When we think of people with clinical depression, we think of individuals who are overtly sad — a permanent frown etched onto their face. We think of people who can’t get out of bed and have a hard time working and performing tasks. People who look exhausted and disheveled. People who are withdrawn and isolate themselves.
Sometimes this is accurate. Sometimes, this is how depression manifests.
But other times, the face of depression is actually that of a happy person. A person who’s put-together and appears to be perfectly fine on the outside. He (or she) might excel at his job and be especially productive. He might go out regularly and be active in his community.
However, on the inside, he’s drowning.
This is called “smiling depression.”
“Individuals appear happy to others, literally smiling, while they experience depressive symptoms,” said Dean Parker, Ph.D, a Dix Hills, NY, psychologist who specializes in mood disorders. Smiling depression isn’t a diagnosis that you’ll find in the DSM-5 (the Diagnostic and Statistical Manual of Mental Disorders, fifth edition), he said. Rather, it’s a term psychotherapists use.
“You could call it ‘high-functioning depression,’” said Melanie A. Greenberg, Ph.D, a psychologist who specializes in managing mood in Marin County, Calif., and penned the forthcoming book, The Stress-Proof Brain: Master Your Emotional Response to Stress Using Mindfulness and Neuroplasticity.
People with smiling depression may experience different symptoms, she said. They “may feel disconnected from their lives or from other people and [be] unable to enjoy their usual life activities.”
While they don’t show it, they still feel a persistent sadness, Parker said. This sadness might stem from an unfulfilling career, a faltering relationship, or a general lack of meaning in their life, he said.
Individuals with smiling depression might still feel anxious, angry, overwhelmed and irritable, and have trouble sleeping, Greenberg said. They might experience feelings of hopelessness, dread and fear, which, again, remain suppressed and unseen by others, Parker said.
Greenberg speculates that men, successful professionals, and stay-at-home moms—who try to be “supermom”—are especially prone to smiling depression (though she’s not aware of specific research). “It may come on following a significant loss that hasn’t been mourned or that threatens their self-image of strength and independence. These individuals may have grown up in families that focused on external success and discouraged the expression of vulnerable emotions.”
Individuals with smiling depression might have grown up poor and are now more successful, she said. They might have grown up in families with alcoholism. They might yearn to be perfect.
Smiling depression tends to go undiagnosed, Parker said, because people deny or suppress their feelings and symptoms. They might not even know they’re depressed. Or they “keep a stiff upper lip, moving forward as if they are not struggling.”
They might not want to burden others or appear weak, Greenberg said. Again, “they may value a self-image as strong and capable, so they push their sad and anxious feelings aside and try not to show them to others.”
For instance, Greenberg worked with John (not his real name), a successful manager at a large company. He was a strong performer and well-liked by his colleagues. He had an active social life. He was a great dad to his three young kids. He made time to coach his son’s soccer team. He cooked dinner during the week and repaired the house on the weekends.
However, on the inside, John was drowning. He had recently lost his father, and experienced a major disappointment at work. His wife, who struggles with chronic fatigue, was emotionally and physically distant. He couldn’t sleep. He felt like he was going through the motions without actually enjoying his life. He felt shame about his work situation. He felt angry with his wife, even though he understood that she was struggling with an illness. He worried often about their finances.
In therapy John struggled with connecting to his feelings of loss, shame and helplessness. He was very much invested in viewing himself as strong and self-reliant. Slowly, he and Greenberg explored his feelings and assumptions about strength. They worked on being more honest with John’s wife. They worked on letting go of the belief that he had to do everything.
“After about 9 months of therapy, he was more able to understand and accept his own feelings and needs. [He felt] more comfortable in communicating them and taking action to address them. The depression lifted and he felt happier and more engaged in life.”
Not addressing your depression can be dangerous. According to Greenberg, you might not realize how hopeless you feel or get the help and support you really need. Your seemingly strong and competent exterior also isn’t sustainable over the long term. Worst of all, untreated depression ups your risk for suicide.
So if you’re struggling or you sense that something isn’t right, seek professional help. Doing so is the opposite of weakness: It takes real strength to admit there’s an issue and to work on solving it. Plus, it means that you’ll feel better. You’ll find relief and reconnect to yourself, to your loved ones, and to your life—which is genuinely something to smile about.