February 2006

When Someone Close to You Has Depression

'I can't get through to you!'  

This is the desperate cry of someone who's trying to care for a person who's depressed - a lover, a child, a parent, a friend. The one who's caring reaches out to hold and comfort the person who's suffering the torments of depression, and what she finds is the wall, invisible but unyielding and impenetrable, that surrounds the person she loves. Psychiatrists say that depression is an illness, but why should an ill person resist all help and exclude all love? 

When we're physically ill we try to get better. Some people might want to stay ill to get compensation for an injury or to avoid doing something they don't want to do, but usually we seek help and act on the advice we are given. But try to help a depressed person and you walk straight into a wall. You suggest they see a doctor, and they refuse. You suggest a walk in the sunshine, a nice meal, something to cheer them up, and the person is mute or else proceeds to show you what an idiot you are for suggesting such a stupid thing. If you press them, they turn on you and say horrible things and you can't help feeling hurt. You try to give them a hug, but they go rigid or else, worse, push you away. Then some visitors arrive and the depressed person either races into his room and slams the door, or suddenly becomes his usual social self, but only until the visitors leave and he sinks back into silence and doesn't answer when you speak. 

Alice found it hard to contain her anger when Julian would chat to visitors but not to her. However, one day she noticed his face just when the doorbell rang. He looked stricken, but then his effort to compose his features into a welcoming smile was clearly visible. Depressed people often put on a face to face the day. 

You know that the person is suffering and you want to help, but you find yourself becoming increasingly frustrated. Naturally your frustration turns to anger. You push the thought, 'Pull yourself together!' from your mind, but now you feel guilty for being so unkind. Guilt is fear of punishment, but along with that comes another kind of fear, the fear that you aren't the person you thought yourself to be. You always thought of yourself as being helpful and competent but now the depressed person is showing you that you're useless. When he does talk, he talks about how terrible the world is, how hurtful and untrustworthy people are. You find yourself agreeing, and with that comes the fear that you too are sinking into a mire of despair.

Tessa always prided herself on her capacity for being sympathetic and helpful. She was sure that she could help her friend Carol over her depression, but somehow everything she suggested to Carol seemed to get thrown back in her face. Tessa alternated between feeling annoyed with Carol and feeling useless. She started to worry that that Carol was dragging her down. 

This is what most people feel when they're with a depressed person. I've run workshops on depression in countries around the world and with all kinds of different people. I always ask them, 'How do you feel when you're with a depressed person?' and even the ones who are trained therapists describe the reaction I've described here. This process is quite different from what we feel when we're with someone with a physical illness, and it shows that we all know that depression isn't a physical illness. 

To understand just what depression is we need to understand something important about ourselves. 

­The Sense of Being a Person 

What you call 'I', 'me', 'myself' is your sense of being a person. It's made up of your ideas about who you are, what you life was, is, and will be, and what the world is. For you to feel secure all these ideas have to be a fairly good reflection of what is actually going on. Alas, sometimes we encounter a terrible disaster and discover that we've made a major error. Can you bear to remember how you felt that moment when you discovered that your life wasn't what you thought it was? Perhaps you found that the most important person in your life had died, or had betrayed you. Perhaps the career where you were so confident you'd achieve was no longer open to you. Perhaps you'd grown up believing that if you're good nothing bad can happen to you, and one day something bad happened to you. Can you bear to remember how you started to feel yourself falling apart, crumbling, even disappearing? Of course what was falling apart were your ideas, but it felt like it was your very self which was shattering. You were utterly terrified.  

If you value yourself and have lots of self-confidence, in this situation you can say to yourself, 'This is terrible but I've got through bad experiences in the past and I'll get through this one.' But if you don't value yourself and feel completely helpless you find yourself in danger of being annihilated as a person. It will be that you don't exist, have never existed. You're utterly terrified. You cast around for something that will save you, for some explanation that will put you and everything back together again. If you've been brought up to be a good person, that is, to believe that as you are you're not good enough and you have to work hard to be good, you know that to be good you must blame yourself for everything that goes wrong. So you say to yourself, 'It's my fault this disaster happened.' Everything falls back into place. You're safe. Safe in the prison of depression. 

When you blame yourself for the disaster that has befallen you, you turn against yourself and hate yourself. Immediately you become frightened of other people who will see how bad you are and punish you. So you cut yourself off from other people. You look to your past and all you see there is evidence of how bad you've always been. There's no comfort there, so you cut yourself off from your past. You look to your future and all that lies there is punishment for your wickedness. You have to cut yourself off from society and from nature because you are too wicked to be part of them. You've cut yourself off from every aspect of your life. This is what depression is, being alone in a prison. You've created your prison unconsciously and swiftly. 

Every depressed person has their own image of the prison. It may be a deep pit, an endless black tunnel, a dungeon without a key, an infinite desert, many images but all with the same meaning, the person is alone in a prison whose walls exclude all love and comfort. 

Jim had no time for 'soul searching'. He believed that if you were decent, kind and honest and did a good job you'd have a successful life. Then the firm he worked for went bust and there was no money for redundancy payments. All his friends assured him he'd find another job, but Jim couldn't get himself together. His world had fallen apart. He couldn't help believing that it was all his fault. If he'd worked harder, seen what was happening, he could have prevented what had happened. Then he started to think that he'd gone mad. There was a glass wall all around him, not clear glass but all smeary. He could see vague figures outside the glass. They were waving, trying to talk to him, but their voices came through as a murmur. It was horrible, yet somehow it was safe. 

