Episode #3: Perfectly Hidden Depression and Self-Worth, with Dr. Margaret Rutherford

Perfectly Hidden Depression and Self-Worth with Dr. Margaret Rutherford 

Let’s say your mother was an alcoholic and unleashed intense emotional abuse onto you and your siblings from a young age. And if you cried, it only got worse. So you learned not to cry. Or to repress your emotions, because expressing them only brought more pain. As an adult, you go through life without opening up much––just to be safe. Instead, you channel your bottled-up energy into being the top of your class or getting promoted. You use achievements as a way to prove to the world that you’re not as useless as your mother always said you’d be.

This is the reality for thousands of people with a syndrome known as Perfectly Hidden Depression. Our guest, Doctor Margaret Rutherford, is the author of Perfectly Hidden Depression: How to Break Free from the Perfectionism That Masks Your Depression. In her work as a therapist, Margaret noticed a trend of patients who seemed to brush off their severe trauma as insignificant. These patients tended to distance themselves from their deepest wounds, letting them fester. When asked, they’d say that nothing is wrong–then overdose, or attempt suicide.

Dr. Ruthorford tells us that this syndrome is different than just typical denial or avoidance. It’s a survival technique, developed as a symptom of devastating early childhood experiences. It might come from growing up in a home where emotional repression was the only way to endure intense abuse or hardship. It may also come from being taught that the only way to win a parent’s love is to get straight As and never “complain.”

All the while, hiding immense sadness, buried deep down, can slowly destroy someone. The pain inside grows and eats away, no matter how many awards they win or people they impress.

Isn’t Perfectionism Kind of a Good Thing?

What’s wrong with wanting to be the best you can be? It isn’t inherently destructive to strive for higher achievement, says Dr. Rutherford. But for those with Perfectly Hidden Depression, their ambition to hide their feelings of intense despair can be catastrophic. For these folks, accomplishment is often irrevocably tied to their self worth, so when they lose out on a promotion or don’t make the team, they can become suicidal.

As someone who spent years in the Air Force, I’ve had my own run-ins with the hazards of perfectionism. In the armed forces, newcomers are taught that mistakes are unacceptable. After being honorably discharged, this fear of messing up plagued the back of my mind for years.

Throw in some good ol’ Christian guilt and fear of the Almighty, and you’ve got a high pressure situation in the face of simple slip-ups. Growing up deeply involved in the Pentecostal Church led me to believe that one “sin” meant I was going straight to Hell. Of course, this mindset is incredibly damaging to one’s self esteem.

 Margaret and I discuss how awful this way of thinking is for those struggling with substance abuse as well. I decided to share my own struggles with crystal meth and addiction recovery on this episode, and how I had to forgive myself when I relapsed. If I weren’t kind to myself, I might still be a user today.

 Dr. Rutherford explains how Perfectly Hidden Depression can hit women and people of color extra hard. This comes from having to work with twice the vigor for the same recognition as white male counterparts. When you have to defy discrimination, you act as though making zero mistakes is a necessity for success. And sometimes, that’s the only way to get a seat at the table. In her practice, Margaret has worked with a great deal of black women who told her they feel as though maintaining a facade of perfection is the only way to protect everything they’ve worked so hard for.

Recovering from Perfectly Hidden Depression

I had to know, how does one begin to recover from Perfectly Hidden Depression? Margaret outlines five different steps in the journey towards recovery: Consciousness, Commitment, Confrontation, Connection, and Change.


Consciousness means being aware of the pain inside. Those with Perfectly Hidden Depression tend to think they’re not allowed to be sad. They believe the trauma they endured is insignificant. They tell themselves making progress means admitting there’s always room for improvement because they’re never enough. Dr. Rutherford wants patients to become aware of their pain, rather than repress it.


Commitment means promising to deal with the pain even if it’s scary or uncomfortable. Listen to the full episode to hear what Dr. Rutherford has to say about mastering Commitment.


Confrontation requires finally facing these dark feelings, and challenging the belief that showing emotions is admitting defeat.


  Connection refers to really accepting who you are but also, connecting the dots. How did all the repression begin? What occurred during childhood that evoked this avoidant behavior?


Change means taking the steps to transform and live a healthier life. The secrets to the five Cs (Consciousness, Commitment, Confrontation, Connection, and Change) can be found inside our this episode of the Sex, Drugs, and Jesus Podcast. Hit play to hear more!

Case Study: Reestablishing Intimacy

 Margaret shares a touching anecdote in the episode about a woman who was able to evolve past Perfectly Hidden Depression. This patient was the victim of repeated sexual abuse in college. Because she had been taken advantage of, she felt the need to totally close herself off emotionally to prevent someone from ever having control over her again. As a result, her marriage had a huge absence of intimacy. Her energy was channeled towards her accomplishments outside her relationship instead. This constantly left her husband aching for connection.

After working with Margaret, she traced her emotional repression to her trauma, and committed to working on herself. Although it was challenging and took a lot of trial and error, she began challenging herself to be more vulnerable with her husband. Over time, they began to uncover things about each other that they never knew, and experienced a level of intimacy with one another that they never imagined.

Top Takeaways from Dr. Margaret Rutherford

What can we take away from Margaret’s expertise in this episode? Well, we’ve certainly got to pay more attention to the connection between perfectionism and depression in our lives. If we put too much pressure on ourselves, we can end up in a dangerous spot. But if we are honest and kind with ourselves, we can work through our deepest trauma and learn to truly love who we are.

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