Dr. Judith Joseph (7:23)

You were built with the DNA for joy. It is literally built into your DNA, but you just forgot how to access it. For those with high functioning depression, they have the symptoms of depression, but they're not stopping, they're overdoing. You can still access those moments of joy and tell yourself you're worthy of it. That's where you begin. Understand the science of your happiness. When we know what we're working with, when we know why we are the way we are, we're able to make better decisions and we are less stressed. We cope by Busying ourselves, just acknowledging it and being aware of it allows you to change. I'm not saying you have to stop, I'm saying to slow down.

Rich Roll (8:10)

Hey everybody. Welcome to the podcast. So I think I want to start this one by saying that I would consider myself a high achiever and a pretty high functioning one at that. This is something that I've always prided myself on, this drive that I have that I think I developed pretty early in life and have deployed to great effect over, over the course of my life, this commitment that I have to kind of outwork my talent deficits and this engine that I think really deserves credit for much of my success as an athlete, as a student, back in the day, as a writer, and now as a podcaster. But I also know the dark side of this disposition, the unhealthy fear based, scarcity mindset, part of it, that developed, I think, as a response to some unhealed past traumas from childhood that leave me a little bit vulnerable to overlooking many other important aspects of life to my detriment and the detriment of those around me. And when this goes unchecked, I've noticed in myself that I can become more irritable, more withdrawn, I can get riddled with anxiety, my sleep becomes impaired, and there's also this numbness to it. It kind of sneaks up on you and it makes it difficult to feel things, especially joy, which then all becomes very weird and confusing and really like guilt inducing because I have so much to be grateful for and such a fantastic life. So in the past when I've flirted with this, I basically chalked it up to burnout or something like burnout, or something nearing burnout at the least. It's only more recently that I discovered that this is actually something different, something that has a name, and that name is high functioning depression, which is super weird because A, it doesn't seem like these two things go together, high functioning and depression, and B, I'm not depressed, not at all. At least not in any traditional sense of the word. But apparently this is a thing. And it's something that is only recently getting attention and being researched, and also much more widespread than you might suspect. So today we're going to talk all about it, this thing called high functioning depression, what it is, what it isn't, how to know if you have it, what to do to avoid it or overcome it, and why it's so vital for all of us to better understand it. And we're going to do it with the world's leading expert on it. Her name is Dr. Judith Joseph and she is fantastic. Judith is a psychiatrist and professor of psychiatry at NYU Medical School. She also runs a research lab where she conducts clinical trials as chief investigator and serves other institutions in various capacities, including Columbia University Medical School. Her credentials and accolades are many too lengthy to list here, but suffice it to say that she's super legit, as is her vital new book titled High Functioning, which if you relate at all to any of the things that I've just shared, I strongly suggest you immediately pick it up. So if you are a high achiever or perhaps you know somebody who is, I think this one is for you, as Judith does quite an amazing job of dissecting this idea of high functioning and putting it to the test. Judith, welcome.

Dr. Judith Joseph (11:55)

Thank you for having me.

Rich Roll (11:56)

I'm delighted to have you here today. Your work and your book is speaking to me in a very profound way at a very particular moment in my life. And I feel like the universe must have conspired to arrange this meeting for a very good reason at this exact specific time, because I am experiencing currently a version of the condition that you talk about in this book. I would say that I'm somebody who gets high on high function, and it's proving to be an urge that is of diminishing returns right now. So I'm in a situation where I'm struggling to sleep. I'm waking up in the middle of the night, and then I'll come in here at a ridiculous hour. I'm working on a book. I've got all these podcasts. I have back surgery in two weeks, so I have to get all these things done, and I'm not going to let anything get in the way of that. And so if there's one thing I can do, it's focus, execute, be productive. And this has been my modus operandi for as long as I can remember. Right. It's a superpower, but it's also an Achilles heel. And I'm at a particular inflection point with it today. I literally woke up at like 1:30 in the morning and started like, you know, cycling through all these things that I have to do and ratcheting up my anxiety. And I was like, oh, this is perfect. Well, it's terrible in that I wish I had slept more for this interview, but actually, you know, kind of amazing that you're here today to talk about this subject matter that is, I think, vitally important.

Dr. Judith Joseph (13:34)

Well, I truly believe in destiny, and I believe in faith, and I'm a scientist and I own a lab, but my dad's a pastor. And for many years I thought you couldn't believe in the things that you couldn't prove. Right? Because if you're a scientist, then you're a scientist and you shouldn't have that conflict. Science is science. Numbers are numbers. But I have been learning over the past couple of years that there are circumstances that bring people together. And it is. Part of it is spiritual and another part of it is, I think, you know, I really believe in destiny. And I think that I came here for you at this point in time because you needed this message.

Rich Roll (14:16)

Well, I believe in that as well. I'm on the same. I'm vibrating on that frequency. I have another frequency that's a little off kilter at the moment. So why don't we unpack this a little bit? You know, on its face, like this idea of being high functioning while it also being this version of depression. These are antithetical ideas. Like, isn't somebody who is high functioning somebody you should aspire to, become, like, to be productive to, you know, get out there and crush it? These are all like goals that we all inspire to better inhabit ourselves. So explain this interesting kind of phenomenon and. Or not phenomenon, like diagnosis that is central to the work that you're now doing.

Dr. Judith Joseph (15:01)

Well, it's interesting because as you're talking about this upcoming surgery that you have, it put me right back in time when I was about to give birth to my first and only child. And I own a lab, I have a private practice, I was a professor at nyu, teaching doctors. All of these wonderful things happening, but probably the most important thing that could ever happen to me, becoming a mother was a thing that I was like, kind of dreading. And so leading up to giving birth, I was doing so much work and I couldn't sit still and I was so busy. And some people would say that's nesting. But I wasn't nesting in the way most mothers nested. I was taking care of my research, trying to line things up so that, you know, if I had to be, God forbid, out of commission for a week, things would run smoothly. You know, I remember having this baby on my chest and having to nurse, and then I had all these lab charts around me. I'm like, what was I thinking? Right? But I do think many of us who are busy, who have our identity and our self worth so closely tied to this role, we cannot sit still. And it's different than burnout. You know, with burnout, by definition, it's an occupational hazard. So if you take the person out of the workplace, they should technically get better. Not with people like us. You know, you take us out of work, we will still find more work. We will still find another project. We know that we have to slow down in two or three weeks, but we just can't accept it. So we wake up in the middle of the night, you know, we're up doing things, working on things. There's no end to it. We cannot sit still. When we sit still, we feel empty. When we're not busy, we feel restless. And that's what I was finding with high functioning depression. We don't check that bottom box like most others with depression. Who has all the symptoms of depression? We don't check that bottom box of are you low functioning or have you stopped functioning or are you in crisis? It's the opposite. We cope by busying ourselves. We try to outrun our problems. We try to outrun our trauma and our pain. We cannot sit still.

Rich Roll (17:07)

So you have this quiz in the book, and I got almost a perfect score on this, in which you basically ask these questions to try to help self diagnose people as to whether they're suffering from this. Can you just walk us through the day in a of somebody who might be a candidate for this so that people can orient themselves and relate their own behavior patterns to what you're talking about?

Dr. Judith Joseph (17:32)

You know, it's interesting because my office is in a very busy part of Manhattan, so I see a lot of people coming in and they're not coming in with the typical breakdowns. They're coming in with something called anhedonia. And it is a lack of pleasure and interest in things that used to light you up. And it's not a crisis. Right? If you go to a doctor and you're like, oh, I don't have jo. They're gonna say, well, are you working? Are you showing up for others? Are you still able to function? And if you say yes, they'll say, well, come back when you break down. But anhedonia, I think, is a crisis. It's a lack of joy, which is a crisis for human beings, because human beings were built with the DNA for joy. This is our birthright. But many of us are walking around with the meh, the bleh. So anhedonia is one of the key signs. It's the first sign that I ask about. But the other things are, you know, when you do sit still, do you feel restless? Is it hard for you to just be alone with yourself? You Know, and I think that's important because we don't realize that this is a part of our fight or flight. This is our trauma response. We cannot just be. We have to do. And I joke, I say you're a human doing, not a human being, because you're trying to outrun something that you haven't fully resolved. For many of us, it's something early in childhood, but for others, there's something that happened in adulthood that is so painful that we just avoid it. And avoiding the pain, avoiding the trauma is a form of busyness. So when you think of combat veterans, I do a lot of research with ptsd, post Traumatic stress disorder. Many of them will avoid a place that triggers them, or they'll avoid a person that triggers them. For those of us with high function depression, we are avoiding our pain by working, by pushing it down, pushing it down. But what happens is that you push it down so much that you stop feeling. And that's where the anhedonia comes in, the lack of pleasure and joy.

Rich Roll (19:36)

So anhedonia trauma, we're gonna get into that. Big traumas, small traumas. But I think just on a top level, just the idea that this would be categorized under depression as opposed to an anxiety disorder is the leap that is challenging for me. Like, I wouldn't consider myself depressed by any stretch of, you know, how I think about that. I certainly have spells of, you know, high anxiety or I'm always revving. And I definitely suffer from anhedonia. Like, it's. I remember saying to somebody recently, like, I mean, I have an incredible life. Like, it's beyond anything I could have imagined for myself. And I've worked very hard for it. And some of those impulses that led me here were healthy and some were not. But joy and being present in it and actually feeling gratitude for it are very elusive things for me. And there are things that I will then sort of push to the side and say, well, that's okay, because I'm on a mission. And those things are less important than kind of moving forward and doing this thing that I do that on some level is an act of service. But I also rationalize it as such. It's for me too. It nourishes me, and it's meaningful for other people, and that's great. But it's almost as if joy, happiness, those things are secondary or they're just lower on the hierarchy of priorities and. And something I can get to later, which is super ironic because I sit across from people all the time talking about happiness. It's like self awareness will avail you nothing. I'm briefed on everything and yet I struggle to actually put some of those tools into practice to move my life towards these things that I want more of. And it reminds me of something that's often said in recovery, like I'm a 12 step person. It's like, well, the brain that created the problem struggles to solve it. Like you're relying on the brain that created the problem to solve it. And when you're in this state of anhedonia, or high functioning depression as you call it, which I clearly feel like I, I have on some level that's a situation in which you don't really want to solve it. Like you can read the book, but then it becomes very difficult to actually like break out of it through action.

