Feb 14 2009
What do you do when someone refuses to seek help for depression?
This is probably one of the most frequent requests I get, and it is extremely difficult to come up with an definitive answer because every situation is unique. Isobel’s heartfelt enquiry is typical.
QUESTION
Dear Graeme
After reading Back from the Brink Too, I was quite inspired and hopeful that I could help. After noticing that I was reading these books, my loved one decided that I was going to preach to him before I even opened my mouth. He is refusing to even listen to advice from his family, friends and me about going to see a Dr. He is spiralling down hill, we are no longer living together, his decision, which makes it hard for me to use what I learned in the book. He says he needs time to sort himself out, and does not want us to fight that is why I had to move out.
I just joined a gym, and they listened to what I needed from them … they actually gave me free vouchers for him to use. I gave them to him, he just laughed them off saying he has no time. This is funny as all he does is sit on the couch and channel surf …
The one thing is that we communicate at least once a day, not always me calling him. He is also expressing himself more to me, although he is very snappy. He always apologises the next day, even though I tell him that it is not a problem. To his parents (he is close to his mom) he hardly says two words, and blows off his friends a lot.
Is the fact that he is actually talking to me about how he feels now a positive sign? I noticed a distinct change in Sept last year when he became sullen and withdrawn, eventually in the second week of January I was able to “lance the boil”. Since then we have both had a hard time, he cries a lot (only twice with me), and is very irritable. I know his work place is the main cause of this, and he has gone to many interviews, especially recently. The problem here is that in South Africa the affirmative action policy does take many of the opportunities away from him.
I am desperate, life with him is wonderful and I really love him. At the moment I am suffering, nothing I do seems to help … I have been to a shrink who seemed to think this was a relationship problem (which it isn’t) and not depression. Although he did give me the book: Living with the Dark dog, his name is depression, and that was insightful. I have also started building my support base, and have started trying to look after myself. The description of the dark hole is how I feel however and it seems to be never ending. It does look like the cases described in your book that most others actually do recognise they need a Dr, he does not at all.
Do you have any other advice for me?
From a very desperate and very sad
Isobel
South Africa
MY RESPONSE
Dear Isobel,
You are in an incredibly difficult situation but you can be assured, you are not alone. This is probably one of the most common questions I get asked. Congratulations on what you have been doing to keep yourself well. I can’t stress how important that is to be able to sustain care.
I will first give my general recommendations and then comment specifically on your situation.
BACKGROUND
Many people (and particularly men) find it very hard to reach out for help. This was an overwhelming finding that came from the research I did for BFTBToo. Some believe that this happens because men have been socialized to be self sufficient and any hint of not coping is perceived as a sign of weakness. I know the first time I was admitted to a psychiatric hospital in 1989, I was totally fearful of anyone finding out that I wasn’t coping – I made my wife tell every one that I was suffering from a virus. Fortunately there has been much progress since then, but still great stigma exists around depression particularly in the work place.
The funny thing is that since I went public with my own story I have had incredible support and respect for having the “courage” to admit I wasn’t coping. With this background I make these comments.
GENERAL RECOMMENDATIONS
· Ask don’t tell
EXCERPT FROM BACK FROM THE BRINK TOO
While it is always dangerous to make generalisations, I offer the following guidelines about discussing depression with men.
1. Men are socialised to be self-sufficient. I remember my wife being totally perplexed and wondering why I had not discussed my absolute despair with her prior to making an attempt on my life. The truth was that I believed I should be able to solve my own crisis. Real men are supposed to do that … aren’t they? Be sensitive to the male ego. Accept that for many men it is very hard to talk about emotions and feelings of doubt and inadequacy. It is best to talk about behaviour rather than threaten his self-esteem. For example, you could say, ‘I’m concerned about you waking up at 4 am and not being able to get back to sleep. I want you to know that I love you and I don’t want you to feel under any pressure to discuss it now, but I want you to know that I’m here if you want to talk about anything that you could be worrying about.’
2. Try multiple choice. In When Someone You Love is Depressed, Rosen and Amador suggest that if a man has difficulty discussing feelings, he may respond better to multiple choice. For example, ‘Are you feeling worried, sad, or angry right now?’ I think this is sound advice.
3. Affirm their competence. Again, remember the male ego. You could say, ‘I have always been impressed with how well you have managed so many things. I know at the moment you seem to be having some difficulty and I was wondering if there was anything I could do to ease your load?’
4. Engage in problem solving through asking the right questions. Let him appear to be in control. You could say ‘I know you have many pressures on your time at the moment, what are the things that are causing you to lose sleep? Why does that worry you so much? What do you think can be done about it? Have you considered asking someone else for help/advice?’ If they are struggling to come up with answers, then this might be the time to suggest strategies or someone they could talk to.
