Caring, Supportive
Relationships
A major problem in helping a relative or friend through depression is a lack of knowledge about the subject, as well as a lack of sensitivity. If you're a "helper" to such a person, reading the previous chapters should give you a good deal of insight into how to support that individual. An accurate understanding of the nature and causes of depression is essential to helping someone who is depressed.
The material in this chapter is specifically presented to guide helpers as they seek to give the most effective understanding and support possible to a depressed friend or spouse. It is not designed to take the place of professional help, simply to make you a wiser and more empathetic helper. If you're in close contact with a depressed person, you'll be an important part of the healing process whether you want to be or not.
This chapter has two broad divisions. The first section deals with general questions and answers that apply to anyone you would like to help — friends or family members. The second section relates specifically to helping family members. For information about helping depressed children and adolescents, read chapter 4.
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DO DEPRESSED PEOPLE WANT TO TALK ABOUT THEIR DEPRESSION?
Very much so, but they don't want to talk to just anybody. They want to talk to someone who will understand and not judge them.
When people are depressed, they're very sensitive to relationships. There may be factors in your relationship that keep the depressed person from exposing too much of his or her inner feelings to you. Sometimes the very closeness of a relationship makes the person uncomfortable with discussing problems. Don't take this personally.
Talking about the depression often results in a sense of relief for the depressed person. Perhaps he or she hasn't yet recognized there's a problem. Or if he or she has recognized it, your being willing to listen at least gets it out in the open. That clears the air and helps communication on the whole depression.
SHOULD YOU LEAVE A DEPRESSED PERSON ALONE FOR A WHILE BEFORE YOU OFFER HELP?
The help should come right at the beginning. It's easier to get involved earlier rather than later. Remember that depression saps energy and self-esteem, and it interferes with a person's ability or wish to get help. If someone you know shows symptoms of depression but hasn't talked to you about it, show your love and concern by drawing that person aside and gently encouraging him or her to talk to you. Often there's a sense of relief when someone approaches and says, "I can see you're hurting. Why don't you discuss it with me so we can be in this together?" That's all we need sometimes to take the first step toward getting help.
The nature of the help you can offer may change through the different phases of the depression, but the help should always be there, assuming you have the proper rapport with the person. If he or she is a stranger or a distant friend, you should realize you haven't yet earned the right to become involved.
HOW CAN I CATCH THE WARNING SIGNS OF DEPRESSION IN SOMEONE EARLY ENOUGH TO PREVENT IT?
It's difficult to catch depression early, because it usually comes on rapidly. By the time you see it, it's fully developed. Reactive depressions, and especially serious psychotic depressions, sometimes come on in a matter of hours, certainly in a few days. You must avoid feeling a failure because you couldn't prevent the depression. If some loss has occurred, the person needs to be depressed. The depression
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will come despite your best intentions. What you do during the depression is much more important than trying to prevent or abort it.
WHEN A DEPRESSED PERSON IS RETREATING FROM EVERYONE ELSE, SHOULD I ATTEMPT TO PUSH FOR A CONTACT?
The word push is too strong, but you do need to be "assertive" in moving toward him or her. You must make the first approach. If you push too strongly, you'll cause resistance. "Gentle nudging" would perhaps be more appropriate than the idea of pushing. But be prepared for some rejection, and keep coming back.
IN MY FIRST CONTACT WITH A DEPRESSED PERSON, WHAT SHOULD I CONCENTRATE ON?
The most important thing is to communicate understanding and acceptance. The person's encounter with most people will lead him to believe his depression is not acceptable, that he should feel guilty about being depressed, and that he should not really be depressed at all. You need to send is, "It's all right for you to show your depression to me. It's okay for you to be depressed. Help me understand why you're depressed." This starts an important process toward the healing of the depression.
WHAT'S THE MOST IMPORTANT THING I CAN DO FOR MY DEPRESSED FRIEND OR SPOUSE?
Again, I cannot stress strongly enough the importance of communicating love and acceptance and of avoiding being judgmental.
I'm not saying that being accepting is easy. We have a lot of difficulty accepting someone who is depressed, because we fear the depression will rub off on us or make us feel uncomfortable. But when you are close to a depressed person, you have to accept the reality of the problem. It's there whether you like it or not, and your responsibility is to communicate love and acceptance in whatever way you possibly can.
