Perfectly Hidden Depression

Scott DeLuzio    00:03    Thanks for tuning in to the Drive On Podcast where we talk about issues affecting veterans after they get out of the military. Before we get started, I would like to ask a favor if you have not done so already, please rate and review the show on Apple podcast. If you have already done that. Thank you. These ratings help the show get discovered so it can reach a wider audience. And while you are there, click the subscribe button so that you get notified of new episodes as soon as they come out. If you do not use Apple podcasts, you can visit Drive On Podcast.com/subscribe to find other ways of subscribing, including our email lists. I am your host Scott DeLuzio. And now let's get on with the show.

Scott DeLuzio:    00:46    Hey everyone. Today my guest is Dr. Margaret Rutherford, who is a psychologist, the host of the self-work podcast and the author of the book perfectly hidden depression. I am certain I am missing a few accolades, so, Dr. Rutherford, welcome to the show.  Why don't you tell us a little bit more about yourself, your background, and what you do?

Dr. Margaret Rutherford:    01:08    Sure. Thanks Scott so much. Oh, there are so many accolades. I can barely, you know, I have paparazzi standing outside the window. Well I have a bit of an interesting route to be a psychologist if you would like to hear that. I was a professional singer in my twenties. I sang jazz and jingles. I think jazz at night, and then I sang, radio and television advertisements. And so, I did that for eight or nine years. I was not doing well with the lifestyle. Music's a hard business to be in and it's pretty cutthroat and there is the longest contract sometimes is a month in a hotel and you are supposed to be glad you got that. So, I was not doing very well.  I heard about this thing called music therapy and I took all the money I had in the world and put it down at SMU in Dallas and began that career.

Dr. Margaret Rutherford:    02:04    And as soon as I finished up my training, I was at an internship site and it was at a psych hospital. And I said, Oh no, this is what I want to do. And I had been in therapy for a long time and it had really helped me. And so, I turned the boat around. And so, it was about nine years before I was at the Fairmont closing the bar there, with my singing and seeing my first patient. So, it took almost a decade to do that, but it was well worth the effort. I loved being a musician, but really, being a therapist is my passion.

Scott DeLuzio:    02:39    Well, that is great. And I always like to hear people's background stories, like how they get to where they are because it is never a straight path. It's never that, I went to college and I knew exactly what I wanted to do and I got my degree in that and I wound up doing that thing for the next 30 something years or whatever.

Dr. Margaret Rutherford:    02:58    There are those people, but many more now are just going from thing to thing. And I am certainly a good example of that. Sure, absolutely.

Scott DeLuzio: Yeah. And it is interesting to hear the different paths that people take.

Dr. Margaret Rutherford:    03:09    Yeah. The fun thing about doing the podcast was that I was in front of a microphone again, I was comfortable in front of a microphone, so that was funny.

Scott DeLuzio:    03:17    That's true too. And it merges the two backgrounds. That is great.  I mentioned earlier that you wrote the book titled Perfectly Hidden Depression. That is not just a catchy title, although it certainly is that too. But it is something that people suffer from, isn't it?

Dr. Margaret Rutherford:    03:39    Yes, it is. Scott, I started thinking about a lot of the people I was doing a blog post for my normal weekly website blog post. And I thought about some people that I had seen throughout the years that when they entered therapy, no one would have called them depressed. I really would not call them depressed. They came in usually for problems about worry or sleeplessness or fatigue or perhaps they had an eating disorder that was getting out of control or they were told at work they were overworked or something and they needed it. And they were, “I don't think I am.” Or their pastor sent them, or their spouse said, “you need to go” because they had a loss that was acute and they did not grieve or they did not know how to grieve. And so, these people would come in and they would tell me about their lives.

Dr. Margaret Rutherford:    04:32    And what I would notice was that when I asked about any kind of trauma or experience of pain, they literally would smile their way through telling me about it. It was as if there was such a contrast between what they were talking about content wise. They could have been talking about a rape or they could have been talking about military service. Or they could have been talking about the death of a child even. And they just had these either stony faces or they were smiling going, “you know that I handled that. It wasn't all that big a deal.” And so, because that would be weak and there are lots of people with problems worse than mine.

Dr. Margaret Rutherford:    05:24    And if I started crying, I would never stop. And so, I do not want to do that, those kinds of excuses. So, I was sitting in my sunroom thinking about those people and the term perfectly hidden depression came to my mind and I wrote a post called the perfectly hidden depressed person and it went viral. I was lucky at that point if 50 people read a post and here this went thousands of people shared it. And then I was writing for the Huffington post at the time and I forgot that I had left my email on the bottom of that. And the next day I received hundreds of emails saying this is me. I think you are inside my head. How have you figured this out? So, I began researching at that time and what exactly was available in the literature and in the research about this connection between perfectionism and depression.

