CW: mental health, self-harm, suicide, drug use mention

A lot of dealing with depression consists of waiting for time to pass, minimizing unhelpful behaviours, and trying to carve out meaning even amidst a deep depressive episode. Friends and family and communities can be the backbone of management and recovery for people living with this particular illness. If you love someone who deals with depression, here are some insights from someone who’s currently in the midst of it.

The following tips are not universally valid; they come from my own experience being a person with major depressive disorder and with unbelievably wonderful friends.

A lot of the content here that has to do with holding space and suicide prevention very closely follows a workshop led by Carly Boyce at Glad Day Bookshop called “Suicide intervention for weirdos, freaks, & queers: helping your friends who sometimes want to die maybe not die.” I’m grateful to Carly and to all of the other participants. The workshop was a really comfy space to talk about a difficult issue.

SOME THINGS THAT MIGHT HELP

1. Hold space.

In the workshop, Carly talked about holding space with people experiencing difficult feelings. She used the metaphor of a container: someone can have a container that’s too full, either because of one huge thing, or simply because of the thousand natural shocks that flesh is heir to. When you hold space with someone by listening, being present, and validating feelings, you temporarily offer them a bigger container. That’s a huge gift.

Here are a few options for kind, validating things to say as you hold space with someone: I love you. I care about you. Thanks for trusting me with this. I’m glad you told me. Do you want to meet up again next week to continue this conversation? That’s so real. [Situation] is really messed up. You deserve better than that. Your feelings are valid. It’s okay to feel that way. If there are ways I can have your back, I want to. You’re important. You matter.

If your friend tells you something that sounds irrational, e.g. that they’re bad company or that they’re not valuable, understand that these things are perfectly coherent from within the internal logic of depression. These thoughts and feelings are no less legitimate for the people experiencing them because they don’t correspond to external reality. Continue to be validating. “That’s not my experience with you” is better than “that’s not true.”

It can also be helpful to allow your loved one to hold a little space for you, if they can handle it. I love it when friends trust me with their problems. It gives me an opportunity to be empathetic and focus on someone outside myself, and I feel more secure in friendships when there is reciprocity.

It’s important to be accepting of however your loved one is coping. Depression is really, really rough, and for someone going through it, it’s easy to believe that the suffering is somehow deserved. Sometimes the person you love will choose coping mechanisms that you don’t think are ideal. Self-harm, drinking, and substance use can be harmful and can become their own problems, yes, but these “unhealthy behaviours” can also help a very difficult period of time to pass. Challenging a friend’s behaviour, out of love, is generally acceptable, but it’s important to approach any conversation with the assumption that your loved one is dealing with the stuff that life is throwing at them in the best way they know how. Don’t be paternalistic. It usually won’t be your job to intervene. It will always be your job to be accepting and to be a safe space for your friend.

Your friend might have their own subjective hierarchy of less-than-ideal coping strategies: having two drinks at a party with friends is healthier than opening that bottle of merlot in your closet when you’re alone and despondent, which is healthier than binge-eating chocolate (again), which is healthier than self-harming, which is healthier than using. Your unhealthy behaviour might be a relatively healthy choice for me. It’s really not your role to make your friend feel guilty or ashamed about the way that they’re coping. If you’re concerned about their safety, ask questions – what does this behaviour mean? are you in danger? what can I do to support you? – but be curious, not judgemental.

As expressed in another blog entry, “time, attention, love, enjoyment > help.”

2. Make concrete suggestions.

Sometimes, company and activity can help to mediate the pain and tedium of constantly living in an existential void. Ask your friend what you can do.

This is something I learned at the workshop: multiple-choice questions are best. It’s difficult to be assertive when you’re depressed. Indecision and insecurity come much more naturally. With that in mind, make concrete offers that your loved one can choose from. Making clear suggestions is also helpful because your loved one may not know what they can ask of you; having a few options will give them an idea of your parameters. You can indicate which things would be really easy for you, which things would take a little rearranging or effort on your part, and which things would be more difficult but still possible.

