Expressing concern without seeming preachy

November 19, 2008 6:35 AM

Help me come up with a (very tactful) way to entreat my boyfriend to seek treatment for depression/anxiety. (long background story)

A few months ago, I started dating "Brian", who has been a close friend of mine for several years. So far, everything is going swimmingly. We have strong chemistry, similar goals and interests, and we really enjoy spending time together. We're taking things very slowly, so I don't think we're yet at a point where either of us would call this a serious relationship.

Brian is truly a wonderful person. He's intelligent, kind, witty, and attractive. For as long as I've known him, he has struggled with depression and social anxiety. He objects to the idea of therapy or medication. I don't think it's a deep ethical objection... I get the impression that his family just doesn't talk about these things, and he doesn't think his problems are serious enough to warrant treatment, especially since the depression comes and goes. He has a tendency to try and "tough out" his emotional rough patches, to varying degrees of success.

This is the second time that Brian and I have tried our hand at dating. The first time was in early 2007. Things started out great... we'd see each other once or twice a week for a dinner date, movie, and/or sleepover. After a couple of months, his demeanor started to change. He began cancelling plans rather frequently, and when we did get together he seemed distracted, stressed, and disinterested. I was frustrated and hurt by the change in his attitude, seeing it as a sign that he "just wasn't that into me". We stopped seeing each other romantically, and I started dating someone else, although Brian and I maintained our friendship via phone and email.

Fast-forward to June of 2008. I was single again, and I started hanging out with Brian much more frequently. One night, he apologized for letting our fledgling relationship fizzle the year before. He chalked it up to a very serious bout of depression, during which he withdrew from all of his friends and family members. He asked me to give him another chance, and I obviously agreed, and we're both quite glad of it. At the back of my mind, though, I continue to worry that Brian's depression will strike again. Over the past few weeks, he has begun talking about feeling useless and having nothing to look forward to. As his friend, I hate to see him dealing with feelings of worthlessness, but as his girlfriend, I (somewhat selfishly) fear that his mood is going to have a negative impact on our relationship again.

I know that he won't get help for his problems until he really wants to, but I want to tell him that I think it's extremely important for him to seek some outside help. How can I bring this up without seeming like I'm posing an ultimatum (I'm not) or trying to sound like I know what's best for him? I feel like I'm likely to offend no matter how I phrase it, since he tries really hard to avoid discussing mental health issues. We're in our mid-twenties, if that seems at all relevant.

posted by anonymous to human relations (8 comments total)

I (somewhat selfishly) fear that his mood is going to have a negative impact on our relationship again.

This is not a selfish thought. Fact is, depression is extremely hard on the people who love the depressee. There's nothing wrong with you feeling like you are being overly taxed emotionally.

In fact, this is the prime reason that he should seek treatment. You should sit him down and say, "I want to help you out as much as I can, but when you get depressed, it really puts a strain on me. I'm afraid that our relationship will not make it through another serious bout of depression. Please go get help, if not for you, then for us."

This isn't an ultimatum, and it isn't telling him what's best for him. It's telling him what's best for you and your relationship. And if it offends him, well, that kinda stuff happens. Try to remind him that depression is a disease, and you gotta get treated for it. No shame involved.

I wish to God that at some point one of my exes would've had this conversation with me, as my relationship with her was really good, and it fizzled because I was depressed. But you seem like you have a really good attitude about all this, so I imagine things will work out right. Good luck.
posted by TypographicalError at 6:54 AM on November 19, 2008 [4 favorites]

Has he ever been through treatment or therapy before, even in elementary or middle school? Most kids with divorced parents will have seen their elementary school's therapist. After my parents were divorced I saw a lot of school counselors and all of them were terrible. If he's had this experience it's easy to understand why he'd rather just 'tough it out'.

