← Your Anxiety Toolkit - Practical Skills for Anxiety, Panic & Depression
Your Anxiety Toolkit - Practical Skills for Anxiety, Panic & Depression
479 Why the Most Responsible People Struggle in Silence (with Dr Margaret Rutherford)
00:33:09
Loading summary
Transcript59 lines
- [00:02]
A
Some of the people who look the strongest on the outside are carrying the heaviest emotional load on the inside. Today we are talking about why the most responsible people often struggle in silence and how perfectly hidden depression can hide behind success, reliability and strength. Today we have Dr. Margaret Rutherford. We've had her on the show before. She is a clinical psychologist whose book Perfectly Hidden Depression has reached global audience. It's been translated into dozens of different languages, and she has a Ted Talk speech that has over 2 million views. Dr. Rutherford has now written her second book, the Perfectly Hidden Depression Workbook, to help readers recognize this and address this hidden crisis. So thank you for being here.
- [00:57]
B
You know, you're one of my favorite people, Kimberly, and please call me Margaret. So. So thank you again for having me on and for writing a incredibly kind and eloquent forward for the book. So I want you to do it. And I was so. I got tears in my eyes when I read it. So thank you so very much.
- [01:19]
A
My pleasure. It was an honor. I can't believe you asked me. Truly, I get goosebumps just thinking about it. So y. You have done such influential work. Now, for those who haven't listened, you've been on the show before, but I just want to give them a little
- [01:34]
B
bit like it was seven years ago. So that was absolutely forgotten.
- [01:39]
A
This book changed my life, right like this. I read your book and I was like, this is me, like. And so it was so. So it was such a movement for me. And so I'm so grateful that you're here now because you've decided to put the book into a workbook for you format. If only I had have had that in my early 20s, I think it would have saved me a lot of suffering. So I'm so excited about your book. We will have links to it in the show notes for anybody who is interested. But let's sort of talk about it. So I polled my Instagram folks and they all really resonated with this idea that, and I'll ask it to you in a form of a question, is that many people who struggle with perfectly hidden depressions are the ones who everyone relies on, right? They're the helpers, they're the achievers, they're the responsible ones. Why do you think the most responsible people often end up being the ones who struggle and suffer in silence?
- [02:43]
B
It's a great question. One would think, oh, the responsible thing would be to go to a therapist or to reveal or something. But the problem is the that sense of responsibility is no longer a true choice. It is a have to. It is a must, they fear, because the responsibility is fueled by a sense of, I can't not be responsible. I have to be responsible, and I have to be uber responsible. I have to be the person in the room who always says, sure, I'll do it. And that has become a trap. Or as I say in this new book, fairly dramatically. But I like theater. Makes sense to me. It becomes its own prison where you are guarding inside of yourself. You know, you have feelings of. You have painful emotions, you have painful memories, and you are guarding those because you've never really learned how to express them. You weren't allowed to express them, talk about them in your childhood. There were secrets in your family that you had to keep. There are many ways of getting there, but basically, you are guarding those. And because you don't even want to think about them and. And you really may not even have language to talk about, you know, it. You have to learn how to talk about emotional pain. You need the words, you know, you. And a lot of times people will say, margaret, who have come in to me, see me, because they identify with this, said, you know, you talk about feelings a lot, but I just. I think a lot. I. I stay in my head a lot. I really don't feel much at all. So part of the prison is the guarding against those. You even feeling those. That emotional pain. The second part of the prison is that you have to guard anybody else from even maybe guessing that there's something underneath the surface that you're not talking about. I talked to a group of women last week who. Philanthropic women here in this northwest Arkansas area. And when I said, you know, I bet all of you have that friend that you think, gosh, you know, I don't think I've ever heard him or her talk about the themselves. You know, do you even know if they're mother. Dead or alive or do you know anything about them? Do you know, you know, they're always, always interested in what's going on with me. And they're always saying, you know, well, let me know if I can help you. But I don't really know. They. They'll say, oh, I have a very uninteresting life. Or they'll make. They'll skirt around conversations about themselves because it's not responsible that. And, you know, I. I surveyed. I interviewed a whole bunch of people before I wrote the first book, and they said, you know, Margaret, you know, I asked them, why. Why are you talking to me? I mean, I'm this therapist in Fayetteville Arkansas. You don't know me. You've. You said, sure, I'll talk to you. I'll open up to you about my story. And what Kimberly, they have said is that I don't want anyone to be as lonely as I have been because I'm just always achieving. I'm always doing, I'm always responsible, I'm always, I am. I have defined that box for myself and I am living in it. And I don't know how to get out and I'm not sure I want to because it's too sc. Does that answer your question?
