How to recognize perfectly hidden depression | Margaret Rutherford | TEDxBocaRaton

Transcriber: Shuo Wen Reviewer: Walaa Mohammed Let me tell you about Natalie. Natalie came to therapy almost apologetically. She laughed as she told me what sounded like panic disorder, her racing heart and difficulty breathing. She may have wanted to run out of the room when she felt pressured. Otherwise, she was very successful. She had many friends, a good marriage and she loved her children. She said: My life is almost perfect. I just need to calm down. She had been a therapist for about eight years when I saw her and I thought, you know, this is a pretty common anxiety disorder.

I need to help her figure out what makes her anxious and what she can do about it. But one afternoon I got a call from her husband, Jeff, and he told me: Something's wrong. I received this strange message from Natalie asking me to pick up the kids when she got back to town and take them to her mother's house. I thought back to our last session and nothing really strange had happened. She had even said that therapy was helping. But I heard Jeff's tone and my instincts said otherwise. So I listened to him, drove to his house and entered with the garage code Jeff had given me.

I enter the kitchen. I see freshly washed dishes and neatly folded towels next to the sink. There is no sound. Just silence. I started calling Natalie, hoping she had turned the corner, embarrassed that I had had another panic attack and wanting to know why and how she was breaking into her house. But instead I found her lying on the bed, with an empty vodka bottle and several stray pills on the table. I called 911 with her and said, Oh, don't call. I'm fine. When the paramedics ran her out. I stayed there. Stunned. I had no idea Natalie was suicidal.

None. I felt guilty and not guilty. What had I missed? What if she had listened to my instincts? What would have happened if she hadn't called Jeff again? But the fact persisted. I diagnosed her with panic disorder and mild

depression

because that was what Natalie had allowed me to see. We all have secrets. And it's not always the secrets themselves that get us into trouble, but the feelings about the secrets that can darken and deepen over time. Some of those feelings can be terror, fear, shame, self-loathing, and worse. Unfortunately, many of us learned that it is not okay, or were simply never taught that it is okay to express those feelings.

That is why we deny its existence abroad. We're ok. While inside there may be immense feelings of desperation, loneliness and hopelessness. Natalie had secrets, but it was her secret feelings that almost killed her. Can you imagine a world where talking about these secrets is not embarrassing? Is it possible to create a culture where expressing those feelings is not shameful but can actually be seen as healthy self-acceptance and even a personal strength? 16 years and hundreds of patients later, I wrote a blog post. I was describing people like Natalie and what it would be like to live their lives day to day.

I just wrote about people who seemed successful and hid their struggles. I didn't think it was particularly deep. But. That post went viral because I had called it and defined it

perfectly

. Hidden

depression

. My email was flooded with messages from people saying: I have these feelings and no one knows. It's like you're in my head. And the more I wrote and received feedback, I began to understand how people can feel trapped in this cage of rigid emotional control with fear and shame, which keeps them terrified of discovery. So I put two and two together and said: Oh, a seemingly perfect life can serve as camouflage.

But there is an obvious problem. How can we identify that someone needs help if they don't tell us, feel like they can't tell us, or don't know how? For example, let's say someone like Natalie takes a tentative trip, perhaps going to the doctor or a doctor's office. The professional would do what they were taught, which would be to evaluate the presence of mental illness using the Diagnostic and Statistical Manual of Mental Disorders. The DSM, as it is called, offers internationally

recognize

d checklists of psychiatric symptoms, some of which are necessary to obtain a given diagnosis. This is based on the medical model of mental illness, which many believe emphasizes the biological aspects of depression.

But. It becomes the lens through which that professional begins to view the problem. And then certain questions are asked that reflect those symptoms and that lens. Does the patient report sleep due to appetite alterations? No. Has the patient lost the pleasure of the things he previously enjoyed? No. Does the patient have foggy thinking? No, not until now. Does the patient have suicidal thoughts? No. My life is too full of grateful things. The exact process he had used with Natalie. The problem is the lens. Your lens determines what you see. Combine the limitations of that professional's lens with the patient's fear of revealing her vulnerability.

