I ask people what “fine” means a lot.

Not because I’m trying to catch them in something. I’m genuinely curious. What does fine look like for you?

After years of sitting across from people with depression, I’ve learned that fine often has surprisingly little to do with how someone feels.

Fine means they went to work. They answered the emails. Got the kids where they needed to go. Met the deadline. Took care of the person who needed them. From the outside, life is still moving.

They are functioning.

For some people, functioning becomes so intertwined with identity that when depression begins to interfere with it, something much deeper gets disrupted. They don’t only feel depressed. They start questioning their self-trust and sometimes who they are.

Who am I if I’m not the capable one?

This isn’t an explanation for depression. It’s one pattern I’ve become increasingly curious about in some of the people I work with.

Shame doesn’t always sound like shame

I’ve been thinking a lot about shame lately while reading Patricia DeYoung’s Understanding and Treating Chronic Shame: Healing Right Brain Relational Trauma (2022).

DeYoung offers a relational way of understanding chronic shame: not simply feeling bad about something we have done, but experiencing something painful about who we are in relationship with others. Her clinical framework considers how repeated experiences of disconnection can become organized around expectations of inadequacy, failure or the need to perform in particular ways to maintain connection (DeYoung, 2022).

That clinical formulation sits alongside a substantial body of peer-reviewed research connecting shame and depression. In a meta-analysis of 108 studies involving more than 22,000 participants, shame was moderately associated with depressive symptoms, with a stronger association than was found for guilt overall (Kim et al., 2011). Much of this literature is correlational. It doesn’t tell us that childhood shame causes adult depression. It does tell us that the relationship between shame and depression deserves our attention.

We tend to imagine shame as obvious: I’m a terrible person. I hate myself. I’m not good enough.

Sometimes it sounds like that. More often, I hear:

I should be able to handle this.

Other people have had much worse happen to them.

I don’t know why this still bothers me.

I thought I dealt with this years ago.

My partner doesn’t even know.

Or simply: I don’t know. My mind is completely blank.

I notice the eyes that suddenly look toward the floor. Hands covering a face while someone talks. The joke that my client makes when the conversation gets vulnerable. Sometimes, particularly with men, I see eyes fill with tears without the person actually crying.

None of those behaviours automatically means shame. People look away, joke or go blank for all kinds of reasons. But they do make me curious.

What just happened?

Shame loves a good “should”

One of the most common things I hear when someone tells me about something painful is some version of, “But someone else had it worse.”

We don’t need to rank pain to decide whether yours counts.

People can experience similar circumstances very differently. Age, temperament, relationships, previous experiences, neurodivergence, available support and what happened afterward all matter. Something that barely registers for one person can deeply affect another.

What concerns me is what happens next.

Something hurt. Then: It shouldn’t have hurt me this much.

Now we aren’t only hurting. We’re judging ourselves for hurting.

Sometimes the shame isn’t simply about what happened. It’s the belief that there must be something wrong with us because it affected us.

Years later, depression can add another judgment: Why am I still like this?

Shame loves a good “should.”

How do we learn what makes us lovable?

I’m a behaviouralist at heart. What gets rewarded is what we repeat.

Children learn relationships verbally and nonverbally. They notice what gets attention, what brings warmth, what makes someone proud, which emotions are easier for the adults around them to tolerate and what happens when they need something.

Sometimes those messages are explicit. Often they aren’t.

A child can start making connections: perform and be seen. Function and be valued. Take care of others and belong. Perform and be lovable.

Research on parental conditional regard offers one way of understanding how these associations can develop. Parental conditional regard refers to giving or withdrawing approval and affection depending on whether a child meets particular expectations. Research has associated it with greater contingent self-esteem and depressive symptoms and with a lower sense of connection or relatedness (Haines & Schutte, 2023).

That doesn’t mean every high-achieving adult with depression grew up with conditional parenting, and it certainly doesn’t mean we need to find a parent to blame.

Parents and caregivers can deeply love their children and still not have the tools or capacity to offer everything that child needed. They may struggle with emotion because nobody taught them what to do with their own. And parents aren’t the only people teaching children about themselves. School, peers, sport, culture, gender expectations and experiences of being different all contribute.

