Saturday, March 21, 2020

How to Help a Depressed Friend

It’s an excellent question, coming to us from a rather old Carolyn Hax Washington Post column. It’s about mental health, specifically depression, and thus it is worthy of this blog. 

The issue is only secondarily about treatment, but it’s about friends being a friend for a friend in need. In this case, for a friend who is suffering from an apparently severe clinical depression.

As it happens, the depressed friend is undergoing treatment. Hax is too kind or too tactful to say so, but it appears that the treatment is aggravating the condition. The depressed friend has been taught, by her therapist, to have frank discussions about her foul moods and her pessimistic helplessness. 

Evidently, this is not working. Besides, when you continue to regale your friends with tales of unfathomable woe, they are likely to identify you as a woebegone soul. To say the least, this is trying on friends. What do you do when a friend is clearly making bad decisions, is withdrawing from human commerce and is thereby driving her friends away, the better to make herself more isolated and more depressed.

Should her friends respect her wishes to be alone? Should they abandon her? As it happens, the psychiatric world has been touting its great new depression treatments for decades now. Whether SSRIs or cognitive behavioral treatments, the fact is, we have more to offer the depressed than we ever did. The letter does not tell us whether the depressed friend is being treated with any of these. One suspects that she is not.

And besides, haven’t we also learned that a good workout does wonders for depressed mood, even the kind that befalls those who are hunkered down under government orders.

Anyway, these questions do not arise. The question that arises for the depressed woman's friends is: should they stick with her? Should they do everything in their power to force her out of the house? Should they disrespect her wishes? 

By my lights, they should. They should not respect her wishes. They should not collude with the depression. If she cannot get up off of her butt, they should drop by unannounced to spend an evening playing board games. I realize that, under the current conditions in today’s America, such is not the most realistic possibility, but still, you should keep this on file when you are thinking of abandoning a friend in need, especially a friend who has stood by you in your own time of trouble.

You might consider it in a different light. What if said friend refuses to consume food. What if she is anorexic and is starving herself to death. Should you respect her wish to continue her fast or should you force feed her? As you might know, today’s psychiatrists lean toward the force feeding option. They do not sit by weakly when someone starves to death… regardless of their express wishes.

Here is the letter, from Perplexed Friend:

One of my friends is in the midst of a long funk. This is no slight period of the blues; this is full-on depression that she tells her friends about on a regular basis. She now is rejecting our invitations, ignoring our calls and wallowing at home every night, and she has an excuse for every suggestion we have when she vents to us.

While some of the girls are still trying to help her out of it, I am on the verge of giving up and realizing that perhaps she doesn't want to snap out of it. I am blunt with her that her frank discussions with her therapist don't seem to be doing the trick. I can't help but feel guilty to give up on her, especially since other girls in the group of friends still are trying to help, yet I feel like it's not in my nature to work for months to try to change someone who wants to wallow in unhappiness. She was very kind to me during a rough spell I had two years ago, so the guilt is multifaceted. What to do?

— Perplexed Friend

Now, the friends would be better friends if they could shut down the constant complaints about her depressed state. They would do well to invite her, even to beg her to join them in group activities, for instance, a shopping trip. If it happens that their wishes to help her are being rejected, they should ask the depressed woman to help them. One of them might ask her to help pick out a new frock or even to join her at a concert. If you have an extra ticket that is going to waste, why not offer it to a friend. The virtue of a concert or a movie is that you do not need to talk. You need merely be good company.

In any event, perplexed friend ought not to try to be an adjunct therapist. She ought not to listen to the friend’s bemoaning her condition. She ought to bring up other topics of conversation.

Better yet, the friends should all adopt an outreach program. Instead of asking what they can do to help, they should do good deeds for the depressed friend...perhaps by texting a funny cartoon or sending a link to an article that might interest her. Even a gift might be a good thing, as the occasion warrants. And of course, why not ask her to take an exercise class together. If she refuses, camp out on her doorstep until she concedes.

After all, someone who is depressed believes that other people do not want to socialize with her. Thus, if her friends abandon her that will fulfill the terms of her hypothesis and convince her that she is a social pariah, unworthy of being a friend. Or else she thinks that they pity her and are pretending to care. Again, the way out of the conundrum is to go do things that do not require any party to share feelings or to recount misery.

In other words, one should not abandon friends in need. One should also not assume that one is being called on to be a better therapist. One should not allow the person to wallow in her depression or to express all of her deep feelings. Doing things together is better than sharing plaints.

Evidently, these are not entirely practicable when you are practicing advanced social distancing. But, keep this in mind the next time you are faced with a friend in need.

1 comment:

Sam L. said...

I would prescribe 20 episodes of Monty Python, but that may not work for everyone.