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.
Lifestyle
Springsteen’s label was about to drop him. Then came ‘Born to Run’
Biographer Peter Ames Carlin describes the making of Born to Run as an “existential moment” for Springsteen. Carlin’s book is Tonight in Jungleland. Originally broadcast Aug. 7, 2025.
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Music
Springsteen’s label was about to drop him. Then came ‘Born to Run’
Lifestyle
Seven books to help you work through the climate anxiety you developed in 2025
With the holiday travel season ramping up, a good book is a must-have for airport delays or to give as the perfect gift.
Journalists from Bloomberg Green picked seven climate and environmental books they loved despite their weighty content. A few were positively uplifting. Here are our recommendations.
Fiction
“What We Can Know” by Ian McEwan
It’s 2119, decades after the Derangement (cascading climate catastrophes), the Inundation (a global tsunami triggered by a Russian nuclear bomb) and artificial intelligence-launched wars have halved the world’s population. The U.S. is no more and the U.K. is an impoverished archipelago of tiny islands where scholar Tom Metcalfe embarks on an obsessive quest to find the only copy of a renowned 21st century poem that was never published.
The famous author of the ode to now-vanished English landscapes recited it once at a dinner party in 2014 as a gift to his wife, but its words remain lost to time. Metcalfe believes access to the previously hidden digital lives of the poet and his circle will lead him to the manuscript. He knows where to start his search: Thanks to Nigeria — the 22nd century’s superpower — the historical internet has been decrypted and archived, including every personal email, text, photo and video.
The truth, though, lies elsewhere. It’s a richly told tale of our deranged present — and where it may lead without course correction. — Todd Woody
“Greenwood” by Michael Christie
This likewise dystopian novel begins in 2038 with Jacinda Greenwood, a dendrologist turned tour guide for the ultra-wealthy, working in one of the world’s last remaining forests. But the novel zig-zags back to 1934 and the beginnings of a timber empire that divided her family for generations.
For more than a century, the Greenwoods’ lives and fates were entwined with the trees they fought to exploit or protect. The novel explores themes of ancestral sin and atonement against the backdrop of the forests, which stand as silent witnesses to human crimes enacted on a global scale. — Danielle Bochove
“Barkskins” by Annie Proulx
Another multigenerational saga, spanning more than three centuries and 700 pages, this 2016 novel by a Pulitzer Prize-winning author tracks the deforestation of the New World over 300 years, beginning in the 17th century.
Following the descendants of two immigrants to what will become modern-day Quebec, the story takes the reader on a global voyage, crisscrossing North America, visiting the Amsterdam coffee houses that served as hubs for the Dutch mercantile empire and following new trade routes from China to New Zealand. Along the way, it chronicles the exploitation of the forests, the impact on Indigenous communities and the lasting legacy of colonialism.
With a vast cast of characters, the novel is at times unwieldy. But the staggering descriptions of Old World forests and the incredible human effort required to destroy them linger long after the saga concludes. —Danielle Bochove
Nonfiction
“The Joyful Environmentalist: How to Practise Without Preaching” by Isabel Losada
It is hard for a committed environmentalist to feel cheerful these days. But Isabel Losada’s book encourages readers to undertake a seemingly impossible mission: finding delight in navigating the absurd situations that committed environmentalists inevitably face, rather than succumbing to frustration.
Those delights can be as simple as looking up eco-friendly homemade shampoo formulas on Instagram or crushing a bucket of berries for seed collection to help restore native plants.
The book itself is an enjoyable read. With vivid details and a dose of British humor, Losada relays her failed attempt to have lunch at a Whole Foods store without using its disposable plastic cutlery. (The solution? Bring your own metal fork.) To be sure, some advice in her book isn’t realistic for everyone. But there are plenty of practical tips, such as deleting old and unwanted emails to help reduce the energy usage of data centers that store them. This book is an important reminder that you can protect the environment joyfully.
— Coco Liu
“Breakneck: China’s Quest to Engineer the Future” by Dan Wang
China’s President Xi Jinping is a trained engineer, and so are many members of the country’s top leadership. Dan Wang writes about how that training shows up in the country’s relentless push to build, build and build. That includes a clean tech industry that leads the world in almost every conceivable category, though Wang explores other domains as well.
