Why High Achievers Feel Exhausted, Anxious, and Stuck | Dr. Judith Joseph

You know, you talk about this idea of high-functioning depression. How is that different from just burnout?

Well, burnout is a workplace phenomenon. High-functioning depression is different. This is the high-functioning brain in the workplace. You still have the stress, the pressures from the outside. You remove that brain from the workplace and they don't get better. This is someone who, when they sit still, they cannot relax. They're humans doing, not human beings, right? What we found was that there was a high correlation between unprocessed trauma and pain and HFD, high-functioning depression. So the theory is that they're in the workplace, they have the symptoms, they're out of the workplace, they still have the symptoms. That unresolved trauma and pain is being carried with them. It's not being processed.

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Welcome, Judith, to the podcast. It's good to have you here.

It's so great to see you again.

Your work is quite fascinating because you, you've had a kind of a flip on the typical thinking in psychiatry. And now, just as in, in the world of sort of health, you know, in medicine, we think of, of, you know, you're okay if you don't have a disease, like the you know, the absence of disease is health, but that's not true. Right. And I think health is something else. It's a sense of positive vitality, wellbeing. And in psychiatry, it's the same thing. You know, if you don't have these clinical depression by these scales or anxiety or whatever it is, then you're fine. But there's another level of like full expression, happiness, joy, feeling that so many of us don't have. And we walk around living our lives in this And I'm speaking for myself here, you know, just overdoing, overachieving, driving, and you're high functioning. Like I was very high functioning. I wrote 20 books in 20 years. I'm like, I have a practice. I've done all these things. I started a Center for Functional Medicine in Cleveland Clinic. I was just so driven. But I remember moments in that journey where I was like just in it and I wasn't happy. Like I was just kind of going through it and there was this deep sense of lack of joy and lack of aliveness that I felt.

I don't think anyone ever used the word joy when I was in medical school.

Yeah.

It's true. Or training.

Yeah. You don't learn about joy in psychiatry.

Not at all. If you use the word joy, people would look at you like something was wrong with you.

Yeah.

And I think, you know, it's interesting. A lot of people who went to medical school experienced depression. I know I did. I didn't know what to call it then because I was very high functioning. I was waking up, getting good grades.

Yeah.

You know, being the teacher's pet, being the good girl. Yeah, the good, the very good girl. But I, I, when I look back, I think I went through several bouts of depression, but in psychiatry, if you're not meeting criteria for lacking functioning and you're having all these symptoms of depression, you don't get the diagnosis and you don't get help. And even in medicine, when doctors recognize actual clinical depression, there's this apprehension about actually reporting it and getting help for it because By law, you're supposed to report your mental health conditions. So imagine you're a doctor and you're struggling and you don't report it because you don't want it to be on your license or on your, you know, records. And you have all the student debt, you know, like you're thinking, well, what's the, what's gonna happen? Am I gonna not be able to practice? I have to pay off these loans. So it really is a system that discourages the healers getting help and becoming healed.

And it's not just, it's not just doctors. It's so many people who are just in society who've kind of taken on the mantle of like, okay, I've gotta achieve, I've gotta do, I've gotta succeed. And many of us have childhoods where we felt unworthy or unloved. And so, I mean, I know I did this. I overperformed for love and overachieve. And then there's a lot of side effects, which are good. I've been successful, have made impact. I've written a lot of books. I've done a lot of things. But underneath it, sometimes I remember, and I really come out of that, but I remember periods of my life where I was like just going, going, going and didn't have this sense of joy. And you talk about this idea of anhedonia, which is lack of I guess, joy or pleasure. Can you kind of define what that is and why, why it's so important to understand?

It's a word that's been around for close to 200 years in medicine, and it's something I think a lot of people experience this, you know, lack of feeling excited about things, lack of interest, feeling meh, blah, right? Many of us go through periods of our time when things just don't light us up, but we don't know that there's an actual term for that. We just think that's life. And I often tell my clients that that's not, that's not the way that life is made to be. We are built with the DNA for joy.

Yeah.

It is literally encoded in our DNA. So why is it that we can't access it? And I think looking at children, because I, I treat children, adolescents, adults, and elders in my practice. And I have these cameras in my lab because sometimes kids are busybodies and they have ADHD that you don't want them running out. Right. I observe them in the waiting area. And a child will be like sitting on the furniture and then standing on the furniture, jumping off, making, you know, paper planes and so forth, having all of this excitement.

Joy.

Joy. Yeah. And you don't have to teach them how to do that. Whereas the adult who has it all will be sitting there on their phone, on their devices, and then like coming into the session super stressed. You know, their mind is somewhere else. So by the time they actually get engaged in the therapy, we have 5 minutes left, right?

Yeah.

So we're built with the DNA for joy, but then things happen, life happens, trauma happens, and we lose sight of it. We can't access it.

Yeah. And I think, you know, you talk about these sort of traumas. It doesn't have to be a big heavy-duty trauma, but these little sort of micro cuts to our psyche and our soul that happen when we're younger that kind of set us up for the programming for doing things in life in a way that are kind of things we feel like we should or have to do without actually being authentic. And whether it's people pleasing or, you know, I'm overachieving in different ways. People don't really have a language for what this experience is, which is I'm not really fully alive. You know, I don't wake up every morning and go, hell yeah, I'm like so excited to be alive. What's going on today? Right. That's what we should be feeling. What I'd love you to sort of walk us through is how do people identify if they're in this thing? You have a quiz or a scale to kind of recognize yourself if you're in this sort of state. Can you kind of walk us through what that is so people can see, oh, is this me or what are we talking about here?

Yeah, it was really important for me to create these rating scales because, you know, in psychiatry it's really difficult to say, okay, let me get a blood test and then, okay, you have depression. There's just nothing like that. We don't have a, let's scan your brain and you definitely have this. There are correlations, there are patterns, but there's just no direct test. We use psychometric rating scales. In my lab, in order to get a medication FDA approved, I, we participate in these clinical trials and these trials are standardized. These sites all over the world use the same psychometric rating scales and we're videotaped, we're audiotaped because we wanna make sure that the data's clean and consistent. But a lot of times the rating scales are just so archaic. And one of the ones that I use, I mean, one of the pioneers in joy and happiness is the Snaith-Hamilton Rating Scale, the SHAPS. But there are questions on there that are very I guess, out of touch, right? Like, and it's a British scale. So things like, you know, when you drink, when you sip your tea, how do you feel? You know, like people don't sip tea in America. They just don't.

Not at all. Your tea and scones at 4 in the afternoon. What's your state of mind?

So I had to update that scale to be relevant. And so I added things that are daily pleasures in modern times. And when you think about joy, it's not just this one feeling, this one emotion of happy, joy. It's a plethora of sensations. So when you're adding up points of joy, you're asking people things like, when you ate your food, was it savory? Did you, did you taste it? When you were lonely and you reached out to a loved one, did you feel connected, seen, and heard? You know, when you were stressed, believe it or not, stress is a part of joy. Were you able to calm and self-soothe? When you were tired and you took a nap, did you feel well-rested? Did you wake up refreshed? You know, these are all these basic human experiences that when we add it up in the research, that's how we see if you're becoming happier. But when people think of the ideas of being happy, they think of, when I get a partner, I'll be happy. When I finally pay off my debt, I'll be happy. You know, when I graduate, I'll be happy. It's always something external that has to happen. Joy is that internal experience, right?

Good luck with that.

Yeah. You know that once you finally get the 20s, that's over.

It doesn't work like that. It doesn't work like that. Right?