- [05:56]
A
It does. And I think for, for really responsible people, it feels irresponsible to admit that you're suffering, right? It feels like you know the rules of response hyper responsibility. You have to maintain it. You're not allowed to ask for help, you're not allowed to let anyone know and you have to maintain this perfect facade or your whole identity goes down the drain. For those who are maybe new to this term, perfectly hidden depression, would you be able to sort of just give us an understanding of what that is?
- [06:30]
B
Yes, I'd love to. Basically when I started writing about perfectly hidden depression, I was trying to write about people that might come into my office and kind of not know why they were there. Just say they had gotten some anxiety that they didn't know what to do with or they were trying to make some decisions or maybe fatigue was a problem. And what I recognized in the way they talked about their lives, these incredibly busy, high achieving, very successful lives, but what they did not know how to do was express emotional pain. They could say, yeah, that's really hard. That's a hard situation. Could they let me see it? Could they let me see their sadness? Could they let me see their frustration? Could they let me see their anger? No. And so I started thinking of perfectionism as this camouflage for underlying unexpressed pain and the memories that are associated with that pain. And what do you think about camouflage? Camouflage? You wear camouflage so you will not be detected, right? So you will be able to do something without anyone knowing you're there. That's what this kind of perfectionism does. And this kind of high achieving drive, what in the research literature is called destructive perfectionism rather than constructive perfectionism,
- [07:52]
A
it
- [07:52]
B
acts to hide this. And actually why I have spent the last decade trying to talk about it from my own little corner of the world to make my dent is because it can actually grow into suicidality. I bet everyone listening to this, I said this in the TEDx either know someone themselves who died by suicide, whose life looked great, or they know of someone that that has happened to more recently because suicide rates are going up and perfectionism rates are going up and they are correlated. So it's not that that is the only reason why people die by suicide. I'm not saying that certainly, but I think, you know, again, we all have people in our lives that we had. No, I mean, they would be the last person we would say would kill themselves. And yet they do.
- [08:40]
A
Yep, Yep. That checks out on my end as well. And I think that's it. I think that this. You know, it's funny you say destructive versus constructive, and I wonder if you could share a little bit more about that because I think we've been fed this idea that being perfect is the goal and you should go for it at all costs and you shouldn't share. Again, it's all very isolated.
- [09:06]
B
If you're struggling.
- [09:07]
A
Right. Like, if you struggle to be perfect, keep that on the down low because that's something to be ashamed of.
- [09:13]
B
Yeah.
- [09:14]
A
Can you help? Just for folks who've never heard that concept, what does that mean, constructive versus destructive?
- [09:20]
B
That is one of the ways, again, academic researchers, people who spend their lives researching perfectionism, like to divide up the. The concept of perfectionism. Constructive perfectionism is where you are fueled by your drive. Your conscientiousness is fueled by creativity, generosity, just, you know, achievement orientation. You just, if I'm going to do it, I'm going to do it. Well, maybe you're going to raise money, maybe you're going to, you know, we just all watch the Olympics. Maybe you're going to become an ice skater or a skier and you want to do really well and you're very conscientious. But you can also say, well, I flubbed that, I made a mistake. You don't have to hide struggles because that's not, you're not, as you just said, the attachment to the idea of I must always look perfect to everybody else isn't there. It's just, it is inherent in the process of doing things and achieving things. You. You want to do them well. Maybe that's loving your children. You just want to do that. Well, destructive perfectionism is much more achievement oriented. It's more goal oriented. It's not process oriented. And it is fueled, again by this fear of not looking perfect, of this fear of, ooh, someone might see me sweat, and I don't. That makes me too uncomfortable. And so I am going to put out this facade, this Persona of I Got this all handled. You actually behind the scenes are staying up until all hours of the morning getting something done or not sleeping or whatever. But you, you want to appear that you're in tight emotional control. You've got this down and that is there is such fear that someone will see you not be that way and, and what you will lose. I've had people tell me I'll lose everyone's respect, I'll lose my job, I'll lose my status in the community. No one will want to invest in me anymore. Both perhaps financially or any other way. There is such fear attached to the idea of being seen as struggling in some way or another that it's just not allowed. It's just not allowed.
