In 2020, psychiatrist and researcher Judith Joseph, MD, MBA, was in high demand. Her clinical practice overflowed with patients as the COVID-19 pandemic took its emotional toll, and the media sought her perspective on mental well-being so often that she had to decline appearances. Her lab buzzed with research to meet deadlines, and she was invited to join an elite group of women in medicine at Columbia University.
Rather than riding high on her success, however, Joseph staggered under the weight of it. Overwhelmed and exhausted — yet dissatisfied and restless — she teetered between fatigue and a relentless drive to keep busy.
Joseph noticed a similar phenomenon among many of her therapy patients: The go-getters, high achievers, and super-reliable types in her practice were at best feeling “meh” about their accomplishments. And they typically felt guilty about not doing enough.
Was this depression? Like her, Joseph’s patients didn’t check all the diagnostic boxes for clinical depression. They could still get out of bed in the morning. They could get through the day without becoming overwhelmed with sadness. But there was a distinct absence of joy in their lives.
Joseph identified this phenomenon as high-functioning depression. She had seen HFD mentioned colloquially on blogs and websites, but it wasn’t an official diagnosis according to the Diagnostic and Statistical Manual of Mental Disorders.
Still, she knew it was real.
“We wear this mask of pathological productivity: On the outside, things look perfect, but on the inside, we are lacking joy,” Joseph explains. “Eventually we either slip into a low-functioning depression, or we start coping in ways that are not healthy.”
“We wear this mask of pathological productivity: On the outside, things look perfect, but on the inside, we are lacking joy. Eventually we either slip into a low-functioning depression, or we start coping in ways that are not healthy.”
Joseph could find no medical or psychiatric research on the health risks of HFD or how to treat it. So she began doing research herself, conducting a first-of-its-kind peer-reviewed study.
Joseph discovered that people struggling with HFD almost always have a history of trauma. These traumas might have been lifeshattering events, or they might be lasting wounds inflicted over time by, say, an overly critical parent.
This year, she published her findings and wrote about them in her book High Functioning: Overcome Your Hidden Depression and Reclaim Your Joy, and she dramatized HFD in short skits that she shares on social media. We sat down with her to learn about HFD and how to move through it.
Q&A With Judith Joseph, MD
Experience Life | The term “high-functioning depression” seems like a paradox. How can someone be depressed and high functioning?
Judith Joseph | Depression can have multiple faces. It’s not just the person who’s crying, who’s not getting out of bed, who’s not showing up.
Depression can look like the person who is showing up, who is the rock, who is taking care of everyone but themselves. This person likely struggles with anhedonia, which is a lack of interest, pleasure, and excitement. Anhedonia is a hallmark of high-functioning depression.
EL | Can you talk about the role of trauma in HFD?
JJ | When you think of classical trauma, [you think of] people [who] want to avoid places, situations, or other people who trigger them. Folks with HFD try to avoid pain by busying themselves. When they are still, they feel empty and restless. We found that these people are trying to cope with pain that’s not processed.
From the trauma and posttraumatic stress disorder research, we know that a lot of traumatized people internalize shame: If something happened to them, they think that they must be a bad person. For some people, this leads to overwork, or they bend over backward for others. A lot of people with HFD are too busy taking care of other people to think about their own pleasure.
EL | In your book, you identify five Vs on the path out of HFD. Can you explain the first V — validation?
JJ | Validation is about acknowledging the pain you’ve experienced — which is hard if you were raised to think about others and not yourself. A lot of people feel uncomfortable validating their own feelings and experience. You may push down your emotions as a coping mechanism.
There’s a grounding technique known as 5-4-3-2-1. You think about five things you can see. Then you think of four things you can touch, three things you can hear, two things you can smell, and one thing you can taste. Over time, this trains your brain to be present and to listen to your body and experiences. (For more embodiment practices, see “10 Practices to Get Out Of Your Head and Into the Present.”)
EL | The second V is venting. How can we vent in a healthy way rather than just complain?
JJ | There’s a large body of data showing that if you just trauma dump and tell everybody your emotions, you don’t feel better. You feel worse.
Instead, think of one or two people you trust — and with whom your relationship is reciprocal. Ask for emotional consent and whether it’s a good time to talk. Rather than gossiping or airing your dirty laundry, ask for honest feedback, even it’s not what you want to hear.
EL | How do you think about the third V — values?
JJ | Values bring meaning and purpose to your life — and a lot of people don’t know what their values are anymore. When I work with my clients, it’s like we’re archaeologists trying to figure out when was the last time they truly felt joyful. That points to their values.
Many of us are taught about superficial values, things with price tags. Personally, I used to chase the accolades and degrees — all price tags!
During the pandemic, I started to wonder: What do I value? I recalled my past — when my dad, a minister, would have us go on stage to perform at church. I thought I’d never perform again. Lo and behold, I started doing social media. I had forgotten my value of entertaining and uplifting people while simultaneously informing them about themes and principles that may ultimately improve their lives. We all have values and joy. They’re somewhere in our past — we just have to take the time to dig them up.
EL | Your fourth V is vitals. What do you mean by that?
JJ | Vitals support your body and brain — things like movement, sleep, and nutrition. But they also include your relationship with technology: If you spend too much time on your screens, you’re changing the way your brain derives joy.
Two other nontraditional vitals are your relationships with other people (if you’re partnered with a toxic person, you’re not going to be joyful) and your relationship with work. Many of us with HFD have a hard time leaving work at work.
EL | How do you define the final V — vision?
JJ | To me, vision is about planning for joy in your life so you can keep moving forward instead of getting stuck in the past. In our happiness research, we ask things like “When you eat your food, is it delicious? When you take a nap, do you feel refreshed? When you are lonely and reach out to someone, do you feel connected?” All of these are points of joy.
Happiness is an idea, but joy is an experience. I want people to slow down. Take the time to understand where you’re losing your joy and how to replenish it. Joy is built into your DNA. It is your birthright as a human being. Know that you deserve it.
This article originally appeared as “Reclaiming Joy” in the November/December 2025 issue of Experience Life. Photographer: Jeff Lipsky/foureleven.agency; Hair: Celly Mendez; Makeup: Miranda Richards/Celestine Agency and Zarielle Washington, Wardrobe styling: Mindy Saad/Celestine Agency
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