- High-Functioning Depression: An Invisible Illness with Unique Risks
- Dealing with High-Functioning Depression
- Therapists, Therapy, and Therapists in Therapy
- Overcoming Mental Health Stigma
- Combatting Depressive Episodes
- Other Coping Methods
- Accepting Your Mental Health
- Seeing is Believing: The Challenge of an Invisible Illness
- Lost and Found: 5 Ways to Overcome The Pain of Invisibility
- 1. Discover your values
- 2. Switch it up
- 3. Affirm yourself
- 4. Crash a boundary
- 5. Find a therapist
- How to Support Those with Invisible Illnesses
- What is an invisible illness?
- Common Invisible Illnesses
- Challenges of Living with an Invisible Illness
- Common Misconceptions
- How to Support Others with Invisible Illnesses
High-Functioning Depression: An Invisible Illness with Unique Risks
I had a difficult time beginning this piece because the topic hit very close to home. I’ve suffered from depression pretty much my entire life.
I have supportive and loving friends, family, meaningful work and engaging hobbies. I have a good appetite and sleep through the night—albeit with a few pee breaks and the occasional need for melatonin gummies.
While there are periods I exist in a miasma of sadness, more commonly my daily experience is a slight impairment of an ability to fully enjoy life. There is an ever-present emotional chalkboard scrape reminding me that to live means to co-exist with knowledge of human and animal suffering that I cannot prevent.
Which is why I won’t leave home without my daily anti-depressant. (I’ve been taking medication for more than a decade.)
Dealing with High-Functioning Depression
My situation is far from rare. Over 6.7% of adults in the United States—16.2 million!—endure at least one major depressive episode annually. My brand of misery—dysthymia, known as chronic low-level depression, occurs in 1.5% of adults in the United States annually.
While the stigma against seeking mental health treatment is lessening, there remain some dangerous myths. Such as that if depression isn’t severe and persistent—involving frequent bouts of uncontrollable weeping, emotional paralysis, and suicidal thoughts—then there isn’t a real problem and one should just tolerate pain with stiff-lipped silence.
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Indeed, the catch-22 of high-functioning depression is that sufferers often believe that since they can push through their sadness while barely missing a step, it would be indulgent to seek help. But that’s believing one’s own happy-on-the-surface social media status updates.
Therapists, Therapy, and Therapists in Therapy
Ashley has extensive professional and personal experience in coping with high-functioning depression. The Nashville-based therapist admits, “I started therapy as an adolescent and began taking psych meds as a young adult.” Ashley, who started her private practice 10 years ago, adds, “The meds allow me to feel normal, myself.”
The therapist has many friends, including mental health professionals who take psych meds and/or are in therapy for depression and anxiety. She explains, “Many of my patients are high-functioning. You’d see them on the street and not know something is wrong.”
Awareness of what depression and anxiety feel helps Ashley get into the psyche of her patients. But she suffers bouts of self-stigma over what sometimes feels a clash between her professional and personal selves. She admits, laughing, “Once I mentioned to my shrink I felt shame about being a therapist and in treatment. My therapist said, “Ashley, I’m in therapy too.”
Overcoming Mental Health Stigma
Myths and misinformation about mental illness delayed Claire’s depression diagnosis until age 20. “I had certain characteristics of depression as a teenager, such as irritability and crying jags, but my parents wouldn’t take me for help. They figured, ‘Oh, you’re a girl. You’re just emotional.’”
Now, at age 26, Claire manages to hold down a high-stress job as a legal office manager for a multimillion-dollar law firm despite battling not only a depressive disorder but also type 1 diabetes and kidney disease.
She says, “There are times when depression affects my productivity because it’s so intrusive. I’m fine, until all of a sudden I’m not. I try to stay on top of my meds as much as possible.”
Therapy has helped her identify triggers such, as “negative thought trains” and lethargy, that signal a potential oncoming depressive episode.
Another major trigger is her physical health.
“I can run a million dollar law firm but I sometimes feel as if I can’t make my body work,” Claire sighs adding, “I might be having back pain, kidney stones, and/or unstable blood sugar.
” Summer is especially difficult for Claire: “When the weather’s nice and everyone is outdoors enjoying physical activity or socializing and I’m not well, I feel really left out.”
Combatting Depressive Episodes
Claire now has an array of coping mechanisms, such as journaling, to help forestall major emotional slides. Other helpful activities that relax and focus her include cooking and exercise. “I’ve heard meditation is very good for depression, but I’m afraid it will turn into rumination. That can be a slippery slope for me. I’d rather distract myself.”
