Summary: Perfectly Hidden Depression By Margaret Robinson Rutherford
Summary: Perfectly Hidden Depression By Margaret Robinson Rutherford

Summary: Perfectly Hidden Depression By Margaret Robinson Rutherford

What Is Perfectly Hidden Depression?

Perfectly Hidden Depression (PHD) isn’t a diagnosis you’d receive from a doctor or a therapist. It’s not a mental disorder. It’s a syndrome, or a set of characteristics that, when they appear together, suggest a specific disorder or problem. You may have been aware, on some level, that something was going wrong. You might’ve searched online about depression, looking for answers, but you didn’t find yourself in the criteria.

Let’s look at the characteristics of perfectly hidden depression. If you experience PHD, you likely…

  1. Are highly perfectionistic and have a constant, critical, and shaming inner voice
  2. Demonstrate a heightened or excessive sense of responsibility
  3. Detach from painful emotions by staying in your head and actively shutting them off
  4. Worry and need to control yourself and your environment
  5. Intensely focus on tasks, using accomplishment to feel valuable
  6. Focus on the well-being of others but don’t allow them into your inner world
  7. Discount personal hurt or sorrow and struggle with self-compassion
  8. May have an accompanying mental health issue, such as an eating disorder, anxiety disorder, obsessive-compulsive disorder, or addiction
  9. Believe strongly in counting your blessings as the foundation of well-being
  10. May enjoy success within a professional structure but struggle with emotional intimacy in relationships

Does this sound like you? If you recognize most or all of these characteristics in yourself, you probably feel relieved to have a name for what’s been your secret truth. That pit in your stomach is real. You’re not just crazy busy.


Stage 1: Attain Consciousness

Right now, you’re like a turtle when it senses danger. Your automatic strategy is to hide any vulnerability within a shell of perfectionism. You abruptly pull any sign of it in and hold on like your life depends on it.

So how do you begin to change what may seem automatic? The first step is to become more conscious of yourself and your reactions. And it takes lots of practice.

Overcoming Denial

No matter what type you identify with, you likely deny the extent of the damage that your perfectionism has created—unless you’ve become terribly despairing or even suicidal. Denial is the opposite of awareness. And you’ve been in a heap of denial.

As you begin to confront your own denial, you may have different emotional responses to reading that your arsenal of choices may not act in your best interest.

First, you may welcome the information. It may feel like relief. It fits with the gut feeling you’ve had for a long time, which is that something’s wrong that you haven’t been able to put your finger on. It’s as if someone has handed you the last remaining pieces of a puzzle—and now you can see the entire picture. The label “perfectly hidden depression” gives what you’ve been experiencing a name—a tangible identity. It can offer a lens through which you can discover and understand what’s been happening in your mind and heart. It’s important for you now to get the facts, so that you can assess what direction you want to go. You’re taking the bull by the horns. You’re eager to pick denial apart when it tries to convince you that perfectionism isn’t a problem.

Second, you may feel overwhelmed. It’s hard work, and you might fight the tendency to put down this book and avoid any more thoughts about perfectly hidden depression. Denial can feel much easier than awareness. It can feel like too much to consider changing. You don’t want any more information. Enough is enough. And you may stay stuck in the syndrome, not being able to believe that healing is actually possible. I hope this doesn’t happen. But if it does, please know that there’s a time for everything. Please don’t put off looking at your perfectly hidden depression too long.

Third, you may struggle with fear and worry, especially that you’ll be labeled as less than or incompetent if anyone finds out. This is normal, given the stigma in our culture and world regarding mental and emotional issues.

Mindfulness and PHD

So what about mindfulness is specifically important for perfectly hidden depression?

Think of emotions as waves in an ocean. Each feeling—each wave—has a life of its own. It begins far out, deep in the sea itself. Then gradually as it rolls to shore, you become aware of its shape, its strength, its power. But when its time is done, when it disappears into froth on the beach, it’s replaced by the next emotion wave. You can feel the undertow reflecting its muted energy under the surface once again. This process goes on and on and on. Mindfulness is being aware of each moment of an emotion wave’s apparent life, riding it until it inevitably comes to an end.

This doesn’t mean that staying mindful or allowing emotions to emerge is a smooth, effortless process. It can be frightening and very intense. If it gets too intense, or if for any reason you don’t feel safe, then it’s time to ask for professional help.

