WEBVTT - When Productivity Becomes Pathological 0:00:14.956 --> 0:00:15.396 Pushkin. 0:00:29.876 --> 0:00:32.196 We were built with the DNA for joy. We're supposed 0:00:32.236 --> 0:00:36.236 to derive pleasure from the basic things in life. If 0:00:36.236 --> 0:00:39.556 you're not deriving pleasure from those things, that is a problem. 0:00:39.596 --> 0:00:41.876 That's a warning sign, because we're supposed to be able 0:00:41.916 --> 0:00:44.036 to experience joy. 0:00:44.156 --> 0:00:47.916 Doctor Judith Joseph is a psychiatrist and a clinical researcher. 0:00:48.556 --> 0:00:51.556 These days, joy is a key part of her life, 0:00:52.036 --> 0:00:55.196 but that wasn't always the case. Just a few years ago, 0:00:55.436 --> 0:00:57.996 things looked great from the outside. She was crushing it 0:00:57.996 --> 0:01:01.196 at work and collecting accolades, but on the inside she 0:01:01.316 --> 0:01:01.956 was struggling. 0:01:02.396 --> 0:01:05.476 And I thought, well, if I'm like this and it 0:01:05.556 --> 0:01:07.996 snuck up on me, I wonder how many people like 0:01:08.116 --> 0:01:11.596 me experience I wonder how many people are hiding behind 0:01:12.036 --> 0:01:16.756 a mask of pathological productivity and they're using that busyness 0:01:16.756 --> 0:01:19.836 to cope with something that they have not processed and 0:01:19.916 --> 0:01:21.156 something that's unresolved. 0:01:25.356 --> 0:01:33.116 On today's show, The Mask of Pathological Productivity, I'm Maya Schunker, 0:01:33.276 --> 0:01:36.716 a scientist who studies human behavior, and this is a 0:01:36.716 --> 0:01:39.356 slight change of plans, a show about who we are 0:01:39.556 --> 0:01:46.876 and who we become in the face of a big change. 0:01:51.756 --> 0:01:54.716 Doctor Judith Joseph is the founder of a research lab 0:01:54.796 --> 0:02:00.156 that explores novel treatments for mental health conditions, conditions like anxiety, depression, 0:02:00.316 --> 0:02:05.036 and ADHD. She's also a professor of psychiatry at NYU 0:02:05.476 --> 0:02:10.116 and a practicing psychiatrist. Judith says that back in med school, 0:02:10.356 --> 0:02:13.756 she surprised her family by choosing to go into psychiatry. 0:02:14.516 --> 0:02:16.876 When I went to medical school, I was the first 0:02:16.916 --> 0:02:19.596 person to graduate from college in my family, the first 0:02:19.676 --> 0:02:22.476 doctor in my family. And so if I went to 0:02:22.516 --> 0:02:24.556 my family and I said I want to be a psychiatrist, 0:02:24.596 --> 0:02:28.156 they'd be like, what, that's not a real doctor. My 0:02:28.236 --> 0:02:30.476 dad is a pastor. He still is a pastor. So 0:02:30.556 --> 0:02:32.636 I was a pastor's kid, went to church three times 0:02:32.636 --> 0:02:35.676 a week. And now that I look back, I have 0:02:35.796 --> 0:02:38.916 these memories of people coming into the church and people 0:02:38.956 --> 0:02:41.676 who were thought to have demons. But now I'm like, oh, 0:02:41.676 --> 0:02:45.436 my gosh, that was actually untreated schizophrenia, or people who 0:02:45.556 --> 0:02:49.236 had mood swings, and you know, I think, well, that 0:02:49.356 --> 0:02:52.836 was actually a substance induced mood disorder. And people with 0:02:52.956 --> 0:02:55.716 severe depression who were told to just pray themselves out 0:02:55.756 --> 0:02:57.676 of it. You know, I see all of these things 0:02:57.716 --> 0:03:00.876 that could have been addressed from a mental health perspective, 0:03:00.876 --> 0:03:05.036 but from a cultural perspective, they were called something completely different. 