When Depression Hits the One You Love
Monday, October 12, 2009

By: Colette Dowling, LMSW

Little is more disconcerting than the peculiar twilight zone of a conversation with someone who's depressed. It can be like dangling expectantly at the top of a seesaw while the other person sits at the bottom, refusing to budge. You call out, you wave your arms, but there he sits, grim-faced and non-communicative. Why is he angry? You wonder if you've done something wrong, but there's also something infuriating about the situation.

"Whenever we talked I would get the feeling that I was disappointing John," said Ellen, a woman my daughter and I interviewed for our book, You Mean I Don't Have to Feel this Way?: New Help for Depression, Anxiety and Addiction. Ellen was describing her experience with her husband before she learned of his depression. "There would be these gaps in the conversation. I would try to fill them. I thought, 'Is it me? What's going on here?'"

Having not the least idea what was going on, Ellen felt guilty. She became anxious as she tried pumping up their flat discussions with her own energy. What bothered her most was the creepy sense that John knew what was going on--knew and took gratification from it. "I found myself feeling paranoid, as if he were manipulating this whole thing and as if I had no real leverage."

It's easy to feel victimized by a loved one who's depressed. In fact, John had little real sense of what Ellen was going through. He was too overwhelmed by his own state to be able to have much sensitivity toward others.

We've been taught to equate feeling sad with depression and believe that we could easily muster up some empathy for a friend or spouse who was feeling sad. But this is not the effect depressed people tend to have on us. They rarely seem sad. What they seem is down or dark or flat and feelingless. And we sometimes find ourselves feeling quite annoyed--as if they were doing something to us.

Depression is more akin to emotional limbo, as if all feelings were on hold. Even people who cry a lot will say they don't feel sad. What they feel is empty. And this empty state is baffling to others, who wonder why they are beginning to feel empty.

What becomes very apparent in someone who's depressed is lack of interest. There is no curiosity. Nothing excites. The person doesn't seem to be taking in much from the world around him or her. This bland insularity can come across as a kind of criticalness. A friend who was visiting for the weekend seemed strangely aloof. She seemed not to be initiating conversations but only responding, and not with much enthusiasm. "What's wrong?" I said. "Oh, nothing," she replied. She said she was going out into the backyard to get some sun, but she continued to sit in the shade, thumbing listlessly through a newspaper. I suggested going to a play but she declined, commenting that she didn't like the playwright. A group of African musicians playing at a local club seemed to spark a little interest, but when we arrived, something about the place turned her off and she wanted to leave. I found myself growing desperate to produce something that would excite her when it occurred to me, suddenly, "She's depressed!" I'd spent three days on the up end of the seesaw waiting for some movement on her part before I figured out what the problem was.

Depression, in someone we're close to, pushes all our buttons. We feel criticized and become annoyed. In conversation, it is we who have to do all the work. And there's that maddening lack of facial expression--"le masque," the French call it, and it seems precisely right. That immobile face seems to take some dark delight in refusing us a response.

It's easy to feel manipulated by someone who's depressed, but the mood-disordered person isn't trying to push anyone's buttons. He's closed up and incommunicative because his brain chemistry isn't functioning properly. When we feel upset by him, it may be because of our own needs. Instead of accepting that our depressed friend is incapable of good conversation, we scurry and perform, trying to get the response that makes us feel comfortable. When that doesn't happen we feel disregarded, even abused.

It's best, while this illness prevails, not to expect too much from the suffering individual. Others may need to assume responsibility. Depression is an illness that can leave its victim unable to seek help. When this is the case, others must take over. Later, when the patient is feeling better, he or she can begin to take responsibility again.

Perhaps the most important thing family and friends can do is encourage the depressed individual to get treatment. The very nature of depression--its feelings of hopelessness and worthlessness--can make those it afflicts too immobilized to take the steps required to get better. This makes them feel even worse.

When symptoms linger--even if there seems to be an event that triggered them--help is needed, and the caring friend or relative should seek out a professional. I've offered to get referrals and make appointments for others. With one friend, I went along to the doctor and waited in the waiting room. Those who are depressed, I've found, are grateful for an offer of help. On some level, they know they need it.

As a psychotherapist, I can assure you that depression destroys self-esteem and confidence. Family and friends can help the depressed person feel worthwhile by providing love, support, and encouragement. It isn't always easy to know the best way to do this, however. The first thing is to try to maintain as normal a relationship as possible. It's important to spend time with the person and not accede to his or her wish to withdraw. Telephone frequently and don't be satisfied with leaving a message on the answering machine. The idea is to try to get the person to engage with you, not just let him or her know that you're concerned.

It's helpful to acknowledge that your friend or loved one is suffering and in pain. It isn't helpful to say, "I know just how you feel." You may not know how the person feels, especially if you haven't been there yourself--and even if you have, the person may believe you couldn't possibly know how terrible it feels. On the other hand, you may say, "I know depression is an illness that makes people feel really terrible. I'm so sorry this is happening to you, but there's treatment available that can help you to feel better again." Communicating your conviction that help is available and that the person will feel better is extremely important. The depressed person's self-doubt spills over into pessimism about things ever being any different. You have to try to push through that pessimism. Of course, optimism can't be faked. If you need reassurance, speak to the psychiatrist or therapist you're thinking of recommending to your loved one. Then you'll be in a position to say, with conviction, "I think this person can really help you."

There is no time like now for kind words and compliments, even if they seem to fall on deaf ears. Remember, this is an illness that diminishes people's ability to respond. So don't expect the usual reactions; just keep offering encouragement and kindness and ignore the feeling that you're dropping your pennies into a bottomless barrel. Your caring is getting through.

Again, and this may seem obvious, express your affection openly. Show that you value and respect the depressed person. This is something that needs to be verbalized because the illness is preventing them from feeling good about themselves. The idea is not, "How could you feel so low when you've tallied up so many accomplishments?" That may be the very question he's asking himself. The point is, he does feel low. He needs you to remind him that this horrible mood is separate from who he is, his accomplishments, his character. Feeling rotten about himself is a symptom that will go away, like a fever in the night, once he gets treatment.

It's important not to do anything that will exacerbate your friend's poor self-image. Refrain from criticizing or voicing disapproval. Believe me, you may be tempted, particularly if it's a spouse or child who's ill. Messy disorder and even personal slovenliness are a hallmark of this illness. Curtail any desire you may have to say, "Darling, your hair is filthy." Or, "Can't you do something about that room?" Instead, you might say, "Let's go to the hairdresser together." Or, "How would you like it if I gave you a massage and a shampoo?" Or, "I know you haven't had the energy to clean. I'd like to clean for you."

The bottom line is to do whatever you can to help your friend or loved one feel better, and to be firm in your conviction that the illness can be treated.

Author : Colette Dowling, LMSW