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HOW DO I STRIKE A BALANCE BETWEEN EMPATHY, SYMPATHY, REASSURANCE, AND CONFRONTATION IN RELATING TO SOMEONE WHO IS DEPRESSED?
I seldom see confrontation as helpful. Sometimes it must be done, but only rarely. I prefer reflecting rather than confronting. In reflecting, you hold up a mirror so feelings can be recognized and accepted by the person.
You can do this effectively by using clarifying questions. Rather than saying, "Well, you're angry, and that's why you're depressed; just get rid of your anger and you won't be depressed anymore," you can say, "Don't you think there might be a large amount of anger in what you feel? Tell me about this anger." By approaching it this way, you are recognizing that the person's emotions are not always deliberate, that he or she might not intend to be angry, self-pitying, or whatever, even though that's the case. This gives your friend a chance to own up to and accept those emotions rather than build up resistance to judgmental confrontations.
Empathy, the communication of understanding and acceptance, is the most helpful attitude. Give reassurance: "Although I can't personally experience your depression, I'm in this with you. I'm not going to leave you alone. I won't abandon you." That's what you need to convey.
IS THERE ANY PLACE FOR CONFRONTATION IN THIS KIND OF RELATIONSHIP?
Obviously, there is a place for confrontation in real relationships. But I would caution against confrontation as a general style. Most times it is damaging, because it's usually done with an element of anger and frustration. How can you, an outsider, confront when you don't know all the details? You only see your side of the issue. We want to rush in because something looks so obvious from our perspective, but we don't always understand the full context. It is far better to hold back and first try to be understanding. That earns you the right to confront later.
A qualified exception would be during the recovery phase of the depression, as I've mentioned before. Then a low-key confrontation, a gentle prodding and pushing, may be helpful.
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SHOULD I BE SYMPATHETIC AND TRY TO ENTER THE DEPRESSED PERSON'S MOOD, OR SHOULD I TRY TO CHEER HIM OR HER UP?
The key word again is empathy. Don't be too sympathetic. Don't enter the individual's mood to the extent that you begin to feel depressed yourself. That doesn't help you or the other person. But do communicate understanding and acceptance. He or she wants someone who can see the loss from his or her perspective and in that context give reassurance.
Don't give advice, whatever you do. Some people feel they haven't done anything helpful unless they've given advice. Don't criticize. Be prepared to listen, and be determined to understand what the person is feeling.
WHY DO WE SEEM TO HAVE THE NEED, AS SUPPORTIVE FRIENDS AND RELATIVES, TO GIVE ADVICE?
As friends and loved ones, we want to be helpful, so we resort to advice giving. This approach is based on the erroneous idea that our friends or relatives have no reason to be depressed. There's always a reason for depression. I'm not suggesting that all depression is appropriate, but if we grant people the right to be depressed when it is, we can relieve a lot of our anxiety and be more supportive.
SHOULD I TRY TO TALK A DEPRESSED PERSON OUT OF HIS OR HER DEPRESSION?
Whatever else you do, do not try to talk the person out of being depressed. It's common for someone who is depressed and who reveals these feelings to someone else to get a response that says something like, "Come on now. You don't have any reason to be depressed. Why don't you just shake yourself out of it and forget about your feelings?" Such statements are callous and unfeeling. They only make the depressed person feel worse.
HOW MUCH DOES IT HELP TO "IDENTIFY" WITH A PERSON WHO IS DEPRESSED?
The reason many people pull away when they're depressed is that they fear others will not identify with them in their depression. They think others won't accept them in their depressed state (very much like the withdrawal of many cancer patients when their disease or treatment causes changes in their bodies). It's not so much that they want to be alone, but they want to avoid being with
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people who won't accept their depression. It's really a protective move on their part. The more you can identify with someone else's depression, without becoming depressed yourself, the greater help you can be.
WHEN THE BIBLE SAYS "WEEP WITH THOSE WHO WEEP," DOES IT MEAN I SHOULD TRY TO SHARE THEIR FEELINGS OF DEPRESSION?
It doesn't mean you should also become depressed. That verse (Romans 12:15) is a call to understanding, not to taking on another person's pain. For some reason, our guilt mechanisms won't allow us to be supportive and understanding to a depressed person without wanting to become depressed with them. This is one of the reasons we avoid depressed people. Our proneness to sympathy triggers the same pain in us.
