#1 Researcher: 7 Signs You May Have High Functioning Depression

Mel Robbins (13:17):

So true.

Dr. Judith Joseph (13:17):

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 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, a doctor's not going to say, let's come up with a treatment plan for you because Wait, are you functioning? Yeah. How are things at home? Everyone's fine. Okay, so no lack of functioning. You have all these symptoms, but no lack of functioning and no distress. Well come back 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 we'll turn into something physical where they're just the body. Something's got to give depression, stress all wears on your body, or they're coping poorly. They may be overmedicating with alcohol or other unhealthy habits,

Mel Robbins (14:28):

I have a couple questions because what you just described sounds like me, and I would've 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 pediatrician on my way into work and just like, go multitask. 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've called that anxiety. Why is that? Depression

Dr. Judith Joseph (15:06):

Generalized anxiety disorder is very different than the criteria for the depressive things that I listed out, right? Depression has certain things that we have studied for years. We've seen them. So things like low energy, poor concentration, poor appetite, feeling like you can't focus as much, feeling that psychomotor restlessness, that's a fancy way of saying physical restlessness or physical slowing. And so lot of 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 different sides of the same coin that they travel together. 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. So I can see how it can be confusing,

(16:07):

But when someone is in your office and you're going through the DSM and I actually do pull it out in my office and I go through it, I will ask them about distress and I'll ask 'em about functioning. But I've seen depression look so different in my office throughout the years in different cultures and men versus women 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 

Mel Robbins (16:47):

So did you come up with the term high-functioning depression?

Dr. Judith Joseph (16:50):

I wish I did, but I was looking for data for these people who are, they're delivering and they're having these symptoms of depression, but not meeting criteria for major depressive disorder. But they were very high functioning, and I saw literature of people saying that they've seen it in their office. Some people were labeling it as neurosis and so forth, but 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's going to look very different than it did back in the day when the DSM first came out.

Mel Robbins (17:28):

Why do you think that is?

Dr. Judith Joseph (17:29):

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. We didn't have these pandemics.

Mel Robbins (17:40):

So is one of the main hallmarks of how depression impacts you, just a lack of feeling that you just kind of feel numb.

Dr. Judith Joseph (17:53):

It's one of the symptoms of depression that people, it's insidious. It's kind of sneaky.

Dr. Judith Joseph (18:12):

Well, what you thought it was was one thing, right? Right. 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 depression looks so different. People cope with their depression by busying themselves

(18:37):

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 has no choice. 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 seals 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 function, depression.

Mel Robbins (19:27):

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 in your brain or in the kind of chemical structure of your body? I think hearing that from you might make somebody who's like, yeah, who cares? So I can't feel my feeling understand why this actually matters.

(20:40):

That may have different patterns in a brain that is depressed. But we also know recent shows us that inflammation can affect depression. And guess what? We just went through a pandemic where some numbers say 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. That's why I say that the 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 going to 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 causes of depression, like inflammation or correlates, inflammation, genetics. When you look at the twin studies of identical twins compared to twins that are not identical, there's a high correlation with depression,

Mel Robbins (21:34):

Meaning both twins will have it.

Dr. Judith Joseph (21:35):

There are higher chances of if one twin has it, who's an identical twin compared to people who are like fraternal twins, they are more likely to have depression. So the twin studies really strongly suggest that there is a genetic predisposition to depression. But again, it's not the causation because some people have family members who have depression and they don't. 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,

(22:07):

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, 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 social media, it's there. We can't turn it off. 20 years ago, we could turn it off, we turn off the news, we didn't want to 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.

Mel Robbins (22:54):

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.

Mel Robbins (23:53):

I think most people don't.

Dr. Judith Joseph (23:55):

I do too, know what

Mel Robbins (23:56):

I mean? I don't think most people want to look at what their, 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 out running 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 across the finish line every day and the bottle of wine takes the paint, 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?

Dr. Judith Joseph (25:20):

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? 

(26:10):

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. 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 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 function depression.

(27:01):

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. That's pathologizing me. 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 going to give somewhere or before they have mental breakdowns.

Mel Robbins (27:31):

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

Dr. Judith Joseph (27:59):

That's why the bio-psychosocial model is so important. The social component of that model is what is the society doing? What's happening in our society that's driving this? It's not all biological because the bio-psychosocial model is real. A 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 going to miss the mark.

Mel Robbins (28:27):

What should you never do? If you are struggling with high functioning depression,

Dr. Judith Joseph (28:33):

Never think that you're a burden. And I hear this all the time, I didn't. We'll get to a point where you feel like I can't go anymore. Something's got to give. Don't think that you're a burden. You may think that your identity, all you have is what you do, 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'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, let's think of another time in your life where you were feeling this when you were, I call it high functioning, right? So let's

Mel Robbins (29:28):

Look back. That sounds sexier than depression. I think we have a branding problem with depression. I think you should call it high-functioning a F. Okay, I like that.

Dr. Judith Joseph (29:37):

I call, it'll take it by social media. But look at a time in your life where you were high-functioning. So we'll pull out the smartphone and we'll go back and I'll say, okay, show me that picture. 

Mel Robbins (30:43):

Of course.

Dr. Judith Joseph (30:43):

Or things like when I came to this country without anything, clothes or anything, and I was hungry, 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, these are trauma. So we have to allow ourselves to look back in our past and 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.

