things that are just innate to being human as being ways to become happier because we're just putting them to the side. We're looking at these external things and I think a lot of us are leaving our basic points of joy on the table because we're chasing this idea of happiness.

B (20:26)

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C (22:38)

We've had Sonia Lyubomirski on the podcast here who's kind of happiness. So you're mitigating depression. And her expertise is, well, for normal people, how do we add more happiness? And she talks about two ways of measuring happiness. One life satisfaction, where they ask people on a scale of 1 to 10 to think of their life as a whole and 10 being your best life. How, how satisfied are you with your life? Which kind of requires you to assess your life, to think back on what have I achieved and, and am I living up to my values? And then she talks about another kind of happiness called positive or negative affect, which is sort of about how you feel on a day to day, moment to moment basis. And they're not at all the same. One is how you evaluate your life. The other one's how you experience your life. And you're talking here, I think about how you're actually experiencing your life, that sort of positive affect from day to day. And I think we get on what psychologists call this hedonic treadmill. You can almost get a visual picture of like a, you know, of a George Jetson on his, on his treadmill or a monkey on the wheel, where we're so goal oriented, we're sold this idea that, you know, you need to get the degree, you need to get the job, you need to climb the ladder, you need to achieve the financial success, the house, the car, the country club. And we work so hard to get there. And then you get there and for just a split second, oh, I got my degree.

B (24:06)

Yay for a day.

C (24:07)

Great. And then you say, oh, guys, now I gotta get a job. Or, you know, I finally got the house. Oh no, now I gotta fill it up with furniture. And it seems the people or the happiness have this ability to shift the focus, their happiness beam onto what they're doing right now. And I'm talking to Judith. She's really smart, she's a wonderful, joyous person. And just not so much thinking about.

B (24:34)

How is this podcast going to do.

C (24:35)

But actually just enjoying the time with you. And I imagine with mitigating this sort of high functioning depression might have. Might share that strategy.

D (24:45)

Yeah, I think so. The only way we know whether or not someone's becoming happier or not or less happy is to ask them. And in my research and in the standardized research, we use these scales that have been measured over time and we ask people about these experiences and that's really the only way that we can know. We can't image your brain. You know, a lot of people will say, oh, you can image your brain and see if you're depressed. Correlation, it's not the same, you know, And I think that what you're talking about in terms of measuring, you know, what's happening on the outside, how you think that you appear to the world, that's that whole idea of the external happiness versus the internal joy. It's really difficult to access joy when you're stressed. And a lot of us, when we're in high stress environments or our body's under stress, we're not able to access the joy. And so this way of thinking about points of joy is based on a model in medicine called the biopsychosocial model. When you think about every human being, every human has a fingerprint, every human has a biopsychosocial model. And think about your biopsychosocial as your unique fingerprint or roadmap for joy, right? So biologically, where are you losing your joy? And biologically has to do with your medical condition or your past medical history. If you're constantly in pain, chronic pain, it's hard to access joy. If you have an autoimmune condition and your body's in an inflammatory state, hard to access joy. For me, I have a low thyroid, so if I don't take care of my thyroid hormone, hard to access joy, right? And then psychologically, that, you know, the biopsychosocial. Psychologically, what are your past traumas or past painful experiences? What's your attachment style? You know, were your parents neglectful? You know, was it a secure bond? What are your resiliency factors? I'll talk about myself personally, my past trauma. I came to this country when I was young. We didn't have a lot of resources. So I struggle with something called scarcity trauma where there are times that I illogically worry about running out of resources. So I'll overwork and I'll hoard resources and I'm missing out on joyful experiences because I'm so worried and so stressed about running out one day. Other people have different traumas, right? They have personal, maybe violence or relationships where there was narcissistic abuse or parents that weren't the greatest.

C (27:16)

Do most people suffer from trauma they don't talk about?

D (27:18)

I think that there are varying levels of trauma. There's like the big T trauma, like in the PTSD research. So I've done about 10 PTSD studies over the past three years looking at classic PTSD according to the DSM, the Bible of psychiatry, right? In order to meet criteria for ptsd, the trauma has to be life threatening, it has to be violent in nature, or either you witnessed it or it happened to you, like sexual trauma and so forth. But if you go to a doctor for a PTSD diagnostic assessment and let's say you say that your partner was verbally abusive or withheld finances, that wouldn't count as a trauma according to the pure, you know, dsm.