Yeah. I mean, I was the same way. Yeah. Yeah. It was always, I came from a background of scarcity. I came to this country when I was very young from Trinidad. Sometimes we didn't have food to eat at times. And I always thought like, I'm gonna get educated, I'll become a doctor, make lots of money, and I'll be happy. But then you get, you know, you get into the Ivy League medical school, still not happy. You know, you, you become the, the doctor, still not happy. You have a successful business, still unhappy, married, you know, all these things. So I, you know, grew up thinking that If I finally achieve these things, I will finally feel full. And I was actually getting further away from joy. Mm-hmm. Right. So creating this scale is really important because I want people to realize that joy is within their reach. It's all of those points that you're leaving on the table. When I started talking about the anhedonia rating scale, I think on one podcast, 10,000 people filled it out at once and it crashed my website.

Wow.

So I was onto something. People were feeling this lack of joy. They just didn't know that there was a name for it.

How do, how do people find it? Don't— I know people are gonna— how do I take that quiz?

Where do It's on my website.

Yeah.

Which is drjudithjoseph.com. Okay. Under quizzes.

Yeah.

And there are several there. There's the anhedonia, there's the menopause, uh, and mental health quiz, the TIES quiz, uh, the high functioning quiz and a trauma inventory.

Okay, good. Well, that's good. It's good to kind of get a, a metric for how you're feeling. Yeah. You know, you're right. They're, they're not, there's not a really clear single biomarker or imaging test where you can say this is depression or this is anxiety or this is any kind of mental distress. But, but there are biomarkers of mental health. Like there are things that, you know, that, that that are causative that, you know, sometimes are not because of your psychological state, but your biological state. So if you're hypothyroid, you're gonna be depressed. If your vitamin D's low, you're gonna be depressed. If you don't have enough B vitamins, you're gonna be depressed. Like there's, there are things where if you have heavy metals, you'll be depressed. So there's, there's things that, that are physiological causes that you should for sure rule out. But if you've done that and you know, Function Health is a great platform to get all that information. Like, oh, my omega-3s are super low. Omega-3s are important for mood and mental health. So, you know, there, there's things you can find out. But if all those are fine and you still don't feel the sense of pleasure, joy, well-being, which I think is kind of our birthright, right? These quizzes really help you identify like where you're at. Then you can start to think about how to navigate out of that. And I will talk about that. You have this framework called the 5 Vs, which I really like, which is a way of sort of reorienting your life towards joy and happiness, which I love. I mean, I think it's like we talk so much about disease and pathology and all this stuff. We don't talk about what is it to be a fully expressed human. You know, you talk about this idea of high-functioning depression and, and I guess I said, you know, we both sounds like we both experienced that at some point in our lives. How is that different from just burnout, from just like overwork and overdoing? How is that different?

Well, burnout is a workplace phenomenon. And when you, if, if you look at the history of burnout, it really only starts to show up 30, 40 years ago in the concrete medical literature. But that doesn't mean that it didn't exist before.

Mm-hmm.

You know, I think people have, especially in the industrial age and with the rise of capitalism, burnout is something that has been around for a while.

Yeah.

But it is an occupational hazard. So when the World Health Organization included it in the nomenclature or the literature, they looked at it as being caused by the workplace. Yeah. So the workplace pressure is causing the symptoms. And I often have this brain in my lab and I use it to demonstrate, you know, these principles with my patients. But like, imagine this is the brain, this is the brain in the workplace, and you're getting all this pressure. Right, and stress from the workplace, and you're experiencing symptoms of irritability, low energy, low motivation, anhedonia, lack of joy, and then you remove that brain from the workplace, over time you start to feel better. You know, you're getting distance from the stressor. High-functioning depression is different. So this is the high-functioning brain in the workplace. You still have the stress, the pressures from the outside, the symptoms are there, you know, low motivation, anhedonia, irritability, low energy, You remove that brain from the workplace and they don't get better. This is someone who, when they sit still, they cannot relax. When they're not working, they feel restless. They're humans doing, not human beings, right? And I thought about this because there must be something in the individual that no matter what setting they're in, they're experiencing these symptoms. And in the study that we conducted in the lab, the first peer-reviewed study in the world on high-functioning depression, what we found was that there was a high correlation between unprocessed trauma and pain and HFD, high-functioning depression. So the theory is that, okay, they're in the workplace, they have the symptoms, they're out of the workplace, they still have the symptoms. That unresolved trauma and pain is being carried with them. It's not being processed. And that's why no matter what setting they're in, they're experiencing these symptoms.

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You know, rather than trauma in the way that we classically think about it, because in the lab we've conducted PTSD studies as well. When you think about trauma, you think of people avoiding people, places, situations, trying to avoid triggers. But with high-functioning folks, they are avoiding not people, places, situations, they're avoiding processing the pain by busying themselves. So that's why when they sit still, they're restless. When they're not working, they feel empty. They're constantly doing, they're not being. And that And that concept, I think, really resonates with a lot of us because this anhedonia, this, why do I feel this way when I'm like not doing anything? It's all tied together. The traumatized, unhealed brain has a very difficult time accessing joy.

That's, that's really an important framework here, which is there's underlying things that you haven't processed that show up in this way. And that, that it's, it's these sort of little or big traumas that happen as, as you go through life, especially when you're a kid, that sort of set the framework of how you approach your life. And I think most of us don't really have the tools or the knowledge or the understanding of actually how to resolve that trauma or to actually kind of work through how to process it in a way that gets us free from it. And I want to sort of go into in a minute how you've kind of created a framework to do that, which I think is really important. But I kind of wanted to double down on this word anhedonia and hedonism because it comes from the word hedonism. And hedonism is basically a sort of a philosophical framework from the Greeks, which, you know, We typically think of it as sex, drugs, and rock and roll, and, you know, kind of in a pejorative sense, you're a hedonist, it's bad, it's you're just seeking pleasure for pleasure's sake. But it's kind of this ethical theory that people should pursue happiness, pleasure, well-being, and it's not actually a bad thing. And it's kind of like this goal of trying to find long-term fulfillment, purpose, connection, growth. And it's kind of a reframe of hedonism. So in a way, what you're kind of encouraging us all to be is find our way back to hedonism, right?

Well, not necessarily hedonism. It's more about those simple joys that we leave on the table.

Yeah.

Right?

Like, for example— But it's pleasure. It's like you're saying— Yes. Antidote is a lack of pleasure in things, right?

Yeah.

So it's like, how do you get back to the sense of joy and pleasure in things as a framework? I kind of like that.

More controlled hedonism, more strategic and intentional hedonism versus just seeking pleasure out of a lack of understanding what's happening inside. And, you know, when you think about processing and acknowledging what you're going through, you know, in a given day, I do this now. I didn't years ago when I wasn't self-aware of what I was going through and why I was working so hard and what I was trying to compensate for. But now when I do these tiny, you know, adjustments or intentional adjustments in my day, I'm thinking, well, why am I getting worked up by this email that I just saw? You know, like, how is that going to increase a point of joy for me? It's not, it's actually going to reduce one point. And that's one point that I'm acknowledging I'm gonna leave on the table just to focus on this one thing. So I do these like very tiny adjustments throughout the day that I've had to teach myself how to do. But the first step was having to acknowledge, well, what, what am I actually experiencing now? Let me face what I'm going through and then I know what to do next.

As you kind of have this sort of reframing, you've clearly worked through stuff that was the origin story of why this pattern got set up. And it's true for so many people. I know for myself, when I was reading your book and kind of going through the philosophy that you've developed and the approach, I was like, oh, this is kind of me. Like I'm somebody whose, you know, self-worth was tied to achievement, to overdoing, to success, to more productivity. And now, and I know where now it came from because I've had to do excavation into my own life. I mean, I'm curious for you, like how do people people go back and look at their life and their traumas and their childhood to identify what are the things that happened and what are the stories that get created and how, how does this pattern get set up for people early on? Because I think in order to really get rid of it or to deal with it, you have to understand it.

One of the symptoms of trauma is forgetting.

Yeah.