How to discuss depression with a woman
Research shows that women are far more likely to discuss their depression with a doctor and/or a partner. Nevertheless, John Gray, author of Men are from Mars, Women are from Venusand Rosen and Amador provides some good insights for men.
1. Stop trying to problem-solve unless invited. Women like to feel heard and understood. They do not think as much about problem-solving as men. You need to concentrate on her experiences with depression. You could say ‘When you say you’re a failure at your job, what makes you say that?’
2. Remember she is an individual. You could say ‘What does depression feel like for you? Why do you think you feel that way?’
3. Empathise with her. You could say ‘I remember when I took on that new role and feeling absolutely swamped and thinking I would never be a success at it.’
4. Only offer suggestions after she feels certain she has been listened to.
Specific recommendations
It is certainly a good sign that you are communicating regularly. He will be finding that very valuable even though it is unlikely that he will be telling you that. You are helping him by having that regular contact. Having read your description of the situation my recommendation would be to write him a letter. A letter can be incredibly powerful as it relatively permanent and unambiguous.
I would say something along these lines:
· I love you very much and we have had such great times in the past.
· It hurts me so much to see you suffering – mention crying incidences and other changes in behaviour – isolating from friends etc.
· These changes in behaviour suggest that you might be suffering from depression
· Depression is incredibly common (the World Health Organisation says that depression is the most disabling disease in the western world today).
· Suggest he reads some of the interviews in BFTB – there are high achievers in there who have suffered and recovered. Social status and general competence offer no immunity from depression – see interviews of Geoff Gallop, Petria Thomas, John Konrads.
· From the research you have done you know that depression is very treatable if you seek the right help.
· Suggest that he does the anonymous Black Dog Institute Depression assessment - http://www.blackdoginstitute.org.au/public/depression/howtotell/selftesting.cfm
· Offer to meet with him and discuss the results
· Say that you are willing to do anything to help with his recovery but that he has to meet you halfway because you can’t help him if he doesn’t help himself.
· If he doesn’t do the self test and discuss the answers with you say that you don’t think you can go on trying to support and help him.
FINAL COMMENTS
Many women in my research asked me at what point do you should call it quits. My answer is, that it is entirely up to them but they should consider the following: is the person with depression trying to help themselves?
DON’T BE AFRAID TO CHALLENGE
Are they trying things that will help them get better? If the answer is no to these (as it is in your case), then the caring thing to do is to challenge them.
By this I mean, say something like “You have been unwell and suffering for 6 months (or however long it is) now. Are you enjoying this?”
They will probably say something like “Of course not”
Then say “Well why don’t you see someone who could be able to help?”
If after this discussion they still refuse to seek help say: “I understand that you are still very reluctant to seek help, but I am still very concerned about you. Do you mind if we review this in a week if you havenb’t made any progress?”
Then go through the same approach a week later. If they still won’t seek help: “We have raised this for a number of weeks and you are still refusing to seek help. I can’t help you if you won’t help yourself. If you don’t see a doctor or psychologist within the week, I can no longer support you and will move out.”
Only consider doing this if you are prepared to carry through with a separation/ distancing. I know of several situations where this has been the final stimulus for the person seeking help.
There were quite a few experienced carers in my survey that wished that they had challenged their partner much earlier as they had hung around for a couple of years in a despairing environment and really became bitter about the whole situation.
The other option is to hang in there indefinitely and learn to detach from the situation and not take it personally – easier said than done. Some people can do that.
Again, the decision is yours, but that is what I would do.
Please let me know if you have any further questions.
Kind Regards
Graeme
If you have been a person with depression who has been very reluctant to seek help you may wish to respond to this question from your perspective.
Likewise if you are a caregiver, and have found an approach that worked for you, I would also love to hear from you.
Graeme
While I think you have given insightful informed information to Isobel I believe that you have skirted roung what the main thing is!! It seems obvious that while she is reading and learning she is changing. Change is good but then again it is scarry to the other part of a relationship. You have to change in a way that is balanced and equal. It seem that Isobel has made changes and with those changes her partner has inevatably changed which is great I feel she is halfway there already. All we ever have to work with is our selves we can never change others even though it is because we love them we urgently want some change. Change will only come by constancy of ones own change. I do not mean beating another up over their non change but allowing them to see the difference in you, while they see that and that the old games that have been part of a relationship are now not played out as they once were they that person has to make some changes, which it looks like he is making some steps. But remember Baby steps is the way of great change. Regards Chris Keep up the great work..
Hi Graeme
I don’t have any answers just a comment about the reality of how hard it was for us to find a doctor Joey would engage with. A few months ago some parents were speaking to me about their son and said he sounds very like your daughter. We were at a Black Dog Institue Question and Answer Session. You may remember me Joey my beautiful 25 year old died from suicide on 13th June 2007. After reading some literature from Black Dog Institute and your book I said to these parents first you must get a proper diagnosis and they said how do we do that? It was quite confronting for me to hear but helpful in a way as I was feeling I had failed Joey and if only I had had all the information I now have I could have made a difference but realised from there question just having the information is not enough.
