【Special topic on smiling depression】During the day, normal and evening collapse, smiling depression is more lethal | Good doctor
(Kuala Lumpur) Smiling depression or high functioning depression is a very common type of depression nowadays.
It is more harmful or dangerous than typical depression, because its symptoms are almost invisible, and patients either do not realize it or choose to avoid treatment.
Therefore, it is easy to miss the golden opportunity for treatment, which eventually leads to unnecessary tragedy.
In the medical literature of psychiatry, smiling depression (smiling depression) or high functioning depression (high functioning depression) is not clearly documented, but for psychiatrists or psychotherapists, it is not only an adjective, but also a It is really happening in different corners of this society.
Psychiatrists often come into contact with cases in outpatient clinics, but compared with cases that are really lurking in different corners of society, outpatient cases only account for the tip of the iceberg.
Compared with general depression or typical symptoms of depression, the biggest difference between smiling depression is that the former can go to work and live like a normal person, and there is hardly any abnormality in appearance. In short, there is a problem of depression. But it hides like a normal person, so some doctors also call smiling depression atypical depression.
Dr. Seed Hon Fei, a psychiatric consultant, pointed out that typical symptoms of depression include depression, lack of motivation to do things, sleep and eating problems, and thoughts of self-harm or suicide. However, smiling depression looks like ordinary people, but behind the smile, the heart is already scarred, full of melancholy and sadness.
“The most direct example is that after many suicide cases, the family members confessed after the tragedy that they didn’t notice anything wrong with the deceased. They went to work like normal people, talking and laughing, but they didn’t know why they committed suicide. The deceased may have suffered from smiling depression during his lifetime.”
Asked whether trained psychiatrists can observe smiling hypochondriacs?
He said that it is necessary to pay special attention to find some clues, and then in-depth tracking can give correct diagnosis and treatment, so it is difficult to diagnose.
“However, fortunately, in recent years, people have begun to understand and accept mental illness. Some patients will actively seek help after realizing that they have symptoms of depression in their hearts. According to the description of the patients, neither family members nor colleagues can see that they have’ illness’, but they know very well that there is ‘really something wrong’ with them, but they can’t describe it, so they will choose to seek medical treatment.”
He pointed out that the inability to recognize smiling depression in time is one of the difficulties in treatment, because compared with general depression, when family members or colleagues notice that the patient is inappropriate, such as behavior or facial expressions, they usually encourage or assist the patient to go Seek medical attention.
“However, patients with smiling depression lack support in this regard, so they often just bear the harm silently. Because the patients do not receive appropriate treatment in time, many times when the condition deteriorates to a certain extent, the patients go nowhere. Lu, this is also the most painful moment for doctors.”
Afraid of being discriminated against and afraid to seek medical treatment
Then why do patients with smiling depression “hide” their true illness?
“There are several factors, including the lack of acceptance of mental illness in Malaysian society and insufficient awareness of mental illness, and the psychological barriers of the patients themselves.”
He revealed that in Malaysia, when a person goes to see a psychiatrist, he will worry about being discriminated against by people around him, including colleagues or classmates, whether he will become a monster in the eyes of others, etc.
“At the same time, he is also worried about whether he will affect his family if he has a mental illness, so he will have unnecessary guilt or self-blame. For those patients who often show themselves as ‘big brother’ or ‘big sister’, they have always been the ones who take care of others. , it is not easy for them to switch to the one who is being cared for now.”
He said that some patients do not know that they have the symptoms of early depression, do not know how to ask for help and who to ask for help, so they think that as long as they continue to maintain a superficially happy or laughing haha, the condition will disappear as time goes by. Improvement, as everyone knows, this is just a delay in the disease.
In addition, some patients will feel, “If people know that I have depression, I will be looked down upon.” Therefore, they are reluctant to receive treatment, and in the thinking of these patients, they will assume that others will treat them because of their depression. And look down on him, see him as weak or incompetent or even stupid or crazy.
“In order not to let others make fun of him, he firmly denied that he had depression and chose to wear a mask. Therefore, smiling depression is sometimes called masked depression or masked depression. When he was at work, he was just like a normal person, but when he got home after get off work, his heart just broke down.”
Suicide rate among patients with thoughtful mobility is high
Compared with typical depression, smiling depression has another more dangerous feature, that is, the patient has both thinking and action.
