How To Recognize Perfectly Hidden Depression

Dr. Margaret Rutherford shares her insights from 30 years of professional experience:

There’s only one way to know

In this video, Dr. Rutherford discusses several (presumably pseudonymized) cases of people who came to her therapy office seeming to have their lives very much together when they very much didn’t, including the woman who came in with symptoms of mild anxiety, and then tried to kill herself, and the man who was outwardly an overachiever while consumed with feelings of guilt and shame.

She discusses how even the most skilled mental health professionals will tend to miss hidden depression, as they focus on visible symptoms from the DSM criteria, which may not reflect the patient’s reality, especially for those hiding their struggles.

So, the crux becomes: why do people hide their struggles? One does not go to the emergency room with a broken limb and then say to the doctor “I’m fine thank you; how are you?” so why do people do that when it comes to mental health issues?

The reality is that the shame of revealing feelings like shame itself, fear, and self-loathing keeps people silent, and in particular, research (Schneiderman et al.) shows that emotional pain plays a central role in suicide, and (per Blatt et al.) perfectionism can drastically alter the presentation of depression, making it even harder to diagnose through standard criteria than it already was.

As for what can be done about it? Dr. Rutherford advocates for a cultural shift where talking about emotional pain, including suicidal thoughts, is seen as normal and not shameful. That people need to feel safe expressing these feelings, to prevent tragic outcomes. Instead of judging or dismissing someone with suicidal thoughts, she encourages a compassionate and accepting approach to open up dialogue and understanding.

In short, that everyone can contribute to a culture that views transparency and vulnerability as strengths, helping reduce the stigma around mental health struggles.

And that’s the only way we’ll ever be able to recognize perfectly hidden depression—if people no longer feel that they have to hide it.

For more on all of this, here’s Dr. Rutherford herself:

Click Here If The Embedded Video Doesn’t Load Automatically!

Want to learn more?

You might also like to read:

• The Mental Health First Aid (That You’ll Hopefully Never Need) ← This is about managing depression, in yourself or others
• How To Stay Alive (When You Really Don’t Want To) ← This is about managing suicidality, in yourself or others

Take care!