Perfectly hidden depression or PHD. I’ve been studying its essence since 2014. But what is it, and how might you know that it describes you?
In this episode of SelfWork, Dr. Margaret Rutherford describes the syndrome of perfectly hidden depression by offering portraits of two people who realized that fighting this need for absolute control was a battle they needed to win.
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What does someone with perfectly hidden depression look like?
Let’s talk about Miranda.
She’s always smiling and appears to have it all together: a good marriage, her own business, and a couple of kids who are thriving. She started the book club you’ve been going to for years, she’s the PTA president, and her employees rave about working with her. Her friends will tell you, “Miranda’s a fantastic friend; always there for you when you need her.” Her life looks balanced and complete.
And you know another guy… pretty much like her. Let’s call him Joe.
Joe is his daughter’s soccer coach and takes time to spend with the kids who need extra support. He 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 his kindness is respected. So everything he touches is a success: people want to be a part of what he’s leading.. He hits the gym every morning, and every once in a while, brings the staff at the front desk their favorite brand of coffee, ”Joe’s the greatest guy. He always greets us by name with such a genuine smile.”
There’s nothing innately unhealthy about Miranda or Joe. They’re devoted to being good parents, caring spouses, solid professionals, and involved community members. And there are lots of Miranda’s and Joe’s out there who are exactly what they seem to be.
Perfectly hidden depression… not being who you seem to be…
But not always. What can seem absolutely real on the outside may be camouflaging very old hurt or pain that’s rigidly tucked away.
Think about camouflage for a second. People wear it to hide. To not be detected. To fit in so that you’re not really seen.
If you’re similar to Miranda or Joe, you may be concealing emotional pain that you don’t want to the world to see. Nor – and this is very important – do you even know how to express that pain. It’s there. But your busy-ness and constant drive keeps you distracted.
So what are the traits of perfectly hidden depression?
If you identify with perfectly hidden depression…
- You’re highly perfectionistic, with a constant, critical inner voice of intense shame that fuels your need to achieve.
- You demonstrate a heightened sense of responsibility toward others.
- You have difficulty accepting and expressing painful emotions.
- You worry a great deal, seek control, and avoid situations where control isn’t possible.
- You intensely focus on tasks, using accomplishment to feel valuable.
- You have an active and sincere concern about the well-being of others, while allowing few, if any, into your inner world.
- You discount or deny personal hurt or sorrow and struggle with self-compassion.
- You hold a strong belief in “counting your blessings” as the foundation of well-being.
- You may not seek emotional intimacy in personal relationships but demonstrate significant professional success.
- You have accompanying mental health issues that involve control or escape from anxiety.
None of these are unhealthy in and of themselves.
It’s when they become the only option you allow yourself that each one of them can become a problem. “I must always express gratitude first and foremost.” ‘I must step forward and take responsibility because I’ve been given so much.” Or “Nothing bad’s really happened to me; certainly not as bad as others had it.”
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 unconscious and solidly entrenched in your thoughts and actions.
It’s simply has become who you are.
Either way, you have pain that has never been healed or likely even addressed. You have rigidly compartmentalized it, 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.
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.
Perfectly hidden depression is real, and is dangerous. Over 2 million people have watched my 2023 TEDx talk on “how to recognize perfectly hidden depression.”
So something is ringing true for those people.
But 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 with someone you trust to gain new understanding and self-compassion.
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!
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It can be so hard to recognize someone who is struggling like that. And hard when they end their lives. Sad all around
Carol
http://www.carolcassara.com
Poignant indeed. My family has been dealing with the aftershocks of suicide for years.
“Something has happened before all these blessings occurred,” is such a powerful statement.
This is so powerful, Margaret, and has made me stop to consider.Thank you for addressing this issue. Truly food for thought.
I am saddened to hear that Doreen. So many of us have things from our past that we carry around – that plague us and can destroy the present. I hope that you have achieved some peace. Thank you for commenting such a private memory.
Thank you Helene. I hope that those who need to consider the potential consequences of keeping their secret will also “stop to consider”. Thanks for reading and commenting.
Especially important – consider what came before this blessed version of a person. Great post, Margaret.
So glad it was something that made sense to you Sharon. I see it all the time. One patient even said, “I bet my problems aren’t near as bad as the person who was just here”. It’s amazing how many people – who are trying with integrity to live their lives – instead get caught up in hiding their vulnerabilities. Discounting their own pain. It can be tragic. Thanks for reading and sharing.
