The Mel Robbins Podcast - 7 Signs You May Have High Functioning Depression

Episode Date: May 2, 2024

In today’s episode, you’re going to learn about something important and rarely discussed that specifically impacts busy people and high achievers.Just ask yourself:- Do you just have coffee for breakfast, because a real meal would slow you down?- Do you eat lunch while you work, instead of taking a break?- Do you mindlessly scroll before going to bed because your mind is too busy?  - Do you take on extra work because you think, “I’m the only one who can do this, right?”- Are you always there for others but don’t take care of yourself? These are some of the signs of high-functioning depression you should not ignore.Joining Mel today is the world’s leading expert and researcher on this topic, Dr. Judith Joseph, MD.Today, Dr. Joseph is here to share her groundbreaking research on this important subject and exactly what to do to feel more energized, excited, joyful, and present in your life again. Dr. Joseph is a renowned double-board-certified psychiatrist who trained at and is affiliated with Columbia University and New York University. She is also a pioneering researcher and the founder and principal investigator of her research institute, Manhattan Behavioral Medicine, where she has conducted over 60 clinical research trials with her all-female medical team, which focus on high-functioning conditions, including high-functioning depression.This episode is for all the busy people who keep it all together, the moms on the move, and the overachievers at work. You’ll be surprised, moved, and feel a sense of relief and peace after today’s episode.For more resources, including links to Dr. Joseph’s research, click here for the podcast episode page. If you liked this research-packed episode, you’ll love hearing Dr. Joseph’s other appearance on the podcast: Want to Be Happier Right Now? Don’t Make This Mistake (New Surprising Science)Connect with Mel: Watch the episodes on YouTubeFollow Mel on Instagram The Mel Robbins Podcast InstagramMel's TikTok Sign up for Mel’s newsletter Disclaimer

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 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 wanna 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. Hey, it's your friend, Mal.

And 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. And this is especially true if you're a high achiever. You know, you're a perfectionist, you're a working parent, a small business owner, a first responder, a caregiver. You know, 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. And as you're gonna learn today from the only expert on the planet that is researching this, it's called high functioning depression. And it's important to know what this is because once you know about it, you'll be able to do something about it.

So 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. And she did her fellowship at NYU, where she has been a professor for the last decade. And 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 hardworking, busy person that you know and love, it would be this one. Because I have no doubt it is gonna change your life. So Dr. Judith, I'm so excited you're here. Welcome back to the Mel Robbins podcast. Thank you for having me back.

Of course. And 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. And for me to be a principal investigator of my own lab, leading a team of women researchers, it's just like, it's really a dream.

Sometimes I pinch myself. 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 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? Like you're going to go to your doctor, you see that your doctor looks like you, you're going to trust them more, right? So representation really matters. And 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. And 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. So 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. So 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? So 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 meeting deadlines, you're collecting accolades, but you're just not really feeling a sense of joy. You're not feeling, 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. And for others 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 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's 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. And you're like, got the DSM-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. 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 this was my husband, by the way. So 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, 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. Isn't that just a typical man?

It's not. 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. And this was a guy who was sober for a number of years. He was meditating like crazy. And by crazy, I mean every single day, he would wake up in the morning, he would meditate, he was exercising, he is 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. 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. 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 male-a-pause, kind of like midlife male dropping the testosterone kind of situation. But it was another doctor that we've had on the show, Dr. Amon, who did a brain scan and called us up

and was like, he has dysthymia, like he's got really treatment resistant depression. And normally I see a brain like this after they're dead. And it's all the things he's got really treatment-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? Absolutely. There's so many factors involved with depression. What is depression? So 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.

So 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 into our office and I was like, I think this is high functioning depression. They're like, but I'm 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 like, well, a depressed person's in bed all day crying. Yes. 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 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, 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.

So 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? And your husband is classic because running a men's group sounds like a lot of people depend on him. Guess who doesn't have time to be depressed? Chris Robbins. 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. 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. Depression means that I can't get out of bed. It means I am in real trouble. 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, no.

You can be a super busy mom 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? 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? And research you're just in your little bubble. And I was working with my social media manager, Johanna, and I said, she said, What's what have you been seeing in your practice? That's interesting. I'm like, I'm seeing a lot of high functioning depression. So she said, Well, let's make a TikTok on that. Let's see what it looks like. So I did it, you know, typical day and 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 right the little joys in life. They just shoved in the coffee, right? They 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 doom scroll. Right? You'd rather

look at your kids on your phone than actually play with your kids, right? How many of us are guilty of that? Right? 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, 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. 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 got to give, right? Depression, stress, all wears on your body. Or they're like coping poorly. They may be over medicating with alcohol

or other unhealthy habits, a lot of social media addiction or like 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 into work and just like, go, go, multitask. I got this, I got this, I got this. Collapse after dinner, go to sleep, multitask, I got this, I got this, I got this, collapse after dinner, go to sleep, wake up, do it again. And I 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, right? Depression has certain things that we have studied for years we've seen them. So like 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, right?

