"The More 'Proper' a Person Is, the More Dangerous It Is" — The Reality of High-Functioning Depression and Its 'Invisible Limits'

Depression is not necessarily a "disease where you can't do anything."

On the contrary, they wake up in the morning, go to work, speak up in meetings, meet deadlines, fulfill their roles as parents, spouses, and children at home, respond to messages from friends, and post seemingly cheerful updates on social media.

Yet, inside, something is quietly breaking.

The German newspaper WELT featured an interview with psychiatrist Erich Seifritz from the University of Zurich Psychiatric Hospital, highlighting the phenomenon of "high-functioning depression." At the core of the article is the stereotype about depression: that people with depression can't do anything, can't work, can't meet people. While this image is partly true, it is not the whole story.

From the outside, they seem to be functioning. But internally, they suffer from depressive moods, loss of interest, fatigue, insomnia, self-denial, decreased concentration, and agitation. These individuals often convince themselves that they are "still okay." Those around them also overlook the issue, thinking "they're functioning, so they're okay." As a result, the problem tends to become prolonged before it is discovered.

"High-functioning depression" is not an official diagnosis at this time. It is not listed as a separate disease name in diagnostic classifications like ICD or DSM. However, the lack of an official diagnosis does not mean there are no people suffering in reality. In clinical settings, there are people who, while overlapping with mild to moderate depression, chronic depression, burnout, adjustment disorders, and persistent depressive disorders, "function externally but are collapsing internally."

The problem is that these individuals are often slow to seek help.

Depression cannot be judged solely by the "moment of collapse."

The World Health Organization describes depression as a "common mental disorder characterized by prolonged depressive mood or loss of interest or pleasure." It also includes changes in sleep and appetite, fatigue, difficulty concentrating, guilt, feelings of worthlessness, and thoughts of death.

What is important here is that "a complete halt in life" is not the only condition for depression.

Indeed, in severe depression, one may be unable to get up, bathe, eat, or go to work. However, not everyone exhibits symptoms in the same way. Some people can't stop crying. Some feel nothing. Some become irritable. Some can't sleep. Conversely, some can't shake off fatigue no matter how much they sleep.

And some people appear "as usual."

This "as usual" is tricky. To those around them, they appear to be capable, responsible, calm, and never complaining. They themselves also do not want to break this image. Therefore, instead of explaining their struggles, they choose to act as their usual selves.

The state called "high-functioning" does not mean being healthy. Rather, it is a state where they are using a tremendous amount of energy to maintain functionality while carrying pain. The external achievements are maintained, making the internal exhaustion less visible.

The Danger Lies in "Serious, Responsible People Who Don't Ask for Help"

The WELT article introduces expert opinions that high-functioning depression is particularly seen in academic and intellectual professions. This is not a simple matter of education or occupation causing depression. Rather, when long hours of self-management, pressure for results, competitive environments, sensitivity to evaluations, and a culture that doesn't easily forgive failure combine with inherent personality tendencies, the struggle becomes less visible.

Particularly dangerous are people like the following:

They can't be satisfied unless they do things perfectly.
They would rather endure than inconvenience others.
They think expressing weakness is "indulgence."
They feel guilty about resting.
They tend to measure their worth by others' evaluations.
When they fail, they deny themselves rather than the event.
Before saying "it's tough," they think "I have to try harder."

Such personalities are often highly valued in society. They are seen as responsible, serious, reliable, ambitious, and capable of self-management. They are valued at work, relied upon at home, and treated as honor students at school.

However, these strengths sometimes take away the ability to ask for help.

Research has repeatedly pointed out neuroticism, the tendency to experience anxiety, depression, self-criticism, and unstable emotions, as personality traits related to the risk of depression. Additionally, perfectionism, especially "excessive fear of failure," "feeling pressured to be perfect by others," and "strong fixation on mistakes," is easily linked to depressive symptoms.

It is important not to misunderstand that perfectionism itself is entirely bad. Having high goals, working carefully, and fulfilling responsibilities can also be a source of strength in life. The problem arises when it turns into conditional self-worth, such as believing that one has no value if they can't achieve results, that they are unforgivable if they inconvenience others, or that they must not show their weakness.

At that moment, the effort becomes a task to escape self-denial rather than for growth.

"Because They Are 'Functioning,' They Don't Realize They Are Ill"

People with high-functioning depression often explain their discomfort in different terms.

"I'm just a little tired lately."
"It's just a busy period, so it can't be helped."
"It might be due to age."
"I'm just sleep-deprived."
"Everyone else is enduring this much."
"I'm still able to go to work, so it's not depression."

Thus, the possibility of illness is postponed.

In reality, the state of mind cannot be measured solely by whether one can go to work. Even if they can go to work, they can't do anything after returning home. Even if they smile and converse, they are thinking "I want to disappear" in their head. Even if they achieve results, they feel no sense of accomplishment. Even if they can be kind to others, they are extremely harsh on themselves.

When such a state continues, "the real self" and "the self shown to the outside" begin to split within the person. Outside, they are a reliable person. Inside, they are at their limit. The greater this gap becomes, the deeper the sense of loneliness grows.

The reason why posts about high-functioning depression resonate on social media is that this "invisible double life" resonates with the experiences of many people. On forums like Reddit, you can find voices saying, "I go to work and talk to people, but inside I'm empty," "No one can tell from the outside," and "I collapse the moment I get home." On Instagram, posts are spreading that emphasize depression is not just for people bedridden but also for those who work with a smile.

On the other hand, there are cautious reactions on social media. Concerns include whether the term "high-functioning" might trivialize depression, whether it might lead to misunderstandings like "if they're functioning, they're okay," or whether it might increase self-diagnosis and distance people from professional diagnosis and treatment.