Dr. Margaret Rutherford:    06:16    I found lots on depression and perfectionism. For example, Dr. Bernay Brown's work is incredibly good and very helpful to many, many people, but I could not find except in some of the research but not in popular literature, something that said a perfect looking life can mask what's going on underneath, which is actually full of emotional pain, memories of trauma that has all been so suppressed and really rigidly compartmentalize, where people don't even know they're doing that. Scott, they do not even know. This is not intentionally knowing you are depressed and putting a smile on your face. That is one thing that is called high functioning depression. This is people who have done this for so long that it has become unconscious. That what started out perhaps as a childhood strategy to emotionally survive situation that we were born into, which we can talk about later, but they do not even realize they are doing it. And so, what these people have told me is when they see the term perfectly hidden depression, they go, “Oh, that is me, I've got to read about that. I've got to find out about that” because that jars something in their gut that has been trying to talk to them for a long time now.

Scott DeLuzio:    07:44    So, we are on the topic of depression here, but I want to just make a quick maybe pit stop over in the land of anxiety; depression and anxiety are both common diagnosis in mental health. But I want to be clear to the audience here about the difference between the two. For anyone who might be listening, who might not know the difference between the two, would you be able to give a quick overview between the difference between depression and anxiety?

Dr. Margaret Rutherford:    08:16    Sure, of course.  I like to say to people that I have never seen anybody with severe anxiety that is not depressed about it. But I have seen people with depression who do not have a lot of the classic symptoms of anxiety and they have some but they do not have depression. Classic depression is mostly that you have a depressed mood, a down mood or despondent mood that not only you can see or other people see it in you and it goes on for a long period of time as well as the other criteria is you don't enjoy doing what you used to enjoy doing. It is called anhedonia. Now there are other mental symptoms or cognitive symptoms of depression, more like problems with making decisions or having sort of a sense of fuzzy thinking like your mind is this swamp that you cannot get going.

Dr. Margaret Rutherford:    09:07    Certainly there are cognitive/mental symptoms of depression, but they do not necessarily look like anxiety. They can worry being one of them. But anxiety disorders are a whole different category. There are several of them. There's obsessive compulsive disorder. There's generalized anxiety disorder, which is literally having a sense of dread and hypervigilance that something horrible is about to happen. You could even visualize it, not the same as a flashback when something is really happened as in PTSD, but people with generalized anxiety disorder are plagued with these thoughts and obsessions about what can happen. Then there's panic disorder, which is you can have panic attacks, you can have these shorter episodes of your heart racing and your Palm sweaty and you want to run out of the room. Those are panic attacks and there's social anxiety. All of it is about anxiety disorder. The number one mental illness in the United States and in fact internationally there is more people with anxiety than depression. We do not necessarily think of anxious people having suicidal ideation, although they might, they might probably be more worried that someone else I love might die by suicide. Certainly, suicidal ideation is maybe the more severe symptom of depression. Now that does not mean you cannot have both. And in fact, people with bipolar two disorder often have, and people with PTSD often have symptoms of both anxiety and depression.

Scott DeLuzio:    10:47    Okay. Yeah, that is interesting. I did not realize that the two necessarily went hand in hand. So, they are not necessarily polar opposites. They could be in certain cases they could be part of the same symptoms that people are having. They could have both. Right?

Dr. Margaret Rutherford:    11:08   I had performance anxiety is a form of social anxiety. And so, sometimes when I get up to speak, my legs will shake, I've always wanted to see what I looked like because I'm sure I look ridiculous, but at least that's what my shame is telling me. But for a while there in my lifetime I was depressed about having panic disorder because I was so ashamed of it. I am not now at all. But back then I was, and so there was depression mixed in with the anxiety.

Scott DeLuzio:    11:42    Interesting. Okay. Well that is good. And I think that that was a good explanation to clear up the difference between the two. And I think even though that is not necessarily what your book's about or what we are necessarily talking about it, I think that is still a good general overview to have. So, people who are experiencing some of those symptoms and do not even realize it could fall back on some of that information. Speaking of your book, let us get back to that and talk a little bit about that. In your book you talk about the difference between being a perfectionist and someone who strives for excellence.  That might sound like a subtle difference between the two of those being a perfectionist and striving for excellence. But there is a difference in there, isn't there?

Dr. Margaret Rutherford:    12:30    As far as what a perfectly hidden depression is concerned, there is a huge difference. Striving for excellence means that there is a learning curve and you are just trying to do the best you can do. And maybe you even want to do flawlessly. I mean, maybe you have this innate desire to really be the best you can be all the time and that can have pressure in it. But then if you typically fail or you do not do as well as you possibly can, your world does not fall apart. You are disappointed. You may have to grieve, but you can say, “well what did I learn during that?” And next time I will strive for excellence again. People, I do not want to say who have perfectly hidden depression, because that makes it sound like a diagnosis.

