profile of black teenager with denim shirt

It has been almost three years since I wrote my first post on “Perfectly Hidden Depression.”

Since then, I’ve received hundreds of emails from people from all over the world. They’ve taken the questionnaire, they’ve listened to my podcast or want to help with my research. I’d have to stop seeing patients myself to have the time to talk to each and every one.

What is Perfectly Hidden Depression or PHD?

I thought you might like to hear the answer from the people who’ve written to me. Their words are no longer my words, describing a syndrome or condition I’ve called PHD. These are actual people who are creating a facade of the perfect life while hiding loneliness, exhaustion and despair. Some are well aware of what they’re doing. Others are beginning to realize, perhaps for the first time, that they are growing more weary of keeping the secrets that haunt them. The stories I chose aren’t the most dramatic examples I’ve heard, where people have described considering some way of killing themselves before they finally reached out for help. Yet these wonderful people speak clearly of the vast difference between what the world believes and what they know, in their quietest of times, about themselves.

I found them compelling in their simplicity. (I’ve also changed the details to maintain their anonymity.)

From Casey, a woman in her 30s:

I am almost embarrassed to be depressed. I feel like if I went to a therapist it would be wasting their time — there are people out there carrying much heavier burdens than I am, certainly. But I am starting to think I need help. My sadness is sort of a constant thing that I deal with (like a low-grade headache that you can forget about sometimes) and some days I feel great. But then something will happen to tip the balance and I am lost. Ever since my dad passed away in July it’s been so much harder. I want to sleep all the time. I don’t want to take care of my house (but I do since I don’t want anyone to see it messy). I don’t want to go out with friends (but I do so they don’t think I’m ignoring them). I even feel angry a lot over silly stuff — I have never, ever been an angry person. But I don’t want anyone to know it (I almost can’t make myself not be happy around others, if that makes sense?).

I feel like I am wearing a mask when I’m out in public. I work with high school students and most of them spend a lot of time in my office because I’m really good at letting people talk (no judgment or advice, just an ear). I think most of my friends and family like me for just that reason. They like Casey the Listener, Casey the Sympathizer, Casey Who Doesn’t Make Fun of You. But they have no idea how there is this constant ache in the pit of my stomach or how tears are right there behind my eyes. I don’t think they would even want to hear about my problems… they like to talk about themselves and 99% of the time I am ok with that.

From Jordan, a man in his late-40s:

It’s like a constant undercurrent, invisible to most casual observers. It doesn’t seem to characterize me. I’m a smart-ass life-of-the-party and all that. But it’s still there. And when it comes out from time to time, people around me are shocked.

I’ve achieved far more in life than I expected. I’m 47. I was the first member of my family to graduate from college.
Two failed marriages. Both were results of hidden despair. I mean the marriages themselves were the byproduct of my despair. I wasn’t emotionally close to either wife. I thought I could be successfully married while managing the relationship in some rational way that would let me remain strong. Or at least seem strong. And I didn’t want to be alone. I wanted the negative to go away. I denied it.

I have secrets I’ve kept from everyone. I’ve never trusted anyone enough to fully confide in them.  I keep myself distracted with adrenaline feeds from triathlon training.

It’s still there. This thing. Always

I find I need to constantly shift my focus away from death. I’m fixated on it as a target. I don’t plan to hasten its arrival, but I’m not doing much to keep it away, either.

And in my darkest moments, I realize I’m not that special. I believe there are millions more just like me.

From Robin, currently a student:

So you know a little of my past. I am the daughter of a drug addict. My mother did pills all of my childhood, and it was what many would say very traumatizing. I still have a problem believing this because I always seen this as “normal” and would tell myself things were not that bad and I was just being sensitive, and went on with my life. I always worked hard in school to have straight As. I also have a habit of caring for others and trying to make sure they accept me and think I’m great. As irrational as it is anything less than perfection makes me hate myself. Yes, I’m the student who got a 104 on a biology exam and was upset that I missed one bonus question. I would cry in my bathtub over getting a B on a math exam, and even hit myself when I got a low B on a statistics exam. If I’m not excelling in school I feel worthless, pointless, and frustrated. I can honestly say at this point in my life I don’t love myself. I love only the part of me that is capable of achieving great success, the part of me that is responsible and can take care of others, the part of me that is put together.

