NYC psychotherapist Colette Dowling, LMSW, is the author of eight books on women's psychological issues, including The Cinderella Complex: Women's Hidden Fear of Independence, which was published in 23 languages.
Little is more disconcerting than the peculiar twilight zone of a conversation with someone who's suffering from depression. Dealing with a loved one's depression 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 he sits, grim-faced and noncommunicative. Why is he 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.
"Whenever we talked I would get the feeling that I was disappointing John," said Ellen, a woman my daughter and I interviewed for our book, "You Mean I Don't Have to Feel This Way?". Ellen was describing what it felt like dealing with a loved one's depression. "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 going on here?'"
Having not the least idea that her husband was depressed, Ellen felt guilty. She tried pumping up the one-way conversations with her own energy but all it got her was feeling anxious. What bothered her most was the creepy sense that John knew what was going on--knew and somehow took gratification from it. "I found myself feeling paranoid, as if he were manipulating this whole thing, and as if I had no leverage at all in the situation."
When dealing with a loved one's depression it's easy to start feeling victimized. In fact, John had little real sense of what Ellen was going through. The depressed person is too overwhelmed by his own state to have much sensitivity toward what's going on with others.
We've been taught to equate feeling sad with depression and believe that we could easily muster up some empathy for a friend or spouse who was feeling sad. But this is not the effect depressed people tend to have on us. They rarely seem sad. What they seem is down or dark, or flat and feelingless. And we sometimes find ourselves feeling quite annoyed--as if they were doing something to us.
Dealing with a loved one's depression is like being in emotional limbo, as if all feelings are on hold. Even people who cry a lot will often say they don't feel sad, exactly. What they feel is empty. And this empty state is baffling to others, who wonder why THEY are beginning to feel empty.
What becomes very apparent, when dealing with a loved one's depression, is how little interest the depressed person seems to experience. There is no curiosity. Nothing excites. The depressed one doesn't seem to be taking in much from the world around him or her. Sometimes this bland insularity can come across as a kind of criticalness.
Depression, in someone we're close to, pushes all our buttons. We feel criticized and become annoyed. In conversation, it is we who have to do all the work. And there's that maddening lack of facial expression--" le masque," the French call it, and it seems precisely right. That immobile face seems to take some dark delight in refusing us a response.
It's easy to feel manipulated by someone who's depressed, but the mood-disordered person isn't trying to push anyone's buttons. He's closed up and incommunicative because his brain chemistry isn't functioning properly. When we feel upset by him, it may be because of our own needs. Instead of accepting that our depressed friend is incapable of good conversation, we scurry and perform, trying to get the response that makes us feel comfortable. When that doesn't happen we feel disregarded, even abused.
It's best, while this mood disorder prevails, not to expect too much from the suffering individual. Depression is an illness that can leave its victim unable to seek help. When this is the case, others must take over. Later, when the patient is feeling better, he or she can begin to take responsibility again.
Perhaps the most important thing family and friends can do is encourage the depressed individual to get treatment. The very nature of depression--its feelings of hopelessness and worthlessness--can make those it afflicts too immobilized to take the steps required to get better. This makes them feel even worse.
When symptoms linger--even if there seems to be an event that triggered them--help is needed, and the caring friend or relative should seek out a professional. I've offered to get referrals and make appointments for others. With one friend, I went along to the doctor and waited in the waiting room. Those who are depressed, I've found, are grateful for an offer of help. On some level, they know they need 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, especially if you haven't been there yourself--and even if you have, the person may believe you couldn't possibly know how terrible it feels. On the other hand, you may say, "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 reactions; 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 needs to be verbalized 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 may be the very question he's asking himself. The point is, he does feel low. He needs you to remind him that this horrible mood is separate from who he is, his accomplishments, his character. Feeling rotten about himself is a symptom that will go away, like a fever in the night, once he gets treatment.
It's important not to do anything that will exacerbate your friend's poor self-image. 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 and even personal slovenliness are a hallmark of this illness. 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 to help your friend or loved one feel better, and to be firm in your conviction that the illness can be treated.
This article is adapted from You Mean I Don't Have to Feel This Way?: New Help for Depression, Anxiety and Addiction, by Colette Dowling, LMSW.
NYC psychotherapist Colette Dowling,LMSW has a private practice in Manhattan and specializes in the treatment of women. She has a masters degree from The Smith College School for Social work and has done advanced training at the Institute for Contemporary Psychotherapy, in New York.
For a consultation you can reach Ms. Dowling at firstname.lastname@example.org, or call 718-594-0201.
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Copyright Colette Dowling, 2006-2010