By the time mental ill health is visible, it’s probably very bad. The best risk assessment is to listen rather than look
In my everyday life, when I see someone who looks happy, I expect them to feel like that, too. I don’t think about it particularly – it’s a reflex. I glance casually at a smiling face and am reassured that all is well. It takes a conscious effort to remind myself of a fact that psychiatrists know very well on an intellectual level but should perhaps recognise more: a cheerful demeanour can be profoundly misleading.
The concept of the “happy” depressive is familiar in art and life, with examples ranging from Pagliaccio to Robin Williams. It seems strange to think that people can be very depressed – with all the debilitating symptoms that entails – yet manage to hide this, sometimes even from family. Is their depression as real, or as valid, because they manage to go to work, to smile, even to crack a joke? I think it is. There may come a point when even the happy depressive will crack, unable to maintain that facade any longer. But does that mean they suffer less when smiling? No: in fact, the strain of keeping up appearances, the weight of a misplaced sense of responsibility to others, can be one of the most onerous aspects of mental ill health. The loss of the smile may even be a relief.
Rebecca Lawrence is a consultant psychiatrist