There's a presentation of depression that we often miss in mental health.
It's not easy to detect, because when you're in the middle of experiencing it, you hide even more carefully from the scrutiny of anyone who might suspect you're struggling.
Your gut knows something's wrong. And in the quiet of the night, the loneliness you allow yourself to feel may come close to plunging you into despair. But you quickly silence the warning signal. Achieving success, smiling, seeming to have a perfect-looking life has been your go-to way of coping for so long, it simply seems like who you are. Or who you've become.
My term for this dynamic is perfectly hidden depression. It's a mixture of beliefs and behaviors that often appear together, kind of like salt and pepper. Where you find one, you'll find the other.
If you experience this type of depression, you wouldn't meet the criteria for minor depression, high-functioning depression, or dysthymia. Those people know they're depressed, but rally by putting a smile on their face, despite struggling every day.
Nor would you qualify as having major depression, because you're far from isolated. You don't look melancholy or agitated. You have friends and activities galore. Tears don't appear. In fact, tears or any expressions of emotional pain are notably absent. You don't talk about wanting to die. In fact, if a therapist or doctor sees you, you're more likely to be advised that you're working too hard, you need to slow down, or you're developing anxiety.
It's depression all right, underneath all of that accomplishment. It doesn't look like the classic kind, but it's there. Your pain stays silent, as despair and intense loneliness remain masked beneath a lifetime of acting as if everything was and is fine. You count on your perfectionism. Maybe you worry and you try very hard to stay in control, but doesn't everyone? Isn't that the normal way to live?
No. It's not.
For where there are secrets, there's shame.
Where there's no self-compassion, there's no self-acceptance.
Where there's no freedom, there's enslavement.
And if there's only silence, vulnerability and true connection are impossible.
A Checklist for Perfectly Hidden Depression
What follows is a questionnaire to help you identify with this. If you do, I hope you will seek out more information. It could literally save your life. For each question below, answer Yes or No. Be honest with yourself. Scoring instructions are at the end.
(This isn't an empirically validated questionnaire and should not be used as a diagnostic tool. But it may act as a helpful mirror to view yourself through the lenses of perfectionism.)
- Do you struggle with confiding in others, especially about your real-life difficulties and problems?
- Do you obsess about things looking perfect, both for yourself and through others’ eyes?
- Do you avoid talking to your partner (or your friends) about feeling hurt by them, or about a growing resentment you might have?
- Do you have trouble sleeping or turning your mind off at night?
- Do you have trouble admitting when you’re feeling overwhelmed?
- Do you push yourself to get the job done, regardless of the cost to you?
- Do you respond to the needs of your friends even when it can short-change your own?
- Did you grow up in a family where feelings of sadness or pain were avoided, or where you were criticized or punished for expressing them?
- Have you ever been hurt emotionally, physically, or sexually, and told no one? Or if you did tell someone, you weren’t believed or supported?
- Did you grow up in a family (or are you still experiencing a family) where you felt like you had to meet defined expectations rather than being allowed to be yourself?
- Do you like to have control of a situation if you’re going to be involved?
- Do you have a growing sense that it’s becoming harder to maintain an organized structure in your life?
- If so, do you feel anxiety or even panic?
- Do you tend to not cry or rarely cry?
- Are you considered ultra-responsible, the one that can always be counted on by your co-workers or family and friends?
- Do you think that taking time for yourself is selfish?
- Do you dislike people considering themselves "victims"—that it’s not their fault when something goes wrong?
- Did you grow up being taught that you were supposed to handle painful things on your own? That asking for help reflected weakness?
- Do you strongly believe in focusing on the positives in your life, or "counting your blessings”?
- Do you have a critical, nagging inner voice telling you you’re not good enough, or that you could have tried harder, even though you accomplished your goal?
- Do you outwardly seem hopeful and energetic while, at times, you struggle with a sense of being trapped?
- Do you make lists of tasks to get done during the day, and if they are not completed, feel frustrated or like a failure?
Count your positive answers to the questions above. If you answered Yes to 5-to-8 questions, you’re likely a very responsible person, though you may need to consider taking more time for self-care. A Yes response to 8-to-11 questions indicates that your life is being governed by highly perfectionistic standards, and something you want to think carefully about. Twelve or more positive responses may reflect the presence of hidden depression.
Lots of driven, accomplished people share these traits but do so in moderation, with their eye on success, but not on success at any cost. That's called positive perfectionism.
But when shame and fear fuel perfectionism? That can lead to true danger if left alone. Please seek help if this is you.
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