Supporting the Mentally Ill.
I’ve been writing and thinking more and more about depression lately, and my basic countenance has been becoming more morbid. I think the stress of the spring and all my new house problems have begun to take a toll on me that is affecting my mental state. So I’ve made an appointment to talk to my physician about it. I’m finding myself feeling obsessive and angry and unfocused. Even in the presence of solutions and progress on the real-world things that are bothering me. Things are, objectively, going reasonably well. And yet I’m frustrated and flummoxed. That means it’s time for a more sophisticated intervention.
We all want to support the people in our lives who struggle with mental illness. As I’ve made repeatedly clear, my depression is a minor and treatable. I know what to do with it. I don’t need much support other than the people close to me acknowledging that it exists and being reasonable in their expectations for resolution timelines. And everyone in my life is amazingly supportive and patient, and I am privileged that way. Not everyone has that.
But I’ve noticed that when talking about mental illness, especially depression, people are very fond of saying that they’ll “be there for [me].” I’m not sure I know what that means. Usually, I take it to mean that people will listen if I feel like I need to talk. They’ll make time to see me if I want to be around people. That sort of thing. And that’s very nice. But it isn’t a treatment for depression.
When I first, many years ago, sought out a therapist for my then-baffling mood disorders, I told her on the very first session: “I feel like I’m betraying my friends by being here.” Aren’t my friends supposed to be the support network who sustain me in difficult times? My family? My partner? People who have taken an interest in my well-being and livelihood? Well, yes, of course, sort of. Having understanding and buoyancy from those people is valuable. But it isn’t a treatment for depression.
Being depressed is like being in the wilderness with a compound fracture. The support of friends can save lives. Friends can lift you up, and carry you from where you lay bleeding for the wolves and bring you, perhaps, to where treatment is possible. It’s agonizing and miserable, even if you want the help. But it isn’t a treatment for the broken leg. It just gets you out of the woods. The leg needs professional treatment, anesthesia, surgeons, physicians, radiology, plastics. A cast. And a lot of convalescence.
My friends and family are wonderful, and my partner is a blessing of the sort I can’t begin to describe. But none of them are a selective serotonin re-uptake inhibitor. And that is what I think I might need right now. Helping someone with their mental illness, being there for them, is wonderful and can save a life. But it can’t fix them. I think a lot of people feel guilty if they can’t repair the depressive, the alcoholic, in their lives. But I think that’s buying in to a stigmatizing vision of mental illness.
Want to help a depressed person in your life? Drive them to a psychiatrist. Let them know that it’s ok to take the time they need to follow their physician’s instructions. Be patient. Don’t be insulted when they get help from an MD that you couldn’t provide. Being there for a person with mental illness doesn’t mean trying to replace treatment. And it doesn’t mean enabling them to avoid treatment. It means helping them get the right treatment for their condition, and being understanding about the process of recovery.
Infactorium 
Good analogy. I had a friend of mine compare herself to an ambulance driver. Her job was to try (with an emphasis on try) to stabilize me and quickly take me to the people who knew what they were doing.
Well put, but when the tendency to isolate is a part of the disease of depression, the company of others can also be a part of the cure.
Many people that suffer from depression, myself included, view themselves as a burden to others when they ask for help. If you notice something, don’t wait for them to come to you.
Yes. Fantastic post once again. The leg analogy is perfect.
It’s also been shown that commiserating with others about your depression and/or anxiety doesn’t always help and can, sometimes, make things worse because it’s like a form of ruminating. I do not have the link to the study handy though.
– The leg analogy sounds good in theory, but it breaks down in reality due to the fact that there are no “treatments” for depression that have been reliably/scientifically shown to beat friends, family, or active placebos.
Depressed people should not underestimate the value of friends and loved ones.
And friends and loved ones should not underestimate their ability to help.
I agree that friends can help, as I said. But I don’t think your first claim – that there is no treatment for depression better than placebo – is (a) true, (b) responsible, or (c) defensible.
There is plenty of effective and scientifically significant, supported, evidence-based treatment for depression.
As both a neuroscientist and 13-year user of antidepressants, I would love to know on what grounds you can claim that nothing is scientifically more effective than placebo/friends/unicorns and rainbows. According to the National Institute of Mental Health, over two dozen antidepressants have been shown to be more effective than placebo in a clinical trial setting.
Do you have a source? This claim usually comes from the JAMA article from a few years ago that claims that SSRIs are equal to placebos, but there are plenty of other papers that demonstrate the benefit of antidepressants, especially for severe depression.
I’m most familiar with the research on psychotherapy — most of the studies that have been done there are too low quality to establish meaningful results. They are often poorly designed and subject to biases and conflicts of interest. When more robust attempts have been made (e.g., using active control groups, including negative results, etc.), the results come out less favorable. I’ve also seen numerous studies on antidepressants that don’t look too good. One that I have handy is this one: http://www.ncbi.nlm.nih.gov/pubmed/22152401
In any case, if people want to use antidepressants or placebos, that’s perfectly fine (and preferable to talk therapies with no safety record http://www.ncbi.nlm.nih.gov/pubmed/24607768). I just think that decisions should be made with honesty and awareness of what the evidence does and does not show. And, most importantly, I think it’s incumbent on all of us to recognize the humanity in everyone — healthy or unhealthy — and not think it’s okay to turn away from friends and loved ones, and pass them off to paid industry. There is a great deal of corruption in the mental health industry, and we can do better.
How about deep brain stimulation? This paper has some 1600 citations
http://www.cell.com/neuron/abstract/S0896-6273(05)00156-X
The only thing that helped my severely depressed mother was lots of ECT and hospitalization. And what helps my wife is seeing her psychiatrist and taking her medication. I can be an ear and give support and love. But I can’t change brain chemistry.
antidepressants are not that effective for mild depression but severe depression can be partly treated with antidepressants. Other medications like ritalin, mood stabalizers, when used in the right combination can be very effective. This is my view from a patient for 30 years and psychiatric epidemiologist for 15