Therefore, the probability of suicide will be higher and relatively more dangerous.
Xue Hanfei pointed out that the typical symptoms of depression patients include depression and lack of motivation. Even if he has suicidal thoughts, he still lacks the motivation to commit suicide. When going out to meet with friends, etc., the physical fitness is relatively good. Once the idea of suicide occurs, it will be executed quickly, which is likely to lead to tragedy.
Cases increase due to coronavirus outbreak
For doctors, smiling blues has been around for a long time, and with the outbreak of COVID-19, cases of smiling blues have only increased, not decreased.
“When I studied the information on smiling depression, I saw similar patients every time I went to the outpatient clinic. They were no different from normal people during the consultation, but once I got a deeper understanding, I found that many patients were consistent with the symptoms of depression. And this is only the patients who come to seek medical treatment, not including those who do not know that they have suffered from depression or are unwilling to seek medical treatment, so it is conceivable how many patients with smiling depression are actually around you and me.”
He emphasized that there are still some supervisors or bosses who have prejudice against mental illness in the workplace in Malaysia. To put it bluntly, they discriminate against employees with mental illness. Because of this, employees with depression are worried. Doctors may no longer be reused, or they may be dismissed so that their jobs will not be guaranteed.
“In fact, compared with foreign countries such as Europe and the United States, local people have a certain awareness of mental illness, so they regard mental illness as part of health. When employees tell them to consult a psychiatrist, it is as normal as going to see a family doctor when they are sick. .”
“However, the national conditions in Malaysia are different. Many times, patients will choose to settle down and accept the illness on their own without going to the doctor.”
Will there be fewer cases of smiling depression in foreign countries because people have a better understanding of mental illness? Not necessarily, he said. One of the main reasons is that the workplace pressure in foreign countries is greater than that in Malaysia, so more people choose to bear the pressure alone instead of seeking medical treatment. Taking Japan as an example, the local suicide rate is quite high, which has a lot to do with smiling depression .
Strengthen awareness and prevent tragedy
In addition, a patient with a perfectionist ideal is unwilling to admit that he is sick, because if he is told that he has depression, it will be a stain in his perfection, and he will also worry that he will be taken advantage of by others after admitting that he is sick.
He said that in the final analysis, the emergence of smiling depression is directly related to people’s lack of understanding of mental illness, especially depression.
“It is precisely because of the lack of understanding or misunderstanding of depression that discrimination against depression occurs, which prevents many patients from seeking treatment in disguise, gradually forming a more dangerous smiling depression, and finally more tragedies occur. Therefore, Greater awareness and understanding of mental illness can prevent tragedies from happening again and again.”
Poor appetite Frequent mistakes at work Discover symptoms from life details
It is known that smiling depression is even more terrifying after the COVID-19 epidemic, because it can happen to anyone, and if you don’t observe carefully, you may miss it.
Its lethality is far more serious than depression. Patients may act calmly during the day, but at night they will have a major emotional breakdown, and then make tragedies that hurt themselves.
Smiling depression or high functioning depression (high functioning depression) is “extremely clever in hiding”, so it is very difficult for family members, colleagues or friends to find out whether the patient has early symptoms in time, and often patients are like Going to work, socializing or having dinner as usual as usual, only after he leaves work alone, his inner emotions will collapse.
Ask about the symptoms of smiling depression, can’t you find any clues?
Xue Hanfei said that it is not impossible to find it. Although smiling depression is a depression hidden under the “smiling face”, it is not impossible to find its symptoms as long as you observe carefully in your life, including eating habits, social interactions, etc. mode and how it works.
Two-week diagnostic gold standard
He revealed that to diagnose whether a person has depression, two weeks is the gold standard, and we must also pay attention to the factors that cause depression, such as excessive stress and the speed of deterioration of the disease, but two weeks is the best way to detect whether a person has smiling depression. basic standard.
Generally, he will observe from three aspects: first, starting from eating habits, psychology will directly affect a person’s appetite, including appetite. The food intake has decreased significantly. Apart from the intention to lose weight, we must be alert to the possibility of early smile depression.
This is because when a person suffers from depression, his appetite will worsen and he will naturally eat less, but it must be noted that there are also some patients with depression who have increased appetite and binge eating. Observe the first tip.
