Leading Psychiatrist: Is High Functioning Depression Harming Your Love Life? - Dr Judith Joseph

27:25I call it a trauma wave. It hits us. We can't catch our breath. Another thing hits us and we don't process it. We just push through it and we're not unscathed. So I actually think that number is higher. So then within trauma, I saw here that you've talked about scarcity trauma. Yes. So this is a whole nother trauma that we have to be aware of. So what exactly is scarcity trauma and why is it so important for us to be aware of it? So personally, we may have had personal histories of scarcity, and that could be going through a bankruptcy. It could be severe student loan debt. I see this a lot in millennials where they're just like, I can't even afford to eat a meal because I have to pay my, you know.

28:14These things are financially traumatizing because it's, again, it's affecting your livelihood. Your life isn't threatened, but your livelihood is. But then there are people who come from backgrounds of scarcity. A lot of migrant populations, like the one I came from, moving from the Caribbean to the United States, you don't have a lot of resources. So you may have gone to bed hungry some nights. You may not have been able to pay your light bills. You know, that type of financial history of scarcity can impact you. And then some people who've never experienced that personally, but let's say their grandparents survived wars or devastating genocides and things like that.

28:51They may still have the impact of that scarcity on their day-to-day lives. So you see things like people eating expired food or people hoarding and holding on to things that are cluttering their lives and causing distress and just making their quality of life poor. Things like, you know, whenever you go somewhere, there's free food. You're like taking the food and the food will sit in your fridge. You're not eating it. Or things like, you know, not finishing, not leaving food on the plate and you're eating a lot of food and you're getting diabetes. You're not even hungry, but you can't leave it on the plate.

29:26When you said, I was thinking of my grandparents saying, make sure you eat everything on your plate. Don't leave anything behind. Scarcity. That's scarcity drama. Yeah. And yes, we don't want to waste. I have people saying, well, that's just not wasting. This is being environmentally friendly. But no, when you dig deeper, if it is creating distress for you, if you're eating that food and you've got diabetes, that's a problem. If you're hoarding and you're getting into fights with your loved ones because there's just so much clutter, that's creating a problem. So it goes beyond that. So I've had my patients come in and I'll be like, open your purse.

30:03We're throwing away those receipts. But, you know, but what if I need to return it? Let's see the date on that. No one's going to take that. It's been a year or even 30 days, right? Get rid of it. And as you shed these things that you don't need, you feel lighter. You actually feel less stressed. You feel clearer. You feel free. So if it's bogging down your life and it's from a position of scarcity, you got to change it. But if you don't know what it is, you're just going to keep doing it. Yeah. And that's why I guess it's so important to know what it is. But what are the consequences of knowing what it is or maybe not knowing what it is and not addressing it?

30:40What are the consequences to our lives and to our loved ones? A lot of the behaviors stem from guilt. And one of the trauma responses in the DSM-5 is guilt. I don't think a lot of people know that guilt and shame are trauma responses. And so if you feel guilty and you feel like a bad person because you leave food on your plate, although you're full, then you're just going to keep eating it. You're going to keep damaging yourself. But then that's going to hurt you in the long run because then you're going to have medical issues that are going to end up costing you way more than if you had thrown that food away.

31:17So it doesn't go away. It may seem little today, but it adds up. It piles up. And if you continue these behaviors, they'll continue to pass down to your kids. It's contagious. It spreads. And again, I've had couples in my office where it's like one person's just like, I need the house clean and the other person's hoarding, but they don't understand where this need to hold on is from. Even if they'll never wear the clothes, even if the thing doesn't fit them anymore, they can't throw it away. So I work with them to challenge that guilt because guilt is a useless emotion. It is useless. Challenge that guilt.

31:55Give the clothes to someone who potentially could use it. That way you're getting rid of it and you're having less guilt, less shame. Yeah. But you see guilt and shame is somewhat different. They are different. And so how do you define shame in this kind of thing? So, you know, the shame is the, if someone sees it, I feel bad about it. It's like more external. The guilt is more internal. So if you can challenge that internal, then the rest goes away. Yes. The guilt is the problematic thing. And I think that it can be very difficult to explain. I see a lot of couples who, One, it comes from scarcity.

32:34The other one doesn't. So it's hard to explain. But when I break it down to that guilt, everyone can understand guilt. Yes. Then it relieves the tension in the room. Yes. There's more empathy. Yes. I love that. That's going to stay with me, that guilt is a useless emotion. It is. It's useless. It is. That's powerful. So if we have a partner who we believe is suffering from scarcity trauma or any form of trauma, What can we do to support them? Active listening. Active listening. Active listening. You know, many times couples want to do. You want to change. You want to fix. And it's the same with parenting.

33:15You just want to fix the situation. You want to get in there, get your hands dirty. Listen. Listen for these themes of guilt. Okay. Help them to challenge it. Because when you start to shame them, it further reinforces that guilt. They're a bad person. You know, they're not worthy of having this home that's free of clutter. You know, they did something to deserve this. So listen to them. Listen to these themes and try to be empathic as possible. You know, we use the word empathy a lot, but it's different than sympathy. Try to envision yourself in their shoes and try to really live their experience because they need you.

