Dysfunction Junction

What follows is more musing from the brain of the craziest person I know. I've been told that the story of people with mental illness is something the world should hear, especially on the more personal level. Welp--you asked for it!

There is a stereotype of the person with depression: the person who disengages from friends and family; the person who struggles to get out of bed, to go to work, or to do any activities at all; the person whose glum demeanor reflects a complete lack of pleasure in anything at all. But of course, that’s more of the prototype, right? We all understand that most people with depression don’t actually fit that image exactly, right? We know that people with depression aren’t just holed up in dark rooms, a blanket pulled over their dejected heads. We’re fully aware that people with depression are walking among us, fully engaged, productive members of society…right? Well maybe not all of us. Someone less wise might have bought into that stereotype. Someone less educated, naturally; it couldn’t be someone as trained and well-versed like a physician right?

Well maybe a few physicians have fallen into that trap of believing only the stereotype. And by “a few physicians” I mean, namely, me. What? You mean a fully trained doctor completely missed diagnosing someone with depression just because that patient didn’t fit all hallmarks of the “classic” depressed person? Well, to be fair, that patient was very engaged, very active, even over-productive some might say. That patient was known to laugh and make others laugh and seemed to enjoy life’s many pleasures. How could this person have depression? Just who was this sad-sack patient anyway?

Spoiler Alert: It was me! (I know none of you saw that coming). Ok, so how did I, a brilliant doctor(*), miss such obvious warning signs of depression in my most important patient (me)? Well, mostly the last sentence just wasn’t accurate. I didn’t have those obvious warning signs. The plain undeniable fact was that I was just way too fabulous(*) to be depressed. I mean, you should have seen me back then: busy surgeon, family man, all around fun dude. No really, I did those extra little things that garnered all kinds of glowing attention. Singing in the O.R. while fixing somebody’s aorta; dancing in my daughter’s production of the Nutcracker - not just a tiny volunteer role, but a lead (volunteer) role with a curtain call and everything; sketching; painting; so many things, how could anyone that cool(*) be all that depressed?

You see, self-hatred is very easily hidden when you’re so busy being such a great guy.

The concept of functional depression is not recognized officially as a formal diagnosis. You will not find it in the DSM-V (For those who don’t know, DSM is the Universal Crazy Guide. The V means Fifth edition because it took them 5 tries to figure out the Crazy, and believe me, one day there’ll be a VI). Basically functional depression is thought to be a variant of depression in which the patient manifests the disease by overcompensating for it. Often an overachiever, the functionally depressed can typically be seen in positions of authority or high function, say, an attorney, a investment banker, or yes, a doctor. They’re often seen as friendly, even social. They might be the opposite of the what you might think of as the stereotypical depressed person. No withdrawl; no dips in productivity; no dour mood. Quite the opposite in fact.

It may not be an official DSM-V, but when I Googled “Functional Depression” the description might as well have been a portrait of me with a caption: “Poster Child”. And because it is not in the DSM, it’s also not taught in medical school (at least it wasn’t 20 years ago when I was on my Psych rotations). So can you blame me for missing all of the signs?

It’s fairly amazing how much mental energy someone can spend convincing others that he was healthy, happy, and not thinking constantly of suicide.

Yeah, that should have been my first tip off. Also there was the uncontrollable irritability. Turns out that when you spend so much mental energy acting like you're healthy, happy, and not thinking constantly of suicide, that when you finally get back to the privacy of your own home you have nothing left. I’d morph into a complete jackass. I mean an insufferable bastard, to my wife, to my kids, and occasionally, but rarely, even to my dog – priorities, you know.

I mention this concept of functional depression, not as an excuse for my sins of the past. I don’t even mention it much to explain how I missed such obvious signs of real depression (yes even signs in the DSM-V). I mention it because I wonder how many others there are like me. Others who have deluded themselves into thinking they’re the true Renaissance man or woman because of how many diverse things they accomplish in a day. Do they do it simply because they are truly super-human beings? Possible. There must be some people that productive, that capable, oh, and that great, too, because of course they are. Perhaps I’m bringing up functional depression as an excuse for why I’m no longer that productive person. Maybe I’m just jealous.

Or are there folks like I was? Folks who work like I worked, played like I played, and were all around good peoples in public? I’m asking this aloud, and I’d love to hear your responses. After all this isn’t even in the DSM, and so it certainly is not being studied. So how about you? Are you super-productive, super-social, and super-cheery? If so, do you also hate yourself, or is that just something I do? Is function truly functioning for you or merely a cover for deeper dysfunction?

* Actual levels of brilliance, fabulousness, and coolness have not been independently verified.