The second part is the social mode. If a person would take the initiative to chat or have dinner with others before, but recently he seems to be very passive, or asks and answers, and seems absent-minded all day long, and even invites colleagues to go out for dinner at night. He also used various reasons to evade, and after one, two or more times, it was still the same, so it must be noted that something might be wrong.
Covid-19 destroys mental health
The last is the way of work. For example, a person rarely made mistakes in his work before, but recently he made frequent mistakes, and these mistakes have never been made before. As a boss or colleague, you can give him timely attention and find out whether he has symptoms of early depression. And support him in going to treatment, rather than yelling at him, which may exacerbate the condition.
“In the outpatient clinic, some patients will take the initiative to seek medical treatment because they can’t bear it anymore and feel that there is something wrong with them, but they don’t know what’s going on, or some patients are so serious that their family members can obviously feel that something is wrong , so take him to see a doctor, there are various situations, but it is worth noting that under the raging epidemic, the number of patients with smiling depression has indeed increased.”
Enhance understanding that everyone can be a victim of depression
Before the outbreak of COVID-19, smiling depression was already an extremely difficult mental illness, but now that the epidemic has entered a stable period, everyone is beginning to coexist with the virus, but they may be the next victim.
Therefore, not only patients must seek treatment, but everyone must also have a better understanding of it, so that they can treat themselves or those around them in time at the early stage of the disease, so as to minimize the harm.
First of all, we must understand more about depression, especially smiling depression. It doesn’t mean that it’s okay to laugh every day; the second is to normalize depression, just like when we mention high blood fat, high blood sugar or high blood pressure , everyone will naturally regard them as normal and curable chronic diseases.
In fact, the same should be true for depression, which should be regarded as a disease that can be treated.
Psychiatric cases increase under the epidemic
Xue Hanfei pointed out that many people have misconceptions about communicating with patients with depression, worrying that they will irritate him or aggravate his condition. In fact, this is a 100% misunderstanding. In many cases, we can communicate with patients candidly, understand his thoughts and encourage them He went to see a doctor and so on.
There is a saying, “Talking about suicide to a person who is thinking about suicide does not make him commit suicide.” Instead, it can help him stop suicidal thoughts by letting him know that there are people who care about him.
Let’s reduce discrimination against mental illness. When we notice that our family members, colleagues or friends have sent out a little distress signal, such as some negative messages on social media, we should not sneer or take it seriously. On the contrary, we should take the initiative to be serious It is impossible for us to care about everyone, but we can care for family members, colleagues or friends. He who is full of joy in front of others may be a patient who has been troubled by smiling depression for a long time.
It has been 3 years since the epidemic has been raging, and now the number of cases of mental illness continues to increase. Taking private psychiatric clinics as an example, compared with before the epidemic and now, the increase rate has gone to 20% to 30%, and this is only the initiative to seek medical treatment. Including patients who do not know and are unwilling to seek medical treatment.
Elementary school students also have suicidal thoughts
According to an earlier study, when the epidemic was severe, many people suffered from mental distress, including insomnia, depression, alcoholism, and smoking more aggressively than before. Even elementary school students would tell their parents that they had suicidal thoughts.
Why do elementary school students develop depression and thoughts of suicide? In the final analysis, it is related to the lack of correct coping skills (copings kills) and problem solving skills (problem solving skills), which include being affected by online videos or mobile phone addiction, etc., and due to lack of communication with people during the epidemic.
Everyone has more or less psychological defense mechanisms, but it is necessary to seek professional advice in the face of mental distress, and professional advice can come from counseling hotlines, counselors, psychotherapists, general doctors and psychiatrists , the premise is that the patient must take the initiative to take the first step, which is to seek professional advice for mental distress.
Any government hospital provides psychiatric services, but due to the earlier outbreak of the epidemic, outpatient clinics in many government hospitals were forced to postpone. If the situation is more serious, you can contact private hospitals or private clinics for psychiatric services.
In fact, general doctors (GP) in private clinics today can also provide basic consultation and treatment of mental illness, including depression and smiling depression, etc., unless the patient’s situation is more complicated, they will refer them to more suitable ones, such as psychological therapist or psychiatrist.
Therefore, for patients who are more resistant to mental illness, they can choose a general doctor at the beginning, or even make good use of the counseling hotline. help.
Text He Jianxing Organize Liang Yingxiu