The Mel Robbins Podcast#1 Researcher: 7 Signs You May Have High Functioning Depression
EVERY SPOKEN WORD
95 min read · 18,704 words- 0:00 – 2:03
Intro
- MRMel Robbins
What exactly is high functioning?
- JUDr. Judith
People who are taking care of their families. They're meeting work deadlines. They're the ones that everyone says, "Oh my gosh, you're doing a great job. You're the rock of the family. You can't stop because people depend on you." You're meeting deadlines, you're collecting accolades, but you're just not really feeling a sense of joy, so we push, push, push through it.
- MRMel Robbins
My husband Christopher suffered from long-term treatment-resistant depression.
- JUDr. Judith
Mm-hmm.
- MRMel Robbins
And this was a guy who was sober for a number of years, he would meditate, he was exercising, he was close to our children, and yet deep inside of him, there was something that was off. It was another doctor that we've had on this show, Dr. Amen, who did a brain scan and called us up and was like, "Uh, he has dysthymia. Like, he's got really treatment resi- resistant depression, and normally I see a brain like this after they're dead."
- JUDr. Judith
People cope with their depression by busying themselves.
- MRMel Robbins
Mm-hmm.
- JUDr. Judith
Because that's the only way they know. So a lot of times people just gaslight themselves, they don't feel what they're feeling, so they end up feeling very little. They have anhedonia, which is a sneaky symptom of depression. It's a joy thief. It comes in the middle of the night and steals your joy. Before you know it, nothing gives you excitement.
- MRMel Robbins
Hey, it's Mel, and today you and I are talking about something that is extremely important and it is only recently getting the research and attention that it deserves. We're talking about high functioning depression, and we're gonna learn all about it from a renowned researcher who's a medical doctor and PhD, and she is also the number one expert in the world on this topic. If you're someone, like me, who considers yourself a high achiever, I have a few questions for you. Do you grab a cup of coffee in the morning because you just don't have time to eat breakfast? Same thing with lunch. You eat it while you work and it doesn't even occur to you to take a break. Or how about this? When the alarm goes off
- 2:03 – 6:19
The 7 surprising symptoms of high functioning depression.
- MRMel Robbins
in the morning, is the first thing that you feel dread about how much you have to get done today? Have you noticed lately that you're spending way more time mindlessly scrolling on social media at night, even though you don't want to? Do you want to take a day off, but you literally feel like you can't? Or you know you need help at work and you need help around the house, but instead of asking for it, you tell yourself, "Oh, it's just easier if I do it." If you answered yes to any of these questions, or you have someone that you love that immediately comes to mind, I dedicate this episode to you. Because according to the world's leading expert on high functioning depression, every single question I just asked you is a symptom of it. And today, the remarkable Dr. Judith Joseph is here to share her groundbreaking research on this important subject and exactly what you need to do to feel more energized, excited, joyful, and present in your life again. So, Dr. Judith, I'm so excited you're here. Welcome back to the Mel Robbins podcast.
- JUDr. Judith
Thank you for having me back.
- MRMel Robbins
Of course. And I'm excited to talk to you today because you are doing so much exciting research. What is it that you're interested in when you think about what's going on in your private practice and in your research institute?
- JUDr. Judith
Research is so exciting, and for me to be a principal investigator of my own lab, leading a team of women researchers, it's just like a... It's really a dream. Sometimes I, I pinch myself. Uh, and, you know, representation matters. For a long time, women were not included in clinical studies. Underrepresented minorities were not included in clinical studies. So you have all of these developments and drugs and treatments available that were being applied to all populations but weren't really studying or including all populations. So it's really important for people that look like me to be heavily involved in clinical research, because it also allows populations to trust, right?
- MRMel Robbins
Yes.
- JUDr. Judith
Like, you're gonna go to your doctor, you see that your doctor looks like you, you're gonna trust them more, right? So representation really matters. And the thing about research is that you never know what you're gonna find.
- MRMel Robbins
Really?
- JUDr. Judith
So many times I know what we're looking for, but we don't know what's going to happen. And the funny thing with research that I found is that not everyone fits into a neat little box.
- MRMel Robbins
Hmm.
- JUDr. Judith
So, we use the bible of psychiatry, the DSM-5, but let's say someone comes in and they're like, "I don't know if I'm depressed. Something's off. I can't tell," and you're asking them the symptoms of depression. So you're saying, like, "Uh, well, uh, do you have appetite changes? Do you have sleep changes? Are you feeling low energy? Do you feel sad?" If someone says yes to some but no to others and they don't fit neatly into a box, let's say they say yes to everything but they're still high functioning-
- MRMel Robbins
Right.
- JUDr. Judith
... or they don't feel distressed, then you're like, "Well, you don't fit into this box, so I guess you gotta come back when you have low functioning or when you're really feeling distressed." How messed up is that?
- MRMel Robbins
That's really messed up.
- JUDr. Judith
(laughs)
- MRMel Robbins
What, what exactly is high functioning?
- JUDr. Judith
People who are taking care of their families. They're meeting work deadlines. They're the ones that everyone says, "Oh my gosh, you're doing a great job. You're the rock of the family." You can't stop because people depend on you. You know, you're me- you're meeting deadlines, you're collecting accolades, but you're just not really feeling a sense of joy.
- MRMel Robbins
Right.
- JUDr. Judith
You're not feeling... You feel like something's missing.
- MRMel Robbins
Right.
- JUDr. Judith
We have to remember that not everyone identifies with that. Not everyone says, "I feel sad," or, "I feel depressed." For some of us, it's cultural. For some of us, you know, we just don't have that language. It's never been in our vocabulary. And for others of us, we have these histories of traumatic experiences-
- MRMel Robbins
Mm-hmm.
- JUDr. Judith
... that cause us to not want to feel, so we push, push, push through it.
- MRMel Robbins
So are you studying depression right now?
- JUDr. Judith
I am. One o- one of the things I study is depression, along with, uh, some major depressive disorder-
- MRMel Robbins
Uh-huh.
- JUDr. Judith
... postpartum depression.
- MRMel Robbins
Yep.
- JUDr. Judith
Um, schizophrenia.
- MRMel Robbins
Yep.
- JUDr. Judith
Really anything within the mental health gamut.
