Mental Health Check-In: Dr. Judith Joseph Reveals Hidden Signs of High Functioning Depression
Show Snapshot:
Succeeding on the outside but struggling on the inside? In this eye-opening episode, Dr. Judith Joseph helps you recognize the hidden signs of high functioning depression that often hide behind your achievements and busy schedule. Drawing from her powerful new book "High Functioning: Overcome Your Hidden Depression and Reclaim Your Joy," Dr. Joseph shares her proven 5-step framework for breaking free from this silent struggle. You'll discover practical ways to identify warning signals in your daily life, learn science-backed techniques to manage stress and overwhelm, and gain effective strategies for healing from past traumas—both big and small. This conversation equips you with actionable self-care tools that help you balance success with genuine mental wellbeing. You deserve to feel as good on the inside as your life looks on the outside—this episode shows you how!
Show Links:
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Dr. Joseph’s book:
High Functioning: Overcome Your Hidden Depression and Reclaim Your Joy
Quotable:
Happiness is an idea, but joy is an experience. Focus on increasing your points of joy every day, and overall, you will be happier.
Transcript:
Katie Fogarty [0:00]: Katie, welcome to A Certain Age, a show for women who are unafraid to age out loud. I'm your host, Katie Fogarty.
Beauties, time for a big, honest self-assessment. Do you ever feel sometimes like you have a "good on paper" life? You know, a life that looks perfectly fine, even shiny on the outside, but inside you are still struggling to feel content, even happy? If so, you're not alone.
Today, we welcome back to the show psychiatrist and leading mental health expert, Dr. Judith Joseph, who is diving into the pages of her brand new book, "High Functioning: Overcome Your Hidden Depression and Reclaim Your Joy." She is sharing groundbreaking research and a guide to creating more fulfillment, purpose, happiness and yes, joy, because here's the thing: we can succeed at work, maintain relationships, and check all the boxes yet still feel emotionally numb, constantly exhausted, unable to enjoy our achievements.
If this is you, you might be among the millions of people with high functioning depression. But here's the good news: Dr. Joseph's research offers a way out in this simple five-part framework that helps you break the cycle of just surviving.
Dr. Joseph has researched the trap of productivity first-hand. She has spent years studying it, and she has rewired her own life around the principle that joy is not a distant destination. It's in small moments we rush past because we were too busy. Today, she's sharing practical tools to help you stop merely functioning and start truly living and enjoying and loving again. Dr. Joseph, welcome back to the show.
Dr. Judith Joseph [1:54]: Thank you for having me. It's great to be here.
Katie Fogarty [1:57]: I am excited. I got so much value out of our conversation the first time you came on the show. I've had the pleasure of hearing you speak on this topic. I have read your book. Hidden depression, mental health - this is an important topic for all of us, but this book is a major milestone for you. First off, congrats on this new book.
Dr. Judith Joseph [2:17]: Thank you. A lot of great things have happened this year, including publishing the first-ever peer-reviewed study on high functioning depression in the world, which is really the science behind this book. So I'm excited to talk about this.
Katie Fogarty [2:31]: Yeah, absolutely. It's like a two-part project. You've done extensive, you know, sort of exhaustive research on this topic and academic papers, but you've also published something that is easily accessible to the rest of us who want to take your learnings, take your research and apply them to our own lives. So this is a book that I think many of us probably desperately needed at different stages of our lives, right? Either something that we're experiencing today or we've done in the past. It's a road map back to ourselves. What made you sit down to write this book based on all of your research?
Dr. Judith Joseph [3:06]: Well, in my lab and in my clinical practice, a lot of people were coming in with symptoms of depression, but they were functioning. In fact, they were over-functioning. They're the busy mom who is taking care of everyone but herself, the educator who has students and doesn't eat lunch and just shows up for her students, the doctor who hasn't had a pee break but has seen 30 patients for the day, the entrepreneur who never wants to slow down because they can't afford to become bankrupt and not be able to provide for their team.
So a lot of us are struggling, and we wear this mask of productivity, and no one knows that we're struggling because everything looks okay on the outside. And I thought, why do we wait for people to break down before we intervene? Why do we wait for them to lose functioning before we check the box in our medical coding system so that we can get reimbursed for insurance that we can provide services? I thought this was a broken model.
And Katie, you and I are in the menopause world, the metaverse. So we know that prevention is key. We talk a lot about longevity science. We know there's a renaissance in medical health right now where people are talking about prevention of cancer, prevention of heart disease, prevention of osteoporosis loss. But no one's talking about mental health prevention. We're not talking about that. Instead, what you're seeing in mental health is we wait for people to check that box and break down and lose functioning, and then we intervene. So I thought this is a broken model, and we need to change this, and I'm going to be, hopefully, that beacon of change.
