Wednesday, October 30, 2013

Three Things Not To Say To A Depressed Person

Depression is a potentially debilitating mental illness that can range from mild to severe. Dealing with a depressed friend, coworker, or loved one can be very challenging. This article highlights three common mistakes people make when talking to someone who is struggling with depression.

When reading this article, please remember that the most important thing to do to help someone out of depression is to believe the person's value and abilities.

Things to avoid saying:

1. "You should see a counselor.", "You need to see a counselor.", or something similar.

Counselors, whether psychologists, psychiatrists, social workers, school counselors, or other types of life coaches can be very helpful for dealing with depression. However, suggesting that someone see a counselor is not always the best way to help a person, and these two statements are some of the worst possible ways to suggest that a person see a counselor. Statements containing the word "should" can come across as moralizing and judgmental, and often make the person they are directed at feel defensive and resistant. The statement with the word "need" is even worse as it implies that the depressed person will not be able to get better on their own. This can make the person feel more hopeless and depressed, and, if the person actually does seek counseling, it does not lay a good foundation for a good outcome of therapy.

Instead, be very cautious about bringing up the topic of therapy and counseling. If you ever feel like there is a natural way to bring up the subject, introduce it in as gentle and non-threatening a way as possible, and speak from your own personal experience. For example: "I talked to such-and-such a counselor when I was dealing with X, Y, or Z, and I found them very helpful." Remember though, not all counselors or types of therapy are right for all people, so it is best to refrain from making specific recommendations about what a person "should" do...simply share your own experience and then let the person seek out therapy on their own, when they are ready to do so.

2. "Have you ever considered medication?" or "You know there's medication for that." or "I went on / know someone who went on antidepressants and it was very helpful."

Medication for depression is a highly controversial and emotionally charged issue. Suggesting that a person go on medication can come across as dismissive, insulting, and insensitive because it can make them feel like you believe they have something fundamentally wrong with them. The basic problem with depression is that a depressed person believes, irrationally, that something is fundamentally wrong with them, so such a statement can actually make them more depressed. These statements can also may make a depressed person become angry, withdrawn, or shameful. Depressed people have very low self-image and if you make a suggestion that they go on medication, they may have thought processes like: "I am so messed up." or "I'm crazy, I'm losing my mind." or "I am hopeless, I can't get out of this rut I am in." The last thing you want to do is to make any statements to a depressed person that can fuel these statements.

Also, unlike with psychotic disorders and manic depression (bipolar disorder), the use of antidepressants to treat major or minor depression, and the use of any form of drugs to treat generalized anxiety disorder (which is related to and often co-occurs with depression) is highly controversial even within the scientific and medical community. Although there are a number of people who strongly feel that antidepressants have worked for them, there are many people who, for legitimate reasons, are cautious about ever taking these medications. There are also concerns about the benefits of antidepressants being overstated in the medical literature due to publication bias; because of the internet, many people, including depressed people, are increasingly well-educated about pharmaceuticals, and are rightfully cautious or skeptical about taking medication. If you suggest medication to such a person, you may undermine their trust in you. There are also factors that lead certain people to respond more or less well to antidepressants, and there are certain groups of people. If you are not a doctor and do not know the full medical and psychological history of the person you are talking to, then it is not your place to talk about medication. Do not bring the subject up.

3. Nothing, or agreement, in response to a depressed person's negative statements.

People who are depressed will often make negative statements about themselves, their life, their circumstances, job, people they know, or even their friends and loved ones. They speak these negative things because their mind is filled with negative thoughts. However, the act of speaking something out loud can actually solidify someone's belief, especially if they receive social reinforcement.

Sometimes people agree with the irrational negative statements that a depressed person makes, because they want to comfort the person. For example, a depressed person might be complaining about their job, and they might talk about how much of a jerk their boss and coworkers are, or they might talk about how their family doesn't care about them, or about how their job search has been fruitless. If you just listen, smile, and nod, or if you respond by affirming them, with something like "Wow, that sounds so terrible.", you may reinforce the person's negative thoughts.

Instead, quickly, assertively, and authoritatively stop them; interrupt them if necessary. Show solidarity but do so in a way that makes more objective, detached statements, with softer emotional content, and then make a positive statement. For example, if someone is complaining that their boss is being a jerk, you can say: "It sounds like your boss was putting you in a difficult situation. I think you are a strong person for being able to handle yourself well in a work environment like that." This sort of statement emphasizes a personal strength of the depressed person and will help nudge them in a more positive direction.

In summary:

Three of the most important things to avoid saying to a depressed person are (1) statements that the person "should" or "needs to" see a counselor (2) suggestions that the person go on antidepressant medications, and (3) agreement or affirmation of the person's irrational negative thoughts or statements. Instead, make statements that help the person to believe in themselves and their own ability to overcome depression.

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