Are you hiding behind your smile?

Too many of us are masking serious depression with a plastered-on grin, soldiering on without seeking help. But, says Marianne Power, dropping the façade is the first step back to happiness.

Last May I went to a friend’s 40th birthday party. The room was full of people I hadn’t seen for years and I spent the night chatting and laughing. I have no doubt I looked like the life and soul – beaming from ear to ear – but my smile was a lie. Beneath the happy mask, I felt empty and exhausted. The sound of people talking hurt me physically; each word felt like a tiny arrow attacking my head, and the effort it took to smile and reply felt greater than lifting weights at the gym.

Jayne Hardy of the Blurt Foundation says other people are often doing what you are – putting a brave face on it
Jayne Hardy of the Blurt Foundation says other people are often doing what you are – putting a brave face on it

Every half an hour or so, I’d lock myself in the bathroom to take a break, but the silence would bring me back to the ticker tape inside my head. ‘What’s your problem?’ the voice demanded. ‘Pull yourself together. You’re here with friends. What’s wrong with you?’ I’d take a deep breath, plaster the grin back on my face and get back out there. I put on an Oscar-worthy performance.

Many of us think that people with depression are unable to get out of bed, let alone socialise or have a career, but that’s not always the case. According to new research, a huge number of us are suffering from what’s being dubbed ‘smiling depression’.

Psychologist Dr Jane McCartney explains: ‘This is when someone appears to the outside world to be happy and successful – enjoying a great job, looking after a family and engaging in an active social life – but inside they’re depressed, numb and full of self-loathing.’

A recent survey of more than 2,000 women by the National Alliance of Mental Illness and Women’s Health found that 89 per cent of women who suffer from depression fall into this category. They keep up a people-pleasing, hard-working façade, all the while hiding the fact they are clinically depressed. The Blurt Foundation, an online support group for people with depression, ran an awareness campaign – #whatyoudontsee – for just this reason. ‘Depression is an illness, not a facial expression,’ says founder Jayne Hardy, who has done a TED talk on her own experience of keeping depression a secret. ‘There’s an expectation that people with depression should “look” a certain way – it affects 300 million people worldwide, and a good proportion of us will appear to be “coping”. We can go about our normal business and not display the typical signs of being depressed.’

Dr McCartney agrees. ‘Smiling depression is also known as “high-functioning depression” but I don’t like that term. It suggests there isn’t a problem, but there is.’ She thinks it begins in childhood: ‘Many of us were brought up to believe that it wasn’t acceptable to be sad; we learned very early on to keep a smile on our faces to get the approval of Mum and Dad,’ she says. Indeed, I grew up with a father who often repeated the phrase ‘smile and the world smiles with you, cry and you cry alone’. It’s a mantra that has stuck with me – it doesn’t matter what’s happening, my first reaction is to smile. But often the bigger my smile, the blacker it is inside my head.

 I was first diagnosed with depression in my late 20s. I was working in a demanding job and struggling to keep up. From the outside I was living the dream but most days began with a feeling of dread that moved into low-grade panic and self-hatred as the hours passed. At that time, I was going to the doctor with a series of colds and throat infections.

On one occasion I walked in to ask for antibiotics and found myself in floods of tears, prompting him to enquire after my mood as well as my throat. After asking me a series of questions, he announced that I had ‘moderate to severe depression’. I told him that he was wrong. I wasn’t the kind of person to get depressed.

‘Do you ever have suicidal thoughts?’ he asked.

‘No!’ I said, before confessing: ‘I sometimes think the only way to stop feeling this way would be to not be alive.’ I shocked myself by saying those words out loud. I’ve since learnt that hopelessness is a major symptom of depression.

I stayed on antidepressants for a year but I was so ashamed I didn’t tell anyone except my mother. They helped. Within six weeks of taking the medication I found myself noticing that it was a lovely day. It was the first time in months that I’d been able to take pleasure from a small thing like a blue sky.

'I was first diagnosed with depression in my late 20s,' writes Marianne Power
‘I was first diagnosed with depression in my late 20s,’ writes Marianne Power

A couple of months later I quit my job to go freelance and since then have had a more balanced life. Slowly but surely, the improvements continued until I felt well enough to come off the medication. Although I told myself this was just a one-off problem, it hasn’t been. I have continued to suffer from regular bouts of depression which I’ve kept hidden, even from close friends who had no idea that I get so low.

Like many people with smiling depression, I feel down even though I have such a privileged life – and this comes with a hefty dose of guilt. The voice in my head says: ‘Why can’t you get on with it like everyone else? You’re not in a war zone, other people have real problems. Pull yourself together.’ So when people ask me how I am, I lie. I fib because I worry that if I tell them the truth – that I’m miserable – they will think I’m a self-indulgent princess and won’t want to be around me. I also assume they won’t understand. So instead of talking to someone and getting help from the GP, I become more frenetic. Depression makes me feel like a failure – as a writer, a friend and a daughter – so I counteract these feelings by pushing myself harder and smiling more.

