When Success Hides Suffering: Understanding High Functioning Depression with Dr. Judith Joseph

Dr. Judith Joseph 00:00:00  In the real world, we think happiness is this like grand destination, and that when we get there, we should be okay. But we’re learning that that’s not it. It’s these plethora of these sensations.

Chris Forbes 00:00:17  Welcome to the one you feed. Throughout time, great thinkers have recognized the importance of the thoughts we have. Quotes like garbage in, garbage out or you are what you think ring true. And yet, for many of us, our thoughts don’t strengthen or empower us. We tend toward negativity, self-pity, jealousy, or fear. We see what we don’t have instead of what we do. We think things that hold us back and dampen our spirit. But it’s not just about thinking. Our actions matter. It takes conscious, consistent, and creative effort to make a life worth living. This podcast is about how other people keep themselves moving in the right direction. How they feed their good Wolf.

Eric Zimmer 00:01:02  You’ve got the job. The house? Maybe even the partner. You’ve checked the boxes. So why do you still feel flat? That question is at the heart of today’s conversation with psychiatrist and researcher Doctor Judith Joseph in her new book, High Functioning Overcome Your Hidden Depression and Reclaim Your Joy.

Eric Zimmer 00:01:21  She explores why many people who look fine on the outside are quietly suffering on the inside with something we rarely talk about anhedonia, the loss of joy, or the loss of ability to feel pleasure. I felt this myself many times. Moments where everything should feel good but nothing really lands. This episode resonated personally for me. As someone who’s learned that sometimes the very tools I use to succeed can become the barriers to actually feeling alive. I’m Erich Zimmer and this is the one you feed. Hi, doctor. Judith, welcome to the show.

Dr. Judith Joseph 00:01:56  Hello. Thank you for having me.

Eric Zimmer 00:01:58  I’m excited to have you on. We’re going to be discussing your book, which is called High Functioning Overcome Your Hidden Depression and Reclaim Your Joy. But before we get to that, we’ll start like we always do with the parable. And in the parable, there’s a grandparent who’s talking to their grandchild, and they say, in life there are two wolves inside of us that are always at battle. One is a good wolf, which represents things like kindness and bravery and love, and the other is a bad wolf, which represents things like greed and hatred and fear.

Eric Zimmer 00:02:28  The grandchild stops and they think about it for a second. They look up at their grandparent and they say, well, which one wins? And the grandparent says, the one you feed. So I’d like to start off by asking you what that parable means to you in your life and in the work that you do.

Dr. Judith Joseph 00:02:45  Well, you know, it’s interesting because wolves are carnivorous and you often think of them as, you know, these predators that are robbing you of something. But, you know, the interesting thing about this parable is that it allows people to realize that you can only let someone rob you of something. If you put yourself in certain situations, for that to happen. And so, you know, in many of these parables that we learn about as children, there’s almost like this, a victim mentality to it, like things are out of your control. There’s a big bad wolf who’s coming to get you. But if you look at it from a different perspective, there is a certain amount of agency involved.

Dr. Judith Joseph 00:03:33  You know, you can choose to give your joy. You can choose to give your power away. and yes, there are bad people in the world. There are situations beyond our control. But there’s always a choice, right? You always have a choice. So that’s the takeaway that I get from this parable.

Eric Zimmer 00:03:51  Beautiful. And that really is kind of to me, what it ultimately boils down to is that we. We have a choice. We are going to be faced with difficult situations. We’re going to be faced with situations where we’re not sure what the right thing to do is, but we have a choice in what we do in those choices really matter. You’ve got a term in the book. High functioning depression. Walk us through what that means.

Dr. Judith Joseph 00:04:13  Well, I’m sitting here in my research lab. I’ve had this clinical research lab, for over ten years now. And I use a diagnostic tool that I’m sure you’re familiar with as a therapist. it’s called the mini and the skid, and it’s used for just about every single behavioral health clinical research study.

Dr. Judith Joseph 00:04:34  you have to use the criteria based on the Diagnostic and Statistical Manual for Psychiatric Condition in the section on major depressive disorder, which most people think about as clinical depression. You have to have these symptoms, and they’re laid out in the, you know, Bible of psychiatry, this DSM five, that’s manual ized into these, tools that we use. And you have to have these symptoms of depression at the very end of the checklist. If you don’t meet criteria for having your symptoms impairing your functioning or causing significant distress, you don’t check the box. You know, we say, well, you don’t meet criteria come back when you break down. And throughout the pandemic, running these clinical studies and seeing all these people coming in who were actually over functioning, they didn’t they weren’t breaking down. They were coping with their pain by taking on more work, taking on more projects, creating a side hustle or to busying themselves. I say that they are humans doing instead of human beings. This was how they were coping and they kept saying, something is off, something’s off.

Dr. Judith Joseph 00:05:41  But I’m not meeting criteria. Every therapist is turning me away. And I was also experiencing this. I had this very successful research lab, you know, when every other office in the building had shut down. I was still going because I have these clinical research studies that have to continue, you know, via the FDA mandates. You can’t you can’t yank people off their meds, you know. Right, right. The research continues through crisis, at least it did back then. But, you know, I was seeing these people who were like myself functioning over functioning, showing up. They were the rocks, you know, but they had this lack of joy. They had this inner struggle, and they were coping with their pain by busying themselves. And I thought, why aren’t we focusing on these folks, too? Yes. It’s important to address people who have broken down, you know. Yes, it is important to address crises. But what if we thought about things differently? And what if we were preventative? What if we prevented the breakdown? Why aren’t we thinking like this in mental health? And I just thought, well, you know, look at all these other fields of healthcare.

Dr. Judith Joseph 00:06:45  When you look at longevity science, you don’t see doctors saying, let’s wait until stage for cancer to do something. We say, let’s educate patients about the risk of cancer and let’s prevent it. Yep. In the menopause space, where I do a lot of work in terms of mental health and menopause, we’re not saying, let’s break the let’s wait for the hip fracture. We’re saying, let’s prevent the osteoporosis by educating patients about things they can do, like, you know, using hormone therapies and weight bearing therapies and so forth. But why in mental health do we wait for people to break down? So I set out to conduct the first clinical research study in high functioning depression. And so in the study we enrolled 120 patients. We interviewed them. We didn’t do questionnaires because we found that that is not effective. You know, talking to people and getting their symptoms is more effective in terms of like collecting real data. And we found that there are these people who have these symptoms of depression, but they don’t break down.