Dr. Judith Joseph (22:12)

Because you're getting rewarded by the system. You know, the more productive you are, the more you give, the more rewards you get. The feedback, oh, you're doing a great job externally, but something inside does not feel satisfied. And that's why you continue to go. I'm glad you brought up anxiety because in depression research, when we're adding up how we know whether or not you're getting better, worse or staying the same, we're literally adding up points. And one of the points that I think many people don't know that we add up is the point point of stress, the point of relaxation, the point of tension. So one of the questions I'll ask that's on that questionnaire is are you able to self soothe? Are you able to relax when you're anxious, when you're tense? And you would think, isn't that anxiety? Why are you talking about tension with relation to depression? But let me ask you something. Do you think it's even possible to be joyful if you're anxious, if you're worried all the time, if you're tense? No, tense. People don't enjoy even the simple pleasures in life. That's why when talking about depression, we have to incorporate anxiety. And it's interesting because it used to be thought that with depression research it was just three chemicals, dopamine, norepinephrine, serotonin. But now we're learning about other chemicals in the brain that are important. You know, look at the glutamate model and the GABA model. GABA is one of those really important neurotransmitters that calms your brain. So you would think, well, why are we talking about calming in depression? Because it's really hard to be joyful and to access the things in life that bring you pleasure when you're tense. So we have to talk about anxiety and depression together. And you know how I mentioned that in my research I found a high correlation between trauma and pain and high functioning depression? Well, if you're constantly revved up, one of the questions in my questionnaire is the psychomotor agitation. That's the restlessness. Then how can you even sit still to enjoy a basic meal? You're just in default mode. You're thinking, you're worrying, you're not even staying present. And that's why when we travel to other countries and we see these thought leaders, these gurus, they just seem so joyful because they're so peaceful. It is really difficult to find joy, to access joy when you're not at peace.

Rich Roll (24:31)

The AA version of that is sobriety is being happy, joyous and free. And the kind of dry drunk is restless, irritable and discontent.

Dr. Judith Joseph (24:44)

Well, there's a lot of anhedonia in chemical dependency. A lot of it. Because people think that, oh, well, you just want to get dependent on something because it gives you joy. It's the opposite. Once you're at a point where your brain is dependent on a substance, the lack of that substance makes you so irritable and feel so unpleasant physiologically that it's not even about accessing joy anymore. You just want to get rid of that pain. And, and that's why I think a lot of people don't really understand what happens with someone who's struggling with addictions. You know, they see it as like, oh, you're just a hedon. You're just hedonistic. You just want pleasure. No, they're trying to get rid of that pain.

Rich Roll (25:22)

Sure. And when you remove the substance and aren't utilizing the tools, you have the emotional pain that is still there. Right. Needing to be addressed. I mean, that's like the real work. And, and in terms of that anhedonia piece, like, it's more than just a lack of being able to feel joy. It's also just a general kind of numbness to all experiences.

Dr. Judith Joseph (25:47)

Yeah, it's a coping mechanism. I think for many of us, we avoid dealing with these feelings in general. And it could be cultural, it could be something we're taught, but it also could be something that was defense mechanism in childhood, that if we didn't feel we walled it off, then we'd be safe. And initially that's helpful, but over time it robs us of our birthright of joy. And it sounds so granola y, but we have to start feeling again. We have to start processing and stop out running so that we can feel all of those emotions, because that's when the healing begins, and that's when we can actually start to access the joy.

Rich Roll (26:27)

Hmm. Let's talk about the trauma piece. Let's parse this out between the big traumas and the little T traumas.

Dr. Judith Joseph (26:37)

So in PTSD research, there's an assessment called the CAPS 5, and many people probably heard about it during the Johnny Depp Amber heard trial because one of the clinicians pulled it out and wanted to measure whether or not any of the individuals in the case had real trauma. But it's a very powerful gold standard tool that's used in psychiatry research, and it was developed out of the veterans hospital to look at whether or not combat veterans had a certain level of trauma. And so some of the criteria for trauma with ptsd, you have to meet criteria based on it being life threatening or something, you know, physically painful happening to you or to someone that, you know, you witnessed this happening to someone else. So the traumas have to be major, like an assault or near death. However, what I was saying, Since 2020, people come into my, into my office saying, you know, I lost my business or I went through a divorce. And they wanted to be in these PTSD studies because they were experiencing that fight or flight. But I had to tell them, like, you don't meet criteria. Do you know how disheartening that is for people invalidating it is? So I have to tell them, your trauma does not meet textbook criteria. But off the record, I'd say I believe you because trauma is anything that is so emotionally significant, psychologically significant, that it shapes the way that you view yourself and the way that you interact with the world. And I say that because one of the most common trauma responses that I see is internalizing self blame, shame and guilt. That's important. You know, it's not as, you know, sexy or flamboyant as a nightmare or a flashback, but it's really important because if you have unresolved trauma and you don't feel worthy without doing for others or having a role or showing up even when you're in pain, then you continued busying yourself. You never process that pain. You cope by just showing up and being the rock. And many people in positions like yours, you know, the thought leaders, the entrepreneurs, the fathers, that's how they cope. They don't ever process those wounds. They continue busying themselves because there's this inner self worth that isn't there. That they believe unworthy because they believe that they are somehow at fault for what happened to them. They feel shame if they talk about it. They don't want to burden others. So they just keep doing. They keep busying themselves, and they don't ever process it. And so I think that it sounds like very, I think, emotional for some people who are not accustomed to facing their problems. But it's important to acknowledge this. This is how you start to change. If you don't acknowledge it, if you don't validate it, it's very difficult to start changing.

Rich Roll (29:38)

What you resist persists and actually grows. I think it was Carl Jung who said that under that umbrella of trauma, like, if you define it broadly enough, it seems as if everybody would fall under that category. I mean, it's like we've all had stuff that's happened, right? And some people have had to weather and suffer through enormous traumatic experiences, others mild emotional experiences. But I suppose it's about how our brain processes it, right? And whether we, you know, move towards it and try to work through it, or whether we compartmentalize it and try to, you know, consistently outpace it.

Dr. Judith Joseph (30:21)

Well, we've all had painful things happen to us, but some of them didn't necessarily shape the way that we view ourselves. You know, some of us will say, oh, yeah, you know, my grandma died. It was sad, but it didn't significantly alter the way that we view ourselves and the way that we see ourselves in the world. But for others, we are different. These instances do shape us. You know, like, divorce is a trauma that many people experience, but they don't talk about it. Why? Because of the shame. You know, people think that somehow they were at blame, and they may have been at blame, you know, but others, you know, it just happens. It's something that happens in relationships. Relationships fall apart. For me personally, when I was going through a divorce, there was a lot of that guilt and shame. Even though on a conscious level, I'm a psychiatrist, I know that this happens. People grow apart. But on a deeper level, I felt, well, there should have been something I could have done or maybe I did something wrong. You know, we all experience this, but because I have tools to acknowledge it, I know how to work my way back and say, okay, this is something I have to challenge as a core negative belief that I have to challenge. But many people, they don't have that. They don't even have the acknowledgement that this is something that can happen due to a trauma that people don't even acknowledge because they say, Everybody goes through that, right? Something that is a common trauma that people don't acknowledge is birth trauma. We'll say that many mothers, they have typical births, but some have very painful births where they don't want to talk about it because every mother gives birth. It's something all mothers do. Why are you complaining about it? But for some, it was very painful. It was very traumatizing. They could have lost their lives, but they don't talk about it because that's what mothers do. You know, there are these things that happen to us as human beings that we just believe that, okay, many humans go through this, so it's okay. Why are we trying to call it a trauma? But for so many of the people I've worked with, these instances have shaped the way that they behave, the way that they view themselves, and the way that they interact in the world. So it needs to be acknowledged. And only when we acknowledge it and validate it can we work our way back to see how it impacts the way that their relationships are, the way that they work in the workplace, the way that they interact with their children. And these are all areas where they're losing their joy because they haven't even acknowledged how these traumas have impacted them.

Rich Roll (32:52)

The word trauma is such a loaded word, though. I almost feel as if we might be better off if there was something else in the nomenclature. Because when you say trauma, it's like, it wasn't a trauma. Like, yeah, it was bad, and, like, I had to get through this. But, like, you know, this is a common experience that many people have to your point. But because the word trauma gets associated with it, it's like, yeah, no, I'm not gonna. I don't. We're not doing that. Right. Like, I'm cool.

Dr. Judith Joseph (33:19)

Yeah, it's like the word trigger, it rubs people the wrong way. Trauma trigger is a triggering word because it's been overused. But I do think that, you know, for some, these painful instances are not traumas. For them, it doesn't lead to this response, and in others, it does. And. And it's validating to name that for the person, because what it tells them is that this thing happened to them. It wasn't their fault. It impacted you in ways that you were not even aware of, and that's why you were coping in ways that you probably wouldn't have if you had known better. Right. If you've known a different way of coping. And this is why you can't access joy. And I think that's powerful for some individuals because that allows them to take that shame and guilt off of themselves so that they can actually start to change.

Rich Roll (34:09)

So let's go back to this idea of the day in the life. Like walk me through, like if somebody is suffering from this, how are they waking up in the morning and making decisions throughout their day?

Dr. Judith Joseph (34:19)

Well, everyone's different. But what I find with my high functioning folks is that they do have a lot of anxious energy. So they end up waking up before their alarm. They don't have a sense of self worth so they don't nourish their bodies or take the time to eat properly. So a lot of them are just so, you know, eating unhealthy foods or not eating at all. They're revved up on caffeine, drinking a lot of coffee so that they can keep doing because that's what's important to them. Or when they do decide to have a meal, they're sitting at their desk, they're working, they're not actually savoring their food, they're just kind of, you know, cramming it in their face and they're ending up with acid reflux. They're not going to the bathroom during the day because they invalidate their basic needs. So they come home and they have to go straight to the restroom. They're with their kids and they're not because their mind is still at work. You know, they can't slow down or their mind is thinking about something else. So they're leaving the basic joys of connection, right? This family that they have, they're leaving that joy on the table because they're not even looking at their child. Their mind is somewhere else. And then when it's time to go to bed, they're thinking about what they have to do the next day. So it's hard for them to relax. So what do they do? They doom scroll because that's their way of controlling the outcome. Let me just keep looking at all this news and maybe if I keep looking at it, something will change. Well, we know the news won't change. It's always going to be there and it's always going to be bad news. And then the day starts again and they're leaving out the points of joy, the simple things such as your dog is at your leg during dinner and trying to get your attention. You're ignoring that dog because you're not present. You know, your loved one just wants you to notice them, but you're not. You are taking them for granted. Your food, which you used to enjoy, doesn't give you the same pleasure because you're so busy thinking about other things you're not even engaging in. Oh, this tastes really good. Like, I like that flavor. You know, you're not being present. And you know, I said that a lot of other countries will have gurus and monks who seem so peaceful and joyful. Well, that's it. You're not at peace. So you can't even sit still to access things such as a meal, you know, enjoying and savoring a meal. Or if you have access to nature, you're not looking outside, you're looking at your phone, or you're looking at your work, or you're focusing on something else. You're leaving the basic joy on the table.

