Latest / Skin Anarchy / Exploring the Depths of Mental Wellness with Dr. Judith Joseph: Unveiling High Functioning Depression and the Art of Self-Care

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Exploring the Depths of Mental Wellness with Dr. Judith Joseph: Unveiling High Functioning Depression and the Art of Self-Care · Skin Anarchy

• 0:00
  SPEAKER_00: Hi guys, welcome back to Skincare Anarchy.
• 0:02
  SPEAKER_00: This is your host Ekna and I am very, very excited about this episode.
• 0:06
  SPEAKER_00: It's truly an honor to be hosting our guest today.
• 0:09
  SPEAKER_00: I'm a huge fan of obviously her work and medicine, but also the amazing content that she puts out on social media platforms for all of us to learn from, to gain an understanding of what you know wellness, mental wellness really means, and to understand it a little bit in our own way.
• 0:24
  SPEAKER_00: So without further ado, I want to introduce you guys to Dr.
• 0:26
  SPEAKER_00: Judith Joseph, who is a renowned psychiatrist and the chair of the Women in Medicine Initiative at Columbia University.
• 0:33
  SPEAKER_00: Dr.
• 0:33
  SPEAKER_00: Joseph is also a clinical assistant professor for child and adolescent psychiatry at NYU Medical Center, and she's conducted extensive research in various areas of mental health.
• 0:43
  SPEAKER_00: So I'm really excited to host you, Dr.
• 0:45
  SPEAKER_00: Joseph.
• 0:46
  SPEAKER_00: Welcome to the show.
• 0:46
  SPEAKER_00: Such an honor.
• 0:47
  SPEAKER_01: Thank you for having me.
• 0:48
  SPEAKER_00: Yeah, I would love to get started, if you don't mind, just to learn a little bit about what sparked your interest in obviously medicine, but specifically psychiatry.
• 0:57
  SPEAKER_01: Everyone has a body, so we all have physical health, but we all also have a brain.
• 1:02
  SPEAKER_01: And so we all have mental health.
• 1:04
  SPEAKER_01: And I think a lot of people don't acknowledge their mental health and they don't take the steps to protect their mental health the way that they do their physical health.
• 1:11
  SPEAKER_01: You know, there's no annual mental health checkup.
• 1:14
  SPEAKER_01: But there are annual physicals for pediatric and adult populations.
• 1:19
  SPEAKER_01: And when we neglect our mental health, that mind-body connection is so strongly important and relevant in terms of our day-to-day functioning that, you know, if we neglect our mind-body connection, then we suffer.
• 1:30
  SPEAKER_01: So I was always interested in the mind-body connection.
• 1:34
  SPEAKER_01: And as an undergrad, I studied neuroscience and wanted to initially be a brain surgeon.
• 1:39
  SPEAKER_01: But then after spending long hours in the operating room and doing two hours, two years of anesthesiology residency, I realized that I'd rather, you know, understand the way that the brain works and how it impacts our behavior than to actually touch the brain or be in the operating room looking at it.
• 1:56
  SPEAKER_00: Yeah.
• 1:56
  SPEAKER_00: Yeah.
• 1:56
  SPEAKER_00: That's so cool that you you switch residencies though.
• 1:59
  SPEAKER_00: I mean, I know what you mean.
• 2:00
  SPEAKER_00: But I mean, you know, I feel like that's that makes sense to me because your work is so, I mean, I find it to be so novel in the space because I know a lot of us know about mental wellness through like, you know, self-help gurus and stuff online.
• 2:14
  SPEAKER_00: You know, there's as you know, the internet is just cluttered with a lot of advice from people without the training, right?
• 2:20
  SPEAKER_00: The education behind it.
• 2:21
  SPEAKER_00: But when it comes to psychiatry, I've always wondered, you know, just as a normal everyday person, like, where are the wonderful psychiatrists of the world, you know, teaching us about what it truly means to be mentally well and to how to take care of ourselves.
• 2:33
  SPEAKER_00: So that's really like my first question for you is this idea of, you know, self-care and wellness, mental wellness.
• 2:40
  SPEAKER_00: Like, could you tell us a little bit about what does mental wellness like when you look at it from your perspective, like what does that really mean?
• 2:46
  SPEAKER_00: You know, because I think it's important to kind of put some landmarks down, you know, about it.
• 2:52
  SPEAKER_01: Yeah, you know, in other countries, people really do spend a lot of time thinking about your spirit, your mind, your body, your soul, you know, the meaning of life.
• 3:01
  SPEAKER_01: There are a lot of philosophers, right?
• 3:03
  SPEAKER_01: Yeah.
• 3:03
  SPEAKER_01: And it's part, it's the accepted part of your way of life, you know.
• 3:07
  SPEAKER_01: But I think that in capitalist societies, we don't do that.
• 3:10
  SPEAKER_01: You know, we've we're so focused on outcomes, we're so focused on monetary gain that we forget that, you know, we are spiritual creatures.
• 3:19
  SPEAKER_01: And I think that my background in religion helps me a great deal.
• 3:23
  SPEAKER_01: I grew up as a pastor's kid.
• 3:24
  SPEAKER_01: So from a very young age, I was learning philosophy and the meaning of life and helping others and purpose, you know.
• 3:29
  SPEAKER_01: And I think that, you know, when we don't think about these types of things, we get lost.
• 3:35
  SPEAKER_01: And a lot of us feel lost.
• 3:36
  SPEAKER_01: We feel empty.
• 3:38
  SPEAKER_01: We are running through the motions.
• 3:39
  SPEAKER_01: We're just doing things.
• 3:40
  SPEAKER_01: We don't even know why we're doing them anymore.
• 3:42
  SPEAKER_01: And we're not creatures that were born into this world for that.
• 3:45
  SPEAKER_01: Even little babies, when they're crawling and they're inspecting the environment, they're just like really taking time to save our life.
• 3:52
  SPEAKER_01: And somewhere along the way, many of us have forgotten how to save our life, and before you know it, we're dead.
• 3:56
  SPEAKER_01: So I think that in my circle of colleagues, quite a bit of psychiatrists who are also philosophers who are just trying to understand how to make life more meaningful because we've figured out that if each of us can do that, our bodies improve, our relationships improve, our outcomes improve overall.
• 4:13
  SPEAKER_01: But we have to make time and space for that type of reflection.
• 4:17
  SPEAKER_00: Absolutely.
• 4:17
  SPEAKER_00: I love that.
• 4:18
  SPEAKER_00: I love that you tied that into spirituality because I agree, you know, I think that there's this part of us that I don't know, we we understand that there's spirituality and there's religion, all these things that teach us like how to be a good human being.
• 4:30
  SPEAKER_00: But then when you apply it to your own self, I feel like a lot of us might miss the mark.
• 4:36
  SPEAKER_00: What I'm trying to say is like we're kinder to people on the outside than we are to ourselves, you know, and that's what I've noticed even with myself and a lot of even my friends, you know, just watching people.
• 4:46
  SPEAKER_00: So I'm just curious like what your opinion on that is.
• 4:49
  SPEAKER_00: Like, what do you think like leads us down this road of like this excessive, like, I don't know if you want to call it like self-criticism or or whatever it might be that's causing a lot of turmoil for people, you know?
• 4:59
  SPEAKER_01: Well, I I run a research lab and so I've done a fair bit of PTSD studies.
• 5:03
  SPEAKER_01: You know, it's kind of like this kind of pairing or parody of a scientist philosopher, right?
• 5:08
  SPEAKER_01: But that's why and I see like a lot of symptoms of trauma and trauma responses in everyday people, not necessarily people who have met criteria for PTSD.
• 5:18
  SPEAKER_01: PTSD is post-traumatic stress disorder.
• 5:21
  SPEAKER_01: It's a specific type of condition that can happen after severe trauma, but I've seen trauma responses, not necessarily PTSD, but symptoms of PTSD, right?
• 5:30
  SPEAKER_01: Because you have to have, you know, a collection of symptoms to meet criteria.
• 5:33
  SPEAKER_01: But a one trauma response is to internalize shame, internalize blame, and to put yourself down.
• 5:39
  SPEAKER_01: And if many of us walk around with unprocessed trauma and we don't even realize it, you know, I give you some an example.
• 5:46
  SPEAKER_01: So a patient of mine a couple of years ago would not ever spend anything on themselves.
• 5:52
  SPEAKER_01: They worked very hard, they were very honest, they did the right things, made all the right choices in life, but would deprive themselves of these simple luxuries.
