What You Need to Know About “Smiling Depression”

By Laura Coward | Sep. 02, 2016

 

“How are you? Really?” This is my mom’s standard line of questioning any time I dye my hair darker. In her mind, darker hair is equivalent to a darker mood. She’s on to something, but in my case, she has it backwards. I’m best at hiding my depression when I’m blonde. When I’m brunette, I feel authentic. I literally let a little more of my darker side show. When I’m blonde, I’m bubbly, social and easy to get along with. When I’m blonde, I’m the face of smiling depression.

What is Smiling Depression?

Smiling depression involves appearing happy to others and smiling through the pain, keeping the inner turmoil hidden. It’s a major depressive disorder with atypical symptoms, and as a result, many don’t know they’re depressed or don’t seek help. People with smiling depression are often partnered or married, employed and are quite accomplished and educated. Their public, professional and social lives are not struggling. Their façade is put together and accomplished.

But behind the mask and behind closed doors, their minds are filled with thoughts of worthlessness, inadequacy and despair. They’ve usually struggled with depression and/or debilitating anxiety for years and have had some experience with therapy or medication. Many don’t disclose their depression due to fear of discrimination from loved ones or employers. “Oftentimes, I am the only person in this individual’s immediate circle who is aware of how he or she is feeling on the inside,” said Dina Goldstein Silverman, Ph.D., a licensed psychologist and assistant professor of psychiatry. 

Why is it dangerous?

According to Silverman, there’s a troubling connection between smiling depression and suicide. In contrast with a patient who has little energy to even get out of bed, chronically depressed patients who report a surge of energy might be more likely to initiate a suicide attempt. Significant traumatic life changes—such as a recent job loss or divorce—are often predictors of suicide attempts, particularly in men. In some cases, having young children or being devoutly religious may serve as protective factors. But many of us know exceptions to that.

One of the deaths that shocked my community the most was the suicide of a Sunday school teacher and youth counselor. Active in our church and several nonprofits, he mentored many and loved connecting people. Was he disheveled, withdrawn and a downer to be around? Absolutely not. He was encouraging, thoughtful and went out of his way to attend and organize events. Often in a suit and always put together, he was who we aspired to be when we grew up. Did we ever ask him how he was doing, if he was hurting or if he needed someone to listen to him for once? No. We bought in to the façade and couldn’t see the pain hiding under the surface.

His life was one-of-a-kind, but unfortunately his story is not. Many who have felt the impact of a friend’s suicide say the same thing: “I had no idea he was suffering. He was the last person I would have expected to do this.”

How can we help?

Create awareness to de-stigmatize mental illness

Many people struggling with smiling depression are perfectionists, or they don’t want to appear weak or out of control. The more we can shift the conversation to show positive role models living with depression—those who advocate for the mix of therapy, exercise, medication, sleep, diet—the less shame and stigma will be associated with it.

Pay more attention to your loved ones (especially the warning signs)

If you have a friend who suddenly stops responding to phone calls or texts or cancels plans, don’t hesitate to ask them what’s going on and if they’re feeling okay. Let them know that they are heard and are not alone. Also, it’s vital to notice if a loved one begins giving away possessions (often a symptom that someone is considering suicide), or begins to isolate and withdraw.

“As a therapist, I try to encourage [my patients] to develop authentic social relationships, so he or she can experience the relief of being heard, understood and validated by friends and loved ones, and build genuine connections,” Silverman said.

If you think you might be depressed:

On the days when your brain seems to be fighting you for your life, remember that you are enough, you are worthy, you are loved and you are not alone.

Find activities and pursuits that are meaningful to you and make you feel productive and accomplished. Try your best to be present in these activities. Silverman says that “mindfulness is the opposite of perfectionism in that it focuses on a balance without judgment, and it’s an important set of skills that someone can learn in therapy.”

Reach out to someone you trust and consider contacting a therapist. Let these influential roles in your life help you to create a more positive state of mind. Rather than become “submerged in a vortex of negative, self-defeating thoughts,” Silverman encourages her patients to learn self-compassion. Above all, please don’t give up. Please don’t let depression win. You are not alone.