Let’s start with a simple mindfulness practice. All you’ll be doing is sitting with your feelings.

Sit somewhere very comfortable in whatever position feels good. Set a timer for five minutes. Breathe deeply, close your eyes, focus on your breathing, and be still. Try staying focused on your breath. Don’t judge the experience or think too much about it. If your mind wanders, bring it back gently to focus on the breath. You can count your breaths if that is helpful for your focus.

When the timer goes off, take another minute or two to see what emotions might be there, like watching the wave of emotion dissipate. You may feel relieved, or you may be frustrated because you’re having a hard time. Open your eyes and write about your experience. Good for you.



Stage 2: Make the Commitment

Your work on perfectly hidden depression is a commitment to yourself. In order to heal, your behaviors need to change. But if commitment to change becomes another thing to do perfectly, you’re much more likely to quit the whole process if you make a mistake or run into difficulty. To help with this, let’s redefine “commitment” as “intention.”

Commitment involves a pledge or promise and a sense of duty. It can easily grow into a rigid measure of success or failure, as with the thought, I’ve made this commitment and I’m sticking to it.

Intention is an aim or a purpose but is innately more flexible. Intention brings with it a sense of soft focus. It’s a choice to commit—but with a little wiggle room. You can absorb fresh information along the way and determine if your intention needs to change.

Begin with the Simplest Goal

Because you’re a perfectionist, you might have the urge to start with the most challenging goal you can think of. But when anyone begins a process of change, it’s usually not a great idea to set the hardest goal first. You want to take small steps that you can more easily accomplish and that will build confidence as you test out a more imperfect, vulnerable self. Remember, you want to set yourself up for success and hope.

Ask for What You Need

You’ve lived much of your life rarely, if ever, asking for help. Going it alone is something you’re quite accustomed to doing. You’ve worked hard to be seen as self-sufficient, the problem solver in a group, or the person who can take charge and get things done. You trust in your ability to help others. Your perfectionistic drive has led you to hide whatever problems might arise, especially those problems associated with feeling confused or lost.

You’re struggling with perfectly hidden depression in part because you haven’t asked safe, supportive people for what you need. Now is the time to build a support network.

Address Other Mental Illnesses You May Have

As you may recall, one of the ten characteristics of perfectly hidden depression is the potential for accompanying mental disorders. Eating disorders, anxiety disorders, obsessive-compulsive disorders, and addictions can all have within them a component of control, fear of losing control, or the need to escape anxiety. And they could be affecting your intention to heal. Therefore, they definitely need to be addressed.

If you’ve not sought treatment for a recognized mental disorder, or it’s very active at the moment, then consider attending to that.

You’ll have to be very honest with yourself and determine if you’re putting the cart before the horse in focusing on perfectly hidden depression. It’s not that perfectionism can’t be destructive and dangerous in and of itself. We’ve recognized that. But it’s far better to begin therapeutic work, especially self-guided therapeutic work, when you’re as emotionally and mentally stable as possible.


Stage 3: Confront Your Rulebook

In this stage, Confrontation, you’ll use the skill of mindfulness as you grow in awareness of how rigidly you’ve followed certain rules. Think of it as living in a box. Rules that may have initially been necessary for your emotional survival—your “must do” and “never do” lists—have governed your life. They’ve created walls around you that have kept difficult emotions and memories out, while they’ve also kept you locked inside.

Confronting Your Rules and Beliefs

Let’s talk about the difference between beliefs and rules. Rules govern conduct. Beliefs are something you accept as true. The two are interactive. Beliefs may define the rules you follow. Yet the rules you follow may limit or expand your beliefs. For example, you might have the rule “I always put a smile on my face, no matter what.” It’s connected with the belief that “People won’t like me if I don’t smile.”

There are thousands of beliefs you could have that define your perfectly hidden depression. Yours will be unique to you and be born from your religion, your family, your culture, your mentors, your native country, your gender, your sexual orientation, your experiences, your traumas—whatever has influenced you to believe what you believe and perceive what you perceive.

If your belief stands up to reevaluation and helps you lead a fulfilling life, then it’s a keeper. If not, you’ll learn to challenge it, realize what kind of hold it has over you, and begin to loosen that hold. That’s your work for this stage and for the rest of your life.

Ten Directions to Move Toward
Self-Destructive Beliefs Self-Constructive Beliefs
1. I want to move toward loosening the grip of perfectionism. I must look competent in everything.

