Judith Joseph, MD, created the first research-backed framework for assessing high-functioning depression. Now, the psychiatrist wants Black women take charge of their happiness with it. Her upcoming book, High Functioning: Overcome Your Hidden Depression and Reclaim Your Joy, promotes a basic but powerful technique — keeping score.
“I don’t encourage you to keep score in all relationships. But in certain situations where there’s a repeated pattern, where there’s no reciprocity or limited reciprocity, it’s important,” Joseph explains. “Human psychology shows us that we tend to treat certain people better than how they treat us, depending on our past trauma and our low self-worth.”
High-functioning depression can cause those with it to find themselves in maladaptive relationships with unbalanced dynamics. According to Joseph’s research, any traumatic experience can cause this. Whether you were assaulted, had a hypercritical father, or dealt with an abusive boss, High-Functioning explains how it can place you at risk for the reduced joy you’re experiencing.
“Trauma makes you self-blame and internalize shame and not want to burden others, and that’s why many of us push down our feelings,” she says. “When people treat you poorly, you just become accustomed or numb to it.” As one example in Joseph’s book illustrates, that numbness can look like organizing elaborate celebrations for others while making excuses for not celebrating yourself.
High-Functioning recommends keeping a score of one’s relationship with oneself, too. Its simple tools help readers connect to past and present feelings. “That’s why I put those tangible tools in there,” she notes. “If you don’t understand where this is coming from, there’s no way to acknowledge it.”
Keeping score can also help manage the trauma response of developing people-pleasing tendencies that sabotage your happiness. “Trauma doesn’t mean that you’re not lovable. It just means that you have to be aware that having trauma makes you feel unlovable,” says Joseph.
Anhedonia, an inability to experience pleasure, is explained in the book and a tool is provided for measuring it. Knowing what promotes and what threatens your happiness can help fight it. But it’s not enough to know. You have to act on it and have a way of measuring that action. For example, the book lays out methods of evaluating your three closest relationships, something that heavily impacts your health. It helps you consider your environment and what you can do to change it should you begin to notice a loss of interest in the things that once were enjoyable.
Joseph knows what it looks like when high-functioning depression sneaks up on you because she doesn’t just study it. She struggles with it. She turns to the tools in her book frequently. If her hair is not done, she knows it’s time to figure out why she isn’t making time to express herself through her personal style. She also encourages and empowers her loved ones to monitor their happiness by utilizing her methods, and in turn, they do the same for her. “The people in my life, they keep me accountable because high-functioning depression is something that you go back into. It’s not like you’re cured,” she says. “It’s something you need to continuously work on like any mental health condition.”
Signs of low-functioning depression like poor hygiene or the inability to get out of bed are loud signifiers that something is wrong. The ways that high-functioning depression sabotages life are quieter. It’s found in the mind fog following the relief of a big win at work, the hours spent zoning out instead of caring for yourself by getting a good night’s sleep, and the failure to listen to your child tell you about their day due to an obsession with getting your inbox to zero. This new work highlights these warning signs so that those impacted can turn things around by seeking help.
To aid in getting her insights and advice to more people, including the uninsured or underinsured, she educates her over 300,000 TikTok followers for free. This book is an extension of that. High Functioning presents solutions for those who can’t simply book a therapy appointment tomorrow, no matter how badly they know they need it. The work might have rigid scales for evaluating one’s depression symptoms, but its framework can be applied flexibly. It also has pages of reviewed and reliable resources and cost-friendly suggestions.
“My mission is to democratize mental health,” Joseph says. “In some parts of this country, there’s only one psychiatrist for every 30,000 people. So I wanted to create something that would allow people to feel as if they have tools that are vetted so that if they don’t have access to care, they have at least methods to start their healing.”
High Functioning: Overcome Your Hidden Depression and Reclaim Your Joy is available on April 8.