C (28:05)

Got it.

D (28:06)

But I would still, as a therapist, not my scientist hat would say that is still traumatizing because you didn't know whether or not you would survive, you know, and this person was emotionally bringing you down, psychologically abusive. So I would count that as a trauma. It wouldn't count as like the big T trauma in this, in the research.

C (28:24)

But it still counts.

D (28:25)

It still counts. It shapes you. It changes the way you interact in the world. It changes the way you see yourself in the world. It's significant. And so I think that would be considered like a little T trauma.

C (28:36)

Let me get down to brass tacks for a minute. Let's say I come into your clinic. I say, Dr. Judith, I have this fantastically successful podcast and it's winning awards and I'm Getting great guests. But you know what? I don't enjoy it. I finish an episode and I feel joyless, I feel empty. How are you going to treat me? Do you talk me through something or do you give me drugs or what do you do?

D (29:05)

Well, that actually puts me right into the next bucket, the social of the biopsychosocial. So socially it sounds like your work is very stressful. Is the work distracting you from the other social things you should be engaging in? Such as, are you not getting the sleep? Are you not getting movement?

C (29:25)

Yes.

D (29:26)

Are your relationships being strained because you don't see them? You don't see your family, you don't see your loved ones? Is your workplace causing you or contributing to you not accessing healthy foods because you're eating the rush foods? Is your workplace so demanding that you're excessively drinking caffeine to stay, you know, energized, all of these things? Or are you coping now with the stress by drinking too much? That's the social bucket.

C (29:51)

I see.

D (29:51)

So what I have my clients do is they'll come in and they'll literally draw out this biopsychosocial model, their fingerprint for joy, and they can see visually all of these different avenues where they're losing joy biologically, psychologically, socially. When I was going through that period of severe anhedonia, I wasn't sleeping well, my relationships were not the greatest, I wasn't eating the best food, definitely wasn't out in nature and the demanding job, people were depending on me. You know, our lab was staying open. The FDA said to continue the trials throughout a pandemic. Very challenging bringing elderly people in for dementia studies because we couldn't take them off their meds. I was constantly worried that they would get sick, they'd get co, the stress was so high. So my biopsychosocial, there are many ways I was losing joy, but the social aspect was where I was draining my joy.

C (30:45)

But so many of us have a job, we have to do it. We have kids, they need to be driven places. What if I, I, I'm doing what I have to do to get by and I'm still feeling this high functioning stress? Can, can you just give me a pill?

D (31:00)

Typically I don't just give medication unless they're warranted. So in order to meet criteria for getting an antidepressant, I would only prescribe it for clinical depression. I'll start.

C (31:12)

Not high functioning depression.

D (31:13)

No, really, because, you know, according to the recommendations, you know, clinical depression, major depressive disorder, they have to meet all these criteria before.

C (31:24)

They can't just be not feeling joy in their life.

D (31:26)

It's different if I have someone who has a history of major depressive disorder. So when you go back to that psychology bucket of the biopsychosocial, someone could have co occurring conditions. I have a lot of clients with adhd and so I'm treating them with like a stimulants for their focusing because if their focusing is impaired, they're stressed out, they're not as great with work, they're impulsive in relationships. So I'm looking at that whole picture and if you're someone who's had a history of major depressive disorder, but let's say right now you're not in the low functioning, you're in the high functioning because you can't dip, you know?

C (32:01)

Yeah, yeah.

D (32:02)

Then for that person I'd consider the antidepressant because of this.

C (32:06)

So. So for high functioning depression, first of all, you can get Dr. Judith's high functioning book here, which I'm guessing you take people through it. Yes, but also it's, it's really taking inventory of your life, what you eat, your social connections, your busyness, your sleep. Kind of the same things we do for longevity are the same things we do to find joy in our lives again.

D (32:33)

Yeah. Well, back to that question about what do you do if you're busy and you're doing all these things and you're not accessing joy? I think the biopsychosocial model is really helpful. I love it because I think that medical students shouldn't just be the ones learning this. Everyone should have access to their biopsychosocial.

