Finding The Courage To Unmask Perfectly Hidden Depression

A guest post by Dr. Margaret Rutherford

No one knows Emily.

They think they do. They know she's traveling up the ladder at work, earning a promotion last month. 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.

This is what people don't know.

They don't know that Emily's father used to scream 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 makes herself throw up to maintain some sense of control – over something.

People don't know that 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. The immense pressure he feels to perform govern his every move.

No one knows that Emily and Patrick are depressed. They themselves may not recognize it for what it is. They keep their pain locked tightly away, hidden behind years of smiling and surviving.

I call it Perfectly Hidden Depression (PHD).

It's depression all right. But it's masked by an almost impenetrable facade of perfection.

There are no tears, no outward signs of the fears and sadness within.

And they tell no one.

This Is My Brave is asking people to do the opposite.

The organization is a major player in the cultural movement to confront the prejudice against those with mental illness. Programs are being organized all over the United States. People with mental illnesses are auditioning to get the chance to speak their brave reality. Audiences are hearing and seeing their neighbor, someone they sit by in church, their lawyer, their hairdresser -- speak openly about the mental and emotional issues they cope with every day. Whether it's hearing voices, dealing with mood swings, having the obsession to count everything in fours, germ phobias, or nightly nightmares of past trauma, people with mental illness cope. Their resilience can be phenomenal. Many seek treatment, and manage what, often, are chronic problems, using medication, therapy, meditation, trauma work, exercise -- whatever helps to keep them stable.

Emily and Patrick may never audition to reveal their struggle. Until they experience such loneliness, exhaustion, or despair, that they can't keep up the facade any more, they will stay silent.

They're not prejudiced about mental illness. No. In fact, they'd likely attend a production, like This Is My Brave, and support the cause. But allowing others into what is their private world?

Someone with Perfectly Hidden Depression cannot imagine revealing who they are.

Their gut knows something is wrong. Their mind will not allow them to explore what it could be. They've been taught or learned that pain is something not to be talked about -- that their persona must always be upbeat. Positive. Hard-working. Giving. Caring. Compassionate. And success will be theirs.

Therapists will miss this kind of depression, because people like Emily and Patrick don’t have any of the classic symptoms – lack of pleasure in life, depressed mood, low self-esteem, hopelessness or helplessness, problems with thinking and decision-making, appetite or sleep disturbance. In fact, they appear to be quite the opposite. People with PHD may even end their lives before they admit something's terribly wrong. Others who knew them will shake their heads, and wonder what happened, or how such a happy, successful person could kill themselves.

One person with PHD said it best.

"If you take one of those depression inventories, they ask, 'Have you ever felt hopeless?' or, 'Have you ever had thoughts of hurting yourself?'  The answer for someone with PHD is, 'No,' although that's not likely a truthful answer. What they should be asking is, 'If you felt hopeless, if you had thoughts of hurting yourself, would you tell anyone?' The answer would still be, 'No', but it would reveal more of the truth."

Stuart Walker's words, in an interview about his own hidden depression, are achingly poignant.

The good news is that our culture is changing. We are being educated about various mental illnesses, and what can be done about them. There are efforts, like This Is My Brave, to heighten awareness and acceptance of mental illness. Stuart himself has been sought out by many, after this interview, with both men and women opening up to him about their own struggle, and 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 have had some issues.... it would be cowardly for me not to share it."

For all who have that same courage, who come forward, who risk experiencing the prejudice that still exists, thank you.

For those of you who may still be hiding, who may be carefully maintaining a rigid wall between yourself and whatever pain is there, realize there’s another way. There’s a way of being that connects with and grows from experienced pain, or sorrow, or anger.

If you experience Perfectly Hidden Depression, you can slowly and carefully take off that mask.

And you can stop hiding.

If you would like to take a questionnaire to see if you identify with PHD, click here.


About the Author: You can hear more about PHD and other topics by listening to Dr. Margaret's new podcast, SelfWork with Dr. Margaret Rutherford, or reading posts on her website