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If You Or Someone You Love Is Hiding Depression — Almost Perfectly

What to Do When “I’m Sorry” Doesn’t WorkPeople who are married or who’ve been together a long time think they know each other pretty well.

You can finish each other’s sentences. You know what they order on a burger, or if California rolls are their favorite. Someone wants to throw them a surprise birthday party? You agree, knowing he’d be as excited as a toddler, or you quickly squash the idea, since you know she hates being the center of attention and doubly hates surprises.

A lot of the time you’re right. Your predictions are accurate. However, it’s nice to occasionally get a good laugh, as you delightfully discover that your partner has actually changed — morphed into someone you can still get to know.

Yet how do you know if a secret is being kept? If who your spouse is trying to be on the outside, isn’t who they know themselves to be? And what if that secret is depression? Or shame? Or trauma?

I’m not talking about intentional deceit. I’m talking about Perfectly Hidden Depression.

Your wife’s a busy lawyer, and has friends galore. Everyone counts on her, and she rarely complains about the responsibility she bears. She’s a problem solver. A doer. A fixer. Her parents — they’re not healthy people — they both drink way too much. But she’s always available, doing what she can to make things right, and says her childhood wasn’t all that bad. You remember one night over a couple of glasses of wine, she said there was something she wanted to tell you. She never did. When you asked, she quickly said, “It wasn’t anything important.”

Your husband is rising in the ranks of his corporation, and he’s a great dad. He doesn’t talk about himself much, in fact, hardly at all, and shrugs off the idea that he could be tired. His folks are highly driven accomplished people, and talk mostly about how proud they are of what he’s done with his life. He had a brother who died as a teenager, but no one discusses it. Ever.

You watch. And sometimes wonder, “When does she slow down? When does he ever admit sadness?”

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Rarely, you sense something. Her eyes are puffy after a shower. He has nightmares.

Or maybe you don’t tune into her eyes or his nightmares. Because you’re not the kind of person either who likes to think about or express much pain. Maybe you tell yourself it’s not healthy to focus on the negative. You’ve got too many blessings. That would be weak or self-centered.

Detaching from a true, more vulnerable self is by no means a new idea. In the mid-1900’s, Winnicott was known for his work on the duality of a true and false self, with other psychoanalysts following his lead. This article quotes from Winnicott’s work on the ego: “The False Self is represented by the whole organization of the polite and mannered social attitude…“. He wrote that the false self was created as a defense against a not “good enough” mother.  Helene Deutsch wrote about a similar syndrome, the “as if” personality.

Dr. Terrance Real wrote about covert depression in men in 1998, in his well-accepted book, “I Don’t Want To Talk About It.” He states, “Women rate high in internalizing, men in externalizing. Internalizing has been found to have high correlation with overt depression. When researchers compared the high rates of externalization in men with their low rates of depression, they speculated that men’s capacity to externalize might somehow protect them from the disease. But while the capacity to externalize pain protects some men from feeling depressed, it does not stop them from being depressed; it just helps them to disconnect further from their own experience. The capacity to externalize helps men escape over depression, only to drive them toward covert depression.”

We need to express, in terms that today’s audience can embrace, the entire range of ways depression can be experienced, by men and women alike. Yet, all the commercials you watch on depression show someone sitting on the floor, not wanting to walk the dog, depicting what Dr. Real would term “internalizers.”

This lack of understanding of the diversity of expressions of depression is becoming more and more dangerous. Therapists being trained learn that depressed mood and/or anhedonia must be present for a diagnosis of depression to exist. Suicide rates are significantly rising, and too many of us know someone who committed suicide, but “didn’t seem depressed.”

Whether you call it covert depression, smiling depression, or Perfectly Hidden Depression (PHD), it doesn’t look like classic depression. In fact, quite the opposite. People with PHD are highly involved, energetic, giving people who are intentionally or unintentionally (out of habit) creating a persona, a facade of who they need others, and in some ways themselves, to believe they are.  There are certain personality characteristics that create it: perfectionism with an inner critical voice, the discounting of past trauma, a sincere focus on the well-being of others, a shame-based avoidance of revealing self, to name a few. Underneath that persona, those choices or behaviors, there exists an intense loneliness — an emptiness that can feel very dark and stagnant. Thoughts of a welcome death can dance on the edges of consciousness, but with time, can invade a mind that is desperately trying to fend them off.

