Tag Archives: depression

Someone You Know Is Mentally Ill

Let’s say you have five people in your family and another five who are close friends. Or four and six – enough to make up ten people in your life, anyway. Statistically speaking, two of those people will experience mental illness at some point in their life. Or the person experiencing mental illness could even be you. The National Association for Mental Illness (NAMI) reports that one in five – or maybe even one in four – people will experience mental illness. That’s 20% to 25% of Americans.

Don’t assume you know who those two people are. Many people with mental illnesses never talk about their difficulties because of the stigma attached to living with a mental disorder. Many others are high-functioning, able to have relationships and work and lead a relatively normal life, especially if they receive proper treatment. 

So, what are we talking about when we talk about “mental illness”?

We’re not talking about the person who straightens pictures and has a neat desk.

We’re not talking about the person who is sad after the death of a pet or grieving after the loss of a loved one.

We’re not talking about the person who is overly bubbly and laughing most of the time.

We’re not talking about the person who always seems to be on a diet, no matter how thin she is.

We’re not talking about the person who has some mood swings.

We’re not talking about the person who’s afraid of spiders and germs.

We are talking about people with serious mental conditions like OCD (Obsessive Compulsive Disorder), major depression, mania, anorexia, bipolar disorder, and anxiety disorder. (There are other psychiatric illnesses, but they are much more rare.)

For harmless habits to be actual mental illnesses, they must persist over time and usually interfere with people’s abilities to accomplish the ordinary tasks of daily living. If a person’s depression lasts for weeks or months (or even years), he may have Major Depressive Disorder. Some of the symptoms are low mood, isolation, feeling hopeless or helpless, and changes in appetite. Of course, all those things happen to most of us at one time or another, but if they last for a long time and keep a person from going out or doing their work, they may be signs of a serious mental illness.

This is not to say that you can diagnose mental illness on your own. A psychiatrist or psychotherapist is needed to tell whether any condition is severe enough to be called a mental illness. And only a doctor can prescribe the medications that can alleviate the symptoms, lessen the effects, and help the person back to stability or mental health.

But if you do have a friend or loved one experiencing mental difficulties – and you probably do – what should you do?

If you are sufficiently close to the person, you could gently express concern and suggest that he might want to tell a doctor what is going on. With an acquaintance, it may be best to simply be understanding and supportive. Don’t be offended when she cancels an outing or can’t make it to a party. Her disorder may be preventing her from going, much as she would like to.

If the person seems to be in danger of harming himself, definitely have a talk with him. Tell him how worried you are and how you’re upset to see him suffering. If the situation warrants, make sure your friend has the number of a suicide hotline or knows that he can call you when he is having excessive bad feelings.

The best thing you can do, though, is to educate yourself about mental illness from reputable sources like NAMI. You’ll find that mental illness is treatable and not likely to lead to violence unless it is very severe. Don’t joke about mental illness. Once I did and it prevented someone with depression from speaking about her condition. Sharing our stories with each other might have brought us both connection and comfort.

Think of a mental illness the way you would think about a physical illness. If a person you know had a broken leg, you wouldn’t ask him to go skiing. If a person you know had cancer, you wouldn’t make jokes about it. If a person you know had the flu, you would understand and might offer to run errands.

Dealing with mental illness is not easy, but it is important. And I assure you, someone you know needs help and support. Think about how you can provide that. Then follow through. It’s often lonely having a mental illness. Do your best to be a good friend. That will help, even if your friend or loved one doesn’t acknowledge it at the time.



When Your Friend Is Depressed

…And by “depressed,” I mean clinically depressed – the sort that has no apparent reason and lasts for weeks or even months. Your friend is not just sad, but feeling hopeless, helpless, discouraged, defeated. even immobilized. She or he may not want to go anywhere or do anything that used to bring happiness. You may even detect a dullness – called “flat affect” – in the person’s voice, a lack of animation, often combined with monosyllabic responses.

What can you do to help your friend?

At first it may seem like the answer is “not much.” And that’s partly true. What your friend really needs is probably help from a mental health professional and possibly from antidepressant medication.

There are, however a few things you can do to help your friend – and a few things you shouldn’t do, not because they will make your friend’s condition worse, but because they simply won’t help.

Let’s start with the things you can do.

Keep reaching out. Even if your friend doesn’t respond, refuses your invitations or doesn’t show up, know that the simple act of staying in touch says that you like the person even though she’s having a hard time and that you won’t abandon her. Make no mistake, many people will. Even if your friend is unable to respond, when she finally does get some relief from the depression, she will realize and remember who stuck by her during the depths. Surely you can spare a minute or two for a phone call or email a couple of times a month. You may think it won’t make a difference, but it will.

