Latest / hol+ with Dr. Taz MD | The Future of Medicine is Holistic / How to Thrive in a World That Prioritizes Productivity Over Well-Being with Dr. Judith Joseph
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- How to Thrive in a World That Prioritizes Productivity Over Well-Being with Dr. Judith Joseph === Dr. Judith Joseph: It is something that I found people are struggling with. The strong ones who don't acknowledge their emotions, who wear that mask of productivity. No one knows they're struggling. We all have emotional traumas. We may not have a trauma that the DSM 5 designates as a trauma, but we all have emotional experiences. Dr. Judith Joseph: Painful psychological experiences that shape us and changes the way that we view ourselves in the world and the way that we interact in the world. Everyone has mental health. We may not all have a mental health condition, but we all have mental health the way that we have physical health and we have to nurture it. Dr. Judith Joseph: We have to take care of it so that we don't develop a mental health condition. Dr. Taz: Anxiety and depression and so many other mental health disorders are on the rise. We know that we have a crisis when it comes to mental health in this country. And honestly, across the globe, I felt like it was really important to dive more deeply. Dr. Taz: into the conversations around mental health. And that's why my next guest is going to help us with this issue. Let me introduce you to Dr. Judith Joseph. She's the author of the highly anticipated book on high functioning depression. Dr. Judith is a board certified psychiatrist and chair of the Women in Medicine Initiative for Columbia University College of Physicians and Surgeons. Dr. Taz: She's a Clinical Assistant Professor of Child and Adolescent Psychiatry at NYU Langone Medical Center. She has conducted several clinical research studies in pediatric, adult, geriatric, and women's mental health as the principal investigator in her own research lab. She recently received a 2023 Congressional Proclamation from the U. Dr. Taz: S. House of Representatives for her social media advocacy and research in mental health. In May of 2024, she lectured at the White House for the Executive Office. of the president of the United States and taught members of the administration a workshop on how to improve their mental health. She's been an expert on various media platforms, made a number of national television appearances and received her education from Duke University, Columbia University, and then Columbia Business School. Dr. Taz: Please join me in welcoming Dr. Judith Joseph to the show. Welcome, Dr. Judith. I'm so glad to have you on the show. Thank you for having me. I'm excited to be here. This is a really important topic at a really critical time. I mean, I think I sort of repeat what everybody already knows. When I say that we have a mental health crisis, it's affecting every age group from our children to our teens, to our seniors and everyone in between. Dr. Taz: And I really wanted you on the show to help us dive into this. topic because I think that we hear a lot of chatter, but we don't really understand what's going on. So I would love to learn more about the work you're doing and how you entered this field of mental health, anxiety, and depression. And, you know, what your perspective is on what everyone's going through. Dr. Judith Joseph: Well, I mean, I entered this field because Honestly, there was a need for this, and this field of psychiatry rescued me. I used to be an anesthesiology resident, and I remember being in the OR, the operating room, and thinking, Like, is this really what I'm supposed to do with my life and feeling so empty and experiencing anhedonia which is something that a lot of people in medical cultures know about, but a lot of people in regular culture have never heard of it. Dr. Judith Joseph: They're like, anho what? Um, but anhedonia is this feeling of Meh, blah, lack of interest. Not happy. Not excited. Not excited. Just really blunted. And I was having that. And the funny thing is, is that I knew what it was. I'd heard of it, studied it, and it snuck up on me. I didn't even realize I was experiencing it. Dr. Judith Joseph: And when I realized that I felt so empty, I was like, I have to make a change. And this is while you're Dr. Taz: in residency or you're already out working and stuff like that. I was in residency. Yeah, I Dr. Judith Joseph: was a resident, which is basically a doctor in training in anesthesiology. And it is a very important field. I have a lot of friends in it. Dr. Judith Joseph: But, you know, if it's not the right fit for you, you can feel very empty doing something like that. Dr. Taz: You know, before we move into mental health, you've brought something up that's really important. I have been in medicine for probably over 25 years. I'm dating myself, but one of the things that I've observed is that anhedonia amongst our colleagues and That can sometimes turn into despair, and it can actually turn into addictive behaviors, destructive behaviors as time goes on, and I think the bravery to be mid path in a profession where you follow a road, you get things done, you keep going, but the bravery to be able to stop for a second and switch is something I want you to talk about a lot. Dr. Taz: For just a second, because this show is not only, you know, for, for patients, but it's really for our physician community too, right? Because as we're trying to change medicine, we want to change it for the doctor too, because the doctor is just as burnt out, just as frustrated, just as empty as many of the patients that they're serving. Dr. Taz: So talk to us a little bit about what made you feel that way as you're going through your training and what really gave you the courage. to make a switch. Dr. Judith Joseph: You know, the healers are not healed. They're just not healed. But the culture of medicine, and this is not just doctors, it's health care providers, health care professionals. Dr. Judith Joseph: The culture is such that if you slow down, if you admit that things aren't okay, you're shamed. You know, you're letting the team down. It's almost like the military. It's like the military. I just told my Dr. Taz: daughter that the other day. I'm like, going into medicine, she's 16. She was like, you know, I like medicine, but I don't know about the journey. Dr. Taz: I'm like, going to medicine is like the military. They break you down. And if you care about people enough, you can maybe make it through, but it's a really rough journey. And Dr. Judith Joseph: if you say the wrong thing, if you appear to be complaining, then you're seen as, well, you're not a part of us. You're letting the team down. Dr. Judith Joseph: Like I went through it. Shouldn't you go through it? Right. So there is this kind of element of hazing involved. And also if you do ask for help, if you're brave enough to ask for help, sometimes you're, told that you have to report your mental health condition to a board. So then imagine being a medical student accruing all this debt. Dr. Judith Joseph: Basically delaying happiness and pushing off youth and then being told that when you do break down You may not be able to work. Right? I mean, that's it's on your record. It's on your record Yeah, it's your worst nightmare because you now, you know are from a position of relative scarcity Yeah, you know you have all this loan all these debts so you're kind of Pushed between a rock and a hard