Dr. Brene Brown’s work highlights the damage done by perfectionism and unspoken shame. She began her research career by studying shame resilience. And yet, she acknowledges in the forward to her book, The Gifts Of Imperfection, that while searching for patterns of what she termed “wholehearted” living, she found a “Do” list and a “Don’t” list. “The Do column was brimming with words like worthiness, rest, play, trust, faith, intuition, hope, authenticity, love, belonging, joy, gratitude, and creativity. The Don’t column was dripping with words like perfection, numbing, certainty, exhaustion, self-sufficiency, being cool, fitting in, judgment and scarcity.” She further defines authenticity as, “…the daily practice of letting go of who we think we’re supposed to be and embracing who we are.” And as far as shame is concerned? “The first thing we need to understand about shame resilience is that the less we talk about shame, the more we have it.” Her work indicates that inauthentic living is characterized by the avoidance of vulnerability and the expression of shame. It’s only a short mental hop to understand that this kind of living can lead to hidden depression and even suicidal ideation.

If you identify with any of the above, or if you actively wonder if your partner or spouse might feel this way, reach out.

If it’s you, revealing pain will feel as foreign to you as being alone in a country where the language is unknown to you. You may not trust, at first, either yourself or whomever you choose to tell. You will have to actively fight not convincing yourself that the whole thing is stupid, and who are you to seek therapy, talk more openly with a friend, or ask for help. You’ll battle the belief that no one will now respect you, or see you as competent.

If it’s therapy you choose, you may have to go for several sessions before you begin to reveal your secrets. You will hide behind smiles. If you don’t pick a therapist that looks past all that, you’ll be disappointed. They won’t see you. They’ll tell you you’re not depressed — that you’re anxious or over-worked. If your therapist gets it, senses what’s underneath, catches the innuendo of what you’re revealing, the benefit can be immense. That therapist realizes that depression can have many faces, and isn’t necessarily defined by someone describing fatigue, or a lack of enjoyment in life. And yours is one of them. Letting go of that persona, and connecting with the pain that it’s hiding, will be frightening. It’s all you know.

If the person with PHD is your life partner, your friend, or your family member, you can offer them information of what you see, and what it’s like to watch them maintain the cover-up. You can support them in how difficult it might be to reveal. You can tell them that you’ll be there along the journey.

The women and men who’ve responded to my own research and work on PHD have reported a huge relief that, “Someone knows what I’m doing, and that I’m doing it perfectly. But I’m not alone.”
You can truly know each other.

This time, for real. Please, reach out.

If You Or Someone You Love Is Hiding Depression — Almost Perfectly

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Dr. Margaret Rutherford

Dr. Margaret Rutherford, a clinical psychologist, has practiced for over twenty years in Fayetteville, Arkansas. Her work can be found on her own website, where her eBook, "Seven Commandments of Good Therapy" is available for free download. She's the author of "Marriage Is Not For Chickens", a feisty and poignant look at marriage. She hosts a weekly podcast, SelfWork with Dr. Margaret Rutherford, as well as regular FB Live sessions on depression for The Mighty and Project Semicolon. Her expertise can be found on The Huffington Post, The Gottman Blog, Reader's Digest, Prevention, The Mighty, The Good Men Project, Family Share and Psychology Today.

APA Reference
Rutherford, D. (2018). If You Or Someone You Love Is Hiding Depression — Almost Perfectly. Psych Central. Retrieved on December 2, 2020, from
Scientifically Reviewed
Last updated: 8 Oct 2018 (Originally: 7 Sep 2017)
Last reviewed: By a member of our scientific advisory board on 8 Oct 2018
Published on Psych All rights reserved.