B (6:07)

Welcome back, Dr. Judith.

C (6:09)

Thanks for having me. It's good to see you again.

B (6:11)

Likewise. Likewise. So the last time we chatted, we were talking all about how your mental health might be impacted by social media. And a lot has happened for you since we last talked. So you've released your first book called High functioning Depression. And I would love to hear from you, Dr. Judith, because you are, like, well read and, like, well versed in so many topics. What made high Functioning Depression the topic for your first book?

C (6:34)

Well, I think a lot of people walk around wearing this mask of pathological productivity. On the outside, they look put together. You'd never know that they were struggling inside without joy, lacking interest, because, frankly, they're not functioning right. They're still functioning. Showing up. They're rocks. They're the ones that people turn to for help. They're the friend who seems like they have it all put together. And in mental health, unfortunately, we wait for people to break down before we start intervening. Whereas in other areas of health, we don't wait until people have, like, stage four cancer. We're like, let's catch the cancer. Let's reduce the risk. Right? We're not waiting for people to have a heart attack. We're saying, let's address the risk of heart disease in mental health. We're still waiting for people to break down. And I just kept seeing people in my practice coming in who. Who were struggling with a lack of joy, something called anhedonia. They didn't know what it was. They'd never heard of it. And I had to educate them that this is something that's in the medical literature. We know of it, but many people don't know what it's called. So there is a way to reclaim your joy. And when I wrote High Functioning, I was very intentional about the COVID of it, where I wanted people to be walking in a bookstore and see, oh, look, high functioning, that's me. Let me open this and be like, hold up, wait a second, I think I'm depressed. The subtitle is about overcoming hidden depression. Because many of us hide our emotions, especially as black women. We push it down. We put our own emotions to the side. We take care of others. And this book is about reclaiming joy Effy.

B (8:06)

So it's interesting. And I appreciate that you're calling out anhedonia because it is one of the classic like hallmark depressive symptoms. And you're saying that you found a lot of your patients just didn't even know that it was a thing that they needed to be connected to or why do you think that is, given that it is one of the like things we are typically looking for to diagnose depression.

C (8:26)

Interestingly enough, I went to a very large therapy conference and I went around collecting content and asking different therapists, what is anhedonia? What is anhedonia? A lot of therapists had never heard of anhedonia. And I think there's this inherent bias within healthcare where we look for people to break down. We're looking for very obvious signs. We're looking for someone crying, we're looking for someone not getting out of bed, we're not looking for someone who's feeling nothing or lacking joy and we overlook it. If you go to your doctor and you're like, I'm not sleeping well, my eating habits have changed, but I'm still functioning, they're not going to say, well, are you still enjoying life? They're going to say, are you suicidal? Are you breaking down? You know, like what's happening in terms of your functioning? They're really not looking for whether or not you're enjoying life, that you're actually seeking pleasure or interested in things. Because in our healthcare system, that's not considered a crisis. That's not a problem that healthcare professionals can fix. So we're very reactive in our approaches to mental health versus being proactive and looking for signs of anhedonia. When you eat your food, does it taste good? When you connect with a loved one, do you feel seen and heard? When you're listening to music, does it light you up? If we were to ask those type of questions, then we would uncover anhedonia. But we're not asking that. We're asking, are you suicidal? Are you having thoughts? You don't live anymore. So because we're always looking for the crisis, the clear crisis, we're missing the existential crisis that is life even worth living for you. And I think many healthcare professionals, especially doctors and nurses, they probably struggle with anhedonia too. When you think about it, they're in fast paced lives. They're taught inherently to take care of everyone else but themselves. Patient comes first. They work long shifts, they don't even like pee or go for bathroom breaks or eat Properly, Right. So they are already inherently anhedonic. So why would you look for something that you're experiencing, that you've normalized? Why would you even look for that in your own patients? You'd be like, well, you're not in crisis, you're not suicidal, come back next year, come back when you break down. And so I think that it's a shift that needs to occur within healthcare, some would say first in order to really address it in the general population.

B (10:55)

And I know you are kind of one of the first doing kind of large scale research on high functioning depression. And I think when I think about like black women and the way that depression often shows up for us, right, like in large part due to our socialization, that stuff just has to keep going. Like you can deal with your mood later. Like you just got to keep going. I would be curious to know if black women don't over index in terms of high functioning depression. Can you talk a little bit about the work that you've done and what your research is showing in terms of black women in high functioning depression?

C (11:28)