Dr. Judith Joseph 00:07:44  So they wouldn’t meet criteria according to any diagnostic criteria that we currently have in the medical field. But in our new criteria for depression, we’re seeing them having these symptoms. But they’re not breaking down. They’re over functioning. And we’re seeing something called anhedonia, which is a scientific term meaning a lack of joy and interest and things that they want to enjoy. And many of these patients were experiencing this. They just didn’t know there was a name for it. And I wish I could take the credit for inventing the term anhedonia, but it’s been around since 1800s. Yeah, but most people have never heard of it. You know, people experience anhedonia all the time. They just don’t even know what it’s called. Many times they’ll say, well, that’s just life. That’s just being a mom. That’s just being busy. Yeah, but Anna Donia literally means a lack of joy and interest and pleasure. And I was also surprised that most people don’t know that in order to meet criteria for depression, you don’t have to be sad.

Dr. Judith Joseph 00:08:40  You don’t have to have a low mood having anhedonia, you know, according to the clinical, traditional sense of depression is enough without a low mood. And, you know, you have to have all the other symptoms. So. Yeah. When I started talking about anhedonia and high functioning depression, I thought maybe, maybe a hundred people would respond. But I was just astounded. Like, millions of people reached out saying, this is me, you know? Can I have more information about it? So, you know, it was validating because, you know, when I did the research, many of my colleagues were saying, well, oh, you know, well, we should be focusing on clinical depression. And but then the same colleagues after, you know, the work was done, said, I think my patient has that. Can I learn more about this? We need to think about this differently. You’re right. We shouldn’t be waiting for people to break down because, I mean, there are just not enough of us.

Dr. Judith Joseph 00:09:30  There are just not enough of the mental health professionals to address the growing demand. So we need to educate patients, allow them to have that access to knowledge so that they can identify when things aren’t right before they break down. And so this preventative health, you know, measure I think is crucial, Sure. Especially now.

Eric Zimmer 00:10:08  Listeners will know this, but I’m a recovering heroin addict, and after I got sober for a few years, I had clinical depression in the sense of like, not functioning very well kind of thing. The classic depression. And I went on anti depressants and I have, you know, in all the intervening years I have learned how to take care of myself physically, socially, spiritually, psychologically. And I find myself in this place where I don’t know what I don’t want to say, what I have, whether I have anything, and let me explain that. So I’m high functioning and I sometimes have Of Anatolia. But I don’t know, like I can tell it it for me, it seems clear when it comes.

Eric Zimmer 00:10:54  It’s all of a sudden there’s no books I want to read. There’s no songs I want to listen to. but that passes in in a day or two often about that time range. I have some of the other symptoms of irritability. And my question is this. And I this is something I think about a lot in regards to myself. At what point is good enough? Good enough meaning do we risk pathology using normal human experience? And when I hear questions about do you, you know, have enough joy or do you have joy? My question is like, well, how much like as a former heroin addict, I’m like, well, joy is way up here, right? You know, when I hear people say, well, low energy, I’m like, well, how much energy? So I kind of just am curious how you think about this sort of question of capable of always thinking of how things could be better, a standard of normal. It’s not even a question, but I’ll let you respond.

Dr. Judith Joseph 00:11:51  Well, in our clinical research protocol, the symptoms had to be present for at least two weeks or more. In research, you have to have clearly defined periods when you submit a protocol to the IRB, which is the review board that really oversees human research. And so what you’re describing are, you know, dips and flows in a day. Right. periods of fluctuation, which are not typically categorized in research or in the medical field. Yeah. so that’s different. usually when we look at mental health conditions, there’s a fixed period of time. It’s a persistent state. it’s not like, oh, I have a bad day today. Oh, tomorrow I’m better. That’s not what is typically used to classify. But in the folks that we did end up interviewing, we talked about a clearly defined period. And we also asked if it was persistent. We also, you know, wanted to know a bit more about their past. They had to do extensive trauma inventory. So we wanted to understand, you know, what it is that possibly could be the root of what was happening.

Dr. Judith Joseph 00:12:53  Many times during these interviews, we’d go through these really extensive questionnaires, and I would encourage people to take a look. We’ve made them available online on the website, but we go through these questionnaires, and then they’d be surprised that that was a painful experience and never acknowledged it. And you’re right, I just pushed it down. I actually just never even thought about it. And that is traumatizing. What we found was that we also do PTSD, like the traditional PTSD studies here. We found that people who fit the profile of high functioning, what they ended up doing was not avoiding people, places and situations in order to not feel triggered. What they ended up doing was they ended up diving into work, diving into projects to avoid processing their pain. So it’s a very different picture, you know, like from what we typically saw in our PTSD studies. you know, we use. We use these tools called the Capps five. It’s it’s a gold standard tool. It was developed in the VA hospitals for combat veterans.

Dr. Judith Joseph 00:13:52  But we actually used this in PTSD research. And usually using these tools, people avoid, you know, places, situations, people that trigger them but are high functioning folks. They were avoiding dealing with the pain by just busying themselves. They were afraid that if they slowed down, something catastrophic would happen. Either they’d break apart, they cried. They tapped into something that they couldn’t control. They weren’t even aware that they were doing this numbing to avoid dealing with the pain. But the problem with that is that when they were numbing, you know, these sensations, they were also possibly numbing their ability to feel that joy. Right? And it wasn’t just a blip. It was like a persistent. Yep. and hedonic a thing that they were going through. But to speak to your experience, Anna Donia, is not something that is just specific to depression. Anna Donia, as you’re well aware, is very prominent in substance conditions. Right. And with people who’ve used substances in the past, because, you know, the theory is that, you know, your brain gets somewhat, you know, changed in a way that you don’t access pleasure as much.

