It's called a breakthrough, not a breakaround

I have heard this often when a person in emotional pain is sitting across from me in a session:

“I hope you have a magic wand that can make my pain go away.”

I wish it was that simple. I wish I could get into people’s heads and make their distressing thoughts, feelings, memories, urges, impulses go away. The fact of the matter is I can’t. No one can. Not even them. We like to believe that we have control over our thoughts and feelings, but we don’t, at least not enough; and the sooner we realize it the better.

We can distract ourselves with music, and breathing exercises, food, walks or runs, or alcohol and other substances, even work, or whatever else you engage in to suppress or avoid those painful thoughts, feelings, memories, but they will come back with a vengeance. It’s like trying to push a plastic ball beneath the surface of the water. Your hand will eventually tire itself out, and the moment you let go of your hold, the ball bounces right back up, maybe higher than ever before.

And in a culture which extols “busy-ness,” where we are told “not to think about stressors,” “look on the brighter side,” “think positive,” “try and control yourself—the way you think and feel and behave,” “move away from the pain,”  you might even experience short-term benefits such as relief from sadness or anxiety. But then I ask this: “Is your pain less or more since you started using those strategies?”

What ends up happening as the days, weeks, and months go by as we struggle with the pain is that we may start becoming high functioning “depressives.” On the surface, we appear to have everything “sorted” with our lives to an observer’s eye, but within we are silently screaming through our psychological suffering.

So, back to that magic wand which people expect of me or any other mental health professional, I am taken back to something another person I worked with in therapy had said in our closing session.

“Sometimes I think depression is like cancer. There’s no one quick-fix. You can only tackle it with a multi-pronged approach. It takes time, the commitment to stay the course, and a supportive ecosystem in addition to a therapeutic approach that is tailored to each individual. And above all, never losing sight of a purpose in life, regardless of the obstacles. ”

Recovery from any psychological suffering, whether one that you struggle with as an individual or one that appears as conflicts and strains between family members, requires learning to understand what it is about in the first place. What are the bottlenecks that exist in the way of us leading a rich, meaningful life? What are the signs and symptoms of the suffering and what are some antecedent events (situations or events, and resulting thoughts and feelings) that may have preceded the onset of the symptoms? These are imperative so that we have a better understanding of what the recurrent triggers and themes are that may emerge as a result.

Let me illustrate this with an example that happened in a conversation with Ami (name changed) today.

Caught in the intense grip of her grief—across a journey that went from the diagnosis of her husband’s terminal illness to losing him a few months later—Ami was deeply distressed and had intrusive thoughts of self-harm. Whenever she would see a set of kitchen knives, or a box of matches, she would want to use them on herself. But she had a child to take care of, so the thing she did was to clear her home of objects that she could use to harm herself.

Ami reached out for therapy 8 years after her husband’s demise. Over the course of a few sessions, we reached an understanding that she was experiencing Persistent Complex Bereavement Disorder.

Over the next few months, Ami worked through her grief, and not around it.

In numerous ways she would seek not to suppress or distract herself from the pain and the memories. And her symptoms of anxiety and depression started abating and her overall sense of well-being started to increase.

Today she wanted to come clean, break with the demons of the past. She shared her discomfort even now around when she chops vegetables or lights a lamp. The painful memories of the past, and the fears around it return, and while she is able to let them go, there still is an iota of “fear” left from the shadows of that past.

“I know I am in a much better space than I was 8 years ago. I know I am much stronger mentally and emotionally. I don’t even know if it makes any sense to talk about it, but it helps to just drop this here with you and to hear what you think about this,” Ami told me.

Ami has shared a lot over the months, as and when she has been comfortable. Some memories have been painful, some have taken immense courage to bring up, and after making space for her pain and grief, she has embraced her fears. This is the part where the healing begins to occur; when the perspectives shift, when the light starts shining in the darkness, and when one begins to do the real work in therapy, on a path of self-discovery, one which includes understanding aspects of the self and taking responsibility for one’s own healing.

From that same past, Ami had also developed an intense fear of doctors and hospitals and would do whatever she could to avoid going for a health check-up. On her husband’s death anniversary this year, she decided to brace her fears and went to the hospital where she had spent several months taking care of her husband and where he eventually passed on. She walked past the nursing station, stood by the door of his former room, spent hours there till she felt she was able enough to confront her fears without the anxiety and the panic arising. Ami mindfully walked the hallways, and when she came home, she messaged me that she had taken this big step. Her daughter was a huge support for her throughout: the ecosystem that truly makes a difference.

In confronting her past, Ami reinforced a fundamental lesson.

Fear makes us avoid triggers, makes us feel incapacitated in the grip of the anxiety that ensues, and further makes us feel guilty and angry about why we feel this way.

But when you look at fear in the eye, it realizes it’s lost the battle and whimpers away.

You just have to learn to make your faith and belief in yourself bigger, and you take that one step towards fortifying yourself.

Ami started stepping out of the shadows of her grief and anxiety, and realized there was a world waiting for her; the one she had wanted to build but never got down to doing: of getting back to work and enjoying it, of reclaiming her emotional and physical health, of redoing her home, building a garden, and getting back to her favorite hobbies of embroidery and textile painting, and a whole lot more that she wanted from life and was working towards.

The knives and matchboxes awaited next, and she willfully took that challenge on. I will know the progress in our next session.

I reflected on Ami’s journey after we ended our call today and realized how telling that parallel between depression and cancer is.

We can’t wish it away, there is no quick fix, you may need more than one resource person to help you through, a therapist who can customize their approaches to suit your needs and requirements. It takes willingness to walk the talk, to endure the pain that comes along, the commitment to stay the course across time, sometimes a multi-pronged approach, and, yes, it takes a supportive ecosystem.

But above all, whatever the suffering may be, what’s important is never losing sight of a life that brings richness and meaning, regardless of the obstacles that may be hurled at you. However difficult the path may seem, when your internal world is able to brave the emotional storm, and you don’t wish away pain or crumble under it, or hide from it, but see it as a part of life, you learn to anchor yourself to stay steady. And that’s when you realize what you’re truly made up of.

This breakthrough transforms you within.

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.