By David Levine,
Depression is a confounding condition, both for those who have it and for their friends and family. Mental illness often makes it extremely hard for the person with the disease to take action to get better. That’s hard to understand for anyone who has never had to deal with it. It’s the main reason people, even with the right intentions, often say the wrong things.
And what people say is important. “Words do matter,” says Dr. Philip R. Muskin, professor of psychiatry at Columbia University Medical Center and secretary of the American Psychiatric Association. “By avoiding stigmatizing statements, you can help stop the shame and fear that is often associated with mental illness. People living with depression fear being judged, and that’s one of the biggest reasons people avoid getting treatment.”
Here are seven things not to say to someone with depression, plus suggestions for what to say instead.
“Get over it.” No one expects a friend or loved one to “get over” diabetes or heart disease, but that is often the response when someone with depression expresses his or her feelings and emotions. Indeed, “get over it” may be the worst thing anyone can say to someone with depression. “Clinical depression is not a choice. Nobody chooses to be depressed,” Muskin says. Neither is depression a moral failing, a weakness of will or a phantom of the imagination. Depression is a medical disorder, a biological disruption of brain chemistry linked to and triggered by some combination of genetics, family history, past trauma, stress and other factors.
Instead, say something like, “What can I do for you?” “This is important, but it comes with a caveat,” Muskin says. “If you really want to be there and help someone, then you need to do what you say you’re going to do.”
“A lot of people have it worse than you.” People with depression often know this, too, and feel guilty about their condition. They don’t need more guilt piled on.
“It might be worth saying it bluntly – ‘If you feel this is overwhelming for you, please tell me. I care about you,’” Muskin says. This is especially true if the person might feel like life is not worth living. Say something like, “I want to get you the care you deserve,” Muskin says. “There is nothing shameful about feeling that way, and no one has ever become suicidal from a friend asking about those thoughts. The reverse is true. It is immensely emotionally relieving to be able to tell someone about such frightening thoughts.”
“Stop it.” “People know they shouldn’t be eating another half-gallon of ice cream. The problem with depression is each person who has it knows the right thing to do but can’t find a way to bring themselves to do it,” says Michael D. Yapko, a clinical psychologist, author and lecturer on depression. “Telling someone how they should feel or act doesn’t tell them how to do it.”
A better solution, he says, is to help the person “develop a realistic pathway to get there.” Suggest “let’s exercise together,” or “let me help you find someone to talk to about this.” “The reason to go to therapy is the hope that the therapist will provide a pathway to make it possible,” Yapko says. “Don’t encourage results without suggesting a means for producing it.”
“You’re crazy.” The American Psychiatric Association stresses the importance of avoiding derogatory language. Words such as psycho and crazy are not helpful. Neither are words like “suffering” or “victim.” Someone “has” depression; she doesn’t “suffer” from it.
Similarly, the APA says, it’s preferable to say someone has depression rather than “she is depressed.” “The basic concept is that the mental health condition (or physical or other condition) is only one aspect of a person’s life, not the defining characteristic,” the APA says.
“Just do something about it.” Depression is so insidious because it makes it very hard to do anything about it. “Depressed people make depressed decisions,” Yapko says. “When you use your feelings as an indicator of what to do, you make bad decisions.” That is often behind the battles people with depression get into with those around them. “They are responding to feelings instead of the larger goal,” Yapko says.
Instead, say, “If you don’t know what to do, let’s talk to somebody who does.” Go after the goal, not the feelings, Yapko says. “Offer to help them through it. Don’t get mad at them. Understand that helplessness is part of depression.” Even therapists get frustrated when patients don’t do what has been asked of them, he says. The point is to understand why they act that way. “Tell the person that trying something new may not feel good or attractive right now, but doing what they’ve been doing isn’t the solution,” he says.
“You don’t need medication; you can pull through this.” That is for a mental health professional to decide. While it is very true that many cases of depression do respond to treatments other than antidepressants, like psychotherapy and exercise, some people do need medication, Muskin says. And those who are already on antidepressants should not stop taking their medication without speaking to their doctor first, he says.
“Everything will be OK.” Someone with depression can’t see that. It’s important to stay positive and encouraging, but it takes action to feel better.
Offer suggestions, such as, “Let’s do something together,” Muskin says. “Depression can keep a person from participating in everyday activities. But you can show your support by offering to go to a movie, or even a quick walk.”
Finally, sometimes the best thing to say is nothing. “Just listen,” Muskin says. “But make it clear you are listening.” When you do respond, stay calm and empathetic. “Getting angry and yelling are the worst things you can do,” Yapko says. “It is not helpful. They need support, and you may have to go out of your way to do things you would rather they do on own, like find a therapist, or take them to appointments, at least initially.”
Am I Just Sad – or Actually Depressed?
