More than flexing or contraction of facial muscles, smiling makes one stand out. It improves your stress level, adds charm and attractiveness and lifts your health status. A warm smile is probably a universal symbol of kindness. “Social smile” a baby reciprocating its cute smile as early as 8 to 10 weeks post birth signifies nature’s contribution to such an important milestone. We generally take smiling people as happy ones but are smiles always spontaneous and full of joy? Do we really check if we can qualify someone’s smile as being miserable, embarrassed, contemptuous, or fake. It should make us wiser that next time someone next to us smiles we categorize and make sure this smile is genuine and prettiest thing someone is carrying and wearing.
Coming to mental health perspective of a smile, a hidden depression can be sulking behind a smile. A common trend observed in my professional discourse especially among young productive age is a palpable shift from the common features of depression like sad mood, anhedonia to a kind of atypicality young and adult somewhat, somewhere masking their agony under a fake smile. If the person is from well off background, in job, no apparent stressor identifiable, their pseudo smile on being greeted or interviewed deviates a service provider from their hidden mental illness and puts a curtain between their agony and outside world and propels them towards much precarious condition like potential suicidal candidates unnoticed and untreated. This kind of masked yet smiling depression (so to say) seems to attack people who are prone for anticipating failures, hard to overcome embarrassment, easily hurt by criticism, negativistic but in my clinical practice I have seen most of them get quickly on happy notes if situational positivities in their life are created like texting from someone, longing for or a pat from the boss, parents, teachers though unusual in our culture and setting.
Moving ahead on atypicality of depression, terms such as depression without depression, hidden or masked depression needs a mention here, and which badly needs to be recognized. Unexplained body symptoms like aches and pains, loss of energy etc., report to (non) psychiatrists more often than psychiatrists probably by their preference by a whooping 40 percent of sufferers thus adding to mystify atypicality more & sadly it has been omitted as a term by DSM V (Mental health manual) as well further complicating its presentation and typicality. Hence, under reporting, under recognition and under treatment of above unusual entities may significantly contribute and is in fact contributing to the disability burden in our society casually quite simply coined as depression in local parlance as well which may not be as simple as thought
Coming to “smile” again, excessive and prolonged pseudo smiling in itself can lead to depressive phenomenon. Youngsters and some adults who have taken to the habit of faking excessive smiles in real as well as virtual, ironically smile even in major life events and upsetting situations quite unaware of the same. In the longer run such things suppress natural emotions and fuel for frank depression as mentioned. It is not easy to pick depression under a normal smile presenting with atypical symptoms by people not trained in mental health though one can relate reasons like work issues, relationship issues, feeling a purposeless life as a cause of being low. Depression itself being rampant one can imagine the prevalence of so called smiling depression in our community. It is sad that sufferers don’t come forward for treatment for many reasons one that they can somehow carry on their routine work, next stigma then lack of insight and though they may feel guilt they use defence mechanism of rationalization denying sadness least of identifiable causes unconsciously of their depression
To break the cycle, it is important to get insight for patients as well as for treatment providers and take smiling depression as a serious issue and help stop rationalizing which will help the victim come to the path of treatment seeker and help them from a future catastrophe. Modalities like CBT, Exercising, Meditation and some antidepressant pills may surely help. Since people are now spending most of their time on digital platform and face to face conversation seems to make way for virtual world, thanks to upgrading of smartphones, monitoring the contents on social media and identifying smiling depression through artificial intelligence could be effective measures in treatment protocols in future. Not to forget training of youth and teachers, smart awareness campaigns and positive mental health messages on internet blogs will help demystify this intriguing phenomenon of BEYOND A SMILE. I strongly agree on the premise that to find meaning of one’s life is the greatest motivation for one, and we as mental health professionals need to help the individual to find that meaning.
Dr Imtiyaz Hussain Mansur, MD, Sr Consultant Psychiatry and Divisional Nodal Officer Mental health DHSK