How can I try to help a depressed, possibly borderline, friend who's trying to isolate herself?

April 8, 2011 9:56 AM

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?

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.

posted by EmilyClimbs to human relations (15 answers total)

This is something I would talk to a therapist about. A therapist for you, not for her. You may not be able to do anything, and if you can do anything, I think you need to be really careful to proceed in a way that doesn't destroy your own boundaries and your own health.
posted by liketitanic at 9:59 AM on April 8, 2011 [4 favorites]

Thanks. I'm working on accepting that I may not be able to make any difference, and on defining my boundaries and protecting myself emotionally. I already have a therapist and will be bringing this up there. But I'd still really appreciate any insight about what might possibly help her, particularly from people who've been there or with loved ones who've been there.
posted by EmilyClimbs at 10:22 AM on April 8, 2011

Sure. I get that. But I have to say, as someone who shares on Metafilter, as much as I can, "any insight about what might possibly help her, particularly from people who've been there or with loved ones who've been there," I have to say that I think this is beyond me or beyond this community.

Your friend is very, very ill. She's so ill, her depression such a distorting lens, that it will be immensely hard for you to find "something really compelling that might have a shot at breaking through that." That's not to say that you shouldn't try or that she is in any way beyond help, but I think you're hanging too much hope on the possibility of finding the magic words. And no, I would not tell someone with such distorted thinking that you think she displays BPD symptoms or needs DBT. She needs to be in a better place to hear it and I don't think it should come from you.

If she is in immediate danger, call the police in her city for a welfare check. Figure out in advance how you would best be able to do that from afar. Don't fuck around.

What you can do is keep reaching out. What I think that means is not diagnosing or offering help, but listening gently and expressing love and compassion and offering basic help, and holding off on bigger stuff--like another go-round about whether she needs therapy--until she asks you.

Keep in mind that the issue isn't whether she truly wants it or not, but whether you will be able to stand being rebuffed a thousand times, whether you will be able to take it if you show up to her city and she shuts the door in your face. Really, the issue is what you can sustain, because we think we can take on the whole world for people we love, and the heartbreaking truth is that doing so will break us.
posted by liketitanic at 10:50 AM on April 8, 2011 [1 favorite]

And even if she's sick--and this became clear to me in helping someone in a similar crisis--even if she's sick, her choices are still her own. Even if they're distorted and fucked up. She is still in charge. The impulse is to tell people who are ill in such ways that they don't know what they're doing, but in doing so we infantilize them and take from them their dignity and self-determination. And that's tragic, too.

There are no magic words, and you are not the one who loves her enough to save her. No one is. Ultimately she has to decide to save herself. You can keep throwing her a line, but the possibility is very real that she will never, ever take it. And that, so sadly, is her choice.
posted by liketitanic at 10:52 AM on April 8, 2011 [2 favorites]

I went through an awful, depressive, stressful period a few years back. I faded away from social things because it was too painful for me to be around people, and my local friends dropped contact. It was really hard for a long time.

What I have learned is that when my friends are in dark times, the best I can do for them is to keep in touch through their difficulty so they know my friendship is not contingent upon them being happy. Because that was what hurt the most - the idea that they only wanted to be friends with the happy me, and when I was sad it was as if I had leprosy.

You can't heal your friend, or be her therapist. That is a lot of hard work she must do on her own. But you can keep her company with phone calls now and then, and keep inviting her to outings, even if she turns everything down. Talk to her about the little things - the dumb thing that happened to you at the grocery store. Ask about her cat/dog. Remember her birthday. Be normal, like the two of you were sitting on a park bench. If she doesn't answer her phone, call a bit later. Honestly, the gift of simple friendship without condition is one of the nicest and very rare things in the world. It really doesn't take much.

In the end I understood why my local friends let things drop, and I really did learn a lot in my isolation. It was what I needed at that time. But I greatly, greatly value the few long distance friends who did take time to reach out to me, to tell me about their day or send me something funny. They hassled me to check in with them. They didn't wait until I was "better" - they took a little effort to show me that they still wanted me around, in whatever condition I might be in.
posted by griselda at 10:53 AM on April 8, 2011 [12 favorites]

What liketitanic says is also very true - there are no magic words, and depending on how sick your friend is, she may refuse your interaction. There's a line between respecting her autonomy and helping. Don't let any blame fall on you for what she chooses to do.