You may know these people. Maybe she’s your kid’s teacher, your buddy, or your classmate.

Maybe you are just like them.

Maybe you also hide by trying to look put together, focusing on others, avoiding painful emotions or vulnerability, and being the person who is successful at whatever you try to do.

You don’t have to.

The people above wrote to me because they felt understood. They were either thanking me for writing about PHD or wanting to help in some way — so others wouldn’t have to live the life they were living.

During one interview, I was laughing a bit and describing the difficulty of trying to get my ideas published. The woman had been calm and engaging, and suddenly, I heard her voice crack. I realized she was crying. “Please don’t give up.”

I’ve worked with too many people just like Casey and Jordan and Robin to give up.

Their real stories need to be heard. Their wounds need to be healed.

And if you have PHD, maybe it’s time for you to reach out — and be known.

If you’d like to take the PHD questionnaire yourself, it’s appeared here on The Mighty. Click here.

You can now listen to Dr. Margaret as she talks about PHD (Episodes 3 and 4) and many other topics on her new podcast, SelfWork with Dr. Margaret Rutherford.

If you or someone you know needs help, visit our suicide prevention resources page.

If you need support right now, call the National Suicide Prevention Lifeline at 1-800-273-8255, the Trevor Project at 1-866-488-7386 or text “START” to 741-741.

We want to hear your story. Become a Mighty contributor here.

Thinkstock photo by jazzmxx


I love inspirational quotes. I keep my Facebook feed full of these little tidbits of wisdom. Some of them I agree with, others I don’t. I can usually just move on when I disagree with one, but “happiness is a choice” has never sat well with me, and it’s one I can’t let go of.

Here’s why I don’t think happiness is a choice and what I choose to say instead. 

1. Mental illness is not a choice.

I didn’t choose anxiety or depression; they chose me. That means I don’t always have control over my thoughts or emotions, even when I know they’re irrational. To suggest I can simply “choose” not to have a panic attack or depressive episode is absurd, and saying so in the midst of one will make me feel even worse. I was once told, “You can choose to be suicidal, or choose to get help.” My desired response to this could be a post in and of itself. Long rant short, it’s nowhere near that simple, and please never say that.

2. It’s stigmatizing.

I have an illness in my brain that affects my emotions. Would you tell someone with an illness in a different part of their body, “Illness is a choice, just choose not to be sick?” But if I’m anxious or depressed, it’s my fault, I’m throwing a pity party, or I’m not trying hard enough to get better. I’m experiencing symptoms, not making a choice to torture myself. I can do everything right to manage mental illness and still struggle. 

 3. It’s OK to be unhappy. 

When did we decide everyone had to be happy all the time? Part of the reason I think happiness has been turned into a choice is that it doesn’t always come naturally, and that’s perfectly fine. Our other emotions aren’t bad; they’re an uncomfortable part of being human. I have a right to feel and express something other than happiness without being judged, blamed, invalidated, or told I’m playing a victim. 

 4. The phrase is often qualified.

I’ve lost count of the number of times I’ve heard people say “happiness is a choice” and then follow it up with a statement that clarifies what it doesn’t mean. That it “obviously doesn’t apply to mental illness” or “It’s still your choice because the opposite of depression is health, not happiness.” If you have to qualify a statement that’s meant to stand alone, there’s probably a clearer way to say what you mean. 

5. It minimizes painful processes.

Whether it’s acceptance, grief, or change, I’ve found a lot of people who say it have gone through some kind of difficult or painful process. When we’re going through something like this, it’s normal to look to those who have been there. But when someone who has had years to work through something says on day one of your similar journey that “happiness is a choice,” it can come across as dismissive of your current feelings and the true difficulty of what you’re facing.

6. It’s stated as universal truth.

No matter what you’re talking about, you’ll often hear that “everyone is different” and “if you’ve met one person with (fill in the blank), then you’ve met one person.” If you’re going to acknowledge that no two people are the same, then you have to accept that different things work for different people. So, before you tell me to “just choose to be happy,” remember that not everyone finds this “choice” empowering, or even possible.

If you or someone you know needs help, visit our suicide prevention resources page.