In "weeping with those who weep," remember that while you may share their feelings, and may indeed weep because they're in pain, you're only going to aggravate their depression if you become depressed as well. You must get involved with their feelings but retain an objective understanding.
Keep in mind that this is their depression, not yours. And you are not Christ. Only He suffered for us and bore our sicknesses on the cross. The best you can do is try to understand.
SHOULD I HELP SOMEONE WHO IS DEPRESSED TO CONCENTRATE ON IDENTIFYING THE LOSS, OR SHOULD I JUST BE AN IMPARTIAL LISTENER?
It's important that the depressed person identify the loss. In providing a listening ear, you can help him or her communicate this loss and develop some understanding of the events that caused it. The key to most good therapy is to help a client discover what's causing the problem, because when that discovery is made it's so much more meaningful and so much easier to take the corrective steps.
Your role is to facilitate the discovery of the loss or the understanding of the disturbed physiology. Of course, if you see something obvious that's being overlooked, you should present this to the person. In doing that, present it in the form of a question rather than a dogmatic statement. For instance, ask, "Do you think you are clinging to your past job because you're afraid you can't get another?" That's better than saying, "I think you're just afraid you'll never get another job."
Using a question lets the person reflect on it. If the notion is rejected, you can
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come back a little later and ask the question again. That way you can help him or her come to realize the significance of what you are suggesting.
IS THERE A PLACE FOR PROBING?
Active listening is the key technique here, not cross-questioning or probing. That means you are constantly checking out what you're hearing by reflecting it back to your friend in a process of clarification: "Now is this what you mean?" "Are you saying that having your spouse walk out on you represents this to you, or are you worried about what the children have lost rather than what you've lost?" In active listening, you are clarifying things for yourself, but more importantly, you're clarifying them for the other person.
BESIDES LISTENING, ARE THERE OTHER BASIC POINTS I SHOULD CONCENTRATE ON WHEN I'M TRYING TO BE SUPPORTIVE?
Beyond helping the depressed person identify the losses that have been suffered, or in the case of endogenous depression ensuring that the appropriate treatment is obtained, you can help in exploring the full implications of the loss. The person needs to get beyond the "global" reasons (I lost my job) to just what that means to him or her. There may be many associated losses such as the loss of self-respect or the respect of a parent, friend or spouse. Once the person has that more-complete awareness, he or she will be able to grieve all the losses fully and finally get on with life.
You also need to support the person's course of medication. Depressed people tend not to want to take their medication.
You need not be a professional counselor to do these things, but you may disqualify yourself as a helpful counselor if you become too personally and emotionally involved with the depression. If the person's loss triggers in you too many insecure feelings, you should back off. That's why, in our culture, it's more efficient and often more effective to get professional help.
WHAT IS THE SINGLE MOST DANGEROUS ERROR I CAN MAKE IN COUNSELING SOMEONE WHO IS DEPRESSED?
Making that person feel guilty about being depressed. On the other hand, if you're able to break the cycle of guilt, you'll go a long way toward alleviating and
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shortening a depression. We reduce guilt by repeatedly reassuring the depressed person that we understand and accept his or her state of mind. As long as we're consistent in showing love and acceptance, we are not aggravating the depression.
HOW DO I RECOGNIZE SUICIDAL TENDENCIES IN A DEPRESSED PERSON?
It's not always easy, because if people are intending suicide, they often become secretive, withdraw, and won't talk to anyone. On the other hand, there's frequently a "cry for help" in some action. If they repeatedly talk about taking their lives and you don't pay attention, they can very easily do it.
Contrary to myth, it's not true that if a person talks about suicide, he or she won't do it. Many people who have committed suicide have talked about it for a long time before acting, and no one paid any attention. Many make statements such as, "I wish I were dead," "I can't take it anymore," "My family would be better off without me," or "I want out."
Some even tell a friend about a plan to kill themselves before they do it. If a friend or spouse talks like that, take it seriously. Immediate steps are necessary to prevent any further damage. If your friend or spouse wants to talk about suicide, by all means encourage him or her to do so. A depressed person needs the freedom to talk about those feelings.
If you feel a person is depressed but not talking about suicide, ask him or her to express thoughts about death. Watch for signs of secretiveness, hostility, or aggression. The suicidal person often has a lot of hostility that can't be expressed. Anything you can do to help the person talk about this anger will be helpful.
