Understanding the tragic trend of perfectly hidden depression

Back in 2014, when hugs were still hugs and the office wasn’t actually the guest bedroom, I wrote a blogpost that described some of my clients’ specific issues with showing emotional vulnerability. Notably, they didn’t do it. They didn’t know how to reveal or connect with pain. What they did do was work to maintain a perfect-looking persona, terrified that anyone might peek behind the curtain and see a human being instead of a wizard. I titled it “The Perfectly Hidden Depressed Person: Are You One?”

The post went viral. Curiosity led me to research perfectionism. What emerged was a drive to reveal perfectionism’s role in masking an overlooked and unseen presentation of depression, one whose symptoms wouldn’t fit the classic diagnostic picture. My term “perfectly hidden depression” came into being.

I found that certain kinds of perfectionism are highly correlated with suicide potential. As suicide rates are skyrocketing in almost every age group, with certain professions such as doctors, dentists, veterinarians and police officers sharing the frightening reality of having much higher probabilities of suicide, we need to understand what’s fueling this tragic trend.

Not all perfectionism is harmful. On one end of the spectrum is a type of perfectionism that’s constructive or adaptive. But the other is quite destructive. Let’s go over the traits of both.

Constructive perfectionism is process-oriented. It focuses on learning and is driven by fulfillment, curiosity and naturally high expectations. Emotional and mental balance is maintained as you absorb the rich meaning of each accomplishment.

Destructive perfectionism is far different. It’s goal-oriented yet fueled by constant inner voices of criticism, fear and shame that goad you into believing that you’ll be “found out” if you don’t succeed or whisper that you have no intrinsic worth. Thus, you must stay in control. And sadly, there’s very little fulfillment; when one task is done, you immediately shift focus to the next. And the next. And then … the next.

One might believe that these two kinds of perfectionism are easy to detect. Yet often, the destructive perfectionist’s need to look perfect was created in childhood as an emotional survival strategy to manage damaging family or cultural dynamics. Since you’ve become an expert at rigidly compartmentalizing or stuffing away emotional pain, you may not be conscious of how isolated from true emotional intimacy you are.

Until one day, you can’t stand the loneliness. You can’t spend one more minute fighting off vicious voices of shame or feeling persistent pressure to win. And you begin to visualize driving off the expressway.

One man comes to mind. Let’s call him Jacob. He was internationally known in his profession, yet his father had died without ever telling him he was proud of him. Quite the opposite. His dad had a much closer relationship with Jacob’s older brother, who eventually entered his dad’s medical practice. When he did accompany Jacob’s mom to baseball games, he talked on the ride home about what Jacob could’ve done better, his mother sitting silently by. As he spoke, Jacob shook his head and gazed out the window, telling me he’d always blamed himself: “I should’ve made my dad proud.”

We started talking about self-compassion. To weather his father’s emotional absence and criticism, Jacob had completely shoved his hurt and confusion away and built a highly successful-looking life. I asked him about his own son. “Oh, I’d never treat him like that.” “Why not?” “Because he needs to know I believe in him.”

Jacob slowly began to risk feeling. In one of his final sessions, he said, “Not only did a tear come to my eye as I wrote in my journal on the plane … but I was where others could see me. And I didn’t care.”

This work takes courage. It takes risk. But it just may save your life.

Dr. Margaret Robinson Rutherford is a private practice psychologist in Fayetteville. The opinions expressed are those of the author.