There's like a 30-list checklist of trauma symptoms called the— on the CAPS-5, which is the VA's— the VA hospital's gold standard for assessing PTSD in combat veterans. But we use the CAPS-5 and for civilians. And think about it, 30+ symptoms of trauma. Most of us only think of, like, flashbacks, nightmares, hypervigilance, but there are so much more. One of those is forgetting. So your brain will push down the memories to protect you so you can function, right? Which is what, you know, the old psychiatry used to really go for, right? Being able to function. But if you can't remember, there are different tools that you can use. Usually you want to work with a therapist because, you know, your brain is pushing those memories down for a reason, and you want to feel safe. And And I use transitional objects in my practice all the time. There are these tools that are real tools, like pictures, blankets, tokens from childhood. They're basically memorabilia that sometimes can jog the mind to remember certain things. So I'll ask my patients who can't remember the last time they really felt joy to bring in things from childhood or from past, you know, memories or experiences where they may have been happier. So they'll bring in these objects and then we'll look at them together and then we'll talk about them. And it is excavating. It's like being the archaeologist of your own psychological history. You're dusting off the past. You're trying to discover the points of joy that got lost and buried along the way. And I'll give you an example of a, of a client, obviously disguised, but he for a long time did not understand why he couldn't be happy. He was the typical New Yorker coming to my office. I have everything, Dr. J. My patients call me Dr. J. You know, why is it that I can't experience joy? You know, why am I a meh, blah? And so we dusted off the past. We looked at the old, you know, pictures and the items from his past. And we realized that when he was much younger, he used to spend a lot of time in nature. And I thought, well, you know, there are all these pictures, these, all these things. What happened? Well, you know, at around, you know, 7 or 8, my parents got divorced and we used to camp all the time. We used to go out together as a family. And after that, we just, we just stopped, you know? And that was a very painful divorce for the family and he they just— they just collectively lost that joy. So his assignment with me was, "Okay, we're gonna start baby steps. We're gonna gradually expose your brain to the idea of getting back into nature." So we started off with looking things up online, like hiking trails, and then, you know, going to the boot store and getting some hiking boots, and then going to Central Park after work every day, and slowly built up to these hikes upstate. And he was like, you know, My life isn't perfect. I still have bouts of depression, but I, I can access these points of joy, which I think is— I think people really need to understand the difference. The aim is not to get rid of the depression because depression is a, it's a, it's a chronic illness. And maybe one day we will, we— there are new medications being developed. Hopefully psychedelic therapy will, you know, really advance that. But it's something that you have to manage at times, right? And so he can access these points of joy where there are weeks where he's being able to feel alive, where he's excited, where he's moving forward versus not having that at all in the past.

Yeah.

It's about these small wins.

It's almost like introducing play back into your life.

Yes. Right? Mm-hmm.

Like you mentioned the kids in the waiting room playing around and fooling around and, mm-hmm. And that's kind of, as adults, we lose that sense of play and creativity. It's, it's amazing. You talk a lot in the book about sort of this self-worth issues and fear as, as sort of being linked and, you know, to, to why we do this and to like high productivity in life and, and that, that fear and self-worth drive this. And I know that was for sure for me, like I didn't want to, you know, be like my dads who were failures. And I was like afraid. And that was part of my overachieving, but I also was like, you know, to feel self-worth and seen and loved, I felt like I had to overachieve. It wasn't conscious, but it was like, it was driving the show for a long time. And you talk about these kinds of tendencies of people pleasing or masochism. Like I was just working 100 hours a week. It was kind of masochistic. I didn't, I never really thought of it that way until you kind of talked about it, but can you talk about what that means in this context of, of your framework of, of, um, you know, high-functioning, uh, depression and, and, and the sort of new model you're trying to get out there?

Well, masochism is not just a dirty word in psychiatry, but when people, you know, in, in regular life think about masochism, they think of like S&M, right? But the masochism in psychiatry is different. So masochistic personality disorder is one that was classified in like the old DSM, which is the Diagnostic Statistical Manual, basically the Bible of psychiatry. And it was in there with the— I think the last time it was there was like the '80s, because there were these people who were classified as being, you know, people pleasers. They bent over backwards for others and didn't expect much in return. In fact, they felt uncomfortable receiving praise and love. People who basically don't think about their own needs and end up in these situations with those who treat them poorly or even at times abuse them. And the reason it was very political and it was removed removed from the DSM was because unfortunately a lot of practitioners were using the term masochistic personality disorder for women who were experiencing intimate partner violence or domestic violence. And so it was highly problematic. But I think that in getting rid of masochistic personality disorder, we, we should have probably just kept in a little bit of the people pleasing and just, you know, said, hey, this could happen to both men or women, and it's not victim blaming. You know, some of us end up in these patterns where we believe that we're only worthy when we're doing for others, that we are unlovable unless we're sacrificing. We're modern-day martyrs.

And people-pleasing is almost a form of masochism, is what you're talking about. That's interesting.

PC version.

Wow.

Okay. And many of us, because we've tied our self-worth to what our role is, we don't know how to be. We've forgotten who we are. And over time, others will pick up on that. They'll see that, oh, we can treat this person like this. And it's human nature. If you're giving, I'm taking, right? It doesn't mean the person's a bad person. Some people Some people are actually, you know, abusive, but most people, you know, if you're given freely and they don't have to return, they'll take. And this happens at the job. You know, the people pleaser at work is, you know, overlooked for the promotion because why give her the promotion? She's gonna do it anyway. You know, they're overlooked in relationships. You know, why commit to you? You're gonna, you're gonna give me what I want anyway. They're overlooked even in families. You know, the, the eldest daughter syndrome and all of that. I think when we realize why we're giving without receiving, and we realize that it's tied to our low internal core belief that we are not worthy unless we're providing something for others. And we challenge that a bit and we say, well, what's the worst that can happen if I say no? If you say no, if you believe that they're not gonna love you, test it out. I do this with my clients all the time. And they're like, you know, Dr. J, they actually called me more. They actually, you know, respected me more. The opposite of my the thing that I feared the most was what happened.

That's a big lesson for me, 'cause I had that people-pleasing thing pretty severely.

I did too.

You know, I didn't actually think of myself as having low self-worth, 'cause you know, I have a good life, I've been successful. I didn't actually identify with that. But when I did Ibogaine and I kind of went back into my childhood and I saw what happened to me and I saw the things that kind of led me to believe You know, that I needed to perform for love. I realized that was coming from a lack of self-worth and I did not even realize that. And I was like, it was a big kind of shock to my nervous system. But once I realized that, I was able to kind of really shift how I'm showing up and to actually take care of myself more and not be in this constant state of self-sacrifice. And I didn't think of it, but it actually is a form of masochism, right? A lot of us who have this, and I'm sure a lot of people listening have this because it's pretty common, our brains aren't working the same. Like there's some kind of neurological shift that makes it difficult for us to sort of feel joy and that we're in this kind of revved up anxious state. Can you talk about that kind of neurologic phenomenon that's going on and why it's so hard to kind of shift out of that?

It's so, I think, fascinating because, and that's why I say you can't just have an imaging and then say, okay, you have this because we're all so different. Different. With my clients, I ask them to say, you know, look at your hand and imagine that, you know, the joy is built in there. You just have to find it. But also look at your hand and remember your fingerprint is different than someone else's. So why are you trying what works for someone else on yourself without really understanding the science of your happiness? And there's a tool in medicine that we've been using forever, but we don't teach our patients about it. Taught it. And I think frankly, a lot of us just kind of like forget it. We're like, oh, we learned it in med school. That's it. But it's the biopsychosocial and it's super simple. And I imagine it to be like a fingerprint. No two biopsychosocials are alike. Even twins don't have identical biopsychosocials.

Mm-hmm.