33:56They really do need that partnership. Okay. And just how do we do that? Because it's interesting. You think, okay, as a partner, you want to be empathetic. You want to feel the emotion of your partner. But how do you do that practically? It's very difficult because when you're in a partnership, you treat your partner different than you would. You do. Things change. It really does change. And so I'm a big proponent of working on yourself first because a lot of times I see this with my clients. You'll focus on the other person. Well, they're doing this and they're doing that. And if they only, well, I wonder if you worked on yourself, if their behaviors would bother you so much.

34:41Yes. Right? A lot of times it's projecting a need to control and to change because you feel out of control. You're not happy with the change that's happening within you. So when I see the rare case, the rare instance of a partner who really focuses on themselves and is genuinely just interested in supporting a partner, it's super rare. It really comes from a place of that person focusing and investing in themselves. Okay. And I do think a lot of times one partner will come in and want to fix someone else, and they don't want to work on themselves. So it's a distraction technique. Unconscious, by the way.

35:19It's not conscious, but it's like this way of dealing with a problem without dealing with it, if that makes sense. Yes. All right. Fair. Fair enough. So then on the flip side of scarcity trauma, there's scarcity envy. Yes. There's so much that we have to... So what is scarcity envy and how scared should we be of scarcity envy? So when I started putting content out about scarcity trauma, I started seeing these comments about how people are kind of hating on the experience of people who come from very little and making it. And my patients would come in and say, you know, I have this boss that when I told them, because again, when you have scarcity trauma, there's shame because it's a trauma.

36:05Yes. So you don't talk about it. So I work with my clients to talk about things openly, like where you came from. Don't hide it. Because I was like that too. I went to these fancy schools where everybody, I felt like everybody was rich and I was the only one who came from basically very little. So I never really talked about my background. And when I started challenging that myself, I would talk about it openly. And my clients started to challenge it and they'd be like, well, I have a boss who, you know, I'm pretty sure they have a lot more than me. But they started talking about their lack of privilege too.

36:36And I was like, that's interesting. And I started hearing more stories about this. So there's like this need for people who come from certain people that come from privilege to identify with those who haven't because it makes them feel more authentic, more connected to the real people. And there is shame about their history of privilege. Not everyone, right? Some people are just like, yeah, I know I'm privileged and like I'm going to help people out and I'm not hiding it. But others, they just want to identify with the more authentic folks. So they put on that, well, my grandparents came from this.

37:12Whereas they would never talk about it had they not had a conversation with someone who really did come from scarcity. Wow. Is this a significant issue, you believe, especially in this day and age? I do. I think that online people want to be authentic. You don't see the real people. You don't see the real projection of what's happening day to day. People want to be something else. And I think there's that need to have that persona where you are basically better than you are. That's the only way to say it. That you are somehow excellent. That you've beat the odds. That you're the underdog when, in fact, you were not.

37:53Yes. Yeah. Thank you for saying this. Because I was like, am I? Am I great? Am I not seeing things correctly? Because online, you see it all the time. You're like, why are you telling this story? How accurate is this story? And now I have a phrase for it. Now it is scarcity envy. That's exactly what it is. Yeah. Okay. And eventually you'll be found out because you can't hide anything anymore. No, not at all. Not at all. It's the eternal struggle most of us face. Building a fulfilling, successful career. but also being an available partner, parent, and friend. It never lets up and sometimes compounds to an overwhelming feeling of being stretched too thin.

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39:14That's F-I-V-E-R-R.com. Or click the link in the description and use code Paul. That's P-A-U-L. at checkout for 10 % off your first order. When it comes to love, we're all on our own journey. And that means any advice we're given should be tailored to our love goals, not someone else's. This is where my show and Tinder, who sponsor this podcast, have teamed up to help you. Each week on We Need to Talk, I'll explore love and relationships through a different lens, so you can get the advice that relates to your romantic situation. Tinder is for all types of relationships, and I truly believe it has the best tools to help you form the connections you're looking for.

39:59That might be long-term commitment or short-term experiences. Maybe it's friendship. But regardless of which part of the journey you're on, Tinder and I are here to support you. Their app is full of possibilities, and it's designed to help you explore every kind of connection. It starts with a swipe. Now, let's go into an area that I know that your lab has done quite a bit of research on. And I believe you have created this term. Is it high-functioning depression? I didn't create it. It's been around for about six or seven years. But I did the first of its kind study in high-functioning depression.

40:35And that is controversial in itself. So when I first started doing the research, I had a lot of colleagues saying, that's not real. It's either depression or not. And it led me to really double down, not run away, right? The light bulb, I followed the light bulb. Because a lot of people were coming in and saying, I have these symptoms of depression. I can't concentrate. I have low energy. I'm not feeling as if I'm excited about life anymore. But they were exceeding functioning. And in the DSM-5, that Bible of psychiatry, you have to, A, have those symptoms of depression, but also have a lack of functioning or significant distress.

