Lifestyle
Avoiding your problems with work? You might have “high-functioning” depression
Judith Joseph has spent most of her life building an impressive résumé. She is a board-certified psychiatrist, chair of the Women in Medicine Initiative for Columbia University’s Vagelos College of Physicians & Surgeons, a clinical assistant professor of psychiatry at NYU Langone Medical Center, the principal investigator of her own research lab — and a mom.
But despite her accolades, once the COVID-19 pandemic hit, Joseph couldn’t shake the sense that something was off. With the world on lockdown, Joseph began sharing skits related to her research on social media, many of which went viral. It was only then that she landed on a name to what she, and many others, had been experiencing: high-functioning depression.
Shelf Help is a wellness column where we interview researchers, thinkers and writers about their latest books — all with the aim of learning how to live a more complete life.
“I wanted to make sure that we weren’t just thinking about depression in the way that our grandmothers think of depression, not being able to get out of bed, crying,” Joseph said.
Instead, with high-functioning depression “you push through and you don’t deal with your pain because too many people depend on you,” she said. “You know something’s off, but you can’t quite put your finger on it. And you don’t slow down because you don’t know how to.”
To Joseph’s surprise, high-functioning depression was absent in medical literature. So she set out to design and execute the first research study on the topic, which published in February. Her first book, “High Functioning: Overcome Your Hidden Depression and Find Your Joy” (Little, Brown Spark), relies on findings from the study, anecdotes from patients from her private practice and lessons from her life to teach people how to understand the science of their sadness, so they can understand the science of their happiness.
The Times spoke with Joseph about her book’s findings and why it’s just as important to practice preventative care in mental health as it is in physical health.
This interview has been condensed and edited for clarity.
Dr. Judith Joseph is the author of “High Functioning: Overcome Your Hidden Depression and Reclaim Your Joy.” (Little, Brown Spark) (Photo by Anthony Steverson)
How would you define high–functioning depression?
With clinical depression, you have five or more symptoms, like low appetite, change in appetite, poor sleep, low energy, feeling restless, guilt, hopelessness, suicidal ideation. But you also have to meet criteria for having a low mood, or anhedonia. And on top of all that, you have to have lower functioning or significant distress.
People with high-functioning depression will have the symptoms of depression, but they’re not low-functioning. In fact, they cope by over-functioning, and they don’t acknowledge having significant distress. In fact, they’re muted. They don’t feel anything.
One of the symptoms of trauma is avoidance. So people think, “OK, I don’t want to go to this place or see this person or be in this situation because it triggers me.” But with high-functioning depression, people are avoiding by busying themselves so they don’t have time to feel, and when they sit still, they feel restless and empty.
A big part of high–functioning depression is being defined by your achievements or what you do for others. Why is it so hard to build identity outside of our external achievements?
Many of us have this coping mechanism of forgetting, and that’s one of the 30-plus symptoms of the trauma inventory. We outrun because we don’t remember what it was like to derive a sense of pleasure from things that truly bring us joy, because our past hides them.
Children, if there’s a conflict, they internalize it and they’ll say, “Well, if I only got straight A’s, Daddy wouldn’t have left.” Or “If I only did my homework, the dog wouldn’t have died.” Children use that magical thinking, but adults use it too. They focus on things like work, a role, on what they can do. In the short run, that’s a positive coping skill, but in the long run, when you continue to intellectualize and you don’t feel, that can show in different ways like binge drinking, excessive shopping, excessive doomscrolling, physical breakdowns or even dipping into low-function depression.
The bottom line is that there is a real value in acknowledging and processing your trauma and healing, because then you can actually experience a change.
“People can search and try to be happy all their lives and never get it. And even if you get the thing you think will make you happy, you’re still not happy. If you shift it, and you’re like, ‘I can increase my points of joy every day,’ then it’s attainable.”
— Dr. Judith Joseph
In the first part of your book, you introduce two key terms: anhedonia and masochism. What is anhedonia and why is it important for people to know what it is?
There’s a real disconnect between the research and the real world, because in research, anhedonia is all over our rating scales. It’s a term that has been around in the medical literature for hundreds of years. “An” is a lack, “hed” is pleasure, and “onia” is a symptom. “Anhedonia” is a lack of pleasure and joy, and it’s a lack of pleasure and joy in things you were once interested in.