Rich Roll (36:46)

What is the difference between somebody who is suffering from high functioning depression and somebody who just by dint of their circumstances and environment simply has a very challenging life? Like, if you are economically challenged, you're a single mom, you've got two jobs, and you got to take the bus and you're on food stamps. I mean, it's environmental. Also approaching it from a holistic perspective, there are many vectors and variables at play. Certainly it could be a trauma response, and then symptomatically you have anhedonia and these other kind of outward manifestations of it. But is there a qualitative difference between somebody who is just doing the best they can and this more striver driven runner and gunner?

Dr. Judith Joseph (37:40)

Yeah, I love that question. Because in my lab I see people who are very, very wealthy and people who don't have very much. And in research, especially the line of work that I do with novel medications, depression does not discriminate. It doesn't care whether or not you are rich or you have nothing. And there's a model that I think that is very helpful to understand because there are many ways that you can be robbed of joy. It's a simple model. It's called the biopsychosocial model. And every medical student knows about it. So biologically, what are the things that get in the way of your joy? So what are your medical conditions? For me, I have a low thyroid. And so if I don't check my thyroid, I have to be very careful about feeling anxious or depressed. But for others, it could be something else. It could be they have really bad asthma or they have an autoimmune condition, they have chronic back pain. Psychologically, what's happening in terms of their past? So do they have attachment styles that are not helping them to have healthy relationships? Do they have unprocessed past Traumas or ADHD or other conditions. And then socially, what is their life like? So what you're talking about with the woman who is a single mom who works hard, who doesn't have resources, she's gonna have a lot of social stressors that are different than someone, let's say, who's upper middle class. You know, she's worrying about finances. She probably is dealing with some, you know, aggressions in the workplace. She's worrying about her kids. She probably doesn't have the support, and she probably doesn' have access to foods that are not processed or access to nature or has the ability to move around and get activity. Right. Those are all the things within the social context. And we also know that people from lower socioeconomic brackets, they have other things to deal with. Their environments may not be clean. They may have toxins in the environment. So those are all areas where absolutely, they make major contributions to whether or not you have depression or anxiety. But what I found interesting is that even when I travel to countries where people don't even have running water, right, People are in dire straits of poverty, you can still find joy, right? You still see people laughing, dancing, communing. So it's not all about what you have, right? And when I talk about joy, I talk about these moments of pleasure. So when you're sitting still and you put your feet up, do you feel rested? You know, when you're hungry and you eat, does it satisfy you? You know, these are these moments of joy. These are the experiences of joy versus the idea, which you know, of. Of happiness, right? When I finally pay off my debt, I'll be happy. When I finally find a partner that I love, I'll be happy. When I finally have, you know, this clout that I desire, I'll be happy. That's the difference. So you can still access those moments of joy that give you hope versus this idea of finally being happy. So when you think of that single mom, because I've worked with many of them, some of them have severe mental illness, like schizophrenia, but you'll still see them connecting with their kid. You know, like, one of the stories I tell often is working in the clinics, I'd work with these moms who had severe mental health issues. And some of the workers in the hospital would say, well, let's not offer this program to them because it's a lot of paperwork, and they're gonna, you know, they may not be able to do it, and we're just gonna overwhelm them. And I would say, don't underestimate a mother who comes from nothing, who's not well educated, who has a severe mental health issue because she's still raising her kids, she's still bringing them to school every day, she's still bringing them to her appointments. Don't underestimate her. So even if you have these challenges, you can still access that joy. It is a mindset. Mindset. It's a mind shift, you know, if you're willing to.

Rich Roll (41:49)

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It's really the only wearable that gives you a truly comprehensive, extensive view of your body, helping you to make smarter decisions about when to push and when to rest. So check it out. Go to join whoop.com roll that's join.wH-O-O-P.com roll the high functioning person generally, in my experience, has a pretty powerful motor. Like they have this drive. They're trying to make their imprint on the world for better or worse, right? And trauma may be the kind of cause of why they are that way, or at least in a related way, but the fuel for that drive is essentially fear of one form or another. And that fear is linked obviously to the trauma or to some other root cause or source. But it is a fear response, right? This fear could be if I don't do it, like everything's going to fall apart or my identity is so wrapped up in what I do, and if I don't show up for it, then who am I? I'm scared of how other people will perceive me. In treating people who suffer from this, I suspect you have to identify the locus of that fear and try to deconstruct it.

Dr. Judith Joseph (48:12)

Yeah, I do. And you're absolutely right. That fear is what we would call anxiety, right? Fear of the not being loved, fear of the running out of money. For me, I have done this deep dive into my own past because I came to this country with very little from the Caribbean. And I didn't even realize how this chasing accolades, you know, not just having one lab, but three labs, you know, having all these roles was tied to this fear of running out of resources. On a conscious level. I knew, okay, there's no way I'm going to run out. The money's in the bank, I'm good. But the inner restlessness came from this unprocessed fear of running out. And many people, you know, they may not have come from the similar background that I have, but the generations before them that could have been passed down. You know, let's say if your grandparents came from a war torn country where they were oppressed and they came here and they lived in ways that, you know, you're not supposed to take risks, you're supposed to hoard, you know, don't waste food. Some of your behaviors are out of this scarcity trauma that was never processed. And that's why it is important to sit still and to trace yourself back to that moment. It could have been in your own, in your past, in your family history. It could have been in your personal history. But it's important to sit down and reflect on it. It's validating.

Rich Roll (49:45)

If you take your foot off the gas, it's all gonna collapse, right? Like, it's all gonna go away. Whether that's an imposter syndrome thing or a scarcity mindset or trauma. Unless I'm there doing it all the time, it's all gonna break down, which is a fear response. It's also, there's a layer of narcissism on top of that. It's as if, like, I'm so powerful, I'm so afraid of being not in control, but I'm also all powerful and I will be able to solve it. And beneath that is a discomfort with uncertainty because this scarcity mindset is really a discomfort with not knowing what's going to happen. And so what can I control? Well, I can control my output and my work and that will solve it. But of course the world is uncertain and no amount of work or effort is going to allow you to transcend that.

Dr. Judith Joseph (50:45)

I love that you said narcissism because one of my professors in training at Columbia once told us to look out for people who have. They're like the flip coin. One side is narcissism and the other side is masochism and narcissists. You know, when we think of narcissists, we think of people who are full of themselves, who lack empathy, who are, you know, prideful and boastful. But we don't think about the masochistic narcissist who bends over backwards, is constantly working, is delaying pleasure because they believe that they're the only ones who can do it right. Only they could do it right. And I think many people with high functioning depression have these narcissistic masochistic tendencies. And it's not because they're a bad person. It's just because they didn't process that pain. And what they end up doing is finding their self worth in that role. So they. It looks very narcissistic. I'm the only one who could do it. But it is masochistic because they're bending over backwards.

Rich Roll (51:45)

But it's self validating also. And then you look at the world through that lens, like, see, when I did it, it worked. And when you didn't, it didn't work. You know, and it's constantly being reinforced that way.

Dr. Judith Joseph (51:56)

But they're not happy. Yeah, they're leaving joy on the table. They are miserable.

Rich Roll (52:02)

I want to talk more about the masochism piece because I watched and listened to a bunch of your interviews, and there's a lot of talk about the anhedonia and the trauma stuff, but less so when it comes to the masochism piece. And that's another kind of loaded word. Right. But I think it's super interesting and, and because at least to me it seems like this is a less discussed pillar in this, that we could take the opportunity to kind of dig a little bit deeper into that.

Dr. Judith Joseph (52:33)

Well, the reason I don't talk about masochism is because the algorithm will block you.

Rich Roll (52:37)

Oh, really?

Dr. Judith Joseph (52:38)

The algorithm thinks that you're talking about sex. So. And I teach media at nyu, so like, I know that that's interesting.

Rich Roll (52:45)

I hadn't even thought about that.

Dr. Judith Joseph (52:46)

Well, if you look at, I mean, for someone who does so much high functioning depression content, it's hard to find me under high functioning depression because I have to change the S to like a dollar sign. Because the algorithm will block the word depression, It'll block the word anxiety, you know, things like that. So I have to be creative to get the word out about this stuff. I have to like disguise it. But masochism is one of those words that most people think of, like sex, but there's actually masochistic personality disorder that was in the dsm, the bible of psychiatry, for years and then around the 80s or ninet was taken out because it was thought to be victim blaming. And so typically masochistic people would be people who somehow incited others to treat them poorly. Right. It does sound victim blaming or, you know, in addition to that, they don't believe that they're worthy of praise, they don't believe that they're worthy of pleasure. They bend over backwards for people, even though those people are takers. And so the more modern version of masochism is people pleasing. A little different than being a martyr because martyrs kind of wear that as a badge. People pleasers are usually miserable, but they can't stop. But the masochistic tendencies that we see with high functioning depression rob people of joy. They end up doing so much. They end up believing wholeheartedly that if they don't do, they're not lovable. If they don't say yes, they'll be rejected or abandoned. And so they don't know how to stop. They're not realizing that if they do say no, if they do set boundaries, people will actually love them more. So I felt that it had to be in there.

Rich Roll (54:26)

No, I think it's important, the idea that you have to not necessarily be a martyr, but you are kind of wearing a hair shirt and flogging yourself. But there's also that narcissistic piece. It is doing something for you. Right. You have to recognize that all of these errant behavior patterns are serving you in a certain way. And when you combine that with that conditional love piece, like, my value is only insofar as I can go out into the world and bring home the bacon or achieve this thing. Right. You're on this habit trail with that, and you're going to perpetuate that even as your experience of anhydenia is going to increase, and then it becomes difficult to get off of it because you have been that person who said, I'm the only one who can do it. And so everybody said, well, okay. And then you're kind of left with yourself. Right. And you're in this lonely, isolated place as a consequence.

