My friend is deeply depressed and is trying to cut herself off from me and her other friends. How can I try to help her? Key questions: 1) Any suggestions on how to try to convince her that I genuinely want to stick around and be her friend and it's not just out of obligation, and/or other other ways to respond to her trying to push me away? 2) She's given up on hope of any treatment or improvement-- I think she might be borderline and that DBT could be a good fit for her regardless-- any suggestions of what I could send her about DBT and/or BPD (or anything else) that would have the best chance of getting through to her and giving her hope that things can get better?
posted by EmilyClimbs to Human Relations (15 answers total) 14 users marked this as a favorite
One of my best friends, who I've known for about 10 years, has struggled with depression for most of the time I've known her, although with varying degrees of seriousness. Things were particularly bad about 5-6 years ago (including a brief inpatient hospitalization which was a horrible experience for her) and back then she used to talk to me about her struggles and her pain from time to time, although more often she would avoid the subject. She's seemed somewhat better since then (although for the past couple years she's lived in a different city than me, and it's hard to be sure long-distance), though I would be surprised if she wasn't at least mildly depressed for the majority of that time. She's been on and off medication, and has seen a number of therapists (she's never found any of them helpful, and in fact has come to feel deeply upset by and distrustful of mental health professionals.) I didn't realize how bad things were lately until this past week, when she told me to cancel a planned trip to visit her and to just let her disappear out of my life.
She says this is partially because it's too hard for her to deal with people but also seems convinced I feel obligated to be friends and stick with her, even when I swear it's not true (she's now switched to saying I feel obligated and just won't admit it to myself.) I think she feels so worthless that she has a hard time imagining it could be true that I really care about her and feel my life's better with her in it than not-- combined with feeling really pathetic about herself and her life, and feeling embarassed about others seeing it.
She says that she's not planning to kill herself right now (because what it would do to her parents-- not her death, apparently, but her suicide specifically), but also that she is miserable and utterly hopeless and hates her life and wishes she were dead. I'm pretty sure I believe her that she's not immediately planning to kill herself, although that could certainly change. She's self-injured before, and in the past regularly would take high but non-fatal doses of pills, which she may be doing again/still, I don't know. She's attempted suicide at least once. In her suicidal periods generally she's strongly wanted to kill herself but struggled with finding the "courage" to actually see it through to the end, but I don't know if she's more capable of that now. She says it's been about 18 months since she last had any hope that things would ever get better, and that when she lost that hope she stopped having good days mixed in with the bad days. But to me things have seemed worse mostly just in the last month or two, which seems to be triggered by some really stressful interpersonal stuff going on at work (which unfortunately contributes to her sense of worthlessness.)
She doesn't really have any friends in her current city, and while she has a number of other long-distance friends (mostly people we both went to college with) who I know care about her, I'm not sure how much they've been in touch lately and she's told me she's trying to disengage from everyone else's lives too (more subtly, though; I believe I'm the only one she's been explicit about this with.) I'm not sure, but I think I'm her closest friend. She has a complicated relationship with her parents and siblings, and her family doesn't really handle her depression issues well.
She's a fantastic person and a good friend and I really enjoy having her in my life, and I care about her and want to be there for her and help any way I can. Clearly she's got a lot of distorted thinking going on, though, and it's so hard to figure out what to say or do that might make a difference right now. While I recognize that ultimately I may not be able to get through to her at all, I'd appreciate any advice from people who've been in a similar state of mind or with loved ones who have.
1) Any ideas about ways to try to convince her that I really do want to be her friend, that I genuinely want to stick around through this? That I'm really not doing it out of obligation and if at some point I reach my emotional limits I'll disengage but I haven't reached them yet, and she doesn't need to make that choice for me? That she doesn't need to feel guilty about how watching her struggle is "not fair" to me? Should I try to convince her that I usually truly enjoy talking to her, that she's funny and smart and fun, or should I avoid that so she doesn't feel like I only want to be around her when she's like that? How can I convey that I feel like my life is better with her in it, even though it seems illogical, since she knows it pains me to see her suffering and she feels like all she has ahead of her is more suffering?