• 5:59
  SPEAKER_01: And it turns out that as we dug deeper into their past, there was significant generational trauma where the person's, you know, forefathers came to this country and they fled war and they fled terrible circumstances.
• 6:10
  SPEAKER_01: So that type of scarcity trauma just passed down from generation to generation.
• 6:15
  SPEAKER_01: And because the person had never processed it, they were living this life that was void of simple luxuries.
• 6:21
  SPEAKER_01: For what?
• 6:21
  SPEAKER_01: You know, they felt guilty when they spent money.
• 6:24
  SPEAKER_01: They felt shame when they splurged a little bit on themselves.
• 6:27
  SPEAKER_01: They even felt guilty when they took a break and they were workaholics.
• 6:31
  SPEAKER_01: So it's like the person wasn't even aware as to how much that generational trauma and being from a scarcity mindset took a role in their lives.
• 6:39
  SPEAKER_01: And so a lot of our work was centered around okay, let's take baby steps.
• 6:44
  SPEAKER_01: What are some simple luxuries that you can start to do?
• 6:46
  SPEAKER_01: Because you've worked very hard.
• 6:48
  SPEAKER_01: You think about everyone else but yourself, you know?
• 6:50
  SPEAKER_01: We started very small.
• 6:52
  SPEAKER_01: I'm very holistic in my practice.
• 6:54
  SPEAKER_01: So I I start with what the person already has.
• 6:56
  SPEAKER_01: Like, let's let's make sure that you go out and buy a very nice cream, one that smells good, one that, you know, stimulates the senses.
• 7:04
  SPEAKER_01: And so, and every night as you are rubbing that cream on your skin, because you're worthy of taking care of your skin and preserving, you know, like the way that you look, right?
• 7:12
  SPEAKER_01: The person felt ashamed for doing these things, you know, felt guilty.
• 7:15
  SPEAKER_01: And then as the person applied this to their skin, they would say in the mirror, I am worthy of love.
• 7:20
  SPEAKER_01: I deserve rest, I deserve simple luxuries.
• 7:24
  SPEAKER_01: And over time, they were able to do things like, you know, take more days off, days that they earned, you know, take vacations that where they weren't staying in these terrible places and taking these connecting flights that they didn't need to take, right?
• 7:37
  SPEAKER_01: Like actually enjoying a relaxing vacation.
• 7:40
  SPEAKER_01: And that took time.
• 7:41
  SPEAKER_01: But if they didn't realize where that trauma started from, if they didn't realize it, then they wouldn't understand that their internalized shame and blame and guilt was related to that trauma and they wouldn't be able to challenge it.
• 7:52
  SPEAKER_00: Yeah, that's I mean, that's really eye-opening because I think we all have that in a way, right?
• 7:58
  SPEAKER_00: I mean, to some degree, because I mean, I can tell you I was traumatized for my medical training.
• 8:02
  SPEAKER_00: Like just, you know, just a little fun little analogy there.
• 8:06
  SPEAKER_00: I mean, I think we've all to some degree, I mean, if you were to ask me, I mean, I'm not an expert, but I I think we all have that a little bit.
• 8:13
  SPEAKER_00: So that's very eye-opening to recognize them.
• 8:17
  SPEAKER_01: And I'm glad you brought that up because in medicine there's a lot of trauma.
• 8:20
  SPEAKER_01: You know, I you I we laugh and we joke about it now, but I remember being an intern and doing because I did anesthesia first.
• 8:27
  SPEAKER_01: So like I did a medical internship and I remember doing chest compressions on someone who passed away.
• 8:31
  SPEAKER_01: No one pulled me aside and said, Oh, you know, let's process this.
• 8:34
  SPEAKER_01: They were like, okay, so who has call tomorrow?
• 8:36
  SPEAKER_01: And I'm just like, Yes, what is going on?
• 8:39
  SPEAKER_00: Exactly.
• 8:39
  SPEAKER_00: It's just like constant, like you're surrounded.
• 8:42
  SPEAKER_00: I mean, the medical profession, you're surrounded with death and life and you know, like all this, and it just never, no one stops.
• 8:48
  SPEAKER_00: I think I read like a statistic when I was in medical school.
• 8:51
  SPEAKER_00: I know this is a little bit, you know, off the path, but I'd read a statistic and it was that the suicide rate, you know, of interns or medical students was exceptionally high, you know, in our profession.
• 9:01
  SPEAKER_00: And I was just thinking, I was like, yeah, you know, I guess we never stop and think about it, you know, we never stop and say, what's really going on, you know, on that deeper level that happens after you've carried out your day, you know.
• 9:15
  SPEAKER_00: So what you said earlier, I mean, even regardless of whether in the medical profession or not, I think that applies to everybody because when we go through our day and then we stop, it's like you have to sit down and process it, right?
• 9:26
  SPEAKER_00: Like, what was my day like?
• 9:28
  SPEAKER_00: Like, what did this really mean to me?
• 9:30
  SPEAKER_00: Kind of thing.
• 9:31
  SPEAKER_01: I tell you, it's it's fascinating because I treat children and adults.
• 9:34
  SPEAKER_01: So I some of my youngest patients are four.
• 9:37
  SPEAKER_01: And so I watch them sometimes.
• 9:38
  SPEAKER_01: And I tell you, if you want to learn happiness, follow a four-year-old around, you know, like they sit in my office and they will sit on my the little waiting area desk, they'll take the tissue and turn it into little figurines.
• 9:50
  SPEAKER_01: They just jump, they just explore, they are living the life, you know?
• 9:53
  SPEAKER_01: Yeah, they really stay present in the moment.
• 9:56
  SPEAKER_01: And when they eat, you know, they play with their food and they it's it's very it's a treat to watch them because they're living life, right?
• 10:03
  SPEAKER_01: But somewhere along the way, especially as medical students, especially in healthcare, as healthcare workers, we just get so busy and bad things happen, and then we're told and we're taught because everyone else in the environment is going along, we're taught that you just you don't process it, you just keep doing.
• 10:18
  SPEAKER_01: And being busy is a coping mechanism for trauma, right?
• 10:22
  SPEAKER_01: We don't think about when we think about trauma, we think, oh, someone's having flashbacks and nightmares and they're shell-shocked and they're hypervigilant.
• 10:28
  SPEAKER_01: But busying yourself is a way to avoid trauma.
• 10:31
  SPEAKER_01: When you look at the Bible of the Bible of psychiatry called the DSM 5, one of the hallmark symptoms of PTSU is avoidance.
• 10:39
  SPEAKER_01: And if you're busy and you're making yourself busy to avoid thinking about the things that are bothering you, then that is a trauma response.
• 10:47
  SPEAKER_01: And so many people in the healthcare profession busy themselves.
• 10:50
  SPEAKER_01: And there are very high rates of self-harm, suicide, depression in healthcare, but it's not talked about because the culture of healthcare is to put others first, put the patient first.
• 11:02
  SPEAKER_01: And in putting the patient first and not taking care of ourselves, doctors make very big mistakes, right?
• 11:09
  SPEAKER_01: There are studies that show that doctors who are depressed make the wrong diagnosis.
• 11:13
  SPEAKER_01: So it's actually costing the healthcare system more when doctors and healthcare workers are unhappy.
• 11:18
  SPEAKER_01: So we really do need to prioritize healthcare workers' mental health.
• 11:21
  SPEAKER_00: Yeah, absolutely.
• 11:22
  SPEAKER_00: I agree with you.
• 11:23
  SPEAKER_00: And I think that the whole field of psychiatry is so valuable.
• 11:27
  SPEAKER_00: It's just even on the outside looking in because we don't understand that these are actual things that have been recorded as medical facts.
• 11:35
  SPEAKER_00: You know what I mean?
• 11:36
  SPEAKER_00: And we need to understand that as people, we get stressed out, you know, we have our days, and there are real repercussions to that if you don't practice, like you said, like that self-hair care aspect, like you're gonna, it's eventually gonna catch up with you.
• 11:50
  SPEAKER_00: And so I think one of my big questions is I know you speak a lot about high functioning depression.
• 11:55
  SPEAKER_00: Remember when I first was watching one of your reels, I believe, and it was about high functioning depression, like a light bulb went off for me, you know?
• 12:01
  SPEAKER_00: And I could really relate to it, and I know there's countless people out there that can relate to it.
• 12:05
  SPEAKER_00: So could you tell us a little bit about that?