So when you look at the biological component of depression, for some people, for those of us in midlife who are women, there's a huge hormonal component to our depression. And this happens because in midlife, for some people, late 30s, early 40s, and perimenopause, you start to experience fluctuations in your hormones, and that can impact the way that your brain processes melatonin for sleep, serotonin, GABA for anxiety. You know, all of these neurotransmitters are being modulated by these very unpredictable shifts in hormones. And so a depression for a woman may be very different than depression for a man who, let's say, perhaps may be struggling with, something like an autoimmune condition, right? Or that typically happens in women, but high inflammatory states, if you're not taking care of your health, right? If you have like a lot of belly fat and so forth. So even the biological components of depression are different across individuals. Looking at, you know, the other part, the psychological component of depression, the second part of the biopsychosocial, women tend to go through a lot more trauma, sexual traumas, right? And you know, there is attachment theory depending on how you were raised or you were cared for or neglected, you may have an anxious attachment or an avoidant attachment, and that's playing out in your relationships. You know, in the psychology part, some of us have histories of ADHD and neurodivergence, and that plays a role in our masking all day long. So, you know, even that psychological component is different for individuals. And then for, um, you know, the social part, we're all in different parts of the world. So socially, some of us don't have access to nature. Others have better access to nutritious foods and organic organic foods. Some of us only have processed, you know, uh, depending on our environment. Some of us drink a lot or smoke a lot or use substances or our relationships. So when you look at that biopsychosocial and encourage my patients to draw them out because they do shift over time, and then figure out where is it that you're losing more of your joy, you know, rather than trying something that works for someone else, think about yourself as this individual that it's so rare because there's only one you, right? There will only ever be one you. Yeah. And the chances of you existing are so small. So you are here for a reason. So just look at that and figure out where are you losing your joy? Yes, there are classic models of depression. Yes, there's dopamine, norepinephrine, serotonin, but we're learning that it's not, yeah, it's not that simple. No. And that there are different avenues for joy. And that's why there's—

it's not like a full chemical imbalance or something. No.

Yeah. And that's why the nutritional aspect is so important. And, and it's being taught now in residencies and training because We're learning that we, we can't just focus on one thing. We have to look at what people are eating, their inflammatory states. There's high inflammation with, with mental health.

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Simon.

I mean, that's it.

That's what you're saying is so important. I'm going to double-click on that because most of psychiatry has not been around what's happening biologically. It's just psychological. And you're now talking about this idea of inflammation, which is so prevalent in our society because of the food we eat, the stress we have, the lack of exercise, environmental toxins, change in our gut microbiome, nutritional deficiencies, which are so common. All these things drive inflammation in the body.

Yeah.

You know, when the science is looking at the brain of someone who's having psychiatric symptoms, it's often an inflamed brain. You know, like I always say that, you know, your, your brain can't really experience pain. Like if you have a swollen knee from inflammation, it hurts. But when your brain is quote hurting from inflammation, it manifests as mental illness.

It does.

Or psychiatric symptoms.

Right. And also like a lot of the medications for psychiatric conditions cause several severe metabolic side effects. And I think for a lot of time we're thinking, well, that's just something something people have to deal with and we just have to treat it. We'll add on a metformin, we'll add on a Topamax. And yeah, but then scientists started looking and saying, well, what if the— they're linked? What if things in the body are actually causing some of these symptoms in the brain?

So amazing.

And now, you know, so we're in this really, I think, very cool area of psychiatry where we're, you know, it used to be like, okay, that's the surgeon, that's a psychiatrist. Like they're never gonna talk to each other. And now people are coming together and saying, we have to work on this together. This is true holistic medicine.

Yeah.

And it's the biopsychosocial, but we've ignored it for so long.

It is. I mean, it, it is. I mean, there's a lot of psychology and trauma and things that are real psychological impacts that affect you. But then there's this whole world of sort of nutritional metabolic psychiatry and psychedelic psychiatry, which is emerging as new tools to actually work with these psychiatric problems. And the high-functioning depression concept, I think, doesn't necessarily require those things because often it comes from childhood stuff. But I think it's important for people to recognize that if they're having psychiatric symptoms, it's not all in their head, right? And that's the problem with psychiatry is it's sort of like you've got this, you know, kind of border between your neck and your head and your body. And it's like they're not communicating, but they are constantly.

They are, they're so connected.

So I wanna sort of shift a little bit and talk about what you call digital depression. And we talk about kids and their phones and distraction and ADD, but you talk about this also for adults and how it's kind of robbing us of joy constantly like creating a state for us of comparison and affecting our mood, affecting our sense of wellbeing, and maybe even, you know, causing some depression. So can you talk about like that phenomenon, not just for kids, but for adults?

Yeah. Most of us are familiar with the literature on children because that great book came out, The Anxious Generation, Jonathan Haidt.

And, um, he's been on the podcast.

We've been a little—

yeah.

I think we're well aware of what's happening with kids, but it was a bit too late. You know, we didn't know what was happening back when children were on devices, we know now. But yeah, there is literature and very recent literature on what happens to adults. There's actually this entire center at Stanford called the Stanford Zoom Fatigue Center where they study what happens.

I think I have that. Zoom fatigue. I'm like, oh, Zoom call.

I mean, they literally study what happens when you're on your screen all day and meetings back to back. And what they found is that, you know, we're supposed to— when I look at you, I don't see my face next to you. Imagine if I was talking with you and then I saw my face. I'd be looking at my face.

There's actually a feature on Zoom where you can hide your face. I encourage people to do that. Get yourself off the screen.

But also, you know, and that causes you to scrutinize yourself. And so when we're on FaceTime, even when we're talking to our loved ones, we're seeing our face. Many of us are not just physicians, we're physician content creators. We're constantly looking at our faces. It's just not natural.

There are no natures in mirror, maybe like like a pond or something.

I don't know. Narcissist, the, the Greek, um, right. I think it's Greek. But, um, yeah, looking at a mirror is one thing. And even, I'm glad you brought that up because sometimes I walk into a room and I, and I see myself in the mirror and I jump. I'm like, oh, I thought it was, it's weird. It's weird for us to see ourselves outside of ourselves. Yeah. And there's a term in psychiatry called the autoscopic phenomenon where when people who have true psychosis like schizophrenia or bipolar with schizophrenia, with psychosis, they hallucinate and they see themselves outside of their body and they become very depressed, very anxious. We're doing that to ourselves.

Interesting.

Wow. So we really have to be mindful of what we're doing to our brains and protect our brains. Also, we're not really built to look at 10 people at once. You know, whenever I go on a virtual meeting, I'm like tense and I really look at my body and I'm like, if these people were around a table, I would not be that way. But you're looking at like 10, 5, 10 people at the same time. Also not natural. So be mindful of that. Be very mindful of getting off screen, not showing yourself all the time, making it a priority in your workplace to do walking meetings where we're just on audio Zooms, getting movement because we're losing so much of that natural movement. We're losing all these points because we're planted in front of a screen versus if we were around a table, we'd be moving this way. All these little shifts matter. So that's one thing. And then there was a recent study out of one of the schools not far from here, actually, in Texas, where they took the smartphone capacity away from adults for 4 weeks. And so you still had your flip phone, you know, a version of a flip phone. You could text and call, but you couldn't get online. You couldn't be on social media. And what they found is that after 4 weeks of being away from a smartphone, the happiness scores went up as if they had treated these folks with an antidepressant. So they thought, well, what's happening here? And when they looked at these individuals and spoke with them, they found that these people were getting better sleep because they weren't on their screens at night. So that's a point of joy that we measure in the research. Research, they were actually socializing more, another point of joy. They were spending time in nature, another point of joy, you know, eating their food and tasting it, not like just staring at a screen and just shoveling, shoving it in their, in their mouths. So they were losing all of these natural points of joy just by being on their screens.

