This qualitative study explores how women in the rural districts of Layyah and Taunsa in South Punjab, Pakistan, experience and conceal postpartum depression (PPD) within a cultural landscape shaped by spiritual beliefs, patriarchal family systems, and healthcare inaccessibility. Using a phenomenological framework, in-depth interviews were conducted with 32 women aged 20–42, all of whom had given birth within the past three years. Data were analyzed thematically, revealing five key themes: spiritualization of distress, gendered silencing, systemic healthcare barriers, reliance on traditional coping, and economic burden. Women interpreted emotional suffering as a spiritual test (sabar) or supernatural influence (saya), often suppressing their feelings to preserve izzat (family honor). Most relied on spiritual healers (pirs) and religious rituals before considering clinical support, which remained inaccessible due to cost, distance, male guardianship requirements, and stigma. Elder female relatives were frequently complicit in denying PPD as legitimate. Economic pressures, especially related to the birth of daughters and dowry anxieties, compounded the psychological toll. The study highlights the inadequacy of biomedical models in such contexts and underscores the need for culturally sensitive, community-based mental health interventions rooted in local language, metaphors, and belief systems.