If you need support right now, call the National Suicide Prevention Lifeline at 1-800-273-8255, the Trevor Project at 1-866-488-7386 or text “START” to 741-741.

We want to hear your story. Become a Mighty contributor here.

Thinkstock photo by Vjom

Depression is lying with my face covered by the quilt, not moving.

Listening to the phone ring and ring and then hearing the voice of a dear friend on the answering machine and not picking up.

Hearing in that voice the strength and care I know I need and not being able to move.

It is thinking the rent is probably due sometime soon and not really caring.

Thinking the rest of the world is able to go on just fine without my input.

It is going to work daily and putting on a pretend face and returning home to crawl back beneath the covers.

Depression is telling whoever might break through the demeanor and ask about my feelings that I am just hibernating and will come out in the spring.

And then spring comes… it is wondering why I said that.

It is a knowing people are fearful of mortality, fearful of real feelings, confused and so befuddled by what they think might be expected of them that they pretend also.

They make believe a person heals in some specific amount of time from a loss.

And because they are afraid, they say nothing, and then I begin to think they do not care.

Depression is what it sounds like — a dent, a literal depression in the heart.

It is sometimes so deep that only many years of work will begin to fill in that chasm.

And it may take my admission that I need help.

That, “OK, doc, I will take those meds.”

That, “Yes, please, friend, do some energy work on me.”

That, “I may need a therapist to just hear me out and be a guide.”

I may even have to accept that help.

I may have to admit I am not superwoman after all.

I may have wonderful laughing days followed by tears and then complete oblivion.

And I will have to keep telling myself, “I am not crazy.”

But, first I must pull the covers back – back from my face, my mind, my heart.

And get out of bed and answer the phone and listen to someone who cares.

If you or someone you know needs help, visit our suicide prevention resources page.

If you need support right now, call the National Suicide Prevention Lifeline at 1-800-273-8255, the Trevor Project at 1-866-488-7386 or text “START” to 741-741.

Thinkstock photo by RadulePerisic

This is for anyone who has a difficult time understanding what all the “fuss” is around mental health. For those who might feel uncomfortable sharing their story. For those who think these stories are not worth sharing.

In the past few years, there have been extensive campaigns to get the word out about mental health – its prevalence, severity, and treatment. Yet somehow despite the great efforts across the country, people still do not feel comfortable explaining their illnesses.

Obviously, most discussions about health are very personal, often making it difficult to share. I don’t quite enjoy discussing my cardiac surgeries or my severe depression.

Yet a key distinction between enduring these two conditions – one physical and one psychological – is the support I expect upon sharing these diagnoses. 

The former – most react with surprise and optimism, reassurances that I’ll be in great hands, followed by a comment of how easily I will recover. 

The latter – I expect surprise, along with a great dose of pity and awkwardness. 

No one quite knows how to react to the news that I’ve been living with depression, most likely because I constantly mask my symptoms behind a smile. Many people apologize and offer support. Several friends have blamed themselves for not having noticed before. Few continue not quite believing my diagnosis is serious.

So why would two health conditions elicit such drastically differing responses? 

In my opinion, we have been raised to believe mental health challenges can be overcome on sheer willpower. Some people unfortunately think it’s the individual’s fault for not being able to get better. Or that it’s their fault they are even in that situation. Jokes are frequently made that belittle the seriousness of depression. TV shows make light-hearted jokes about suicide, making depression an everyday word – but not in a supportive manner. Somehow this translates into friends sarcastically joking that someone “would rather die” than root for the Yankees or that “we should just kill them now” because they anticipate failing an exam. These jokes are completely inappropriate, unwarranted, and almost always facetious – yet we hear them on a daily basis, not just on TV.

So why did jokes about suicide somehow become funny?

How did these jokes become funny?

By making depression a laughing matter, it has perpetuated the stigma around mental health. These comments essentially tease anyone for having suicidal thoughts because humor makes these sentiments too ridiculous to believe. You never know whom you may be hurting when making a joke about mental health. Personally, all of this discourse has made me feel as if my thoughts should not be concerning.