So imagine you’re eating your favorite meal and you’re not even tasting it, you’re not savoring it. Or if you are listening to your favorite song, and it doesn’t move your body the way it used to, it doesn’t light you up. Or if you’re looking at a beautiful part of nature, like the sun is setting and it’s exquisite, and you’re just checked out. Or if you’re with your partner, and you’re being intimate and you just want to rush through it; you’re not even in the moment. These are all the simple joys that make life worth living.
In research, you will rarely see the word “happy” on our rating scales, but what you do see are points of joy. Whereas in the real world, the patient will come in and say, “I just want to be happy.” But we’re like, “No, we’re just trying to eradicate your depression by increasing your points of joy.”
Happiness is an idea, whereas joy is an experience. If you can reframe that and think about it as: Anhedonia is robbing [me] of my joy; it’s not that I have to be depressed and weepy and sad, but if my points of joy are low, then that’s an indication that something is off.
It’s a really important shift because people can search and try to be happy all their lives and never get it. And even if you get the thing you think will make you happy, you’re still not happy. If you shift it, and you’re like, I can increase my points of joy every day, then it’s attainable. There’s hope. Today, you may get two points, but tomorrow maybe you get three.
How does masochism contribute to high–functioning depression?
When people think of masochism in the real world, they think of sex, which is not what we’re talking about. We’re talking about masochistic personality disorder. Masochistic traits are ones where people tend to bend over backward for others. They tend to sacrifice their joy for the sake of others. It’s almost like self-sabotaging. In today’s speak, it’s called people-pleasing.
What I found in my study was that a lot of people who are caregivers have high rates of anhedonia. Well, that makes sense. These are people who are not thinking about themselves. They’re putting others first, often at the expense of their own happiness. Because high-functioning depression is closely tied to trauma, and because a symptom of trauma is low self-worth and shame and self-blame, that may be a part of the reason why people with high-functioning depression can’t relax: They’re constantly doing for others.
If you’re someone who knows your self-worth and you know that your role doesn’t define you, you’re not going to bend over backward. You’re not going to keep going, even though you feel off and you feel burned out. You’re going to take care of yourself.
The second half of the book gives the reader concrete steps to reclaim their joy using what you call the Five V’s: validation, venting, values, vitals and vision. How did you develop these five Vs?
If you think about it, there’s been this renaissance in physical health, but there’s nothing for us in mental health. Why do we wait to check that box of low-functioning? We need to show people how to increase their points of joy and prevent these breakdowns on their own.
So, I came up with the five Vs based on what I learned about happiness and research, and derived them based off of things that I felt that people needed to do in order to overcome trauma and how to find sustainable joy.
Validation is the first step. Because many people, again, don’t acknowledge how they feel. They push through pain, they just get through life, and that’s how they cope. But if you can acknowledge how you feel, and accept how you feel, then you could actually do something about it.
Venting is expressing your emotions. Some of my clients are neurodivergent, so they’re not the most verbally expressive. But there are other ways you can vent. You can draw, you can write, you can pray, you can sing. You could talk about your feelings, if that’s how you want to express it. You can cry. Venting has different ways of getting that emotion out and decreasing your stress.
Values are things that, when you tap into them, you feel a sense of purpose and meaning. I would say that values are things that are priceless. Many of us with high-functioning depression, we’re chasing the accolades, and we’re chasing the things that look good on the outside but don’t really give us true meaning.
With Vitals, I wanted to put in the traditional things like sleep, movement and diet, which are all important. But I also wanted to add things like our relationship to technology, our relationships with other people and work-life balance, because the quality of our relationships with people in our lives is the No. 1 predictor of long-term happiness and health.
Vision is how do you plan joy so that you keep moving forward instead of getting stuck in the past? Celebrating your wins so you don’t have to live for tomorrow’s. Start planning joy today. That’s the whole point. Don’t hold your breath for happiness for the future.
(Maggie Chiang / For The Times)
For someone who’s avoidant, it can be really scary to slow down enough to really examine your interior life. What do you say to that person who doesn’t know how to broach the five Vs?