• 12:07
  SPEAKER_00: Like, what is high functioning depression or anxiety?
• 12:10
  SPEAKER_00: And how can we really kind of figure out if we have that or not?
• 12:13
  SPEAKER_01: So high functioning depression is not yet in that Bible of DSM 5.
• 12:17
  SPEAKER_01: But you know what else is not in that Bible of psychiatry?
• 12:20
  SPEAKER_01: Imposter syndrome.
• 12:21
  SPEAKER_01: And you know what else is not in that Bible of psychiatry?
• 12:24
  SPEAKER_01: Burnout.
• 12:24
  SPEAKER_01: But no one would ever tell you that imposter syndrome and burnout don't exist, right?
• 12:28
  SPEAKER_01: They'd be like, it absolutely exist, you know, because people have experienced it or witnessed it.
• 12:33
  SPEAKER_01: Well, high functioning depression in my work is the prodrome up to what could be a depression, could be a physical breakdown, or what could be leading to substance use.
• 12:43
  SPEAKER_01: And when you look at the actual criteria, when you have symptoms of depression, what's required in the DSM 5 to meet criteria for a major depressive episode is a lack of functioning or lowered functioning and or significant distress.
• 12:58
  SPEAKER_01: But in my research lab, what I was finding was that over the pandemic, I would have people coming in saying they had symptoms of depression, but they didn't meet criteria.
• 13:06
  SPEAKER_01: They didn't fit into that box because they were high functioning.
• 13:10
  SPEAKER_01: So they exceeded functioning and right, so that's the busying yourself, and they weren't necessarily identifying the distress because they were busying themselves to avoid it.
• 13:19
  SPEAKER_01: So they weren't meeting criteria.
• 13:21
  SPEAKER_01: Did I think they had symptoms of depression?
• 13:23
  SPEAKER_01: Absolutely.
• 13:25
  SPEAKER_01: But if you go by the DSM V criteria, they didn't meet criteria.
• 13:28
  SPEAKER_01: So in my work, I'm trying to identify these individuals who have these symptoms but are actually exceeding functioning or not acknowledging their distress and prevent them from actually having a major depressive episode where they have lost functioning or having a breakdown in their physicality because, you know, the mind-body connection, or developing something else like excessive substance use, excessive social media use, excessive gambling, you know, excessive spending.
• 13:54
  SPEAKER_01: I've seen all of the above go up, you know, during the pandemic because people are self-soothing with excess.
• 13:59
  SPEAKER_01: So they feel something's off.
• 14:00
  SPEAKER_01: They're having a lot of anhedonia, which is a lack of interest and pleasure, that black feeling that we don't know what it is.
• 14:06
  SPEAKER_01: It's like when someone asks you if you're okay and you're like, Yeah, I'm okay.
• 14:08
  SPEAKER_01: And it's like, are you really okay?
• 14:10
  SPEAKER_01: You you just feel nothing walking around like that and they don't know what it is.
• 14:13
  SPEAKER_01: So they're self-soothing by consuming.
• 14:16
  SPEAKER_01: And that's just making them feel even more restless because you know, it feels good in the moment, but it doesn't last very long.
• 14:23
  SPEAKER_01: It's not sustainable relief.
• 14:25
  SPEAKER_01: So hoping to identify these individuals and shift the way that they are behaving.
• 14:30
  SPEAKER_01: Because in my line of work, a lot of focus used to be spent on switching the thought and then the thought changes, and then the feeling changes, and then the behavior changes.
• 14:38
  SPEAKER_01: But I find that with these individuals, if you change their behaviors, right?
• 14:42
  SPEAKER_01: If you get them up away from the desk, they're eating outside, they're taking their lunch breaks, they're taking their potty breaks, right?
• 14:47
  SPEAKER_01: Many of these people just work through and then they don't even realize they're gonna have to go to the bathroom.
• 14:51
  SPEAKER_01: If you're changing their behavior, so they're not busying themselves and they're more present and they're feeling and they're processing, that a lot of those symptoms get better.
• 14:59
  SPEAKER_01: And people are, they tend to be afraid.
• 15:01
  SPEAKER_01: People have functioning depression tend to be afraid of feeling because they feel like, well, what if I do tap into what I'm actually experiencing inside?
• 15:08
  SPEAKER_01: Or then what if I fall apart?
• 15:10
  SPEAKER_01: The people that I depend on, you know, they need me.
• 15:13
  SPEAKER_01: And the opposite is true.
• 15:15
  SPEAKER_01: They do feel, they do cry, but then they start to actually live again.
• 15:19
  SPEAKER_01: And the people around them, they sense the change and they start to change because you know, this is contagious.
• 15:24
  SPEAKER_01: This busy body, this anhedonia, this high functioning, it spreads.
• 15:28
  SPEAKER_01: You know, think about the bad boss you had who worked everyone to the bone and everyone was miserable.
• 15:32
  SPEAKER_01: If that boss was happy, everybody would be happy because they wouldn't be working to the bone, right?
• 15:35
  SPEAKER_01: So the way that misery is contagious, joy is contagious.
• 15:39
  SPEAKER_01: So if we change, if we if we acknowledge that we can change, then everyone benefits from it.
• 15:44
  SPEAKER_00: Absolutely.
• 15:45
  SPEAKER_00: Like, yeah, that that really just resonates so much because I don't know, like for me, I grew up in like my parents are immigrants, right?
• 15:54
  SPEAKER_00: So, like I grew up in a family that was always like, you know, go, go, go.
• 15:57
  SPEAKER_00: You know, dad was all about science, mom was in tech and IT, and it was this environment of like just work all the time, you know, always strive better for better and better and better.
• 16:07
  SPEAKER_00: And I've talked to so many people, you know, within the medical profession, you know, my colleagues, but then also outside of it.
• 16:12
  SPEAKER_00: And they're like, yeah, me too.
• 16:14
  SPEAKER_00: You know, like I had this family structure that was all about productivity, you know, and that was the center goal of everything.
• 16:21
  SPEAKER_00: As children, your job was to get good grades, go and have these, like, you know, very reputable professions, and that's what you do.
• 16:28
  SPEAKER_00: But then I also wonder now, you know, like we're having this conversation, how many of us have gone through that?
• 16:35
  SPEAKER_00: And then you realize at one point in your life where it's like, wait a minute, you know, I missed all those steps of checking in with myself and figuring out like, am I doing any of these things that, you know, some of the things that you described here with the high function depression?
• 16:49
  SPEAKER_00: Like, am I really practicing some of this?
• 16:51
  SPEAKER_00: For example, you know, we're a skincare podcast.
• 16:53
  SPEAKER_00: We talk a lot about skincare products, beauty products.
• 16:55
  SPEAKER_00: But how many times do we overconsume?
• 16:59
  SPEAKER_00: You know, you had brought up overconsumption.
• 17:00
  SPEAKER_00: How many times are we buying like five skincare items that are doing the same thing, but we don't even know why we're doing it?
• 17:07
  SPEAKER_00: And I feel like it kind of, I don't know, it's kind of a mind-boggling feeling when you start to think about this stuff, you know, that wow, it's all been adding up.
• 17:15
  SPEAKER_01: And if we just decided to do nothing, right?
• 17:18
  SPEAKER_01: Like when you're feeling upset instead of reaching for the bag of chips or for the Amazon checkout cart, you know, or for the for the glass of wine, what if we just felt?
• 17:28
  SPEAKER_01: What if we just acknowledged?
• 17:30
  SPEAKER_01: What if we stopped gaslighting ourselves, right?
• 17:32
  SPEAKER_01: Like just sit and be like, you know what, I'm miserable, right?
• 17:36
  SPEAKER_01: I had it like that during the pandemic.
• 17:38
  SPEAKER_01: I run a lab, I have employees that depend on me.
• 17:41
  SPEAKER_01: And I was in the middle of a talk where I was, it was actually with healthcare workers.
• 17:45
  SPEAKER_01: I did several back-to-back healthcare worker talks because people were, I mean, people were like really panicked.
• 17:51
  SPEAKER_01: They were worried about losing their clinics, worried about losing their lives, you know.
• 17:55
  SPEAKER_01: Like, yeah.
• 17:56
  SPEAKER_01: So I, you know, and and after one of those talks, I just remember like closing my laptop, closing the Zoom, and just thinking, wait, I I'm miserable.
• 18:04
  SPEAKER_01: Like this sucks.
• 18:04
  SPEAKER_01: You know, like I need to slow down.
