What you should know about high functioning depression
It’s usually easy to spot ‘the crazy ones’. It’s just the crazy ones who have to “go see a good doctor”.
Most of the time I’m not considered ‘one of them’. I get up in the morning, I go to class when I’m supposed to, I have a girlfriend. Well, wait. Cross off the last one. It was informed this makes me ‘not-normal’ — thank you.
Anyway, you get the picture. My life goes on. I’m even managing to go to the gym five times a week. I must be the master of my will. Then why am I so weak that I cannot just ‘think positive’ or simply ‘not think about it’. Come on, I even go out for drinks every now and then!
If only I didn’t go to the gym just because it became some sort of obsession in the attempt of delaying self-loathing. If only I could sleep more than four hours every night. Or if I could sleep four hours even when I know I will be speaking in front of other people the following day. If only three weeks didn’t go by without setting foot outside (the gym is on the ground floor, so I literally don’t have to go out). If only taking a shower in the morning wasn’t the hardest thing and if only I knew where to find the strength to start my day.
No one, with the exception of my girlfriend, sees any of this. What people saw last year was my sudden return to my home country because I had attempted suicide twice in two weeks (I didn’t succeed the first time, better try a second time. I’m clearly a slow learner). My friends were aghast. Me? Doing something like that? The conversation with them went like this:
«But you’re ok now, right?»
«Yeah, of course»
«All right, that’s the important thing now»
Well, technically I wasn’t even lying. I was back to my normal self. I had never stopped being my normal self. My normal self simply isn’t what they think.
I am lucky enough to have my partner who tries to understand me and my illness and trusts me when she doesn’t. But why did my struggles not to give in to depression become an obstacle to my wellbeing? I’m regularly registered at a GP surgery. I booked multiple appointments and tried to explain what was going on in my head. Still I never got to see a psychiatrist, partly because I managed to drag myself to the doctor’s and my words made sense. I couldn’t be crazy after all.
One of the GPs I saw tried to change my medications five minutes into a seven minutes appointment. An alleged psychiatrist tried to do the same thing over the phone after a very unpleasant conversation in which she should have assessed if I was ‘fit’ to go to their clinic to see a psychiatrist. I wasn’t, because I wasn’t suicidal — yet.
I was offered four sessions of cognitive behavioural therapy (CBT) at a IAPT Centre, a sort of one size fits all approach that is being used in place of a real assessment for anxiety and depression. It didn’t help at all. Not because my therapist wasn’t competent enough, but it wasn’t what I needed, or at least not the only thing I needed.
The one time I have actually managed to see a psychiatrist face-to-face in the three years I’ve lived in the UK — albeit for just four minutes — was while I was half unconscious in the corridor of a hospital after the second attempted suicide. I’ll venture to say it was a bit too late.
The misunderstanding of mental health goes way beyond a lack of resources in the healthcare system. Under what other circumstances would a phone call qualify as a psychiatric assessment, especially when the patients’ medical records include previous suicide attempts?
I was and I am highly functioning. A psychiatrist I saw a few years ago in my home country told me that all those ‘highly functioning individuals’ worried him even more than ‘the crazy ones’. Why? Simple: no one would ever look at us. I sometimes try to think about it from someone else’s perspective. I am actually better off than many who — as far as I can tell — don’t suffer from any mental health problem, which always prompts the inappropriate remarks: «But… Why would you be this sad? Look at what you have!» Oh, don’t I know that.
I am yet to find an effective way of explaining why mental health doesn’t work like that. Not that I have the desire to go up to people and give them a lecture, but there are people around me who need to know. If at some point the whole of society could expand its perspective on mental health I would be much grateful. The more widespread the awareness, the easier it will be for everyone to cope with one’s condition, recover, relapse and recover again. Or at least it would spare us the annoying explanation that I cannot ‘just do it!’ I’m busy loathing myself, thank you very much. But the prospects of my near future require the people around me to rethink their understanding of mental health, right now. The problem still stands: how do I relate to others?
How do I explain to my friends that I cannot go out for drinks because I quit my job after three months of barely opening my eyes at the thought of being around people for eight straight hours? Or that I can’t go out with them, again, because I’m dreading the moment I would have to walk out the door to meet them? How do I tell them I’m not an asshole if I stop replying to their texts or disappear for weeks? And how do I make my doctor understand it’s not enough that I managed to go their surgery and that was the highlight of my day?
Many times I have wondered if I was worsening my condition by keeping up this high-functioning facade at all costs. I scrape by, but what’s in it for me? Most of the time I tell myself it’s a good thing if I manage to do what’s expected of me (by others and myself). But is this me? No, I don’t have multiple selves that swap depending on how severe my depression is. What I mean is that I wonder for whom I’m doing it. It’s clearly not saving me from relapsing into severe depression and anxiety and it’s costing me all the energy I’ve got. Should I aim lower and not even attempt to ‘function well’?
If I read these words I can see a look of contempt on my face. Look at the insignificant problems I’m discussing. It’s true I function well. How could I ever question what I’m doing if I wasn’t actually doing it? It’s not genuinely clear to me what my self-standards are and how attainable they are. What I do know is that I’m not the person I pretend to be and I can no longer hold on to something I’m not, acting as if my illness had taken away my real self from me, but somewhere behind it all I was still there. I see the weary signs of surrender and I can feel my head making room for that kind of emptiness that simply numbs me. Is this what high functioning depression is?
I couldn’t have even conjured these thoughts as little as a year ago. But if you think about it, theses are legitimate questions. What am I gaining from it? Certainly not the actual means to get better.
One might think that when I do what I’ve always done I am just like everyone else. A mental illness doesn’t work like that. It’s not as if I’ve had a cold for six months and then I finally breathe properly for six weeks. Do I breathe like ‘everyone else’ in those six weeks?
I never ever breathe properly and the six weeks when I hardly ever sneeze are costing me everything and ironically are alienating me from anyone who could help me and from those whom I wouldn’t want to shut off.
This struggle is not visible and surely I wouldn’t want it to be. I didn’t recognise it myself for a very long time. It comes down to this: high functioning depression is making it harder to get the help I would benefit from. At the same time it’s the only thing that makes me feel I’m moving forward — at least every now and then. From an outside perspective, I see why my situation is more adaptable to the neurotypical narrative. It makes it easier not to address the existence of mental health issues and it makes it easier for the well-intentioned who are unfortunately mislead by their opinions.
Think about how mental health terminology is being misused. Your neighbour’s son has ADHD, your friend was depressed this morning or he suffers from OCD because he reorganised his sock drawer. I don’t wish to play down people’s struggles or stressful moments, but being diagnosed with depression, bipolarism or anxiety — to mention a few — is what gives a name to someone’s worst enemy. Those same words are the disruption of one’s everyday life, relationships, one’s ability to take care of her body. I appreciate many are aware of the distinction, yet they are co-opting terms that are so differently understood by those who are seriously affected by mental health problems.
I can try to understand how people are thrown off when I put on the act of an average good life and then I dismantle everything when I utter the word ‘depression’. Regardless of what particular exterior face I keep, having to prove the truth to others cannot continue to be an additional burden. I already have enough of my own.
