By how much work you get done. That's it. You can be the saddest sack of shit in the whole wide world and, as long as you keep being productive, nobody will notice.

At my worst, I kept grinding even though I was one step away from jumping off the nearest bridge so nobody could tell I was this depressed.

But also, violence, unsafe sex and excessive risk taking are all reactions to mental health problem. People engage in them to make whatever issue they have feel better.