A Psychiatrist’s Journey in Social Media Advocacy and Clinical Research

Judith Joseph, MD, MBA

CLINICAL CONVERSATIONS

With a mission of “Bridging the gap between advanced research and real-world understanding,” Judith Joseph, MD, MBA, finds opportunities to better herself, the field of psychiatry, and mental health education for the general public. In fact, based on her reach and success, the US House of Representatives recently acknowledged her popular presence on social media, where she leverages her experience, clinical research, and expertise to help patients as well as to advocate for better treatments.

Joseph, who is a clinical assistant professor in the department of Child and Adolescent Psychiatry at New York University’s Langone Medical Center, also serves as a medical board member for the national nonprofit organization Let’s Talk Menopause and chair of the Women in Medicine Board at Columbia University Vagelos College of Physicians and Surgeons. She is also the principal investigator at Manhattan Behavioral Medicine, where she has been part of more than 60 clinical trials and has mentored numerous early career investigators, and she has worked as a child and adolescent and adult psychiatrist.

Psychiatric Times invited Joseph to share her journey, lessons learned, and hopes for the future of psychiatry.

Psychiatric Times: How did your social media journey begin?

Judith Joseph, MD, MBA: When I was a first-year fellow at New York University in the department of child and adolescent psychiatry, a reporter came to the psychiatric emergency department and interviewed me about the services that were being offered. When I read the article, I was disappointed in my interview, and I asked the director of education at my fellowship if the department would enroll me in a media training course. My director’s response was a Socratic one. He said, “Judith, you should develop the course yourself. And then when you finish writing the course, you should teach it to the rest of us.”

Initially I thought that he was joking, but he wasn’t. In fact, he suggested that I focus on media training as the topic of my second year senior project during my fellowship program. I wrote the course after doing extensive research in journalism and medical media reporting, and then I taught the course to the NYU child psychiatry fellows and NYU film undergraduate students who were taking CAMS (Child and Adolescent Mental Health Studies Minor) courses at NYU.

The course is titled “Meet The Press,” and I am in my tenth year teaching this course at NYU. During this course, I teach doctors and health care professionals how to give press interviews. The first half of the course is skills based in which I teach specific tools and skills, and the second half of the course is practical and consists of videotaped mock press interviews during which the doctors learn how to implement the tools that were taught in the first half of the course. We play back the video mock interviews to the class in real-time so that their peers and I can give them constructive feedback.

I started to become active on social media so that I could teach my students. I had no idea that I would have this much personal and career success in such a short period of time.

Teaching this course opened up so many opportunities for me. I used my media skills to give press interviews with local radio and news stations, and eventually I found myself as a regular medical media expert, appearing from 2017 through the present on national television shows such as the Today Show, Dr Oz, ABC News, and many more. This exposure led to consulting work as a medical writer. I worked on a fiction series, The Crowded Room, starring and produced by Tom Holland for Apple TV. I also have served as a true crime mental health expert for Investigation Discovery’s show “Crimes Gone Viral” for the past 4 years.

After 2021, people were increasingly getting their information from social media platforms. To teach young doctors how to use social media, I first had to understand social media. So I did the work and began to research how to create evidence-based entertaining content (edutainment).

Now the course includes how to create social media content that is evidence-based. I also recently updated the course to include how to give podcast interviews and social media “Live” interviews in addition to traditional television press interviews.

I started to become active on social media so that I could teach my students. I had no idea that I would have this much personal and career success in such a short period of time. My social media reels went viral, and within 2 years I had almost 1 million followers across TikTok, Instagram, Facebook, and Threads. My social media advocacy and research led me to receiving a US House of Representatives Proclamation in June 2023. I was nominated by Congresswoman Sheila Cherfilus-McCormick in honor of Caribbean American Heritage Month and invited to Vice President Kamala Harris’s reception at the White House after my proclamation was read before Congress. Most recently I teamed up with Fides, an advocacy group within the World Health Organization, to help other health professionals around the world combat online misinformation by becoming leading voices for health care advocacy.

PT: What have been some of the pros and cons of being a popular psychiatric clinician on social media?

Joseph: There are so many benefits to being online because we are highly skilled and highly trained medical doctors. Becoming a content creator has allowed me to start my own mental health podcast, The Vault, and has created opportunities for me to work and partner with brands that I love.

I am not an influencer, I am a “physician content creator,” and what I am doing helps to inform millions of people every day. I still have a research lab and a clinical practice where I see one patient at a time. But, using my iPhone, in 60 seconds I can create a reel that helps millions of people all over the world.

Doctors belong on social media because we know how to provide information in ways that are responsible and evidence-based. If we don’t dominate the mental health social media space, then less educated, less informed, and less reputable individuals will take up the space. This is dangerous, because there is so much misinformation online.

The only significant negative aspect that I have identified to being online as a professional is that you get a lot of trolls. However, the network at Fides provides guidelines and support for dealing with trolls.