41:19But if you're dealing with populations who have symptoms of depression, but they're not saying that they're lacking functioning, they're actually killing it at work, they're crushing it, or they're not identifying with distress, then you're just not going to do anything for these people. If you go to a doctor's office and you don't meet criteria, you don't check all the boxes, they're going to be like, come back in a year. Yeah, keep going. There's nothing for you. So then let's start with then just depression without it being half-functioning. What is depression? So depression by definition has to have these set criteria.

41:52You have to have five of the SIGGY caps. And in medical school, we use a lot of acronyms. So, SIGICAP's sleep. I is lack of interest. G is guilt. E is energy, low energy. C is concentration. A is appetite. P is psychomotor retardation or agitation. So, it's restlessness or being still. And the last S is suicide. So, you have to meet five of those. and then also the depressed mood or anhedonia, which is a lack of a pleasure. The problem is that if you don't meet the criteria for having a low mood, or if you're not having a lack of functioning, where it's significantly impairing your life or you're distressed, you're not going to be treated.

42:40No one's going to look and say, let's do something about that. And that is the preventative model that I'm trying to really push. because why are we waiting for people to lose functioning? Why are we waiting for them to be in significant distress? If we start seeing the signs, we can prevent this. And it's more important today than ever because we have all of these mental health conditions. The rates of depression, anxiety are just going up. We don't have the providers. We don't have the therapists. So let's prevent it. Let's start like at the doctor's office when we go for our annual checkup, let's start looking for these signs of depression.

43:15Let's not wait for that box of lack of functioning to be checked. Right? Let's not wait for them to be in significant distress. Let's start implementing things to prevent a major depressive disorder or to prevent a health issue that can result from stress from the depression or substance abuse or, you know, soothing that's unhealthy, like being online all the time, shopping. All these behaviors are just soothing mechanisms to take away from what's really happening. Yes. Are we as a society more depressed than ever? I think so. I really do think so. And I think it is unprocessed trauma because we were told to keep going, to not look back.

43:57And there's just so much happening today that is different than before. A simple model that I use is the biopsychosocial model. Simple. Biopsychosocial. For me, it's simple. People are like, what? I'm like, what? But I think about it in these, like, bubbles. And that's how the model looks. It's a classic model used in medical school. So the bio is your biology. What in your DNA or in your biology makes you more likely to have a depression, right? So it could be a past history, a family history, could be medical conditions, could be things, medications that you're taking that you don't know that, you know.

44:36So that's the biology. The psych, psycho part could be past trauma. It could be that maybe you're someone who copes in not so adaptive ways. Maybe you're someone who has IQ or learning issues, right? Or attachment styles that, you know, set you up for certain outcomes in relationships. Yes. And then the social part, that's like the, you know, the nurture versus nature. This is the nature part. What are you doing in your life that may not be helping you to stay away from a depressed state? So it could be lack of movement. We don't walk as much as we used to. We're online a lot more, so we're not as active.

45:18Certain people are overusing alcohol or substances. So those are the things. And then eating certain foods that are just highly processed. So that's the social part. And also the people in our lives, maybe if we're on toxic people. So the biopsychosocial model is very useful, not just for medical people, but for, I think, patients. Yes. And so what I do with my clients is I have them sit down and we do the biopsychosocial together and we focus on areas that we have control over. You can't change your genetics. Right. But you can change the amount of toxic people you're around. Yes. You can change toxic habits.

45:51You can't change your past trauma. That's the psycho part. But we can work on your attachment style. We can work on the way you see yourself in the world. We can challenge that guilt. And certain things within biology we can change. We can start some medications in some cases, but in other cases, you know, we can work on the medical conditions that put you at risk for depression or anxiety. Yes. You know, I love that. When you first said that, I was like, this is going to be so complicated. You explained it simply, biopsychosocial. And would you say that from those three that they equally contribute to depression?

46:26Do they equally do that? And that's a great thing about biopsychosocial is that everyone has a unique biopsychosocial. So in some cases, someone's going to have a heavier bio, right? If I have someone who has an autoimmune illness that is really creating havoc in their whole body and in their mind, then I'm going to focus more there. And I'm going to work closely with the neurologist, with the immunologist to get that under wraps, right? Because sometimes when you focus on one area at that point in your life, things get better. For others who have, let's say, a significant history of trauma, I'm going to focus on the psycho part, right?

47:01I'm going to put them in either EMDR therapy or consider psychedelics in some cases, you know. So, and then the social part, if you're, you know, if you're doing everything you can, but you're with a narcissistic abusive partner who's draining your life source. I mean, we can give you all the good food and meds that you want, but that person's got to get out of your life. Yes. Right. Yes. But you're now talking about high function depression, which means that you're depressed, but yet you're functioning. Yes. I would imagine that many of us fall within high-functioning depression. The common mistake is thinking that it's a CEO.

