In this conversation, Dr. Judith Joseph and I discuss high functioning depression, a condition where depressed individuals appear to be functioning well on the outside while struggling internally. She emphasizes the importance of recognizing and addressing this hidden depression proactively rather than waiting for a crisis. Dr. Joseph introduces her framework of the Five V’s—Validation, Venting, Values, Vitals, and Vision—as a way to help individuals reclaim their joy and improve their mental health. The discussion also touches on the significance of understanding personal happiness and making small, actionable changes to enhance well-being.
The following is the raw transcription of our conversation.
Introducing Research Psychiatrist Dr. Judith Joseph
Emma McAdam (00:00)
Today I’m so excited to introduce our amazing guest. It’s Dr. Judith Joseph. She’s a psychiatrist who works in a lab in New York City. She works and tests various treatments for various conditions all the time. She’s a working psychiatrist and has amazing expertise in so many areas, but today we’re going to be talking about high functioning depression, and she recently wrote a book on this that’s like a bestseller. We’re going to be talking about when your coping mechanism for depression is over functioning and why that leaves you feeling numb, empty, or without joy or happiness in your life, and then of course what to do about it. Really excited about this interview, let’s jump in.
Emma McAdam (00:39)
Well, Dr. Judith Joseph, thank you so much for being here. I’m really looking forward to talking with you again.
Dr. Judith Joseph MD (00:45)
Yeah, it’s so great to see you. Thanks for having me.
Defining High Functioning Depression in Psychiatry
Emma McAdam (00:47)
Yeah, and I’m so excited to talk about this topic that you’re such an expert in, high-functioning depression. Yeah, what is high-functioning depression?
Dr. Judith Joseph MD (00:53)
Let’s do it.
Well, clinical depression is what we mostly know about, right? It’s when someone has all these symptoms of depression, like low mood, anhedonia, which is a lack of joy and interest and pleasure and things that use to really excite you, and other symptoms like changes in how much you’re eating, if you’re eating too much, too little, low energy, not sleeping well, all these symptoms. But then at the very bottom of the checklist, those symptoms have to cause significant distress or they have to impair your functioning. But I’m a therapist and I was seeing a lot of people coming in to my therapy practice and then my research lab who were having all these symptoms of depression, but they weren’t breaking down. They were over-functioning. They were like the rock. They were the mom. They were the entrepreneur. So they weren’t getting the help because you got to break down or you got to be in crisis in order to get helped because you have to meet this very set criteria and fit neatly into a box, right?
So that led me to wonder, well, I wonder how many people are really struggling. Like they have a lack of joy, they have these symptoms of depression, but no one knows it because on the outside they look put together and they’re functioning. And to be honest, I was one of those people, I was going through a period of my life where I was struggling and no one knew because I was the boss, I was the mom, I was the entrepreneur, the therapist, you know? And so…
If I was going through this and it kind of snuck up on me, I wondered how many other people were going through it. So I set out to do this study in my lab on high functioning depression, enrolling patients who had all these symptoms of depression, but were actually over-functioning. And what I found was so surprising. What I found was instead of shutting down, use work, they use other tasks to busy themselves from this pain that they want to avoid. And you would think, like someone has pain.
Emma McAdam (02:27)
Mm-hmm.
Mm-hmm.
Hmm.
Dr. Judith Joseph MD (02:51)
They don’t want to get triggered, right? They avoid people, places, and situations like in trauma, classic PTSD. But those of us with high functioning depression, we avoid our pain by over-functioning. When we sit still, we feel empty. When we’re not busy, we feel restless.