0:03:05.236 --> 0:03:07.676 And when I actually told my parents that I was 0:03:07.716 --> 0:03:11.876 switching from antisysiology to psychiatry, my dad was like, well, 0:03:11.916 --> 0:03:13.636 why you want to work with them crazy people? You 0:03:13.636 --> 0:03:17.196 know they're from the Caribbean. And I said, well, Daddy, 0:03:17.396 --> 0:03:19.716 the brain is part of the body too, and so 0:03:19.796 --> 0:03:22.596 if someone were to have asthma, you wouldn't tell them 0:03:22.596 --> 0:03:24.396 to pray out of it. You'd say, oh, you should 0:03:24.396 --> 0:03:26.636 really go to a doctor and get an inhaler and 0:03:26.676 --> 0:03:29.356 think about all the allergens that are triggering that. But 0:03:29.476 --> 0:03:32.556 for some reason, in many cultures, it is still pervasive, 0:03:32.636 --> 0:03:35.076 this idea that if you have, you know, a mental 0:03:35.116 --> 0:03:38.476 health condition, somehow you should be able to pull yourself 0:03:38.516 --> 0:03:41.716 out of it. That's different than physical health. But we 0:03:41.796 --> 0:03:43.556 know that the brain is connected to the body, and 0:03:43.636 --> 0:03:45.276 I believe it's the most important organ. 0:03:45.316 --> 0:03:46.396 But that's my bias as. 0:03:46.316 --> 0:03:49.956 A psychiatrist, it's my bias as a cognitive neuroscientist. 0:03:50.676 --> 0:03:52.236 We share the same bias. Judents. 0:03:53.796 --> 0:03:56.796 You know, you had your own struggles with mental health 0:03:56.876 --> 0:03:59.636 early in the pandemic, and I'm wondering if you can 0:03:59.676 --> 0:04:02.316 bring me back to that period of time and set 0:04:02.356 --> 0:04:04.996 the scene about what was going on in your life. 0:04:06.036 --> 0:04:10.556 I was giving this talk to very busy, large hospital 0:04:10.596 --> 0:04:14.236 system in April twenty twenty, and they had asked me 0:04:14.236 --> 0:04:16.196 to give the talk because a lot of the healthcare 0:04:16.236 --> 0:04:20.836 professionals were very anxious, very stressed out, and concerned about 0:04:21.076 --> 0:04:21.956 their mental health. 0:04:22.116 --> 0:04:23.636 No one knew what was going to happen. 0:04:24.236 --> 0:04:27.116 The world was in a state of uncertainty, and I 0:04:27.196 --> 0:04:30.636 was supposed to be one of the voices of hope 0:04:30.796 --> 0:04:34.996 giving people skills. But halfway through that talk, I just 0:04:35.036 --> 0:04:37.716 felt like, I think I'm depressed, Like it kind. 0:04:37.556 --> 0:04:39.116 Of stuck up on me. You know. 0:04:39.156 --> 0:04:41.356 In the past, given a talk like that would have 0:04:41.796 --> 0:04:44.996 been really pleasurable for me, you know, but I just 0:04:45.036 --> 0:04:48.916 felt kind of muh bleh. And I just felt really 0:04:49.276 --> 0:04:53.876 lost because the hopelessness was palpable in that presentation. People 0:04:53.876 --> 0:04:56.276 were writing in things like they don't know if they're 0:04:56.276 --> 0:04:57.756 going to be able to see their family, they don't 0:04:57.796 --> 0:05:00.836 know if they could infect people, and it's just like, well, 0:05:00.876 --> 0:05:02.316 I don't know how I'm doing. How am I going 0:05:02.356 --> 0:05:03.916 to help you? I can't even take care of myself. 0:05:03.916 --> 0:05:05.956 That was the moment I had in that moment. But 0:05:06.076 --> 0:05:09.196 you know, on the outside, everything looked perfect. I I 0:05:09.196 --> 0:05:12.396 had just gotten onto this prestigious board of women from 0:05:12.436 --> 0:05:16.516 this MV League institution. My lab was the only lab 0:05:16.516 --> 0:05:18.476 in the building still running. You know, I was still 0:05:18.516 --> 0:05:21.276 taking care of my team, my employees. I had a 0:05:21.276 --> 0:05:24.716 little cute kid at home, perfect marriage, what it looked 0:05:24.756 --> 0:05:25.356 like on the outside. 0:05:25.396 --> 0:05:26.356 But I couldn't slow down. 0:05:26.516 --> 0:05:29.156 In fact, I think that I was probably at the 0:05:29.196 --> 0:05:32.676 height of the most I've ever worked in my entire life. 0:05:33.516 --> 0:05:36.556 My worst fear was not being able to provide from 0:05:36.556 --> 0:05:40.316 my team for my family, letting my patients down. 0:05:40.956 --> 0:05:42.516 So I was coping with that. 0:05:42.596 --> 0:05:48.196 By overfunctioning, overproducing, overworking. I could not sit still, and 0:05:48.236 --> 0:05:51.116 I thought, well, how did I let this happen? I 0:05:51.156 --> 0:05:53.756 internalized that shame and blame, like I should know better. 