Katie Fogarty [4:43]: Absolutely. This book is so easy to read. There's sort of a three-part setup where you really define what high functioning depression is, sort of what puts some of us into that spot, allows us to understand this sort of condition that you've identified, and then there's this five-part framework that really allows you to take actionable steps to kind of manage it.
So I want to start a little bit and roll back for a minute. In that opening chapter, when you start to talk about your own recognition that perhaps you were depressed, like you literally said out loud in your office and the privacy of your own space, "Am I depressed?" because you had, quote, "a sort of a tidal wave of overwhelm" with what was going on in your personal and professional life at that moment. People are going to have to read the book to figure out what that is.
But you, ostensibly, were very high functioning. You were knocking it out of the park, doing your research. You were becoming a sort of a burgeoning media expert, a sort of a social media communicator, a content creator, and you didn't have that, like, "I can't get out of bed" problem. So before we even dive into your research, into some of your solutions that you offer, can you help our listeners understand what this definition of high functioning depression is and why is it so easily overlooked and under-diagnosed?
Dr. Judith Joseph [6:05]: Yes, you know, when you go to a doctor and they pull out what is called the DSM-5, which is the Bible of psychiatry, what they will do is go through a checklist. Or, if you go to a therapist, they'll ask you about symptoms of depression, like changes in your appetite, changes in your sleep, changes in your energy, concentration, your mood, whether or not you have something called anhedonia, which is a lack of pleasure and interest in things.
Most people don't even know what that is, and I think most doctors don't really ask what it is. It's an old term, but it's been in the medical literature for years, and I study it. And then they'll get to the bottom of that list, and then they'll ask you how your functioning is. Now, if you are showing up to work and you're taking care of your family and you're doing all the things, then you don't meet criteria, or if you're not in significant distress, you know, if you're not like suicidal or saying that you're significantly distressed by your symptoms, you don't meet criteria.
So what happens? Many times they'll say, "Well, you don't meet criteria for this. Come back when things are broken, come back when you're not functioning, come back when you're in distress." But why are we thinking about it that way?
And I kept seeing people saying something is off, and that symptom—that anhedonia—a lot of people don't even know what it is. They'll say, "I feel meh or blah," but they've never heard of anhedonia. I went to a research conference recently, and another research conference, a clinical conference, where there were a lot of therapists there, and I went around with a mic, and I asked them what anhedonia was. No one knew what it was. There was maybe one or two persons who knew—and that's because they saw a social media reel that I did on it.
Katie Fogarty [7:43]: They were like, "Yeah, I know this."
Dr. Judith Joseph [7:46]: This is a term that is all over my research protocols. We know it well in the research world. And I thought, why is there this information that we're seeing in the research and the real world doesn't have this information?
The other thing that, you know, I felt like was important to understand was that some people who don't process their trauma, avoid their trauma, their past pain, by busying themselves. So I've done a number of PTSD studies in my research career, and I've used an assessment called the CAPS-5, which was heavily used at VA centers for combat veterans when we're looking at PTSD symptoms, but the CAPS-5 has been modified to all types of trauma, not just combat trauma. And there are over 30 symptoms of trauma, and I don't think people know that.
And so one of the symptoms of trauma is avoidance. And classically, what you would see is people avoiding things that trigger them, like situations, people, places. But people with high functioning depression, they avoid their pain by busying themselves, and that's their version of avoidance. And in their mind, there's this magical thinking that if I just keep doing, if I keep moving through, if I don't process pain, it'll go away.
Well, they're wrong, because that pain and that unprocessed trauma shows up in other ways. That may show up as your body breaking down, that may show up as you drinking too much. We know the rates of binge drinking in previously protected groups of people have skyrocketed. It shows up as you eventually breaking down mentally or psychologically, or you may be excessively shopping or excessively using devices to self-soothe.
So it's important to process that trauma and to identify the source of this overworking. Many of the people that I work with who have high functioning depression will say, "Well, when I sit still, I feel empty. When I'm not busy, I feel restless," and so I just keep doing. But if they only knew that that was tied to this unprocessed pain, this unprocessed trauma, and that's why they can't slow down, then they would stop, and they would try to figure out how to slow down. They would process that trauma so that they could actually live a life that is happier.
And the reason I say happier is because I have two practices. I have a traditional therapy practice where I see children and adults for medication and therapy, and then I have my research lab. And when you're in the research lab, we very rarely see the word "happy" on our rating scales and our psychometric scales where we measure depression. But in my therapy practice, people come in, they're like, "I just want to be happy. I want to be happy."