Emma McAdam (03:05)
Mm-hmm. my gosh. it’s like hitting home a little bit for me right now. Life’s been like really stressful for me and I recently talked with a psych nurse about like well, I’ve recently been diagnosed with ADHD. I’m like maybe getting on a stimulant would would like just help me be able to like manage what’s going on with my home. I’ve got four kids. I’m running a business, right? I’m trying to like take care of myself too. Like it’s wild. So I thought you know, maybe I could just
try like a stimulant and ADHD med, maybe that’ll help. And the psych nurse did like a two hour assessment, like the most thorough assessment. And at the end of it, she’s like, Emma, like your symptoms might like line up a little better, like with depression, like some of this irritability and you’re not having fun with your kids, like you’re not enjoying being with your kids, but you’re doing great at work. I’m like, no, I don’t have depression. But like we did a family.
Dr. Judith Joseph MD (03:50)
Mm-hmm.
That was me.
Emma McAdam (04:01)
Yeah, we did like a family history and it’s like, yeah, let’s see. My dad’s had depression. Five out of six of my siblings have had depression. Like my grandma had depression. Her dad killed himself. Like you look at the things and it’s like, so it’s so interesting to hear you say like the way we cope with our emotions is by trying to over function. That’s so interesting.
When Coping Mechanisms Mask Mental Health Struggles
But I also wanted to ask you about that and you brought it up right away in the DSM.
Dr. Judith Joseph MD (04:12)
Hmm.
Emma McAdam (04:27)
it says it has to impair functioning or cause severe distress. So if you’re functioning, if you’re over-functioning, is it still depression? You know? And like, what do we do with it? Yeah, go ahead,
Dr. Judith Joseph MD (04:37)
Right, and that’s the question.
so I was seeing my colleagues from medical school doing all these innovative things in health, right? Like my friends who are orthopedic surgeons, they’re like, let’s not wait for the hip fracture. Let’s start women on like hormone therapy so that they don’t develop osteoporosis and end up with disabilities because that’s like the number one disability in women in midlife and beyond, right? They’re like, let’s prevent this. And then my friends who are cardiologists were saying,
Emma McAdam (04:56)
Yeah.
Dr. Judith Joseph MD (05:06)
Why would we wait until there’s a heart attack? Let’s like prevent it. My friends who are in cancer and oncology, they’re like, we don’t wait until stage four cancer. We teach patients how to prevent it. But here we are in good old psychiatry saying, let’s wait until you break down. And once we can classify you, then we can like prescribe medicine or therapy. And I just thought, well, why are we so backwards? Why are we in the dark ages? Let me just start talking about.
Emma McAdam (05:21)
Seriously.
Dr. Judith Joseph MD (05:31)
these are the symptoms of depression. Let’s not wait till you break down. Let’s not wait until you lose function. Let’s not wait till you’re in crisis. Let’s teach you how to identify it. Let’s teach you how to reclaim your joy, right? Versus waiting for you to break down when it’s actually harder for someone once they have broken down, right? It’s harder to get them out of that. So I wanted to really be this voice of we’re not waiting. We’re doing we’re not being reactive. We are proactive.
Emma McAdam (05:35)
.
Mm-hmm. Mm-hmm.
Yeah.
Yeah.
Dr. Judith Joseph MD (05:59)
And initially,
people in my field were like, why are you trying to pathologize things? Why are you trying to pathologize life? And I was like, really? Because why are we in this business of not helping people to find joy? Why are we in this business of rescuing people? I think it has to do with a reflection of a lot of us in mental health. We develop our whole identity about rescuing others. When we ourselves need to be rescued, we don’t have joy. Right? So if we had this shift and thought,
Emma McAdam (06:25)
Mm-hmm.
Dr. Judith Joseph MD (06:28)
Why don’t we just start to actually help people live joyful lives? Maybe we wouldn’t need to, you know, be in this position where all these people are taking our roles, right? Like there are all these people out there talking about their experiences and like, do this for your mental health, do that. And they have no training, right? Not to say that there’s anything wrong with that. We need those stories. But like we are becoming less relevant and we’re the ones who should be really helping others. But maybe we need to change our mindset. Maybe we need to talk about, OK, joy is important.
why joyful people are physically more healthy. They have better relationships. They have better careers. They’re more likely to go out and change their community for good. So let’s shift this. Let’s focus on helping people reclaim joy, prevent them from breaking down so that they live fuller, healthier lives and their families are also thriving.
