What is “perfectly hidden depression” | Dr. Margaret Rutherford

What is “perfectly hidden depression” | Dr. Margaret Rutherford

You’re going to love what my guest today has to say, and you might even love more how she says it. An incredible voice, the clinical psychologist, Dr. Margaret Rutherford. Dr. Margaret, welcome to Med Circle for the first time. Thank you, Kyle. I’m really really so honored to be here. I was I’m excited. Yes, I’m excited, too. I want to jump right into this topic of something that you’ve coined, which is perfectly hidden depression. And it sounds like a page right out of my diary. What do you mean when you say perfectly hidden depression? What I mean is that it’s a it’s a presentation of depression that’s often missed by mental health professionals. Exactly. Because when you when you present or when you maybe let’s say you go to a therapist and and you start talking about your life as a perfectionist and you’re anxious and you try to get everything right and what you don’t know how to do in in perfectly hidden depression. These are people who do not know how to express painful emotion. They have literally stuck it away for so long. uh and it’s become so automatic even unconscious would be the psychoanalytic word that they don’t realize that sometimes it’s even there and that’s why I call it perfectly hidden depression because even the people that may be carrying it around just know something’s off something’s wrong but their life looks perfect I met with Dr. Judith Joseph who’s a doctor and researcher you might know her out of New York and she was talking about high functioning depression and I believe she often talks about overcoming the hidden depression. Is this in that same bucket? It’s a great question. Um actually when I came up with the term perfectly hidden depression I had not heard of high functioning depression. Um and I have ordered uh I don’t know Dr. Joseph. But anyway, I know about her book and my take on it. I actually messaged her, so I hope she gets back with me. Dr. Judith, come on. God, really? Come on. I may be from Arkansas, but my lord, when I think of high functioning depression, I think of people who know they are depressed. They may be on medication. They may be going to therapy. They may recognize that they have feelings that they don’t easily express. And they um they’re different than people with more classic depression who literally struggle with energy and and have a lot of um trouble focusing making decisions that they don’t necess they don’t necessarily no one would give them the diagnosis of classic depression because they may not fit it. And so yes, high functioning depression would fit under the rubric of perfectly hidden depression, but there’s a subgroup and that’s the group that I’ve been trying to reach. These are people who don’t recognize that the way they feel on the inside is there’s something wrong with it. They they have this sense of pressure that they’ve got to succeed and achieve and go from task to task. Uh a famous researcher Dr. Gordon Fled on perfectionism says you know that there are kinds of perfectionism that it’s like you’re on a treadmill but you have no control over the speed or the incline. I love that quote. And this is my concept of perfectly hidden depression. These people don’t necessarily think of themselves as depressed. It’s just the way they are. But they they don’t seek out any kind of intimacy in relationships. it’s too uncomfortable. Um, they go from responsibility to responsibility and that is how they begin to think of themselves as a good person because they’re they’re task oriented and they get things done and people count on them and that’s what gives them a sense of self-esteem. The problem is that they discount, dilute or deny any of the pain in their lives. They say, “Oh, you know, everything stuff happens to everybody and my childhood was just fine. I’m not going to go blame my parents for stuff.” So, they they don’t really understand or acknowledge some of the hurt and the pain from their child’s their their lives as children or sometimes even as early adults. Mhm. I remember when I was 18, I officially came out to my dad and we were talking about it and I said something like, “Yeah, but dad, you know, every everyone has challenges and struggles and blah blah.” And he goes, “You know, Kyle, you’re the type of guy that would get in a car accident, lose his leg, and then go, yeah, but like there are some people with no legs and at least I have one leg. You’re allowed to be upset that you lost a leg, you know. Exactly. Exactly. I I call it an and. You can be you can be happy about something and you can be, you know, disappointed or you can grieve it. I mean, it’s like you say, I’ve got one leg and I’m not going to, you know, about it, but at the same time, I I’ve had a trauma. I’ve had a loss. And that’s important. It’s so hard for people who are depressed to even recognize they’re depressed. I I I think for a lot of people um especially if we are and correct me if I’m using the wrong term here but coping with our depression through perfectionism through our work through our output. So how do we how