Even in my adult life I've maybe met one good therapist, although my husband assures me that he has seen one and they do exist. If your boyfriend agrees to be treated and finds it useless prepare yourself to make the argument that he should try with another individual before giving up.
posted by Niomi at 7:03 AM on November 19, 2008

If you can talk about it, ask him to make a list of things that depression has cost him over the years, and if he can't think of anything, feel free to point out that you were nearly one of those things. Imagine how many other things/opportunities it cost him that he wasn't even conscious of because of his isolation!

Honestly, maybe YOU should see a counselor and talk to them about what you should be doing. If he asks why you're seeing one, tell him you've been feeling anxious about your relationship falling into the same pattern as last time and you need help figuring stuff out. Leading by example in this case might open him up to the idea, make it seem like a normal and easy thing to do. Maybe you two could see someone together.

In the meantime maybe you can remind him that feeling useful and having something to look forward to aren't states that one simply occupies, we have to STRIVE for them. Having feelings of uselessness etc. points us toward a deficit in ourselves, one which doesn't go away or become filled without careful and thorough examination. He's lucky he snapped out of it before, but does he really want to roll the dice and hope that happens again? Sometimes "toughing it out" means addressing a problem on its own terms, not on OUR own.

He should be able to understand why you're worried; he himself has told you that this is how you lost him before. This time there are more facts on the table between you and you have an opportunity to nip it in the bud.
posted by hermitosis at 7:11 AM on November 19, 2008

You're not being selfish. You do want him to be happy, right? Not just you.

As a person who has suffered from depression and anxiety, the hardest thing is to take the first step. What's the point, if there's no light at the end of the tunnel? It's just easier to lie here in bed and hide under the covers.

First, give him something to look forward to. Find some activity he will like - rollerblading, kite flying, mountain biking. It's better if it's outside. Make him do it - phrase it as "we're going to do X today." Don't whine and beg and plead, just be firm. You really really really want to go rollerblading and it would make you SO happy if he came along. Make sure YOU'RE in a good space of being content and happy. Once he's doing the activity, he's likely to feel better. Getting out of the house and doing stuff is half the battle with depression. (If he refuses, try again the following week.)

Now, go for coffee or lunch while he's still in this OK mood (no alcohol!). Tell him how you love seeing him having fun and it makes you so happy that he came with you today. You've really been concerned about him and you're worried he's going to withdraw again. You want the best for him, but you can only help him so much, and he hasn't been able to get out of this funk on his own. You want him to come with you to talk to someone about how you both can live a happier life. You've already made an appointment with this person for next week.

Yes, this is pushy as hell and I'm sure some will disagree with me. On the other hand, I know personally that it takes some pushing and shoving and a slap across the face to overcome the inertia that is depression. He needs to know that he matters enough to you to take the risk that he'll be upset. It may well backfire, but try not to get upset. Be as calm and centered as you can. Focus on how much he deserves to be happy and not your fears about the relationship.
posted by desjardins at 8:01 AM on November 19, 2008 [2 favorites]

I agree with what everyone else has said - that you're not being selfish, you owe it to yourself and the relationship to speak up for what you need, etc. - but just want to warn you that getting your SO to seek psychological treatment for whatever seems to be ailing him can EXTREMELY tricky thing to accomplish. In addition to the stigma of having to officially label yourself with diagnosis: depression, there may be some very real professional complications with Brian seeking treatment, esp. if he plans to use insurance to pay for treatment. That's in addition to his family's perceptions of the situation. I guess all I'm saying is tread lightly and really consider if you're willing to make his seeking treatment a deal breaker before you begin the conversation.
posted by smallstatic at 8:34 AM on November 19, 2008

You're obv. right when you say that he wont seek help until he wants to. You can, reasonably, assist him in coming to this place. You've given us some clues about how he currently rationalizes his situation: he thinks this is no big thing, and that it just "comes and goes," that he regrets the bout of depression when it is over (esp. when it impacts relationships), etc. This? This is depression! This is how it works!

I remember having a really funny conversation with someone in the lobby of my law school one day while just sitting there. I said something about the past week being a tough one, and that I just didn't leave the house or get dressed or get out of bed or eat regularly. And she said, "Yeah, it really sucks to have a breakdown like that." And my immediate reaction was, "I didn't have a breakdown." Which she, very kindly, laughed at. And she said, "Hon - that's what a breakdown is." I just couldn't see it.

