Having Difficult Conversations: Depression Edition

The last couple of days have been hard for me. I’m moving out of my apartment and the whole “leaving the country” thing is starting to get real. That means my emotions have been all out of whack, and I’ve been trying to rely on the coping skills I’ve built up in the past year to deal in a healthy manner. One of the things that I’ve really been trying to practice is asking my friends for help when I’m in a bad place, particularly if I think I’m going to use symptoms. But as I experiment with this, I’ve noticed that there are some serious potential pitfalls to asking for help. As someone who wants to be a responsible adult who manages their emotions without demanding things from other people, I want to be able to ask for help without being manipulative, obnoxious, or clingy.

The first issue I’ve run into is that when I tell someone that I think I’m about to use symptoms (especially self-harm), it can come across as extremely manipulative. “Pay attention to me or else!” it screams. “If you’re actually busy and can’t make time, it is ALL YOUR FAULT if bad things happen” seems to be hiding under “I think I want to hurt myself”. Partially this is your support person’s responsibility: they need to learn that they are not responsible for your behavior, and that a request for help is not the same as foisting off responsibility. Oftentimes when we think we’re going to use symptoms we have to pull out every coping mechanism we have, and even when we do everything right we still slip up and do the thing we’re not supposed to do. That’s ok. Part of being a good support person is knowing that you can’t fix the other person or control their behavior.

All of that being said, there are better and worse ways to ask for help. Any “if…then” statements should probably be avoided (e.g. if you don’t talk to me then I will hurt myself). If you are capable of letting your support person know what it is you want from them, that’s also preferable (instead of just saying HELP, say “I want to talk to you/I want someone here/I want a giant hug and a bowl of ice cream”). One of the hardest parts of this for me is giving the other person a way to say no if they legitimately feel as if they can’t help in that moment. It comes across as super passive aggressive when you say “well it’s not important but…” or “don’t worry about me, I’ll be fine…”. These things seem to imply that you really really actually do want and need the other person you just don’t want to be pushy about it. I have yet to find a really solid method of signalling to my friends that it’s ok for them to say no in nasty jerkbrain situations, but thus far the best method has been to let them know that I do have other people I can go to.

But there is some tension in trying not to put too much pressure on someone while also letting them know that you are really truly struggling. This does actually make a difference because a. if you want help it’s best to be honest about that rather than just trying to chat with someone and then halfway through sliding your problem into the conversation and b. your friend might be a lot more willing to make themselves available if they know what’s up. There’s a balance to be found between signalling that you really could use some help and that your support person should probably prioritize this interaction higher than any old chat, but also signalling that they have the space to set boundaries and take care of themself. I suppose this is just a microcosm of the struggle that is all human interaction, namely finding ways to get what you yourself need while allowing the people you interact with to get what they need as well.

So even asking for help is extremely difficult, but let’s say that you ask your friend for some time and they say yes: one of the other things that is extremely difficult is that when you’re in the midst of a depressive episode, your honest to god feelings are things that are not deemed socially appropriate. They’re things that no one knows how to respond to, they’re things that are ugly and gross and embarrassing. And quite often, they come with an intensity that means it can feel as if you’re beating your friend about the head and shoulders with your Sad!feels.

I have been on the receiving end of an interaction in which one party just throws all of their depression at me. It’s overwhelming and leaves the support person fairly incapable of doing anything useful or helpful. It feels icky and like the individual is fishing for compliments and over the top. Especially when the depression feels are of the self-hating variety, it’s like walking through a minefield (often because the person with the self hatred feels both wants to be contradicted and validated).

The problem is that when you are in the midst of feeling incredibly depressed, you really truly feel that you are the least lovable human being on the planet, and that you’re ugly and horrible and stupid and disgusting and cruel and selfish. And for me personally, I often just want to be able to say those things out loud to get them out of my head. But what do you and your support person do with those ugly words once they’re out in the open? How do you make them something that is ok to talk about and acknowledge and validate while also letting your support person pull you back onto the solid ground of facts and reality?

I mean, if I knew the answer to this I’d probably be making a lot of money off of an innovative therapy technique, but it seems to me that it might be a good idea to ask your support people to set up some ground rules with you before you’re in the midst of a shitty headspace. These might include: no invalidation (I get to feel however I want), if you have evidence that might change my feelings, please present it, or here is our secret signal for when I just need you to listen to how I feel. Conversations in which someone who has a mental illness can actually tell another person what they feel about themselves without being judged and without putting pressure on the other person to fix or reassure are few and far between, but they also have the potential to be transformative. While they are difficult and terrifying and vulnerable, they also illustrate to someone with mental illness that those bits they feel the most shame about are acceptable and wanted. I’m still working on my scripts for these conversations, but hopefully we can share them as we make them.