do we really determine if no I I’m alone because I want to be alone and I work really hard because I I want to work really hard. I’m not alone because I’m afraid of intimacy and I’m not working and I’m working really hard because I’m just trying to cover up my these feelings that I have and I don’t want to feel them. How do we determine how do we find that line? Does that make sense? You know, when I first started writing about this, I got a lot of feedback that I was trying to pathize resilience. Um, you know, and I said, “No, I’m really not trying to pathize resilience. Resilience is a good thing.” But I will tell you what, I interviewed over 60 people for the the original book, Perkeley and Depression, and they volunteered. They were reading the material I was putting out on my website about it. Because I was trying to figure out what it was, frankly, Kyle. Um, and they reached out to me and said, “I will volunteer talk to you about my life.” And I asked all of them, why would you reach out to a psychologist, a complete stranger in P in Favville, Arkansas, and tell your story, their gut-wrenching story about And they said to a tea, I don’t want anyone to live the life I have lived. It is so lonely. Really, no one knows who I am. No one. I haven’t let anybody know who I am. And so that is my answer to people who say,”Well, why upset the apple cart?” Yeah. You know, that was a long time ago or I don’t want to I I want to count my blessings. I I need to be grateful. And that’s true. We all for whatever blessings we have want to be grateful for those blessings. But I’ll get back to my end. You can be grateful and you can have something about what you’re grateful for. you maybe you wanted a big family and you’ve got four children. That’s great, but you’ve also got four baseball games or four lunches or four home for Yeah, I was going to say you also got four children. Yes, you also got four children. And so, you know, it can be an and you can talk about both. And so, I just feel like um I mean I frankly I wrote my first post about it in 2014. I called it the perfectly hidden depressed person. Are you one? I was shocked when it went viral. I was like, well, why is this so important? And then I was writing for Huff Post at the time. We put it on there and I got hundreds of emails. It’s like you’re in my head. H, how do you know about this? I never wanted I never had aspirations to write a book or anything. Um, I loved being a therapist. And so I started investigating. I found Bnee Brown’s work, which of course is magnificent. and and yet she doesn’t go as far as I think you need to go. And what I mean by that is um you actually can become suicidal and no one knows it and you can kill yourself with certain kinds of perfectionism. It’s much more you’re much more prone to that than other more constructive perfectionism. There’s a thing called destructive perfectionism. And so you and and unfortunately very tragically perfectionism rates are going up as are suicide rates. So it’s you know you may think I can handle it. I don’t need anyone to listen to me. I don’t need to connect with anyone. But we all need to connect with someone. All we all need that. Yeah. I don’t I don’t like when people bring up co but I’m going to bring it up. Okay. um going to break my own rule because I that was the first time that I realized I needed to connect with people was during coh because the forced isolation I it it I it made me realize oh my gosh I’m not the same when I’m not around people and different now I came out of that and it changed me from being somebody who at one point I I was fine. Dr. Margaret, you know, I I talk to my friends, see a couple people during the week, but I’m good the rest of the time by myself. Now I just love being around people. And I think being away from people for so long made me want to be around people. And so I got revalidated in that when one mental health month in May, I interviewed all these lived stories and all these people with lived experience and I go, “What was the number one thing that helped you through your, you know, mental health obstacles or troubles or whatever?” Great question. Number one over and over again is my community, my support system. More than therapy, more than psychoeducation, more than the medication, more than exercise, diet, and sleep. It was the people. The people. That’s right. That’s right. And there are people who think they don’t need people for whatever reason, you know. Yeah. But I but I’m with you. I think everybody maybe with minor minor exceptions, everybody needs a person, at least one. You know, the Harvard study, which I had um the the man who’s in charge of that and he’s written a book now called the what is it called? I have it over here. The good life. Robert Waldinger, I think is his name. Anyway, that’s a 75 year old experiment uh with people. They’re they’re looking at, you know, as you get older, what what what do you look back and say, “This is what’s made me happy.” And it’s connection. It’s people. So, uh yeah. And I I I have been contacted by so many people over the last six or seven years. My husband was like this. My wife was like