I think my friend has depression and a panic disorder. I fear that encouraging her to seek help will push her away. I am really worried about my friend X. I’m pretty sure she has been struggling with depressive episodes since high school and she really isn’t in a good place right now.

We’ve been friends since high school, but we don’t live in the same city anymore so we don’t get to see each other very often. She lived through some hard stuff, including the suicide of 2 friends. She was always prone to risky behaviours that we let go as teens who weren’t acting much better. As we grew up, she started working long hours in bars on top of being a full-time student, which was a good setting as any to let these patterns fester: overworking herself, overusing alcohol, drugs and gambling and still finding the time to get top grades and also engage in a series of unhealthy relationships. Unbelievably, she manages to still look on top of things. You would think she is a fun-loving, intimidating and self-confident girl with vaguely superhuman powers. Until she crashes and burns, usually after binge-drinking.

She gets panic attacks, yelling, insulting us and rejecting our help, hyperventilating and/or puking. She always winds up revealing her fears about being a failure, a burden and never being loved -Asking why she can’t stop being like this, hating herself for not being happy, and other thinking patterns that I recognize from members of my family who also struggled with depression.

These episodes are getting more frequent . Last night, she had one while she was out with our other long-time friend Y. Luckily, they were in my city and Y finally succeeded at getting her to mine at 6 AM. I’ll spare you the details, but we almost took her to the hospital and Y was so close to her breaking point she had to leave.

I know that the drinking and all are not the cause, but merely coping mechanisms. We let this go on too long, inadvertently enabling her. But I don’t know how to even talk to her about getting help. I know that she will only feel exposed as vulnerable, and that’s pretty much stripping her last defence away.I don’t want her to pull away because if Y and I don’t do it, I don’t think anyone will. And I can’t even see her regularly. Please, do you have any tips on how to help?

A: This is a really tough question. Without knowing the whole story, I even hesitate to respond. So please take this only as some thoughts, not as “advice” about what to do.

You think the alcohol abuse is a way she copes with depression. I’m wondering if the depression is a result of the alcohol abuse. If so, the best thing she can do is quit drinking and drugging. Even if they are not the cause, these behaviors certainly aren’t helping her any.

I also wonder if continuing to be so helpful is really helpful any more. Maybe it’s another type of “enabling”? One way to move forward is to tell her that you are worried that your help is preventing her from getting the help she really needs. Yes, urge her to see someone for an evaluation. Remind her that an evaluation doesn’t obligate her to do anything. It only costs a couple of hours of her time. And often an evaluation leads to some good suggestions for steps toward a happier life. Also urge her to consider finding a chapter of AA to help her with her drinking problem.

Meanwhile, you might find it helpful to attend a meeting of Al-Anon, the organization that provides support and information to those who love someone whose drinking is out of control. You can locate a local chapter by searching on the internet.

Your friend is fortunate to have a friend like you. It’s difficult for you to admit that you just don’t know how to help her any more but that may be the best thing for you to acknowledge to her – and to yourself. There’s a limit to how much a person can care for someone who doesn’t care about herself. She — and you — need more support.

I wish you well.
Dr. Marie