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Podcast: Hiding Depression- Using Perfectionism to Hide Our Struggles

Are you always in control and always perfectly put together? Are you professionally successful, a great friend, and always showing a happy face to the world?  But what about on the inside? Is there something in the background or in the past that you don’t talk about?  Do you feel disconnected, like no one knows the “real” you? Deep down do you just know something is wrong? Well, you might have “perfectly hidden depression.”

Today Gabe speaks with Dr. Margaret Rutherford who has done extensive work on the relationship between perfectionism and depression.  Dr. Rutherford tells us how childhood trauma can lead to the development of coping mechanisms that don’t serve us as adults and how those behaviors might be masking depression. Then she shares how to challenge those beliefs and show ourselves the same compassion we would give to anyone else.


Guest information for ‘Hidden Depression’ Podcast Episode

Dr. Margaret Rutherford, a clinical psychologist, has practiced for twenty-six years in Fayetteville, Arkansas. Earning the 2009 Arkansas Private Practitioner of the Year award for her volunteer work at a local free health clinic, she began blogging and podcasting in 2012 to destigmatize mental illness and educate the public about therapy and treatment. With a compassionate and common-sense style, her work can be found at, as well as HuffPost, Psych Central, Psychology Today, The Mighty, the Gottman Blog and others. She hosts a weekly podcast, SelfWork with Dr. Margaret Rutherford. And her new book, Perfectly Hidden Depression: How to Break Free from the Perfectionism that Masks Your Depression, will be published by New Harbinger in November 2019.

About The Psych Central Podcast Host

Gabe Howard is an award-winning writer and speaker who lives with bipolar disorder. He is the author of the popular book, Mental Illness is an Asshole and other Observations, available from Amazon; signed copies are also available directly from Gabe Howard. To learn more, please visit his website,

Computer Generated Transcript for ‘Hidden DepressionEpisode

Editor’s Note: Please be mindful that this transcript has been computer generated and therefore may contain inaccuracies and grammar errors. Thank you.

Announcer: Welcome to the Psych Central Podcast, where each episode features guest experts discussing psychology and mental health in everyday plain language. Here’s your host, Gabe Howard.

Gabe Howard: Welcome, everyone, to this week’s episode of the Psych Central Podcast. Calling in to the show today we have Dr. Margaret Rutherford, a clinical psychologist who has practiced for 26 years in Fayetteville, Arkansas. She’s the author of a new book, Perfectly Hidden Depression: How to Break Free from the Perfectionism that Masks Your Depression. Margaret, welcome to the show.

Dr. Margaret Rutherford: Thank you very much. I’m more than delighted to be here. This is a subject I’ve been passionate about for over 5 years, so any time I get to talk about it, I’m delighted.

Gabe Howard: Well, that’s wonderful. Now you have been a therapist, as we established, for well over twenty five years. How did you come up with the term perfectly hidden depression and why do you decide to write a book about it?

Dr. Margaret Rutherford: Well, I actually was sitting down to write a blog post one day. I had been blogging for, I don’t know, a couple of years by that. And I thought about several people that I had seen and I just sort of thought well, they are perfectly hidden. They don’t talk about their depression, they’re not open about their depression. But if I say, gosh, could you be aware that there’s something in the background that you’ll tell me a bad story or a painful story and there’s a smile on your face, but you’re not crying about it. So there was this problem between someone talking about something traumatic and yet not having any kind of painful emotion that was connected with it.

Gabe Howard: I know that a lot of times people think that depression is supposed to look a certain way. Whenever we see pictures of depression, it’s always somebody with their hands on their head or they are crying or dark storm clouds. But that’s not really the reality. There’s a lot of people who suffer from depression that upon visual inspection look perfectly fine.

Dr. Margaret Rutherford: Yes. And you know, in the literature that’s often called high-functioning depression or smiling depression. These are people who really know that they are depressed, that they have even the classic symptoms of depression, like it’s hard to get out of bed or they’re not as enjoying as many activities that they had in the past or something like that, or they even know when they get home from the office, here comes this negative energy or with this tendency to want to withdraw. Perfectly hidden depressed people can look like that. They can be aware on one level that they are depressed. The difference is there’s also a huge group of them that really don’t actually know they’re depressed. They have been hiding for so long. They have been pushing away trauma or painful emotions. Maybe they weren’t even allowed to talk about pain when they were children. There are all kinds of situations that can foster a perfectly hidden depression. And so this process is so automatic that they’re not really sure anymore. They know maybe their gut is telling them something’s wrong with this little tiny voice inside of them says, you know, this isn’t right. You should be happier. You should be actually more fulfilled. But they try not to listen that voice, because, of course, their major focus is on looking like they have the perfect looking life.