And so a lot of the, like that restlessness that I described that is one of the symptoms of major depressive disorder, a lot of the 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 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. 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, 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 and men versus 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 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 very, they're delivering, right? And like 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 like 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. 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 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. So 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? It's one of the symptoms of depression that people, it's like insidious, it's kind of sneaky. Like, so 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. 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 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. 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 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. 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. ["The Daily Show"] 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 chemical structure of your body? 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. So, you know, there's correlations. They're not causation, but they're correlates. 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 very fancy ways of saying particles

in your brain, the joy chemicals, that may have different patterns in a brain that is depressed. But we also know 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. 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, right? When you look at 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 like fraternal trans, 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, 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, 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? 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. 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? You know, not everyone wants to talk to a doctor, and so I want to validate that as well. And not if there's a complete lack of joy, but diminished joy, right? Sometimes, if you go to my website,

you'll 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. 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 mean, like, 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 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 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? 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, right? No one else can do it. And 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 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. 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 and 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, 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 going to give somewhere, or before they have mental breakdowns. 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 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? 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. 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.

What should you never do if you are struggling with high functioning depression? Never think that you're a burden. And I hear this all the time. Like I didn't, 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 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 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, so like, let's look back. That sounds sexier than depression. I think, 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 that on my social media. But like, look at a time in your life where you were a 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 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? Because 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 because I find that, again, there's the word trauma, it's a word that people are trauma again. 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 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. Like, things like that are not there. But those are traumas because you couldn't be your full self, right? Of course. Or like things like, you know, when I came to this country without anything, clothes or anything, like, and I was hungry.

Like, 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 in our past and acknowledge these emotional experiences that impact it the way that we see ourselves and the way that we approach the world and others. And when we do acknowledge that, 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. 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? Absolutely. So, 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. 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 on to expired food that clutter your life and cause distress. And you're like, what, why are my cabinets full of all this? or holding on to expired food that clutter your life and cause distress. And 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. 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, or if personally, maybe they had resources, but they went through like a really bad business, 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. So there are all these odd kind of symptoms that don't really impact the 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. So in a lot of these families where they're like just focused on survival, right? There's not a lot of like talking about emotions, like what's that? What's emotions? Or warmth? Anybody grew up in a very cold family? 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, where 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 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 fears. 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 fears 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, 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? 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. You know, 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 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. 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 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 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? And 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. 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. And it's also where the emotional scarcity comes from because there's no dinner together until the chores are done. And when they got 500, had a cattle to take care of and you're worried about the crops and everything else, there's no time for failings. 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 going to eat it.

Many of us still do it. Like I can't see food waste. You know, that you're eating. But that can lead to really unhealthy behaviors and unhealthy physiology, right? So we want to think about all these ways that it's impacting us. It's not just being frugal or cheap. It's, is it causing distress? So if 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 home, but start to challenge that thought, that core belief that you're bad because you're wasteful. You're not wasteful. Like what's the evidence that you're wasteful? Put that thought, you used to be an attorney,

put that thought on the stand, right? 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, right? 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? 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? 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 you didn't know what was there and you just started swinging because you're like, oh my gosh. And 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. And we, and as someone who treats children and adults, we see how important it is to name the feeling with the children.

You know, you have the feelings charts and you teach, 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. 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. And you know, one thing I just wanna 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, people in my family feel offended if I'm doing something slightly different. And is that something that you see a lot too? I do. I see a lot of 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. 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.

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? Well, definitely high-functioning depression.

And when I- Wait, what? People give you crap for saying that there's something called high-functioning depression? You when I... Wait, what? People give you crap for saying that there's something called high-functioning depression? You know, really, depression is serious. And there are some people who have depression every day. And you know, 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 gonna do something about it. They're gonna 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, like that to me, that to me just blows that 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 bed. It's not a competition. It's not a competition. There are no words 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-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, you know, 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. And right now I'm working on a series called Ties. So basically the mental health ties to menopause. So T-I-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 were still you. The emotions, we see a lot of depression and anxiety with midlife, and a lot of it is hormonal. 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, 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 gonna be at risk for depression. 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 more than half the population. And what specifically are you excited about when it comes to the research related to menopause?

So I work 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 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'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 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. 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 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 wanna 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. Thank you for having me. Of course.

Oh 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 days. Okay, 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.

Camera A, Dr. Joseph. Hit me. This is what we need, just a little bit at the top. Oh, your nails look good. Thank you. Affect, like affect? Affect. Affect, not like that, it's affect, like A-F-F.

Yeah, A-F-F. I'm about to demonstrate my lack of spelling skills, everybody. A-F- like that. It's affect. Like your affect. AFF. Yeah. Easy. I'm about to demonstrate my lack of spelling skills, everybody. AFFECT. 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? OK, great. Thank you. Sounds good. That was good. That was good. Amazing. Amazing.

All right. Oh, and one more thing. And 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. Stitcher.