So there's this disconnect between research and the real world. In research, what we're in the business of is eradicating depression, and we try to increase our points of joy, which are, if you're hungry, get some food and feel satisfied. If you're thirsty, have your thirst quenched with some water. If you're lonely, connect with someone. If you're tired, get rest. These are the points of joy that we measure in terms of looking at happiness in research, but in the real world, people have this image of what happy is to them.
And so the way I explain it is that happiness is an idea, but joy is an experience. And if I can show you the science of your happiness, because Katie, you're different than me, there's only going to be every one Katie, only ever going to be one Judith in the future of the universe and the history of the universe. Understand the science of your happiness.
But in order for you to understand the science of your happiness, you have to understand the science of what's making you unhappy, which is understanding the science of your depression, your sadness, and when you reframe and you're not in search of happy, you're not in search of this idea, this ideal, and instead, you focus on increasing your points of joy every day, overall, you will be happier, because getting points of joy is doable, but obtaining happy may feel so unreachable and so hopeless for so many people.
Katie Fogarty [11:42]: And I feel like happiness, too, has this sort of, you know, connotes like nothing's wrong, or that you're sort of like... it feels like—I don't want to use the word "capitalistic," because that sounds too dramatic and awful—but I had a wonderful guest on the show, a woman named Dr. Thema Bryant, who wrote a book called "Joy Is My Justice," which basically says that happiness is sort of formal, it's brought on by situational things, but joy is an innate human quality, and it is something that we should all have access to at any given time.
And I thought that was such a marvelous distinction, because I had truly never even thought of that notion until she shared it. And that is just—your book is sort of imbued with the same idea too, that joy is accessible to all of us, and that it doesn't need to be transitory the way that happiness is.
Dr. Judith Joseph [12:36]: Well, when you think about a child that's born, you know, if you put a toddler on the ground, you don't need to teach children how to find joy. They will find a piece of garbage and put it in their mouths and enjoy that. You know, they'll roll around in dirt.
Katie Fogarty [12:51]: I am still laughing because my daughter when she was young—reminds me so much of a four-year-old niece that I have right now. And my husband and I describe them as "joy bombs." They were like, constantly going off with just like explosions of enthusiasm and just energy and happiness and presence. And it's just like, so delightful to witness that kind of energy.
Dr. Judith Joseph [13:18]: But it goes away. Joy is built into our DNA. If you imagine your hand—like hold your hand up, and joy is in all of our DNA. We're built with that, but somewhere along the way, we forget how to access it, and that's why I think many of us feel this way. We feel empty. We feel restless when we're not doing. And that's why I developed this methodology in my book to help people to access joy again.
And I purposely and intentionally used five because most of us have five fingers, so you imagine that joy is literally within your reach, but you just forgot to access it. And I'm hoping that people can learn to access joy again by using this methodology.
Katie Fogarty [13:58]: We are going to head into a quick break, but when we come back, we're going to explore this five-finger framework that you have to reach out and sort of hold joy in our hand again. We'll be back in just a minute.
Dr. Joseph, we're back from the break. When we went into it, we talked about the notion of sort of just reaching out with open palms extended to grasp joy within our lives and our day-to-day and our human experience, and you have a five-step framework that we're going to go through in a minute. But I do want to just sort of close the loop on this notion of joy as just not as more than a nice-to-have, but sort of a must-have for our mental health.
So for somebody who's listening, I think most people think, "Yeah, I want joy in my life," but they don't prioritize it when they're racing through their to-do list. So before we go into that framework, could you give us a little bit more information on why having these points of joy in our life is actually needed for our mental health?
Dr. Judith Joseph [15:03]: Well, I just took the recertification for our boards—every 10 years, we have to do this—and one of the facts that I found in the board exam was that doctors who are unhappy make mistakes. And I thought, wow, like being unhappy is literally costing our healthcare system money because of lawsuits and lives. There are lives lost.
So it's worth it to invest in joy, not just to prevent negative patient outcomes and mistakes, but also people who are joyful—people want to be around them. There's less turnover rate on the job, so it's actually costing corporations less money. People who are joyful, they tend to have better health. It's worth it to invest in joy. This is not just to feel good and just to have a feel-good episode. Joy is necessary for good health, for better outcomes.
Katie Fogarty [15:57]: And interpersonal health as well. You know? I mean, we've all had the experience of having to interact with somebody who's not having joy. And you know, if we have a loved one who's struggling with depression, we are there for them as we are there for ourselves. But interpersonal health is such an important component of our overall health. I think that for that reason, joy is another reason we should be prioritizing it.