- [11:27]
A
Yeah.
- [11:27]
B
It's so lonely. Like I said before, it is just so lonely.
- [11:30]
A
Yeah. And I find that so what you've just described so interesting that to the same behavior can be fueled in two different ways and cause two massively different emotional experiences. Reaching for the stars, working very hard, wanting to be the best you can be. You could be doing that from that really hopeless, undeserving lack of worthiness place. Or like you were saying with the constructive is like I really want to reach this goal. It would bring me so much joy. How fun to try and goal for something like two completely different agendas. But it might look the same.
- [12:13]
B
That's right.
- [12:14]
A
And I think that's where it gets really interesting. So for the person who has this destructive perfectionism, talk to me about the depressive piece of that. Would you say they're hiding depression or are they doing this behavior that's causing depression or how would you differentiate? Now as you know I have a private practice. I have have six amazing therapists in Calabasas, California. However, we do not take insurance. Now if you are looking for insurance covered OCD or BFRB treatment, I want to let you know about nocd. NOCD provides face to face live video sessions with specialized licensed OCD therapists. Now their therapists use exposure and response prevention. We know this is the golden standard for ocd. So you can be absolutely confirmed that you're in the right place there. And they have a clinically proven app that helps you stay connected to your therapist and others who have OCD between sessions so you'll always feel supported. Now the cool thing is NOCD is available in all 50 US states and even internationally and they accept most insurance plans making it affordable and accessible. We love that. Now if you think you might have OCD or you're struggling to manage your symptoms, you can book a free call, just click the link in the show notes@nocd.com I am honored to partner with NOCD. I want to remind you that recovery is possible. Please do not forget that. Now big hugs and let's get back to the show.
- [13:59]
B
That's such an excellent question. What? I wrote the first book and it was published in 2019 and so I was writing it for the couple of years. I mean, I can't tell you how many times I say, should I call this perfectly hidden depression or perfectly hidden pain or perfectly hidden vulnerability or perfectly hidden, you know, what should I call it? Because it's, you know, and people said, but it's not really depression because, and it's not classic depression. It doesn't look like classic depression. Which is kind of scary really. A lot of the TEDx comments that have been left have said this scares me to death. Because what if this person I love and am so appreciative of everything they do in the community also struggle like this? So I think the, the issue is it, it's what I say in my clinician workshops is this. When cardiology finally woke up and started paying attention to the research that was on women, they realized that the symptoms of a potential heart attack in men and women could be different. And so when women were coming to them saying I have back pain or I have this, they go, oh no, no, that's not, you know, that's not, but it is for women. And so they changed their measuring stick, they changed their way of thinking about what is the risk, what could be the risk of, of heart attack. We need to do that in mental health for depression. That depression can look like classic depression. That's anhedonia, depressed mood that everybody can see, even the person sees it. Isolation, low self esteem, hopelessness, helplessness, decision making problems, foggy thinking, I mean, you know, all lack of eating, eating too much, suicidal ideation. That's classic depression. And that's a problem. And, and it's, you know, people can really struggle. But there's this other type of depression that the question is not, if you're asking about it, the question would not be, well, do you ever feel hopeless? Because someone who's hiding would say, no, no, I have far too many blessings in my life to ever be hopeless. If you ask them if you felt hopeless, would you tell anyone? No. So you've got a little window into who they are because they're telling you no. I don't really think I would. You know, I just worked my way through it. And you, you begin to get this little picture of. Wait a minute, could there be something on the other side of this? Maybe not, but there could be definitely something on the other side of this that is this picture perfect person. You know, I was asked to do the TEDx, Kimberly, because one of the co organizers of it contacted me over LinkedIn and she'd had a friend who had killed herself who they were all shocked that she'd killed herself. She very purposefully killed herself. Mother of two, loved in the community, loved by her husband, supposedly, you know, all. Everything was great. But they found perfectly hidden depression. They found my book on her bedside table. So she. Which just made me very, very sad at that point. But that's when they called me to say, or texted me to say, who are you and what is this?