Gabe Howard: I know that when I was depressed, I thought that it was some sort of moral failing and, you know, my parents would say things to me like, well, what do you have to be upset about? Why? Why aren’t you happy? You have more than others. You know, I grew up in the era where we heard about, you know, starving children in other countries all the time when we didn’t want to eat dinner. So there was just always this comparison. And that made me, as a young adult, believe, well, yeah, since I don’t have a reason to be depressed, I must not be depressed. Is that what you’re trying to highlight and discuss with, you know, your work, your research, and in your book?

Dr. Margaret Rutherford: That’s certainly one of the traits. There are 10 commonly shared traits of perfectly hidden depression, Gabe. And one of them is an emphasis on counting your blessings to the point where you don’t even see that some blessings have vulnerabilities or problems attached to them. For example, I have a successful practice in Fayetteville, Arkansas. I’m very proud of that. I’ve worked hard for that. I’m very honored by that. But sometimes I get tired and we all have… Maybe you’re a great beauty or you’re wealthy and you wonder, are people attracted to me because I’m beautiful or because I’m wealthy? Let’s say someone has four children and they love having a big family. But then when it comes down to carting children to four different things or or having four different sets of homework or just buying clothes for four kids. There are some hardships that come along with blessings. And when you are trying to, well, what you said you were told as a child you don’t have anything to complain about. Then you were told, don’t talk about vulnerability, don’t talk about pain. It’s unseemly. You’re not being grateful. And I think that that sets up this dynamic where you shame yourself for not being grateful enough. Perfectly hidden depressed people, and even perfectionists in general, that perfectionism is often fueled by shame. Where you do you have to do your very best, because if you don’t, there are all kinds of shameful consequences for that. And you are completely self-critical and not counting their blessings is one of those criticisms.

Gabe Howard: Has research demonstrated a relationship between perfectionism and depression?

Dr. Margaret Rutherford: Yes, perfectionism actually started being written about, I don’t want to go into too much history, but back in the 1930s. It began getting some attention as a psychological problem. And there are some researchers now that are actually finding some correlation and a strong correlation between perfectionism and suicide. When I think about some of my own patients thinking, OK, what are the threads that might define or identify these people? What are the things that they spend a lot of time thinking about or doing? And I came up with 10 of them. Some I’ve already mentioned like being highly perfectionistic with a lot of shame, having an excessive sense of responsibility. These are people who have their hands up in the air all the time. They stay in their head. They tend to be very rational people. They detach from pain by being analytical. They worry a lot and they need a lot of control over themselves and their environment. They can easily focus on tasks because what they do is how they feel valuable. This is the kind of person that if they go to a party and they’re not given a role to do, they’re very uncomfortable. They really don’t know.

Dr. Margaret Rutherford: So they’ll start picking up plates. They’ll assign themselves some role because that’s where they’re most comfortable. Again, I’ve said this already. They don’t allow people into their own inner world, but they really sincerely focus on the well-being of others. They mean it’s not made up. It’s not fake. They discount personal hurt or sorrow. And they have hardly any self-compassion. They believe strongly in counting your blessings. We all often talk about that. They actually may enjoy success professionally, in fact, but they don’t know how to be emotionally intimate in their relationships. So their relationships are often very troubled. And the last one is something a little different. A lot of times these folks will show up in your office or just in life with a panic disorder or an eating disorder and obsessive compulsive disorder or an addiction. And when you think about that, the thread of all those disorders is the fact that they’re all about control. So they may have some accompanying diagnostically accurate mental health issues. And those are important to address. But the important fact about them for me, with perfectly hidden depression is the fact that those diagnoses reflect a problem with control.

Gabe Howard: Is there a way that a person can recognize this in themselves, if I’m somebody listening and I’m listening to what you said, or are there some cues or questions that I can ask myself so that I know if I’m falling under this?

