The dilemma I have a lovely husband, two gorgeous girls, a lovely home and a high-flying job. However, I cry every night because I hate myself. My inability to cope with pressure – financial, intellectual and emotional – horrifies me. I see others dealing with genuine problems and don’t understand why, with my myriad advantages, I cannot manage mine. My husband thinks I was over-praised as a child and am always chasing an unattainable A grade. My work is high-stress, involving huge budgets. Separately, five years ago I lost a baby in utero – a hugely painful experience. I fear stopping work would damage my daughters and place a large burden on my husband. But seeing our girls for less than an hour a day is miserable. I think I may be depressed, but admitting it may mean my children are taken away and I’ll lose my job and ruin my family.

Mariella replies You’ve got a lively imagination. I can assure you that depression, if that’s part of the issue, would not mean your children being taken away. It’s a diagnosis in expectation of a cure, not a condition from which, once identified, all will unravel. As parents, if we were to be deemed inadequate the moment life started getting us down, there would be few if any children not being swept into care. You might be surprised to hear how many people there are, in every walk of life, struggling with issues of self-esteem and depression. A happy life is not necessarily made up of the ingredients we’re told are imperative, and that disappointment lies at the heart of many a current malaise.

What to do when you’ve got everything, but it feels like the opposite? You are not the first person to struggle with such a conundrum. If money really could buy happiness it would be a lot more worthwhile to pursue, but in my five decades I’ve seen too many examples of the opposite to hold that true. Nevertheless, it appears as though your elevated expectations of life are getting in the way of any possibility of experiencing satisfaction about what you’ve achieved so far.

You’ve been blazing like an inferno and now you are burned out

You’re a curious anomaly, aren’t you? It’s not that there’s anything shocking about the division between what you outwardly appear to be and what you are inwardly feeling. That’s a condition experienced by many of us. The conundrum is how inflated your doomsday predictions for yourself are compared to the reality of your life. To say you display “all-or-nothing’ tendencies would be to underplay the drama of those contrasting instincts. It sounds like you’ve been blazing like an inferno for much of your life and you’ve burned yourself out.

From what you describe the notion of taking time to work out what you want from your short tenure on the planet would be anathema to you. Yet it’s exactly what you need to do. We may live in a world that tells us outwardly manifested success is imperative, but we all know, deep inside, that rarely does what impresses others bring personal satisfaction. The least constructive choice is to carry on, maintaining the status quo, while desperately hoping for fundamental change to occur. Every area of your life is blinking red and that means you need to take your wellbeing seriously and learn to be kind to yourself.

The first thing you need to do is pay a visit to your GP or contact an organisation that you can unburden your feelings to (try Mind, the mental health charity, on 0300 123 3393, mind.org.uk). Professional involvement will make a huge difference in diagnosing your current mental condition and offering support.

I can only read your letter and look with increasing concern at the world we’ve created. It really makes me want to get to the bottom of the meaning of life – which can’t be to charge around, desperately latching on to any and every opportunity for greater riches or acclaim to the detriment of our health, until our bodies collapse under the strain of expectation.

This summer I found myself in remotest Ireland and on a tiny island in Greece, both of which have a similar outlook on what constitutes a good life: food in your belly, time for friends, family, relaxation and sleep, along with enough distance between you and a whirlwind world to be able to see things in proportion instead of being trapped in the eye of the storm. They may not be the most thriving economies, although Irish enterprise is a thing to behold, but they are certainly less likely to lie on their deathbeds wondering where the time went!

I can’t be sure that your husband will be happy sharing more of the load, but I know that battling every day to maintain a lifestyle that doesn’t bring you joy does not make for a healthy, sustainable existence. How much of your current discontent is connected to the loss of your baby is another unknown, but it’s one of the many areas that you should stop and take a look at as you attempt to reboot your settings. You sound like a phenomenal woman with incredible energy, none of which is currently directed at your own wellbeing. For the benefit of not just yourself, but your children too, I suggest you make yourself the priority.

If you have a dilemma, send a brief email to mariella.frostrup@observer.co.uk. Follow her on Twitter @mariellaf1