I’ve written a book about what I term perfectly hidden depression. It describes the phenomenon of leading a perfect-looking life on the outside, while carrying around a tremendous amount of silent despair – which can tragically lead to suicide.

When what “seems” is far from what actually “is”…

In talking about this kind of perfectionism, I’m not offering the absolute, never-has-been-considered-by-anyone-else warning signal for depression or suicide. Perfectionism has been known to be correlated with depression and in more recent research, suicide.

What I’m offering is the idea that “seems” can hide much more pain than you realize. Perfect-looking people are just that. Perfect. Looking. Perfect. Seeming. And seeming is not the same as being.

What follows is an excerpt from my upcoming book Perfectly Hidden Depression. The stories are real, told to me by my actual patients or people who came forward to be interviewed, many of whom were talking behind closed office doors or in their garage because they were still hiding. These are people at huge risk and they could be… you.

An excerpt from Perfectly Hidden Depression... 

One day as Brittany—a tall, attractive young woman—came into my office, I wondered (as I always do in a first session) what problem or issue would come forth.

“I saw you on Periscope talking about perfectly hidden depression,” Brittany said. “I’ve never been to therapy. But I know that you’re describing me, and I’ve got to get help, because things are getting worse.”

She stopped abruptly, seeming to immediately regret telling me even that much about herself. Smiling brightly, she sat a little sheepishly on the sofa, one of her legs nervously pumping up and down. She didn’t know what to do, and she waited for me to respond.

“Well, if you identify with PHD, you’re not used to openly talking about yourself. So, I bet being here is hard.”

She nodded, looking down at her feet.

I reassured her, “We can take all this very slowly. I’m here to listen, but you’re in charge of just how fast or slow this goes. So, is there something that’s happened recently that’s made you more worried about yourself?”

Brittany didn’t tell me everything about her life in that session. In fact, it was months before I knew her whole story. Occasionally, she’d blurt out a hurtful secret that she’d been keeping, all the while very closely watching to see my reaction, as she gradually took more and more risks in sharing her real life. Still, her ability to openly express the emotions connected to those secrets was very limited. I’d see only an occasional tear, quickly covered by a blank look or a change of subject.

And that’s perfectly hidden depression. Shame, trauma, hurt, anger—so many of these experiences and feelings have been kept under wraps that opening up can be a slow process.

Brittany wasn’t the first person I’d seen with this kind of emotional disconnect between the pain of what she was saying and the feelings she would allow herself to express. Others before her had shown this same kind of denial or detachment:

  • Elizabeth recounted a story about waking to find herself lying naked on a beach, having been drugged and raped. “I’ve never thought the story was all that important. It was a long time ago,” she told me, smiling hesitantly.
  • Linda hadn’t cried in years, even after her mother’s sudden death. “Crying makes me uncomfortable,” she said. “I think it’s a sign of weakness.”
  • Jackson talked about strange, secret impulses to drive off the road, then followed his confession with, “I have a good wife and family. I’m just a little stressed.”

Like the others, Brittany didn’t look depressed in the classic sense. She was extremely rational and highly organized (if a bit rigidly), her planner stuffed with sticky notes and extensive to-do lists. She stayed very busy with dinners with girlfriends and a steady boyfriend. She was professionally successful, although highly anxious about making the right decisions for her future. She didn’t look sad; in fact, she was often quite jolly and funny. What Brittany allowed others to see looked pretty perfect.

If you experience perfectly hidden depression, you don’t equate what’s going on as depression. Depressed people are sad. Depressed people have no energy. Other people notice that they’re listless or agitated, or that they sleep all the time. The very idea of you being depressed may seem ludicrous to you—at least before you started reading about PHD.

If you’re completely honest, you can confess nervousness about what others would think if you admitted feeling down or hopeless. You fear the stigma against mental illness. You’ve said to yourself, Oh, my gosh, I’m not depressed. Crazy busy maybe. But not depressed. You’ve handled pressure after pressure, loss after loss, and you’ve carried on. You’ve worked hard, parented hard, volunteered hard. You’re always upbeat.

Most important, admitting depression would be admitting a flaw. And if you’re perfectionistic, flaws are to be hidden.

You’re like Brittany. And Elizabeth. Linda and Jackson. Because yours is not the classic presentation of depression.

No one suspects anything is wrong. Yet you’re the person who might kill yourself, and no one would know why. Brittany told me months after our initial session that she’d been planning to take her own life before she walked in my door. She knew she couldn’t live like she was living anymore, hiding so much pain and hurt, feeling hopeless and trapped underneath all that smiling.

It’s depression all right. Perfectly hidden depression.

Through accepting yourself and by letting go of shame, you’ll lead yourself away from the voices that tell you your life isn’t worth fighting for… if it’s imperfect.

If this is you, risk what Brittany and Elizabeth and Linda and Jackson risked. They began talking. They risked looking imperfect. And they lived.

I’ve heard too many times than I want to hear, “If I hadn’t done this work, if I hadn’t come in, I wouldn’t be alive now.”

Please don’t wait.

If you wonder where you might fit on the spectrum of PHD, here’s a questionnaire.

Other important links:

Call for The Suicide Prevention Hotline

Text for help with Suicide Prevention

You can hear more about perfectly hidden depressiob 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!

Photo by Josh Hild from Pexels.

Post originally published September 12, 2019; republished on October 9, 2021.

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