Hiding in Plain Sight: The Perils of "Smiling Depression"

“You? And depressed? I could never tell! I have always seen you smiling and so upbeat! Are you sure? You barely shirked work, you were there when friends in need reached out to you. It doesn’t add up.”

“I did have to be on anti-depressants for 6 months till I worked through the depression and was back to being OK over time.”

“Why didn’t you tell me?”

You may wonder who this “YOU” is. It could be you, someone you know in the family, someone you work with, someone you know of.

Or, it could be me.

And yes, it is me, but a me that I encountered 12 years ago.

I'm open about admitting my vulnerabilities, having dug deep into them. And I have found life's biggest lessons in those spaces.

“YOU? YOU and depressed?!”

Here we go again. 😊

There are many of us who look seemingly happy on the outside and are struggling within, with thoughts that are depressive in nature, with feeling low, sad, melancholic, and sometimes, just “blue.” A scream within that rips our soul. And we hide behind a mask for several reasons, reasons that don’t need to be judged but need to be empathized with.

We assume and expect depression to show on our faces and in our behavior: A furrowed brow, a sad look in the eye, crying, slow speech, little conversation, an occasional outburst of anger, relationships getting affected, work suffering, insomnia, and so on.  We expect people to show that they just can’t function, or become so debilitated that life seems like a struggle.

But get this: nearly half of the people with depression appear happy.

I’ll wait for that to sink in.

“Smiling Depression” (not really a technical term that we psychologists use) is steadily being talked more about now. In mental health realms as a diagnostic category it is better known as “atypical depression” or “persistent depressive disorder.” But if calling it “smiling depression” helps destigmatize depression and mental illness, then so be it. If it helps people to sit up and notice the title which seems like such an oxymoron (how can someone with depression smile?) then so be it. At least we are raising our awareness levels about mental illness and its ravaging effects if unaddressed. And I hope this conversation would then translate to people taking action soon, before it is too late.

So, what is smiling depression. It’s a condition where we seem happy to others while we internally struggle with depressive symptoms, where we put up a façade of wellness, and we successfully cover the anguish within. A sizeable number of us may feel a low mood, a withdrawal or loss of interest in activities that once gave us joy, and may become particularly vulnerable to suicide because of the hopelessness we feel in light of things around us externally being A-OK. In other words, we are “high functioning” depressives.  

“I referred my colleague to you for counseling. She seemed so happy and has everything going for her. I just couldn’t figure out if she is really depressed or just seeking attention or maybe just faking it?”

I heard this from a friend recently. I did thank her for the referral, and also had this to say so that she reflects on what she just said.

Depression is not about what we have or don’t have externally in terms of money, a home, a good relationship, a job etc., but how we process and see the world through our internal, mental filter. We may have “everything” but the way we “see” ourselves, being self-critical, having low self-esteem and self-confidence, being critical about our relationships with people, our way of maneuvering within our world – these are what dictate our thoughts, our mood, and our behaviors.

So this “he/she has no reason to be depressed about” is not for us to say. We need to step into their shoes to see what they see, hear what they hear, feel what they feel. Even then, we may only be able to get a snapshot of their realities, not the entirety of their experience.

It’s tough to spot someone struggling with smiling depression. They may always smile at you, greet you with a pleasant hello, have full fledged conversations, be able to function well at their jobs or manage their relationships, appear to have a good time if they do decide to make it to social dos.

But inside? Inside, it’s a whole different story.

They feel hopeless and down, crippled internally with feelings of anxiety, fear, irritability, anger, tiredness, and general despair. They may find getting up and going difficult in the morning. They may be getting dressed for work, and once they are at work they may have a power packed day and get through it well. And then things take a hit.

Self-care takes a hit because energy is expended in taking care of the basic things in the daily routine. Their mood worsens in the evening, having managed the weight of the day and end up feeling tired. They may also experience more physical aches and pains. Emotional eating may increase, exercise gets pushed to the wayside, and they find hanging out with friends (mostly) emotionally very draining.

They struggle and fight with their own demons inside, the thoughts that clamor around in their head. Thoughts such as those of abandonment and/or rejection, being easily hurt over criticism, tending to ruminate or think excessively about unpleasant situations that have taken place. Thoughts and feelings which can’t be or are not spoken about. They often sleep more to avoid facing the day, or stay awake intermittently through the night feeling tormented.

There is a gnawing feeling that “something or everything isn’t right.” “My life seems lacklustre and meaningless, purposeless.” “There is an emptiness or a void which I just can’t seem to fill.” “No one will understand.” And then…

“It’s 6 AM. Time to wake up the kids, send them off to school, and get ready for work.”  The façade is back.

Why the façade or the mask, you may ask.

The reasons are individualized and personal, but the common ones I have gleaned through in people I have worked with in sessions, except the obvious one about the perceptions of stigma, are:

“I feel guilty talking about my deeper feelings, because on the outside everything seems fine. I have a decent life going on, so what do I really say?

But something just doesn’t “feel” right. An attempt to rationalize and “do away” with the feeling of unnecessary sadness adds to their feeling pressurized and self-critical.

“I don’t want to be a burden on anyone by sharing all that I am going through.”

