July 7, 2025 • 36 mins
These days, psychiatrist Judith Joseph knows joy. It’s the feeling she has after eating a delicious meal, celebrating the completion of a successful study in her lab, or watching her children play happily together. But just a few years ago, things looked different. Or rather, felt different. On the outside, everything looked as it should, and that was the problem. On today’s episode: the masks we wear to hide how we feel inside.
If you or someone you love is struggling with depression, help is available. Call 1-800-950-6264 for free, confidential support and resources. More information available at nami.org.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:14):
Pushkin.
Speaker 2 (00:29):
We were built with the DNA for joy. We're supposed
to derive pleasure from the basic things in life. If
you're not deriving pleasure from those things, that is a problem.
That's a warning sign, because we're supposed to be able
to experience joy.
Speaker 3 (00:44):
Doctor Judith Joseph is a psychiatrist and a clinical researcher.
These days, joy is a key part of her life,
but that wasn't always the case. Just a few years ago,
things looked great from the outside. She was crushing it
at work and collecting accolades, but on the inside she
was struggling.
Speaker 2 (01:02):
And I thought, well, if I'm like this and it
snuck up on me, I wonder how many people like
me experience I wonder how many people are hiding behind
a mask of pathological productivity and they're using that busyness
to cope with something that they have not processed and
something that's unresolved.
Speaker 3 (01:25):
On today's show, The Mask of Pathological Productivity, I'm Maya Schunker,
a scientist who studies human behavior, and this is a
slight change of plans, a show about who we are
and who we become in the face of a big change.
(01:51):
Doctor Judith Joseph is the founder of a research lab
that explores novel treatments for mental health conditions, conditions like anxiety, depression,
and ADHD. She's also a professor of psychiatry at NYU
and a practicing psychiatrist. Judith says that back in med school,
she surprised her family by choosing to go into psychiatry.
Speaker 2 (02:14):
When I went to medical school, I was the first
person to graduate from college in my family, the first
doctor in my family. And so if I went to
my family and I said I want to be a psychiatrist,
they'd be like, what, that's not a real doctor. My
dad is a pastor. He still is a pastor. So
I was a pastor's kid, went to church three times
a week. And now that I look back, I have
(02:35):
these memories of people coming into the church and people
who were thought to have demons. But now I'm like, oh,
my gosh, that was actually untreated schizophrenia, or people who
had mood swings, and you know, I think, well, that
was actually a substance induced mood disorder. And people with
severe depression who were told to just pray themselves out
of it. You know, I see all of these things
(02:57):
that could have been addressed from a mental health perspective,
but from a cultural perspective, they were called something completely different.
And when I actually told my parents that I was
switching from antisysiology to psychiatry, my dad was like, well,
why you want to work with them crazy people? You
know they're from the Caribbean. And I said, well, Daddy,
the brain is part of the body too, and so
(03:19):
if someone were to have asthma, you wouldn't tell them
to pray out of it. You'd say, oh, you should
really go to a doctor and get an inhaler and
think about all the allergens that are triggering that. But
for some reason, in many cultures, it is still pervasive,
this idea that if you have, you know, a mental
health condition, somehow you should be able to pull yourself
out of it. That's different than physical health. But we
(03:41):
know that the brain is connected to the body, and
I believe it's the most important organ.
Speaker 4 (03:45):
But that's my bias as.
Speaker 3 (03:46):
A psychiatrist, it's my bias as a cognitive neuroscientist.
Speaker 1 (03:50):
We share the same bias. Judents.
Speaker 3 (03:53):
You know, you had your own struggles with mental health
early in the pandemic, and I'm wondering if you can
bring me back to that period of time and set
the scene about what was going on in your life.
Speaker 2 (04:06):
I was giving this talk to very busy, large hospital
system in April twenty twenty, and they had asked me
to give the talk because a lot of the healthcare
professionals were very anxious, very stressed out, and concerned about
their mental health.
Speaker 4 (04:22):
No one knew what was going to happen.
Speaker 2 (04:24):
The world was in a state of uncertainty, and I
was supposed to be one of the voices of hope
giving people skills. But halfway through that talk, I just
felt like, I think I'm depressed, Like it kind.
Speaker 4 (04:37):
Of stuck up on me. You know.
Speaker 2 (04:39):
In the past, given a talk like that would have
been really pleasurable for me, you know, but I just
felt kind of muh bleh. And I just felt really
lost because the hopelessness was palpable in that presentation. People
were writing in things like they don't know if they're
going to be able to see their family, they don't
know if they could infect people, and it's just like, well,
(05:00):
I don't know how I'm doing. How am I going
to help you? I can't even take care of myself.
That was the moment I had in that moment. But
you know, on the outside, everything looked perfect. I I
had just gotten onto this prestigious board of women from
this MV League institution. My lab was the only lab
in the building still running. You know, I was still
taking care of my team, my employees. I had a
(05:21):
little cute kid at home, perfect marriage, what it looked
like on the outside.
Speaker 4 (05:25):
But I couldn't slow down.
Speaker 2 (05:26):
In fact, I think that I was probably at the
height of the most I've ever worked in my entire life.
My worst fear was not being able to provide from
my team for my family, letting my patients down.
Speaker 4 (05:40):
So I was coping with that.
Speaker 2 (05:42):
By overfunctioning, overproducing, overworking. I could not sit still, and
I thought, well, how did I let this happen? I
internalized that shame and blame, like I should know better.
I'm a psychiatrist, I studied depression. How did this snake
up on me?
Speaker 4 (05:58):
And I think a.
Speaker 2 (05:59):
Lot of therapists go through this. We deal with a
lot of emotions, grief, We deal with this vicarious trauma
because we hear people's pain all the time, and we
just we put on that mask because we have to
show up for others, so many of us feel alone.
(06:20):
But I thought, well, if I'm like this and it
snuck up on me, I wonder how many people like
me experience this. I wonder how many people are hiding
behind a mask of pathological productivity and they're using that
busyness to cope with something that they have not processed
and something that's unresolved.
Speaker 3 (06:39):
You've written that you were caught off guard hearing yourself
say that you felt depressed because you were so functional
and so productive.
Speaker 2 (06:49):
Well, it's interesting because every day I have to use
the DSM five to diagnose people, the Diagnostic Statistical Manual.
So symptoms of depression are low concentration, things like guilt,
low energy, changes in your appetite, changes in your sleep,
You feel restless, you can't sit still. Depression by definition,
(07:09):
does not require a low mood, and I don't think
people know that. By definition, you could either have a
low mood, you know, the classic depression, crying sadness or
anne Hondonia, which is a lack of interest and pleasure
in things that you once enjoy. So there are a
lot of people out there who don't look sad, but
they're struggling with Anne Hondonia and they don't even realize
(07:32):
that you don't have to be sad to meet criteria
for a depression. And listen, I was someone who experienced this,
and I knew the criteria. I looked at the data
sent every day, and it still snuck up on me.
So I just thought people need to know about this.
Antonia in research is such a boring term, But when
I started talking about online, it just blew up and
I was like, why are people so interested in this
boring term. It's because they could finally name what they
(07:54):
were experiencing. It was validating because they knew something was off,
they knew something didn't feel right, they just didn't have
a name for it. And in psychology there's a term
called affic labeling. If you can identify the emotion, if
you can name it accurately, that in itself decreases your
own certainty because not knowing and then thinking, well, why
am I not feeling better? What's wrong with me? That
(08:14):
uncertainty just makes you feel more stressed. And it's really
hard to be joyful in at peace when you don't
know what's happening. So naming the antaedonia identifying it in
itself is very powerful.
Speaker 3 (08:27):
Yeah, what happened next? What did it take for you
in that moment to try and seek help.
Speaker 4 (08:34):
Here's the thing.
Speaker 2 (08:35):
As someone who is used to being the good girl,
the people pleaser, I wasn't even aware as to how
I was people pleasing in my own therapy. I didn't
want to tell my therapist that I was experracy anadonia
because I didn't want to let her down. And I'm
a therapist.
Speaker 3 (08:51):
You are speaking my language, so it's like, yeah, wow, continue,
I just need to say that I feel so seen
right now.
Speaker 4 (08:59):
Oh thank you.
Speaker 2 (09:00):
I mean initially I did feel a lot of shame
and blame, but I didn't share with my therapist. And
she said, you know, I knew something was going on.
I just I was waiting for you to say it.