Dr. Judith Joseph [16:20]: And leaders who are joyful don't make terrible mistakes. They don't create selfish systems. You know, they don't—joyful people don't create conflicts. So it's worth it to invest in joy. Though I truly do believe the world will be a better place if people are more joyful and they invest and prioritize joy versus "happy" the state, you know the thing, the ideal, right?
People who chase the clout, the money, the greed, in their minds, they've told themselves that that is happiness, but they don't stop. They keep going. They're restless when they're still. They keep hunting because they don't really understand joy.
And I think that when people think about joy again, they conflate the two. They think about what happiness is, and they mix the two up. But the experience, the plethora of being a human, the plethora of sensations that I talked about earlier, you know, when you're lonely, connecting to someone, when you're tired, resting, when you're hungry, savoring a meal instead of eating it in front of your computer or in front of your phone, when you're feeling uninspired, taking a walk in nature, that is what joy is. That is what makes you a human being instead of a human doing.
And I think that when people make that shift, then they feel hopeful, because joy is possible. I can work on getting two points of joy today if I got zero yesterday, and then I can work on getting three points tomorrow. You know, but "happy" that state, that ideal—people may never have that.
Katie Fogarty [17:52]: How do you define "point of joy"? Dr. Joseph, because you use that phrase, which I love. It's in your book, and it's something that we—I'm taking on for myself, but bring our listeners in. How do you define it?
Dr. Judith Joseph [18:05]: It sounds more whimsical than it is, but literally, when I'm sitting down and I'm scoring what happiness is in my lab, we are adding up points. And the points—when you think of points—which way you think of like sparkling and these drops in the sky, but it's literally points. I'm sitting there adding up these points.
So I'll ask things like, when you were with your loved one and you were being intimate, did you find pleasure there? But people who have joyless lives, they may not find that intimacy pleasurable. It's something to just get over with, right?
And when I'm sitting and I'm scoring things like, when you were about to eat, were you looking forward to it, or did you just shove that food in your mouth so that you had fuel to do what you were doing? These are the points that I am literally adding up. And that's why my book and my work uses a lot of psychometric rating scales.
You know, people think of scales and quizzes as like, "Oh, it's fun. It's something you do in a magazine." But in research, especially behavioral research, that is how we quantify whether someone is getting better, getting worse, or staying the same. We know—the science is not in the area where I can scan your brain or take a blood test and say, "Oh, you have this level of anhedonia." What we depend on are rating scales and answers to questions. And when we think about what true happiness is in research, it's all these points that I told you about that we have to add up and keep track of.
And I'll give you an example. There was a patient that I mentioned—obviously have to disguise them in the book—but they were feeling uninspired, a lot of anhedonia, they couldn't remember something that used to light them up. So we had to kind of trace back, and I had to ask about a time in life when they did feel that way, when they were lit up, and they were like, "Oh, I think it was before my parents divorced," you know.
And it turns out that before her parents had divorced, she used to camp a lot with them. She was in nature a lot. Now she's living in the big city and has a fancy job and doesn't really have access to nature. So we had to work back and figure out how to get her more access to nature and to see if it was something that she could find joy in again. And slowly but surely, you know, we started off with a plant in her office. Then we went on with looking at pictures of nature, then taking a walk in the park. And slowly she realized that was something that brings her true joy, but she had lost sight of that.
We all have past histories where we at some point or another, we were not feeling anhedonia, and when we do a little bit of the things that once brought us pleasure and joy, then we're getting more points. And when you think about that, it sounds so simple, but it is so profound. And a lot of times the solutions to these complicated problems are simple, but we just don't know how to access it. We don't know how to tap back into it.
Katie Fogarty [21:01]: So in our modern life, like your patient, she had put herself into a situation where she was living in a city, not connected to nature, which is a place that allows the roots for joy to flourish. Quite often we move through life and we find ourselves in circumstances where we are maybe not capable of thriving.
You mentioned that you do a lot of measuring and grading. Your book offers a high functioning depression grading scale where readers are able to do a self-assessment to see where they fall on the scale. We're not going to be able to walk through the entire assessment now—it takes up about a page and a half in the book—but everyone's going to buy the book and do it.
But for listeners right now, what are one, two, maybe three, questions to ask oneself, if they are wondering if they're experiencing this type of depression? Is there a surprising question they might ask that they might not have considered to help them make this diagnosis while they're listening to us?
Dr. Judith Joseph [22:02]: Yeah, I think that it's really important to understand what your science is. And I put a tool in the book called the biopsychosocial tool, because we are all human, and we all have a biopsychosocial. However, the components of our biopsychosocial are going to be different.
My biological risk factors and my biological history is going to be different than yours. I have something called low thyroid, and that can play a role into how I feel. I'm in perimenopause—that may play a role into how I feel. But someone else maybe has some other biological factors that are different than mine, or they may have a past medical history in their family of something that's different than mine, you know, like, understand what that is.