- 6:19 – 7:02
The surprising truth about medical research.
- JUDr. Judith
into a box, but were leaving my office like, "Then what is it?" You know?
- MRMel Robbins
Were you in a situation where somebody's sitting across from you and you're like, got the DMS-5 out... Not that you have it out physically, but you know what I mean. And you're like, "Okay. Box check, box check. Okay, doesn't technically quite meet the criteria, but I know this motherfucker has depression."
- JUDr. Judith
(laughs)
- MRMel Robbins
You know what I'm saying? Like, you know, that's how I would say it. That's not how you would say it. But do you have this sense, like, something's off and you're depressed and E- This was my husband, by the way.
- JUDr. Judith
Mm-hmm.
- MRMel Robbins
So what, what are you researching right now in the lane of depression for these people that do not fit into the box?
- JUDr. Judith
I'm looking at depression with different faces.
- MRMel Robbins
Okay.
- JUDr. Judith
Depression presents so differently depending on who's in front of you. For example,
- 7:02 – 8:23
How depression shows up differently for men.
- JUDr. Judith
men, they don't express depression the way that we classically think of depression. They may be irritable. They may come home and, you know, knock a couple of beers back, right? They may be checked out. They may have anger issues. Depression looks so different depending on the individual, and we don't want to miss those people.
- MRMel Robbins
Isn't that just a typical man?
- JUDr. Judith
It's not.
- MRMel Robbins
And I don't mean to make a joke, but I feel like-
- JUDr. Judith
Mm-hmm.
- MRMel Robbins
... at least in my experience, my husband, Christopher, we've talked very openly on the podcast about this, suffered from long-term treatment-resistant depression.
- JUDr. Judith
Mm-hmm.
- MRMel Robbins
And this was a guy who, um, was sober for a number of years. He was meditating like crazy. He, like... And by crazy, I mean every single day he would wake up in the morning, he would meditate. He was exercising. He was close to our children. He had started a men's retreat, uh, helping other men who were feeling this lack of joy. And yet deep inside of him, there was something that was off. And the way that I would describe it as his wife is, it's like the guy that I married 28 years ago, the light was off behind his eyes. Like, there was just a spark and an aliveness that was missing, and it went on for years,
- 8:23 – 9:58
What happened to Mel’s husband, Chris when he was struggling.
- MRMel Robbins
and because he was getting it all done. Like, first of all, he didn't think there was anything wrong. He just thought this was, like, maleopause, you know? Kind of like midlife male, dropping the testosterone kind of situation. But it was another doctor that we've had on this show, Dr. Amen, who did a brain scan and called us up and was like, "Uh, he has dysthymia." Like, he's got really treatment resi- resistant depression, and normally I see a brain like this after they're dead, and it's all the things he's doing that is keeping him okay. And Chris resisted the label. Like, he thought it meant that he was weak. And so this is an area that you're looking into, high-functioning depression. Is that what you're calling it?
- JUDr. Judith
Absolutely. There's so many factors involved with depression.
- MRMel Robbins
What is depression?
- JUDr. Judith
So depression, according to the DSM-5-
- MRMel Robbins
What is it according to you?
- JUDr. Judith
(laughs)
- MRMel Robbins
Who cares about the DSM-5 right now? No, I'm serious.
- JUDr. Judith
(laughs)
- MRMel Robbins
Like, because you have... Just like trauma.
- JUDr. Judith
Mm-hmm.
- MRMel Robbins
DSM describes it one way.
- JUDr. Judith
Mm-hmm.
- MRMel Robbins
I want to hear Dr. Judith Joseph's definition of how you think about depression and why that matters.
- JUDr. Judith
So again, we do use this construct because we have to be able to study it-
- MRMel Robbins
Of course.
- JUDr. Judith
... and to use a standardized system.
- MRMel Robbins
Yes.
- JUDr. Judith
But like your husband-
- MRMel Robbins
Yes.
- JUDr. Judith
... and what you experienced with him, people don't always identify with the word depression. I can't tell you how many times someone came into my office and I was like, "I think this is high-functioning depression." They're like, "But I'm not depressed." Well, they don't think... They don't see this as depression. They're like, "Well, a depressed person's in bed all day crying."
- 9:58 – 12:33
What is high functioning depression?
- MRMel Robbins
Yes.
- JUDr. Judith
No. Depressed people have something called anhedonia, which is a lack of feeling, a lack of pleasure. And you ask them, "Well, how do you feel about these things that used to give you joy? Do you feel like seeing people? How do you feel when you, like, enjoy a meal?" And they'll say, "Uh, uh, meh. I don't really enjoy it that much." But if you don't know what the feeling is, if you can't identify it, then you're not gonna know that it's depression. So you're just gonna be like, "Well, I guess this is just how it is." You think it's like, you know, midlife men crisis, right?
- MRMel Robbins
Right.
- JUDr. Judith
And this... And your husband is classic because running a men's group-
- MRMel Robbins
Yes.
- JUDr. Judith
... sounds like a lot of people depend on him.
- MRMel Robbins
Yes.
- JUDr. Judith
Guess who doesn't have time to be depressed?
- MRMel Robbins
Chris Roberts.
- JUDr. Judith
Exactly. People depend on him. So you get so caught up into your role, into your title, into what you do every day, that you stop allowing yourself to feel or to process what you're experiencing.
- MRMel Robbins
So how is high-functioning depression different than, I think, the stereotypical thing that a lot of us feel? Because I do agree with you. If I were to sit in a doctor's office, which I often do, or I'm talking to my therapist and my therapist goes, "Mel, you're struggling with anxiety." I'm like, "You're darn right I am. I get that. I am vibrating really high. I am consciously, like, on the go. I'm anxious. I'm on edge. Got it, got it, got it." If somebody were to say, "Mel, you're struggling with depression," I would say, "Oh, shit. I'm in trouble," because depression means that I am not functioning.
- JUDr. Judith
Mm-hmm.
- MRMel Robbins
Depression means that I can't get out of bed. It means I am in real tr- Like, that's a serious thing. Not to say that anxiety doesn't feel serious, but there's something about the reputation that that word carries that I don't think is fair to people that experience it and that hinders somebody from accepting what you're saying, which is, "No, no, no, no. You can be a super busy mom-"
- JUDr. Judith
Mm-hmm.