Offer to help with practical matters. If your friend has decided to get professional help, you can make doing that easier. You may not realize it, but the simple acts of getting up, dressed, and out of the house can seem insurmountable to him. Offer to drive him to his appointments or to the pharmacy to pick up his prescriptions. Give him a pill caddy to help him remember to take his meds every day.

Imagine your friend is physically ill. In a way, she is. The depression is a result of a neurochemical imbalance in her brain. What would you do if a friend were recovering from an illness or perhaps surgery, or even the death of a loved one? Bring her a hot meal once in a while or pick up an extra sandwich if you’re getting one for yourself? Offer to do laundry or another household chore? Enlist other friends to help? Pray for her healing and tell her you are doing so? None of this will make your friend magically well, but they can help her through the worst phases of a depressive episode while she’s waiting for medication to take effect (which may take as long as six weeks).

There are also some things that you shouldn’t do for your friend because they simply will not work. Here’s a brief list.

Don’t try to “fix” him. As much as you may care, you do not have the power to make it all better. Trying to do that will only frustrate both of you. Leave your psychological theories and miracle cures at home.

Don’t give “pep talks.” Telling your friend to snap out of it or to smile more or to think of others who have it worse will not alter his brain chemistry for the better. He most likely won’t be able to appreciate jokes and humor, either, even if he did before the depression.

Don’t expect quick results. Clinical depression lasts for weeks or months, or in some cases even years. It’s frustrating to see your friend suffering for that long, but if your friend sees you give up, she may too.

Don’t ignore suicidal talk. Suicide is a real risk for a depressed person, even if he is getting professional help. Most people who kill themselves give warnings – they talk about being better off dead or give away their possessions. Stay with your friend. Make sure he has the number of a suicide hotline. Call his therapist. Take him to an emergency room.

My advice for someone who lives with a depressed person is similar: Do what you can and realize what you can’t do. If you truly care about the person and stick with him or her through the bad times, you may find one day that you have your friend or loved one back – maybe not as good as new, but on the way to getting better.

That’s when you’ll find that all your efforts have been worth it. Helping a depressed friend survive and heal is an accomplishment not to be taken lightly.

The Ups and Downs of Positivity

The only thing making you unhappy are your own thoughts. Change them. 

When it rains, it pours…but soon, the sun shines again. Stay positive.

I see lots of posts and pass-alongs like these on Facebook: memes claiming that all our problems are in our heads and that we have the ability to change our circumstances by changing our thoughts.

With apologies to Norman Vincent Peale and Joel Osteen, I have trouble with the whole positive thinking movement. My back pain makes me unhappy. My brain chemistry won’t let me control my thoughts (I’m bipolar). Thinking about being rich does not attract money to me. Ordinarily I view positive thinking as wishful thinking.

But I know many people believe in positive thinking and its ability to change their lives. So I set up a little hypothetical dialogue. On one side is Barbara Ehrenreich, author of Bright-Sided: How Positive Thinking Is Undermining America. I have selected quotations from her book, particularly those dealing with health, and juxtaposed them with comments from Leslie Larkins, who embraces positive thinking.

Larkins, a former scientist, has always been extremely rational, so it surprised me that her outlook is informed by positive thinking. And she has plenty that she could be negative about. Larkins has been diagnosed with multiple sclerosis (MS), and had a bout with breast cancer and a surgical mistake that (if not caught) would have subjected her to a completely unnecessary mastectomy. At various times in her life, she has also been treated for depression.

Larkins says that her embrace of positivity came with her MS diagnosis: “When I realized that the problems I had been having at work – trouble with focus, forgetting things – had an actual cause and I accepted that I couldn’t continue to do my job, it was actually a little bit of a relief because I had been feeling out of control for a year or so and couldn’t understand why….I did a lot of research on MS and realized that I could end up in a wheelchair any time, so if I wanted to do something in my life, I shouldn’t put it off. That thought was actually quite empowering to me.”

Ehrenreich, in the first part of Bright-Sided, focuses on the breast cancer movement, particularly the pink-ribbon side of things: “Positive thinking seems to be mandatory in the breast cancer world, to the point that unhappiness requires a kind of apology….The cheerfulness of breast cancer culture goes beyond mere absence of anger to what looks, all too often, like a positive embrace of the disease….[I]t requires the denial of understandable feelings of anger and fear, all of which must be buried under a cosmetic layer of cheer.”

She quotes Cindy Cherry, who stated in The Washington Post: “If I had to do it over, would I want breast cancer? Absolutely. I’m not the same person I was, and I’m glad I’m not. Money doesn’t matter anymore. I’ve met the most phenomenal people in my life through this. Your friends and family are what matter now.”