47:39It's someone who's, like, exceptional. No. The working mom who's single, who's just doing everything she can to keep her kids out of the streets, fed, you know, shelter, making sure the bills are paid, who doesn't look after her own needs, who doesn't take the time to feel and process, who's just on the go. She's at risk for high-functioning depression. The student whose parents didn't come from much, who's just trying to make straight A's, trying to take everyone out of the hood, high-functioning depression. The CEO who doesn't want to ever have a bankruptcy again, who works nonstop, rarely takes a break, high-functioning depression.

48:18And the athlete, we see a lot of athletes now being very vocal about what they've gone through in terms of depriving themselves of simple pleasures, pushing through trauma to make sure the team wins and neglecting themselves, high-functioning depression. So it's everywhere. It is literally everywhere. But because these are the rocks, these are the people who help others, who others depend on, because they don't seem as if they're suffering, because they're still meeting expectations, exceeding expectations, they don't get the support that they need. And that's why we hear these scary cases where it's like, this person, everything seemed fine.

48:56This suicide came out of nowhere. Well, nobody was checking in on that person. They were the strong one. That's what we always say. The strong ones need to be checked in on. They do. Yeah. So if we feel as if we have that person as a friend, as a partner, what do we do? That person has somehow along the way forgotten who they are. They have tied the role with the person. And the two are separate. You showing up for other people is not who you are. You were a person before those other people came into your life. Yes. And so because they've forgotten who they are, they don't want to be a burden.

49:36They don't want to ask for help. And know that when they open up to you, they're going to feel guilty, right? We talked about unprocessed trauma and guilt being a real hallmark of this. They're going to feel bad. Just be with them. You know, tell them that you're not a burden. The one thing I hear all the time is I just don't want to burden people. They're waiting for you. They want to help you. But just make sure that you're not making them feel like a burden because they feel that way. You know, I feel as if I have several friends in this category, high-functioning depression. And I've never heard it said so frank because I think we're told exactly what you're saying is that depression means that you're no longer functioning.

50:22So you're in bed, cover's pulled over, you're not eating. But there are so many people that I know that are in this high-functioning category. And I think, okay, given what you've just said, I can approach them in that way. But I feel as if they're going to say, you know what, I don't need, don't worry about me. I'll be fine. I'll keep going. You know, you keep going. If that becomes their pattern, if that's how they respond, is there anything else that we can do to support those high functioning, depressed people in our lives? Meet their basic needs. Because I can tell you they're not meeting their basic needs.

51:03When you're going at that rate and you're doing so much, you're not meeting your basic needs. So that's a great way to show that you care. If they are working hard, give them permission to rest. And that could look like, you know what, I'd like to come over or I'd like to make you dinner. Let them see that it's okay for others to take care of them because they're used to taking care of everyone else. If they need sleep, create that opportunity for them. If they're someone at home that you live with, show them that it's okay for them to rest. You know, they're on the go. They're doing so much, but they have permission to slow down.

51:46They just need that. They need you to tell them it's okay to slow down. When you were talking about depression, at the very end, you said anhedonia. And I've never heard of anhedonia before. It's a very strong word. I like it. Anhedonia. Am I pronouncing it correctly? You are. Anhedonia. Anhedonia. An is a lack of, head is pleasure. And then the onia is like the condition, like the symptom. Yeah. Okay. So what in the world is it exactly? What is anhedonia? In research, we rarely use the word happy, right? And that's where I talk about the disconnect between research and regular world, real world.

52:24When a patient comes in, they're going to be like, I just want to be happy. In research, we're like, well, we just want to make you undepressed, right? So medicine is all about eradicating disease and not cultivating joy, not cultivating health. And that's where I'm talking about we need to prevent. So a patient will come in and say, I want to be happy. But we're in the business of eradicating depression. So in research, when we score whether or not someone is getting better, staying the same, or getting worse, we're looking at certain points. And I call it points of joy because what is truly happiness?

53:03It is a plethora of experiences. It is when you're thirsty, feeling quenched. When you're tired, feeling rested. When you're lonely, feeling connected. That's what happiness is. But if you tell someone happiness is this picture of you in front of this mansion with this partner, they're going to be searching. Some people will never get that. Right. And they'll never find happiness. That's why we have to shift the way that we think about things. Because if we think about it in terms of points of joy, then you can try and get as many points in a day. Yes. Because the one thing we have in common with each other is that tomorrow is not promised.

53:41My dad's a pastor. He used to say that all the time on the pulpit. Tomorrow is not promised. and never knew what that meant until I became a psychiatrist. It is not promised. So try to get your joy today. And what does that look like? When you have your meal, rather than shoveling it in your face and in front of a phone or on a call, chewing your food, tasting it. Like last night I had sushi and there were these little crispy rice balls and I was like, oh, I like that, you know? I'm eating differently because I want to savor my points of joy. Yes. Right? Getting that rest, that is joy. But we always think about happiness as being these things, but happiness are these sensations.

54:21And so anhedonia happens when you're not able to derive that joy, those simple pleasures in life. You don't feel as interested in people or in things that you used to. The things that used to light you up, they just don't light you up anymore. And it's a sneaky symptom. And a lot of people will say, oh, I feel blah, or I feel meh. And I'm like, that's anhedonia. I mean, they're like, Anna what? But if you know what it is and you can identify it, then you can do something about it. So just feeling blah is anhedonia. Or is it, because interesting when you said chewing your food and actually tasting and getting the sensation and tasting the crispy rice balls, et cetera.