0:05:53.796 --> 0:05:57.516 I'm a psychiatrist, I studied depression. How did this snake 0:05:57.596 --> 0:05:57.996 up on me? 0:05:58.916 --> 0:05:59.916 And I think a. 0:05:59.876 --> 0:06:03.076 Lot of therapists go through this. We deal with a 0:06:03.116 --> 0:06:08.796 lot of emotions, grief, We deal with this vicarious trauma 0:06:08.836 --> 0:06:13.516 because we hear people's pain all the time, and we 0:06:13.676 --> 0:06:16.796 just we put on that mask because we have to 0:06:16.796 --> 0:06:20.196 show up for others, so many of us feel alone. 0:06:20.316 --> 0:06:23.396 But I thought, well, if I'm like this and it 0:06:23.476 --> 0:06:25.956 snuck up on me, I wonder how many people like 0:06:26.036 --> 0:06:29.116 me experience this. I wonder how many people are hiding 0:06:29.156 --> 0:06:33.716 behind a mask of pathological productivity and they're using that 0:06:34.036 --> 0:06:37.596 busyness to cope with something that they have not processed 0:06:37.716 --> 0:06:39.356 and something that's unresolved. 0:06:39.796 --> 0:06:43.156 You've written that you were caught off guard hearing yourself 0:06:43.236 --> 0:06:47.036 say that you felt depressed because you were so functional 0:06:47.076 --> 0:06:48.036 and so productive. 0:06:49.076 --> 0:06:52.916 Well, it's interesting because every day I have to use 0:06:52.956 --> 0:06:57.396 the DSM five to diagnose people, the Diagnostic Statistical Manual. 0:06:57.556 --> 0:07:00.996 So symptoms of depression are low concentration, things like guilt, 0:07:01.596 --> 0:07:04.356 low energy, changes in your appetite, changes in your sleep, 0:07:04.556 --> 0:07:08.956 You feel restless, you can't sit still. Depression by definition, 0:07:09.476 --> 0:07:11.876 does not require a low mood, and I don't think 0:07:11.916 --> 0:07:14.836 people know that. By definition, you could either have a 0:07:14.876 --> 0:07:18.676 low mood, you know, the classic depression, crying sadness or 0:07:18.756 --> 0:07:22.556 anne Hondonia, which is a lack of interest and pleasure 0:07:22.956 --> 0:07:25.956 in things that you once enjoy. So there are a 0:07:25.996 --> 0:07:28.396 lot of people out there who don't look sad, but 0:07:28.436 --> 0:07:31.836 they're struggling with Anne Hondonia and they don't even realize 0:07:32.116 --> 0:07:34.596 that you don't have to be sad to meet criteria 0:07:34.596 --> 0:07:37.716 for a depression. And listen, I was someone who experienced this, 0:07:37.836 --> 0:07:39.876 and I knew the criteria. I looked at the data 0:07:39.916 --> 0:07:42.076 sent every day, and it still snuck up on me. 0:07:42.556 --> 0:07:44.356 So I just thought people need to know about this. 0:07:44.836 --> 0:07:47.196 Antonia in research is such a boring term, But when 0:07:47.236 --> 0:07:49.436 I started talking about online, it just blew up and 0:07:49.476 --> 0:07:50.996 I was like, why are people so interested in this 0:07:50.996 --> 0:07:54.236 boring term. It's because they could finally name what they 0:07:54.236 --> 0:07:57.676 were experiencing. It was validating because they knew something was off, 0:07:57.716 --> 0:07:59.756 they knew something didn't feel right, they just didn't have 0:07:59.796 --> 0:08:02.316 a name for it. And in psychology there's a term 0:08:02.356 --> 0:08:05.676 called affic labeling. If you can identify the emotion, if 0:08:05.676 --> 0:08:08.876 you can name it accurately, that in itself decreases your 0:08:08.876 --> 0:08:12.236 own certainty because not knowing and then thinking, well, why 0:08:12.276 --> 0:08:14.516 am I not feeling better? What's wrong with me? That 0:08:14.596 --> 0:08:18.476 uncertainty just makes you feel more stressed. And it's really 0:08:18.556 --> 0:08:20.876 hard to be joyful in at peace when you don't 0:08:20.876 --> 0:08:24.956 know what's happening. So naming the antaedonia identifying it in 0:08:24.996 --> 0:08:26.876 itself is very powerful. 