I knew something was going on. She says, whenever you
get really busy, something's off. And you've been really busy again,
(09:22):
back to that pathological productivity. Yeah, I go to for
coping with pain is busying myself. But in the trauma research,
in the PTSD research that I do, most people think
of avoidance as avoiding people, places, or situations that trigger you.
(09:43):
But those of us who use busyness, we avoid dealing
with our pain by trying to outrun it with work,
by taking on side projects. There's something within us that
doesn't allow us to rest. So we're constantly moving. We're
constantly busy. When we are not busy, we feel empty.
When we are not working, we feel restless.
Speaker 4 (10:02):
We just do, and it doesn't necessarily have to be work.
Speaker 2 (10:05):
Maybe it's cleaning out your garage, maybe it's taken on
a side hustle, maybe it's taken on other people's problems
or projects.
Speaker 4 (10:11):
You just can't sit still.
Speaker 2 (10:13):
You're avoiding processing what's really happening with and so that
was me. So she said to me, you know, you've
been so busy. I just knew something was off. I
was just waiting for you to tell me, and I'm
so glad that you did.
Speaker 3 (10:26):
You also started to notice around this time that so
many other people were sharing a similar constellation of symptoms.
You eventually identified this as high functioning depression, but you
saw that there was little clinical research on this condition,
and so you and your lab decided to start focusing
on it. Since high functioning depression is likely a new
(10:48):
term for a lot of listeners. I'd love if you
could define it for us.
Speaker 2 (10:53):
It's that type of depression where you don't look sad
and you're weepy. It's that type of depression where you
don't feel joy. Clinical depression happens when you meet the
criteria for certain symptoms of depression like changes in your sleep,
changes in your appetite, low energy, restlessness or being sluggish, guilt, hopelessness, etc.
(11:14):
And you have to have either low mood, depressed mood,
or an hedonia. But you also have to meet that
final box of I'm not functioning. And so a lot
of folks don't meet that checkbox. They can't slow down,
they're like me, they're running from something, or they're busy.
But if you don't, at the very bottom check that
(11:35):
box of your lacking functioning or you're in significant distress,
your healthcare professional will just say, well, come back when
you break down. And so I thought, well, how come
we don't ever look at these other types of depressions.
When you look at what's happening in medicine these days,
especially in the longevity space, it is the complete opposite.
We're saying, let's not wait for stage four cancer, let's
(11:57):
educate patients and catch the cancer risks. Or with the
menopause space, we're seeing people saying educate women about hormones,
educate them about their diet and their movement. Because we
want to prevent a heart issue, we want to prevent
a bone breaking from ostroporosis. So in other fields of
medicine we're experiencing this renaissance of preventative care, but in
(12:19):
mental health, we're still waiting for people to check that
box before we do something. And I wanted to focus
on those of us who don't break down. We were
built with the DNA for joy. We're supposed to derive
pleasure from the basic things in life. But if you're
not deriving pleasure from those things, and some of the
things that are on that rating scale are things like
(12:41):
when you eat a meal, do savor it? When you're
having a sip of tea, does it refresh you? When
you take a rest, when you take a nap, do
you wake up refreshed?
Speaker 4 (12:51):
Like?
Speaker 2 (12:51):
These are all things that are supposed to be points
of joy for human beings. So if you're not able
to access that, that is a problem. That's a warning sign.
It doesn't look as flashy as crying in bed and
staying in bed all day. But it is still a
crisis because we're supposed to be able to experience joy.
Speaker 3 (13:09):
Yeah, I'm just thinking about one of my best friends
in the whole world, and she's described what I'm now
registering as anaedonia as being almost like seeing the world
in gray scale. So she's like, there's nothing palpably wrong
in any given moment. But I don't, like you said,
I just don't feel joyful about the things, Like I
(13:29):
almost feel a sense of remove when I'm in experiences
that would otherwise have brought me joy. And just like
reflecting on how valuable this conversation would be for someone
like her, who has, never, like you said, met the
criteria for depression. She goes to a doctor. Doctors like,
you're keeping up your job, You're still in a happy marriage,
things are stable for you, Like what gives why are
(13:52):
you here? But like you said, humans are designed to
feel joy, and so it's important that we allow people
that access right to.
Speaker 1 (14:00):
One of the most primal needs of human beings.
Speaker 2 (14:03):
Joy doesn't mean that you're everything is perfect. It doesn't
mean that you have no problems. Joy is acts a
saying those experiences where you're able to find pleasure. So
if you're in your life and you're not connecting with
your partner, you're not finding that satisfaction anymore. You're eating
your food and you don't even taste it, you're just
kind of shoving it in. These are all points of
(14:25):
joy that you're losing. So it's worth investigating. It's worth
understanding what's happening in your life because joy is your
birthright as.
Speaker 4 (14:32):
A human being.
Speaker 2 (14:33):
If you're not feeling it anymore, it's a red flag
that you need to dig a little deeper and figure
out what's happening.
Speaker 3 (14:39):
Yeah, I mean, I really do think we put such
a premium on the alleviation of suffering, but we rarely
think about the inverse, which is the reclamation of joy.
Speaker 2 (14:48):
Well, many of us are trying to outrun suffering, like
myself included.
Speaker 4 (14:52):
So what did I do.
Speaker 2 (14:53):
I chased accolades, chase success, money, hoard at all these resources,
but I was left feeling completely joyless. So you think
you're trying to alleviate your suffering, but you're actually robbing
yourself of joy.
Speaker 3 (15:12):
We'll be back in a moment with a slight change
of plans. After years of research, Judith and her colleagues
(15:39):
published the first empirical study on high functioning depression. Judith's
new book is called High Functioning, Overcome Your Hidden Depression
and Reclaim Your Joy. It draws on original research, patient stories,
and her personal journey with the condition. Are there particular
populations of people who are more predisposed to high functioning
(16:02):
depression and if so, why do you think it's more
prevalent in these populations.
Speaker 2 (16:06):
Well, I've done the only study in high function depression,
so it's hard to make a claim. But what I
do know about depression is that depression tends to impact
women twice as likely as men.
Speaker 4 (16:16):
Whenever I hear that number, I'm like what, But then
I'm like, okay, yeah, that makes sense. There are a
lot of reasons for.
Speaker 2 (16:23):
Us, psychologically and socially. I also think that underserved populations
go through a lot of trauma. And we know that
black populations have high rates of PTSD, and some studies
indicate the highest, And yet we're the population that seems
to survive just about everything thrown at us. We survive slavery,
(16:46):
civil rights, injustices, but a lot of that unprocessed trauma
will catch up to us. We do have to acknowledge
our mental health, and even though we have high rates
of trauma, we're not as likely to seek treatment. And
that's from a host of different reasons, access to care,
the social determinants of health, and not having enough providers
that even look like US healthcare professionals are at high
(17:08):
risk for depression, and the rates of societality and residence
in medical residence is higher than the general population, so
the healers are on healed. I think it's really hard
for doctors to address antedonia as a symptom and a
problem in their patients because they probably feel a lot
of antadonia themselves, and.
Speaker 4 (17:26):
They're like, well, why would I diagnose something that I expect.
Speaker 3 (17:28):
Welcome to the club being human, right, this is my
baseline state?
Speaker 1 (17:32):
Yeah, exactly.
Speaker 3 (17:33):
Yeah, that makes so much sense before we get into
some first steps people can take. If they are listening
to this conversation and thinking, oh my god, Judith, I
definitely have high functioning depression. I just want to quickly
ask about the journey you've had as one of a
very small percentage of black physicians in the US trying
(17:53):
to put forth a somewhat revolutionary and controversial idea, novelty
of any kind, and feels like this will receive pushback,
but I want to know what the experience was like
to like challenge conventional wisdom and put forth this idea.
Given that just under three percent of physicians in the
US are black women.
Speaker 2 (18:12):
Yes, and less than two percent of psychiatrists are black,
so it's like wow. But yeah, Initially when I was
doing this work, I got a lot of messages from people,
psychologists and psychiatrists messaging me, calling me, emailing me, Oh,
this is just another thing you're trying to pathologize. But
(18:32):
fast forward now it's the opposite. I have doctors reaching
out to me saying your book has changed my life,
thank you for speaking to this. Can you come to
my hospital. The majority of us are experiencing this.
Speaker 1 (18:45):
And what do you think is responsible for that change?
Speaker 2 (18:48):
Well, you know, I think that people are a bit
more traumatized.
Speaker 4 (18:54):
Now, I'll else to say it. A lot has happened
in the past five years.