55:02If there are no points of joy in that, if you're tired, you rest. And there are no points of joy in that. That's anhedonia. Yes. If you're not getting pleasure from the basic things in life, you're sitting with your friends, they're all chatting and laughing and enjoying. And you used to enjoy it, but you're just like, when is this going to be over? Got to get home, right? And if you used to, right, we're going back to your baseline. If you used to eat food, like your pasta and like, oh, I love this lasagna. And then you're just like, like, it's not that good. That is a sign of anhedonia. You know, if you're like with your partner and you used to be really excited about it, but you're just like, let me just get the sex over with.

55:41Anhedonia. It's super sneaky. If you used to enjoy work and you were working and you derived a sense of pleasure from your work and now work just seems mundane, that could be a sign of anhedonia. But if you don't know what it is, you just ignore it. You think, well, that's how everybody feels. And anhedonia is closely correlated with trauma, closely correlated with substance abuse. And after the pandemic, a lot of people have unprocessed trauma and a lot of people are using more substances than they used to. And the substance is not necessarily a drug or alcohol. A substance is your phone, right?

56:17The substance is your online shopping. You're excessively doing these behaviors to self-soothe from something you don't understand. But if you can get back into your body and you start actively trying to enjoy the things you once, you know, enjoy, but don't, no longer enjoy as much, you can retrain your brain to be happier again. Okay. So then how harmful is anhedonia? Anhedonia can be very problematic in relationships in particular. You know, when you are paired with someone who no longer enjoys life, it can really take a toll. It can feel very hard on the household unit. And if you're someone who is all work, no play, and you're just about getting things done and not really enjoying life, that's contagious.

57:03I have these clients in my office, and sometimes I do treat the parent and the child just because there aren't a lot of therapists available. And you see the patterns. You see this parent who's overextended, overwhelmed. And then you see this kid who's in a gazillion activities, and you're just like, wow, it is contagious. And many times when I treat the parent and the parent gets better, then the child gets better. So it affects your whole unit. If you're a boss with anhedonia and you're all about like getting things done and who cares about pleasure, it's going to spread to your organization.

57:36People are going to get burnt out. They're going to get unhappy. They're going to leave. So it's a very serious problem. Wow. I can see it spreading from boss throughout the corporation, then into the homes of those down to the children. Even down to the pets because nobody's going to walk that pet and take it to the park. pets what dog is and hedonia you know when you said that i laughed and i think my chihuahua peter gabriel he doesn't eat chicken like he used to oh he doesn't like chicken like he used to you're working too hard i think am i the reason why he doesn't eat chicken anymore he's like i don't chicken whatever is that is that what it is i mean it could be your pet is telling you something.

58:19You may be working too hard. Gosh. Okay. So then if this is me or this is anyone listening, watching, what do we do? If we can now recognize it and say, oh, this is us, what do we do? You have to make a conscious effort to slow down and to savor the experiences. Do an experiment. When you go about your next week, right? Okay. Start to slow down a bit. slow down even more than you have been. Start to savor your experiences and see if your pet starts to savor their chicken.

58:57After one week, I'm going to let you know Peter Gabriel's eating his chicken again. Listen, we laugh about it, but it really does work. And sometimes you don't need this elaborate solution. Sometimes it is simple, but sometimes the simple is so difficult to do. Sometimes people will say, just give me a pill and fix it. They just want to do that. They don't want to slow down. They're afraid that if they slow down, they'd feel that pain. Sometimes if you're not working, you feel empty, you feel restless. You feel like there's something off. Feel it. Explore it because then we can do something about it.

59:30But if you keep busying yourself, you'll never feel it. You'll never address it. I have to be honest. That was the first time I've ever heard the term anhedonia. And I didn't realize how serious it is. But listening to Dr. Judith say that it is contagious made me realize that anhedonia not only impacts the person, but everyone around the person. So what do we do? The first step, and perhaps the most important, is to be self-aware. And why? Because once you have awareness, it leads to a more empathetic and supporting environment. And that is ultimately what allows you to become better. Is this something that we all should do?

1:00:11Whether or not we suffer from anhedonia or not is just to slow down and be able to check in on each sense, in essence, in the moment. You know, I remember I was talking to a researcher at one point and she said, you know, what we should do, whatever we're eating, for example, is you should sit, taste, smell, hear, right? If you can do that in every moment, which we can't practically, but the more that we can do that, the more enjoyment that will derive. What she's explaining is the 5-4-3-2-1 method of mindfulness. And that is where you're engaging your senses in one experience. And that's how we teach mindfulness and meditation, by using these very simple, everyday things like having a cup of tea and just looking at it and describing five things you can see, right?