- MRMel Robbins
"... and you can be just burning the candle at all ends." And can you describe what the life of somebody that has, quote, high functioning depression looks like in your opinion?
- JUDr. Judith
So I wanted to test this theory out because a lot of times as researchers we're in our labs and we're doing these fun things. No one has any idea what we're seeing or doing because we don't share it, right?
- MRMel Robbins
Yeah.
- JUDr. Judith
In research, you're just in your little bubble.... and I was working with my social media manager, Johanna, and I said, she said, "What, what have you been seeing in your practice that's interesting?"
- 12:33 – 14:18
What a “day in the life” of someone with high functioning depression looks like.
- JUDr. Judith
I'm like, "I'm seeing a lot of high functioning depression." So she said, "Well, let's make a Reel on that. Let's see..." Or like, "Let's make a TikTok on that. Let's see what it looks like." So I did it. You know, typical day in someone with high functioning depression, they get up because early, before the alarm, uh, rings, because they have so much pent-up angst that they get up before it even rings. They rush to work, don't eat, right? The little joys in life, they just cr- uh, shove in the coffee.
- MRMel Robbins
Right.
- JUDr. Judith
They, they work through lunch.
- MRMel Robbins
Yeah.
- JUDr. Judith
So, they don't savor those meals. Those little points of joy are, again, flattening out.
- MRMel Robbins
Yep.
- JUDr. Judith
You're not getting them. You're coming home, you're too burnt out to even spend time with the people you love, so you just doom-scroll.
- MRMel Robbins
Yep.
- JUDr. Judith
Right? You'd rather look at your kids on your phone than actually play with your kids.
- MRMel Robbins
(laughs)
- JUDr. Judith
Right? How many of us are guilty of that, right?
- MRMel Robbins
So true.
- JUDr. Judith
So, you're missing out on the things that really make life worth living, but you're killing it at work. You're, like, high functioning. You're, like, delivering, you're taking care of the kids at home. You're doing all the things. You're not letting anyone down, but you're letting yourself down. You're not feeling anything. You may have anhedonia, where things just don't feel as pleasurable anymore. And if you go to a doctor-
- MRMel Robbins
Yes.
- JUDr. Judith
... the doctor's not gonna say, "Let's come up with a treatment plan for you because, well, are you functioning? Yeah. How are things at home? Everyone's fine, everyone's okay." So, no lack of functioning. You have all these symptoms, but no lack of functioning and no distress. Well, uh, come back when you're, when you're low functioning. Come back when you're in distress. So, we're missing all of these people who have these symptoms that eventually one day will turn into something like a major depression, or will turn into something physical where they're just, you know, the body... Something's gotta give.
- MRMel Robbins
Right.
- JUDr. Judith
Like, depression, stress all wears on your body. Or, they're, like, coping poorly. They may be overmedicating with alcohol or other unhealthy habits, a
- 14:18 – 16:37
What makes high functioning depression different from low functioning depression?
- JUDr. Judith
lot of social media-
- MRMel Robbins
Mm-hmm.
- JUDr. Judith
... addiction, or like-
- MRMel Robbins
Mm-hmm.
- JUDr. Judith
... work addictions and so forth. So, we're missing out on these people before, when we can actually do something to stop this from getting into a crisis mode.
- MRMel Robbins
I have a couple questions. Because what you just described sounds like me, and I would have called that anxiety. Because when I hear that sort of bolt out of bed, racing thoughts, slam a cup of coffee, always on the go, getting it done, calling the, the pediatrician on my way into work and, you know, just like, go, go, multitask. "I got this, I got this, I got this." Collapse after dinner down a bottle of wine, go to sleep, wake up, do it again. And I would have called that anxiety. Why is that depression?
- JUDr. Judith
Generalized anxiety disorder is very different than the criteria for the depressive things that I listed out, right?
- MRMel Robbins
Uh-huh.
- JUDr. Judith
Depression has certain things that we have studied for years. We've seen them. So, like, things like a low energy, poor concentration, poor appetite, um, you know, feeling like you can't focus as much-
- MRMel Robbins
Mm.
- JUDr. Judith
... feeling that psychomotor restlessness. A fa- that's a fancy way of saying physical restlessness or physical slowing, right? And so a lot of the con- like, that restlessness that I described, that is one of the symptoms of major depressive disorder, a lot of it overlaps with anxiety. And a lot of researchers are saying that they're really kind of like the, uh, different sides of the same coin.
- MRMel Robbins
Mm.
- JUDr. Judith
But they travel together.
- MRMel Robbins
Yes.
- JUDr. Judith
That's why a lot of the treatments for anxiety are similar to the treatments for depression, like the SSRIs or cognitive behavioral therapy. Anxiety has more physical kind of symptoms with it, so when you go through the symptoms of anxiety, you'll see a lot of physical conditions, excessive worrying, but the two do travel together.
- MRMel Robbins
Huh.
- JUDr. Judith
So, I can see how it can be confusing.
- MRMel Robbins
Yeah.
- JUDr. Judith
But when someone is in your office and you're going through the DSM, and I actually do pull it out (laughs) in my office, and I go through it, I will ask them about, you know, distress, and I'll ask them about functioning. But I've seen depression look so different in my office throughout the years in different cultures, in men versus-
- MRMel Robbins
Right.
- JUDr. Judith
... women, and, that I know that not everyone identifies with saying, "I'm sad," or, "I'm depressed," or even acknowledging their feelings. So, we have to start thinking about it differently and asking it differently, because we wear
- 16:37 – 18:05
What depression looks like in 2024.
- JUDr. Judith
these masks, and we're not aware that we're wearing them. And if you don't have the language to identify it, if you can't name it, then how can anyone help you? You can't even help yourself.
- MRMel Robbins
So, did you come up with the term high functioning depression?
- JUDr. Judith
I wish I did. (laughs) But I was looking for, you know, data for these people who are very, they're delivering, right? And like, they're, they're having these symptoms of depression, but not meeting criteria for, for major depressive disorder, but they were very high functioning. And I saw literature of people saying, like, that they've seen it in their office. Some people were labelling it, labelling it as neurosis and so forth, but I, I wish I had come up with the term. But it's been around for about five years, and I think it's not a coincidence that it's been around very recently. I think that we're in an age where depression is gonna look very different than it did back in the day when the DSM first came out.