 

** A variation of this blog previously appeared on The Mighty http://themighty.com/2016/05/smiling-depression-what-you-need-to-know/

Laura is a writer and non-profit fundraiser who lives in Dallas. She has a journalism degree from Texas A&M University, and is active in The Writer’s Path at Southern Methodist University. Laura loves music and travel, and tries to combine the two whenever possible. She’s also mildly obsessed with her 2-year-old Corgi mix, Corbin. If Aaron Sorkin wrote it, she’s probably quoted it. Never met a pun she didn’t like. Read more from Laura at https://betweengriefandhighdelight.com

Comments
axel
It's one of the best article for High-Functioning Depression
3/28/2017 1:39:01 AM

Naomi Hatfield
So how does one get out of this "smiling depression"? My daughter is the classic case. She is going to an Ohio State University out patient treatment center, but her relapses are just as they were before she started the program. She has us all fooled. Its devastating for her and her family....
11/4/2016 10:31:33 AM

Jon
This hits home to me so much. I sometimes even convince myself I'm not depressed until I totally break down and bawl my eyes out. It really interferes with seeking help or having anyone around you know that you desperately need help. Thank for this article.
10/28/2016 12:16:50 PM

Danita Applewhite PhD, CRC
Smiling depression is common among the Adult Learners that contact White Apple Institute. We help Nontraditional Adult Learners and Student Veterans overcome emotional challenges associated with disability (learning, mental, non-visible, as well as physical) Most of our Adult Learners are Veterans and parents trying to balance their lives around class and work schedules.We encourage them to take a bite of White Apple Wisdom to change the perception of disabled to differently-abled and succeed in higher education and the workforce.Learn more at www.whiteappleinstitute.org
10/4/2016 3:12:47 PM

Jennifer
Thank you for writing this. I have Bipolar I with psychotic features, PTSD, ADHD, and Panic disorder. Whenever someone asks me how I am doing my response is typically, "Fine, I am doing okay, but I have to be okay." Nobody seems to realize that I am often depressed, lonely and isolated because I "have to be okay" and as a consequence have learned to be stronger than I feel most of the time.
10/2/2016 4:26:48 PM

Katherine Heizer
This article is true. I feel like Peter's comment above. Communication with others to understand just gets off perceptions, wrong communication, misjudgements, misinterpreted, and so your back at square 1. Educated family but unless a person has been battling with this their whole life those are the ones who can relate to me. Trouble is the battle to open up.
9/29/2016 5:00:02 AM

Lisa
I have bipolar 2 disorder. I have become an accomplished actress when it comes to "smiling depression". You have your happy face when all is well with the world, and the mask you wear when you are deeply depressed and would rather pull teeth than get up and go to work, school, or whatever. I am glad you wrote this article. I will copy it and share with my NAMI support group at our next meeting.
9/28/2016 10:01:06 PM

Daniel
Great article. Human emotions are complex too. Not as bad any more, but I used to wake up every day not wanting to go on living, yet I would go in to work and be told I had one of those smiles that made people's day better. It wasn't a facade or an act. I can laugh, love cracking jokes, then I'll walk behind a door and not want to go back out. We can have both positive and negative thoughts running parallel.

I once volunteered at a clubhouse for people with mood disorders. There was one lady that I felt the most affinity to; she smiled a lot at people, helped others, appeared strong. All attributes that I felt described me. During my time there, she was only one that committed suicide.

I suppose the distinction I see is being able to smile at others, and then failing to smile for oneself.
9/28/2016 8:24:38 PM

Janice
yes. All of this.
9/28/2016 8:15:26 PM

Mickie
Sometimes, you are alone.
9/28/2016 8:14:04 PM

VD
As a person living with clinical depression for most of my life I thank you for this article. I worked in mental health for may years and i think many individuals don't know the symptoms of the different kinds of depression. I didn't know for years , nor did my parents about why I had low mood and crying spells. I was a smiling person on the outside , yet feeling lost and sad on the inside until I found help. Thanks !
9/28/2016 7:42:49 PM

Patricia Hansen
How are you, they ask ( they being the masses). Do you want my socially acceptable response or do you want the truth, how I am dying inside? VERY, VERY few of the masses want to know how depressed, suicidal, fearful of life one is.

I AM NOT CONTAGIOUS!