The parents had taken there son to a number of doctors, as I did with Joey,( there were so many doctors we went to) but there son did not want to go to any more doctors and tell his story again, I think that was the case for Joey too she did not engage with any of the proffessionals and became worn out trying differnt doctors. I fascilate between thinking she had a responsibility to engage with the professionals and the medical system let her down.
I ended up giving the parents I spoke to your book and hoped it was a help to them.
Sorry this is not very helpful just sounds a bit hopeless, I understand if it is not appropriate to post. I guess there is a whole question after you actually are successful in a peron getting professional help how to find the right one for them and the responsibility they have and the professional has in making this a helpful successful step in their recovery.
Dear Isobel/Graeme,
I am a person currently suffering from depression. I am in a relationship also. The irrational and scary thoughts that enter into my mind make me feel such shame and guilt, that I find myself also pushing my partner away, (which makes me feel just awful as well). These thoughts are something I don’t want to share with my partner, in case he changes his mind about me, and once they are out there, I can’t take them back. I have thought of running away, but that is not going to solve any problem, and when I eventually settle and think rationally, I really don’t want our situation to change. It is very hard and I feel like I’m doing a daily battle and it’s harder to remain normal for the both of us. It’s just guilt upon guilt upon guilt!
Isobel, maybe your partner feels the same way, in some way like me he is protecting you from how he feels, although we show a funny way of dealing with it. I recently made the decision to tell my psychologist how I really felt which was very hard. I also recently told my trusted sister how I was really feeling. She had been through depression a few years ago, and told me that was how she felt also. I also visit a psychartrist and will talk to him about how I actually feel as well. These are all very hard decisions, but hopefully your partner just like me will find that they just have to talk to someone (it is better if it is a professional) about his true feelings. Only now is a little bit of pressure comming off and I can calm irrational thoughts down although it takes some time. My partner does not believe I have depression (I must be up for an Academy Award), so he is very lucky that you are there to understand and that you are in contact. I can only suggest that you arm yourself with information for yourself and him.
Unfortuanately Isobel this illness takes the longest time and it feel like you are picking bits of brick out of a brick wall every day. I wish you the best of luck and continue to look after yourself.
kind regards
Leisa
PERSONAL CHANGE
I agree with Chris that you can only change yourself but when I was depressed I often felt that I was beyond help and so there wasn’t great personal motivation to try new things. This is where I think the carer plays an invaluable role. They can often remember what thingS were like when their partner was well. Although patience is essential, I believe that in order to hasten the recovery process it is desirable for the caregiver to encourage positive action.
FINDING A SUITABLE DOCTOR
There have been some excellent insights here which only highlight what a complex issue it is. Finding a mental health professional that the person relates to can be a big challenge as Meredith highlights. This is often compounded with a young person, as there are very few doctors that specialise in this area.
THE SHAME ASSOCIATED WITH DEPRESSION
Leisa raises an excellent point regarding the shame people often feel to have a mental illness. I know in my earlier episodes of depression that I was bordering on paranoid trying to keep my illness secret from the world.
What I have come to understand is that friends and family are much more understanding regarding depression than they once were (workplace still has a long way to go). I can only speak for myself but I have found that the response from people has been overwhelmingly supportive when I outlined what I am going through.
Graeme
This is a really tough question for me. I lost my brother to suicide 5 years ago and had similar discussions with him. I would tell him that you love him and care for him. I would give him some information regarding statistics of male depression and suicide and say that you are concerned that he may be depressed and that it is actually a manageable condition but that he needs to reach out and get the proper advice. You could also mention that often depression is a symptom of another underlying physical illness and that everybody needs a good check up from time to time. If you are really concerned I would visit his doctor. The doctor does not have to discuss anything about his case with you but you can alert the doctor to the issue and then it is up to the doctor to follow up. Perhaps even talk with one of his mates and get them to raise the issue. If you can get someone to assist him to write a care plan with some advanced directives as to how he would like to be managed should he become more unwell it would be really helpful and would not only enable the help to come to him, it would also empower him to seek help.
Heather
Dear Graeme
Thank you for posting my story, I appreciate all of the heart felt stories, however Chris and Leisa made me feel a lot better.
Chris your positivity made me feel silly for doubting and feeling sorry for myself, and Leisa, the experience you are going through is really difficult. I wish all of the best for you and your family! I think your description made me more understanding and possibly patient?
All of the best
Isobel
I just came back from vaction and my boss surprised me with a lay off. So I’m pretty depressed right now and looking for another damn job. I got plan to make some money and got my self in Hawaii, I just dream about that wonderful place in the world.
uV2G8e Good point. I hadn’t thought about it quite that way.