Proactive Care for Emotional Well-Being
Emma McAdam (07:18)
Mm-hmm. Yeah. So what do you do? Like if you’re in this, I mean if I think of this as a spectrum and we assume depression is only this like 10 % or whatever, where people can’t get out of bed, if you’re more in the middle and you’re like, I’m functioning, but I’m not enjoying life. I’m functioning, but I’m irritable. I’m functioning, I, know, whatever. Like what do you do? What do you do about it? How do you treat it?
Dr. Judith Joseph MD (07:40)
Yeah, the motto of our lab, the Science of Your Happiness Lab is understand the science of your happiness, right? So what does that mean? You know, we’re we’re constantly reading a book. I love to read. But sometimes I read a book and I’m like, I tried this. It didn’t work for me. A lot of my patients the same way. They’ll be like, my friend tried this and she’s happy, but it didn’t work for me. Or I read this meme and this guy said this on, you know, the social media platform and it worked for his followers, but didn’t work for me.
I always say, what is the science of your happiness? Do you even understand where you’re losing your joy? Before you go out and try something, where are you losing joy in your life? Because then when you can identify that, then you can strategically add that joy back. And I often explain it this way. say, in my therapy practice, people come to me and they’re like, ⁓ I just want to be happy. And I’m like, OK, well, what does happiness mean to you? And it’s often something like when I finally pay off my debt.
Emma McAdam (08:33)
You
Dr. Judith Joseph MD (08:37)
when I finally meet my soulmate, when I finally have a family, when I finally have the dream job, it’s always external, right? But in the research practice, when we’re studying the science of your happiness, the way that we measure if someone’s becoming happier is we’re adding up all these points of joy. So I’m asking things like, when you ate your breakfast this morning, was it yummy? Did you savor it did you just shove it in, right? When you were lonely and you reached out to your loved one, did you…
Emma McAdam (08:42)
Mm-hmm.
Dr. Judith Joseph MD (09:04)
feel disconnected or did you feel seen and heard? When you were stressed, were you able to self-soothe? When you were tired and you took a rest, did you wake up refreshed or still groggy? All of those little points of joy, those human experiences, when we add that up, that’s how we know you’re becoming happier versus in the real world, people are like, well, I just want to be happy when something external happens. So happiness is external. Joy is internal. It’s
Emma McAdam (09:15)
Yeah.
Interesting.
Dr. Judith Joseph MD (09:30)
built into our DNA as humans. We all have access to it. We all have the ability, but sometimes we forget how to reclaim it. And so what does that mean for your joy and understanding your happiness? You’re familiar with something called the biopsychosocial model. sounds super complex, but most of us learn it in training. And I thought, why don’t we teach patients how to map out their own biopsychosocial? So the way you do it is you draw three circles. One is biology.
and I’ll use myself as an example, biologically, what are your medical problems, right? So like, for me, I have a low thyroid. If my thyroid’s off, I’m not happy. You know, I’m also likely in perimenopause. You know, a lot of people in their late 30s, early 40s are going through this hormonal fluctuations. So if I’m not cognizant of that, you know, maybe that’s where I’m losing joy too, because there are mental health symptoms for that. But for others, it could be other things. They may have metabolic issues, autoimmune issues. That’s the biological.
Emma McAdam (10:13)
Yeah. ⁓
Dr. Judith Joseph MD (10:28)
Psychologically, what’s your past trauma? Some people have been in some horrible, relationships with their parents. They have attachment trauma. Others have personal traumas like, you know, really bad ⁓ domestic violence and so forth. Personally, I have a history of scarcity trauma. I came to this country when I was very young from Trinidad and we didn’t have much. So if I don’t challenge that, I will go into these overworking modes where I’m like, I’m going to run out. I’m going to run out when I’m not going to run out. But logically,
But here, if I don’t process that, then I don’t slow down, right? So I’m losing out on joy. And then the social aspect, and then to speak about psychology too, others have like neurodivergence, right? If you have ADHD and you’re not taking care of it and you’re multitasking, you’re going to be unhappy, right? Without support. then socially, what’s happening in your day-to-day life? For me, when I was going through a period of anhedonia, like not feeling joy, feeling meh, blah. Socially, I was very, very stressed. had, my husband at the time was a frontline worker.