The interesting thing about my study is that it's the first study in high functioning depression in the world. And when I was writing it up and submitting it to IRBs and in the process of peer review, I remember the people who were reviewing it were like looking for other papers in the world and they just kept looking and then they were like, wait, this is the first study in the world? And I was just shocked. It is the first one. We do need more research in this area, but what we found in this first study is that there seems to be a high correlation between caregiving and anhedonia, which is not rocket science. Right. If you are taking care of other people all the time, and because that's your priority, you're not really prioritizing yourself. You're not going to have interest in things you once enjoyed. You're not going to be feeling joy. And so that was not a surprising finding. Another finding was that there's a high correlation between HFD and trauma. And that was interesting because our hypothesis is that people who are trying to outrun past pain may be using busying as a coping mechanism. So when you think of the classic trauma responses, usually people want to avoid people, places and situations that trigger negative emotions. But with high functioning folks, people avoid negative emotions by just taking on other tasks. So these are the people who will say, I sit still, I feel restless, when I'm not busy, I feel empty. Why? Because their go to coping Mechanism is too busy to distract. And you know, initially it doesn't look all that bad, right? It looks, you know, productive, pathologically productive. Because on the outside, you're doing all these great things. People are saying you're killing it, but secretly it is actually killing you, right? Because over time, you're going to neglect your basic needs. Over time, your body may break down, you may actually develop a depression where a depressive episode where you stop functioning, or you may start to cope with your pain in ways that are not healthy, like excessive drinking, other excessive behaviors that are not really healthy for you. So something's going to give eventually. And so we found those two correlations. This trauma and when we're interviewing patients, we didn't just do a survey. We, I have a lab in Manhattan. We had the research staff myself interview people, collect the data. Because what we found is that when you send out surveys, it tends to not be as accurate as when you're talking to people. Sometimes people don't understand something. They ask for clarification. So when we were talking with people, we were surprised to learn that a lot of times people didn't even realize that like, oh, this painful thing that happened was a trauma. And I didn't know how it shaped me. I just kind of just pushed it down, never talked about it, and just kept going. And so when we did our trauma inventories, we were very intentional about including things that we typically don't see in a PTSD diagnosis. So in order to meet criteria for ptsd, your trauma has to be either life threatening or assault. You know, like something like a combat or a motor vehicle accident or someone attacking you. But if things like, let's say a severe bankruptcy and that left you homeless in the real world, a therapist would say, oh, that's traumatizing. But according to textbook standards, that doesn't count as a trauma. So we wanted to include these experiences that are painful that shape the way that you view yourself in the way that you view yourself in the world.

A (14:50)

And Dr. Drew, did you find that

B (14:52)

there were any particular, like, categories of trauma that seemed to be more correlated

A (14:57)

with high functioning depression?

C (14:58)

Definitely the big T traumas. So more severe traumas like being physically attacked, the ones that typically meet criteria for ptsd, those tend to be highly correlated. And that makes sense because, you know, one of the symptoms of trauma, and there are like over 30 symptoms of, of trauma, people think it's just like hypervigilance or flashbacks or nightmares. There are 30 plus. And so one of the symptoms of trauma is actually like internalizing self blame, shame and guilt. And we know that this is like the human brain's way of coping with how did something bad happen to me? Why did something bad happen to me? And many times when that bad things happen to us, our brains automatically goes into this like very regressive default mode. Like, like a child would think, like, oh, I must have done something bad. There must be something about me versus a more mature or a higher level way of thinking about it would be, oh, bad things happen to good people all the time. Right? I didn't do anything. But our brains do that as a way of kind of controlling the situation because we don't like uncertainty. So it's like something bad happens to me because I'm bad. Right. And so many times folks who don't have their trauma processed will go on this path in life where they people please, where they bend over backwards, where they don't feel worthy of rest because they don't feel worthy internally. And that is a trauma response that many folks don't even connect. They don't even make that correlation because they haven't fully dealt with their trauma. They're still trying to outrun it.

A (16:40)

More from our conversation after the break. You probably heard the saying, success leaves clues. Well, I found this to be true. The people we look up to and admire often share lots of information about the path they took to get to where they are in life and how you might do the same. There's no need to look too far for your next source of inspiration. You can find it right in a session on Masterclass. Someone I've been endlessly inspired by is Issa Rae. And in her class on creating outside the lines, she shares how to create in a way that's authentic to who you are, how to speak to audiences that are aligned, and how to vet opportunities so that they're consistent with your values. All, of course, shared with Issa's typical comedy and candor. What inspiration are you seeking? Perhaps hoping to get better with your makeup looks? Take Sir Jones class. Hoping to get better with your decision making. Melody Hobson's class might be a perfect fit. Plans start at $10 a month, billed annually, and you get unlimited access to over 200 plus classes taught by the world's best business leaders, writers, chefs and more. Classes are the perfect addition for your commute, walks in the park or those marathon laundry days. Wherever you go, Masterclass goes with you. Right now, our listeners get an additional 15% off any annual membership@masterclass.com therapy. That's 15% off@masterclass.com therapy masterclass.com therapy I'm Dr. Joy from the Therapy for Black Girls podcast. Ever been at the pharmacy counter and the pharmacist asks do you have any questions? And suddenly your mind goes blank? That's exactly why you need to listen to beyond the Script from CVS Pharmacy and iHeartMedia. Hosted by Dr. Jake Goodman, a board certified psychiatrist and health educator, this show takes you behind the counter to answer the questions you wish you'd asked, like which medications might not mix well, what vaccines you should consider before a big trip, and even those questions you were too embarrassed to say out loud. Each episode busts myths, decodes health trends, and gives you real, trustworthy advice from the experts you see most your neighborhood CVS pharmacist. No white coats, no lectures. Just real talk, real answers and maybe a few laughs. Listen to beyond the script on the iHeartRadio app. Apple Podcasts are wherever you get your podcasts these days, most things cost an arm and a leg, especially vacations. But not in Rhode Island. Between affordable luxury stays, succulent seafood right from the source, and and spectacular shopping that won't break the bank, you get a real bang for your buck in the Ocean State. The memories will be priceless, but the cost will be a lot less. Rhode Island. All that Plan your trip today@visitroadisland.com that's visitroadisland.com we've all been there. You're trying to get dinner started or just need 10 minutes of peace to finish a phone call. You want to give your kids something to do, but you want it to be good content. That's where LingoKids comes in. It's an app for kids 2 to 8 that focuses on peer interactive joy. It turns their time into an adventure where they're exploring and playing in a safe space built just for them. You get a moment to breathe and they get an experience they're actually excited about. It's the kind of win win every parent needs. Lingokids Everything kids love. Give your kids the play they love. Download the Lingokids app now on your phone or tablet and it's free. Tired of long wash days and heat damaged hair? I hear you. That's why you should know about Revair, the game changing hair dryer that uses reverse airflow to dry, stretch and smooth in one step so you spend less time styling and more time living your life with gentle airflow and multiple heat settings. Revair locks in shine, reduces frizz, and respects your curl Pattern, whether it's coils, kinks, braids, locs, or extensions. Visit myravaire.com and use promo code therapy50 for $50 off your device or total package. That's myreva.com your crown deserves it.