HOW CAN I BEGIN TO MOTIVATE SOMEONE WHO IS DEPRESSED?
The motivation, not surprisingly, comes out of this supportive relationship. Depressed people are not motivated to seek help, and the deeper the depression, the less they will seek it. The depression itself destroys motivation. Motivation is created and builds as they feel there is understanding and reassurance. When you make yourself available to listen in an understanding way, you begin to build motivation.
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HOW DO I RECOGNIZE THE TIME TO STOP LISTENING AND BEGIN TO GIVE POSITIVE SUGGESTIONS?
You never stop listening. The question should be, "When do I add some positive suggestions to my listening?" That depends on the severity of the depression and the stage at which you find the person. During the recovery phase, you can be a lot more assertive and directive. It's a safe time to do that. The mistake is attempting it in the early stages of the depression, when the person is not yet ready to respond.
It's not easy for a lay person to know exactly when the turning point occurs. One important clue is when the depression shows some little signs of lifting. Perhaps there are moments when the depression is not as intense, or the person may laugh for a moment. Now you can be a bit more positive and directive in what you say — but never stop listening.
WHAT CAN I DO TO SHORT-CIRCUIT A FRIEND OR RELATIVE'S DEPRESSION?
The notion of "short-circuiting" always implies that you do something to prevent the depressive process from running its full course. When you try to do that by, for instance, getting the person to immediately get a new cat to replace one that died, you invariably aggravate the depression.
In rare cases, you might make just the right comment to give the person the perspective he or she needs to resolve the depression before it gets too deep. But that would be more a matter of luck than skill. We shouldn't be so afraid of sadness. It plays an important role in developing maturity.
There are certainly no general rules I could give to help short-circuit a depression. A more important emphasis is to allow the sufferer the freedom to experience a full and appropriate depression. That's the quickest way to bring healing.
Love, acceptance, and understanding can work miracles to speed up our grief. An example of this is a couple who came to see me because of the husband's deep depression. As I worked with them, it became obvious that he had some legitimate reasons for his depressions. In treatment, all I did was help the wife to become more accepting and understanding of his losses. Within days, the man was out of his severe depression.
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You see, he suffered more than just the original loss. It had been compounded by the loss of his wife's love, acceptance, and understanding, which was perpetuating the depression. You can't go wrong by giving loving support.
IF I HAVEN'T EXPERIENCED SIGNIFICANT DEPRESSION MYSELF, DOES THAT DISQUALIFY ME FROM BEING EFFECTIVE AND SUPPORTIVE?
No, it doesn't, as long as it doesn't make you less understanding. Unfortunately, people who haven't experienced a major depression are not always understanding. If you've never experienced much pain, it's difficult to understand what it's like to be in a lot of pain. If you haven't experienced depression, it's hard to know what it is to be depressed. But being a good listener will quickly teach you, and it's the better way to learn.
IF I'VE HAD MY OWN DEPRESSION, SHOULD I DESCRIBE MY EXPERIENCES?
There are times when describing your own depression experiences can be helpful, but avoid doing so with an attitude of, "Well, I've been depressed, too, and it didn't affect me as much as it seems to affect you." You may think you are helping the other person by putting his or her experience in the perspective of your depression, but this self-glorifying approach only increases guilt and depression.
Discuss your experiences sensitively, always keeping the focus on the other person. An attitude of "We're all in the same boat" is helpful. What's important is to work at building rapport, where the depressed person feels he or she can open up to you in trust. You must establish a base of acceptance, which is granted by the depressed person, before you can begin describing your own past.
AM I IN DANGER OF BECOMING DEPRESSED AGAIN BY HELPING SOMEONE ELSE IN DEPRESSION?
Not at all. As I've mentioned several times, depression is not contagious in this sense. The particular reasons for your own depression may be quite different from those of the other person, so you're not likely to become depressed just by being helpful. If anything, you are likely to be more understanding and accepting of your own experiences. You do, of course, need to avoid becoming sympathetic. That could suck you down into depression. By remaining objective and reminding yourself that this is not your depression, you can avoid that pitfall.
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HOW DO I ENCOURAGE SOMEONE WHO IS DEPRESSED TO CONSULT A PROFESSIONAL THERAPIST?