Dr. Judith Joseph (55:27)

Yeah. The takers will continue to take. They will take as long as you're giving. It's human nature. It doesn't mean that the people in your life are bad, but we learn, you know. You know I said that trauma shapes the way that you see yourself and the way you interact in the world. Well, if you're gonna keep giving because you believe that that's the only way you're valuable, then people will continue to take, and then you will end up feeling depleted and without joy.

Rich Roll (55:53)

You don't set boundaries with others, but also with yourself. Right? Yeah. That's not a great situation to be in, is it?

Dr. Judith Joseph (56:02)

It's not. The great thing about it is that when you start realizing it, you start to change. I remember when my very first therapist said to me, judith, what you have is contagious. And I was like, what are you talking about? And this is from someone who resisted therapy. Because I came from a very Caribbean religious background, I didn't think I needed therapy. I was like, that's for people who have severe mental health issues. But training at Columbia, they offered us free therapy with some of the greatest psychiatrists in the world. And I remember my first therapist saying to me, what you have is contagious because. Because it's masochism. You don't believe that you're worthy enough to do this very special type of therapy where you're getting these resources at a very small amount of money. You don't think you're worthy. So you're coming late to all your appointments. But what you're doing is you're making me late for the next guy, the guy who's waiting in the waiting area. It Spreads.

Rich Roll (57:00)

There's a selfishness to it.

Dr. Judith Joseph (57:02)

There is, and it is contagious. This unhappiness, this masochism, it spreads. And there have been bouts in my life when I've looked around, when I was going through my masochistic tendencies, and everyone in the lab, they were overworked too. When I'm busy, when I'm masochistic, my team is. But when I slow down and I start to tap into joy, they start to be joyful too.

Rich Roll (57:25)

So just to put a finer point on it, how is this masochism root or why is it so important to really understand in terms of overcoming this disorder?

Dr. Judith Joseph (57:40)

Just acknowledging it and being aware of it allows you to change. There's something called affect labeling in psychology. If you acknowledge the issue, if you acknowledge the feeling or the experience, then that decreases uncertainty and it allows you to create change. So I often liken it to, let's say you're in this very dark room and you can't see and you hear a loud crash. You know, some of us would start running, some of us start swinging, some of us would start screaming. But if you turn the light on and you saw that, oh, it was a vase that broke, then you're more at ease knowing what you're working with, knowing that, okay, I tend to be a masochistic people pleaser. That explains so much for many people. And knowing that it's related to unresolved trauma or low self worth, that decreases the uncertainty for the human brain.

Rich Roll (58:39)

Right. If you are able to identify the behavior, then that becomes a window into perhaps the trauma that gave rise to it in the first place.

Dr. Judith Joseph (58:48)

And it just allows you to feel that there are things that are more certain. Uncertainty is not great for the human brain. Look at 2020. None of us knew what was going to happen. And many of us became depressed and anxious. When we don't know what we're working with, we are tense, we are anxious, we make terrible decisions. When we know what we're working with, when we know why we are the way we are, we're able to make better decisions and we are less stressed.

Rich Roll (59:15)

How long did it take you to recognize this within yourself? Like, I'm just imagining, you know, the young version of you coming from the family of origin that you did and your background and circumstances to be this a student, top of the class, Columbia. You're the classic striver, and your upward mobility is skyward. So at some point, what was the inflection point or the crisis or what kind of intervened to make you more Reflective about this in your own life?

Dr. Judith Joseph (59:50)

Well, there are many of those times, but there was one that really, I think, created a change and a shift for me. It was. I was at my desk in 2020 and I was given this talk to this large hospital system, and they were frantic. Some of the questions coming through were like, you know, am I going to even survive? Like, how do I get through this? I'm seeing so much death. And I was supposed to be the healing voice. And halfway through the talk, I was just like, I think I am depressed. It just hit me and it wasn't the first time I've been depressed because I couldn't go back in my life and see these moments where I just wasn't even acknowledging it. I was high functioning af, you know, but that moment I was like, wow. Like, I just felt. I felt like so much anhedonia. And I was like, what am I doing here? You know, I'm helping this hospital system, but my lab is still going, you know, so it's full throttle. We can't shut down these FDA monitored studies. The city's quiet, look like, you know, Zombieland. And here I am, this young mother at the time, still married and having to stick to this role of leader, this voice of reason, you know, this healer. When I'm unhealed, you know, so that is a moment in time where I just thought, wow, if I'm like this, how many people are like this? There's gotta be someone else like this. And, you know, there have been times after that where I find myself, you know, experiencing anhedonia and being masochistic. But now that I know what this is, I tell myself I just gotta do more of the things that I really love. I need to go back to the basics. I have to understand the science of my happiness, you know, because the science of my happiness is gonna be different than yours. For me, I know that that points of joy that really make me feel spiritually full and fed have to do with being close to my family, being able to see my daughter frequently and not overworking, being connected to my team. So I know now that when I'm feeling masochistic and anhedonic, I just gotta be more connected. But it could be different for you, right? You're gonna be different than me. The science of your happiness is different than mine. And that's why I want this information available in my book. I want people to understand that there's only one you and there will only ever be one you. So understand the science of your happiness. What are the things that are taking away from your points of joy. And when you understand that, then when you're feeling this anhedonia and you're feeling this masochism, you know where to add those points back because you finally understand you.

Rich Roll (62:27)

There's a boldness to taking action on this that I would imagine is not always well received. Like, if you're in the medical profession, you know, I have stories about this from being a lawyer, or you come from, from a family that has established certain expectations around how you behave and suddenly you decide you're going to do something different that's not necessarily going to be well received at your place of work or at home. And so it takes a lot of courage, I think, to take a stand for yourself and say, I'm not going to be this people pleaser anymore and I'm going to set my own trajectory. That's going to be a little bit different. You're going to ruffle some feathers. I know, like, this has happened with my family, but also I'm remembering being a corporate lawyer and there was one weekend where I was working on a Sunday and a partner came in and he had just come from his wife having given birth. Like, he literally left the hospital and went to go finish a brief. Right. And you're in this environment that's reinforcing that behavior. So to your point of contagion, like, there's an expectation and a sort of pridefulness around this behavior. And if you're to say, yeah, I'm not going to do that anymore, they're like, hold on, you know, no, this is how we do things here. You're gutting again, you're going against the grain.

Dr. Judith Joseph (63:49)

Lawyers, medicine, it's very similar that, that you're in the trenches kind of culture, you know, like, what makes you so special that you get to slow down, you know? And I used to be an anesthesiologist before I was a psychiatrist. And I had to leave that field because, wow, like, talk about trauma and unprocessed trauma. There's a lot of that in medicine. You know, I remember one of my first months as an intern and giving chest compressions to someone who ultimately passed. And then there was no like, oh, let's sit and talk about this. It was like, well, who's got the next shift? You know, there's just so much of this culture of like, man up, you know, like, this is part of the job. Get over it. So the healers are really unhealed. And I see this in fields like lawyers, attorneys, the Legal fields, you get shamed if you show feelings. Come on, talk about unprocessed trauma. I think it's important to talk about these things now. Not to say that everyone should just stop what they're doing and stop working. People with high functioning depression have something called all or nothing thinking. When we hear you gotta slow down, we think, I can't stop. Slowing down is not the same as stopping. We automatically go to, well, people need me. No, I'm not saying to stop everything. You know, slowing down can just look like, okay, during lunch today, for one day of the week, I'm going to make an intentional decision to close my screen and eat my lunch and like take the time to chew it and notice the flavors and enjoy it. Like, have pleasure in a basic thing. That's what slowing down looks like. It doesn't mean that you're going to miss the board meeting because you're sitting there eating your salad. It means you're going to treat yourself like a human being.

Rich Roll (65:33)

How is is HFD different? Maybe it's not from what Arthur Brooks talks about. The Strivers dilemma. Have you heard this? It's just basically like you can't get off the treadmill. The happiness and the joy and all these things that you're seeking, whether unconsciously or consciously, are always on the other, right around the bend, on the other side of the next promotion or accolade.

Dr. Judith Joseph (66:01)

Well, that's different because the Strivers dilemma is someone who delays happiness. Right? They're saying that they still have to do this one thing and then it's not enough. They get the one thing done, they continue going, it's not enough. And they're constantly on the go. Right. High functioning depression. You know, when you look at depression and criteria, there are specific checklists in there. There are symptoms like poor sleep, you can't focus, low energy, feeling shame and guilt, and hedonia. But then you're different than people with the clinical depression because you're actually overdoing. You're not stopping functioning. Right. That's very different. And then the Strivers dilemma, maybe he does talk a bit about the lack of joy at the anhedonia. But for those with high functioning depression, they have the symptoms of depression, but they're not stopping, they're overdoing.

Rich Roll (66:59)

How has all this discourse in the book and your work in this area been received by your peers?

Dr. Judith Joseph (67:07)

Wow. I get so many doctors coming up to me saying, thank you for doing this. This is me. I would never say that I had this, but it's me you know, on the flip side, I get people saying, well, clinical depression is more important. And, you know, it's not a competition. There's enough depression for everybody. Right. I think what people want to focus on specifically in psychiatry, is people who have broken down and you know what? They do deserve support. Right. People in crisis deserve support. But my whole philosophy is, why are we waiting for people to break down? You know, we're seeing this boom in longevity where people are saying, don't wait for the cancer to spread. Like, let's teach people how to identify the signs and to avoid the risks. And with menopause, you know, you're seeing, don't wait for the osteoporosis and the heart disease. Let's try to prevent it. In psychiatry, we're in the dark ages. We're still saying, well, let's wait for that box of let's break down.

Rich Roll (68:01)

When you can't get out of bed, call me. Yeah, I mean, there's a prophylactic sort of preventative angle to all of this, but I also know there's people out there who think you're minimizing depression by characterizing it in this way.

Dr. Judith Joseph (68:16)

Well, you know what I'm saying that two things can be true. Why do we wait? You know, why are we waiting for people to be in crisis, to break down? Let's teach people the tools that we learn in medical school. Let's teach them about the biopsychosocial model. Let's teach them about trauma, even if it's not like major traumas. Let's teach them about how they cope negatively by pushing down these emotions rather than processing them. Because if we don't, we are just not going to have the mental health health professionals to deal with what we're seeing now. And, you know, look at 2020, they were asking out of work psychiatrists to come back into the field. Why? We just didn't have enough. We didn't have enough professionals to address the crisis. We still don't have enough. If you go to most major cities, you'll still be on a wait list to see a psychiatrist for six to eight weeks. You know, in other rural areas, there's one psychiatrist for every 30,000 folks. We're not being proactive, we're being reactive. This is a proactive approach, giving people the tools, letting them recognize the symptoms and the signs of mental health issues before they break down. Let's not wait for them to check that box. Let's teach them about ways to prevent that box from being checked in the first place.