Speaker 2 (18:57):
Yeah, I think people have been through so much politically,
There's been wars and death and violence and so many changes, and.
Speaker 1 (19:05):
There's like a reckoning of some kind.
Speaker 4 (19:07):
Just so much bad news.
Speaker 2 (19:09):
Yeah, it starts to wear on you and then you're
just like, you know, I'm not okay. And I also
think that a lot of people are becoming more open
to the idea of those of us who are put
together having struggles. You know, There've been a couple of
high profile, unfortunately suicides in the past couple of years,
and so I think it's opening up this language for
(19:30):
people to say depression does look different, it's not what
I thought it was, or even to say, yes, I
am depressed, or I experience that. I've had people that
I respect and who are not very open about what
they experience personally come up to me and say, I
think I experienced that, and I just I don't think
I knew what it was. And these are physicians, We're
taught this stuff, you know. So I think it's really
(19:53):
been a stark change from when I started this.
Speaker 4 (19:55):
Work to now.
Speaker 3 (19:56):
Yeah, and I think I mean another hypothesis is that, look,
as we talked about before, right, you can only diagnose
and consider, you can only consider something a real category
if you're not in denial about having it yourself. Right,
And so one of the things we talked about is
maybe so many healthcare professionals are like, hey, this is
just status quo, like this is what it means to
live life. And I think one service of COVID is
(20:19):
that it was shining a light actively on the mental
health of first responders right for the first time, and
the effects weren't immediate, but over time, we as a
society came to appreciate the profound psychological burden that they
face day to day. And I wonder if that allowed
for a reckoning of sorts too. For the first time,
as a culture, we gave space for first responders to
(20:42):
say I'm not okay, and it was that recognition that
allows them to then say I'm not okay, which means, yes,
this might be a real thing. High functioning depression might
in fact be a real category.
Speaker 4 (20:53):
I think that's spot on.
Speaker 2 (20:54):
You're right, because after the pandemic, people were holding their
breath to get back to normal, and when normal never happened,
They're like.
Speaker 4 (21:00):
Okay, this ain't going away.
Speaker 2 (21:02):
We're five years out, almost six years out. Something's got it,
something's off, you know. And I think you're right that
time that distance away from you know, that event, people
are realizing it's not getting better. In fact, some of
my symptoms are getting worse, so I have to do
something about it.
Speaker 3 (21:16):
Yeah, high functioning depression currently isn't listed in the DSM,
the Diagnostic Statistical Manual, so that's the official handbook for
diagnosing mental illness. How do you think about this? I mean,
the DSM has terrible and problematic history on the one hand.
Speaker 1 (21:33):
On the other hand, it.
Speaker 3 (21:34):
Is a guide used by most healthcare professionals today. I
just wonder how you think about that tension and what
role it will play in the future of your work.
Speaker 2 (21:43):
Well, think about it things like postparm depression. There was
a time when post palm depression was not in the DSM,
but we wouldn't say it didn't exist. Burnout wasn't in
the DSM.
Speaker 5 (21:53):
Yeah.
Speaker 3 (21:53):
Also, wasn't homo sexuality pathologized at something?
Speaker 4 (21:57):
It was?
Speaker 2 (21:57):
Yeah, homosexuality was in there as a disorder. Yeah, you know,
we do need a diagnostic manual to conduct studies, but
at the same time we have to acknowledge it to things.
Speaker 4 (22:09):
Can be true.
Speaker 2 (22:09):
There are problems with our current manual and we have
to keep an open mind. And if we continue down
this road of let's wait till people break down to
do something about it.
Speaker 4 (22:19):
Then we are doing the public a huge disservice.
Speaker 2 (22:21):
We need to empower people because in some parts of
America there's only one psychiatrist for every thirty thousand people.
You know, in New York you have to wait for
six to eight weeks sometimes to get a psychiatrist. So
we have to think about things differently. We don't have
the professionals to meet the need. We have to train
people about how to identify these symptoms so they can
(22:42):
support themselves before they break down.
Speaker 3 (22:45):
Sure, but you do see it as a longer term
goal to try and advocate for inclusion of high functionivasion
in the DS.
Speaker 2 (22:51):
Or different forms of depression, because it's not just one
form for.
Speaker 3 (22:55):
Someone who's seeing themselves in all that you've just described anedonia,
hyper productivity. What recommendations do you have for treatment, Well, I.
Speaker 4 (23:04):
Would say start with validation.
Speaker 2 (23:06):
I call these the five v's Validation, venting, value, use, vitals,
and vision.
Speaker 4 (23:12):
I like invalidation too.
Speaker 2 (23:14):
If you're in a dark room and you hear a
loud crash and you don't see it, some of us
will start screaming, some of us start running, someone start
swinging because we're afraid but when you turn that light
on and you see what fell, or if it was
an object that fell, you're safe, you feel calm. Many
of us who are high functioning, we don't take the
time to acknowledge and accept how we feel. We just
(23:35):
push it down, We say we'll deal with it next time,
and then we just keep ongoing. The first step is
to acknowledge and name how you feel. If you're listening
to this and you realize that you have anadonia, you're
not enjoying things and you're lacking joy, name it, accept it,
and acknowledge it. If you're someone who's feeling very, very
stressed and anxious, name it, acknowledge it. If we don't
(24:00):
accept and acknowledge how we feel and we just keep
on this path of being this human doing and not
a human being, we're missing out on these precious moments
in life where we can be accessing joy.
Speaker 4 (24:12):
And I think that step is.
Speaker 2 (24:13):
Really difficult for many people because if you were raised
in a household where people didn't really talk about feelings,
or maybe you're in a relationship where you're not validated often,
or you're in a field of work where the workplace
doesn't really validate you. You just it becomes your coping mechanism.
But when you continue to push down your feelings, you
(24:35):
also numb yourself to feeling joy too. So you have
to feel the feels. You have to go through it,
you know, like I did. It wasn't easy for me
to acknowledge that I wasn't okay, and I fared it.
I fared saying it out loud. I avoided it. But
being able to get comfortable with that discomfort allowed me
to take the steps that I needed to heal.
Speaker 4 (24:56):
And to change.
Speaker 1 (24:58):
Beyond validation, what else do you recommend?
Speaker 4 (25:02):
Venting is very powerful.
Speaker 2 (25:03):
When I bring people into my lab, I'll fill up
a red balloon and I'll ask each purchase meant to
try and push that balloon into this tub of water,
and one hundred percent of time that balloon pops up.
Why you can't out math physics? Right?
Speaker 4 (25:17):
Physics is physics.
Speaker 2 (25:19):
But then when I ask all those people to then
try and deflate the balloon, they let the air out,
then that balloon glides in the water, or you could
easily push it down. If we don't learn how to
express our feelings, it will pop up in our relationships
in a nasty fight.
Speaker 4 (25:33):
It'll pop upbout work.
Speaker 2 (25:35):
It'll pop up when we're driving home from work and
we cut someone off. It can pop up in our health.
So being able to express your emotions intentionally, not just
like going out in trauma dumping, not just telling anybody
how you feel all the time, but if that's to
a therapist, that's really powerful. When I started talking to
my therapist about how I was feeling, it just felt
like a load had been lifted off of me.
Speaker 4 (25:58):
And then I wonder, why did I do this sooner?
That was silly.
Speaker 2 (26:01):
But for those of us who aren't in therapy, talking
to a trusted faith leader or to a family friend,
you know, being careful about who you talk to. You
don't want to talk to your people who are in
lower positions than you, like your kids, because they're going
to listen, but they're going to worry about you, and
so that's an unfair power dynamic, or to your employees.
But venting it can also be in writing, like journaling.
It could be through singing, through praying, through crying, just
(26:23):
express those emotions to release some of that anxious energy.
For a very long time, I was chasing the accolades,
the achievements, but I forgot why I actually went into
my role. I wanted to learn out of curiosity, this
thirst for knowledge. And when I started to seek knowledge
(26:44):
and curiosity versus the accolades, I started to feel a
sense of purpose again. And so I classify value as
things that are priceless, not with the price tags. So
many of us chase these things that we think will
make us happy, but they end up causing us more stress.
So try and tap into things that actually bring you
meaning and purpose. For me, it was connection with others
(27:06):
and curiosity and learning others. It could be things like
nature or their faith or community.
Speaker 4 (27:13):
And then the.