If the person is not your spouse, you first need to consult with those closest to him or her — a spouse or significant close relative. You all need to be in agreement on what action should be recommended. It is far better if the direction comes from those closest to the depressed person. You could make the suggestion to them and encourage them to follow up on it.
If you're the closest person or there is no one but you, you need to come right out with it in a straightforward manner. Be sure to put it in the context of your love and care for your friend or relative; don't present it in a critical or judgmental way.
IS THERE A DANGER THAT THE DEPRESSED PERSON WILL BECOME ANGRY AT THE SUGGESTION?
That's a risk you have to take. If there is an angry response, you need to work through that anger together. Receive it — don't draw away or become offended. Engage the anger: "Well, why does it make you angry to have me caring for you this much? Is it because you don't realize how depressed you are?" In this way you can drain a lot of the anger and work it through to a point where he or she is ready to accept your suggestion.
CAN I HELP SOMEONE OVERCOME CONCERNS FROM THE PAST THAT ARE TRIGGERING DEPRESSION?
You can do a lot in this direction. You can't help your friend or spouse get over every problem, but there's much you can do to help him or her bear concerns more courageously. The early traumas of life tend to set us up with memories that can re-create, at some later time, all the painful feelings of those experiences. They then haunt us and often cause depression.
The most important thing you can do is to encourage the person to talk about them. The more he or she can do that, the more rapidly some perspective on these early events can develop. Just by discussing them with you, he or she may gain some fantastic insights and come to an "Aha!" experience. It all begins to fall into place then.
This listening is critical to helping someone overcome early traumas that may be bothering him or her. I once counseled a young woman who a year earlier had had an abortion. She came to consult me because she was severely depressed, but she didn't really know why. As I explored with her what was going on in her life,
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she began to think a lot about the abortion. She hadn't wanted it, but her husband had insisted. She realized it was wrong at the time, but to please her husband she had gone through with it, and now she regretted it.
As we talked and she said what had happened, she interjected, "You know what has suddenly occurred to me? There's nothing I can do to change that event from my past." Her face lit up. That idea freed her. By the end of the session, we had broken the back of her depression.
We can't change history, and we can't always just forget the past. But we can remove from our memories the power to re-create hurts in the present. It was this belief that freed her to give up her depression.
IF RE-CREATING EMOTIONS FROM THE PAST CAN LEAD TO DEPRESSION IN THE PRESENT, CAN WE TURN IT AROUND AND HELP A PERSON OUT OF DEPRESSION BY RE-CREATING PLEASANT EMOTIONS ASSOCIATED WITH THE PAST?
Yes, we can help by reminding depressed people of pleasant past experiences. But that's only helpful during the recovery phase of a depression. During the early phase, when they're still going into a depression, the depression distorts their outlook, including memory. By drawing attention to the good things in the past, we may just be accentuating their awareness of the bad things in the present.
Once they have started to recover and are beginning to show signs of normality, focusing on pleasant experiences and emotions from the past can help put things in a better perspective. By remembering what it's like to feel good, they begin to feel more hopeful.
HOW DO I HELP KEEP A DEPRESSED PERSON FROM TURNING TO ALCOHOL AS A WAY OF COMBATING DEPRESSION?
If proper treatment is being provided, there is little tendency for the individual to turn to alcohol. Alcohol is primarily a tranquilizer, used to alleviate anxiety. The depression itself does not make one prone to alcohol; it's the anxiety associated with the depression that causes it. So anything you can do to alleviate anxiety will help to reduce the need for alcohol. A minor tranquilizer could be given. But the best antidote for anxiety that I know is to be surrounded by loving, caring, and accepting families and friends.
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HOW CAN I BE POSITIVE IN MY CHRISTIAN INFLUENCE ON MY FRIEND OR SPOUSE WITHOUT APPEARING TO BE SUPERSPIRITUAL OR HOLIER-THAN-THOU?
Just be yourself. Don't put on spiritual airs or play the superior game. But there are certain values and perspectives that, as Christians, we have to remind each other of. It's the attitude with which we do this that avoids giving the impression we are superspiritual or holier-than-thous. The most positive thing we can do as Christians, and the most positive influence we can bring to bear, is captured in the concept of Christian love. If that's the context of your concern, you need not fear the reaction. You will fulfill your responsibilities as a Christian in a beneficial way.