Dr. Margaret Rutherford:    13:21    It is not, it is a syndrome of behaviors that are found together. Beliefs and behaviors are found together. It is called a syndrome.  From my perspective, these folks are driven by fear and shame that if they do not do things perfectly, if they do not perfectly meet the expectations of both themselves and especially others, that they cannot tolerate that. That is something they will stay up 48 hours to make sure that does not happen. They are not process oriented; they are goal oriented. And so these are people who literally are completely pressured and because, again, I think it's born from what they're told as children, that they're never going to amount to anything or they're told that or they review themselves, and they say, “I've got to find my competence in what I do.” All the people with a perfectly hidden depression are credibly accomplishment oriented. Meaning if I am not accomplishing, I am not valuable. And that is a shame. You can hear that that’s shame based.

Scott DeLuzio:    14:33    Right. So, it is the difference between somebody who is starting something new, maybe they are trying to learn a new skill or start a new job or something like that. And, maybe it doesn't quite go as well as they planned and someone who is striving for excellence, might have a more realistic expectation of themselves and knowing that this might take some time to learn as opposed to the perfectionist who, if they don't get it right away, then they might feel like they are a failure or they they're letting someone down. That type of thing. Is that correct?

Dr. Margaret Rutherford:    15:13    Yeah, that is a great way of putting it. In fact, I wish I had thought of that, thank you very much. Thank you.  I do not want to get too clinical on your listeners, but there are three different types of perfectionism. One is self-oriented meaning more striving for excellence. One is other oriented where you expect other people to be perfect around you. And the other one is called socially prescribed perfectionism, which is about this pressure to meet these expectations for others. And it is as if you are on a treadmill that is going faster and faster and faster and faster. Because how many times have these people heard from someone, “we cannot believe that you raise that much money for this organization. We can't wait for you to share this next year it'll be even better.” Or you are at work and you

Dr. Margaret Rutherford:    16:05    get something done two days ahead of time and your supervisor says, “wow, we're not going to give you that much time again.” It is like you get caught in this trap of I am not just expected to do well, I am expected always to do better than my best was the last time.  And you buy into that. You do not say, “Hey, no, that's not quite what happened.” You buy into that where someone was self-oriented perfectionism might say, “well that really is kind of my max. You know, what I was able to give on this project was my max and so we need to negotiate.” If you are going to expect more and someone who fit into the rubric of perfectly hidden depression would not say that until they read my book. Of course.

Scott DeLuzio:    16:51    And that is a good distinction to make. Knowing that the differences between how people might react to situations like that where they are under promise and over deliver, in a work setting, for example. And then that just becomes expected as the baseline, whatever was delivered and then can you do a little bit better and then the next time can you do a little bit better and a little bit better, and then, like you said, it's like a treadmill that just continuously gets faster and faster and faster.

Dr. Margaret Rutherford:    17:25    Well, and you see, since it's based on fear and shame, it's as if they absorbed the sense of, if I get told that it could be better than I must meet that expectation because then I wouldn't be being perfect. It's interesting to me as I've talked with more and more people doing these interviews and people have written to me, they'd say things like, “I never thought of myself as perfect as a perfectionist because I never do anything perfectly.” Meaning they thought, I think there are people out there who really do things perfectly and they do not, none of us do things perfectly.

Scott DeLuzio:    18:04    They get lucky once or twice, but yeah.

Dr. Margaret Rutherford:    18:06    But you know, even then, there is still someone else's perception of what perfect is. And so, I cannot control what someone thinks about this podcast or what I might say to them in session or whatever. I am not in control of that. But people who identify with perfectly hidden depression, they do not even give themselves credit for what they do. Well, they have just got to keep proving themselves over and over and over.

Scott DeLuzio:    18:42    Switching gears just a little bit here, a lot of times, especially with people who have been in the military, we tend to detach from our emotions. I have seen it both ways where everything bothers people or the opposite where nothing bothers them. Almost like they completely shut off all emotions, and you talk a bit about the latter in your book where people are detached from their emotions. What causes that type of behavior?

Dr. Margaret Rutherford:    19:16    Well, again as you and I talked about it, you were kind enough to invite me on this podcast.  I don't work with veterans very much. I have worked with a handful of them and so I am not as aware as maybe other people are of the exact why’s of that. But certainly, the trauma literature will tell you that someone's response to trauma is based mostly on two factors, the intensity of the trauma and then whether they have had mental health issues in the past. I know I'm very well aware that I had worked with first responders and so, I'm very well aware that their training is, and I'm sure it's the same in the military, are relatively sure that the training is, you run toward the emergency situation, you don't run away from it.