I think that's so true. And I think I remember, I remember, you know, different moments in my life where I've been off, like I was, you know, I remember being in Mongolia, um, you know, riding horseback for like 10 days and there was like no cell service. There was no phone. I just put my phone in my bag and it just, it was just, life felt different. And I, I, I mean, I'm old enough to know when there was no phones and how different the quality of my days were and my experience was and how much more present I was and how much more experienced this sort of subtle textures of life and the subtle joys and the subtle things that you kind of don't notice when you're constantly like this all the time. Any spare moment, You pop up your phone, you're looking at your messages, you're looking at, you know, your Instagram, whatever the hell you're doing. And it is kind of toxic. And I think what you're saying is that our addiction to our devices is actually causing a mental health crisis, not only for kids, but for grownups.

Yeah, it is. I think we went through this collective trauma in 2020 of not knowing, the uncertainty of the pandemic. I I think rewired our brains to wanting to know too much. Like, that trauma of not knowing what was going to happen and then being connected— the only way to be connected was through a device— has made us believe that, well, as long as we know things, we'll be safe. It's creating so much havoc for us in terms of our anxiety. And with some of my clients, I say, let's do an experiment, because you're so important. Let's see what happens when you don't have your phone at this party. You know, leave home and no one has said, oh my gosh, I missed something. They're like, you were so right.

Yeah.

I did not need that. Because think about it, 30, 40 years ago, that's what we did.

Yeah.

We did not have access to our emails. We did not have access to our boss, our kids all the time. We had a life.

Yeah.

There's a great restaurant in New York I like to go to where they have like a box in front of me in the center of the table. It says, put your phones in here. And everybody puts their phone in and it's great. You have a great dinner conversation. Nobody's distracted. Nobody's, you know, just checking their messages. It's pretty good. So what, what does a healthy like relationship with technology look like? Because these things aren't going away. Like we're gonna, we're gonna have our phones, we're not giving them up. So what, what is the right relationship that can actually help manage some of these sort of psychiatric impacts of our technology?

Well, I developed something called the RESET Method, and initially it was to help these children and these parents who were both on the phones and the devices together, right? I'd have these parents coming in, they're like, my kid, every time they take the device away, there's a meltdown. We have these huge fights. All of our Our fights are centered around technology. And then I would talk to, with, with parents and be like, okay, like tell me about your technology patterns. And they were like, this is not about me, this is about my kid. But then when we, when we sat down and we looked at things, they were on their screens just as much as their kids were. So it's one thing to tell your kids to do something, but if you're doing it, they're not gonna listen to you. Right. Um, so the RESET method, the R is realize how screens are impacting you. So are screens helping you to stay connected? You know, I want you to make a list of pros and cons. Is it making you more distracted? Is it causing you to get worse sleep? Is it creating a lot of fights in your family? You know, how is it impacting you, the good and the bad? That's the realization. The E is the education part. You know, educate yourself about the recent data. There's so much on kids, but you know, there's emerging data on adults like I just— we just talked about, right? How is it impacting you from the science? And then the S is your strategy. What's your plan as a family? Are you gonna say everyone off of devices during dinner? As a family, are you gonna say, you know, after 9, no devices? As an individual, are you going to say, I'm only gonna follow these account and unfollow those? I'm only gonna use this, you know, at one hour a day. Have a clear strategy, you know? And then for kids in the household, know the ages that are recommended, you know, like the American Academy of Pediatrics American Academy of Pediatrics, they often put out recommendations, you know, under 18, no screen time, and, and so until 18 months, no screen time. You know, there's an organization called Wait Until Eighth to not give devices to kids. Wow. Hey, I see it all the time. Toddlers on the screens and they know how to swipe, you know. So really know what the recommendations are and follow those.

Before they can talk, they can swipe. Holy cow. It's really, that's terrifying. Yeah, I'm about to have a grandson and I'm like, I'm going to talk to my daughter and I think she's probably very much with this program because I'm like, the kids shouldn't have a phone till they're maybe in high school or later.

8th grade, I say wait until 8th. It's when they're— they start to, based on developmental stages, they start to know who they are based on their peers. And if they're getting that access to bullying bullying 24/7. Imagine I was a nerd, so I got bullied. I cannot imagine being bullied 24/7 because of phone, right? Because Snapchat is always on, you know? So we really have to be mindful of developmental stages and what our children are experiencing. That's— and that's the strategy part. And then the, the next E in RESET is expectation. What are you hoping to get out of this? So like, are you hoping to feel less stressed, get better sleep, feel more motivated, better connections? Have clear expectations. And then the T in RESET is thoughtfulness. Did this work? Work? Was this plan too rigid? Was it too relaxed? What do we have to modify here? And RESET is a clear guideline. We all need to feel safe. We need a plan. And it allows people to have a discussion, families to have a discussion around their tech use.

Yeah, so it's important. I mean, we all are addicted to our devices, and I think including myself. And I think it's in the times that I feel most alive, the time that I feel most joy, which is what we're talking about today, is when I'm not connected to a device, when I'm just in nature or with my friends or, you know, like, you know, last night I had some friends over for dinner and like, nobody was on their phone. I mean, nobody looked at their phone. We just spent 4 hours talking and going really deep. And it was amazing actually. I was like, oh, this is cool. I didn't look at my phone. And I think that's kind of what we're all craving. We're all craving connection through our phones, but it's actually interrupting our connection.

And include like computers into that too. Recently I got locked out of my computer crashed and I was locked out of it for a day and it was so freeing.

Yeah.

I was, I, I told my team like, make sure you're not missing any important research or, you know, patient emails. Yeah. But like, it was so nice. My daughter often grabs my phone and she throws it into the bedroom. She's like, that's staying in there. You know, while we play. She's learned.

How old is she?

She's 9.

Oh, that's amazing. I wanna talk about the 5 V's in a minute, but I wanna talk about sort of women hormones and this sort of midlife shift that happens. And you talk about this sense of lack of joy and pleasure being really common in women around particularly perimenopause. And it's, it's happening like both biologically and emotionally. So what, what's going on and like, what are women feeling and, and you know, why are so many women mislabeling what they're experiencing as they go through this?

Well, I got into this work, I think accidentally because when I was in medical school, we, I think we probably got one course on menopause and that is, I'm learning.

You mean one class?

Literally one class. Not a course. I misspoke.

Yeah.

One class.

Yeah.

One class. Literally one class. One lecture. Right. And I remember who gave it. It was someone that I greatly admired and she's a forward thinker. She's an OB-GYN. That was it. And so when I was practicing in my research lab several years ago, we had just started working on the first, which is now the first FDA-approved medication in postpartum depression. So it's a neurohormone and brexanolone, xaranolone. And so what I was seeing with these patients who were more on the older end of the maternal spectrum, spectrum was that when they were, you know, going after the giving birth, they were having like a repeat depression, not postpartum, but in midlife. And I just thought, what's going on here? And I was seeing a lot of the similar symptoms, fatigue, brain fog, um, moodiness, irritability. And I thought, is this hormonal? You know? And I started to really look out for seminars and branch out to other doctors who were looking at perimenopause and menopause. And getting so many referrals of women in midlife who were like, I have ADHD for the first time in midlife. And I thought that's, I mean, it is possible women are not diagnosed as much as boys are not. Boys are overdiagnosed, I think more diagnosed than, than girls. So it's not impossible, uh, you know, to get a late diagnosis of ADHD, but it was just sudden ADHD. Like you didn't have symptoms of lack of focus when you were younger, you didn't have inattention or multitasking issues. And why all of a sudden now? And ADHD by definition is a childhood diagnosis. So you have to have the symptoms by, before the age of 12. And it, and it's persistent throughout life. So it doesn't just suddenly pop up in midlife.

So, oh yeah, but I think a lot of us have acquired ADD because of our culture and our stimulation. So it's like, you know, maybe, maybe that's the wrong term for it, but it just feels like we live in a distracted world.