Claire’s primary “distraction” is burying herself in her consuming job. “I work 11 hours a day. For me, being productive gives me a purpose, which helps mitigate some of the depression.” (Other common forms of distraction people might resort to as a way to avoid tough emotions include hobbies, playing video games and drinking or using drugs.)
She has good days and knows how to handle the bad ones. Still: “I know I’m never going to wake up and say, ‘I don’t have depression.’”
Other Coping Methods
*Ellen calls herself, “A high-functioning person who also has bipolar disorder.” Seven years ago, the now 36-year-old, experienced a b mania as a reaction to an anti-depressant she was taking. Being a problem-solver, the financial executive, wife, mother and perennial volunteer leaped into action to find a way to “bail out the leaky ship.”
These days she employs “a variety of techniques” to keep herself well. “I can tell the difference when I slough off. It’s not recovery, but an ongoing journey.”
She goes to therapy (psychodynamic and occasionally EMDR, a type of therapy involving eye movements) sees her psychiatrist, exercises, gets acupuncture and allows herself to sleep more than average knowing fatigue is a side effect of the psych meds. Ellen says, “I have occasional bouts of depression but over-all I’m doing really well.”
Accepting Your Mental Health
The secret ingredient to Ellen feeling content, she says, is acceptance of her illness. When depression bites at her, Ellen is gentle with herself. “I enjoy my fast-paced life and normally being busy helps combat the sadness, but when I need to I give myself permission to slow down, play with my daughter, take a day or two off from work…
She explains, “I can hide my depression so well that people around me have no idea what I’m dealing with unless I clue them in.
What I wish everyone realized is that allowing yourself to reach out for help is half the battle.
The other half is continuing to help yourself because depression can always be there waiting to trick you with these awful, untrue thoughts : ‘You’re worthless,’ ‘You’re no good,’ ‘No one cares.’”
Seeing is Believing: The Challenge of an Invisible Illness
For people with high-functioning depression, the “invisible illness” aspect of the mental state can feel particularly searing. A few years ago, after shoulder surgery, my arm was in a sling. People fell over themselves to cluck with sympathy at my pain—socially sanctioned pain. It felt good to be the object of so much caring.
But on the days when listening to the sorrows of others exacerbates my own and I feel spent, I typically stay silent, not wanting to advertise my own vulnerability. Why is it so much easier to let others in on pain when it’s physical?
It was difficult to begin this article, but writing it has helped free me from a shame-shackle: My name is Sherry and I’ve suffered from depression pretty much my entire life. And I’m okay with that. My mental struggles have made me a more insightful, caring person and a better therapist than I would have been with fewer cracks beneath my emotional veneer.
*Name and identifying details changed
Lost and Found: 5 Ways to Overcome The Pain of Invisibility
“It is joy to be hidden, but disaster not to be found”.
“She’s super shy,” Serena said. She’d met Pearl a few times, at the Richardsons’, but hadn’t yet heard her say a word. “She probably just doesn’t know how to make friends.”
“It’s more than that,” Lexie mused. “It’s she’s trying not to be seen. she wants to hide in plain sight.”
Little Fires Everywhere, Celeste Ng
The experience of ‘hiding’ and ‘being found’ begins in childhood, with the age-old game of hide and seek. The game often ends with squeals of delight when a young child is discovered – but what happens when the game is long over, and you are never found. Or when you’re left feeling that you don’t deserve to be found.
One thing I often hear from my clients is that they feel ‘seen’ by me. This means a great deal to them as, despite their considerable success, these entrepreneurs and business leaders often feel ‘invisible’.
For them invisibility means not being seen for who they really are, or for what they truly care about.
To ‘fit in’ these people create a false-self, the person they believe deserves to be found leaving their true self hiding in plain sight.
Feeling invisible is a painful experience. It’s often related to the belief that we are ‘not enough’ as we are, or that we are an imposter: the constant fear someone in authority will tap us on the shoulder and say they made a mistake hiring, promoting, or just being friends with us.
How do we give ourselves the gift of being found, or of being enough? Buddhist psychotherapist Mark Epstein believes that being found requires we let go of ‘doing’ – our neurotic ambition that sees our self-worth inextricably linked to our achievements – and focus instead on ‘being’.
The sometimes difficult, painful self-awareness of the hurts and slights we have suffered and the need to face and own them.
Donald Winnicott, a London pediatrician and psychoanalyst defined the difference between doing and being in terms of having a ‘False’ or a ’True’ self. If we have a false self we want to fit-in, to be accepted at any cost.
