Depression hidden behind functioning and success

Sunday morning. Somewhere between five and six I wake up abruptly. My head immediately has a thousand things to do - I jump out of bed. It's been like this for years. Laundry, dog, breakfast. I go for a run and think about the upcoming week and how hard it's going to be. I'm tired. Actually, I'm always tired.

Soon after, my son tells me he lost his bank card. A small thing. Really. But a movie starts inside me. I can't stop crying and tell my husband that I'm done with this life. "Can you take care of our child if I'm gone?"

A trivial trigger. And that's what scares me. But suicidal thoughts don't bother me - quite the opposite. They bring me peace. They act as a solution, an exit strategy from a life that brings no joy, that feels only more heavy, empty and exhausting.

"Depression" looks different to me

I was diagnosed with depression two years ago. I go to therapy once a week. For a long time I thought that was enough. After all, I was always able to go to work, take care of my family and household, and maintain social contacts.

Now I'm in a day clinic and surrounded by people who find it a huge effort to empty the dishwasher. Who some days don't even get out of bed. Who haven't even thought about work or sports for a long time.

My problem is the opposite: the worse I get, the faster I move and rush through everyday life. I hear the term “high-functioning depression” somewhere. Here, the sluggishness that often accompanies depression is missing. Sufferers seem able-bodied and productive. That term describes how I experience my life: as a nightmare tailored to efficiency.

Depression is depression.

In the international classification of diseases, this term does not exist. So, it is not an official diagnosis made by psychiatrists or psychologists. Ulrich Hegerl is a psychiatrist and chairman of the board of the Foundation for Helping People with Depression and Preventing Suicide in Germany. Depression is depression, he says.

"I don't put much weight on the term 'high-functioning depression,' it's just a buzzword that always comes around."

The fact that people continue to function for a long time despite depression is explained by their personality:

"People who suffer from depression are often people who are there for others, who are committed, who are very responsible, who don't want to disappoint anyone, and that's why they often continue to achieve results even with their last strength."

"At home, they collapse into bed, completely exhausted," says Hegerl. And that's when productivity is over.

"Feelings of exhaustion, constant inner tension, feelings of guilt, appetite disorders, sleep problems, a tendency to overthink - we find all the typical symptoms of depression in people with 'high-functioning depression' as well as in everyone else," says the psychiatrist.

Daniel Heiss, a specialist in psychiatry and psychotherapy and head of the department of general psychiatry at the LVR clinic in Bonn, does not use the term in practice either. The clinic speaks of mild, moderate or severe depression.

"We don't find high-functioning depression in ICD-10. But that doesn't mean it doesn't exist," says Heiss. It's possible that people who meet the diagnostic criteria for depression but still manage to lead a normal life aren't seen in hospitals at all. It's more likely that people who can no longer cope with the demands of everyday life end up in hospitals.

A millimeter away from a complete breakdown

"The biggest misconception is that someone's suffering is minimized just because they appear successful or productive on the outside," says Adriana McCullars, a doctor of psychology at a network of clinics in Florida that treat mental disorders.

He believes that the term "high-functioning depression" can help make this form more visible - a form that is often overlooked. Even among sufferers themselves. Many think: as long as I can get up and do my chores, it can't be that bad.

But it's dangerous: depression is the most common cause of suicide in Germany.

Adriana Mekalars also disputes the assumption that high-functioning depression is automatically a milder form of the illness. “Some people, when they have symptoms of depression, become overactive or overproductive — as a way to cope with those symptoms.”

That's how I experienced it myself. I thought: if I get everything done quickly, my to-do list will be shorter and my feeling of being overwhelmed will decrease. If I stay on the move, I won't be tired until the evening and I'll be able to sleep. If I work hard enough, I can keep that nagging feeling of guilt that I constantly feel under control - towards my family, colleagues, friends.

"Organized doing nothing"

This functioning and constant achievement of results, which society values ​​highly, can be a form of distraction, says Daniel Wagner, a psychological psychotherapist with his own practice in Cologne.

When the deep suffering of depression hides behind high performance and success, it is often because silence and peace are avoided “where a state of being that is difficult to bear becomes apparent,” says Wagner.

In behavioral therapy, we work with such people to feel, to allow them to access their emotions, and to allow them to recover. Mindfulness exercises are designed to do just that — the psychotherapist calls it “organized doing nothing.”

In psychoanalysis, we go deeper and ask the question: why is this so? What is the "guilt" that drives such activity?

However, behavioral therapy can also help with breathing exercises or guided meditations, where the goal is not to change anything, but simply to be present and observe. Vagner says he systematically incorporates such phases of recovery into his patients' daily schedules.

Escape from facing oneself

The psychologists at the clinic did something similar. I was given a weekly plan to structure my time every day: work, household chores, sports, and things that bring me pleasure and benefit. For me, that last point is still the biggest problem and the most painful place.

In silence, my thoughts become louder and my feelings more unpleasant. I would rather start running again, and run away from the responsibility of facing myself. That means: stop, endure, do nothing.

This text deals with topics such as depression and suicide and can be emotionally demanding. If you are feeling affected or having suicidal thoughts yourself, it is important to seek help.