place. Dr. Judith Joseph: You can't ask for help even though you know you need it. And a lot of people are struggling. So I was one of the brave folks. You were, I'm so proud of you. At the time, I was just like, I cannot do this anymore. And, um, I left that field and psychiatry was the residency that I entered and I entered psychiatry because a girlfriend of mine was like, this is great. Dr. Judith Joseph: Judith, you would love this. You did this rotation as a medical student in South Africa and you were doing these trauma focused groups with these orphans and you came back glowing, like, this is your calling. But I'm from a family, a Caribbean traditional family, where the real doctor has the scrubs, is in the operating room, you know, has the whole get up. Dr. Judith Joseph: So when I told my family, I was like, I think I'm going to become a psychiatrist. They were like, what? They're like, and my parents are Caribbean, so they're like, you're going to go on a look with crazy people. What's wrong with you? I was just like, crazy. Um, but entering a Columbia residency, we all had the opportunity to start our own therapy. Dr. Judith Joseph: So I had never been in therapy and when it was offered to me, I was just like, well, I don't need that. You know, even I had stigma, right? I was like, that's for like, really severely mentally right people. Right. But boy, was I wrong? Starting therapy as a resident changed my life. Wow. I mean, I was, I thought I didn't have trauma. Dr. Judith Joseph: I was like, that's what other people, I unpacked traumas that I wasn't even aware of. Right. Uh, it changed my life. It changed the way that I think about people. It changes the way that I interact with others. You know, I became aware of my attachment style. Not everyone has a mental health diagnosis. Not everyone has a DSM 5 condition, but we all have attachment styles. Dr. Judith Joseph: You know, we all have emotional traumas. We may not have a trauma that the DSM 5 designates as a trauma, but we all have emotional experiences. painful psychological experiences that shape us and changes the way that we view ourselves in the world and the way that we interact in the world Dr. Taz: and our decision making, right? Dr. Taz: DSM 5, by the way, guys, is the way that we diagnose different mental health conditions, different categories. Uh, just to clarify that for just a second, the Bible of psychiatry, the Bible is a great way to, and it gets updated periodically, right? So, you know, so you're in therapy, you're unpacking your own traumas, which you were unaware of. Dr. Taz: What is that? Is that talking? Is that just for somebody watching? Is therapy always talking? Is it always talking and going through? How did, how do you get to that point of walking in not thinking you need it? And then going down a road of like, wow, that's what I'm doing. And that's the way I'm behaving. Dr. Judith Joseph: Well, there are different types of therapies, just like there are different types of treatments and other medical fields, right? But The type of therapy that residents, at least in our residency, what we were offered was a psychoanalytic psychotherapy, which is a very, uh, deep introspective type of therapy where you're working closely with the therapist and you're kind of playing out themes in life. Dr. Judith Joseph: Mm-hmm . Like attachment themes and so forth. But there are different types of therapy. Uh, you know, there's dialectical behavioral therapy that's focused on emotional regulation, uh, distress tolerance, interpersonal. there's cognitive behavioral therapy, which is a behavioral therapy that's very helpful with, uh, anxiety, depression, sleep. Dr. Judith Joseph: Um, you know, there's more like, um, like parent child type of therapy. So you have. Many different types, somatic therapies, but the type that I was in focused on my, you know, early experiences, my attachment, and my therapist, and I talked about, I talked about this in my book, High Functioning, my therapist said, I think you're masochistic. Dr. Judith Joseph: Huh. And I was like. But wait a second. That was taken out of the DSM IV. It was in the DSM III, the Bible of Psychiatry, but they removed it from the IV. So how could it be something that's not in there? And a little secret, us therapists, we use terms sometimes between ourselves, but, you know, technically masochism was removed because it's something that people thought was victim shaming. Dr. Judith Joseph: Right. A masochistic individual will put others first, will sometimes bend over backwards, even though They themselves are not, you know, happy. It's actually hurting themselves. Sound like medicine, right? Self abuse. The patient first, we, we suffer, you know, doctors work long hours in surgeries. You're holding your urine. Dr. Judith Joseph: Oh, yeah. For hours. Yep. You know, you're not eating. You're putting the patient first. But this is a noble. There are a lot of masochistic people in medicine, but we're not allowed to say that, right? Dr. Taz: So my therapist Why does masochism have such a negative connotation then? I think instantly like selfish and all these other words come to mind Dr. Judith Joseph: when I hear that. Dr. Judith Joseph: term? Well, because traditionally, you know, medicine has a lot of things. Psychiatry has problems from the past, right? So, um, traditionally masochistic patients were seen as women who were in abusive relationships, who kind of provoked people to, you know, hit them, right? So there was a connotation with that. Dr. Judith Joseph: It's like the abusive side, but there are elements of masochism that still apply, right? You don't have to use those type of inciting violence. traits. But what we call masochism today, the acceptable form is people pleasing. You know, how many memes have you seen about people pleasing? A million. Dr. Taz: People pleasers are us. Dr. Taz: Recall now there's that one that I see all the time. Dr. Judith Joseph: We laugh about it, but women are still the primary people pleasers. You know, we, we put our children first. We have to put on the facade of We're a career mom. You know, we take care of the elderly parents. We're the ones who are dependable. How many business owners do I know? Dr. Judith Joseph: Who've been like, I like to hire women because they show up, but it's really code for their people pleasers. You know, they go above and beyond and they don't complain, but that has repercussions. Women have twice. The risk of depression, twice the risk of anxiety, make up 80 percent of those with autoimmune conditions. Dr. Judith Joseph: Think about that. It's not all hormones. There's a cultural and societal element to it. We are literally driving down our health and our mental health because of people pleasing. Wow. Dr. Taz: And how, so you discover this about yourself. What sort of enabled you personally to be able to then make a change? Was it sort of like, wow, this is who I am and what's my next step? Dr. Taz: Because I'm just thinking about somebody watching or listening who might be in the same boat. You know, they're like, I do spend the majority of my time making sure everybody else is okay. Which again, a lot of women are doing over and over again. You know, how do they, maybe it's through therapy, but how do they get to that next step? Dr. Judith Joseph: In my own work with my therapist, I wish I could say that therapy healed me. But the reality is that when you have a pervasive pattern in your personality style, you, the