And then the psychology—I talk about my history of trauma, both personal and past things like scarcity trauma. I grew up having very little resources, and that has impacted me in ways that I'm still discovering, and I'm a board-certified psychiatrist, and my own personal traumas from losing my mentor early in my career, and other traumas that I mentioned. And then my attachment style, my resiliency factors—all of that plays a role.
And then my social risk factors: where I live, I'm a single mom, I have a business, my movement, how much I get exercise, what I eat, whether or not I engage in using alcohol or substances—all that stuff, all that plays a role, right? All of these things make up your biopsychosocial. And we all have a different biopsychosocial, but we all have one. We all have a biopsychosocial, but they're all different.
And so understanding the science of your happiness is important. And in medical school, we learned this, but I thought, why are we keeping this information to ourselves? Why aren't we teaching patients this so that they can understand what's taking away from their happiness, and so that they can know where to focus?
Katie Fogarty [24:13]: And that's exactly what you're doing, because it's truly amazing when you outline all the things that go—you know, our mental health, like anything else, is multifactorial, right? There's so many different strands that get woven together to support us. And I think that we can often measure ourselves with a stick that we think is universal, and then find that we maybe fall short, or we try to do things that are working for our friend, you know, like, "Oh, my friend seems happy now because she's doing X, Y and Z," and we try to copy that.
So your book really makes clear that we have to do some of the work for ourselves to figure out what the factors are. I do want to ask you about a word that you just used, which you mentioned a little bit earlier in the show too, which is that of trauma. And in the book, you spend time talking about this, and you distinguish between what you call "big T trauma" and "little T trauma," and you help the reader understand that having a little T trauma still can impact your mental health.
And too often, people disregard these and think, "Well, things should be fine, since I haven't experienced big T trauma." Can you walk our listeners now through the distinction between the two?
Dr. Judith Joseph [25:27]: In my research, PTSD is something—Post-Traumatic Stress Disorder is something that in the DSM-5, which is the Diagnostic and Statistical Manual, the Bible of psychiatry—in order to meet criteria for that type of trauma, you have to either have experienced something life-threatening or an assault. So you think of combat, you think of sexual assault. You think of, you know, a dangerous motor vehicle accident. So it has to either happen to you or you experience it, meaning you saw it happen to someone else.
But when I do my research studies, I tell you, so many people get excluded because they don't meet criteria. So they'll come in and say, "I was in a toxic relationship where the person just tore me down mentally." And I have to ask, "Well, did they hit you? Did they—were they physically aggressive? Was it life-threatening?"
"Well, no," and I have to say, "Well, I'm so sorry, but your trauma doesn't meet criteria." And imagine how invalidating that is for someone to be told that something that has shaped the way that they view themselves in the world and the way that they interact in the world does not count as a trauma, right?
And again, the reason that the medical system uses these types of systems to distinguish is for research purposes, so that it's standardized across several sites. But when we don't acknowledge that these traumas, even if they're just emotional, not physical, not life-threatening, that they are traumas—that could do wonders for a person. And why? Because there are, like, over 30 symptoms of trauma. Most of us only know one or two, like flashbacks and nightmares or avoiding things and triggering, getting triggered. But there are other symptoms of trauma.
There are things like internalizing shame, blame, and guilt, right? So if you're in a toxic relationship for many years where the person's belittling you and emotionally and psychologically abusing you, you're going to internalize that shame and blame and guilt. You may not tell your friends about what's happening. You may not ever share it, and you walk through life seeing yourself as someone unworthy, and how you may respond to that is you overwork yourself. You may tie your entire life to a role because you feel unlovable without that role because you haven't processed that trauma.
And that's why, when I modified my trauma inventory, I included things that are typically not on trauma inventories. I included things like being rejected because of your cultural background or because of how you identify. I put in things like going through bankruptcy or going through a divorce in adulthood, because these are all things that are emotionally traumatizing, but they don't count according to the classic inventories.
And I want people to know that these quote-unquote "little T's" do shape the way that you view yourself in the world and the way you interact in the world. And most of the trauma skills that are known are childhood trauma skills, but I wanted to include adulthood traumas as well, because even though the brain technically is pretty much formed by the time you're 25, there's something called neuroplasticity, where your brain continues to shape and change in terms of how it functions as you age, and things that are painful emotionally and psychologically to you can shape the way that your brain functions and the way that your body responds.
So I wanted people to feel seen in this work, so that they know that the trauma is valid and it happened, and that it's not their fault. And it's important to do that, because if you don't distinguish that, then people internalize that shame and blame. They think, "Well, it happened to me because I must have done something" rather than "Something happened to me and I didn't deserve it."