0:08:27.716 --> 0:08:30.636 Yeah, what happened next? What did it take for you 0:08:30.676 --> 0:08:33.516 in that moment to try and seek help. 0:08:34.156 --> 0:08:34.876 Here's the thing. 0:08:35.476 --> 0:08:38.876 As someone who is used to being the good girl, 0:08:38.956 --> 0:08:41.916 the people pleaser, I wasn't even aware as to how 0:08:41.956 --> 0:08:44.036 I was people pleasing in my own therapy. I didn't 0:08:44.036 --> 0:08:47.916 want to tell my therapist that I was experracy anadonia 0:08:47.916 --> 0:08:49.556 because I didn't want to let her down. And I'm 0:08:49.596 --> 0:08:50.356 a therapist. 0:08:51.596 --> 0:08:55.636 You are speaking my language, so it's like, yeah, wow, continue, 0:08:55.636 --> 0:08:57.796 I just need to say that I feel so seen 0:08:57.916 --> 0:08:58.316 right now. 0:08:59.076 --> 0:08:59.756 Oh thank you. 0:09:00.076 --> 0:09:01.916 I mean initially I did feel a lot of shame 0:09:01.956 --> 0:09:05.996 and blame, but I didn't share with my therapist. And 0:09:06.036 --> 0:09:08.036 she said, you know, I knew something was going on. 0:09:08.156 --> 0:09:10.516 I just I was waiting for you to say it. 0:09:10.636 --> 0:09:13.756 I knew something was going on. She says, whenever you 0:09:13.796 --> 0:09:22.316 get really busy, something's off. And you've been really busy again, 0:09:22.356 --> 0:09:26.636 back to that pathological productivity. Yeah, I go to for 0:09:26.796 --> 0:09:32.316 coping with pain is busying myself. But in the trauma research, 0:09:32.436 --> 0:09:36.276 in the PTSD research that I do, most people think 0:09:36.356 --> 0:09:42.556 of avoidance as avoiding people, places, or situations that trigger you. 0:09:43.276 --> 0:09:46.876 But those of us who use busyness, we avoid dealing 0:09:46.916 --> 0:09:50.076 with our pain by trying to outrun it with work, 0:09:50.396 --> 0:09:54.236 by taking on side projects. There's something within us that 0:09:54.276 --> 0:09:57.076 doesn't allow us to rest. So we're constantly moving. We're 0:09:57.116 --> 0:10:00.356 constantly busy. When we are not busy, we feel empty. 0:10:00.636 --> 0:10:02.556 When we are not working, we feel restless. 0:10:02.556 --> 0:10:04.796 We just do, and it doesn't necessarily have to be work. 0:10:05.156 --> 0:10:07.596 Maybe it's cleaning out your garage, maybe it's taken on 0:10:07.676 --> 0:10:10.196 a side hustle, maybe it's taken on other people's problems 0:10:10.316 --> 0:10:10.916 or projects. 0:10:11.236 --> 0:10:12.396 You just can't sit still. 0:10:13.196 --> 0:10:18.036 You're avoiding processing what's really happening with and so that 0:10:18.196 --> 0:10:19.796 was me. So she said to me, you know, you've 0:10:19.796 --> 0:10:22.276 been so busy. I just knew something was off. I 0:10:22.316 --> 0:10:24.436 was just waiting for you to tell me, and I'm 0:10:24.516 --> 0:10:25.636 so glad that you did. 0:10:26.276 --> 0:10:29.076 You also started to notice around this time that so 0:10:29.196 --> 0:10:33.076 many other people were sharing a similar constellation of symptoms. 0:10:33.836 --> 0:10:38.076 You eventually identified this as high functioning depression, but you 0:10:38.116 --> 0:10:41.076 saw that there was little clinical research on this condition, 0:10:41.316 --> 0:10:44.396 and so you and your lab decided to start focusing 0:10:44.436 --> 0:10:48.596 on it. Since high functioning depression is likely a new 0:10:48.676 --> 0:10:51.636 term for a lot of listeners. I'd love if you 0:10:51.676 --> 0:10:53.076 could define it for us. 0:10:53.436 --> 0:10:55.676 It's that type of depression where you don't look sad 0:10:55.716 --> 0:10:58.516 and you're weepy. It's that type of depression where you 0:10:58.556 --> 0:11:03.476 don't feel joy. Clinical