work takes time, you know, like, it's not like set my fingers and it's okay. It's not. And you're going to go through pattern, uh, like places in life and times in life and frames in life where you're actually doing good work, right? Dr. Judith Joseph: You're constantly self reflecting. You're saying, I'm not, I'm going to stop these habits. I'm going to, you know, really make a change. But then, You'll fall back into old patterns and that's okay. Personally speaking for myself, I find myself in these patterns and in my book I talk about the things that I use. Dr. Judith Joseph: Yeah. The tools that I use to keep in check. So, um, you know, I talk about the five V's to thriving. Number one is validation. Mm hmm. I have to constantly self validate and make sure that I'm acknowledging my feelings because people pleasers And, and people who have masochistic traits, they will many times push down how they feel. Dr. Judith Joseph: They won't take the time to acknowledge how they feel because they're thinking about everyone else. And it sounds very simple, but self acknowledgement and validating your feelings, it really is difficult when you're not accustomed to doing so. Dr. Taz: And this is just a conversation with yourself right now. Dr. Taz: We've seen the other memes too. Like, can you, can we talk about my feelings right now? You're not validating my feelings. We've seen that too, but you're starting just with. You the individual and recognizing and acknowledging how you feel. Dr. Judith Joseph: Absolutely. And in my book I talk about all the different ways that people get validation. Dr. Judith Joseph: So it could be external. You can get it through your therapist. I talk about how I use assessments in my clinical practice. How sometimes showing someone a score. A trauma score is validating in itself, because many times in mental health, it's not like we can take a blood test and say, Oh, look, this is the level of your trauma. Dr. Judith Joseph: We don't have that. Right, right. But we do have clinical assessments, like the CAPS 5, which is the gold standard for trauma. And if I show someone a CAHPS 5 that's really high, it's like, wow, like I was not acknowledging my trauma all this time. Had I known I was walking around with a CAHPS 5 that high, I would have been kinder to myself. Dr. Judith Joseph: So there are many different ways to Dr. Taz: assess that. Correct. So let's talk about the CAHPS 5. Are there others too, in addition to the CAHPS 5? I think there's another one that I'm blanking on the name of that Dr. Judith Joseph: I've seen too. In my clinical practice, um, the ones that I Typically use other gold standards. So for depression, I use the Madras, the Hamdi, but for my own, uh, personal research, I've developed my own trauma inventories because many of the trauma inventories focus on childhood traumas. Dr. Judith Joseph: Right, which are really important like the ACEs, which you're probably familiar with. That's what I was thinking of. Yes. Yeah, and there's two versions of the ACE that is familiar. So there's like the one that was the original that the CDC Kaiser Permanente had and then there's the Philadelphia modified one. Dr. Judith Joseph: That's based on a more like, um, I think, comprehensive experience. So it includes more urban environments, but they're, they mostly focus on childhood events. And the reason they focus on the childhood trauma is because your brain is thought to fully develop when you're 25. But we know that just because it's mostly developed doesn't mean that it is static. Dr. Judith Joseph: So it changes. There's neuroplasticity. So in my trauma inventory, I included a lot of adult experiences such as divorce. That's traumatizing. Yes. Uh, bankruptcy, bankruptcy, traumatizing, business loss. I mean, you know, seeing a loved one in the ICU traumatizing, but in the classic sense of, uh, the DSM, the Bible psychiatry, a trauma is something that's life threatening or an assault or combat. Dr. Judith Joseph: So something like being, you know, in the hospital for a prolonged COVID 19 would account. Right. But try, you know, like when I have a patient in front of me telling me that that's traumatizing. And I have to tell them that doesn't meet criteria for this study. Right. It's so invalidating. So I go off the record. Dr. Judith Joseph: I'm like, for this study, it's not trauma, but between you and me, it's trauma. You may not meet criteria for this one, but I believe you. And it, that for someone is so powerful. You know, that validation is so. powerful. There's something called affect labeling in psychiatry. If you name a feeling that decreases the anxiety tremendously, it is therapeutic to name a feeling. Dr. Judith Joseph: I mean, that gives me goosebumps every time because many people walk around. They don't know how they feel. They don't know why things aren't going well for him for them. And if you can name it, It's not only validating, but it is therapeutic because it decreases the stress of the unknown. And human beings cannot handle uncertainty. Dr. Judith Joseph: It is terrifying. You know, that's why we're like, take the Band Aid off, just pull it off. We just would rather know. So naming the feeling is very powerful. Dr. Taz: So self valid, and we could spend an hour on self validation, honestly, but I just think it's so important because so many people walk around with, including us, walk around with blinders on. Dr. Taz: It took a lot of stumbling and bumbling around to figure out that that's what was happening, right? Can somebody on their own, we by the way have mentioned the ACE, we've mentioned the CAP 5, you have your own trauma inventory. I know you have a book coming out, right, in April. Does it have the trauma inventory in it? Dr. Taz: Because I think that, would you recommend all of us to be doing assessments like this on ourselves in some fashion. Maybe we do it every six months or so or once a year just to see where we are. Dr. Judith Joseph: You know, I went into this field because there's a shortage of psychiatrists, the shortage of therapists in some parts of the United States. Dr. Judith Joseph: There's one of me for 30, 000 people. Wow. I can barely handle 30 people. Dr. Taz: So in Dr. Judith Joseph: the midst of a mental health crisis, imagine that. And as a researcher, I have my own lab. I find again, these quantitative mathematical ways of showing someone, this is what you're experiencing. This is the number of your trauma. Dr. Judith Joseph: And after the treatment, let's see if that number goes down. Right? Or after the treatment, let's see if that number goes up. Maybe we're worsening things, right? I find it so powerful to have a number. And because there's a shortage, no, I'm not encouraging self diagnosis, but I am encouraging people to learn about their symptoms and to have some type of metric for understanding how severe they are. Dr. Judith Joseph: So that's why I created these skills to democratize mental health because they're just not. enough mental health providers out there to meet the demand, to Dr. Taz: meet that demand. Wow. All right, let's move from self validation. You said there were five V's. So tell me about some of the other Dr. Judith Joseph: ones. So the second V is venting. Dr. Judith Joseph: Okay. Now that you know how you're feeling, how do we express it? And I love venting because I, I studied, uh, chemistry and physics. And so venting, if you think about a balloon that's really tense with the air, but once you start