Depressed people will admit that, terrible though their prison is, they don't want to leave it because they feel safe there. The prison is a defence which holds the person together until he can feel strong enough to face the turmoil that lies outside. This is why it's a waste of your time to offer help other than loving support until the person is ready to change and find their way out of their prison. In her wonderful book Sunbathing in the Rain the poet Gwyneth Lewis told the story of how she became depressed and how she discovered that depression is a defence which can heal, if only we are wise enough to let it. Gwyneth wrote, 'My mind and body had delivered me a breathing space which I would never consciously have permitted myself. They had given me a chance to relinquish old ideas and experiences which had been exhausting me and time to adjust to the new facts about my life.' She went on, 'Depression is a very kind disorder, and will return only if you refuse to learn the lessons it has to teach you.' Long term research shows that people treated only with antidepressants are very likely to continue to have periods of depression but people who are able to work out, perhaps with the aid of a counsellor, how their ideas had led them, as Jim's did, into the prison of depression they are able to change their ideas and not get depressed again.  

When Jim managed to give up his cherished belief that if you're good nothing bad can happen to you and he accepted that we live in a world where things happen by chance, he left the prison of depression forever. He decided to be good because it pleased him to be good and not because he expected the mythical reward of being safe. 

Every depressed person has suffered a loss. It may be a loss which others can see, or it may be a very private loss. The lesson which depression teaches is that you have to acknowledge and accept your loss. 

How to Help 

Don't say, 'Pull yourself together' or 'snap out of it.' If the depressed person could, he would. Don't use 'tough love' or challenge the person's thoughts and actions. He's busy punishing himself. He doesn't need you to join in. 

Don't try to take the person's depression away. The depression is a defence which the person will hang on to until he feels he's strong enough to face the chaos outside the prison. Accept that being depressed is what the person needs to do.  

Be there ready to talk if the person wants to talk, be silent when he wants to be silent. Giving advice is a waste of time, but you can ask, 'Would you like to go for a walk?' If he does accept don't say, 'Why couldn't you do this yesterday?' 

Depression prevents the immune system from working properly and as a result depressed people often become physically ill. Make sure that the person has access to a healthy, ordinary diet but don't kid yourself that some special diet will make him better. The person has to start to care about himself before he can seek the benefits of good food and exercise.

A depressed person will not seek help until he reaches a point where he cannot bear to be depressed any longer. One person told me, 'I got so low the only way was up.' Another said, 'I couldn't stand the pain any longer,' and another, 'I just got so bored I had to change.' 

Accept that if the person does learn from his depression and not get depressed again he'll no longer be the same person he was before. If he changes are you prepared to change in ways which you can't predict? Loved ones can keep a depressed person depressed because they aren't prepared to let him change. 

When the depressed person wants to talk, be prepared to talk things over, even if you find the things he wants to talk about challenge your way of thinking. It may be your relationship which you need to discuss. If it's a sibling or a parent who is depressed the person may not want to raise certain matters which he feels would worry you. Talking to a stranger is often better than talking to a loved one. 

A cognitive therapist can help a person to look critically at the way he habitually thinks, but often the person needs explore his childhood with a therapist and consider the conclusions he drew as a child but has never reassessed. For instance, small children often blame themselves when a parent dies or an adult sexually or physically abuses them.

Looking After Yourself 

You can feel very lonely when you're looking after someone who's depressed. At times you'll feel drained and tired. Don't spend all your time with the depressed person. Go out, enjoy yourself, rest and recuperate. 

Gwyneth Lewis advised, 'No one has the right to tell another human being how they should feel. However, if that person is taking it out on you, being critical, vicious, blaming you for what isn't your fault, they should be called to account.' 'Tough love' doesn't help, but do say firmly to the person, 'I can accept your feelings but I can't accept being spoken to in that way. You must not take your bad feelings out on me.' When Julian Clary was talking to Sue Lawley on Desert Island Discs he told her how he at first couldn't handle his success because he believed he didn't deserve to be successful. He became depressed and behaved very badly. He said that when he told his agent that he wouldn't travel in a maroon limo his agent should have said to him, 'Don't be silly,' but, alas, the agent didn't.  

Don't feel that you are responsible for making the person better. To leave the prison of depression the person has to go on a journey of self-discovery. All you need to do is be a good companion on the journey.  

Dorothy Rowe Depression: The Way Out of Your Prison Routledge, third edition.

How to Help Someone Who Is Depressed.

Accept that the person is depressed and know that eventually this will come to an end.

1. Don't give advice but sometimes say, 'Would you like to . . . ?'
2. Try to show through your actions as well as your words that you value the person.
3. Accept the person's feelings but be firm if he behaves badly.
4. Accept that to end this depression the person has to change, and so you'll also have to change.  

How to Help Yourself When Someone Close to You Is Depressed.

1. Remember that your job is not to cure the person but to give support in the hope that the person will decide to change.
2. Try not to take it personally when the person
   1. Shuts you out
   2. Pulls away from your embrace
   3. Is rude and angry with you
   4. When visitors come the person either hides in his room or seemingly cheers up, chats to the visitors, and sinks back into silence when they leave
3. Accept help from others so you can have time to yourself and mix with cheerful people.
4. Remember that if you don't look after yourself you won't be able to look after anyone else.

www.psychologies.co.uk