depression happens when you meet the 0:11:03.476 --> 0:11:07.556 criteria for certain symptoms of depression like changes in your sleep, 0:11:07.636 --> 0:11:14.036 changes in your appetite, low energy, restlessness or being sluggish, guilt, hopelessness, etc. 0:11:14.556 --> 0:11:17.556 And you have to have either low mood, depressed mood, 0:11:17.676 --> 0:11:20.796 or an hedonia. But you also have to meet that 0:11:20.836 --> 0:11:24.956 final box of I'm not functioning. And so a lot 0:11:24.996 --> 0:11:28.956 of folks don't meet that checkbox. They can't slow down, 0:11:28.996 --> 0:11:31.796 they're like me, they're running from something, or they're busy. 0:11:32.516 --> 0:11:35.116 But if you don't, at the very bottom check that 0:11:35.276 --> 0:11:38.756 box of your lacking functioning or you're in significant distress, 0:11:39.236 --> 0:11:42.276 your healthcare professional will just say, well, come back when 0:11:42.636 --> 0:11:45.316 you break down. And so I thought, well, how come 0:11:45.356 --> 0:11:47.876 we don't ever look at these other types of depressions. 0:11:48.716 --> 0:11:51.036 When you look at what's happening in medicine these days, 0:11:51.156 --> 0:11:54.756 especially in the longevity space, it is the complete opposite. 0:11:54.796 --> 0:11:57.436 We're saying, let's not wait for stage four cancer, let's 0:11:57.516 --> 0:12:01.076 educate patients and catch the cancer risks. Or with the 0:12:01.116 --> 0:12:05.236 menopause space, we're seeing people saying educate women about hormones, 0:12:05.436 --> 0:12:08.836 educate them about their diet and their movement. Because we 0:12:08.876 --> 0:12:11.796 want to prevent a heart issue, we want to prevent 0:12:12.316 --> 0:12:15.756 a bone breaking from ostroporosis. So in other fields of 0:12:15.756 --> 0:12:19.756 medicine we're experiencing this renaissance of preventative care, but in 0:12:19.796 --> 0:12:22.436 mental health, we're still waiting for people to check that 0:12:22.556 --> 0:12:27.396 box before we do something. And I wanted to focus 0:12:27.436 --> 0:12:30.476 on those of us who don't break down. We were 0:12:30.516 --> 0:12:33.196 built with the DNA for joy. We're supposed to derive 0:12:33.316 --> 0:12:36.796 pleasure from the basic things in life. But if you're 0:12:36.876 --> 0:12:39.436 not deriving pleasure from those things, and some of the 0:12:39.436 --> 0:12:41.316 things that are on that rating scale are things like 0:12:41.556 --> 0:12:44.516 when you eat a meal, do savor it? When you're 0:12:44.556 --> 0:12:47.996 having a sip of tea, does it refresh you? When 0:12:48.036 --> 0:12:49.756 you take a rest, when you take a nap, do 0:12:49.756 --> 0:12:50.996 you wake up refreshed? 0:12:51.156 --> 0:12:51.276 Like? 0:12:51.556 --> 0:12:54.596 These are all things that are supposed to be points 0:12:54.596 --> 0:12:56.836 of joy for human beings. So if you're not able 0:12:56.876 --> 0:12:59.476 to access that, that is a problem. That's a warning sign. 0:12:59.556 --> 0:13:02.556 It doesn't look as flashy as crying in bed and 0:13:02.596 --> 0:13:05.116 staying in bed all day. But it is still a 0:13:05.156 --> 0:13:08.276 crisis because we're supposed to be able to experience joy. 0:13:09.236 --> 0:13:11.516 Yeah, I'm just thinking about one of my best friends 0:13:11.596 --> 0:13:15.396 in the whole world, and she's described what I'm now 0:13:15.516 --> 0:13:18.476 registering as anaedonia as being almost like seeing the world 0:13:18.556 --> 0:13:22.836 in gray scale. So she's like, there's nothing palpably wrong 0:13:22.916 --> 0:13:26.516 in any given moment. But I don't, like you said, 0:13:26.716 --> 0:13:29.796 I just don't feel joyful about the things, Like I 0:13:29.836 --> 0:13:33.276 almost feel a sense of remove when I'm in experiences 0:13:33.276 --> 0:13:36.556 that would otherwise have brought me joy. And just like 0:13:36.956 --> 0:13:40.516 reflecting on how valuable this