How People Who Are Suffering the Most Learn to Look “Okay”
A lot of people think depression or suicidal thoughts will look obvious. They believe the individual should appear outwardly frantic and dysregulated. They’ll stop going to work, caring for their family, and let their basic responsibilities slip away. In other words, day to day life should be grim, dark, and unmistakably heavy, with behaviors that match the hopelessness and helplessness that often accompany depressive symptoms and suicidal ideations.
But here’s the hard truth:
Many people who are struggling the most actually look fine on the outside.
They’re smiling.
They’re showing up.
They’re taking care of others.
They’re functioning — sometimes at an impressively high level.
From the outside, nothing looks alarming.
But on the inside, they may be barely holding themselves together. They learn to be this way.
And in the culture we live in — a culture that rewards performance, punishes vulnerability, and equates emotional suppression with strength — I think we’re all at risk.
They Learn Early That Showing Distress Is Dangerous
For many people, “looking okay” isn’t a choice — it’s a survival strategy learned long before they had the words depression, emotional dysregulation, or suicidal ideation. What they learned instead was a simple, painful rule:
Showing distress is dangerous.
This rule forms in countless subtle (and not-so-subtle) ways:
maybe they were punished for crying
maybe their sadness was ignored
maybe their parents became angry or overwhelmed
maybe nothing changed no matter how bad they felt or how they tried to express their pain
maybe vulnerability only made life harder
So they adapted.
They learned to:
keep emotions quiet
stay calm when they were anything but calm
take care of others even while falling apart
stay “easy” and undemanding
present as stable to avoid conflict or burden
perform strength instead of expressing pain
This wasn’t conscious or calculated — it was required for acceptance, safety, or connection.
And over the years, these external behaviors crystalize into internal rules, rules that dominate the inner world of someone who is suicidal or severely depressed.
The Thought Life Becomes Governed by Survival Rules
These individuals begin to carry rigid beliefs like:
“Things are already bad enough. If I show how I really feel, I’ll make everything worse.”
“If people see how much I’m struggling, they’ll pull away.”
“I should be able to handle this on my own.”
“Needing help makes me weak, dramatic, or defective.”
“If I fall apart, I’ll lose whatever stability I have left.”
“No one will understand, so why bother?”
These thoughts are not dramatic — they’re protective.
They become the rules of engagement for navigating the world.
And these rules shape everything:
how they talk
how they behave
how they show emotion
how they hide pain
how they interact with others
how they speak (or don’t speak) about suicidal thoughts
Emotional Expression Becomes Restricted — Not by Choice, but by Conditioning
By adulthood, many people find that they can’t show their emotions outwardly anymore — not because they don’t feel anything, but because their body learned long ago that expressing emotion wasn’t safe. And this isn’t just an idea; it’s something we consistently see in research.
Studies on childhood emotional neglect and invalidation show that when kids grow up in environments where feelings are punished, ignored, or dismissed, they automatically learn to shut those feelings down. Trauma specialists describe this as the brain shifting into “survival mode,” where staying calm, pleasant, or quiet becomes a way of avoiding further pain. And attachment research shows that children who felt unseen or unsafe being vulnerable often grow into adults who struggle to express distress, even when they desperately want support.
So when someone talks about depression or suicidal thoughts with a straight face, a calm voice, or even a smile, it’s not because they don’t mean it.
It’s because their nervous system was trained — often over many years — to hide their pain.
Now, let’s tie all of this together.
Looking at this shows us that this is a top-down and bottom-up issue, since it handicaps the individual in the area of emotional processing and regulation across both the thinking brain and the survival brain.
In other words:
Top-down: the beliefs, assumptions, and internal rules formed through years of invalidation, rejection, punishment, or emotional neglect begin shaping how a person interprets their world. These mental frameworks dominate their inner experience and tell them it’s safer to stay quiet, composed, and “strong.”
