" sufferers of depression, who can elect to keep their feelings private, experience chronic, unremitting emotional alienation. Each moment spent “passing” as normal deepens the sense of disconnection generated by depression in the first instance. In this regard, depression stands as a nearly pure case of impression-management. For depressed individuals, the social requirement to “put on a happy face” requires subjugation of an especially intense inner experience. Yet, nearly unbelievably, many severely depressed people “pull off the act” for long periods of time. The price of the performance is to further exacerbate a life condition that already seems impossibly painful "