My long-distance best friend is depressed and suicidal. Help me help her!

August 31, 2012 12:32 AM

My extremely-gifted best friend halfway across the world was depressed and then recently diagnosed with breast cancer. Now she's nearly suicidal. I'm in over my head and I don't know what to do...

We met at a study abroad last year in Amsterdam. I went back to my home in the 'States, and she (Isabella, not her real name) returned to her hometown in South America. Towards the end of her time in Amsterdam she met a local woman and the two fell madly, deeply in love, and then a few months after that Isabella's girlfriend callously dumped her. The breakup was devastating, sending Isabella deeply into depression and making her insomnia worse.

Isabella is an extraordinarily-gifted young woman, who possesses a staggering IQ, an ability to learn things abnormally quickly, and an amazingly detailed memory. She excels at chess, math, science, and tries very hard to conduct herself with integrity and sincerity. She is also fiercely independent, bored easily, scrappy, and completely atypical; growing up she was a rebel and a punk, but also heavily repressed for her intelligence, sexuality (her country is not kind to LGBT'ers), and general maverick-ness. I mention these things because she strongly distrusts psychologists (and the mental health industry in general) because of abuse she suffered at their hands when she was younger, and because she feels she is smarter than them (unfortunately, she probably is).

She lives in South America (I'd rather not say where specifically), and me in the USA. I cannot afford to see her right now and our interactions are limited to Skype and Facebook chat.

Recently Isabella was diagnosed with Stage-3 breast cancer. She's gone from manageably depressed to someone flirting with the concept of suicide. She sleeps very little due to insomnia, and when she tries to sleep she tells me she is instead haunted by the memories of her former love. She's returned to the world of drugs and goes on binges to push her body to its limits, and tells me she does so because she can, and that she can't feel anything anymore. In all things she claims to be completely honest with me, but lately when I ask her what she is putting in to her body she dodges the question -- even when I call her out on this uncharacteristically evasive behavior. I used to be able to consistently cheer her up but, now, sometimes we just end up fighting. She lives with her family but won't tell them about the cancer. She parties relentlessly (for a week straight sometimes), but seems lonely and does not have any close friendships nearby.

I feel that I am in over my head. I plan on completing some of my studies in her hometown next semester (I'm a global business management major, they want us traveling so it's not difficult to arrange), but I'm not even sure if I'll be able to afford to do that. I feel that if I could fly out and see her ASAP maybe it would lift her spirits enough to feel that she could fight this -- but I don't have any credit available to me, don't have the cash, and aborting my classes like this would cause all sorts of havoc. The only way I could see her sooner is if I sold all my possessions. All I can do is sit here and talk.

Lately, I've gone from being able to consistently cheer her up, to mostly fending off various barbs and hostility. I plead with her to be strong, and remind her that these low points don't last forever. In our argument this evening she called me selfish for pleading with her to continue treatment (she began chemo today), accusing me of "keeping her around" for me. I said I was not trying to be selfish but if she is going to accuse me of it then so be it. She immediately logged off.

I am usually very good with people, and I'm used to dealing with mopey-depressed folks (seems to run in the family) but I really feel that I am in over my head with her. I want to help her, I want her to live, I want her to be strong and fight this. She has such an incredibly bright future if she could only get there. I love her to pieces, and powerlessly watching this from a distance is incredibly painful. Her willpower seems is failing, and beneath the twin burdens of her memories and this cancer I am very afraid she is just going to give up, stop fighting, and crawl up in a little ball and die -- and that's if suicide doesn't claim her first. She needs someone for support, and I am doing my best to be that person, but it is not enough. She doesn't seem to be reaching out to many people for support.

I love Isabella dearly. Her depression is exacerbating my own mental problems, and I want her to both regain her willpower and, if possible, not treat me (or make me feel) like shit in the process (I need my willpower for fighting my own demons, which are also serious). Any advice?

posted by luciphercolors to human relations (11 answers total)

Her depression is exacerbating my own mental problems,

Therapy. That is foremost. You need advice about managing your own health and advice about how you should manage this situation in a way that does not harm you.
posted by heyjude at 12:51 AM on August 31, 2012 [2 favorites]

It sounds like you see a lot of you in this person. That's got to be tough. It's great that you have so much empathy for another human being. What a wonderful quality.

