What if your friend, mother, sibling, or father-in-law is severely depressed but refuses to recognize it?
Most of us have been there at least once in our life: the awkward spot where you know a loved one has a mood disorder or drinking problem, but is too stubborn to admit it and to proud to get help. You might see the consequence his behavior is having on his children, his job, or his marriage, but he is blissfully blind or is in too much pain to see the truth.
What can you do, short of taking the person by his shoulders, shaking him, while screaming, “Wake the hell up and see what you are doing?!?”
It’s very complicated.
Because people are different.
Mood disorders vary.
And families are as unique as the illnesses themselves.
After doing a bit of research and consulting with a few mental health professionals, I have compiled this list of suggestions, to be read as merely that: suggestions.
1. Educate yourself.
The first responsible thing you can do is to educate yourself. Because you can’t really spot a type of disorder without knowing its symptoms. In guessing that a sister is depressed, you should know if there have been any significant changes in her diet, sleep, energy, and so forth. You can’t really assume your brother-in-law is bipolar based on Matt Damon’s performance as a pathological liar/bipolar freak in “The Informant!” or that a friend is obsessive-compulsive because her behavior resembles Jack Nicholson’s in “As Good As It Gets.”
Educating yourself is not only going to help you gather the facts that you need in order to know how sick your loved is, but it is going to help you feel more in control of the situation—so that you can guard yourself against the fruitcake that will be hurled at you come Christmas dinner. It won’t be a TOTAL surprise.
2. Gather the information.
Here comes the fun part. You get to pretend you are a detective for a month or so and gather any facts you can about the person without a) invading her privacy, or 2) bringing on an awkward confrontation. If you think she is depressed, ask about her diet. “Are you still eating Chipotle’s Burrito Bowl for lunch? No? Why not? Are you still playing tennis on Tuesday nights? Why have you stopped? What book are you reading for your book club? Have you hosted any of the meetings recently? It’s helpful to get together with any mutual friends and/or family members who would have additional information, so that together you can get a truer picture of what’s going on. The person may tell you something that contradicts your sister’s information, and the discrepancy can be even more significant than either of the answers. After studying the symptoms of the disorder that you think your loved one has, you will better know the information you need to find out.
3. Make a plan.
Here’s where it gets hard, because there is no right solution, and you can’t know the appropriate approach until it’s over. There is, of course, the intervention: when you gather together family and friends of the person and you all publicly confront the person with his behavior. Everyone either expresses a way that he/she has been affected, or reads a letter, or does something that ultimately communicates, “Dude. Uncool.” The intervention is the most extreme approach, and isn’t right for every situation. It can be when a person is in danger of either hurting himself or hurting someone else –by suicide, recklessness, or severe substance abuse. In some cases, police may even need to be called.
As much as we’d like to be able to force a sibling or friend or parent into treatment, we simply can’t. They have to meet strict criteria for being committed involuntarily to an inpatient hospitalization program. Someone has to prove that they are incapable of meeting their own basic survival needs (paying bills, proper hygiene, nutrition) or that they are a danger to themselves or others. States vary with regard to the criteria, but it is not easy to make the case because you have to bypass all those human rights and stuff that we have.
So, that leaves ….
4. State the facts.
You’ve studied up. You have the evidence. You know that she is depressed, but not so severely that she presents a risk to herself or to her family. And yet … the disorder is clearly wreaking havoc on her home life as well as her friendships and job. What do you do?
You start with the facts, and depending on how the conversation is going, you end with the facts. No one can dispute facts. They are what they are. They have no emotion or judgment or attitude attached to them. And they are especially heard when spoken from a person who has done her homework.
For example, when I was in that spot—being confronted by a friend about my severe depression six years ago—she simply listed a few things that I couldn’t deny: 1) there was food on my robe, 2) I couldn’t stop crying, 3) I had lost 15 pounds in two months, 4) I wasn’t speaking in coherent sentences, 5) she wasn’t the only one worried about me — there were at least three others.