These criticisms need to be heard. The term high-functioning depression is not a medical diagnosis. If it walks alone as a convenient label, it risks oversimplifying complex suffering.

However, it is also true that some people only realize "this might be about me" because of this term. The important thing is not to make the term the goal. Instead of self-diagnosing whether one has high-functioning depression, the sign of "functioning yet suffering" should be used as an entry point for consultation or seeking medical advice. That is the proper use.

Empathy Spreading on Social Media: "The Pain No One Notices"

 

Looking at social media reactions, empathy regarding high-functioning depression can be divided into three main categories.

First, the reaction of "that's exactly me."

They continue to work, go to school, take care of their family, and show up for appointments with friends. Yet, their heart remains heavy. They can't find interest in things they used to enjoy. Nothing satisfies them. After meeting people, fatigue overwhelms them when they are alone.

These voices reveal the surprise of those who have convinced themselves "because I'm functioning, I'm not ill." The misconception that depression can only be recognized after life completely falls apart has led them to underestimate their suffering.

Second, the reaction of "not being understood by those around them."

People with high-functioning depression appear normal to those around them. They may even seem exceptional. Therefore, they are told, "You look fine," "You're overthinking," "If you're working, you're okay," "If you were really depressed, you couldn't be so active."

These words further corner the individual. Because they themselves are telling themselves the same things: "If I were truly struggling, I would be more broken," "I'm just being indulgent," "Everyone is enduring." The lack of understanding from others strengthens their inner self-criticism.

Third, the reaction of "the term 'high-functioning' is painful."

The term "high-functioning" sounds like something superior. However, for those affected, it is not a state to be proud of. Rather, it is a state where they are barely holding on to their daily life, not allowed to break even though they feel like they might. On social media, you can find sentiments like "it's not high-functioning, just hiding the limit," or "it's not functioning, just delaying the collapse."

This perspective is important. We should not glorify high-functioning depression as "high ability." Continuing to work while suffering is not a testament to strength; it might be a dangerous state that makes it difficult to connect with support.

Signs That Should Not Be Overlooked

When considering high-functioning depression, what those around should pay attention to is not just "major collapses." Rather, it is the accumulation of small changes.

They respond more slowly than before.
They smile, but their expression is thin.
They excessively blame themselves for mistakes.
They can't do anything on their days off.
"Exhausted" becomes a catchphrase.
Their appetite or sleep rhythm changes.
Their interest in hobbies or socializing wanes.
They jokingly say, "I want to disappear" or "I want to quit everything."
They appear perfect, yet they are always blaming themselves.

Of course, having just one of these doesn't mean it's depression. However, if multiple changes are ongoing, it shouldn't be dismissed as mere fatigue.

For the individual, it's not necessary to assert, "You have depression." Instead, words like "You seem more tired than before," "I'm worried about you," "I'm here to listen if you want to talk," or "Shall we look for a place to consult together?" are more likely to reach them.

Especially for serious and responsible people, being directly worried about can lead to reflexive denial. They might respond with "I'm fine," "I'm just busy," or "I don't want to be a burden." It's important not to take this reaction as rejection. Even if the conversation doesn't resolve things immediately, knowing that someone has noticed can become a support later on.

Treatment Is Not About "Changing Personality"

When it comes to high-functioning depression, the conversation often drifts towards a simplistic conclusion like "just stop being a perfectionist" or "just change your mindset." However, this is dangerous.

Depression is not a weakness of character. It's not a lack of willpower. It is a disease that arises from the interplay of the brain, body, living environment, human relationships, stress, past experiences, and thought patterns.

Treatment involves a combination of psychosocial environmental adjustments, psychotherapy, and medication as needed. Cognitive-behavioral therapy helps individuals recognize self-denying thoughts and extreme interpretations, gradually regaining a realistic perspective. Medication is considered based on the severity and course of symptoms. Reviewing sleep, workload, relationships, and household roles is also important.

The goal here is not to become a different person.

There is no need to abandon responsibility. There is no need to lose ambition. There is no need to deny the attitude of living carefully. However, it is necessary to question whether "responsibility that breaks oneself" is truly responsibility.

Seeking help is not a sign of low ability. Resting is not a loss of value. Expressing weakness is not a nuisance to others. Rather, recognizing one's limits is a technique for living longer.

"Being Proper" Is Not Proof of Health

We overestimate the functionality visible from the outside.

They're going to work, so they're okay.
They're smiling, so they're okay.
They're achieving results, so they're okay.
They're managing the household, so they're okay.
They're updating social media, so they're okay.

However, people can keep moving even while breaking. Especially those who are serious, responsible, and have consistently met expectations cannot stop until just before reaching their limit.

The value of the term high-functioning depression lies in visualizing the "suffering of people who appear healthy." However, it should not be consumed as a buzzword. What is important is that after empathizing with the term, one should reflect on their state and, if necessary, connect with a professional.

If recently, nothing seems enjoyable, fatigue doesn't go away, you can't sleep or sleep too much, your appetite has changed, you can't stop blaming yourself, you can act normal in front of others but collapse when alone, don't leave it unattended just because "you're still functioning."

Depression doesn't become a disease only after collapsing.

The time spent desperately enduring to avoid collapsing might already be a sign that help is needed.

And those of us around should also remember: "The more 'proper' a person is," the harder it might be for them to ask for help. Therefore, it's necessary to pay attention not only to their achievements and smiles but also to their changes.

Invisible suffering is not non-existent suffering.

Noticing it can be the first step toward recovery.

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WELT. The starting point of this article includes an interview article on