B (20:55)

So I wonder if you can talk about, if we're talking about some symptoms that aren't necessarily like your classic depressive symptoms and some that are. So what would it look like? Is this a diagnosis that people are

A (21:07)

getting of high functioning depression?

B (21:09)

Like, how would you talk with your therapist or your psychiatrist about, like, hey, I read this book when I think that this might be me. Like, what kinds of things would you be looking for to figure out? Like, oh, is this something I'm struggling with?

C (21:21)

What's interesting is that years ago when I first started creating content about high functioning depression, I had a lot of therapists saying, oh, that's not real. Why are we talking about high functioning depression? We need to be talking about clinical depression. What I said was, listen, there's enough depression to go around for all of us, right? Like, let's not try to compete with each other. But now I have therapists reaching out to me saying, thank you for this book because I have so many clients who are still killing it, who are still crushing it, who are still showing up, but they are struggling with anhedonia, they're using work, they're using busyness as a coping mechanism. And frankly, there's like nothing out there for them. And so now I think a lot of therapists are realizing that depression has many different faces, that not everyone stays in bed, not everyone's crying, not everyone's shutting down, some people can't sit still. And many times it's misdiagnosed as anxiety. And not to say that the two don't travel together, but anxiety has a lot of physical symptoms. When you look at generalized anxiety disorder, there are a lot of physical, physiological symptoms of anxiety, like tummy ache, tension in your body, heart racing, sweaty palms, feeling like you're going to pass out, and you don't see anhedonia there. And so the key thing a lot of these therapists are seeing is something called anhedonia, this lack of interest, this lack of pleasure. And it's one thing if your client is busy and productive and enjoying it. But what these therapists are telling me is that they have these clients that look great on the outside, they're doing many things, but they don't enjoy it and they can't slow down. And that is the key, right? Because as human beings, we were built with the DNA for joy. It's literally built into our genetic code. So if you are not experiencing joy, if you've lost your ability to reclaim joy, that is a problem, right? It's not going to get you admitted to hospital. It's not medical emergency. But it is an existential crisis and it's something that are deserving of. So if you're lacking joy, don't ignore it.

B (23:27)

So that is what you would really kind of qualify as. Like, the hallmark of high functioning depression is this anhedonia and like the lack of joy.

C (23:35)

The lack of joy, the anhedonia and the inability to sit still. Right. Because that's what makes it different than this anxiety. Right? The inner restlessness. What we found in our clinical research study is this inability to sit still because you're outrunning pain. You think you're chasing happiness, but you're trying to outrun something you haven't processed in the past. When people finally click that together, they really want to understand, well, when did I actually stop experiencing joy? When did this painful situation occur? Like, I need to figure this out. And this is important because this can actually help you to start to change the way that you cope with pain. Rather than pushing it down, you may start to validate it. And that's why I put the 5 Vs in my book. Because I wanted people to use a simple method, a step by step path towards reclaiming joy. And it starts with validation.

A (24:29)

So can you talk More about the 5vs?

C (24:31)

5 is a number that's been popping up in a lot of my travels. I traveled the world studying mental health issues. And five, I think, pops up across the globe because most of us have five fingers, right? And so validation is the first V. When you think about validation. Validation is acknowledging how you feel and accepting it no matter what, without judgment. It usually uses analogy of. Imagine you're in a dark room, pitch black, you can't see anything, and you hear a loud crash. Well, some of us would start freaking out, some of us start screaming, some would start swinging, some start. Some of us would start running. But if you turn the light on and you saw that it was an inanimate object that fell and you're safe, then you're like, you know that uncertainty has gone away. You feel at ease. So when you acknowledge how you feel and you turn the light on, on, what's really happening? That's how many of my clients feel. Sometimes I have men come to my office and they're like, I am so angry. My wife says, I need Anger management, we peel back on that emotion. Like, are you really angry? What makes you think you're angry? Well, I was yelling, and I said, well, that's a behavior, right? The yelling could be anger, but it could be something else. Well, I slammed doors again. It's a behavior. What did you really feel? And then we take some time, we figure it out, and the person's actually quite worried. They're worried about not providing. They're worried about being a failure. And so that's why it's important to name your emotion and name and acknowledge your experiences. Because only then when you turn that light on, can you actually figure out the appropriate mechanism. Because the tools for anger, you know, this very different than the tools for worry. And so validation can be self validation. It could be you acknowledging it and accepting it for yourself. We can validate other people with my tools in the book, the Quizzes, I find these rating scales to be very validating because in medicine, if you have like a heart condition or you can go for a test, you can get an ekg. If you have high cholesterol, you can go for blood work. But for mental health, we don't have that as yet. So I needed to have these measures, these ways to validate using actual tools. And so validation can be in the form of a rating scale. If you're wondering, oh, do I have anhedonia? Created these rating scales based on some of the other research tools that I use in my lab for my clinical studies so that you can say, okay, what level do I have of anhedonia? And some of my clients, they'll flop the Anadonia rating scale, and they'll be like, oh, my gosh, like, I don't enjoy half the things I used to, right? And I would not have known had I not filled out this rating scale. So there are many ways to validate. The second V is venting. So in my lab, I'll have people take turns with this big balloon, and we'll take turns dunking it into a big tank of water. And 100% of the time, that balloon pops up. Why? Because you can't out math, physics, right? It's going to pop up 100% of the time. And then we'll take turns deflating this balloon. And what happens? We can easily push this balloon, deflated balloon, at the bottom of the tank. And so I like this analogy, because if you don't express your emotions, if you don't get it out right, then you imagine that balloon, your emotions will pop up in your health, right? Many of us have these migraines, we have these tummy pains, we don't even know what's going on. Body aches. It'll pop up in our relationships, so we snap at our loved ones. It'll pop up at work. So that's why it's important to get in the practice of expressing how you feel. And venting can be done verbally. It could be done in a therapy setting with a therapist. It could be done with journal writing. Validating. Venting can be done through expressions such as prayer for people who are faith based. So you can vent in many different ways. You got to find a way that's healthy for you.