Dr. Margaret Rutherford:    20:08    And so, you must detach from your emotions. However, it is interesting that in Dr. Bernay Brown's workshop that she has a Netflix show. One of her tenants is that in order to get to courage, you must go through vulnerability. And there was a guy who stood up who had done three rounds of service in Afghanistan and he still had his uniform on and he stood up and he said, you know, you are right. He goes, “people don't want to admit that. But every time I went back into the service and did another Afghanistan tour, I had to work through my vulnerability and my fear all over again, to handle it at all well.”  I think what makes people early on, if it is not about training, you detach from your emotions because of many things.

Dr. Margaret Rutherford:    21:09    Maybe you were reared in a family where it was not allowed. I can remember my uncle who was a West point graduate, none of his children, my cousins were not allowed to speak in anger or in sadness. It just was not done around his house. And whereas, my parents did not advocate for it necessarily, but if it happened it was more acceptable. And so, a lot of people grow up in families where there's military families are buck up or whatever, that's not manly or only babies cry. How many times have I heard that? So, there could be that it could be that you were abused, as I said a few minutes ago, that you were told you would never amount to anything. And so, you have to shut off those feelings of being hurt as a child and come up with some kind of strategy to deal with it that a lot of people decide to be very accomplished at school.

Dr. Margaret Rutherford:    22:03    Something else is a more unusual situation perhaps, but perhaps you have a parent that really counts on you for his or her happiness. And so, they say, gosh, “I get so proud of you when you do X, Y, or Z.”  And so, whether you like it or not, you do X, Y, and Z. So you get into this way of being that my way of getting love or feeling loved is by not tuning into who I am, but tuning into who somebody else needs me to be and then I become that person and being a people pleaser. And so, you do not really know why you are doing what you are doing. You are just doing it to feel valuable.

Scott DeLuzio:    22:44    Yeah. And is that to make yourself feel happy that you are making other people happy? Does that make sense? Is that one of the reasons why someone might do something like that?

Dr. Margaret Rutherford:    22:56    It becomes your job, not necessarily one that she asks you or that you ever applied for, especially if you're a child, but you could feel…I've had people say to me, my mother or my dad used to say, I don't know what I'd do without you. And not mean it like in an offhand, I love you so much, but literally I need you to be who you all are because I wouldn't be able to exist if you weren't this way. There's a story in the book about a woman who just became a, I think it was a dentist, she didn't like dentistry, but her dad expected her to be a dentist and her mother had died or something. And so, she just went to do that. And so, some of that is family loyalty and some of that is you do not always get to do what you want to do. I understand all that. At the same time when you completely cut yourself off from “my life is fine, I don't have any feelings that I need to explore,” then there is something wrong.

Scott DeLuzio:    24:00    That's interesting. And there is probably way more to it than just a simple one sentence kind of answer, in terms of why people detach from those emotions as you mentioned, there are lots of different reasons.

Dr. Margaret Rutherford:    24:20    Trauma is a huge one. I'm sure people in the military know, you get traumatized and one of the hard things about being a therapist is that you do hear a lot of stories that you have to shake your head and you get it. I cannot believe that really happened, but it does. And it does not just happen because of poverty. It does not just happen because of where you live or anything about you. It happens all over the board. And it can hurt so much that you must suppress or compartmentalize those feelings and some people never get back to connecting.

Scott DeLuzio:    24:59    All right. We spoke a little bit before we started recording here about removing the stigma of getting treatment, the mental health treatment that people might need. They tend to put it off or they just do not go and seek that help because there is a stigma. They do not want to be seen as someone who might be crazy or who is weak or any number of other excuses or reasons. Going into your book, someone who has perfectly hidden depression might see themselves as being selfish for taking care of their mental health, certainly going to therapy or getting treatment, that type of thing and really it couldn't be further from the truth that they're selfish or anything like that.

Scott DeLuzio:    25:56    And then that stigma against seeking help just compounds that issue.  A lot of it boils down to just being vulnerable and opening up and the ability to open up. It is something that scares us. So, why is it that becoming vulnerable is such a big issue to people who might have a perfectly hidden depression and the feeling of being selfish that they are getting the help that they need?

Dr. Margaret Rutherford:    26:35    Well, you just said a phrase; it so important. They are getting the help that they need when they must. They will have to be someone who knows how to accept help and they must believe they need it. Okay, so basically, I did a study; this was before I ever started writing a book. I just had my highly successful blogger friends put a questionnaire on their blog post and their website, which was very helpful. I got about 1500 answers from men and 1500 from women about the reasons why they would not go to therapy. And guess what? There are no huge surprising results. Men did not go because they thought they should solve their own problems and women did not go because they did not want anybody to know that they were going to therapy. So, one was ego-based and one was socially based.

