#1 Researcher: You May Have High Functioning Depression But Don't Know It Yet! Ft. Dr. Judith Joseph
Here are the top 10 key takeaways from Dr. Judith Joseph's groundbreaking discussion on high functioning depression and how to reclaim your joy.
1. High functioning depression is an epidemic hiding in plain sight
High functioning depression affects people who maintain their daily responsibilities while secretly struggling with lack of joy and meaning. Unlike traditional depression where people can't get out of bed, these individuals continue working, parenting, and socializing effectively. They appear successful on the outside but feel empty inside. The current medical model waits for complete breakdown before offering help, which Dr. Joseph argues is fundamentally flawed.
This condition is particularly insidious because it goes unrecognized by both sufferers and healthcare providers. People with high functioning depression often hear "come back when you're not functioning" from doctors. They don't meet traditional diagnostic criteria because they haven't lost their ability to work or maintain relationships. The result is millions of people living below their emotional potential, never receiving the support they need.
2. Anhedonia is the silent twin of depression that steals joy
Anhedonia represents the inability to feel pleasure or joy in activities that should bring happiness. Dr. Joseph describes it as depression's "silent twin" that sneakily robs people of their capacity for bliss. Unlike the weepy, bedridden image of depression, anhedonia shows up as someone going through the motions without emotional reward. They might be productive at work but derive no purpose from it, intimate with partners but want it to be over quickly.
This symptom is particularly common among high achievers who cope with emotional pain through over-functioning. When they can't understand why they feel empty despite their accomplishments, they often respond by doing even more. This creates a dangerous cycle where they become human doings instead of human beings, always busy but never fulfilled.
3. Trauma doesn't require major events to reshape your life
The traditional understanding of trauma focuses on major events like combat or assault, but Dr. Joseph introduces the concept of "little t trauma." These include experiences like bankruptcy, toxic relationships, neglectful parenting, or even a series of disappointments that accumulate over time. Each disappointment acts like a small wound that, when combined with others, creates significant emotional impact. The key insight is that these experiences don't need to be life-threatening to be genuinely traumatic.
These accumulated disappointments can fundamentally alter how people view themselves and interact with the world. A person might collect disappointments from failed relationships, missed promotions, or unmet expectations. Over time, these experiences dull their emotional responses and ability to experience joy. The brain learns to protect itself by numbing positive emotions, leading to the anhedonia that characterizes high functioning depression.
4. Busyness serves as a trauma response and avoidance mechanism
Constant busyness often represents a sophisticated form of emotional avoidance rather than productivity. Dr. Joseph explains that over-functioning is actually a trauma response where people stay busy to avoid processing painful emotions. This avoidance might work short-term but creates long-term problems as the underlying issues remain unaddressed. People become addicted to doing because stopping forces them to confront uncomfortable feelings.
This pattern typically develops in response to early experiences where a person learned that their worth depended on their productivity. They might have grown up in environments where love was conditional on performance or achievement. As adults, they continue this pattern, believing unconsciously that if they stop being productive, they'll lose their value or be abandoned. The constant motion serves as both a distraction from pain and a misguided attempt to earn love and acceptance.
5. The biopsychosocial model provides a personalized roadmap for healing
Understanding your unique combination of biological, psychological, and social factors is crucial for addressing high functioning depression. Biological factors include things like thyroid function, hormonal changes, family history, and genetic predispositions. Psychological factors encompass past trauma, attachment styles, personality traits, and coping mechanisms. Social factors include relationships, work environment, lifestyle habits, and access to resources like nature or supportive communities.
Each person's biopsychosocial profile is unique, which explains why generic approaches to mental health often fail. What works for one person might not work for another because their underlying factors are different. By mapping out your specific risk factors and strengths across all three domains, you can create a targeted approach to healing. This model also helps explain why someone might develop high functioning depression and what specific areas need attention for recovery.
