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Smiling Depression

VOICES case study 5

Names have been changed to protect identity.


Smiling Depression is a term for someone living with depression on the inside, while appearing perfectly happy or content on the outside. Unfortunately, this was all too true for Dave.


In late 2018 I was met with a beaming smile, strong handshake and a what seemed like a happy go lucky personality. The 1-hour conversation that followed consisted of me trying to gain his trust and then a powerful statement from him, “I need help”.

Dave was residing in temporary accommodation and had been for a few months. In this time, he had built up good relationships with other residents and referred to a few of them as good friends and family, it was clear that he was very well thought of. My immediate thought was one of concern, as most of these ‘good friends’ were dealing with their own problems and poor mental health.

During my next chat with Dave he managed to open up to me and went on to discuss his real family, plus reasons why he did not see many of them. It became apparent that behind the smile, Dave was struggling quite badly with his mental health and he did not want to drag his family into what he described as “my f**ked up world”.

Off the back of this I managed to secure Dave an appointment at a specialist mental health service, this was the beam of light that I hoped would materialise into a much brighter future. How wrong I was.

Fast-forward to the day before the appointment. Dave was showing all the signs of anxiety and made me aware that he was scared that the mental health service were going to open-up his mind and leave him to deal with the consequences. Still he managed to smile.

The next day, we arrived for the appointment and Dave was extremely nervous . He had spent the previous night trying to put down in writing how he really felt, this proved unsuccessful. Whilst in the waiting room I desperately tried to reassure Dave that what was going to happen next would benefit him moving forward.

Given Dave’s trust issues with professionals he found himself sat in front of a guy he didn’t trust, who was asking question after question, he could not cope and stormed out. After I managed to talk him around, Dave came back in to the room with his head held high, he was determined to keep the assessment going. Unfortunately having his thoughts and feelings poked and prodded lead to him leaving the room again, it was all too much. This time he did not come back.

When I next saw Dave, he was back to his usual self, smiling, cheerful and cracking jokes. We attended probation, we went clothes shopping and even had a sing along to the car radio on the way back.

Dave was clearly still hiding his true feelings, as only 5 days later he was found unconscious after downing a whole bottle of vodka. After further tests and discussions, it was decided that he needed support with his mental health and he was admitted as an inpatient. Unfortunately, it was wasn’t long before Dave was unexpectedly discharged.

Why was this? Could the doctors not see through his smile? Did they assume that because he was laughing and joking he was “OK”?


2 days later Dave sadly took his own life.


Although public understanding of depression has improved slightly over the years, we as a society still frequently misunderstand or overlook depression and its symptoms.

Because of the continuing stigma, we don’t always recognise when people are struggling with this illness. Worse, too many people go undiagnosed because of erroneous assumptions about how depression manifests and what to look for.

This results in a number of people whose depression is hidden, either from others or from themselves. Especially when a person with depression is undiagnosed, they may develop ways of coping with their problems that conceals their illness from those around them or keeps the person from recognising their symptoms for what they are.

We need to unlearn the assumption that suffering is always clearly visible to us, so that we can better understand and help those who struggle with illnesses that go unseen.

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