Why So Many High-Achieving Women Hide Their Depression
“Everyone thinks I’m always happy. People at work are constantly commenting on my smile and positive attitude,” Sara (42) said, that ever-present smile visible through tears. “If they only knew how completely miserable and stressed out I am half the time…”
Sara is like so many outwardly busy, successful women I see in my practice. They spend all their time taking care of everyone and everything else that there’s no time left for them or their feelings.
According to the World Health Organization, nearly 5% of the population is currently experiencing some form of depression. That works out to about 280 million people worldwide.
Even though depression is a common mental health issue that affects millions of people of every race, class and culture, far too many people still struggle in silence because of the stigma and shame tied to it.
While women are 33% more likely to suffer from depression than their male counterparts, as a therapist, I’ve found that this is especially true for my successful, high-functioning female clients.
A disproportionately high percentage of high-achieving, outwardly successful women suffer from a specific variation of depression that is sometimes called smiling depression or high-functioning depression.
Understanding High-Functioning Depression and Smiling Depression
High-functioning depression, also known as dysthymia or persistent depressive disorder (PDD), involves a chronic low mood that lasts for a long time (usually two years or more).
People with this type of depression manage to keep up with their daily responsibilities. To the outside world, they seem to be doing fine in their personal and professional lives, even though they feel a chronic sense of sadness that is often accompanied by a sense of low self-esteem.
Characteristics of High-Functioning Depression:
Feeling down for at least two years.
Losing interest or pleasure in activities.
Chronic feelings of being tired or having low energy.
Constantly feeling worthless or having low self-esteem.
Trouble concentrating or making decisions.
Changes in sleep and appetite.
Smiling depression, a particularly insidious form of high-functioning depression, is often very similar except the person appears happy and cheerful on the outside but is experiencing depression on the inside.
They’re able to keep up a positive and outgoing demeanor, making it hard for others to see that they’re struggling. This can create an even greater sense of isolation, loneliness, and despair.
Additional Characteristics of Smiling Depression:
Feeling sad or hopeless but hiding it behind a smile.
Staying busy and social to distract from their feelings.
Hiding true feelings due to fear of judgment or not wanting to burden others.
Managing daily responsibilities despite internal struggles.
When I ask my high-functioning female clients why they work so hard to keep their depression hidden or private, they often tell me that they’re too busy to deal with it. No one else is there to pick up the slack with their kids, the spouses, at work or with their aging parents.
If they fall apart, everyone else will fall apart too.
But often under the everyday sense of duty and responsibility, these women carry painful feelings of shame that slowly bubble to the surface.
They also lament the fact that they feel an overwhelming sense of guilt because despite feeling like they are “blessed” and often economically fortunate, they wonder why they can’t just be grateful for everything they have.
This just reinforces a deep and painful feeling of shame
Let’s look at two different women and how Smiling Depression shows up in their lives.
The Successful Professional
Sara, a single 42-year-old VP of marketing at a large firm, consistently meets her deadlines, delivers impressive presentations, and is well-liked by her colleagues. On the surface, Sara appears to have it all together. However, internally, she feels a persistent sense of sadness and emptiness.
Sara reports that she struggles to get out of bed each morning, experiencing a heavy sense of dread. She often hits snooze multiple times before finally dragging herself up.
At work, Sara is productive and efficient, but she feels disconnected from her achievements. The praise she receives from her boss and colleagues feels hollow.
Putting on a warm smile, Sara has a busy social life attending events and gatherings, but she reports that it’s like she's just going through the motions. She often sneaks out of events and parties early, feeling drained and eager to be alone.
The Dedicated Parent
Lily (38) is a happily married, stay-at-home mom who takes excellent care of her two kids. She ensures everyone else’s life runs smoothly. She helps with homework and manages the kids’ calendar of endless activities.
She volunteers on several committees at her kids’ schools. When talking to other parents, Lily puts on a cheerful facade. But inside, she feels isolated and believes no one understands what she's going through.
Friends and family see Lily as a devoted and loving mom. However, Lily feels a persistent low-grade sense of sadness and struggles with feelings of guilt and worthlessness.
Her meticulously clean, organized, and well-decorated home is the envy of her neighborhood, but she feels little to no sense of accomplishment. Cooking, cleaning, and caring for the kids feels like an endless cycle.
Lily admits that she rarely takes time for herself. She struggles to find joy in activities she once loved, like book club and yoga.
What both of these women have in common is that almost no one in their lives would suspect anything is wrong. And they both feel an overwhelming sense of worthlessness and shame.
The Role of Shame in Depression
Shame can be a big part of why people don't talk about their depression or seek help. Here’s why:
Societal and Cultural Factors
Stigma: Yes, we’re getting better about normalizing mental health issues. But mental health issues, including depression, are often still stigmatized. Those suffering from depression fear judgment and scorn. Deep down they may feel they are weak or have failed in some way.
Misunderstanding and Misinformation: Many people don’t understand depression and might think it means someone is lazy, not trying hard enough to get better or just looking for attention.
Cultural Expectations: Some cultures value toughness and emotional control, which can make people hide their depression to fit in. This is often doubly true when women are competing in a high-pressure corporate work environment or competitive social circles.
Personal Factors
Perfectionism: Women who strive for perfection often see their depression as a failure to meet their high standards, leading to shame.
Fear of Judgment: Worrying about how others will perceive them and their issues can stop people from talking about their depression.
Self-Stigma: Internalizing negative beliefs about depression can make people see themselves as weak or inadequate.
Lack of Visible Symptoms: Unlike physical illnesses, depression often doesn’t have clear outward symptoms, making people question the legitimacy of their experience.
Impact of Shame on Depression
Unfortunately, these factors can lead to a self-sabotaging cycle that can make the issues worse over time. The shame associated with depression can have serious consequences:
Delayed Treatment: Shame can stop people from seeking help, delaying diagnosis and treatment, which can worsen symptoms and make recovery harder.
Isolation: Feeling ashamed can lead to social withdrawal, increasing feelings of loneliness and isolation.
Increased Severity: Shame can intensify the emotional burden of depression, creating a vicious cycle where depression feeds on the shame and vice versa.
Be Kind to Yourself: Things Really Can Get Better
Encouraging individuals to practice self-compassion and recognize that depression is a medical condition, not a personal failing, can help alleviate feelings of shame.
If nearly 5% of the population is suffering from some form of depression, then know that you are not alone.
Understanding the complexities of depression, including high-functioning and smiling depression, is essential for providing effective and compassionate care.
By addressing the societal, cultural, and personal factors contributing to shame and utilizing a multifaceted approach, you can work toward easing the symptoms of depression.
REACH OUT & SCHEDULE YOUR FIRST APPOINTMENT
310-730-1956/ lisa@dalesandro.com
LISA DALESANDRO, M.A, Licensed Marriage and Family Therapist
