Hey, it's your friend Mel, and welcome to the Mel Robbins podcast.

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 going to learn all about it from a renowned researcher who's a medical doctor, 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 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 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. Hey, it's your friend Mel. Today, you and I are going to talk about something that is so important because it's impacting millions and millions of people, which means it's likely affecting you or someone that you love. This is especially true if you're a high achiever. You're a perfectionist, you're a working parent, a small business owner, a first responder, a caregiver, you Well, you. You're doing a million things and feeling this pressure that you always have to have it together. Well, there's a name for this pressure. As you're going to learn today from the only expert on the planet that is researching this, it's called high functioning depression.

It's important to know what this is because once you know about it, you'll be able to do something about it. Let me tell you about what an honor it is to have one of the most respected medical researchers on the planet here in our studios in Boston today. Her name is Dr. Judith Joseph. She is a pioneering researcher. She is the founder and principal investigator of the research institute, Manhattan Behavioral Medicine, where she has conducted over 60 clinical research trials with her all-female medical team. Now, this is the only clinical research lab of its kind on the planet because they focus on mental health challenges that high functioning people like you and me who are doing pretty well, are silently struggling with. Now, Dr. Judith Joseph is also a renowned, double board certified psychiatrist. She earned her medical degree, her MBA, and did her residency at Columbia, where she is the Chairwoman in Medicine Board. She did her fellowship at NYU, where she has been a professor for the last decade. More recently, Dr. Joseph received a US Congress and House of Representatives Proclamation Award for her social media advocacy and mental health research. If you just said yourself, Wow, holy cow, we haven't even scratched the surface on how much you are about to learn.

Dr.

Judith Joseph is brilliant, impactful, and caring, and she is here today to share her new research on this epidemic of high functioning depression with you and your loved ones.

I simply cannot wait to see what epiphanies that you have and what meaningful changes you make because of what you are about to learn from her today. If there was ever an episode to bookmark, to listen to again and again, and to share with every hard work busy person that you know and love, it would be this one, because I have no doubt it is going to change your life.

Dr. Judith, I'm so excited you're here. Welcome back to the Mel Robbins podcast.

Thank you for having me back.

Of course. I'm excited to talk to you today because you're 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?

Research is so exciting. For me to be a principal investigator of my own lab leading a team of women researchers, it's really a dream. Sometimes I pinch myself. Representation matters. For a long time, women were not included in clinical studies. Underrepresented minorities were not included in clinical studies. 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. It's really important for people that look like me to be heavily involved in clinical research because it also allows populations to trust. You're going to go to your doctor, you see that your doctor looks like you, you're going to trust them more. So representation really matters. The thing about research is that you never know what you're going to find.

Really?

So many times I know what we're looking for, but we don't know what's going to happen. The funny thing with research that I found is that not everyone fits into a neat little box. 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. You're saying like, Oh, well, 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 or they don't feel distressed, then you're like, Well, you don't fit into this box. I guess you got to come back when you have low functioning or when you're really feeling distressed. How messed up is that?

That's really messed up. What exactly is high functioning?

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. You feel like something's missing. 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, we just don't have that language. It's never been in our vocabulary. For others of us, we have these histories of traumatic experiences that cause us to not want to feel. So we push, push, push through it.

So are you studying depression right now?

I am. One of the things I study is depression, along with some major depressive disorder, postpartum depression, schizophrenia, really anything within the mental health gamut. But the interesting thing about depression was that I was seeing people who did not fit neatly into a box, but were leaving my office like, Then what is it?

Were you in a situation where somebody sitting across from you and you're like, got the DSM 5 out. Not that you have it out physically, but you know what I mean. You're like, Okay, box check, box check. Okay, doesn't technically quite meet the criteria, but I know this motherfucker has depression. You know what I'm saying? 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? This was my husband, by the way. What are you researching right now in the lane of depression for these people that do not fit into the box?

I'm looking at depression with different faces. Depression presents so differently depending on who's in front of you. For example, men, they don't express depression the way that we classically think of depression. They may be irritable. They may come home and knock a couple of bears back. 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.

Isn't that just a typical man? I don't mean to make a joke, but I feel like, 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. This was a guy who was sober for a number of years. He was meditating like crazy. 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, helping other men who were feeling this lack of joy. And yet deep inside of him, there was something that was off. 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. There was just a spark and an aliveness that was missing, and it went on for years. Because he was getting it all done. First of all, he didn't think there was anything wrong. He just thought this was like male laplace, midlife male, drop the testosterone 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, he has dysthymia.