this. I got the opportunity to do the TED talk because one the one of the co-organizers of that TED talk is um lost a friend to suicide whose life just was going great. You know, she just looked like she had that she had kids, she had a great career, she had what looked like a great marriage, and she hung herself on Valentine’s Day. So, and and well, and the kind of dramatic part of it all, but I don’t say it for that because it’s true, she said her husband came up to the woman who killed herself’s husband came up to her and said after the funeral, I found this on the woman’s bedside table and it was my book. So, you know, it’s like she was looking for answers. Yeah. And sadly didn’t find them. So yeah, for for those of let’s let’s lean into the supporter side a little bit. Okay, maybe we have that friend or spouse and they look like they got it all going on. How do you find the signs that they need help when it all looks like they got it going on? Do we have to look extra close on the nightstand for that book? I hope not. you know, u I had sold that many books. So, well, and I don’t I don’t mean literally your book, but I mean we have to go deeper and go, you know, they they’re looking back from from supporters of people who’ve who’ve died by suicide, they’re like, when I look back, there were little things where I go, ah, you know, so but when someone’s presenting so quote perfectly, that becomes harder to do. It’s what they don’t talk about. It’s what they don’t express. And I know it’s hard to notice the absence of something, but it’s actually not as hard as you think. Let’s say their best friend moved away. Um maybe even to another country and they never talk about it. Then they’re like, I really miss her. or they or they get asked after they um have co-chared or chaired some event and and earned all this money for a nonprofit and you know it nearly killed them to do that. They were working day and night on that sucker and somebody asked them to do the next years and instead of going you know I will help someone I will consult but I just can’t take it on next year they go well sure it’s the absence of self awareness the absence of self reveal the absence of uh talking about things that are hard Um, and so that’s what you can say. You can say, you know, if my mother was still alive, I used to say to her, “Mother, I never see you cry. I never see you cry.” And she’d say, “I’m just not a crier. You know, if I started crying, I’d never stop crying.” And so, and my mother was a great example of someone with perfectly hidden depression. Um, and so I that is how you can approach because remember these folks are scared to be found out. A lot of the people that I interviewed for the book said, “I would lose my job or I would lose the respect of my community or I would lose X, Y, or Z if anyone knew, you know, what I deal with on a on a daily basis or how hard this is for me. I, you know, people would people would see me and I don’t want them to see me. I don’t want them to.” Now, unfortunately, a lot of these people are going to pick other people that also don’t want to be seen as friends or as partners. Um, they also want to look like they’ve got the world by the tail. And so, they don’t reach out to this person say, you know, and and so they surround themselves with people who are making similar decisions. That Okay, y’all. That’s my big That’s my big take from Dr. Margaret is seek being aware of the absence of what’s being discussed. That is that is huge for me. I had never thought about it that way. I always thought, look at what they’re talking about. Look at what they’re doing. Here are the signs of depression. here that Yeah. But if there I get that and I’m going through the my rolodex and going I’ve done that too. You know, I’ve I’ve said I’m putting this away. I don’t want to talk about um you know, like I don’t have a my mother died when I was 16. I don’t have a picture of her anywhere. Nowhere. I don’t want to see it. I don’t want to be reminded of it. And look, I’ve gone to therapy. I’ve talked all about it. But like my mother That’s right. That’s right. And by the way, y’all, perfectly hidden. Sorry about your mom. Um, thank you. How to break free from the perfectionism that mass your depression, Dr. Margaret. It’s available on Amazon. Um, and has incredible, uh, reviews and ratings and, um, you can pick that up anywhere. Kindle book, audiobook, paperback, everywhere. Uh, we’ll also link it in the description below this video. That’s my big takeaway on because I I do pride myself today, eight years ago, not not a great supporter to to my friends. Okay. I was I was pretty much like, “Suck it up. Get over it. Tell your problems to somebody else.” Now I’m a much more empathic supporter. Um, but I I have this new tool in my kit, which is to be aware of what they’re not saying. Now, I want to dive deeper. If I’m if my friend is not talking about his father’s recent heart problems, can I bring that up with him? And I’m certain depends on my relationship with my friend, but what how do I what role is it for the supporter to point out, hey, you’re not talking about this? Well, I don’t ever cry. I don’t