• 18:06
  SPEAKER_01: I shouldn't, I shouldn't be giving these people talks.
• 18:08
  SPEAKER_01: I need to work on myself.
• 18:09
  SPEAKER_01: Right.
• 18:10
  SPEAKER_01: Really get my get take a hard look in the mirror and say, this is tough.
• 18:15
  SPEAKER_01: Like, I'm miserable.
• 18:16
  SPEAKER_01: Like, I'm worried too.
• 18:17
  SPEAKER_01: What if my clinic gets shut down?
• 18:18
  SPEAKER_01: What if I can't run my clinical trials?
• 18:20
  SPEAKER_01: What if I can't, you know, pay my employees' bills and benefits?
• 18:24
  SPEAKER_01: Like, I'm allowed to be stressed and panicked and anxious and depressed too.
• 18:28
  SPEAKER_01: And that was when a light bulb went off for me.
• 18:31
  SPEAKER_01: And I was like, there are many people feeling just like me, but we're just pushing through because we're so afraid that if we stop, something bad's gonna happen.
• 18:38
  SPEAKER_01: But the opposite is true.
• 18:40
  SPEAKER_01: If we don't stop, something bad will happen.
• 18:43
  SPEAKER_01: Our bodies are gonna give, our minds are gonna give, our families are gonna give.
• 18:47
  SPEAKER_01: So we have to take the time and acknowledge and validate what we are experiencing as human beings, that we're all just doing this thing called life for the first time.
• 18:55
  SPEAKER_01: We shouldn't feel like we figured it out.
• 18:57
  SPEAKER_01: Yes, we're smart and yes, we're accomplished, but we still don't know it because this is our first time and no one figures it out on the first time.
• 19:03
  SPEAKER_01: Give ourselves grace and let ourselves rest and realize that we don't have to keep going.
• 19:09
  SPEAKER_01: We're allowed to take a pause.
• 19:11
  SPEAKER_00: Yeah, yeah.
• 19:12
  SPEAKER_00: I mean, it's genuinely like it's easing my soul talking to you, but hearing you say that because I really feel like a lot of us just, I think a lot of us do feel this way, you know.
• 19:22
  SPEAKER_00: There are a lot of people out there that feel this way, but to hear, you know, that this is an actual phenomena, you know, this thing where you can keep going, but there is a part of you that still needs that time, you know, and that self-care.
• 19:36
  SPEAKER_00: I mean, it's really very novel, you know.
• 19:38
  SPEAKER_00: So I I really applaud you for being a pioneer in this work because it's so needed.
• 19:42
  SPEAKER_00: Like, really.
• 19:43
  SPEAKER_00: I mean, thank you for working on this, genuinely.
• 19:46
  SPEAKER_01: I appreciate your kind words.
• 19:47
  SPEAKER_01: Many people will say, and you can watch these debates online, oh, high functioning depression is not a real thing.
• 19:54
  SPEAKER_01: You know what I say to them?
• 19:55
  SPEAKER_01: I said, Well, you know what?
• 19:56
  SPEAKER_01: A lot of doctors have it.
• 19:58
  SPEAKER_01: That's why I want to acknowledge it, right?
• 20:00
  SPEAKER_01: Because if you go to your doctor's office and you're like, I have all these symptoms of depression, and then they ask you those those two questions, like, oh, are you you know missing out on your functioning?
• 20:09
  SPEAKER_01: Are you do you have lower functioning?
• 20:10
  SPEAKER_01: No, I'm actually doing well at work.
• 20:12
  SPEAKER_01: So are you in significant distress?
• 20:13
  SPEAKER_01: I don't, I don't think so.
• 20:15
  SPEAKER_01: Okay, well, I will see you in a year, right?
• 20:17
  SPEAKER_01: They'll kick you out and be like, you're good to go, right?
• 20:20
  SPEAKER_01: In their minds, well, well, no one's happy.
• 20:22
  SPEAKER_01: I remember when I was a medical student and then I went to residency, I was in my anesthesiology residency, and an attending stopped me.
• 20:28
  SPEAKER_01: She was like, You don't look very good.
• 20:29
  SPEAKER_01: I was she was like, You look actually depressed.
• 20:31
  SPEAKER_01: I said, Yeah, I am.
• 20:32
  SPEAKER_01: She goes, Oh, go home, you know, take a take, just go get some rest.
• 20:35
  SPEAKER_01: And next day I came back to work, it was almost like we never had the conversation, back to doing back-to-back epidurals.
• 20:40
  SPEAKER_01: It was like wow.
• 20:41
  SPEAKER_01: And I just think about it and I think about doctors, and I think about how many colleagues I know who were afraid to report that they had anxiety or depression or anything because they didn't want their licenses taken away, or they would get bullied, or they'd be called weak.
• 20:54
  SPEAKER_01: And so I think a lot of people in healthcare, you know, will invalidate it because they're walking around that way.
• 20:59
  SPEAKER_01: They're like, well, no one's happy.
• 21:00
  SPEAKER_01: You know, they're like, everyone just works and is busy.
• 21:03
  SPEAKER_01: This is life.
• 21:04
  SPEAKER_01: No, it doesn't have to be life, it doesn't have to be your life.
• 21:08
  SPEAKER_01: And I think when people know that this is not okay, you are not okay, and that is okay, then they know that there are options, that they can actually do something about it, that this is not just normal.
• 21:17
  SPEAKER_00: Yeah, no, exactly.
• 21:18
  SPEAKER_00: That that makes sense.
• 21:19
  SPEAKER_00: And also, like, you know, we spoke a lot about like, you know, the healthcare profession, but even when I think of like working moms, you know, like, or just motherhood in general.
• 21:29
  SPEAKER_00: I mean, how many?
• 21:30
  SPEAKER_00: I have so many friends that are like amazing mothers, right?
• 21:33
  SPEAKER_00: Like they're they will go to any degree for their children.
• 21:37
  SPEAKER_00: They go to all the practices, you know, all the PTA meetings, they're doing everything for their husband.
• 21:42
  SPEAKER_00: They're so many things on their plate.
• 21:44
  SPEAKER_00: But then no one, none of them ever come to me or anyone, you know, they don't ever say, I need a minute for myself.
• 21:51
  SPEAKER_00: You know what I mean?
• 21:52
  SPEAKER_00: Like I need to sit down and think about where I'm at in my mental like well being.
• 21:57
  SPEAKER_00: And so this is such an important topic.
• 22:00
  SPEAKER_00: So for anyone sitting out there in the medical field saying this is not a real thing, it is a very much a real thing, you know?
• 22:05
  SPEAKER_00: So it's I I know from my end, like just as in the medical profession, but even just as a normal person, like every day I meet people like this, you know, in my walk of life.
• 22:15
  SPEAKER_00: So it's such a huge topic.
• 22:16
  SPEAKER_00: And especially, you know, and we talked about depression, but even with anxiety, like I think, you know, more people now are are coming out and saying they have anxieties than I've ever seen before, like on social media and stuff.
• 22:28
  SPEAKER_00: Like I see it all the time.
• 22:29
  SPEAKER_00: I don't know if the data backs that, but I mean, how what have you noticed with the whole anxiety conversation?
• 22:35
  SPEAKER_00: I mean, do you think that that feel is also evolving, like compared to before?
• 22:39
  SPEAKER_00: How we understood it?
• 22:40
  SPEAKER_01: Yeah, I definitely do.
• 22:41
  SPEAKER_01: I mean, the data shows that younger generations are reporting higher rates of anxiety.
• 22:46
  SPEAKER_01: And if you think about what we've been through as a society, you know, throughout the past couple of years, there was the pandemic, then there were these uprisings with, you know, the government, and then there were police brutality, then there were wars, and it's just like one thing after the next.
• 23:00
  SPEAKER_01: You know, there's just so much uncertainty.
• 23:03
  SPEAKER_01: And at least, you know, older generations had periods where they didn't have so much uncertainty.
• 23:08
  SPEAKER_01: But the younger generations, it's like they, it's like uncertainty is the new norm.
• 23:12
  SPEAKER_01: So being in a constant state of panic and anxiety is what they're experiencing.
• 23:18
  SPEAKER_01: And so, you know, rather than telling them that, okay, like, oh, you were just coddled and you you just you know grew up soft, no, and validating it and saying, you know what, you gotta, there's a lot to be anxious about, you know, there is a lot going on.
• 23:30
  SPEAKER_01: This is unusual.
