A Personal and Professional Wish List
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I have worked in the healthcare profession for over 30 years, frequently with people who suffer from depression. My family also has a long history of clinical depression, which I have dealt with personally all my life.
People often feel helpless wanting to assist their loved one because they either don’t know what to do, or they find what they are doing is ineffective. There are some things I wish the people around me who genuinely wanted to help had known when I was at my lowest.
Learn: Ask “What can I do?” and request clarification if there is something you don’t understand. It can be difficult for people to ask for help, even in their best moments, much less when depressed, so make sure you are receptive and encouraging. Don’t take it personally if they reject your help, appear irritated, or answer, “I don’t know.” They aren’t necessarily withholding or unwilling to engage, but they may genuinely not know. During periods of deep depression, people sometimes disconnect from their emotions. If they are unaware of their feelings, they can’t tell you what would help. If this happens, offer some options. They may be better able to answer a multiple-choice or yes/no question than an open-ended one.
Depressed people can go into overload, becoming unable to process what feels like too much information, and this can have a snowball effect. If they shut down, you should stop, come back another time and try again. This process takes patience and self-monitoring.
Put Aside Your Ego: If the depressed individual tells you ways you can help that you think aren’t very good; you may have the urge to blurt out some of your “better” ideas. Don’t. Remind yourself of the task at hand, which is to listen. Don’t repeatedly try to convince them to take your advice if they are resistant. If you do so, you will become frustrated, and your loved one may perceive you as nagging, annoying or unhelpful.
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Resistance: The primary symptoms of depression are sometimes readily apparent. But occasionally the depressed individual is so good at hiding their emotions that the signs can be difficult to read. They may not feel safe sharing certain feelings with anyone, not just you. Don’t take it personally.
Reasons for Resistance: Sometimes your loved one won’t reach out to you because they are afraid they will scare you off, believing you may not be able to handle their pain or that it will cause you pain, resulting in more feelings of guilt and unnecessary worry. They may feel they need to protect you from themselves.
There is also the ever-present stigma associated with mental health problems which comes in many different forms. One is the belief that the individual, who may be viewed as a strong, independent person, should be able to solve all their problems on their own.
Admitting that they have weaknesses, along with distorted beliefs about their meaning, can become tantamount to a depressed individual experiencing a full-frontal assault on their self-esteem, a humiliating acknowledgment that they are inherently defective. This is frequently reinforced by lifelong messages they have received from the culture of their families, religion, geographic norms and the media.
Resolve Resistance: If your loved one is unwilling to receive treatment, traditionally from a psychotherapist for talk therapy and/or a psychiatrist or primary care physician for medication, make sure they know that you are available for them whenever they want to talk.
If you yourself, a friend or family member have suffered from depression, normalize your loved one’s experience by sharing your own story. If the depressed person knows you won’t judge them, they may see you as the ally that you are. Sometimes your support along with their own desire to feel better will be enough to get them to seek help.
Listen Without Fear: A significant part of your role is simply to listen. If your loved one shares feelings or thoughts that make you uncomfortable, don’t change the subject. It is not uncommon among severely depressed individuals to have thoughts of suicide. Research has consistently shown that there is less danger of suicide from individuals who talk about it than from those who keep it inside. Don’t let your own discomfort with the topic prevent the two of you from talking about it.
If you are very concerned and your loved one is already in treatment, you might ask them if you may join for a session. Respect their decision either way. Unless there is imminent threat of death, the healthcare provider cannot share any information with you, but they can listen and take into account what you share.
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Make It Easy: If your loved one is severely depressed, they are going to need help with daily tasks. If they are forgetful, keep track of, and remind them about their therapy and doctor’s appointments. If their appetite is poor and you don’t see pre-made, ready-to-eat food in the refrigerator, cook or buy it for them. Easily accessible foods are more likely to be eaten than food that requires even a little bit of effort to assemble. Being depressed can make household chores feel insurmountable. If you take the trash out and do the laundry for them, this can offer huge relief. Environment has a significant impact on mood. Looking around and seeing a mess everywhere that they are incapable of cleaning up reinforces negative beliefs about themselves. Help them sort through the maze.
Enabling vs. Helping: When your loved one’s depression starts to resolve there will be a period when they still need your help but can do more for themselves. If they have become reliant on you managing their daily lives, they may be less motivated to take over tasks even when they become more capable of doing them. It is important for you to identify the signs of depression resolving and, if you see that it is, encourage them to slowly do more. However, this isn’t the time for “tough love,” e.g. withdrawing completely.
If this sounds difficult on several levels, you are correct. Helping your loved one means you need to be mindful of your own needs, limitations and emotions. Make sure you do not absorb their pain. Empathizing while maintaining the separateness of your emotional identity can be a difficult but necessary task. Remember to reach out for help if you need it yourself.
How to Help a Depressed Loved One was originally published in Invisible Illness on Medium, where people are continuing the conversation by highlighting and responding to this story.