- [16:59]
A
Yeah. And I think that it's. So many men and women, but mostly women that I have seen have said they've gone to the doctor and they have finally said, I think something's wrong. And they'll say it's impossible. You are too high functioning. Look at you. You're a great mom. You're a great, you know, you're great in the community, You're a great public speaker or whatever it is that they're doing. You're doing great in your job. This, you can, no, that can't be you. Which I think is devastating. Right. Because I think we do have this idea that depression is in bed, not motivated and so forth. When that's. There's a whole crew of people who are struggling with perfectly hidden depression. And, and absolutely. You talk about how people with perfectly hidden depression have difficulty expressing painful emotions.
- [17:54]
B
Yes.
- [17:55]
A
Why is vulnerability so threatening when for these particular people.
- [18:00]
B
Well, I think that from what they will tell, what they tell me is that part of it is they don't want to let other people see. It's like I have a really messy closet. I. My husband looks at me and says, you look nice today. But how you came out of that closet, I have no idea how you pull that off. So I always make sure the door to my closet is shut tight. If I want people to think I'm a normal functioning human being, I don't want anybody to even open that sucker up a little bit. Now obviously I'm using this as an example. I don't really care. I mean, you're gonna judge me on my closet, just please do. And it is messy, it's disgusting. But you know, that's what they're doing. They're just keeping that door tightly Shut. Because for them opening up just a little bit is something that is so tremendously fearful. Fear inducing for them.
- [18:59]
A
Yeah.
- [19:00]
B
That they can't imagine doing. Everything would be over if somebody knew that about me. It would be, you know, horrendous. You know, my mother, who I talk about much more openly in this book than I ever did in the first, I mentioned her in the first book, but I decided, I, well, actually decided that she wouldn't keep me out of heaven if I, if I did this. That maybe she'd still talk to God and say, sure, she let her in. Because she. I really haven't struggled. I'm a perfectionist, but I have not struggled particularly with depression in my lifetime. Mine is anxiety. I have lots of anxiety. But mother had a. She had anxiety, but she also was very unhappy. But no one would have noticed. I never saw her cry. I never saw her really express anything that was difficult. And what the, the way she did that was that she was prescribed medication in her 30s that just kept her functioning. She was beautiful, she was smart, she was talented, she was loved. And she didn't die by suicide, but she killed herself with those pills to where the last 15 years of her life, she couldn't take them anymore. And she literally sat in a chair for 15 years. So I watched that and I didn't understand it. And I don't think perfectly hidden depression is a perfect way of expressing it. Some people say, well, she was just a drug addict. And I guess, you know, you could say that she was a high functioning drug addict. So. But I watched her misery and I don't if there's any chance that words of mine or an example of mine, you know, the workbook. Well, it's a true workbook. So. But what I did with this workbook is I, I, it's not very past oriented. It's not like, let's go back and look at how all this happened. And that was a lot what the first book was about. Okay, if this is you, let's take these reflections of this kind of perfectionism in your. The hyper responsibility, the not talking about anything unpleasant, the focus on gratitude, you know, so much gratitude that it turns into toxic positivity. All those things. Let's take each one of those things and decide what you like in your life, what you think is actually beneficial about that to you, and what is getting in the way of you being able to be more real and be yourself. Don't throw the baby out with the bathwater. No. If that's important to you, that's fine. But what of it is holding you back from, or keeping you lonely or keeping you just so struggling out? I mean, just, you know, achievement at any cost.
- [21:37]
A
Yeah. For. For me, I. I'll just reflect on my own experience with that. Question is I wasn't able to be vulnerable because the shame I would feel was so painful that it's less painful to stay perfect and shut down than to feel the shame I would have to feel by being vulnerable. So it was sort of like. And you talk about that this sort of happens naturally in your book is like. It's like opening that little door and then you can close it if you want, and then you open it a little bit more and then you close it and you just practice being with these feelings and exploring that shame and exploring what is going on. And. And that was the case for me too. Like, I was unlucky in that I didn't get your book until I'd done a lot of therapy on that sort of area, not knowing that it was called this. But so often I think those hyper responsible people, those perfect people are just locked in with so much shame and guilt. Or even a client said to me the other day, feeling guilty for their privilege, like, I can't. I can't complain. I have a house over my roof, over my head, and I have a great job, so who am I to complain? And that kept them logged in. So I. Again, I'm just so grateful that. That you're here talking about it and that you have this workbook that people can actually, actually work through step by step.