Dr. Judith Joseph 00:14:58  Right? Right. Antidote is also really prominent in conditions like dementia and schizophrenia. You know, schizophrenia is one of those mental health conditions where you have like the positive. And I, I really don’t like the term positive and negative, but that’s what they call it in science. Yeah. It makes sense in the science world. But in the regular world people are like, what? Is it good. But the positive symptoms of schizophrenia are like hallucinations, delusions, bizarre kind of behaviors. Right. Positive meaning? Not good, but positive meaning. You can see them. Yes. And the negative symptoms in schizophrenia not mean that they’re bad, but, you know, are the depressed depression, the anhedonia, the, the concrete thinking, the flat affect you know and so and disorganized thinking at times. So you know anecdote is something that is throughout multiple mental health conditions. So it’s not just specific to depression, but you know, as you’re aware, you know, when you have recovery from substances and so forth, you can have comorbid or co-occurring depression, co-occurring anxiety, you know, insomnia, all of these things that are part of the healing journey after, you know, you’ve made that change in your life.

Eric Zimmer 00:16:12  I totally agree, I’m a long way off from that experience. That was in my early 20s. And one other thing I think you said at one point, like, that I might know as a therapist, I want to be clear. I’m not a I’m not a therapist. I have talked to hundreds of them on this show and paid a dozen others a fair amount of money over the years to help me, but I’m not one my myself, so.

Dr. Judith Joseph 00:16:35  I’m sorry about that. Please edit that out. Yeah, no. That’s fine. Therapist.

Eric Zimmer 00:16:38  I just wanted you to know, as you as you talk to me. Yeah, exactly. So people who fall into this category of high functioning depression. Do they know something is wrong? They just can’t put their finger on it. Is that what we’re talking about? They. You know, this is not the person who just says, well, I’m kind of busy. I’m a little bit overwhelmed. Sometimes I feel this is somebody who has a sense that something is off.

Eric Zimmer 00:17:04  They don’t know what, though. Is that accurate?

Dr. Judith Joseph 00:17:06  Yeah, they they don’t necessarily come into my office saying I’m depressed. They come in and they say something’s off and usually it’s Antonia, you know, it’s different than when you’re like doing well. You’re, you’re you’re engaging in your work and you’re, you’re busy. But it’s not pathological productivity. You’re actually enjoying the work. You’re looking forward to it. You’re excited about it. That’s very different than doing these things. Busy yourself and actually not enjoying it at all, and not understanding why you can’t slow down two different experiences, you know, and it’s possible that at one point you did enjoy things. Maybe you did get excited. You you did know why you were doing things. You had purpose. And then you you find yourself no longer feeling purposeful, no longer enjoying it, feeling numb and just not knowing how to stop. You don’t even know why you’re doing it anymore. That’s typically what I see. Yeah. and, you know, I’m located in a very busy intensity in Manhattan.

Dr. Judith Joseph 00:18:05  Yeah. And so I see this a lot. And people are like, well, I, I know something’s off. I don’t know what it is. And you’re like, you’re a top psychiatrist, so you can figure it out. Please help me. And that’s usually what happens, you know. And that’s why it’s so powerful to have that term anhedonia. Because many times people will have a lot of guilt. They’ll say, I don’t know why I’m not happy and why am I here spending all this money? I have a great life. I have all these things going for me. I, I, you know, I survived all these bad things and yet I’m still feeling this way. I thought I would be happy, And I explain that, you know, for many of us, you know, we drank the Kool-Aid. We thought if I, you know, do all these things in life and I do the right things, I will be happy. But we’re learning in the science of happiness that when we have that mindset of when I finally get, you know, the partner, when I finally get the job, when I finally graduate school, I will be happy.

Dr. Judith Joseph 00:19:00  We’re learning that that delayed model of happiness actually makes us unhappy. We avoid the actual joys in life because we’re so busy chasing this idea of happiness that we don’t even realize we’re actually outrunning some past pain. And if we just slow down a bit and we tapped into our senses and we literally smell the roses, we would actually feel more joyful. Doesn’t mean that the problems are going to be solved, but by accessing these tiny points of joy along the way, you can actually become happier. And I say points of joy because in the research that I do, when we are adding up to see if someone’s actually becoming happy. We’re literally adding up points. We are asking them. You know, when you took a nap. Did you feel refreshed? We’re asking them when you were feeling lonely and you reached out to your loved one. Did you feel connected? We’re asking them when you were stressed. Were you able to self soothe all of these? Are these little points that we literally add up? To determine if someone’s becoming happier.

Dr. Judith Joseph 00:20:03  But in the real world, we think happiness is this like grand destination, and that when we get there, we should be okay. But we’re learning that that’s not it. It’s these plethora of these sensations, even in the in the suicide research that we’re doing. We’re reframing it for patients because if we if they have this idea that I will be happy one day, they may never get that. But we’re teaching them that actually, you know, it’s slowing down. It’s eating your food, savoring it. It’s going for that walk and noticing that beautiful tree and feeling that wind on your face. Right. Like all of these sensations are really what it is to experience joy, and that’s how you actually become happier in life, not this grand destination that even when you get there, the science shows us that you’re still not happy.

Eric Zimmer 00:20:48  Yeah, I love that. I mean, that accords with one of my core foundational ideas is that little by little, a little becomes a lot, right? Like, that’s how.

Eric Zimmer 00:20:56  That’s how we change. You know, and little moments accumulate over time. Little moments of goodness accumulate. And over time you start to at least my experience is over time that starts to change the overall climate inside. I have a question I want to ask though, about happiness, because happiness is one of those things that we can get fairly obsessed with. You know, I’m going to be happy. Am I happy enough? All of that? And the the science for a while, and I don’t know if it’s changed, which is kind of why I’m asking you, was that there was a certain genetic set point of happiness for people. And you could you could move it some. There’s portions of it that you could move, but that people would have sort of a set point that they would sort of settle back to something bad happens. They’re going to eventually come back to that, that point, something good happens. They’re going to feel good for a little while. They’re going to kind of come back to that point.

Eric Zimmer 00:21:56  How do you think about that in terms of the work that you do?

Dr. Judith Joseph 00:22:01  Well, there’s a field called epigenetics, and we know that things in the environment can change the way that genes are expressed. And it’s just fascinating. When I was in college I never heard of it. Right. You know, we’re learning that, you know, things in your environment can literally modify the way that your genes are expressed. And there used to be this idea that, you know, you can’t do anything about it. You’re just born this way. You know, genetics are important, but they’re not everything. Yes, In my book, I talk about a tool that most people have probably never heard of, but everyone in healthcare uses, and it’s called the biopsychosocial model. And the way that I break down the biopsychosocial system doesn’t seem too large and too like lofty is that everyone has a fingerprint. We all have our own fingerprint, but all of our fingerprints are unique. Everyone has a biopsychosocial. There are no two biopsychosocial that are identical.