Help me, please
9/25/2016 8:20:51 AM

Steve
Thank you for putting this so well. I keep reading we need to reach out, ask friends and family for help. But so far, in my experience, that just multiplies the hurt because they have no idea what to do or say. Or they want to solve it, and when you don't take their suggestions they are frustrated and that's one more relationship to feel bad about.
9/21/2016 8:28:52 AM

Tim
What if it seems like that's what you're dealing with, but you know that you don't have a mental illness? You described my life almost spot on, and yet I know that I have no mental illness. The stories I've heard, they are definitely NOT me. But this is. Sorry, just confused and a bit curious
9/18/2016 12:17:34 AM

Bobbie
Thank you for a great article that explains my major depressive disorder perfectly. In 2011 when I ended up in the hospital even my close friends said that they didn't notice anything different. I go to a PROS program now and it is a godsend!
9/17/2016 1:28:48 PM

Kim
What if you truly are alone? Family wants nothing to do with me, and I'm so depressed I can barely function. Their rejection of me is a huge source of the depression. My mom committed suicide, and they never mention her; it's as if she never existed. People so readily say suicide is not the answer, but they don't do anything to help you except make trite, uninformed comments like "try to be more positive." Let them try dealing with clinical depression, have no support system whatsoever and try to be more positive. They condemn you for being sick. They promote suicide by simply ignoring you and not getting involved. I truly feel like people, by their actions or lack there of, are saying, "Go ahead. We'll be fine without you." Sadly most people don't believe someone until it's too late, and you still have to question if they would have done anything differently had they actually known beforehand. I don't believe most people would do one thing differently; it simply sounds too cold and cruel to admit it. It's societally incorrect to admit you're fine that someone killed themselves, but I think society truly doesn't care one way or the other.
9/12/2016 5:48:43 AM

Geraldine
Your article was spot on when describing smiling depression. I have been like that for years now. But I always feel I've got to put on a happy face when i'm around people. The comment was made regarding not wanting to be around other people, that fits me perfectly!! I don't like being in the situation to always be smiling like everything is fine. Because it's not! I am struggling everyday.
9/11/2016 2:18:01 PM

Cathy Wood
I had smiling depression. My life eventually imploded; lost my home, job, everything. I have BP2 , major depression, and various other mental illnesses. My brother can't wrap his head around what has happened to me. He said the other day he was looking at old pictures and said, "You sure looked like you were happy." I was the greatest actress in the world and nobody knew it.
9/10/2016 3:23:03 PM

Connie Wedmore
great information THANKS!
9/7/2016 9:54:58 PM

Gayla Gerken
I suffer from depression and am trying to educate myself about it. I found your blog very informative.
9/7/2016 8:11:30 PM

Peter Grimes
Please let someone be alone if they chose. Not all depressives are just wanting to know they're not alone; some actually can't stand having people around.
9/6/2016 10:27:25 PM

Sue
The medical insurance industry has sabotaged depressed people who really need long-term, sheltered care, with opportunities to stay connected to their studies or work.
9/6/2016 8:31:02 PM

Kristi Prince
Yes! Yes! Yes! Sometimes I think people only associate suicide with long term depression. Our son was everybody's favorite and the life of the party. I have even written blogs about "Behind the Mask".
9/6/2016 6:23:31 PM

Lucille Frazier
I feel I'm one experiencing "Smiling Depression" when your mind is always filled with confusion, regrets, guilt due to lack of being slow to function, to think decisions that turn out wrong, I am tired of going thru every day feeling hopeless, worthless, a big loser if this is life, living sorry, inadequate useless I can't go on like this. It's not going to get better, no I'm sick of these supposed sweet endings. Not real life, at least not mine.
9/6/2016 6:09:14 PM

Kris Eiffert
Thank you for explaining this so well. Two of the comments that hurt the most are "how can you be depressed if you have faith in God?" and "you don't look depressed." I know many just don't understand and that is why NAMI is so important to help in the understanding of mental health .
9/6/2016 4:52:38 PM

lan
Laura, Thank you for this important article and perspective!
9/6/2016 4:17:14 PM

Kelly
Thank you for putting words to the reality I live every day.
9/6/2016 3:28:00 PM

Cordelia carrick
Yup - everyone says "But, you smile all the time and are so cheerful!" I have to tell them: I was like this before depression, and like this now with a high dose of medication. Without it? Well, i am a mix of the Hulk, sleeping beauty, and a crybaby!
9/3/2016 2:15:24 PM