Born in China, Wang grew up in Canada and studied in the U.S. before going back to live in his native country from 2017 to 2023. That background helps his analysis land with more gravity in 2025, as the U.S. and China face off in a battle of fossil fuels versus clean tech. — Akshat Rathi
“Entangled Life: How Fungi Make Our Worlds, Change Our Minds and Shape Our Futures” by Merlin Sheldrake
A JP Morgan banker might seem an unlikely character in a book about fungi. But R. Gordon Wasson, who popularized the main compound found in “magic mushrooms” with a 1957 article in Life magazine, is only one of the delightful surprises in Merlin Sheldrake’s offbeat book. The author’s dedication to telling the tale of fungi includes literally getting his hands dirty, unearthing complex underground fungal networks, and engaging in self-experimentation by participating in a scientific study of the effects of LSD on the brain. The result is a book that reveals the complexity and interdependency of life on Earth, and the role we play in it.
“We humans became as clever as we are, so the argument goes, because we were entangled within a demanding flurry of interaction,” Sheldrake writes. Fungi, a lifeform that depends on its interrelatedness with everything else, might have more in common with us than we realize. — Olivia Rudgard
“Toms River: A Story of Science and Salvation” by Dan Fagin
When chemical manufacturer Ciba arrived in Toms River, N.J., in 1952, the company’s new plant seemed like the economic engine the sleepy coastal community dependent on fishing and tourism had always needed. But the plant soon began quietly dumping millions of gallons of chemical-laced waste into the town’s eponymous river and surrounding woods. That started a legacy of toxic pollution that left families asking whether the waste was the cause of unusually high rates of childhood cancer in the area.
This Pulitzer Prize-winning masterpiece of environmental journalism reads like a thriller, albeit with devastating real-world fallout. It also shows how companies can reinvent themselves: I was startled to learn that Ciba, later known as Ciba-Geigy, merged with another company in 1996 to become the pharmaceutical company Novartis. At a time when there’s been a push to relocate manufacturing from abroad back to the U.S., this is a worthy examination of the hidden costs that can accompany industrial growth. — Emma Court
Bochove, Woody, Liu, Court, Rudgard and Rathi write for Bloomberg.
Lifestyle
The real ping pong champion — and hustler — who inspired ‘Marty Supreme’
Marty Reisman practicing in New York in 1951.
Ed Ford/AP
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Ed Ford/AP
In the 1940s and ’50s, New York City table tennis was a gritty subculture full of misfits, gamblers, doctors, actors, students and more. They competed, bet on the game or both at all-night spots like Lawrence’s, a table tennis parlor in midtown Manhattan. A talented player could rake in hundreds in cash in one night. In this world, a handsome, bespectacled Jewish teenager named Marty Reisman was a star.
His game was electric. “Marty had a trigger in his thumb. He hit bullets. You could lose your eyebrows playing with him,” someone identified only as “the shirt king” told author Jerome Charyn for his book Sizzling Chops and Devilish Spins: Ping-Pong and the Art of Staying Alive.
The new movie Marty Supreme recreates this world. Timothée Chalamet’s character, table tennis whiz Marty Mauser, is loosely inspired by Reisman.
Nicknamed “The Needle” for his slender physique, Reisman represented the U.S. in tournaments around the world and won more than 20 major titles, including the 1949 English Open and two U.S. Opens.
Like Chalamet’s Marty Mauser, Reisman was obsessed with the game. In his 1974 memoir The Money Player: The Confessions of America’s Greatest Table Tennis Champion and Hustler, Reisman wrote that he was drawn to table tennis because it “involved anatomy and chemistry and physics.”
One of the game’s “bad boys”
Reisman was a daring, relentless showman, always dressed to the nines in elegant suits and hats. “His personality made him legendary,” said Khaleel Asgarali, a professional player who owns Washington, D.C. Table Tennis. Asgarali would often see Reisman at tournaments. “The way he carried himself, his charisma, his flair, the clothing, the style … Marty was a sharp dresser, man.”
He was also one of the game’s “bad boys,” just like the fictional Marty Mauser. In 1949 at the English Open, he and fellow American star Dick Miles moved from their modest London hotel into one that was much fancier. They ran up a tab on room service, dry cleaning and the like and then charged it all to the English Table Tennis Association. When the English officials refused to cover their costs, the players said they wouldn’t show up for exhibition matches they knew were already sold out. The officials capitulated — but later fined the players $200 and suspended them “indefinitely from sanctioned table tennis” worldwide for breaking the sport’s “courtesy code.”
Marty Reisman demonstrates an under-the-leg trick shot in 1955.