going through a lot of stress with the pandemic. My daughter was really young at the time and she was having a lot of ⁓ transitional changes happening. And my work was very stressful. I ran this lab and we were really worried about keeping patients in the studies in spite of the pandemic. It was very stressful. So I was losing a lot of joy from all the stress in my life. But for others, socially, it could be things like not sleeping well. I know I wasn’t sleeping well during that time. I wasn’t eating well, I was eating.
processed foods, not foods that really fortify my brain. I wasn’t getting the movement that I needed. So there’s a lot of things in our personal social lives where we could be losing joy. So when you map out your biopsychosocial and you understand where you’re losing your joy, then you know, okay, maybe these are the areas I need to start focusing on. And then it looks like a lot more hopeful because rather than, happiness is one route, you’re like, no, I can…
Get points of joy from all these different routes on this biopsychosocial that’s based on the science of my own happiness.
Emma McAdam (12:28)
Yeah I love that so much because when we think of mental health in a more holistic way it gives us so many options for what we can do to just increase our happiness, decrease our stress, improve our health, and just like make these little tweaks. So my husband and I’ve been been like okay we aren’t like our home is not as joyful as we’d like it
What are we going to do? And our goal is each month to decrease our stress 1 % and increase our joy 1%. So, that’s, and that’s basically what you’re describing is what it looks like. It’s like, oh, we’re going to make sure to exercise a couple mornings a week. And we’re going to make sure to slow down and get quality time, like fun time with our kids. And that’s it. Like for the month of November, those are our goals. And it’s already like, it’s still stressful, but it’s not like, I think we’re doing, I think we’re like,
one or two percent happier and that’s that’s my approach. love I love that perspective of like let’s look at all these aspects and let’s just make some small changes.
Dr. Judith Joseph MD (13:28)
I love that. I for me, I like I think about it as points like I got one point today that I didn’t get yesterday. Right. And when you when you teach patients how to think that way, it’s like way more hopeful versus I just need to be happy. Everything buttoned up and perfect. No. What if you just got one more point today? What if we live in a city? I mean, New York City. What if you walk through Central Park on the way home versus just taking the subway one more stop?
And then while you’re walking through the park, you’re like, wow, I feel the breeze on my skin. I see the bird. I see the, you know, the trees and I’m getting that point of awe. Right. For personally, it’s a small intervention of one of we watch because my daughter and I watch Dancing with the Stars every Tuesday. When we watch Dancing with the Stars, I’m not going to be on my phone and I’m not going to be on my computer. I’m just going to literally look at every dance with her and talk with her.
Emma McAdam (14:06)
Mm-hmm. Mm-hmm.
Dr. Judith Joseph MD (14:22)
Like it’s those small things that really matter. You don’t have to have everything perfect. But if you can access a point here, a point there, that’s how we actually measure happiness in the research. And you’re doing it for yourself based on the science of your happiness.
Emma McAdam (14:22)
Yeah.
Hmm. Yeah, that makes so much sense to me. And I found that like as I slow down throughout the day and I get present, like I do experience more of that joy. Like, like today I was getting my kids off to school and that’s always like a rush and we’re trying to get them on their scooters and get them down the road to the school. And I took a breath and I slowed down and I just watched my three year old kick her scooter like fast. And I was like, okay, I can just enjoy this moment of like my three year old just loving her scooter for a sec.