Guilt becomes a hallmark thought and feeling that creeps in.

“I don’t want the world to know what I am going through.”

The mask acts as a defense mechanism.

“People may not understand. They see me functioning well and just may not get what I am going through.”

“I will deal with this on my own.”

“Everything is fine some/most of the times. So why bother? Isn’t this normal?”

And they may very well experience a genuine lift in mood as a result of something good or positive that happens in their external world. For example, meeting a close friend and having a good time, or being able to perform well at work and being appreciated for it. But soon they go back into that spiral of hopelessness and sadness.

All of this makes it easy for the rest of us to assume that they may be “attention seeking” or “faking it” without knowing about how they are truly feeling because we again assume that they may have some secondary gains (for e.g., time away from work, attention from spouse) by revealing that they are depressed.

In an already heavily opinionated and judgmental world, it would be good to let go of this perception especially for people struggling with mental health issues. Sensitivity, an open heart and mind to listen to others without our own perceptions tainting our vision, being there for them, and demonstrating empathy is what we need.

You’ve heard me say this so often.

So what do I do if I seem to have “smiling depression?”

Start by acknowledging the elephant in the room. That the sadness and hopelessness exist, between moments of being OK, that they need to be voiced and that you need to seek help for it. We need to do away with the rationalizing we engage in when we tell ourselves that it’s not so bad, when in reality it is. For some, this realization itself makes them  feel like they have taken charge towards a path of recovery and self-development, and that often is the first crucial step in breaking free from the shackles of smiling depression. For those who continue to keep their feelings bottled up within, the risk of suicide is higher. Simply because they have the strength to not only manage their daily routine chores mechanically, but also to do something to end their suffering once and for all. Yes, suicide is a real risk.

I have also had clients sit across from me and tell me how they have accepted that this is how they will be: “anxious,” “depressed,” “angry” or whatever label they ascribe to themselves. That they resign to their condition and lead sub-optimal lives. To people like them, I would like to emphatically say that they do not need to live in the shadow of those labels. There are many ways mental health professionals work in facilitating recovery, from counseling and psychotherapy, medications if and when needed, key lifestyle changes such as engaging in physical activity/exercise, nutrition, sound sleep hygiene, and helping in finding their purpose and meaning in life.

The most important thing?

Don’t do nothing.

Start somewhere. Talking to someone close to you, someone you can confide in with ease, is a good place. Air out the concerns and feelings without feeling like you are a burden on them. After all, wouldn’t we be there for our loved ones if they needed us?

The support, a patient ear, an openness to embrace all that one goes through including the shame, guilt, fears, blame; a shoulder to cry on, and a hug to feel comforted in go a long, long way. When our deepest, hidden scars burn with self-loathing, it helps to know that someone deeply cares for you and that sets us free by gently leading us towards self-compassion and a resolve to put those demons to rest.

 So instead of that muffled, anguished, yet silent scream which only we can hear inside in our despair, we must commit to ourselves to have someone give us a space where we let go.

Because letting go is the first step to finding ourselves all over again.

(Part 2) Forgiveness: The Key to Freeing Ourselves

I’ve been staring at the blank screen on my laptop, with the cursor blinking, goading me to write. Like now, sometimes I am faced with a block and nothing flows from the heart, which is how I usually write. It’s been two days. But then as I was enveloped in a sea of silence on this Diwali, a stark contrast to how it would have been if Mom was around, I realized what I wanted to write about when it came to the concluding part from my previous post on Forgiveness.

Why did a sombre Diwali finally get me going? As I glanced at all the WhatsApp forwards I received, I realized how festivals and occasions make their mark with the people we love and cherish in our lives. And how their absence makes it lacklustre, how that gnawing, huge gaping hole in the heart threatens to consume us, and how we at some point question the value of life, of how we have led it, of who traveled with us on the journey, of who wronged us, of who we need to seek forgiveness from. One ponders on attempting to rebuild relationships that fell by the wayside, just because misunderstandings cropped up, our egos came in the way, life took over, or the hurt was monumental.

It’s only when you are faced with a grave loss, especially that of a loved one, that you realize life may need recalibrating. And we start reflecting more on the choices we make, the relationships we treasure, the ones we let go. We aim for simplicity, because in the end, all the complex weaves and webs of baggage-laden relationships weigh us down, and they don’t make sense to us. And we decide to free ourselves from those. We make our peace with ourselves, first and foremost.

That is what forgiveness for us is all about, even when the other person doesn’t change, doesn’t express remorse at what was done, or isn’t there anymore to have a dialogue with, either because they have passed on, or choose not to communicate. It’s always about us, and freeing ourselves of the baggage, in an unselfish way. It’s about the relationships we value and would want to do our best to not let them rot away. It’s about what brings us joy, peace of mind, and contentment. Because if we don’t value ourselves and what psychological space we operate from, how can we even begin to connect with the world.

But, and here’s the big condition, it may not always be a two-way street and we have to understand that.

And so the questions pop up, unbidden:
“If he/she doesn’t realize what he/she did, then why should I bother?”
“If he/she is not going to change the behavior that affected me, then what’s the point?”
“I know things will continue to be a mess and there will be no resolution, so why go through this process?” (And all these questions may all be right.)