• 23:31
  SPEAKER_01: Also, they've existed in a world that's always had the internet, so they've always had access to the information and the bad news.
• 23:37
  SPEAKER_01: Whereas, you know, older generations, you know, we didn't have the internet from time we were little kids, you know, we we we didn't know what was going on in other countries.
• 23:45
  SPEAKER_01: These younger generations, they know everything.
• 23:47
  SPEAKER_01: And sometimes knowing everything that's happening, it's a good thing because you want to be informed, but it's also like overwhelming.
• 23:53
  SPEAKER_01: So you have to give your brain a break from it because you know, you're in a constant state of anxiety and panic if you're just anticipating what the next bad headline is going to be.
• 24:03
  SPEAKER_00: Right.
• 24:03
  SPEAKER_00: Exactly.
• 24:04
  SPEAKER_00: No, that makes sense.
• 24:05
  SPEAKER_00: And I agree with you, you know, about the the exposure to the internet, even on the plane.
• 24:10
  SPEAKER_00: You know, I always see like parents handing their child like an iPad, you know, to keep them busy or whatever.
• 24:15
  SPEAKER_00: Like it's just everywhere, you know.
• 24:17
  SPEAKER_00: So that makes sense that there's just they're being bombarded, you know, with a lot of news.
• 24:22
  SPEAKER_00: And I don't know.
• 24:23
  SPEAKER_00: I I'm curious to see how this translates when they get to their 30s and their 40s, you know.
• 24:28
  SPEAKER_00: But um, I want to actually shift gears a little bit and talk to you um and get your opinion on how all of this really impacts our skin.
• 24:35
  SPEAKER_00: Because, you know, we talk a lot, you know, from the molecular and cellular biology side, you know, I've had these conversations with, you know, people about like, for example, like cortisol levels going up, right?
• 24:46
  SPEAKER_00: And like that's gonna impact your skin.
• 24:48
  SPEAKER_00: It causes skin thinning.
• 24:49
  SPEAKER_00: But um, I'm really curious, you know, anything that you've noticed about this and tying it in with how it really projects itself, you know, into skin health complications or anything related to our the things that we identify with wellness, right?
• 25:05
  SPEAKER_00: The things that we want to improve on through buying products or creams or whatnot, like anything you can share with us on that?
• 25:12
  SPEAKER_01: Yeah, absolutely.
• 25:13
  SPEAKER_01: You know, it's in some cases the stress that you go through actually impacts the skin.
• 25:19
  SPEAKER_01: And in other cases, your skin problems impacts your mental health, right?
• 25:24
  SPEAKER_01: And the two are very uh closely tied.
• 25:27
  SPEAKER_01: And like when you go back to neurobiology um and you look at cellular structures, you know that some of the initial cells when you were being formed as a fetus and as an embryo, um, some of those same cells that turn into brain cells also turn into skin cells, right?
• 25:45
  SPEAKER_01: It's interesting because um in the field of psychodermatology, uh what I've noticed is that people who are stressed may, um, you know, let's say that the stress started first, uh, they may engage in behaviors that are harmful for their skin and for their hair.
• 26:02
  SPEAKER_01: So I've seen cases where people don't are not even aware that they're picking at their hair, that they're picking at their eyelashes, they're picking at their eyebrows, they're picking at their hair on their scalp, they're picking at this the hair on their arms and legs.
• 26:15
  SPEAKER_01: And so they're coming in with these um with this anxiety, but they also have these like abrasions and these infections and these bald spots.
• 26:23
  SPEAKER_01: In other cases, I've seen where people are picking at their actual skin, simply because stress leads to high rates of inflammation and makes people vulnerable to infections.
• 26:33
  SPEAKER_01: And so you see a lot of the stress in the mind affecting the body.
• 26:37
  SPEAKER_01: And also when people are stressed or depressed, they don't get good nutrition, they don't drink a lot of water, they're not getting nutrients.
• 26:43
  SPEAKER_01: So that can impact the skin and the hair and the nails.
• 26:46
  SPEAKER_01: And so that's very closely tied.
• 26:49
  SPEAKER_01: But then in situations where people have eczema or psoriasis or have other um skin issues like vitiligo and so forth, that can impact their self-esteem.
• 26:58
  SPEAKER_01: Some people who have like um hair loss through the medical issues, but also just genetic hair loss, you know, those issues impact self-esteem and self-confidence.
• 27:06
  SPEAKER_01: So, you know, I've I've looked at the body language um, you know, using these psychiatric assessments and people are making poor eye contact, they're looking at the ground, they're they're fidgeting, you know, they're just not having um a high quality of life as they should because these physical issues are harming their mental health.
• 27:24
  SPEAKER_01: And when they go to the doctor, they're told, well, you know, at least it's not life-threatening, you know, like, but that's not reassuring, you know.
• 27:32
  SPEAKER_01: Um they're made to feel ashamed and foolish for being vain, but no, you know, like uh people can tell you all they want that, like, oh, looks don't matter, but you get judged the moment that someone lays their eyes on you.
• 27:44
  SPEAKER_01: And should it be that way?
• 27:45
  SPEAKER_01: No, but that's the reality of the world.
• 27:47
  SPEAKER_01: And so you have small children who have um acne and have issues with their hair and skin, and they're getting teased.
• 27:55
  SPEAKER_01: If you tell a kid, oh well, you're beautiful on the inside, they're not gonna want to hear that, you know, even if it's true.
• 28:01
  SPEAKER_01: They want to feel validated, like, yeah, this sucks that I have this acne.
• 28:04
  SPEAKER_01: This sucks that I have that these hair issues.
• 28:06
  SPEAKER_01: I need help.
• 28:07
  SPEAKER_01: They want to feel supported.
• 28:08
  SPEAKER_01: There's nothing wrong with that.
• 28:09
  SPEAKER_01: So that mind-body connection is very important with the skin and the hair.
• 28:14
  SPEAKER_00: Absolutely.
• 28:14
  SPEAKER_00: No, you brought up such great points there because you're right.
• 28:17
  SPEAKER_00: I mean, at the end of the day, I mean, if you really look at the beauty industry, right?
• 28:22
  SPEAKER_00: And and uh like from a business perspective, it looks like you know, we're making these great products that are solutions to things, and they are a lot of them are, you know, there's a lot of efficacy behind a lot of products, and and that's great.
• 28:35
  SPEAKER_00: But really, what I see from my lens is a lot of clutter.
• 28:39
  SPEAKER_00: And I wonder where that stem of that comes from.
• 28:43
  SPEAKER_00: And it really like, you know, everything you've explained here, it makes me think of, you know, when we're buying products or we're looking for, you know, that new skincare routine or that new beauty routine.
• 28:54
  SPEAKER_00: Do we really need it?
• 28:55
  SPEAKER_00: You know, it's more of like asking, like for me, I don't think I ever stop and ask myself that.
• 29:00
  SPEAKER_00: Like, do I really need this?
• 29:02
  SPEAKER_00: Because it's more of like, oh, that is going to fix, you know, whatever it is I'm worried about that day in that moment.
• 29:08
  SPEAKER_00: And it's this impulse purchase that happens.
• 29:11
  SPEAKER_00: And so, you know, just that impulsivity, like I'm curious, like, do you think that comes from what you said earlier about this like trauma response?
• 29:19
  SPEAKER_00: Or where do you think that stems from?
• 29:22
  SPEAKER_01: Impulsivity can come from various conditions.
• 29:24
  SPEAKER_01: So I've seen impulsivity with ADHD, I've seen impulsivity um with behavioral conditions, with some mood disorders.
• 29:32
  SPEAKER_01: Um, but with regards to what I'm talking about with this trauma response, the impulsivity I think comes from this need to self-soothe.
• 29:41
  SPEAKER_01: You know, you're feeling dysregulated and you want something in that moment to fix that dysregulation.
• 29:48
  SPEAKER_01: And for some people, that's food, and for others, it's a glass of wine.
• 29:52
  SPEAKER_01: For others, it's you know, smoking cigarettes.
• 29:55
  SPEAKER_01: Um, for and for some it's shopping, right?
• 29:58
  SPEAKER_01: And um, and shopping these days has just become so much more easy, right?
• 30:04
  SPEAKER_01: Like it's so easy to just press a button and something comes to your home and it's something to look forward to, and then you wait for it to arrive, and then you unbox it, and then and then what's left?
• 30:13
  SPEAKER_01: Oh, I gotta buy something else to have that same feeling, right?