letting that air out and we do this in our lab, um, It, the tension goes down, so we got to get it out somehow, but not everyone is verbal, you know, not everyone likes to talk about things. Dr. Judith Joseph: So I wanted to provide people with skills and tools that felt comfortable and authentic for them. So I talk about some of my artists that I work with in my practice, their venting is through singing. So I'll ask them to sing a song or to draw a paint, paint something or draw, um, a sketch. To express how they feel, but for others, I mean, I, I love to talk for me. Dr. Judith Joseph: It's talking with my therapist, like that feels good. Or talking with a loved one. My dad's a pastor for him. He prays every day, sometimes three times a day, but he feels better after he prays because he's talking to a higher power that he believes loves and cares about him. So there are different ways to express how you feel. Dr. Judith Joseph: Um, one of the ways that I started using over the past, Two and a half years with social media. I was a newbie to social media. I started venting over it And then I grew to almost a million followers It really is Dr. Taz: power. So validation venting these are tools that you yourself used personally I use them person in your journey to kind of go into psychiatry. Dr. Taz: What's that journey like been in Dr. Judith Joseph: psychiatry? So, you know it like many fields of medicine psychiatry is very conservative. Yeah, but I had to spice it up a bit. Dr. Taz: Love it. There are so many Dr. Judith Joseph: Trinidadians. It's like, okay, tracing of medicine over here. And that's why my lab, the model of my lab is the science of your happiness. Dr. Judith Joseph: There is a field called the science of happiness. But to be to be honest, it is primarily Populated by people who don't look like me, right? So I wanted to write a book where people could see themselves. I've traveled to over 30 countries learning about mental health and The science of your happiness includes your personal experiences your culture your beliefs And so the third V is values. Dr. Judith Joseph: We all have different values. When we come to a country, we think, okay, money's the thing. We got to get that house. We got to get the American dream. But at the end of the day, when we're on our deathbeds, we're not going to be like, I wish I had, I wish I could have gotten a Porsche. Right. You're thinking, I wish I had. Dr. Judith Joseph: done things that I really, you know, gave me a sense of meaning. I wish I spent more time with the people that I loved, right? I wish I was doing things that gave me purpose. So your values are really those things. And I, and I say, it's the things that are priceless, not the things with a price tag. So if you can feed into those values, even a little bit a day, right? Dr. Judith Joseph: For me, it's kindness. So if I can buy my, my team lunch, Great. I feel good. And it's a little selfish, right? Or if I can hold the door for someone, uh, you know, feeling connected to others, that's my value. But for someone else, it could be nature. So, you know, if you can take a walk outside, if you get, instead of taking the train walk through central park, if it's safe, you know, things like that. Dr. Judith Joseph: So really trying to figure out. And, you know, I give a platform to things that give you meaning and purpose in life. Dr. Taz: So you, so this is a really, this is important and it comes home for me a little bit. You know, you, you're tying together values and culture, values, and obviously both of us have not had the traditional, you can look at us and know we've not had the traditional experience, you know, here in this country. Dr. Taz: And when I even think about. You know, my childhood home, there was a lot of dysfunction, which was cultural, you know, a lot of cultural dysfunction, you know, a lot of trauma for all three of us as sisters in terms of what we experienced and dealt with, you know, how, when we're dealing with mental health and it looks different in different packages and different people. Dr. Taz: And I'm like fascinated by you traveling around the world. So we're going to have to talk about that too in a minute. You know, how do we help? People understand that they can't look at their anxiety and at their depression in a singular fashion. How do they embrace their culture? How do they embrace sort of the background that they were raised in? Dr. Taz: You know, to then put a context to their anxiety, depression, whatever their mental health story is. Dr. Judith Joseph: And that's why I use the science of your happiness. Your happiness. Your happiness. When I go on talks, when I travel, um, I always say, Mental health is not someone else's, it's yours. And that is very powerful. Dr. Judith Joseph: Recently, I gave a talk to people who are from the Caribbean diaspora. And I said, you know, when you're whining, because we move side to side in our dancing, when you're whining, you know what that is? It's bilateral stimulation. It is your left and right brain communicating, talking to each other, and you're feeling better, you're feeling less stress. Dr. Judith Joseph: And bilateral simulation is something you'll see, taught at Harvard, right? The tapping, the EMDR, you know? But did you realize that you wind in side to side, that was your, your way of practicing bilateral? Uh, stimulation. And they're just like, Oh, wow. And I'm like, yeah, it's healing. That's why you feel so good when you whine. Dr. Judith Joseph: And I said to them, you know, like the curries that you eat, that pepper, the pepper sauce, that's anti inflammatory. So you didn't even realize that you were healing yourself. That, yeah, that makes your brain feel better. That makes your joints feel better. And when I, in my book, I talk about all the different cultures. Dr. Judith Joseph: I've been to Israel, I've been to the Middle East, I've traveled to Asia. There's elements in your culture that you did not realize. Was mental health. You just called it something different. So don't, don't be deterred by it. Don't say, Oh, it's not me. Like I don't have those problems. Yeah. Mental health is yours. Dr. Judith Joseph: You just forgot about it. And I think when people can take that ownership and they reclaim it, it feels authentic. They want to nurture it. They, everyone has mental health. We may not all have a mental health condition, but we all have mental health the way that we have physical health and we have to nurture it. Dr. Judith Joseph: We have to take care of it so that we don't develop a mental health condition. Dr. Taz: Do you think that We can't complete our individual mental health stories until we accept the cultures from which we came. Dr. Judith Joseph: I think it's very difficult to reconcile, you know, if your past, right? It's difficult to reconcile your problems in the present if you're not acknowledging your past. Dr. Judith Joseph: And I do think that it just allows us to take more ownership when we think about the way that Our past culture, our cultural groups impacts our present thinking. Many of us want to run from it. We want to assimilate. That's where I was going with this. Yeah, that's exactly where I was going with Dr. Taz: this. I think that the story for many of us that are, I guess, what are we? Dr. Taz: First generation, second generation, whatever we are. You know, is the initial story. And actually, I look at my daughter too. I think the story is we want to assimilate. Yeah. We don't