Depression isnt always what we think it is.
They overachieve, they stay busy, they excel at work and in relationships, all while silently suffering.
She argues that we need to stop waiting for people to break down before offering support.
What is high-functioning depression?
Typically, these symptoms must cause significant impairment in daily life to qualify as a clinical diagnosis.
But what happens when someone checks every box except impairment?
Instead of acknowledging distress, they over-function, Joseph says.
Traditional mental health care often dismisses these individuals, telling them to return when their symptoms cause real dysfunction.
Joseph argues this is a mistake: Why dont weprevent mental health conditionsthat cause breakdowns?
Lets not wait for people to break down.
Let’s give them the tools to prevent a breakdown.
People think this is just life, that youre supposed to feel meh about things, Joseph says.
But anhedonia is a red flag.
Joseph estimates that about 75% of people with high-functioning depression experience anhedonia.
Other signs include restlessness, feeling constantly busy, or an inability to sit still.
It might look like productivity on the outside, but underneath, its often a way to outrun discomfort.
The trap of the hedonic treadmill
Joseph connects high-functioningdepressionto thehedonic treadmilltherelentless pursuit of external achievementsto achieve happiness.
But in research, Joseph and her team dont measure happinessthey measure points of joy.
Happiness is the idea, joy is the experience, she says.
When people make this shift, they stop chasing an unattainable future and start living in the present.
And when they do, something powerful happens.
Slowing down can be contagious.
Joy can be contagious, she says.
Whenwe prioritize joy, it spreads, and it changes peoples lives and their communities.
One of the avoidance symptoms of trauma is busyness, Joseph explains.
Another is feeling unworthy.
So what do people do?
But by recognizing these patterns, people can start making intentional choices instead of running on autopilot.
Reconnecting with what really matters
Josephs solution?
The rock represents what truly anchors themfamily, purpose, deep connections.
Then, she muddies the water with dye, representing external distractions like career pressure or material success.
When we focus on things with price tags, we lose sight of the priceless, she says.
She encourages her patients to carry a small rock with them as a tangiblereminder to stay grounded.
Holding something reala rock or a meaningful objecthelps reconnect us to the present moment.
The takeaway
High-functioning depression is real, and its more common than we think.
The people who seem like they have it all together may be struggling the most.
Because at the end of the day, happiness isnt in the next achievement.
Its in the small, everyday moments we choose to embrace.