You seem to care deeply about Brian - as a friend and SO - and so I would suggest that you will know the best way to approach him with compassion and care which will help him understand that his condition is not something to be ashamed of, and that you are happy and willing to help him learn more about it (and that you yourself wish to become more educated about it), and that you hope that in the context of your relationship this is something that you two can work on together to strengthen the bond that you either have or would like to have.

Good luck.
posted by greekphilosophy at 11:15 AM on November 19, 2008

I remember having a really funny conversation with someone in the lobby of my law school one day while just sitting there. I said something about the past week being a tough one, and that I just didn't leave the house or get dressed or get out of bed or eat regularly. And she said, "Yeah, it really sucks to have a breakdown like that." And my immediate reaction was, "I didn't have a breakdown." Which she, very kindly, laughed at. And she said, "Hon - that's what a breakdown is." I just couldn't see it.

This.

The worst part about depression — worse, even, than the foul mood itself — is the cognitive distortion that comes along with it. Everything seems either small and insignificant, or far too big to confront. Nothing is manageable. You feel, not just sad, but hopeless, powerless, shameful, unworthy and unremarkable.

And all this cognitive distortion makes it extra-hard to get help. The feeling of insignificance tells you, "The way you feel is not important; just ignore it." The hopelessness and powerlessness tells you, "Nobody can help you anyway. You're doomed to feel this way, so just ride it out." The shame and the sense of unworthiness say, "It's your own damn fault you feel bad. A stronger person would just fix this on his own." The sense of being unremarkable says, "This is nothing special. Everyone gets sad. They just hide it better."

One of the best things anyone ever did for me when I was depressed was to tell me how miserable I looked. I know this probably sounds counterintuitive — you don't want to add to all the negativity, right? — but it's strong medicine against that cognitive distortion. I could tell myself, "Well, my girlfriend noticed I was sad, so maybe my feelings are important after all. And she thought it was worth commenting on, so maybe it's unusual — maybe some people aren't always this sad. And she isn't yelling at me or blaming me for it, so maybe it isn't my fault..."

Long story short, refusing to put a happy face on things can be really helpful. If he looks awful, it can be a deeply kind and compassionate thing to hug him and look him in the eye and say "Man, you look awful."
posted by nebulawindphone at 12:16 PM on November 19, 2008 [6 favorites]

From the perspective of the depressee, this is gonna be quite an undertaking. There will be lots of times where the progress you make falls down. The key is to keep encouraging it back up.

Being in the throes (yes, throes...it can be that serious) of a depressive episode can be crippling. You know you should go out and get some groceries. You know that your loved ones want to see you. You know that your dog wants you to play with him. You know that you need to wake up eventually. But you see no point because you feel that you're really only a shell of flesh. You don't feel human or worth caring about. You're just doing what you need to do to survive. Eventually, even that seems useless. There are times when a dissenting "wait a minute, I'm worth more than this," thought comes into your head. That thought is immediately vanquished by another thought, "No you're not. Back to your hole."

Trouble with insurance aside, I recently decided that I needed to remain in treatment because of the effect it's been having on my husband. He has been there each time I've fallen and helped me back up. I can see it's starting to take a toll though. I don't like seeing the pained look on his face when he comes home and sees me still in the same clothes I'd been wearing for 2 days straight. Nor do I like seeing how resigned he's become to my near constant state of misery. I realized not only it's no way for either of us to live.

The best thing I could advise you is to just be there for him. Reading up is also a good idea, as it might help you. This, this, and this might be a good starting point. Also, while you're doing all this, remember to take care of yourself as well. If he won't get counseling, you should avail yourself of it. It's necessary to be strong during this, but you can't do it alone.

Good luck and please do follow-up. :-)
posted by arishaun at 1:28 PM on November 19, 2008 [2 favorites]