Dr. Judith Joseph 00:23:05  And so when you use this model and you imagine it, imagine like this Venn diagram, these three circles that overlap. Think about yourself. You know there’s only one. You there will only ever be one you. So really take the time to understand the science of your happiness. And what I mean by that is draw this biopsychosocial. Look at your biological risk factors. Where are you losing your points of joy? Biologically, I use myself as an example, I. I have a low thyroid, so my endocrinologist has to be on top of my thyroid. If I get to high functioning and don’t go to my appointments. You know, like I’m not going to be able to have as much joy, right?

Eric Zimmer 00:23:48  Is it manifest as low energy that then translates into lack of joy? Is that kind of the mechanism or is it something different.

Dr. Judith Joseph 00:23:55  For my thyroid? Yeah. Low energy could be changes in sleep can be irritability. Yeah. You know, but other people have other medical conditions. Some people have autoimmune conditions where their bodies in this high state of inflammation.

Dr. Judith Joseph 00:24:09  Right. some people have other health issues. You know, whatever it is, where you’re losing your joy. Think about biologically what makes you different. Psychologically, that’s the other bubble in the Venn diagram. What is your past look like. What is your past trauma. What are your attachment styles. You know when I say past trauma you know people often think okay well I didn’t have anything bad happen, but maybe there were other traumas, you know? Maybe you had a divorce, or maybe you went bankrupt. Or maybe you didn’t grow up with much in life. You know, these are things that we traditionally don’t think about as being traumas. When we think trauma, we think, oh, combat near life, near-death experiences, attacks and things like. But other things can be painful, and they can shape the way that you view yourself or the way that you interact in the world. But if you don’t process it and acknowledge it, then you just don’t deal with it. And attachment styles.

Dr. Judith Joseph 00:25:03  You know, it’s another thing that we don’t often think about who is in our life, how do we interact with others? And then, you know, what are our comorbid conditions? What are our other things that we deal with every day? Some of us have ADHD. Some of us are neurodivergent. That’s all in the psychology, right? And then in the social bucket of the Venn diagram, what are the things in our day to day life? Are we getting good nutrition? You know. Are we eating foods that build up our brain? Or are we eating processed foods that are increasing inflammation in our brain? You know, all of these things interact with our genetics. What are we putting into our body? Do we have access to nature or are we in a toxic environment in terms of pollution? you know, are we around healthy individuals or are we around people that are bringing us down and increasing our stress levels? Are we getting the movement that we need so that our body is relieving stress, or are we sedentary and not, you know, living the healthiest lifestyle in terms of how much movement we’re getting? All of these things are the social things.

Dr. Judith Joseph 00:26:08  So that’s why it’s important to look at your unique biopsychosocial, because that is your fingerprint. That is your fingerprint for what you are experiencing in life and where you are losing your points of joy. And this is important because let’s say you’re someone who’s biological, you know, that part of your biopsychosocial that’s dominating where you’re really losing your points of joy. Then you’re going to focus your efforts there. You’re going to say, okay, my medical issues are getting in the way of my joy. They’re causing me all this pain and all this physical stuff. Let me prioritize there and let’s see if my life becomes a bit more easier to deal with, right? Less stressful. Yeah. But for others who are, let’s say they’re physically healthy, maybe it’s the past, maybe they’re past traumas or things that they haven’t resolved. Maybe that’s what’s blocking their joy because they’re constantly revved up in fight or flight. They can’t access joy. And for others, it’d be social. You know, it’s what’s happening in their day to day lives.

Dr. Judith Joseph 00:27:04  That’s where they’re having a loss of their points of joy. And that’s why I like this model, because it reminds people that there’s only one you, and there will only ever be one use. You got to really take the time to understand the science of your happiness, so that you can be strategic about where you want to focus your efforts to reclaim your joy.

Eric Zimmer 00:27:23  I really love that you said that, because that is a belief I’ve grown more and more into over the years that we are all different, and there are some principles that are can be helpful about being happier, about healing, and about all living a better life. All of these things. But what each of us need could be very, very different. And that’s why when we hear one size fits all mental health advice or one size fits all like life coaching advice or one size fits all diet advice like this is the right diet. I’m just I just as somebody who really sees the nuance and everything, I kind of bristle and I’m like, well, people are really different, you know, different.

Eric Zimmer 00:28:07  And I did a lot of coaching for a number of years, and I’ve started doing some again. And that’s one of the big things I learned over the years that I got better at understanding is like, oh, hang on a second. We need to understand this person more before we start thinking about what they should do. You know, you can have this bag of tools, but I think a lot of the art comes in. Like, what tool do you actually pull out to help?

Dr. Judith Joseph 00:28:29  Absolutely. I mean, in your work, you’ve seen so many different people and you would you would never just take one cookie cutter plan and apply it to one person and then use that same one. You take the time to understand what makes one person’s journey so unique. You know, what were their unique struggles because their challenges are going to be different compared to someone else, even though from like a far view, let’s say you’re like, oh, they have similar, you know, life histories. When you zoom in, you see how unique they are.

Dr. Judith Joseph 00:29:06  I think that that’s very validating. You know, like, I think when you can show someone like, this is what makes you you, right. And this is why when you read that book, when you listen to that podcast, when you when your friend sent you that meme, it didn’t work for you. It wasn’t. Yeah. That it was. You were the problem. It’s just that you didn’t understand the science of your own happiness. So you’re trying to apply someone else’s happiness to you? Yeah, it’s not going to work. And it’s very, I think, validating when I bring people into my lab and they do this tool, they just sometimes they literally break down crying and they’re like, well, I finally get it. Like, I wish I had this sooner. And it’s a tool we all use in healthcare, but most people don’t know about it. I’m really trying to change that, to make it available to everyone, so that you have the tools that you need based on the science of your happiness.

