This piece was first published on Feminism in India: Your Everyday Intersectional Indian Feminism
In 2010, when I first talked to a general physician about depression, he dismissed my concern as imaginative. “All that is nothing. Just be happy“, he said in a father-like manner. If he had taken the time to listen to my symptoms then, which included fatigue, insomnia/hypersomnia, impaired concentration, feelings of guilt & worthlessness, and suicidal ideations, I would have been diagnosed with walking depression and could have been treated for the same. However, I was not.
More popularly known as ‘smiling depression’, walking depression according to a blog published by Laura Coward on National Alliance on Mental Health (NAMI), is “a major depressive disorder with atypical symptoms.” Individuals with walking depression continue to be functional – having a personal, social, and professional life – and often appear as cheerful, upbeat, and happy.
However, they continue to be so without disclosing (to themselves or others) the inner anguish, gloom, and anxiety that they feel and live with. Coward writes, “People with smiling depression are often partnered or married, employed and are quite accomplished and educated. Their public, professional and social lives are not suffering. Their façade is put together and accomplished. But behind the mask and behind closed doors, their minds are filled with thoughts of worthlessness, inadequacy, and despair.”
INDIVIDUALS WITH WALKING DEPRESSION CONTINUE TO BE FUNCTIONAL AND OFTEN APPEAR TO BE CHEERFUL, UPBEAT, AND HAPPY.
The traditional image of clinical depression is of an individual who may experience one or more of the following symptoms:
- Diminished interest or pleasure derived from activities which were earlier pleasurable;
- Recurring thoughts of suicide or death or self-harm;
- Persistent sadness, gloom, or emotional distress;
- Mood swings including excessive crying, apathy, or hopelessness;
- Numbness or fatigue;
- Loneliness and social isolation;
- Loss of appetite, sleep, or weight loss;
- Lack of concentration, slowness in activities & thoughts
Walking depression, just like other depressions, manifests and is experienced differently by different individuals, which makes it more dangerous. The psychiatrist Dina Goldstein Silverman, Ph.D. has established a connection between walking depression and suicide. According to her, an individual with walking depression, owing to her/his ability to remain functional is more likely to act out a suicidal ideation than individuals with clinical depression. Because individuals with walking depression can put up an easy-going and upbeat exterior, their symptoms which manifest in isolation alone, are more difficult to be spotted, diagnosed, and treated.
WOMEN ARE SYSTEMICALLY DENIED VALIDATION TO THEIR EMOTIONS, AND MAY NOT BE AWARE OF THEIR DEPRESSIVE SYMPTOMS.
In some cases, individuals may not even be aware of their depressive symptoms or may consider them as “not bad enough”. This is unfortunately truer for women, who often are systemically denied validation to their emotions, or censor themselves (sometimes without wanting to) to believe that “this is my life”.
The psychiatrist Ken Duckworth Ph.D. at NAMI says that because the symptoms look manageable and not as serious as the traditional markers of depression, women may remain undiagnosed for a longer period of time. But walking depression is more insidious. Carol Landau, Ph.D. from Brown University contends that women, because they have to “prove themselves” especially in professional spaces, tend to protect their image from any vulnerability, including a medical diagnosis.
This is confirmed by a survey undertaken by Women’s Health and NAMI of over 2,000 women. In this survey, 62 percent of the women surveyed admitted to smiling rather than talking about what they really felt on the inside. 53 percent said they withdrew from social obligations, had posted “happy pictures” on social media, or did not give an honest answer to “How are you feeling?” as a way to not appear as weak or as out of control. Dr Gail Saltz at Cornell University adds, “People are ashamed and they don’t understand [what is happening to them]” or they may feel “guilt about everything and anything” especially about their depression.
It is only of late that walking/smiling depression has been recognized by the global mental health community when mental healthcare professionals learned of the universal and common nature of this form of depression. Most professionals believe that the stigma around mental health and the presence of depression as a common parlance makes it more difficult for individuals with walking depression to admit, accept, and seek help. Alison Gresik, a writer and life coach, writes in her blog, “You feel like it would be insulting to those who are much worse off than you” about the mixed feelings an individual with walking depression may have.
Healing from walking depression is possible. One advice, which most mental healthcare professionals advocate, is to seek support. This support could be in the form of a social group (parent, friend, or peer), a therapy (Cognitive Behavioural Therapy or other talking-based therapies) or virtual support (mental healthcare blogs or forums). Talking-based therapy or a heart-to-heart with a well-wisher is particularly helpful to cope owing to its element of acknowledgement and validation. Both, acknowledgement and validation are cathartic in nature and allow for significant healing.
In my case, at different points in time, I relied on different combinations, to navigate the depressive episodes. Pursuing art in the form of writing and sketching, building a strong support system, and not overexerting myself were more personal ways I cultivated. The change has been rewarding.
- 5 Ways to Deal with Smiling Depression, F. Diane Barth, May 2017
- 10 Signs of Walking Depression, Alison Gresik, March 2012
- Symptoms: Major Depression vs. Walking Depression, Project Helping, July 2015
- Living with Walking Depression – When You Can’t Stop Carrying On, Harley Therapy, November 2013
- Smiling Depression, Carrie Arnold in Women’s Health Magazine
- Smiling Depression, Rita Labeaune, November 2014
- What You Need to Know About ‘Smiling Depression’, Laura Coward, September 2016