A good way to think about the ‘False’ self is to use the story of Procrustes. In Greek mythology Procrustes was an inn keeper with a difference. He boasted that his beds would perfectly match the size and shape of any guest.
What Procrustes didn’t volunteer was the method by which his “one-size-fits-all” was achieved; namely, as soon as a guest lay down, Procrustes went to work, stretching him on a rack if he was too short for the bed and chopping off his legs if he was too long.
While we may not actually check ourselves into Procrustes inn, our fear of being found (out) or of not being enough drives us to painfully stretch or censor parts of ourselves. What’s more, we are often unaware we are hiding our true selves and living out someone else’s expectations.
On the other hand, our true self is vital, creative and visible. We unapologetically and unselfconsciously embrace all sides of ourselves; we don’t need to use precious energy hiding or fitting in.
You might be thinking, ‘why wouldn’t all of us choose to have a true self?’ The problem for a number of people is they don’t have the confidence, self-awareness or ego strength to make that positive choice.
1. Discover your values
As hard as it might be to accept, hiding behind a false self is a choice. By discovering what you value you will have a greater capacity to make choices more in line with your true self next time you feel ‘less than’ or an imposter.
Psychologists call certain types of situations that challenge our values ‘choice points’. For example, imagine you are in a meeting and someone interrupts or constantly talks over you. Or perhaps it’s an out-of-work-situation and you’re feeling exposed and alone.
When these kinds of situations happen you can choose to sit quietly and be ignored, continuing to feel isolated and vulnerable, or you can make a different decision, one that is more in keeping with the type of person you want to be and who is living his or her values.
Here’s an exclusive link to an excerpt from a course I have created that will help you start identifying your values, and a roadmap to making healthier choices.
2. Switch it up
Small changes matter. One of the things people do who want to hide out is to make sure they don’t wear anything that calls attention to themselves or hints at their individuality.
I once had a client who made the decision to switch from dark colored outfits to more colorful, expressive choices in order to feel more in touch with her true self.
It was a small change but a huge win for her growing sense of self confidence and personal expression. What small, incremental changes could you start to move into the spotlight?
3. Affirm yourself
This isn’t a hallmark moment, it’s an opportunity to remind yourself of what you and the world are missing by hiding out. Think about your values, strengths or beliefs. You will have a number of these.
Spend some time putting these words into a phrase of statement.
Some examples of ‘authentic’ affirmation’s are illustrated in the statements that some adult survivors of American Foster Care System came up with:
- “I am evidence change is possible”
- “Can’t give up”
- “ I have the power to say no”
- “I choose life”
- “I choose grace”
- “A dominant spirit”
4. Crash a boundary
One other behavior utilized by people who want to avoid being ‘seen’ is to censor parts of themselves. Typically, censorship happens whenever they go to work, school or hang-out with friends or family. They may have a great sense of humor or a deep knowledge of a particular topic, but these attributes are kept under wraps.
One way to begin to be seen (and heard) is to crash a few of these self-imposed boundaries. What parts of yourself do you keep hidden or censor? How might you make a hard decision to crash through this boundary? It might be wearing something you love but feel too visible in; it could be sharing a belief or point of view with friends or family that you feel may be contentious.
Or it could simply be the act of showing up
5. Find a therapist
Seriously. A compassionate, gifted practitioner can help you discover how to access your true self. For some, myself included it can be a painful but ultimately life changing decision. Here’s a case study that captures beautifully the transition from living with a false self to owning a true self.
Sharon was a 44-year-old who was suffering with, “intense feelings of hopelessness, meaninglessness and emotional depletion”. She had learnt that to survive in her family of origin she needed to create a compliant, False Self. As an adult she had an extraordinary need for control, was highly self-sufficient and had little need for approval from others.
On the face of it these seem very positive attributes. However, Sharon was also, “Generally unrealistic about her abilities, feeling superhuman in her ability to handle anything, while at the same time feeling helpless and incompetent.” No amount of self-help books would help Sharon.
She needed the stability and skills of a psychotherapist to penetrate the shell of her false self and help her true self emerge.
Taking the time to ‘find’ yourself means you can let go of the constant feeling that you are a round peg having to fit in a square hole. It takes courage to feel you deserve to be found and that you are worth being ‘seen’, but it’s easier than living a life hidden behind the curtain of your false self.
How to Support Those with Invisible Illnesses
How to Support Those with Invisible Illnesses
Imagine suffering from debilitating chronic pain. Every step you take causes discomfort, and it’s perpetually at the forefront of your mind.
The internal battle you’re fighting takes mental and physical energy and just going through daily tasks can be debilitating.
However, those looking at you may have no indication you’re suffering, let alone that you have a chronic disease. You suffer from an invisible illness.