Katie Fogarty [29:13]: It's such a much more expansive way of looking at the experiences we've gone through and how they shape both our emotions and our mindset, but the stories that we tell ourselves as well. To your point about whether or not people feel shame for allowing somebody to belittle them, I'm thinking of—this is nothing, it's probably like, even like a smaller than lower T, but like, for many years, I told myself the story that I wasn't good at public speaking because of something that happened in college.
And I—I mean, it was so crazy, and I really—it was a small trauma of embarrassment, I guess, and shame about not being prepared. And I avoided public speaking for decades, until I finally put the work in to manage it. And so it's not quite the same thing as having a relationship that sort of eats away and corrodes your sense of self-worth, but we can definitely limit ourselves by taking on and sticking to really unhelpful narratives and having that define who we are.
So your book gives listeners a five-framework set of guidance to really navigate our way through this sort of continuum of human experiences. And to be human is to have beauty and joy and wonder in our—in awe, in our lives and love. But it's also to have traumas. No one gets to the north side of 40 without experiencing something difficult, challenging, upper and lower case traumatic.
So can you share with our listeners a very quick top-line overview of the five V's—this 5V framework, and then maybe we'll try to dive into one or two of them with a little bit more depth?
Dr. Judith Joseph [31:07]: Yeah, I'm glad that you said that, because I hear that a lot. "Well, who doesn't have trauma?" It's almost like, you know, it's the same with "Well, every woman has their period, and every woman goes through menopause, just get over it." Well, no, just because it happens to everyone doesn't mean it's not hard, you know.
Katie Fogarty [31:23]: Hello, menopause. I mean, that's like, if you're born with ovaries, that's happening, and it's not always easy.
Dr. Judith Joseph [31:29]: Like, "Oh, everyone gives birth. Like, get over it." Well, no, 80% of women experience postpartum blues. So those pamphlets of people looking happy with a baby, that's invalidating, you know, but that's another story for another episode.
But the five V's are based on evidence, based knowledge, on the science of happiness. And I keep saying the science of happiness, I should let your listeners know that there are curriculums all over the country where colleges and universities are teaching about the science of happiness as a curriculum. So this is being studied at major institutions.
And the first is "validation," so acknowledge how you feel and accept it. And it may sound so loosey-goosey, but the reality is, is that when human beings don't know what they're dealing with, when they don't know how they feel, that uncertainty creates anxiety. And I liken it to entering a room, and then someone shuts the light off, and you don't know what fell. You hear a really loud thud. Some people will start swinging. Others will start screaming. Some will try to escape the room. But when you turn the light on and you realize that something fell, then you're not afraid.
And that's how it is when you identify emotions, when you know what you're dealing with, when you can say, "Oh, that emptiness when I sit still, when I'm not busy, that's anhedonia. Oh, okay, now I know what it is. I know what I'm working with." And once you acknowledge and accept your feeling, expressing your feeling, the second V to thriving is "venting."
And people can vent in different ways. I have so many methods in my book for venting, because I've traveled the world. I've been to over 30 countries, trying to understand the way that mental health and well-being are experienced across the globe. And in some cultures, people feel more comfortable with praying. And other cultures, people don't cry, but in other cultures, they cry, and it's okay to cry and express emotions that way.
Some people feel more comfortable writing their emotions. Other people, who are neurodivergent, are not the best with words, so they try to find other ways to express—maybe it's through art or movement, but the important thing is to get those emotions out, to express them.
And then the third V to thriving is "values." I say that these are things that are priceless and not things with price tags. So things like the causes that you feel are important to fight for, the family, the faith that gives you a sense of purpose and meaning. But many of us with high functioning depression, we're so busy chasing the things with price tags, the things that we think will make us happy, right? The idea, the ideals that we don't realize that on our death beds we're not going to even care about those things. We're not going to say, "I wish I had a Porsche or-"
Katie Fogarty [34:10]: A Birkin. Nice, yeah.
Dr. Judith Joseph [34:13]: I'm not gonna be like, "Man, I wish I got the mini Birkin." I'm gonna say, "I wish I had five more minutes with my daughter." You know, tap into those meaningful values, the things that are priceless, not with price tags a little bit as much as we can every day that makes us happier.
And then the fourth is "vitals." And these are the things that are nourishing our body and brain. Because we only get one, we only get one body and brain. It's up to us to take care of it. I tell my daughter that every day.
And the traditional vitals are sleep, getting good sleep. We know it's important, and I put tips in there for that, how to feed your brain with things that are nourishing and decreasing inflammation. So that's, you know, nutrition. And the third is getting good movement. And you can do that however it feels culturally authentic to you. I'm from the Caribbean, so I like to dance.