But usually, so ADHD has to be present in two settings. So it can't just be at work where, you know, or at home. It has to be in two settings since childhood. Yeah. And definitely things contribute to a lack of focus.

Mm-hmm.

But ADHD has, you know, symptoms of impulsiveness. You know, people, getting into heated arguments and rejection sensitivity, um, you know, losing things, uh, having a hard time, you know, organizing, um, attention to detail. So it's, it's really a lot of symptoms. And, you know, what these women were actually experiencing was a lack of concentration due to, you know, these hormonal fluctuations. And so putting them on a stimulant, yeah, it might help a little because everyone benefits from a stimulant at some point, but it doesn't really correct the course of what's happening because they're also having these physical symptoms. They're having the dry, itchy skin, the hair, you know, changes, the poor sleep, the urinary issues, and so forth. So I developed a system called the TIES method to help my patients identify whether or not they were going through something related to hormones versus another psychiatric condition like depression, right? And it's interesting because major depressive disorder. When you look at the DSM-5 and in all the research, there are no physical symptoms under major depressive disorder. And so I, at first I started teaching my clients about the 3 Ps. So how do you know if it's depression or if it's, uh, mood symptoms or related to perimenopause or hormonal shifts? Yeah. Right. So the first P is period changes. There is nowhere in the literature under major depressive disorder where your period should be changing in terms of like how heavy it is, how infrequent it is. Yeah. You know, the cycling. So if you're having period changes and mood changes, talk to your doctor about perimenopause or menopause. The second P is physical changes. You know, I mentioned some of those, the urinary, you know, having to urinate a lot, you know, the itchy skin, the hot flashes, the palpitations. None of those are under major depressive disorder. Yes, you can have palpitations with generalized anxiety disorder, but not major depressive disorder. So another red flag. And then the third is your past. History, the, the last P. People who have a history of things like PTSD, bipolar disorder, trauma, they're going to be more vulnerable during midlife with those hormonal fluctuations. So even if you have a history of ADHD, some— it will get worse during midlife because hormonal fluctuations impact your brain chemicals. They impact dopamine, serotonin, GABA for anxiety, melatonin for sleep. So it's all all, you know, tied together, no pun intended. And then the S in TIES. So those are the 3 Ps, but I'll go into the, the TIES method. So the T is the thinking, thinking, uh, memory problems like brain fog. Yeah. You're about to say something, tip of your tongue, you forget it. Um, the I, uh, in TIES is identity issues. So a lot of women will say that they don't know who they are anymore. They feel like they're losing themselves. The E is the symptoms of emotional fluctuations like mood, moodiness, anxiety, and so forth. And then the S is sleep. So you have problems with sleep. So the The 3 Ps help you to distinguish whether it's, you know, due to a primary psychiatry condition versus hormonal fluctuations causing these psychiatric symptoms. And then the TIES allows you to understand what are the mental health symptoms related to these hormonal fluctuations so you get the right treatment. Because it's very different getting hormonal treatments and then having your body feeling relieved and then your brain feeling relieved versus someone, you know, giving you an antidepressant and then you still have all these physical symptoms. Yeah.

I mean, you're saying it's so important, you know, there's this sort of continuum between psychological causes of mood disorders and biological causes, and they overlap and they kind of reinforce each other. But it's important to get the biological things out of the way so you can deal with the psychological things.

Yeah. You may still need an SSRI. You still may benefit from the support of a stimulant, but it's very difficult to get through a day and not feel moody if you're sweating. Yeah. You know, if you're feeling itchy and you're not happy with the way you look.

Yeah. My joke is I always say it's much easier to be enlightened if you're your B12 level's normal or your thyroid's working or you're not mercury poisoned, you know, like you, you can meditate on it all you want. If, but if these things are not optimized in your biology, then your brain can't function properly and then your mood is affected and your wellbeing is affected and your ability to experience joy is affected. And all these things can be actually managed. And so you kind of have to work on both ends of the spectrum, you know, both your psychological patterning and your beliefs and your childhood traumas, but also you, you know, we have so many people with biological things going on Function Health. We, we, we have 80 million biomarkers now on half a million people. And it's, it's just stunning to me to see the number of, of people with undiagnosed things that are affecting the quality of their life. And it's, you know, like 13% have autoimmune thyroid disease, 70% have a nutritional deficiency at the minimum level for deficiency disease, not what's optimal, like vitamin D or iron or, you know, omega-3s. And, and we're seeing that, we're seeing it's 46% of people with inflammation. Inflammation that's affecting them. We see probably 90% with some metabolic insulin resistance problem. It's on the spectrum of that. And we have 65% who have insulin levels that are over the limit of the lab test, which is way too high. It's like 18 for insulin. It should be 5 or less. And 65% of people who do our diagnostics, and these are health-forward people, are over 18. So this is a staggering problem. Problem. And if we don't deal with the biological effects, it's going to be hard to deal with the psychological stuff.

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That's peaklife.com/Hymen. But let's kind of shift over to this joy because I think that's ultimately what we want to feel and we want to be happy. We want to— Dalai Lama talks about this. It's sort of like, how do you find happiness, right? And you talk about these 5 Bs and reclaiming joy and the future of sort of mental health. So I'd love you to kind of walk through how we can approach this differently. You say we're wired for joy, but we forget how to access it. What does that mean? And can you walk us through the 5 Bs and how someone would start applying these, this framework? And I love your little acronyms and your little—

I teach medical students and doctors, so you have to have the acronyms. They, you know, we love that in medicine, right? Well, when I, when I developed the 5 Bs, I wanted people to have a very simple way of tapping into one or two tools to reclaim joy, not doing all five at once. Like, don't be high functioning like that. Pick one or two.

Don't overachieve in the 5 Bs.

'Cause sometimes you become super unhappy trying to chase after these, um, points of joy. But really think about one or two things. And I think starting with validation is important. Like how you mentioned when you finally realized that it was your need to be loved and your need to find self-worth that allowed you to realize, I don't have to do everything. I can actually relax a bit. I think many people struggle with the first V, which is, I think, the most important. So validation is accepting and acknowledging what you're experiencing and feeling without judgment, you know? And that's super hard for many of us who are accustomed—

whatever it is, if it's sadness, depression, depression.

Oh yeah. And I think for many of us who are accustomed to pushing down our feelings, we just push down, we push down. But the problem with that is if you continue pushing pushing down the negative and not processing, then you push down the ability to feel that joy. And so, with validation, imagine you're in a very dark room and you can't see anything. And you're like— you hear this loud crash. You know, some of us would start screaming, some would start swinging, depending on how you were raised. Others would just, like, freak out, right? But if you turned the light on and you saw that, oh, it was just like a vase that fell, fell, then you feel safe. You know, the mess is still there, the problem's still there, but at least you know what you're dealing with. And so when you shared your story about, I finally understood, you know, what it was that was driving me, you know, the problem's still there, but at least you know what you're dealing with. And the human brain does not like uncertainty. So knowing what you're working with is very powerful, but many of us try to run from it.

Validating your emotions, what you're feeling, whatever the qualities of those emotions are, right? Mm-hmm. Saying, okay, this is what's happening for me.

Yeah. And it sounds so simple and granular, but it is, I think, the hardest step for a lot of high-functioning folks. They don't wanna deal with it. They're trying to outrun it.

Right.

And they think they're chasing happiness, but they're trying to outrun something they haven't processed in the past. And then the second V is venting. And this is how you express in an authentic way what you're going through. So venting can be verbal. You know, if you have a therapist, great. Like when people come to see me, you know, you're paying me so you can say whatever you want. Sometimes people just come in, they're like, they don't even ask how you're doing. It's just like right into the session, which is fine. You're paying for that. Right. But when you don't have someone who's a mental health professional and you're venting, be very careful because, you know, some people use it against you. So be thoughtful about who you're going to vent to. Is it 1 or 2 people where there's confidentiality? Yeah. And I go to you, you come to me, we don't gossip.