- MRMel Robbins
Why do you think that is?
- JUDr. Judith
There's so many changes in our society. There's so many things that are happening that are very different that didn't exist back then. We didn't have the internet back then. We didn't have social media.
- MRMel Robbins
So, is-
- JUDr. Judith
We didn't have these pandemics. (laughs)
- MRMel Robbins
So, is one of the same, is one of the main kind of hallmarks of how depression impacts you just a lack of feeling, that you just kind of feel numb?
- JUDr. Judith
It's one of the symptoms of depression that people... That's, it's, like, insidious. It's kind of sneaky.
- MRMel Robbins
Like, so let's just say-
- JUDr. Judith
Mm-hmm.
- MRMel Robbins
... I have high functioning depression.
- JUDr. Judith
Mm-hmm.
- MRMel Robbins
What is going on in my body that would have
- 18:05 – 20:20
Watch out for this sneaky symptom of depression.
- MRMel Robbins
that be depression, if what I thought it was isn't actually representative of all the different forms of it?
- JUDr. Judith
Well, what you thought it was was one thing, right?
- MRMel Robbins
Right.
- JUDr. Judith
Challenge that idea. So, when you're listening, what do I think depression is? Many of us think it's someone at home crying, or in bed, or not delivering, and having these symptoms. As a doctor, we look for the symptoms I just mentioned.... but you, depression looks so different. People cope with their depression by busying themselves-
- MRMel Robbins
Mm-hmm.
- JUDr. Judith
... because that's the only way they know. Maybe they saw that because their parents were immigrants, came to this country, it was not an option to feel. "We don't talk about feelings in this house. Work, deliver, and you'll be okay." The American Dream. Then you have the mother at home who's... has no choice. Like, if she does not take care of her kids, no one else will. If she doesn't deliver, people could take her kids away. She has no choice. So, a lot of times, people just gaslight themselves. They don't feel what they're feeling, so they end up feeling very little. They have anhedonia, which is a sneaky symptom of depression, and I call it sneaky because it's a joy thief. It comes in the middle of the night and steals your joy. Before you know it, nothing gives you excitement. You feel blah. You feel meh, and it's one of the symptoms that's highly correlated with depression, especially high-functioning depression.
- MRMel Robbins
Wow. Dr. Joseph, that makes so much sense. Thank you for explaining that in such detail. And this feels like a great moment to take a quick pause, so we can hear a word from our sponsors. And while we do that, please share this episode with somebody in your life who is either really struggling with busyness or feeling blah, you know that they would benefit from this incredible information. Stay with us. Welcome back. It's your friend, Mel Robbins, and you and I are spending time with the incredible Dr. Judith Joseph. So, Dr. Joseph, what's happening, like, in your brain or in the kind of chemical structure of your body? Like, I think hearing that from you might make somebody who's like, "Eh, who cares? So, I can't feel my feeling," like, understand why this actually matters.
- JUDr. Judith
So, you know, there's correlations.
- 20:20 – 23:34
What is happening in the brain and body when you have high functioning depression.
- JUDr. Judith
They're not causation, but they're, they're correlates.
- MRMel Robbins
Yeah.
- JUDr. Judith
So, we look for signals of dopamine, which is the reward chemical in the brain, and there's a lot of science behind dopamine, which is a neurotransmitter. Serotonin, norepinephrine, these are, like, very fancy ways of saying particles in your brain-
- MRMel Robbins
Right.
- JUDr. Judith
... right? The joy, the joy chemicals-
- MRMel Robbins
Right.
- JUDr. Judith
... that may have different patterns in a brain that is depressed. But we also know, right, recent data shows us that inflammation can affect depression, and guess what? We just went through a pandemic where, like, some, some numbers say, like, 70 to 75% of people had an infection, a COVID-19 infection, at one point. We don't know how that inflammation has changed our brains.
- MRMel Robbins
Yep.
- JUDr. Judith
That's why I say that depression that we thought we knew what it was, I think it's changing, and I think that we have to... If we don't keep up with the changes in the way that it presents, we're gonna miss out on this group of people who need help. They just don't know what it looks like because they don't know what they're dealing with. They don't have a name for it. So, there are cau- causes of depression, like inflammation or correlates, inflammation, genetics, right?
- MRMel Robbins
Right.
- JUDr. Judith
When you look at the twin studies of, um, uh, identical twins compared to twins that are not identical, there's a high correlation with depression, and-
- MRMel Robbins
Meaning both twins will have it?
- JUDr. Judith
There are higher chances of if one twin has it, who's a identical twin, compared to people who are, like, fraternal twins, they are more likely, um, you know, likely to have depression. So, the, the twin studies really strongly s- suggest that, uh, there is a genetic predisposition to depression, but it's, again, it's not the causation, because some people have family members who have depression, and they don't, right? So, there are multiple factors. I talked about trauma heavily with you before, how things that happen to us, if we don't process them-
- MRMel Robbins
Right.
- JUDr. Judith
... if we don't take the time to feel and to heal, unresolved trauma, that can really present as a depression. And if you think about what happened to us, we talked about this, you know, the pandemic, then these things that happened with political uprisings, then police brutality, and then the wars that we're seeing, it's like back-to-back trauma. We're not even getting any time to process it. Before we know it, there's another tragedy. And then, you know, social media, it's there. We can't turn it off. 20 years ago, we could turn it off, right? We turn off the news 'cause we didn't wanna hear it, but we're constantly bombarded with images. And so all of these culminate into this picture of a depression that I think looks very different than what it looked like 20 years ago, 50 years ago.
- MRMel Robbins
So, is the message, based on what you're researching right now, that if you're getting through your day, but you are completely devoid of feeling and joy in your life, go talk to your doctor and ask about depression?
- JUDr. Judith
You know, not everyone wants to talk to a doctor-
- MRMel Robbins
Okay.
- JUDr. Judith
... and so I want to validate that as well, and not if there's a complete lack of joy, but diminished joy, right?
- MRMel Robbins
Okay.
