You know her.

She’s always smiling and appears to have everything together: a good marriage, a thriving business, and a couple of kids who do well in school and athletics. She started the book club you’ve been going to for years, is the PTA president, and her employees rave about working with her. Her life looks balanced and complete. Her friends will tell you, She’s a fantastic friend; always there for you when you need her.”

You know him, too.

He’s your daughter’s soccer coach who never misses his son’s band performances. His career is solid, his yard (although filled at times with kid toys) is always neat as a pin by nightfall. He’s in charge of the community Alzheimer’s walkathon and people are involved because it’s him who does the asking. He hits the gym every morning before work, and every once in a while, he brings the staff at the front desk their favorite brand of coffee, ”He’s the greatest guy. He always greets us by name with a genuine smile.”

There’s nothing innately unhealthy about these people who are devoted to being good parents, caring spouses, solid professionals, and involved community members. Maybe you are some version of her or him.

Could your perfect-looking life be a coping strategy for depression?

But maybe this scenario is based on something other than you being your best self. Perhaps it’s a coping strategy to hide a deep sadness lurking underneath that veneer of perfection. You may be concealing emotional pain that you don’t want to the world to see.. Perfectionism, over-responsibility, not allowing anyone in on the real you? 

These are traits of perfectly hidden depression, a term I coined in 2014. 

To be clear, we all develop a persona of how we handle ourselves in public and the anxiety that sometimes can bring. I myself have the persona of “jokester.” I try to make people laugh to ease my own anxiety. People do other things. Maybe you are a “wall-hugger,” or “big talker,” or “social butterfly.”

If you’re perfectly hiding depression, you’re more likely to act like the “hostess,” to take care of everyone’s else’s needs. This is because you don’t make anything about you at all. You’re helpful, conscientious, and giving. You pride yourself on your strength, your standards, and your accomplishments.

You may be aware that this strategy is how you began coping with childhood pain and confusion. Or you may have been doing it for such a long time, the patterns are unconsciously and solidly entrenched in your thoughts and actions. It’s simply who you are.You may feel like you’re being strong by swallowing your tears when your beloved pet dies. You may think your spouse is being a bit of a slacker when they tell you to be less uptight about your child not getting straight-A’s in school. You may be proud of how you’re constantly busy and never sit back and relax. If it’s worth doing, it’s worth doing well. Right?

Yet perhaps what you’re doing is hiding depression. Perfectly. 

But how can depression exist when it doesn’t look like depression?

Yet how could you be depressed? Depressed people are withdrawn, noticeably sad, and lack energy. People around them are worried about them. “She’s just not herself.”  

I’ve heard story after story from the many people who’ve contacted me since 2014 and who identified with perfectly hidden depression. They described knowing something wasn’t right. They searched for the symptoms of depression. Yet they couldn’t relate. “My life is full. I love my family. I socialize and enjoy my career. I’m grateful every single day for all of my good fortune.” So what did they do? They crept away in shame, criticizing themselves harshly for even considering such a thing. Until they heard the words perfectly hidden depression. 

And light bulbs began turning on.

Classic depression is real. And it’s dangerous. But perfectly hidden depression is also real. And also dangerous.

What they didn’t realize then, but are beginning to recognize now, is that you can have blessings in your life. And feel their weight. Just because you’re admitting that doesn’t mean you’re not grateful for those same blessings. If I won the lottery, that might seem outstanding. Would I also feel fear? Anxiety about that? Sure. If you are a great beauty, our culture would deem that a stupendous blessing. But would it be hard to garner all that attention and fear not being recognized for your intelligence? Yep. Doesn’t mean you’re not grateful.

“I have many close good friends.” “I have 4 wonderful kids.” “I am extremely involved in my career.” “I survived breast cancer.” All great things that can involve anxiety at the same time.

Let’s stress again that something has happened before all these “blessings” occurred. You have pain that has never been healed or even addressed. You have rigidly compartmentalized that pain, buried it deep within your mind, and covered it with accomplishments and achievements and successes. 

Those secrets, that pain that is stashed away, coupled with the energy it takes to maintain the perfect-looking life, is a set-up for extreme loneliness and despair. 

If you feel like perfectly hidden depression describes you, you need understanding, coping and self-care strategies before your depression gains more power. Because perfect-looking people can become too lonely and too despairing to bear their secrets any longer. 

Please seek help if this is you. You can learn to balance your fear with courage. To accept your pain without being overwhelmed by it. To admit vulnerability without losing your strength.

And to share those secrets and gain new understanding and self-compassion. 

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.

And there’s a new way to send me a message! You can record by clicking below and ask your question or make a comment. You’ll have 90 seconds to do so and that time goes quickly. By recording, you’re giving SelfWork (and me) permission to use your voice on the podcast. I’ll look forward to hearing from you!


This was originally published on Apr 19, 2014 and was updated on May 26, 2019.


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