You can’t “fix” someone who has depression. What you can do: Find ways to show you care and encourage them to seek help.
By Robin L. Flanigan
It’s hard watching someone you care about struggle with depression. The woman you fell in love with because of her adventurous spirit now spends all her free time on the couch, watching Netflix. The guy you bonded with at work frequently calls in sick, and when he’s on duty, he’s distant and irritable.
But what to do about it? You want to be supportive, of course, but you’re unsure exactly how. What if your words of encouragement come across as insensitive or patronizing? How do you offer to help without sounding like you’re pushing for a solution?
Being on the sidelines comes with its own struggles, but talk to any mental health professional or advocate and they’ll say you have a crucial role to play when you notice someone—a friend, romantic partner, relative, colleague, neighbor—becoming despondent, losing sleep, expressing hopelessness, or showing other signs of depression. And that’s to become a coach of sorts, a voice that tells the person who is depressed that he or she is not alone, that someone cares enough to notice the shift in behavior and is willing to risk the awkwardness of mentioning it.
Those professionals and advocates will also say this: Too often, well-intentioned attempts to help fall completely flat, and sometimes make matters worse. Commonly used phrases like “Look on the bright side” or “You’ll snap out of it” have no place in a conversation about depression, which has nothing to do with choice.
When Susan C. of upstate New York told a close friend recently that she was grappling with depression, the friend answered, “What do you have to be upset about? Your life is golden right now.”
True, Susan owns a business, creates art nearly every day, has a solid marriage and children who are committed to making a difference in the world. But that’s not the point.
“There still is a chemical imbalance in my brain that doesn’t go away,” says Susan, who finds meditation and exercise helpful in weathering her depressive episodes.
The response she would have liked to hear?
“What I appreciate the most is when people say, ‘I don’t understand what you’re going through, but I’m here for you.’ That’s a whole different ballgame because they’re acknowledging they haven’t walked in my shoes.
“We don’t have to exactly understand someone else’s journey to appreciate and support it,” she adds. “Often just understanding someone needs a little bit of love is enough.”
Part of the problem has to do with the way the word “depressed” is thrown around in casual conversation, notes Sally Winston, PsyD, a founding clinical fellow of the Anxiety and Depression Association of America.
“People often say, ‘I’m having eight people for dinner and I’m so depressed because I can’t figure out what kind of pudding to have,’” explains Winston, whose therapy practice is based at the Anxiety and Stress Disorders Institute of Maryland.
“People think that’s what clinical depression is, or that it’s like [a situation] when they were able to shift their own state of sadness by sheer will. It’s definitely not the same thing.”
Winston says that if you have a close relationship with someone who can’t get out of bed or is neglecting personal hygiene, you should try to have a serious discussion about the need to seek help—an intervention, if you will.
What to do: Give assurances that there’s no need to be embarrassed. Point out that a familiar primary care doctor is a good place to start (unless the situation is unusually complicated) and can prescribe antidepressants if necessary. Above all, let the person with depression know you care.
“Here’s what’s good to say: ‘The real you is crouched down inside and is going to come back up undamaged. I know that even if you don’t know that, and I’m not going away,’” Winston advises. “The main thing to know is that the depressed person fears abandonment, and [fears] that they’re hurting the relationship in a way that will be permanently damaging.”
For couples, how one person responds to a partner dealing with stress has “pronounced and far-reaching” implications, particularly when depression is involved, according to Matthew Johnson, an associate professor of family science at the University of Alberta in Edmonton.
Johnson is a co-author of a six-year study that found that the way couples relate to each other during depressive episodes correlates with the likelihood of relapse.
When women had partners who were more supportive, they got a boost in self-esteem and had fewer depressive episodes one year later. For men, a supportive relationship reduced the number of depressive episodes one year later, but had no impact on self-esteem.
“I study couples for a living, and they are happier and have more stable relationships when they support each other during stressful times,” says Johnson.
That said, Johnson offers a word of caution to those on the sidelines about meddling too much: “Don’t feel that this particular burden [depression] has to become your burden as well. We grow as individuals by overcoming our own challenges.”
There’s a useful saying from the substance recovery moment, known as the three Cs, that applies equally here: “I didn’t cause it, I can’t control it, and I can’t cure it.”
Susan has her own take: “It is totally arrogant and a misconception that we can save anyone else other than ourselves.”
KNOW THE SIGNS
Increasingly, mental health advocates are trying to raise greater awareness of how important it is for people to speak up when they notice someone exhibiting symptoms of depression.
The national nonprofit Give an Hour recruited former U.S. First Lady Michelle Obama, Britain’s Prince Harry and other celebrities to lend their star power to public service announcements for the Campaign to Change Direction.