Dr. Margaret Rutherford:    27:20     But let me correct a huge assumption that is incorrect and that is therapy is only about asking for help.  Good therapy is about consulting with someone who is consulted with a whole lot of people just like you. Hundreds, if not thousands of people and they have some ideas about how you can think about something or what you can do about it or how other people have felt about it, how other people have worked around an issue or through an issue. And so, therapists are a conduit between the people before you that have had a similar, if not the same problem and your current situation. So, now there is strength and power to the therapeutic relationship because literally there are some people who have never had the experience of sitting in the room with someone and really being listened to, really being listened to.

Dr. Margaret Rutherford:    28:31    And yes, you can feel vulnerable, you could feel like, “Oh wait, this person really wants to see all of me.” And so that is what takes courage.  I always know I have someone in front of me who struggles with this because they will say things like, I bet the other people you see are so much worse off than I am. Or I do not know why I am here. This seems silly. Or the only reason I am here is because my wife told me I needed to be here and I am only going to come for one session. I have got to go. Okay. All right. Vulnerability in and of itself is not always about sudden exposure. It is about letting someone in to see what you struggle with, what you think about.

Dr. Margaret Rutherford:    29:24    And a therapist does not come and just rip something off you. That is not good therapy. You said something about, is it selfish?  You are talking about you. You're right but I would counter that if you're a happier person, a more fulfilled person, if you figure some things out about your own life and what makes you tick, then you're going to be a better father. You are going to be a better mother. You are going to be a better parent. You are going to be a better friend. You are going to be a better colleague at work.  So, you are not just helping yourself. You are helping a lot of people that you love in your world. I have been gratified. I do a podcast as well and a lot of people have said to me, because I say at the beginning of the podcast, I'm reaching out to three people, three kinds of people, the people that are already familiar with these kinds of ideas.

Dr. Margaret Rutherford:    30:26    I am reaching out to people who have been initially diagnosed with these kinds of ideas and have lots of questions. And I am reaching out to the people who think they would never walk through the door of a therapist, but they are simply curious enough to see what it feels like. I have heard from so many people that say, I am in that third group, and until I listened to your podcast, I did not realize that therapists can be only normal people. I talk about my panic disorder. I talk about my history with anorexia. I talked about my divorces. It is not like we have some sort of weird place with candles and incense and hold your hand and say you are going to be okay. We have techniques that we have been trained in and gotten a lot of training in that really can be helpful to people.

Scott DeLuzio:    31:19    I think a good visualization that, it is not like some crazy incense magic thing that you are going to be walking into. It is not like anything like that. It's just you're walking into a room and you're going to sit down and you're going to talk to another person for whatever period of time that you're sitting there and you're just having a conversation the way you and I are having a conversation right now.

Dr. Margaret Rutherford:    31:45    At the holidays, people know, because I always have a big glass of Sonic iced tea sitting in front of me that I sip on all day long. I get extra Sonic ice because Sonic ice is to die for. Right? And so, I get extra Sonic ice. And I sip on it until it is not tea anymore. It is just water. I have had so many people come in and say, we love it and you just drink Sonic tea. You do not like to have herbal tea or sometimes you do not walk in in flowing clothes, you cuss, you laugh like I do. I am a therapist, I do not kind of take on this aura of soothsayer.

Scott DeLuzio:    32:25    So, you're walking in, you're talking to a regular person and I've had other mental health professionals on the show before and one of the things that we've talked about is that, you might go and start talking to somebody, a therapist and the first session maybe doesn't go so well. You're not comfortable with it yet, and the second session, maybe you open up a little bit more, third maybe, and then it might take three, four sessions before you start to get a little bit more comfortable with going to therapy. But if you just go to the one session and then call it quits because you were not comfortable with it, you are not really giving it a chance.  I think it is important that people do stick it out but also recognize that, like any other human interactions, not everybody is going to be the right fit for you. They are not all going to be your cup of tea. You might go in and after four or five sessions, you might just say, you know what, this person is just not clicking with me. They maybe are not understanding the issues.

Dr. Margaret Rutherford:    33:39     I would say, Scott, that a distinction to make is that if you are struggling to open up and be comfortable, that is one thing. If you don't even feel like your therapist is tuned into you or that they're asking you questions that at least make you think or give you some hope or say, Oh, I think she gives me a sense of confidence. There are plenty of therapists who get into therapy because it is just, they are drawn to the profession. They want to help people, but they do not really know how to connect well with others. They are just like doctors or lawyers or anybody. So, since we are in a profession where we deal with, as you said before, vulnerability, then that can make it a little hard. But I'm so with you about don't just decide you don't like it, but if you don't like it, if you walk away from the first session thinking, well, that was uncomfortable, then I would go back to the second session and say, I was really uncomfortable in the first session. I would take a very proactive approach to it. And you can say, I do not know if that is me or if there is something that could be headed in a different direction this session? And let me see, it might be me, but it also might be that I am not responding to the way you are approaching this.

