The silent struggle of women with high-functioning depression

While women are rightfully praised for their unwavering strength, there's a hidden battle that often goes unnoticed. Picture: Unsplash/ Emma Simpson

While women are rightfully praised for their unwavering strength, there's a hidden battle that often goes unnoticed. Picture: Unsplash/ Emma Simpson

Published Aug 29, 2023


In the vibrant tapestry of South African culture, there exists a powerful sentiment that resonates with the strength and resilience of women – “Wathint' abafazi, wathint' imbokodo” (You strike a woman, you strike a rock).

But behind the façade of courage, many women find themselves caught in an impossible dilemma – the elusive pursuit of “having it all”.

Juggling a successful career and a stable family seems like an unattainable dream, forcing them to make tough choices and leaving them struggling silently.

While women are rightfully praised for their unwavering strength, there's a hidden battle that often goes unnoticed. Twice as many women experience depression compared to men.

What's even more alarming is that many of these women silently suffer from high-functioning depression, skilfully masking their pain as they navigate through their daily lives.

What is high-functioning depression?

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, does not recognise high-functioning depression as a clinical disorder.

High-functioning depression looks different from major depressive disorder. It is a term commonly used to describe people whose depression is so well hidden that it does not affect their day-to-day functioning.

Depression is the most common mood disorder but it doesn’t affect everyone in the same way. It can range from mild to severe.

According to a recent study in the “Journal of the American Medical Association”, depression often goes untreated, and those with less serious symptoms are less likely to receive treatment compared to those with serious conditions.

Dr Ayanda Mbuli, general manager of Health Policy and Clinical Advisory at AfroCentric Group, provides insights into this deceptive adversary known as high-functioning depression.

It cunningly disguises itself, making it difficult to detect. These women, seemingly leading normal lives, bear the weight of depression without ever revealing their pain.

Dr Ayanda Mbuli, general manager of Health Policy and Clinical Advisory at AfroCentric Group. Picture:Supplied

“This form of depression may be less debilitating than other forms and allow a person to live a relatively ‘normal’ life, maintaining relationships and coping at work.”

Behind closed doors, women with high-functioning depression experience a constant battle within themselves. They may excel in their careers, fulfilling their responsibilities, and appearing perfectly put-together to the outside world.

However, beneath the surface, they grapple with overwhelming feelings of sadness, emptiness, and exhaustion, explained Mbuli.

In South Africa, the prevalence of mental health issues, including high-functioning depression, is concerning.

A survey conducted by the South African Depression and Anxiety Group (Sadag) indicated that around 30% of respondents reported symptoms of depression, and this figure might be higher when taking into account high-functioning depression, where sufferers appear functional on the surface.

Globally, it is estimated that depression affects around 264 million people worldwide, according to the World Health Organization (WHO).

Many of these individuals may be dealing with high-functioning depression, especially in societies that place a strong emphasis on achievement and success.

Why is depression more prevalent in women?

There is evidence to suggest that women have higher biological vulnerability to depression compared to men

A study by the National Institute of Health indicates that depression in women is often associated with hormonal changes, particularly during puberty, before menstruation, following pregnancy, and during perimenopause.

“Women who experience high-functioning depression may excel in their careers, maintain active social lives, and fulfil familial duties while concealing their emotional turmoil. This phenomenon often leads to their struggles being overlooked or dismissed,” said Mbuli.

According to her, South Africa's recent history has been marked by resilience and transformation, but it has also been marred by injustice, discrimination, and social pressures. For women, the burden can be even heavier.

“Traditional gender roles and societal expectations add to the weight they carry, making it harder to express vulnerability. This cultural backdrop can exacerbate high-functioning depression, forcing many women to bear their emotional burdens silently.”

A study published in the “Journal of Psychology South Africa” by Kinyanjui Mungai and Amiena Bayat on high-functioning depression among women in South Africa presents a variety of reasons why black South African women may be more susceptible to chronic depression.

Women in South Africa have less economic and social influence than men and bear significant familial responsibilities. South Africa has a high proportion of single mothers, who must balance family and work obligations.

Mbuli shares some of the key indicators of high-functioning depression that women may experience:

Persistent feelings of sadness: While individuals with high-functioning depression may appear cheerful on the outside, they often battle constant feelings of sadness, emptiness, or hopelessness in their inner world. These emotions can be challenging to manage.

Overwhelming fatigue: Despite managing their responsibilities effectively, those with high-functioning depression may experience extreme fatigue and low energy levels. Simple tasks that were once effortless might become physically and mentally draining.

Decline in interest and pleasure: A noticeable decrease in interest or pleasure in activities that were once enjoyed can signify high-functioning depression. Hobbies, social gatherings, and even personal relationships may lose their appeal.

Difficulty concentrating: High-functioning depression can lead to difficulties in focusing, making decisions, or concentrating on tasks. This can impact work performance, further contributing to the internal struggle.

Disrupted sleep patterns: Insomnia or irregular sleep patterns are common among people with high-functioning depression. On the other hand, some women might find solace in sleep, using it as an escape from emotional distress.

Appetite changes: Fluctuations in appetite, resulting in weight loss or gain, can indicate high-functioning depression. Emotional eating or loss of interest in food may also be observed.

Feelings of guilt or worthlessness: Individuals may experience intense feelings of guilt, worthlessness, or self-criticism, even if there is no objective reason for such emotions. These feelings can contribute to a cycle of negative thoughts and emotions.

Concealed emotional turmoil: Perhaps the most defining characteristic of high-functioning depression is the ability to hide emotional pain behind a facade of normality. Individuals may excel at work, engage in social activities and fulfil responsibilities while privately battling internal distress.

Social withdrawal: While some may maintain social engagements, others might gradually withdraw from friends and family, finding it difficult to engage in meaningful interactions.

Physical health: High-functioning depression can manifest in physical symptoms such as headaches, muscle aches, and digestive problems, further blurring the lines between psychological and physical well-being.

Mbuli said: “Breaking through the walls of silence surrounding high-functioning depression is crucial, especially for the mental well-being of South African women.”

She believes that education is the first high-functioning step towards resolving the problem of high-functioning depression.

Awareness initiatives that highlight the complicated nature of mental health, particularly in the context of depression, can help debunk myths and reduce stigma.

“Additionally, we need to create accessible mental health resources that cater to the diverse needs of South African women. This includes offering counselling services that respect cultural sensitivities and linguistic diversity,” she said.

“Breaking the silence around high-functioning depression is a collective responsibility. Families, communities, and the society at large must unite to create an environment where women feel safe to seek help and embrace their vulnerability.

Remember, the strength to heal often begins with the courage to share the pain.”