But then I added three more vitals that are not traditionally there. One, our relationship with technology, and I truly do believe one day there will be a whole section of the DSM-5 Bible of psychiatry dedicated to tech use and how it impacts us. The other non-traditional vital in there is your relationships with people, because in longevity science, we know that the quality of your relationships is a number one predictor of your outcomes. So if you're with a toxic individual, they are literally draining your life force.
And then the third, non-traditional vital that I put in there is your work-life balance, because I think people with high functioning depression have poor work-life boundaries.
And then the fifth is "vision." The fifth V to thriving is vision. How do you plan joy in the future and in the present so you keep moving forward instead of getting stuck in the past? And there are these five things that you can do. I don't recommend tapping into all five at once. I think focusing on one or two and trying to get a point of joy in one or two a day, for example, if you want to say today, "I'm going to validate how I feel and I'm going to vent it," that's going to be how I'm going to get my points of joy. And why does that bring joy? Because acknowledging how you feel decreases uncertainty and decreases stress, and that is joy. People don't think about not having stress as being joy. You know?
Katie Fogarty [36:22]: I know. I'm actually in the middle of trying to sell our longtime family home and declutter and stage it, and there's a lot of stress, and there's a lot of venting, and I will share that by sharing my anxiety and what I'm going through with a good friend and my partner, it makes it easier. I mean, truly, I still have to pack all this stuff, and I'm like donating 800 books, but it's, you know, it makes it feel more manageable.
I will share with the listeners that I took something away from every one of these five frameworks that you identified, and you give a lot of great thinking around it. And to the point about validation, just even reading this book and immersing yourself in this five-framework idea feels validating, because it makes you see that there are tools to help you manage the different things that kind of might come up, and that there are ways of accessing these points of joy within this framework. So I thought it was really useful.
I know we're nearing the end of our time, and I got a couple more things I want to ask you, but I do want to sort of pull back for a minute and talk a little bit more about venting in particular. As I shared, I've been venting, and I think many of us are. We have no problem with low-key venting, right? We all have a sister or girlfriend, somebody you know, maybe your husband, a spouse that you vent to, and that works.
But the thing that can be harder for people is to be truly vulnerable around bigger, deeper issues that you just can't like bitch about to your girlfriend, necessarily. So I would love it if you could offer maybe just a little bit of thinking or coaching to our listeners about how, why, and maybe a tool for truly becoming more vulnerable and more open. Because I'm a big believer that when we share our stories, we connect, and in connecting, the quality of our relationships as you shared is such an important part of our mental health, and that helps really make them more dynamic. So what might you offer to our listeners about sort of bigger, deeper venting?
Dr. Judith Joseph [38:29]: When you vent, there is venting etiquette, and I lay it out in my book, because I think people do need help with this, and who better to prepare you to vent than a therapist who hears venting all day long. And venting to a therapist is very different than venting to a friend, because a therapist is paid and—I mean, think about—and a professional. Think about, yeah, they know how to respond. Yeah, I went to four years of medical school, four years of residency, two years of fellowship, and then I've been practicing for 10 years. I know how to accept a very difficult vent, right? But most people don't.
And so when you think about something difficult, maybe it's something that you've held in all of your life, you want to first think about that—what those one or two people that you trust the most to share this thing with. And you want to first think about whether or not you're going to benefit from this. Are you going to benefit? What are you going to gain from sharing with this person?
And you want to think about if this person can handle this. Because if this is a person you're considering, you probably know them very well, and you probably know about their level of past trauma and what they're dealing with in the present, and whether or not this is a person that can hear this right now, because the worst thing that you can do for yourself is finally share something that's truly difficult and then feel as if you're rejected.
Human beings can't handle rejection well. In some cases, when you light up a brain, when you look at a brain under imaging and a human is rejected, the same parts light up in that brain as if they were being physically hurt. So if this person is someone who is likely to not be able to hear it, then that's probably not the best person to go to at that time. Doesn't mean that they're a bad person. Doesn't mean they're not a good friend. It's just not the right time and person for that.
But if you do find the person and you think they're the right person and it's the right time, you want to ask for permission. So it basically is emotional consent. So you may say something like, "There's something that I've had on my mind for some time and it's, it's really painful for me, and I really thought about sharing it for quite some time, but I just didn't know how to, and you're the person that I think can handle it. Is it okay if I share it with you?" Right? Asking for consent, and the person may actually say to you, "Yeah, like, go ahead." Or they could say, "I really want to be that person for you, but right now I don't have the time. Like, can we schedule time to talk about it?" So like, that way you again, you feel safe. There's psychological safety there.