conversation would be for someone 0:13:40.556 --> 0:13:42.916 like her, who has, never, like you said, met the 0:13:42.956 --> 0:13:45.836 criteria for depression. She goes to a doctor. Doctors like, 0:13:46.356 --> 0:13:49.236 you're keeping up your job, You're still in a happy marriage, 0:13:49.236 --> 0:13:52.236 things are stable for you, Like what gives why are 0:13:52.236 --> 0:13:55.156 you here? But like you said, humans are designed to 0:13:55.196 --> 0:13:58.516 feel joy, and so it's important that we allow people 0:13:58.676 --> 0:14:00.516 that access right to. 0:14:00.476 --> 0:14:03.116 One of the most primal needs of human beings. 0:14:03.356 --> 0:14:05.716 Joy doesn't mean that you're everything is perfect. It doesn't 0:14:05.716 --> 0:14:09.036 mean that you have no problems. Joy is acts a 0:14:09.156 --> 0:14:13.956 saying those experiences where you're able to find pleasure. So 0:14:14.356 --> 0:14:16.836 if you're in your life and you're not connecting with 0:14:16.876 --> 0:14:21.036 your partner, you're not finding that satisfaction anymore. You're eating 0:14:21.076 --> 0:14:22.516 your food and you don't even taste it, you're just 0:14:22.636 --> 0:14:25.316 kind of shoving it in. These are all points of 0:14:25.396 --> 0:14:28.636 joy that you're losing. So it's worth investigating. It's worth 0:14:28.756 --> 0:14:31.996 understanding what's happening in your life because joy is your 0:14:32.036 --> 0:14:32.676 birthright as. 0:14:32.556 --> 0:14:33.036 A human being. 0:14:33.076 --> 0:14:35.716 If you're not feeling it anymore, it's a red flag 0:14:35.836 --> 0:14:38.116 that you need to dig a little deeper and figure 0:14:38.116 --> 0:14:38.916 out what's happening. 0:14:39.756 --> 0:14:41.596 Yeah, I mean, I really do think we put such 0:14:41.636 --> 0:14:44.836 a premium on the alleviation of suffering, but we rarely 0:14:44.836 --> 0:14:47.396 think about the inverse, which is the reclamation of joy. 0:14:48.196 --> 0:14:50.836 Well, many of us are trying to outrun suffering, like 0:14:50.956 --> 0:14:52.276 myself included. 0:14:52.876 --> 0:14:53.676 So what did I do. 0:14:53.756 --> 0:14:59.196 I chased accolades, chase success, money, hoard at all these resources, 0:14:59.316 --> 0:15:03.916 but I was left feeling completely joyless. So you think 0:15:03.956 --> 0:15:07.516 you're trying to alleviate your suffering, but you're actually robbing 0:15:07.556 --> 0:15:09.636 yourself of joy. 0:15:12.596 --> 0:15:14.756 We'll be back in a moment with a slight change 0:15:14.796 --> 0:15:39.236 of plans. After years of research, Judith and her colleagues 0:15:39.276 --> 0:15:44.556 published the first empirical study on high functioning depression. Judith's 0:15:44.556 --> 0:15:48.476 new book is called High Functioning, Overcome Your Hidden Depression 0:15:48.716 --> 0:15:53.396 and Reclaim Your Joy. It draws on original research, patient stories, 0:15:53.796 --> 0:15:57.956 and her personal journey with the condition. Are there particular 0:15:58.036 --> 0:16:02.156 populations of people who are more predisposed to high functioning 0:16:02.196 --> 0:16:04.676 depression and if so, why do you think it's more 0:16:04.716 --> 0:16:06.036 prevalent in these populations. 0:16:06.556 --> 0:16:08.556 Well, I've done the only study in high function depression, 0:16:08.596 --> 0:16:11.276 so it's hard to make a claim. But what I 0:16:11.356 --> 0:16:14.356 do know about depression is that depression tends to impact 0:16:14.396 --> 0:16:16.076 women twice as likely as men. 0:16:16.636 --> 0:16:19.596 Whenever I hear that number, I'm like what, But then 0:16:19.636 --> 0:16:22.516 I'm like, okay, yeah, that makes sense. There are a 0:16:22.556 --> 0:16:23.396 lot of reasons for. 0:16:23.436 --> 0:16:29.476 Us, psychologically and socially. I also think that underserved populations 0:16:29.596 --> 0:16:32.756 go through a lot of trauma. And we know that 0:16:33.116 --> 0:16:36.876 