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Three Stories of How Perfectionism and Depression Got Way Too Close To Suicide

Do you believe that suicide is predictable?

It’s not sadly, and tragically. Suicidal thoughts can be part of your neighbor’s everyday life — your professor’s daily existence — or your boss’s regular mental fare. And you might never know it.

And if you’re perfectionistic or afraid of mental illness stigma, then the chance is even less likely that you will reveal how you actually feel or think.

For example, there’s Emily.

People think they know her. They know she’s traveling up the ladder at work. They know she’s an extremely loyal friend, and always has time for everyone who needs it. They know she’s fun, ready to go anywhere and do anything. In fact, she’s always going. And doing.

Patrick is a lot like Emily.

He’s the guy people turn to in a crisis. He’s a more-than-dedicated volunteer in the community, heading up fundraisers and chairing committees. He’s the guy who makes you comfortable by telling a joke or laughing at himself.

If you’re a perfectionist, you’re an expert at hiding…

What’s underneath Emily and Patrick’s behavior? What’s their back story?

Emily’s father used to tell her how worthless she was, as she tried to stay out of the way of his nightly drunken binges. Her mother still tells her that it wasn’t that bad, and won’t talk about the past. She only sleeps three hours a night, and after bingeing on junk food, makes herself throw up in order to maintain some sense of control.

She’s suffering from Bulimia.

Patrick’s mother died when he was very young, and he was told never to speak of her again. Any pictures of his mother disappeared. He was forced to call his new stepmom, who appeared five months later, “Mother.” He watches how others so easily trust, but he cannot seem to relax. He struggles with believing that disaster is right around the corner, and worries constantly.  There’s no way he can go to sleep, so he pops a Xanax nightly.

Patrick has Generalized Anxiety Disorder.

Both “diagnoses” are a secret. In fact, neither has ever been to a doctor or a therapist. Emily and Patrick keep their pain locked tightly away, hidden behind years of smiling and surviving. They’re perfectly hiding what they perceive as a flaw, a vulnerability. And, to them, mental illness of any kind, and the stigma it may likely bring with it feels like a flaw.

Researchers understand the connection between perfectionism and suicide and have long been finding that it can be live alongside several mental illnesses. The major identified suicide risk factors have been hopelessness, impulsivity and believing you’re a burden for those you love. Yet suicide still seems to be unpredictable, and that unpredictability is frightening to realize; I call this Perfectly Hidden Depression, or PHD.

Three stories of coming far too close to suicide…

Here are true personal stories of PHD from patients I’ve worked with – can you relate?

  • “I was very much trying to control things, but I didn’t have any answers. I didn’t want to tell my wife the exact thoughts I had. I was lost. Every day, I thought about driving off a bridge, as I smiled and waved at customers. I finally broke. My wife made an appointment for me with a therapist, and it literally saved my life.”
  • “Until recently I thought I had everything under control but a year ago I had a meltdown and sat in the garden with a gun in my mouth determined to do it – I have no idea why I didn’t – I just didn’t. Outwardly I have it all – I’m dead inside and feel often as if I am just going through the motions. The only thing that stopped me was my kids.”
  • “Five years ago, just before my 39thbirthday, I was seconds away from driving my car into the path of a tractor trailer. The only thing that stopped me was seeing the driver’s face. I realized he would think he killed me and my pain would simply be transferred to him. I couldn’t be responsible for that. The next day I went to my doctor and, for the first time ever, spoke freely about what I learned later was anxiety and depression. I’d been seeing my doctor for over fifteen years. I remember the pain in her eyes as she said, ‘I had no idea. Why didn’t you say anything?’”

Notice the emphasis on control for the first two. And incredible sensitivity to others in the last. These people felt hopeless, despairing to let anyone know, not even a healthcare professional, how out of control their lives felt. They believed that would be weak — that revealing would demonstrate a flaw.

They all three now know that the revelation of their true feelings was the beginning of personal emotional freedom and self-compassion.

But all came far too close to ending their lives.

If you feel this way, please risk telling someone — someone who will respond with empathy and care. Someone who will help you get the help you need, even if they’re surprised by what you have to say. Talk to a family member, go to a doctor or a therapist. If you’re a perfectionist, you don’t have to continue to listen to the constant self-berating and self-criticism that’s inside your head.

The shame that’s talking to you doesn’t want you to be free, to find self-acceptance and self-compassion.

But you can stop listening to that shame, and heal from whatever has kept all of you locked away for far too long.


To reach the Suicide Prevention Awareness Hotline here in the United States, click here. 

Here’s a questionnaire to determine where you may belong on the spectrum of Perfectly Hidden Depression.

You can hear more about Perfectly Hidden Depression and many other topics by listening to Dr. Margaret’s new podcast, SelfWork with Dr. Margaret Rutherford.



Three Stories of How Perfectionism and Depression Got Way Too Close To Suicide

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 Stories of How Perfectionism and Depression Got Way Too Close To Suicide. Psych Central. Retrieved on June 6, 2020, from


Last updated: 1 May 2018
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