I always say don’t do the five Vs all at once, because people who are intense like myself will want to do everything at once. The goal is not to use all five at once; use one or two. I would say start with validation. It doesn’t have to be this big, grand thing. It could be as simple as looking in the mirror every day and just reflecting on how you feel. Or, if that’s too intense for you, there’s sensory tools like a 5-4-3-2-1 method that is a grounding tool that allows you to be present in your body. Just practice that every day for one to two minutes and, slowly, you should be able to start to self-reflect and acknowledge and accept what you’re feeling and move from there.
You directly tied the idea of “vision” to fostering joy and combating anhedonia. What’s the relationship between vision and anhedonia?
People with high-functioning depression want to keep doing what they’re good at. But it’s important to retrain your brain and slowly reintroduce yourself to the things that you once enjoyed.
For example, in the book I talk about a patient who forgot that they actually enjoyed nature. When they were a child, their parents used to take them camping and when the parents got divorced, they stopped going camping, and they forgot that that’s what they love doing. Now they live in a big city and what they usually do for fun is go see a show or something that is more accessible in a city. But when we identified that trauma, we started to challenge them to go back into nature again. By slowly introducing the person back to the things that they used to like, their anhedonia in relation to nature got better.
TAKEAWAYS
from “High Functioning”
At the end of the book you break down the various types of therapy and drug interventions for someone struggling with their mental health. For someone who has your book in hand and is looking for next steps, what would you recommend them?
I’d recommend for them to take the quizzes [throughout the book] and to see where they are in terms of the levels of anhedonia, depression and trauma and then move from there.
Let’s say, biologically, you’re healthy and psychologically you don’t have very many risk factors. Then you have to work on the social aspect. What is it about you that’s keeping you in that toxic environment? What’s hindering you from leaving there? Because that’s where you’re losing joy.
For another individual, it could be that the social bucket is fine. The psychological bucket is fine. But biologically, maybe there’s an untreated autoimmune issue, or maybe you’re going through perimenopause. Well, then that’s where you need to focus on the science of your happiness.
For others who have trauma that’s never been processed, and they’re constantly in fight or flight, but biologically and socially, things are not as draining for them, then that’s where we need to focus.
There is only ever going to be one you in the history of the universe and in the future of the universe. That, to me, is so powerful because then you know that you’re here for a reason.
So I want people who read this book to really try to understand the science of your happiness, because there’s only one you. And then when you fully understand what’s draining from your happiness, then you can work on those efforts to increase your joy, using the book as a guide.
Shelf Help is a wellness column where we interview researchers, thinkers and writers about their latest books — all with the aim of learning how to live a more complete life. Want to pitch us? Email alyssa.bereznak@latimes.com.
The Wicked Witch ‘Adelphaba’ (played by Gigi Zahir) on stage at the Pleasance Theatre in North London
Ella Carmen Dale/Handout
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Ella Carmen Dale/Handout
LONDON — Foreboding music begins. A scary green witch announces her arrival with a cackle. It’s the opening of Wicked Witches, a British holiday-time play known as a “pantomime,” at a North London theater.
But soon after she walks on stage, it’s clear the witch isn’t happy with the audience.
She says the audience is being too quiet, and should boo her as loudly as they can, because she is the “villain” of the pantomime. She leaves the stage and comes back on — and this time, the audience does what it’s told, heckling with loud boos.
Throughout the two-hour play, the audience is expected to join in, shouting out classic lines that most people who attend already know, even if they haven’t seen this play. Pantomimes are famous for crowds calling out catch phrases e like “it’s behind you!” — to alert the actors to something, or someone, they can’t see on stage.
All across Britain during the festive period, families attend pantomimes — often shortened to “pantos” — which help get them into the Christmas spirit. Pantomimes are usually based on a well-known story, often a fairy tale, which is then given a bawdy twist. Traditionally, they feature female characters, or “dames,” played by a man in drag, and include lots of music, particularly pop parodies.
The show at the Pleasance Theatre is inspired by The Wizard of Oz and Wicked. Its storyline imagines a blizzard that brings Dorothy (whose name has changed to Dor) back to Oz, 20 years after that first visit. But in many ways, the plot comes second to the silly jokes, innuendos, and songs.
Actor Sir Ian McKellen playng Toto the Dog in a video clip for the Wicked Witches pantomime.