And if she just says that it's too difficult and painful and embarassing for *her* to interact with me in her current state, how much do you think I should keep pushing versus respecting her wishes? (If you've ever felt that way, was it better for you for your friends to keep trying to connect with you or for them to back off for awhile?) I want the best for her, and so if that means leaving her alone for awhile I'll certainly do it, but I'm unsure whether that actually is best... I've seen some depressed people say after-the-fact that they were glad people kept reaching out to them even though they resisted it at the time. And if I do back off for awhile, any suggestions about when/how to try to re-engage in the future would be good too.
2) She is feeling utterly hopeless about ever feeling significantly better. She's tried various medications and different therapists over the years, but has come to deeply distrust therapists for reasons that aren't entirely clear to me. Recently I've been reading a lot about Dialectical Behavior Therapy and about borderline personality disorder. I suspect she may have BPD, although if so, it appears to be very inwardly-directed rather than outwardly-directed. She doesn't generally lash out at other people or otherwise harm them, and generally tends towards being emotionally inhibited in relationships and keeping people at a distance (which could be driven by fear of abandonment/rejection, I don't know) rather than the more typical BPD characteristics of having intense relationships and avoiding being alone. The things that seem like they really fit include feelings of emptiness, not having a strong sense of self, moodiness/high emotional sensitivity, self-harm/"parasuicidal" acts and suicidality, bulimia, tending towards black-and-white thinking, and just the acute, intense emotional pain and self-hatred.
Anyway, I know I can't diagnose her myself (and I know that a lot of those symptoms are typical of depression in general) but this is primarily relevant in the sense of possibly giving her (and me) hope that there may be a name and a promising treatment for what she's suffering beyond "depression that nothing seems to fix." And whether she does or not, she seems to have a lot of the symptoms of it which DBT has been successful in treating (plus from what I know about the DBT style, I think it's a good fit for her.) The thing is, I am hesitant to suggest to her that I think she might be borderline, considering how much negativity is out there about BPD and how bad she feels about herself already (and how hard a time I'm already having convincing her that I like having her as a friend, without adding the suggestion that she has a disorder which is generally associated with being really difficult and hurtful to friends, where friends are repeatedly urged to get away from BPD sufferers!)-- not to mention that so much of the material out there, even when written in a sensitive way, focuses on symptoms like outward rage/anger and intense relationships/idealization-and-devaluation which don't fit her very well and might make it harder for the descriptions to resonate with her. Of course I could just send her something about DBT without referring to borderline, although since DBT is so strongly associated with treating BPD, she might just assume I'm saying that anyway.
I would really love to find something that essentially sends the message "There are lots of people out there like you, who have felt as miserable and hopeless as you do right now, who have successfully gotten better. There is hope. Please, consider trying DBT." Any suggestions? Articles, websites, books, etc? (Additionally, if possible, it would be good if it illustrates things about the DBT therapy style, like the commitment of the therapist to an honest and trusting working relationship, the sometimes irreverent interactions, the validation of deep pain combined with a focus on practical techniques to make things more bearable.) Given her conviction that things are hopeless and her prejudice against therapy, I'm looking for something really compelling that might have a shot at breaking through that, and haven't found anything so far. Otherwise I'm afraid the downsides of "maybe you're borderline" might do more harm than good.
I should add that I don't mean to focus overly on DBT or on BPD, anything else that might awaken some hope for her would be great too and very welcome.
3) More generally, are there any other things you'd suggest I say or do that would have that best shot of getting through to her and being helpful (either in the short-term or as something she might at least remember and come back to)?
Sorry this is so long. It's just so difficult to see her suffering so much, and it's so hard to feel like I'm failing at convincing her how much she means to me and that she doesn't need to isolate herself from me. I know I need to remember and accept that there may just be nothing I can do that will make a difference, but I still want to give it my best shot. Thanks for any suggestions you can provide.