Author of the following article on helping a depressed loved one, Colette Dowling, L.C.S.W., has written You Mean I Don't Have to Feel his Way?: New Help for Depression, Anxiety and Addiction. Her book The Cinderella Complex: Women's Hidden Fear of Independence, was a NY Times bestseller that was published in 23 languages.
Helping a depressed loved one can be challenging. Little is more disconcerting than the peculiar twilight zone of a conversation with someone who's suffering from depression. It can be like dangling expectantly at the top of a seesaw while the other person sits at the bottom, refusing to budge. You call out, you wave your arms, but there se sits, grim-faced and noncommunicative. Why is she angry? You wonder if you've done something wrong, but there's also something infuriating about the situation. Depression may be the last thing that comes to mind.
While gathering information on helping a depressed loved one for my book, "You Mean I Don't Have to Feel This Way?", I interviewed a woman who described what it was like being with her depressed husband. "There would be these gaps in the conversation. I would try to fill them. I thought, 'Is it me or is it him? What's happening, here?'"
At the time this woman. I'll call her Ellen, didn't understand that her husband was depressed. She tried pumping up the more or less one-way conversations with her own energy but all it got her was feeling anxious and guilty. The worst part, she said, was the creepy sense that her husband John knew something she didn't. "I found myself feeling paranoid, as if he were manipulating this whole thing, and I had no leverage in the situation."
When helping a depressed loved one it's easy to start feeling victimized. In fact, John knew little about what his wife was going through. He was too overwhelmed by his own mental state to have much sensitivity toward others. The depressed seem self-absorbed, distant, sometimes agitated and irritable.
We've been taught to equate depression with feeling sad and we can easily muster some empathy for a friend or spouse who's feeling sad. But with depressed people it can sometimes be hard to empathize. For one thing, they rarely seem to be feeling sad. What they seem is down or dark, flat and feelingless. We can sometimes find ourselves becoming quite annoyed--as if they were doing something to us. And we don't feel at all equipped to help.
Helping a depressed loved one is like being in emotional limbo, as if all feelings have been put on hold. Even depressed people who cry a lot will often tell you they don't feel sad, exactly. What they feel is empty. And this empty state is baffling to others, who may find themselves wondering why they are beginning to feel empty.
What becomes very apparent is how little interest in anything the depressed person seems to have. There's no curiosity. Nothing excites. The depressed one doesn't seem to be taking in much from the world around him or her. and may have little interest in the news, say, or even reading.
Depression in a loved one can push all our buttons. We can feel criticized by their withdrawal and overburdened in conversation where we're the ones doing all the work.
And then there's that maddening lack of facial expression--le masque, the French call it. It's as if the person beneath that immobile face is taking some dark delight in refusing to respond to us.
The Depressed Brain
Remember that the mood-disordered person isn't trying to push anyone's buttons. He's closed up and uncommunicative because his brain chemistry isn't functioning properly. When we feel upset by him, it may actually be because of our own needs. Instead of accepting that our depressed friend is incapable of good conversation, we scurry to perform, trying to get a response so that we can feel comfortable. When that doesn't happen we can feel disregarded, even abused.
It's best not to expect too much from the individual whose brain neurotransmitters have been affected by depression Think of it as a physical illness (it is) that can leave its victims unable to seek help. When this is the case, others must take over. Later, when patients are feeling better, they can begin to take responsibility for their own wellbeing again.
Perhaps the most important thing family and friends can do in helping a depressed person is to encourage him or her to seek treatment. The very nature of depression--its feelings of hopelessness and worthlessness--can make those it afflicts too immobilized to take the steps that are needed if they're going to get better. This makes them feel even worse.
When symptoms linger for a month or more--even if there seems to be an event
that triggered the depressed state--help is needed. I've offered to make referrals and even gotten
appointments lined up for those who approach me for help. With one friend, I went along with her to the doctor and
waited in the waiting room. Those who are depressed are usually grateful for an offer of help. On some level, they know they need it. And while they can't always express it, they do, actually, feel gratitude that you're reaching out to them.
Helping a Depressed Loved One: Ways to Do It
As a psychotherapist, I can assure you that depression destroys self-esteem and confidence. Family and friends can help the depressed person feel worthwhile by providing love, support, and encouragement, and by doing what they can to help the patient understand his illness.
The National Institute for Mental Health (NIMH) has set fourth some guidelines that I've found helpful. The first thing is to try to maintain as normal a relationship as possible. It's important to spend time with the person and not accede to his or her wish to withdraw. Telephone frequently and don't be satisfied with leaving a message on the answering machine. The idea is to try to get the person to engage with you, not just let him or her know that you're concerned.
It's helpful to acknowledge that your friend or loved one is suffering and in pain. It isn't helpful to say, "I know just how you feel." You may not know how the person feels at all, especially if you haven't been there yourself--and even if you have, the person is likely to believe you couldn't possibly know how terrible it feels.
On the other hand, it's important to say something like, "I know depression is an illness that makes people feel really terrible. I'm so sorry this is happening to you, but there's treatment available that can help you to feel better again."
Communicating your conviction that help is available and that the person will feel better is extremely important. The depressed person's self-doubt spills over into pessimism about things ever being any different. You have to try to push through that pessimism. Of course, optimism can't be faked. If you need reassurance, speak to the psychiatrist or therapist you're thinking of recommending to your loved one. Then you'll be in a position to say, with conviction, "I think this person can really help you."
There is no time like now for kind words and compliments, even if they seem to fall on deaf ears. Remember, this is an illness that diminishes people's ability to respond. So don't expect the usual responses, just keep offering encouragement and kindness and ignore the feeling that you're dropping your pennies into a bottomless barrel. Your caring is getting through.
Again, and this may seem obvious, express your affection openly. Show that you value and respect the depressed person. This is something that you need to verbalize because the illness is preventing them from feeling good about themselves. The idea is not, "How could you feel so low when you've tallied up so many accomplishments?" That is likely the very question she's tormenting herself with. The point is, she does feel low. She needs you to remind her that this horrible mood is separate from who your friend is, her accomplishments, her character. Feeling rotten about herself s a symptom that will go away, like a fever in the night, once she gets treatment.
Refrain from criticizing or voicing disapproval. Believe me, you may be tempted, particularly if it's a spouse or child who's ill. Messy disorder in the home, and even personal slovenliness, is a hallmark--an outward sign of a person's inner disorganization. Curtail any desire you may have to say, "Darling, your hair is filthy." Or, "Can't you do something about that room?" Instead, you might say, "Let's go to the hairdresser together." Or, "How would you like it if I gave you a massage and a shampoo?" Or, "I know you haven't had the energy to clean. I'd like to clean for you."
The bottom line is to do whatever you can in helping a depressed loved one feel better, and be firm in your conviction that the illness can be treated.
This article on helping a depressed loved one is adapted from You Mean I Don't Have to Feel This Way?: New Help for Depression, Anxiety and Addiction, by Colette Dowling, LCSW.
NYC psychotherapist Colette Dowling, LCSW has a private practice in Manhattan and specializes in the treatment of adult men and women. She has a masters degree from The Smith College School for Social work and has completed training in psychotherapy and psychoanalysis at the Institute for Contemporary Psychotherapy, in New York.
To get help for yourself, or for helping a depressed loved one, you can reach out to Ms. Dowling at firstname.lastname@example.org, or call 718-594-0201.
To hear Colette speaking on what it's like to begin therapy with someone new, click the button.
Copyright Colette Dowling, 2006-2010