Bottom-up: the nervous system adapts to these same experiences by learning automatic survival responses — shutting down emotion, restricting expression, freezing, fawning, or going numb. Even when a person wants to show what they feel, their body often restricts this expression—making it difficult for the individual.
Together, these two systems create the perfect storm:
a mind trained to hide pain and a body trained to suppress it.
This is why someone can be suffering intensely yet appear calm, pleasant, and composed.
It’s not that they’re “fine.”
It’s that every part of them — their thoughts, their beliefs, their body learned long ago that looking okay was the safest way to survive. And this looking “okay” becomes a conditioned competence (closely related to apparent competence in DBT).
Conditional Competence: High Functioning That Hides Deep Suffering
One of the most confusing things for loved ones — and sometimes even for clinicians — is that many people who are suffering the most actually function extremely well in certain areas of their lives.
This is what I call conditional competence. It means someone can go to work, take care of their family, pay their bills, smile in public, make jokes, or appear responsible and steady and still be internally collapsing.
Onlookers see competence.
But the person experiencing it knows it is performance.
Their functioning is real — but it’s narrow.
It only works in environments with the following conditions:
structure
routine
predictability
external pressure
familiar expectations
Take them out of those conditions, or add emotional stress that exhausts their skill set to manage them, and the entire system falters.
This mismatch often leaves them feeling ashamed and confused:
“Why can I handle work but not my own thoughts?”
“Why can I be there for everyone else but not myself?”
“Why do people assume I’m okay when I’m barely getting by?”
Conditional competence is not a sign of strength. It is rather a sign of adaptation, and not all adaptation is healthy. We’ll discuss this more in the next section.
The Breaking Point No One Sees Coming
When someone has spent years — sometimes decades — learning to look “okay,” their pain becomes nearly invisible. They can function. They can smile. They can hold conversations and responsibilities. As noted above, they can appear relatively steady in environments with the above noted conditions.
But every survival strategy has a limit and even the strongest mask eventually cracks.
The tragedy is that the breaking point often comes as a shock to everyone around them — not because the signs weren’t there, but because the signs didn’t look like what we expect. We look for tears, chaos, and obvious distress. But for people who have learned to hide their pain, the outward signs rarely match the internal experience.
And so we miss it.
We assume they’re handling things.
We assume they’re resilient.
We assume their calmness means safety.
But calmness can be a shutdown.
Smiling can be masking.
Functioning can be fawning (people-pleasing as survival)
When you’ve been conditioned your entire life to hide distress, you don’t suddenly become visibly dysregulated when you’re in crisis. You become quieter. More contained. More “fine.”
This is why deeply struggling people so often go unnoticed until they reach their breaking point: their suffering has been invisible for so long that no one knows how to see it or, due to their own discomfort around the subject of mental health and suicide, they rationalize what they see away—never directly addressing the issue.
What This Means for All of Us
This doesn’t just apply to people with trauma histories, chronic depression, or borderline traits. It applies to all of us living in a culture that rewards composure and punishes vulnerability.
It means:
We cannot rely on appearances to tell us who’s okay.
We must listen to words more than presentation.
We must take calm disclosures seriously.
We must stop assuming that functioning equals safety.
We must create spaces where emotion isn’t punished or pathologized.
And perhaps most importantly:
We need to check on the people who look like they’re doing fine.
The coworker who always says “I’m good.”
The friend who jokes about their pain.
The parent who holds everything together.
The one who never asks for help.
Sometimes the people who look the strongest are the ones who are carrying the most.
A Closing Reflection
If you’re someone who has spent years hiding your pain, please hear this:
You didn’t learn these patterns because you’re weak.
You learned them because, for a long time, they kept you alive.
But you don’t have to keep surviving that way.
There are safer ways to be seen now.
And you deserve spaces where your pain is met with compassion, not consequences.
Looking “okay” may have been your shield —but find those it is safe to put the shield down around. Find your tribe, your people, who will support you. And I can’t encourage you enough to find a skilled therapist to help you navigate your inner world.