IS THERE ANY EFFECTIVE WAY TO HELP AN AGED FRIEND OR RELATIVE COPE WITH DEPRESSION?
People who are nearing the end of life and who become depressed need two things above all else, structure and reassurance.
I use the term structure in a broad sense. When people reach old age, their memories don't function as well as before, so they need to know that everything is in its place. For an older man, it may be that in his workshop he needs to have his tools in the proper place, where he can put his hands on them easily. For a woman, it's knowing that a particular pan is always in its special place. This is needful physical structure.
Older folks also need structure psychologically. Make sure they have emotional and social structure. Don't change the pattern of things unnecessarily. Set up a regular routine. Often there's a desire to take a depressed elderly person out of his or her regular environment, but that often causes confusion.
Not long ago, I saw a well-meaning adult son insist that his aged and depressed mother come to live with him in California. She had lived all her life in the East. He thought the change of environment would help her. Needless to say, her depression got worse. When the son consulted with me, my first recommendation was to put her back in her structured and familiar environment. She is much more likely to be able to cope with her depression in that familiar structure than out of it.
The second thing an aged person needs is reassurance. The tendency to avoid depressed persons is accentuated when the person is older. This withdrawal and avoidance, especially by family members, will aggravate the depression. Give him or her reassurance. Provide as much love as you can show. This is essential for recovery; it prevents the development of other losses.
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CAN A HUSBAND EFFECTIVELY COUNSEL HIS WIFE, OR A WIFE HER HUSBAND?
Couples need to accept that there's a limit to what counseling can be done between spouses. You can't be everything to one another, and I encourage couples not to try counseling each other. Because of the intimate relationship between them, there is often too much personal and emotional investment in what the spouse is thinking or doing. You can't remain impartial and detached. Just accepting that limitation can go a long way toward avoiding the guilt of not being able to help. It also frees your spouse to seek counsel with someone else.
Having said that, I also realize much can be done by one spouse to help another. I find my own wife to be extremely helpful as a friend and confidante. And it gets better as you get older. As you build a mature relationship, your ability to help each other increases.
I'M FRUSTRATED IN TRYING TO FIND THE CAUSE OF MY WIFE'S DEPRESSION. SHOULD I KEEP PROBING?
Stay in a listening mode and you'll never make a mistake! You see, the depression may be endogenous, having a biochemical basis. That means there's no psychological cause. It may be an early symptom of an illness or a disease. If you keep probing too much, you may just cause more confusion. That will intensify the depression.
HOW MUCH IMPACT DOES MY REACTION TO MY SPOUSE'S DEPRESSION HAVE ON HIS OR HER OVERCOMING IT QUICKLY?
In the severe endogenous depressions, your reaction is not likely to have that much effect. The problem is more physiological, more internal to the individual. In the reactive depressions, however — especially in the recovery phases, where there's a lot of potential for a person to return to the depression — it can be harmful. I've known many instances where just getting the spouse to be more accepting of the depression has greatly helped the person to recover.
I recall a particular couple where the husband had been depressed for many months. His business wasn't doing well, so he was in a continuous state of loss and was depressed most of the time. He couldn't talk to his wife about his problems, because she had shut out communication to protect herself from becoming depressed. He didn't force the issue, as he didn't want her to become depressed, either. So he kept it all to himself. I was able to prepare her so she could receive
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what he wanted to say without becoming depressed. Just being able to share his problems with her helped to lift his depression.
The wonderful thing was that as soon as his depression lifted, he was able to do something about restoring his business. He had been caught in a vicious cycle. He wasn't doing effective sales work because of his depression, and that was hurting his business, so he became more depressed. Being able to share his depression with his wife and have her accept his feelings and cooperate with him freed him to be more effective in his work. As a result, he was able to get his business out of the low spot it had been in.
HOW CAN I COPE WITH THE FRUSTRATION OF NOT BEING ABLE TO HELP MY SPOUSE OUT OF HIS OR HER DEPRESSION?
You need to realize that helping your spouse is beyond your resources. You're disqualified from being helpful to some extent because of your relationship. In fact, you may be part of the cause of the depression, in which case you need to stand aside. Your anger and frustration will only increase your spouse's guilt at being depressed. A mate's role is primarily one of support. The main therapeutic work needs to be done by a professional.