Rich Roll (69:34)

I want to get into the tools. But before we do that, I think it's important to spend a few minutes talking about, about the people who are at risk. Because it's not just these type A ambitious people.

Dr. Judith Joseph (69:48)

It's not. I mentioned the single mom who can't slow down, who maybe doesn't have a partner to support her, who doesn't have the financial resources. It's not just the high powered lawyer or doctor. It's someone who, like me, comes from scarcity trauma, who didn't grow up with much. Maybe they have an immigrant background too and they don't know how to stop working because they're always afraid of running out. You know, it could be the educator, the teacher who doesn't even eat lunch because she's so busy trying to help her students and she neglects her own needs. You know, the entrepreneur who doesn't want to be bankrupt again, so doesn't stop working. In fact, can't even enjoy vacations, right? This is different than burnout. When you remove them from the work, they're still busy. So think about the everyday people in your life. Who are the rocks, you know, who can't say no, who do for others, who give. They can't slow down and they don't acknowledge their pain. Eventually it could lead to a clinical depression, or eventually it could lead to a physical breakdown, or it eventually leads to coping in ways that are unhealthy, like excessive substance use, being on your phone, too much gambling, things like that.

Rich Roll (71:02)

What's happening in the brain?

Dr. Judith Joseph (71:04)

So depression, what we used to think in the brain had to do with three neurotransmitters. It used to be thought that there was a depletion with dopamine, norepinephrine and serotonin. But now what we're learning is that this was an old model. For example, if it were just about those neurotransmitters, then we could just put everyone on a pill and everyone would get better, right? We'd all be happy, there'd be no depression. But it's not that simple. And what we're learning now, that it's about a lack of healthy connectivity, not neuroplasticity, which is a fancy way of saying that our brain cells are not being connected in ways that they should be so that we can feel a sense of joy. The reason that we know that is because when we look at brains using functional MRIs, we know that depressed brains are not as connected as brains that are not depressed. And that it's not just about These three chemicals mentioned earlier that there are other chemicals involved. Glutamate, gaba. The gaba, the one for anxiety and stress, that all play in a role together, to work together to make sure the brain is connected in ways that is healthy. And I wish I could say that you could just image your brain and say, this is what's happening. But we're not there yet. But we are learning that experiences can change your brain. For example, meditating, things like being still and present mindfulness. Sometimes we see that with the brain. The way that a brain that is mindful and meditating. It looks as if the brain is being treated for a depression. Right? Because we're able to open up these pathways by utilizing skills to help us to have more emotional regulation.

Rich Roll (72:49)

I imagine that the patient who suffers from this may be more treatment resistant than the average person who's suffering. Because despite the anhedonia and the kind of isolation that that produces, there is something self affirming about being high functioning and for good reason. Like, it feels good to like be productive and get things done. And irrespective of the symptoms that you're experiencing, what you're proposing is we untie this knot and that's sort of like a threat, right? Like, oh, you're telling me that all these things that I need to do and have done forever, that have propelled me throughout my life, I now have to put the brakes on or set aside like, no, thank you, that's too scary because then my whole life is going to collapse. Your whole worldview has to be rewired.

Dr. Judith Joseph (73:51)

It's that all or nothing thinking with my clients that I see, it's like, what do you mean? In order to access joy, I can't be the person I was. You're not able to access joy because you are the person that you are. It is a complete different mindset for these people. I'm not saying you have to stop. I'm saying to slow down just a little. Try just one day. You know, it could be that one day that you say, rather than waking up and going straight to the coffee and then going straight to work, waking up, sitting and journaling, or, you know, instead of going from meeting to meeting, you literally pencil in a bathroom break so you can go and relieve yourself. It's really hard to feel pleasure when your belly's distended with urine. You know, pain.

Rich Roll (74:35)

Is it that bad? Like, people won't go to the bathroom.

Dr. Judith Joseph (74:37)

They will not. I actually gave a talk recently to a room full of high powered executive women. And I Asked them how many of you have worked straight through a day and you really had to pee and you didn't, and they just like started laughing. It was like this human experience that they all had together, you know, because we invalidate our bodies all the time in the way that we invalidate what has happened to us in the past. And the way that we invalidate our emotions, we invalidate our bodily sensations all the time. You know, when you think of athletes who they're in pain and they don't stop, and the doctor says, you have to stop, you're gonna really hurt yourself. But they don't, they're like, nope, no pain, no gain. And then they finally have this incredible, really serious injury and it stops them. Their body says no. And when your body says no, you have to, you have to stop. You know, it's the same thing. They don't invalidate how they feel physically or emotionally or psychologically.

Rich Roll (75:34)

It's weird how the human brain is so resistant to these ideas until you hit the wall and crash and burn. And then it's like, okay, now I'll look at this and do something about it. But obviously the course correction was available all along. Right. It's just that we have to, despite however many books we read, we have to crash the car before we're actually willing to entertain it.

Dr. Judith Joseph (75:59)

Yeah. As thought leaders, you have to constantly slow down and practice the things that you learn and the things that you preach. And it doesn't mean that you're not intelligent. It just means that as humans, we go back into our defaults. This is who we are.

Rich Roll (76:16)

Is it, in your experience, more acute with women and women of color who are in the workplace? Because there is this very real thing that, you know, look, I've got to show up and go above and beyond to distinguish myself in a male dominated environment. For example.

Dr. Judith Joseph (76:33)

Well, with women, for sure, women are twice as likely to have depression and anxiety compared to men. Twice. And so there's some real science to that. When you look at the science of your happiness as a woman, you know, biologically, you are dealing with hormonal changes once a month. And that could be related to either your period or perimenopause or menopause. Right. And then if it's perimenopause and menopause, that's more frequent than once a month. And then when you look at psychologically, women tend to have a lot of personal traumas that sometimes don't even get addressed. They have attachment styles that maybe they're partnered with the wrong person. And then socially they have pressures that men don't have. They have to be career moms. They tend to be people that are caregivers. And then the other aggressions that happen. And then when you look at black women, Black women have high rates of trauma. PTSD is really high in the Black community. And then they have other aggressions, social issues that, you know, others don't have to deal with. So absolutely, women and women of color, they constantly have to wear a mask of pathological productivity. If they slow down and if they say something's wrong, someone else will take their job, or you're called emotional, you know, or people say that you're complaining, you should be grateful to be where you are. So I definitely see that in women and women of color. Foreign.

Rich Roll (78:04)

Let'S get to the I spent my life challenging conventional narratives about fitness, about nutrition, about what's possible now and in the future as we age. Something that I'm increasingly focused on as I inch closer to my sixth decade. And with that, there's a conversation that's becoming increasingly urgent, and that is how do we reimagine midlife not as a period of decline, but as this profound season of growth and possibility? Well, on June 5th, my friendship, Conley and I are bringing that conversation to life and in person with an event called Wise and Wild, A Midlife Journey into Longevity, Purpose and Peak Living, which is this really beautiful one day immersive experience experience that's taking place in LA and is about breaking free from outdated scripts. I'll bring the endurance mindset, the relentless curiosity about human potential. And Chip's going to bring decades of wisdom about emotional intelligence and purposeful living. June 5, Louisiana this isn't just an event, it's an invitation to reconnect with your deepest self, to design a next chapter, the next driven by intention, not fear. So if you're 40 or older, feeling that relentless call to go deeper, to challenge your own limitations, this is your moment. Early Bird pricing is available through May 20th. Go to meawisdom.com richroll to learn more and reserve your spot. 5V's yes, let's start to solve this problem, right? What's your sort of introduction to orienting us around the tools that we can all use to begin to take a different direction? If you're somebody who is suffering from this.

Dr. Judith Joseph (79:55)

So the reason that I thought of the 5Vs was because I've traveled the world looking at different cultures and there are certain numbers that pop up across different countries. The number three, the number seven, the Number five. And I thought about five, because most of us have five fingers, you know, so there's something about five that connects us as human beings. And I wanted to have with my clients something that they could readily access when they're feeling empty and they're having anhedonia. I want them to look at their hands and say to yourself, you were built with the DNA for joy. It is literally built into your DNA, but you just forgot how to access it. And just imagine tapping into one of the five Es and reclaiming your points of joy. And the reason I say points of joy is because I don't want people to think, oh, I'm going to be happy once I do the 5Es. It's not about happy. It's not about this idea of my problem's being solved and I'm fixed for good. It's about getting those small points every day and saying, today I have a point, tomorrow maybe I'll have two. It's not about a state, it's about just getting those pleasurable moments. So the first V is validation. Validating yourself looks like accepting how you feel and acknowledging it. And I talked about how if you're not able to acknowledge how you feel, there's a great deal of uncertainty and a great deal of anxiety because you don't even know what emotion you're feeling. And so that's really important because people with high functioning depression tend to push down their emotions.

Rich Roll (81:34)

It feels indulgent to do that.

Dr. Judith Joseph (81:36)

It does, trust me. I know when I started validating and self validating, I would be like, you're just being lazy or you just gotta get over it. It takes a lot of practice.

Rich Roll (81:51)

And also, how is this related to happiness?

Dr. Judith Joseph (81:55)

The uncertainty of not knowing how you feel creates anxiety. One of the points that is measured in happiness is that tension, that uncertainty. And so if you're able to decrease points of uncertainty, that in itself is bringing you joy. You know, it's when you think about being happy, people think it's just one emotion, like in a smile, but adding up all of the sensations that bring joy. It's not just a smile, it's a. When I'm tense, I feel relaxed. You know, when I'm tired, I can get rest. When I'm hungry, I feel satisfied. These are all the points that we add up to measure happiness. So knowing how you feel and naming it and having that certainty decreases that anxiety. And that's how it relates to joy.

Rich Roll (82:51)

It also feels like a tool to rewrite a story that isn't working anymore. And by that I mean we all have a story about who we are and why we do what we do. But if your story is like, I need, this is how I do, you know, this is how I do it. And I'm, you know, like, I'm not the most talented, but I'm going to out, you know, all of that, right? By understanding what's beneath it and putting a word to it, you can reframe the story and start telling a different one. I think. You know, and I think, I think, I think a lot about, like, how the stories we tell ourselves inform our behavior and what we do. And we're so locked into them, we rarely ever even, you know, put them under a microscope and analyze whether they're actually true or not.

