What is the message, based on what you're researching right now, that if you're getting through your day, but you are completely devoid of feeling and joy in your life, go talk to your doctor and ask about depression?

Not everyone wants to talk to a doctor, and so I want to validate that as well. And not if there's a complete lack of joy, but diminished joy. Sometimes, if you go to my website, you'll see scales for anhedonia. So you can fill out an anedonia scale and see where you are on that pleasure scale or that joy scale. Or you can fill out, if you think what I'm talking about resonates with you, a high functioning depression scale, and you can see where you are in terms of those symptoms of depression. But really go to your doctor and talk about the symptoms and say, Listen, hey, I think something's happening, and how can I address this? Not everyone wants to do therapy, Mel. Not everyone wants to do that.

But there are other- I think most Most people don't.

I do, too.

I mean, I don't think most people want to look at what their... They don't want to go deeper. They want to outrun it. And that was me for years. As I listen to, here's what I'm hearing. If you extrapolate what you're saying, what you're basically What you're basically saying is you're actually hardwired for joy, and you're hardwired to thrive. And when you get to a point in your life where you are disconnected from that natural intelligence and wiring and what you deserve, that's an issue. Stop out working it, stop out running it, stop telling yourself that just because you're getting through the day and just because you're able to get it all done, and just because you're barely dragging yourself, like across the finish wine every day, and the bottle of wine takes the pain, that that is not the way to go through life, that there is something better that is available to you, and you deserve that. The first step is understanding that the depression that our parents may have had where you're alone in a dark room smoking a cigarette or laying in bed all day, that is not the depression that you're seeing today.

It's really important that you take that seriously because there's something else available to you. I want to ask you something, what are some of the things that you've said as a psychiatrist that you get a lot of heat for?

Well, definitely high functioning depression. Wait, what?

People give you crap for saying that there's something called high functioning depression?

Really Really, depression is serious. There are some people who have depression every day, and there's so much stigma around it. But there are some people who are like, Well, I don't think we should call one high versus low because then It just makes one seem good versus bad. I disagree completely. Use the language that the person identifies with because it's invalidating. If someone says, You know what? I think I have high function depression. Guess what? They're going to do something about it. They're going to about it. But if you're like, Oh, you know what? You're not low functioning.

No. I would love to have you walk me through a day in the life of somebody that struggles with high functioning depression. What does this person look like at work?

At work, this person may be delivering, but they may not necessarily derive joy from the work. They may be someone who feels that, You know what? This work can't be done right by anyone but me. They are highly controlling, right? No one else We can do it. And one of the things I see is that their identities are tied to their work, so they may not even know what they really enjoy anymore. Maybe years ago, they were into photography, maybe they were into art. Now, they don't even want to do those things because right now, they're focused on their roles. And it's not just people in the workplace. This is for caretakers at home, people taking care of young kids who may not have to leave the house to work because their work is at home. They may be so tied into what they're doing for others. That they don't know that they lack joy. They may have problems with sleep, so their sleep isn't as rich. They don't feel refreshed, and they may not find joy in food. So again, appetite. It's changes. Either they're eating too much or eating too little. They may have problems with focusing.

Their concentration really is a challenge for them. They may have low energy. You have all these symptoms of something that looks like a depression, but you don't identify as having low functioning. You're actually delivering, maybe overdelivering. You may not even identify with the distress because you don't deal with those feelings. It's something that you don't process. You don't validate yourself. So you're not someone who will meet criteria. If a doctor sees you, they're going to say, Well, you don't really meet criteria. And here's the thing about medicine. It's a bit controversial. I think that a lot of doctors and nurses and health care workers struggle with this thing called high function depression. I think it's hard for them to diagnose something in someone because it looks like them. They're going to be like, Well, I don't want to diagnose you because that's pathologizing me. There's this projection that happens that, Hey, if you're functioning and you're delivering, come back to me when you're not. I think that's a broken model because I think that we're catching all these people. We're missing these people that we could catch before they go into crisis mode, before they develop poor coping skills and start drinking, before they have physical breakdowns because the body is going to give somewhere, or before they have mental breakdown.