And as you're sharing with this person, you want to check in with them. Like, as you're sharing something that's really heavy, you want to say, "How are you feeling here?" That shows reciprocity. And there are actually studies that look at healthy venting versus unhealthy venting. The science shows that if the venting in itself doesn't have empathy, that it's not beneficial. If you're venting without being thoughtful, and you're just basically trauma dumping, and you're in a position of feeling emotionally dysregulated and you're rageful, that will actually make you feel worse. In fact, the study that I'm thinking about says that it's like pouring gasoline on a fire. So you want to make sure that you—
Katie Fogarty [41:51]: I've had a few of those conversations.
Unknown Speaker [41:55]: Moving is stressful.
Katie Fogarty [41:58]: There has been gasoline. Well, we've been married for like, a long time, so we've had other stressors. But you know, yes, I totally relate to that, but that is also fascinating. I'm so glad I asked you this question live and I've got you on the mic, because I really feel like what you shared about venting—the way you talk about it—it's so powerful and it's so needed, because we all want to be able to share ourselves, that this notion of emotional consent is so important.
We want to make sure that the person who we're hoping to receive us is ready and able. And I think most of us, and I put myself in this camp, really want to be a good listener and a good partner for somebody who needs to come to us, you know, ourselves with their own issues that they want to talk through or wrangle with, and so that is such a generous support structure and sort of questions and that reciprocity that you outlined, I think it's so powerful.
And this book is full of wisdom like that. It's also full of great stories you did. You know, there's more that you share about what it was like to be a first-generation immigrant to America and how that shaped you, and how that shaped the family that you're in, the communities that you grew up in and where you were educated. It's really an interesting, fascinating book, but I know our time is coming to an end, and you have patients to see and a book to promote.
So I want to be mindful of your time and ask you just one last question. Creating a book, writing it, publishing and promoting it is an enormous amount of work, and it's also an enormous amount of vulnerability. You're sharing a lot of your work, your research here and offering this book to the world. How have you been finding points of joy across this process?
Dr. Judith Joseph [43:42]: I am so fortunate that I work with my sister who is—and my siblings are very close by, and they are my points of joy. I have a beautiful eight-year-old daughter who wants to be a "psychirist." That's what she calls it—
Katie Fogarty [44:02]: That's hysterical. And she is just, she'll learn to say it, then she'll learn to scroll. That comes next, psychiatrist, it's a—
Dr. Judith Joseph [44:10]: —hard word. Yeah, she wants to be a "site-kairos," a model, and a dancer. So she's just—
Katie Fogarty [44:17]: Let's go, let's go, speak it out, make it happen. And—
Dr. Judith Joseph [44:22]: —and I'm fortunate. I get to work with a great team every day. I have a lab in Manhattan, and I really, truly have the best team. And I'm lucky, because most therapists, they're in a silo, they work in an office by themselves, but because I have a lab, I have a team.
And so I'm one of four siblings. I talk about this in the book, and my point of joy is connection. I just—I love being with people that I care about, and if I have access to the people that I love, then I'm good. Things can happen in life that are terrible and hard, but as long as I feel connected to my loved ones, then I can access joy.
And this is actually something I found around the world. Children, people who are in really terrible situations, they can still access joy. You just have to understand the science of your happiness, and then you understand what makes you unhappy, and then you could do something about it. Absolutely.
And one
Katie Fogarty [45:18]: of the things you can do about it is get your hands on this book, "High Functioning: Overcome Your Hidden Depression and Reclaim Your Joy." Dr. Joseph, thank you so much for coming back on the show, for giving us a taste of your research, the framework that you outlined in your book, and just reminding us that we have agency over so many things in our lives. There's things that we don't control, but we can control a lot of things, and this book puts tools in our hands to help us to do that. So I really appreciate your time. How can our listeners find you and keep following your work?
Dr. Judith Joseph [45:52]: Well, thank you, Katie, for having me. You can follow me at Dr. Judith Joseph. I'm on all the socials and DrJudithJoseph.com.
Katie Fogarty [46:01]: This wraps A Certain Age, and this wraps up a truly important conversation. We need to be focusing on and taking care of our mental health. It is so foundational to our well-being. This show is being recorded and aired in April, which is World Stress Month. We are heading into May, which is Mental Health Awareness Month, but we need to be taking care of our mental health all year long.
Please share this show with friends and family. Show them some love. Let them know you're thinking about them. Let them know that you care about their mental health. Thanks for sticking around to the end of the show. Special thanks to Michael Mancismu, who composed and produced our theme music. See you next time and until then, age boldly, beauties, and take care of your mental health.