Dr. Margaret Rutherford: That’s a great question, Gabe. You know, one of the people said to me, in fact, many people said to me, “When I saw the term perfectly hidden depression, I knew you had figured something out about me. Yes, I’m perfect looking. But yes, I have known something was wrong for a long time. And I am lonely and I’m despairing. No one knows me. And I have these thoughts of hurting myself that I don’t share with anybody.” I mean, I think you could recognize yourself in those 10 commonly shared traits. Probably the only one I hope that got confusing a little bit was the one talking about the other diagnoses that could accompany it. But I think even if you’re one of that huge group that I talked about a few minutes ago, that really this has become so automatic or unconscious that they don’t quite realize what they’re doing. They would never tell you that they were, depressed, however. What the people I interviewed told me is what they are very clear about is that they’re getting lonelier and lonelier. It’s getting harder and harder to maintain that mask. You’re feeling more and more pressured at work or at church or wherever you put your energies.

Dr. Margaret Rutherford: Because once you accomplish something, you have this sense of now that’s my “I have to top that.” And then the next one is I have to top that and I have to top that. The pressure is incredible. We know on a gut level and they know on a gut level if it’s them or you know what, if it’s you that something is amiss. And when you go back to your childhood and you think, how could I have learned this? You figure out, well, I was screamed at because I was told I would be no good. And so I decided to look perfect all the time or I took care of everybody in my family because my dad was an alcoholic and I never got to talk about anything bad for me. So, you know, guess what? I’m living my life as an adult that way. Or you were the star of your family where your mother or your dad or both said, “Gosh, you’re so talented. We don’t have to worry about you. You are great. You’re so successful.” And so you took it on like, oh, this is the way I get attention. I have to be this in order to be loved.

Gabe Howard: And these are examples of all the things that causes somebody to want to look perfect or appear perfect or be perfect?

Dr. Margaret Rutherford: Yes, exactly. There are several different causes. There are many roads to Rome, do you say? There are many ways to or paths that lead you to creating this: sexual abuse, neglect, just bad parenting and especially growing up in families where if you were crying or sad or angry or just wanted to voice your own opinion, that was not allowed. You adopted this drive, this strategy, for lack of a better word. I think it’s a good word, in fact, this strategy, to I just can’t let anybody in to my own vulnerabilities. It’s not allowed. I’m shamed for it. So then you shame yourself for it. Many of us have a childhood strategy that we came up with given the family we were born into. And that strategy helped us survive that family. Maybe you were smothered and you learned, you know, I’ve got to sometimes be more independent because I will get smothered if I don’t. We all have different ways we handled our parents’ vulnerabilities. What happens as an adult is often that strategy is no longer working. But we’re still using it. And so a perfectionist may have learned in their childhoods that they needed to create a perfect looking life in order to handle whatever was going on in the family. But then you come into adult life and looking perfect is something you’re still doing, but it’s gradually going to erode and sabotage your own joy and fulfillment in life.

Gabe Howard: We’ll be right back after this message from our sponsor.

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Gabe Howard: And we’re back with Dr. Margaret Rutherford. So what can somebody do if they identify with perfectly hidden depression? Is there an end? Can they get better? What’s the solution?

Dr. Margaret Rutherford: You know, I thought this book was… I was going to describe something. And I sent my book proposal in to all the publishing houses and that’s what it was. New Harbinger got back to me and said, no, no, no, no, no. If you want to describe it, fine, you need to do that. But you also need a treatment strategy.

Gabe Howard: Wow.

Dr. Margaret Rutherford: And so. Oh, goodness. And so what I did was I came up with a model that I use with almost every patient. They don’t have to be perfectionists. It’s a general model of what I do with therapy. And the model is you have to be conscious. Consciousness is the first stage. You have to be committed. So consciousness, commitment and with perfectionists, there are a lot of hurdles to commitment. A lot of them. Then you have to confront beliefs that you learned in childhood. This is really sort of cognitive behavioral work where you go back and you look at what you learn. You should, ought, must, have to, always do. And you begin to question those beliefs. Some of them are great, but which ones are causing a problem? And you look back on all that with an objective eye as much as you can, and then begin to think what beliefs do I want to live through? What beliefs do I want to live by now? The fourth stage is connection. And this is one of the toughest for perfectionists because we’re going to go back and do a trauma timeline about their childhoods.

