How to Deal With Someone's Clinical Depression
April 19, 2012 8:09 AM   Subscribe

After I blew it, how do I now help a clinically depressed good friend who prematurely ended treatment that was working?

I have a friend ("they/them") who has suffered extreme, extended bouts of clinical depression that required electric shock therapy in the past, serious meds, and hospitalization. Over several decades I've been able to support this friend just by showing up regularly as part of the swat team of friends they've needed on site so they wouldn't kill themselves, and to assist exhausted family members.

Always, I just knew to listen to their "crazy talk" without ever denying that these thoughts were as real to them as the color of their eyes. The most I would offer were words about change, e.g. "Nothing stays the same, even this." As part of the help team, I gently guided this person to eat and to get outside even though they didn't want to do anything but sleep. I wrestled with what to say about ECT and meds because this person is an alternative treatment believer big-time, and the conventional treatments are brutal. However, they were the only things that worked, so that put me on "that side" since they know I'm an evidence-based person as is pretty much everyone on the swat team.

Eventually, the episodes would end, the dawn came, and this charismatic, creative wonderful spirit emerged from the cave like a colorful butterfly. The rest of us were grateful, but exhausted, especially family members who had to hear that it wasn't the "bad" Western treatments that ended the depression but this or that potion, expensive quack, etc. Maybe it was all of the above.

Anyway said friend had the longest, most awful bout of depression last year, which lasted six months. Finally, they agreed to some new meds, which seemed to have started working within a few weeks. Whatever it was, the friend stopped taking them. "I feel so great, I don't need them," while the rest of us looked at each other askance. Within weeks, another profound crash followed. The friend blamed everything but the premature cessation of the conventional treatment.

I said nothing about this unwise decision during a recent, difficult conversation. However, I let my squelched frustration out in other ways. Instead of just listening as in the past, I tried to talk them out of their own feelings, using reason and my ingrained practicality to "get them to see" the irrational things they were saying and thinking.

I hate myself for this. I have since apologized. Understandlably, they are now on the defensive, trying to explain, via e-mails since I'm not nearby this time, why their thoughts are rational. Yes, they are . . . to them. This is what they feel. I have to honor that, but I'm faking it. I'm faking it while I listen to the new quack therapies they want to try.

What can I say or do from now on to regain this person's trust in me while they are still depressed? They want to call me to explain how they feel. How do I respond to their paranoia and guilt without the impatience I exhibited? How do I deal with their complaints about (actually stalwart, patient) family members and helpers who aren't helping, according to this very, very depressed person? I usually just say: "Being a caregiver is tough. They're doing their best."

If you've suffered such profound depression, tell me what to say and how to proceed kindly and helpfully.
posted by anonymous to Health & Fitness (6 answers total) 3 users marked this as a favorite
First, be kind to yourself. It sounds like you have been through a lot and you are not a bad person for feeling the way you feel.

Can you consider that patience and kindness toward people who are in the throes of unreal experiences, while certainly noble and good, are not infinite resources? Can you let it be okay that you, a human with your own life and needs and wants and expectations for friendship, sometimes get frustrated with someone -- even though they have a mental illness that is not their fault*?

Consider that maybe you needed to set some kind of a boundary with your friend, and you've been ignoring that need for a while now, and so in a moment of weakness, you didn't set the boundary mindfully, patiently and kindly, but instead set it in haste? That it is the manner in which you set the boundary which you regret, but not the fact of it? Maybe you acted out of your own needs, and it is perfectly okay of you to do so.

I'm hearing, from your description of the situation, an awful lot about how you, and your circle of friends, and your depressed friend's family, have to go out of their way to help this person. I'm not hearing a lot, at all, either about how this person is helping themself**, or about how your relationship with this person is a two-way street.

I don't know your friend, I don't know what they are like when they are in the throes of their depression. I do think that sometimes, just going along with what someone says when they are in the grip of their worst side may not be the best thing for them. Especially if they are already inclined to paranoia. It sounds like there are times when your friend says that something is the case, and all of you nod and say, "sure, that's true" and then communicate to one another with all of your body language that you absolutely don't think that's true at all. Consider what effect that might have on someone who is already paranoid. Consider that, by pretending to be patient when you aren't, you may in fact be feeding the paranoia.

Maybe, in order to earn this person's trust back, you need to be honest with them instead of just yessing them when they say things that you know aren't true. You don't have to confront them with their wrongness, you can use a lot of I-statements ("I don't see it that way, I don't think that's how it is. I know you see it differently but this is how I see it") and even say things like "I don't want to get into a big discussion about this. We disagree and that's fine." Maybe they can trust you to be honest with them and to have their best interests at heart. Or maybe they can't. Maybe they don't want people who have their best interests at heart but instead they want people who are going to cater to their mental illness the way it sounds like they have catered to it over the years. It is okay if what they want is not something you will provide to them.