Yeah. It stays here.

Is here and there's reciprocity. You know, I'm gonna ask for consent before, emotional consent. Is this a good time? Can I talk to you about something?

Can I dump on you right now?

Yeah. It's like the opposite of trauma dumping. It's like, can we, can we get together and talk? Because I need to process something. And it's not with the expectation that they're gonna tell you what you wanna hear. Mm-hmm. I think a lot of us pick people that we wanna, they're gonna tell us what we wanna hear. So that's where we go to them. Venting in the right way is intentional. You, you want to come up with a, a solution that's going to help you and help you to grow and move forward. And then really think about the hierarchy. Who are you venting to? It shouldn't be your kids because your children will not reject you. They want to attach to you, but they'll worry about you. You know, your employees, they're not going to say, shut up, boss, right? They're going to say, oh, all right, I'm listening to this guy, but they're going to go home and then trauma dump on their family, right? So really be mindful about the hierarchy.

I, I have a question. Yeah, given that, I mean, what about if your kid, your your children are adults, you know, like what if they're mature adults? Like what? Because I struggle with that. How much do I tell my kids? How much do I tell my daughter? Like what I'm going through? Like what, how do you think about that? Because your kid's 9, obviously you're not going to do that, but mine's 38, almost 39.

So I think, I think that's a really great question because developmental level is super important. And I have this conversation about a host of things with parents in my office when let's say there's like a death of a grandparent and they have to be able to deliver that news to a child, right? So there are developmental stages you want to think about. If you have an adult child and this is not something that you've done since the child was young, right, you don't want to re-traumatize them. You know, it's different than if you had a child, you know, you're— when the child was very young and you told them about your problems and you continue talking about—

my mother did that to me. It was not good. I'm just saying, that was not good.

It's, it's not, because, you know, it's, it's really burdening this child, and they worry, and they don't want— that's how they've learned to attach to you, is by like being your go-to. And that's— well, who is their go-to, you know? Uh, it becomes very unsafe for them. So it's very different if that was not your relationship when your child was young, and then they're an adult now and they're professional. Totally fine. I think once you do set— like, they're not your person that you dump everything onto. It's like, oh, I need help with something. I think that's appropriate. Yeah. But you want to also think about that adult child too, because if this is an adult child who has their own mental health, you know, challenges and they have their own traumas and they're not, and they're fragile, then, then maybe not an appropriate person. So it's a great question, but it is case by case.

So the validation, venting, uh, and it can be through journaling, through other healthy outlets, through processing, through workshops, through all kinds of ways to kind of get stuff out.

Journaling is a great way. I mean, once there's something about that hand-eye coordination and getting something onto paper and unpacking it and then putting it away that I find powerful for many of my young, my Gen Z clients. Clients, they love to journal, and they're just like, Dr. J, I just like wrote it all out and I put it, and then it was there.

Yeah.

It was like a compartmentalization for them. Um, but for my older clients, like, you know, people who are my dad's age, they're very faith-based. And so I, I joke that my dad's a pastor. I joke that he'll never go to therapy, but that man can pray. He prays 3 times a day and that's his venting. Yeah. So you have to do what feels authentic to you.

Yeah. Yeah. So then the next B is values.

Values. Uh, one that I struggled with for a long time because I was chasing these things that were the clout, you know, the, the degrees. At one point I was like, I wanna get a JD too. And I was like, this is, this is outta control. Like MD, MBA and a JD. Like, what are you trying to prove here? Right. Plus it's very expensive.

But you know, when I started to focus on the things that really mattered, like my family, you're only gonna be a doctor, a lawyer, and a CEO, right? I love that.

But yeah, you know, we, we chase the things that are the superficial values. Like we need money, we need clothing, we need shelter, right? We still need those things, but we also have to prioritize prioritize things that, let's say, when we have 5 minutes left on this earth, well, how would we want to spend that time? And I often think about my daughter, and I think about my family, and I think about my faith. And, you know, this tiny island, Tobago, where my dad was born, that was so beautiful. I always say, like, I need to spend more time there, you know? So all of these things that are deep, meaningful, purposeful values that we just put on the shelf, we need to prioritize those things more.

Yeah, I think it's important. You know, not living through obligations, achievement, people pleasing, like what, what actually matters to you and how do you focus more on that and on those things? And what's the next V?

Vitals, which is your expertise, the mind-body, the body-mind connection, right? Um, thinking about what you eat, what you're putting into your body, you know, how much you're moving, how much you're sleeping. Those are the traditional vitals doctors will tell you about, but the non-traditional vitals vital signs are things like technology, which we've talked about, our relationship with that, our relationship with our work, you know, leaving work at work and having a life outside of work. And then our relationships with people, you know, the research around people in your life and having strong, solid relationships being the key to a lot of our longevity factors. Having a physically healthy life depends on who we're around. And, you know, I, I, I joke with my clients when they're struggling with relationships. I never tell my clients what to do, right, with, with their, with their relationships unless they're in harm, right? And I say, you know, you can eat all the kale in the world, but that guy is gonna be a jerk forever, you know, like, and he's gonna drain your life, right? So think about who you're surrounding yourself with. I'm Caribbean. We can't cut people off. You know, you ain't cutting me off. You know, you, you stuck with me, but I could put you at a, I could set limits with you. I could say, I'm only gonna see you to do twice a year under these circumstances. I'm not going to cut you off. So think about who's draining your life and really pour into people who have your back. We take people for granted. We say, oh, that's a good friend, I don't need to call. That is who you should be investing in. Many of us are chasing after the friends who don't even like us, you know, who are jealous of us, who treat us like, you know, crap. But we're like, oh, we— well, we have to save that. It's like the rubber band effect. We're like running after them and pulling away, focus on the ones who are actually making your life better. Pour into them.

Yeah, I mean, I think that's important. I think the cultivation of our social network is important. And I don't mean social media, I mean actually people. And it requires a deliberate, intentional thing to reach out, to go see them, to spend time, to cultivate that. It's to me one of the most important aspects of my happiness and joy at this point in my life is that. And I make it a real priority. Because it's so easy to just kind of fall into just work, technology, obligations, and not actually take the pause. And then you have a fifth V, which is vision.

Yes.

Yeah.

How do you, how do you, how do you move forward? How do you have something to look forward to so you don't get stuck in the past? And it's different than goals. It's more about, okay, I know the science of my happiness. For me, it's connection. I know what makes me happy because during the points in my life when I was the most unhappy, I was the least connected to people in my life. You know, when during 2020 I was sitting in my lab and by all means on the outside of success, you know, I have so many degrees I can't even hang them, right? Literally they're under my bed. You know how it is on the outside. People thought I had it all. I had married to a physician, cute little daughter, the businesses, you know, always on TV, but no one knew I was struggling, not even my therapist. Like, I hid that from my therapist, and I'm a psychiatrist.

Yeah.

And, uh, you know, she was really surprised when I was going through my divorce shortly after that, and she was like, you never really talked about it. Yeah. And I said, well, I didn't want to worry you, which is like, so, you know, the people pleasing. I'm paying this woman, I don't want to bother her.

Okay, that's a good one.