want to accept that we were A, B, C, or D, right? And in that running from, I think we run from ourselves. And at some level, I think we create more anxiety and more angst almost, you know, so that's, that's why I asked that question. Dr. Taz: I don't know what you've observed and seen in your travels, like when you're going to all these different countries, whether it's Israel, I don't know if you've been to other areas of the Middle East yet or not. I'm so curious to, to know what you saw there, you know, what are you seeing in terms of how those communities heal themselves? Dr. Taz: And then how individually, many of these communities around the world are, are family centric. It's not about the individual. So how does the individual survive in those constructs, in a mental health construct? Because my, you know, again, limited observation has been that in a lot of these units, it's ignored. Dr. Judith Joseph: Mm hmm. You know, or dismissed. You know, A lot of the cultures that I've interacted with will say that well, it's not about the individual, it's about the family, and so don't shame us, right? And how dare you be selfish and try to create boundaries. Right. That doesn't exist. Exactly, it's a boundary. You know, it's, it's really difficult when you're trying to have one step in. Dr. Judith Joseph: One culture and then trying to assimilate and so it is more challenging when you're in a different country. But what I've noticed when I've traveled is that people tend to find ways to separate themselves from others as well. So like I was in China and the main cultural group was separating themselves from subcultures. Dr. Judith Joseph: So they're even within. A larger country. A dominant culture. There are, there are still separations. But what I do find is that if you can bring it back to the goal, right? What is the goal for everyone? We are in the same boat. You know, even if, let's say a parent doesn't agree with a child, you know, younger generation, Just think about what the real goal is. Dr. Judith Joseph: The goal is for you all to be happy, to be together, to be, um, to experience abundance. So you're really not fighting against each other. You may have differing ideas, different perspectives, but you still have the same goal. And I find that very simple. message. That simple theme tends to unify people. But often I see this recurring theme, no matter where I travel, that people within certain cultures forget that they have the same goal. Dr. Judith Joseph: That happens all the time. And that creates conflict. It does. It creates conflict. So one person may. Like agree that mental health is important. We should take care of it. We should see a therapist. And the other person's like, no, that's not part of our culture. But when you bring it back to the goal, like you all want to be healthy, you want to be together, you want to be unified. Dr. Judith Joseph: You really want the same things. You're just looking at it differently. Dr. Taz: I love approaching the family unit that way. Like we all are on the same mission. We have the same purpose. So values, venting, validation. And vitals. Vitals. We know that word. What does it mean for you? Dr. Judith Joseph: So of course it's like the, the typical boring doctor stuff. Dr. Judith Joseph: Like eat well. Pulse, heart rate, blood pressure. Yeah. That's what I'm saying. Eat well, but really eat foods that nurture your brain. There's a whole Like field of nutritional psychiatry now that shows that certain brain foods can be so powerful and in some studies Can be very effective even as effective as certain medications So leafy greens, omega 3 fatty acids All are brain healthy. Dr. Judith Joseph: You know, you know, these things, eating things that are not processed because that increases inflammation. Um, and then getting movement. And so, you know, not necessarily going to a gym, but like getting some dancing in every day, walking steps instead of elevators. And then, um, looking at things like sleep. Dr. Judith Joseph: So sleep is restorative. We all need sleep. Um, making sure that you practice good sleep hygiene, that you have good boundaries in the bedroom with regards to not taking work into the bedroom. Work life balance, you know? Um, and then your relationship with technology. This is something that a lot of doctors aren't asking about, but I think it's going to be a big deal. Dr. Judith Joseph: I think that the Bible Psychiatry, the DSM, will eventually include a whole Set of disorders related to tech because technology impacts us and it's relatively new in terms of human history, right? And then relationships your doctors don't necessarily ask about your relationships, but in longevity science We know that the quality of relationships that's the primary factor in terms of your outcome in terms of your longevity Wow, if you have negative toxic relationships Then that's draining your life source. Dr. Judith Joseph: If you have positive relationships that can actually extend your life. So all of these things are vitals. I call it my new vitals. I like Dr. Taz: it. I like it. So relationships. So these are personal relationships. What about career or professional relationships? Dr. Judith Joseph: The same. Equal value? Perhaps not equal but very important. Dr. Judith Joseph: You know, think about where you spend the most time. Right. If you're spending more time with your boss, Then maybe that is, maybe that is the most important relationship in your life because if that relationship is toxic, that's draining your life source. I teach my patients, and then in my book, I teach people how to write a biopsychosocial model. Dr. Judith Joseph: And if you, if you're social, um, so bio is, is your biology, like your genetics, your chronic conditions, the medications you take, psych, the psychology. Bucket is, you know, your past trauma, your resiliency factors, your IQ, your attachment style, your past psych history. Social is basically everything in the environment. Dr. Judith Joseph: So what you eat, how you move and so forth, but also your relationships. So if you're spending the majority of your time with the boss that's toxic, that belittles you, that praises you, that you don't know what's gonna happen, that's dysregulating your physiology. That's wearing on your heart. That's breaking down your longevity. Dr. Judith Joseph: So if that's the person you spend the most time with and they're not healthy for you, you got to reconsider that. I could tell you to eat as much kale as you want. And it's not going to make up for that. That person is toxic and draining your life source. That's the real problem. Right? So I include that in the vitals because. Dr. Judith Joseph: Unfortunately, in modern medicine, we only have like 15 minutes to talk to patients sometimes as a, as health care providers. So, how do you feel about that? I don't feel like we can do this medicine in 15 minutes. I, I absolutely cannot do that. So, I mean, most psychiatrists don't have that model, but I think A lot of, uh, general practitioners do, and they're, they're in a bunch. Dr. Judith Joseph: They're, they're really stuck between a rock and a hard place. They're burnt out and they want to do better, but they're really have so many constraints. That's why it's important to democratize this information. So people know what to look for so they can edify their own lives, you know, because 15 minutes is just not enough. Dr. Judith Joseph: Doctors aren't asking you about that. They're not