1:01:06Four things you can feel in that moment. three things you can hear two things you can smell one thing you can taste it's five four three two one and the reason it's not just like loosey-goosey it's based in science because remember i talked about trauma one of the trauma responses is depersonalization and derealization so you're feeling disconnected from your body because your body's trying to your brain trying to protect you from feeling pain. Yes. And you're removed from the situation because you're trying to be removed. So people walk around in this state of like not knowing and blah, not feeling.

1:01:46Five, four, three, two, one grounds you and it puts you in a present state. And the more you practice these present states, the better your life will be. I started practicing mindfulness five years ago, late for a therapist. But I went through some stuff five years ago And I was just like, now when I'm feeling like, I don't know how I feel, I feel dysregulated. I just sit and do 5, 4, 3, 2, 1. And then I realized like, wait, I'm feeling this way because this happened. And it's leading me to feel this about myself. And like, if I just take more time, more moments to ground myself and to feel the feels, it can impact the way I behave in the next week.

1:02:27Interesting. Interesting. Interesting. So with this, this 5-4-3-2-1 method, this is a moment to put ourselves in a mindfulness state. And it could be anything. It could be the tea that you mentioned. It could be we're sitting on the train and we're just observing what's happening. It's at any moment of our lives. And you know what comes to my mind? This is terrible. This shows you maybe I am really going through anhedonia. When you said that, 5, 4, 3, 2, 1, I was like, I don't have time for that. How long does that take to do that? Listen, I taught this a course of the White House recently to the executive office of the president.

1:03:11And I was speaking with really intelligent people who love what they do. I mean, they wouldn't trade their jobs for anything. And they were just like, we don't have time for that. So what I said to that was, maybe you don't have time for all of them, but just pick one. Really be intentional about what you're tasting and describe what you're tasting. Just do one minute of that and then slowly build up to the other senses. And I think that that's the way to go with your dog, your third child. Yes. When you're playing with your little one, really be engulfed in that play. And I think with other living creatures, it's easier to be mindful, but try to get the most out of that interaction.

1:03:56There are many ways you can do it. Another tool I use is worry procrastination. And when you couple that with this mindfulness, it works. If you can schedule your worrying to one part of the home or the office that you don't spend a lot of time in and you keep it the same time every day, 20 minutes a day, and you try and save all your worries for that one corner, by the time you get to that corner, people don't even have the worries anymore. And they realize how much power they have over their thinking. It's metacognition. So what you just did just showed you that you can have control over your thoughts and your feelings.

1:04:33It doesn't mean that the problems in life aren't happening. but they're happening, but they're not controlling you. Yes. I have a question as it relates to when we are seeking a partner, when we are in the pursuit of love, and we begin to recognize through dating that, wow, our partner looks like they are suffering from anhedonia, right? They don't seem to have these pleasures around life. Maybe they're suffering from depression or high-functioning depression or there's another trauma. is that someone because we often hear baggage yes in relationships and i don't really like that phrase but in this context it sounds like that's someone with baggage and we all have baggage yes but would you say that it is to our benefit or detriment to continue to pursue a relationship with someone who is exhibiting depression high functioning depression and hedonia we all have something, right?

1:05:33We may not have a diagnosable condition, but we all have attachment styles, right? That's not a diagnosis, but we all attach in certain ways. I think that when you are with someone who has been brave enough to open up about their mental health condition, understanding A, the severity is really important because we're assuming that depression looks the same and I'm here to tell you it doesn't. So there's a range of depression. There's severe treatment-resistant depression. And then there's high-functioning depression, you know? So you want to understand how severe the condition is. And that's for anything, OCD, eating disorders, bipolar disorder, schizophrenia, there's a range.

1:06:15And then, you know, really think about what you can do. If you're someone who is a highly anxious person and you worry and you tend to ruminate and obsess and need to fix, then you may not want to pursue a relationship with someone who has a severe condition where you're going to need to be there a lot, you know? But if you're someone who you're okay with that, you know, and you, that's your personality is that, you know, like you'll just deal with it when it, as it happens, then that's not as much of an issue. So you want to understand the severity of that. If you're someone who has a past of having a parent who was severely mentally ill and you were taking care of that parent, you may not want to go down that route again.

1:07:00You may not want to partner with someone like that. So the situation is very unique. And neurodiversions is a word that's come out fairly recently. And I think we're becoming more aware of the differences in the way that we think and behave and being respectful of that and inclusive. And so understanding the different types of neurodiversity and what that means in terms of behaviors and interactions, that's a great way to start. Start educating yourself. And many times you don't know. You're partnered with someone and they don't tell you until you've attached. And then you're like, oh, well, what do I do now?

1:07:36Educate yourself. That's the, when you love someone, educating yourself about what they're going through is one of the best ways to show love. Now, this is a very important topic, perhaps the most important as it relates to how we connect with others as adults. And what is this? Attachment style. What I would recommend everyone do is read the book Attached by Amir Levine and Rachel Heller. You can also go to their website to take a free attachment quiz to better learn what your attachment style is. Just on that note too, is that are we all on a neurodivergent scale? You know, I see it as sexuality, right?

