This article deals with the topic of depression and suicide. Reader discretion is advised.
If you are suffering from severe emotional stress or suicidal thoughts, do not hesitate to seek professional help. You can find information about where to get such help, no matter where you live in the world, on this website: https://befrienders.org/
It is Sunday morning, about between 5 and 6 o’clock, when I am suddenly jolted awake. Instantly, thousands of unfinished tasks flood my mind. I jump out of bed and start moving. This has been happening like this for years.
I do the laundry and take care of the dog and make breakfast. I exercise thinking about the week ahead and how exhausting it will be. I am tired. I am always tired.
Shortly after, my son told me that he had lost his bank card. Actually, it is not a big issue, but something inside me is reacting and suddenly I am crying, telling my husband that I am fed up of this life. “Can you take care of my baby while I’m gone?”
My sudden breakdown was caused by something so small and simple that it scared me.
depression and drive
Two years ago, I was diagnosed with depression. 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 and take care of my family and home, even socializing.
Now I’m in a day clinic, surrounded by people suffering from depression who require enormous amounts of effort for simple tasks like cleaning the dishes. Some people don’t even have the energy to get out of bed. For many of them, going to work, or playing sports, is out of the question.
This is contrary to me. The worse I feel, the more I rush through everyday life. I’ve heard of the non-diagnostic term “high-functioning depression” to describe people who experience depressive symptoms yet maintain their will. On the outside, people who are affected appear efficient and productive. This sums up how my life feels to me: a highly efficient nightmare.
not an official diagnosis
High-functioning depression is not an official diagnosis in the International Classification of Diseases (ICD‑10). Therefore it is not a mental health diagnosis that can be made by a psychiatrist or psychologist.
“I don’t think much about the term ‘high-functioning depression,'” said psychiatrist Ulrich Hegerl, chairman of the board of the German Depression Aid and Suicide Prevention Foundation. “It’s a ridiculous word that keeps coming up again and again.”
Hegerl said that the fact that some individuals remain motivated despite suffering from depression can be attributed to their personality. He said, “Even when they recover, people who suffer from depression remain committed to others – committed, responsible, unwilling to give up and determined to carry on to the last of their strength.”
But, Hegerl said, at home, these types of people go to bed completely exhausted, drained of energy.
“Feelings of exhaustion, constant internal tension, feelings of guilt, appetite disorders, sleep disorders, a tendency to worry – these are all typical symptoms of depression found in people with ‘high-functioning depression,’ just like everyone else,” Hegerl said.
Daniel Heuss, an expert in psychiatry and psychotherapy and head physician of the LVR Clinic in Bonn, also does not use the term. Instead, he said, his clinic diagnoses the severity of depression, classifying it as mild, moderate or severe.
“High-functioning depression is not in the ICD-10,” Huse said. “But that doesn’t mean it doesn’t exist.” However, he said that the patients he has encountered are people who can no longer meet the demands of everyday life and are breaking down.
Depression is hidden behind success!
This is exactly the problem. “I think the biggest misconception is that just because the person is outwardly successful or productive or whatever, that those things make their suffering any less,” said Adrienne McCullers, a psychologist at Rogers Behavioral Health, a network of clinics to treat mental illnesses in Tampa, Florida.
He said the term “high-functioning depression” could help make this form of depression easier to recognize. Many people think: As long as I can get up and get things done, it can’t be that bad. But this is dangerous – depression is the most common factor in suicides in Germany and many other countries.
McCullers also refuted the notion that high-functioning depression is a mild form of the illness. “Many people actually become more motivated or highly productive when they feel those depressive symptoms as a way to cope or avoid them,” he said.
Performance becomes a coping strategy
I experienced it myself. I thought: If I get everything done quickly, the to-do list will be shorter and I won’t feel so overwhelmed. If I keep moving, exhaustion won’t creep up on me until the evening, when I can finally sleep. If I do enough work, I can keep aside the constant guilt I feel toward my family, my coworkers, my friends.
This efficiency and achievement, which is highly praised by society, can be a distraction, said Daniel Wagner, a psychiatrist with his own practice in Cologne.
When the deep pain of depression is hidden behind performance and success, there is often silence and avoidance of silence, Wagner said, “in which a situation becomes apparent that is difficult to bear.”
Mindfulness as a strategy for depression
In therapy, Wagner said, the goal is for patients to “get in touch with their emotions, enable access to emotions and allow regeneration.” This is exactly what mindfulness exercises are good for – psychotherapists call it “organized walking”.
This may include breathing exercises or guided meditation, in which the aim is not to change anything, but simply to be present and observe. Wagner said he integrates such periods of regeneration into his patients’ daily routines in a structured way.
The psychologists of the clinic also proceeded in a similar manner. I found a weekly plan to help me structure each day: work, housework, exercise, and things I enjoy and are good for me. For me, the last point is still the biggest problem and most painful issue.
In peace, my mind becomes louder, emotions become more unpleasant. I want to run away again, to avoid the responsibility of dealing with it myself. It means: to wait, to endure, to do nothing.
This article was originally written in German.