There’s some really good stuff over at Captain Awkward:

I think one thing you can do to help your friends who are depressed is to reach out to them not in the spirit of helping, but in the spirit of liking them and wanting their company. “I’m here to help if you ever need me” is good to know, but hard to act on, especially when you’re in a dark place. Specific, ongoing, pleasure-based invitations are much easier to absorb. “I’m here. Let’s go to the movies. Or stay in and order takeout and watch some dumb TV.” “I’m having a party, it would be really great if you could come for a little while.” Ask them for help with things you know they are good at and like doing, so there is reciprocity and a way for them to contribute. “Will you come over Sunday and help me clear my closet of unfashionable and unflattering items? I trust your eye.” “Will you read this story I wrote and help me fix the dialogue?” “Want to make dinner together? You chop, I’ll assemble.” “I am going glasses shopping and I need another set of eyes.” Remind yourself why you like this person, and in the process, remind them that they are likable and worth your time and interest.

Later in that blog entry, the author also points out that depressed people often do not have the emotional resources or the confidence to initiate plans. It can help to take initiative and “meet your friends a little more than halfway.” Be gracious if your friend cancels plans. Respect their boundaries – don’t force yourself on them – but remember that depression snatches away energy and confidence and self-worth and that that may be why your friend is avoiding you. Ask if they want you to keep inviting you to things and checking in, even if their social cues are saying otherwise. The answer may very well be yes.

The most significant thing that my friends have done for me has been helping me to stay connected (with them, with the world beyond myself) and reassuring me that I’m not a burden. It’s different for everyone. Based on my experience, here are some options that you can suggest.

Would it help you if I…

… took you for a walk, even a very short one?

… took you out to a movie or brought popcorn and my Netflix login?

… sat on the floor with you?

… stayed over or had you over for a sleepover?

… showed up at your door with takeout, came over to make dinner, helped you with dishes or laundry? (As for the tidying up bit, be sure to ask about this; sometimes having a messy room can be really comforting, and paternalism is seldom helpful.)

… stopped talking for now and touched base later?

… sat with you while you called your mom / made an appointment / started a new medication?

… sat silently on Skype with you?

… planned a small adventure?

… let you know the next time I was going for a run / checking out a new store / doing errands so you could come along?

… reminded you of the reasons why I like you and why you’re valuable?

… helped you cross a thing or two off your to-do list?

Don’t offer more than you can follow through on willingly. You want to be able to communicate to your friend that whatever you’re doing together isn’t burdensome for you. There’s more about boundaries in the next sections.

3. It’s okay to explicitly ask about suicide.

You won’t cause any harm by asking. Don’t worry about saying the wrong thing: we all do at some point, and it’s always okay to say “I’m sorry, that came out wrong.” As long as you approach this conversation with sensitivity and love, and you have a good sense of your own boundaries, you’re golden.

It’s also okay if, for any reason, you’re not able to have this conversation with your friend. If that’s the case and your friend brings it up, be honest about your limits and ask if you can help them find someone else who would be better able to be in that conversation with them.

Euphemisms are unhelpful: hurting yourself, dying, and carrying out suicide are not the same thing, and it’s important to be as clear as possible. If there’s ambiguity, ask a question. If your loved one says something that worries you, here are some questions that it’s okay to ask:

– Are you talking about suicide?

– Do you mean that you’re considering ending your life?

– Do you have a plan? Have you thought about methods/timing/etc.? (If your friend says that they are considering ending their life, you likely won’t cause harm by asking this, and it may be helpful as far as risk assessment goes.)

– Do you feel safe? What would make you feel safer? (Open-ended questions can be difficult to answer for us depressed folks, so here are some options you could suggest: removing certain objects from the environment, being with a safe person such as a friend or family member, calling a crisis line to talk through some options with a professional, being under supervision at a hospital or crisis centre, having a plan for friends to check in at a certain point.)

– What can we do right now to get through this moment?

– Do you want to stay with me? Do you want me to stay with you? (There isn’t an obligation to offer this, but if you are willing and able, by all means. Asking if there is another place your friend can stay may not be helpful, as it may highlight a lack of economic or social resources.)

– Are there certain objects, medications/substances, or environments that you need to avoid? How can I help facilitate that?

Sometimes holding feelings can be more immediately important than safety planning. Don’t panic, don’t be afraid to ask questions, and don’t forget to let your friend steer the conversation.

4. Remember that depression is often a long-term thing.

Crisis support is important, but depression often operates on long time scales. This means that your boundaries are important. Don’t take on more than you can handle: it won’t do you or your friend any good. If you want to be part of your loved one’s support network, be assertive about your boundaries so that you don’t burn yourself out in the first crisis and then disappear – sometimes the monotony of everyday life can be every bit as icky as the big crises, and it’s good to have support through that monotony, too. To quote Carly, “the kindest and most supportive thing we can do is to be honest and realistic about what we can offer.” It’s good for everyone if the way that you support those around you is sustainable for you.

