In the hours leading up to her suicide, former Miss USA Cheslie Kryst, who was an attorney, an entertainment news correspondent, a fashion blogger and a volunteer, shared a photo of herself on Instagram with the caption that read: "May this day bring you rest and peace."
With the 30-year-old's impressive list of accomplishments and bubbly personality, one may never have guessed she was dealing with depression which she hid from everyone -- including her closest confidant, her mother-- until very shortly before her death. This is not to mention the numerous friends and acquaintances she had touched throughout her young life.
Kryst's depression, which media reports described as "high functioning", was so well-hidden that even people close to her believed that the news of her death must have been a mistake.
Her untimely demise has gotten society talking about depression, suicide and what the warning signs of both look like. How do individuals with so much promise decide to end their life with little to no red flags shown to family and friends around them?
To get a psychiatrist's take on what is there to know about "high-functioning" depression and suicide, Life sat down with Dr Supara Chaopricha, many of whose patients suffer from depression.
"Depression has become very common and thus should be taken seriously when it comes to treatment," she noted while explaining that the term "high-functioning" reflects the adverse stereotypes connected with depression. It is also not recognised as an official diagnosis.
"The term alone is more of a descriptor that emphasises continuing stereotypes about depression, including the belief that patients with depression are 'low-functioning' or lethargic, can't get out of bed, or simply aren't pushing themselves enough to overcome their limitations," said Dr Supara.
"What the public should know is that depression exists on a spectrum -- it's not a one-size-fits-all condition. People with the same diagnosis of major depression may have entirely different experiences. And without knowing someone's private life well, it's hard to decipher where they sit on this spectrum, as was in the case of Kryst. For instance, one person may be the stereotypical depressed person who is lethargic, moving slowly, eating less than usual and has lost weight, and can hardly get out of bed.
"On the other hand, another person could be high-achieving, but experience feelings of general lack of fulfilment, emptiness, lack of self-worth and melancholia rather than the stereotypical outward signs of depression. In short, their external presentation isn't congruent with what they are internally experiencing. There are also cases where they may experience typical symptoms of depression, but develop ways to hide it. Behind closed doors, they may well be spending a lion's share of their time in bed, suffer from a lack of appetite but eat to not lose weight, etc."
Dr Supara said the manner in which depression impacts an individual's ability to function can also vary from person to person -- they may be "high-functioning" in certain ways, but not others.
"For example, interference in functioning could be the inability to have an intimate relationship or even distress regarding how someone relates to self, which will be a much more private encounter than a loss of occupational functioning," she said.
Dr Supara said cases such as Kryst are also happening in Thailand. Thus, there is a need to raise awareness on the subject. She said that while Thai society today better understands the fundamentals of depression, there is still stigma attached to it. There is still reluctance when it comes to seeking treatment.
One way to tackle this, she said, would be to create awareness towards visiting a psychiatrist when facing an emotional crisis.
Dr Supara explained this is a pivotal step in addressing depression, which when left untreated can lead to thoughts of self-harm and also hurting others.
"Depression can be classified as mild, moderate or severe, from which we can evaluate the risk of suicide. Research has found that patients in the high-risk group are mostly unemployed elderly single men that live alone with little to no support from family and friends. Men are also more successful in committing suicide than women. However, when it comes to depression, they found that there are more women than men who suffer from it, the onset of which occurs during their youth. The age of patients is also getting younger."
Support is key, she said, regardless of how a patient with depression is classified. The crux of the matter is not whether it is "high-functioning" or "low-functioning", but rather that they have a mental health condition that requires treatment.
Unfortunately, most people opt to not seek support because they don't believe their depression is severe enough to warrant help from a psychiatrist.
"There's a lot of ideas about how bad it should become before people get help," Dr Supara explained. "But I always tell my patients that it's never too early for somebody to seek help if a need arises."
While depression can be successfully treated no matter how severe it is, treatment is often most effective when begun early, she said. "This means the sooner you talk to your doctor or mental health professional about what you're experiencing, the better."
Dr Supara also reiterated that not all people who commit suicide show warning signs.
She said it is equally difficult for medical experts to foretell with certainty which patients with depression or other mental health concerns will have suicidal thoughts or behaviours.
"It's not so simple. It's so much more than meets the eye when it comes to seeing someone who's suffering and then knowing that suicide is going to be the outcome," explains Dr Supara.
For instance, she said there could be patients that suffer from severe depression who are suicidal for a while and have even been treated in an emergency room once or more because of an unsuccessful suicide attempt.
The ability to reach them in time could be because they show the typical warning signs of suicide, such as being preoccupied with death, talking about dying or creating a plan or method for suicide.
"However, the point here is that not everyone who dies by suicide shows these telltale signs beforehand. There's this whole other group of people who never make it to the emergency room because even if they're thinking about suicide, they never show outward signs.
"Let's remember that suicide can also be spontaneous and impulsive, making it even more unlikely that warning signs would be detected beforehand."