This is so me. I am too busy trying to put on the happy face for others that when I am alone I feel emptiness. I have to remind myself of all the blessings in my life including my two children that only have me.
Sylvia I am so glad you wrote a comment. Being a single parent is a lonely job. There’s no one there to play “tag, you’re it” with when you get tired. But that emptiness you describe is what can be harmful. I hope that you look for ways to be who you really are with others instead of always “putting on that happy face”. Thanks so much for reading!
This is a post that I suspect many of us should read — and then read again.
Your comment Suzanne suggests you know this dynamic well. I’m glad it was helpful. Thanks for reading.
It is so hard to carry it around, especially when you think you have dealt with it, processed it. No one really wants to know what’s wrong. Everyone has their own lives and their problems. I’m not complaining, it just seems like that over and over and again. I am grateful, very much so. Just exhausted 🙁
Hi Robin. I can hear your exhaustion in your words. There is a lot in what you are saying – everyone does have their own problems. But I know people can also be very compassionate. I don’t know why perhaps people are backing off or not supportive of listening. There could be several reasons. No one but you can do something about that exhaustion however. When I read your comment, my first reaction was “she may need to learn how to put herself on her care list”. Just an intuition! If you rise to the top of that list enough, just enough, you might get the emotional and physical rest you need. Thanks so much for reading and commenting.
Read this post from fb and I find this frighteningly describes myself.
Hi Gracieandpepper. By making this comment you have bravely stopped hiding. At least for a moment. I hope that means you could risk even more. I encourage you to do that. Take very good care.
I was that woman just a few years ago. I felt so unseen by everyone around me and when I tried to explain it to my husband, he didn’t or couldn’t understand. I’m no longer there and I honestly have no idea how I got out. I remember distinctly that I felt I should leave my husband and children because I thought they would be better off without me! I think I had some type of hormonal problem – I had just found out my thyroid was low – and getting on the right meds helped so much. But since I didn’t know what was wrong with me, I couldn’t share with my friends. There wasn’t anything to share.
Thank you so much for this Amy! You point out that this kind of depression could be caused by many things – genetic predisposition, hormonal changes, trauma, family or situational factors, ongoing psychiatric disorders… so many! I am delighted you found your way out. I would encourage you to do some thinking about the “how”. Just so if it ever happens again, you will know what skills you used to help yourself out of that fog. Good luck!
This is definitely me.
I was diagnosed about 7 years ago as bipolar/manic depressive. I tried to get all of my family (hubby, kids, mom, and siblings) to read up on this condition so they would understand and help me deal with and cope with what I had been dealing with for close to 20 years without knowing what was.
No one, except my husband and our daughter even bothered to look at any of the information I shared with them.
To this day, I’m still just the narcissist, drama queen who only cares about herself.
I am currently estranged from almost everyone in my immediate family due to this.
BUT… After years of dealing with this BS from them, I have decided that I am a good person who deserves to be treated just as everyone else…. even if that means not speaking to my siblings and at least one of our sons.
I am worthy, yet I am a depressed person. The depression sometimes still overcomes me, but I won’t let it consume me any more.
Chris, it sounds like you really identified with this post. And I am glad you wrote in. However, the facts as you present them don’t quite add up to the ones that i suggested might be reflected in someone with a Perfectly HIdden Depression. Your diagnosis of Bipolar Disorder and in fact your own report of what your experience with your family does not sound to me quite like it fits this particular rubric. I would hope that would keep open to ideas about reconciliation of some sort. Good luck.
With all due respect, Dr., I feel this description of the PHDP fits me quite well.
Very few know of my troubles because I hide them from the world. I am the planner/organizer, “healer,” confidant to whoever needs me, but I don’t discuss myself.
I related to your missive because I can relate to your description of this type of person. With each section, I said….that’s me.
Chris if it helps you to understand yourself, then that is all that matters.
The first phrase that comes to my mind is “even good stress is stress.” I also think of times when those of us who had great parents who still screwed up sometimes in painful ways (you know, the whole being human thing) always feel the need to talk about how great their parents are before they talk about how their parents hurt them emotionally. This was incredibly poignant.
Really good points Jamie. There is a protective quality isn’t there? Sometimes for parents and certainly for self. Thank you for reading and commenting.
