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The 3 Different Types of 'Hidden' Depression


Quite a few people have been writing about what’s been called “high-functioning” depression lately. Everyone from author and food writer David “Avocado” Wolfe, millennial freelance writer Shin Hye on Huffington Post, to counselor Annie Wright on The Mighty, are describing a depression that isn’t readily apparent, at least some or most of the time.

As I’ve been a passionate advocate for what I term “Perfectly Hidden Depression (PHD),” I was eager to read them. I hugely applaud any effort to educate others about how depression doesn’t always look the same. It can look like agitation or anger. It can look like melancholy or despair. And it can be ignored or misunderstood when it doesn’t look either way, as in high-functioning depression.

So, what’s the difference between this phenomenon and Perfectly Hidden Depression? And why does it matter? As long as folks are recognizing the fact that depression can wear many faces, I don’t particularly care what it’s called. High-functioning depression. Perfectly Hidden Depression. Whatever term hits you in the gut and makes you realize, “That’s me and I need to pay attention” — that’s what matters to me as a clinician.

But each kind of depression has its own healing course — and that’s important to know.

Join the conversation by answering the question below:

I'm wondering what's the hardest part for you? For me, it's having to hide it. Wanting people to see and care, but not wanting them to see because they shouldn't have to worry. #Depression#Anxiety#suicidal#MentalHealth

Let’s talk first about how PHD can get started.

Whatever their situation, all children do what they can to emotionally survive. That may sound dramatic to you. It may not be actual physical survival that’s at stake (although in the most horrific families or environments this could be true). It’s emotional survival. Given what was yours to face, you came up with a strategy for coping. Siblings, reared in the same home, can adapt differently. One may rebel. One may try to please or make people laugh. One may work to fix the situation, and another may become invisible. You didn’t recognize your own strategy as a strategy. It simply became you. “Oh, that’s just Jason. He stays out of the way.” Or, “You can always count on Gail.” Underneath the obvious, superficial behavior was an unconscious strategy, and it’s likely to greatly affect you now in the way you approach your life.

If you learned it was safer to hide or cover up painful emotions, then hide you did.

But there is diversity in the presentation of this hiding, this PHD. I’ve divided the syndrome PHD into three groups. All may identify with PHD, but are different from one another.

Group #1. “I’m hiding and I know it…”

Let’s call the first group the “aware” group. The “I’m hiding and I know it” group. In this group, hiding may have been intentional for quite some time (similar to high-functioning depression). You’re doing it “on purpose.” If you’re in this group, you know, for example, that you rarely talk about yourself with others. In fact, you choose not to do so. You may know quite well when it started, how it started or why it started. You make a conscious choice every day to keep your own troubles invisible.

The healing work for you is slowly tearing down the emotional walls between yourself and others, far easier said than done. It involves challenging whatever irrational beliefs there are (the ones that keep you hidden) and connecting the emotional dots between your past and your present.

Group #2. “I know something’s wrong. I feel it in my gut. But I haven’t a clue what it is.”

If you’re a member of this second group, the “unaware” group, you may have been largely unconscious of what you’ve experienced or created. But when you see the term Perfectly Hidden Depression, a lightbulb goes off. Your gut understands. This new concept has to be absorbed, and the whole idea that your PHD exists could be life-altering. What you’ve never given much thought to is now something you’re questioning. You may never have considered that the way you were functioning was a problem. It was simply the way you lived.

Let’s talk for a minute about what is meant by “unconscious.”

Hopefully, this example will help make that term clear. When you step into a dark but well-known room in your home, you don’t have to think about where the light switch is. Your hand shoots up automatically, and easily finds its place on the wall as you flick it on. You don’t give it a thought. It’s an automatic, unconscious action. Your body remembers. Your mind remembers, but without thinking about it in that moment. We do unconscious things all the time — things that have become second nature. We could go deeper and talk about unconscious urges and drives, but for the sake of our discussion, that’s not necessary. The more something is known, old hat or habitual — the more likely that it’s tied into unconscious behavior.

This isn’t high-functioning depression. It’s quite different. It’s people like Rebecca who told me, “Before I read about PHD, I’d never have thought of myself as depressed. Ever. If I even wondered, if I listened to my gut that knew something was wrong, I’d feel incredible shame, like I didn’t appreciate the good things in my life. I can’t even imagine allowing myself to think or say some of the things I’ve said to you since we’ve been working together. I didn’t even realize how I was living. Or not living.”

Rebecca was making what had been unconscious, conscious. That’s the work of this second group.

Group #3. “Sometimes I know I’m hiding. But other times, I can’t figure out what’s going on.”

This third group is a mixed bag. Some of the 10 characteristics are known and quite intentional. Others are more surprising when you realize their place as part of the syndrome and you, again, haven’t been conscious of them as problems.

The work for all three groups can sometimes seem as if you’re trying to chew and swallow all at the same time.

The hiding behaviors, the push and the pressure that you’ve put on yourself, needs to stop, while you’re also simultaneously trying to go deeper emotionally and connect with long-suppressed trauma or pain. It’s confusing and even frightening, because you’re giving up your defensive or protective actions while increasing your vulnerability.

If this is you, please pay attention. It can offer a freedom and an acceptance that you’ve never imagined.

Getty image via ArtKoArtKo