Dr. Margaret Rutherford: What that means is you go back at year 1, 2, 3, 7, 9, 11, whatever years you think are important. And you talk about the positive things that happened, but you also let yourself write down the painful things that happened. And as you do that, you want to go back with self-compassion. What would you do with anybody else? Now, of course, all of that is about really rediscovering or discovering a new way of being for you. The last part is the part that’s about change. Changing your behavior. If I’ve learned one thing as a therapist, I’ve learned you get a lot of insights. Insight is wonderful; insight is great; insight helps you see things. It helps put the puzzle pieces together. But where you get your hope is in behavior change. What’s it like to act on these new beliefs? What’s it like to confront something that you’re sabotaging yourself with? What’s it like to feel emotions that you have suppressed for so long? It’s probably pretty frightening, actually. And so you want to start putting those things into your own life and into your behavior. And that’s where you’re going to get your hope.

Gabe Howard: I’m fascinated by this idea that something that individuals did not know was a problem is able to change their life in such a dramatic fashion. What kind of feedback are you getting from people who have utilized these methods? How are their lives improving by embracing this?

Dr. Margaret Rutherford: That’s a great question. I will tell you, and I promise you, I’m not being dramatic, just this year I’ve had two people have said to me, I wouldn’t be alive right now if I had not done this work. They actually were so miserable that they had those thoughts and they were so afraid they were going to act on them that that’s why they came into my practice. So I don’t think that’s true of everybody. But what I have heard is that, for example, one woman came, a young woman came into my office and she said there’s something about that term, “perfectly hidden depression” that I’m drawn to, and I’m not sure why. Well, come to find out. There was a lot of trauma in her lifetime that she had never talked about with anybody, didn’t even see it as trauma. When I used the term trauma, she started laughing. Oh, that’s not traumatic. And her father had hit her so violently when she was a young child that she’d had surgeries on her face.

Gabe Howard: Wow.

Dr. Margaret Rutherford: She didn’t consider that traumatic. So you’re trying to wake people up to the idea that what they have considered well, that was just my life or again, they have discounted it of what their reaction would be to someone else telling them that had happened in their lives, they would be horrified. And so you’re inviting people to get in touch with feelings. Another example, and this is gonna be about sexual abuse. So please listen carefully if you have any history of that. But a woman came in who had had a college sexual relationship, a boyfriend, that she had been with him for years, and he had been sexually abusive to her. When she first brought it up, she said, “You know, maybe this is important, maybe it’s not. But, you know, I should probably tell you about this relationship in college.” Yeah. I mean, it was very important in the way she was living her present life. So often these people just want you to confirm was this trauma, was this more difficult than I thought?

Gabe Howard: It’s obviously interesting to think about what we see as trauma and other people versus what we think about as traumatizing for ourselves. The examples that you used. I’m like, oh yeah, that that’s absolutely traumatic. But maybe you don’t recognize that in yourself. Is this what you’re noticing? Could there be perfectly hidden trauma? I mean, does all of this sort of go hand in hand?

Dr. Margaret Rutherford: Huh, that’s an interesting kind of thought, isn’t it? Yes. I mean, I think we are in a culture often that tells us to buck up. Don’t call it a problem. You know, you’re whining. Quit it. It’s selfish to think about that. In fact, it’s one of the funny, not funny but ironic examples. Years ago, you know, I had 7 or 8 patients a day typically, and sometimes I run real tight between sessions and one person had gone and the other person who came in, I don’t know, a minute after her sat exactly where she had sat on the sofa so she could feel the warmth of the body, warmth from the sofa that was still holding that warmth from the other person. And she looked at me and she said, you know, all of a sudden I get this feeling that I bet that person’s problems are a lot more important than mine. I feel silly being here. And I looked at her and I said, so you felt warmth on the sofa and somehow you jumped to the idea and the belief that you’re not important. Why you’re here isn’t important. So help me understand that. Amazing to me how many people have things in their life that they have very courageously gotten through. And I admire their courage.

Dr. Margaret Rutherford: I admire their resilience. It’s when resilience is on steroids that I have the problem. Don’t sweat the small stuff. OK, fine. Don’t sweat the small stuff, but sweat the big stuff and call it big. Berne Brown, of course, has written incredibly and presented incredibly about shame and vulnerability. One of her tenets is that you could only get to courage through vulnerability. She said a man stood up in the audience because people kind of going in, well, you know, maybe. But courage is courage. Courage is a lack of fear. And the soldier stood up, he had had three stints in Iraq. He’d been shot at. I mean, he’d seen people die and he looked at her and said, you are so right. I was afraid over there. And I had to recognize that fear and that vulnerability before I could get to my courage. Rudy Giuliani said it after 9/11. And I’m not going to say it as eloquently as he did. But he said something like, I thought I knew the definition of courage before 9/11, and that was the absence of fear. I found out that I’m wrong. Courage is feeling your fear and going forward. Recognizing vulnerability, admitting vulnerability, revealing vulnerability. And that way you can work your way toward true courage.