- JUDr. Judith
Sometimes... If you, if you go to my website, um, you'll h- see scales for anhedonia, so you can fill out an anhedonia scale and see where you are on that pleasure scale or that joy scale. Um, or you can fill out, if you think what I'm talking about
- 23:34 – 25:31
If you feel diminishing joy and don’t want to seek medical help, here’s what you can do.
- JUDr. Judith
resonates with you, a high-functioning depression scale, and you can see where you are in terms of those symptoms of depression. But really, go to your doctor and talk about the symptoms and say, "Listen, hey, I think something's happening, and how can I address this?" Not everyone wants to do therapy, Mel. Not everyone wants to do that, but there are other-
- MRMel Robbins
I think most people don't.
- JUDr. Judith
(laughs) I, I do too.
- MRMel Robbins
No, I mean, like, I don't think most people want to look at what they're... They don't want to go deeper. They want to outrun it. Here's what I'm hearing. If you extrapolate what you're saying, what you're basically saying is you're actually hardwired for joy, and you're hardwired to thrive, and when you get to a point in your life where you are disconnected from that natural intelligence and wiring and what you deserve, that's an issue. And stop outworking it. Stop outrunning it. Stop telling yourself that just because you're getting through the day, and just because you're able to get it all done, and just because you're barely dragging yourself, like, across the finish line every day, and the bottle of wine takes the pain, that-... that is not the way to go through life, that there is something better that is available to you and you deserve that. And the first step is understanding that the depression that our parents may have had, where you're alone in a dark room smoking a cigarette or laying in bed all day, that is not the depression that you're seeing today. And it's really important that you take that seriously, because there's something else available to you. That makes so much sense, Dr. Joseph. Wow. I would love to have you walk me through a day in the life of somebody that struggles with high-functioning depression. What does this person look like at work?
- JUDr. Judith
At work, this person may be delivering, but they may not necessarily derive joy from the work. They may be someone who feels that, "You know what?
- 25:31 – 27:48
Do you take on extra work because you think, “I’m the only one who can do this, right?”
- JUDr. Judith
This work can't be done right by anyone but me." They are highly controlling, right? No one else can do it. And one of the things I see is that they're tied, their identities are tied to their work, so they may not even know what they really enjoy anymore. Maybe years ago they were into photography, maybe they were into art. Now, they don't even want to do those things, because right now they're focused on their roles. And it's not just people in the workplace. This is for caretakers at home, people taking care of young kids who may not have to leave the house to work because their work is at home. They may be so tied into what they're doing for others that they don't know that they lack joy. They may have problems with sleep, so their sleep isn't as rich. They don't feel refreshed. And they may not find joy in food. Either they're eating too much or eating too little. And they may have problems with focusing, so their concentration really is a challenge for them. They may have low energy. So you have all these symptoms of something that looks like a depression, but you don't identify as having low functioning.
- MRMel Robbins
Hmm.
- JUDr. Judith
You're actually delivering, maybe over-delivering. You may not even identify with the distress because you don't deal with those feelings. It's something that you don't process, you don't, like, validate yourself. So you're not someone who will meet criteria. If a doctor sees you, they're going to say, "Well, you don't really meet criteria." And here's the thing about medicine. And it's a bit controversial, but I think that a lot of doctors and nurses and healthcare workers struggle with this thing called high-functioning depression. I think it's hard for them to diagnose something in someone because it looks like them. They're going to be like, "Well, I don't want to diagnose you 'cause that's pathologizing me," right? So there's this projection that happens that, hey, if you're functioning and you're delivering, come back to me when you're not. And I think that's a broken model, because I think that we're missing these people that we could catch before they go into crisis mode, before they develop poor coping skills, before they have physical breakdowns because the body's gonna give somewhere, or before they have mental breakdowns.
- MRMel Robbins
How do you discern, though? Because if somebody has that kind of schedule, I would think the schedule is what's making them have terrible sleep and poor eating habits and a lack of hobbies and a feeling of disconnection. And so it seems like
- 27:48 – 29:49
What is the biopsychosocial model and how Dr. Judith uses it in her practice.
- MRMel Robbins
this has been very easily missed, because you think the work habits are the cause, when actually the work habits are a symptom of this. Is that what you're saying?
- JUDr. Judith
That's why the biopsychosocial model is so important, right? The social component of that model is, what is the society doing? What's happening in our society that's l- driving this? It's not all biological, because the biopsychosocial model is real. Lot of components feed into the symptom, they feed into the condition. So we have to look at it from that holistic picture, or else we're gonna miss the mark.
- MRMel Robbins
Um, what should you never do if you are struggling with high-functioning depression?
- JUDr. Judith
Never think that you're a burden. And I hear this all the time, like, "I didn't..." 'Cause it will get to a point where you feel like, "I can't go anymore. Something's gotta give." Don't think that you're a burden. You may think that your identity, all you have is what you do, how m- how you perform, what you deliver for others. People love you. They don't want you to think that you're a burden. They want you to ask for help. They want you to say, "Listen, I know I'm always there for you, but I really need to tell you something." They just, they're just waiting for you. But if you don't allow yourself to share, if you don't allow yourself to feel worthy of that, of being heard, if you don't validate yourself, then no one can help you. No one can be there for you. And I hear this a lot, like, "Oh, I just felt like I was a burden." So I tell my patients, like, "Let's think of another time in your life where you were feeling this, when you were..." I call it high-functioning AF, right? Like... (laughs)
- MRMel Robbins
(laughs)
- JUDr. Judith
So, like, let's look back to-
- MRMel Robbins
That sounds sexier than depression.
- JUDr. Judith
(laughs)
- MRMel Robbins
I think, I think we have a branding problem with depression. I think you should call it high-functioning AF. Okay? I like that.
- JUDr. Judith
(laughs) I call it that on my social media.
- MRMel Robbins
I'll take that.
- JUDr. Judith
But, like, look at a time in your life where you were high-functioning AF, right? So, like, we'll pull out the smartphones and we'll go back and I'll say, like, "Okay, show me that picture. If the
- 29:49 – 31:56
If you feel like a burden to your friends and family, listen to this.
- JUDr. Judith
people in your life..." 'Cause there'll be pictures of them being around others.
- MRMel Robbins
Right.
