Need to know
‘If it’s worth doing, it’s worth doing well.’ How many times did I hear that growing up? My parents were attempting to teach me (just in case I hadn’t absorbed it from their actions) the importance of striving for excellence. They were encouraging what some psychologists call ‘constructive perfectionism’ or ‘healthy perfectionism’ – a personality trait that’s associated with finding enjoyment and even fulfilment in life from doing things as well as you possibly can. With constructive or ‘positive perfectionism’, the focus is process-oriented; you learn from mistakes or even failure. It’s generally considered a beneficial trait that’s linked with being more conscientious and self-disciplined.
Yet perfectionism can have a darker side. The American academic and author Brené Brown defined this kind of perfectionism in her first book, The Gifts of Imperfection (2010), as ‘a self-destructive and addictive belief system that fuels this primary thought: if I look perfect, live perfectly, and do everything perfectly, I can avoid or minimise the painful feelings of shame, judgment and blame.’ This form of perfectionism, which is fuelled by inner shame that must be quelled, involves trying to constantly meet perceived expectations of what ‘perfect’ is. This perfectionism isn’t fulfilling and it’s far from enjoyable. Yet many people feel it’s mandatory to look as if all is perfect. They believe that not to do so would imply imperfection.
This is what’s known in the wider psychological literature as ‘unhealthy perfectionism’ or ‘destructive perfectionism’. In this case, the purpose has nothing to do with process. It’s goal-oriented. It’s driven. It’s pressured. And I believe it’s increasingly contributing to mental health problems.
Constructive perfectionists, let’s say if they’re swimmers, want to beat their personal best. That brings with it all kinds of positive vibes. Winning the race is great, if indeed they do.
But destructive perfectionists want to be the perfect swimmer. And winning every race is the goal; if not, shame says to them that they have little to no value or worth.
Many perfectionistic people will fall somewhere on a spectrum between the two poles. But in my clinical practice I’ve noticed another issue. Ironically, destructive perfectionists might not even recognise themselves as perfectionists, because they never believe their best is good enough. There’s always the next achievement. And then the next. And the next.
So, what are the roots of destructive perfectionism? I believe people often develop this way of thinking and being when they grow up without a sense of support, safety and nurturing. It can also be a reaction to childhood trauma or extreme cultural expectations, where appearing perfect becomes a mandatory strategy to emotionally survive, and where vulnerability is disdained.
Over the past decade, I’ve treated more and more people who didn’t quite know why they’d come to therapy. They’d erected huge barriers against revealing any kind of emotional pain; I wondered if they even had the capability of expressing such feelings. Outwardly, they didn’t seem depressed at all; the descriptions of their issues sounded more like the result of overwork, fatigue or mild anxiety.
My interpretation is that they were destructive perfectionists who were running out of steam, but not sure what, if anything, was wrong. Their emotional pain was expertly, and often unconsciously, hidden.
If I asked them if they were depressed, I’d hear a firm denial. ‘I have too many blessings in my life.’ If I questioned whether or not their childhood provided safety and security, they’d laugh and deny or discount any kind of problem. Or sometimes they’d become very quiet and look out the window, as if they wished they were anywhere but my office.
Yet as they returned for more sessions, they’d slowly risk sharing one shame-filled secret after another. Their seemingly impenetrable cloak of silence would slowly slip off, only to reveal tremendous loneliness and despair.
And in many cases, as they let down their guard, I found they could also understand that what was ‘wrong’ or unhealthy might not fit the rubric of classic depression. But it was just as real. And just as damaging.
I began researching the popular literature about perfectionism, shame and fear of vulnerability. I found a wealth of research and writings about the importance of vulnerability and the cost of shame by the aforementioned Brown, the much earlier thoughts on ‘covert depression’ by the author and family therapist Terrence Real, and the book Self-Compassion (2015) by the psychologist Kristin Neff. But crucially I couldn’t find anything for the general public about the relationship between perfectionism and a form of potentially serious depression.
So, drawing on the experiences and stories of the many clients I’ve seen in my practice over 25 years, I formulated my own ideas about this distinct problem and how it can be addressed most effectively and compassionately. My work – laid out in my book Perfectly Hidden Depression (2019) – is based on how a dangerous kind of perfectionism-fuelled depression can affect someone’s life; how even if someone scores low on a standard depression inventory, they can be living with deep-seated emotional difficulties and unresolved traumatic experiences that might ultimately threaten their will to live. This is the syndrome I call ‘perfectly hidden depression’.
I’ve identified 10 traits that manifest in the daily decision-making and behaviour of people who exhibit signs of this syndrome:
- You are highly perfectionistic, fuelled by a constant, critical inner voice of intense shame or fear.
- You demonstrate a heightened or excessive sense of responsibility and look for solutions.
- You have difficulty accepting and expressing painful emotions, remaining more analytical or ‘in your head’.
- You discount, dismiss or deny abuse or trauma from the past, or the present.
- You worry a great deal (but hide that habit) and avoid situations where you’re not in control.
- You are highly focused on tasks and others’ expectations, using accomplishment as a way to feel validated. Yet as the last accomplishment fades, new pressure assumes itself, and any success is discounted.
- You have an active and sincere concern for the wellbeing of others, while allowing few (if any) into your inner world.
- You hold a strong belief in ‘counting your blessings’ and feel that any other stance reflects a lack of gratitude.
- You have emotional difficulty with personal intimacy but demonstrate significant professional success.
- You might have accompanying mental health issues that involve anxiety and control issues, such as obsessive-compulsive disorder (OCD), generalised anxiety disorder (GAD), panic and/or eating disorders.
If you read these 10 traits and find that many or all of them match you, then hopefully this is in some sense reassuring – it might give you an inkling of why you feel the way you do, how you haven’t known what was wrong and have been ashamed to even consider it. If suddenly a light has come on – you recognise that you can’t bring yourself to share any vulnerability; or perhaps you recognise these traits in someone else, then first – breathe. And know this: I’ve found there is an antidote to perfectly hidden depression – self-acceptance...
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