saying, okay, are you taking your blood pressure medicine and is your boyfriend toxic? They're not doing that. They have to prioritize. It's on a prescription right here. Go home and show it to him. It's the rule of twos, right? Medicine doctors know that they only have chance. Dr. Judith Joseph: They only have a time for 15 minutes to prioritize one or two things. Everything else you're on your own, Dr. Taz: right? Definitely. So relationships obviously are impacting. Your overall mental health. Where does that fit into the five V's? Is it a part of the vitals? Okay. And so there's one more V that I think I missed. Dr. Judith Joseph: Vision. People who are high functioning tend to be onto the next. They finish one goal and they're onto the next, but they very rarely plan joy. They don't schedule it. They don't celebrate their wins. And that is a problem and it doesn't have to be a big win, you know, it doesn't have to be like, Oh, I got a promotion or I got this award a win. Dr. Judith Joseph: A small win is getting your kid to school on time. You know, when I get my daughter to school on time, I'm like, yes, I'm going to sit and drink this coffee and that's my little celebration. I'm like giving myself praise that I did it. You know, it sounds like trite, but it's not, you know, like celebrate your small wins. Dr. Judith Joseph: If you called a friend who was down and you made time for that friend, That's a win. Celebrate it, you know, and the big ones are important as well. Right, right. I have so many. Um, students that I've treated along the years who skipped graduation ceremonies, who skipped certificates. I'm like, you worked hard for that. Dr. Judith Joseph: Go to that ceremony. You know, if people name you as employee of the week, celebrate it. Talk about it. It's a big deal. Yeah. If you were able to set boundaries with your mother in law, that is a huge win. Dr. Taz: Celebrate that one. Well, here you are now entering the field of psychiatry. You've switched from anesthesia, you know, What do you have to say about psychiatry as it's practiced today? I know you're innovating, you've come up with the five V's, you have your own trauma inventory, you're innovating the field and we need innovators like you. Dr. Taz: But what's happening within the field of psychiatry? Because I know from a patient perspective and even maybe a little bit from a colleague perspective, there's a lot of frustration and a lot of trepidation with going to a psychiatrist today because medication and pharmaceutical management seem to be the only tools offered. Dr. Taz: Talk to us Dr. Judith Joseph: a little bit about that. So I'm in this New York city bubble where I don't know very many psychiatrists who just do medication. It's mostly therapists. But I, I would imagine that the majority of the country is not like that. Right. People, again, there's a shortage. So a lot of psychiatrists are not able to do that. Dr. Judith Joseph: They're asking their patients to be in a therapy with a therapist who could be a psychologist or a A licensed social worker, because that's the majority of the therapists now, um, just because it's just a shorter amount of training and more accessible to become that right. Unless student loans and so forth. Dr. Judith Joseph: But, but in, in with the psychiatrists that I know, um, they're very holistic. So they are learning about things like menopause and hormones and diets, you know, and nutritional psychiatry and movement and lifestyle. And Yes, it's not possible to find a psychiatrist like that the majority of the time, but you can have a comprehensive treatment plan with a therapist. Dr. Judith Joseph: and a psychiatrist. Building a team. Building a team. Yes. That's collaborative. And a general practitioner too, because you do need labs done every now and then if you're on certain medications. Yeah. So you are also a part of the treatment team. Don't think that I have like one, two, three specialists and that's it. Dr. Judith Joseph: You're the glue that holds that team together. So be active. Be an active participant in that team. Take, you know, notes about how you're feeling. I, I, I ask my patients to log. You know, basically what they eat during the day, how much caffeine they're consuming, who they're interacting with, and take these quizzes, right, so that you can see, oh, on this day, You know, my depression score was higher, meaning higher, as in not a good thing. Dr. Judith Joseph: What happened that day? Did I get sleep the night before? Did I have too much caffeine? Did I interact with a toxic individual? You know, so really become your own historian. Be the best historian. Be the best part of the treatment team that you can be because you are really the glue that holds it together. Dr. Taz: I love that. Do you think within the field of psychiatry, there's more research being done on some of the effects of food in mental health, technology in mental health, you know, relationships and men's hormones and mental health? What, what does the research world look like? Cause I know you're, you've got your hand on that. Dr. Taz: So tell me a little bit about what you're seeing. Dr. Judith Joseph: There is a lot more research. There's a whole burgeoning field of nutritional psychiatry. I, it's changed my life. I, when I started learning about the foods that you can eat to beat depression, to beat inflammation, I changed my whole diet. Like I, it was radical. Dr. Judith Joseph: I'm high functioning AF. So of course I did it all at once. But I really, I cut out, you know, sugary foods. I used to love the sugar in my coffee. Now, I wouldn't even think about it. Um, I, I mean, my guilty pleasure, which is kind of gross, is like red candies. You know, like, but the red dye is so bad. Oh, what did I used to like? Dr. Judith Joseph: I used to like cherry Dr. Taz: sours. Do you remember those? I was addicted to cherry sours. Dr. Judith Joseph: Obviously Dr. Taz: not Dr. Judith Joseph: anymore. There are a lot of TikToks on sour candies helping you with like mindfulness and so forth. But mine was red Skittles. Red and purple. I cut out a lot of processed food. If I can't pronounce it, I will not eat it, which is really difficult to do. Dr. Judith Joseph: So do it slowly. But I found that eating better made me think clearer. I was less irritable. I got better sleep. I just felt better. So it was just like a no brainer for me. But I understand that not everyone has that, you know, in them. Um, start small. You know, like say, I'm going to get more protein. I'm going to get more fiber. Dr. Judith Joseph: Pick one meal or one snack of the day to do Dr. Taz: right. Do you think it's more important, and I get asked this in the exam room, that's why I'm asking you, do you think it's more important to prioritize clean food, less processed food, die free foods, or focus more on protein, Dr. Judith Joseph: fiber, that type of thing? It depends. Dr. Judith Joseph: If you're a woman in midlife, protein and fiber, like all the way. But for my patients with depression and anxiety, I'm like no process, like try to limit the process for clean foods, you know? Um, sometimes it's cheaper to eat foods that don't have all of the. you know, processed stuff in it. Um, but it depends, but I really, for, for the women in midlife that I work with, I try to protein, protein and fiber. Dr. Judith Joseph: Yeah. Dr. Taz: And then, well, now that we're, let me back up now that we're thinking about. different segments of the population. I really want