B (28:35)

What about the other three?

C (28:37)

Well, and before I go into the other three venting, there are do's and don'ts, right? You don't want to be trauma dumping on people. I always tell my clients, if you're venting to your kids, I'd rather you vent to me. Because your child isn't going to say, mommy, I don't want to talk to you. Your child will listen because they want to feel connected to you. They don't want to be rejected, but they're going to worry about you, right? So think about, think about who you're venting to. Is it someone in a lower position of power than you? Is this person going to resent you like an employee? And also be very intentional about it? Are you venting just to get people on your side and you don't really care about the resolution? Or are you really intentional about, okay, I have a problem. I need to get it solved. I'm going to be unbiased. I'm going to ask people who I trust to give me honest feedback, right? And before you vent to people, if it's not your therapist, because if you pay your therapist, you can say whatever you want, right? But when you're venting to people in your life, really check in and ask for emotional consent. Ask, is this an okay time? Is this going to trigger you? Right? So there are do's and don'ts to venting. And what's exciting, Dr. Joy, is that there's recent research on why proper venting. Why? Like there's evidence based venting, why it's important. Because if you're venting in that trauma dumping way, you actually feel worse. They liken it to pouring gas on a, on a fire. So you want to vent with intention. You want to vent with emotional consent. The third V is, well, Dr. Joseph, I want to.

B (30:01)

Dr. I want to stay here because there's been lots of conversations around, like, common dumping online. And I'm really glad you dove into that because in my mind, there is a difference. Difference? Like what I am doing with clients in session, even if they are venting, so to speak. Like, we are processing, working through it. What I imagine happening with venting to, like a best friend is just like, you might say, like, oh, this thing happened to me. And maybe your friend is just saying, like, oh, my gosh, that's really messed up. And that feels very different to me. So can you talk about, like, the difference in what like would be venting to a therapist versus venting to a friend. And if you are venting to a friend, should you expect there to be some resolution from the venting?

C (30:40)

That's a really great question. Usually with my clients, what I advise is you pick one or two people because, and I talk about this in the book, you don't want to be like a sprinkler. You don't want to be like anyone who could listen. This is what happened. This is what you know, like, because that will, unfortunately, that will bite you in the end. People talk and you can't trust everyone. But when you get into a practice of identifying one or two trusted individuals, you want to nurture that relationship. And what I mean by nurturing is you want to make sure there's reciprocity. Right? If you're my go to friend, I'm your go to friend, right? When you need help, I'm there. When I need help, you're there and check in with them. Emotional consent looks like I have something really painful to tell you and I'm really struggling. Is this a good time or can we schedule a call or. Right, that's what emotional consent looks like. It doesn't look like, let me call this person and start crying on the phone. Right? And yes, none of us are perfect. We'll have those days. But generally speaking, you want to have that relationship as being sacred. Now, it's different with a therapist. You and I know that when someone has trusted us with their mental health, it's not about us, Right? Not to say you treat your therapist poorly, but you know, your therapist is there to listen to you and to literally understand your patterns over time, to take notes, to guide you, but not tell you what to do.

A (32:07)

Right.

C (32:07)

That's why we go to school for so many years and then to pull on these, we go and we do our research and we come back with these different tools because this is a therapeutic relationship. So it's very different. You don't have to be like, is it okay if I tell you this? No, we want you to tell us. There's none of that. Usually we don't share. There are some cases where we do share if it is appropriate for the treatment, but usually it's not like, okay, now it's my turn. You know, and if you're in a therapy and your therapist tells you way more than they should be, you may want to think about that. Right. So they're very different relationships, but generally I would say pick one or two people and there's this understanding that this is how you vent. We're not just trying to, like, pour gas onto a fire. When we get together and when we share something that's happened to us, we're looking for an honest feedback and how to resolve a situation. Not just gossiping, not just tearing people down, not just doing this because it feels good in the moment, then feels awful later. There's a real goal to this venting.

A (33:08)

Got it. Thank you for that clarification.