Pleasance Theatre
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Pleasance Theatre
Pantomimes are also known for featuring celebrities and public figures. This one features politician Jeremy Corbyn, who used to lead Britain’s Labour Party He appears on video as the Wizard of Oz-lington, a pun on Islington, the area of London he represents, now as an independent, in Parliament. Even more exciting is actor Ian McKellen — famous for playing Gandalf in the Lord of the Rings films — who is seen in a video clip as Toto the dog.
The Wicked Witches pantomime in North London was actually written by an American, Shane “ShayShay” Konno, who comes from California’s Bay Area but has lived in the United Kingdom for 12 years. “I didn’t grow up in the U.K., and when I moved here, starting to understand pantomime felt like a huge cultural hurdle,” Konno says.
Pantomime has its roots in Italian commedia dell’arte, a form of theater that dates back to the 16th century. In Britain, it has gradually developed over the years. “The actual history of pantomime is it started in East London, and it used to be this huge thing where the whole community would come together,” Konno explains.
Konno is nonbinary, and their pantomime is consciously inclusive of LGBTQ people, featuring a nonbinary character in the lead role of Dor, and a message that people should accept people who are different from them. “I wanted to make something that made an explicitly LGBT version of The Wizard of Oz and Wicked, because that’s such a beloved franchise for the queer community,” Konno says.
There are two versions: one for families with children, and one just for adults. But Konno says they aren’t as different as you might think. Many of the ruder jokes remain in the family-friendly show, but they are carefully disguised. “When a quite rude joke is said, but one that goes over the kids’ heads, it does tickle the adults in the room more than it would in an adult show because they’re like, ‘Oh my goodness, I can’t believe that they said that in front of the children,’” Konno says.
Characters perform on stage at the Wicked Witches pantomime in north London, on Dec. 6.
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Robbie Griffiths/NPR
Most theaters around Britain have an annual pantomime in the festive period — and it’s often their most popular production of the year. Johnny McKnight, from Paisley, a town near Glasgow, Scotland, has been performing and writing pantomimes in Scotland for 20 years, and says it’s a vital part of many British people’s Christmas celebrations.
“I’ve always said to everybody, when you do a pantomime, and you’re doing 12 shows a week, you’re giving people the gift of their Christmas ritual, their Christmas night out,” McKnight says. McKnight often plays the role of the dame, dressing up in drag.
McKnight has seen different generations of the same families grow up watching his shows, and explains that pantomime is often the first time that children in Britain ever visit the theater. “A lot of the time it’s a child’s first entry point,” McKnight says. “It was certainly mine — my first entry point into live theater.”
At the Wicked Witches show in North London, there are lots of children at the theater for the first time. Imogen Coackley is 8 years old, and attending with her father Alex and 5-year-old sister Emily. Imogen explains that she likes the pantomime because “they say very funny jokes and talk to the audience.”
McKnight says that seeing children enjoy his shows is one of the best parts of the job. “There’s something … magical in that, that you’re creating something accessible that talks to its audience rather than at them, that asks them to participate,” he says.
Driving through Southern California can feel like entering a different world. There are rules, yes, and you must learn them. The city, county, state and feds pass and enforce laws that govern our conduct on the road.
But within the confines of these rules, drivers take all sorts of liberties: They rush through at the tail end of a green light, prevent their peers from merging and snake through neighborhoods slow enough to read every street sign. The variations are endless and endlessly annoying.
Everywhere you turn, there’s another study ranking California drivers as among the worst. In fact, there’s just about only one thing California drivers all agree on: Everybody else on the roads has lost their minds.
As the holidays approach, we want to do our part to help eliminate the scourge of bad and selfish driving across the state. We asked Essential California readers to send in their complaints about other drivers on the road, and boy did they deliver.
Hundreds of emails later, we put together some tips for driving etiquette. We hope you’ll use them, and submit more of your own by emailing us at essentialcalifornia@latimes.com.
One surprising response wasn’t a complaint at all, but a compliment to L.A. drivers. “Every time we visit Los Angeles from Connecticut, we notice how well people drive in Los Angeles,” Wyn Lydecker wrote. “People are polite. They follow the rules of the road and it’s amazing to us.”
