My friend is very troubled and I don't know how to help.
December 3, 2011 10:23 AM   Subscribe

Can you give me any advice on how to help my very troubled friend? She seems to be very despairing but I can't convince her to see a therapist.

I've known my friend M for seven years and we are both 23. We went to high school, college, and university together. We've stayed very close throughout this time despite having different interests and other friends from different groups. We've confided in each other very closely and regularly over the course of our friendship. But I've become very worried about her in the past few months as she seems to be suffering from a lot of despair, and I can’t understand why.

I graduated from our university last May, and before that I was away doing my practicum ( I am a teacher), so since January we have been in different cities, however we have kept in touch online. It seems since the start of the summer she has become very despondent about the state of her life. I’ve always known she was prone to mild-to-moderate depression from time to time, especially when under stress from school, but this was something new. Her parents are worried about her and as she wouldn’t tell them what is wrong, they asked me to try to talk to her and I only last week got her to open up to me.

I found it hard to understand what was wrong since she says she’s not depressed, but this is how she explained it to me. She says that after the winter semester ended and she returned home for the summer, she felt a sense of utter failure. She has been in university for an extra year because of a double major, and for some reason not graduating at the same time as her peers has made her utterly despondent. I tried to reason with her and point out that there are many students who take an extra year, and that 23 really is not old to still be in university. She says she knows that she is not old, but that she feels extremely old and that she has failed. She tried to explain that this feeling of failure is not really a rational judgment so much as a very intense emotion; something she said that really worried me is that she sees no hope for finding fulfillment in the future. I think she is worried about graduating university and working full time, and thinks she will have to settle for a meaningless job, and that thought terrifies her ( she has always been a philosophically-minded person).

To me, it seems like she is suffering from depression. I’ve researched the characteristics of depression, and many of them sound exactly like what she says she’s experiencing: extreme difficulty concentrating, terrible short term memory, feelings of hopelessness, lack of energy, loss of pleasure for normally pleasurable activities, excessive guilt, feeling worthless, etc.

I’ve explicitly told her she needs to see a therapist but she thinks no one will be able to help her at this point. She says she just knows that she has failed and that nothing anyone says can change that. She says she has lost all capacity to feel any emotion, and the way she described it was that she felt her “heart had died.” I felt so sad when I heard her say that. I don’t understand what it means either.

When I told her to see a therapist she said there was no point; she has such a sense of certainty that she is a failure, and that her “heart has died”, that she thinks nothing can be done for her. She says she’s thought of suicide but that she won’t go through with it. I am really worried and want her to be happy. I’m not a therapist, and I don’t know what it means when someone says their heart has died, or what to do when they say that. I’m lucky to be going through a particularly happy period in my life (apart from my friend), and I want to help my friend, but I find it hard to understand why she is so despondent.

tl;dr: How can I convince my friend to see a therapist if she thinks there is no hope and that nothing can help her? Do you think there is ever a point at which there is no hope for a human being (Even if there is, it seems to me it would not be when one is young and physically healthy, and I am utterly perplexed as to why she thinks she has come to this point)? What does it mean if someone says their heart has died????
posted by anonymous to Human Relations (7 answers total) 1 user marked this as a favorite
Your friend is lucky to have you :)

Your friend seems to have moved on from mild/moderate depression to severe depression. She probably needs professional help to overcome this. However she needs to want to seek this help, you can't make her.

What you can do is be her friend. Be there for her, listen to her, gently encourage her. You really don't need to understand what exactly she means when she says her heart has died or the other things she said about how she perceives her situation at the moment. All you need to understand is that she is hurting badly and you have understood that. You're no professional and you don't need to be one. Just continue to be her good friend. Show her you care and you do have hope for her.

This may sound harsh to you but be clear that all you can do is be supportive - it is not your responsibility to make this right. She'll need to do that. All you can do is be a good friend. Please reach out to your family or other friends and talk to them. They will have seen people they cared about be in a lot of pain. And they will hopefully also have seen these people get better again.
posted by koahiatamadl at 10:50 AM on December 3, 2011 [1 favorite]

What does it mean if someone says their heart has died????

It means she's depressed. I've spent most of my life in a similar state-- your description sounds just like me at 23. And 24, and 25... I don't know if there's anything much you can do about it if she is sufficiently headstrong in just the wrong way to accept help. I didn't go to a therapist or psychiatrist until I was 29, because I also didn't feel that anyone could help me. And you'd be very impressed, and also horrified, at the complexity and cleverness of the rationalizations one can create to support one's thesis that one is worthless.

The trouble is, you can't argue someone out of that. Even my husband couldn't manage to get me to a brain-doctor for years. I finally did realize that I couldn't live like that anymore and I needed help, but it took a really long time and a lot of support.

