Comforting the Depressed - You're Not a Professional

This is part of a series and I would recommend starting from the beginning if you have not done so already. You can find all the posts in the series under the tag "Comforting the Depressed".

Don't try to replace one, and don't let yourself bear the burden of one.

There's a reason that this is #4 and not #1 on the list. Because coming straight off the bat with "go see a therapist" or "have you tried medication?" is neither listening nor validating.

BUT. You are not a professional. You are not trained to deal with what has been studied as the phenomena of clinical depression -more than just catching glimpses as you go through life. Even those -such as myself, who has been through much more exposure than the average person- cannot and should not view themselves (knowingly or unknowingly) as being wise enough to know the most effective way of delivering help, or what the most effect help to be delivered is. It's something that I must remind myself of constantly when offering support to others with depression: I must accept my role as a peer despite how much I believe (often rightly) have "learned".

In essence, there are two parts; (1) don't let yourself be caught up in the trap that what worked for you works for all, and (2) acknowledge that deferring to others who have more wisdom or experience or training is actually the best form of support you can do for the other person's long-term well-being. You can offer personal support as a peer but if you see someone heading down a dark path, gently suggesting (or sometimes, with tough love, "suggesting") that seeing a therapist or psychiatrist might be a course of action (or if they're in crisis, calling a hot line or going to a hospital).

This is a fine balance to walk with being available. You don't want to sound like you're bailing, but explaining why you are suggesting them helps (even as simple as what I said before "I'm not trained"). But for the mother of god don't jump straight to the word "should". If they are in a crisis, yeah, tough love. But if you're casually talking and you bring the topic up, there's a reason I use the word "suggesting"; "should" (not always, but) can be interpreted as a judgment, because it's saying what ought to be, and for someone with mental illness, what "should be" and what "is" are sometimes what add to a large part of what makes coping with their mental illness difficult. If they're not keen on the idea of seeing a therapist, being told they "should" can feel invalidating; if they want to but feel afraid or unmotivated, it can make them feel as though they're failing (or even another form of invalidating because "should" is up there with "just" on how much weight it carries with it. But that's another post I'm working on.)

Best way I've found to do this: suggest it from a place of care, and don't be pushy. Both "Have you considered going to therapy?" and "what makes you adverse to medication?" are both pretty non-confrontational, but be wary of the "Fix it" invalidation by attempting to "prove" to them that it's the right answer if you continue pressing the issue (even with kind language).

The other half of the coin is that professionals do exist and if your limits are reached or your boundaries are crossed and the other person needs....well, professional help, there's still ways to support them in this manner.

Speaking from personal experience, someone helping me find a therapist had a huge impact on my life. The extent can be a lot of things but if someone is willing to seek help but does not feel capable of doing the work to find a therapist and set up an appointment, doing that is massively helpful and, for me, life-changing. I wouldn't have any shred of the "health" part of "mental health" were it not for family who helped me find therapy. But of course: you must respect their boundaries. I'm certainly not a relationship expert but setting up an appointment for them without their knowledge and trying to force them to go as though it were an intervention is.....well it certainly doesn't sit right with me.

The other piece of traditional (and damn effective) treatment is medication. This one is quite a bit more difficult just because of it's nature: it's much more involved than talking to a person, it involves taking substances that alter the way the mind works, and there can be adverse side effects. And the depressed person can be averse to medication for any or all of these. And, if you haven't caught on, their feelings are Valid.

The approach to this highly depends on the individual and the nature of the relationship, and -if I haven't harped on it enough- it has to be sincere and you cannot be sincere for things of which you are ignorant.

In my situation, I'm not quite sure how to approach it from the angle of someone who doesn't have depression talking to someone who does; it's always a "both" deal for me. Hopefully there's glimmers here for both situations, but in any case, here's my own general approach when talking to other depressed people:

Personal experience in therapy

Not selling it as a insta-fix, and being real that it takes time. Saying that it also takes time to move into the deep stuff, and also to build trust with the therapist. And being brutally (though gently) honest with the scale of that time. It may be harder to hear in the short-term, but if I'm honest and say "Look, it can take months to build a sense of trust with your therapist, and there may be a time within and even after that period where it feels as though nothing's moving. It's totally natural to feel as though it's 'not working', but 'giving it time' means sticking it out even though your mind is telling you that it absolutely is not working or downright actively rejecting it."

