I’d like you to introduce me to someone.

The person is not a stranger.  You’ve gone to bed with them every night for years. They’re right there, waiting for you when you wake up in the morning.

She, or he, is a part of you that stays hidden — a part of you that only you know — a part of you who struggles with depression.

What made you start hiding?

Maybe you had to devise a survival strategy in the family you grew up in — a way of dealing with getting hit, or being ignored. Maybe you had an alcoholic parent, or maybe there wasn’t enough food in the house. Maybe you had a family where no one ever talked about anything sad or painful, especially not that Dad would sometimes sneak into your bedroom at night, or Mom would emotionally fall apart. Maybe the praise you did get was for what you accomplished as a kid, the high score you made, but then came the heavy criticism for the shot you missed.

The causes could be varied, but the message, clear. Your job was to keep pain to yourself. So you created a way of being, a face that you’d allow the world to see.

You became someone who needed to look and be carefully put together. In control. Someone who others could count on. A great friend to all. The face you showed to the world was and is happy. You’ve got a great family, and people who love you.

Yet no one really knows you. No one knows this other being that lives inside you, the hurt that is hiding. Sometimes, you don’t want to believe it’s there, still, waiting to be healed. Or you may actually deny its presence.

I call it Perfectly Hidden Depression.

It’s depression, all right. There’s self-loathing, fatigue, shame, worry, sadness, sleep problems, even suicidal thoughts. But these things are covered up, very skillfully.

In 1998, Terrence Real wrote about covert depression in men in his wonderful book, I Don’t Want To Talk About It. Brene Brown, more recently, has eloquently written about the problems inherent in being perfectionistic, in her book The Gifts Of Imperfection. They are describing real problems in our culture. In my practice, I frequently hear people saying things like, “I could never tell anyone about who I really am, or how I really feel. They’d think I was weak.” Or someone relays a trauma from their past, and not a tear is shed. I could be watching them talk about their grocery list, rather than the fact that they were raped.

Those people have carefully crafted a sturdy wall between what they look like to others, and what’s in the deepest part of their memory and psyche.

Perfectly Hidden Depression (PHD)  doesn’t present like classic depression. One of the two major features of classic depression is anhedonia, or lack of pleasure in previously pleasurable activities. The person with PHD doesn’t look like that at all. He’s the popular coach of the soccer team. She’s the chairperson of the PTO. They are all over everywhere, doing, volunteering, filling needs in the community or church.

No one even suspects depression.

Tragically, sometimes those thoughts of death explode, and someone commits suicide. People shake their heads. “He seemed great. He just got that job promotion.” Or, “I saw her last week in the grocery store. She looked like she had the world by the tail.

If you’re hiding, you can stop. It takes breaking a life-long habit. It involves emotional risk.

What can you do?

1) You can challenge the belief that focusing on yourself is selfish.

This is a primary issue with many with PHD, who focuses her entire life on the needs of others. You’re not necessarily comfortable with self-focus, so if you convince yourself it’s “selfish,” then that provides justification for always taking a back seat.

There is a huge difference in being selfish, and being self-aware. If you give yourself permission to become more of the latter, then some of what is hidden may begin to emerge.

2) You can risk telling someone.

Therapists are often the first, and perhaps only, people that a person with PHD will confide in. “I can talk to you because I know you can’t legally tell anyone about it,” is what I hear often. And that’s a great place to start. You can begin learning how to connect with your emotions safely.

You might have chosen people as friends who live life fairly superficially — they wouldn’t ask questions. One of those people might not be the best choice. But often, if you stop and think, one person will come to mind that you could risk telling, and that you know would be supportive. They don’t have a need for you to stay in some box you have created for yourself.

3) Realize that the childhood strategy you came up with to emotionally survive may be self-destructive now.

As a child, you came up with a strategy, a plan, to emotionally survive. For example, if you avoided attention from an out-of-control parent by going to your room. Now, as an adult, you may tend to withdraw or isolate when there is conflict with your partner, which may cause even more conflict. You have to assess whether your “plan” (or what has become an automatic habit) is working for you in the present.

People with PHD learned to disregard emotional pain. Healing takes delving into that pain, and working through it.

4) Accept that change may be difficult.

Your world is built on you performing at your peak, all the time, for everyone else. Changing that can be difficult at first. Others may resist you changing or not know how to take the “new you.”

They will adjust with time.

And it’s so worth it.

These are some beginning steps. But it’s up to you whether or not you come out of hiding.

I hope you do. I, and others, would like to meet you.

The real you.


If you identify with this post, you can take this questionnaire to determine if you might experience PHD.

You can hear more about depression and many other topics by listening to Dr. Margaret’s podcast, SelfWork with Dr. Margaret Rutherford. Subscribe to this website and receive her weekly blog posts and podcasts, as well as  free downloadable ebook, “Seven Commandments of Good Therapy.”!

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My new book entitled Perfectly Hidden Depression will be arriving November 1, 2019! Its message is specifically for those with a struggle with strong perfectionism which acts to mask underlying emotional pain. But the 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. More to come.