And my friends. We have a problem. In 1993, the founder of the American Suicide Allergy Association, Edwin Schneiderman, was a highly respected intellectual leader and researcher in the world of suicide and depression. He coined the term called psychological pain, which means intolerable emotional and psychological pain. And his research disrupted common psychiatric thinking at the time because he discovered that the psychic had more to do with suicide than it did with depression. Pain is at the core of suicide, he said. Which means that the response to treatment for people with suicidal feelings does not lie in assigning a diagnosis, but in recognizing and working through that pain.

Two years later, Sidney Blatt, another renowned researcher, warned that when perfectionism is found alongside depression, it can drastically change the presentation of depression and should not be evaluated through diagnostic measures, but through understanding the perception that it person has of himself and his world. But we are so governed by the medical model of mental illness that unless someone's depression meets the official DSM criteria for depression, it is likely to go undetected. While suicide rates skyrocket around the world. I bet it won't be long before every single one of us, every single one of us, knows someone personally or has heard someone's story.

His life was going great. And they committed suicide. That person, your friend, your neighbor, your son's soccer coach. Your pastor, your teacher, your coworker. And maybe even your child is keeping his pain a secret. Now why? Once again, those who identify with what I call

perfectly

hidden

oppression feel that they must protect themselves with this shield of silence. They will not fit the pre-assigned DSM criteria. And in fact, they are ashamed that anyone would think of them or see them as depressed. So what can we do? How can we change or set the stage for greater transparency?

Believe. I know we need to

recognize

that. Suicidal feelings. And the thoughts that accompany them. They are, believe it or not, normal. To be clear, I am not saying that suicide is normal. What I'm saying is that suicidal thoughts are much more common than most of us realize. I can't count the number of people over the years who reveal those feelings to me. Sometimes with hesitation, fearing that he will do something radical or take away their rights, sometimes with great relief, because they begin to let out a shame. That has literally seeped into the depths of his being.

And sometimes with sadness because they realize how close they have been. Now there are people who intend to die, have the means to do so, and can't say why they shouldn't. Those people tell someone like me because they want my help to keep them safe and they should be taken very seriously. But so many suicidal feelings. They are natural and normal human responses to what has happened in your life. So why don't we treat it as something normal? Why don't we talk about the feelings we would talk about otherwise? Why don't we ask? Well, when do you feel this?

When do you not feel this? What's it like to talk to me about that? Have you ever wondered what would make it go away? Questions we would ask about any other feeling a person was trying to understand and cope with? But. These are not questions about symptom criteria. We're going to go in the direction that John Summers Flanagan wants us to go, which is to work toward a strength-based assessment of suicide. What does this have to do with you? He probably isn't a doctor or a doctor. How would you respond if someone told you that they were thinking about taking their own life?

Unfortunately, instinct usually is. I can't believe you said that. You know, you have people who love you. How can you be so selfish? And the quickest way to end a conversation. It's blaming someone for the way they feel or suggesting that no one who was literally loving and caring would have that feeling. What if, instead, we could approach it not with judgment, but with acceptance? Many more conversations will take place. Let me tell you about Michael. Michael was an internationally prominent person in his field when he came to see me and was laughing because he said no one would ever imagine I would go to therapy.

He had grown up in a family where feelings, especially painful ones, were not talked about. But his father had died suddenly and Michael had never told him that he loved him, despite the tumultuous relationship they had had. And Michael couldn't forgive himself for that. As we talked about his childhood and the current decisions he was trying to make. He began to see patterns. He could see how he had covered up the horrible abuse of him as a child and had tried to cover it up with ever greater achievements to achieve some kind of destiny that would erase or cloud the painful secrets he kept

hidden

deep inside of him.

But it does not work. One day he told me, very painfully, that he too had feelings of intending to die. I told him that those feelings were normal, given the magnitude of his pain and how long he had felt it. In our continued work, he discovered that he could have compassion for himself without carrying the shame he did not have to bear. He could cry without lashing out with self-loathing and he could decide to live. I will truly never forget the day Michael walked into my office, with a big smile on his face and said, Hey, doctor, I have to tell you something.

He was on this plane full of people journaling instead of working. Writing about my childhood and my father in public. And when I felt a tear roll down my cheek. I did not care. We all have secrets, but the cost that can accompany the feelings of those secrets has never been more evident. You and I can realize that we can make an impact right now on our culture so that transparency is seen as a strength. Thank you.