B (33:11)

So you were moving to the fourth

C (33:12)

B, I believe the fourth V. Values. These are things that bring your life meaning and purpose. You see the. The accolades in the background. I have so many degrees, I can't even hang them all. There was a time in my life when that was all that mattered. And I'm from a Caribbean background. I came to this country with very little. So it was always like, you got to get as many degrees as possible. You're here and other people aren't. You got to take advantage of any and all opportunities. And there was a time when I did that. And not to say that it's necessarily a bad thing, but over time, if you have to really think about what it is that's happening, are you seeking out things that have price tags or are they truly priceless? And for me, the priceless part of my love hate journey with knowledge and learning, the priceless part was when I was a lot younger and I just loved to learn. I was very curious. I wanted to get my hands on everything just for the sake of learning. But for pre medders out there, when you start that pre med journey, sometimes it can be so intense that you're just about, I just don't want to fail. You just want to, like, get through it and you stop. Actually, at least for me, it stopped being about the knowledge and the curiosity. It was more about, well, I just can't fail. So then you start to get numb to the A's and the accolades. And it was during 2020 where personally, I was at a peak in my career where I just gotten onto this board at Columbia, this prestigious board, and, like, it was always on tv and, like, everyone was like, wow, you're doing so well. And I was experiencing the worst anhedonia of my life. And I just thought, well, what's the point of having all the success if there's no joy? And I had to do a deep dive into what really brought me purpose and meaning. And for me, it was going back to my past and looking at times where I actually felt full and fed. As in, like, wow, this is meaningful. And I remember it was when I was helping others and when I was learning for fun. So I started reading again for I just started one step reading again. I remember I read Michelle Obama's book Becoming, and I was like, why didn't I read this before? Like, oh, because I was so busy reading research protocols and journal articles, right? So I just started, like, reading for fun again, and it just, like, lit me up. And then I thought, well, let me start doing things for others that don't pay me, just out of, like, the goodness of my heart. Because I grew up in the church volunteering, and that used to make me feel joyful. Started doing that again, and slowly my anhedonia went away. But I think many of us, we don't realize that the things that are really priceless, those are things that really matter. Because when you're in your last minutes of life, you're not going to be like, I wish I had another degree, or, I wish I had a house, another house. You're going to say, like, I wish I could spend five minutes doing the things that made life worth living. You know, so that could be your family, it could be your faith, it could be a cause that you believed in. Usually it's not things with the price tags. So try and tap into those things. And that's what the values are. And there's a lot of evidence on values. There's a lot of research on it, both in the spiritual community and the religious community and in the mental health community.

A (36:29)

More from our conversation after the break. You know that moment when your kid asks for your phone and you're already bracing yourself for whatever random video they'll disappear into? Have you heard of Lingokids? It's an app where kids are actually playing, singing, tapping, and exploring stories. It's colorful, high energy, and designed so kids stay curious instead of just zoning out. They think they're getting a treat, and it was built just for them. Lingokids everything kids love. Download the Lingokids app now on your phone or tablet. It's free. I'm Dr. Joy from the Therapy for Black Girls podcast. Ever been at the pharmacy counter and the pharmacist asks do you have any questions? And suddenly your mind goes blank? That's exactly why you need to listen to beyond the Script from CVS Pharmacy and iHeartMedia. Hosted by Dr. Jake Goodman, a board certified psychiatrist and health educator, this show takes you behind the counter to answer the questions you wish you'd asked, like which medications might not mix well, what vaccines you should consider before a big trip, and even those questions you were too embarrassed to say out loud. Each episode busts myths, decodes health trends, and gives you real, trustworthy advice from the experts you see most your neighborhood CVS pharmacist. No white coats, no lectures. Just real talk, real answers and maybe a few laughs. The Listen to Beyond the script on the iHeartRadio app, Apple Podcasts, or wherever you get your podcasts These days, most things cost an arm and a leg, especially vacations. But not in Rhode Island. Between affordable luxury stays, succulent seafood right from the source, and spectacular shopping that won't break the bank, you get a real bang for your buck in the Ocean State. The memories will be priceless, but the cost will be a lot less. Rhode island all that Plan your trip today at visit rhode island.com that's visit rhode island.com as you step into a new year, you're probably thinking about all the things you can do to truly make this your year. To invest in your growth while still showing up for everything and everyone in your life. Most of us carry so many roles. Partner, employee, caregiver. But there's another role that can open new doors when the time is right. Degree holder. That's where a national university comes in. They understand the reality of busy working professionals and address your needs by offering flexible online formats, four and eight week courses and monthly class starts that work with your life, not against it. In fact, NU confers more graduate degrees to diverse populations than any other institution in the country, with more than half earned by women. And right now, National University is offering the Year of youf Scholarship, providing up to $6,000 per year for eligible bachelor's and master's students who apply by March 31st. If you've been waiting for a sign to make this the year of you, this is it. Learn more @nu.edu tired of long wash days and heat damaged hair? I hear you. That's why you should know about Revair. The game changing hair dryer that uses reverse airflow to dry, stretch, and smooth in one step. So you spend less time styling and more time living your life with gentle airflow and multiple heat settings. Revair locks in shine, reduces frizz, and respects your curl pattern, whether it's coils, kinks, braids, locs, or extensions. Visit myrevair.com and use promo code therapy50 for $50 off your device or total package. That's my revere.com. your crown deserves it.

B (40:15)

Well, Dr. Judith, I want to stop you because something you mentioned makes me think about. I know you are a mom. I'm a mom. Lots of moms in the community, lots of people with little ones in our lives. And so many of us come from these families where it's the whole idea of, like, you got to work twice as hard to get half as much success is really driven by, like, degrees. And so when you think about, like, maybe with your own child and like, any suggestions for people who are raising little ones, the ones around, like, how to not reinforce this idea that this is what really makes you happy? Like, these are the things that really matter.