But unfortunately too much of any good thing can be bad, and our esteemable intentions can overwhelm and mask some of our more basic human motives - like wanting to be loved, wanting people to listen to us, wanting to be right - and convince us to do some really stupid things in the name of a good cause.

Can you deny that there is a little bit of selfishness involved in every decision we make, no matter how altruistic our motives are? After all, we are only human; how can we not be a little bit selfish? And that's totally okay. Welcome to being normal.

So, an impartial observer like myself might wonder why, out of all the people in the world that could benefit from your love and attention, you connect so strongly with someone that A. needs a lot of professional help that you can't offer, B. is really far away, and C. is behaving in a way that is pathologically self-destructive? Funny how only ONE person is involved. How could this be?

The last thing you would probably want to conclude - and often the last thing anyone will ever tell you - is yes, you are in a way being selfish by pleading with her and making her problems into your problems, and by judging her for not telling her family about the cancer, etc. Hell, one could say that you're selfish for wanting her to get better! :)

I've heard what you're going through described as "the ego masquerading as love." I love that phrase. The ego masquerading as true love. This can give rise to a lot of pain and conflict in meaningful relationships. We love a person and want something to be - and often for good reason - but it's not happening that way. So we get upset. Love, upset. Love, upset. Welcome to the spin cycle.

You probably think of your love as being unconditional! But it turns out.. the way you've set up this story, there are some pretty hardcore conditions: you need this person to be healthy and productive. Well, when we apply any conditions on others (in the form of an expectation), sometimes people fail to live to up them in spectacular fashion. And learning how to be okay with that, my friend, is a huge part of growing up. Because, by and large, things are going to be the way they're going to be no matter what you do

So from my own experience, I can say the following. If you are involved in a "super-electric" relationship or things are "hanging in the balance unless you do something" type of situation, that is a RED FLAG. First of all, just don't do anything. Whatever your head is insisting you must do is probably wrong. You sound like you're right on the edge of doing something nuts. If you sell all your worldly possessions, give up your studies and move half-way across the world, it's going to be a disaster. I know a small part of you knows this to be true.

I don't know why some people have a death wish. I don't know why there is sickness exists in this world. I don't know why certain people can deal with catastrophe and others can't.

What I do know is that healthy relationships aren't supposed to be like rollercoasters. And healthy relationships aren't formed by two broken pieces making a whole. And the right thing to do rarely involves doing something extremely nuts. In movies, there is a damsel in distress that needs to be saved. In reality, she needs to pick herself up, and so do you. You need to have some boundaries.

You are there to be her friend. And if you can come to terms with the fact that her disease is causing her to be this way and she is really afraid and hope to God she comes around, that would probably do you a world of good. At the end of the day, an (admittedly) impossibly high standard does exist. You can show love towards a person no matter how they treat you or themselves - even if that means backing away for a while or biting your tongue - and then you will stop taking things so personally, and come to understand how people "are," and start to practice unconditional love.
posted by phaedon at 3:28 AM on August 31, 2012 [20 favorites]

You're trying to take on way too much here. It's not your job to heal/save her, and you can't do it. She has some big time issues that she will need to work out on her own (including through help she actually decides to seek), and all you can do is be a supportive friend.
posted by J. Wilson at 5:29 AM on August 31, 2012

In our argument this evening she called me selfish for pleading with her to continue treatment (she began chemo today), accusing me of "keeping her around" for me. I said I was not trying to be selfish but if she is going to accuse me of it then so be it. She immediately logged off.

Trying to have a conversation like this over the internet is, well, challenging.

I feel that if I could fly out and see her ASAP maybe it would lift her spirits enough to feel that she could fight this -- but I don't have any credit available to me, don't have the cash, and aborting my classes like this would cause all sorts of havoc. The only way I could see her sooner is if I sold all my possessions. All I can do is sit here and talk.

It should not be important to you that she "fight this". It's not your battle. It's hers. All that should be important is that you be the friend SHE needs, whatever that might be. Honestly spoken, your own havoc is nothing compared to what your friend is going through. Beg, borrow, or steal some money. Buy a plane ticket. Go and visit your friend. Hold her hand. Be with her. There is no substitute for that.

