We live in a fast-paced environment where everybody needs to be “on” all the time.
Going to work, having to socialise, taking care of the family, juggling multiple things at once – these are the things that we do every day.
There is hardly any time to pause or to rest, and you just keep pushing through.
On the outside, it may look productive and that you have everything under control, but the inside tells a different story.
Let’s look at Fatimah, a productive working adult who gets to work on time, meets deadlines, socialises with her colleagues and climbs up the career ladder.
From the outside, she looks happy and content.
However, when she reaches home, she’s totally exhausted, yet constantly replaying past conversations in her mind, thinking about what to do next, and just cannot relax or switch off.
In her mind, she’s thinking: “I’m functioning and everything looks fine, but why don’t I feel fine?”
Functional, but struggling
Fatimah is one of the many Malaysian adults who appear stable, but are quietly struggling on the inside with anxiety, depression and emotional burnout.
Mental health cases have risen in recent years, with cases nearly doubling since 2019.
According to the National Health and Morbidity Survey (NHMS), we can see that reported depression cases have risen from 2.3% in 2019 to to 4.6% in 2023.
Yet, many cases still go unnoticed because individuals are “still functioning”.
This group of people are described as experiencing “high-functioning anxiety” or “silent depression”.
They experience high levels of anxiety or depression internally (i.e. self-criticism, self-doubt) and may feel the physical symptoms, but are able to hide it from the world.
They put on a front and still do what they need to do, but on the inside, they are constantly in a battle with themselves.
This leads to a growing population of people that look ok, but are not ok.
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High-functioning distress often goes unnoticed because the outside world thinks they are thriving.
However, the silent inner battles, the constant worry, emotional numbness, fatigue and/or self-doubt are running rampant inside.
Individuals tend to build coping mechanisms that hide their distress, which are caused by overworking, perfectionistic tendencies and building that perfect appearance, rather than addressing imperfections and internal struggles.
Many individuals doubt whether they even need the help because they are still functioning well.
Many believe the word “functioning” equals “I’m ok, I’m good!”
However, functioning does not always mean thriving.
This mismatch makes it difficult to detect and seek help.
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Contributing factors
Several factors could be contributing to the increase in silent mental health struggles in Malaysia.
One is the intense work demands and “hustle” culture.
Individuals are expected to always perform at their best, leading to perfectionism and unrealistic demands on themselves.
High demands translate to longer working hours and limited recovery time, which further contributes to higher distress.
Another factor that plays a significant role is social media, where constant comparison to curated lifestyles intensifies feelings of self-doubt and feelings of inadequacy.
There is a pressure to keep up appearances, even if individuals are struggling.
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Furthermore, cultural attitudes towards mental health add another layer.
There is still stigma around mental health, and in many communities, asking for help can be perceived as a sign of weakness or low religiosity.
Emotional distress is minimised and often ignored.
There is a comparison with others that they are doing fine, so why aren’t you?
People often say, “just be strong”, “move forward” and “others may have it worse”, which leads to internalising and normalising the emotional distress.
Seek help early
When individuals feel distress, it’s easier to ignore or avoid the emotions brewing inside of them.
It is much easier to just continue pushing through than to acknowledge their internal struggles.
For example, Fatimah might think that everything is the way it’s supposed to be because she is attending work, getting the job done, socialising with her colleagues and friends, and taking care of others, but she is ignoring the constant inner struggle that makes her feel uncomfortable.
The perception of “everything is fine” wins, therefore, she struggles on alone.
A fellow psychologist reported that some clients doubt whether they should even be in therapy because they are “functioning”, but in reality, they are overwhelmed and barely holding on.
Being “functional” is seen as the way to go, but in the long run, there are detrimental effects.
When people avoid seeking help early because of “looking ok”, symptoms may worsen over time.
It may lead to burnout, breakdowns and mental health disorders.
And it takes a much longer time to recover.
It is important to recognise the early signs of emotional distress.
When individuals face emotional distress such as fatigue, low mood, emotional numbness, chronic exhaustion and constant feelings of being overwhelmed, even when they are functioning, the signs should not be ignored.
Seeking help early is important as it improves long-term outcomes, prevents symptoms from worsening and enables faster recovery.
Barriers to getting care
However, there are barriers to seeking help early.
The most common is the stigma around therapy or seeking mental health services.
Many individuals fear being labelled, judged or misunderstood.
Some might also think that their concerns are not serious enough to warrant therapy.
Cost and accessibility are also some of the challenges.
Some individuals cannot access help because of the cost, while some do not even know where to start, even if care is accessible and affordable.
Many individuals think that therapy is only for severe cases, but in reality, early support can prevent deterioration later on and improve quality of life.
Therapy is open to everyone and is not only meant for times of crisis.
It can help elevate your life, keep you proactive about your mental health, improve relationships, facilitate growth and self-discovery, foster resilience and provide a safe space for expression.
Addressing silent mental health struggles is not limited to the individual level.
It involves cultural change, normalising conversations around emotional well-being, encouraging help-seeking behaviour, and reframing what it means to be “ok”.
Workplace and educational institutions play a role in creating an environment that acknowledges, supports and advocates for mental health.
Not all mental health crises in Malaysia are loud and visible.
Silent internal battles are on the rise.
Some people who look like they are thriving and holding it all together on the outside, are actually struggling emotionally inside.
What people should know is that it’s ok not to be ok – you do not have to pretend.
It is important to know your own limits and honour them.
Listen and take care of yourself because you are worth it.
Alyssa Suraya Ahmad Farouk Faizi is a clinical psychologist at the Management and Science University. For more information, email starhealth@thestar.com.my. The information provided is for educational and communication purposes only, and should not be considered as medical advice. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this article. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.
