This story discusses suicide. If you or someone you know is in crisis, call 988 to reach the Suicide and Crisis Lifeline. You can also call the network, previously known as the National Suicide Prevention Lifeline, at 988, text HOME to 741741 or visit SpeakingOfSuicide.com/resources for additional resources.
Gregarious, joyful and full of light are just a few of the sentiments that people close to Stephen “tWitch” Boss have shared about him following his death by suicide at 40. For people who knew him through TV and phone screens, his bright smile and always-dancing legs may come to mind.
The multi-hyphenate media personality first made a name for himself as a finalist in the reality competition “So You Think You Can Dance” and went on to DJ and executive produce “The Ellen DeGeneres Show.” He and his wife, fellow dancer Allison Hoker Boss, shared three children and celebrated their anniversary days before his passing. He recently told TODAY co-anchor Hoda Kotb about his desire to host his own talk show.
In the days since Dec. 13, many have struggled to reconcile Boss’s outward persona and resume with someone who took their own life, which has ignited a conversation in some social media circles about high-functioning depression.
“High-functioning depression is a real thing, and it can have serious consequences if not addressed and treated,” wrote one Twitter user whose bio states that they’re a medical doctor.
Another influencer, ShiShi Rose, shared on Instagram a carousel of photos of tweets with a caption criticizing the oft-repeated notion that “checking in” is enough to combat suicidal thoughts.
“High-functioning depression is scary as f--k because no one knows you’re not okay, and even if you say something no one realizes the severity because you don’t seem like someone who is falling off the deep end,” one of the tweets read.
Another Twitter user wrote: “Prayers for Twitch’s wife and kids, always check on your strong friends. high functioning depression is real. rest in paradise.”
What is high-functioning depression?
High-functioning depression is a colloquial term and not a technical clinical diagnosis, explains Rheeda Walker, Ph.D., psychologist and leading researcher on suicide in the Black community. The official diagnosis for depression is major depressive disorder.
“There are a number of different things that fall under the umbrella of depression. Major depressive disorder, you have to have five (symptoms) at least, and they have to persist for a couple of weeks or more,” Walker said. “If you fall below that — everybody has a bad day ... you’re not going to meet criteria for ... major depressive disorder.”
Some symptoms of major depressive disorder, per Mayo Clinic, are: feeling sad or hopeless, angry outbursts or irritability, sleeping too much or too little, lack of energy, weight loss or weight gain, anxiety, feeling worthless or guilty, trouble concentrating, suicidal thoughts and unexplained body pain.
Persistent depressive disorder is another official diagnosis that, for some patients, may include high-functioning depression, Walker says. But she also stresses that because high-functioning depression is not a technical diagnosis, she’s hesitant to say they’re the same. Mayo Clinic defines persistent depressive disorder as “continuous, long-term” depression that’s “not as severe as major depression.”
Walker adds that for high-functioning depression, the bad feelings may fluctuate: “Stressful things happen at work ... but then on the weekend or after work, you go spend time with people who support you and love you ... and it’s like, OK, I got that. I can go back and I can take on the world.”
It’s common for people with depression to overcompensate for feelings of emptiness by becoming the life of the party, she says.
“I was a fan of [tWitch] and ‘So You Think You Can Dance,’ and I can’t help but to wonder if the people who sometimes are the presumably happiest on the outside are the ones who are trying to create something ... that they want for themselves,” Walker says.
Suicide and the Black community
Many prominent Black people have died by suicide this year, several of them within one week in January: Ian Alexander Jr., actor Regina King’s only child, died Jan. 21 at age 26. Kevin Ward, 44, mayor of Hyattsville, Maryland died Jan. 25. “The Walking Dead” actor Moses Moseley died Jan. 26 at age 31. And former Miss USA and attorney Cheslie Kryst died Jan. 30 at age 30.
The young age of these figures highlights what Walker, who teaches psychology at the University of Houston and directs the Culture, Risk and Resilience Lab on campus, knows too well from her own work: Black people who die by suicide tend to be younger than white people who do.
The suicide rate among the U.S. Black population peaks between age 25 and 34, whereas for white people, it’s between age 45 and 54, according to a 2021 report from the National Vital Statistics System.
The same report found that the suicide rate is lower in the Black population than in the white population — for Black and white men respectively, 12.9 deaths per 100,000 versus 27.1, and for Black and white women, 2.8 versus 6.9. But a 2021 study indicates the Black suicide rate is likely higher than documented because the manner of death is often misclassified.
Walker says there’s no data confirming why suicide affects the Black population at a younger age, but she’s called for more research because, clearly, “there’s something that’s happening differently for Black Americans.” Her theory is that the transition to adulthood and experiencing racism, possibly for the first time, play a role.
