My Friend is Depressed. What Do I Do?

It’s not uncommon for friends and family of mine to come to me with questions about mental health, support, and services. Recently, I’ve had a couple of people ask about how they can support someone with depression, anxiety, or another mental illness. Specifically, what do you do when you have a friend or family member who is really struggling and doesn’t know what to do. I hope to put together some ideas for folks who themselves are in the spiraling downwards stage of depression and link that here, so that you can pass it along if you’re worried about a friend, but in the meantime, how do you encourage someone to get help and support them in making healthy decisions when they can barely get out of bed?

Before I begin, these are suggestions. They are based on my experience of depression and what I found helpful. Everyone who deals with mental illness is different. If possible, ask your friend what would be helpful for them, and always check in to see if what you’re doing works for them. This one’s going to be a long one because I want to throw out a bunch of options for people to work with. You don’t have to try all of these things, but maybe try one a week.

So here are a few things you can do to support someone who’s in a nastybad place.

  1. Be Honest

One of the things that was very frustrating to me about being incredibly sick was the way that people would dance around the topic. Very few people said to me straight to my face “You have an eating disorder. I’m worried about you. I want you to be healthy. What can I do?” It’s refreshing when someone says what they mean. It doesn’t have to sound like an after school special either. Use the language you normally would use, whether that’s “Hey I see that the jerkbrains have you down right now,” or “You seem really unhappy lately.” Whatever you do, don’t try to manipulate the person into health or sneak your support in without making sure they want it. Even if they are sick, they’re an adult, and they deserve the loudest voice in their treatment.

2. Be Proactive

It’s very common for supportive family and friends to ask “how can I help?” This comes from a very understandable place. You want to be helpful, you’re not sure what they want or what you can do, so you ask. Unfortunately, one of the things that is most overwhelming about being incredibly depressed/anxious is that you often have NO idea what will help. So instead of asking a really wide open question like that, I’d recommend making specific suggestions. Something like “Would you like me to make you food? I can make a sandwich or a salad.” “Does it feel better to talk about it or be distracted?” “I’d like to come over and see how you are today. Is that ok?” Depression is exhausting and makes every decision feel impossible. Keep the decisions as small as possible: yes or no, this or that. Don’t wait for them to give you an idea of how to help, come up with one yourself.

As a sidenote, this is a great way to help someone with things you think would be good for them. From the outside, it’s easy to look at someone who’s seriously depressed and think that they should eat better, go outside, move their body, leave the house…the list goes on and on. That can be incredibly difficult to do when you’re depressed. So instead of simply telling them that they should, help them. Offer to make them a meal, suggest you take a walk together, ask them to meet up for coffee (you could even say you’ll pick them up and carpool together to decrease the barriers they face). If you can think of something that is getting in their way that you could do for them, do it. This might sound infantilizing, but it’s just like any other acute illness. They’re spending all their energy fighting: you’re giving them a little bit of space to breathe.

3. Be Willing to Be a Normal Friend

Sometimes it’s important for you to jump in to “supporting and helping” mode. But someone who is in a crisis level of depression is still a person and still has the need for connection on a basic human level. Sometimes they want to talk about normal things or act like any other friend: they want to see a movie, they want to make a joke, they want to laugh or smile. So if they seem up for it, it can be nice to do a normal friend activity and not bring up depression for at least a little bit. If it’s possible to distract them from the overwhelming pain, that is a huge gift you can give.

4. Do the Minutiae

Most of helping someone with depression isn’t listening to them late into the night or giving them a great speech that convinces them not to hurt themselves. Most of it is actually really boring. It’s sitting with someone while they call their doctor because otherwise they won’t make an appointment. It’s checking in to see if they’ve taken their meds. It’s doing a load of laundry for them so that they don’t feel too disgusting to leave the house. If you really want to be the supportive friend, you have to truly accept that not only are you seeing them at their most vulnerable, you have to be vulnerable too. You have to be willing to get messy and be bored and do unpleasant things. It’s worth it though.

5. Accept the Awkwardness

One of the more vulnerable things in life is letting another person see you when you are really struggling with your mental health. Imagine someone seeing you when you can’t seem to dress yourself, feed yourself, wash yourself, or do other basic tasks. It’s an experience that can be embarrassing. It’s easy to feel like a child. You are witnessing someone in this situation and they are fully aware that they’re asking for help with things that seem like second nature to you. So recognize that someone is showing you an incredibly vulnerable side of themselves. You may even want to let them know that you’re aware, and that it’s OK, that they can take as much or as little time as they need to do things, and that they can ask you for anything.