My husband could have told me in vague language that he was worried about me, but I probably wouldn’t have listened because he wasn’t a doctor and he wasn’t laying down concrete evidence. I could hear what my friend was saying because I knew she had done her homework and was merely calling out the obvious, not making a general judgment of me.
5. Be sincere.
If you speak from your heart, you can’t really go wrong. What is done in love isn’t always interpreted with love, but you can live in peace knowing that you spoke the truth and you acted in love. In twelve-step support programs, step nine involves making amends to people we have harmed in the past. If we choose to express our regrets and say we are sorry, we are advised to concentrate on our half: on our intention, the reason we are doing it, and keeping it there — to not attach expectation of any kind. If we go in thinking that we are going to rectify an estranged relationship, we are setting ourselves up for disappointment.
The same philosophy holds for a confrontation. If the intention of our confrontation is to make our friend get help for her disorder, we may very well come away shattered. However, if we voice our concern simply as an act of love, we will be at peace knowing we have spoken the truth and tried, even if she continues to deny the problem.
6. Say “I.”
As a kid of an alcoholic who was sent to twelve-step meetings for families of alcoholics before I hit high school, I learned early on to begin all my sentences with “I.” If you begin a sentence with “You,” you are usually making some unfair, or maybe even incorrect assumptions. But if you stay with “I,” you have a much better case because you and you alone control your feelings. Therefore, try saying, “I feel sad when I see you …” instead of “You are making a mess of your life.” Even though all you’ve done is stuck in “I” in the sentence, you come across a tad less judgmental and a bit more empathetic.
Words need to be chosen carefully in these situations. For that reason, I compiled two lists awhile back: “10 things you SHOULD say to a depressed person,” and “10 things you should NOT say to a depressed person.” Some of these would definitely work on a friend or relative swimming in denial. They are conversation starters or gentle introductions to the big elephant conversation, even if you want to skip over the elephant for now.
7. Ask questions.
In addition to using “I” statements, you can ask questions. This allows the person to arrive at her own conclusion on her own schedule. Planting the seed with some gentle inquiries like, “Do you think you might be depressed?” is often more powerful than a statement like “I think you’re depressed,” because you have left her with a question that she can answer in her own time. I recently asked an older, wiser friend what to do about a friend of mine who, I fear, is heading in a dangerous direction. “Ask her a few questions,” he advised me. “Plant the seeds for whenever she is ready to deal with it.”
8. Provide some resources.
If you do decide to confront your loved one, or try to plant the seed, you might want to be ready with some resources she can use should she ever wake up to her problem. Fortunately for me, I’ve been to most psychiatrists in Annapolis, so I know which ones are the best. I’m also on a first-name basis with most of the therapists. I have a list of names, support groups, and reading material to hand to a person suffering from depression, which gets them from point A to point B, should they ever choose to go to B.
When a high school teacher confronted me about my alcohol abuse, she gave me the number of a friend of hers that attended twelve-step support groups. She was prepared to help me make the first leap to recovery. I would not have called a hotline asking for the closest meeting. That would have been too scary. By providing some resources, you are helping your loved one make that first step.
9. Leave the door open.
After asking questions, using “I” statements, and providing resources, the only thing left is to leave the door open. “I’m here if you need me” is all you really have to say. And that goes a long way. Trust me. Sometimes it has taken me years to get to a place that I can walk through the door. No one ever forgets an open door, even if she choose not to walk through it.
10. Set boundaries.
To protect yourself, be sure to set your own boundaries. For example, if your best friend is drinking too much and you think she has a problem, but she refuses to go there, you might want to cancel girls’ night – because you have had enough of the obnoxious behavior. Or you may want to always drive separately because you don’t want to wait around until she is ready to go, and you don’t like being the chauffeur everywhere. Or you might pull the plug on those fun sleepovers she used to plan with your kids. Unfortunately our human powers are only good on ourselves.
11. Take care of you.
You can’t force recovery on your loved one but you CAN keep yourself well and sane. Be sure to get the help you need in dealing with her behavior, because she can’t begin to dig herself out of the hole, if you fall in with her. Seek support for yourself so that you can stay resilient amidst the inconsistency and confusion that mood disorders and addiction bring into a home.