black populations have high rates of PTSD, and some studies 0:16:36.916 --> 0:16:42.316 indicate the highest, And yet we're the population that seems 0:16:42.316 --> 0:16:45.716 to survive just about everything thrown at us. We survive slavery, 0:16:46.036 --> 0:16:50.316 civil rights, injustices, but a lot of that unprocessed trauma 0:16:50.316 --> 0:16:53.076 will catch up to us. We do have to acknowledge 0:16:53.076 --> 0:16:55.356 our mental health, and even though we have high rates 0:16:55.356 --> 0:16:58.316 of trauma, we're not as likely to seek treatment. And 0:16:58.356 --> 0:17:00.876 that's from a host of different reasons, access to care, 0:17:01.276 --> 0:17:04.756 the social determinants of health, and not having enough providers 0:17:04.796 --> 0:17:08.796 that even look like US healthcare professionals are at high 0:17:08.876 --> 0:17:12.796 risk for depression, and the rates of societality and residence 0:17:12.796 --> 0:17:16.156 in medical residence is higher than the general population, so 0:17:16.196 --> 0:17:18.876 the healers are on healed. I think it's really hard 0:17:18.876 --> 0:17:23.236 for doctors to address antedonia as a symptom and a 0:17:23.276 --> 0:17:25.476 problem in their patients because they probably feel a lot 0:17:25.516 --> 0:17:26.636 of antadonia themselves, and. 0:17:26.636 --> 0:17:28.556 They're like, well, why would I diagnose something that I expect. 0:17:28.596 --> 0:17:31.316 Welcome to the club being human, right, this is my 0:17:31.396 --> 0:17:32.236 baseline state? 0:17:32.316 --> 0:17:33.156 Yeah, exactly. 0:17:33.636 --> 0:17:37.316 Yeah, that makes so much sense before we get into 0:17:37.516 --> 0:17:40.036 some first steps people can take. If they are listening 0:17:40.076 --> 0:17:43.116 to this conversation and thinking, oh my god, Judith, I 0:17:43.236 --> 0:17:46.076 definitely have high functioning depression. I just want to quickly 0:17:46.116 --> 0:17:49.756 ask about the journey you've had as one of a 0:17:49.876 --> 0:17:53.676 very small percentage of black physicians in the US trying 0:17:53.716 --> 0:17:59.276 to put forth a somewhat revolutionary and controversial idea, novelty 0:17:59.316 --> 0:18:02.036 of any kind, and feels like this will receive pushback, 0:18:02.116 --> 0:18:04.436 but I want to know what the experience was like 0:18:04.476 --> 0:18:07.796 to like challenge conventional wisdom and put forth this idea. 0:18:07.836 --> 0:18:10.916 Given that just under three percent of physicians in the 0:18:11.036 --> 0:18:12.636 US are black women. 0:18:12.556 --> 0:18:15.596 Yes, and less than two percent of psychiatrists are black, 0:18:15.916 --> 0:18:19.076 so it's like wow. But yeah, Initially when I was 0:18:19.116 --> 0:18:22.236 doing this work, I got a lot of messages from people, 0:18:22.796 --> 0:18:29.076 psychologists and psychiatrists messaging me, calling me, emailing me, Oh, 0:18:29.116 --> 0:18:32.836 this is just another thing you're trying to pathologize. But 0:18:32.956 --> 0:18:36.756 fast forward now it's the opposite. I have doctors reaching 0:18:36.796 --> 0:18:39.716 out to me saying your book has changed my life, 0:18:39.796 --> 0:18:41.996 thank you for speaking to this. Can you come to 0:18:42.036 --> 0:18:44.716 my hospital. The majority of us are experiencing this. 0:18:45.196 --> 0:18:47.676 And what do you think is responsible for that change? 0:18:48.196 --> 0:18:52.356 Well, you know, I think that people are a bit 0:18:52.436 --> 0:18:54.276 more traumatized. 0:18:54.316 --> 0:18:56.596 Now, I'll else to say it. A lot has happened 0:18:56.596 --> 0:18:57.436 in the past five years. 