Public Bliss, Private Hell

In the aftermath of the death of 30-year-old Cheslie Kryst, Miss USA 2019 and an Emmy-nominated television correspondent, a relatively new mental-health term emerged in 2022: high-functioning depression. This description can't be found in the Diagnostic and Statistical Manual of Mental Health Disorders, so it's not a clinical term. Instead, high-functioning depression is a way to define the extent to which people are struggling. It captures the idea that people can have a mental illness and still look and behave as normal. Tierra Kirkland, a mental health clinician with Hope Community Clinic at Project 658 in Charlotte, North Carolina, sees high-functioning depression "as someone experiencing symptoms of depression but is able to function in a way that is less noticeable to others, as well as sometimes less noticeable to the individual because they operate with ‘business as usual' while suffering internally and silently. So the individual may be perceived as being fine, but once the layers are peeled they are not."Some mental health professionals disagree about how useful the colloquial term is. Some think it helps people realize they're not alone. Others believe it helps to raise awareness that people of wealth and fame can be depressed. Still others think the term might be viewed as a less-serious form of depression. "Because the symptoms of high-functioning depression can appear less severe than those of chronic, severe, major depression," says Althia McLaughlin, a psychotherapist and owner of Well Way Counseling in Charlotte, "many people are unaware that they even have a problem." That's also true for family members, friends, co-workers, even strangers who interact with depressed individuals."High-functioning depression contradicts the image most people think of when they think of depression," says McLaughlin. "People typically envision a depressed person as someone who has a hard time getting out of bed, someone who self-isolates, someone who feels too low-energy to perform well at work or to even maintain employment." Some high-profile athletes have admitted that although they appear normal, they have mental health issues. Many have stepped down from their highly demanding roles to address those issues. They include tennis player Naomi Osaka; gymnast Simone Biles; and NBA players Kevin Love, De Mar De Rozan and Paul George. All of these successful professionals have gone public with their diagnoses and experiences with depression, anxiety and overall mental health, and have sought help. Detecting high-functioning depression in youths can be challenging, says Kwame Dance, doctor of psychology and dean of the health-and-wellness team at Boston Arts Academy, "but there are signs. Acting up, cutting and suicide notes on paper and online, which always must be taken seriously, are some of the ways high-functioning depression manifests in young people."Black adults can articulate their feelings but often don't because of the stigma attached to mental health disorders. However, "there's been a shift in the narrative in our communities," says Karen Craddock, Ph.D., and vice president of programs and community initiatives at The Wellness Collaborative based in Roxbury, Massachusetts. TWC is an interdisciplinary collective working to improve health outcomes of the underserved. "The murder (of) George Floyd and Breanna Taylor, and other violent, virulent and vehement examples of anti-Blackness have been on display. The consequences of those experiences on our community's mental health can no longer be ignored nor denied." ‘Push-through-it' personalities According to McLaughlin, people battling high-functioning depression have "push-through-it" personalities and "are often perfectionists who are unwilling to confront their painful emotions. Or they may feel that what they are experiencing is just in their heads. Within the Black community, the ‘high-functioning' component is particularly prevalent due to the demands often placed on Black Americans to be ‘strong Black women' and ‘strong Black men.'"On the job, the belief that we must work twice as hard as our white colleagues, coupled with other stressors that are common at work, can collide to trigger high-functioning depression. (And) Black people often don't feel that they have permission to ‘give in' to the symptoms of mental illness."

Or as Tierra Kirkland puts it: "This idea of being strong has been the coping strategy that has been utilized to just get through, to survive."Other contributors to high-functioning depression, says Myque Harris, a clinical mental health counselor and integrative psychotherapist with Myque Harris Therapies in Charlotte, are "lack of emotional, financial or other types of resources, like time, or access to care. Some people acknowledge that they need to address their depressed mood but admit they don't have the emotional energy, money for therapy, hours in the day or access to care to fully attend to their concerns." Added to that, says Harris, is the issue of intergenerational mental health. "Research on intergenerational mental health shows how depression and trauma impacts different generations in similar ways. I believe this generation is not the first generation to experience high-functioning depression; it may simply be the first generation to have a name for it."Many Black men and women have seen their parents or family members operate in high-functioning depression. Therefore, they have been exposed to years of this behavior being modeled and it shapes their own behavior."Treatment is crucial for healing"(The pandemic) was a stark reminder that isolation and disconnectedness is unhealthy," says Karen Craddock, a citizen of the Aquinnah Wampanoag Tribe. "Our communities, especially Indigenous ones, are suffering." Treatment will likely involve determining the underlying issues triggering high-function depression. "Whether it's physically or emotionally, we need to explore our underlying affliction to truly heal," says Myque Harris. "High-functioning depression is a sign that a person's "life is out of balance – and has been for too long."

First published in Black Mental Health Today, Summer 2022 (Vol. 4).