That’s great, Wyn, but we have no idea what you’re talking about.
We identified seven of the most frustrating things people do while driving, and we’re here, with the California Driver’s Handbook, to correct them. Please take note.
Turn signals were invented to be used
(Liam Eisenberg / For The Times)
Improper signaling or failure to use signals at all was the most common complaint we heard from readers.
“It seems obvious to me that when approaching a turn, you first signal, THEN BRAKE!,” Bill Pucciarelli wrote in. “So many drivers suddenly brake in front of you, for seemingly no reason. Then after we all come to a stop, turn on their signal. Why bother at this time?”
Bill is right. In fact, you are supposed to signal at least 100 feet before you turn; before every lane change; at least five seconds before you change lanes on a freeway; before pulling next to the curb or away from the curb; even when you do not see other vehicles around you; and when you are almost through the intersection if you plan to turn shortly after crossing the intersection.
Drivers, be more like Bill!
Please put your phone down. The light turned green and we’re all waiting behind you
(Liam Eisenberg / For The Times)
The second most complained about thing drivers are doing on the road? Looking at their phones.
“One of the most frustrating things is when there is only one car in front of me at a red light, then when the light turns green, the driver waits for several seconds to go, more than likely because they are looking at their cellphone, not hands-free,” Kim Sturmer wrote. “This happens at least once a day.”
Maybe these drivers were looking at their navigation app for directions. Or they were answering some non-crucial Instagram DM. Both are illegal in California. A state appeals court ruled in June that the state law prohibiting drivers from texting or talking on a cellphone while driving also makes it illegal to hold a phone to look at a map on the screen.
Whatever’s going on on your phone, it’s not worth the $158 fine for distracted driving (or worse).
Think before you merge
(Liam Eisenberg / For The Times)
Our readers also really don’t like when drivers improperly merge into lanes.
- “I strongly dislike drivers that commonly hit their brakes when attempting to merge into traffic rather than accelerating into an open spot,” Scott E. wrote. “After all, God gave them an accelerator pedal as well as a brake pedal.”
- “The things that frustrate me the MOST are: rude and inconsiderate drivers…drivers who drive on the shoulder of a freeway and create their own lane so they can CUT in front of you,” Lillian Bailey wrote. “Drivers who suddenly swerve across freeway lanes because they’re about to miss their exit, another pet peeve!”
- “Nothing annoys me more than drivers that cut in front of me on the freeway and then go slower than the speed limit,” Lorraine Lawrence wrote.
Improper merging is also one of the most common reasons California Highway Patrol officers stop drivers on the road. “We stop people mostly for speed or unsafe lane changes,” CHP Officer Katherine Hendry said. “In fact, probably both those reasons are also the No. 1 and No. 2 reasons why people get in accidents, which is why we focus on that so heavily.”
In case you need a refresher, don’t forget the SMOG method of changing lanes:
- S is for Signal: Tell the world of your plans, please!
- M is for Mirror: Check your mirrors to check traffic behind and besides you
- O is for Over the shoulder: Turn your beautiful head and use your eyes to check your blind spots as best as possible. Don’t drift while doing this. Make it a quick move.
- G is for Go. Merge. Do not stop or break or freak out. Move into your new lane.
(Scott, I hope you feel vindicated with this one!)
Say it with me: Red means stop (even if you are turning right)
(Liam Eisenberg / For The Times)
This should be common sense, but at red lights and stop signs, you’re supposed to stop. One of them even says STOP in large capitalized letters!
Disregarding both while on the road is frustrating for our readers.
- “Here in Fresno, there are many drivers for whom stopping at a red light is an option, not a requirement,” Reilly Rix wrote in. “I see cars blow through red lights at least once a week nowadays.” Us too, Reilly.
- “There is a new trend of speeding up when a signal turns yellow,” Cynthia Fletcher wrote to us. “Worse yet, I see people simply not stopping at stop signs.”
In case you don’t know the rules, let me break it down for you:
- When at a stop sign, drivers are supposed to make a full stop before entering the crosswalk or at the limit line.
- If there is no limit line or crosswalk, stop before entering the intersection and check traffic in all directions before proceeding.
A red traffic signal also means stop. Even if you can legally turn right on red, which is not always the case, you are still expected to stop and look before making your turn, and to yield for pedestrians.