Stronger Than The Pills: Dependence and Identity

I was talking the other day with a friend about how people can act completely differently around their significant others. Some people are super bothered by that. “They’re not being themselves!” these hypothetical people whine. “They’re changing!” There are a lot of people who argue that you shouldn’t allow other people to change who you are, that you should “be yourself”.

My friend and I went back and forth for a while about what this meant for your “real” self, but by the end of the conversation we had mostly agreed that everything we do and everyone we interact with affects our brain. Brains are malleable things, and there’s evidence that (especially when we’re young) even single interactions can have impacts for years to come. Relatedly, we all adjust our behavior and self based on context. We change our clothes when we go to work, our language changes based on who we’re around. When there are different inputs and contexts, our “self” has to adapt. This is part of being a successful and functional human being.

Brains tend less to be like a static identity and more like a processor: we have ways that our brains like to interpret things or respond to things, but there is always something there to interpret, there’s always stimuli coming in that will make slight adjustments to our processors. So it doesn’t seem to be that big of a deal if you choose to be around someone who affects your processor.

What does this have to do with pills you might ask?

Well some of those things that people say about relationships that affect your personality are things that people say about pills. I’ve been listening almost nonstop to Neon Trees for a few weeks and one of their lyrics says “I’m stronger than the pills”. I’m so done with phrases like this. They imply that anything that affects your brain chemistry is a crutch, a cheat, a way out of being you.

The biggest problem with this is that just like a relationship that affects the way you act, there is no integral self to interrupt. “Self” is choosing which inputs you would like. There’s really no way we can figure out what we’re like without the influence of our environment and the food we eat and the sleep we get and the people we talk to and the job we have (see: Judith Butler). We’ve got influences from the moment we’re conceived. This is not to say that there aren’t some elements of personality and self that stay consistent across time, just that it’s silly to imagine that you can have a pristine, untouched self that would be horribly tainted forever by the introduction of meds.

Strength is knowing what allows you to behave positively and functionally and choosing to put yourself under that influence: because you will never be without influence. “Being true to yourself” is about what you choose to surround yourself with. Changing our inputs is part of how we remain independent. Unless you cannot choose to change your inputs, you are always stronger than they are.

Another issue some people have with meds or serious relationships is dependence. They don’t want to have to rely on something external to themselves. I hate to break it to you all but we’re all dependent on things that are external to us. we’re dependent on food and on sleep for god’s sake, and those things affect our brain chemistry and biology. There are things we need each and every day, whether that is a medication or 20 minutes of alone time or running or food or a book or your Facebook. We’re dependent on the world around us. And all of these things affect your brain in ways similar to your relationship or your drugs.

It doesn’t feel nice to realize how dependent you are on external things, how fragile you are. And when you’re dependent on things that others aren’t dependent on (like pills), it’s a reminder over and over that we have to choose our inputs but that we don’t get to choose whether or not there are inputs. That can be scary. It can feel like you have no control over your Self. But you do. You get to choose (to some extent) what things affect your Self. You get to choose whether to sleep enough or work a shitty, stressful job, or eat healthy, or be around validating people, or whatever it might be that turns you into a processing machine or a bumbling Windows ’95.

That’s all the power you get. So yes, your identity will be dependent on your pills. It might change who you are a bit. But that’s ok. Because everything and everyone you encounter does. If you don’t like how you change then you get a choice: you can continue to depend on it or you can move away from it. But if you want to stop being influenced, if you want your identity to be pure and unadulterated you, then you’re pretty much just going to have to die because that’s the only way you stop being influenced.

Making choices to change yourself so you don’t act like a dick is not selling out: it’s being an adult.

 

Asking for Help and Taking Responsibility

When someone you care about is dealing with depression or a mental illness, it can be incredibly hard to figure out how much to help and how to take care of yourself while also being there for them. And when you are suffering from a mental illness, sometimes it feels like all you can do is just yell for help. Two things that all parties are often told is that everyone is responsible for their own emotions and that it’s important to ask for help. I have found that on both sides (as a support person and as someone suffering), these two things often feel contradictory.

Let’s say you’re feeling really down. You go to your best friend and you tell them you’re struggling.  You tell them you don’t know what to do. You say “help”. From your perspective, you’re taking responsibility. You’ve owned up to your feelings and now you are asking for help. From their perspective, it seems like you’re foisting off the responsibility for your emotions and they’re expected to simply fix what’s happening, make it better, make you happy. Who’s right? Where’s the balance?

There is a difference between asking someone to help you take care of your mental health and making your mental health someone else’s responsibility. No one else is capable of fixing your depression or anxiety or sadness or whatever else might be getting you down. Sure, they might be able to alleviate it for a while (especially if you’re dating them and you get the nice fluttery feelings around them), but that doesn’t actually turn out to be a long term fix. It’s too much pressure to be the only source of someone’s happiness, to be expected to turn on a switch that makes the bad go away. It’s taken some time for me to start to identify the signs of “fix me” rather than “help me”, but for those who are still navigating a relationship in which mental illness plays a role, here are some things to watch out for.