But here’s my question to you.

Tell me, behind the ego-driven defenses that come up quickly to the rescue, is there not a tinge of hurt/anger/resentment/sadness that makes its presence felt? Subtly? Be honest with yourself when you answer this question. And if there is even an iota of hurt, then we owe it to ourselves to resolve it and live honestly, joyfully, peacefully.

There is that other big question that I will address first: Do we always need to forgive?

Short answer: No.

It is a complex process, both emotionally and psychologically. And often the premise becomes that if we don’t bring ourselves to forgive someone, then we must feel some guilt, or feel the weight of unfinished businesses. That is damaging to the self.

If we look at the situational factors that involve forgiveness, the scenarios are thus:

1. Someone hurts us, suffers emotionally themselves, begs for our forgiveness, and it is somewhat easier for us to grant them forgiveness because they have assumed responsibility, taken it on themselves that they messed up. It’s also easier to forgive, knowing the chances of them going down the hurtful path is low because they have suffered the anguish themselves too. 

2. Someone shows no remorse or does not own up to their actions that may have hurt us. But we think, hey, I value this relationship, and this is how the person is (blunt, moody, temperamental, anxious, depressed etc. etc.), may not intentionally want to hurt me, but doesn’t know that s/he ended up doing that, so hmmm, can I be compassionate, and show some empathy and try to understand what led to this hurtful behavior? Can I put myself in their shoes and try to understand why they behaved in such a way? If one is unaware of their actions that caused pain, can I forgive that person? Can I step back from the hurt, and work this through patiently, over time? I have also been forgiven time and again for the hurt I have caused to others; so clearly I could reflect on and learn from that.

3. But when someone derives pleasure from our hurt and pain, shows absolutely no remorse despite knowing how much their behavior affected us, and continues to hurt us to gain personal satisfaction, it is that malevolence that must not be forgiven. In asking to forgive the “unforgivable,” like in the case of child abuse, we may actually end up compromising the sense of self, self-esteem, and their understanding of themselves, the world, and the people in it. There is a need to understand and accept what one went through, and to work through the hurt, but at the same time trying to not “hold onto” the blame on the wrongdoer, because that “holding on” may bring up those encrypted, coded memories that will keep disturbing our peace of mind. It’s best to understand, accept, grow, and move forward. But do we need to forgive? No.

Next big question: What if the person I’m forgiving doesn’t change?

My answer is in a series of questions: Is that person’s behavior, will, intention, in our control? If they don’t change, and it is important for me that they must, then what do I want to do with this relationship? Is it worth it to let go of this one? How damning are the consequences of that behavior? Was it a minor hurt I can let go of, or something significant which had major repercussions? Or can I let go of the anguish and learn to deal with the situation better, without harming my self-concept and self-esteem? The answers lie within you.

But this much I can say, getting the other person to change his or her words and actions is not the point of forgiveness. Forgiveness is for us, and how it can change our lives, by bringing us peace, a calmness of mind, and a soul that is unfettered and soars.

What if I am the one who needs forgiveness?

This is often the one that we struggle the most with; one of the greatest challenges that we will ever face. Simply because it is asking us to love ourselves, accept ourselves as whole despite our flaws, be willing to accept without judgment, everything about us, including our shortcomings and our strengths. We become habituated to beating ourselves up, of keeping ourselves small and unworthy, of being our worst critics, and then couple it with something we did to cause anguish to another person, we bring on double the ammunition for the self-inflicted terror.

Where do we start?

By being gentle with ourselves. Even if we have to remind ourselves of this golden rule for a gazillion times, we have to do it; by exercising this choice from the heart and not just as mere words.

Silence that inner critic that goads you to pay penance for what you have done by inflicting more self-loathing and guilt.

It’s only when we are gentle with ourselves that our hearts open up to healing and self-love.

Self-forgiveness is a process which starts by acknowledging our actions and taking responsibility for what we’ve done. We move on to learn from the experience by acknowledging the deeper feelings that motivated the behaviors and thoughts for which we now feel guilty about and hold ourselves in judgment.

Open your heart…I will say it again, open your heart and hold yourself compassionately.

Listen to the fears and your calls for help and give them their space to be heard. Acknowledge that they reside within and need to be put to rest. It’s only then we can move towards healing our emotional wounds by heeding those calls in healthy, responsible, and loving ways. Aligning ourselves with our true Self which is meant to be guiltless, always loving, always embracing, and remaining centered within, is the way to be. It’s like having the ripples of a lake return to the stillness and placidity that it was always intended to have despite the pebble stirring the surface.

So, why was it easier to write this piece after a sombre Diwali, in the face of Mom’s passing ten months ago? The context told me to do what I’d recommend you, and all of us, to do: I want us to reflect on our relationships, our living life with honesty and authenticity. About which meaningful relationships can be rebuilt if we keep our egos and grudges aside and move forward to forgive. About how we owe it to ourselves to treat ourselves with love, kindness, and self-acceptance.

Life is short, and the moment is now, to live it well, with the people who truly matter. Starting with ourselves.