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Three Compelling Stories Revealing The Pain Of Perfectly Hidden Depression

Trying to understand Perfectly Hidden Depression ® (PHD), what it is, how it came to exist, how it’s maintained and what you can do about it are overarching goals for this column. Today, I want to describe, both through my own discovery as a therapist, and through the stories of three people who’ve reached out to me, what Perfectly Hidden Depression sounds like. We’ll hear their own voices, as they each describe what’s going on in their minds and hearts, as they fight off the fear of reaching out and revealing what’s behind the smile and the perfectionistic facade.

They may win that battle, or they may not. They may be aware, or they may not of what that war is costing them, and those they love. But they know something’s not right.

These three people wanted to describe that battle, and to help with our own comprehension of that cost. I’m very grateful to them.

Let’s start with me. The short video below describes how, as a therapist, my own journey of understanding began — catching someone as they tried to hide, suggesting there was another way of labeling their tears, and giving them permission for self-compassion and self-acceptance.


What follows are the words of three people (their personal details have been changed) who are busy creating a facade of the perfect life, while hiding loneliness, exhaustion and despair. These stories aren’t the most dramatic examples of emails I’ve received, where suicidal ideation has crept in, or even an attempt has been made. Yet these voices speak clearly of the vast difference between what the world believes about each of them, and what they know in their quietest of times about themselves.

I found them compelling, yet simple.

The story of Casey, aged 30…

I am almost embarrassed to be depressed. I feel like if I went to a therapist it would be wasting their time — there are people out there carrying much heavier burdens than I am, certainly. But I am starting to think I need help. My sadness is sort of a constant thing that I deal with (like a low-grade headache that you can forget about sometimes) and some days I feel great. But then something will happen to tip the balance and I am lost.

Ever since my dad passed away in July it’s been so much harder. I want to sleep all the time. I don’t want to take care of my house (but I do since I don’t want anyone to see it messy). I don’t want to go out with friends (but I do so they don’t think I’m ignoring them). I even feel angry a lot over dumb stuff — I have never, ever been an angry person. But I don’t want anyone to know it (I almost can’t make myself NOT be happy around others, if that makes sense?).

I feel like I am wearing a mask when I’m out in public. I work with high school students and most of them spend a lot of time in my office because I’m really good at letting people talk (no judgment or advice, just an ear). I think most of my friends and family like me for just that reason. They like Casey the Listener, Casey the Sympathizer, Casey Who Doesn’t Make Fun of You. But they have no idea how there is this constant ache in the pit of my stomach, or how tears are right there behind my eyes. I don’t think they would even want to hear about my problems….they like to talk about themselves and 99% of the time I am ok with that. 

Jordan’s story, a man in his mid-40s…

It’s like a constant undercurrent, invisible to most casual observers. It doesn’t seem to characterize me. I’m a smart-ass life-of-the-party and all that. But it’s still there. And when it comes out from time to time, people around me are shocked.

I’ve achieved far more in life than I expected. I’m 47. I was the first member of my family to graduate from college. 

Two failed marriages. Both were results of hidden despair. I mean the marriages themselves were the byproduct of my despair. I wasn’t emotionally close to either wife. I thought I could be successfully married while managing the relationship in some rational way that would let me remain strong. Or at least seem strong. And I didn’t want to be alone. I wanted the negative to go away. I denied it.

I have secrets I’ve kept from everyone.  I’ve never trusted anyone enough to fully confide in them.  I keep myself distracted with adrenaline feeds from triathalon training.

It’s still there. This thing. Always.

I find I need to constantly shift my focus away from death. I’m fixated on it as a target. I don’t plan to hasten its arrival, but I’m not doing much to keep it away, either.

And in my darkest moments, I realize I’m not that special. I believe there are millions more just like me.

From Robin, a college student…

So you know a little of my past I am the daughter of a drug addict. My mother did pills all of my childhood and it was what many would say very traumatizing. I still have a problem believing this because I always seen this as “normal” and would tell myself things were not that bad and I was just being sensitive and went on with my life. I always worked hard in school to have straight A’s, I also have a habit of caring for others and trying to make sure they accept me and think I’m great.

As irrational as it is anything less than perfection makes me hate myself. Yes I’m the student who got a 104 on a biology exam and was upset that I missed one bonus question, I would cry in my bathtub over getting a B on a math exam, and even hit myself when I got a low B on a statistics exam. If I’m not excelling in school I feel worthless, pointless, and frustrated.

I can honestly say at this point in my life I don’t love myself. I love only the part of me that is capable of achieving great success, the part of me that is responsible and can take care of others, the part of me that is put together. 

You may know these people. Maybe she’s your kid’s teacher, your hanging buddy, or your classmate.

Maybe your inner life is like theirs. 

But maybe, you can also hear their struggle. You can decide, as I hope they are, that you don’t have to lead that life.

If you suffer from PHD, maybe it’s time for you to reach out — and be known.


You can always reach out to me via my email: [email protected] It’s confidential and I’ll get back with you. I’m continuing research on PHD and would love your feedback.

You can hear more about PHD and many other topics by listening to Dr. Margaret’s new podcast, SelfWork with Dr. Margaret Rutherford or click here to read her other work.

Perfectly Hidden Depression® is a registered trademark.




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Three Compelling Stories Revealing The Pain Of Perfectly Hidden Depression

Dr. Margaret Rutherford

Dr. Margaret Rutherford is a clinical psychologist who's practiced in Fayetteville, Arkansas for twenty-five years. Her passion for researching Perfectly Hidden Depression began in 2014 and she's currently writing a book to be published next year by New Harbinger. Her work has been featured on Psychology Today, The Huffington Post, The Mighty and The Good Men Project, among others. She's the author of "Marriage Is Not For Chickens", a blogger (Https:// and podcaster (SelfWork with Dr. Margaret Rutherford). She welcomes your questions and comments -- [email protected]

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APA Reference
Rutherford, D. (2018). Three Compelling Stories Revealing The Pain Of Perfectly Hidden Depression. Psych Central. Retrieved on February 21, 2020, from


Last updated: 22 Feb 2018
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