We all have a mental image of what depression looks like.
Google the word, and you’ll find countless pictures of brooding, melancholic people curled up in bed with tear-stained faces, or gazing vacantly out of the window at the falling rain.
But, for many of us, that’s not how depression looks.
Instead it looks like neatly ironed clothes and immaculate make-up.
It looks like working a nine-to-five job, taking the kids to their swimming lesson or meeting friends for drinks.
This is high-functioning depression.
Laura Peters, manager of the advice and information service for mental health charity, Rethink Mental Illness, tells Metro.co.uk: ‘The term “high-functioning depression” refers to someone who, from the outside, seems to be anything but depressed, but underneath is masking symptoms like feeling guilty or worthless, and even having thoughts of self-harm or suicide.’
This is the reality for many of us who have depression.
We’re well enough to keep up appearances, but the very act of getting on with our everyday lives feels like wading through treacle.
We say we’re fine, but, really, we’re not.
Sarah, 35, a marketing manager, has suffered from depression and anxiety for over 10 years. ‘On the surface, I live a normal, functioning life,’ she explains.
Those with high functioning depression may effectively fulfill the obligations of everyday life, such as working a nine-to-five (Picture: Ella Byworth for Metro.co.uk)
‘I’m successful in my career, rarely take days off work, have an active social life and enjoy holidays with my boyfriend and prosecco with the girls.
‘But, underneath, I’m hiding dark struggles that include panic attacks, self-harm and bingeing and purging.’
According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), there are three levels of depression: mild, moderate and severe.
People whose illness falls within the ‘mild to moderate’ bracket are those who often appear high functioning – and it’s an exhausting experience.
You’re not ill enough to justify phoning in sick or cancelling a planned night out, but keeping the mask in place requires phenomenal effort.
Rich, 48, has had depression since childhood. ‘I work as a university technician and have won several awards for my dedication to helping students, but daily life is a difficult grey drizzle of fulfilling society’s expectations of me to work and pay my taxes,’ he says.
So why do so many of us who struggle with depression appear fine on the outside?
‘People sometimes feel that their only option is to just carry on: keep working, studying, juggling work, home and a social life,’ explains Laura.
‘Anything else is just too overwhelming to think about. For a while, this seems to work, but, ultimately, bottling everything up makes things worse in the long run.’
The infamous stiff upper lip often plays a part, too.
We’re conditioned not to seek attention or make a fuss, so we see no option but to ‘keep calm and carry on’ – that most British of attitudes.
‘I often have to force myself to get through a successful day at work, then collapse in bed in tears when I get home,’ Sarah says.
‘I’m paranoid that everyone will see through the mask and work hard to keep it fixed on.’
Asking for help can be scary
The stigma around mental illness may be lessening, but there’s still a sense that depression is somehow ‘shameful,’ which can lead to us trying to hide it for fear of being judged.
‘Some people might feel ashamed or embarrassed about accepting they have a problem, or feel uncomfortable talking to anyone about it,’ says Laura.
This can certainly be the case for me. I feel weak and pathetic for letting my depression take over, and guilty for not being happy even though, on paper, life is good.
People who have high-functioning depression sometimes struggle to get the right help because their illness doesn’t seem to impinge on their daily life.
‘When I asked my GP for counselling and support, I was told that the NHS is overstretched and, as I’m able to go to work and perform normally, I don’t qualify,’ says Rich.
Indeed, the fear of not being taken seriously – whether that’s by your doctor, friends and family or colleagues – can deter people with high-functioning depression from getting the help they need. And keeping your feelings hidden can have catastrophic effects.
‘We often hear from the friends and relatives of people who have taken their own lives, saying that they had no idea anything was wrong; that he or she was the life and soul of the party, and was a straight-A student, or always seemed happy,’ Laura explains.
I’ve experienced the consequences of this pressure-cooker effect, trying to keep my depression under wraps and then hitting crisis point.
Had I asked for help sooner, I might have avoided being hospitalised because of my illness.
Sarah, too, eventually fell apart after years of trying to be strong and keep her depression hidden.
‘I broke down at work and was forced to go home and take a couple of weeks off sick,’ she explains. ‘Three months on from that crisis, I’m still working reduced hours.’
Of course, there’s nothing wrong with getting on with everyday life if you feel able to.
Keeping to a regular routine of work or family life can help distract you from negative thoughts, and there’s an element of ‘fake it till you make it’ involved, too.
But what matters is that you’re able to ask for help when you need it.
‘Depression is linked to an increased likelihood of suicide, as well as alcohol problems and misuse of prescription or illegal drugs, so it’s really important to get help as soon as possible,’ Laura says.
‘Your GP can still diagnose you with depression even if to the outside world, it seems like everything is OK. The most important thing is to be honest with your doctor.’
It’s also important to build a support network of people who you can talk to openly and who see beneath your mask.
‘I have a team who “have my back,” which takes a huge amount of pressure off as I’m not constantly trying to hide my condition,’ Sarah says.
As someone who’s always been high-functioning – and high-achieving – I know how difficult and downright scary it can be to admit that you’re struggling.
I hate being a burden on my friends and family, and try my hardest not to ask for help.
But, having pretended everything was fine and then ended up in crisis on more than one occasion, I’m learning that it’s far healthier to be honest about my limitations.
Do I still feel weak, pathetic, useless for not being able to function at as high a level as I used to? Yes, absolutely, even if I shouldn’t But with the help of my own support network (my endlessly patient husband, my family, my friends) I’m starting to accept a new normal where I don’t have to be perfect, and ‘enough’ is good enough.