6. Validate

It’s easy to see someone who’s struggling and follow your first impulse to try to make them feel better, or tell them it will be ok. What often gets forgotten is that when you’re overwhelmed by depression and anxiety, it can seem like one half of your world isn’t real. There’s such a huge disconnect between your internal emotional experience and the behaviors you witness in the rest of the world. You can feel like you’re losing your grip on reality, or like you must be making things up. It helps a lot for someone to just say “those feelings are totally real. You are not making up how bad it is. You really are fighting a hard battle, and it seriously sucks, and I’m so sorry.”

No, it doesn’t fix anything, but it is incredibly validating to hear that other people believe you, see what you’re doing, and recognize your experience as real. It helps to bridge some of those gaps between internal experience and external reality. It can particularly help if there are negative things happening in someone’s life to point out “Hey, you are not making this up. You’ve been dealing with hard things and maybe your reaction is particularly strong, but it makes complete sense to struggle with this.”

7. Walk the walk

Take care of yourself. I know in many other places in this article I’ve recommended being willing to do anything. What I mean by that is not letting pride get in the way. However you have limits too. If possible, demonstrate healthy boundaries and good self care. Saying something like “I’d really like to help out, but I can’t do x night because it’s date night. Can I help you on y night instead?” If you’re having a chat with them, it’s good to mention things you’re doing to take care of yourself, e.g. “I saw my therapist the other day and we talked through x problem.” It helps to normalize the steps that you’re asking the other person to take, and it also helps them feel less lonely. They’re not especially broken and sick. Other people are working on the same things.

8. Be Willing to Be a Safe Place

This one might be a little bit controversial, but it’s something that I think we should talk openly about. I and many of my friends who have dealt with self harm and suicidality have an intense fear of someone calling 911 on us. Especially for people who are black, autistic, trans, or another vulnerable group, interacting with the police is something to be avoided at all costs because it is dangerous. If you have a friend who has told you that they do not want to go to the ER or interact with the police, please respect that. Work with them to find other ways to keep them safe. Drive them to the ER yourself to get them stitches. Forced hospitalization is not fun for anyone, and if we can avoid it that’s great.

As a side note, one of the things that was most stressful to me when I was self harming was managing other people’s emotions about my self harm. I know that seeing someone you love injuring themselves is AWFUL. It is terrifying and it is painful. Those feelings are real. However in the moment when the person has hurt themselves is not the appropriate time to have that conversation. That’s the time when you need to be calm, ask them if they need to be cleaned up, if they need stitches or a bandage, and hold them tight. I cannot express how big of a deal it was for me when I finally met someone who reacted to my self harm in a calm manner rather than with fear and anger. There is something so validating about a person who loves you accepting that you’ve done this and still communicating that they love you. Save the fear and anger for a less charged moment.

If you have any other suggestions, feel free to drop them in comments!

An Open Letter to a Struggling Friend

Hey you.

It looks like things aren’t going so well right now. In fact it looks like things suck balls right now. It looks like you’re terrified and hurting, and you don’t know how to let people help without giving up who you are and all your coping mechanisms.

Trust me, I understand. I understand what it’s like to know, deep down in your gut, that what you’re doing is right and that everyone else should piss right off because they don’t get it. I understand what it’s like to know that you can’t get through a day without doing those things that everyone else says are “bad” and “dangerous” and “self-destructive”, but you know that you wouldn’t even be alive right now if you couldn’t use them to cope.

I also know what it feels like to not want to be alive anymore. I don’t have any trite words of wisdom about how it gets better. Some days I’m still not convinced that I make the right decision by choosing life over and over again. Life is exhausting and thankless, and seems to be a hamster wheel of attempts at happiness. I don’t know what we get out of it, and I don’t know whether it’s worth it. What I do know is that I care about not hurting people, about being a compassionate, decent human being. I know you do too. And I know for a fact that hurting yourself will hurt many, many other people. Not a small, insignificant hurt either. The kind of hurt that lasts and lingers and comes out of nowhere when you least expect it.

You know that kind of hurt.

I know it comes across as unfair and guilting when other people ask you to be healthy for their sake. They don’t know how hard it is. You’re not doing anything to them. You have the right to your own life, and they need to get over it. You’re doing what you need to do to get by, so screw everyone else who wants to change that. Why is it your responsibility to take care of everyone else’s god damned emotions?

