Why Depression Isn’t Always Sad On The Outside
Everyone gets their share of bad days, whether it’s your boss throwing a hissy fit at work or losing your beloved pet. The beautiful thing about the human body is that it manages to find ways to cope with these episodes of sadness, eventually returning to its usual self. No one wants to feel sad, but it’s an important emotion to have. On the other hand, no one should want to feel depressed. Ever.
It’s easy to tell if one is sad, but one who’s depressed can hide behind any façade. Depression that hides behind a smile is the most frequent and dangerous form, lying in wait while carrying on with life. By the time anyone realizes what’s going on, it may be too late. The afflicted person may have gone off the deep end, figuratively and literally.
Scientists have been hard at work uncovering the true nature of depression, but it still eludes them to this day. It’s a feeling that won’t go away just by telling someone that ‘everything will be okay.’ However, there’s enough information nowadays that everyone can know how it works and what to do about it. Let’s start with the elephant in the room.
Depression Is Not Sadness
As mentioned earlier, sadness is an important emotion. It’s a product of evolution, serving some purpose in one’s survival instinct. Scientists were unable to understand it back then, but technology today paints a clearer picture.
Research performed by Joseph P. Forgas, professor of psychology at the University of New South Wales in Australia, discovered that sadness could be beneficial in four ways.
- People who felt sad were more likely to remember things more accurately than those who felt happy. As a negative mood, sadness lowers the risk of false information from distorting original memories.
- Because of the accuracy mentioned above, sadness helps make sounder decisions. Hence, it lessens the risk of biases (i.e., overemphasizing a person’s traits and paying too much attention to out-of-date details), which are more prevalent among positive moods.
- Sadness acts as a ‘mild alarm’ that signals a person to exert more effort when exposed to a challenging environment. On the other hand, people experiencing positive moods exert less effort since they’re in a safe environment.
- While happiness helps with communication, sadness can also do the same in some cases. When faced with uncertainty, sad people tend to focus on external cues and act accordingly. Furthermore, owing to accuracy, they produce more concrete and persuasive arguments.
Forgas adds that these benefits don’t necessarily imply the need to be sad most of the time. On the contrary, prolonged episodes of sadness signify a debilitating problem. While it’s necessary to be happy, it won’t hurt to accept sadness in one’s life now and then.
Depression, however, is an entirely different emotion. Whereas sadness goes away after some time or through venting or crying it out, depression sticks around and worsens over time. A person who says that they’re ‘depressed’ is usually sad, but one suffering from depression doesn’t say anything. Being unable to know what’s bothering a friend or relative is scary.
Furthermore, depression is so complex that it’s nearly impossible to pinpoint the exact cause. However, various treatment centers, like the Alvarado Parkway Institute, typically consider the following risk factors:
- Past Abuse/Trauma – Having experienced physical or emotional abuse or situations like losing a loved one or suffering from a major disaster.
- Substance Abuse – Drug or alcohol abuse make up a large portion of cases. Some drugs are known to cause side effects that can lead to depression.
- Family History – People whose ancestors had also suffered from depression are also more prone to such (though a direct link to genes has yet to be proven).
- Life Changes – Significant changes like moving to a new home or giving birth to a child (postpartum depression) are known contributors.
Depression Is A Health Problem
In 2013, the American Psychiatric Association updated the checklist that doctors and professionals use to confirm depression among patients, which is now known as DSM-5. Although it indicates a total of nine symptoms, called A-criteria, fulfilling just five are enough to prove the disorder. They should also be consistent for at least two weeks straight.
- Feeling depressed for most of the day, as observed
- Losing interest in enjoyable activities, as observed
- Weight loss or gain of more than 5% every month
- Having trouble sleeping or going to sleep
- Constantly feeling irritable or restless
- Easily fatigued even when performing routine tasks
- An extreme sense of guilt or worthlessness
- Unable to think or make decisions, as observed
- Thinking a lot about death, contemplating suicide
Among the minimum of five confirmed A-criteria, one of these has to be either A1 or A2. On top of these, DSM-5 also needs potential cases of depression to establish that:
- The symptoms have impaired the patient when at work or hanging out with friends.
- Substance abuse or a pre-existing condition didn’t directly cause the symptoms.
- The symptoms have triggered major depressive and manic episodes daily for a week.
- The patient has never experienced a manic episode before.
- Schizophrenia or any other related disorder doesn’t describe the case.
All these and more can happen behind a fake smile or poker face.
Imagine seeing your best friend at work with groggy eyes for days. They’ll refuse to join you and your colleagues for lunch, don’t feel the drive to meet deadlines, and ponders on anything but work. Every time you ask them what’s wrong, they would smile and assure you that everything’s just fine. Such signs should be a cause for concern, more so a reason to seek professional help.
Depressed People Have To Smile
Remember earlier about depression hiding behind a smile as being the most frequent and dangerous? Depressed people have to keep a smile or anything but a long face for fear of being stigmatized.
