Smile Like You Mean It
Anhedonia, High-Functioning Depression, and the Great Performance
Quick pop quiz:
Which of the following are symptoms of high-functioning depression (aka: "smiling depression")?
Waking up, dragging yourself through a day like a soggy dishrag, but still hitting every deadline.
Nodding empathetically while internally feeling like you're watching life through bulletproof glass.
Being so good at "faking it" that coworkers say "You're always so positive!" while you contemplate whether existence is optional.
Answer: All of the above. Welcome to the secret hellscape where anhedonia and high-functioning depression join forces like a grim buddy cop movie.
Anhedonia is the loss of interest or pleasure in activities you used to love. It’s not just "I'm bored." It's "I logically know this should make me happy…and it doesn't." In high-functioning depression, you don't necessarily "look" depressed. You move through the motions, meet expectations, and might even seem successful. Internally, though, you're operating on emotional fumes. Neurologically, dysfunctions in the brain's reward circuits (specifically dopamine and sometimes serotonin systems) mean that pleasurable activities don't "hit" like they used to.
How This All Shows Up in Healthcare Workers:
Hyper-competence: You might actually lean harder into being "the reliable one." Because if you’re productive, maybe no one will notice the emotional dead zone you're dragging behind you like a weighted cape.
Overcompensating Empathy: Oddly, you might get better at delivering comforting words, even when you feel hollow saying them. Think: method acting, but for survival.
Chronic Exhaustion: Faking emotional engagement takes enormous cognitive and physiological energy. Studies on emotional labor (the act of managing feelings to fulfill the emotional requirements of a job) show that it’s biologically draining—-increasing cortisol, disrupting sleep cycles, and eventually frying your executive function like a sad little egg.
The Energy Cost of Faking It:
Pretending to be "on" at work (smiling, nodding, laughing at jokes) requires executive functioning to override your natural emotional state. Think of it like having two apps open at all times: the "Actual You" (gray, glum, minimal bandwidth) and the "Socially Acceptable You" (animated, attentive, reassuring).
Research into emotional labor shows that this dissonance, the gap between felt and displayed emotion, is associated with increased burnout, higher rates of depression, and even immune system dysregulation. (Yes, faking your mood can literally make you sick.)
When People Start Noticing...
At some point, your mask slips. Or it doesn't slip exactly. It just gets... thinner.
Friends, coworkers, even patients might start saying things like:
"You don't seem like yourself anymore."
"You're not as happy as you used to be."
"You used to love this. What's wrong?"
Cue the guilt tsunami. Now, not only are you battling your own malfunctioning reward system, but you're also grieving the way others are grieving you—-the version of you that felt things deeply, laughed loudly, loved easily.
Guilt becomes another full-time job. You start blaming yourself for your brain's neurochemical drought, even though if you had, say, a broken leg, no one would expect you to sprint a marathon while whistling cheerfully.
So What Does Survival Look Like?
Microdoses of Authenticity: You don’t have to be "all better" to be real. A genuine "Today is hard" shared with a trusted person can be more healing than 100 fake smiles.
Conservation of Energy: Choose your "performance zones." Maybe you give your best at work but go totally feral at home. That's valid.
Reframing Guilt: When someone says, "You're not as happy anymore," try hearing it as "I miss your light," not "You're failing." Because you’re not failing. You're healing. Slowly. Awkwardly. Beautifully.
Remembering the Science: Your lack of joy is a symptom, not a moral failing. It’s a physical reality, not a character flaw. Neurons misfiring do not make you less lovable or worthy.
In Conclusion:
If you are dragging yourself through work with a tired smile, surviving via coffee and sheer stubbornness, feeling guilty for the emotional gaps others are starting to notice, you are not alone.
Your light isn't gone. It's resting.
You are still here.
And that’s enough.
For today, for tomorrow, for as long as it takes.
I'll be over here too, raising my lukewarm coffee to your gritty, radiant survival.