He's got really treatment-resistant depression. Normally, I see a brain like this after they're dead. It's all the things he's doing that is keeping him okay. Chris resisted the label. He thought it meant that he was weak. This is an area that you're looking into, high functioning depression. Is that what you're calling it?

Absolutely. There's so many factors involved with depression.

What is depression?

Depression, according to the DSM 5.

What is it, according to you? Who cares about the DSM 5 right now? No, I'm serious. Because you have, just like trauma, DSM describes it one way. I want to hear Dr. Judith Joseph's definition of how you think about depression and why that matters.

Again, we do use this construct because we have to be able to study it- Of course. And to use a standardized system. Yes. But like your husband and what you experience with him, people don't always identify with the word depression. I can't tell you how many times someone came in our office and I was like, I think this is high functioning depression. They're like, But I'm not depressed. Well, they don't see this as depression. They're Well, a depressed person is in bed all day crying. Yes. No. Depressed people have something called anhedonia, which is a lack of feeling, a lack of pleasure. 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 enjoy a meal? They'll say, I don't really enjoy that much. But if you don't know what the feeling is, if you can't identify it, then you're not going to know that it's depression. You're just going to be like, Well, I guess this is just how it is. You think it's like a midlife men crisis, right? Right. And your husband is classic because running a men's group sounds like a lot of people depend on him.

Yes. Guess who doesn't have time to be depressed?

Chris.

Exactly. People depend on him. 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.

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 on the go. I'm anxious. I'm on edge. Got it, got it, got it. If somebody were I would say, Mel, you're struggling with depression. I would say, Oh, shit, I'm in trouble because depression means that I am not functioning. Depression means that I can't get out of bed. It means I am in real trouble. 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, you can be a super busy mom and you can be just burning the candle at all ends. Can you describe Can you describe what the life of somebody that has high functioning depression looks like, in your opinion?

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. In a research, you're just in your little bubble. I was working with my social media manager, Johanna, and she said, What have you been seeing in your practice that's interesting? I'm like, I'm seeing a lot of high functioning depression. She said, Well, let's make a TikTok on that. Let's see what it looks like. I did it. Typically, A little day in someone with high functioning depression. They get up before the alarm rings because they have so much pent up angst that they get up before it even rings. They rush to work, don't eat, the little joys in life. They just shove in the coffee. They work through lunch, so they don't savor those meals. Those little points of joy are, again, flattening out. 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 doomscroll. You'd rather look at your kids on your phone than actually play with your kids.

How many of us are guilty of that? So true. You're missing out on the things that really make life worth living, but you're killing it at work. You're high functioning. You're delivering. You're taking care of the kids at home. You're doing all 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. If you go to a doctor, a doctor is not going to say, Let's come up with a treatment plan for you because 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, come back when you're low functioning. Come back when you're in distress. Wow. 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... The body, something's got to give. Depression, stress, all wearers on your body. Or they're coping poorly. They may be over-medicating with alcohol or other unhealthy habits, a lot of social media addiction or 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.

I have a couple of questions because what you just described sounds like me, and I would have called that anxiety. Because when I hear that bolt out of bed, racing thoughts, slam a cup of coffee, always on the go, getting it done, calling the pediatrician on my way in to work and just like, go, go, multitask. I got this, I got this, I got this, collapse after dinner, go to sleep, wake up, do it again. I Why would have called that anxiety? Why is that depression?

Generalized anxiety disorder is very different than the criteria for the depressive things that I listed out. Depression has certain things that we have studied for years. We've seen them. Things like a 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. A lot of that restlessness that I described that is one of the symptoms of major depression disorder, a lot of it overlaps with anxiety. A lot of researchers are saying that they're really the different sides of the same coin that they travel together. Yes. 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 symptoms with it. 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. 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 them 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 we wear 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.

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

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

Why do you think that is?

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.

It was one of the main hallmarks of how depression impacts you just a lack of feeling that you just feel numb.

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

Let's just say I have high functioning depression. What is going on in my body that would have that be depression if what I thought it was isn't actually representative of all the different forms of it?

Well, what you thought it was was one thing, right? Challenge that idea. 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 with their depression by busying themselves 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. 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. It's one of the symptoms that's highly correlated with depression, especially high function depression.

Wow. Dr. Joseph, that makes so much sense. Thank you for explaining that in such detail. This This feels like a great moment to take a quick pause so we can hear a word from our sponsors. 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 and I are spending time with the incredible Dr.

Judith Joseph.

So Dr.