At the heart of the campaign, which aims to encourage more open conversation about mental health, is publicizing five signs that indicate someone may be in emotional distress: personality changes, agitation, withdrawal, poor hygiene, and hopelessness.
People who are educated about the five signs should more easily recognize those in need, and ideally reach out and guide them toward the appropriate care and resources.
“This is about giving people permission to reach out with a very simple message that says, ‘I care about you,’” says licensed clinical psychologist Barbara Van Dahlen, PhD, founder and president of Give an Hour.
Van Dahlen realizes that making such a gesture may feel uncomfortable and require a large dose of vulnerability. Yet she questions why our culture deems it fit to show up on a neighbor’s doorstep with a casserole after hearing about a cancer diagnosis, say, but steers clear of any interaction with a family dealing with a loved one’s psychotic break.
You don’t have to follow any sort of script to be of assistance, Van Dahlen assures.
“It’s OK to start with, ‘I don’t know what to say that could be of help to you, but I want to be of help.’ That’s a wonderful bridge. It’s almost impossible to have that go badly.”
Perhaps if we were more familiar with discussing mental health concerns, we wouldn’t have to approach those kinds of conversations with so much trepidation.
That was the idea behind the Kognito Challenge, a joint campaign by the campus advocacy organization Active Minds and a New York City-based company that develops role-playing simulations. The need is high: The most recent National College Health Assessment survey in 2016 found that 58 percent of college students admitted feeling overwhelmed and 37 percent had difficulty functioning because of depression.
During the 2016 fall semester, 7,000 students across 205 university campuses went through a simulation called At-Risk for Students. As an avatar interacts with a virtual friend who would benefit from seeking help for emotional distress, the role-player chooses from a menu of responses, receives feedback on the choices, and learns about mental health resources to recommend.
According to Kognito, 51 percent of students who participated reported feeling better prepared to approach and discuss concerns with a friend in distress, and 96 percent said they felt confident about encouraging a suicidal student seek help.
“It’s not that we as friends or colleagues or family members don’t care about others, it’s just that these conversations are not very easy to have,” says Kognito CEO Ron Goldman, adding, “We have a strong belief in the power of conversations to change behavior in a positive way.”
KNOW YOUR LIMITS
Fran L. of Colorado has some advice for sideline coaches: Separate the person from the disease.
Fran describes watching the man who had been his best friend for decades transform from a gregarious guy, an extreme sports athlete dedicated to traveling the world to rock climb or wind surf, into a recluse who didn’t want to come out of his room and became suicidal.
It was obvious that his buddy wasn’t himself—and equally obvious that the problem was bigger than Fran could handle on his own.
At one point, Fran had his friend hospitalized for three days after the other man took a bunch of pills in his presence and admitted that he’d taken a bunch more not long before.
“I had to remember that this is a consuming sickness and one person isn’t going to be able to fight it,” Fran says. “What I did was easy because the only other option was death. It didn’t matter what he thought about it at the time because I knew he was going to be pretty appreciative that I kept him alive. And he was.”
Fran continues: “The best thing you can do for somebody is be their advocate. You’ve got to be the lighthouse.”
Of course, the type of relationship you have with the other person will influence what type of assistance you’re called on to provide. Sometimes little actions that cast forth an encouraging beam may make a surprising difference.
When Susan feels low and someone sends a card, or brings her an unexpected cup of tea, or invites her to go for a car ride, she’s reminded she has important people in her life—and that she is important to them.
“No one can possibly understand everything everyone else is going through,” she says. “Sometimes all we need is for somebody to give a damn.”
* * * * *
SPEAK UP TO HELP
If you see someone struggling with depression, it’s important to speak up, even if you don’t quite know what to say. Depression can be a very lonely experience, and you can make a difference just by showing you care enough to notice. A few practical tips:
Be a cruise director. Gently encourage people with depression to do things that would normally give them pleasure, even if that pleasure takes a while to show up. Instead of saying, “This will make you feel better,” try: “This may fall completely flat, but try to keep yourself activated,” recommends Sally Winston, PsyD. “Always acknowledge what a huge effort that is, and that it’s not going to work instantly.”
Stay the course. Don’t abandon your efforts, especially if you know the person well and are more available to offer your support. “You can be a broken record,” says Barbara Van Dahlen, PhD. “Sometimes it takes more than one approach before somebody lets us help.”
Listen first, advise later. If you talk too much at first, your plans to help may backfire. When you do talk, ask open-ended questions such as “How are you feeling?” or “What would you like to do?”
Printed as “Sideline Coach,” Fall 2017
via Esperanza – Hope To Cope
(This and our other articles are provided by some of our curated resources. We encourage readers to support them and continue to look to these sources in times of need and opportunity.)