It isn’t fair. In no way is it fair. However it is also the reality of the situation that your actions affect others, and if you want to be consistent with your values you have to start taking care of yourself. You also have to start listening. I know that you are a strong, brazen individual who doesn’t give a fuck…except that you do. You give so many fucks and that’s why it hurts so bad when others are hurting. That’s why you have to poke and poke at the people who want to hurt you, that’s why you want to prove you’re stronger than it all, that’s why you want to look stone-faced. It couldn’t possibly get any worse, could it? Maybe it will get bad enough this time that you won’t have to keep going, you’ll be able to give up.

That doesn’t work. I have tried nearly every trick in the book to turn off the feelings. They keep coming back. Always.

And you and I have something in common that means you will never give up. We have a special kind of stubborn streak. You may be the only other person I’ve met who has one quite like mine. It’s the kind of stubborn streak that means we never leave things half-assed, including our own lives. Oftentimes it leads to problems. But this is one of those times where the stubborn can be used to your benefit. You will hold on to your bad patterns with the strength of Superman, but you will also hold on to life because change is terrifying and you’re used to being alive. Relish that stubbornness. Relish the fact that you’ll survive just to prove that you fucking can and you’ll be fine without any help thanks very much.

Except of course that you won’t be fine without any help.

There are people who are telling you that they love you and that they want to help. That’s not what you want to hear. You want to hear that they’ll leave you alone because you don’t even know what help looks like and you don’t know how things could possibly get any better (because they always seem to find a way to get worse). Somehow it doesn’t hit that these people really might have a perspective that you can learn from. How on earth would they know better than you about your life? They think they care about you and they think they love you, but if they knew who you really were they wouldn’t? They’re lying, it’s a trap, it’s a trick, they’re condescending fucks.

Or that’s what you tell yourself.

In reality, you cannot understand how terrified and in love your friends are. You will never understand what you mean to them. You will never understand how badly it hurts them when you lash out, when you tell them that you know they hate you. You think that you have to be the one to manage them all, to keep them in line. You have to come up with the magic bullet that will fix all your problems and they’ll stand there and smile nicely and maybe lend a hand, but they don’t know what’s going on and so they can’t help.

Except that each of your friends has an entire lifetime of coping behind them. The feeling of finally being able to fall into their arms and give it all up is amazing. They might not know exactly what to do, but a little bit of trust goes a long way: they probably know how to help a lot better than you think they do. They are willing to put up with so much more than you think they are.

Imagine, briefly, that one of us was far away and hurting. Imagine that we were cutting off contact, instigating fights, hurting ourself. Imagine what you would do to get to us, to save us, to make god damn certain that we were ok. Imagine how badly you would want to fold us in your arms and get us to a doctor and shut out the rest of the stupid world until we were safe.

And I get that it feels like we want to control you, and I get that it feels like you’re a damned adult and you can handle yourself, and I get that this all feels like a stupid overreaction and you don’t want it. But you know what being an adult means? It means taking responsibility for your relationships. It means being willing to do shit that is hard and terrifying and unpleasant. It means being willing to talk to your friends and listen when they say they’re worried and do silly, potentially useless things to help calm their fears.

Because really, how would it hurt to let them in? Besides the overwhelming fear of rejection (which you’ve already forced by pushing them away), what would happen? You’d have to stop doing all the things that rip your body apart and leave you broken but in control (or so you tell yourself). You’d have to stop holding so damn tightly to all the little things in your life that are making you feel human.

So yeah, it does hurt to let them in. And maybe some of them won’t be able to handle it. And that is a horrible, miserable feeling. But I can promise you that if you don’t let your friends in, none of them will be able to handle it and you’ll be really, truly alone. I can promise that you KNOW it hurts right now. It may very well get worse if you ask for help and you do the damned hard work of learning new ways to cope. In fact it probably will. For a while. It is a thankless task. But when you hear your friends and family saying things like “I never could have said this to you a year ago”, or you notice how much more relaxed they are around you, or how you haven’t felt like you have to hide or lie in weeks…somehow it’s a little bit worth it.

I’m not going to tell you it will all get better. There are no rainbows and unicorns. But you can get better. You can do better. And I expect better of you. I know that you’re hurting, but that doesn’t give you license to treat your friends the way you have. So please, stand up and be the version of yourself that is vulnerable, open, and compassionate, to yourself and to others.

I love you more than you can imagine.

Olivia