We can hold multiple truths.

Your parents may have done the best they could, and you may still have needed something they couldn’t give you. You can understand their limitations and still feel angry or alone. You can grieve what you didn’t receive without making someone else a villain.

Their inability to give it was never evidence that you shouldn’t have needed it.

When competence becomes evidence

There is nothing wrong with being competent. Or ambitious, independent, empathetic, helpful or reliable. Those are real strengths.

As a therapist-I'm more interested in what happens when you can’t be those things.

Can you make a mistake without questioning yourself? Ask for help without feeling guilty? Disappoint someone without immediately trying to repair their experience of you? Rest while something remains unfinished? Say what you want when someone else might not like the answer?

Do you know what you want before you know what everyone else wants?

That’s where I sometimes see the difference between competence as a strength and competence as evidence.

I think Depression complicates this because it interferes with the very things someone may have relied on to feel okay.

They’re tired. Numb. Less motivated. Concentration changes. They withdraw. Things that should feel good can feel strangely underwhelming.

Then they judge themselves for that too.

Why can’t I just enjoy this? I have so much to be grateful for. I should be able to handle this better.

For someone who has spent years proving they’re okay through what they can accomplish, depression can take away the strategy.

And underneath Why can’t I function? can be a much harder question to sit with:

Am I still worthy when I can’t?

I think of this as the worthiness wound.

I ask about birthdays

I sometimes ask clients how they feel when their birthday comes around.

I hear things like, “I’d rather skip it.” “It’s painful.” “Another year has passed and I’m still in the same place.”

Birthdays can become an annual audit of the self.

Where should I be by now? Why am I still struggling with this? Why haven’t I changed? Why haven’t I done the thing I thought I would have done by this age?

There’s the should again.

I also wonder whether birthdays can expose something else: our comfort with receiving.

For one day, people may celebrate us simply because we exist. We didn’t accomplish something or take care of somebody to earn it.

For someone who is much more comfortable giving than receiving, that can be surprisingly uncomfortable.

And you can have a partner, children, friends and a phone full of birthday messages and still feel deeply lonely.

Being celebrated isn’t necessarily the same thing as feeling known.

You can be loved and still feel unknown

Some of the loneliest people I meet aren’t alone.

They’re partnered. They have families, careers and friendships. But they feel guilty having needs. They minimize their feelings. They mask or distract themselves. They monitor other people and accommodate.

They give enormous empathy to everyone else and very little to themselves.

Other people get context: They’re exhausted. They’ve been through a lot. Of course they’re struggling.

They get judgment: I should be handling this better.

I see a version of this often with men. Research suggests that traditional masculine norms, including expectations around self-reliance and emotional control, can influence how some men experience, express and seek help for depression (Seidler et al., 2016).

In my own practice, the men who come into my office with depression seldom start by telling me they’re sad. They tell me they’re numb. Stressed. Tired.

Eventually, I often hear: I should be able to handle this.

Many have received plenty of affirmation throughout their lives. They’re good providers. Successful. Dependable. Competent. People know what they accomplish and what they do for everyone around them.

But that isn’t necessarily the same thing as feeling known for their character or inner life.

You can withdraw parts of yourself while remaining completely present in your life.

Sometimes someone tells me something deeply important and then says, “My partner doesn’t even know.”

That gets my attention.

“My mind is completely blank”

People often come to therapy wanting strategies. Tell me what to do. How do I stop this? What can I try?

Strategies have their place. I use them.

But sometimes we need to stay with what is happening before trying to fix it.

A client may tell me their mind is completely blank. We might notice what is happening in their body. What sensations are there? Is there an image? What feeling might be present? What thoughts were there just before everything went blank?

Daniel Siegel uses the acronym SIFT—sensations, images, feelings and thoughts—as one way of paying attention to different parts of an experience (Siegel, 2010).

Sometimes “I don’t know” means exactly that. Other times, I wonder whether the person simply hasn’t had words they’ve been able to string together to describe this. Maybe this is the first time they’ve heard themselves say these thoughts while sitting with another person.

I work with plenty of psychologically minded people. They can tell me about their childhood, their attachment patterns and why they respond the way they do.

Understanding matters.