It can also be a good idea to debrief about a crisis after it has passed.

– A few weeks ago, [thing] happened … was [supportive action] helpful or unhelpful? How would you want things to play out differently in the future?

– Do you want me to be on your support team? What does that look like?

– What can we do to make things easier for you in the future?

SOME THINGS TO REMEMBER

1. You’re not in the driver’s seat.

This was a good metaphor brought up in the workshop. The person you’re supporting is in the driver’s seat, and they get to choose the direction you go, the acceleration, etc. Carly pointed out that people who are experiencing deep pain or crisis are often experiencing feelings of disempowerment, and it can be very helpful to locate the person you’re engaging with in a position of power within the conversation.

Be a listening and accepting presence in the passenger seat. Employ silence in your conversations. “I’m just processing” works if you feel uncomfortable with too much silence. If you don’t feel safe with where the car is going – for example, if you feel triggered – you get a say in that.

Validate your loved one’s experiences. There are different ways to talk about mental health; follow their lead. Maybe the person you’re supporting sees depression as a benign thing to manage rather than as something pathological. Maybe they find the recovery narrative frustrating because they’ve been dealing with mental health challenges for so long; maybe the survival narrative is more helpful for grinding onwards. All of that is valid. Driver’s choice.

2. It’s not your job to fix this.

Don’t grab the wheel. Don’t worry about getting all the facts. You’re not an expert, and you’re not expected to be. As Carly pointed out, you don’t have all the resources to fix someone’s entire life, and even if you did, you shouldn’t situate yourself as the fixer. The person you’re supporting has agency; their current state of heightened brokenness doesn’t change that.

In the context of suicide intervention, the uncomfortable corollary is that it’s not your job to keep anyone else alive. In fact, you might not be able to. That is a difficult truth to accept. It’s one of the many reasons why loving someone with depression is hard. However, you will be a much better friend and support if you stay calm, de-escalate your own fear (Carly), and remain attentive to your own needs.

3. You are not just a caretaker.

You need to take care of yourself, too. This is really important. If you have triggers, be up-front about them. Can’t handle conversations about self-harm? Struggle with anxiety every time you talk about abandonment? Mention that. Boundaries are important. You are not expected to be everything for anyone.

It’s okay to need to debrief with someone. There’s a huge caveat here, though: make sure you check in with the person you’re supporting. Respect confidentiality and be transparent about who you plan to talk to ahead of time. It’s also generally a good idea to follow the ring theory: comfort the people in the centre of a crisis, and seek support from those who are less affected by it than you are. One option is to call a mental health hotline to debrief with someone anonymously; they aren’t only there for crises.

Don’t forget that you are a person. You are important, and so are your job, your health, your sleep, your boundaries, etc. It’s okay to have sharply defined boundaries. In fact, it’s good. I feel most at ease when I am with people who have been clear about their boundaries. Then, I don’t have to spend any time second-guessing whether they can handle being there with me.

People may not like your boundaries. That’s okay. Validate whatever feelings your loved one brings up. Listen for the underlying needs and talk about how those can be addressed, by you, by someone else in your loved one’s support network, or by someone who hasn’t yet been brought in to that network. You’re not responsible to take on more than you can handle.

4. You are not an island.

If you find yourself in a position where you are becoming a sole support for a friend, open up a conversation with them about building a network. I talk to a different friend depending on whether I am having a crisis of faith, a hard time with mental health, or an existential crisis induced by reading too much Kierkegaard. It’s a huge source of comfort to have those options in a network that surrounds me. It can be difficult, from a position of being very depressed, to reach out: you can help your friend to make this support network happen.

Community mental health resources can also be helpful. Sometimes psychiatric difficulties become big and scary and dangerous and it makes sense to seek medical supervision. Your friend can walk into any emergency room or go to a psychiatric hospital. Most universities and colleges have some sort of counselling service. Most cities have some sort of crisis centre. There are many mental health crisis lines, some of which specific to youth, people facing housing difficulties, LGBTQ+ folks, etc. If you’re aware of these resources in your city, ask your friend if they’re familiar with them. In Toronto, some of those resources are collected on the Centre for Addiction and Mental Health website. It’s 100% okay to gently suggest professional help if you think that makes sense.

I’m sure it isn’t easy to break into the maelstrom of mental illness and sit there with someone you care about. To those of you, then, who are supporting someone with depression and/or another mental health challenge: thank you. What you’re doing is a gift.