think you do it in a way that’s, you know, real aggressive or assertive. I mean, you can just say, this is what I notice and it concerns me. Mhm. You know, because I know if it were my family member that had heart issues, I I would want to talk about it or I can you, you know, do you realize this about yourself? And they may go, “Oh, yeah, yeah, yeah.” You know, they may kind of go, “Oh, that’s I just don’t think it’s important to share or whatever they might say.” Um, but I think that if you if you really care about them, you can say, “Well, you know, would you would you trust me to talk about something like that?” If you could, um, you know, I had a client, no, she wasn’t. I’m sorry, he wasn’t a client. I interviewed him for the book. Um, never met him, but he had gone to a psychiatrist’s office, taken the Beck Depression Inventory. Of course, he was perfectly hiding his depression. So he said, “No, I’m never hopeless. No, no, no, no, no.” And the psychiatrist said, “I’m not real sure why you’re here.” And so he left. Three weeks later, he tried to kill himself. And for some reason, I’m not sure even the context of this, but the psychiatrist found out about it. And and went to go talk to him and he said, “You were just in my office three weeks ago.” And the man who was telling me the story said, “I looked at him and said, “You were asking me the wrong question.” The question is not, “Do I ever feel hopeless?” Because since I’m uncomfortable sharing that with you, I would say no. The question to ask is, “Do you ever feel hopeless?” And would would you if you ever felt hopeless, would you talk about it? Would you admit it? My gosh. No, I would not. That would be really hard. And so you begin to notice the flip side of it, you know, rather than I tell the story in the book of a a woman that I saw years ago, years and years ago uh that I had not diagnosed with depression. I had no clue she was suicidal and I won’t go into the story, but I she did try to kill herself and and um I just felt bereft. I mean I was like what why didn’t I see this? Um, and I started noticing more. Now, I’m I I can’t make this a Disney story and say, “Oh, that’s when I figured out about Perfectly Hidden Depression.” No. But she was one of the people that when I was beginning to start talking about this and delve into it that I thought a lot about what had I what had I noticed about her? She was always bright and sunny and shining and laughing. And she was there because she was trying to decide whether to uh quit her job or not because she began having panic attacks at her work. And but she kind of laughed about it. Well, they’re really embarrassing, you know. And so I I bought into that. I bought into it. Yeah. And now and since then, I hope I kind of look at someone and go, you know what you just said. You have panic attacks. I have panic attacks, which I do. I said, “They’re really scary.” And why would you laugh about it? Isn’t, you know, can you explain that to me? So I You notice how people are talking about something, not necessarily what they’re talking about, but how they’re talking about it. You’re really good. This is this is such everyone who’s watching this will resonate with what you’re saying even if it doesn’t impact them because it will impact somebody they know and I would even argue that y’all haven’t we all been there to some capacity like haven’t we all kind of just laughed about our panic attacks you know like our own version of that and so this is this is a much more universal way to get people to to I think look at their own feelings is as uncomfortable as that is for a lot of us, myself included. Hello. If you’ve watched Med Circle, you know how I am about that. Um, but it’s it’s it it makes it more accessible. It having this conversation makes my feelings more accessible and so I thank you for that. And I I’ll add one other thing. The troublesome part again, I’m not pathizing courage, resilience, kind of making fun of yourself. I laugh all the time about, you know, stuff that happens. If that’s your only option, I have one way to function in this world and that’s to not ever admit that I feel hopeless or down or sad or afraid or whatever because that’s the only option I have. Then that’s when it can be a problem. I’m going to repeat the question mostly for my own so I remember it. it. The question is, and do you ever feel helpless or hopeless? The question for this that person was um if you felt helpless and hopeless, would you would you share that? Right. Probably not. Probably. And probably not. Wow. Not if you’ve got trauma that you know you got stuffed away back there so far that you’re scared that door would burst open if you start talking about it. Yeah. Yeah. Get that. Um, someone buys your book, they read it, they get to the last page. Mhm. What will they have learned and what will they feel like? Well, the book is not a formal workbook. I wanted it to be, but it was not. Um, but there are 60 exercises, reflections exercises in the book. A little over 60. A lot of people read the book and they’ll say, “I I loved your book. It was really helpful. It turned on a lot of light bulbs for me and I really