I’m okay with anxiety but I can’t admit depression.

Shame keeps me stuck.

I must keep the pressure on or I’ll turn into a slug.

I can accept that I make mistakes.

I can admit that I feel depressed.

Shame keeps me in line.

I don’t have to push to accomplish.

2. I want to move toward allowing others to take the lead. I need to feel in charge.

I cannot disappoint others.

I like being helpful and want to experience being part of a team.

It’s okay to say no.

3. I want to move toward tolerance of emotional pain. If I feel my pain, it will never stop.

I don’t do feelings and I like it that way.

I can learn to manage my emotional pain.

I may fear feeling and I can confront my fear.

4. I want to move toward calm and away from the need to worry. My worry keeps the people I love safe.

If I don’t look in control, I will appear weak.

My worry keeps me unavailable in the moment.

The more I try to look in control, the more lonely I am.

5. I want to move toward enriching my life with creativity and play. I cannot relax.

I like things with answers.

I have to have something to do.

I want to learn to listen to my body and rest.

I want to learn more about my creativity.

I want to learn to focus on the moment.

6. I want to move toward allowing others into my emotional world. Others would be burdened by my problems.

My worth is in what I can do for others.

Having the spotlight on me is selfish.

I can give others the chance to be a good listener.

Healthy relationships include give and take.

Being self-aware is different from being selfish.

7. I want to move toward self-compassion. What happened to me is nothing if I compare it to what other people have to deal with.

The past is in the past.

It only happened once.

What happened to me is important.

I can feel the pain from the past. It’s important. I’m important.

I will honor what happened to me.

8. I want to move toward accepting and managing my health issues. My anxiety isn’t out of control.

It’s weak to seek therapy.

I can recognize the severity of my symptoms.

It’s empowering to reach out and reveal.

9. I want to move toward seeing both the positive and the negative. I refuse to feel sorry for myself.

Positivity is the thing that keeps me sane.

Every pro has a con, every gain a loss.

Rigid positivity keeps me from feeling vulnerable. I want to choose vulnerability.

10. I want to move toward building vulnerability and intimacy in relationships. Real life isn’t like what you see on TV.

It’s not fair to change our relationship now.

Real life is messy. And that’s okay.

All healthy relationships change and grow.

It can be very powerful to experience letting go of a rule or belief that has held you hostage for many years, and then choose the unfamiliar path. And although very positive in many ways, it can feel extremely awkward and “wrong.”



Stage 4: Connect with Emotional Pain for Healing

It can be terrifying to consider connecting with how you really feel—what’s underneath your smiling persona. Looking in control, pleasing others, keeping your foot on the accelerator at all times—all these choices have protected you. Vulnerability’s like shedding your armor when you’re still in the middle of a battle. To confront shame headon, to connect with your anger, to admit fatigue—it’s too hard. It’s too vulnerable. You can easily fear feeling far too exposed. And you can withdraw into whatever shell you can find.

Building a Timeline to Achieve Emotional Awareness and Growth

Let’s again ask: How do I get to my feelings? Your path has four steps:

  1. Compassion: viewing yourself through a warm, sensitive lens—the same lens you use with others.
  2. Acknowledgment: recognizing your feelings as normal and a natural consequence of the situation.
  3. Mindful connection: gently allowing emotions to emerge and connecting with them.
  4. Acceptance: accepting all you’ve discovered

What is a timeline? It’s a chronological ordering of powerful events and experiences you’ve had in your life that were important markers for you. In creating your timeline, you will write about experiences—both happy and painful—that were important to you in becoming who you are. Perhaps you met a mentor. A teacher was especially kind. You won a competition. You didn’t get into the college you wanted, your beloved dog died, or a great friend moved away. Please consider all such impactful events.

Organize your timeline as you wish. One option is to draw a horizontal line and segment it into years. Then above the line you can write down positive experiences, below the line you can note traumatic or painful ones. You want to be able to view it easily so that you can see as much of it at one time as you can.

Step 1. Compassion—Viewing Yourself Through an Empathic Lens

You may have the urge to do this perfectly. Please resist that temptation. Be loving with yourself, as if you are guiding a child to do this work. You don’t necessarily need to access the memories you’ve shoved into your emotion closet. In fact, it’s preferable if you recall the ones that come easiest. Again, be kind to yourself; this work should not feel like torture.