Dr. Judith Joseph (83:41)

Well, I mean, I use myself as an example. I recently had to go to this really important, intense meeting with these world leaders and I was just feeling so, like, I didn't know how I was feeling. I was like, just jumpy. And then I had to tell myself, I was like, judith, you're nervous. And then I had to trace back and be like, well, why are you nervous? Well, it's because you don't feel like you're enough. And why don't you feel like you're enough? Well, because all these people are older than you. Well, why is that? Well, because, you know, they've been doing this a long time. It's like, oh, but Judith, remember, you're the expert in this and you're going to be there helping them. And I'm like, oh, that helped. And it sounds so indulgent, right? Like sitting there and acknowledging my feelings and tracing back. But knowing why I felt that way allowed me to then self soothe and feel more joyful. And then I was actually able to relish in the experience. You know, I was chatting and joking and I walked away with a very different experience than I would have five years ago. You know, five years ago I would have still had my stomach in knots and probably would have been ruminating and analyzing every interaction. But now I can access joy of like, being in other people's presence, learning from others. I walk away feeling as if I got some points from that interaction versus leaving the points on the table.

Rich Roll (84:59)

It also allows you to change the memories you select, right? Like if you have that good experience, like if you're somebody who's like, well, all I'm anxious because your brain will point to a variety of memories in which you were in a similar situation. And maybe it didn't go so well, but now you have these new memories and experiences that can inform that new story.

Dr. Judith Joseph (85:22)

It's really changing a narrative. I do talk about that in my book.

Rich Roll (85:27)

What about the venting part?

Dr. Judith Joseph (85:29)

The venting? Well, venting from a scientific perspective, venting in physics is when you, let's say you have a balloon and you're letting the air out, so the air is escaping and you're releasing pressure. Venting from a psychological perspective is expressing negative emotions. And for many people, you know, they believe that venting is the same as trauma dumping. You know, like, I feel a certain way, I'm going to go and talk to someone and just like let them have it. But it's not the same. Healthy venting is doing so with intention. So when you're going to talk to someone about something, you are going to have this intention of, okay, I want a resolution, I want feedback, I want to solve this problem. It's just not for me to feel good letting out how I feel. Because there are recent studies that show that if you're just trauma dumping, you're just like telling people how you feel, good or bad, and you're not really being empathic in the intervention. You're not asking them how they feel about it. If they're right, ready, you're not getting that emotional consent from them, then you're essentially making yourself feel worse. The research paper says that it's like pouring gas into a fire. So when you do decide to verbally vent and talk to someone, make sure that you first self validate. You walk through your emotions and why you're feeling that way, that you self vent to yourself, maybe talk to yourself. There's recent data showing that people who talk to themselves actually get to better resolutions and they feel better when they vent and that you're not just picking random people to vent to. So many of us, unfortunately, we vent to our kids and we have to think about that power dynamic. Your child is not going to say no. They want to feel attached, they want to feel accepted by you. So they're just going to listen, but they're going to worry about you. Think about who you're talking to in your workplace. If the person reports to you and you're venting to them, they're not going to want to piss off the boss. Right. So really think about, about who you want to talk to and vent with intention and ask for emotional consent.

Rich Roll (87:35)

The vomit version of that is making it somebody else's problem as opposed to being a collaborator in looking for a solution.

Dr. Judith Joseph (87:44)

Yeah, because then that person will Just go ahead and vent to someone at home and it just becomes a cycle.

Rich Roll (87:49)

It's the contagious part, right?

Dr. Judith Joseph (87:51)

Yeah.

Rich Roll (87:53)

And then there's the value, which is basically just being clear on, like, who you are and what's important to you and having a compass.

Dr. Judith Joseph (88:01)

It's important. I do believe that over time, our values do change. The things that give us purpose and meaning. I remember when I was younger, I really loved reading. And it wasn't about the prize, the gold sticker. It was about having this experience of escaping these, you know, situations where I didn't have much and just being able to fantasize and imagine myself in a world. And just reading gave me so much pleasure. But then over time, reading became, oh, well, you're the fastest reader in the class. You're going to get this award, and then you're going to go into these schools. And over time, reading was a way to not fail. You had to read the organic chemistry or you failed the exam, and. And I just stopped really enjoying learning and reading. It was just something to do to avoid failure. So I do think over time our values change and it's helpful to again, sit still and reflect and to go back in time and figure out what was it that lit you up? You know, why is it that I feel meh or blah? At what point did I lose that?

Rich Roll (89:09)

I'm curious in your own life if this is an issue for you now because you're in this new chapter of your life, right? You strived, you got to a certain place, you had to reconcile all of these issues within yourself so you could be more joyful and happy, et cetera. But then you write this book about this thing, and suddenly you're on the Today show and you're traveling here, and I'm sure you're in high demand as a speaker, et cetera. Those are very activated for that disposition to be high functioning in an unhealthy way. So it's almost as if the universe delivered you like, okay, you're gonna write the book about this. Let's see if you can practice it in the most intense set of circumstances in which you're gonna be given opportunities to be lured right back into that way of being.

Dr. Judith Joseph (90:01)

Yes. And that's why I have to constantly go back to the science of my own happiness. I was just talking about to a friend of mine who has a very successful podcast earlier this week, and she told me, she was like, make sure you're taking it all in. Make sure you're doing the things that bring you joy. So I am intentional on my travels, when I see someone in the audience who I can tell that they're really impacted by my work, I will make it a point to talk to that person. And they may cry, you know, they may laugh, they may hug. But again, I understand. For me it's connection. Connection makes me feel joyful. And so if I'm going from place to place and I don't have time to even connect with anyone, then I know that this is a problem. I'm going to end up with anhedonia. And not to say that you're going to be completely healed. I think it's important to know. I don't want you to tap into all 5Vs all the time. Don't be high functioning like that. You know, really focus on one or two that you need in the moment. And when you do understand yourself and you understand the science of your happiness, it becomes very clear what are the things that you need to do to stay joyful. And you will be intentional about protecting those things. And that's where the values really come in. What are the things that anchor you?

Rich Roll (91:17)

The next one is vitals.

Dr. Judith Joseph (91:20)

This is the one that.

Rich Roll (91:20)

This is basically lifestyle.

Dr. Judith Joseph (91:22)

Yes. It's the mind, body. You only get one body and brain. You have to take care of them. Them. You know, I won't, I won't bore you with the traditional ones, sleep and movement and diet, but there are those non traditional ones that we don't acknowledge, you know, like our relationship with technology is a huge one. I'm on socials and I teach social media to doctors so I have to like be up on that. But I have to be very careful not to spend too much time on my phone because it is, is literally draining your joy. Talk about anhedonia. When you're on your phone all the time and you're not out in the world and you're not talking with people and you're not engaging in the physical sensations of being a human being. That is how you become anhedonic, you know for sure. Yes.

Rich Roll (92:10)

What do we know or not know about the incidents of this in our current moment? Like it feels like we're in a situation in which, in which we're just rife for this being, you know, kind of epidemic in proportion. Is that the case? And if so, beyond just get off your phone. Like how do you make sense of that, like forensically? Like what's going on in our culture that is fueling and contributing to this?

Dr. Judith Joseph (92:40)

Well, there was a recent study that came out of One of the Texas University universities where they took adults out, you know, it was in a lab setting, but essentially they changed the settings on their smartphones so that instead of having the capacity to go online seamlessly, their phones became kind of like the old flip phones where you couldn't, you know, be on social media, you could use your phone to stay connected and call people, but you couldn't constantly be online. And. And what they found is that when they limited this for these individuals for two weeks, the amount of joy that they started to experience was similar to as if they had gotten a treatment for a depression. And the reason that they found that this worked is because these people were spending less time on a device and more time connecting or walking in nature or moving or sleeping. Right. All of the things that I said, when we add up points of joy, this is what we measure happiness with, right? So all of those human sensations were being accessed more when you weren't on your screen. I don't think there's a way to measure anhedonia across the country and the nation yet, but we all have smartphones, most of us do. So imagine if we just knew that this science was out there. We would probably be more intentional about how much time we spend on our phones. There's a lot of focus on kids, a lot of focus on children, but not enough on adults. And these are the studies that we need because this is showing us and validating for us what we're already experiencing. Those who are listening, who are like, why? How did I get this way? Why am I so anhedonic? These studies are important because they not just explain and validate, but they give us solutions.

Rich Roll (94:26)

Covid hearkened in this zoom culture work from home as a normal thing, even among young people. So I suspect that drives disconnection and loneliness and more screen time. But it's not just the screens. It's the combative, antagonistic nature of what the algorithms are increasingly serving us up, as well as the comparison aspect of it, where everybody's living a better life than you, that that's fueling on some level depression, perhaps, but also might be catalytic for this particular condition of high functioning depression, because it's reinforcing this idea, like, you've got to get out there, you have to do something with your life and you can't take a break and all of that, and that you're not good enough.

Dr. Judith Joseph (95:22)

Yeah, you're not.

Rich Roll (95:24)

And you're never going to be because every night you look at your phone and you realize, like, there's People much better. It's like an incessant reinforcement vehicle that is just creating more and more of this sense of depression. Right.

Dr. Judith Joseph (95:42)

Of unworthiness. Yeah. Looking at your phone and seeing what other people are doing, it further reinforces that idea that you're unworthy. And then what do you do? Then you have to do more, and then you have to continue people pleasing, and then you're depleting yourself of joy. Right. It all ties together. It's interesting that you brought up zoom because.

Rich Roll (95:59)

Which is its own masochism. Masochistic.

Dr. Judith Joseph (96:04)

You know, the zoom fatigue is real. There's a entire study center at Stanford called the Zoom Fatigue Center.

Rich Roll (96:11)

Really?

Dr. Judith Joseph (96:12)

An entire center. I had to learn about it because I do these corporate talks, and many people are feeling, blah, blah, and they're like, well, how did I get this way? And I'm like, you know. You know, seeing yourself all day long is not healthy. You know, if I had an image of myself behind you right now, I would be so distracted. I'd probably be like, oh, my gosh, are my allergies, you know, flaring up? I would not.

Rich Roll (96:34)

It's weird that they show you. Like, they should get rid of that part.