Eric Zimmer 00:30:08  Check in for a moment. Is your jaw tight, breath shallow? Are your shoulders creeping up? Those little signals are invitations to slow down and listen. Every Wednesday I send weekly bites of wisdom. A short email that turns the big ideas we explore here in each show. Things like mental health. Anxiety. Relationships. Purpose. Into bite sized practices you can use the same day. It’s free. It takes about a minute to read and thousands already swear by it. If you’d like extra fuel for the weekend, you also get a weekend podcast playlist. Join us at one you feed. That’s one you feed. Net newsletter and start receiving your next bite of wisdom. All right, back to the show. I love the biopsychosocial model also, because if we go back to me in dealing with recovery from substance abuse, which then, you know, sort of was co-morbid with depression and dealing with that, for me, it was it was all of those things were critical. You know, antidepressants were part of that for me.

Eric Zimmer 00:31:19  The food that I eat is part of that. For me. The exercise that I do, the people I, I talk to, the everything I used to say, like I just kind of thrown the kitchen sink at this, which is another way of saying biopsychosocial, right? It’s got to you’ve got to look at all aspects and, and but I love your way of prioritizing also of picking a place to start because that’s often the hard thing is to figure out where to start. And over time, little by little, we can start to layer more things on.

Dr. Judith Joseph 00:31:50  Absolutely. You know, the way you described your journey, it sounds like there are so many different avenues to gaining points of joy, right? Because when you get stuck and you’re like, well, this is the one thing you try medication, it doesn’t work, which is actually quite common in psychiatry, like so common. And but many people will start it and they’ll be like, oh my gosh, it didn’t work for me.

Dr. Judith Joseph 00:32:13  I feel hopeless versus all of these different avenues to joy. If I you maybe walked a block more a day, or if I changed my eating habits, ate Eat more leafy greens or more fish, or whatever it is that you choose to modify. You know, if I connect it with loved ones, if I tweak the medication, you know, all of these are different avenues to joy. But if we only think there’s one path, and that one path doesn’t work, we can feel so deflated, so hopeless. But learning that there are all these different paths to joy, I think provides so much more hope and opportunities for people.

Eric Zimmer 00:32:48  I love that idea and that hope idea because it can be really deflating. And that’s why I think when we think something is the answer, we’re setting ourselves up, right? Or more often we’re being set up by someone and we’re going to be disappointed, usually because life isn’t that easy. And for me, all of the different things, as they come together, they also amplify each other.

Eric Zimmer 00:33:15  It’s a cliche, right? But they come. They become more than just the sum of their parts for me in some way. And had I only done medicine, I would have had some help in the same way. Like some people only give up alcohol or drugs, which is a great step. I mean, if you if you just do that, that is a huge step really, really hard for most people to do. But my experience was I would have missed out on a whole lot that made life rich and rewarding by actually going into recovery. And I’d love to transition this conversation in that direction now, because you do have, the five V’s you talk about, which are ways of working with this high functioning depression. And so I’d love we’ve kind of talked about what the what the problem looks like. Now, I’d love to move towards some of what you think the solution is. And I’d like to start with the first V, which is validation. And you say that it’s in essence both the hardest and the most foundational of all of the other ones.

Eric Zimmer 00:34:17  So talk to me about what we mean by validation.

Dr. Judith Joseph 00:34:19  Validation is the hardest. And when I explain validation, I like to use this analogy of imagine you’re in a very dark room and you can’t see anything pitch black, and you hear a loud crash. Some of us would start screaming, some would start swinging, some would start running. But if you turn the light on and you saw, oh, it’s nothing. It’s just an inanimate object that fell. I’m safe. That is what validation is. It is turning the light on and understanding and acknowledging what you’re dealing with emotionally, what you’re experiencing. Good or bad, we’re not putting any judgment on it. Many of us, we don’t acknowledge how we feel. We invalidate ourselves all day long. We will work through lunch and ignore that hunger pain in our belly. We’ll go through a day and not use the bathroom and invalidate that, you know, sensation in our pelvis. It’s like you need to go to the bathroom. You know we will.

Dr. Judith Joseph 00:35:16  Not even the ability.

Eric Zimmer 00:35:17  To do that starts to cease when you get to be my age. It’s all of a sudden like you’re like, well, you know, I, I’m not sure I got a choice in the matter anymore.

Dr. Judith Joseph 00:35:26  That’s true. Our bodies will give eventually.

Eric Zimmer 00:35:28  Eventually.

Dr. Judith Joseph 00:35:29  We often we do. We often, you know, things happen to us and we just pass it off and say, well, this happens to everyone. But what is powerful in this exercise is that you’re actually saying this is happening. This is what I’m feeling. I’m going to acknowledge it. And it’s really useful, especially if you’ve been mis naming an experience your entire life. I have a lot of people who come in, especially men, and they’re like, I am so angry all the time. I’m so angry. And then we we actually unpack this anger and it’s actually anxiety. A lot of these, the men that I work with, they’re very, very nervous. They’re very, very anxious. They worry all the time.

Dr. Judith Joseph 00:36:09  But it was not a part of their culture to say that they worry. It just didn’t seem manly. It didn’t seem strong, but a lot of their anger would look like anger was actually rooted in anxiety. You know, they’d snap, they’d be irritable, they’d yell. But it wasn’t related to being internally angry. It was related to being internally anxious.

Eric Zimmer 00:36:31  They were afraid. And so that’s why.

Dr. Judith Joseph 00:36:33  They were afraid. Yes. Fear is not great for humans. Right. You know, it’s that. So we turn the light on and we name the emotion and we name what the worry is. And they’re no longer afraid. And so validation can sometimes be the hardest part. Many people don’t want to acknowledge how they feel. They’re afraid. They say, you know, Doctor Judith, if I name it, if I finally deal with what I. I’ve been avoiding, then maybe I’ll break down. Maybe I’ll. I’ll stop. But the opposite happens. It’s so freeing. Yeah. It is just.

Dr. Judith Joseph 00:37:02  It just releases so much tension. And you know how I said in in the happiness research, we add up those points. You know, one of the points of joy that we miss out on is that the point of stress. People used to think, oh, stress and anxiety. That’s one part of the brain. Depression’s the other side. We’re learning that. No, no, no, it’s not true. It’s really important to manage that stress and anxiety so you can access joy because you don’t know very I don’t know very many people who are stressed out and also joyful.