Speaker 2 (27:14):
Fourth vas vitals, and that's really honoring the fact that
you only get one body and brain and really taking
care of that. When I was in my highest high
functioning ways, I'd go through a day and I'd like,
at the end of the day, I'd be like, oh
my gosh, I didn't even go to the bathroom. I'd
be running to the bathroom as soon as I got home,
you know, not eating properly, just eating the fastest thing
I could get my hand on. Take the time to
(27:36):
take care of your body. Pencil in those breaks in
between your zooms. What's the worst thing that could happen
if you go and use the bathroom. What's the worst
thing that happened if God forbid ate your salad without
looking at a screen, or trying to cram in a
meeting while you ate. These are all the things that
are the simple things in life. And there was this
recent study where they took the smartphone capacity away from
(27:57):
these phones and people for two weeks could only use
their phones as if it were just like a flip phone,
like protecting and calling. And what they found was that
after two weeks, their mood scores went up as if
they were being read it with an answer depressant. Why
Because they were sleeping more, they were eating and tasting
their food, they were out in nature, they were connecting
more with others. They were getting all those points of
(28:19):
joy that I was talking about that we actually add
up to determine how people are becoming happy in depression research. Right,
they were actually getting those points because they weren't so
busy on their phones.
Speaker 4 (28:29):
So really honor your body in that way.
Speaker 3 (28:32):
It's so funny you mentioned that there was this moment,
maybe it was like a year or two ago where
I was sitting down to have lunch and I had
my laptop and it was playing something, but that wasn't
stimulating enough because I feel like this level of stimulation,
I think it's addictive. It feeds on itself. It's like
adapting this sugar. You just need more and more of it.
So that I'm also on my phone scrolling like Instagram
(28:54):
as this video plays as I'm eating my lunch, and
I'm like, when was the last time you sat down
to eat anything without your phone? And it was astonishing
how infrequent that experience was for me, certainly during lunchtime.
Speaker 2 (29:08):
Well, you know, I'm glad you brought that up, because
I'm so intentional about my lunch these days. Because there
was a period in time where I had to take
acid pills every day because I was just shoving it
in in front of a meeting, putting on mutes so
I could crunch my salad some people in the here
that I was eating and then off right, and then
I have, let's say ask, I'm like, what was I thinking?
(29:30):
One of the basic joys is eating food and savoring it.
There was no need for that.
Speaker 4 (29:35):
You know, no one was going to.
Speaker 2 (29:37):
Lose anything if I actually God forbid ate my salad
in peace.
Speaker 1 (29:41):
Yes, exactly, exactly, but many of us lose.
Speaker 2 (29:44):
That point of joy, that's simple point of joy because
we think that we're not deserving of it. And then
the fifth fee is vision, and vision has two prongs.
It's celebrating your winds and planning joy. And the celebrating
of the winds is something that I just I mean,
there was a large point in my life when I
(30:05):
kid you not my ivy le degrees were under my bed.
Speaker 4 (30:11):
What was that for? Take your degrees and hang them up.
Speaker 2 (30:15):
If you do something at work, plan a small celebration,
you know, like with my lab. When we finish our trainings,
everyone has to put it in a binder. And if
one of us finishes a big milestone, we'll meet in
the lab. We'll have like cupcakes, or we'll have a lunch.
We celebrate the small things that we used to take
for granted. It's important to have these things to look
(30:36):
forward to, to bond together and to represent the fact
that you didn't have to do what you did, but
you did it. And rather than going on to the
next let's take some time and reflect on this great
thing that you did. And it's a huge mind shift,
and so I tell myself that all the time. Like
the Judith I am today is so different than five
years ago because when I finished a training, I have
(30:57):
to do so many trainings for research.
Speaker 4 (30:59):
I'm like, I did this training, I like put it
up on the board.
Speaker 2 (31:04):
That's act and I'm like, now I'm worthy of a break,
and it's something I have to do myself, Like totally,
I did this, and now I get this break and
it has drastically changed my quality of life. And this
is not like big stuff, but it's so important. It
sends a message that I am a human being. I'm
not a human doing.
Speaker 3 (31:23):
What is your experience like today, Judith, Like, as someone
who has high functioning depression, Like, do you still consider
it an active diagnosis? Is it something you continue to
work through? Or probably yes?
Speaker 2 (31:35):
The bookstore is not something that encourages healing from high
functioning depression.
Speaker 4 (31:39):
Let me just put it that way.
Speaker 3 (31:40):
I was just gonna say, there is such an irony
to your story, right, which is that you had this
breaking point, but then through the work you've done on
high functioning depression, you kind of elevated into this superstar psychiatrist.
And I'm imagining your time is even more tax than
before given all your obligations. And so what is your
relationship like with high functioning depression? Like, how do you
keep things in check?
Speaker 2 (32:02):
Well, you know, I had to let go of a
lot of things that I used to hold tight to.
There you used to be just belief that no one
can do it better than you, and I had to
challenge that worst case scenario. Many times we think, if
you don't do X, the worst thing will happen. And
now I've let go of so many things and I
just trust people more. I'm letting the worst thing happen,
(32:24):
which is nothing happened, Nothing that happened.
Speaker 1 (32:27):
Yeah, in fact, I okay to ask for you.
Speaker 2 (32:30):
I'm not in every single space, I'm not in every
single meeting.
Speaker 4 (32:33):
I just let go.
Speaker 2 (32:34):
And you know, I told you that this antedonia is contagious.
This joy is contagious too. When you relax and you
let people who want to help you help you, they're
so happy to help you. When you start to prioritize
joy and you slow down and you save your life,
others around you will see that too and they will
change as well.
Speaker 4 (32:54):
It is. It's contagious.
Speaker 3 (32:57):
As someone who you've mentioned you've experienced anedonia. I just
want to know if you can reflect on, like this
past week, what were your top moments of joy, just
to give people hope that they can reclaim what you've experience.
Speaker 2 (33:09):
I got a new serum for my skin, and it's
something that I look forward to every day. As a child,
you know, my mom had four kids, and I grew
up in this tiny, one bedroom apartment, and you know,
when we bathed, she had to bathe us all together.
When she loationed us, she had to loation us all together.
So I was not someone who was raised gently like
caressing my face and skin. It was always this rushed,
(33:31):
hurried type of process. And I realized this later in
life that these type of rituals are really important for
sending a deeper message that you care about yourself, that
you're worthy.
Speaker 4 (33:41):
So I look forward to my skin routine.
Speaker 1 (33:43):
I love it.
Speaker 2 (33:44):
I look forward to my bedtime routine. I just as
someone who used to pride themselves on like I only
got four hours of sleep or five hours. I am
like eight hour at night person. Like I pride myself
on that I protect my sleep. Sleep feels yummy again,
you know, like that sleep when you're a kid and
(34:04):
you used to feel like, oh yeah, I get this
yummy sleep again. And then nature. I'm Portunida, I'm from
the Caribbean. I grew up going to the beach every weekend.
I made it a point, and I was intentional to
live close to the water in Manhattan and really be
close to the water and close to nature. So that's
what brings me joy, very simple.
Speaker 3 (34:22):
I know, I love it, and I was just gonna
see you mentioned Anaedonia can be contagious, but your joy
is contagious.
Speaker 1 (34:28):
I've got the biggest.
Speaker 3 (34:29):
Smile plastered on my face right now just hearing about
those moments. So I'm so glad you shared them with me,
and thank you so much for coming on the show.
Speaker 4 (34:36):
Thank you.
Speaker 3 (34:59):
If you or someone you love is struggling with depression,
health is available, call the National Alliance on Mental Illness
Helpline at one eight hundred ninety five ZO six' two six'
four for free confidential support. And resources you could also
find the number in our show notes and join me
next time for my Conversation With, jessica slice an author
(35:22):
who writes about living. With disability she talks about how
her disability renewed her relationship.
Speaker 5 (35:28):
With herself for all THOSE years i thought that it
was in my control to, be perfect or to form a,
perfect life or to be, good enough and, BECOMING disabled,
i mean so little isn't my? Control NOW and i
like my life as a disabled person far MORE than
(35:49):
i liked my.
Speaker 3 (35:50):
Life before that's next TIME On A slight Change. Of
plans see. YOU Then A slight Change of plans, is
created written and executive produced By Me. Maya Schunker The
slight changed family includes Our Showrunner, tyler green our Senior
Editor Kate, parkinson morgan Our Producers britain Cronin And, megan
lubin and our Sound Engineer. Erica Huang louis scara wrote
(36:14):
our delightful, theme Song And ginger smith helped arrange. THE
Vocals A slight Change of plans is a Production Of,
pushkin industries so big thanks to, everyone there and of
course a very special Thanks To. Jimmy lee you CAN
Follow A slight Change of Plans on instagram At Doctor.