Since my diagnosis in October 2015, my friends were alongside me through the year’s roller coaster of depression. And for a while, they had no idea how to help. This is with no offense to them – I also had no idea what to do. We just have never had learned the proper mindset about dealing with mental health. Although they have the greatest intentions, they don’t fully understand the disease. So that’s why I was told to “just cheer up already” and that I was simply “blowing everything out of proportion.” When my depression reached its lowest point – I even heard how I wasn’t being a good friend anymore. I learned (too late) that some felt pressure to always be strong for me, not expecting me to capably reciprocate, thereby limiting our relationship. Soon I became sick of pretending to be happy, so I lost interest in spending time with others. I didn’t want to be a burden on anyone.

Struggling with the loss of my grandfather, the closing of our family-owned store, my parents’ divorce and my own relationship ending, I felt as if my problems were insurmountable. Several counselors told me that time and time again I was trying to mend a broken heart. Unlike my cardiac surgery, there is no set solution to this diagnosis. I started doubting the pieces could be put together.

My friends tried to comprehend how my disease restricted my thoughts and actions, but they couldn’t fully connect. I think this was primarily because the emotions surrounding depression are unfathomable unless you have lived with this disease. 

Never before had I understood hopelessness until I felt it. Never before had I genuinely believed I was incapable of healing. Never before had I wanted to let go…

The outward manifestations of my cardiac and mental health recovery were surprisingly similar. Both conditions left me either wide awake at night in great agony, or asleep too early, worn out by pain. With heart surgery, this pain was very visible – after all, my sternum was broken and I still had drainage tubes in place (disgusting, I know). However, the pain in depression is not at all visibly noticeable, only through its symptoms.

In both circumstances, I had lost a great deal of weight and strength – both times due to immobility and lack of eating, yet for vastly different reasons. 

After heart surgery, I was physically immobilized for several weeks and constantly nauseated from painkillers. 

Through depression, I have been mentally immobilized. There are evenings when I am completely unable to get off the floor because I am either uncontrollably crying or stuck feeling nothing at all. I slowly stopped eating because my medication and mindset gave me a constant stomach ache. I rationalized that eating is not worth the imminent stomach ache. I rationalized that eating may not be worthwhile because I am not worthwhile. I wished my cardiologist could fix me once again – because this broken heart of mine was becoming more painful than ever.

Neither of these situations are easy to discuss. But what is it that makes mental health so much more difficult to discuss? 

Why haven’t I shared more about this? 

Recently it’s become apparent to me how infrequently I share that I have depression. As previously mentioned, I’ve lost weight due to this illness, and in the past several months, people have commented on “how great” I look. Every time I hear this comment, my stomach churns and I wish I could explain that the weight loss doesn’t mean I am healthy. After all, for my physically broken heart, it would have been easy to correct someone by pointing to my scar from surgery. So through these emotional heartbreaks, I wish I could scream that I’m not doing well.

But I don’t do that.

Because by doing so, I am a burden.

At least that’s what I’ve come to feel through sharing my diagnosis. Those with whom I am not as close feel awkward by the situation, embarrassed for themselves. They take pity on me. My closest friends have been overwhelmingly supportive – yet it is apparent that none of them can “fix” me, so, in turn, I feel like a stressor in their lives (even though they are too kind to admit it).

But that’s the key — I shouldn’t expect my friends to “cure” me. This should not lie on them. 

Why should these two conditions be viewed so separately that for one, I need to see an esteemed cardiologist, but the other I’m just supposed to fix on my own or through friends?

After all, in both situations my heart needed mending. Mental health has become too much of a sensitive topic that many are wary of seeking help, so we end up falling back on friends for support. Even after seeking help, I realize I’m still not as open about this condition as I had been about surgery – even though both are life-threatening.

Why is it that while recovering from surgery I received mountains of teddy bears and flowers, but for depression, many of those aware often avoid bringing it up altogether? Why is medication expected post-surgery, yet unwelcomed for mental conditions?

Why is it that through one heartbreak, my hand was held in many doctors’ offices for consultations and procedures, but for the other, I’m left to find my own clinical help? Why is it that since the pain I feel from depression is not visible, that people assume that it has vanished?

Mental health should be more openly discussed to acknowledge its severity and eliminate the differing perspectives between physical and psychological health. Heartbreak is heartbreak.

Just because this pain exists in my mind does not mean it is not real.

If you or someone you know needs help, visit our suicide prevention resources page.