appreciate your understanding.” And I go, “Great. How were the exercises?” “Oh, I didn’t do them.” And I said, “Oh, that made me a little uncomfortable.” So, it depends on if people read the book and did the exercises or if they read the book and just have a mental understanding, a cognitive understanding of it. And that’s fine. That’s a place to start and that’s if that’s what you can do, fine. Then do that. The exercises are meant to help you begin to find self true self-acceptance and self-compassion and to begin to connect the dots between how you are now and who you are now and what kind of choices you make now and what happened to you back when. So, and how to acknowledge that, embrace that. That’s too cy too weird a word. embrace how you how you deal with it and um and then go on with your life. So, you know, and and where you’re not dragging around a bunch of stuff that you’re scared to talk about or admit happened because that gets heavy. Um again, you can get Perfectly Hidden Depression on Amazon and I I I just looked at it and brought it up. Um it’ll be here on Saturday for me. It’s um sweet. I hope it helps. Yes, it’s uh 9% off right now, too, on Amazon. So, go a little go get that little discount. Well, that was for me. I don’t know going to affect the 37 cents I get every sales. Exactly. And by the way, you’re talking about how um people a lot of people don’t do the exercises. I get that. I host workshops every week at MedCircle for our members. Okay. and they they show up and they listen and they ask questions and they’re really intent and then we do the exercises and I’m screaming through the camera, are you doing it though or are you just sitting there watching me do it? Because if you’re watching me do it, you can’t go to the gym and watch me work out. You got to actually work out too, right? And when we created our first workbook for Med Circle, we’re going around, we’re like, what are we going to call this workbook? And I go, we’re going to call it doing the workbook. That’s what we’re calling it because I I let’s not sugarcoat it. Go do the work. When you open this, I want you to go, I’m going to work. I’m working on this stuff. Well, my podcast is the selfwork podcast. The self work. That’s right. Which is don’t worry on my on my docket. Yeah. So, I get that y’all. It’s like and and here’s where Dr. Margaret, I think people really get screwed up and it’s laughable to me is sometimes the exercise is really simple. Really simple. Mhm. And it’s so simple that people go, “Well, then why would I even bother? I don’t need to sit and reflect on that question.” Well, could you just try it, Lisa? Come on. Could you just get it? Just give it a go. And if you hate it, you never have to do it again. But if it works, what a great thing you found. You found a simple thing to do that works. Oh my gosh. So, try the exercises, y’all. Yeah. Yes. Um, tell us about your podcast. Oh, well, I’ll tell you why I started the podcast. Uh, my book was getting turned down by some of these major publishing houses. They love the idea, but nobody knows who you are, Margaret Rutherford. So, I thought, what would I enjoy doing that would give me more a sense of presence in the mental health community in in the United States, in the world? actually I didn’t think about the world but um and so I listened to a couple of podcasts and I said I think I can do that and so I started it almost nine years ago now and I have a wonderful team selfwork my my saying on selfwork is we’re going to talk about what you can do about it every almost every episode has the theme of okay you have this issue problem struggle uh what can you do about it I like to pick uh speakers, authors who also have a very proactive approach to uh whatever kind of mental health problems that they would be talking about in their book or whatever. So, because I am a I’m not a I wouldn’t call myself a solution focused therapist, but I’m definitely someone who says you come to me because you’re struggling. you you are um you are you know demoralized about your life. So we’re going to talk about what you want to feel do say experience that will help you feel do say and experience what you where you’re where you want to go. Where do you want to go? What do you want? What would be your your um next best choice? And so that is what the podcast is like too. And I’ve I’ve ended loving doing it. Um I have wonderful guests. Um and about half of the about half of the um episodes are I research a topic that often my reader my readers or listeners have said we’d like to hear more about this. Uh I research the topic and then I put in my two cents of being a therapist for over 30 years. So uh what I think about that yeah I I have listened to many episodes of your podcast. Oh the how to find your purpose is anytime you use that I always perk up. I know you did a podcast on per you’ve probably had more than one, but I listened to one on how to find your purpose because I I talked to so many people who are so ready to go, so excited, and just wish they knew what to do with all this excitement. What’s next? Like, I want to do it. I’m ready to work hard. My response to