- [22:58]
B
You know, the shame is probably one of the most. Well, what's the word I'm looking for? Destructive emotions. Because it. It is hard to feel. I mean, I certainly have done things that I feel ashamed about. It's the carrying it around and hiding it. It only grows more potent when you do that. I tell the story in the book as well that before my now husband of 35 years, 30, I was married twice before. And actually those were very chaotic relationships. And I had a chaotic 10 or 12 years of my life. And when we moved to Arkansas from Dallas, I told my therapist at the time, well, I'm just not gonna say anything about that. You know, I let people think that my husband is my only husband. If they ask, I'm not gonna lie, but I'll say, oh, yeah, I've been divorced, but I'm just not gonna say anything. And he kind of looked at his therapy way, you know, how all therapists do, and said, well, that's an option, you know, I didn't for a long time because my own shame about it was still so strong that I could not even imagine in a small town in Arkansas, letting people know that I had failed that. That what, you know, that's what I was telling myself until the powers that be plopped a woman in front of me who I had not met. And she was crying and she said, I'm about to get my second divorce, and I am just. This was not supposed to be my life. I can't believe this is my life. And she looked down and Kimberly, she looked up at me and she said, but you would know what that feels like. And I said, you're about to join a club I've been a member of for quite a while. And I didn't talk about it anymore, but she smiled and she said, really? And I said, yes, So I can help you.
- [24:40]
A
Yeah.
- [24:40]
B
And that kind of. Now, did I think that the world was going to end when I did that? Did I think she was going to stand up and go, well, you can't help me. You're a big flop yourself. Yeah, sure, there was a little voice of shame inside of me that, that. That said that, but that's not what happened at all. That's typically not what happens. Shame is something that if you allow it to hide, then you're giving it power.
- [25:08]
A
Yeah.
- [25:08]
B
And if you accept it and say, yep, I did that, or, yep, that was me, it's not going to define you any more than anything else.
- [25:15]
A
Yeah, absolutely. That's beautiful. Thank you so much for sharing. It's a powerful, powerful story. If someone's listening to this and they've spent their whole life or spent many years being responsible for everyone and everything, and they're struggling inside, what is maybe the first step towards letting that or breaking free of that or working on that.
- [25:41]
B
Another great question. I believe that the. Well, okay, I'll give you another example. You know, I'm a storyteller. Sorry, Kimberly. I like to tell stories. Patient comes to mind, client comes to mind. That did great work for three or four months. She'd come. She'd come in because of perfectly a depression and her awareness just got out of the roof. She'd come in and go, I see now where my perfectionism is seeping into this, and I can't talk about that. And I don't want people to know about this and all that. And. And yet could she talk about it? Could she move from awareness to risk? Not yet. Not yet. Because it's such A hard move. Move. I'm aware that this is a problem, but I also feel ready to let someone in to my world. Just. Even if I open that closet door just a little bit and they kind of go. And then I'm gonna close it. Even if I just do that, you're not gonna. Even if I say, you're not gonna quite believe what's behind this door. Even if I say I'm really terrible about talking about myself and I want to try to learn how, and I think you're the kind of person I could do it with with. Could you be that person for me? And probably they'd say, of course. And I'm so honored. And if that's all you can say, that's all you can say. But you have let someone begin to see that this Persona is not all there is.
- [27:01]
A
It's funny. I was actually gonna. I was thinking the first step might be. Here I am, I'm making a plug for your book. Is if you're not ready to tell anybody. So you're so wonderful you wouldn't have thought to do this, but if you're not willing to tell anyone, just get the workbook and you can start to open that do.
- [27:19]
B
That's true.
- [27:20]
A
A little with yourself.
- [27:21]
B
That's true.
- [27:22]
A
Sometimes you're saying, like, it's a baby step, tell one person or go to a mental health professional, someone who's trained. Or maybe it's just exploring it on your own and just being like, what is this? Like, we don't have to change it. Nothing has to change. But maybe we could just like, dig around and be like, what's happening here? Why. Why is this so scary? What. What is it that this. This hyper responsibility and this perfectionism. What it protecting me from? And so even if you're not ready, the book might be an option for them.