1. Diversify

We all need people. It’s part of our emotional needs. We need to socialize, we need to talk, we need people to take care of us when we’re sick and people to share things with. All that makes perfect sense. But as adults, we also need to realize that no one person can meet all of our emotional needs. There’s simply not enough time in the day. That’s why we have networks with a variety of people. Our networks don’t have to be huge: mine is basically my parents, my boyfriend, and one or two close friends (plus my therapist). But each of these people provides a new perspective and can support me in different ways. It means that when my mom is having a horrible week at work, I can give her some space and go ask my boyfriend to hang out with me for a bit. No one should be required to always be on call, and if you find that you’re constantly waiting for one person it might be a good time to think about building up some other relationships.

2. Make a good faith effort

If your first recourse when you’re depressed is to call that certain someone, this might be a sign that you don’t have other coping mechanisms or that you aren’t trying to rely on yourself. It’s certainly ok to call someone, but there should be other tools in your toolkit that you’re willing to reach for first (and this can be dependent on the seriousness of a given situation. If you’re experiencing severe suicidal ideation then PICK UP THE PHONE. If you’re feeling kind of blah and bored and empty, then see what options you’ve got). This can also be on a larger scale: if medical help is feasible, you should probably be willing to try that out (e.g. meds or therapy). You might try changing your situation (volunteering, getting out of a bad housing situation, etc.). Of course making an effort is one of the hardest things to do when depressed, but before you tell your friend/SO about how miserable your day was, you should at least have tried to get out of bed, shower, and leave the house.

3. Articulate what you need (as best you can)

One of the things that leaves a support person feeling like they should be able to snap their fingers or wave a magic wand and just “fix it” is when their loved one doesn’t give some hint of how to help. Of course there are times when we don’t know what we need and we have to do our best to explain how we’re feeling and ask for a general kind of help, but as best as you can, let the other person know what you need. Tell them if you need to vent or if you need to brainstorm solutions. Call someone up and say “I need a distraction do you want to go out” instead of simply saying “I’m bored help”. This means more work on your part. You have to brainstorm what might help you. That’s part of being responsible. If you can’t figure it out, you can ask for help figuring out what you need (e.g. “I feel horrible and I can’t figure out what to do. Do you have any suggestions?”). Simply expressing how you feel without giving the other person an idea of how they fit in feels like you’re just throwing your depression at them.

4. Be independent

This can mean a lot of things, but at its heart it says please don’t have one person be your only social life, job, or interaction all day long. Have a job, have interests, volunteer, have friends, have a side project. Have things that belong to you and that you’re willing to do by yourself or with a different friend. There’s something intensely unpleasant about having another person waiting around for you all day to entertain them. If your partner/support person sees you at the end of the day, your answer to “what did you do today” should not always be “nothing”. Sure there are days when you can’t manage anything. Sure, there are days when the depression gets too bad and all you can do is crawl out of bed. But if the only times you get out of bed, get dressed, talk to people, accomplish something, or have fun is when that one special person is there, you’ve made them responsible for you.

5. Never imply or say that the other person is required to be there for you.

I’ve had people tell me that they need me, that they’ll have to kill themselves if I leave, that if I’m not around they’ll hurt themselves, etc. etc. Don’t do that. Don’t call someone from your vacation and tell them how miserable you are because they’re not there. Make a serious effort to have at least a few examples you can point to where you were on your own and you were ok so that they can trust that you can spend a night without them.

That crap is not romantic. It’s cruel.

6. Be willing to feel like crap.

This might sound odd, but for people with mental illness, one symptom seems to be a serious inability to tolerate distress. Because many of us start to panic and look to bad coping mechanisms when we feel bad, our support people worry whenever we are in a bad mood. Something that is oddly reassuring is to tell your support person “yes, I feel like shit right now, but I will be ok. I’ll get through it.” As a corollary to this, if you have to ride out a shitty mood, your partner/support people get to choose how much they want to be around you. It’s nice to give them a little heads up: “I feel like crap right now. If you’d like to come over you can, but I’m going to be miserable company and that probably won’t change at least for today.”  This lets your support person take care of themselves. They can let you know they’re willing to be on call if things go really bad, but they’ll see you tomorrow, or they can choose to see you anyway and brace for a bad mood.

 

All of these things exist on a spectrum. Most of the examples I gave were towards the extreme end. Obviously it’s fairly abusive to threaten suicide if someone isn’t always around you, but that type of behavior can exist in a subtler way (the passive aggressive sigh and “I guess I”ll be ok with you”). But if you notice these types of behaviors in  yourself or your partner it might be a good time to reevaluate what’s happening to treat the mental illness in the relationship and have a frank discussion about who is responsible for what.