Dr. Joseph’s Five Vs for Joy
And so those moments seem to really help me, but I also find, I wonder if you see this with your patients, that when I try to slow down and do less, ⁓ sometimes that’s very uncomfortable and I resist it. Or I try to do more by being more happy and more healthy and more happy and more healthy. it’s like, so do you see that? Where people have a hard time letting go of this coping skill of just being amazing at work or whatever.
Dr. Judith Joseph MD (15:30)
Yeah, I see that often because remember in the research I saw that it was based on this unresolved inner pain that you’re busying yourself. So when you sit still, you feel empty. When you’re not working, you feel restless. So then you become a human doing, not a human being, right? And for that, I wanted people to have a framework to heal, right? And I call it the five V’s because I want people to look at their hand and say, I’m built with the DNA for joy.
I just forget how to access it sometime, but joy is my birthright as a human. And to tap into any one of the five Vs every day to reclaim your joy. And I came up with the number five because I’ve traveled the world looking at mental health. I’ve been to over 30 countries and I found the number five showing up a lot. I think it’s because most of us have five fingers, most of us do.
The First V: Validation
But the first V is validation and to what you’re saying like.
Emma McAdam (16:19)
Yeah, most people.
Dr. Judith Joseph MD (16:25)
when people can’t slow down and even if they try and they’re intentional about it, they still busy themselves. I would start with validation. Validation is acknowledging and accepting what you’re feeling and what you’re experiencing without judgment. And many of us can’t do that because we’ve learned to push down the pain. We don’t want to deal with the pain. But when you push down as a coping mechanism, not only do you numb yourself from the pain, you numb yourself from the points of joy, right? So
The validation is almost like you’re in this really dark room and you can’t see anything and you hear a loud crash. Depending on your defense mechanism, some of us would start screaming, some would start running, some would start swinging. But if you turn the light on and you saw, ⁓ that was just a vase that fell, it’s an inanimate object, I’m safe, then that uncertainty goes down and you feel better. It’s the same way.
Emma McAdam (17:06)
Mm-hmm.
Dr. Judith Joseph MD (17:19)
with your emotions, if you turn the light on on your emotion and you identify what’s really happening. And for me, it’s like, I’m worried about running out. That’s why I can’t slow down. But if I challenge that, I’m like, you know, that’s from my scarcity trauma. It’s anxiety. For others, it could be I don’t feel good enough. I don’t feel worthy. You know, I was unlovable in my past. So my role is what is how I define my worth. Right. That’s the validation. Like turning a light on on your emotions and your experience without judgment and fully accepting it.
The Second V: Venting
The second V is venting. In my lab, I bring people in and they’ll each take turns with this red balloon and they try to push it into this tank of water. And I take this experiment on the road off and people love it because I think deep down we’re all kids and we want to play. But they try to push this red balloon into this tank of water and 100 percent of the time that balloon pops up and makes a splash. Right. You can’t out math the physics. But then we take turns deflating that balloon.
Emma McAdam (18:13)
Yeah. Yeah.
Dr. Judith Joseph MD (18:18)
and we can all push it down, there’s no resistance, right? If we don’t learn to express our emotions, to deflate that balloon, which is ourselves, right? Our emotions are gonna pop up in our work, it’s gonna pop up with our kids, it’s gonna pop up in our health in ways that we cannot control. So venting, you know, could be to a therapist, but if you don’t have a therapist, you wanna be intentional about who you vent to. If it’s your partner, if it’s a friend, there’s gotta be emotional reciprocity. I vent to you, you vent to me. We don’t trauma dump, we don’t gossip.
But venting doesn’t have to be verbal. could be through writing in a journal. It could be through prayer. If your faith-based, it could be through artistic expression. But just get that out.
Emma McAdam (19:02)
Yeah, okay, great. So validation, venting.
The Third V: Values
Dr. Judith Joseph MD (19:04)
And the third V is values. So values are things that bring our life meaning and purpose. For a long time, I got caught up in the accolades. If you ever come to my lab, you’ll see like a gazillion awards and degrees. But at the end of the day, I’m not going to be on my deathbed like, I wish I went to law school too. I’ll be like, no, I wish I spent more time with the people I love, the causes that I love.