- JUDr. Judith
"Do you think that if you had opened up to them then, that they would have said you were a burden? 'Cause it looks like you just met up with them the week after. Do you think you were burdening them?" So you're challenging that core belief that if you're not perfect, if you don't deliver, if you ask for help, that you're not lovable. You're challenging that. And I ask them to challenge that thought. I also ask them to try and process the trauma, 'cause I find that, again, there's the word trauma. It's a word that people are like, "Oh, trauma again."
- MRMel Robbins
Yeah. (laughs)
- JUDr. Judith
But there are big traumas and little traumas, and there are little traumas that we just don't acknowledge. Like, for example, a lot of the questionnaires for trauma, like the ACEs and, like, the modified ACEs, they don't capture things like, "Well, when I was a little...... boy or a little girl, people teased me 'cause they said I was gay. Like, things like that are not there, but those are traumas because you couldn't be your full self, right?
- MRMel Robbins
Of course.
- JUDr. Judith
Or, or like, things like, you know, when I came to this country without anything, clothes or anything, like, and I was hungry. Like, they don't, people don't think about those things, the scarcity traumas. They just don't process it, so they're like, "Well, I'm just lucky to be here." No, like, these are traumas, so we have to allow ourselves to look back on our past and ack- acknowledge these emotional experiences that impacted the way that we see ourselves and the way that we approach the world and others. And when we do acknowledge that and we validate that, then we can start to do something about it.
- MRMel Robbins
I- I'm just taking this all in. I- I feel empowered by everything that you're sharing with us, Dr. Joseph. So, let's take a quick pause and give you a chance to hear a word from our sponsors that are bringing you the amazing Dr. Judith Joseph at zero cost, and don't go anywhere. We'll be waiting for you after a short break. Welcome back. It's your friend, Mel Robbins. You and I are here with the Dr. Judith Joseph. So, Dr. Joseph, talk to us about scarcity trauma, like what is it? And can you explain how it impacts somebody through the generations?
- JUDr. Judith
Absolutely. So, people don't realize that the little things they do could be rooted in scarcity trauma. It's when you have
- 31:56 – 36:18
What scarcity trauma is and how it shows up in your life.
- JUDr. Judith
a history of a lack of resources, and you may not have realized that, how this impacted you. Maybe you were very little, but your parents still behaved in a way that any day now, resources could run out. So, you may do things that are illogical, like not wearing things that you just bought, right? They're just hanging out in the closet with the tag on. Or holding onto expired food that clutter your life and cause distress, and you're like, "What? Why are my cabinets full of all this?" Or having a hard time getting rid of clothes that doesn't really, you don't wear them anymore.
- MRMel Robbins
Yeah.
- JUDr. Judith
So, you hold onto these things 'cause on an unconscious, unprocessed level, you're afraid that any minute, things will be lost, right? You'll lose it all. So, people engage in these behaviors with a scarcity mindset out of trauma of not having resources, and it's not just immigrants. I see it in, in, in, uh, people whose parents or grandparents, there's generational trauma, so if their, uh, grandparents were refugees or survivors of war-
- MRMel Robbins
Mm-hmm.
- JUDr. Judith
Um, or if personally, maybe they had resources but they went through, like, a really bad business, um-
- MRMel Robbins
Yeah.
- JUDr. Judith
... you know, period where they went bankrupt or a divorce, and they're afraid of losing it all, so they behave in these irrational ways that are trauma responses, so they hoard. Some people do the opposite. They spend too much. I've seen this a lot, where it's like, "I'm not accustomed to having abundance, so I'll just spend." So, you're like, "Wait, you have all this money and then you just lost it." "Well, I'm not accustomed to having it." Uh, so there are all these odd kind of symptoms that don't really, um, impact a person's life in the way they want it to, so they really hurt them and causes stress. And another thing I see is s- emotional scarcity, so in a lot of these families where they're, like, just focused on survival, right?
- MRMel Robbins
Mm-hmm.
- JUDr. Judith
There's not a lot of, like, talking about emotions. Like, what's that? What's emotions?
- MRMel Robbins
Or warmth.
- JUDr. Judith
Or warmth, right. (laughs)
- MRMel Robbins
Anybody grow up in a very cold family.
- JUDr. Judith
So, there's emotional scarcity. So, you see all these ways that a lack of resources impacts a family, a generation, and it gets passed on. So, if you're someone who's like, "Wait, I have those things," look back at your family. It could have been coming from generations where they didn't have much, or they fled war. There was something that led to that mindset. Or it could be something present-day, like a divorce or, you know, hard financial p- And then it's like, wait, you come from scarcity, so you have these unconscious, like, fears that you haven't processed. Let's start to challenge it. What's the worst that'll happen if you start decluttering your purse? Let's throw away some of those receipts. Let's start to give some of that clothes to charity. And they actually want to do these things, but they need help, and like, exposure therapy, it's a, it's a form of, uh, cognitive behavioral therapy where you slowly challenge the fears.
- MRMel Robbins
Yeah.
- JUDr. Judith
And so we slowly start to give things away, and people feel very, you know, anxious sometimes about it. But they have to understand that these behaviors are rooted in these unwarranted fears due to a history of, of scarcity.
- MRMel Robbins
Yeah.
- JUDr. Judith
And if you know where it comes from, then you're going to be like, "Okay. I can actually challenge this a bit more. I can, I can live for today," right? We talk a lot about happiness and the idea of happiness. People are living for the future, a future that's not promised, so how do you be happier today?
- MRMel Robbins
Well, what I love about this topic is I think it's very relatable, and I also, whether you're talking about it on the physical side of things that you're holding onto from this lack of resources, or whether it is an inability to talk about feelings or express feelings or express warmth and be affectionate with each other because of the scarcity of that in your family, I can see how that pattern gets passed down and passed down and passed down and passed down. And one of the things that I really like about what you're saying, and giving it a name, is that you realize, oh, this isn't me. This is a pattern from history that I am now reenacting that is not mine to own. It's mine to complete for this family, so I don't pass it on, and I don't cause myself the distress. I come from a long line of farmers, and, um, my, uh, grandmother, I would open up her fridge when
- 36:18 – 40:12
Do you feel like you can’t waste any food…ever?
