Perfectly Hidden Depression

How to Break Free from the Perfectionism That Masks Your Depression

Margaret Robinson Rutherford, PhD

Who should read: Anyone who operates under perfectionism

Favorite quote: “…the characteristics of perfectly hidden depression, in moderation, can be helpful. But when they begin to govern every aspect of your being, they can become a huge problem.” 

“If the opposite of depression is vitality, the opposite of perfectly hidden depression is self-acceptance.” 

Why I feel it is important to veterinary medicine: We are conditioned to present our very best selves, spanning from vet school applications, academic performance, clinical rotations, as an employee and as a trusted health care professional. We are ripe for hiding the things that are wrong to our own detriment. This topic resonated very deeply with me- both for my own life, but also for the profession as a whole. A study has shown a strong connection between perfectionism (generated from other’s expectations) and suicide. 

How many of the following do you identify with? 

• Plagued by perfectionism and worry
• An enormous sense of responsibility
• A need to control yourself and your environment
• Focus on the well-being of others, but exclude them from your inner world
• Your sense of value is established by your accomplishments
• A sense of shame or fear of being “found out”
• Discounting and disconnecting from your personal hurt and struggles
• Struggling with self-compassion- or complete lack thereof
• Detaching from painful or troublesome emotions
• Direct your focus to your blessings, regardless of the level of difficulties you are experiencing
• Appearing like you cope with highly stressful situations well, but feeling otherwise

The list above are common traits for individuals that suffer from perfectly hidden depression. Dr. Margaret Rutherford, a clinical psychologist, describes a syndrome of characteristics or behaviors that obscure the identification of depression. Classic depression is diagnosed if feelings of depression are present for prolonged periods of time, or an absence of pleasure in activities once found pleasurable exists. What happens if you develop behaviors that mask the clinical symptoms of depression? Perfectly hidden depression is the term Dr. Rutherford has coined to describe this scenario she has encountered many times in practice. People who are incredibly driven, active, and appear well put together. People who may not even recognize depression in themselves, but recognize something is “off”. Even close friends and family are not allowed to see the struggles and pain, so the afflicted suffer undetected for much of their lives. Whereas classic depression is described as a lack of vitality, perfectly hidden depression is a lack of self-acceptance. 

One important point that Dr. Rutherford makes is that most of the behaviors that lead to perfectly hidden depression are in fact helpful behaviors that serve a purpose when used in moderation. In fact, most of them probably led to the success of the individual. But when those behaviors start to govern or control the individual’s life and they cannot control those behaviors, they create huge problems for the individual. When we start to live by socially prescribed perfectionism (the sense of pressure from others to appear perfect), our risk of suicide is increased. And our willingness and ability to share our struggles and seek help diminishes. 

Her prescribed recommendations for overcoming perfectly hidden depression is the following path: 
1. Consciousness: Awareness of the problem. 

2. Commitment: A conviction and willingness to seek change

3. Confronting your rulebook: Identify the traits and behaviors that have contributed to perfectly hidden depression, and redefine them. 

4. Connect with emotional pain: Allow vulnerability to feel your pains and sorrows. 

5. Shift focus from perfection to true happiness: Replace perfectionism with self-compassion

She does point out that perfectly hidden depression shares symptoms and traits with several psychiatric disorders, so your wisest strategy is to seek professional assessment. 

While the book does serve to educate and raise awareness about the issue, she also outlines very structured exercises and growth points to guide you through the pathway of healing. So know that working with a therapist will likely be the most efficient path towards progress, but this book also serves as a very strong resource and proactive guide along the journey. 

If anything about this information resonates with you (personally, or in reference to a loved one), I urge you to pick up your own copy and explore it! 

Practical Implementation Exercises: 

1. Consider the traits and qualities you feel were most vital for you to achieve your current status in the veterinary profession. Are those traits still serving you in a positive manner? Are they creating any problems for you? 

2. Do you consider yourself skilled at self-compassion? If not, what do you imagine your life would look like if you were? Is that something you want for yourself? 

Additional resources: 

Dr. Rutherford’s podcast

Self-work podcast discussion about veterinarians

Self-Compassion