Emma McAdam (19:12)
That’s my favorite.
Yeah.
Dr. Judith Joseph MD (19:32)
And so I often tell my clients to carry around these stones with the name of their values on it because when they’re feeling lost, pull it out. in psychiatry, we call that a transitional object. It’s like a tactile, physical reminder of what really matters. So tap into that every day. You know, that’s why I got involved in this advocacy work because I grew up in a very religious home where we would every weekend go out and volunteer. My dad’s a pastor and that’s what brought my life meaning and purpose. wasn’t all the accolades, it was the helping people, the purpose.
The Fourth V: Vitals
The fourth V is vitals. You only get one body and brain. So take care of it. Like what you were talking about, how you and your husband want to exercise and get more movement in. ⁓ But vitals are things like eating nutritious foods that are not processed, getting, good sleep. And the vital that I struggle with, which is screen time, right? Like being on screens is
Emma McAdam (20:09)
Mm-hmm.
Dr. Judith Joseph MD (20:28)
not helpful for our mental health, but we’re content creators. finding that right balance of like, you know, because this data is showing that it’s hurting us, it’s hurting our brains. There was a study at University of Texas earlier this year where they took the smartphone capacity away from these phones, from these adults, where they only had like basically a text phone, a calling phone. And for several weeks, they saw the scores of happiness go up as if they were being treated with an antidepressant.
Emma McAdam (20:31)
Right.
Wow, ⁓ fascinating.
Dr. Judith Joseph MD (20:58)
Right? Because they were sleeping better, they were getting better ⁓ communication with their partners, with their families, they were more socially connected, they were out in nature, they were getting more movement, right? So we’re doing this to ourselves. And the other non-traditional vitals are our relationship with people and our work-life balance.
The Fifth V: Vision
And the fifth V is my favorite vision. Planning joy in the future so you don’t get stuck in the past. And it doesn’t have to be a big thing, it could be a small win, like every day when I get my kid to school on time.
I sit in my living room and I have my coffee and I savor it. And I’m like, I did that, right? Small wins. Like after I’m done with you today, I’m going to eat a sandwich and be like, oh, this is yummy. I’m going take a break, right? Because like we don’t treat our bodies like we’re human beings. We’re always human doings. And we’re missing out on these basic joys in life. And then we’re like, well, why am I not happy? You’re missing out on the basic joy.
Emma McAdam (21:33)
Yeah. Yeah.
Haha love that. Okay, so helpful. Thank you so much.
Resources for Finding Joy
And can you tell my audience about your book so they can learn more?
Dr. Judith Joseph MD (22:01)
There are so many evidence-based tools in there. I wanted to make it a book that is like, OK, it can’t replace a therapy, but there are tools in here that you can start that process. While you’re on a wait list for a therapist, while you’re on a wait list for a group therapy, here are some tools just to help you understand the signs of your happiness so you can then be strategic about where in your life you want to focus to reclaim your joy. And I wanted to make it simple enough so that you don’t need a graduate degree to understand it.
that it’s accessible and shareable. And it’s now in over 20 countries and over 17 languages. Because why? Joy is universal. We all want more of it. We just forget how to reclaim it at times.
Emma McAdam (22:36)
So cool.
That’s so great. Can you tell us the name of it? Hold it up. Show us what it looks like so people can find it.
Dr. Judith Joseph MD (22:45)
Yes.
High Functioning [as in high functioning depression]. And Mel Robbins, my good friend, wrote the foreword. And it’s High Functioning. Overcome Your Hidden Depression and Reclaim Your Joy.
Emma McAdam (22:57)
Okay, we will link that in the show notes and thank you so much for squeezing us in between all of the important and valuable things you’re doing. Really appreciate it. So fun to see you.
Dr. Judith Joseph MD (23:07)
my gosh, you bring me so much joy anytime. Thank you for having me.
Emma McAdam (23:10)
Great.