We went through EMDR, um, which is a trauma-focused type of treatment, and it just unpacked so so much for me. And I thought, I really think I started really thinking about the points in my life when I was the most joyful. And it was always when I was around the people that I loved and I was connected to them, even though I had very little, you know, uh, my, I have 3 siblings and, you know, we used to play together and we didn't have toys, but we'd make toys out of like boxes. And so, and those were the happiest times for me when I was a broke med student, you know, hanging out with my medical student colleagues, that was joy for me. But the more successful I got, the least connected I was to the people that I love the most. So, for me, it's really important to plan points of joy where there's a lot of connection. So, whenever we finish a big study in our lab, we don't just say, "On to the next," right? That used to be the old me. Like, "We gotta get the next study. I gotta get the next one," right? Now it's about, "Okay, let's celebrate. You know, let's— when are we gonna get together for our, like, our retreat?" When are we going to get together in the lab just to, like, have a little dessert? Because I'm celebrating the point of connection, not the idea of happiness, which is the goal. That, oh, check the box, we did that study. And when I prioritize that and I plan it and I put it on my schedule and I protect it, I have found that that's when I'm the happiest, right? So plan things in your future, your near future. I have this practice where every day after I drop my daughter to school, I sit in my living room and I drink this cup of coffee and I found it, I discovered it in St. Martin and I figured out how to get it here in the US. But it's like this rum cream flavor. There's no rum in it, there's no alcohol, but it's just so delicious. It literally transports me back to the Caribbean and I sit there, everyone knows that's my time and I just like savor it and then I go to work. I used to just go straight to work and like, okay, let's, but I've found that when I take these moments to just like intentionally relax, that I actually make better decisions. I'm less grumpy, you know, I'm, I am more successful, more productive. All the things I feared, the fear of running out of resources, all those things, the opposite happened. The abundance just flowed. So really understand, you know, what is it that brings you true joy and then protect that in your schedule and look forward to it.

Yeah, I love that. I think that's important because we schedule all these other things, but we don't schedule joy or time to actually cultivate it. It or feel it. It's beautiful.

Or to celebrate the wins. It's always on to the next. But what's the point of it if like you're not enjoying it?

And a lot, a lot of this you talk about in your book, High Functioning: Overcoming Your Hidden Depression and Reclaiming Your Joy. I think that's such an important kind of concept because it's, you know, most, most psychiatric kind of focus is on pathology, not on well-being. And I love the kind of flip of that. And I think this is what's happening in psychiatry in general. We're kind of moving into this really interesting moment. Where, you know, when I was in college, I read this book called Madness and Civilization. And it was by this French philosopher that talked about the history of mental illness throughout time and how we have different meanings we attribute to it. It's, you know, it's a, you know, possession by, you know, demons, or it's like imbalance in your humors, or it's, you know, Freud and his, you know, Oedipus complex or whatever, like, and then it's the chemical imbalance theory. And then we're kind of moving through all these attempts to try to explain the human condition. And I think now we're kind of entering in a really interesting moment in psychiatry where we're seeing this convergence of metabolic and nutritional psychiatry and functional medicine approaches to mental health along with psychedelic psychiatry. Can you kind of talk about where we're going in the future and how these things are going to shape and change the field of psychiatry?

Well, I'm, I'm particularly very excited about this. You know, I mentioned I grew up in a church. My dad's a pastor and psychodelic therapy has a lot of elements of spirituality, right? And years ago, whenever we'd have the ground rounds of the spirituality person, you know, at the places I trained, it was always like, oh, that's not the important lecture. I wanna come back for the guy on schizophrenia and the brain and like all the imaging stuff. But now we're realizing that when you look at Gen Z and the younger folks, they're actually going back to religion and spirituality. So why is Why is that? You know, why is it that they're doing that? Well, we are in an age where the machines are taking over and we feel this loss of control, right? The jobs are being scooped up. But what are the things that are inherently human? Love is human. A machine can't learn love. If you talk to an AI therapist and they, you know, spit back something to you like, "Oh, I get it. I know how you feel." Do you? Do you really know how I feel? Have you ever had a breakup? Have you ever had a loss? Has anyone died in your family? Oh, forgot you don't have a family. Right, right. Um, and that's why I'm good at faking it. They're so good at faking it. But, you know, they're not human. But the things that are human are things like love, loss, faith, you know, like spirituality. And I think we're really rebelling— some of us are rebelling against the machines, and we're trying to feel connected into things that are inherently human. Art— AI can replicate art, but what is that inspiration from? It's from a human experience. So we have to really protect things that make us worth being on this planet, for allowing us to, you know, survive through evolution and protect what's really human. Psychedelic therapy is very spiritual. In fact, you know, you hear these, like, anecdotal stories of people going away but then coming back, and then some of them saying they're cured forever. And it does happen for some, but most will say, "I had to go back and I had to, you know, continue to get dosed." Well, the reason that a lot of the treatments aren't sustainable is because there are several elements of psychedelic therapy that involve spirituality. You, you're not just getting dosed, you know, in our unit, in our, I think our psychedelic unit, it looks like an apartment. It doesn't look like a lab. We have a lab that looks very sterile. And then we have a part of the lab that looks very cozy. And, you know, therapists will sit with the individual after dosing and they'll go through all of these grounding and mindfulness tools. And then they'll have integrative sessions after the dosing to build on the principles So it's not just about one dose, it's about, okay, what have you learned from that session? How do we build on it? How do we continue to change your brain over time? And so a lot of the research and a lot of the future, I think, in mental health is leaning towards spirituality and incorporating it. It's different than religion, very different. Religion is mostly, you know, having to do with rules and, you know, dos and don'ts and, you know, social constructs. Drugs. Spirituality is different. You don't have to believe in a deity to be spiritual. You could feel connected to a greater thing like nature, feel a sense of awe. You don't necessarily have to be religious. So I think that's where we're moving in. We're actually doing a study in our lab. One of our sub-investigators, Dr. Deepa Valeti, is heavily in the— into the spirituality world. And we're looking at Gen Z and whether or not people in the Gen Z group are happier being spiritual versus religious. So we're really excited about that. I don't know how that's going to turn out, but we'll see.

Well, it's really a sense of meaning, right? It's like, you know, I talk about the ingredients for health and one of them is meaning and purpose and how we find those, how we achieve those, how we think about them is really important. And I think, you know, a lot of it, you know, has traditionally been through religion, which is an attempt to codify spirituality. But spirituality, like you said, is separate from religion and from dogma. And it's really our sense of connection to something greater or something meaningful or something that gives us purpose or belonging. And I think that's, that's what we're all craving. So I kind of love this reframe. I love the fact that you're talking about joy as a state that we should be cultivating. And if we don't feel that or we don't have it, it's something we should pay attention to. And I think people can learn more about all of this by reading your book, High Functioning, and following you on your, your social and your websites. Drjudith or judithjoseph.com, right?

drjudithjoseph.com.

Yes. And also you have, you know, so much online and so many resources and I think people can kind of, kind of dive in and actually see what's, what's happening for you.

And, um, you've got the website for the book is highfunctioningbook.com, but you can find it on my website, drjudithjoseph.com.

Great. Well, thank you for your work. Thanks for pioneering a whole new frame and thank you for the joy you brought into my podcast. It's really great. I can feel it. And, uh, it's good to see you again., and thanks for just kind of being a voice for something that's, you know, being unspoken in our society and how to navigate through that for us. And sure, for me, I had a, when I was kind of prepping for this podcast, like, oh God, I kind of think I'm one of those guys who has experienced that. And I think it was very helpful for me to understand your framework. So thank you.

Thank you for your work. My patients benefit from your work and thank you for your vulnerability. I think that's what most impressed me when I met you was your vulnerability. A lot of men are not vulnerable. And I truly believe that if they were and they opened up and they prioritized their joy, the world would be better. The research shows that joyful people are like physically healthy, they have better relationships, but they also are more likely to help the world and make the world a better place. So imagine if every man focused on their joy and, you know, were vulnerable and reflective.

Like, well, I think, I think that's the mistake people make, especially men, is that they associate associate vulnerability with weakness, not strength, but it's the opposite.

It is.

Yeah.

Yeah.

All right, well, thank you for having me. Thank you. If you love that last video, you're gonna love the next one.

Check it out here.