Really, this sounds like an awful and difficult situation and I hope you can get some support for all that you have been through. It's possible that the support you need may come from having some distance from your friend. That distance doesn't have to be permanent, either. It just sounds like you're in a sick system right now and it might not be the most important thing for you to work to regain your friend's trust right away. Take care of yourself.

Good luck.

* How they're choosing to treat or not treat their condition is something for which they certainly do bear a certain amount of responsibility, and I don't really see that responsibility in your description of your friend.

** Indeed, you're describing someone who is repeatedly and actively choosing to obstruct their own treatment. I know it's complicated. It really is. But also, your friend is making it more complicated than maybe it needs to be.
posted by gauche at 8:59 AM on April 19, 2012 [10 favorites]

Understandlably, they are now on the defensive, trying to explain, via e-mails since I'm not nearby this time, why their thoughts are rational. Yes, they are . . . to them. This is what they feel. I have to honor that...

Sounds like both of you are confusing thoughts with feelings. they are distinctly different. Yes, she may be able to relate what she feels accurately. That's a good thing. But her thought processes are screwed up badly. She needs to be aware of the distinction in order to get past being blocked by those crazy feelings. If she is unable to distinguish thinking from feeling, she will not change long term.

Please don't patronize her by validating crazy thinking. Validate her actual're right, they are real, it's what she feels. But do not let crazy thinking and reasoning go unchallenged. It doesn't help her. Has it worked to get her real change yet?

And yes, I have suffered profound depression. I came out the other side years ago with the help of a good therapist and medication. I don't believe I will ever be there again.

Good luck.
posted by txmon at 9:01 AM on April 19, 2012

Supporting someone with profound depression is exhausting, frustrating, depleting, and scary. You sound like a stand-up friend. I've been on both sides of this one. It's tough.

When I was profoundly depressed, one of the worst parts was dealing with the loss of rational thought and perspective. Having friends like you to gently check my head was a lifesaver. I needed people to help me talk back to the irrational thoughts.

It was also helpful to have friends gently set limits, and help guide me away from having our conversations be all about my problems. It was absolutely OK to have someone say, "OK, look , I'm getting a little burned out here. I love you, you know I'm here for you. Let's talk about something else for a bit."

The way you're handling your friend's complaints re: their caregivers is tactful. Setting limits here again would've been fine with me when I was down: "I know you're frustrated with your progress, but these people love you and are doing their best. They're on your side."

Really, you sound thoughtful and supportive, and I don't see that you did anything you should be hating yourself for. You're allowed to not walk on eggshells, to question your friend with respect and kindness, and to take care of yourself while you are taking care of your friend. Leave the heavy lifting for the therapists.
posted by quivering_fantods at 9:08 AM on April 19, 2012 [1 favorite]

"Being a caregiver is tough. They're doing their best."

Just to follow up, it is not at all inappropriate for you to show yourself the same compassion that you show others in your situation. Being a caregiver is tough. You are doing your best.
posted by gauche at 9:30 AM on April 19, 2012 [2 favorites]

Maybe instead of doing a back and forth with them about them explaining their rational, you could express your past agreement with them (as you were always agreeing), but tell them you are NOW starting to think differently. So they don't see it so much as a betrayal of trust, rather a change in your viewpoint. That way it's not so much a flat wall in front of you, but a curved one, where there can be a bit of movement.

And it sounds like you are doing great, btw.
posted by Vaike at 10:11 AM on April 19, 2012

Yeah, like txmon said, it's important to distinguish between thoughts and feelings... it's not clear to me whether you were invalidating your friend's feelings (saying that they shouldn't feel the way they do) or trying to argue against their thoughts or beliefs. I mean, even if you were invalidating their feelings out of frustration, you still shouldn't hate yourself for it, none of us can act in an ideal manner all the time, and you've been dealing with a ton of really difficult stuff with this person, so it's totally understandable. And if you were just arguing against the accuracy of their irrational beliefs, while that might not be the wisest way to go about it, there's nothing terrible about trying to tell someone the truth as you see it.

It's really hard to deal with someone who's thinking and acting in ways that seem irrational to you without ever challenging anything they say (especially when you care about them and see how their irrational beliefs are hurting them)... it's understandable that that's frustrating to you. And it's not necessarily in their best interest either. While it's really important to validate their feelings, and it's probably not helpful to try to argue them out of their irrational thoughts and beliefs, that doesn't mean you need to pretend that you agree, either. You can gently present your view of the truth and maybe that will keep you from getting so frustrated from bottling it up. If they take issue with your statement, you don't need to argue, just keep saying things along the lines of "Well, that's just how I see it, anyway. But I understand that you see it differently, and maybe you're right, but let's just agree to disagree. "

Here is some information about a three-step process called SET, which stands for Support, Empathy, Truth.

Anyway, it sounds like you've been working incredibly hard and doing a really good job caring for this person for such a long time. Please don't be so hard on yourself for occasionally not living up to exactly how you'd like to act. You're human, don't expect yourself to be super-human!
posted by EmilyClimbs at 12:59 PM on April 19, 2012

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