6. The five V's method offers a structured path to reclaiming joy
Dr. Joseph's five V's method provides a practical framework for addressing high functioning depression. Validation involves acknowledging and accepting your true feelings rather than dismissing them. Venting means expressing emotions through talking, crying, writing, or prayer. Values focus on pursuing meaning and purpose rather than external achievements. Vitals encompass caring for your physical health, relationships, work-life balance, and technology use. Vision involves planning moments of joy and celebrating wins rather than constantly deferring happiness.
The beauty of this method is its accessibility and flexibility. You don't need to implement all five V's every day or in any particular order. Even focusing on one or two areas can create meaningful change over time. The key is consistency and intentionality rather than perfection. This approach recognizes that healing happens gradually through small, sustainable changes rather than dramatic overhauls.
7. Scarcity trauma creates invisible barriers to success and joy
Scarcity trauma develops when people experience or inherit fears around not having enough resources, whether money, food, shelter, or love. This can stem from personal experiences of poverty or deprivation, or from family histories of struggle that get passed down through generations. The trauma manifests as behaviors like hoarding, over-working, difficulty taking risks, or constantly preparing for disaster. People might accumulate degrees, money, or achievements as insurance against future scarcity.
Dr. Joseph shares her own experience of "hoarding degrees" - pursuing multiple credentials not out of genuine interest but from a deep fear of not being enough. This pattern is common among high achievers who grew up with scarcity. They might achieve external success but struggle to enjoy it because they're always preparing for the next crisis. Recognition of scarcity trauma is the first step toward breaking these patterns and learning to trust in abundance.
8. Hormonal changes significantly impact women's mental health
Women face unique vulnerabilities to depression during hormonal transitions including puberty, menstruation, postpartum, and menopause. Dr. Joseph's TIES method helps identify menopausal mental health symptoms: Thinking problems (memory, concentration), Identity issues (body changes, role shifts), Emotions (mood swings, anxiety), and Sleep disruption. These changes are often misattributed to aging or dismissed by healthcare providers who lack training in hormonal mental health.
Understanding hormonal influences helps women avoid self-blame and seek appropriate treatment. The symptoms aren't character flaws or signs of weakness but biological responses to hormonal fluctuations. With proper recognition, women can make lifestyle adjustments, seek hormonal support when appropriate, and develop coping strategies. The key is recognizing that mental health symptoms during these transitions are common, treatable, and don't reflect personal failure.
9. Supporting someone with high functioning depression requires patience and presence
People with high functioning depression often internalize shame and blame, making them reluctant to seek or accept help. They've learned to equate their worth with their productivity, so they fear that showing vulnerability will result in rejection or abandonment. When supporting someone with this condition, consistency and unconditional presence matter more than trying to fix them. They need to experience love that isn't contingent on their performance or achievements.
Effective support involves modeling vulnerability, offering practical help without being asked, and repeatedly demonstrating that your love isn't conditional on their productivity. This might mean sitting with them during difficult moments, helping with basic needs like food or rest, or simply being present without trying to solve their problems. The goal is to gradually reshape their attachment style by proving that they're lovable even when they're not performing.
10. Practical techniques can help manage worrying thoughts and stay present
Rather than trying to eliminate anxious thoughts, Dr. Joseph recommends learning to coexist with them through techniques like worry procrastination and the 54321 grounding method. Worry procrastination involves designating a specific time and place for worrying, saving concerns throughout the day to address during that designated worry time. Most worries lose their power by the time you reach your worry corner. The 54321 method helps ground you in the present by identifying five things you can see, four you can feel, three you can hear, two you can smell, and one you can taste.
These techniques recognize that trying to control thoughts often backfires, especially for anxious people. Instead of fighting thoughts, you learn to let them exist while staying focused on the present moment. It's like allowing a train of worry to pass by while you remain on the platform rather than jumping aboard. With practice, these methods help retrain your brain to spend less energy on unproductive worry and more energy on meaningful present-moment experiences.