Step 2: Acknowledgment—Recognizing the Messages You Learned

There’s something important to discuss before we head forward, and that’s the difference between blame and acknowledgment. There are plenty of people who believe that therapy involves blaming your parents or your past for who you are now. There could be nothing farther from reality. In fact, anyone stuck in blame will only become bitter. That’s not helpful at all.

This step isn’t about blame, it’s about acknowledgment. Acknowledgment is recognition. It’s owning that something existed or exists.

Step 3: Mindful Connection—Being Present with Your Emotions

In this step, as you fully acknowledge the messages you received, you want to allow your emotions to come to the surface. You want to feel the absorbed message’s emotional impact. If the message was from a more positive experience, such as winning an award or having someone in your family go out of their way to make time for you after school, those messages might have been: “When I try hard, I can accomplish a lot.” Or, “I felt loved simply because I existed.” Emotions created from these messages could be pride and feeling secure. These positive emotions may be easier for you to allow than painful ones.

Particularly if the message was harmful or demeaning, it can be more difficult for you to connect with its resulting emotion. You’ve been avoiding the pain for a long time. You may say to yourself, But I don’t like feeling sad or angry or afraid. It feels wrong somehow. And yet there’s no emotion that makes you “bad.” In fact, if you allow your emotion to surface and are mindful of its presence, you’re much more likely to recognize when it’s affecting you.

Step 4: Awareness—Realizing Unconscious Patterns and Relationships

This step is exciting as you grow in your awareness of and insight into patterns that have come into your consciousness. You begin by wondering how the events or experiences of your timeline influenced you. You can begin to question, If X hadn’t happened, would Y have happened? Or, Could Y be happening now because X happened in the past? You saw this very powerfully in Shondra’s story.

Step back a little from your timeline and see how you were shaped by these experiences and the messages and emotions linked to them. How is each related to the others? Does one seem to lead to another? Is there a theme or repetitive pattern in your thinking or behavior that you can recognize? Can you make the connection that a feeling you have in the present is similar to a feeling you had before? Let yourself begin to wonder and see where your mind and heart take you.

Then you can look around and see how those patterns may be repeating themselves in your life now and in your relationships with others. This is where you can begin true insight and notice when those old messages are popping into your head. That insight can lead to true change.


Stage 5: Change Your Focus from Perfection to True Happiness

A Native American wisdom story tells of an old Cherokee who is teaching his young grandson about life. “It is a terrible fight and it is between two wolves. One is evil—he is anger, envy, sorrow, regret, greed, arrogance, self-pity, guilt, resentment, inferiority, lies, false pride, superiority, and ego. The other is good—he is joy, peace, love, hope, serenity, humility, kindness, benevolence, empathy, generosity, truth, compassion, and faith. The same fight is going on inside of you—and inside every other person too.” The grandson thought about it for a minute and then asked his grandfather, “Which wolf will win?” The old Cherokee simply replied, “The one you feed.” —Kristin Neff, author of Self-Compassion

The part of you that you feed is the part of you that will flourish. What does it mean to feed some part of you? It’s your focus—where you live and spend your time in your mind and heart. You’ve lived in self-criticism. You’ve lived in fear of making a mistake or faltering in any way. You’ve lived under constant pressure.

Yet, with every emotional connection made, you’ve begun feeding the good wolf inside of you. Letting go of perfectionism takes an acceptance of risk and the vulnerability that comes with it. You aren’t perfect. You don’t have to look perfect or act perfectly. Your weaknesses are going to show to others.

Sitting with your vulnerability means that you can admit that both the good and the evil wolf exist in you and that the best you can do is try to feed the one that’s fighting for love and compassion. There will be times when you feel jealous, when you wallow in self-pity, or when you’re insensitive or overreactive. Those are emotions and actions we all fall into. They are what make all of us imperfect. Admitting them, living with them, others knowing them because you told them—all of it takes vulnerability.

Acceptance of your own vulnerability makes it much easier to take risks. Because if you fail or struggle, that failure or struggle doesn’t define you any more than your success would. You learn from those failures. You don’t have to hide them. Acceptance of vulnerability brings with it freedom.

Getting Down to the Brass Tacks of Change

We’ve talked about facing your fear, sitting with vulnerability, and trudging through grief to freedom. Now it’s time to allow the power of that awareness to spur you into action.

Let’s revisit the ten directions we outlined in Stage 3. We’ll use them as guideposts.

Continue Reading: Perfectly Hidden Depression Part 2