Dr. Judith Joseph (96:37)

It's completely unnatural. The same thing, because everybody's looking at.

Rich Roll (96:39)

Themselves the whole time, they're looking at themselves.

Dr. Judith Joseph (96:42)

And there's this phenomenon in psychiatry called the autoscopic phenomenon. And with people who have psychosis or, you know, hallucinations, like people who. Some people with schizophrenia, some people with bipolar psychosis, they may have these hallucinations where they see themselves, and it is really stressful for them. Some of them become very depressed. Some of them become so anxious that they don't want to leave their rooms. So imagine we are walking around. We don't have psychosis, but we're giving ourselves that autoscopic phenomenon by looking at ourselves all the time. We're not supposed to look at ourselves while looking at other people. I'm supposed to be talking to you.

Rich Roll (97:19)

You.

Dr. Judith Joseph (97:19)

And seeing whether or not you agree or disagree or whether or not you're harmful or safe. You know, we were made to look at others and to get information from others because we're social creatures. Once in a while, looking at yourself in a mirror or in a reflection is okay, but looking at yourself all day long is unnatural.

Rich Roll (97:36)

Yeah. And on Zoom, if you turn off the camera, then people just assume you've left the room or, you know, you're just pretending to pay. You're stuck. You have to. Right?

Dr. Judith Joseph (97:47)

Yeah.

Rich Roll (97:48)

They should have an option, though, to have it on but allow you to not have to look at it.

Dr. Judith Joseph (97:52)

They do. But the problem is that culturally we're taught, and you see this with the generations, older generations think that that's you being rude, right? So, like, there's this peer pressure, this culture that everyone has to be on zoom, and if you're off camera or if you don't see yourself, you're considered rude. So there's that pressure from the cultural side of work.

Rich Roll (98:16)

What kind of studies is this center at Stanford running on this?

Dr. Judith Joseph (98:19)

Oh, wow. They have an entire zoom fatigue survey. When I first started talking about it, I would encourage people to go to that website and take their surveys. But the other things they found was that when you're on zoom, you're not moving as much. Again, we weren't made to sit at a desk all day long. And so some of the things that they suggest is getting a standing desk or taking calls while walking, getting an external camera so that it forces you to pivot a little bit. There are all these tools that they have and also encouraging others to let's all be off camera, let's all give ourselves a break so that it's a part of the work culture. And you're not staying at your screen because what that is doing is that you're forcing yourself to not look. Just look at yourself, but you're also looking at all these faces at once. Again, if you were in a board meeting, you wouldn't be looking at everyone like this all the time. Time you'd be looking at one person, another person. So there's something very unnatural about it, and it's. It's harming our brains.

Rich Roll (99:18)

I can sit at my desk and work or write and be very focused and calm, but the minute I get on a zoom call, I feel like I have. I'm, like, agitated. Like, I don't. I feel like I need to get up and move around or whatever. It's a very different experience.

Dr. Judith Joseph (99:34)

There's a lot of pressure involved. It's unnatural. You know, it's very different than if you were saying, let's all meet in person. You don't get the same angst. But when you have to be on a zoom and there's all this pressure to be presenting yourself all the time, you're causing your brain to go into overdrive. It's unnecessary work. Again, one of the points of joy is releasing and decreasing stress, and you're not able to access that if you're in this, like, state of I have.

Rich Roll (100:01)

To perform the final V is vision. In so what is that all about?

Dr. Judith Joseph (100:07)

Well, this V is very important for me because if I don't plan joy, it is not going to happen. For many of us who are busy and who have we get into these patterns of doing, we often don't plan the joy. And it doesn't have to be big joy. It could be the small joys. Like, you know, after I speak with you today, I'm going to go and sit and have a nice meal and I'm to going, going to taste it and not rush it. But for others, it could be something like, you know, if I get my kid to school on time, I'm going to sit in my living room and have a cup of coffee in silence and I'm going to acknowledge this win, you know, so planning joy is important because there's this large body of research in fantasy, right? When we can imagine things and we look forward to things, we're more hopeful, we are less stressed. You know, we experience these points of joy more. So it's important to plan things in the future so that you don't get stuck in the past, so that you keep moving forward.

Rich Roll (101:05)

What about pharmacological interventions? We all know about the challenges and kind of ineffectiveness overall of SSRIs. Is there an appropriate intervention in that way for something like this or is it just the 5Vs and this is what we should focus on?

Dr. Judith Joseph (101:25)

Well, many of my, my patients who have high function depression, they've also had clinical depressions or they can slip into a clinical depression. And these medications, antidepressants, they are FDA approved for major depressive disorder. And some people will need medications and that's okay, right? We all have a unique biopsychosocial, just like we all have a unique fingerprint. And so for some people, I will need to prescribe medications, especially if they have a major depressive disorder. For others who have in the biopsychosocial, there's the psychology part. Some people have comorbid ADHD and sometimes I have to prescribe stimulants because it's really hard to get things done if you can't focus. And if you don't get things done, you feel bad about yourself and that can create a depression. And for others, their traumas are severe enough that they're physiologically in fight or flight. So I may have to prescribe things that dampen the fight or flight so that they can actually do the work and feel safe. Everyone's different, you know, and when you look at the biological, some people have medical conditions like an autoimmune condition that makes it really difficult to access Joy. So they may need support there. Or thyroid issues like myself. You know, everyone's going to be different, and it's a case by case scenario. But I am not against medication for the treatment and relief of symptoms. But it's not the only thing that's important.

Rich Roll (102:51)

Are there other conditions that have a high correlation with this, like ADHD or something like that? That common?

Dr. Judith Joseph (102:59)

You know, you see ADHD for sure. A lot of folks who are neurodivergent, they feel as if they have to put in so much more effort to show up. And again, if you believe that you're not anything without your role, then you're working overtime. Many of my patients with adhd, they're constantly masking. They're constantly trying to be something, to be loved, to be accepted, and it's draining. And that's why there's a high correlation between ADHD and depression. They travel together, and so does anxiety. You know, if you have to use so much of your mental energy to get things done, then that again, increases stress, and having stress detracts from joy.

Rich Roll (103:46)

Tell me about your lab. So you run this all women lab. What are you looking at, what are you studying at? And what are some of the interesting findings that are coming out of your lab?

Dr. Judith Joseph (103:58)

Well, we just hired our first man in years.

Rich Roll (104:01)

You can't make that claim anymore.

Dr. Judith Joseph (104:04)

It was never intentional to be all women. It just happened to be that way. At one point, it was all mostly men. So things work out how they work out. We have a great team.

Rich Roll (104:11)

Poor guy.

Dr. Judith Joseph (104:12)

He's awesome. But it's interesting. I have this lab where I do a lot of. Of research that is cutting edge right now. One of our biggest studies is looking at psilocybin and postpartum depression. And you know, in order to do these types of studies, you have to have a certain license with the dea because it's not legal for use in New York, I believe it's only legal in Oregon, I think. But even then it's not federally legal. But we're looking at approaching depression differently in postpartum brains compared to other avenues. And you know how I talked about how depression isn't just those three neurotransmitters. Serotonin, dopamine, norepinephrine. With a lot of postpartum brains, they are highly anxious. And that's why a lot of women will say, I keep checking on my child, like to make sure they're breathing and I can't stop. And there's so much anxiety around giving birth, you know, and it takes away from the joy of connecting with your child. You're not getting that bonding that is so important for you as a mother and for your child. And with depression in mothers, we are looking for solutions that are quicker because, you know, we want these moms to be able to have that attachment with their child. So I'm really excited about some of the studies that we're doing in this area because I don't know if it's going to work or not. It's double blind, placebo controlled, so we don't have access to knowing who's on what. But the goal is that we provide options that help you to recover more quickly.

Rich Roll (105:51)

Yeah, there's an immediacy to it, like an immediate effectiveness with also the possibility that it is more persistent and long lasting. I mean, that's the hope, right? Like, but you have to go into this. You can't have that preconceived, you know, attachment to the outcome.

Dr. Judith Joseph (106:07)

The interesting thing about this work is that, that it's not just about this exposure to this drug. A lot of the work, the sustained work has to do with continuing your meditative and mindfulness practices going forward. So it's not enough just to dose people. You have to train them in how to meditate, how to practice mindfulness throughout this exposure, and to continue that work afterwards, which I think is part of that whole spirituality thing. You know, in my early years, I felt like I had to choose either my faith or science. And this type of work is so validating because you see aspects of both. You know, how I talked about how with monks, when they meditate and you see the changes in their brains similar to what you would see when you're treating depression. Well, this type of research validates that because you have to do a lot of the meditative work while you're going through these dosing sessions, and then you have to continue the work afterwards.

Rich Roll (107:07)

Happiness requires a relationship with faith on some level, like a relationship with something transcendent. And we're in this highly secular world in which the rational mind has, you know, domain over these ideas, which are sort of thought of in a lesser way, I suppose. But I think that that is at cross purposes with the happiness that we seek and on some level is fueling the happiness crisis that we're experiencing.

Dr. Judith Joseph (107:37)

I 100% agree. I mean, you don't have to be religious, you know, you don't have to believe in God. But when you walk out in nature and you see these incredible landscapes. You just realize, wow, I'm here for a reason. The chances of me existing are so small to begin with. So I'm here for a reason. And that just creates that sense of awe and, you know, the research on that. So I would challenge you to not to just go beyond the things that you can read in a paper. You know, we don't know everything. And I think we are losing sight of that faith aspect. You know, believing in things that we can't prove or see. I think being on phones has a lot to do with that. You know, when you're constantly on a device, you're not thinking about others, you're not practicing compassion. There's this, I think, void of compassion education in our systems. Like, we don't. Unless you go to a religious school, you're not learning about empathy and compassion. So you're not thinking about who you are in relation to others in the world and how to connect to others in the world.

Rich Roll (108:43)

What's the most difficult aspect of this for you to practice? Like, what comes up for you where you're like, no, I don't want to do that. Yeah, I want to go back to my old ways.

Dr. Judith Joseph (108:53)

Oh, my goodness. If there's a great opportunity, I have to lean on my team to be like, please help me to say no.

Rich Roll (109:01)

It gets harder to say no. Right. The opportunities are cooler, more fun, and pay more the more you kind of ascend this hill that you're on.

Dr. Judith Joseph (109:10)

But then they take me away from the things that bring me the most joy. For me, it's my daughter. So right now, if I'm like, hmm, I could get make a lot of money and I could meet these cool people, but I will miss out on time with her. And I'm like, no, I want to.