Scott DeLuzio:    35:04    It is kind of funny last night I found out my wife had never watched the show the Sopranos.

Dr. Margaret Rutherford:  I have not either.

Scott DeLuzio:  So, this might be lost on you, but anyone who might be listening

Dr. Margaret Rutherford:   There is a therapist, there is definitely a therapist.

Scott DeLuzio:  And in the very first episode that the initial pilot episode, this tough guy, mobster guy, walks in to the therapist office and he's shut off, he's not having anything to do with this and he doesn't want to do it, but he goes back a couple times throughout the episode but by the end he's in tears and he's crying and it's over. It is over. These ducks that used to live in his swimming pool in his backyard. And then they flew away and he felt like he was losing his family of ducks that flew away. And ducks, you know, exactly. They kept digging and they found out what the root cause of all of this was. And you know, he was all afraid that everyone is going to find out that he is going to therapy, they are going to think I am nuts and all this kind of stuff. But he went and it ended up helping him. And so, if some tough mobster can get some benefit out of it, I think we all can.

Dr. Margaret Rutherford:    36:25    That's funny. There was a guy that I treated a couple of two years ago who had identified Berkeley Hayden depression. He was a highly successful professional here in Northwest Arkansas. I did not know that he was famous, but he was famous. I did not know that. He really wanted to work on this sense of perfectionism and this persona that he gives out to everybody that he's got it all together and how I can begin to loosen up and have more true enjoyment and fulfillment and freedom and self-awareness and self-acceptance and blah, blah, blah. So anyway, I had given him this assignment, he had had a parent die. He was an adult and he had not gotten to say to this parent what he wished he had. And then the parent died.

Dr. Margaret Rutherford:    37:15    He'd never let himself feel about it. And so, I asked him to write about it and what he wished he had said and what he wished he had heard his parents say. And he was doing this exercise in his first-class seat on the plane. And he said, not only was it absolutely incredible that I was allowing myself to cry on the plane, but I had your book open and people could see if they wanted to that I was reading a book on depression. He said that was two minor miracles all the second time. He said, I did not cry a lot. I let one tear slip down my cheek, but he was just kind of going, wow. You know, and so you are right, people can make, uh, I had all kinds of people. I have had people who work on oil rigs, I have had people who were first responders, I have had farmers, I have had everybody in the book, as a therapist.  I love being a therapist in Arkansas because you cannot get such a, such a wide array of patients. So, we are getting a little away from perfectly hidden depression.

Scott DeLuzio:    38:24    That's okay. Yeah, it is a good to see that there are people from all walks of life that can struggle with this type of stuff. And you know, the people who might be listening to this, you know, if you are feeling like, gee, that might be me. You know, you are not alone. You are in good company of people who work on oil rigs and farmers and first responders and probably everything in between, every profession in between. There are those people. So, going back to the book, you talk about, five steps to healing that you talk about. Can we dig a little bit into what those steps are and how that relates?

Dr. Margaret Rutherford:    39:09    Well, I must tell you a funny story again. The publisher who ended up buying the book contacted me about two weeks before my final book proposal was supposed to go again to them and they would decide. I said, well, we have decided you cannot just describe the problem. You must come up with a treatment strategy for it and you have two weeks. I thought, Oh gosh, that is like more than half the book in two weeks. Okay. So, I had thought about doing that, but not in such a formal form. So, I sat down, Scott and I just said, okay, what are the five things I really do with everybody? Five stages of what I think must happen for someone to decide they want to change in a certain direction. Okay. Because therapy is about change, right?

Dr. Margaret Rutherford:    40:02    First thing they must do is recognize a problem as a problem. You know, if you have bipolar disorder or you have depression or you have perfectionism or you have shame or you have whatever, if you don't think it's a problem and are aware of the impact it is beginning to have on your life, then you won't do anything about it. So, consciousness is the first stage. You must be conscious of something that can take some mindfulness and awareness. The second thing is commitment. There are all kinds of things that get in the way of committing and to the work itself. That can be anything from, well, I do not know what that is going to do to my work life or how will that change my relationship? Or perfectionist will sometimes say, well, I try your exercise and it was too hard.

Dr. Margaret Rutherford:    40:57    And I said, well, what was the exercise you tried? Well, you told me to pick something small and then do it in an inferior manner, which is something hard to tell people to do. And I said, so what would you choose? Well, this work project I have, I tried to one day do it in an inferior fashion. I could not do it. I said, you chose something too big. You chose something too hard. Guess what? They are perfectionist. So, you can sabotage yourself, you can do all kinds of things that get in your way of really committing to the process. And frankly you can just be afraid. Familiar pain is so much easier to stick with something that is may me painful, but it is familiar then to trade that in for unfamiliar pain. The third is confrontation. And what I mean by this is a very cognitive, behavioral kind of schema.