C (32:50)

Because you know these terms, because you're a real psychiatrist.

B (32:53)

But what's, can you simplify that?

C (32:56)

Biosocial.

D (32:57)

The biopsychosocial?

C (32:59)

Yeah.

D (32:59)

Imagine a Venn diagram where you have biology, psychology and social.

C (33:05)

Okay.

D (33:06)

And they're overlapping. The reason they overlap is because within biology you might have some things that are also social. Like sleep can overlap because people can have biological insomnia. But then their social habits can interrupt their sleep if they're excessively on their phones at night or they're drinking too much caffeine. Right. There's an overlap, There's. And so when you look at your biopsychosocial and you see, okay, I have a busy life, but I also have my physical health to take care of my past medical problems, and I also have my past psychiatric conditions to take care of, there are different avenues to replenishing the joy. And I say Understand the science of your happiness. There's a field called the science of happiness. But what is the science of your happiness? Right. There's only one you, there's only one me. But sometimes we look at what works for other people and it's not working for us because we're not understanding our own happiness. We're not understanding where we're actually losing our own joy. And that's why this model is helpful, because you're seeing where you're losing joy from all of these different buckets. Right, the three buckets. That way, if you strategically think about it, you can add back your joy in different angles versus it being linear.

C (34:24)

So it's not a silver bullet, it's sort of silver buckshot. It's doing the self assessment, finding where you're not putting enough focus and readjusting your focus.

D (34:35)

Yeah, if it was as easy as a pill, we'd all be on a pill. There'd be no depression. We'd all be on an antidepressant. It's not as easy.

C (34:42)

Are we getting close to that? You tell me that you're testing different pharmaceuticals for depression.

D (34:48)

The reason that I choose to do this work is because when I was in training, we had access to a formulary from a hospital. So you can pick maybe one of five meds to prescribe. And that's just not the reality of the research. There are so many different medications out there. But most people who've been in training, like myself, they'll finish their training, they'll go off and practice and they get comfortable with their one to five drugs that they feel comfortable prescribing, even though there are newer, better medications available because they just don't have access to it. So I wanted to be able to be a part of that research to work on drugs that didn't even have a name when I was. When they were researched in our lab. But then they come out to the public and I've worked on those studies.

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C (36:49)

Learned from the blue zones is that.

B (36:51)

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C (37:31)

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B (37:34)

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C (37:40)

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B (37:46)

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C (38:02)

Let'S say I'm listening to this podcast right now and I'm feeling depressed. Either clinically or high functioning depressed. I don't have access to you and your clinic in Manhattan. What's my first step for getting over depression? Is it right away go to a psychiatrist? Or is there an intermediate step? Are there resources people should be looking to if they suspect they're suffering depression?

D (38:27)

Well, the first step is understanding the science of your happiness. Where are you losing your points of joy, really?

C (38:34)

Are there tools that you can recommend for people to do that?

D (38:38)

Start with the biopsychosocial model, that fingerprint.

C (38:42)

And where do we find the biopsychosocial model?

D (38:44)

That's in my book for sure. Okay, so earlier on.

C (38:47)

So the bottom line is get.

D (38:50)

Start mapping out where you're losing your joy. Okay, that's a really important tool. How can you be happier if you don't even realize where you're losing joy to begin with? Right? I mean, there's only one you, right? So really try to understand you. That's where you start. The next step I came up with five simple tools. Anyone can do this. I made it so simple because I treat pediatric adolescent adults and elder populations.

C (39:16)

It's a man's point.

D (39:17)

It's me. So that anyone at any age can use these tools. Right. The first V is validation. You know, acknowledge and accept what you're feeling and what you're experiencing without judgment. And I think it sounds so simple and so granola y. But many of us who have high functioning depression and who struggle with joy, we just, we don't tap into our emotions, we push it down. We just say, oh, it could be worse or someone else has it worse than me.

C (39:49)

That's very Minnesotan, by the way. Midwest, Norwegian farmer.

D (39:54)

A lot of people don't validate how they feel. They push it down. They push it down. But if you don't acknowledge your emotions and process your pain, it's really hard to access joy too. You just feel like, numb and empty.

