Please, let's stop using the term ‘smiling depression’

There they were, all my depressive symptoms laid out in front of me – with any validation I should have felt completely overshadowed by how uncomfortable the term “smiling depression” made me feel.

New research reveals up to 40 per cent of people suffering from depression appear happy and upbeat on the outside, but internally feel hopeless and low – with Google searches for this depressive state, otherwise known as “smiling depression” dramatically increasing this year.

A third of Generation Z’s are permanently quitting social media because of its detrimental impact on their mental health, a pertinent reminder of the immense pressure social media puts on people to curate picture-perfect lives.

Instagram, arguably the most damaging social media platform to our mental health, may be just shy of a decade old, but trying to hide mental illness is nothing new.

It’s an age-old coping mechanism and a by-product of a millennia old stigma: a stigma which “smiling depression” feeds into.

The term “smiling depression” fails to acknowledge the nuances and many faces of depression. It perpetuates the idea that mental health only manifests in extreme forms and risks limiting people's understanding of mental illness to head cluster stock images or someone feverishly beaming away.

Critics might argue “smiling depression” simply summarises the complex nature of being in a depressive state – but we can never be too careful choosing our words.

Just like Piers Morgan’s myopic suggestion to scrap the phrase “mental health” in favour of “mental strength”, conflated mental health with mental weakness; “smiling depression” conflates happiness and pretences with depression.

Smiling is associated with happiness, and at the other end of the spectrum is sadness – yet, being sad and suffering from depression are two entirely different things. “Smiling depression” aligns the performative with a mental health condition, considering some people still don’t “believe” depression is real, we’ve now found ourselves in very murky waters.

The term “smiling depression” is not used by psychologists, with the closest recognised medical term being “atypical depression”.

Despite its misleading name, “atypical depression” is over twice as common in women as men and is more chronic than melancholic depression, with an average earlier onset.

What makes this form of depression “atypical” is the fact that people who have it can experience mood boosts when positive situations arise, whereas individuals affected with melancholic depression do not tend to be susceptible to mood improvements.

Other symptoms of “atypical depression” include increased appetite and weight gain, hypersomnia or insomnia, leaden paralysis and interpersonal rejection sensitivity. Mayo Clinic cites key brain differences and inherited traits as some of the main causes for this condition.

Usually, people with depression experience extremely low energy and struggle to get out of bed in the morning, often meaning they don’t have the energy to act on any suicidal thoughts.

Whereas with atypical depression, energy levels are often unaffected (except when a person is on their own), placing individuals at a greater risk of acting out suicide ideation, as they might possess the energy and motivation to follow through with plans.

“Smiling depression” sounds like an attempt to skirt around depression’s heaviness, making it lighter and more palatable to the mainstream. But shying away from depression’s oppressive nature creates a breeding ground for silence and shame, making individuals more vulnerable to suicide.

Making smiling this condition’s focal point is futile, since smiling often serves the sole purpose of deception among many people with depression. When I first opened up about my mental health struggles, my friend’s stunned cries of "But you're so happy!" and “I never would have guessed!” made the extent of my deceit more alarming – yet this is what makes this depression so hard to understand.

Instead, we must focus on the other symptoms associated with this depressive state, such as restlessness, highly reactive moods and being extremely sensitive to rejection – alongside any events which might have triggered them.

Speaking from personal experience, receiving a course of Cognitive Behaviour Therapy (CBT) through the NHS changed my relationship with my mental health.

Before seeking therapy, I never wanted to burden anyone with my feelings or negativity; I was a master at deflecting “how are you?” and getting friends to discuss their lives, so I could animatedly listen and avoid questions about my own.

I felt ashamed I had so many things in life I was grateful for: a loving family, boyfriend, friends and financial stability – yet I still couldn’t shake this oppressive cloud over me.

I used to rationalise away my mental health issues, thinking if I continued ignoring them they might eventually disappear. But after suffering in silence for over a decade, I came to my lowest point, and could no longer cope on my own.

While my depression will never go away, learning how to manage it has been invaluable. I can now identify my unhealthy thought patterns and have a range of coping mechanisms to put into practice when I’m feeling low. Most importantly, therapy forced me to confront my depression in an environment where no amount of deflection or forced smiles would get past my therapist.

Ironically, the first time I reached out for help and was offered a course of CBT, I turned it down, thinking its more pragmatic approach wouldn’t resonate with me. But I would later learn that it was a better fit for me than counselling.

Of course, CBT does not work for everyone, and a “one size fits all” approach is problematic for individuals who do happen to respond better to counselling or other therapies that are becoming increasingly difficult to access.

Similarly, it’s not as clear-cut as reaching out for therapy and receiving it – with those with severe mental illness waiting up for two years for treatment from the NHS.

We need both the government and the media to acknowledge mental illness is a societal issue, rather than fixating on the individual. There is a deepening mental health crisis looming over all of us, and as hard as the underfunded, understaffed and outdated NHS tries, it is still starved of resources.

The use of mental health stock images in the media, rather than recognising the many nuances of mental illness doesn’t help either. As people continue suffering in silence and face demoralising, long waiting times, we must cultivate an open environment where we can continue having discussions about mental health and fight the stigma, because only then can we even begin to fathom letting these age-old defences down.