• 30:17
  SPEAKER_01: Yeah, but if we if we don't uh if we're not careful and we're not figuring out ways to self-soothe in healthy ways, then we're gonna continue these spirals of habit-forming behavior.
• 30:30
  SPEAKER_01: And in some people it looks like a full-on addiction, in other people it looks like, you know, a bad habit or a maladaptive habit.
• 30:38
  SPEAKER_01: Um, but you know, you know what it looks like in yourself.
• 30:41
  SPEAKER_01: And so I what I tell my patients to do is, you know, when you're feeling that way, name the feeling, right?
• 30:48
  SPEAKER_01: Many of us don't even know what the feeling is, we just know that we don't like it.
• 30:52
  SPEAKER_01: So what is that feeling?
• 30:53
  SPEAKER_01: Like, are you feeling unloved?
• 30:55
  SPEAKER_01: Are you feeling lonely?
• 30:57
  SPEAKER_01: Are you feeling worried?
• 30:58
  SPEAKER_01: Are you feeling sad?
• 31:00
  SPEAKER_01: Right.
• 31:00
  SPEAKER_01: So the feeling is not just, you know, kumbaya or or or granola.
• 31:07
  SPEAKER_01: It's really evidence-based, you know, it's called affect labeling.
• 31:11
  SPEAKER_01: And studies show that if you can label and name the way that you feel, that in itself is therapeutic because we as human beings need to have answers.
• 31:20
  SPEAKER_01: We need to know what's happening.
• 31:21
  SPEAKER_01: And it's almost like we turn the light on and we and we know what we're dealing with now.
• 31:26
  SPEAKER_01: And and so when you name that feeling, like let's say you are feeling unloved, then you can reach out to someone to let them know that you need to feel loved, right?
• 31:33
  SPEAKER_01: If you're feeling lonely, you can go in the next room and cuddle with your loved one, right?
• 31:38
  SPEAKER_01: Or cuddle with your pet.
• 31:39
  SPEAKER_01: If you're tired, you can go take a rest.
• 31:42
  SPEAKER_01: But a lot of us are just walking around feeling something and we don't know what it is, so we press a button and we buy something.
• 31:48
  SPEAKER_01: Or, you know, we open up social media and we zoom scroll, you know, or we open the fridge and and pour one or two glasses of wine, right?
• 31:56
  SPEAKER_01: But name how you feel helped.
• 31:58
  SPEAKER_01: So when you're when you're feeling that urge to buy something that you don't need, you know, try this.
• 32:04
  SPEAKER_01: Take a pause, name the feeling, and then try and get to the root of that.
• 32:09
  SPEAKER_01: So again, if it's one of those things, if you're feeling, you know, if you if you don't know how you're feeling, journal, you know, like take deep breaths.
• 32:19
  SPEAKER_01: Um, you know, there are different ways to to label that affect to get to the root of it.
• 32:24
  SPEAKER_01: Um, but when we press a button and we buy, we're avoiding.
• 32:28
  SPEAKER_00: Yeah, yeah, that makes sense.
• 32:29
  SPEAKER_00: Like, because I I think that's the that's really what I was wondering is like, you know, what is the like when we're actually purchasing something or just, you know what I mean?
• 32:38
  SPEAKER_00: Like drowning out everything and saying, I'm gonna go shopping, you know what I mean?
• 32:42
  SPEAKER_00: Like this is what I'm doing today for self-care is I'm gonna go on a shopping spree and I'm gonna treat myself.
• 32:47
  SPEAKER_00: I mean, are we really treating ourselves?
• 32:48
  SPEAKER_00: You know, that's the that was my main uh question behind that.
• 32:52
  SPEAKER_00: Because I I don't know, sometimes it doesn't feel like it because I mean I know I'm guilty of it.
• 32:57
  SPEAKER_00: I've gone on a shopping spree and come back an hour later and I'm feeling like, okay, well, I just spent a bunch of money, you know.
• 33:03
  SPEAKER_00: I don't know if I really even like what I bought.
• 33:06
  SPEAKER_00: It just looked great in the store, you know, and then you just sit there and uh wonder, you know, like what did this really do for me?
• 33:12
  SPEAKER_00: And this really actually brings me to, I had um seen, I think it was one of your interviews, and you had spoken about this um in terms of like self-care.
• 33:21
  SPEAKER_00: And I um it really stuck with me because you made a point about how self-care isn't this elaborate thing sometimes, you know, it's the little things.
• 33:31
  SPEAKER_00: And I am really curious about that.
• 33:33
  SPEAKER_00: If you could speak a little bit more about that for our audience to in understanding, you know, when we talk about self-care now, I'm seeing everybody, you know, on social media or wherever people are consuming content.
• 33:44
  SPEAKER_00: We've got these 10-step skincare routines, you know, 10-step hair care routines.
• 33:48
  SPEAKER_00: But is that really necessary?
• 33:50
  SPEAKER_00: You know, and what is your perception of self-care and how we should be approaching it?
• 33:55
  SPEAKER_01: I, you know, I agree.
• 33:56
  SPEAKER_01: Self-care, when the more elaborate it is, the more work it is, and it's not therapeutic, right?
• 34:01
  SPEAKER_01: Think about the effort it takes to plan a spa day.
• 34:04
  SPEAKER_01: And it's it's it's so much effort.
• 34:07
  SPEAKER_01: Yeah, so many things to pack and to think about.
• 34:10
  SPEAKER_01: By the end of it, you need a day to recover from your spa day.
• 34:13
  SPEAKER_01: But when you think about self-care, it should be really meeting your basic needs.
• 34:18
  SPEAKER_01: And ask yourself, are you meeting your basic needs, right?
• 34:21
  SPEAKER_01: Are you are you fed?
• 34:22
  SPEAKER_01: Are you quenching your thirst?
• 34:24
  SPEAKER_01: Are you all rested?
• 34:25
  SPEAKER_01: Are you connecting with a loved one?
• 34:27
  SPEAKER_01: Are you eating your food and actually tasting it instead of just like some of us just like shovel it in our mouth and we don't even chew?
• 34:33
  SPEAKER_01: It's like it's amazing that we all walk around without, you know, choking, but like we don't.
• 34:38
  SPEAKER_01: And how many of us ignore our bodies when when we have an urge to go to the bathroom, we just work through it, you know?
• 34:44
  SPEAKER_01: Self-care is is taking breaks and not eating food in front of your laptop at work, right?
• 34:50
  SPEAKER_01: Actually having a lunch break, actually having a coffee break, you know, going outside, you know, taking an actual break from work, you know.
• 34:59
  SPEAKER_01: Right, right.
• 35:01
  SPEAKER_01: These are the very simple things in life that you can do that don't cost a lot of money.
• 35:07
  SPEAKER_01: A lot of them are built into our day, we just don't take the time, right?
• 35:10
  SPEAKER_01: Yeah, and if we can meet our basic needs, then we feel human again.
• 35:16
  SPEAKER_01: You know, it's not it's not a very human existence, it's not humane to sit at your desk when you know you have to go to the bathroom and you're just like, well, I just gotta send one more email.
• 35:25
  SPEAKER_01: We treat ourselves with such indignity as human beings, and if we could just meet our basic needs again and we listen to our bodies, truly listen to our bodies.
• 35:34
  SPEAKER_01: Like when your stomach's gurgling and you're hungry and you actually go and get food, right?
• 35:39
  SPEAKER_01: And you talk to your, and that's that's just showing some kindness to your body, right?
• 35:43
  SPEAKER_01: And you're like, you know, my body is worth it.
• 35:45
  SPEAKER_01: Like, I need to nourish this body.
• 35:47
  SPEAKER_01: This is the only body I'm gonna have.
• 35:48
  SPEAKER_01: I need to treat this body in a sacred way, you know.
• 35:51
  SPEAKER_01: Yeah, like I have I should be going on walks.
• 35:54
  SPEAKER_01: Walks are good for my mental health, they they clear my brain, they help me with stress, they're good for my heart, and I should be doing this for my body because my body deserves it.
• 36:03
  SPEAKER_01: When we start treating our bodies like that, and we start listening to our bodies and to our souls, our spirits, and we're we treat it sacredly, then then that is self-care.
• 36:15
  SPEAKER_01: Right?
• 36:17
  SPEAKER_01: If you're not taking bathroom breaks and you're eating junk at your desk and you are not, you know, making time to touch and love, you know, one of your closest people or your pet, you know, then one day at the spa isn't gonna fix all that, right?