C (40:07)

Got it.

D (40:08)

And I often describe validation as, let's say you're in a dark room, you can't see anything, and you hear a loud crash. Some of us would start running, some would start swinging, some would start screaming. But if you turn the light on and you saw, oh, it was just a vase that fell, that uncertainty goes down. Right. Human brains don't like uncertainty. So when you validate, it's like turning the light on on your emotion. You see what you're dealing with, you accept it and you acknowledge it. If you're feeling lonely, acknowledge that. If you're feeling ashamed, acknowledge it. Many of my clients will come in and they'll say, I'm so angry. I'm so angry. It's not anger at all, it's anxiety. And so if you're using tools to mitigate anger, when it's really anxiety, you're not gonna get better. Right.

C (40:57)

It's like using a wrench when you need a hammer.

D (40:59)

Yeah. But it's very difficult to self validate. We're often looking for external validation and there are many ways to feel validated. The rating skills, the psychometric rating skills that we use in the research. When someone comes in and let's say they have high trauma and they've just been pushing through life without even thinking about it. And we administer something called the CAHPS V, which is a gold standard for assessing trauma, and they see like, oh my gosh, my caps 5 is so high, it's validating. It's like, there was nothing wrong with me. There's a reason that I feel stuck. That score is so high. Right. We can't. We can't do a blood test in mental health. We can't scan your brain yet to see that this is what you're dealing with. But we can use these rating skills to assess how you're feeling. So that's a validating tool.

C (41:48)

As a psychiatrist, I think everybody today struggles. They struggle with busyness. They struggle with the state of our world, with politics, worrying about the climate. What is one strategy that we can all use to better our mental health?

D (42:09)

Well, I was taking you into the five Vs, okay? And there are five tools. I wouldn't say use all at once. Use one or two.

C (42:16)

So take through all five quickly.

D (42:18)

Well, we talked about validation.

C (42:20)

Validation.

D (42:21)

The second is venting. Venting is expressing your emotions in a healthy way and jumping up and down. There are different ways to venture. Uh, you know, if you're going to verbally vent, I would say use someone that there's reciprocity or there's an understanding that you go to each other. And it's not trauma dumping. It's not gossiping. You're really venting with intention.

C (42:44)

Okay.

D (42:45)

And I. Often when people come to my lab, I'll use this experiment where they take turns with a red balloon, and they, like, try to push it into water, and it pops up. It's very dramatic. Water splashes everywhere.

C (42:56)

Yeah, yeah, yeah. But it's not really violent.

D (42:58)

And then we take turns deflating the balloon, and we can push it easily into the water. And I use that as an example, because if you're not venting and expressing your emotions, it can pop up in your relationships, in your health, in ways you can't control. So when you choose someone to vent to, make sure it's someone on your level. Don't vent to your kid, because that's a power dynamic. That's not fair. They're gonna worry about you. Don't vent to your employees, because they're not gonna say no to the boss, but they'll talk about you. Right? Vent to someone where there's reciprocity and there's an intention. You want to come up with a solution?

C (43:31)

Can you just go out in your backyard and scream?

D (43:33)

You can. There's self venting. I've done that several times, made sure my daughter wasn't there. All right, there's self venting. There's prayer. My dad is a pastor. He will never go to therapy. But that man prays three times a day. And after he prays, he has, like, a glow, right?

C (43:51)

Note to self.

D (43:53)

For those who are faith, Based. That's a great way to vent. Writing in a journal, you know, that's a nice way to unload those feelings.

C (44:02)

All right.

D (44:03)

If you're artistic expression, you know, and then the third V is values. You know, I know you. You talk about purpose a lot.

C (44:11)

Yeah.

D (44:12)

But for many years, I lost sight of my values. I was chasing things that I thought you're supposed to do, checking the boxes. I was very unhappy. But when I tap back into what really matters for me is giving to others and helping others, that's when I became happier.

C (44:31)

I love that. I actually recommend, when it comes to purpose, that people list out their values. Don't just, well, yeah, I know my value. Well, what are they? Are you Christian, or do you care about women's issues? Do you love animals? Are you conservative? Whatever it is, get it down on a piece of paper, an empty screen, and better imprinted on your daily life.