All you can really do is listen, and make sure she knows that you're there for her, and you love her. That can make so much more difference than you know. And I don't want to paint an awful picture-- I was always pretty severely depressed, and since this is a new and worse state for her she well might not be nearly as bad as me or take nearly as long to get better. I hope she won't. Do try to encourage her, but don't harp on therapy. If she doesn't want it, then repeated suggestions will probably make her feel like you also think she's a failure, she's broken.

I wish I could be more helpful. But it's an intractable disorder, and it makes its sufferers really difficult to deal with. Speaking, of course, as one of them. I hope this is a relatively brief period for her, and, by extension, you.
posted by Because at 11:14 AM on December 3, 2011

I would buy her a copy of the wonderful book The Noonday Demon. It describes the author's own struggles with depression and is beautiful and insightful. He calls depression "the flaw in love". It's not a self-help book. That said, I credit it with tipping me towards making a decision to get help and treatment for my own depression. It was also a great comfort to read.
posted by kitcat at 2:40 PM on December 3, 2011 [2 favorites]

You may find this site helpful: Helping Someone With a Mood Disorder. You should also talk with NAMI.

(The direct approach isn't going to work. You need some education before you can convince her of any particular course of action, and even then you may not be successful. Good luck.)
posted by SMPA at 2:43 PM on December 3, 2011

I just wanted to clarify - I was in denial about my depression until I read that book. Just like your friend.
posted by kitcat at 8:22 PM on December 3, 2011

That sounds exactly like depression. One of the most frustrating things about depression is that it convinces the sufferer that treatments that have helped millions of others cannot help them. There's just this pervading feeling of pessimism.

One thing that might help, since she admits that her beliefs/feelings are irrational, is to make it really explicit. In Feeling Good, which I recommend for anybody suffering from depression, David Burns spells out some cognitive distortions which contribute to (cause?) depression. One of them is emotional reasoning -- believing that if you feel something strongly enough, it must be true. If you can, try to argue with her very calmly, taking her objections one at a time and trying to get her to agree that they are irrational, provoking the insight (spell it out if you have to) that it is the depression itself that is causing these beliefs. The goal is to convince her to just give therapy a try. Just try it, even if you're skeptical, who knows, it might work, it's helped all these other people. What do you have to lose?

It's hard to describe exactly, but this is what I did with a very depressed friend. He trusted me and can follow logic well (he's a computer guy) and so I was able to convince him, but it took many weeks and several conversations. It's hard to walk the line between being assertive enough and not being too assertive and certainly never judgmental, but it can happen. He got much better after getting treatment.
posted by callmejay at 5:13 PM on December 4, 2011

Now that you've already encouraged therapy, sit back and be a listening ear but try not to overly react to any super negative stuff she tells you ("my heart has died"). The burst of attention you give her enables that dramatic thinking. You can probably help her best by being a stable positive force in her life. For instance, have a weekly catch-up meeting with her, or give her a phonecall once a week, rain or shine. Text her a joke. Tell her funny stories of things that happen to you. Keep her in the loop with news of mutual friends. Be really positive about anything good in her life she mentions. If she wants to bleed off some of the negative she's feeling, listen to her, but don't deny her reality ("It's not that bad!"). Ask questions that help you understand how she feels. Don't really push for her to do X or Y as a depression fix, because it can feel like you only want to be around her when she's happy. The depression will tell her she doesn't deserve friends if she's not happy.

Sometimes people already know what they need to do, but doing it is like climbing an ice mountain in a blizzard wearing socks. There's suffering-suffering-suffering until a person gets truly sick of it and swallows their pride. Because in a weird way, seeking therapy is admitting your failure to manage your life on your own. Nobody likes to fail.

If you can be a listener (without letting her depression get to you - very important), you might help her get to a point where seeing a therapist sounds like a good idea. Maybe you could gently remind her - "Wow, you're really going through a hard time lately. As your friend I can listen, but I'm not trained to help you the way you need. I'd very much like you to feel better." If she starts in on why therapy won't work, just reaffirm that you are her friend and want to see her get better. If she says she'd like to give therapy a chance, be really positive about her taking that step, and maybe check in to see if she's actually called and set an appointment, etc.

Getting a therapist isn't a sure cure, either. Not many people mention that not every therapist works for every person. So your friend may go to the first therapist and not get better at all, and that's very discouraging - finally reaching out for help and getting nothing. It'll confirm what she's been saying to herself. She may need your encouragement then more than ever. You can help by telling her it's normal, and encouraging her to be persistent and try again. She will need that.

What does it mean if someone says their heart has died?

It's like having your heart really set on something (going to Disneyland, for instance) and then having that opportunity snatched away to the point that you will never, ever, ever get to go to Disneyland, no matter what you do. There is a grief process in accepting that you can't have that reality. If that was a huge goal in your life for five, ten, twenty years, it can really knock you on your ass, and it will take time to even see that there are other fun things to do besides going to Disneyland. Then you have to reimagine your life with this new thing as the goal. Then you have to get up and try.

It really sucks.
posted by griselda at 2:13 PM on December 5, 2011

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