that, my response to that, Kyle, is just do something. You don’t have to start in the in the in the right direction. Mhm. Uh, you know, we were talking about me being a jingle singer before and I I I did. Yeah. But you you you you you breeze over that like that’s like not a big deal. Y’all, you know, when you’re listening to the radio and they got people singing, that’s her. She’s the one singing on the radio. Used to be. It’s incredible, though. But I, you know, I went from jingle singing to music therapy and then I did an internship in a psych hospital and I had been in therapy for a long time myself and really screwed up my life and needed to be in therapy. Um, and so I thought, “No, I want to be a clinical psychologist.” So it took me nine years. Uh, my one of my last gigs in Dallas was the at the Fairmont Hotel in downtown. And um the next singer they hired was Jennifer Flowers, by the way. Interesting. May you you may be too young to know who Jennifer Flowers was, but she was an interest of Bill Clinton’s. Anyway, um and I closed down that gig and then nine years later opened my office as a as a clinical psychologist. So, it’s a long time. What a turn. Yeah, that that uh that idea of people are just waiting for everything to be lined up to get started. I took a business class in college called Ready, Fire, Aim. And the whole premise was like just get going. Just go. You’ll, you know, you’ll figure it out once you’re going real much faster than if you just wait around and try to figure it out. Totally agree. Yeah. Okay. So, hopefully one day I’m going to be a guest on the Selfwork Podcast. When that is available, we’re going to link that in the description of this video as well. And uh Dr. Margaret, if people want to connect with you, what’s the best way to do that? They can go to my website at drargarford.com. That’s a very original name. Uh, certainly listen to my podcast. My email is askdrmargraret rutherford.com. I love for people to email questions to me or topics. Um, and u I like to be interactive with people. I, you know, I can talk about what I think is important, but I much rather talk about what other people think is important. And uh you just reminded me y’all if you’re going to the selfwork podcast and you don’t know where to start, you can take one of my recommendations. Yes. Uh episode 414 on how to find your purpose. Really good. But she did episode 394. It’s called Do You Feel Guilty for Not Doing Enough? Nine helpful reminders. And I get enough emails to know that people need to listen to that one. So yeah, I have 452. So there’s quite a there’s quite a selection. Yeah, I know. So I would start with one of those. Those were some of my favorites. So Dr. Margaret, thank you for coming on. We’ll link everything below the notes and hopefully we’ll talk again soon. That sounds great. Thank you. Thank you for listening. I’m Kyle. Remember, whatever you’re going through, you got

🔓 Unlock access to MedCircle’s depression workshops & series, plus connect with others who are living with depression through your MedCircle Community.
Join now: https://my.medcircle.com/community-yt

Clinical psychologist, Dr. Margaret Rutherford discusses her concept “perfectly hidden depression”, which is depression that is often missed by mental health professionals because individuals who live with it appear successful and high-functioning, but struggle to express painful emotions.

#depression #depressionawareness #mentalhealtheducation

Learn more from Dr. Margaret:

https://www.instagram.com/drmargaretrutherford/
https://www.facebook.com/DrMargaretRutherford/
https://www.linkedin.com/in/drmargaretrutherford
https://youtube.com/@DrMargaretRutherford

Margaret Robinson Rutherford Ph.D., a clinical psychologist with thirty years of experience, is also an author, TedX speaker, and podcast host. Her book, Perfectly Hidden Depression: How to Break Free from the Perfectionism That Masks Your Depression, has reached thousands here in the US, as well as having an international impact, with translations reaching from Korea to Italy, Turkey to Germany. Her highly popular podcast, The SelfWork Podcast, has been continuously rated as one of the best podcasts for mental health and depression.

Dr. Margaret’s known for her vibrantly engaging and theoretically well-crafted presentations, whether live or virtual. Whether her diverse audiences are made up of mental health professionals, construction workers, or office managers, her passionate message is that healthy mental and emotional lives can be created through becoming more transparent with one another. Sharing who you really are with those you trust is a huge step toward connection and good mental health. Rates of depression and suicide are skyrocketing. And there’s something we can do!

She’s further challenging the mental health profession to question their overreliance on the official symptom checklist for diagnosis. Instead, we need to create normalcy around suicidal feelings, listen to each person’s actual experience of their life, and respond with safety and compassion, rather than stigmatizing this very real and excruciatingly painful part of human existence.