SHOULD I GO AS FAR AS FORCING MY SPOUSE TO SEE A COUNSELOR?
In very severe depressions, the person won't want to seek help. You will need to exert control in such a situation. Of course you shouldn't resort to force until you've exhausted all other means of reasoning and persuasion. Point out that the depression is not only destructive to him or her, but to everyone around as well. Only if everything else fails should you use force to obtain professional help. If you consult a professional psychologist or psychiatrist, your legal rights to enforce treatment will be explained.
I FEEL A GROWING RESENTMENT OVER THE FACT THAT MY WIFE HAS TO TALK TO SOMEONE ELSE TO RESOLVE HER DEPRESSION.
I can understand that feeling. It seems like an intrusion into your privacy and the intimacy of your relationship. This feeling often arises because we feel we should be all things to our spouses, that we should be able to resolve all problems privately. Up to a point, we can. But a major depression is another matter.
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The resentment you feel may arise because of what you're saying to yourself: If I were the proper kind of husband (wife), I would be able to help him (her) more or Who can help her (him) better than I can? I know her (him) better than anyone else. You need to realize that the depression may be a symptom of an illness, or that the losses suffered are so severe that professional help is needed. Concentrate on giving love and being supportive and understanding.
HOW CAN I AVOID MAKING MY SPOUSE FEEL MORE GUILTY THAN HE OR SHE ALREADY FEELS?
The most important way is to be accepting of the depression. If you communicate any resistance to it, any feeling of being deprived as a result of it, you're going to increase the guilt. People who are depressed do not want to be (although paradoxically, if the depression lasts a long time, they find it difficult to give it up). If your spouse realizes his or her depression is causing you pain, the guilt will be intensified.
WHAT CHANGES IN HOUSEHOLD ROUTINE COULD EASE A DEPRESSION?
The change I would suggest is that you remove unnecessary responsibility. If it's the wife who is depressed, provide some help with the cooking, the housework, or in taking care of the children. You should modify the expectations of everyone in the house to avoid increasing the burden felt by the spouse. To demand full normal performance is totally unreasonable.
Other changes that can help include providing adequate stimulation to the spouse. He or she may be depressed because of lack of variety — nothing interesting or exciting is taking place. Provide a change of routine occasionally. Take your spouse to dinner, for example. That offers a change and removes responsibility as well.
SHOULD I SEEK TO KEEP THE HOUSE QUIET, OR SHOULD I LET THINGS RUN PRETTY MUCH AS USUAL?
Keep things as normal as you possibly can. To make too many adjustments may reinforce the depression by communicating to the depressed person that he or she is disrupting the normal routine. Maintaining routine will help to create a sense of safety and security.
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WILL THE RESPONSIBILITIES A SPOUSE FEELS BE ENOUGH TO ACTIVATE HIM OR HER?
No, they won't. The very depression that is the cause of the problem also distorts your spouse's perception of his or her responsibilities. This is especially true in severe depressions where, for example, a mother may not realize the responsibility she has toward her child who needs care. You must gently, lovingly and understandingly reason with your spouse to convince him or her to keep going.
HOW CAN I HELP MY SPOUSE GET GOING IN THE MORNING?
First, give lots of supportive love. Make sure you don't communicate any aggravation or irritation. Keep some pressure on by explaining clearly how important it is that he or she get up and get going. Give reasons for getting up. Don't assume that because you've said it once, it's understood. Remind your spouse again and again how important it is for him or her to get up, to keep going, to avoid letting his or her bodily system go down unnecessarily.
Don't demand anything, however. Don't invent things to be done. It only creates conflict. I know of some who set up games with their spouses by inventing things to do. The depressed spouse will see through this and resist it. The most important reason to give for getting up is that some energy, some activity, is important in helping the recovery period.
MY HUSBAND'S DEPRESSION IS PUTTING US IN A REAL FINANCIAL SQUEEZE. HOW CAN I COPE WITH THAT ON TOP OF EVERYTHING ELSE?
It's very disturbing when a depression drains the financial resources of a family. It creates more losses. What you need to do is seek assistance. Make sure you're getting all the help you can from your medical insurance and that the treating professional knows what's going on. Perhaps you need to change from an expensive therapist to a community-based clinic where you can pay on a sliding scale based on income.