It will be good for both of you and you will never, ever in your whole life regret doing it.
posted by three blind mice at 5:58 AM on August 31, 2012 [1 favorite]

phaeton has great advice. But I must admit that I recognise your narrative from a dozen other internet friendships.
Suicidal over a relationship that only lasted a few months? Totally misunderstood by everyone IRL? "Smarter than all physciatrists"? Fatal disease that is socially acceptable and hidden from her family? physically inaccessible to you? Cool self-destructive drug use? I'd back off this dynamic of being her audience while IRL people are dealing with the consequences of her metal illness(es). I think you are making things worse and harder for her to recover.
posted by saucysault at 6:05 AM on August 31, 2012 [20 favorites]

You can't cheer her up. IANAP but it's obvious that she's clinically depressed and the drugs she's doing are going to make it worse. So stop trying to cheer her up. You can't and your trying is probably just making her feel worse.

She's lashing out at you because that's how people in pain are, especially with those they trust- she's expressing her pain. Don't take it personally and try not to let it get to you. When she accuses you of things like selfishness, it's not a carefully thought-out concern from a rational person; it's someone in pain lashing out. This is not about you, it's about her, so don't make it about you. (If a dog with one foot in a trap tried to bite you, you wouldn't take it personally, right? You'd understand that the pain caused the animal to become vicious. People are the same way.)

Push back. Tell her that you love her and you're worried about her and you think that she should see someone about getting antidepressants and keep going to chemo and lay off the drugs because they are making her feel worse. She won't listen and she'll probably get really mad at you. That's fine. Don't push the issue or nag her; but you need to tell her the truth at least once.

Whenever she accuses you of being selfish because you don't want her to die, tell her that she's right, you want her alive because you love her and not having her around would hurt terribly.

Call and check up on her every day or couple of days, but don't nag her or even ask her about her condition, drug use, etc- just make conversation and reassure yourself that she's still alive. If you start to get upset, or
she is starting to get attacky and you can't handle it, tell her that you'll call her again soon but that you have
to go. Don't take on more than you can handle, but do be there for her.

At the end of the day, you can't fix this or make her better. This is a dark place and she has to get through it on her own. And, I'm very sorry, but she might not survive it. She probably will, but might not. It's not your responsibility to keep her alive; it's your responsibility to be there for her and to be as healthy as possible. That's why you need to be seeing a counsellor or therapist too.

I can't tell you whether or not to go to her. That's your choice, and you know her better than I do to know how she might react.

I'm sorry that you and she are going through this. All the best.
posted by windykites at 6:15 AM on August 31, 2012 [1 favorite]

You ARE in over your head, and your friend Isabella is manipulating you. She may or may not be aware of it, but her drama is enveloping your life.

Step away. You can't save her. You are not her therapist. You are her friend. Here is something that you can say to her.

"Isabella, you know that I love and cherish you. I think you are an amazing person and it pains me to see you in such a terrible place. I want to support you, but clearly your problems are beyond the scope of what my friendship can do for you. I know that in the past you've had issues with therapists, but really, you're in a medical and mental crisis right now and I'm begging you to find someone that you can trust who can help you through this time."

As much as you love your friend, you don't have the expertise to help her. No friend would expect you to drop your whole life to come sit with them, no matter how sick or scared they were.

Please, get some distance from this situation. Why don't YOU call a suicide hotline and ask them for advice for how to speak to Isabella.

You sound like a good and caring friend, and Isabella has way more problems than you are capable of helping her with.
posted by Ruthless Bunny at 6:16 AM on August 31, 2012 [1 favorite]

It sounds like Isabella lives in a big city. There's probably a local LGBT organization. One thing you can do over the Internet is ask them to recommend a decent therapist, and any pertinent support groups (e.g. for LGBT folks dealing with serious illness, if the cancer story is true -- but saucysalt's skepticism seems especially reasonable given the rarity of breast cancer in young women and the difficulty of concealing chemo side-effects from one's co-residents).

As for being too intelligent ... Isabella really needs to get over herself, dammit: she may be brilliant in some ways but she's acting dumb as horseshit in others. The point of a therapist is not to outsmart the patient, unless the therapist is doin it rong (which the ones she's met likely were); it's to help the patient channel their own smarts.
posted by feral_goldfish at 8:11 AM on August 31, 2012 [3 favorites]

I plead with her to be strong ... pleading with her to continue treatment ... I want her to regain her willpower

As a two-time cancer survivor myself, I am going to ask that you stop (or at least try to stop) doing this. As others have said, this is not your battle to fight -- it's hers, and its hers to fight or not, however she chooses. There is this incredibly pervasive cultural notion out there that people with cancer are automatically drafted into the Noble Warrior Army, and it's our obligation to be strong and fight. (There's all sorts of additional baggage that gets put on women with breast cancer, too.)