Eric Zimmer 00:37:29  It’s very hard to do.

Dr. Judith Joseph 00:37:30  Yeah. Being able to very, very difficult, very difficult when your body is revved up. So yeah, being able to name these emotions, identify them allows that calm, you know, what you’re dealing with in what you’re working with. And then you can choose the appropriate action.

Eric Zimmer 00:37:46  You talk about the cognitive triangle, which is a CBT concept that says, you know, an experience is really kind of thoughts, emotions and behaviors and thoughts are usually what we have at the top of the triangle.

Eric Zimmer 00:38:00  And I have spent a lot of time thinking about the relation between thoughts and emotions, and recognizing where cognitive approaches are really helpful, and then starting to learn where they’re not. And I love that you say we should pivot the triangle a little bit and put feelings at the top. I have realized for me that’s essential because one of my great strengths is a certain mental equanimity, a certain ability to see the whole picture or the certain, the ability to zoom out, the ability to have perspective. Right. Which is a great skill. And it can be a way of never letting myself feel anything because I talk myself out of it immediately. And so for me, it’s been useful to first go, oh, you’re feeling something? What are you feeling? Okay. Acknowledge that. Okay. It’s okay that you feel that way. And now I can think about, you know, okay, that’s being driven because I’m thinking about x, y and z and is x, y and Z actually true? Is it useful? But if I don’t flip it, as you say, I don’t allow myself ever to get too emotional because my cognitive is sort of a superpower that just takes over.

Eric Zimmer 00:39:16  But that’s not. That’s not good for an emotionally developed life.

Dr. Judith Joseph 00:39:20  It’s not an I used to be the same way, you know, before I became a psychiatrist, I was actually an anesthesiology resident. And I, you know, when people think about anesthesia, they think, oh, you’re putting someone asleep. But it is a highly traumatizing field. You know, 90% of the time it’s easy. You know, you’re just like, put intubated someone, you put the IVs in and you’re coasting, you’re just monitoring, and then you wake them up and then they go home. They never see you again. But 10% of the time you are literally saving someone’s life. And it could happen at any moment where things can go south. And so, you know, in healthcare you see a lot of death, you see a lot of pain, you see a lot of gory stuff, but you are conditioned to just focus on doing your job and showing up the next day and not complaining. And that’s just part of it.

Dr. Judith Joseph 00:40:13  You are in the trenches, similar to like military fields. You know, you just it’s part of the culture is just you see trauma all day long and that’s just part of it. That’s what you signed up for. And over time, many health care professionals, including myself, you just learn to just push it down. You don’t validate it. You don’t say, wow, that was tough seeing someone die. Oh, that was really hard. You know, doing a code and doing chest compressions like that was traumatizing. We don’t do that. You just show up the next day and you act like nothing happened. So that was my go to coping for a very long time when I was going through the pandemic. And, you know, this uncertainty of like, well, what’s going to happen to the world? What’s going to happen to my patients, what’s going to happen to my team? What’s going to happen to my family? I was just coping by like pushing it down. But it was when I started to realize that that wasn’t working and I was going through severe anhedonia.

Dr. Judith Joseph 00:41:04  I started to realize that I was avoiding my feelings. So now I regularly name my feelings. If I’m, like, feeling antsy, I’m like, well, why am I antsy? Oh, it’s because I didn’t sleep well. Why was I not sleeping well? Well, because I was worrying about this new study that I’m starting up and it’s not working the way that I want. You know, like, I’m able to actually verifies myself, whereas before I was pushing my feelings down. You know, that’s why it’s important to to name these feelings, not to avoid them and not to get so caught up in the thoughts. Right. And that CBT triangle, we scrutinize those thoughts way too much. And a lot of times we just need to start feeling our feelings.

Eric Zimmer 00:41:42  And it’s not that we just let the feelings run the show. One of the things I have thought a lot about is how this kind of, there’s this sort of an art, I think. And this gets back to knowing yourself.

Eric Zimmer 00:41:55  There’s an art I have found for, like, when when do I lean into the emotional? When do I lean into the cognitive? When do I lean into the behavioral. Right. Because one of my favorite sayings is sometimes you can’t think your way into right action. You have to act your way into right thinking, right? So when do I need to intervene behaviorally? And as you said, I think for most of us, the emotional is the piece. And one of the things I’ve started to do, because I can have a feeling and I can cognitively also be like, okay, that’s not really what’s happening here. I’ll give you a personal example. I like you about a year behind you on when my book comes out in April, but it’s about now that I start thinking about like, who’s going to help support me in launching this book? You know, of all the podcast guests I’ve had on who can I who can I talk to? Who could say like, oh, I help, or I’ll share it in my newsletter, which means you’re you’re reaching out and asking for something from all these people.

Eric Zimmer 00:42:49  And I have found it to be decidedly uncomfortable. And some of it is that I don’t like asking for help. But I think on a deeper level, what I identified is it feels a little bit like being in high school and going, well, will I get into the cool kids club? So I know that’s not what this is, right? I know that somebody’s choosing whether somebody does or doesn’t blurb my book or does or doesn’t share. It has an awful lot to do with a thousand factors, of which I am just a small part of. So I intellectually. But I’ll name that thing to my partner. I’ll say, this is what I’m feeling, even though I know the answer right. Cognitively, I want to name what I feel because that’s my history is to just ignore the feeling.

Dr. Judith Joseph 00:43:32  Yeah, it’s very powerful. Naming your feeling and acknowledging it and seeing it and turning light on it. You may still have that intense emotion, but it doesn’t linger as long as it used to, and it doesn’t interfere with everything else as much as it used to be.

Dr. Judith Joseph 00:43:50  Because you know what it is. Yeah, and it’s a way of not invalidating it, but living with it, living alongside it, letting it write itself out versus trying to push it down. And and that leads us into the next venting because people come into my lab. I’ll. I’ll have them take turns with this red balloon, and we’ll. They’ll try and dunk it into this tank of water. And 100% of the time, that balloon will pop right up. Right. Because you can’t out math the numbers. Can’t out math physics. But then when we take turns and we start to deflate that balloon, we can push that balloon so easily down into that tank of water. And for me, being able to say out loud, I’m anxious about this thing, it like, it just feels so much better. Like it just it’s almost it’s like that deflating that balloon and naming the feelings and acknowledging it and expressing it has been extremely powerful. And you know, when you vent and you express your emotions, you want to be intentional about who you’re venting to unless it’s your therapist.