In his 2001 article published in the British Medical Bulletin, Lewis Wolpert shared his experience recovering from severe depression six years prior. His wife hadn’t told anyone that he went through that rough patch for fear of affecting his career as a professor at the University College London in the U.K. Then again, he also admitted to sharing the widespread stigma.
He cites a notable case: former pro footballer Stan Collymore. He faced stigmas in the form of his then-coach for Aston Villa, who told him that depression was a ‘woman living on a 20th floor flat with kids.’ That same year, The Sun ran an article mocking him for being depressed when he was earning so much.
The good news was that Collymore came clean about his depression in 2019 (including his ‘second worst’ in 2011) and is fighting back by hitting the gym. The bad news is that depression still carries this stigma, preventing the seriously ill from seeking help.
Women suffering from postpartum depression are vulnerable, a kind of depression that manifests in negative thoughts and fears. One day, after giving birth, a mother may find herself doubting her ability to raise her children well, let alone the fear of them dying. She has to deal with the imminent existential crisis–that her children will grow up, get sick, and eventually die.
At first glance, it may not make sense; hence, the stigma. Wolpert argued that the lack of education regarding depression, how widespread it is, and how to treat it had stifled awareness. Heart attack and the flu are more relatable to the public because they know how destructive these diseases are–attacking the organs. With depression, however, it’s a mixed bag.
The stigma also affects friends and family members of people suffering from depression. They can be subject to the same self or public stigma that aggravates the problem, cascading until they, too, suffer from depression. One’s depression has caused that of the other.
Depressed People Don’t Know They’re Depressed
A quick Google search for ‘am I depressed?’ will yield several surveys that determine if you’re at risk of depression. Most of them are multiple-choice tests that determine how much you agree or disagree with a statement.
Experts and advocates, however, argue that the scope of mental health is vast. It’s possible for one to feel depressed but not have depression or feel anxious but not suffer from anxiety. Having the worst day of your life or multiple bad days doesn’t translate to depression on a whim. Conversely, it’s possible to have the best time of your life to signify a problem.
Seth Gillihan, psychologist and host of the ‘Think, Act, Be’ podcast, experienced depression years ago and never realized it. All it took was looking back at a young man that he knew whose fridge always barely had any food in it because ‘he was a loser.’ Years of practicing cognitive behavior therapy failed to prepare him for slipping into the same mindset as the man.
Depression tends to appear like snowflakes–no two cases are the same. Person A may feel down in the dumps but not fatigued, while Person B feels tired even after getting his eight hours of sleep. Fatigue might as well stem from the fact that there has been more work than usual. The feeling of sadness may go away tomorrow.
Such thoughts recur day after day, and the person is none the wiser. As days turn to weeks, these thoughts snowball into far worse feelings, such as losing motivation or appetite. It’s difficult for a person to monitor themselves since they’ll spend most of their time observing the world around them. Then, when they finally take a good look in the mirror, the negative emotions take hold.
To an extent, this context also works both ways. Non-depressed people might not know that they’re not happy. Because they feel nothing wrong, they don’t feel the urge to seek help. Essentially, depression is a master of the art of deception.
So, to summarize:
- Sadness doesn’t always translate to depression.
- Physical damage is as evident as emotional in depression.
- Stigma prevents people from admitting their depression.
- People can feel nothing for months yet have depression.
At this point, taking decisive action might seem useless. However, awareness has been on the rise thanks to known sufferers, like Collymore, sharing their stories. Having battled the darkness inside them and come out on top is enough proof that depression is manageable. As science continues to discover new forms of treatment, family and friends can contribute to the cause.
Start by lending an ear and devoting your full attention to someone in trouble. Choose your words carefully, avoiding denials like ‘it’s all in your head. Instead, assure them that they’re never alone. Offering a shoulder to lean or cry on helps the person deal with one less emotional baggage. It may not look much, but it’s for the wellness of the sufferer.
Be vigilant enough to look for signs hinting at suicide or any form of self-harm. These hints range from reckless behavior at work or unusually bidding goodbye to colleagues. Never be afraid to be the first to initiate a conversation about the person’s suicidal thoughts because it may be the only way to stop them from carrying it out.
Also, there are national suicide prevention hotlines that you can contact, such as the:
- National Suicide Prevention Hotline (1-800-273-8255)
- Crisis Text Line (text HELLO to 741741)
- Veterans Crisis Line (1-800-273-8255) for veterans
- Lifeline via TTY (1-800-799-4889) for the hard of hearing
Lastly, and most importantly, encourage the person to seek help. Depression gets worse the longer it stays. Consulting a physician is an excellent first step as they can determine if the depression is medical. From there, you can make your way to a psychologist or psychiatrist and eventually to a help center. Support their treatment every step of the way.
Everyone gets their fair share of bad days, but they shouldn’t dictate the course of one’s life. But if they do and start wreaking havoc on one’s welfare, intervention is necessary. Just standing by someone with a heavy burden will go a long way in saving their life from a fatal decision.