Mel Robbins (31:15):

I'm just taking this all in. 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. What is it? And can you explain how it impacts somebody through the generations?

Dr. Judith Joseph (31:49):

Absolutely. So people don't realize that the little things they do could be rooted in scarcity trauma. 

(32:30):

So you hold onto these things because 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 people whose parents or grandparents. There's generational trauma. So if their grandparents were refugees or survivors of war,

(32:58):

Or if personally, maybe they had resources, but they went through a really bad business 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. So there are all these odd kind of symptoms that don't really impact a person's life in the way they want it to. So they really hurt them and cause the stress. And another thing I see is emotional scarcity. In a lot of these families where they're just focused on survival, there's not a lot of talking about emotions like, what's that? What's

Mel Robbins (33:45):

Emotions or warmth? Anybody grew up in a very cold family,

Dr. Judith Joseph (33:48):

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 a hard financial, and then it's like, wait, you come from scarcity. So you have these unconscious 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 exposure therapy, it's a form of cognitive behavioral therapy where you slowly challenge the fares. And so we slowly start to give things away and people feel very anxious sometimes about it, but they have to understand that these behaviors are rooted in these unwarranted fares due to a history of scarcity. 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 live for today. 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?

Mel Robbins (35:05):

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. 

Dr. Judith Joseph (37:30):

And I love that example of the farmers, because farmers have such rich history. They go through so much and they don't process because the animals depend on them. The community depends on them, but 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 trauma is real.

Mel Robbins (37:53):

And it's also where the emotional scarcity comes from because there's no dinner together until the chores are done. And when you've got 500 head of cattle to take care of, and you're worried about the crops and everything else, there's no time for failings

Dr. Judith Joseph (38:06):

And a lot of eating behaviors around scarcity. 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 going to eat it. Many of us still do it. I can't see food waste, blah, blah, blah.

Mel Robbins (38:18):

Yes,

Dr. Judith Joseph (38:19):

But that can lead to really unhealthy behaviors and unhealthy physiology. So we want to think about all these ways that it's impacting us. It's not just being frugal or cheap.

(38:33):

Is it causing distress? So of being able to free yourself of it because you're able to name it, 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 purge your entire home, but start to challenge that thought, that core belief that you're bad because you're wasteful. You're not wasteful. What's the evidence that you're wasteful? Put that thought. You used to be an attorney. Put that thought on the stand and really cross examine that thought. What's the evidence that you're wasteful? What's the evidence that you're bad person? It's not there. So slowly challenge it. Give away one thing, throw away that one expired, can you're not going to eat it. Start to see how that feels, and you can do it, but you have to be able to name it first.

Mel Robbins (39:23):

I love that. I'd never even heard that term until I knew you were coming on and I started looking at your social media. I'm like, scarcity. That's a thing. 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? It's called affect labeling. Affect labeling. This is not about diagnosing anything or anyone. It's about bringing the issues that are bothering you in your life from the back of your subconscious mind out into the world and looking at it separately from yourself so that you can see it as a problem.

Mel Robbins (41:00):

And 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, your own space, it's one thing. But when you get inside the ecosystem, I just want to acknowledge that for me personally, people in my family feel offended if I'm doing something slightly different. And is that something that you see a lot too?

Dr. Judith Joseph (41:48):

I do. I see a lot of that, and I see a lot of, well, I'm just doing it to be friendly to the earth. It's very different to recycle versus to create clutter. You're not doing anyone a good when you do that. You're just passing on your trauma to someone else. So to really be real with it and challenge it, 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 holds. Nobody wants that, right? So it's just a really hard time letting go of certain things because of this unfounded fare that you could lose at all.

Mel Robbins (42:24):

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. 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?

Dr. Judith Joseph (42:42):

Well, definitely high functioning depression. And when I wait,

Mel Robbins (42:44):

What people give you crap for saying that there's something called high functioning depression.

Dr. Judith Joseph (42:49):

Really, depression is serious. And there are some people who have depression every day, and there's so much stigma around it. But there are some people who are like, well, I don't think we should call it one high versus low, because then it just makes one seem good versus bad. And 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 going to do something about it. They're going to learn about it. But if you're like, oh, you know what? You're not low functioning. No, yeah, you're not

Mel Robbins (43:24):

Depressed enough so you don't deserve to, that to me just blows the people get like that. First of all, there's enough depression to go around for everybody, and just because you can get through your day doesn't mean you don't feel worse than the person that's lying in

Dr. Judith Joseph (43:41):

Bed. It's not a competition.

Mel Robbins (43:43):

It's not a competition. There are no wards 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?

Dr. Judith Joseph (43:54):

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. And I'm a huge advocate for menopause and creating change within research. There's not a lot, just not enough information on menopause and menopause research. And I talked about midlife and people experiencing problems with brain fog. 

Mel Robbins (45:54):

Or you're going to 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 more than half of the population. What specifically are you excited about when it comes to the research related to menopause?

Dr. Judith Joseph (46:15):

My wonderful friend, Tam Zindel, got me involved in an organization called Let's Talk Menopause. It's nonprofit, 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 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.

Mel Robbins (46:50):

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. I'm not kidding. 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 going to 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.

Dr. Judith Joseph (47:57):

Thank you for having me. Of

Mel Robbins (47:59):

Course, my God, don't you love her? 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. Alrighty, 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.

(48:42):

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