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

So there's correlations. They're not causation, but they're correlate. So we look for signals of dopamine, which is the reward chemical in the brain. There's a lot of science behind dopamine, which is a neurotransmitter, serotonin, norepinephrin. These are very fancy ways of saying particles in your brain, the joy chemicals, that They have different patterns in a brain that is depressed. But we also know, the recent data 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 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. I think that 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. There are causes of depression, like inflammation or correlates, inflammation, genetics. When you look the twin studies of identical twins compared to twins that are not identical, there's a high correlation with depression.

Meaning both twins will have it?

There are higher chances of if one twin has it who's an identical twin compared to people who are fraternal patients, 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, if we don't take the time to feel and to heal, unresolved trauma, that can really present as a depression. 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. Then social media, it's there. We can't turn it off. Twenty years ago, we could turn it off. We turned 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.

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?

Not everyone wants to talk to a doctor, and so I want to validate that as well. Not if there's a complete lack of joy, but diminished joy. Sometimes, if you go to my website, you'll see scales for anhedonia. You can fill out an anhedonia scale and see where you are on that pleasure scale or that joy scale. Or you can fill out, if you think what I'm talking about 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, 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- I think most people don't. I do, too.

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. 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. Stop out working 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 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. 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. 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?

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? This work can't be done right by anyone but me. They are highly controlling. No one else can do it. One of the things I see is that 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 they're 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. They may have problems with focusing, so their concentration really is a challenge for them.

They may have low energy 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 overdelivering. 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. Here's the thing about medicine. It's a bit controversial, but I think that a lot of doctors and nurses and health care workers struggle with this thing called high function 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 because 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. 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.

How do you discern, though? Because if somebody has that 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. It seems like this has been very easily missed because you think the work habits are the cause when actually the work habits a symptom of this. Is that what you're saying?

That's why the biopsychosocial 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 biopsychosocial model is real. A lot of components feed into the symptom. They feed into the condition. We have to look at it from that holistic picture or else we're going to miss the mark.

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

Never think that you're a burden. I hear this all the time. Because 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 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. I call it high functioning AF. Let's look back.

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

I call it my social media. But look at a time in your life where you were high functioning AF. We'll pull out the smartphones and we'll go back and I'll say, Okay, show me that picture. If the people in your life, because there'll be pictures of them being around others, do you think that if you had opened up to them then, that they would have said you were a burden? It looks like you just met up with them the week after. Do you think you were burdening them? 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. I I ask them to challenge that thought. I also asked them to try and process the trauma because I find that, again, the word trauma, it's a word that people are, Oh, trauma again. But there are big traumas and little traumas, and there are little traumas that we just don't acknowledge. For example, a lot of the questionnaires for trauma, like the aces and the modified aces, they don't capture things like, Well, when I was a little boy or a little girl, people teased me because they said I was gay.

Things like that are not there. But those are traumas because you couldn't be your full self, right? Of course. 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. They're like, Well, I'm just lucky to be here. No, these are traumas. 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. When we do acknowledge that and we validate that, then we can start to do something about it.

Dr. Joseph, I'm just taking this all in. I feel empowered by everything that you're sharing with us.

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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?

Absolutely. People don't realize that the little things they do could be rooted in scarcity trauma. It's when you have 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. You may do things that are illogical, like not wearing things that you just bought. They're just hanging out in the closet with the tag on. Or holding on to expired food that clutter your life and caused distress. You're like, 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. You hold on to these things because on an unconscious, unprocess level, you're afraid that any minute things will be lost. You'll lose it all. People engage in these behaviors with a scarcity mindset out of trauma of not having resources. It's not just immigrants. I see it in people whose parents or grandparents, there's generational trauma. If their grandparents were refugees or survivors of war, or if personally, maybe they had resources, but they went through a really bad business, a period where they went bankrupt or a divorce, and they're afraid of losing it all.

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 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 symptoms that don't really impact the person's life in the way they want it to, so they really hurt them and caused the stress. 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. What's that?

What's emotion? Or warmth? Anybody grew up in a very cold family?

There's emotional scarcity 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 period in your life. And then it's like, Wait, you come from scarcity. So you have these unconscious fears that you haven't processed. Let's Let's start to challenge it. What's the worst thing 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. They actually want to do these things, but they need help. 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.

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. How do you be happier today?

Well, what I love about this topic is I think it's very relatable. I also, whether you're talking about it on the physical side things that you're holding on to 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. 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 my grandmother, I would open up her fridge when we would visit in the summer, and it was always really dimly lit. 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.

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 I'm not a good person. If you're wasteful, if you're this. Then I've now gone in the other direction, which Which is I barely have anything in my fridge. Those light bulbs are always brand new, so I can see everything in there. I really relate to what you're talking about. I think we're going to get a lot of questions about this. If you're somebody who is listening to this and they're shaking their head and they're going, I do that. I do that. Yeah, I don't wear my nice clothes ever because I think something's going to happen. I'm afraid to go out to dinner because I'm afraid I'm going to lose my money again. I'm afraid to celebrate. 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?