1:08:19Like no one is 100 % straight. And when I say that, I don't mean as in you're acting in a way or the behavior. Most women will open a magazine and see a beautiful woman and say, wow, beautiful, right? And have some type of like, not desire, but some emotion, some eroticism coming out, but they're not gay. They won't ever engage in behavior, nor did they want to, right? The same for men. When men see other handsome men, they're like, whoa, that's a good-looking guy. They may not be gay. I think that neurodiversity is on a spectrum. We all have something. We may not have a DSM-5 criteria, but we all attach in certain ways.

1:08:58We all have some psychological pain in our past. So I do think that being more educated and aware is helpful, but I don't want to be irreverent because there are some people who will have conditions that do create problems for them that are real challenges for them. But know that no one's perfect and no one's unscathed. We all have experiences that shape us and we all have a psychological history. Yes. Yeah. Hear, hear on the scale. And thanks for saying that, too, in terms of sexuality, because I think that's one that's not talked about enough. No. I think that was originally a Kinsey study. And it needs to be, because when you understand that, you could begin to better appreciate others.

1:09:46Yes. Right? And there's less ignorance, which ultimately is, you know, I think that's the number one stressor in life is ignorance. Yeah. There's limited access to therapy, psychiatry, et cetera, for a variety of reasons. We want to be self-aware, but I feel as if what we're doing is we're misdiagnosing as a result of being hyper-aware. Right. So how do we become aware but not misdiagnose? Right. I think self-awareness and self-education is key. Okay. Self-diagnosis, absolutely not. Like, you know, I went to four years of medical school, four years of residency, and then practiced for years. And sometimes I'm still like, which diagnosis is this, you know?

1:10:31Why should you be at home trying to figure out what you are? Right. You know, I think that identifying symptoms and understanding if they impact your life is important. But, for example, something like ADHD can look very much like generalized anxiety disorder, right? And then people who are autistic can have symptoms of ADHD and depression and anxiety. And it's just like a lot to ask someone to try and parse out everything. I do think that educating yourself about symptoms is very difficult because people don't want to read. You know, like we'd rather look at a TikTok and be like, oh, I think I had that on with my life.

1:11:08Then go to like the Mayo Clinic and list out the resources and read the papers. Nobody wants to do that. Right. No one wants to do that. So I think that teaching yourself and giving yourself the gift of knowledge is the best thing that you can do. And it's important. I'm seeing that a lot with women these days who are getting diagnosed with depression and what they really have is a perimenopausal mood disorder. So completely different treatments. And because they're not, you know, a lot of the doctors don't have training in menopause, they're misdiagnosing. So if it's confusing for a doctor, why are you doing it?

1:11:47So when we have control over our thoughts, which we do, we have control over our thoughts, then you're saying then we can therefore control our feelings. Yes. You can pick and choose which feelings you want to give a pedestal to. Okay. Okay. You can choose to feel dysregulated or regulated. And most people feel like, well, I can never be regulated. You can. Yes. That's incredibly powerful because I think many of us feel as if our feelings are given to us by the environment. But you're saying no. No. We assign what those feelings are. So we control our thoughts and our thoughts control our feelings.

1:12:25It's more along the lines of, I don't want to invalidate your feelings, but I can show you how to give certain feelings more of a pedestal, right? So it's like, yep, the feelings are still there, but which ones do you want to put more on a pedestal? Which one would you want to give more attention to? Yes. And that level of control can be mind-blowing for people who felt that things were happening to them all their lives, that they had no control. Yes. So in the context of a relationship, let's say an argument, disagreement, right? Right. So in those moments, we can then control our feelings in those moments.

1:13:06You can choose the feelings you want to give prominence to. Okay. It's almost like pulling the curtains out and here's the actor. You can be like, which feeling do I want to portray right now? Do I want to come out angry, guns a-blazing, or do I want to come out and be thoughtful? And do I want to be a bit more compassionate right now. Yes. Yes. And then would you say then, then our feelings then control our behavior? They can. And that then impacts outcomes. It can. And also, you know, the cognitive behavioral triangle, it can go the other way. Sometimes you don't feel like getting out of bed, but if you get out of bed, it shifts everything.

1:13:50So, you know, understanding and visualizing that is giving, it just gives people so much power. Yes. Like, I don't want to do this thing. But if you do it, then maybe that'll change that don't want to anymore. Yes. That changes it. It's extremely powerful. And when you start to get it, there's like no turning back. It's that light bulb. You'll just keep following the light. You'll keep doing it. And in the cognitive behavioral triangle, the points of that triangle are? The thought, feeling, behavior. It used to be thought that the thought leads to the feeling, which leads to the behavior. But now we're learning that some people need to spend more time in the feelings part because some people don't take the time to feel.

1:14:32And then other people need to spend more time in the behavior part. And that shifts everything the other way around. That changing the behavior changes the way you feel, which changes your thinking. And for some, it's about changing that thought. Yes. Right? So everyone's different. And at certain points in your life, you may be able to focus on one of those corners. But knowing that those corners even exist is important. Yes. So powerful. So powerful. I have two more for you. Okay. Very end. When you were four years old, if you can go back and give yourself advice when you were four, just arriving to America, what would you have told yourself?