Dr. Margaret Rutherford:    41:50    And cognitive behavioral folks believe that if you change what you think, you will change the way you feel. And so, there is a whole section of the book on what are the rules you are following? What are the should’s, must have to’s, cannot not do, whatever it is that is ruling your life and which one of those you actually think is helpful to you and what you want to keep. And that is valuable and which is not anymore. In fact, there are old rules that you have that you could have brought with you from childhood. I cannot voice my anger; I can never let anybody know that I am scared. I can never let anybody know that I am confused. There is one woman I worked with who said that she worked from home and she said in her conversations with her supervisors, she always had to have the answer to the question that they're about to ask next.

Dr. Margaret Rutherford:    42:49    And she was always having to say she could not ever look confused or like she did not know. A lot of people have that. And then of course, the part of that is you want to challenge those rules and begin to change them. And that is where the issues come. But kind of fun. It is refreshing. At least the fourth one is connection. And what I mean by that, it is consciousness, commitment, confrontation, they are all C’s. That is marketable, right? And connection. And what connection is, is you must go back, you do not have to, you can choose to go back with compassion and that is very important. And look at your life like it is a timeline. And you go back and you say at age two, this happened at age three at age five, at age eight, age 11 at age 18 and age, whatever.

Dr. Margaret Rutherford:    43:37    And you do not go back to feel sorry for yourself. You go back to acknowledge huge differences. You want to go back and acknowledge this. If this happened to anybody, you would affect their lives. If you move to a new school, when you were in the third grade and you were bullied horribly, or you were elected school something or other, either one of those most popular kid or something, either one of those experiences would have changed. You would have altered you in some way. So, you want to go back and you want to have compassion for that and you want to see who you are likely to be in the present because of those things that have happened. And that is a whole chapter in and of itself. The last one is guess what, change. I mean, this whole thing is about change. And I go through all the 10 traits of perfectly hidden depression and we go through them all, for example, the one that we have already talked about where you get your sense of worth, real accomplishment. I talk about how you really start to change that is through play. How do you learn how to play again? Now maybe you do not know that kind of thing. So, each one of those traits has a direction that you want to change. You want to go toward.

Scott DeLuzio:    44:53    Okay, so we are talking about taking that step to go get help and get the treatment that you need.  These are some of the steps to healing that will get you to that place. Ideally if you go through those steps and you do not self-sabotage yourself, in trying to tackle a big project with like you were saying before, some smaller one, you can do it, too.

Scott DeLuzio:    45:25    Yeah. It could be two small words, insignificant, and it does not really matter that type of thing.

Dr. Margaret Rutherford:    45:33    I want to point out that the book is more like a workbook, although for some reason the publisher did not want to call it a workbook. It has over 60, very specifically designed by me, exercises to help you through this whole process with lots of understanding and recommendations that if it gets too hard, you may have to find a therapist to work with. If you have really been traumatized, which many people said, I am sad to say, have been, then going back and connecting with those emotions can be overwhelming and you do not want to get overwhelmed.

Scott DeLuzio:    46:06     And doing that on your own could be troublesome too if you are not being guided along with somebody who knows what they're doing and what to look out for in that type of thing too. So, like I said, we went through, going in, taking that first step, and getting the help. There are the steps that you might need to go through. Let's try to wrap up because I don't want to take up all of your day here on this episode, but maybe try to wrap up with some healthy coping skills that people can use to deal with life as it comes at us. What are some of the things that people can do, as it relates to perfectly hidden depression? What are some of those kinds of coping skills that people could use?

Dr. Margaret Rutherford:    46:59    I talk a lot, Scott, about self-acceptors that may not seem like a coping skill, but like the soldier who got up and made a comment to Dr. Brown, I think that a lot of times when something's coming at you, and it's not something you expect, it's not something you've planned for or even if it is sometimes; like we may know a tornado is coming, but it's not until we hear it's force that we can really understand what's about to happen. But I think that an eco skill to have is to know what your strengths are, even to be able to write them down. And sadly, some people do not know what their strengths are and we all have strengths. So, you want to be able to identify what your strengths are.

Dr. Margaret Rutherford:    48:03    But then again, take note of what you know, your vulnerabilities are, the skill is involved in and it's the self-acceptance is involved in not allowing either one to define who you are. One, does it define you more? I have a PhD after my name. I am proud of that. I worked hard for that, but that does not define me anymore than having panic disorder does, they are both facts about me. And if I am ashamed of the panic disorder, then I will either try to hide it or I will be defensive about it or I will deny it. If I accept it, I do not resign myself to it, but I accept it, then I can work with it and manage it. So, when you are facing stress, you want to manage those vulnerabilities while you count on your strengths.