Speaker 1 (36:30):
Maya schunker see you. Next week
Pushkin.
Speaker 2 (00:29):
We were built with the DNA for joy. We're supposed
to derive pleasure from the basic things in life. If
you're not deriving pleasure from those things, that is a problem.
That's a warning sign, because we're supposed to be able
to experience joy.
Speaker 3 (00:44):
Doctor Judith Joseph is a psychiatrist and a clinical researcher.
These days, joy is a key part of her life,
but that wasn't always the case. Just a few years ago,
things looked great from the outside. She was crushing it
at work and collecting accolades, but on the inside she
was struggling.
Speaker 2 (01:02):
And I thought, well, if I'm like this and it
snuck up on me, I wonder how many people like
me experience I wonder how many people are hiding behind
a mask of pathological productivity and they're using that busyness
to cope with something that they have not processed and
something that's unresolved.
Speaker 3 (01:25):
On today's show, The Mask of Pathological Productivity, I'm Maya Schunker,
a scientist who studies human behavior, and this is a
slight change of plans, a show about who we are
and who we become in the face of a big change.
(01:51):
Doctor Judith Joseph is the founder of a research lab
that explores novel treatments for mental health conditions, conditions like anxiety, depression,
and ADHD. She's also a professor of psychiatry at NYU
and a practicing psychiatrist. Judith says that back in med school,
she surprised her family by choosing to go into psychiatry.
Speaker 2 (02:14):
When I went to medical school, I was the first
person to graduate from college in my family, the first
doctor in my family. And so if I went to
my family and I said I want to be a psychiatrist,
they'd be like, what, that's not a real doctor. My
dad is a pastor. He still is a pastor. So
I was a pastor's kid, went to church three times
a week. And now that I look back, I have
(02:35):
these memories of people coming into the church and people
who were thought to have demons. But now I'm like, oh,
my gosh, that was actually untreated schizophrenia, or people who
had mood swings, and you know, I think, well, that
was actually a substance induced mood disorder. And people with
severe depression who were told to just pray themselves out
of it. You know, I see all of these things
(02:57):
that could have been addressed from a mental health perspective,
but from a cultural perspective, they were called something completely different.
And when I actually told my parents that I was
switching from antisysiology to psychiatry, my dad was like, well,
why you want to work with them crazy people? You
know they're from the Caribbean. And I said, well, Daddy,
the brain is part of the body too, and so
(03:19):
if someone were to have asthma, you wouldn't tell them
to pray out of it. You'd say, oh, you should
really go to a doctor and get an inhaler and
think about all the allergens that are triggering that. But
for some reason, in many cultures, it is still pervasive,
this idea that if you have, you know, a mental
health condition, somehow you should be able to pull yourself
out of it. That's different than physical health. But we
(03:41):
know that the brain is connected to the body, and
I believe it's the most important organ.
Speaker 4 (03:45):
But that's my bias as.
Speaker 3 (03:46):
A psychiatrist, it's my bias as a cognitive neuroscientist.
Speaker 1 (03:50):
We share the same bias. Judents.
Speaker 3 (03:53):
You know, you had your own struggles with mental health
early in the pandemic, and I'm wondering if you can
bring me back to that period of time and set
the scene about what was going on in your life.
Speaker 2 (04:06):
I was giving this talk to very busy, large hospital
system in April twenty twenty, and they had asked me
to give the talk because a lot of the healthcare
professionals were very anxious, very stressed out, and concerned about
their mental health.
Speaker 4 (04:22):
No one knew what was going to happen.
Speaker 2 (04:24):
The world was in a state of uncertainty, and I
was supposed to be one of the voices of hope
giving people skills. But halfway through that talk, I just
felt like, I think I'm depressed, Like it kind.
Speaker 4 (04:37):
Of stuck up on me. You know.
Speaker 2 (04:39):
In the past, given a talk like that would have
been really pleasurable for me, you know, but I just
felt kind of muh bleh. And I just felt really
lost because the hopelessness was palpable in that presentation. People
were writing in things like they don't know if they're
going to be able to see their family, they don't
know if they could infect people, and it's just like, well,
(05:00):
I don't know how I'm doing. How am I going
to help you? I can't even take care of myself.
That was the moment I had in that moment. But
you know, on the outside, everything looked perfect. I I
had just gotten onto this prestigious board of women from
this MV League institution. My lab was the only lab
in the building still running. You know, I was still
taking care of my team, my employees. I had a
(05:21):
little cute kid at home, perfect marriage, what it looked
like on the outside.
Speaker 4 (05:25):
But I couldn't slow down.
Speaker 2 (05:26):
In fact, I think that I was probably at the
height of the most I've ever worked in my entire life.
My worst fear was not being able to provide from
my team for my family, letting my patients down.
Speaker 4 (05:40):
So I was coping with that.
Speaker 2 (05:42):
By overfunctioning, overproducing, overworking. I could not sit still, and
I thought, well, how did I let this happen? I
internalized that shame and blame, like I should know better.
I'm a psychiatrist, I studied depression. How did this snake
up on me?
Speaker 4 (05:58):
And I think a.
Speaker 2 (05:59):
Lot of therapists go through this. We deal with a
lot of emotions, grief, We deal with this vicarious trauma
because we hear people's pain all the time, and we
just we put on that mask because we have to
show up for others, so many of us feel alone.
(06:20):
But I thought, well, if I'm like this and it
snuck up on me, I wonder how many people like
me experience this. I wonder how many people are hiding
behind a mask of pathological productivity and they're using that
busyness to cope with something that they have not processed
and something that's unresolved.
Speaker 3 (06:39):
You've written that you were caught off guard hearing yourself
say that you felt depressed because you were so functional
and so productive.
Speaker 2 (06:49):
Well, it's interesting because every day I have to use
the DSM five to diagnose people, the Diagnostic Statistical Manual.
So symptoms of depression are low concentration, things like guilt,
low energy, changes in your appetite, changes in your sleep,
You feel restless, you can't sit still. Depression by definition,
(07:09):
does not require a low mood, and I don't think
people know that. By definition, you could either have a
low mood, you know, the classic depression, crying sadness or
anne Hondonia, which is a lack of interest and pleasure
in things that you once enjoy. So there are a
lot of people out there who don't look sad, but
they're struggling with Anne Hondonia and they don't even realize
(07:32):
that you don't have to be sad to meet criteria
for a depression. And listen, I was someone who experienced this,
and I knew the criteria. I looked at the data
sent every day, and it still snuck up on me.
So I just thought people need to know about this.
Antonia in research is such a boring term, But when
I started talking about online, it just blew up and
I was like, why are people so interested in this
boring term. It's because they could finally name what they
(07:54):
were experiencing. It was validating because they knew something was off,
they knew something didn't feel right, they just didn't have
a name for it. And in psychology there's a term
called affic labeling. If you can identify the emotion, if
you can name it accurately, that in itself decreases your
own certainty because not knowing and then thinking, well, why
am I not feeling better? What's wrong with me? That
(08:14):
uncertainty just makes you feel more stressed. And it's really
hard to be joyful in at peace when you don't
know what's happening. So naming the antaedonia identifying it in
itself is very powerful.
Speaker 3 (08:27):
Yeah, what happened next? What did it take for you
in that moment to try and seek help.
Speaker 4 (08:34):
Here's the thing.
Speaker 2 (08:35):
As someone who is used to being the good girl,
the people pleaser, I wasn't even aware as to how
I was people pleasing in my own therapy. I didn't
want to tell my therapist that I was experracy anadonia
because I didn't want to let her down. And I'm
a therapist.
Speaker 3 (08:51):
You are speaking my language, so it's like, yeah, wow, continue,
I just need to say that I feel so seen
right now.
Speaker 4 (08:59):
Oh thank you.
Speaker 2 (09:00):
I mean initially I did feel a lot of shame
and blame, but I didn't share with my therapist. And
she said, you know, I knew something was going on.
I just I was waiting for you to say it.
I knew something was going on. She says, whenever you
get really busy, something's off. And you've been really busy again,
(09:22):
back to that pathological productivity. Yeah, I go to for
coping with pain is busying myself. But in the trauma research,
in the PTSD research that I do, most people think
of avoidance as avoiding people, places, or situations that trigger you.