0:18:57.596 --> 0:19:00.676 Yeah, I think people have been through so much politically, 0:19:01.116 --> 0:19:05.356 There's been wars and death and violence and so many changes, and. 0:19:05.436 --> 0:19:07.276 There's like a reckoning of some kind. 0:19:07.516 --> 0:19:09.556 Just so much bad news. 0:19:09.836 --> 0:19:11.716 Yeah, it starts to wear on you and then you're 0:19:11.756 --> 0:19:13.836 just like, you know, I'm not okay. And I also 0:19:13.876 --> 0:19:17.476 think that a lot of people are becoming more open 0:19:17.476 --> 0:19:21.196 to the idea of those of us who are put 0:19:21.196 --> 0:19:23.236 together having struggles. You know, There've been a couple of 0:19:23.316 --> 0:19:26.836 high profile, unfortunately suicides in the past couple of years, 0:19:26.836 --> 0:19:30.476 and so I think it's opening up this language for 0:19:30.556 --> 0:19:34.036 people to say depression does look different, it's not what 0:19:34.116 --> 0:19:36.596 I thought it was, or even to say, yes, I 0:19:36.636 --> 0:19:39.156 am depressed, or I experience that. I've had people that 0:19:39.236 --> 0:19:43.116 I respect and who are not very open about what 0:19:43.196 --> 0:19:45.396 they experience personally come up to me and say, I 0:19:45.436 --> 0:19:47.676 think I experienced that, and I just I don't think 0:19:47.676 --> 0:19:49.676 I knew what it was. And these are physicians, We're 0:19:49.716 --> 0:19:53.236 taught this stuff, you know. So I think it's really 0:19:53.236 --> 0:19:55.436 been a stark change from when I started this. 0:19:55.516 --> 0:19:56.076 Work to now. 0:19:56.396 --> 0:20:00.676 Yeah, and I think I mean another hypothesis is that, look, 0:20:01.076 --> 0:20:03.836 as we talked about before, right, you can only diagnose 0:20:03.996 --> 0:20:07.996 and consider, you can only consider something a real category 0:20:08.036 --> 0:20:10.596 if you're not in denial about having it yourself. Right, 0:20:10.636 --> 0:20:12.316 And so one of the things we talked about is 0:20:12.316 --> 0:20:14.476 maybe so many healthcare professionals are like, hey, this is 0:20:14.476 --> 0:20:16.116 just status quo, like this is what it means to 0:20:16.156 --> 0:20:19.916 live life. And I think one service of COVID is 0:20:19.916 --> 0:20:22.476 that it was shining a light actively on the mental 0:20:22.476 --> 0:20:25.476 health of first responders right for the first time, and 0:20:25.756 --> 0:20:27.956 the effects weren't immediate, but over time, we as a 0:20:27.996 --> 0:20:33.356 society came to appreciate the profound psychological burden that they 0:20:33.396 --> 0:20:36.196 face day to day. And I wonder if that allowed 0:20:36.236 --> 0:20:38.636 for a reckoning of sorts too. For the first time, 0:20:38.956 --> 0:20:42.316 as a culture, we gave space for first responders to 0:20:42.516 --> 0:20:46.156 say I'm not okay, and it was that recognition that 0:20:46.236 --> 0:20:49.316 allows them to then say I'm not okay, which means, yes, 0:20:49.396 --> 0:20:51.596 this might be a real thing. High functioning depression might 0:20:51.636 --> 0:20:52.836 in fact be a real category. 0:20:53.156 --> 0:20:54.156 I think that's spot on. 0:20:54.356 --> 0:20:57.756 You're right, because after the pandemic, people were holding their 0:20:57.796 --> 0:21:00.436 breath to get back to normal, and when normal never happened, 0:21:00.476 --> 0:21:00.836 They're like. 0:21:00.796 --> 0:21:02.036 Okay, this ain't going away. 0:21:02.316 --> 0:21:05.516 We're five years out, almost six years out. Something's got it, 0:21:05.556 --> 0:21:07.396 something's off, you know. And I think you're right that 0:21:07.516 --> 0:21:11.316 time that distance away from you know, that event, people 0:21:11.356 --> 0:21:13.516 are realizing it's not getting better. In fact, some of 0:21:13.516 --> 0:21:15.116 my symptoms are getting worse, so I have to do 0:21:15.156 --> 0:21:15.916 something about it. 0:21:16.436 --> 0:21:21.436 Yeah, high functioning depression currently isn't listed in the DSM, 0:21:21.916 --> 0:21:25.436 the Diagnostic Statistical Manual, so that's the official handbook for 0:21:25.716 --> 0:21:29.076 diagnosing mental illness. How do you think about this? I mean, 0:21:29.836 --> 0:21:33.076