Dr. Margaret Rutherford:    49:00    And people who can only see themselves with their strengths do not cut off, rigidly suppress anything that they might see as vulnerabilities. And then people who are stuck in their vulnerabilities are not saying, I do have some skills to handle this.  I do not have to cower in the room and be afraid of what is going to happen next. What's the situation I faced when I was a child that I found my courage and how can I tap onto what that child knew or how can I tap onto the fact that I miscarried and I handled it or we all have things that have happened to us that are difficult and how did you handle that? Sometimes people think I just do not know what to do. And yet they really do know what to do. They can identify their strengths and if they accept their vulnerabilities, then they can manage those while they're looking at the glass half full and realizing, I've got to stay more positive and know that I do have strengths to help me handle this.

Scott DeLuzio:    50:03    And any of the setbacks that we face in our lives, throughout our lives, even from very early childhood, they help us learn and learn how to react to those similar situations in the future. It may seem like a very small thing to adults who already know this, as a young child who puts their hand on a hot stove, they didn't know prior to doing that, that's going to hurt them, but they sure as heck know after they did it, but it's going to hurt them. So, they will now go throughout the rest of their lives and not do that again because of that one experience that they had. That was a bad experience. But, you can also take that as you're an adult, they're bad things happen all the time to people and you have these experiences, good and bad experiences that you learned from; do more of the stuff that creates a good experience and do less of the stuff that creates a bad experience.

Scott DeLuzio:    51:05    And, you tend to learn and grow from that. So, if you are not willing to accept some of those things that have happened to you and your reactions to them and things like that, you are probably not going to grow very much. It is going to be harder.

Dr. Margaret Rutherford:    51:23    I had a lot of people who volunteered to be interviewed with perfectly hidden depression. I have between 50 and 60 interviews who were doing that anonymously. I did not know who they were. Everything from brain surgeons to a motivational speaker. All kinds of people came forward and

Dr. Margaret Rutherford:    51:49    most of them said things like, if I begin trying to disentangle my need to look perfect with this permission to accept vulnerability, then people will reject me because I'm seen as someone who always knows what to do. I am the person who makes the decisions quickly and efficiently. And I cannot give that out for me to look around and go, I do not really know what to do. It is just complete. I would lose all sense of respect and status of all my peers. Or if I said, I cannot take that on this year, I am just too busy, then, what does she mean? She is too busy? You know? So, you must sort of face this fear of what other people think about you and see you as more vulnerable than you really are. It is just you are setting boundaries; you are setting limits.

Scott DeLuzio:    52:48    So Dr. Rutherford, I wanted to thank you so much for taking the time to join us today and like I said, I probably could talk to you all day about this book and this topic. I would love to go deeper into the book on the podcast, but I also do not want to give it all away.  I want people to go out and buy the book and learn about it. If any of this stuff that we talked about seemed to resonate with anyone, go get the book. Like you said, it does read sort of like a workbook where there's exercises and things like that that you can go through. I encourage you to go and seek help from a professional who can help them out.

Dr. Margaret Rutherford: It is available in e-book form as well as just a regular paperback and it is not expensive.

Scott DeLuzio:    53:44    Where can people go to find that book? I am sure it is on Amazon.

Dr. Margaret Rutherford:    53:48    Yeah. Amazon, Barnes and Noble. You can go to your book seller and they will be able to order it for you if they do not have it on their shelves but they will certainly get it forthwith, as I say.

Scott DeLuzio:    54:00    I am sure a lot of local, independent booksellers are probably hurting for business these days with everything going on. So, go out and try to support them once when things start opening back up.

Dr. Margaret Rutherford:  That's right.

Scott DeLuzio: So, thank you again for your time. Where can people go to find out more about you and your work, your podcast, and things like that.

Dr. Margaret Rutherford:    54:22    The website is DrMargaretrutherford.com. The podcast again is the self-worth podcast and that is on Spotify, Iheart radio, Apple podcast, Stitcher, SoundCloud, anywhere you would want to listen to it.  I do have an Instagram account that I have a lot of fun with and anyway. I have an email ask Dr. Rutherford and Dr.MargaretRutherford.com.

Scott DeLuzio:    54:51    Wonderful. Definitely reach out to Dr. Rutherford with any questions that you might have; reach out to find out more about the book, or just go get the book and read it yourself and find out about it that way. So, thank you again for joining us on the show today.

Dr. Margaret Rutherford:    55:14    Oh, thank you. Thanks to your listeners, for those of you who have been in the military that we really appreciate what you have done for our country, so thank you.

Scott DeLuzio:    55:23    and we appreciate that. Thank you.

Scott DeLuzio    55:29    Thanks for listening to the DriveOnPodcast. If you want to check out more episodes or learn more about the show, you can visit our website, DriveOnPodcast.com we are on Facebook, Twitter, and Instagram at DriveOnPodcast.