But knowing why you learned to hide your needs is different from allowing someone to see you have them.

“I thought I worked through this”

Healing isn’t linear. We change, and the perspective we bring to our own history changes too.

I see this often in my work with people who receive an ADHD or Autism diagnosis later in life. Experiences they had blamed themselves for can suddenly make sense differently. That can bring relief, but it can also bring grief.

Maybe I wasn’t lazy. Maybe I wasn’t too much. Maybe there were reasons this was harder for me.

Emerging research reflects some of this complexity. A recent systematic review examining identity reconstruction following an adult diagnosis of autism and/or ADHD found that diagnosis can become an important identity event. Across the included literature, adults described revisiting earlier experiences with new understanding, alongside experiences that could include self-compassion, grief, anger, confusion and questions about identity (Meldrum et al., 2026).

Revisiting something doesn’t mean you failed to heal it the first time.

Sometimes something comes back because you’re finally able to understand it differently.

Shame needs to be witnessed

This is where vulnerability gets hard.

Letting another person see the unmasked you. Experience you. Know you.

Sometimes when I offer compassion, the person looks away. Sometimes they joke or say, “I know, I know.” Sometimes, they describe feeling angry when they perceive that someone is pitying them in their personal lives.

Sometimes there are tears. Sometimes there is silence and eye contact. Sometimes I just hear an exhale or a sigh.

Those are often the moments when I do less. I go inward.

The best way I can describe what I hope I’m communicating is:

I see you, and I’m not going anywhere.

DeYoung’s (2022) relational framework is useful here. If chronic shame can develop through experiences of disconnection, then relational experiences may also matter in how we work with it.

Therapy isn’t a relationship of perfect understanding. We misunderstand each other. There can be disconnection and repair. But there is something important about experiencing vulnerability without automatically losing connection.

Shame needs to be witnessed.

What does “fine” mean to you?

I don’t want someone to read this and discover another thing about themselves they need to fix.

The people I’m describing are often already exceptionally good at fixing things.

So I think I’d rather leave you with the question I started with.

What does fine mean to you?

Does it mean you feel okay?

Or does it mean you’re still getting everything done?

Listen for the shoulds. Notice how easily you give context to someone else’s behaviour while judging your own. Notice what happens when you need something, disappoint someone or can’t perform at your usual level.

And pay attention to who actually knows when you’re not fine.

I wish friends sat around and talked about this stuff more.

Because a lot of people are functioning.

That doesn’t necessarily mean they’re fine.

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Maybe it’s time to stop trying to figure it out alone.

If you’re tired of feeling stuck, overwhelmed, disconnected, or like you should be able to handle it better, let’s talk.

Book a discovery call and let’s see if working together makes sense for you.

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References

DeYoung, P. A. (2022). Understanding and treating chronic shame: Healing right brain relational trauma (2nd ed.). Routledge. https://doi.org/10.4324/9780367814328

Haines, J. E., & Schutte, N. S. (2023). Parental conditional regard: A meta-analysis. Journal of Adolescence, 95(2), 195–223. https://doi.org/10.1002/jad.12111

Kim, S., Thibodeau, R., & Jorgensen, R. S. (2011). Shame, guilt, and depressive symptoms: A meta-analytic review. Psychological Bulletin, 137(1), 68–96. https://doi.org/10.1037/a0021466

Meldrum, P., Johnson, B. P., Lo, B. C. Y., Bedelis, M. L., & Rabba, A. S. (2026). “You become yourself, your full self, the true self”: A systematic review of neurodivergent adults’ experiences of identity reconstruction following diagnosis of autism and/or ADHD in adulthood. Autism in Adulthood. Advance online publication. https://doi.org/10.1177/25739581261427260

Seidler, Z. E., Dawes, A. J., Rice, S. M., Oliffe, J. L., & Dhillon, H. M. (2016). The role of masculinity in men’s help-seeking for depression: A systematic review. Clinical Psychology Review, 49, 106–118. https://doi.org/10.1016/j.cpr.2016.09.002

Siegel, D. J. (2010). Mindsight: The new science of personal transformation. Bantam.

This article is intended for psychoeducation and general information and is not a substitute for individualized mental health care.

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