Above all, you have to remind yourself about priorities. I've known wives to complain about their husband's depression and what it's costing for medication and therapy, and then go out and buy some relatively unimportant but expensive things. This is true of men as well. They may go out and buy an new car, all the while
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complaining about what their wife's treatment is costing. You must face your priorities and make sure they're balanced. Your spouse's happiness should take priority over other claims on your finances.
I FEAR MY HUSBAND'S DEPRESSION WILL DEEPEN TO THE POINT THAT HE WON'T BE ABLE TO PROVIDE FOR US FINANCIALLY. HOW CAN I AVOID LETTING THIS ANXIETY ADD TO HIS DEPRESSION?
You need to get some help in keeping that anxiety down. Talk to your pastor or your doctor. Find someone to share your feelings with. Trying to carry them within yourself is a sure way of communicating your pain to your spouse.
In my practice, if I have a husband who is deeply depressed, early in the process I will invite the wife to come as well. I realize what a burden the depression imposes on her. She needs to talk about her reaction to it and how she's handling her anxiety so that I can help her reduce it. You, likewise, need to find ways of keeping your own anxiety to a minimum.
IS MY DEPRESSED HUSBAND LIKELY TO HURT ME OR THE CHILDREN?
Not really. Depression itself is not a dangerous disorder, nor does it create any danger. In fact, it's quite the reverse. Your spouse is likely to become passive and will retreat from conflict rather than become aggressive toward family members. There is nothing you need fear when a spouse is depressed.
HOW CAN I HELP MY CHILDREN COPE WITH MY SPOUSE'S DEPRESSION?
Children are remarkably resilient. They have the ability to detach themselves, if necessary, to protect themselves. Most of the time you won't have to worry about how your children are handling it. But your children's reaction to your spouse could aggravate the depression. You need to sit down alone with them and explain the nature of the problem. The more information they have, the more understanding and accepting they can be. Then encourage them not to be judgmental but to emphasize acceptance and love.
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SHOULD I ENCOURAGE SOCIAL CONTACTS WITH OUR FRIENDS EVEN THOUGH MY SPOUSE DOESN'T WANT THEM?
You can encourage ongoing contact with close friends, and certainly other family members, who are accepting of the depression. Maintain contact with them as much as you can. But don't expose your spouse to more-distant friends who may not accept the depression or who will be callous and misunderstanding. Strangers should be kept far away. Your depressed spouse will not be able to build new relationships.
HOW CAN I BEGIN TO GET MY SPOUSE SOCIALLY ACTIVE AGAIN?
Encouraging social activity should only be considered during the recovery phase. It won't be helpful to force social activity during the earlier phases, and certainly not during the deepest part of depression. In the recovery phase, begin by inviting close, understanding friends who haven't been around for a while to renew contact. Start with those nearest you, and slowly expand the circle outward as your depressed spouse builds social tolerance. A few good experiences with others builds the depressed person's confidence. If the experience is bad, you may have to wait a bit before trying another. Of course, I'm assuming contact has been maintained with immediate family members throughout, where there is a greater level of acceptance.
SHOULD I TELL OUR PARENTS THAT MY SPOUSE IS RECEIVING TREATMENT FROM A PSYCHOLOGIST OR PSYCHIATRIST?
As a general rule, I believe in total honesty. No secrets! I would encourage openness wherever possible. I don't see any value in concealing the fact that your spouse is seeking help, although some may have to make an exception where parents are not understanding. Usually, though, the more people who know about it, the more love and encouragement your spouse can receive from them.
We also need to break down the stigma attached to seeking help. Not only should we not be ashamed about this, but it's even a mark of maturity and courage that we're willing to expose our needs and seek help from someone outside the family.
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CONCLUSION
Having read through the core of this material on depression, you have seen two major themes. (1) Depression is often an appropriate emotion or a symptom of some biological disturbance. (2) Communicating understanding and acceptance is the key to the effective support of a depressed person. The second theme clearly rests on the first, for if you won't accept depression as an inevitable experience of life, you can't give the empathetic support that will help to resolve the depression.
I would encourage you, as a concerned helper, to persist in developing an understanding of depression. But more importantly, I urge you to work at communicating understanding and acceptance of a depressed friend or relative in the context of love. That is your Christian responsibility, and it can only be achieved completely through the power of Christ. You will need all the help He can give you.
