Ruth has a demanding corporate job. She is required to drive and deliver on many projects – and keep a cool head while she does it. Her boss and her co-workers know her as an employee they can rely on, and at the same time as someone whose snappy wit makes them laugh. It’s the professional Ruth they work and have fun with. A certain side of her remains invisible to them.

The private Ruth is a volunteer counsellor for a text-message helpline for people in crisis. Two nights a week, she listens and texts with a chorus of unhappy voices, many of them quite young. They are depressed, they have anxiety attacks, they cut themselves. And when Ruth encourages them to confide in the people closest to them, she hears a constant refrain in their responses:

They tell her that outwardly, they’re able to appear happy and positive. Inwardly, though, they’re about to collapse in a swirl of painful emotions. “They’re all so afraid,” Ruth says, and what they fear – or know from experience – is that they’ll be judged and rejected as weak and negative. And it’s not just young people Ruth engages with. Recently she texted for several hours with a man who wanted to kill himself because his wife had left him and taken their young boys. Ruth tries to help people who are afraid to talk with the people in their lives. And she understands. Since her mid-30s, she’s slipped into and out of depression, and she knows a great deal about keeping your vulnerability hidden.

Ruth’s family has a strong genetic predisposition to mental illness. Her grandmother, for instance, was committed to a mental hospital for a long period in the ’70s, when Ruth was a little girl. Her grandmother’s illness was shrouded in silence. The hospital was referred to as “that place”, and Ruth knew that she shouldn’t ask why Grandma was there. Even today it’s something of a mystery.

Depression entered Ruth’s own life back when she was a stay-at-home mother with two small boys. She was living what she describes today as “a dream life” – and yet she felt ashamed. She felt ashamed that she wasn’t happy. Ruth recalls one particular day when she was walking on the street, and what she calls her “underlying malaise” formed into the thought “I’m so … nothing. I’m not … there.” She demonstrates with her fingers: that small. That unreal. During those years, she says, she was a small caterpillar taking cover under a leaf.

Ruth herself believes that what triggered it was long-term exhaustion after the birth of her second son. Night after night, the restless infant would keep her awake. Ruth has always suffered from sleep disturbances, and when after six months her boy inally slept through the night, she was no longer the same. She began to retreat from her surroundings. As often as she could, she drew the blinds to block out the daylight in her bedroom and slipped under the covers. “ ‘Mom’s taking a nap!’ I used to say.” Ruth shudders at the memory. “It sounds so weird to me now.”

In sleep, she could disappear. Outside the bedroom lurked a world she could not inhabit. She didn’t have any strong feelings – other than a hyperirritability that could flare up at the repeated clicking of a ballpoint pen or the sound of someone chewing gum. In childhood, Ruth was taught to suppress her negative emotions, and now she responded to her growing peevishness with an increasingly strict self-control. Yet her anxiety spilled over onto her two boys. Everything they did struck her as dangerous. “Careful!” she kept warning them. “Watch out!”

Outwardly, she was a privileged wife and mother who enjoyed her life. Only her husband and twin sister knew she was in a bad way – and only her sister knew the full story. Ruth did have friends, but no confidantes. Often she was on the point of opening up and then held herself back. But perhaps she wasn’t the only one, she muses. When Ruth thinks back on that time of her life, she has no clue how the other women in her circle were really doing. In 2000, Ruth was diagnosed with depression. Yet treatment didn’t help much. In 2008, she got divorced, and today she believes that her depression contributed to the breakup of her marriage.

No one at her workplace knows that story, and no one will. It’s a friendly work environment, but experience has taught her what can happen to employees with depression. Ruth sums up their fate in a few words: “They didn’t fare well.” One particular incident at a previous workplace is burned into her memory. A co-worker would occasionally burst into tears; she had mood swings and her performance was uneven. This woman received no help. She was labelled as “awfully unprofessional” and fired. Ruth loves her job and has a lot at stake. “I would never dare to share my history for fear of appearing weak,” she says. “The less emotion in the workplace, the better.” In her cubicle hang only a few private photos.

But there is one setting where Ruth has broken her silence. A few months ago, she told her parents about how she’s struggled with depression for years. She told them in connection with a difficult conversation about one of her boys. In recent years, Ruth has responded well to treatment, and she finds herself in stable remission. Yet depression is not absent from her life. Her younger son has had serious psychological problems since he was 12. Now he’s in college and lives near campus. Ruth describes him as intelligent, knowledgeable and witty. He’s been through many different kinds of therapy and treatment, to no avail. “I hate my life,” he tells her.

Ruth’s son is stuck in a place in his life where she was once stuck too. He has much to be happy about – but he doesn’t feel that way. And like many of the people who text Ruth on the crisis hotline, he blames himself for not being able to pull himself together. He’s facing a new type of treatment, and he fears that it too will fail to work. “Won’t that mean that I’m lazy and have a bad attitude?” he asked Ruth recently. “Do you want me to pretend I’m happy?” True happiness and fake happiness can look like each other, but they lie worlds apart. Ruth has known both. She takes pleasure in her life now, and she talks about what a profound difference that is. And she fervently hopes that one day, her son can join her in finding genuine joy.