• 36:31
  SPEAKER_01: But if you can do a little bit of these basic steps every day, overall, that is self-care.
• 36:37
  SPEAKER_00: Yeah, no, that makes sense.
• 36:39
  SPEAKER_00: That makes so much sense.
• 36:40
  SPEAKER_00: And that actually sounds a lot better than a spa day.
• 36:43
  SPEAKER_00: Um, you know, if I were to sit down and actually exactly what you described, like just go on a walk or something simple.
• 36:49
  SPEAKER_00: Like I think I have personally had that feeling of wow, I do feel better because I took a minute to breathe, you know.
• 36:56
  SPEAKER_00: So it's it's very applicable.
• 36:58
  SPEAKER_00: And I and I wonder because you know, we get to this point, and this is something I really want to discuss with you is this idea of like when we get for as women, especially after a while, you get to this point in your life where you realize, okay, now I'm at a point where now my body is changing again, you know?
• 37:16
  SPEAKER_00: And so then you have this added level of stress.
• 37:19
  SPEAKER_00: And that's where I want to um ask you about menopause as well.
• 37:23
  SPEAKER_00: What are your views on that?
• 37:24
  SPEAKER_00: You know, what when somebody is undergoing something like menopause and and having to deal with the stress and the stress that your body's inducing on top of everything else, like how does, I mean, how does all of that work?
• 37:35
  SPEAKER_00: And what are some tips that we can, you know, utilize to kind of get through that?
• 37:41
  SPEAKER_01: You know, menopause is one of those things that I started to really focus on because my patients were coming in and I was getting referrals for people who had depression or ADHD.
• 37:51
  SPEAKER_01: And I just thought, you know, these are some women that have never been depressed in their lives, and a lot of them had never had ADHD symptoms.
• 37:57
  SPEAKER_01: It turns out these were hormonal changes.
• 37:59
  SPEAKER_01: This was not ADHD.
• 38:00
  SPEAKER_01: This was not major depressive disorder.
• 38:02
  SPEAKER_01: And so I'd really thought, you know, there are so many women who are going through this and they don't know.
• 38:07
  SPEAKER_01: Let me start creating content around it.
• 38:09
  SPEAKER_01: Um, similar to my content around, you know, other mental health conditions that get misdiagnosed.
• 38:14
  SPEAKER_01: And um, and so I think that with menopause, it's really challenging because most doctors only get one class in menopause after they graduate medical school.
• 38:25
  SPEAKER_01: So you're really talking about doctors not having knowledge about the physiology of a woman for half of their lives.
• 38:32
  SPEAKER_01: And it's really gross um negligence in the medical community.
• 38:37
  SPEAKER_01: Uh a lot of the clinical studies did not include women until the late 80s.
• 38:41
  SPEAKER_01: So the drugs that we have, the treatment protocols we have, they're they're made for a man's body.
• 38:46
  SPEAKER_01: And women have hormonal fluctuations throughout their entire lives, you know, starting with puberty.
• 38:53
  SPEAKER_01: So, you know, we don't really have a full understanding as to what happens in a woman's body.
• 38:57
  SPEAKER_01: And that is that's scary.
• 38:59
  SPEAKER_01: So you have women coming into offices and they're like, I have these biz bizarre symptoms.
• 39:03
  SPEAKER_01: Is this supposed to happen?
• 39:04
  SPEAKER_01: Is this supposed to happen?
• 39:05
  SPEAKER_01: And because doctors have never seen it, they don't know, they're like, Well, you must be depressed.
• 39:09
  SPEAKER_01: Um, and so you know, we talked about how labeling the emotion, labeling the feeling, and having the right name can be therapeutic.
• 39:18
  SPEAKER_01: Well, when women find out that there's nothing wrong with them, that their hormonal fluctuations are the things that are causing them to have these symptoms, and that if they can get that under control by, you know, possibly using hormone therapy or other modalities, then they can feel, you know, more at their baseline again.
• 39:37
  SPEAKER_01: Then it's it's such a relief for them because many of them feel like they don't know who they are anymore.
• 39:42
  SPEAKER_01: They're like going through these moods, they're having brain fog, they're having physical changes.
• 39:48
  SPEAKER_01: Um, and so what I tell the women I treat is that look for the three P's.
• 39:51
  SPEAKER_01: This is how you know if you're going through menopause or if you're having a major depressive disorder.
• 39:55
  SPEAKER_01: Number one is if you have period changes, right?
• 39:58
  SPEAKER_01: Yeah, you know, you have a year of period changes leading up to the final period.
• 40:03
  SPEAKER_01: That's likely due to menopause.
• 40:04
  SPEAKER_01: That's not major depressive disorder.
• 40:06
  SPEAKER_01: If you have physical changes, like hot flashes, um, changes in your skin, changes in your hair, body order, ringing ears, itchy ears, visual changes, teeth changes, gut changes, like you know, the way you have your bowel movements, the way that you're urinating, if you're urinating frequently frequently, there are tons of symptoms.
• 40:21
  SPEAKER_01: Physical changes don't happen with major depressive disorder, right?
• 40:24
  SPEAKER_01: So that's the second P.
• 40:25
  SPEAKER_01: Yeah.
• 40:26
  SPEAKER_01: And the last one is as past history.
• 40:28
  SPEAKER_01: If you have a past history of depression or a past history of anxiety, you're more likely to have a major depressive disorder in midlife.
• 40:35
  SPEAKER_01: However, if you've never had a history of this stuff and you're having it for the first time in midlife, your doctor should be thinking about menopause, right?
• 40:41
  SPEAKER_01: Because hormonal fluctuations can impact your mood and your anxiety and your sleep.
• 40:45
  SPEAKER_01: So, so um, you know, those are the things I tell my patients.
• 40:49
  SPEAKER_01: And I also I also inform them about the the ties, T-I-E-S, between menopause and mental health.
• 40:55
  SPEAKER_01: So the thinking issues that that's the brain fog, that tip of the tongue, like I can't remember what I was saying, or I can't find my keys.
• 41:00
  SPEAKER_01: Um, the I, the identity, feeling like I don't know who I am anymore, because like I can't do certain things, or I feel like I can't do certain things the way I used to.
• 41:08
  SPEAKER_01: Um, the emotions, what I talked about with the anxiety and depression and those symptoms that can come with the hormonal um fluctuations.
• 41:15
  SPEAKER_01: And the S is the sleep because sleep is really um dismantled a bit in when the hormones fluctuate.
• 41:22
  SPEAKER_01: So when so when women know what they're dealing with, if you if you can help them identify it, then they don't feel like they're going crazy.
• 41:29
  SPEAKER_01: The problem is that you have to educate women because a lot of doctors don't know.
• 41:32
  SPEAKER_00: Yeah, yeah.
• 41:33
  SPEAKER_00: No, that's that's so true about what you said with the with the knowledge that we're given in medical school.
• 41:40
  SPEAKER_00: There's no knowledge about this stuff.
• 41:41
  SPEAKER_00: Like we don't learn this, you know.
• 41:42
  SPEAKER_00: And at the end of the day, like menopauses, I feel like now it's emerging more than ever, you know, especially in the mainstream.
• 41:50
  SPEAKER_00: People are realizing, like, hey, listen, half the you know, population of the world is going through this or going to go through this.
• 41:57
  SPEAKER_00: Like we need to pay attention to it.
• 41:58
  SPEAKER_00: And I know, like, you know, your work is extraordinary in this field, you know, and raising awareness around it.
• 42:03
  SPEAKER_00: And I I just wonder to myself, you know, how many women out there are going through menopausal symptoms and they don't have a support system or they don't have anyone they can talk to and express these emotions, you know, and express what they're going through.
• 42:15
  SPEAKER_00: Because I know I can tell you, you know, with my own family, right?
• 42:19
  SPEAKER_00: My mother, I watched her go through menopause and my mother never spoke to anybody about it.
• 42:23
  SPEAKER_00: It was almost like taboo, you know, just it makes me wonder how many women out there have been buried under that, you know, and and that whole societal pressure of can we discuss this and can we talk about what we're actually going through to get real help, you know, when we need it.
• 42:39
  SPEAKER_01: There's a lot of shame, you know, and like a lot of the symptoms of menopause affect the skin and the hair, you know, like your skin starts to change.
• 42:47
  SPEAKER_01: You may it may be painful to have sex because of the skin, it may be difficult to urinate.
• 42:53
  SPEAKER_01: Um, you know, it your hair may start to fall out or thin.