Rich Roll (109:27)

Go to the values V for that one.

Dr. Judith Joseph (109:29)

Yes, yes. And that's what really makes me feel joyful because I can go and do these great things and I get a sense of purpose. But if I'm sacrificing too much of my connection, you know, with the people that I love, then it is not worth it.

Rich Roll (109:44)

I want to take a turn here and spend a few minutes talking about public health communication. You've been teaching media training for over 10 years now, right? At NYU?

Dr. Judith Joseph (109:55)

Yes.

Rich Roll (109:56)

So I want to hear how that even came together. But we were talking before the podcast. I think a lot about the importance of the public facing scientist, medical doctor, psychiatrist, who understands how to communicate their expertise in a public facing way. And I think there is a real need Right now, for people who are skilled at that, you're certainly one of those people, but we need more of them. And it is a skill that has to be taught and learned and practiced. And I think a lot of people in your profession and related professionals are very good at what they do, and they understand it completely, but they don't exactly know how to communicate it in a way that is impactful to the public. And I think because of that, we have a lot of confusion out there across the board on a number of issues. And that void is filled by people who don't understand the science as well, but are very effective at communicating whatever. Whatever perspective it is that they feel compelled to share.

Dr. Judith Joseph (111:07)

Yeah, I mean, I. When I first started this media road, it was by accident, really. I was in training at nyu and I was in the ER at the time. Bellevue just opened the first major psychiatric emergency room for children. I did adult psychiatry first, and then I did child psychiatry. And the head of the hospital system, she wasn't seeing patients anymore. So she asked me, can you do this interview with me, with this reporter? They want to learn about the er. And I said, sure, because I'm working in the er, she's not. And after I saw the interview published, I was like, oh, my gosh, we need media training. Because I was terrible. So I went to the director and I said, we need media training. And he was like, well, you create the training. And that was the solution. It was like a very Socratic method of teaching. And I developed this question course. And early on in the course, I worked with NYU undergrads in the film school because they would. It was almost like a barter system. They got credit. They would help me to film these grand rounds and make them digestible for the public. And in return, I would help them with their scripts because they would put a lot of psychological themes into their scripts. So it was really interesting. And then it evolved into teaching young doctors how to give press interviews. And it started off with traditional press, like television, radio, print. And then after the pandemic, they wanted more information as to how to provide this news online using social media. And they found it challenging because their patients would come to them and say, I saw this TikTok. I think this is what I have. And they'd be like, no, you don't have it. And they were like, we need help. We need to be able to talk about this in a way that's entertaining and also evidence based, which is really difficult to do in 60 seconds or less right now, 40 seconds because of the short attention span. And so I help these doctors to, number one, get over their fears. Because many times in medicine you are so worried about how people perceive you that you're careful. So you say things like, I gotta say this, right? And say this study right? And by the time you're done saying what you're saying, no one can understand it. And they've already turned the channel. I work with them to say it's okay to make mistakes, you're not gonna get sued. Just stick to what you know and what you know to be true. Like have an agenda and have a story. People connect to stories. And so now when they're in front of the cameras or they're doing tiktoks, they're bringing all of these medical terms into a story that a patient can understand. So that hope, the hope is that the patient will look at their TikTok or their reel and follow them. Them versus, you know, some of the other people online who are not experts. They were never trained, but they're really good storytellers.

Rich Roll (113:52)

What is the perspective writ large, like big Med, like in terms of medical doctors being, you know, information and content creators? Like, is it more receptive than it used to be? Because I, I can only imagine not that long ago where it was like, no, you're not, you're here to do this, not do this, do that, when you're home. Like, like that's a distraction from your core job. And it is kind of, I mean, it is taking you away from the thing, right?

Dr. Judith Joseph (114:23)

You'd be surprised. Doctors are so efficient with their time. Most of the creators I know, they create all their content in a batch because they're high functioning, like myself. You shoot for three hours a day. That's three hours a week and that's it. Or two hours a week in your own time. But initially when I was doing the, this work, people were saying things like, oh, what are you trying to be an actress? Or why are you online? Aren't you worried that people won't take you seriously? The opposite happened. The more that I gave information online, the more people wanted this information. And larger institutions were saying, can you teach us? So now I create these courses for larger hospitals. I've been to multiple hospitals teaching this because the doctors want to know how to do this. They understand that their patients are getting this information online. So it's best to come from them and not an influencer.

Rich Roll (115:11)

I told you I'm getting back surgery soon. So I had my first appointment a while back with the surgeon and of course, there's the resident, right? So the resident comes in and sees me first, and we go over a bunch of stuff and he goes away, and then the surgeon comes in with the resident. But I had an opportunity to really talk with the, with the resident for, for quite a bit of time. And I really liked him. That was like, several weeks ago. And then I'm on my. I'm scrolling Instagram. Like, a video comes up and I'm like, wait, I know that. I was like, that's my. That's the resident. And he has 400,000 followers. And he's, he's posting these incredible videos where he's talking about neurosurgery and the brain and he's showing these diagrams and he's doing it. This is what it's, you know, here's a day in my life and, and I'm, you know, UCLA is a teaching hospital, and here's how it works. And I was like, this is kind of incredible.

Dr. Judith Joseph (116:07)

It is.

Rich Roll (116:08)

And I thought it was really cool. But obviously there's more and more of this going on, and I think that's a good thing. You know, as I said earlier, like, it's like free education. Like, in 60 seconds, I learned something about the way the brain worked that I didn't know.

Dr. Judith Joseph (116:22)

Well, it is, and it's actually being studied now at Harvard T chan School of Public Health because they partnered with. With the who. And the who, the World Health Organization, has doctors all over the world trying to use this new research to educate people and also entertain people. Because when you're doing it on your own as a physician, you can feel so lonely, and you may stop doing it because maybe some people in your circles don't approve or you just don't feel encouraged. And the WHO has partnered with Harvard and other platforms like TikTok and other other social media platforms to create this community of content creators who are physicians and healthcare professionals so that we can combat this misinformation in a fun way, an entertaining way. There's a great need for it. What I've found in my. The course that I teach, the doctors will say it hasn't just helped me to create more joy in my life, but it's also allowed me to communicate better with my patients in real life. Because you're learning how to communicate in such a short amount of time and to be entertaining online, you're actually improving your skills of patient communication in person. So I think this is only going to spread and become more relevant. There's more research happening in this field and more support. And so I think this is going to be the future of medicine, beyond.

Rich Roll (117:44)

The short form aspect of it. I think orienting people around how to be effective on a podcast in long form, I mean, you're very good at it. This has been fantastic. But not all scientists and medical doctors are, because they're in their own world and they have less objectivity about what's landing with an audience and what isn't and how to communicate their expertise in the context of a story or something relatable for an audience that engages them, them such that they remember it well.

Dr. Judith Joseph (118:21)

I. I told you already, I think you're going to be Professor Rich. We're going to do my future.

Rich Roll (118:26)

Yeah. All right. So my future, my future life is. I would love to come and talk to your students, but not on Zoom. Can I do it in person or is it only online? All right, well, next time I come to New York, final thing. So I come into your office, I'm suffering anodynia. I can't sleep, sleep. I'm anxiety ridden. But I gotta keep going because I've got this thing and I've got that thing and whatever. What is the prescription that you provide me before I leave your office? Like, what is the top level thing that I need to do first? There's all these V's. I get it theoretically. But like, what can I do right now, today that will move the needle in the right direction?

Dr. Judith Joseph (119:09)

Well, I mean, whenever I have someone in my office like this, first of all, I ask them to thank themselves. And I say, you know what, you should be grateful to yourself because you didn't have to be here, but there was something in you that you listened to. You didn't ignore it and you didn't push it down. And because you were able to do that, you were going to create change in your life. And if you can keep doing that, that's where you start, is that self validation. And you just do a little bit of it every day. Over time, you're going to get closer to getting the answers that you need need to really unlock the signs of your happiness. It's so important. Start small. Start self validating every day. Take that time and tell yourself you're worthy of it. That's where you begin. And it may sound really cheesy, but many people have a hard time doing it. Yes, it is even saying it right now. You know, some people may be feeling super cringe. Yes, yes, they feel cringe. But it is so important, you know, if you can't validate yourself, then how are you going to expect to get validation from others? And that's what many of us are seeking.

Rich Roll (120:18)

Well, I'm going to take that to heart and I'm going to practice it. And this has been very, very helpful to me. And like I said, I do think the universe conspired to bring us together because I needed to read your book. I needed to meet you. And this has proven to be be very, very helpful to me on a personal level. So thank you.

Dr. Judith Joseph (120:37)

Oh, thank you for having me.

Rich Roll (120:38)

Thanks for the work that you do. You're a marvel. I would love to have you back. I want to stay abreast of the work that's happening in your lab and I celebrate you.

Dr. Judith Joseph (120:47)

Thank you.

Rich Roll (120:48)

Yeah, thanks for being here today.

Dr. Judith Joseph (120:49)

I appreciate you.

Rich Roll (120:51)

Cool pe. That's it for today. Thank you for listening. I truly hope you enjoyed the conversation. To learn more about today's guests, including links and resources related to everything discussed today, visit the episode page@richroll.com where you can find the entire podcast archive my books, Finding Ultra Voicing Change and the Plant Power Way, as well as the Plant Power meal planner@mealplanner.com richroll.com if you'd like to support the podcast, the easiest and most impactful thing you can do is to subscribe to the show on Apple Podcasts, on Spotify and on YouTube and leave a review and or comment. And sharing the show or your favorite episode with friends or on social media is of course awesome and very helpful. This show just wouldn't be possible without the help of our amazing sponsors who keep this podcast running wild and free. To check out all their amazing offers, head to richroll.com sponsors and finally, for podcast updates, special offers on books, the Meal Planner, and other subjects, please subscribe to our newsletter, which you can find on the footer of any page@richroll.com Today's show was produced and engineered by Jason Cameolo. The video edition of the podcast was created by Blake Kirk Curtis and Morgan McRae with assistance from our Creative Director, Dan Drake, Content management by Shana Savoy, copywriting by Ben Prior and of course our theme music was created all the way back in 2012 by Tyler Pyatt, Trapper Pyatt and Harry Mathis. Appreciate the love, love the support. See you back here soon. Peace Plants Namaste.

Dr. Judith Joseph (122:43)

It.