High-Functioning Women Wait Years Before They Ask for Help
Specializing in exercise science and nutrition, Melissa Coetzee leads Algarve and Africa Wellness with a dedicated one-on-one approach. Her eight years of sobriety fuel a deeply personal commitment to helping clients achieve sustainable health transformations through professional expertise and lived experience.
Someone told me recently that I look amazing. I said, “Well, my face is fine. I am not.” I did not plan to say it. It came out before I could soften it, and it is the most honest sentence I have said in months. I run a business that exists to tell other people they are allowed to stop. I am one of the worst people I know at taking my own advice.
I hear a version of my own sentence from almost every woman who calls me: “I have no right to feel like this.” She has an excellent life, by any outside measure, and she is not telling me she feels fine. She is telling me she is not allowed to feel otherwise. Those are two very different sentences, and the second one keeps women stuck for years.
Coping well is not proof that a problem is small. In the women I work with, it is usually the reason nobody looked.
The World Health Organisation defines burnout narrowly, as an occupational phenomenon resulting from chronic workplace stress that has not been successfully managed. It is marked by exhaustion, a growing distance from the work, and a drop in how effective you feel doing it. It is not a diagnosis on its own, and it is not a catchall word for every kind of tiredness.
I want to be precise about that because the women I am describing are usually dealing with more than just their jobs. The exhaustion runs wider than any single definition can hold, and that is exactly why it gets missed.
Nobody is coming to stop you
For most people, something eventually goes wrong in front of other people. It is humiliating when it happens, and it is also useful because afterward they cannot pretend it did not happen.
That does not happen to you. Nothing gets dropped. This week I ran an operations meeting while I was still getting dressed, with no gap between that call and the next thing on my calendar. My husband asked what was wrong when I couldn't get my hair done for the second time in one week. I had no answer for him beyond pointing at my own diary.
The people near you will not raise it either. Some of them work for you. Your advisors exist to protect your name and your time, so their instinct is to smooth a thing over rather than open it up.
Research on women in leadership often addresses work that lacks a clear label. It involves recognising those who are struggling, managing tension, and conveying decisions while still achieving results. However, none of this effort ever shows up on a calendar.
Caregiving responsibilities extend beyond the workplace. Research consistently shows that women experience a greater burden and higher rates of depression compared to male caregivers in similar roles. A significant review by the National Academies confirms this trend.
Unfortunately, no one is dedicated to recognising your efforts, so you have to be the one who notices, both at work and at home. So you make this decision alone, with nothing pushing you, while exhausted.
I have only recently started planning the next day's work the night before, something I never used to do. It is a small thing. It took me this long to give myself even that much.
Eat, breathe, sleep, the business
There is a particular version of this for the women who built the thing they are now burning out inside. I hear myself say it, and I have heard dozens of clients say some form of the same line.
If you believe there is such a thing as perfect time management while you are actually running a project, I would argue you haven't built it yet. In the beginning, flawless time management doesn't exist. This is not a complaint, it's simply a reality. As a result, the exhaustion you feel may not look like burnout to others. Instead, it comes across as commitment.
McKinsey and LeanIn's Women in the Workplace research found that 42% of women reported feeling burned out often or always. That compares with 35% of men. Research on women entrepreneurs specifically has linked this kind of conflict between work and family to emotional exhaustion. At least one study has tied that exhaustion to weaker firm performance.
It is not only a personal cost. It becomes a business risk, which is usually the only version of this argument some of you will actually act on.
Your doctor has the same blind spot
You may have already raised this once. Most women repeat the same advice back to me: walk more, improve your diet, get more sleep. You did it. You are extremely good at doing what you are told. Nothing lifted, and you drew the conclusion anybody would draw, which is that the problem must be you.
It is not you. It is how this gets diagnosed. A paper in BJPsych Bulletin this year described high-functioning depression plainly. It involves real depressive symptoms in people who keep succeeding outwardly. The distress gets missed precisely because the functioning stays intact. It was not written about women specifically. It did not need to be.
Most diagnostic thresholds still require visible dysfunction, and you have spent your adult life making certain you never become dysfunctional. So you did everything right, and it removed you from the group of people anyone thinks to help.
Staying quiet about it is completely normal, and it is not a personal failing. You knew exactly where to go. You decided you weren't entitled to go.
