It can take a LOT of courage for someone to confide in someone about a mental health problem. The problem with mental health problems as opposed to physical ones, is that it will make you feel guilty for asking for help. It will make you feel like you're not worth help, like none of these problems are real and that you're making them up, or being pathetic for not being able to cope. You really believe that this is not an illness in your brain, but that you are just being worthless/lazy/pathetic. The reality is that it is as much a physical illness as a mental one. Scans of people's brains with and without various mental illnesses show a marked difference in the make-up of the brain and the chemicals within it. It affects the way you think and process information, and skews everything about yourself into a negative. You get trapped in negative cycles of thinking, and no matter what other people say, your brain creates and maintains new pathways of these negative thoughts and ideas, allowing them to grow and become stronger over time.
It can make everyday tasks feel completely overwhelming, so you leave them, and it then makes you feel like a failure for leaving them and not being able to do them, which creates a vicious cycle which is extremely difficult to break. Personally, when things are bad it can actually be very useful for people to treat me as if there's nothing wrong, as the more I focus on the bad things, the more credence I give to those thoughts and it increases the spiral of negativity. Distraction, and becoming involved in everyday things can really help sometimes.
There are other aspects, such as becoming very drained from social situations, sometimes just from being around one or two people. It can be very hard to say that you need to leave a situation, especially if it's just people being lovely to you, because your brain makes you feel guilty for not wanting to be with them. People making it clear that there's no pressure to be there *can* help, but depressed brains often don't believe things that other people say. Being offered the option now and then to be on my own without having to bring it up myself can be really useful, not necessarily as a direct 'do you want to be on your own?' question, because again my brain would tell me that saying yes would be interpreted as selfish and uncaring, but being around other people who occasionally say things like 'I might go and read in my room for a bit', etc makes it feel like a more normal thing to do.
Also, it can be hard, but keep in mind that this is an illness. It can feel frustrating that your best efforts aren't making someone feel better, but depression is not sadness. It is a chemical imbalance in the brain, which cannot be fixed simply by hugs. Treatment of some kind is the key. Medical care is needed - they cannot 'sleep it off', 'snap out of it', or 'decide to get better' any more than someone with a broken arm can make it get better any faster. Try not to feel bad that your support can not solve their problem.
Depression can make you lose interest in things you once cared about, believe that you have no friends and that no one cares about or wants to be around you. I find that when I'm feeling low, I believe that no one would want to be around me when I'm like that, because I'd bring everyone down and ruin their time, and that they must be frustrated with me for not doing things, seeing them often enough, or for not 'trying hard enough' to get better. Making sure you keep in contact - inviting them to things, just checking up on them or calling for a chat - is so important. Even if they don't come to things, it's really helpful to know that people still care and are thinking about you. Keep inviting them to things, even if they hardly ever accept. Offers of help with practical things like tidying or washing up are always helpful, but a lot of people won't take people up on non-specific offers like 'call me anytime' or 'I'm happy to help with things if you need'. Specific plans like 'I'll come round at 10 on Saturday and help with the washing up, and then we can have a cup of tea and chat' will be much more likely to be accepted, although will still be difficult.
The main thing is not to give up. It's extremely hard to accept help, or to believe that people really do want to help, and that's not because they don't think you're a nice person. Their brain changes the way things are processed, and it can be very hard to recognise a healthy thought to one that comes from the brain changes that depression causes.
Things I've found helpful in the past are group classes of things like CBT, and mindfulness. Group classes are especially helpful because they allow you to see that you're not alone, that this is a real illness that other people suffer, and is not just you being useless/lazy/pathetic.
Oh, also - praise small goals. Sometimes getting out of bed can feel like an insurmountable challenges. Sometimes just making sure you eat is tough. Depression can make the smallest tasks seem enormous. On days like this, reminding them that they are ill, and that little things like this are accomplishments in themselves and not to beat themselves up for not being able to do much is really helpful.
It can be hard to understand how difficult depression makes things, especially as it's not something you can see. Please do not doubt what your friend tells you about how hard things are, or not being able to do things. This will only add to their negative thoughts about being worthless or pathetic. Yes, it can feel hurtful when someone consistently cancels plans, or doesn't do simple things, but it's simply the way their brain is working at that time. Letting them know that there's no pressure to do anything they don't feel up to is enormously helpful.
Let them know that they are not alone in this, that they are important to you and that you care. Reassure them that they are not going crazy, they are simply ill. It can feel like you can't trust your own brain, or you believe empirically all the harmful thoughts it creates. Tell them that you're not going to leave or abandon them because of this, and that once they're recovered both of you will still be here.
If they ever talk about suicide or self-harm, stay calm. Firstly, self-harm is generally a way to prevent suicide. Its purpose is not to kill, but to save. Personally, it can feel like cutting and letting some blood out can release the huge build-up of feelings I'm not able to deal with, so I feel calmer and more grounded and stable afterwards. It can be different for everyone of course, but for most people I know, death is not the intention. Make sure they are doing things safely, and encourage them to see a doctor to get help. Self-harm can quickly become an addiction, where it is the only way you can cope with overwhelming feelings.
We have a very strong self-preservation instinct. Even in our most suicidal moments, where everything feels hopeless and nothing seems worth living for, there is a human element that still tries to keep us alive. In general, we will try to get help to preserve this part of us. If someone tells you they are feeling suicidal, it is because this part of them is trying to help. They want to find a reason - any reason - not to go through with things. First off, don't panic. Don't make them feel guilty for feeling like this, or tell them how selfish it is. Their brain is ill and they need help. Ask if they have a plan, and if they have the means to carry it out. Most of the time, this won't be the case.
If they have a plan, ask what it is, and if they are alone. See if there is anyone they could ask to come over and be with them. They don't need to tell them they are feeling suicidal if they don't want to - it can feel very embarrassing to admit for some reason, like you're letting people down. Most of the time, simply having someone around until the feeling subsides is enough. Often, just the act of talking to them will help the feelings to subside. Keep them on the phone (or talking, if you're with them) about anything they want to talk about. Ask them questions, keep them talking. The few times I've called samaritans with these feelings, 5 or 10 minutes later I've felt ok again, and safe enough to be on my own again, or calm enough to call a friend to get someone to come round.
If talking doesn't help, you can tell them you're phoning an ambulance. Keep them on the line and keep them talking and calm while you call the ambulance on another line. If you can't do this, tell them you'll phone them back in X minutes, and ask them to keep the phone by them so they can answer.
Most of all, be understanding. They're suffering from a horrible illness where their brain has stopped them from being able to experience any pleasure at all, only suffering. This is their desperate attempt to stop the mental pain they've been going through, and not an attempt to get attention, or a selfish act. The brain stops you from being able to feel anything sometimes, even love for those you normally care about.
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