Jacobsen/Getty Images/Hulton Archive
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Ping pong offered quick cash — and an outlet
Reisman grew up on Manhattan’s Lower East Side. His dad was a taxi driver and serious gambler. “It was feast or famine at our house, usually famine,” Reisman wrote. His parents split when he was 10. His mother, who had emigrated from the Soviet Union, worked as a waitress and then in a garment factory. When he was 14, Marty went to live with his father at the Broadway Central Hotel.
Hustling was “just baked into his DNA,” said Leo Leigh, director of a documentary about Reisman called Fact or Fiction: The Life and Times of a Ping Pong Hustler.
“I remember [Reisman] telling me that when he wanted to eat, he would wait until there was a wedding in the hotel, put on his best suit and just slip in and just sit and eat these massive, amazing meals,” said Leigh, “And then he’d be ready for the night to go and hustle table tennis.”
Reisman suffered panic attacks as early as nine years old. Playing ping pong helped with his anxiety. “The game so engrossed me, so filled my days, that I did not have time to worry,” he wrote.
“Finding this game of table tennis — and finding that he had this amazing ability — became almost like an escape, a meditation,” said Leigh.
Marty Reisman shows a behind-the-back trick shot in 1955.
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“Einstein, Hemingway, and Louis wrapped into one”
Reisman wanted to be the best ping pong player in the world. “To be an Einstein in your field, or a Hemingway, or a Joe Louis — there could be nothing, I imagined, more noble,” Reisman wrote. “And table tennis champions were to me Einstein, Hemingway, and Louis wrapped into one.”
The game was respected throughout Europe and Asia, turning ping pong stars into big names: In Marty Supreme, one who was imprisoned at Auschwitz tells the story of being spared by Nazi guards who recognize him. (Reisman’s memoir tells a similar true story of the Polish table tennis champion Alojzy “Alex” Ehrlich.)
But in the U.S., ping pong was considered a pastime people played in their basements. New York City was an exception: “Large sums of money were bet on a sport that had no standing at all in this country,” wrote Reisman.
Reisman dazzled spectators with his flair on the table.
“If you look at footage of Marty in the ’50s and ’60s, you could almost compare it to the footage of Houdini,” said Leigh. “He would blow the ball into the air and then he would, you know, knock it under his leg or just do some acrobats. It was almost like putting on a show.”
One of his gimmick shots was breaking a cigarette in two with a slam.
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Marty Reisman after winning the final men’s singles game at the English Open in 1949.
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Chasing a dream “that no one respected”
Marty Supreme co-writer and director Josh Safdie grew up playing ping pong with his dad in New York City. “I had ADHD and found it to be quite helpful,” he told NPR. “It’s a sport that requires an intense amount of focus and an intense amount of precision.” Safdie said his great uncle played at Lawrence’s and used to tell him about the different characters he met there, including Reisman’s friend and competitor Dick Miles.
It was Safdie’s wife who found Reisman’s book in a thrift store and gave it to him. When he read it, Safdie was finishing a dream project that was years in the making, the 2019 movie Uncut Gems starring Adam Sandler. “Every step of the way, there was either a hurdle or a stop gap or a laugh in my face,” said Safdie, “And very few believers in that project.”
Safdie likened the experience to Reisman’s obsession with becoming a table tennis champion “who believed in this thing and had a dream that no one respected.”
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A new racket changes the game
In 1952, Japanese player Hiroji Satoh stunned the table tennis world by winning the Men’s Singles at the World Championships playing with a new type of racket that had thick foam rubber. Unlike the traditional hardbat, the sponge rubber silenced the pock of the ball hitting the racket. Reisman wrote that the new surface caused the ball “to take eerie flights … Sometimes it floated like a knuckleball, a dead ball with no spin whatsoever. On other occasions the spin was overpowering.”
“Marty really liked the sound of the old hardbat,” said Asgarali, “When the sponge racquet came out, Marty wasn’t competitive anymore. He totally fell out of the game.”
Leigh said Reisman would tell just about anyone who would listen how Hiroji Satoh destroyed his game.
He was “constantly analyzing and reanalyzing his personality, who he is, where he’s going,” said Leigh. He would “sit with all these academics and these writers and these almost philosophers and just talk for hours” about how the rubber bat “completely” ruined his game. “He was always searching for something.”
In 1958, Reisman bought the Riverside Table Tennis Club on Manhattan’s Upper West Side, a popular spot frequented by celebrities including Matthew Broderick and Dustin Hoffman. In 1997, at age 67, he won the United States Hardbat Championship.
Marty Reisman died in 2012 at age 82. A The New York Times profile of him less than a year prior started with the headline, “A Throwback Player, With a Wardrobe to Match.”
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