(09:43):
But those of us who use busyness, we avoid dealing
with our pain by trying to outrun it with work,
by taking on side projects. There's something within us that
doesn't allow us to rest. So we're constantly moving. We're
constantly busy. When we are not busy, we feel empty.
When we are not working, we feel restless.
Speaker 4 (10:02):
We just do, and it doesn't necessarily have to be work.
Speaker 2 (10:05):
Maybe it's cleaning out your garage, maybe it's taken on
a side hustle, maybe it's taken on other people's problems
or projects.
Speaker 4 (10:11):
You just can't sit still.
Speaker 2 (10:13):
You're avoiding processing what's really happening with and so that
was me. So she said to me, you know, you've
been so busy. I just knew something was off. I
was just waiting for you to tell me, and I'm
so glad that you did.
Speaker 3 (10:26):
You also started to notice around this time that so
many other people were sharing a similar constellation of symptoms.
You eventually identified this as high functioning depression, but you
saw that there was little clinical research on this condition,
and so you and your lab decided to start focusing
on it. Since high functioning depression is likely a new
(10:48):
term for a lot of listeners. I'd love if you
could define it for us.
Speaker 2 (10:53):
It's that type of depression where you don't look sad
and you're weepy. It's that type of depression where you
don't feel joy. Clinical depression happens when you meet the
criteria for certain symptoms of depression like changes in your sleep,
changes in your appetite, low energy, restlessness or being sluggish, guilt, hopelessness, etc.
(11:14):
And you have to have either low mood, depressed mood,
or an hedonia. But you also have to meet that
final box of I'm not functioning. And so a lot
of folks don't meet that checkbox. They can't slow down,
they're like me, they're running from something, or they're busy.
But if you don't, at the very bottom check that
(11:35):
box of your lacking functioning or you're in significant distress,
your healthcare professional will just say, well, come back when
you break down. And so I thought, well, how come
we don't ever look at these other types of depressions.
When you look at what's happening in medicine these days,
especially in the longevity space, it is the complete opposite.
We're saying, let's not wait for stage four cancer, let's
(11:57):
educate patients and catch the cancer risks. Or with the
menopause space, we're seeing people saying educate women about hormones,
educate them about their diet and their movement. Because we
want to prevent a heart issue, we want to prevent
a bone breaking from ostroporosis. So in other fields of
medicine we're experiencing this renaissance of preventative care, but in
(12:19):
mental health, we're still waiting for people to check that
box before we do something. And I wanted to focus
on those of us who don't break down. We were
built with the DNA for joy. We're supposed to derive
pleasure from the basic things in life. But if you're
not deriving pleasure from those things, and some of the
things that are on that rating scale are things like
(12:41):
when you eat a meal, do savor it? When you're
having a sip of tea, does it refresh you? When
you take a rest, when you take a nap, do
you wake up refreshed?
Speaker 4 (12:51):
Like?
Speaker 2 (12:51):
These are all things that are supposed to be points
of joy for human beings. So if you're not able
to access that, that is a problem. That's a warning sign.
It doesn't look as flashy as crying in bed and
staying in bed all day. But it is still a
crisis because we're supposed to be able to experience joy.
Speaker 3 (13:09):
Yeah, I'm just thinking about one of my best friends
in the whole world, and she's described what I'm now
registering as anaedonia as being almost like seeing the world
in gray scale. So she's like, there's nothing palpably wrong
in any given moment. But I don't, like you said,
I just don't feel joyful about the things, Like I
(13:29):
almost feel a sense of remove when I'm in experiences
that would otherwise have brought me joy. And just like
reflecting on how valuable this conversation would be for someone
like her, who has, never, like you said, met the
criteria for depression. She goes to a doctor. Doctors like,
you're keeping up your job, You're still in a happy marriage,
things are stable for you, Like what gives why are
(13:52):
you here? But like you said, humans are designed to
feel joy, and so it's important that we allow people
that access right to.
Speaker 1 (14:00):
One of the most primal needs of human beings.
Speaker 2 (14:03):
Joy doesn't mean that you're everything is perfect. It doesn't
mean that you have no problems. Joy is acts a
saying those experiences where you're able to find pleasure. So
if you're in your life and you're not connecting with
your partner, you're not finding that satisfaction anymore. You're eating
your food and you don't even taste it, you're just
kind of shoving it in. These are all points of
(14:25):
joy that you're losing. So it's worth investigating. It's worth
understanding what's happening in your life because joy is your
birthright as.
Speaker 4 (14:32):
A human being.
Speaker 2 (14:33):
If you're not feeling it anymore, it's a red flag
that you need to dig a little deeper and figure
out what's happening.
Speaker 3 (14:39):
Yeah, I mean, I really do think we put such
a premium on the alleviation of suffering, but we rarely
think about the inverse, which is the reclamation of joy.
Speaker 2 (14:48):
Well, many of us are trying to outrun suffering, like
myself included.
Speaker 4 (14:52):
So what did I do.
Speaker 2 (14:53):
I chased accolades, chase success, money, hoard at all these resources,
but I was left feeling completely joyless. So you think
you're trying to alleviate your suffering, but you're actually robbing
yourself of joy.
Speaker 3 (15:12):
We'll be back in a moment with a slight change
of plans. After years of research, Judith and her colleagues
(15:39):
published the first empirical study on high functioning depression. Judith's
new book is called High Functioning, Overcome Your Hidden Depression
and Reclaim Your Joy. It draws on original research, patient stories,
and her personal journey with the condition. Are there particular
populations of people who are more predisposed to high functioning
(16:02):
depression and if so, why do you think it's more
prevalent in these populations.
Speaker 2 (16:06):
Well, I've done the only study in high function depression,
so it's hard to make a claim. But what I
do know about depression is that depression tends to impact
women twice as likely as men.
Speaker 4 (16:16):
Whenever I hear that number, I'm like what, But then
I'm like, okay, yeah, that makes sense. There are a
lot of reasons for.
Speaker 2 (16:23):
Us, psychologically and socially. I also think that underserved populations
go through a lot of trauma. And we know that
black populations have high rates of PTSD, and some studies
indicate the highest, And yet we're the population that seems
to survive just about everything thrown at us. We survive slavery,
(16:46):
civil rights, injustices, but a lot of that unprocessed trauma
will catch up to us. We do have to acknowledge
our mental health, and even though we have high rates
of trauma, we're not as likely to seek treatment. And
that's from a host of different reasons, access to care,
the social determinants of health, and not having enough providers
that even look like US healthcare professionals are at high
(17:08):
risk for depression, and the rates of societality and residence
in medical residence is higher than the general population, so
the healers are on healed. I think it's really hard
for doctors to address antedonia as a symptom and a
problem in their patients because they probably feel a lot
of antadonia themselves, and.
Speaker 4 (17:26):
They're like, well, why would I diagnose something that I expect.
Speaker 3 (17:28):
Welcome to the club being human, right, this is my
baseline state?
Speaker 1 (17:32):
Yeah, exactly.
Speaker 3 (17:33):
Yeah, that makes so much sense before we get into
some first steps people can take. If they are listening
to this conversation and thinking, oh my god, Judith, I
definitely have high functioning depression. I just want to quickly
ask about the journey you've had as one of a
very small percentage of black physicians in the US trying
(17:53):
to put forth a somewhat revolutionary and controversial idea, novelty
of any kind, and feels like this will receive pushback,
but I want to know what the experience was like
to like challenge conventional wisdom and put forth this idea.
Given that just under three percent of physicians in the
US are black women.
Speaker 2 (18:12):
Yes, and less than two percent of psychiatrists are black,
so it's like wow. But yeah, Initially when I was
doing this work, I got a lot of messages from people,
psychologists and psychiatrists messaging me, calling me, emailing me, Oh,
this is just another thing you're trying to pathologize. But
(18:32):
fast forward now it's the opposite. I have doctors reaching
out to me saying your book has changed my life,
thank you for speaking to this. Can you come to
my hospital. The majority of us are experiencing this.
Speaker 1 (18:45):
And what do you think is responsible for that change?
Speaker 2 (18:48):
Well, you know, I think that people are a bit
more traumatized.
Speaker 4 (18:54):
Now, I'll else to say it. A lot has happened
in the past five years.
Speaker 2 (18:57):
Yeah, I think people have been through so much politically,
There's been wars and death and violence and so many changes, and.
Speaker 1 (19:05):
There's like a reckoning of some kind.
Speaker 4 (19:07):
Just so much bad news.