Personal experience with medication

Being real about side effects: yes, they exist. But I've been on a med that made me "zombified" (a common fear), but I quickly discontinued it and tried something else. And also, yes, it can and probably will take a while to find the right "cocktail" that works for your system. And again: real with the timeframe: years, most often. That's a hard truth to hear, but it is a truth. This again reiterates that: it takes time, and in this case, often ineffectiveness. You will have to try med after med, dealing with adverse side effects as they come, seeking a mix that works for you; but I believe that it's important to know that going in. Because while it's a hard truth in the long run and may seem like it will make them less receptive to the idea, if it speak from a point of true sincerity I believe it the honesty about what's real gives the other person a true base upon which to embark on their journey with medication.

Everyone is different

For therapy, finding a therapist that you feel comfortable with and (can begin to) trust is vital, and not all therapists are a good fit for all people. For meds, it's absolutely crucial for everyone in the friggin world to understand that everyone's body processes antidepressants differently and you cannot make judgments based on other people's experiences with medications. People often ask "have you ever been on X?" and sometimes my answer is "yes, and it didn't work for me/gave me a bad side effect. BUT. Everyone's body is different." (Note: looking up potential side effects is very different and I'd recommend it, but it's vastly different than "Jonny had side effect X on medication Y and so I will too".) And it should equally go without saying that, while it's ok to suggest looking into any medication that helped you in the hopes that it might be benefitial to them as well, providing an implied or direct guarantee that it will work is not only dishonest but setting them up for intense feelings if and when it does not react the same for them as it does for you.

Say how much it's worked.

In my experience, people ask questions about their fears, about the negative aspects. I believe it's important to also make sure you (truthfully) stress how much therapy and/or medication has helped you. Don't lie by omission (e.g. neglecting to mention that you did indeed experience bad side effects on some drugs, or that you've had shitty therapists or even just fights with good therapists) and be absolutely open about how you feel about therapy and medication.

Talk about your own hesitations.

These come to me without even having to think. (Obviously these are personal to me and are examples only)

• "I was taught that itherapy was unnecessarily and even ineffective, and that who I was was all that I needed."
• "I was so resistant to even trying antidepressants because I felt as though it was cheating in some weird way."
• "I was so in denial about anti-anxiety medication because I was convinced that I should have just tried harder."
• "I didn't want to accept a PTSD diagnosis because I felt it was disrespecting the people who had it as a result of extreme cases like combat or abuse."

Furthermore, talk about your experience after your hesitations.

Again, these come so readily to me because they are so sincere; they're things that I've thought many times to myself, not just for the sake of telling other people.

• "I so wish I had started therapy at 16 instead of waiting through so many years of deepening suffering."
• "Eventually I saw antidepressants like insulin for diabetics, that something in my brain is malfunctioning and that it's not a weakness of character or an easy way out. That they aren't the solution, but they provide a baseline for you to do the real healing."
• "As soon as I got on anti-anxiety meds it became clear to me that I could have spent years just 'trying harder' when the meds make me stable enough to be effective in working toward recovery."
• "I finally accepted that, even though I didn't think I'd 'earned' PTSD, that I have some of its symptoms and the targeting treatment for it works for me, and I don't have to compare myself to others to acknowledge what is true about myself."

I'll sum it up with, what I think, is a perfectly pragmatic way to view things, which you can mix in with all that I said above.

Perhaps the biggest rule for a depression chatroom that I frequent (and moderate) is that it is not a crisis resolution service; that it is a peer support group. If someone comes in stating that they are having a crisis, that they are actively suicidal or are making hints or threats about harming themselves, the protocol is to redirect them to a hotline or the nearest E.R. In fact, to not allow them to continue in the chat. That sounds incredibly cold unless you understand the reasonings behind it:

1. "We are not professionals"; the basic premise for this post: we're not trained.
2. "A professional is the best way we can help you"; a part of tough love, but saying the equivalent of "Look, your arm looks seriously broken. Creating a splint for you is not enough and it would be irresponsible of me to do anything but direct you to a real doctor."
3. To exactly quote the rules brought up in such a situation: "Furthermore, such behaviour puts immeasurable and unfair pressure on others". It sounds selfish to say to someone who is deeply hurting but it truly is that putting the weight of (potentially) their life into someone's hands who is not trained, who may be going through their own shit, or even who just has other aspects in life to deal with, is not fair. Harsh, but true. I think it's natural tendency to, when seeing someone suffering, want to do whatever is in your power to help them. But, to bring back the previous analogy, the pressures of performing surgery on a broken arm if you are not a doctor are immense in so far as what's at stake. Don't scrub up. Page the real docs.