Mask of Joy

It is widely assumed that a person suffering from depression is a picture of sadness, despair, and isolation. However, that is not always the case — a person who seems perfectly happy and content on the outside too can be depressed, a  phenomenon known as ‘Smiling Depression’. On the surface, the person may seem normal thanks to their happy and energetic public appearances, but inside everything is crumbling.

According to various studies, one in ten people suffer from depression and about 40 percent of them suffer from ‘Smiling Depression’.  While the condition isn’t recognised as a mental disorder, it’s a major depressive disorder with
unusual features. “Someone experiencing this form of depression will have unusual behaviour. The person will not appear depressed, in fact, he will appear smiling and happy. But that person would be experiencing the distressful symptoms of depression inside,” explains Dr Maya Kirpalani, Consultant Psychologist and Family Therapist at Jaslok Hospital and adds that the mood is not the predominant symptom. “The patient is not necessarily smiling but they don’t look sad either,” adds veteran Neuropsychiatrist, Dr Rajesh Parikh.

Putting on a mask
Generally, people suffering from this condition do not open up about their depression and  are capable of hiding their issues.

“It is not very known to people, but it is there. At times, the person doesn’t want to show his sadness because he doesn’t want to be tagged as depressed,” observes Dr Shubhangi R Parkar, Head of Department of Psychological Medicine at KEM hospital.

Instead of the typical desolate emotions that come with depression, people experiencing this ailment may face somatic symptoms such as body ache, fatigue, lethargy, change in appetite, weight, and sleeping patterns, a feeling of hopelessness, lack of self-esteem, and low self-worth.

“Some people would even seem not interested in pursuing something that they enjoyed at times. They would either be withdrawn or extremely reactive,” says Dr Kirpalani.

Identifying the problem
Although ‘Smiling Depression’ isn’t a clinical diagnosis for many, it’s a problem when people pretend that they are active and high-functioning individuals. Dr Parkar notes that feeling low sometimes is normal, but long-term negative feelings need to be questioned.

“You can’t manage to feel good when things are not normal, but if it is prolonged, then there is something. It is very tangent and the first level of mental disorder so if you can’t accept it, then you will become more miserable,” she asserts.

Dr Parikh adds that taking a detailed history from both, the patient and family, can help professionals identify these patients.  “Psychometric tests are useful diagnostic tools for these patients. Low mood is usually transient and substantially different from clinical depression,” says the neuropsychiatrist.  

However, Dr Kirpalani warns that before heading for any treatment, one must get a full psychological assessment done. “It should be determined whether the person really needs medication. Sometimes, you go to a psychiatrist and get the medication, but it doesn’t help because the patient doesn’t get counselling,” suggests the family therapist, who feels that families need to be empathetic towards the patient.

“Families need to enquire whether the person needs some help. They should provide emotional support and try to be with them. As parents, they should try to find out what is bothering the person,” she suggests.

Experts also believe that encouraging communication with the person can also help the patient overcome the issue. “One can help them by encouraging free communication, family support, counselling, and even medication if necessary,” explains Dr Parikh.

“The term “smiling depression”-appearing happy to others while internally suffering depressive symptoms-has become increasingly popular.  It can be very hard to spot people suffering from smiling depression. They may seem like they don’t have a reason to be sad and masking the state of their mind with a smile will not solve the issue. One cannot smile or put on a happy face forever. Consulting an expert is one option if you are not able to share your problems or reasons for stress with anyone else. There is also a social stigma involving like any other kinds of mental illness. People suffering from depression tend to hide it from everyone fearing the society,” says psychologist, Dr. Mini Rao.   

Not a stigma anymore
Just like other types of depression, this form of depression can be triggered by situations such as failed relationships or even losing a job or a loved one. The issue can, therefore, go untreated at times because the person behaves as normal and does not speak up, which experts chalk up as the fear of being tagged as ‘depressed’.

“There is a stigma around mental health. We have accepted HIV and leprosy but we are apprehensive about accepting depression, and that’s why many people try to appear normal and happy,” asserts Dr Parkar and suggests that education around accepting the issue is required.  

On the other hand, Dr Kirpalani opines that people are becoming more open in getting help from counsellors or psychotherapists. “I don’t think people in metropolitan cities shy away from taking clinical counselling. The only thing one needs to do is to be vigilant towards the symptoms,” she says in conclusion.