1:15:11When I was four, I told myself I wanted to be a scientist and a doctor. Right? Here I am, a scientist and a doctor. Sure. But wow, like the differences in the scientist and doctor that I am today versus five years ago, it's night and day. I mean, before when I was a child, it was all about work and then the happiness will be there, right? If you work with work, happiness will be there. Now I'm like, happiness happens today. I can make happiness today. Forget about down the line. It is still important, but I want to focus on today because tomorrow is not promised. So I live my life like that now.

1:15:55And it is just, again, it's a mind shift. It's like, how do I increase these points of joy every day so that every day my life feels rich, feels full, feels happier? Yes. Are you happy? I am. If you can't tell. I can definitely tell. I love what I do. I love helping people. And at one point, I don't know how much you know about medical doctors, but they study a lot. Yes. And when I was a child, I loved reading. I just, knowledge was like everything. But at some point along the way, I think it was maybe in between organic chemistry and neurosurgery, Learning just became something you had to do to just get to the outcome.

1:16:41And I think a lot of doctors are like that. I think a lot of them have anhedonia and they have high-functioning depression. So when they see it in their patients, they don't identify it because they're like, well, you're fine. You're just like me, right, on an unconscious level. But that's why there's so much burnout in medicine, so many, such high rates of suicide and substance abuse in medicine, because you're living your life for some future rather than today. And I think when we change that, when we shift that within our medical culture, it'll bleed out into the population. We'll change the way we see patients rather than going to your doctor's office and they're checking the boxes.

1:17:16They're going to be like, so what brought you joy this month? And you're going to be like, what? I came here from my heart. Wrong doctor. No. But when you think about it that way in medicine, because most of us will never see a psychiatrist or a therapist, but we will see a primary care doctor. We will see a pediatrician. Yes. When we shift that way about thinking and about approaching life, we're going to see a change in the amount of heart disease, you know, the amount of autoimmune issues. Just everything will get better. And I think when we shift and we start focusing on points of joy rather than this elusive thing that may never happen, I really do think the world will be better.

1:17:54People will be less angry. They'll be more tied to their communities. They'll be off their phones more. They'll be about the greater good. So I do think it has the infinite possibility to change the world. Yes, I'm with you. I'm with you. There is a question that we ask all of our guests here. And that is, you have had, we know, you've had some amazing conversations in your life. Some incredible conversations with incredible people. If you can choose the most memorable conversation, who was it with and what was the discussion about? Well, I mentioned that five years ago, something terrible happened.

1:18:36But so my mentor had just had passed away and he was an extraordinary person. And I didn't take the time to process that because he passed away, left me all of his patients. I was a young practicing physician. I inherited this huge caseload, but I just didn't want to let him down. So that was a trauma that I just didn't process. But I remember when he passed, he said to me, Judith, our last conversation, he said, it goes by so fast. It just goes by so fast. And he just said, like, don't make the mistake I made. Like, make sure you spend time with your loved ones. And that stuck with me. So, like, that is the most memorable conversation.

1:19:22I have to leave you with this is that hit me on another level. because my most memorable conversation was with an uncle who was on his deathbed. And you know what words he told me? What was that? It goes by so fast.

1:19:42Those were the last words that I heard from him. But when you're on your deathbed, you're not going to be thinking about, I wish I got that big account. I wish I had done this one great TikTok. You're going to be like, I wish I had more time with the people that I loved the most. So it goes by fast. You got to take the time to save for it. Yes. Dr. Judith Joseph, thank you so much. Thank you. It has been a pleasure. Yes, it was mine. The pleasure is mine. Thank you. Thank you. This was an incredible episode. And here are my top takeaways. Number one, the biggest shift you can make in any relationship starts with self-awareness.

1:20:18When we develop mindfulness, we enhance our emotional regulation and improve communication, which helps us build deeper connections. Judith's insights remind us that instead of focusing on what others are doing wrong, working on ourselves often makes what has bothered us about others fade away. By taking this approach, we become less reactive and more present, which strengthens our relationships in meaningful ways. Number two, mental health issues like anhedonia are serious and can impact entire relationships and work environments. When someone can't find joy in life, it affects not just them, but everyone around them, creating disconnection within families and leading to burnout in workplaces.

1:21:02Recognizing this is the first step in creating more supportive and empathetic spaces where people feel valued and understood. Takeaway number three, past trauma and scarcity mindset can significantly shape how we relate to others, often leading us to be overly self-reliant and guarded. We just learned how attachment trauma, like separation from family at a young age, can create a pattern of depending solely on ourselves. Recognizing how these experiences influence our relationship behaviors allows us to bring more empathy and resilience into our connections, helping us break cycles rooted in fear and creating healthier, more supportive relationships.

1:21:44And number four, happiness isn't just something to chase for the future. It's something we can create today. By focusing on joy and meaningful connections in the present moment, we enrich our relationships and make them more fulfilling. Always remember, life is short, so make today count.