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Is it possible a bright smile, positive attitude, and professional work ethic masked a severe case of depression in the entertainer Stephen "tWitch" Boss? The husband, father of three, and multimedia personality was only 40 years old when he took his own life on December 13, 2022. Boss's suicide has led to speculation that he might have suffered from high-functioning or "smiling" depression.
Professionals like Kristin Francis, MD, a child and adolescent psychiatrist with the Huntsman Mental Health Institute at University of Utah Health, have listened closely to the discussion and debate generated by Boss's death. "A lot of people are talking more now about persistent depressive disorder and depression with atypical features," Francis said. "They are calling it hidden depression. People with this disorder may smile more; they may be able to laugh. In fact, they may often overcompensate by being a bit more of the life of the party."
Even though the description of atypical depression may fit the Stephen "tWitch" Boss many of us watched on TV and social media platforms, Francis said it would be impossible to make a clinical diagnosis of depression without more information. "There are lots of reasons people die by suicide," she said. "Most of the time, we just think they are depressed, and major depressive disorder is a big subgroup of people who die by suicide. Other reasons people may die by suicide can be due to a financial loss, a relationship change, a terminal illness or new medical diagnosis, or a major life stressor that someone feels they can no longer endure. Until his family tells us more, Boss's cause of death is speculation."
The renewed discussion of both suicide and depression is still a healthy development, according to Francis, who believes the attention will continue to raise awareness and understanding of the issues. "Depression and anxiety can be treated and eventually go away," Francis said. "These are mental health issues that are treatable. So, it is extremely important to talk about the fact that people can be depressed without openly showing they have the condition."
Child and young adult psychiatrists like Francis work with a population that is more vulnerable to atypical depression or hidden depression than older age groups. She encourages parents and friends of kids who are seeing unexplained changes in someone they care for to overreact and reach out for help. "We actually recommend overreacting because it is good to bring your child to a professional," Francis said. "Even your pediatrician or primary care doctor can evaluate them and find out more about what has happened or is happening."
"If you are seeing poor grades or weight changes that don't seem to be understandable, likely they are not attributable to growth or [just being] more sensitive," Francis added. "These are all reasons to reach out for help." Francis said these more subtle signs of trouble should not persist for more than two weeks before parents alert a professional.
The best advice in these delicate situations is also to be honest with your child about worries over their mental health. "I recommend being open with your kids and just expressing your concerns," Francis said, "like 'Hey, I've noticed that you seemed x, y, and z. Have you noticed that? What do you think is going on?' Or 'Hey, I just read this article about young people and rates of depression, and I just wanted to check in with you and see if you know anyone who is going through this. Or are you yourself going through this?'"
When someone has a form of hidden depression, their moods can quickly change, which parents often attribute to the normal physical, mental, and emotional growth patterns of an average teenager. It can be confusing, but Francis recommends erring on the side of caution. She described a conversation she has had with several of her patients' parents.
"When we do see more atypical depression in young people, the parents will say, 'Well, they seem fine. They get happy when they are with their friends. It's just when they are home that they act sad, and they start isolating themselves.' So, it is obviously confusing, but at the same time, there are a lot of people out there who are well-trained in figuring out if this is depression or if this is a life-changing situation that is causing stress for someone."
The confusion and frustration parents can feel when dealing with a young person who may be battling a hidden form of depression is what makes the Stephen "tWitch" Boss case so difficult to explain. "It is hard to understand because these social media personalities are often only showing the public a snippet of their lives," Francis said. "And it is the very best part of their lives. So, it is just so hard to know if that was how he normally was throughout his day, or was it just brief 20- to 30-second snippets of his day? If he did have atypical depression, maybe he was just able to play up for the camera."
It turns out that even the strongest people in your life may need help, but their cries for assistance are muted by certain forms of depression or anxiety. Mental health professionals note that anxiety can be as strong a predictor of suicidal tendencies as depression. Perhaps that is why Francis wants to see the current conversation over depression expanded.
"The conversation that I see out there right now is all about depression," she said. "What I really wonder is if the conversation should also be about suicide, because again, they are not synonymous. Yes, they are related, but it is a much deeper question about the factors that go into a person's mental state at the point they decide to take their life."
If you or someone you know is experiencing suicidal thoughts, call or text 988 to be connected to trained crisis counselors. 988 is confidential, free, and available 24 hours a day, 365 days a year. Access is available through every landline, cell phone, and voice-over-internet device in the United States.
