What is smiling depression?

The term "smiling depression" may initially seem counterintuitive. Most people would imagine depression as a disorder where one experiences low mood, feelings of hopelessness and helplessness, and impairments in functioning. It is hard to imagine individuals with depression smiling and happy. However, not everyone experiences depression the same way. Smiling depression occurs when an individual conceals his inner thoughts and feelings with a facade of happiness.

Individuals with smiling depression go through their daily activities, appearing happy and put-together on the outside while internally suffering depressive symptoms. Think of the times you heard of an unsuspecting individual suddenly attempting or committing suicide. Smiling depression is not an official diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). These individuals may meet the criteria for major depressive disorder with atpical features or persistent depressive disorder. However, they mask their symptoms and try to be strong in order to be able to maintain their level of functioning, e.g. going to work and interacting with friends (Bradley, 2019).

What causes smiling depression?

There are many reasons why these individuals choose to mask their depression with a smile:

• They fear the reactions of others.

• They want to avoid being associated with depression due to fear of stigma and discrimination.

• They are afraid of being a burden to their loved ones.

• They feel guilty for being depressed because they have many objectively good things in their life.

• They are pressured by expectations that they should have their life together.

Smiling depression could be more prevalent in cultures like Singapore. Firstly, Asian values place greater emphasis on selflessness and putting community needs above individual needs. This tendency is known as collectivism and is usually found in societies where people are deeply embedded in their social contexts. As a result, individuals may refrain from expressing their emotional distress as they prioritize the well-being of their family and friends above their own. In addition, individuals from collectivistic cultures may experience greater shame about depression because they carry with them the identity of their community. For instance, if they were to be diagnosed with depression, they do not just worry that their reputation will be affected but also the reputation of their family.

Secondly, Singapore has a strong culture of excellence in the workplace. Individuals with depression may fear stigma from their employers and co-workers and therefore choose to conceal their depressive symptoms. In order to meet the high expectations of others, they may cope by burying themselves in work and appear to be highly functioning.

Detecting smiling depression

The difference between smiling depression and other forms of depression is that individuals with smiling depression may occasionally be in good spirits in response to positive events in their lives. Nevertheless, there are some signs to look out for. In fact, the symptoms of smiling depression are rather similar to that of atypical depression (Remes, 2019). In other words, these symptoms may be the opposite of common depressive symptoms.

Signs of smiling depression:

• Excessive smiling

• Cheerfulness in stressful situations

• Self-deprecating sense of humor

• Occasional social withdrawal

• Occasional thoughts of suicide

• Easily hurt by rejection or criticism

• Tendency to anticipate failure

• Rumination about negative situations

The dangers of smiling depression

In contrast to major depression or other subtypes of depression, the nature of smiling depression may give off a false impression that it has less serious consequences. Unfortunately, this is not the case.

Individuals with smiling depression usually do not express their negative feelings and thoughts. Instead, they bottle up their feelings for a long time. Without an outlet, these negative feelings and thoughts may reinforce each other, creating a toxic cycle that pushes individuals deeper into depression (Fader, 2018).

In addition, smiling depression easily goes undetected because these individuals do not exhibit prominent symptoms of depression. However, smiling depression could affect anybody – even the person who is at the top of the corporate ladder or someone who is happily married with lovely children. In fact, individuals with smiling depression may appear successful in the typical areas of life.

When smiling depression goes undetected, the individual becomes increasingly isolated. These individuals usually do not receive the social support they need because the people around them are completely unaware. Overtime, it may lead to increased feelings of hopelessness and helplessness and even suicide if they do not receive adequate help.

How to help

Here are some ways that you can help your loved ones who may be dealing with smiling depression:

• Be actively present in their lives by checking on them frequently

• Remind them of your love and tell them that you care about their well-being

• Encourage them to express their thoughts and feelings freely without fear of judgement

• Listen actively while acknowledging what they are sharing

• Acknowledge that their feelings are valid

• Offer to be a listening ear in the future

• Help them to recognize that they are depressed and their need to seek help

• Support them as they decide to see a therapist, especially for the first time (You can find out how to do so here)

Depression, in any form, should not be underestimated. It is important to be aware of the many forms it can take, as recognition of the illness is the first step to help-seeking and recovery.

References

Bradley, S. (2019, April 26). True Or False: Depressed People Rarely Smile. Retrieved from https://www.womenshealthmag.com/health/a27243083/smiling-depression/

Fader, S. (2018, February 17). Causes And Symptoms Of Smiling Depression. Retrieved from https://www.betterhelp.com/advice/depression/causes-and-symptoms-of-smiling-depression/

Remes, O. (2019, February 24). Commentary: 'Smiling depression', depressed while appearing happy, a dangerous combination. Retrieved from https://www.channelnewsasia.com/news/commentary/smiling-depression-appearing-happy-dangerous-mental-health-11275972

Article written with Tay Shi Ying. Shi Ying is a psychology undergraduate at the Nanyang Technological University (NTU) undergoing internship with ImPossible Psychological Services. She is supervised by our senior clinical psychologist, Haikal.