C (40:47)

The thing I love about my daughter, she just turned nine, is that she's very different than me. She's more about, like, the soft life. She'll be like, so I'll be, you know, I'll be like, okay, we got to do this. We got to do this. And she's like, mom, I'm tired, and you look tired, too. And I'm like, you know what? I am tired. Thank you. You know, so I really like now to listen to the people in my life. I listen to my daughter. I listen to my lab. Like, the people that work in my lab, if they're like, listen, we're doing too much. I listen and I slow down. Whereas before it was like, come on, guys, we just have to do more. We just have to. But validating others, right? You know, the first V has been very instrumental in my journey. And I used to have this deep fear that if I slow down had all or nothing thinking, that meant stopping. Slow down. Slowing down is not stopping. And what I found personally is that when I slow down and I focus on one or two projects that are really important, I flourish versus trying to do everything, because then none of those projects flourish. They're just, like, half done. So listening to others has been a tool that I've incorporated in my life. But for my patients who maybe don't have a network of people around to listen to or to get feedback from. I say listen to your body. We all have a part of our body that starts to. It's like our tell, right. Personally, if my nails are not being done, I'm like, okay, I'm too busy. Right. But for others it could be if you're back, there's a certain part of your back that's aching. It means that you're working too much or you're doing too much. For others it could be their hair. Right? Just listen to your body, it could be your skin. There's a whole field of psychodermatology where your skin literally will tell you what's happening, you know, mentally. So if you don't have someone to guide you, just listen to yourself self validate and that can help you to point you in the right direction.

B (42:47)

So it sounds like modeling really for the little people in our lives is really helpful, right. Like getting a check on our own kind of productivity and then modeling that so that the kids, kids can have a soft life, as you mentioned.

C (43:00)

Yes. So my daughter, I'm very intentional about. Okay, we're going to do things slowly and with compassion, right? Self compassion. I was raised by a mom who had four kids back to back, like one one year apart. And we have a lot of hair. And my mom, she's of Indian Caribbean background, my dad's Afro Caribbean. So she didn't really know how to do the curly hair. And so she would be struggling pulling her hair. Now when I do my daughter's hair, I just have these, you know, again, I had to go back in my memory lane. I'm very slow with doing her hair. I'm very careful. I don't want her to feel that rush. Like combing hair should be pleasurable. It should be like a relaxing wind down technique. And so I'm very careful about not passing on a lot of those busy type of cultures to her so that she can access joy through many ways in life.

B (43:53)

Okay, so I misspoke. Values was number three. Now we are moving on to number four.

C (43:58)

Oh, vitals.

B (43:59)

Yes, vitals, Vitals.

C (44:01)

When my daughter turned two, I started telling her every night we had this routine, this bathtub routine. How many bodies did God give you? And she'd say, one, mommy. And I'd say, what do you have to do with that? Take care of it. And it's something that she knows to this day. Right. You only got one body and brain. And so it's really up to us to take care of it. So taking care of your vitals looks like, you know, Getting good movement and that doesn't have to be like a workout regimen. It could be okay. Instead of working through meetings all day, I'm going to get up and I'm going to go for a walk around the block or walk down the hall to get water. Getting any amount of movement. And if you're not into exercising, you could be dancing to your favorite song every day. But that's really important. Taking care of your vitals looks like eating foods that are not highly processed. And there's a whole field called nutritional psychiatry where you eat foods that are good for your brain, that decrease inflammation. And this is actually very helpful in letting your brain release those happy chemicals. Taking care of vitals looks like getting good deep sleep without being on your devices at night. So you get that rich REM sleep. And also a part of the non traditional vitals that I put in my book have to do with technology. Now, I was on your show last year talking about the reset method and about all of the ways that technology can be harmful for our brains. So knowing ways that technology may be impairing your happiness and putting limits on that and then, you know, taking care of your vitals, a part of that is making sure you're nurturing your healthy relationships. Because there's a whole body of research coming out of Harvard now showing that the quality of your relationships is a huge predictor of your longevity. So you can heal all the kill that you want. If you're partnered with someone toxic, you know you're not going to be healthy. Right. So those are all important ways to take care of your body and brain because you only get one. And the final V is is vision. How do you plan joy in the future so you don't get stuck in the past? And this is includes celebrating your wins. So, you know, rather than saying, okay, I'm supposed to do this, say I did it. Right. It's like a slight shift. But let's say you get your kid to school on time like I do every day. I'm going to sit in my living room and I'm going to have some coffee and just say I did that before rushing off to work. And I've grown to like, really look forward to that moment where I get to sit and rest and relax and enjoy the fact that I did this thing.

A (46:32)

Are there any myths about high functioning

B (46:34)

depression that you feel like? We have not discussed that you feel like it would be really important to debunk for the community?

C (46:40)

Yes. When you think of high functioning depression, you often think of Someone who looks depressed, right? So like, people think, oh, this is just someone who looks depressed, who is actually busy. No. You know, I talk about Chesley Christ, who was Miss usa, beautiful, always smiling, bubbly, but ended up dying by suicide. And her mother, April Simpkins is a good friend of mine and she actually endorsed my book. And she said Chesley had anhedonia, but no one knew it. Right. I want people to know that you can be beautiful and bubbly and smiling and the life of the party and still struggle with high functioning depression. It's not just someone who's like high powered and has a grimace on their face and getting things done.