The world in (no) color
Your team loses, your best friend moves away, your preteen claims to hate you – if you’re human, you feel sad. But if your team wins, your best friend announces a surprise visit, your preteen apologizes and you still feel sad, you may be clinically depressed. “A person is blue if they have deep, colorful emotions in response to loss in life,” says Lara Honos-Webb, a clinical psychologist in San Francisco and author of “Listening to Depression: How Understanding Your Pain Can Heal Your Life.” “Depression is more like the color black – there [are] no subtle colors to the emotion but stark pain.” How else do experts explain the difference between normal and disordered?
The mental health spectrum
Just as we’ve all sneezed but don’t all have allergies, we’ve all experienced symptoms of some mental illnesses without having a mental illness. That’s part of the reason why identifying these conditions – which affect 25 percent of Americans at some point in their lives – can be so difficult. Still, most mental illness diagnoses come down to a few key considerations: how long the symptoms have persisted, how intense they are, how appropriate they are to the situation and how much they’re affecting a person’s daily life. A mental health professional can drill down to the specifics – and provide treatment if necessary. Here’s what they might look for in seven conditions:
Am I just absent-minded – or struggling with ADHD?
Forget to add a contact to your cellphone? Honos-Webb will give you “absent-minded.” But if “half of your contacts are organized alphabetically by last name and the other half is organized alphabetically by first name,” you might have attention-deficit hyperactivity disorder, says Honos-Webb, who also wrote “The Gift of ADHD: How to Transform Your Child’s Problems Into Strengths.” While the condition is ideally diagnosed before age 12, adults often live with it undiagnosed. Check out the World Health Organization’s screener to see if you should seek a formal diagnosis – something that’s often a relief to adults who’ve attributed their symptoms to character flaws, the Attention Deficit Disorder Association assures.
Am I just shy – or do I have social anxiety disorder?
Your boss asks you to deliver a work presentation next month. Do you worry about it days before – or all month? Does preparation calm you down – or feel useless? Does a smile from an audience member pacify you – or are you gripped with uncontrollable physical reactions like sweating? If you can relate more to the latter experiences, you may have social anxiety disorder, says Linda Sapadin, a psychologist and author in Valley Stream, New York, who specializes in helping people overcome self-defeating patterns of behavior. The condition, which affects about 7 percent of American adults, is often treated with a mix of medications and talk therapy.
Am I just a neat freak – or obsessive-compulsive?
Meet Allen, a 22-year-old with obsessive-compulsive disorderwho’s described in “Understanding Mental Disorders,” the American Psychiatric Association’s guidebook to its diagnostic manual. Allen is so fearful of contracting HIV that he spends hours washing his hands – with bleach, no less – up to 30 times a day. Dedicating extensive time and energy to a rigid routine that brings little joy and is often triggered by a knowingly irrational but persistent thought is a sign of obsessive compulsive disorder. While perfectionists prefer to do things well, Sapadin says, someone with OCD “is driven to do it, regardless of the toll it takes on him or those he works or lives with.”
Am I just a party animal – or an addict?
What do you think about first when you score an invite to what’s sure to be the party of the year? If it’s who will be there, what you’ll wear and how you’ll dance all night, party on! If it’s how much alcohol will be served and how you’ll get your hands on it, you may have a substance abuse problem. “The ‘party animal’ loves every aspect of the party scene,” explains DeAnna Jordan, clinical director of New Method Wellness substance abuse treatment center in Orange County, California. “The addict is obsessed with attaining the booze.” Treatment – often a combination of medication and individual or group therapy – can help.
Am I rightfully worried – or a hypochondriac?
Good news: Your doctor assures you that your mole, cough and stomach discomfort are nothing to worry about. How do you feel? Relieved? Or “do you still believe the doctor made a mistake and something is dreadfully wrong?” asks Sapadin, who wrote “Master Your Fears: How to Triumph Over Your Worry and Get on with Your Life.” Feeling the latter could be a sign of hypochondriasis, a specific phobia in which the fear of sickness far outweighs the risk. “Hypochondriacs live in constant dread of having the next awful disease,” Sapadin says. Seeking professional help for any phobia is especially important, APA’s guide points out, since having one raises the risk for suicide.
Am I just a bad sleeper – or an insomniac?
Michael Grandner, director of the Sleep and Health Research Program at the University of Arizona, calls it the 30-30-3 rule: If it takes you more than 30 minutes to fall asleep or back to sleep at least three nights a week, you might have insomnia – but only if you’ve also given yourself sufficient time to sleep and are suffering the consequences of sleeplessness during the day. The condition (or its symptoms) can strike in response to a situation (say, a job loss), coincide with a different condition (like an anxiety disorder) or be chronic, and is typically treated with medication and behavior therapy.
Do I just overdo it on food – or do I have binge eating disorder?
Whoops. There goes the whole pint of ice cream – again. If you shrug it off and remember how delicious it was, blame your sweet tooth. But if you’re riddled with guilt and remember feeling out of control, you might have binge eating disorder – the most common eating disorder, which can be treated with psychotherapy and medications, according to the National Eating Disorders Association. “All of us have eaten a meal or a snack when we were full or not hungry because of boredom, peer pressure and the like,” Jordan says. The binge-eating disorder sufferer, on the other hand, does it often – and often in secret.