They Ask How You Are And You Say Fine But Are You?
By: Sarah Fader
Updated January 11, 2021
Medically Reviewed By: Merlena James Leger, LPC
Even though depression affects millions of people throughout the U.S. alone, it's still difficult for people with depression to talk about it. Sometimes, your friends and family mean well when they ask how you are and you say that you’re fine, but are you? Individuals with depression tend to write off their depression, both to other people and to themselves. So, we'd like to explore why that is and why it's okay to say you're not fine.
You've probably seen this Katy Perry meme floating around the internet, but like a lot of quotes, her words are taken from a much larger context. So, it might be valuable to see what else Perry said and why it's so relevant to this discussion.
In an interview with an Australian program, Perry opened up about the depression she experienced following the divorce of her now ex-husband, Russell Brand. Here's what she had to say:
"You know, sometimes you can be blinded by your extreme emotions…and yeah, I was depressed and sad…But I wanted to share that side of my story because I know there are so many other people out there that have gone through things like that, and you always feel like you're the only one going through that. You walk out the door, and you see someone you know, and they ask you how you are, and you just have to say you're fine when you're not fine, but you just can't get into it, because they would never understand."
So, perhaps one of the first reasons why people with depression keep it to themselves is because they, like Perry, believe that they're the only ones going through it. Whether it's a friend, coworker or family member, when they ask you how you are and you just have to say that you're fine, the question is: Do you have to? Let's find out.
Why Do You Say You're Fine When You're Struggling With Depression?
In the Ted Talk, Depression, the secret we share, which has garnered over seven million views, writer Andrew Solomon shared both his own experience with depression and everything he's learned from the many interviews he's conducted with depressed individuals, too.
Among his many valuable points, Solomon introduced the idea that depressed individuals have great insight and grapple with existential questions. However, unlike mentally healthy people, they become absorbed with these thoughts, and have many delusional perceptions, believing in the fact that "the truth lies."
Licensed clinical psychologist, Alicia H. Clark, Psy.D, backs this up by saying that depression is "an insidious condition that makes it hard to see clearly what is going on."
Therefore, for an individual with depression, their reality can differ greatly from those without this mental disorder, and they can firmly believe things which are simply not true: that no one loves them, even when many people do. Or, that they're not worth anything, even when, in fact, they can offer a great deal of value to the world. Or, like Katy Perry, that "you're the only one going through that."
And perhaps it is perceptions like these that make it difficult for people with depression to talk about their mental illness. Talking about their depression would mean pushing past a strong belief, and that simply takes too much effort, because as Solomon shared, "The opposite of depression is not happiness, but vitality."
So, what beliefs can people with depression have that make them say they're fine, even when they're not?
- You believe your depression will go away on its own
Sadness comes and go, but clinical depression isn't just a negative emotion you can get over with time - it is a mental illness. And if an individual hopes the depression will go away on its own, they can often wait too long - "until their symptoms are unbearable," according to clinical psychologist, Nikki Massey-Hastings, PsyD.
What's more, lingering depression can add to other health problems. According to Erik Nelson, M.D., "heart disease is one [medical problem] that has been most linked to depression, but research also suggests a link between depression and metabolic issues such as obesity, diabetes, and diseases such as Alzheimer's and cancer."
2. Shame keeps people from talking about their depression
They ask how you are and you just have to say that you're fine because you're ashamed of your depression. Even though depression affects millions of people all over the world, there is still a strong stigma attached to it.
Why do people feel shameful about this mental illness? Shame can be an issue if you believe that your depression indicates that you, as a person, are deeply flawed. You may believe that having depression means you're failing, either as a spouse, parent, partner, or even to yourself.
Another way shame creeps in is that since you didn't "beat" your depression, you must be weak. And if you can't "tough it out" without medications, you failed somehow. But Deborah Serani, Psy.D, a clinical psychologist, explains that "mental illness is a combination of neurobiology and psychological influences, not a weakness in character."
These are some of the ways you might feel shame towards your depression, and this can keep you from opening up about it.
But there's another way that shame prevents us from speaking up about this mental illness. In an interview with Oprah Winfrey, researcher and best-selling author, Brené Brown, offers some enlightening perspective on shame and how it affects our communication with others.
According to Brown, if you have a shame story, you want (and need) to connect with someone about it. Now, even though depression is nothing to be ashamed about, people can and do still feel shame towards it, and even if they need connection, it can be difficult to find the right person to confide in.
As Brown puts it, there are six types of individuals with whom you shouldn't share your story with when you feel shame, and here's who they are:
- The person who feels shame with you but is horrified by what you've shared rather than supportive and kind.
- The friend who responds with sympathy rather than empathy, and says things like, "Oh, you poor thing." This can be a very real struggle for individuals with depression. According to the Centers for Disease Control and Prevention (CDC), "only 25% of adults with mental health symptoms believe that people are caring and sympathetic to persons with mental illness."
- The person who needs you to be their pillar of strength. And by sharing your depression, you let them down. You must be there for them, but they aren’t there for you.
- The friend who is uncomfortable with your vulnerability, and will act as though you've done something wrong for having depression.
- The friend who refuses to acknowledge that what you're saying is true. In fact, they'll say you're exaggerating.
- The person who tries to one-up you with their own "problem."
For better or for worse, Brown says it's unusual for us to have one or two people who we can open up with and share our "shame story" with. This could be a reason why when they ask how you are, you say “fine.” It's just easier that way.
- You don't talk about your depression because people don't talk about depression
Medical doctor and life coach, Ayomide, shares that in his home country of Nigeria, people are more likely to discuss pregnancy than infertility and miscarriages. This happens not only because these last two issues are seen as negative, but also because there's a lot of guilt and shame surrounding them - just like depression.