Sometimes I do such a good job of faking it, I almost convince myself I’m OK. If I come home from a dinner at which I laughed and talked, I tell myself that I’m all right, but then I wake up the next day and I’m back in the black hole, feeling as though there is a lead weight on my back. Often my first thought is, ‘I can’t do this.’ Then I remember that, actually, I’m not fine.

Dr McCartney says this cycle is very common. ‘People think that if they say they are “fine” it will be a self-fulfilling prophecy but it doesn’t work like that.’ And the danger of smiling your way through depression is that instead of getting help at the beginning, you push things so far that your emotional state gets worse. The National Alliance of Mental Illness survey found that half of the women who had smiling depression have considered suicide. ‘It’s so dangerous because nobody sees the signs,’ she says.

Many of us think that people with depression are unable to get out of bed, let alone socialise or have a career, but that’s not always the case
Many of us think that people with depression are unable to get out of bed, let alone socialise or have a career, but that’s not always the case

Last summer, after months spent trying to carry on as normal, hoping my depression would go away, I became so sick I couldn’t get out of bed. Shortly after my friend’s party I developed flu-like symptoms. One morning I lay in bed and tried to instruct my limbs to move, but they wouldn’t. I stayed in bed for two weeks. Some days I cried; other days I felt numb. Then my mother intervened and told me I had to go to the doctor. When I finally had to cancel plans and could no longer talk on the phone, I was forced to admit how I was feeling to close friends and family. They were sad I hadn’t told them sooner. My best friend was frustrated because she knew something hadn’t been right but I had kept denying that there was a problem.

I now think that often the people with the biggest smiles are the ones hiding the saddest thoughts. We smile because we want to be good enough, we want to be liked, we want to be kind. We put ourselves under huge pressure to be perfect. It’s exhausting. And I’ve realised the only way to escape the trap of smiling depression is to accept myself as I am – someone who has ups and downs. Someone imperfect. I also have to trust that my friends can accept the real, up-and-down me. I read somewhere that Eeyore in Winnie the Pooh is the perfect example of how we should treat people with depression: he was a miserable old donkey but he was always invited to join in with the others, who accepted him just as he was. ‘You don’t have to be all singing, all dancing every time you are with people,’ agrees Dr McCartney, ‘You can aim for the middle ground – to be neutral. If you are worried about being a burden, say something like, “I’m not at my best at the moment”.’

HOW TO HELP A FRIEND

Stay in touch You can’t force someone to get help, but you can show them you’re there for them. Jayne says a text with, ‘Hello, I’m thinking of you, I hope all is OK,’ is a sign you care but doesn’t require a response (which can be hard when they’re unwell).

Really listen Make an effort to spend time with your friend. They may resist company, worried that they’ll bring you down – but suggest a cup of tea and a chat.

Show empathy This may encourage them to open up.

Be loving Your friend will be struggling to see what they have to offer you. But ‘show them that you care about them, value them, and that you’ll always be there for them – however bad things might get,’ says Jayne.

So that’s what I did when I arranged to meet two friends last week. ‘Sorry if I am not great company,’ I explained when I arrived. ‘I seem to be having an off day.’ I didn’t smile as I said it, nor follow it with a joke. It’s funny how brave this felt. A huge part of me thought I was being selfish for not being perky but it turned out that the real me that day was fine. One friend squeezed my hand and the other told me she’d been crying all morning because her nanny had left the country. ‘It’s so stupid,’ she said. ‘I just hate saying goodbyes.’ We laughed and then we ended up talking about emotions and life.

It turns out I wasn’t the only one at that table to suffer from depression, but it was only by admitting it and being the real me that the other person could be themselves, too. That’s the thing with smiling depression – you’re not the only one. Many of us are experiencing all sorts of struggles behind our smiles and it’s only by being honest that we can help ourselves and each other.

WHAT TO DO IF YOU HAVE SMILING DEPRESSION

You are not alone Jayne Hardy of the Blurt Foundation says other people are often doing what you are – putting a brave face on it.

Seek help If you have been feeling low for more than two weeks, talk to your GP. ‘We think we should soldier on but we don’t need to struggle alone,’ she says.

Talk about it ‘We may feel ashamed and embarrassed, but talking is the first step in accepting and addressing the problem.’ If you don’t have friends or family you feel able to open up to, try online support groups such as the Blurt Foundation (blurtitout.org).

Show yourself kindness ‘When we’re suffering with depression we can be pretty mean to ourselves,’ Jayne says, ‘but practising self-care is a much more effective way to tackle smiling depression. The kinder we are to ourselves, the more likely we are to get better.