When Depression Smiles

By: Rick Qualls

I was smiling, at least I thought I was. Although depressed, I was a high functioning depressive. Occasionally it would overwhelm me, but for the most part I wore a mask. A mask was so intertwined with my personality I couldn’t tell where the it ended and the real me began.

Smiling depression, sometimes called high functioning depression, is still depression and needs treatment. Depression is an illness. It is an illness that affects you physically, mentally, and spiritually.

I was doing all of the pastor things, preaching, counseling, funerals, and helping people with grief.  It went on long enough that I didn’t know I was depressed. Able to do virtually all of my pastoral tasks, most people thought I was just a bit moody, but I thought it was well hidden.

What does high functioning depression look like?

Often, behind a well constructed facade there is anxiety that may have been there for years. Anxieties reach levels that interfere with daily life. The smiling mask is worn and our inner world may be hidden from even those the closest to us. There is great fear that loved ones or fellow employees may, without intending, unmask us.

There is a Bible verse that helps me remember that God cares about my inner world.

“You have turned for me my mourning into dancing; you have loosed my sackcloth and clothed me with gladness,“ Psalm 30:11 ESV  The sadness can be changed.

But when you are depressed joy is lost. People can’t tell. You may have loss of pleasure in the things you once enjoyed. Activities with others feel as a burden to avoid. It is easier to lose oneself in work where the mask can stay firmly in place.

Self criticism and perfectionism go hand in hand with depression. What may look like having high standards to others are actually feelings of worthlessness that drive you to pursue high standards. But your accomplishments are never enough.

Decreased energy plagues you. There are times life cannot be handled. It takes all your strength and motivation just to get through the day. The Bible reminds me that depression does destroy my inner life.

“The thief comes only to steal and kill and destroy. I came that they may have life and have it abundantly.” John 10:10 ESV

Sadness is hidden behind the mask. This sadness cannot be pinpointed. It is just there. Most days it is manageable. Others are difficult to function.

High functioning depressives are often surprised to discover that they could be be depressed.

All of these things describe how I lived for years. It lasted  until—I couldn’t do it anymore. It took several years of treatment before I was correctly diagnosed as having bipolar 2. Bipolar 2 is experienced as an intense form of depression. The manic states are not very noticeable but the depression side of the disease is extreme.

In time my doctor and I discovered the correct meds to treat the illness. With medication I am able to function without a mask hiding my inner life. Smiles are genuine not faked.

What to do if you think you might be a smiling depressive? The first step is to find a therapist. There are many types of depression and a therapist trained in discerning the types of depression is important.

Engaging both a psychiatrist and counselor helps to combat your depression in two ways. A psychiatrist is a specialized medical doctor able to prescribe medications for mental illness.

A counselor helps you manage your inner world, feelings, and thinking processes in a healthy manner and help you change negative thinking patterns. A verse that reminds me of the importance of the patterns of thinking is Romans 12:2:  “Do not be conformed to this world, but be transformed by the renewal of your mind, that by testing you may discern what is the will of God, what is good and acceptable and perfect.”

Be patient it may take time. But becoming healthy is worth the effort.

“But they who wait for the Lord shall renew their strength; they shall mount up with wings like eagles; they shall run and not be weary; they shall walk and not faint.” Isaiah 40:31 ESV

After I was able to get a correct diagnosis and on correct meds I was able to continue my last years as a pastor being real with people. How did people respond to learning of my illness?  There were all kinds of reactions but it opened a ministry to people who were quietly suffering from various issues. Out of illness came good.

May your smile may be real. May it reveal an inner world of joy and healing.

“May the God of hope fill you with all joy and peace in believing, so that by the power of the Holy Spirit you may abound in hope.” Romans 15:13 ESV


Fresh Hope is a faith-based non-profit that empowers people to live well in spite of their mental health challenge.

YOUR gift will provide a person with God’s Fresh HOPE for daily living. Click here to donate, today.


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