D (44:53)

I actually have a list of values in my book because many times my clients will come to me and they'll say, I don't even remember what I valued. And we, like, try to go back in their past, and I ask them to bring in, like, old photos from their childhood.

C (45:08)

That's a good way. This is where I come from.

D (45:11)

Right. And what were you doing at that time when you felt purposeful, who were you around? And often they can figure out what their true values are when they feel lost. You know, nature is a big one in the big city in New York City. A lot of my clients were not from the city, and they used to have access to nature. They used to go on hikes, they used to camp, and now they don't. And so some of the homework that I give them is, okay, well, go to Central Park. Yeah, this week, go to Central Park. Next month, plan a, you know, a little trip upstate. And when they start to tap into things that really matter, they start to feel happier. Right. But sometimes you need help. You need a reminder, because you do lose sight of that.

C (45:52)

And the fourth V, the fourth V.

D (45:54)

Is vitals, which you spend a lot of your work on. You know, how to take care of your body and your brain because you only get one. Right?

C (46:02)

Right.

D (46:03)

Since my daughter was two, like, I would tell her every night, how many bodies did God give you? And she'd be like, one mommy. What do you gotta do with it? You gotta take care of it. And she still knows that. Right? So the non traditional vitals are the ones I'll focus on because we all know the traditional ones like sleep, eating, movement, the Non traditional ones are the things we were talking about our relationship with technology. You know, like our brains are just so impacted by tech these days. And there's a recent study at the University of Texas where they took adults and they removed the smartphone capacity from their phone. So it essentially made it a flip phone. So they couldn't get online and they couldn't search on the Internet. They could only call or text. And after several weeks, the scores, their happiness scores looked as if they were treated with an antidepressant note to sell. And when they asked them like, so what is this? What were you doing? They were spending more time outside. They were getting better sleep because they weren't on their phones. Right. They were having better relationships, talking more, communicating more. They were actually savoring their food. All those points of joy that we measure in the happiness research, they were getting more of those points because they weren't on their screens.

C (47:19)

I've seen this graph of childhood depression, anxiety and suicide. And it was essentially flat or near flat. And then in2011, it began to hockey stick. It began to soar. You know what else happened in 2011?

D (47:36)

I think it was one of the social apps, wasn't it the iPhone? Yeah. Oh.

C (47:40)

So as soon as the iPhone came on, an increase in childhood depression, anxiety and suicide also occurred.

D (47:49)

And most recently, a once protected group is now vulnerable. These are young boys, black boys. Highest rate of suicide in children. So I think there's something about not just the phone, but the nature of what's being produced on the phone. Yeah, that's changed most recently. And the final V. The final V is vision. How do you plan joy in the future so you don't get stuck in the past? And that includes celebrating your wins.

C (48:18)

There you go.

D (48:19)

Not these big grand things like a spa day, but the little things.

C (48:23)

For me, it's, boy, that's powerful. It is. Because you talk about this high functioning depression and being so motivated about achieving things, and then we get there and rather than savoring it, we're onto the next one. So it's just a blur of accomplishment without any of the sugar of the juice.

D (48:43)

I practice this with my lab. It used to be all about, okay, did we get this competitive study because we all compete in New York, the labs, and like, did we get the psychedelic. Did we get the new study? And now it's about we finish it together. It's not just checking the box. It's like we sit in the lab together, we'll order from the Portuguese pastry place downstairs, and then we just sit in the lab and we just laugh and we talk about the best parts of the study. That's the connection, right? That point of joy, the connection versus the external goal, that idea of happiness. It's the connection that we remember. And that's the savoring of the wind. Right?

C (49:22)

Wow. Well, you're doing important work. Thank you for pointing out the fact that many of us are high functioning, but not in getting all the joy we should out of life. How do we keep in touch with you? What's the best way to connect with you and your work?

D (49:35)

Follow me on Socials, which is DrJudithJoseph and Dr. JudithJoseph.com and get high functioning.

C (49:43)

Your first step if you're not getting all the joy you deserve out of life. Dr. Judith, thank you very much.

D (49:49)

Oh, thank you for having me. It was a real joy.