How do you It's a concern, though, because if somebody has that schedule, I would think the schedule is what's making them have terrible sleep and poor eating habits and a lack of hobbies and a feeling of disconnection. It seems like this has been very easily missed because you think the work habits are the cause when actually the work habits are a symptom of this. Is that what you're saying?

That's why the biopsychosocial model is so important. The social component of that model is what is the society doing? What's happening in our society that's driving this? It's not all biological. And when you say, Oh, let's see if we could scan the brains, that's why you're not going to see certain patterns in all people because the biosechosocial model is real. A lot of components feed into the symptom. They feed into the condition. So we have to look at it from that holistic picture or else we're going to miss the mark.

What should you never do if you are struggling with high functioning depression?

Never think, and this is very difficult, that you're a burden. And I hear this all the time. Because we'll get to a point where you feel like, I can't go anymore. Something's got to give. Don't think that you're a burden. You may think that your identity, all you have is what you do, how you perform, what you deliver for others. People love you. They don't want you to think that you're a burden. They want you to ask for help. They want you to say, Listen, I know I'm always there for you, but I really need to tell you something. They're just waiting for you. But if you don't allow yourself to share, if you don't allow yourself to feel worthy of that, of being heard, if you don't validate yourself, then no one can help you. No one can be there for you. And I hear this a lot like, Oh, I just felt like I was a burden. So I tell my patients, Let's think of another time in your life where you were feeling this. I call it high functioning AF. Let's look back- That sounds sexier than depression.

I think we have a branding problem with depression. I think you should call it high functioning AF. Okay, I like that.

I call it that on my social media, but Look at a time in your life where you were high functioning AF. We'll pull out the smartphones and we'll go back and I'll say, Okay, show me that picture. If the people in your life, because there'll be pictures of them being around others, do you think that if you had opened up to them then that they would have said you were burden? Because it looks like you just met up with them the week after. Do you think you were burdening them? So you're challenging that core belief that if you're not perfect, if you don't deliver, if you ask for help, that you're not lovable. You're challenging that. And I ask them to challenge that thought. I also ask them to try and process the trauma because I find that, again, the word trauma, it's a word that people are, Oh, trauma, again. But there are big traumas and little traumas, and There are little traumas that we just don't acknowledge. For example, a lot of the questionnaires for trauma, like the aces and the modified aces, they don't capture things like, Well, when I was a little boy or a little girl, people teased me because they said I was gay.

Things like that are not there. But those are traumas because you couldn't be your full self, right? Of course. Or things like, When I came to this country without anything, clothes or anything, and I was hungry. People don't think about those things, the scarcity traumas. They just process it. So they're like, Well, I'm just lucky to be here. No, these are traumas. So we have to allow ourselves to look back in our past and acknowledge these emotional experiences that impacted the way that we see ourselves and the way that we approach the world and others. When we do acknowledge that and we validate that, then we can start to do something about it.

Talk to us about scarcity trauma.

This is something that I have personal experience with. I came to this country when I was a child from of that. As the first person in my family to go to school, to go to college, to go to medical school, it was this burden. Oh, my gosh, you got to be perfect. You got to deliver, you can't fail. I was always trying to perform, to never stop, to always deliver. And what takes the back burner? Joy. I was that little kid who loved to read, would read anything I get my hands on. And reading used to be fun for me. But But after a while, when you're in medical school or you're in college, you're studying organic chemistry, you're studying anatomy. After a while, reading is not pleasurable. It's like you have to do it because then you got to regurgitate the information, take a test and pass it. And a lot of people identify with this. They started off joyful. They started off doing things that they really enjoyed, and then they lost that joy along the way, and it became work. All human beings are born and know how to play. If you look at a toddler and you give them something to play with, it could be an inanimate object, they'll play.

We all know how to have joy. But along the way, we lose it. And many people with high function depression will lose the basic joys of life because they get so focused on what they're doing and the role that they're playing. So I try to think about it in terms of a loss of a joy, because I think people can accept that more than depression. Depression just sounds so serious. But high functioning depression has that hallmark of a lack of joy.

What exactly is high functioning?

People who are taking care of their families, they're meeting work deadlines. They're the ones that everyone says, Oh, my gosh, you're doing a great job. You're the rock of the family. You can't stop because people depend on you. You're meeting deadlines, you're collecting accolades, but you're just not really feeling a sense of joy. So we push, push, push through.