When I first started to ramp up my online content, some of my colleagues told me that no one would take me seriously as a researcher and psychiatrist if I became an “influencer.” My response was that I am not an influencer, I am a “physician content creator,” and what I am doing helps to inform millions of people every day. I still have a research lab and a clinical practice where I see one patient at a time. But, using my iPhone, in 60 seconds I can create a reel that helps millions of people all over the world. Some of those same colleagues who once criticized me have since apologized and have asked me for advice on how to build their online presence. I help them because I want more doctors online. We need to take up this space, because we are the most qualified to have these platforms.

In addition, the social media advocacy has led me to experience so much growth in my lab; our lab space and team have since doubled.

I will be offering the media course to all providers this year. Individuals can sign up for my newsletter to learn how they can attend this course virtually from anywhere in the world.

PT: You mentioned your lab—Manhattan Behavioral Medicine. How did you get started in clinical research?

Joseph: Before I was a resident in psychiatry, I was a resident in anesthesiology at Columbia University Medical Center. I loved intubating, doing IVs, and lumbar punctures. I loved the work, but I missed talking to patients and I missed working in teams. I was fortunate to leave my anesthesiology residency at Columbia 2 years into my training and to secure a spot in psychiatry residency at Columbia. I immediately loved psychiatry, but I missed the procedures. Clinical research in psychiatry allowed me to still use my hands and practice psychiatry.

In my lab, Manhattan Behavioral Medicine, I do ECGs, blood draws, insert IVs, and administer subcutaneous injections and intranasal medications daily. We even do lumbar punctures when we test cerebrospinal fluid for dementia studies. Some of our studies require EEGs and pulmonary function tests. I love learning new skills and sharpening old skills. We recently opened a third office, where we are focusing on psychedelic studies, involving psilocybin-like compounds and ketamine.

This is a very exciting time for psychiatry, and some of the drugs we investigated via clinical research are proving to be important agents in psychiatry, included the recently approved brexanolone (Zulresso) and zuranolone (Zurzuvae) for postpartum depression and xanomeline-trospium (KarXT) for schizophrenia, scheduled to be reviewed by the US Food and Drug Administration in September 2024.

PT: What advice would share with clinicians who are interested in pursuing clinical research?

Joseph: My advice for residents who are interested in clinical research is that they get involved in clinical research as a resident in training and then look for jobs in labs after your training so that you can work with established principal investigators.

I have research mentors from my residency that I still keep in touch with. If you have completed training and you are looking to become involved in clinical research, consider taking a job at a clinical research site where you can train under a principal investigator. I love training new sub-investigators as the principal investigator of Manhattan Behavioral Medicine.

PT: Among your passions is menopause advocacy. Can you tell us about your work with Let’s Talk Menopause?

Joseph: I became heavily active with Let’s Talk Menopause because Black women go through menopause sooner than other women, and menopause lasts longer and with more severe symptoms than other women. I am on the board for Let’s Talk Menopause, and I am the only board member who has not gone through menopause. I am also the only Black board member.

Black women have some of the scariest rates of postpartum depression, postpartum suicide, postpartum complications, perinatal death, and negative perimenopause/menopause outcomes.

There is a saying in the Black community: “Black Don’t Crack.” Unfortunately, this is not true in regards to health outcomes. Black women have some of the scariest rates of postpartum depression, postpartum suicide, postpartum complications, perinatal death, and negative perimenopause/menopause outcomes.

My patients who experience physical and mental health symptoms related to menopause benefit from hormone replacement therapy (HRT) and other interventions like psychotherapy and cognitive behavioral therapy for sleep. Some patients benefit from antidepressants and sleep aides. However, most people are not offered HRT, and this is problematic. According to a 2019 Mayo Clinic survey of resident physicians, only 6.8% felt adequately prepared for managing the treatment of women in menopause and only 58% of the participants had up to one lecture about menopause during residency training. This gap of knowledge in medical providers plays a large role in the lack of menopause competency in health care.

In addition, many patients going through perimenopause and menopause are misdiagnosed as having major depressive disorders because of the similarity of the symptoms. They present to their doctors with cognitive concerns, identity loss, sadness, moodiness, anxiety and insomnia—symptoms that may occur in both major depressive disorder and in perimenopause. Often, these patients do not have a primary major depressive episode; they are experiencing mood symptoms related to hormonal fluctuations.

The disconnect in physician knowledge is largely due to the fact that the 2002 Women’s Health Initiative study was misleading and concluded that HRT had risks that far outweighed the benefits. This statement has since been debunked, but the message that HRT was harmful was so pervasive in health care that doctors stopped prescribing it and patients have suffered as a result.

Let’s Talk Menopause educates women for free via webinars, events, and social media content. In addition, advocacy is a large part of our mission and activities. We recently advocated alongside Congresswoman Yvette Clarke in front of Congress to support the MREA (Menopause Research and Equity Act).I also developed the T.I.E.S. Method to help patients identify the mental health symptoms of menopause and how to discern them from primary mental health conditions.