This pressure to Be Strong! Stay Positive! And Fight! To Your Last Breath! can be unbelievably exhausting, insulting, and infuriating. Please understand that I know -- and Isabella almost certainly knows, in her heart of hearts -- that you do not intend your comments to be taken this way at all. But what someone in this position truly needs is not for someone else to tell them how they should feel and what they should do, but rather to fully, even radically, accept them in this exact moment of how they do feel.

She is facing her mortality. She needs the acknowledgment that her pain and fears are real, not exhortations to be strong and to make choices that she does not want to make, all for the sake of other people not wanting to face the chance that she might die. Chemo, for example, FUCKING SUCKS. It just does. And frankly, it's her choice to continue it or not, whether or not you think that's wise and whether or not you would make the same choice for yourself. (I myself made the choice to modify my own chemo regimen and to go with a less aggressive protocol because I felt the high risk of long-term side effects, combined with the hideous immediate misery, were not offset by the theoretical 3 or 4 points that might be added to the percentages of my chances of survival. Some of my loved ones were upset that I wasn't Fighting Hard Enough. Honestly, I viewed that as their problem, not mine.) Again, she is facing her own mortality. She is not obliged, despite what our death-denying culture insists, to endure every available treatment. She has free will, and she's exercising it -- even if in a difficult, self-destructive, painful way.

I apologize if this sounds like I'm lecturing you; I'm really not. I say all of this gently and with respect for your deep love for your friend and your desire to help her. But I would say that you do not help her -- and you do not help yourself, just as crucially -- by trying to force her to meet you on your wavelength. Instead, I think you will be giving both her and yourself a great gift by radically accepting her where she's at. It allows you to show your concern while at the same time stepping out from this push-me/pull-you cycle it sounds like you've developed.

But here's the thing. She may very well die from this. And if she doesn't die from this, she's going to die from something. Because we all are. There is no getting out of here alive. The fear of your own pain and grief that you will experience if Isabella dies of this is also very, very real. Isabella's illness and her refusal to be drafted into the Noble Warrior Army is an extremely painful reminder of our shared mortality and vulnerability. I would gently suggest that the most important thing for you to do for your own sake is to find a way to let this most profound of painful truths find a place to exist in your life -- some ways to do this are through therapy, meditation, joining a support group, reaching out to clergy (if you're religious), etc.

Certainly, you should not sell your possessions and fly down there to try to cheer her up. This is one of those things for which there may be no cheering up. I don't say that to be grim, but rather to be realistic. In Buddhism, it is believed that suffering comes from attachment -- an attachment to how we think things ought to be, rather than an acceptance of how they really are. But when we stop fighting reality, we can find that even in the midst of pain and sorrow and fear and the terrible proof of our own mortality, that's where we can start to find connection and compassion and grace.

I wish you and your friend peace.
posted by scody at 8:46 AM on August 31, 2012 [29 favorites]

Thank you for the answers. I have a much clearer picture of what I must do now.

@feral_goldfish: She does not live in a big city -- I think her town is some 60,000 people. She's a few hours away from the capital of her country. In the past we've discussed going to the big city to find an LGBT community to belong to, but she does not like this idea.

So, an impartial observer like myself might wonder why, out of all the people in the world that could benefit from your love and attention, you connect so strongly with someone that A. needs a lot of professional help that you can't offer, B. is really far away, and C. is behaving in a way that is pathologically self-destructive? Funny how only ONE person is involved. How could this be?

None of these things (except the distance) ever revealed themselves in our time together. It's all new to me. I'm a bit prone to distance relationships, it seems.
posted by luciphercolors at 9:39 AM on August 31, 2012

A friend who is like a sister to me was diagnosed with breast cancer while she was going through a divorce. Luckily for me, she lives only hundreds, rather than thousands, of miles away, so I could be with her when she had her surgery and for a while afterward. But my therapist really helped me deal with the stress of having a dear friend in such a tough situation, and my frustration at not being able to do more to help. If it's at all possible for you to talk with a therapist even for a couple of sessions to vent and to strategize, I strongly recommend it.
posted by Sidhedevil at 11:05 AM on August 31, 2012 [1 favorite]