Help for the helpless

Supporting a family member with depression does not have to be an isolated battle.

Two women stroll in the rain in Jerusalem (photo credit: Marc Israel Sellem)
Two women stroll in the rain in Jerusalem
(photo credit: Marc Israel Sellem)

Judy, a 55-year-old schoolteacher, called for a consultation. More than a year ago, her husband Yitzchak, 58, had been laid off from his job as a mechanical engineer and had been unable to find any work.

“He sits home all day, totally bored and depressed,” she said. “He has lost several kilos because he doesn’t feel like eating, and he feels that his productive life is over.”
Judy stated that she was really frightened, having never seen her husband like this before. She was worried that he might hurt himself. She tried desperately to get him to seek help, but he refused, stating that nothing was wrong. She asked me what she could do to get her husband to do so.
Everyone occasionally feels blue or sad. But these feelings are usually short-lived and pass within a couple of days. In contrast, clinical depression, like the kind of debilitating depression that Yitzchak has, lingers on, interfering with daily functioning and causing emotional pain and mayhem for both the depressed person and those who care about him/her.
Scientific studies have shown that depression does run in families, so there are definitely genetic factors at work. However, while it is well established that people may have a biological vulnerability to becoming depressed, psychosocial factors are usually the culprits that trigger the condition.
Yitzchak is not alone; the prevalence of clinical depression is staggering. Fourteen percent of the world’s total population will suffer from it sometime during their lives. Two-thirds of people with clinical depression, unfortunately, never seek any professional help. This is tragic, since 80% of those afflicted who seek treatment improve, usually within weeks. Without treatment, symptoms can persist for weeks, months or years. In fact, two-thirds of all suicides are related to depression.
The two most common types of depression are major depressive disorder and dysthymic disorder.
Major depressive disorder, which affects about 6% to 7% of the general population each year, is characterized by a combination of symptoms that interfere with a person’s ability to work, sleep, study, eat, and enjoy once-pleasurable activities.
Major depression is disabling and prevents a person from functioning normally.
Some people may experience a single episode within their lifetime, but more often a person will have multiple episodes. Major depression is often triggered by a major loss or change in one’s emotional life and/or physical health, when the person’s normal coping defenses become overpowered. Yitzchak had major depression.
Dysthymic disorder, which mental health practitioners also call chronic lowgrade depression, affects 3% to 6% of the population every year. It is characterized by long-term (two years or longer) symptoms of depression, but is not full-blown enough to disable the individual the way a major depression does.
Other types of depression include minor depression, psychotic depression, postpartum depression, seasonal affective depression and bipolar depression.
The literature points to some do’s and don’ts to help family members get help for their depressed loved ones. “Tough love” – forcing the individual to seek professional help – rarely works. Resistance to this approach may stem from a depressed person’s feeling of shame about the condition, or impaired judgment keeping him/her from seeing or admitting that he/she is depressed. Clinical experience has shown that a softer, non-confronting approach is more successful in motivating someone to get help for their depression. The following techniques are useful: • Be gentle and patient. Your loved one likely feels very vulnerable. Simply saying, “I love you,” will help.
• Share your own vulnerability. If you’ve accepted help for anything – a problem at work, an illness, an emotional problem – tell your loved one about it. This will help reduce their shame, which is a contributing factor to denial.
• Stop trying to reason. Don’t get into a debate about who is right and who is wrong. Ask questions instead. Learn what your loved one is thinking or is most worried about.
• Focus on the problems your loved one can see. Suggest he/she get help for those issues. For example, if he/she acknowledges sleep loss or problems concentrating, ask him/her to seek help for those problems. It is easier for this person to think about the symptoms of the depression rather than hear over and over that “you’re depressed and you need help.”
• Suggest that your loved one see a general practitioner. It is often far easier to persuade someone to go see his/her family doctor rather than a psychiatrist. A family doctor can start by prescribing an anti-depressant medicine and then decide to make a referral to a mental health professional. Of course, if your family member agrees to see a mental health specialist, be it a psychiatrist, psychologist or clinical social worker, this is an excellent starting place for treatment.
• Work as a team. Ask if you can attend an appointment with the doctor or mental- health professional, just once, so you can share your observations and get advice on how best to help.
• Get help for yourself. See a therapist to discuss how you are doing and to get help problem solving.
• Enlist others. Who else loves this person and can see the changes in his/her behavior? Perhaps a sibling, parent, adult child, close friend, rabbi or teacher can help motivate your loved one to get help.
• Leverage your love. Ask the person to get help for your sake or for the sake of the children. This often motivates a resistant person to agree to an initial appointment for help.
Once the depressed person does seek help, scientific studies have shown cognitive therapy to be a very effective method in treating clinical depression and is often combined with the new generation of antidepressants as an adjunct to psychotherapy.
My advice to Judy was not to give up on her husband. When a loved one resists treatment, a little patience and a non-confronting approach can go a long way.
The writer is a marital, child and adult psychotherapist with offices in Jerusalem and Ra’anana. He also provides online videoconferencing psychotherapy.