Speaker 2 (19:09):
Yeah, it starts to wear on you and then you're
just like, you know, I'm not okay. And I also
think that a lot of people are becoming more open
to the idea of those of us who are put
together having struggles. You know, There've been a couple of
high profile, unfortunately suicides in the past couple of years,
and so I think it's opening up this language for
(19:30):
people to say depression does look different, it's not what
I thought it was, or even to say, yes, I
am depressed, or I experience that. I've had people that
I respect and who are not very open about what
they experience personally come up to me and say, I
think I experienced that, and I just I don't think
I knew what it was. And these are physicians, We're
taught this stuff, you know. So I think it's really
(19:53):
been a stark change from when I started this.
Speaker 4 (19:55):
Work to now.
Speaker 3 (19:56):
Yeah, and I think I mean another hypothesis is that, look,
as we talked about before, right, you can only diagnose
and consider, you can only consider something a real category
if you're not in denial about having it yourself. Right,
And so one of the things we talked about is
maybe so many healthcare professionals are like, hey, this is
just status quo, like this is what it means to
live life. And I think one service of COVID is
(20:19):
that it was shining a light actively on the mental
health of first responders right for the first time, and
the effects weren't immediate, but over time, we as a
society came to appreciate the profound psychological burden that they
face day to day. And I wonder if that allowed
for a reckoning of sorts too. For the first time,
as a culture, we gave space for first responders to
(20:42):
say I'm not okay, and it was that recognition that
allows them to then say I'm not okay, which means, yes,
this might be a real thing. High functioning depression might
in fact be a real category.
Speaker 4 (20:53):
I think that's spot on.
Speaker 2 (20:54):
You're right, because after the pandemic, people were holding their
breath to get back to normal, and when normal never happened,
They're like.
Speaker 4 (21:00):
Okay, this ain't going away.
Speaker 2 (21:02):
We're five years out, almost six years out. Something's got it,
something's off, you know. And I think you're right that
time that distance away from you know, that event, people
are realizing it's not getting better. In fact, some of
my symptoms are getting worse, so I have to do
something about it.
Speaker 3 (21:16):
Yeah, high functioning depression currently isn't listed in the DSM,
the Diagnostic Statistical Manual, so that's the official handbook for
diagnosing mental illness. How do you think about this? I mean,
the DSM has terrible and problematic history on the one hand.
Speaker 1 (21:33):
On the other hand, it.
Speaker 3 (21:34):
Is a guide used by most healthcare professionals today. I
just wonder how you think about that tension and what
role it will play in the future of your work.
Speaker 2 (21:43):
Well, think about it things like postparm depression. There was
a time when post palm depression was not in the DSM,
but we wouldn't say it didn't exist. Burnout wasn't in
the DSM.
Speaker 5 (21:53):
Yeah.
Speaker 3 (21:53):
Also, wasn't homo sexuality pathologized at something?
Speaker 4 (21:57):
It was?
Speaker 2 (21:57):
Yeah, homosexuality was in there as a disorder. Yeah, you know,
we do need a diagnostic manual to conduct studies, but
at the same time we have to acknowledge it to things.
Speaker 4 (22:09):
Can be true.
Speaker 2 (22:09):
There are problems with our current manual and we have
to keep an open mind. And if we continue down
this road of let's wait till people break down to
do something about it.
Speaker 4 (22:19):
Then we are doing the public a huge disservice.
Speaker 2 (22:21):
We need to empower people because in some parts of
America there's only one psychiatrist for every thirty thousand people.
You know, in New York you have to wait for
six to eight weeks sometimes to get a psychiatrist. So
we have to think about things differently. We don't have
the professionals to meet the need. We have to train
people about how to identify these symptoms so they can
(22:42):
support themselves before they break down.
Speaker 3 (22:45):
Sure, but you do see it as a longer term
goal to try and advocate for inclusion of high functionivasion
in the DS.
Speaker 2 (22:51):
Or different forms of depression, because it's not just one
form for.
Speaker 3 (22:55):
Someone who's seeing themselves in all that you've just described anedonia,
hyper productivity. What recommendations do you have for treatment, Well, I.
Speaker 4 (23:04):
Would say start with validation.
Speaker 2 (23:06):
I call these the five v's Validation, venting, value, use, vitals,
and vision.
Speaker 4 (23:12):
I like invalidation too.
Speaker 2 (23:14):
If you're in a dark room and you hear a
loud crash and you don't see it, some of us
will start screaming, some of us start running, someone start
swinging because we're afraid but when you turn that light
on and you see what fell, or if it was
an object that fell, you're safe, you feel calm. Many
of us who are high functioning, we don't take the
time to acknowledge and accept how we feel. We just
(23:35):
push it down, We say we'll deal with it next time,
and then we just keep ongoing. The first step is
to acknowledge and name how you feel. If you're listening
to this and you realize that you have anadonia, you're
not enjoying things and you're lacking joy, name it, accept it,
and acknowledge it. If you're someone who's feeling very, very
stressed and anxious, name it, acknowledge it. If we don't
(24:00):
accept and acknowledge how we feel and we just keep
on this path of being this human doing and not
a human being, we're missing out on these precious moments
in life where we can be accessing joy.
Speaker 4 (24:12):
And I think that step is.
Speaker 2 (24:13):
Really difficult for many people because if you were raised
in a household where people didn't really talk about feelings,
or maybe you're in a relationship where you're not validated often,
or you're in a field of work where the workplace
doesn't really validate you. You just it becomes your coping mechanism.
But when you continue to push down your feelings, you
(24:35):
also numb yourself to feeling joy too. So you have
to feel the feels. You have to go through it,
you know, like I did. It wasn't easy for me
to acknowledge that I wasn't okay, and I fared it.
I fared saying it out loud. I avoided it. But
being able to get comfortable with that discomfort allowed me
to take the steps that I needed to heal.
Speaker 4 (24:56):
And to change.
Speaker 1 (24:58):
Beyond validation, what else do you recommend?
Speaker 4 (25:02):
Venting is very powerful.
Speaker 2 (25:03):
When I bring people into my lab, I'll fill up
a red balloon and I'll ask each purchase meant to
try and push that balloon into this tub of water,
and one hundred percent of time that balloon pops up.
Why you can't out math physics? Right?
Speaker 4 (25:17):
Physics is physics.
Speaker 2 (25:19):
But then when I ask all those people to then
try and deflate the balloon, they let the air out,
then that balloon glides in the water, or you could
easily push it down. If we don't learn how to
express our feelings, it will pop up in our relationships
in a nasty fight.
Speaker 4 (25:33):
It'll pop upbout work.
Speaker 2 (25:35):
It'll pop up when we're driving home from work and
we cut someone off. It can pop up in our health.
So being able to express your emotions intentionally, not just
like going out in trauma dumping, not just telling anybody
how you feel all the time, but if that's to
a therapist, that's really powerful. When I started talking to
my therapist about how I was feeling, it just felt
like a load had been lifted off of me.
Speaker 4 (25:58):
And then I wonder, why did I do this sooner?
That was silly.
Speaker 2 (26:01):
But for those of us who aren't in therapy, talking
to a trusted faith leader or to a family friend,
you know, being careful about who you talk to. You
don't want to talk to your people who are in
lower positions than you, like your kids, because they're going
to listen, but they're going to worry about you, and
so that's an unfair power dynamic, or to your employees.
But venting it can also be in writing, like journaling.
It could be through singing, through praying, through crying, just
(26:23):
express those emotions to release some of that anxious energy.
For a very long time, I was chasing the accolades,
the achievements, but I forgot why I actually went into
my role. I wanted to learn out of curiosity, this
thirst for knowledge. And when I started to seek knowledge
(26:44):
and curiosity versus the accolades, I started to feel a
sense of purpose again. And so I classify value as
things that are priceless, not with the price tags. So
many of us chase these things that we think will
make us happy, but they end up causing us more stress.
So try and tap into things that actually bring you
meaning and purpose. For me, it was connection with others
(27:06):
and curiosity and learning others. It could be things like
nature or their faith or community.
Speaker 4 (27:13):
And then the.