If you need support right now, call the National Suicide Prevention Lifeline at 1-800-273-8255 or text “START” to 741-741.

We want to hear your story. Become a Mighty contributor here.

Image via Speeotoole Instagram

Depression can make you feel like part of you is missing. That feeling of emptiness is the subject of Janelia Mould’s photo series “A Girl Called Melancholy – A Story Of Depression.”

“I tried to capture the lack of being,” Mould, a self-taught photographer from South Africa, told The Mighty. “I am always looking for topics or themes to express myself through. I try to convey some sort of message through my images and was inspired by my own life-experience for this series. The images are a very subjective to my journey with depression.”

9. illusions - cheekyingelosi


Each photo in the series is missing its subject’s face, a purposeful exclusion Mould said helps magnify how empty and hopeless depression can make you feel.

“The character in this series has no face and sometimes has missing limbs, firstly, so that anybody that either suffers from depression or has dealt with it in some way, can identify with her.” Mould said describing her series. “Secondly, its keeps the viewers’ attention on the feelings often experienced through depression, like emptiness, vacantness and not recognizing oneself anymore.”

woman without a head laying on a mattress with her feet up in the air.


Mould also includes quotes from famous figures to unknown authors alongside her photos. Her photo “Barren” (shown below), features a quote from an unknown author, which poignantly complements her photo.

Some days, I feel everything at once. Other days, I feel nothing at all. I don’t know what’s worse ― drowning beneath the waves, or dying from the thirst.

Woman without a head standing under an umbrella in the rain.


Mould hopes her photo series will help others understand what it’s like to live with depression. “If you are suffering from depression, you need understanding and patience from others, not a quick fix,” she said.

Woman without a head wearing a dress hanging on a clothes line. Dangling 

Her series currently contains eight photos, but Mould may add more with time. “I have not decided how many more photos I will add or when it will be finished,” she said. “I guess I will take more inspiration from my journey ahead and see where the road leads me.”

You can view the rest of the series below or on Mould’s Facebook page and website

6. forgotton - cheekyingelosi Forgotten

4. uninhabited - cheekyingelosi Uninhabited 

photo of a dress in a suitcase with legs sticking out Withering Away

2. its complicated - cheekyingelosi

It’s Complicated

For me, a combination of anxiety, depression, and physical illness has given me a negative perception of myself as a person and what I deserve in life.

I am a firm believer in karma and sending good energy out into the universe. You get what you give. What goes around comes around. But what happens when you only give negative energy and thoughts to yourself? What are you left with to give out to the world if all you tell yourself is how unworthy you are?

Self-worth, self-love and self-care are all intertwined. We are told, for both mental and physical health, the importance of taking care of ourselves. Our bodies and minds need rest, nutrition, space to breathe.

But when I am dealing with a bad anxiety day or a day full of physical symptoms, instead of acknowledging that I need and deserve a break, I agonize over something I might have missed because I wasn’t feeling up to it. I beat myself up if I think that I made a mistake at work because I wasn’t feeling well.

When I do allow myself the space and time to supposedly relax, I worry I am not being social enough or that there is something else I should be doing. I think I have not “earned” my time to just be. This is not conducive to a mindful lifestyle.

It can become a vicious cycle, one I am still learning how to break. I am trying to have more positive thoughts about myself so when I do need to step back I can allow myself to do so without thinking that I do not deserve it.

Part of this has been saying and thinking positive thoughts about myself and to myself. I have adopted a mantra I learned from one of my yoga classes, and it has gotten me through some tough situations: (Inhale) I am (exhale) OK.

Acknowledging I am OK when I feel anything but OK is important. But now I want to be more than just OK. I want to feel that, despite my challenges (and we all have them, even if it doesn’t seem like it on the outside), I am worthy of truly thriving.

For now, even though I am not 100% comfortable saying these things to myself, I will say them to you:

You are worthy.

You deserve love.

You deserve to be happy.

You are allowed to ask for help.

You are more than you think you are.

You are a fighter.

You are strong.

You are enough.

And I will continue to say these things to myself until their truth sinks in.

We want to hear your story. Become a Mighty contributor here.

Thinkstock photo by andrej_k

Real People. Real Stories.

150 Million

We face disability, disease and mental illness together.