to dial into a couple of different things. What's happening with our Children? Why are we seeing an escalation of mental health issues among Children? And then when we look at teens, it's rampant. Dr. Taz: Tell me what's going on there. So, Dr. Judith Joseph: you know, it's no surprise that 2020 was Traumatizing. And a lot of our kids have not recovered from that. They're experiencing delays in math. They are experiencing social anxiety. You know, that whole removal from society for a while set them back. And we have to validate that. Dr. Judith Joseph: Let's not just say, oh, like, get over it. It happened to them. And they were vulnerable during that time. Also, the way that they interact now is on screens. And we're learning about how Devices impact the developing brain that it's not positive, you know, like yes, there are positive of social media. You can connect more, you find people that look like you, you can use it to learn. Dr. Judith Joseph: However, this constant exposure, you know, that's unregulated when you have parents who are working like nine to seven jobs. That's a reality these days. That the iPad, that you know, the phone, that's a babysitter. We have to acknowledge that. So, is there a quick fix? No. But, many people If they do this as a community, if they say to each other, like, we're going to try our best to not have our kids on these phones, that we wait until they're 13, you know, it's called wait until 8, there's an organization, that maybe that's a fix. Dr. Judith Joseph: But that's very difficult to do. It's very difficult to do if you don't have the resources, if you don't have supports, right? Who's going to watch the kids? Who's going to entertain them? Right. Um, but Yes, social media has impacted their brains. Being on screens all day has impacted their brains. They're not connecting with each other. Dr. Judith Joseph: They're feeling lonelier more than ever. They have these delays in education. I think this is the recipe for disaster. And not to mention corporate greed. You know, like parents are working hard and they're not making much. So you're not having your attachment figures present. They're stressed. So it's impacting the most vulnerable, which are the kids. Dr. Judith Joseph: What's Dr. Taz: the antidote? How do we Turn this around. Are there things that we can do within the home or within our schools that might start to make an impact on this? Dr. Judith Joseph: Most child psychiatrists will tell you it has to be done in the schools because by the time you wait for home. It's too late. Like, the parents are tired, you know, they don't have time for that. Dr. Judith Joseph: And also, who has access to a therapist after school? So, a lot of the interventions are in the school. So, what some of the schools are doing is that they're teaching mental health education. This wasn't a thing when I was growing up. We learned sex ed. Yeah. But now schools are bringing in mental health education. Dr. Judith Joseph: So this is, you know, how do you know the signs that you're having depression? How do you know the signs that you're suicidal? How do you know signs of anxiety? They're even talking about neurodivergence. So kids are learning about ADHD. And then they're taking it a step further and they're teaching children, distress tolerance and skills in schools and meditation and mindfulness. Dr. Judith Joseph: And some schools are like. just rock stars and they're teaching children about toxic relationships. I'm like, this is great. I Dr. Taz: wish I had learned that. They'd like to learn Dr. Judith Joseph: about love. Save me about a decade. But anyhow. Why are we waiting until like you're like already married to be in couples counseling? Dr. Judith Joseph: You should be learning about love early on before you start falling into these patterns. So such a good point. I really do believe it. belongs in the schools, not for the teachers because the educators are already burdened, right? And like it's not fair to have them now teach about something that they're not even skilled in, right? Dr. Judith Joseph: So I do think that schools that are doing it well have a separate department focused on emotional well being, mental health education, and skills training. And when children are learning this, they're able to grow in ways that are more adaptive. They're able to cope in ways that are more adaptive. Dr. Judith Joseph: They're not turning to substances to make it. They're not turning to their phones. And schools that are removing phones from the classroom, from the school campus, They're seeing improved mental health. They're seeing improved education. Our schools are doing that. Both of our, for both my Dr. Taz: children, my teenagers. Dr. Taz: You mentioned something that I don't want to leave on the table. The attachment style of the parent when they come home from work, you know, or even maybe they're not working, they're working in the home, you know, talk, talk a little bit about that and mental health for the family unit, right? Uh, talk to us about that for a second. Dr. Judith Joseph: If a parent is not healthy, chances are The Children won't be. I mean, it is no secret of mental health when we treat Families, excuse me, when we treat families, we focus on the parents too because if a parent is coping better, if a parent is not depressed, if a parent is not stressed, it, it, the children see that. Dr. Judith Joseph: Children look to their attachment figures for guidance. So if you're looking at an attachment figure who's A, not present, that's neglect. Or if you're looking at an attachment figure that's emotionally dysregulated, you're learning those coping skills there. So we really want the parents to learn as well, at least when you're in a therapy setting. Dr. Judith Joseph: Right. Uh, so it's, the treatment is not just the child. A lot of the work is done with the parent. And the hope is that in schools when you're teaching children emotional regulation and distress tolerance, that some of that education is going back to the home as well. Usually the parents know what's happening. Dr. Judith Joseph: Hopefully they know what's happening. Um, and that they get some type of curriculum, but we really want to focus on parental health. We don't want to burden parents with having to now take care of the child's mental health. Dr. Taz: Is there something we as parents or can do within our homes to foster mental health? Dr. Taz: Is it spending time? Is, you mentioned being present. I think, you know, I kind of can look at the mirror and look at myself and be like, am I really? Doing a good job at that. As busy as I am. You know, are there certain rituals, practices that we can develop, you know, within the structure of our family units, you know, to establish that? Dr. Taz: And then one more follow up question to that. Is there a tool families can use to screen the health of a family? Not just the individual, but the health of the family. Within Dr. Judith Joseph: my home, we practice the 5 V's. I love the 5 V's. We validate. We acknowledge how we feel. My daughter is very good at that. If I'm like trying to be Ms. Dr. Judith Joseph: busy body, high functioning. She'll be like, Mom, slow down. I'm tired. I'm like, I'm tired too. Maybe we should not, we shouldn't do that activity. And I'm like, why was I doing that? Right. So, you know, that's the unit checking me. Right. Yeah. Um, we vent, we talk about our feelings. Values we really pour our energy and our time and our resources into