Speaker 2 (27:14):
Fourth vas vitals, and that's really honoring the fact that
you only get one body and brain and really taking
care of that. When I was in my highest high
functioning ways, I'd go through a day and I'd like,
at the end of the day, I'd be like, oh
my gosh, I didn't even go to the bathroom. I'd
be running to the bathroom as soon as I got home,
you know, not eating properly, just eating the fastest thing
I could get my hand on. Take the time to
(27:36):
take care of your body. Pencil in those breaks in
between your zooms. What's the worst thing that could happen
if you go and use the bathroom. What's the worst
thing that happened if God forbid ate your salad without
looking at a screen, or trying to cram in a
meeting while you ate. These are all the things that
are the simple things in life. And there was this
recent study where they took the smartphone capacity away from
(27:57):
these phones and people for two weeks could only use
their phones as if it were just like a flip phone,
like protecting and calling. And what they found was that
after two weeks, their mood scores went up as if
they were being read it with an answer depressant. Why
Because they were sleeping more, they were eating and tasting
their food, they were out in nature, they were connecting
more with others. They were getting all those points of
(28:19):
joy that I was talking about that we actually add
up to determine how people are becoming happy in depression research. Right,
they were actually getting those points because they weren't so
busy on their phones.
Speaker 4 (28:29):
So really honor your body in that way.
Speaker 3 (28:32):
It's so funny you mentioned that there was this moment,
maybe it was like a year or two ago where
I was sitting down to have lunch and I had
my laptop and it was playing something, but that wasn't
stimulating enough because I feel like this level of stimulation,
I think it's addictive. It feeds on itself. It's like
adapting this sugar. You just need more and more of it.
So that I'm also on my phone scrolling like Instagram
(28:54):
as this video plays as I'm eating my lunch, and
I'm like, when was the last time you sat down
to eat anything without your phone? And it was astonishing
how infrequent that experience was for me, certainly during lunchtime.
Speaker 2 (29:08):
Well, you know, I'm glad you brought that up, because
I'm so intentional about my lunch these days. Because there
was a period in time where I had to take
acid pills every day because I was just shoving it
in in front of a meeting, putting on mutes so
I could crunch my salad some people in the here
that I was eating and then off right, and then
I have, let's say ask, I'm like, what was I thinking?
(29:30):
One of the basic joys is eating food and savoring it.
There was no need for that.
Speaker 4 (29:35):
You know, no one was going to.
Speaker 2 (29:37):
Lose anything if I actually God forbid ate my salad
in peace.
Speaker 1 (29:41):
Yes, exactly, exactly, but many of us lose.
Speaker 2 (29:44):
That point of joy, that's simple point of joy because
we think that we're not deserving of it. And then
the fifth fee is vision, and vision has two prongs.
It's celebrating your winds and planning joy. And the celebrating
of the winds is something that I just I mean,
there was a large point in my life when I
(30:05):
kid you not my ivy le degrees were under my bed.
Speaker 4 (30:11):
What was that for? Take your degrees and hang them up.
Speaker 2 (30:15):
If you do something at work, plan a small celebration,
you know, like with my lab. When we finish our trainings,
everyone has to put it in a binder. And if
one of us finishes a big milestone, we'll meet in
the lab. We'll have like cupcakes, or we'll have a lunch.
We celebrate the small things that we used to take
for granted. It's important to have these things to look
(30:36):
forward to, to bond together and to represent the fact
that you didn't have to do what you did, but
you did it. And rather than going on to the
next let's take some time and reflect on this great
thing that you did. And it's a huge mind shift,
and so I tell myself that all the time. Like
the Judith I am today is so different than five
years ago because when I finished a training, I have
(30:57):
to do so many trainings for research.
Speaker 4 (30:59):
I'm like, I did this training, I like put it
up on the board.
Speaker 2 (31:04):
That's act and I'm like, now I'm worthy of a break,
and it's something I have to do myself, Like totally,
I did this, and now I get this break and
it has drastically changed my quality of life. And this
is not like big stuff, but it's so important. It
sends a message that I am a human being. I'm
not a human doing.
Speaker 3 (31:23):
What is your experience like today, Judith, Like, as someone
who has high functioning depression, Like, do you still consider
it an active diagnosis? Is it something you continue to
work through? Or probably yes?
Speaker 2 (31:35):
The bookstore is not something that encourages healing from high
functioning depression.
Speaker 4 (31:39):
Let me just put it that way.
Speaker 3 (31:40):
I was just gonna say, there is such an irony
to your story, right, which is that you had this
breaking point, but then through the work you've done on
high functioning depression, you kind of elevated into this superstar psychiatrist.
And I'm imagining your time is even more tax than
before given all your obligations. And so what is your
relationship like with high functioning depression? Like, how do you
keep things in check?
Speaker 2 (32:02):
Well, you know, I had to let go of a
lot of things that I used to hold tight to.
There you used to be just belief that no one
can do it better than you, and I had to
challenge that worst case scenario. Many times we think, if
you don't do X, the worst thing will happen. And
now I've let go of so many things and I
just trust people more. I'm letting the worst thing happen,
(32:24):
which is nothing happened, Nothing that happened.
Speaker 1 (32:27):
Yeah, in fact, I okay to ask for you.
Speaker 2 (32:30):
I'm not in every single space, I'm not in every
single meeting.
Speaker 4 (32:33):
I just let go.
Speaker 2 (32:34):
And you know, I told you that this antedonia is contagious.
This joy is contagious too. When you relax and you
let people who want to help you help you, they're
so happy to help you. When you start to prioritize
joy and you slow down and you save your life,
others around you will see that too and they will
change as well.
Speaker 4 (32:54):
It is. It's contagious.
Speaker 3 (32:57):
As someone who you've mentioned you've experienced anedonia. I just
want to know if you can reflect on, like this
past week, what were your top moments of joy, just
to give people hope that they can reclaim what you've experience.
Speaker 2 (33:09):
I got a new serum for my skin, and it's
something that I look forward to every day. As a child,
you know, my mom had four kids, and I grew
up in this tiny, one bedroom apartment, and you know,
when we bathed, she had to bathe us all together.
When she loationed us, she had to loation us all together.
So I was not someone who was raised gently like
caressing my face and skin. It was always this rushed,
(33:31):
hurried type of process. And I realized this later in
life that these type of rituals are really important for
sending a deeper message that you care about yourself, that
you're worthy.
Speaker 4 (33:41):
So I look forward to my skin routine.
Speaker 1 (33:43):
I love it.
Speaker 2 (33:44):
I look forward to my bedtime routine. I just as
someone who used to pride themselves on like I only
got four hours of sleep or five hours. I am
like eight hour at night person. Like I pride myself
on that I protect my sleep. Sleep feels yummy again,
you know, like that sleep when you're a kid and
(34:04):
you used to feel like, oh yeah, I get this
yummy sleep again. And then nature. I'm Portunida, I'm from
the Caribbean. I grew up going to the beach every weekend.
I made it a point, and I was intentional to
live close to the water in Manhattan and really be
close to the water and close to nature. So that's
what brings me joy, very simple.
Speaker 3 (34:22):
I know, I love it, and I was just gonna
see you mentioned Anaedonia can be contagious, but your joy
is contagious.
Speaker 1 (34:28):
I've got the biggest.
Speaker 3 (34:29):
Smile plastered on my face right now just hearing about
those moments. So I'm so glad you shared them with me,
and thank you so much for coming on the show.
Speaker 4 (34:36):
Thank you.
Speaker 3 (34:59):
If you or someone you love is struggling with depression,
health is available, call the National Alliance on Mental Illness
Helpline at one eight hundred ninety five ZO six' two six'
four for free confidential support. And resources you could also
find the number in our show notes and join me
next time for my Conversation With, jessica slice an author
(35:22):
who writes about living. With disability she talks about how
her disability renewed her relationship.
Speaker 5 (35:28):
With herself for all THOSE years i thought that it
was in my control to, be perfect or to form a,
perfect life or to be, good enough and, BECOMING disabled,
i mean so little isn't my? Control NOW and i
like my life as a disabled person far MORE than
(35:49):
i liked my.
Speaker 3 (35:50):
Life before that's next TIME On A slight Change. Of
plans see. YOU Then A slight Change of plans, is
created written and executive produced By Me. Maya Schunker The
slight changed family includes Our Showrunner, tyler green our Senior
Editor Kate, parkinson morgan Our Producers britain Cronin And, megan
lubin and our Sound Engineer. Erica Huang louis scara wrote
(36:14):
our delightful, theme Song And ginger smith helped arrange. THE
Vocals A slight Change of plans is a Production Of,
pushkin industries so big thanks to, everyone there and of
course a very special Thanks To. Jimmy lee you CAN
Follow A slight Change of Plans on instagram At Doctor.
Speaker 1 (36:30):
Maya schunker see you. Next week
Host
Dr. Maya Shankar
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