- MRMel Robbins
we would visit in the summer, and it was always really dimly lit. And you want to talk about expired food? I mean, when you have a farm and you're taking care of all these animals and you're growing produce, you do not throw anything away. And I couldn't understand why until I worked with a therapist and realized, oh, this is, like, I can't throw anything out. It means I'm bad. It means, like, I'm not a good person if you're wasteful, if you're this. And then I've now gone in the other direction-... which is, I barely have anything in my fridge. Those light bulbs are always brand new, so I can see everything in there. And I really relate to what you're talking about. So if you... And I think we're going to get a lot of questions about this. So if you're somebody who is listening to this, and you are... They're shaking their head, and they're going, "Uh-huh, I do that. I do that. Yeah, I don't wear my nice clothes, ever, 'cause I think something's gonna happen. I'm afraid to go out to dinner, because I'm afraid I'm gonna lose my money again. I'm afraid to celebrate my..." Like, just, "It's all going to go away." What is one step that somebody can take, other than recognizing that this is a very real thing, to start to take control of their life again?
- JUDr. Judith
And I- I love that example of the farmers, because farmers are like... Have such rich history, right? They go through so much, and they don't process, because the animals depend on them.
- MRMel Robbins
Mm-hmm.
- JUDr. Judith
The community depends on them. But their- their livelihood is so fragile, because if they have a bad storm, if it's not a good season, guess what? It's all gone. So that scarcity mindset, that's- that trauma is real.
- MRMel Robbins
Yeah, and it's also where the emotional scarcity comes from-
- JUDr. Judith
Mm-hmm. Mm-hmm.
- MRMel Robbins
... because, uh, there's no dinner together until the chores are done, and when they got 500 head of cattle to take care of, and you're worried about the crops and everything else, there's no time for feelings.
- JUDr. Judith
And a lot of eating behaviors around scarcity, like, if you can remember a family member saying, "Eat that food off the plate," and you're like, "I'm not even hungry, but I'm just gonna eat it."
- MRMel Robbins
(laughs)
- JUDr. Judith
Many of us still do it. Like, "I can't see food waste." Blah, blah, blah. You know, like, you-
- MRMel Robbins
Yes.
- JUDr. Judith
But that can lead to really unhealthy behaviors and- and unhealthy physiology, right? So we want to think about all these ways that it's impacting us. It's not just being, like, frugal, or-
- MRMel Robbins
Right.
- JUDr. Judith
... cheap. It's, is it causing distress? So being able to free yourself of it, because you're able to name it, right? Then you can do something about it. So I want people to approach it in a very systematic way. You don't have to go and like purge your entire, (laughs) you know, home. But start to challenge that thought, that core belief that you're bad because you're wasteful. You're not wasteful. Like, what are the... What's the evidence that you're wasteful? Put that thought... You know, you used to be an attorney. Put that thought on the stand.
- MRMel Robbins
Right.
- JUDr. Judith
And really, you know, cross-examine that thought. What are the- what are the- uh, what's the evidence that you're wasteful? What's the evidence that you're a bad person? It's- it's not there. So slowly challenge it. Give away one thing. Throw away that one expired can. You're not gonna eat it, right? Start to see how that feels. And you can do it, but you have to be able to name it first.
- MRMel Robbins
I love that. I'd never even heard that term until, um, I knew you were coming on, and I started looking at your social media. I'm like, "Scarcity? What? That's a thing?" And then, as I was watching your reels, I'm like, "Oh, my God. That's a thing." And there is a term for it. What is the term for why actually calling out what something is empowers you to ch-
- JUDr. Judith
It's called affect labeling.
- MRMel Robbins
Affect labeling. This is not about diagnosing anything or anyone. It's about bringing the issues that are bothering you in your li- in... The issues that are bothering you in your life from the back of your subconscious mind, out into the world, and l- looking at it separately from yourself so that you can see it as a problem.
- JUDr. Judith
It's powerful to name it,
- 40:12 – 44:24
How affect labeling can free you of your problems.
- JUDr. Judith
because affect labeling, naming the feeling, allows your body to be less afraid, less anxious. It's like if you were in a dark room and something fell, and you didn't know what was there, and you just started swinging, 'cause you're like, "Oh, my gosh." And then you turn a light on, and you're like, "A book fell." You're not gonna be swinging, 'cause you know what it is.
- MRMel Robbins
Hmm.
- JUDr. Judith
And we... And as someone who treats children and adults, we see how important it is to name the feeling with children. You know, you have the feelings charts, and you te- you spend all this time teaching them sad, happy, right? Like, you want to be able to name the feelings for children, because it allows them to control the outcome.
- MRMel Robbins
Right.
- JUDr. Judith
But we somehow forget that along the way. Adults need that help too. We need to name the feeling, because when we know what we're dealing with, we're less anxious. We're less afraid. And when you're afraid, you don't make good decisions. You make poor decisions.
- MRMel Robbins
And, you know, one thing I just want to go on the record and say is that it is no joke to do things differently than your family does things. Not having a Tupperware drawer full of takeout stuff, not having a fridge that is jam-packed, sitting at a family table and not eating everything on the plate, because you're just... Are not hungry, it can feel like a gigantic act of defiance to your entire lineage. And so, I think for some of us, when you're doing it in the privacy of your own space, it's one thing, but when you kind of get inside the ecosystem... I just want to acknowledge that, for me personally, like, people in my family feel offended if I'm doing something slightly different. And is that something that you see a lot too?
- JUDr. Judith
I do. I see a lot of that, and I see a lot of, "Well, I'm just doing it to, um, be friendly to the Earth." It's very different to recycle versus to create clutter. That's not-
- MRMel Robbins
Hmm.
- JUDr. Judith
You're not doing anyone a good when you do that. You're just passing on your trauma to someone else. (laughs)
- MRMel Robbins
(laughs)
- JUDr. Judith
So to really be real with it and challenge it... You know, if it makes you feel better that someone else is getting use out of it, give it to charity, if it's usable. But a lot of times, these are items that are just like holes. Nobody wants that, right? So it's just a really hard time letting go of certain things, because of this unfounded fear that you could lose it all.
- MRMel Robbins
So, first of all, I was not expecting to learn that much about high functioning depression. Who knew it was a thing? I need to talk to my therapist about it clearly. (laughs)
- JUDr. Judith
(laughs)
- MRMel Robbins
I want to ask you something. What are some of the things that you've said as a psychiatrist that you get a lot of heat for?