Due to circumstances, suicide was not an option for me. That will make things far more complicated for your friend, and you.

Be careful.
posted by griselda at 11:15 AM on April 8, 2011

I've talked about this before here... for me, personally, when i was depressed, the best thing I did was cut off my friends. Having friends, being friends with them, everything that goes along with that was too much work and made me worse. I felt so obligated to continue to be friends with these people, there was so much pressure on me because of it (people doing basically exactly what you're doing) and it was awful. There was the one or two people that I kept close, but everyone else it was better for me to lose. I never re-connected with them after I got better and, although they were all excellent people whom I have nothing bad to say about and who wanted to help me, it was far better for me, personally to cut them off and never go back.

That said, I understand that my experience is probably in the vast minority, but if you want personal anecdotes, there's mine, and there's especially why you should heed advice like liketitanic's that crowdsourcing the answers to this is not going to be helpful, because you don't know if she's like me or if she's not. She's seriously ill and you can't just make her better.
posted by brainmouse at 11:21 AM on April 8, 2011 [4 favorites]

brainmouse-- was there any particular difference betwen the one or two people you kept close and the others? For the others, what kinds of things made you feel obligated and pressured, and was there anything they could have done differently that would've expressed their concern and support without making you feel that way? (I definitely hear your point that everyone's individual, I'd just like to know.)

Thanks everyone. This is helpful. I'm listening.
posted by EmilyClimbs at 12:42 PM on April 8, 2011

The two people I really held tight to as friends had two things in common: I'd known them forever and they were not easily extricable from my life (one was my sister, the other I'd been friends with since kindergarten and his family was close with my family), and they never talked about my depression. The "concern and support" is pretty much exactly what I'm talking about as what I hated. I didn't WANT "concern and support", I wanted friendship like I'd always had it.

Instead of thinking about how friendship is a good thing, all I thought about when I thought about my friends is "oh god, what am I going to say to her this time, how am I going to explain it, what if she says something about it, how am I going to respond when she looks at me like that and says 'how do you feel?'. If I don't talk about it, is she gonna think I'm avoiding the subject? What is she going to read into me not wanting to talk about it? How do I make her stop thinking about my depression all the time? What's the best way to phrase what's been going on? What if she says X, how will I respond? What about if she says Y? What if she says something I haven't thought of and I have to come up with a response on the spot and it comes out wrong?"

They were absolutely concerned and supportive, and they were doing the best they could, but it just wasn't what I needed. When I got them out of my life I was finally able to stop thinking about being depressed all the time, and focus on other things, and this is how I started to eventually get out of it.
posted by brainmouse at 1:03 PM on April 8, 2011 [4 favorites]

Another anecdata point: My experience of suicidal depression is more like griselda's than like brainmouse's. When my depression has control, I self-isolate because I feel like a waste of skin and oxygen and like I would be such crappy, horrible company that people are much better off without me around. The most supportive friends were the ones who were able to convey the message "I want to see you because I care about you. We don't have to do anything and I'm not expecting anything from you. If you sit there and stare at your toes the whole time, it's okay — I just want to see you. Because I love you. And that's true even when you don't feel like you can be funny, or witty, or charming, or intelligent, or anything. I love you for you, not for what you can do."

It was also helpful when, after asking "how are you", they would respect my reply, "Crappy but still breathing, and I don't really want to talk about it."

liketitanic: The impulse is to tell people who are ill in such ways that they don't know what they're doing, but in doing so we infantilize them and take from them their dignity and self-determination.

Yes... and no. This is so, so tricky and delicate. The thing is — and I'm speaking as somebody with more than 30 years of living with major depression — when the depression is in control, I am not in my right mind. And I mean that quite literally: when the depression is in control, I cannot think or evaluate things well. The research seems to back this up; in Peter Kramer's Against Depression he describes studies in which people with depression — intelligent people, many of them college graduates as I remember — were unable to correctly complete simple connect-the-dots diagrams.

What helps for me is that my husband is able to reflect my own previous insights about my depression back to me, to help me remember: "Remember when you said that having depression was like having an occupying army in your brain? Remember when you told me 'I don't want me to be dead, it wants me to be dead, and I desperately need your help remembering that'? This is not you, sweetie. This is the depression talking." Has your friend ever said anything to indicate that she's able to conceptualize the depression as something separate from her self? If she has, that might be something you could remind her of.

