In a society where only productivity is celebrated and rewarded, life moves pretty fast. It's a story as old as time itself. Study hard, get a good job, work hard at said good job and be a useful member of society. Do you have a choice? Not really. Do otherwise and well, you're a deadbeat. And nobody likes a deadbeat.
If you want to sift through several thousand lines of cultural anthropology from Claude Lévi-Strauss (yes, like the jeans), it'll tell you that all human relations are founded on reciprocity. That's to say: you take something, you have to return something of equal value to hold onto your place in society. Pretty reasonable, isn’t it?
Of course, there are exceptions to this arrangement, and with good reason—like with mental health, for instance. According to the World Health Organisation, depression tops the list as the single largest contributor to global disability, affecting over 300 million people worldwide. In recent decades, awareness of mental health and its impact are growing not just one’s personal life, but at the workplace as well. It's gradually and steadily gaining a greater foothold in company cultures across the world.
There’s just one catch: You’ve got to be able to prove it.
Talk About An Oxymoron: High-Functioning Depression
What would you say if you've discovered a well-groomed man in an immaculately pressed suit on your morning commute has depression? Society’s prevailing perceptions of how depression emanate on a person—often marginalises on those who experience depressive symptoms—but lead the perceived successful and ‘normal’ life (by community norms).
In plainspeak, it's known as persistent depressive disorder (PDD) or high-functioning depression and can be characterised as the presence of depressed mood for most of the day over a period of at least two years.
“Metaphorically speaking, depressed mood can be thought of as the main driver of the car that is our life,” says Patrick Sheehan, founder and clinical psychologist specialising in anxiety and depression (check out his guidelines for treating it here) at the Adaptability Practice, a Sydney-based clinical psychology practice.
PDD, Sheehan adds, is a grave chronic form of depression than other major depressive disorder. “Research about treatments for PDD are still in their infancy—however, current research suggests that those who have grown up in families where there has been the presence of maltreatment, abuse or neglect experience more relapse and slower response to treatment.”
A Heavy Heart To Carry
“High-functioning depression is hard to detect in the face or the body,” says Elsher Lawson-Boyd, 27, from Sydney, Australia. She was diagnosed with depression, alongside complex post-traumatic stress disorder (PTSD) and an eating disorder—not an unusual occurrence as additional diagnoses for those living with depression is fairly common.
“Most of the time, people suffering in this way look cheery and ‘healthy’ by conventional standards but inside, you’ll find anxiety, despair and anger lurking—that's what hurts them most.”
Therein lies the kicker of bearing the burden of an invisible illness these individuals carry around unwittingly in silence; Not looking ‘depressed enough’ to be taken seriously due to the impression they’re alright.
“In those moments, life felt overwhelming,” Lawson-Boyd recalls. “Dealing with the little things in my daily life becomes excruciatingly difficult. And the worst part, at least for me, is not knowing how to communicate and care for it. And I feel ridiculous and mad for feeling this way."
"Often, I channel my pain into the most socially acceptable and respectable kind of productivity: work, weight control and food obsession.” Her words are a reflection of society’s relentless expectation that every act (or inaction) must be based on a bedrock of productivity. This logic of productivity trivialises the validity of those living with PDD, compelling them to internalise this doctrine—and in the process, self-diminishing the validity of their experience and disorder—without even realising it.
Kieran Tan (not his real name), 30, from Singapore, likens high-functioning depression to ‘dragging his legs in mud’. “While we look no different from anyone else and are capable of powering through our daily routine, depression hovers, whether conspicuously over your head or in the background. I turn to self-blame if assignments aren’t up to expectations. The continual pessimism and prolonged lack of self-confidence eventually triggered panic attacks.”
Just as depression is not one-size-fits-all, so are the coping techniques adopted by every individual in learning how to cope. For Lawson-Boyd, it was finding and growing a group of close-knit friends that she could confide in to address her thoughts.
Activities that allow Tan to direct his focus elsewhere, such as reading or spending time in libraries and museums, offer a calming source of respite for him. Both have shared their love of dance cardio and the physical release it provides, which for them, has been especially effective as a grounding exercise to assuage periods of depression. “There’s nothing else better than the rush of post-workout endorphins,” says Tan.
The thing about mental health awareness is that one day of campaigning—although it has certainly opened up space for dialogue to take place—is simply not enough to alleviate the silence that bookends it each year.
The first step that can be taken is recognising that these group of individuals are no less capable than those living without mental health conditions, but rather, differently-abled. As members of the same society, it is our responsibility, not theirs, to educate ourselves on how we can offer support.
“As individuals, we have to catch our thinking biases of presuming people are having a charmed life if they appear to have it all together,” Sheehan says.
“The tragedy is that these same people never have a chance to learn that many others can be patient, kind and open to the pain they experience in life,” Sheehan continues. “There is no substitute for people with these qualities who are receptive to whatever feelings we might be experiencing.”
Lawson-Boyd agrees. “I think one of the best things you can do for other people is to reflect on your own values and beliefs. Listen to the people you care with an open and quiet heart. It’s great that we are starting to talk more openly about mental health, but there’s still a long way to go. It’s actually super common and when you do, you give them the space to be honest as well. And that’s wonderful.”
Tan adds: “Be sensitive with their feelings and never disregard them. You may not always have the right words—and sometimes, there really isn’t—but standing by them by encouraging and listening to them means just as much. Include them in your life, but also stay mindful of respecting their personal space, when they need it.”
And for those living with high-functioning depression? Lawson-Boyd and Tan have a message for you. “You are not alone,” Lawson-Boyd emphasises. “Depression is overwhelming and exhausting. There is no shame in feeling everything you are feeling, no matter what it is. We all need to feel like we matter, and that people care for our wellbeing. It can literally save our lives. You are important and precious, and let me repeat this again: you are not alone.”
“Never give up on yourself,” says Tan. “Always include necessary breaks into your schedule for a breather. Even though everyone’s plight differs, know that you’re not in this alone. Pursue what makes you happy, keep an open mind and allow self-love into your life.”
If you need someone to talk to, there are resources and hotlines available:
Samaritans of Singapore: 1800-221-4444
Singapore Association for Mental Health: 1800-283-7019
Institute of Mental Health’s crisis helpline: 6389-2222
Care Corner Counselling Centre (Mandarin): 1800-353-5800
Silver Ribbon: 6386-1928
Tinkle Friend (for primary school-aged children): 1800-274-4788
Beyond the Label HelpBot: A Facebook messenger bot with resources, helplines and information about mental health.