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When Depression Doesn’t Always Look Like Depression

Sometimes the simplest of things get missed, until you see. Then you can’t help but see. It’s so obvious.

Depression doesn’t always look like depression. It’s one of the reasons I’m so passionate about identifying Perfectly Hidden Depression (PHD) ® as a syndrome that masks depression. You may not see PHD in your partner. You may not see it in your friend. You may not even see it in your child.

And that can have tragic consequences.

You may suspect something. She seems worried and pressured to get things done, but thrives on being busy. She refuses to talk about things that happened to her in the past but you can hear your laughing on the phone with friends, making plans that she’s excited about.  He’s checking on his mom and dad a lot, dedicated to being a good son. They look, sound and act like they have for years.

How can this person be depressed?

You’re supposed to change if you’re depressed. In fact, it’s a requirement for the diagnosis. Your ability to act, to engage, to be active is supposed to show a deterioration. The person is either supposed to admit, “Yeah, I’m really down” or “I just don’t feel like doing anything.” Or others around her are supposed to notice: “Are you sure you’re all right? You’re not yourself.”

What is the simple thing that keeps Perfectly Hidden Depression invisible…

This is the simple thing that’s screaming at us. Classic depression diagnostically requires a change from functioning fairly well to being far less functional.  When you’re hiding, nothing changes. You’re the same. You appear happy. You’re energetic, committed. You may get a little tired. But you’re right back at it the next day.

Even if you’re becoming more aware of the effort it’s taking to perfectly hide, you’re such a master of illusion that you pull life off, seemingly effortlessly.

Even if you seek help, even if you admit, “Something doesn’t feel right,” there’s no obvious emotional or mental deterioration.

So even a therapist may not see it.

Stuart’s story…

Stuart Walker is a bright, articulate, funny, and kind man who came to me a couple of years ago. He’d experienced PHD and wanted to open up about it. His entire interview can be found on YouTube. It’s very moving, as he talks about having two special needs children, running his own local gym, trying to be a good husband, while fighting off growing suicidal thoughts. This excerpt is achingly poignant as he describes his everyday struggle.

He’d been hiding, and doing it so well, that it had to reach a breaking point before he reached out for help.

Stuart has been sought out by many, after this interview, with both men and women opening up to him about their own lives, revealing their own perfectionism and fears of giving it up, while thanking him for his honesty.

Toward the end of the interview, I asked Stuart why he had risked revealing what had, up to this point, been his own private knowledge.

Knowing that I’ve had some issues…. it would be cowardly for me not to share it.”

What PHD means for the treatment of depression…

We have to stop putting depression in a box and believing that it always surfaces a certain way. We have some leeway. We already recognize that it can look like anger. We already discuss how it can have a huge anxiety component. We already understand it as being on a spectrum, from mild to severe.

When I see a mental health professional being interviewed on a morning talk show about depression, and they trot out the same old same old criteria, I want to throw a pillow at the TV. “Be on the watch for isolation, or not wanting to do things they used to want to do, or not sleeping or sleeping too much.” Yes. These factors describe classic depression.

But there’s more. There’s Perfectly Hidden Depression.

If you’d like to take a questionnaire to see where you might be on the PHD spectrum, please click here.

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.



When Depression Doesn’t Always Look Like 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). When Depression Doesn’t Always Look Like Depression. Psych Central. Retrieved on August 9, 2020, from


Last updated: 6 Apr 2018
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