Why High Functioning Depression Needs Intensive Treatment
High functioning depression is often an invisible illness that goes undetected by those around you. Indeed, the appearance of full functionality can act as a form of camouflage, keeping your struggle hidden and preventing you from getting the help you need. Because many people delay seeking care or receive inadequate care, a residential mental health program may be the best option for treating your high functioning depression.
I was diagnosed with depression on the same day I found out I got into the top-ranked MFA program in the country. My psychiatrist asked if my grades were suffering, if my creativity was waning, if I lacked motivation, and the answer was no to all of the above. On the drive home, my Lexapro prescription lay pressed against my acceptance letter and on my tongue were two new words: high functioning. And I clung to it.
High functioning became a buffer. Sure, I was depressed, so depressed that sometimes I could not stand it. So depressed that I cried every day while getting ready and every night when I came home and often in between. So depressed that, yes, I did sometimes believe life was not worth living and I dutifully circled a 2 on question 9 of the Beck Depression Inventory: “I would like to kill myself.” The Lexapro didn’t work. Nor did Celexa or Wellubtrin or Effexor. And, yet, “high functioning” provided solace; how bad could it be when I was achieving, when I was exhibiting, when I was brushing my hair every day? I was good even at being depressed.
But high functioning depression doesn’t mean depression lite. In reality, my high function was not a sign that things weren’t so bad but a barrier that kept me and those around me from recognizing how ill I had really become. I didn’t look the way you expect a depressed person to look. I wasn’t missing school. I didn’t stop working—I worked more than ever. I didn’t fall apart in the way you imagine depressed people do. Even when I was self-injuring nearly every day, I didn’t look like an emergency. I looked like an emerging artist and a successful one at that. There would be no intervention for me, no watchful friends worrying that I hadn’t left my bed in a week, and even I missed the steepness of my own descent into acute psychiatric illness. My depression wasn’t broadcasting at the right frequency. No one could hear it.
If you are struggling with depression but remain able to participate in daily life, chances are that you are deeply aware functionality and illness can co-exist. After all, you witness it within yourself every day. But what you and those around you may not realize is that high functioning depression requires intensive treatment.
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Visible vs. Invisible Illness
For young people today, it can be difficult to remember a time when people did not speak about depression. Thanks to astounding awareness-raising efforts by public figures and everyday people, depression has transformed from one of the most deeply stigmatized of illnesses to something ordinary, something common. But even as many of the myths about depression are being dismantled, one of the most damaging misconceptions about depression remains largely intact: that the severity of depression can be measured by loss of function.
It is often said that one of the difficulties with mental illnesses is that we can’t see them; they are invisible illnesses. But that’s isn’t exactly true. We can indeed see some types of depression; when someone’s function is diminished to a point that interferes with everyday living, depression becomes painfully visible. This can manifest in everything from withdrawal from work, school, and social relationships to poor personal hygiene to flat affect. And this visibility lends legitimacy—we believe that people with low-functioning depression are depressed. Their illness becomes observable fact and, as a result, they are more likely to seek and receive help.
High functioning depression, however, often eludes detection. “A lot of people don’t realize that there’s actually a significant difference in depression types,” writes Robert Parmer.
Those with high functioning depression usually struggle less with tasks such as getting out of bed, engaging socially, or working. But that doesn’t make high functioning depression less dangerous than low functioning. In this context, depression is more frequently ignored and buried. It lingers in the backdrop of life, and can quietly fester.
Dr. Carol Landau, clinical professor of psychiatry and human behavior and medicine at Brown University, agrees. “People often say being ‘high functioning’ is better than being low functioning,’ but that’s not really true because the most important thing is for a depressed person to get help—which a high functioning person is limiting herself from.”
Function as Camouflage
High function, then, can act as a kind of camouflage, allowing depression to hide in plain sight. With your illness invisible to those around you, the burden overwhelmingly lies on you to identify and disclose your depression to others, which may be both difficult and painful. It can be tempting to trick yourself into believing you are okay, taking your functionality and achievements as proof. Even if you do confide in others, they may not truly understand the struggle you are going through because they see no outwardly proof of your affliction. Indeed, even mental health professionals may miss important signs of depression in high functioning people due to a heavy focus on functionality.
Amanda Leventhal’s psychiatrist, however, saw the danger of high functioning depression clearly. A star student, Amanda’s depression hadn’t hampered her academic performance by the time she entered the doctor’s office in her junior year of high school. “It’s teens like you who scare me a lot,” her psychiatrist told her. Amanda didn’t understand, but slowly, over the course of years, the answer began to come. In a powerful essay for published on Upworthy, she writes:
It came to me every time I heard a suicide story on the news saying, ‘By all accounts, they were living the perfect life.’ It came to me as I began to share my story and my illness with others, and I was met with reactions of ‘I had no idea’ and ‘I never would have known.’ No matter how many times we are reminded that mental illness doesn’t discriminate, we revert back to a narrow idea of how it should manifest, and that is dangerous. Watching person after person—myself included—slip under the radar of the ‘depression detector’ made me realize where that fear comes from.
And that is the true danger of high functioning depression—that your suffering will be stealthy, leaving infinite missed opportunities for help.
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Treating High Functioning Depression
Because high functioning depression so often flies under the radar, many people either don’t seek help until their condition has progressed to a severe state or their clinician doesn’t recognize the severity of their illness, leading to inadequate treatment. If this is your experience, residential treatment can provide the best path toward recovery.
Residential treatment programs allow you to focus fully on your recovery without the everyday demands you are likely struggling to keep up with or the work you throw yourself into to escape the reality of your pain. Here, you are able to investigate the true nature of your illness without the cloak of achievement and functionality that have kept your illness hidden for so long. In the company of others who share your struggles, you can be truly honest about your depression; you can be seen and you can be heard and both can be tremendously powerful.
Throughout the course of treatment, it is imperative that your treatment providers recognize the ways in which your high level of function affects your experience of depression and how it can be leveraged to improve your prognosis. Your treatment plan should be tailored to your unique situation and draw on your strengths to create a healing experience that speaks to you. In doing so, your functionality can be transformed from a barrier to an opportunity, opening up the door to deep therapeutic engagement and profound personal growth.
Through an intensive, comprehensive curriculum of individual, group, and holistic therapies, you can take control of your depression and develop the coping skills you need to move forward in a healthy and rewarding way. But the best residential treatment programs do more than simply treat your illness—they help you discover who you can be beyond illness. After all, you are more than your diagnosis and there is a whole life out there for you waiting to be lived, one without limits of depression.
Bridges to Recovery offers comprehensive residential treatment for people suffering from mental illness as well as co-occurring substance abuse and eating disorders. Contact us to learn more about our innovative program and how we can help you or your loved one start on the path to healing.
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