Dr. Judith Joseph 00:45:01  Because with therapists you can vent. You’re paying them for that. That’s what they’re there for. If it is a family member, if it’s a partner, you want to be very careful. You want to vent with empathy. You want to say, is this a good time? Can I? Can I talk to you now? And you want to have an intention. You don’t want to just vent just to get it out. The intention should be either a resolution or something that you’ve thought through. And if you don’t have someone to talk to him, not everyone does. You can vent using a pen and paper. You can write in a journal. Journaling has been very effective for many of my clients. for for some of my faith based clients, prayer has been very powerful for them. You know, they talk to whoever they believe in about their emotions. They feel better. For my artist clients, singing, dancing, expressing it that way for my pediatric patients, they cry and I say, it’s okay to cry.

Dr. Judith Joseph 00:45:49  You know, a lot of the parents say, you know, my kid cry so much and I’m like, try this to tell your child when they’re crying, it’s okay to cry. You know, sometimes you feel sad and you cry. They stop crying. What do you tell a kid?

Speaker 4 00:46:03  100%.

Dr. Judith Joseph 00:46:04  They cry more.

Eric Zimmer 00:46:05  100%. That has been my experience. It was completely my experience raising my son when I was like, oh, you’re really sad. It’s okay that you’re sad. He would kind of go through it. It’d be a minute or two, and then he, you know, he’d be like, oh, look at that balloon over there and run off and start playing. But if I was trying to get him not to feel it, it just kept it was it became an episode. You know, it’s so funny the way that is. I used to have this thing written on my, you know, some of us stick things on our walls that we really need to remember.

Eric Zimmer 00:46:34  And mine said it helps to talk to people even when you know the answer. And what I meant by that was, I’ve done 800 of these podcasts. I’ve been in recovery for 30 plus years. I’ve I mean, I’ve read a thousand books on this stuff, right? Like, I generally know the answer, but that’s not what talking to somebody else is about. I mean, it can be about that person bringing perspective, but it’s often about talking about it. And I had to kind of remind myself that even when I was like, well, I know what I should do, I should do x, y, and Z. Okay, I’ll go do that. I had to remind myself. Talking helps even when. But I want to ask you a question about this. You’ve got a sentence that I loved, which is we should think of venting as complaining. Savvy older sister. And you talked about having an intention there. And I want to talk about how does venting become useful and not a case where I tell you how bad my life is.

Eric Zimmer 00:47:32  And you, you agree with me how bad my life is. And then I tell you, tell me how bad your life is, and I agree. You imagine two people complaining about their boss, right? And they just keep ample. It just amplifies, right? So how do we keep venting from becoming that?

Speaker 4 00:47:46  Well, what you describe.

Dr. Judith Joseph 00:47:47  That amplification was actually recently published in a study where they found that, when you vent in that manner, like it is like pouring gas onto a fire, you don’t feel better, you feel worse. Yeah. And so with with my clients, I suggest they start self eventing first. So first you start, you know, and even talking to yourself. People who talk to themselves out loud. It may look weird, but it works. It’s like they are trying to get through these emotions on their own. So what’s happening is that you’re actually de-escalating. You know, you may feel your emotions at 100%, and we don’t want to change your emotion.

Dr. Judith Joseph 00:48:27  We want you to validate it. But as you go through this process of self venting, maybe writing or talking to yourself, you actually start to get some more clarity. You start to understand what it is that you want and what’s the best way to go about doing that. And as you start to talk to yourself and your self venting and then you say, okay, now I want to talk to someone else, I’m going to check in with them. I’m going to be empathic. So that’s, you know, using that emotional consent, you know, is it okay to talk now and then that empathy. Right. Because you don’t want to just go and tromp it up on someone and they’re not ready to hear it. Maybe they have their own problems going on. Right. And you want to have a clear idea as to what you want. What is the outcome. Do you want to resolve this issue? You want to, you know, have more clarity. So when you go about venting that way, you’re going to feel better.

Dr. Judith Joseph 00:49:12  But if you go about venting in a way that you’re not even thinking about the person you’re talking to, maybe you’re talking to someone who’s in a position of power below you, like your child, who’s not going to say no. They’re going to listen because they want to feel attached to you, but they’re going to worry about you, or like to an employee who’s going to be like, well, I have to listen to the boss. And then they go home and they trauma up on their family. You know, you really want to be intentional about how you vent so that you actually have a resolution.

Eric Zimmer 00:49:38  I love the nuance in that. I’ve kind of commented on that a couple times in what I’ve seen in your work, because it’s not like venting is all good, and it’s not like you should keep everything to yourself. It’s like there’s a way to do this that’s more skillful.

Dr. Judith Joseph 00:49:53  Yes.

Eric Zimmer 00:49:54  So we’re not going to have time to go through the other three V’s, which are values, vitals and vision.

Eric Zimmer 00:50:00  But in the conclusion, you kind of walk through yourself practicing these five V’s in in a situation. I’m wondering if you could just maybe walk us through you using these in a real situation in your life.

Dr. Judith Joseph 00:50:13  Yeah. So the third V we’re landing right now was really important for me, the values. Because on the outside I got so much admiration for like being on these prestigious boards, having this research lab, everything looks so great. And again, I was experiencing anhedonia. And so I had to really go back into my past and be the archaeologist and dig up, like, where did I go wrong here? You know, I was chasing the values that the world says are important. The things with the price tags, you know, had the family, had the house, had the job, had the accolades, but feeling empty. And when I started to really look at my past and where I found meaning and purpose, you know, the things that have that don’t have price tags and things that are priceless.