- JUDr. Judith
Well, definitely high functioning depression. And when I-
- MRMel Robbins
Wait, what?
- JUDr. Judith
(laughs)
- MRMel Robbins
People give you crap for saying that there's something called high functioning depression?
- JUDr. Judith
You know, really, depression is serious, and there are some people who have depression every day and, you know, it's...... com- there's so much stigma around it. But there are some people who are, like, "Well, I don't think we should call one high versus low, because then it just makes one seem good versus bad," and I, I disagree completely. Use the language that the person identifies with, because it's invalidating. If someone says, "You know what? I think I have high-functioning depression," guess what? They're gonna do something about it.
- MRMel Robbins
Yes.
- JUDr. Judith
They're gonna learn about it. But if you're like, "Oh, you know what? You're not low functioning," no.
- MRMel Robbins
Yeah. "You're not depressed enough-
- JUDr. Judith
Yeah. Right. (laughs)
- MRMel Robbins
... so you don't deserve to..." Like, that to me, that to me just blows, that people get like that. First of all, there's enough depression to go around for everybody.
- JUDr. Judith
(laughs)
- MRMel Robbins
And just because you can get through your day doesn't mean you don't feel worse than the person that's lying in bed.
- JUDr. Judith
It's not a competition.
- MRMel Robbins
It's not a competition. There are no awards for being more depressed than somebody else. Since you're doing so many clinical research trials at your institute in Manhattan, is there anything else that you want to talk about?
- JUDr. Judith
Well, I'm excited about my high-functioning depression research, because it will come out in my book in 2025. But I'm also excited about what's happening with women in research.
- MRMel Robbins
Ooh.
- 44:24 – 49:20
The information on menopause that needs to be talked about.
- JUDr. Judith
There's just not enough information. And talk about how function depression, women in the workplace, when they're going through midlife and they're losing their identity, because they can't do things that the way that they used to, they feel like they can't deliver, talk about depression, right? So that's why we see a lot of midlife depression. And right now, I'm working on, um, a series called TIES, so basically, the mental health ties to menopause, so-
- MRMel Robbins
Oh.
- JUDr. Judith
T-I-E-S.
- MRMel Robbins
Okay.
- JUDr. Judith
All the cognitive changes that happen, so brain fog, forgetfulness, problems with planning, simple things like decluttering, putting things in one place, not stressing your brain out, those can support you, the, the thinking part. Identity, people feel like they don't know who they are anymore. They lose themselves. So using a lot of mindfulness practices to ground people, so they don't feel like they don't know who they are anymore.
- MRMel Robbins
Mm-hmm.
- JUDr. Judith
Challenge that thought-
- MRMel Robbins
Mm-hmm.
- JUDr. Judith
... because you are still you. You may be going through something, but you are still you. The emotions. We see a lot of depression and anxiety with midlife, and a lot of it's hormonal, um, so using CBT and other methods to support people. And then sleep, sleep is a big disruptor in midlife, and there are wonderful treatments, like cognitive behavioral therapy for insomnia. There's sleep hygiene. Some people don't even know they have sleep apnea in midlife, because they don't have the classic presentation. So there are things that women can do, but if you don't have access to someone, if you've never heard of this and you just think there's something wrong with you-
- MRMel Robbins
Mm-hmm.
- JUDr. Judith
... why can't you deliver, you're gonna be at risk for depression.
- MRMel Robbins
Yeah, or you're gonna just suffer through menopause. And there are too many doctors out there that are like, "Well, it'll be about 10 years and you'll feel like yourself again." And that's just not an acceptable answer for half of the popul- for more than half the population. And what specifically are you excited about when it comes to the research related to menopause?
- JUDr. Judith
So I work... My, my wonderful friend, Tam Zinfidel, got me inter- uh, involved in an organization, um, called Let's Talk Menopause. It's nonprofit.
- MRMel Robbins
Yep.
- JUDr. Judith
And we're working with different congresswomen to bring legislation changes. We're really trying to see changes happen, so that women have more research behind them, so that we understand menopause, so that there are more resources, and to get the word out there, because people are suffering and they just don't know what's happening to them. They just feel like, you know, they're just not delivering. There's something wrong with them. It's their fault. But they're not alone, and there are resources and there are things that they can do.
- MRMel Robbins
Awesome. So Dr. Judith, as always, you got my head spinning and my heart full, and I feel like there are things that I need to dive a little deeper in with a licensed professional. (laughs) I'm not kidding. Like, I... Like, one of the reasons why I love these conversations is because I'm not immune to any of this, and I learn shoulder to shoulder with absolutely every one of you that is listening to this conversation right now. And so as I sit in the seat and I sit across the table from you, I'm not only thinking about how this is gonna help people around the world. I'm thinking about the fact that you're speaking directly to some of the experiences that I have for myself or with my loved ones. And so I just want to thank you for talking about these topics in a way that are both clinical, so that we trust you, but that are deeply relatable, so that we can see ourselves or our loved ones in the issues that you are seeing every single day in your practice and in your research. So thank you.
- JUDr. Judith
Thank you for having me.
- MRMel Robbins
Of course. My God, don't you love her?
- JUDr. Judith
(laughs)
- MRMel Robbins
I love, love, love Dr. Judith, and I love you. In case nobody else tells you today, let me be the one to tell you that I love you and I believe in you and I believe in your ability to create a better life. And I think this conversation today really highlights the importance of being honest with yourself about where you're not happy, about the areas of your life that are creating chaos or that are just not fulfilling. You deserve to have a better life. And today, Dr. Judith gave you and me very specific things to take a look at, and I hope you will, because if you do, you will create a better life. All righty. I'll see you in a couple of days. I'm back. I just want to thank you for being here with me on YouTube. Wasn't she incredible? Of course, she was. And one thing that would be incredible is please hit the subscribe button. That's one way that you can give back to me and my team. Supporting this channel allows us to bring you world-renowned experts at zero cost. Please also share this with somebody. There are people in your life that are silently struggling with high-functioning depression, and this information could change the rest of their life for real. And all it takes is a share. So thanks again for subscribing. Thanks for sharing, and I know you're thinking, "Okay, what should I watch next?" I think this is the perfect video for you to check out next.
Episode duration: 49:20
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