• 42:57
  SPEAKER_01: These are things that, you know, and women are told, well, you're not dying.
• 43:01
  SPEAKER_01: It's like, no, is that supposed to be the the threshold for my survival?
• 43:05
  unknown: I'm not dying.
• 43:07
  SPEAKER_01: But but if a man goes in and he's like, I can't, you know, have an erection anymore, it's like, oh my, it's like, let's hold the horses, call in the emergency carriages.
• 43:15
  SPEAKER_01: Right.
• 43:15
  SPEAKER_01: Like, let's get to this, let's get to the root of this.
• 43:18
  SPEAKER_01: But like, we don't get the same sympathy.
• 43:21
  SPEAKER_01: And I think that it's important to have women leadership and to have um more, you know, women medical students and to teach the current medical students.
• 43:29
  SPEAKER_01: I I whenever I get together with the medical students at Columbia, um I tell them you got to be learning about menopause.
• 43:36
  SPEAKER_01: You know, that's something that wasn't in the medical curriculum, it wasn't the requirement, but we had to change that.
• 43:41
  SPEAKER_01: Um, I think I got like a one course on it in medical school.
• 43:44
  SPEAKER_01: That is not enough.
• 43:45
  SPEAKER_01: You know, women spend you like ups upwards to half of their lifetimes postmenopausal, and we don't know anything about like we don't, we're not learning this, you know, we're not learning the the body in the in in this stage.
• 43:56
  SPEAKER_01: This is it's unacceptable.
• 43:58
  SPEAKER_00: Exactly.
• 43:59
  SPEAKER_00: No, I mean.
• 44:00
  SPEAKER_00: Even now, I don't see a lot of training around this either.
• 44:03
  SPEAKER_00: You know, even like postgraduate work and you know, going through residency, going through, you know, fellowship, like you don't learn about these, about menopause.
• 44:10
  SPEAKER_00: Nobody talks about it for some reason.
• 44:12
  SPEAKER_00: And I feel like now we're finally getting to the point where we have now that everybody's on social media constantly, you know, there's an actual opportunity to be able to speak on this topic, you know, and have people listen because now we have brands and stuff popping up and people are just more aware.
• 44:29
  SPEAKER_00: So I guess, you know, one of my questions is also if you do have someone in your life, like if you are a man and your like wife, for example, is going through menopause, what are some tips that you could recommend to like somebody in that situation that could be supportive of that person, you know, rather than doing anything that makes them feel shame?
• 44:47
  SPEAKER_01: Well, one of the best things you can do is learn about it, right?
• 44:50
  SPEAKER_01: Like get a book.
• 44:51
  SPEAKER_01: There are many great books, read about it.
• 44:54
  SPEAKER_01: Um, you know, like help your partner, your family member come up with questions to ask the doctor after you do your reading.
• 45:00
  SPEAKER_01: Um, yeah, you should never, I think never go to a doctor without having your questions and having done your own research.
• 45:07
  SPEAKER_01: See if they're if they're um knowledgeable, have your questions ready, have a little bit of knowledge yourself so that you know how what to ask and what it means when they use terms.
• 45:17
  SPEAKER_01: Um, and and you know, if someone wants to be supportive, listening, you know, a lot of times we feel like we have to do and we have to fix, but sometimes just listening can be so powerful.
• 45:29
  SPEAKER_01: If we all at the end of the day want to feel heard, we all want to feel validated, we want to be seen.
• 45:34
  SPEAKER_01: And so when your partner or your family member or whoever it is, your friend, when they're talking about what they're going through, rather than you know, just trying to fix it, listen.
• 45:44
  SPEAKER_01: Right.
• 45:44
  SPEAKER_01: And then and then that in itself can be therapeutic.
• 45:49
  SPEAKER_01: That makes sense.
• 45:49
  SPEAKER_00: Yeah, that definitely makes sense.
• 45:51
  SPEAKER_00: I hope there's uh some men in the audience listening in, you know, definitely take that to heart because yeah, I think you know, listening can be more helpful than anything sometimes.
• 46:01
  SPEAKER_00: So I definitely I can see that.
• 46:04
  SPEAKER_00: Um, I just you know, I just wonder because I think there's a lot of people that are going through things in silence, you know, and then it's kind of like you they're going through it, but then the people around them want to help but don't know how.
• 46:16
  SPEAKER_00: And that's why I'm just like always curious, you know, what it's important to address, like, yes, if you're the actual person that's experiencing it, that's obviously something to address.
• 46:25
  SPEAKER_00: But then also if you're a family member or a spouse or a bystander that's just there to help, you know, there's no guideline for people, you know, and and I feel like there needs to be a little bit more awareness on that side as well, you know, where you need to be a little bit more proactive.
• 46:41
  SPEAKER_00: If you see somebody around you that's suffering, ask questions, the right ones, or just listen, you know.
• 46:46
  SPEAKER_00: So yeah, very interesting.
• 46:48
  SPEAKER_00: I I want to just I want to round out the interview though, and I'm just asking for some just some fun advice about if we are looking to, you know, just improve our overall mental well-being and just take care of ourselves, you know, on the baseline.
• 47:01
  SPEAKER_00: What are some things that we can do?
• 47:03
  SPEAKER_01: I do think that if we can each start to listen to ourselves, right?
• 47:09
  SPEAKER_01: We start listening to how we feel, naming how we feel every day, you know, and reflecting, that's a start.
• 47:17
  SPEAKER_01: Everyone can do that.
• 47:19
  SPEAKER_01: I think that we can all focus on our basic needs, the ones that I talked about, getting good rest, not being on our devices right before bedtime, because that disrupts our melatonin.
• 47:30
  SPEAKER_01: Uh reaching out to a loved one, right?
• 47:32
  SPEAKER_01: Loneliness is a is a huge epidemic right now.
• 47:35
  SPEAKER_01: Um, reaching out and having a meaningful interaction, not just texting someone a meme, you know.
• 47:41
  SPEAKER_01: Yeah.
• 47:42
  SPEAKER_01: Eating foods that feed our brain, you know, there is a body of literature that show that food is medicine, and there are certain foods that you eat that actually help to improve your mental health, improve your memory, improve the levels of inflammation in your body.
• 47:58
  SPEAKER_01: And some studies are showing that that's even more effective than some medications.
• 48:02
  SPEAKER_01: Uh, getting good movement, you know, making sure that we're getting circulation, that we're getting out in nature.
• 48:08
  SPEAKER_01: Even if we live in a city, you know, going for a walk can be very therapeutic.
• 48:13
  SPEAKER_01: So these are like very basic things that we can all do.
• 48:16
  SPEAKER_01: But we, if we don't make the time for it because we're not validating ourselves, we're not reflecting, we're not naming how we feel, then we're gonna be stuck in a rut, you know, and then and then we're gonna feel blah and we're gonna feel anhedonic.
• 48:29
  SPEAKER_01: We're not gonna have that pleasure and that interest that we should have.
• 48:33
  SPEAKER_00: Right.
• 48:34
  SPEAKER_00: That makes sense.
• 48:35
  SPEAKER_00: And and some really great advice.
• 48:37
  SPEAKER_00: So I really encourage everyone listening out there, you know, definitely do a little self-reflection, I guess.
• 48:42
  SPEAKER_00: You know, if you've tuned in for this episode.
• 48:45
  SPEAKER_00: Um, I mean, I've learned a lot here.
• 48:46
  SPEAKER_00: Uh, Dr.
• 48:47
  SPEAKER_00: Joseph, this has been very um eye-opening for me.
• 48:50
  SPEAKER_00: So thank you so much for the for the you know honor for coming onto the show and sharing all this wisdom.
• 48:55
  SPEAKER_00: It's very, very appreciated.
• 48:57
  SPEAKER_00: And I know there's a lot more work that needs to be done.
• 49:00
  SPEAKER_00: And I just really applaud you for being such a trailblazer in this space.
• 49:03
  SPEAKER_00: I wish I could clone you.
• 49:05
  SPEAKER_00: I really do, because we need more of you, you know, out there just advocating for what it means to be truly mentally well and taking care of yourself.
• 49:13
  SPEAKER_00: So thank you so much.
• 49:14
  SPEAKER_01: Thank you for having me.
• 49:15
  SPEAKER_01: It was a pleasure.
• 49:16
  SPEAKER_01: Thank you.
• 49:17
  SPEAKER_00: Hey guys, so I hope you love that episode.
• 49:20
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• 49:25
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• 49:27
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• 50:24
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