Written by: Nyama Amat
Edited by: Christine Huang
Depression is one of the most commonly diagnosed mood disorders globally, often categorized as a pervasive and debilitating illness. An estimated 21 million adults in the United States have experienced at least one major depressive episode; as of 2021 data, a number which represents 8.3% of all adults in the country (NIMH). Despite the abundance of depictions and portrayals of depression in various forms of media, such as books, movies, and even music, depression is often hidden in plain sight by those afflicted. Oftentimes those who deal with depression become adept at concealing their inner feelings and struggles, taking on this mental toll alone and in silence. There are manifold reasons why an individual may resort to masking their true sentiment from loved ones, spanning from inner turmoil to societal stigma. This is a critical issue in mental health awareness, due to the understated importance in recognizing and understanding this silent struggle many endure.
Although more recent generations have spurred movements supporting mental health awareness and de-stigmatization of mental illness, many people living with depression opt to hide their condition behind a metaphorical mask. Major depressive episodes are categorized by the presence of 5 or more depressive symptoms, a few of them showing symptoms of insomnia, fatigue, feelings of worthlessness, and suicidal thoughts/ideation (DSM-5). However, an individual masking depression may choose to present themselves as high-functioning and emotionally content as they continue their daily activities without impediment.This outward discrepancy from their inner reality is fueled by many factors such as societal stigma, fear of judgment, as well as a personal perception that one may be burdening loved ones. Societal stigmatization of mental health and the individuals who are living with these illnesses has long been a significant barrier for many when it comes to seeking help. An individual may also fear judgment or ostracization from a loved one if they decide to disclose their true feelings and inner turmoil. In many cultures across the globe, strong emphasis is placed on family reputation and a sense of family honor, which in turn may view mental illness as “shameful” or reflecting poorly on the family. This can lead to individuals fearing backlash from their relatives and direct society, which prompts them to mask their depression rather than face possible repercussions. Although the United States has become increasingly progressive when it comes to mental health awareness and addressing related topics in the public, not too long in the past mental illness was highly stigmatized due to the lack of understanding and increasing societal misconceptions. For a greater part of American history, individuals with mental illness were discriminated against and treatment options were limited and often severe, which discouraged many from seeking help or even discussing how they feel with a loved one.
Depression is a condition that affects every individual differently and can manifest itself in a variety of ways. Depression must be diagnosed based on criteria of 5 or more depressive symptoms being present nearly everyday, with the exception of weight gain and suicidal ideation, during the same 2-week period. Depressed mood must be present for most of the day nearly everyday, or markedly diminished interest or pleasure in activities. These indicators and progressive changes in behavior, however, can be subtle and easily overlooked by those around the individual. Changes such as loss in energy or withdrawal from social activities can be attributed to temporary stress or fatigue, rather than recognized as greater symptoms of a mental illness. Moreover, there are also many individuals who are high-functioning and mask by implementing their depression into daily routines rather than create a disruption. An individual may resort to substance use to cope with depressive symptoms, such as alcohol or drugs which may help temporarily numb feelings and provide short-term relief. One may also choose to overcompensate in other areas of their life such as work or social settings, through being overly energetic or engaged as opposed to the latter. Immersing oneself in career or academics can help to distract an individual and those around them from their symptoms. A most common strategy an individual may resort to is simply “putting on a happy face.” They may feign happiness in social settings and be able to smile and laugh in conversations, aptly deflecting from their true emotional state. The continuation of one’s normal routine and upkeeping with outward appearances can be a deliberate attempt to appear just “ok” enough to others. Masking these behaviors can make it challenging to identify and reach out to a loved one who may be in need of help, but understanding these behaviors can lead to greater awareness and early detection of depression.
Depression is often hidden by a facade of happiness, and the tendency of individuals to mask symptoms must be understood to help those who suffer in silence. Although the United States has evolved greatly in its acceptance and understanding of mental health, there is still an imperative need for society to become more empathetic to individuals with mental illnesses. Individuals with depression often feel as if they have no valid reason to be sad, due to the complex nature of this disorder which can make one experience feelings of guilt and worthlessness. They also may not be experiencing a direct external cause for their feelings of distress, since depression can commonly be attributed to internal factors such as biological and psychological. Thus, individuals experiencing depression and those around them should understand that this is a multifaceted condition and is not always easily explainable. Depression is masked by many due to fear of judgment, social stigma, or fear of being a burden to loved ones. Compassion and empathy are the foundation towards fostering a safe space in society to invite every individual dealing with internal battles to have access to and receive the help they need.
References:
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
NAMI: National Alliance on Mental Illness. (2023). Major Depression.
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