“My team has found that race-related stress is related to thoughts of suicide in the Black community,” she explains. “Those individuals ... may’ve been protected by family, protected in other ways but then went out into the world and saw institutional discrimination and racism ... and it’s like, ‘OK, I’m on my own now. I’m ready to thrive, ready to participate in society.’ But all those goals are ... thwarted. Then at some point, you start to lose hope. So it doesn’t happen right away, but it can take some time.”
Reggie Howard, 31, who lives with major depressive disorder and attempted suicide multiple times in the past, says he was struggling with “the pressure of being a father and the pressure of coming from poverty.”
“It’s not that I wanted to not be here alive anymore,” he says. “It was the pain and internal struggles ... that I was going through. It just felt like that was the best option.”
Hearing about tWitch brought up some difficult emotions in Howard.
“It just showed me that people are still hurting,” he says. “I’m not all the way through with some of the trials and tribulations that I have in my life, and it triggers flashbacks of when I had those feelings inside of me (and I’m asking myself) do I still feel like that?”
After his last suicide attempt several years ago, Howard saw an ad on Instagram advertising “Free Therapy for Black Men,” and it changed his life. He’s now on the leadership team for Black Men Heal, the organization that provided him with free therapy. He’s in his third year as an undergrad at Drexel University in Philadelphia, and he hosts the “Black Mental Health Podcast,” which has been downloaded 150,000 times.
Reflecting on his mental health journey, Howard says: “I try to come from a place of gratitude first and ... cherishing the things that I do have and the things that I have accomplished as a father, pulling myself out of (depressive states).”
Depression in the public eye
April Simpkins lost her daughter, Extra TV correspondent and Miss USA 2019 Cheslie Kryst, in January to suicide. Simpkins says Kryst had persistent depressive disorder and had attempted suicide before. Simpkins stresses that public figures are not immune to suicidal thoughts, no matter how bubbly they may appear.
“When you have someone who is an achiever and who does enjoy life, it is very easy for the general public to assume that they must be OK, that they couldn’t possibly be hiding something,” Simpkins tells TODAY.com. “How could you hide something behind a smile that is so genuine? But I think it’s also important to realize that the general public is not with those people 24/7, and what you are seeing is what they are presenting in that moment at that time.”
Before Kryst died by suicide, Simpkins says she began paying closer attention to her daughter because she’d talk about some things over and over and wouldn’t stop. Simpkins saw it as a sign that something was wrong. In response, Simpkins would simply listen, which she says helped extend her daughter’s life.
“When I hear people saying, ‘Check in on your strong friends,’ which has become a very common mantra (along with), ‘It’s OK to not be OK,’ I think what gets dismissed in that is, if you have strong friends who are telling you they’re not OK, we don’t know how to listen,” Simpkins says. “We’re waiting for a five-alarm fire, and they’re telling us it’s smoldering. Then we miss it (because) we dismissed it.”
Coping with depression
Treating depression usually involves medication, therapy or both. Howard, who aspires to be a psychiatrist, leads a few mental health support groups and says they can also be a powerful tool to get people comfortable sharing their experiences and to learn coping strategies. For Black people, Howard recommends seeing a Black therapist, even if it’s difficult to find one, because it’s worth it.
“You want to date, you want to shop around,” he says. “One of the things that my Black (therapist) said to me was, ‘Hey, I understand you.’ He made me feel seen because he looked like me. ... He was almost like a fatherly figure to me, and I never had that. I saw myself represented.”
“He would make hip-hop references, he would make TV show references, he would make certain culturally competent references that made me resonate with the therapeutic information that he was sharing with me,” Howard explains.
If you’re concerned about a loved one attempting suicide, Walker notes that anxiety is “as strong a predictor” as depression. She also cautions against calling the police for help with a potential suicide and recommends the suicide prevention hotline, 988, instead.
And she encourages staying in close contact with anyone you’re concerned about.
“If someone seems like they’re in a low place or they’re acting out of the ordinary, go to them physically if possible,” Walker says. “If not, check on them because ... (they) can’t problem solve from a bad place, and so they have to rely on other people to be able to stand in the gap when they can’t problem solve. That’s why we desperately need a more educated society.”
Howard says more education will help break the stigma that the Black community commonly associates with mental health. Practicing self-care is something he teaches his sons, ages 10 and 4, to better prepare the next generation.
“Not too long ago, mental health was a taboo topic,” he says. “I do want to impart upon my sons that it’s OK to express yourself. ... The goal for me is to make sure I’m leading with vulnerability so that they feel comfortable to be able to share. My mental health goal is to make sure I create that safe space for myself and my children so we can have these type of conversations.”
This story first appeared on TODAY.com.