Dr. Judith Joseph 00:51:04  That’s where I started to reclaim my joy. And growing up, I had very little. I came to this country from the Caribbean with very little resources, but we always, always helped out other people. You know, it wasn’t like, oh, like we don’t have much, so let’s just hoard our resources for ourselves. It was how do we help others? And that’s how my family found joy as a collective. My dad is a pastor. My mom’s very active in the church. And every weekend we would spend, giving back to the community. Either it was the YMCA or a dementia unit, you know, helping others to have some hope. And, you know, for me, getting the accolades, having the degrees, having the lab, I just I wasn’t helping others, like, I was helping people in the traditional sense of like, you’re a doctor, you help others. But there was no community outreach in the sense of, let’s just do something for the greater good. So when I started to tap back into that, you know, bringing youth into my lab to learn about Stem, creating content to educate others, just for, you know, the purpose of helping people to understand mental health.

Dr. Judith Joseph 00:52:14  I experienced this abundance of joy. And that’s for me is is what I value is connecting with people and and helping communities. But for others, it could be something else. You know, I write about in my book how clients forgot that they actually loved nature, and they were living in a big city and everything looked so successful, but they forgot that that’s what helped them to feel rooted and grounded. So we had to work together to get them back into a lifestyle where they were accessing nature. You know, so if anyone’s listening to this and they’re just like, I don’t know what I value anymore. Like, look, in your past, you know, go back to old pictures. What lit you up, you know? Was it tinkering? You know. Did you used to use your hand a lot and you don’t use your hands anymore. You’re in front of screens. Try and tap back into that, because there may be these pockets of joy that you’ve forgotten, because you’ve gotten so busy in life and things have changed around you.

Dr. Judith Joseph 00:53:10  And see if you can tap back into those aspects of your life.

Eric Zimmer 00:53:14  Before you check out, pick one insight from today and ask, how will I practice this before bedtime? Need help turning ideas into action? My free weekly Bites of Wisdom email lands every Wednesday with simple practices, reflection and links to former guests who can guide you even on the tough stuff like anxiety, purpose and habit change. Feed your good wolf at one you feed. Net newsletter again one you feed net newsletter excellent and so do you want to give me an example of applying a couple of the other V’s in your own life?

Dr. Judith Joseph 00:53:51  The fourth V is vitals. Vitals are anything that supports your body and brain. Because you only get one, you’re only going to get one body and brain in this life. And the traditional vital signs are things like, you know, getting movement, eating foods that are nutritious and fortifying for your brain and body, things like getting adequate sleep. But there are these non-traditional vital signs that I also highlight in my work.

Dr. Judith Joseph 00:54:20  One of those is our relationship with technology. You know, we we use so much technology these days. We’re on screens all the time. And I recently gave a talk about something called the auto phenomenon, where we’re looking at our faces too often and we’re instead of instead of, you know, looking at others and figuring out, is this person attaching to me? Are they, you know, are they a threat? Am I connecting with them? We’re looking at ourselves. We’re looking at our faces when we’re on these zoom calls all day long, when we’re on these, you know, face times, when we’re on our social media, we’re looking at ourselves too much. So what ends up happening is we’re not connecting with others and we’re scrutinizing ourselves. We’re judging ourselves. It’s creating a lack of confidence. It’s creating a lot of anxiety. And the autistic phenomenon is something we see in mental health, usually with people who have a psychotic illness or psychotic condition, like schizophrenia or bipolar disorder with psychosis.

Dr. Judith Joseph 00:55:17  Or it’s when they see themselves outside of their body, so they literally see themselves walking into a room, and it creates a lot of anxiety for them. Stress. We’re doing that to ourselves willingly by looking at ourselves all day long. So I really try to get my clients to develop boundaries with technology so that they are not living their lives on screens. And there was a recent study out of one of the University of Texas schools where they took adults, and they removed the smartphone capacity from their phones. And instead of being able to get online and be seamless, and, and access to, to socials all the time, they could just use their phones for communicating with text or phone calls. And what they found was that being away from that smartphone capacity for two weeks, they actually appeared to become less depressed. Right. The the amount of points that increase over two weeks. And these were not people who were depressed to begin with, but it looked as if they were being treated with an antidepressant.

Dr. Judith Joseph 00:56:13  So it’s just interesting because what they found was that these people were sleeping better. They were connecting more with others. They were in nature more. You know all those points that I said we add up in in the research, they were getting more of those points just by not being on their screen. So that relationship with technology is so crucial to examine our personal lives. And then another non-traditional vital sign that we’re learning is really important these days is our connections with others. So, you know, being in healthy relationships and not being paired and partnered and around people who literally drain us of our life force, that’s an area we need to work on. And you may not be able to just up and leave, right. But you can set boundaries so that you’re protecting your peace a bit more. And then the fifth vital, the fifth V is a vision. How do you celebrate your wins?

Speaker 5 00:57:07  I love this.

Dr. Judith Joseph 00:57:07  How do you plan joy in the future? Yes. As someone who used to, like, only celebrate the accolades.

Dr. Judith Joseph 00:57:14  Now I celebrate the small things. If I get my kid to school on time every day. I, like, give myself a pat on the back and I’m like, I’m going to sit in my living room and I’m going to enjoy my Caribbean coffee because I have this really delicious coffee from I got from Saint Martin that I love. And I’m just going to celebrate that one. And I’m going to plan joy in our lab whenever we finish a training. We celebrate it. You know, whenever there’s a birthday, we celebrate it. We acknowledge the small things. And it’s not just the big things. That is very powerful because it keeps us hopeful. It keeps us moving forward, and it keeps us from getting stuck in the past. So the wins. I think many of us don’t celebrate our wins enough, and it doesn’t have to be grand. It could be small, but it’s another point of joy that we tend to overlook.

Eric Zimmer 00:58:01  Wonderful. Well, we are out of time, but thank you so much for coming on.

Eric Zimmer 00:58:05  I enjoyed reading the book and I’ve really enjoyed this conversation, so thank you so much.

Dr. Judith Joseph 00:58:09  Thank you so much and I look forward to reading your book as well. Congratulations. Celebrate that one. It’s a big deal.

Eric Zimmer 00:58:16  Indeed indeed. Thank you so much for listening to the show. If you found this conversation helpful, inspiring, or thought provoking, I’d love for you to share it with a friend. Sharing from one person to another is the lifeblood of what we do. We don’t have a big budget, and I’m certainly not a celebrity. But we have something even better. And that’s you just hit the share button on your podcast app, or send a quick text with the episode link to someone who might enjoy it. Your support means the world, and together we can spread wisdom. One episode at a time. Thank you for being part of the one You Feed community.