Larkins responds: “Thankfully I did not have to have the ‘full cancer experience’ because I didn’t have chemo and therefore didn’t lose my hair, so I was kind of a stealth cancer patient and could only tell people who I wanted to know. I wasn’t forced into ‘breast cancer culture.’ I also was in a place where I could handle the emotional issues myself, so I didn’t encounter the support groups and such. I think the ‘Cheer up, it’s good for you’ comes from people who don’t know what to do or say, trying to help when they have no idea what’s going on.”

She adds, “I definitely would not want cancer and I would not want MS, but I do really understand this one. I sometimes joke that being diagnosed with MS was the best thing that ever happened to me. It forced/allowed me to focus on the present, not the sins of the past and not the possible mistakes or failed plans of the future. Once I started doing that and it became a habit, it became much less likely that I would fall into the despair of those worries. It was definitely a paradigm shift for my outlook.”

Larkins’s scientific rationality may have helped her as much as or more than the positive thinking movement. At least it gave her a logical base for embracing positivity. “I think having the medical background and a good handle on statistics and human psychological reactions to probability helped me think clearly about all of it, rather than letting it bury me in despair,” she says. “I think it mostly allowed me to stand back and see what I was doing in my head from an objective view.”

Larkins and Ehrenreich also disagree on the benefits of psychology and support groups. According to Ehrenreich, “Psychotherapy and support groups might improve one’s mood, but they did nothing to overcome [my] cancer.” Indeed, a claim that a psychological uplift can cause a remission in cancer seems (to me, at least) both unwarranted and unprovable.

Larkins, however, swears by Cognitive Behavioral Therapy, not for its cancer-killing results (if any), but for its influence on her ability to deal with her various diagnoses. She does see a distinction between “positive thinking” and CBT (don’t Google the acronym, she warns).

“Positive thinking can be a result of CBT,” she says, “but if you just say ‘I’m going to think positive thoughts’ you will end up frustrated. CBT is the method for changing how your brain functions, and it does, indeed, change your brain physically.”

She explains the process: “The more you think about something – an event or a problem – the stronger the neural connections that make up that memory become. My analogy is that it’s like carving a groove or rut in a path by going over and over it again and again …. As the groove gets deeper, it’s easier to fall into it any time you get close to it. By consciously stopping yourself from treading that same neural path, and actively carving another one that has more positive, pleasurable feelings associated with it, you allow that groove to smooth out and the new, positive one to take its place ….

“It’s not that I never fall into a repeating loop of self-recrimination, but if I catch myself there, I consciously tell myself to go down another path, one that I’ve predetermined so as to have it ready and at hand when I need it. It has gotten much easier with practice….”

Back over to Ehrenreich: “Breast cancer… gave me, if you want to call this a ‘gift,’ …  a very personal, agonizing encounter with an ideological force in American culture that I had not been aware of before – one that encourages us to deny reality, submit cheerfully to misfortune, and blame only ourselves for our fate.”

“[I]f you’re denying feelings, you’re doing psychotherapy wrong,” Larkins insists. “You’re also doing meditation and CBT wrong. It’s not about denying, it’s about experiencing them, evaluating them and deciding consciously if they are doing you good or harm.”

Nor is positive thinking the only method Larkins used for alleviating her depression. “Medication definitely helped!” she says. “When I’ve gone off the SSRIs [antidepressants] entirely, I found myself getting weepy and feeling out of control, even though I could see, objectively, that I was OK and even reasonably happy. The meds allow me to control my brain enough to take control of my brain, if that makes sense.”

What about other areas of life? Positive thinking has been touted as an answer for everything from poverty to relationship issues. Ehrenreich explains, “People who had been laid off from their jobs and were spiraling down toward poverty were told to see their condition as an ‘opportunity’ to be embraced, just as breast cancer is often depicted as a ‘gift.’…In fact, there is no kind of problem or obstacle for which positive thinking or a positive attitude has not been proposed as a cure.”

“This,” says Larkins, “I see as a struggle to make sense of and control an uncontrollable world. The same way that religious people call everything ‘God’s will’ or less religious folks say ‘[E]verything happens for a reason’ as a way to feel better about bad things….I think a lot of the ‘positive thinking’ rhetoric is more [a way] of actively distracting yourself from dwelling on the bad things. If you’re not predisposed to depression, that may be a workable method. If you already have malfunctioning brain chemistry, it’s not likely to help, but concentrated cognitive therapy can.”

As for me, I try to notice positive things in the world (which means not watching very much news); I try to add positivity to the world by thanking servers, clerks, cashiers, my husband – anyone who helps me in the course of a day; I appreciate things that make me laugh; I try to find some little thing I can agree with, even if I disagree with most of what a person says. I give myself permission to feel rotten when I feel rotten, but know that it won’t last forever. I do the best I can.