I’ve been writing and speaking about perfectly hidden depression for many years now. Recently, it was an honor to speak about it on the TEDx stage.
So, how’s it different than classic depression?
Let’s start with classic depression. Often, if you’re moderately depressed, you don’t realize how slowly the lights have gone down on the joy or satisfaction with your life. But you realize on some level how much you’re struggling with negativity, irritability, or sadness. “I’m just not myself.” You’re isolating from others to protect yourself and even those you love, and feel as if your energy is imploding inward.
And this kind of depression can worsen.
More severe depression may have entrenched itself into who you are and how you think. It’s robbed you of the ability to see opportunity, realize options, or focus on others. Perhaps you’re at the point where you barely function. You take your kids to school, but you go back to bed when you go home. You go to work, but can’t focus, so you offer excuses why you’re not meeting a deadline. You’re feeling more and more lost.
And perhaps you’ve had thoughts that death would be welcome, or even that taking your own life would be the answer.
And then someone, a friend, a doctor, a therapist, tells you, “I think you’re depressed.” And dependent on your beliefs about mental health and mental illness, you can accept that- almost with relief – and seek treatment.
The good news is that you can get better. With exercise, therapy, medication, mindfulness, newer treatments like Ketamine or Transcranial Magnetic Stimulation (TMS), and of course hard work, you can take the first of many small steps toward moving through your depression. As Andrew Solomon wrote, ” The opposite of depression isn’t happiness, it’s vitality.”
So, how is perfectly hidden depression different?
Perfectly hidden depression (PHD) is a term I coined to describe a syndrome, or a set of characteristics and behaviors, that enable you to hide or detach from your emotional pain. That doesn’t mean your pain isn’t there, or that it’s not having an effect. But you’ve learned to automatically and perhaps even unconsciously keep it camouflaged by a persona of perfectionism; this process is the likely way you survived emotionally as a child. And now as an adult. Yet, internal voices of shame can constantly berate you for what you aren’t, what you haven’t accomplished, or who you should’ve been if you’d tried harder. You turn to the next task – to an expectation that you must surpass or exceed, to prove your worth.
So what does PHD look like? You’re performing to the best of your ability all the time, every day. You push yourself to the limit, putting others before yourself, even believing that any focus on yourself is somehow selfish. You’re living very deliberately, getting things done, accomplishing the seemingly impossible…all while ignoring the memories of how you were deeply hurt in your childhood, how you were taught to never reveal sadness or anger, or that revealing those emotions was wrong or not to be tolerated.
You avoid revealing too much about yourself, laughing off your fatigue. You don a mask of happiness every day, and you may have even be fooling yourself that the mask is the real you. Others admire you. “You have an awesome family.” “I could only dream of living your life.” The only choice that feels safe? Maintaining that image.
And you can become terrified of discovery.
When depression is “seen” and when it isn’t…
If you identify with with classic depression, you may struggle to admit it, or fear you’ll be stigmatized if you do. Yet others notice, others see the change in you. You see the change in you. In fact, this change being “seen” or “noticed” is a basic part of classic depression’s diagnosis. And hopefully, you’ll seek help.
But if you identify with PHD (here’s a questionnaire if you’re wondering if you might), no one is concerned about you. You’re alone in whatever awareness you have that something is deeply wrong. And again, you can fear that your vulnerability might be discovered.
Let’s change that.
Know that perfectly hidden depression is real. It is its own type of depression that will not fit classic diagnostic criteria. Yet, it’s just as real as its classic cousin. And… it can be just as lethal.
Because being invisible hurts.
You can hear more about mental health and many other topics by listening to my podcast, SelfWork with Dr. Margaret Rutherford. Subscribe to my website and receive one weekly newsletter including my weekly blog post and podcast! If you’d like to join my FaceBook closed group, then click here and answer the membership questions! Welcome!
My new book entitled Perfectly Hidden Depression has arrived and you can order here! Its message is specifically for those with a struggle with strong perfectionism which acts to mask underlying emotional pain. But the many self-help techniques described can be used by everyone who chooses to begin to address emotions long hidden away that are clouding and sabotaging your current life.
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Updated and republished on July 15, 2023.