Gabe Howard: Dr. Rutherford, I completely agree and I’ve learned a lot and of course, getting to the end of our show, obviously we can find the book on Amazon. What is your Web site? I know that you write for So obviously you can check out Dr. Margaret Rutherford there. Where can folks find you if they want to learn more?

Dr. Margaret Rutherford: Sure. My Web site has the creative name of

Gabe Howard: I love it.

Dr. Margaret Rutherford: And I’ve been blogging there for seven years. I do have a tag. You know, if you click on the tag, it will take you to all my posts on perfectly hidden depression. I also have a podcast that I’ve been doing for three years now. It’s called Self Work with Dr. Margaret Rutherford. And that’s on i-Tunes, on Stitcher, SoundCloud. It’s now on Spotify and I Heart Radio. So I really love the podcast. I can go more in depth with topics on the podcast than I can through blog posts. You know, I can spend 20-25 minutes talking about something where, you know, a blog post maybe has maybe a thousand words. I’ve got a Facebook page, I’m on Instagram, Pinterest, it’s all under Dr. Margaret Rutherford or Pinterest is Doctor Slash Margaret, I think. I would love to have your listeners join me. And the book does come out November 1. I’m thrilled that New Harbinger is publishing it. It is a much better book because they were involved because I’ve never written anything. I never thought I would write anything. And they have made it really, I think, a very readable book. I include lots of stories of these people I interviewed as well as my own patients, of course, anonymously. So I hope you’ll join me there.

Gabe Howard: Thank you so much, Dr. Rutherford. My final question before we hop on out of here is did you have personal reasons for writing this book?

Dr. Margaret Rutherford: Yes, I did. I wouldn’t call myself perfectly hidden and depressed. But certainly, my mother was. She ended taking anxiety medications in her thirties that developed into a prescription drug addiction and actually sabotaged a great deal of her life in the last decade or two of her life. But my mother was extremely perfectionistic. I can remember the dining room table being set for a party and we couldn’t go in there for a week. I remember that party would occur and my mother would ask me, was the food any good? Because she would always look for people who needed her help or her conversation because they might be uncomfortable. She got up at 4:00 in the morning so no one would see her without her makeup and her high heels and hose. I mean, that’s maybe being Southern and being a 1950s housewife, but a lot of it was her perfectionism. So I saw how miserable it made her. And I also adopted a great deal of her perfectionistic standards until I became a therapist. And I began working my own way through those and realizing that those were actually my mother’s vulnerabilities speaking to me and I no longer wanted to live my life like that. So people have said to me, your mother would be so proud of you for talking about yourself on the Internet. And I said, no. My mother would think it was terrible. So I don’t want people to live in that same prison that my mother lived in. And I hope that it will be helpful to those who want to get out.

Gabe Howard: Well, thank you so very much for everything that you do for our community. Thank you for everything that you do for And thank you for being on today’s show. We really, really appreciated having you.

Dr. Margaret Rutherford: The thanks is mine, and the gratitude is mine, Gabe. Thank you very much for asking me and everyone have a wonderful day. And if you are hiding, please, if you can, get the e-book if you don’t want to buy it for real. There’s also an e-book and an audio book is coming.

Gabe Howard: Very cool. And remember, everybody, if you want to interact with the show on Facebook, all you have to do is go over to And don’t forget to review our show on whatever podcast player you found us on. Do me a favor, tell a friend to share us on social media. And remember, you can get one week of free, convenient, affordable, private online counseling anytime, anywhere, simply by visiting’ll see everybody next week.

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Podcast: Hiding Depression- Using Perfectionism to Hide Our Struggles

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Central Podcast, T. (2019). Podcast: Hiding Depression- Using Perfectionism to Hide Our Struggles. Psych Central. Retrieved on December 1, 2020, from
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Last updated: 9 Oct 2019 (Originally: 10 Oct 2019)
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