- [27:55]
B
I. I think that's right. And you need to be in my marketing because obviously I'm not very good at it.
- [28:05]
A
No, no. But that's why I love you so much. Like, your response is perfect. But then I was also thinking, like, if it is too scary, you we can dabble around and look at the literature and so forth. Yes, absolutely.
- [28:18]
B
Many publishers and I mean, there was some really big deal publishers, Random House and some of those people that were interested in the book. And they told me two things. The one said, you know, nobody knows who you are. You're a therapist in Fable, Arkansas. You're not with Yale or Stanford or Harvard or something. That's why I started the podcast and but the other thing they said is, we don't think perfectionistic people will buy a book on. On depression. So I asked those people that I was interviewing, would you buy a book on depression that go, yeah, I tell everybody it was for somebody else.
- [28:50]
A
Yeah, that's so interesting.
- [28:52]
B
I'm buying this for my aunt. I'm buying this for my. Yes. Yeah, I'll just tell somebody it's for somebody else. And then.
- [28:59]
A
And actually, let me tell you a secret. I remember buying a book on perfectionism, and I got a brown paper shopping bag and I covered the COVID of it so that if I was in this is like before, we had had smartphones and we were on our phones in the coffee shop. I would be at the coffee shop and I'd wrap the. The COVID of it so that people wouldn't see what I was reading.
- [29:23]
B
Other people did that with 50 shades of gray.
- [29:25]
A
And you know me, it was books about depression.
- [29:28]
B
And you did it.
- [29:30]
A
Oh, I love it so much. Okay, let me ask you one more question and then you can share where people can find out about your book. If somebody listening has spent their whole life. Life being the strong one, but inside they're exhausted and they're hurting, what would you want them to hear today?
- [29:46]
B
Certainly we are not pathologizing. Resilience. And your strength and your ability to be there for other people is something that we are not saying. There's something horribly wrong with that. What we are suggesting, but I am. Well, you are too. We are suggesting is that when that is the only option you allow yourself, that is not a choice. It's. It's a prison. It's a hole that you're falling in and you can't get out of. And it is. It is a role that has become more and more rigid in your life and that what you fear will happen. You and I are both therapists. We've had people tell us things that they will look at us and say, I was so scared to tell anybody this. And yet when they do, they figure. They figure out, you know, it really wasn't all that bad. It's happened to other people. Nobody said, oh, my gosh, you know, so that risk, that trans. But I steered away from using the word vulnerability because so many people tend to think of it as weakness. So I have started using the word transparency, that it is being emotionally transparent. That is actually where your strength can lie. Someone pointed out to me this week in therapy, she said, you know, if you say the things that you struggle with and nobody can really hurt you because you're already saying the things that they might say. Well, you know, she also was divorced while. Well, yeah, she, she talks about that.
- [31:13]
A
I agree with that.
- [31:14]
B
You can't hurt her with that. And so, you know, the things that you reveal, even if they're things that you wish were different or that you struggle with, are actually empowering for you.
- [31:26]
A
Beautiful. It has been an honor to have you tell us where people can find out about your new workbook and you and your podcasts and all the things.
- [31:34]
B
Sure. Of course. The the book is out April 1st and so the new workbook you can pre order if this happens to if you publish before April 1st and that's Amazon, that's Barnes and Noble, please go to your local bookshop and ask them to order it. That would be lovely. I my website is drmargartrutherford.com I will have the book on a landing page there. New Harbinger is the publisher so they also have it for sale. And in fact if you want want several copies, like if you wanted to buy it for a group, they have special group rates that they could give you so it won't be quite so much to to to buy them. And those are all place all the places. My podcast is called the Self Work Podcast and I'll be talking a lot, probably reading some excerpts from the book for that. And the TEDx is called how to Recognize Perfectly Hidden Depression and it got up to two and a quarter million last week. So there are many people who are saying this is real and maybe you can learn from them as well.
- [32:37]
A
Thank you. I'm so happy that you're here and we got to spend some time together.
- [32:41]
B
Me too.
- [32:45]
A
Please note that this podcast or any other resources from CBTSchool.com should not replace professional mental health care. If you feel you would benefit, please reach out to a provider in your area. Have a wonderful day and thank you for supporting CBTSchool.com.