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.

Yeah. It's also where the emotional scarcity comes from because there's no dinner together until the chores are done. When you 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.

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. You're eating. But that can lead to really unhealthy behaviors and unhealthy physiology. We want to think about all these ways that it's impacting us. It's not just being frugal or cheap. Is it causing distress. So if being able to free yourself of it because you're able to name it, then you can do something about it. 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 a 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.

I love that. I 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. 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.

It's powerful to name it 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 didn't know what was there and you just started swinging because you're like, Oh, my gosh. Then you turn the light on, you're like, Oh, my gosh. Then you turn the light on, you're like, A book fell. You're not going to be swinging because you know what it is. As someone who treats children and adults, we see how important it is to name the feeling with children. You have the feelings charts, and you spend all this time teaching them sad, happy. You want to be able to name the feelings for children because it allows them to control the outcome. 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. When you're afraid, you don't make good decisions. You make poor decisions.

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-pack, sitting at a family table and not eating everything on the plate because you just are not hungry, it can feel like a gigantic act of defiance to your entire lineage. 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 get inside the ecosystem system. I just want to acknowledge that for me personally, people in my family feel offended if I'm doing something slightly different. Is that something that you see a lot, too?

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. 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 holds. Nobody wants that. It's just a really hard time letting go of certain things because of this unfounded fear that you could lose it all.

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. 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?

Well, definitely high functioning depression. Wait, what?

People give you crap for saying that there's something called high functioning depression?

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 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 function 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 depressed enough. 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. Just because you can get through your day doesn't mean you don't feel worse than the person that's lying in bed. It's not a competition. It's not a competition. There are no wards for being more depressed than somebody else.

Exactly.

Since you're doing so many clinical research trials at your institute in Manhattan, is there anything else that you want to talk about?

Well, I'm excited about my high function 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. I'm a huge advocate for menopause and creating change within research. There's just not enough information on menopause and menopause research. I talked about midlife and people experiencing problems with brain fog. There's just not enough information. And talk about high function depression. Women in the workplace, when they're going through midlife and they're losing their identity because they can't do things 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. Right now, I'm working on a series called Ties. So basically, the mental health ties to menopause. So T-I-I-E E-S. 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 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.

Challenge that thought because you are still you. You may be going through something, but you are still you. The We see a lot of depression and anxiety with midlife, and a lot of it's hormonal. So using CBT and other methods to support people. And then sleep. Sleep is a big disruptor in midlife. There are wonderful treatments like cognitive behavioral therapy for insomnia. They're 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, why can't you deliver?

You're going to be at risk for depression. Or you're going to just suffer through menopause. There are too many doctors out there that are like, Well, it'll be about 10 years and you'll feel like yourself again. That's just not an acceptable answer for more than half the population. What specifically are you excited about when it comes to the research related to menopause?

I work in an organization called Let's Talk Menopause. It's nonprofit. 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.

Awesome.

So, Dr. Judith, as always, you got my head spinning 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. I learn shoulder to shoulder with absolutely every one of you that is listening to this conversation right now. 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. I just want to thank you for talking about these topics in a way that are both clinicals 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.

Thank you for having me.

Of course. My God, don't you love her? I love, love, love Dr. Judith. 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. 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. 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.

Hey, you ready?

I say that as if you're waiting on me when I'm really waiting on me.

Are you ready, Mel? I'm ready, Mel.

For A, Dr. Joseph. This is what we need, just a little bit at the top.

Oh, your nails look good. Thank you. Like affect? Like that, affect? Not affect, not like that.

It's affect. Like your affect.

I'm going to demonstrate my lack of spelling skills, everybody. A, F, F, E, C, T. I'm going to take this off because I'm starting to sweat.

If you're someone like me who considers yourself a high achiever, we need to go a little faster on the scroll. Is it lagging? Oh, God, let me go back up to the top. Does that sound okay? Is that out of the thing? My water bottle? It's not in the shot. Is it? Okay, great. Thank you.

That was good. That was amazing. Amazing. All right. Oh, and one more thing. No, this is not a blooper. This is the legal language. You know what the lawyers write and what I need to read to you. This podcast is presented solely for educational and entertainment purposes. I'm just your friend. I am not a licensed therapist, and this podcast is not intended as a substitute for the advice of a physician, professional coach, psychotherapist, or other qualified professional.

Got it?

Good. I'll see you in the next episode.

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