A (47:27)

It.

C (47:27)

It's the friend that you know makes you laugh. It's the family member that is always there when you need them. It's an entrepreneur who's taking care of all of their employees but not taking care of themselves. It's that student who's getting straight A's, but who's actually struggling.

B (47:44)

It may be a little early, given that you are kind of on the cutting edge of a lot of this research, but is there any like, genealogy connection? Like, are we looking at like, oh, is this something that has like a genetic component that maybe your mom and your grandmother also struggle with high functioning depression and you didn't know it?

C (48:00)

I didn't do any genetics testing in my study, but I've done studies where genetics were involved. And we're trying to pinpoint whether or not there are different types of depression. I know that I believe it's Stanford that just came out earlier this year with a study looking at the different types of depression based on genetics and imaging. And that article is interesting. They didn't talk about high functioning depression, probably because there was no other study besides mine, but they did talk about different types of depression. And so I think people are starting to realize that a lot of mental health conditions have different subtypes. There's a recent article, I can't remember which university published this, but there were like different subtypes of autism. Right. So a huge part of medicine that is missing is what's called precision medicine, right. Or precision psychiatry, where we're trying to figure out what type of subtypes, what phenotypes there are. And in my write up, when you search the NIH website and you look for my paper, you'll see that we put. We're looking at a different phenotype, right? We're trying to see the not so typical face that people associate with depression. We're trying to see if there are Categories that are often overlooked. It's important to do this work because we know that if we wait until people break down, we're too late. Why wait? We should just show people the sign so they can actually start taking the steps to reclaiming their joy before they break down.

A (49:32)

Dr. Judith, what does it look like

B (49:34)

for us to continue these conversations, especially in the community of black women? Right, like, so that we aren't shaming people for what they're experiencing, but that we are decreasing some of the stigma related to high functioning depression?

C (49:46)

Well, I think talking about things openly definitely helps in sharing stories. I was recently at Essence Fest and I had my book. I had a fireside chat with one of the editors, Dominique Flicker, and she actually said during the talk, I think I may have struggled with this. And it's like having those conversations out loud in a room full of people and being able to say that and then have people in the audience shaking their heads and agreeing. I think that's huge because it like not long ago, people weren't saying that. They weren't acknowledging it. They were saying, oh, that was someone else. And I think there's still a lot of work to be done. Usually when you go to especially like high powered events or workplaces, people feel more comfortable using terms like burnout and oh, I'm burnt out too. Oh, yeah, me three. But if you say I'm depressed, people are like, oh, there's not like a so am I or me three. It's like, we should do something about that. Right? So I do think that the word burnout is actually overused. I think people are actually. A lot of people are actually depressed, but they're too afraid to say it. And burnout seems more culturally acceptable. But we have to remember that the term burnout wasn't even in our medical literature until like 30 years ago. Right. It's a relatively new phenomenon. And the difference between burnout and high functioning depression is that burnout is a workplace condition. I have this brain model here that I often use. So when you think about the brain, the brain in the workplace experiences a lot of symptoms and burnout because the pressures of the workplace are causing the burnout. But when you remove that brain from the workplace and that brain gets rest and is away from the stressors, that burnout gets better. Right? High functioning depression in the workplace, you have all the same pressures of the workplace. You saw the symptoms. You remove that brain, what happens? They don't get better. They're finding other work to do. They can't sit still. They can't relax when they're not busy, they're empty when they're not doing work, they feel restless. So that's a difference. Burnout is caused by the actual environment. High functioning depression is something internal. There's something inside that's not resolved. So even if you take them out of the environment, they can't relax. And so I think a lot of education needs to be done about that, and that's why people are taking all these burnout courses and they're still not feeling better. I think a lot of people have individualized pain that they're not acknowledging and it's being mislabeled.

A (52:19)

How would you say the pandemic kind

B (52:21)

of interacted with high functioning depression? What are your guesses around whether that led to maybe more high functioning depression or what?

C (52:30)

