There is a particular kind of exhaustion that does not show up on a performance review. You hit your targets. You reply to emails on time. Your manager has nothing to flag in the quarterly check-in. Yet, underneath it all, something is quietly falling apart. This is not a rare scenario. Nearly 84% of employees report facing at least one mental health challenge, and a huge chunk of them are still showing up, still performing, still getting their work done. Around 47% of employees keep working even when they are mentally unwell, a pattern researchers call presenteeism. It sounds clinical, but it basically means being there in body, absent in everything else.
And the cost of this is not just personal. Globally, depression and anxiety cause a loss of 12 billion working days every year, adding up to nearly a trillion dollars in economic damage, according to WHO data.
Why Does This Keep Happening?
So why do so many workplaces only notice a problem once someone has already burned out, broken down, or quietly quit in spirit long before they quit on paper? Part of the answer is that managers are trained to read performance. The system is built to catch falling numbers, not a person who is barely holding on while still hitting every number asked of them.
To understand this gap, we spoke to Dr. Shaunka Ajinkya, Consultant Psychiatrist at Kokilaben Dhirubhai Ambani Hospital, Mumbai. Dr. Ajinkya explained what is actually happening when mental health struggles hide behind a functioning employee, and why the workplace so often mistakes the symptoms for something else entirely.
Can someone continue performing their job well while struggling with significant mental health challenges?
Dr. Shaunka Ajinkya: Yes. Functional asymmetry is more common than most people realise. Someone can be hitting every target at work while quietly coming apart inside.
A lot of this comes down to compartmentalization. Work offers structure, clear expectations, and routine. For someone in distress, that predictability becomes a kind of shelter. They put on a professional mask and hold it together through the day, even though doing so takes far more out of them than anyone sees.
Hyper-compensation plays a role too. The overachiever who never says no, obsesses over every detail, and volunteers for everything is not always driven by ambition. Sometimes it is anxiety in disguise, a way of staying in control and making sure nobody looks too closely.
What makes this harder to catch is that mental health conditions do not hit every part of life at the same time. Work gets protected. Everything else — home, relationships, social life — starts to slip. Irritability creeps in, emotional withdrawal follows, and the people closest to them often bear the weight that work never sees.
And because performance stays intact, nobody asks questions. Colleagues assume things are fine. Managers see results. The family sees someone who seems to be managing. The suffering stays invisible until it cannot anymore — until exhaustion or crisis finally makes it visible.
What are some common signs of burnout, depression, or anxiety that managers might incorrectly interpret as disengagement or laziness?
Dr. Shaunka Ajinkya: Burnout, depression, and anxiety do not always look like someone falling apart. Sometimes they look like someone who has simply stopped caring — which is exactly where the misreading happens.
Executive dysfunction is one of the first things to surface, and it almost always gets mistaken for laziness or poor time management. The brain's ability to prioritise, start, and organise tasks breaks down. Deadlines get missed, work piles up, simple things feel impossible — and none of it is about attitude.
Avoidance driven by anxiety looks different but gets misread just as easily. The employee who stays quiet in meetings, turns down new projects, or backs away from feedback is not lacking ambition. They are trying to keep themselves from tipping over. Social withdrawal tends to go unnoticed the longest. When someone stops joining team lunches or goes quiet in group chats, it rarely raises flags. But depression strips away the capacity for connection and pleasure. They are not being antisocial; they are running on empty.
Irritability and defensiveness are perhaps the most damaging to be misread. Someone who snaps at feedback or reacts strongly to small things is often carrying far more stress than anyone around them knows.
The pattern that matters most is change. When someone who was once reliable and engaged starts behaving differently, that shift deserves attention — not a performance review.
How does the fear of being labelled ‘unprofessional’ affect employees with mental health difficulties?
Dr. Shaunka Ajinkya: Being quietly labelled as difficult, unmotivated, or unprofessional does not just sting; it actively makes things worse. Someone already managing depression, anxiety, or burnout now has a new fear layered on top: that their career, their reputation, the way people see them, is slipping away too.
Negative self-labelling tends to take hold quickly in people who are already struggling. When concentration dips or thinking slows down, they do not think "this is a symptom." They think "something is wrong with me." That interpretation increases stress, which then makes the cognitive difficulties worse. The cycle feeds itself.
Fear of judgment leads directly into presenteeism — showing up, going through the motions, and saying nothing. Taking a sick day feels like an admission. Asking for support feels like a risk. So they stay, they push through, and the problem gets quieter on the outside while growing louder on the inside.
Keeping up appearances at work also burns through whatever emotional reserves a person has left. By the time they get home, there is nothing left to give. Relationships suffer, self-care disappears, and the people who love them start to feel the distance.
Eventually, the workplace stops feeling like just a stressful place and starts feeling like a threat. Every email, every piece of feedback, every small interaction gets scanned for danger. Sleep goes. Physical symptoms show up. And without real support, that cycle is very hard to get out of.
Support Before Crisis
The biggest mistake workplaces make is assuming that if someone is performing well, they are doing well. But mental health does not always show up as missed deadlines or poor results. Sometimes it looks like answering every email, meeting every target, and smiling through meetings while quietly running on empty. That is why paying attention to changes in behaviour matters just as much as tracking performance. A conversation can make a bigger difference than another review. Because by the time someone's work starts slipping, they have often been struggling for much longer than anyone realised. Real support begins before the crisis becomes impossible to ignore.