things that we value family. Dr. Judith Joseph: We value family so my daughter will spend a lot of time with her cousins because She values it. I value it Vitals, you know getting good sleep being falling asleep at the right time waking up at the same time my daughter Great diet, like she eats a lot of veggies. I'm lucky I have one of those kids that doesn't like, you know, sweets. Dr. Judith Joseph: She is an anomaly. Yeah. But we get good movement and like if I'm doing my exercises, she's doing them with me. Yeah. You know, we practice. You're modeling it. Modeling it. Yeah. Right? Um, she's not allowed to have an iPad. You know, she doesn't have the only screen she gets is like a television. She gets a set time So I'm really trying to do these things for her and she'll tell me mom you've been on your phone I'm like, oh my gosh, I gotta put it away right? Dr. Judith Joseph: She keeps me in check. Yeah, so envision we plan joy We have a calendar on our refrigerator with But the big things that we want to celebrate and the little things that we celebrate, right? So I think the five V's every family can do it. They're free I want to democratize mental health and you don't have to do all of them at once you pick one or two The rule of twos, right? Dr. Judith Joseph: One or two that you think you really need to focus on so if it's values if if you feel like your kids are just like like valuing materialistic things, then let's figure out how to bring them back to what our family culture values. If it's volunteering, maybe we'll do something like that once a month, right? Dr. Judith Joseph: Or if you feel like the vitals isn't a place where you're strong, then maybe setting better boundaries around your, you're taking care of your body like a category and just spending Dr. Taz: parking there and spending some time on that as a family unit. Yes. Can probably reset the cadence for everybody Dr. Judith Joseph: there. Dr. Judith Joseph: Absolutely. If communication is not great in the home that may be focusing on venting and saying at least one day a week, we're gonna, we're gonna have a dinner together. Um, and talk about. you know, what we're experiencing, validating how we're feeling, inventing it, right? That could be the thing. And people don't know this, but the number one predictor of whether or not young girls don't, you know, commit suicide is having, like, Family dinners, family dinners and team sports. Dr. Judith Joseph: Why? There's open communication, right? There's validation happening in team sports. Same thing with family dinners, right? There's open communication and validation. If families knew that, they would do that more. You don't have to go out and spend a lot on a fancy therapist. Right. Some cases you do. But, you know, for the majority Just sitting and talking sometimes, talking about how you feel openly and honestly and validating each other. Dr. Judith Joseph: It's so powerful. But if we are on our screens and if we're not making time, right? If the system is oppressing and not allowing us to spend time with each other, we're not going to be able Dr. Taz: Yeah. Oh my gosh. There's so much more we could get into it. There's, this is such an important topic and I know we're pushing up against time here. Dr. Taz: I do want everyone to get a sense, and I actually want to know to tell us a little bit about your lab, the research you're doing. Tell us a little bit about what people can find in this book that's coming out on my birthday, by the way, guys, I love that. So, uh, just, Dr. Judith Joseph: just connect us with kind of what's happening in your world. Dr. Judith Joseph: Well, my lab is studying high functioning depression, and it's not a term that's recognized by the Bible of psychiatry deism. But it is something that I found people are struggling with. The strong ones. The mom who's taking care of everyone but herself. Successful ones, right? The successful ones. The teacher who's taking care of her students and not eating lunch. Dr. Judith Joseph: The doctor. Who will work through a surgery and not go to the bathroom? You know the strong ones who don't acknowledge their emotions, who wear that mask of productivity. No one knows they're struggling. No one knows. I wanted something for them because in the DSM, the Bible Psychiatry, you have to check a box saying you've You're decreased in functioning or you're in distress. Dr. Judith Joseph: But what about people who have these symptoms, but they're still going? They're overachieving. They're Overfunctioning, right? They don't slow down because they can't people depend on them. What about them? There's nothing for them. Absolutely nothing for them so I wanted to make a book that spoke to the strong one who actually is struggling and you know, it's something that you know, if You're someone who's high functioning in your life and they don't talk about their feelings you can the book will speak for you And I think there's a lot of stigma too for the Dr. Taz: strong ones, right? Dr. Taz: Like I don't need that I don't need a therapist. I don't need you know, I'm fine. I got this. I'm gonna power through So I think this is a great way to maybe start to open up those Conversations so that people can use the five V's and apply it to themselves and to their family unit as well. Absolutely. Dr. Taz: That's incredible Dr. Judith Joseph: Or the person who's culturally can't talk about how they feel, like the student who's an immigrant, who's like, you know, they're the first person to have the opportunity so they can't complain because those before them didn't have the opportunity, right? So it's for people who are not traditionally acknowledging how they're feeling, and these are simple ways for them to feel full and fed, to feel whole. Dr. Judith Joseph: To beat anhedonia, right? To Dr. Taz: process their trauma. Anhedonia is an important word. I hope everybody heard that today. I think many people walk around in that state and assume that that's just the way things should be. And they sometimes blame midlife. They sometimes blame a partner, a job, a boss, but really it needs a little bit more inner work. Dr. Taz: Well, this has been amazing. I've got to ask you one last question before I let you go. What makes you whole? Dr. Judith Joseph: What makes me whole is connection with others. I'm from a family of four, four kids, four kids. I grew up in a church, so I had a community and I know when I'm slipping, when I'm, when I stopped reaching out. Dr. Judith Joseph: So. What makes me feel whole is connection with others. Dr. Taz: And this is from a woman who is grounded in so much science and at the end of the day it's our human experience that needs each other. And I love that. Well, thank you so much for joining me today. I think this is such an important conversation. I hope after this episode families will sit down at the dinner table and hopefully really take a hard look at where everybody is, you know, in terms of their mental health so that we can start to chip away at this crisis. Dr. Taz: Thanks again. Thank you for having me. Thank you so much for listening and watching today's episode of Whole Plus. Be sure to share this episode with your friends and family. And if you haven't already, please take a moment to subscribe to this podcast on YouTube or click the follow button on Apple, Spotify, or wherever it is that you get your podcasts. Dr. Taz: Don't forget to follow me on all social channels at DrTazMD. Until next time, stay healthy and stay whole.