Yeah, and I'll bring my brain out again with the pandemic. Like, if you think about trauma as an ocean, we got hit with this uncertainty. Okay. Then before we could recover, we're told, oh, actually, you can go back. We're safe. Okay. But then we're like, oh, sorry, there's another variant. You have to hide again. So another wave. Oh, and then there's Black Lives Matter and George Floyd. Here we go. We hit again with another trauma. And then the Capitol hit again with another trauma. This environmental disaster is hit again. Wars abroad hit again. Seeing people dying in terrible ways we just don't get. We haven't had a moment to recover. Our brains have just been hit by so much, and it doesn't seem like there was a break. This is a consensus that I've seen around everywhere. It's like, what's next? And over time, if you get trauma wave after trauma wave after trauma wave, and you're just not able to literally catch your breath, you start getting numb. You start to see things online, and you're like, you don't even feel anything anymore. When you see disasters, it's like, meh. So anhedonia is tied to trauma as well. And that's why it's important for us to have these terms to understand what's happening to our brains so we can protect our brains. Right. If you know that your brain is being traumatized over and over again by images, you're going to learn. Okay, maybe I need to take a break. I need to turn off my phone. Not to say that you shouldn't be plugged into what's happening or informed, but you don't have to be informed 24 7. You know you're worthy of rest. You're worthy of self care. So what would you do instead? You limit your phone use, go out in the world, touch some grass, interact with people. When you hold a loved one's hand, when you hug a loved one, when you kiss a loved one, oxytocin is released. It's the love attachment hormone. You're not getting that when you're just like texting them. You want to be able to get out in the world and experience points of joy because it's literally healing. And when I say points of joy, I used that term very intentionally because in, in the research, the way that we measure happiness is by adding up points literally on these rating scales. But in the real world and therapy world, when patients come in, they're like, oh, Dr. Judith, I just want to be happy. They don't think in terms of points. They're thinking. When I ask them, what is happiness for you? Well, happiness is when I get like this dream partner or happiness is when I get a big job or pay off my debt, right? They're thinking about these events. But happiness is just that. It's a situation that depends on the external. So when something happens externally, then you get happy, right? Joy is very different. Joy happens when you experience these sensations that literally are responsible for making your brain feel, experience happiness. So that's joy. Looks like when you eat your food, you're tasting it, you're savoring it, it's yummy, right? When you decide to take a nap, you wake up and you feel refreshed. When you are lonely and you reach out to a loved one, you feel seen and heard and connected. When you're stressed, you're able to self soothe. Stress is actually measured in the happiness research. People don't even realize that it's really hard to access joy when you're very, very stressed. So, you know, the joy are all these experiences that we're literally leaving on the table and sometimes because we're on our phones all the time, right? So try this. When you're eating your food, put your phone away, put it in like the next room and literally just eat your food in peace and taste it and savor it. When you're talking to your loved one or playing with your pet, put the phone together and just be really present, right? All of these experiences literally release the points of joy that we add up to see if someone's becoming happy versus people who say, well, when X happens, I will be happy. Because that delayed happiness model doesn't work even when you get those things that you're holding your breath for you're still not happy. So try and experience the points of joy in the everyday because that's how you actually measure whether or not you're becoming happier.

B (56:41)

Thank you so much for that, Dr. Judith. I know so many people will resonate with everything that you have shared here today. I know lots of conversations will happen. Please let us know where can we stay connected with you and grab our own copy of High Functioning.

C (56:55)

Thank you so much for having me. It's so great to see you at all these events. You can follow me at Dr. Judith Joseph and you can buy my book wherever books are sold. High Functioning.

A (57:09)

Perfect.

B (57:09)

Thank you so much Dr. Judith. We'll make sure to include all that in our show notes.

C (57:13)

Thank you.

A (57:17)

I'm so glad Dr. Joseph was able to join us again for today's conversation to learn more about her and her work. Be sure to visit the show notes at therapy for black girls.com session456 and don't forget to text this episode to two of your girls right now and tell them to check it out. Did you know that you could leave us a voicemail with your questions or suggestions for the podcast? If you have ideas about topics you'd like us to discuss, drop us a message at Memo FM therapyforblackgirls and let us know what's on your mind. We just might feature it on the podcast. If you're looking for a therapist in your area, visit our Therapist directory@therapyforblackgirls.com directory. Don't forget to follow us on Instagram at Therapy for Black Girls and come on over and join us in our Patreon community for exclusive updates, behind the scenes content, and much more. We can't wait to see you inside. You can join us at community.therapy for black girls.com this episode was produced by Elise Ellis Indechubu and Tyre Rush. Editing was done by Dennison Bradford. Thank y' all so much for joining me again this week. I look forward to continuing this conversation with you all real soon. Take good care. You know that moment when your kid asks for your phone and you're already bracing yourself for whatever random video they'll disappear into? Have you heard of Lingokids? It's an app where kids are actually playing, singing, tapping and exploring stories. It's colorful, high energy, and designed so kids stay curious instead of just zoning out. They think they're getting a treat and it was built just for them. Lingokids Everything kids Love Download the Lingokids app now on your phone or tablet it's free. These days, most things cost an arm and a leg, especially vacations. But not in Rhode Island. Between affordable luxury stays, succulent seafood right from the source, and spectacular shopping that won't break the bank, you get a real bang for your buck in the Ocean State. The memories will be priceless, but the cost will be a lot less. Rhode island all that? Plan your trip today@visitroadisland.com that's visit Rhode Island.com tired of long wash days and heat damaged hair? I hear you. That's why you should know about Revair, the game changing hair dryer that uses reverse airflow to dry, stretch and smooth in one step so you spend less time styling and more time living your life with gentle airflow and multiple heat settings. Revair locks in shine, reduces frizz, and respects your curl pattern, whether it's coils, kinks, braids, locs or extensions. Visit myravair.com and use promo code therapy50 for $50 off your device or total package. That's my revair.com your crown deserves it. As you step into a new year, you're probably thinking about all the things you can do to truly make this the year of you if earning a degree has been on your mind, National University has your back. They understand the realities of busy, working professionals like you in their flexible online formats. Four and eight week courses and monthly class starts help you fit school into your life, not the other way around. And Right now, National University's Year of Use Scholarship offers up to $6,000 annually for eligible bachelor's and master's students who apply by March 31st. Make this the year of you at NU. Learn more today @NU.edu. ready or not, here they come. The new generation of leaders is in the making, and these girls are already strong, smart and bold. Girls, Inc. Is the leading expert on girls, and they're dedicated to helping them develop their inherent strengths and abilities, uncover new ones and tell the world about their potential. No matter what path she chooses or dreams she has, Girls Inc. Equips each girl with experiences, skills and confidence to succeed, whether you're ready for them or not. Visit girlsinc. Org this is an iHeart podcast guaranteed human.