You might get a copy of The Depression Book by American Zen teacher Cheri Huber. (I recommend her books rather a lot because they have literally been lifesaving for me; if I hadn't found her books, I am sure I would have attempted suicide by now.) Cheri has written about her own suicide attempt, so what she writes comes from her own personal experience of depression. It's a short book, easy to pick up and read a bit and then put down, and might speak to your friend. Or it might not, of course.

Best wishes to you and to your friend.
posted by Lexica at 1:57 PM on April 8, 2011 [4 favorites]

Didn't read the other answers so forgive me if this repeats....sometimes when you are depressed just being around people is painful-it's like you just can't be around their energy, for lack of a better term.

You may just want to tell your friend you are there if needed but that you will wait till summoned.
posted by St. Alia of the Bunnies at 2:46 PM on April 8, 2011

As someone who has spent much of the past five years standing staunchly by someone I love who has been very, very depressed, and has gone through many of the feelings and phases you say your friend has, the only thing I have found to be helpful enough to be a maxim is just be consistent in your support of her. My friend rarely believed me on individual occasions that I loved him, would be there for him always, and was not doing so out of any obligation - what seems to have gotten through is just that I never wavered. I was always there, and took advantage of opportunities to show I cared when they came around - visits, cards at hard times or milestones, encouragement with necessary steps in his life - but I think it was just that I expressed my care and support over so much time that he came to be unable to deny it. He doesn't understand it, but he knows it now.

Best of luck to you, truly. This is a hard road to follow for a loved one of someone with depression, but I understand your investment. You're doing a wonderful thing - but do take care of yourself along the way.
posted by AthenaPolias at 5:12 PM on April 8, 2011 [1 favorite]

I've been through some pretty severe depression in my life. During one particularly prolonged period, I lost contact with most of my friends, except for one guy who kept coming by to chat. He wasn't incessant about it and didn't try to diagnose me or fix me. He'd just drop by every week or so, and we'd talk about politics or gossip, just the usual stuff we were interested in and would talk about. Sometimes he'd suggest going around the corner to get some beers, and I'd get off my depressed ass, drink a couple beers, eat a sandwich or something, and talk.

Just that. The thing is he kept doing it despite how unpleasant I must have been to be around at that time. Later I realized that what he did helped a lot and that he really cared about me.

So, what I can say is maintain contact with your friend, talk to her, and keep talking to her. Don't try to diagnose her (you really can't do that). Don't try to push her into a particular kind of therapy.

I think this kind of meshes with what griselda and brainmouse have been saying.
posted by nangar at 5:22 PM on April 8, 2011

Has she ever tried a depression support group led by a mental health professional? They are for people just like her. She may find it possible to discuss her situation when the discussion is with peers who understand from personal experience what depression is, and can share their own stories. It may support her, keep her going, give her some options. If you want to see if there are any groups in her town, you could start with NAMI.
posted by exphysicist345 at 5:42 PM on April 8, 2011

Thanks everyone. It's really helpful to take your individual perspectives, in combination with what I know about my friend specifically and her personality and history, to help guide me in moving forward. (I also found the answers to this earlier question helpful.)

She's reached back out to me so at least for now she's backing off the no-contact thing. So I'll plan to just keep being there for her, keep reaching out, keeping talking, focusing mostly on ordinary everyday stuff. And I'm continuing to try to watch myself and know my limits and protect my emotions.

I really would like to know, for some point in the future, if anyone has any suggestions about if/how to communicate about things like possible treatment options like DBT. When she actively tries to convince me that she has tried different ways to get better and they've failed so it's not just her perception but a true fact that there's no hope of improvement, it feels almost irresponsible not to share information that I have and she doesn't about something that might actually help her. Even though I know that she may not, in fact likely will not, pursue it. It's not like I have any illusions that there is a a high chance that she will follow up on it and it will work. But it's hard to keep it to myself when there's even a small chance it will. I want to respect her experiences and her decisions about her life, but it seems important to just share information about possibilities, although then back off and let her make her own choices from there. Am I wrong? Are there ways to do that?
posted by EmilyClimbs at 9:46 AM on April 11, 2011