I am so sad to hear of this woman. I have been this invisible woman. Fortunately, I have caring friends and the ability to make myself heard to help me address my issues. That people suffer quietly like this breaks my heart. I believe that having people who we can truly talk to (without being judged) is critical for mental health.
Andrea I am so glad that something shifted for you – within you. I totally agree about talking with friends. It saves me all the time. Thank you for reading and sharing your own story.
Andrea I am so glad that something shifted for you – within you. I totally agree about talking with friends. It saves me all the time. Thank you for reading and sharing your own story.
I sincerely appreciated this post and wish I had read it years ago. I was one of those women and finally found my release by writing my memoir – which I published last year. People that read it who had been friends for years were very angry that I had not shared all the pain and trauma — but for whatever reason, at the time, I felt it had to be hidden. Now, that I have ‘come out of the closet’ I am in a position to help so many other women who are going through the same problems. If I had only known sooner that would happen, how wonderful it would have been to have had that support. Thank you
I can hear the regret Carol and am so sorry that you went for so long, keeping whatever secrets you did. I am sure your story has been and will be very meaningful for many. Thank you so much for reading and commenting.
The response has been far beyond anything I could have hoped or dreamed. Through sharing my weakness, I became strong 🙂
Thank you
Carol @ Battered Hope
Thank you again Carol.
My sister just skipped the step where the healing should have taken place BEFORE she ran into her future. And she’s been suffering ever since. Now in her 50’s that young woman is hard for her to connect with, but that young woman still needs mending. I try the best that I can to be there for her, but it’s the hard- for both of us. Nice post.
She may have to take the risk Cheryl of stopping running away from that part of herself. Turn around and face whatever she is afraid of. It’s so hard to watch someone you love not take care of themselves. I will hope for the best. Thank you for commenting.
I am struggling with depression and this really resonated with me. When I tell people they all look at me like they can’t believe it. On paper I have a great life, but I am slowly dying inside. Thank you for writing my story.
You’re so welcome Elize. I hope you’ll read more of my posts on PHD, and consider opening up to a therapist about what you’re experiencing inwardly. You can feel better! I’ve conducted interviews with at least three dozen people that have identified with PHD, and quite a few of them were beginning to take steps to change. Please think about it, and thanks so much for letting me know.
I took the plunge a few months ago when my life started to fall apart. I couldn’t keep it hidden anymore. 40 years of youth and adult trauma has taken it’s toll and burying myself in work hasn’t helped. I am slowly feeling better, but the inside voices are still really loud at times.
Good for you. Sometimes you feel worse before you feel better with therapy. Hang in there !
I’m a48year old man and I’ve been dealing with this for my entire life and I am very good at hiding it most of the time but im tired and I don’t want to be here anymore I can’t take it much longer I m tired I never sleep my partner doesn’t understand he thinks im on drugs and im not I just don’t sleep I barely eat I’m totally drained and I don’t know how to do this anymore I can’t keep a job anymore I don’t want to be here anymore im so sad and I don’t know why
Douglas, it sounds as if you’re needing immediate help and support. Please contact, if needed, the suicide prevention hotline http://suicidepreventionlifeline.org/ where they can refer you to therapists or doctors in your area. Sleep deprivation can cause terrific problems, and can also be diagnostic of several mental disorders. I would recommend that you find a doctor immediately for help — a family physician or going to the ER — whatever you can do where you live. If your partner doesn’t believe or understand you, then find someone who will.. Please advocate for yourself. You’ve reached out for a reason.
I wish it was easier for others to see… it’s a very lonely place to be.
It certainly can be Brit. I’m glad you commented, and hope that perhaps you can open up to someone who might understand.
I think I have PHD too. Its hard to tell anyone that I have been in a bad mood for a long time and it seems like depression, specially my parents who wait for a good news about me to be happy. When you see yourself in your parents’ eyes, just strong independent smart girl who controls her feelings, you cannot tell them that you are depressed, instead of this, you decide to be quiet cause not only parents but also everyone has his/her own problems which are more than enough for them.
Hello Salma. You make a great point — that when someone, especially a parent, gives you the message that their happiness depends on you, and you absorb that responsibility, then it gives you a reason to hide. You might want to read the book, “The Emotional Incest Syndrome” as it might be helpful. Thanks so much.