What is an invisible illness?
An invisible illness is one that does not exhibit externally visible signs or symptoms. Those with invisible illnesses and disabilities may have symptoms such as pain, fatigue, dizziness, weakness, or mental health disorders. Many of these conditions deeply impact the people suffering, but show no obvious signs to an outside observer.
By 2020, the US Department of Health and Human Services estimates that 157 million Americans will be afflicted with a chronic illness and the US Census Bureau estimates 96% of chronic illnesses are invisible.
Invisible illnesses disproportionately impact women and many are not yet well understood by health care providers or the general public.
This lack of understanding inevitably contributes to feelings of isolation and hopelessness for those suffering from such conditions.
Common Invisible Illnesses
A vast majority of chronic illnesses are invisible. Some examples of invisible illnesses include:
- Allergies and food intolerances
- Arthritis, especially rheumatoid
- Chronic Fatigue Syndrome
- Depression and mental illness
- Digestive disorders such as Celiac, colitis, and irritable bowel syndrome (IBS)
- Migraine and headache sufferers
- Heart conditions
- Lyme Disease
- Multiple Sclerosis
- Sjogren’s Syndrome
Simply because external observers can’t see symptoms of these very real illnesses, they may be less empathetic and understanding of the people suffering from them.
In a series of focus groups conducted in 1999 by the National Pain Foundation (NPF), lack of validation (belief the patient was suffering what the patient said they were suffering) was identified as the most significant challenge faced by people in pain.
Challenges of Living with an Invisible Illness
In addition to the various symptoms of a chronic and invisible illness, people suffering from these illnesses can also experience frustration, guilt, exhaustion and embarrassment.
For those diagnosed with an illness at a young age, the common stereotype that younger populations are supposed to be healthy makes it especially difficult. For those diagnosed later in life, many feel guilty they are unable to more actively participate in the lives of their families and be active with their children and grandchildren.
Invisible illnesses impact people in all aspects of their lives, personally and professionally. They can severely impact ability to routinely work and may lead to social isolation and depression.
Nearly all of those experiencing an invisible illness have to deal with common misconceptions regarding their condition. Here are just a few of those most frequently dealt with.
- The way a person looks reflects how they’re feeling physically. Someone may look healthy, but that doesn’t mean they are.
- Invisible illnesses are ‘all in the person’s head.’ Keeping stress at a minimum may reduce symptoms of a chronic illness, but it doesn’t mean the root cause of the disease is psychological.
- Resting up will make people feel better. Just as people not suffering from chronic or invisible illness are unable to bank sleep (rest for a long period of time in order to recoup or “make-up” sleep or to expend extra energy), neither are those with chronic illnesses. The same amount of rest leading up to different events, on different days, may not yield the same results, as symptoms ebb and flow, often unpredictably.
- If a person suffering from a chronic illness is enjoying themselves, they must feel ok. Don’t assume a person who’s enjoying themselves, laughing, and participating in activities is symptom-free. Many people have learned to cope with their symptoms to participate in important events and activities, but that does not mean they are feeling well.
- Stress reduction techniques are a cure for chronic pain and illness. While these techniques may assist with symptom relief, they are not a cure-all.
- Being home all day is a dream lifestyle. Being home all day, but in constant pain and suffering from an invisible illness does not make for a dream lifestyle, regardless of location. Many people are often couch-bound or bed-bound due to extreme pain. They also experience boredom, as not being able to actively participate in the world around them can be frustrating and disappointing.
How to Support Others with Invisible Illnesses
If you know someone with an invisible illness, there are several things you can do to support them. It’s important to remember everyone wants to enjoy life and no one wants to be a burden; however, people suffering from chronic and invisible illnesses do appreciate your support and understanding.
- Accept you are powerless to make them better. Your love and understanding are what they need.
- Take time to talk to them and learn about their illness. Ask questions about symptoms and treatments, and be patient. The more you learn, the better you’ll be able to understand and show empathy.
- Be with them when they need it and give them space when they want it. Many chronic illnesses become socially isolating, as people are house-bound or lose companions due to the lack of understanding around invisible illnesses. Being around and accessible may be one of the best support methods available.
- Try not to get frustrated. One of the biggest challenges associated with invisible illnesses is you get sick and then you continue to get sick, the cycle does not stop. At times, this may get frustrating to care givers and it’s important for them to realize it’s normal for people suffering this way to be emotionally needy, distant, angry, or sad.
The experts at NWPC specialize in the care and treatment of a variety of invisible illnesses. For resources, support, and additional information, we’re here to help.