PT: On the other end of the spectrum, much has been said about the mental health crisis in youth. As a clinical psychiatrist, what has been your experience?

Joseph: I am a child psychiatrist who also treats adults, and can report that this issue is not just in children, it is happening across all ages. The post-pandemic mental health crisis seems to be worsening and people do not have access to quality mental health care.

Recently I have been working with US Representative Ro Khanna and other mental health advocates to address the crisis in youth. One of the suggestions that I have made is to focus on funding mental health services and education in schools. We need to approach this from a preventative approach and teach children how to use social media responsibly, how to regulate their mood, and how to determine if relationships are harmful.

We need to provide these types of workshops in the workplace for adults as well. Preventing mental health issues is where we should focus our efforts, because the reality is that it will take decades to create and disseminate new therapists and mental health professionals. The shortage of professionals is far too great, and 1 in 3 Americans lives in an area where there is a shortage of these professionals.

Moreover, minority mental health is often overlooked in adults and youth. There are very few Black therapists compared with other therapists, and this creates a barrier to care. For this reason, I create social media content that directly addresses Black patient populations so that they are informed and are receiving support and resources from a cultural competency perspective.

When I was a resident, I received a SAMHSA minority health grant to focus on cultural competency in the Black community, and I use what I learned during that grant period to create evidence-based content to support my community. I have also done several events with the Congressional Black Caucus around Black mental health in children and adults.

PT: Another area of interest of yours is high functioning depression (HFD). Can you tell us more about this condition and what you have found in your research?

Joseph: I am very excited about my research in HFD. In this post-pandemic period, we are learning about patients who have hidden conditions, like HFD which is often masked by busyness.

HFD affects highly visible successful figures as well as everyday individuals. People with high functioning depression may include the chief executive officer who runs her company and masks her symptoms in light of grave financial uncertainty; or the famous sports figure who has to bring home a win for his franchise. Think of the teacher who works through lunch to grade his students’ papers on time so that they pass the state exams or the single working mom who stretches the dollar to make sure her kids are fed and gets them to school on time every day despite a lack of support. I also think that many health care professionals, specifically doctors, suffer from HFD.

People with HFD push through painful situations to meet or exceed their performance expectations. Those with HFD often report symptoms of anhedonia. Although individuals with HFD have some symptoms of depression (eg, poor sleep, low energy, or self-doubt), their symptoms do not meet the DSM 5 criteria for major depressive disorder because the individuals exceed basic functioning; they push through pain and they don’t always identify as being emotionally distressed. This is why HFD often goes unnoticed by medical providers and mental health professionals; clinicians are looking for a lack or loss of functioning, and these patients do not have that.

HFD is contagious, not in the way that a virus spreads, but in the way that unhealthy habits may rub off on those around us. Think about the boss who works themselves and their team to the bone, or the parent who never seems satisfied with their child’s academic progress; this can spread, if not contained. If we can contain HFD and its most insidious symptom, anhedonia, we can hopefully put an end to this epidemic and spread joy instead.

My research and upcoming book on the topic shares evidence-based tools for combating symptoms of anhedonia so that life feels more meaningful and purposeful. The book and research findings are set to be released in March 2025. In the meantime, the High Functioning Blog on my website offers the high functioning depression scale and the anhedonia scale to learn more about the symptoms. I also have a free weekly newsletter that provides evidence-based tips on how to improve mental health.

PT: Thank you!

Resources

#1 Researcher: 7 Signs You May Have High Functioning Depression. The Mel Robbins Podcast. Accessed June 24, 2024. https://www.youtube.com/watch?v=yQu-Ct9-6dg

HR 6749 - Menopause Research and Equity Act of 2023, Rep Clarke, Yvette D [D-NY-9], House-Energy and Commerce, Introduced 12/13/2023. Accessed June 24, 2024. https://www.congress.gov/bill/118th-congress/house-bill/6749/text

Immigrant Mental Health Awareness. The Annual Shorty Impact Awards. Accessed June 24, 2024. https://shortyawards.com/8th-impact/immigrant-mental-health-awareness

Joseph J. High Functioning Depression Blog. Accessed June 24, 2024. https://drjudithjoseph.com/highfunctioningdepression/

Joseph J. The Vault Podcast. Accessed June 24, 2024. https://drjudithjoseph.com/podcast/

Manhattan Behavioral Medicine. Accessed June 24, 2024. https://manhattanbehavioralmedicine.com/

PW Staff. Book Deals: Week of October 20, 2023. LB Spark Strikes ‘Gold’ with Joseph. Publisher’s Weekly. October 27, 2023. Accessed June 24, 2024. https://www.publishersweekly.com/pw/by-topic/industry-news/book-deals/article/93597-book-deals-week-of-october-30-2023.html

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