The first 10 minutes are never the real answer
The first ten minutes of any call are polite. It has been a busy season. A holiday will sort it out. Then something shifts.
What follows is often this: the fog is more frightening than the fatigue. Words tend to escape during meetings. Some people rehearse what they plan to say in advance so that no one notices, and more than one woman has privately questioned whether this issue is more serious than just hormonal changes.
The tablet stopped being optional some time ago. A doctor prescribed it, so it didn't feel like admitting anything, and now sleep doesn't happen without it.
Two glasses became three. It happens at dinner, in good houses, so it still looks like hospitality. Stopping, even for a week, feels impossible because everything rests on one person, and she knows exactly who that is. I want to be clear about what that list means because women hear it and panic. It does not mean anyone is falling apart. It means several things are happening at once, and nobody has looked at them together.
It has been 2 years, and you think you should be past it
This is the objection I hear most, and money has nothing to do with it. Time passing without relief is not evidence that you are handling it. It is information. It tells you this isn't the kind of thing that goes away by outlasting it.
The other thing I hear is that other people have real problems. It is also why women get here so late. By the time they do, the drinking has usually settled into every evening, and the sleeping tablet is no longer something they could stop taking if they decided to. Work that would have been short has become long.
One team, looking at all of it, in a single sitting
Care for a woman in this position does not start with her productivity, and it does not start with a label. It starts with one team looking at all of it in a single sitting, which is probably something nobody has done for you yet.
That includes sleep, mood, physical health, hormones where they are relevant, alcohol, whatever is being taken to sleep or to get through the day, losses that were never properly sat with, the marriage, and what is actually being carried at home. The point is that the clinicians talk to each other. That is the benefit of one sitting instead of four separate waiting rooms. Nothing about you gets lost in the handoff between specialists who have never spoken.
If your first thought just now was that you could not leave your family, say that in the first conversation. More women rule themselves out over this than over money. Find out what is actually possible before you decide it is not.
The part that doesn't help me commercially
We built Algarve Wellness this way because the other way kept failing the same woman. Deal with the drinking and leave whatever is sitting underneath it, and the drinking comes back, usually within a few months. I have seen that often enough to stop calling it bad luck.
Sometimes an assessment concludes that coming here is not what somebody needs. That is a good outcome, even though it doesn't help me commercially. Knowing exactly what is happening is worth a great deal on its own, whether that knowledge leads to us or somewhere else.
If this isn't about you
Some of you are not the woman I have described. You advise her, or you employ her, or she is your patient.
The question you are asking is almost certainly the wrong one. Ask how she is, and you will get the answer she gives everybody. Ask about her sleep instead, and ask how long it has been like this. Then listen for whether she answers in months or in years, because with this group it is nearly always years.
You will not get the truth the first time. Ask again in a month. That is the whole intervention, and hardly anybody does it.
Not so you can cope better
You already cope better than anyone you know. What women tell me at the end is very ordinary. They sleep without taking anything. They sit with their children in the evening instead of running the evening. They stop rehearsing before meetings. Most of them say, at some point, that they just wanted to feel like themselves again.
Nobody is going to ask you the real question. It is not whether you are coping. It is what the coping is costing you.
If nothing changes, nothing changes. The meetings keep getting run from odd places. The appointment you keep cancelling stays cancelled. None of it fixes itself because you are too competent to let it show, and nobody is going to interrupt you to ask.
So you will have to be the one who says it first, and the part of you that holds everything together will find that almost unbearable. Do it anyway, while you are still standing.
If this sounds like you, or like someone you love, speak to me directly. The first conversation is private. It is with me, not a form or an admissions inbox, and there is no charge.
Read more from Melissa Coetzee
Melissa Coetzee, CEO & Co-Founder of Algarve Wellness
Focusing on the intersection of longevity approaches and science-based wellness protocols, I provide a transformative experience for one individual at a time. My professional foundation in exercise science and nutrition is complemented by a deep personal understanding of resilience, having maintained eight years of sobriety. Supported by a multidisciplinary team of experts, I design bespoke programs that prioritize long-term vitality and sustainable health. My work is dedicated to those who require exclusive, high-touch care that addresses the whole person. Click through to my profile to see how our collective knowledge is distilled into personalized protocols for our clients.