All this tailgating will be the end of us
(Liam Eisenberg / For The Times)
Angelenos treat tailgating like an Olympic sport. You’d think you could win gold by getting as close as possible to the car in front of you.
Well, play stupid games, win stupid prizes. Tailgating is dangerous and crazy. What’s stopping the driver in front of you from making a mistake or doing something erratic? Keep your distance, so you have time to react.
Reader William J. McHale cited tailgaters as one of the driver types that annoys him the most.
I agree. Why are you following so closely in the middle lane? Get in the fast lane if you want to go faster!
In case you hate tailgaters too, or are a tailgater yourself, here’s what to do:
- If a vehicle merges in front of you too closely, take your foot off the accelerator. This creates space between you and the vehicle ahead.
- If a tailgater is behind you, maintain your course and speed.
- Then, when safe to do so, merge right to change into another lane and allow the tailgater to pass.
This brings us to the next one:
If you insist on driving slow, get out of the left lane
(Liam Eisenberg / For The Times)
No matter how much I’ve poked fun at my grandfather for driving like a snail my entire life, he continues to drive slowly on streets and freeways. He’s even gotten a ticket for driving too slow. I didn’t know that was possible, but it is in many states, including California.
Of course, you must drive slower through heavy traffic or bad weather.
But do not block the normal and reasonable flow of traffic by driving too slowly.
And please, if you’re going to drive slow, get out of the left lane. Let people use it for its purpose: Passing.
On that note: If you’re anywhere but the far right lane and a faster driver comes up on your tail, safely merge right so they can pass you. You are not being noble or righteous by slowing other people down, you’re creating danger.
Don’t blind us with your high-beams
(Liam Eisenberg / For The Times)
Most readers wrote a list of complaints or several paragraphs.
Michael West kept it short by simply writing, “High beams.” The rules for using high beams on the road are also pretty short.
Only use high-beam headlights when driving at night on open country roads or dark city streets (dim to avoid blinding the driver of an oncoming vehicle) and in areas where they are legally allowed.
Robert Smith, left, Simon Gallup, center, and Perry Bamonte of British rock group The Cure hold a plaque after being inducted into Hollywood’s Rockwalk in Los Angeles, Friday, April 30, 2004.
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Chris Pizzello/AP
NEW YORK — Perry Archangelo Bamonte, longtime guitarist and keyboardist for the influential goth band The Cure, has died. He was 65.
The band made the announcement on their official website on Friday.
“It is with enormous sadness that we confirm the death of our great friend and bandmate Perry Bamonte, who passed away after a short illness at home over Christmas,” the band wrote.
“Quiet, intense, intuitive, constant and hugely creative, ‘Teddy’ was a warm hearted and vital part of The Cure story,” the statement continued. “Our thoughts and condolences are with all his family. He will be very greatly missed.”
Bamonte worked with the band in various roles from 1984 to 1989, including as roadie and guitar tech. He officially joined the band in 1990, when keyboardist Roger O’Donnell quit. It was then that he became a full-time member of the group, playing guitar, six-string bass and keyboard.
Having joined just after the band’s mainstream breakthrough, 1989’s “Disintegration,” Bamonte is featured on a number of The Cure’s albums, including 1992’s “Wish” — which features the career-defining hits “Friday I’m in Love” and “High” — as well as the 1996’s “Wild Mood Swings,” 2000’s “Bloodflowers” and 2004’s self-titled release.
Bamonte was fired from The Cure by its singer and leader Robert Smith in 2005. At that point in time, he had performed at over 400 shows across 14 years. Bamonte rejoined the group in recent years, touring with the band in 2022 for another 90 gigs.
In 2019, Bamonte was inducted into the Rock & Roll Hall of Fame alongside the rest of The Cure.
His last performance with the band was on Nov. 1, 2024 in London for a special one-off event to launch their latest album and first in 16 years, “Songs of a Lost World.” The concert was filmed for “The Cure: The Show of a Lost World,” a film released in cinemas globally this month. It is also available to purchase on Blu-ray and DVD.
The Associated Press described “Songs of a Lost World” as “lush and deeply orchestral, swelling and powerful” — one of the best of the band’s career.
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