But depression isn't picky, and it can affect anyone. Ayomide concludes that we don't talk about our depression because depression is not something we discuss in general. This confirms what Solomon shared. After all, his Ted Talk was entitled, Depression, the secret we share.
- Talking about depression means you have to face it, along with possible medications
Not only is there a stigma surrounding depression, but antidepressants get a bad rap, too. And people will avoid talking about depression because they also want to avoid getting proper medical help.
However, pharmacotherapy is just one approach to addressing depression, and by speaking with a licensed professional, you can discuss a variety of treatment options, including psychotherapy, talk therapy, and others.
- Talking about your depression takes a lot of energy
Individuals with depression can experience fatigue and a lack of energy. Associate professor of psychology at the University of South Florida, Jonathan Rottenberg, Ph.D., reminds us that for an individual with depression, "almost any activity or task becomes a painful ordeal, even things as simple as taking a shower or getting dressed."
And if getting dressed is a huge feat, one can only imagine how difficult it can be to talk about your depression - especially if people don't understand depression. Unfortunately, people still confuse sadness with depression. And because people think sadness and depression are the same, they think you can simply "snap out of it."
Having conversations like these are enough to deter you from talking about your mental illness. After all, these exchanges should be where you can open up and be vulnerable. But instead, you end up educating and defending, which, on top of your depression, is exhausting.
Even if you speak to a professional therapist who truly understands mental illness, it can be very difficult to face painful topics, past trauma, and suppressed emotions. In the end, it can seem easier to say that you're fine even when you're not. But this silence doesn't help an individual with depression. Unfortunately, it only exacerbates the mental illness.
For one thing, if we avoid conversations about depression, we avoid depression itself and also make it much more difficult to deal with. This study, conducted by researchers from King's College London, the World Health Organization, and Harvard Medical School, examined individuals from different socioeconomic backgrounds across 21 countries. They found that of the more than 50, 000 individuals studied, "only a minority of participants [16.5%] with MDD [major depressive disorder] received minimally adequate treatment."
This 2016 study, which was published in the journal JAMA Internal Medicine, specifically explored adult depression in the United States. The research screened over 46,000 individuals with depression and found that less than 30 percent of them sought treatment.
Why do so few people get the proper treatment necessary? According to one professor, Brandon Kohrt, "there needs to be increased awareness that depression can be treated."
But perhaps we should take this one step further. Maybe individuals with depression need to become aware that their depression can be treated; that despite feeling misunderstood, ashamed, embarrassed and guilty about their depression, their depression is not hopeless.
It's okay to say that you're not fine.
Unfortunately, many women feel pressured to say yes, rather than no, and to play along, rather than to win as their male counterparts do. This goes for everything from projects at work to personal commitments. In short, women are very good at stretching themselves thin and pretending that they're fine, when in fact, they're unraveling.
And since this 2015 study shows that depression is more prevalent among women, it's safe to say that many of these women say "No" to their depression, as well. What does this mean? It means that many of them may deny and avoid it. And when it comes to concerned family and friends, they ask how you are, and you feel as though you have to say that you're fine.
But do you?
Glennon Doyle, the author of the New York Time's best-selling memoir, Love Warrior, says that "from an early age, [woman] are conditioned to ignore the voice within…and if you refuse to listen long enough, [the inner voice will] stop speaking."
Regarding depression, ignoring it and hoping it will pass can mean a worsening of symptoms until they're too severe, as we've come to learn.
So, perhaps instead of focusing on talking about "depression" per se, it's important to let everyone talk about the good, the bad and the ugly - especially the ugly. Perhaps in this way, we can make it easier for individuals with depression to feel safe and respected when it comes time for them to say they're not fine.
How BetterHelp Can Help
We know that talking about our mental health isn’t easy. Fortunately, BetterHelp’s easily accessible therapists are here to help!
Online therapy has been found to be just as effective as in-person therapy overall, with some studies even finding it to be more effective. In fact, a study conducted by the University of Zurich on the efficacy of online therapy specifically for moderate and major depression found that in the medium and long-term, online therapy can indeed be more effective than face-to-face therapy. Their results found that depression could no longer be detected in 53% of online therapy clients, as opposed to 50% of in-person therapy clients. Perhaps more telling, at three months post-treatment, 57% of online therapy clients could no longer be diagnosed with depression, as opposed to just 42% who used traditional therapy.
BetterHelp is highly accessible and convenient – you’ll just need an internet connection to get started, and to have sessions depending on the mode that you choose. Sessions can be held via phone call, video chat, live voice recordings sent back and forth, instant messaging/texting, or any combination thereof – whatever works best for you, and all can be done from the comfort of your own home! Additionally, the remote nature of our therapy enables us to be overall cheaper than most in-person therapy options.
Below you’ll find reviews of some of our experienced, board-certified therapists from people seeking help with depression
“Melissa is a really kind person, she helped me coping with my depression that was getting worse due to worries regarding Brexit and the stress caused by the lockdown I imposed on myself to protect others. She is very flexible in her methods and she accomodates your needs really fast, either you need exercises or you just need to chat about your worries. She has been really supportive and positive. She checks her messages every day and she answers really quickly to make sure her clients are ok. I appreciate Melissa not only as a therapist but also as a person. Thank you!”
“Kenneth is a spectacular and very understanding counselor. I really appreciate that he genuinely understands my experiences with ADHD, as well as anxiety and depression, and gives me very helpful, step by step, plans to overcome my issues and get to the root of them. I also greatly appreciate that he is great at validating and giving me a safe space to talk and not feel judged, but rather empowered and happy! I highly recommend him!”
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