I certainly received a lot of comments on my last post – many, many more than I was hoping for or expecting! A couple of people suggested that it might be useful and/or interesting to see a similar list of ten things which would be helpful to say to someone experiencing depression. I have also had some interesting discussions in the past 48 hours about whether people can sometimes be unintentionally insensitive, because they simply don’t know what to say and feel awkward and embarrassed about not knowing what would help. So today’s post is a list of the warm, supportive, empathic things that people have said to me, that have helped me get survive my most recent depressive episode. It’s not intended as a definitive list, or a guideline, but anyone wanting to support someone struggling with depression could do a lot worse than taking a look some of the more general of these.

(A brief word about what I haven’t included. I’ve left out, “I love you” and “how are you?” I see both as somewhat double-edged, depending on who’s saying them and how they are said. “I love you” is usually a very positive and helpful thing for me to hear, but it has also been said in a way that increases my sense of guilt when I am feeling suicidal – “but I love you!” = “how could you think of doing that to me?”. “How are you?” when asked in sincerity can express a genuine desire to hear how you are coping, but all too often is a social nicety which doesn’t really want a serious answer.)

1)  “Here’s my number.  Call me any time.  And I mean any time.”  (Various friends)

An interesting feature about clinical depression is just how hard it makes it to reach out to people. As I sink deeper into an episode, my ability to connect with people – something I usually feel is one of my strengths – slowly peels away. First, I don’t have the heart for socialising in groups, attending evening classes, going to family gatherings, etc. Next, I stop wanting to meet friends on a one-to-one basis. Around this time, the idea of speaking to people on the phone starts to become abhorrent too.  In my last depression, in the spring of this year, I became so socially withdrawn after stopping work that eventually I stopped going into shops; the basic please and thank you, the smile and the eye-contact,  had become too difficult. I realised that I was becoming almost phobic about social interaction. If I went out, I went to parks or gardens and headed for what looked like quiet areas; if other people drifted near me, I moved away, terrified I might end up having to speak to someone. Sometimes I would go a whole day without uttering a sound and wonder if my voice even worked any more. The only way I felt I could communicate was through text, so Twitter and email became a real lifeline.

So when someone offers me their phone number during a depression, I am 99% sure I won’t ever call them (although I might text). But that doesn’t actually matter; it’s the offer, the genuine attempt of a friend or colleague to put themselves at my disposal, which helps. Someone cares, and they want me to know it.

2) “What can we do to help you regain your equilibrium?”  (Friend)

The person who said this is a friend in her own right, but she is also the mother of one of my son’s dearest friends, so our families know one another well. She was therefore concerned about my own well-being and also about how my children might be feeling. I couldn’t actually think of anything specific when she asked me, but I knew from her question that if I should ever need the children to be entertained for a little while, someone to talk to, or other practical help of any kind, she would do what she could to provide. I particularly liked that she did not say, “What can we do to make you feel better?” or, “What can we do to get you through this?” and that she dropped her question into our conversation as if it were the most natural thing in the world. There was no wanting me to be fixed, to hurry up and get better, but simple faith that my equilibrium could, and would, be regained over time.

3)  “That must be very difficult.” 

Two people in my life (one a friend, one a relative) take time to listen to me, and don’t say very much other than this. They sometimes ask questions, but they don’t offer advice; they don’t say they’ve had the same experience; they don’t try to suggest things aren’t as bad as I think they are. They simply acknowledge that what I am going through – whether the illness itself, the medication side-effects, or the consequences for my career – sounds as if it must be very hard to deal with. The result: I feel heard.

4)  “I know you’re taking your meds, but they’re not working for you, are they, sweetie?”  (Senior colleague)

A slight edge of constructive “tough love” in this one. I was explaining to my colleague that I didn’t understand how I could be becoming depressed again, because I was doing all the “right” things. I’d completed my NHS therapy, and my workplace counselling, and my self-funded Mindfulness-Based Cognitive Therapy; I was exercising; and I was taking exactly the same dose of antidepressants that had kept me on an even keel for nearly ten years. Without realising it, I had started to believe that the treatment plan was unquestionable, so I must be the problem, in my failure to respond to it. My colleague helped me to see the reality: that the treatment was no longer working for me, and it was time to try something different. I left her having promised that I would make an appointment with my GP and request a referral to a psychiatrist for at least a medication review. And thank goodness I kept my word, because things got much, much worse in the interim.

5)  “What sense do you make of everything that’s been happening to you?”  (Consultant psychiatrist)

Full marks to my psychiatrist for working in a collaborative way with me to establish a diagnosis and treatment plan. He took a very detailed history, but at the point where many doctors would deliver an expert verdict on diagnosis, he asked me this question. I think he had already sensed that he and I had reached a similar conclusion, but he wanted to hear it from me, rather than imposing his views onto my experiences. I really appreciated that, because it left me feeling credited with intelligence and awareness, and with being the expert on my own condition, despite my evident state of crisis. I am very lucky in that my GP also sees me as having the best knowledge and insight into my own mental health. When I came to her saying that I needed to see a psychiatrist, after over five years of being treated quite happily in the Primary Care sector, she didn’t question my need for a referral for even a moment. If I was saying things were bad, things were bad. The NICE clinical guidelines for treating depression and bipolar stress that healthcare professionals should “be respectful of the patient’s knowledge and experience of the illness” and that they should “build a trusting relationship and work in an open, engaging and non-judgemental manner”, but I know only too well that not every doctor works in this way.

6)  “The times when you’re unwell don’t matter!  I’d rather have one of you than ten other people with a clean sickness record.”  (Manager)

This came from one of my first managers I had when joining my current employer. I had disclosed my condition as a disability under the Disability Discrimination Act (now superseded by the Equality Act 2010) and had been doing well for over a year, when I hit a low-mood blip. I was going through a difficult relationship breakup, and hating myself for not being able to hold things together at work. My manager came into the staffroom and found me sitting alone, crying. I was mortified, because I was sure that she would think so much less of me for seeing me in that state. On the contrary, she was extremely warm and supportive. I expressed my fear that my tendency towards depression made me less credible as a professional person. She helped understand my worth to her and to the department, and my potential within the organisation, by showing me that my illness was small part of what she saw in me. OK, she was clearly exaggerating in saying I was worth ten other people, but it did me good to hear that my skills, productivity and general attitude far outweighed my mental health difficulties in her eyes.

7)  “Just let me know when you’re ready to come back.”  (Choir director)

Singing has always been a joy to me, and an excellent way to switch off my busy mind, but sometime in the spring I stopped going to choir rehearsal. As I’ve already said, I was finding any sort of social interaction tough, and choirs depend on you being an active part of a group. As if that wasn’t enough, I was beating myself up because I found it difficult to practise during the week, and becoming increasingly anxious about messing up in rehearsal or not being performance-ready for the next concert. Choir has taken a break for the summer now anyway, but the director has been in touch to see how I am doing and whether I’m likely to be back in September. It’s audition only, and there’s usually a waiting list to join, so I was starting to think that having been away so long might be legitimate grounds for her to give my place to someone else. Receiving an email saying that I don’t have to rush back if I I’m not ready yet, but that I will be welcomed whenever I choose to return, has put my mind at rest.

8 ) “I’m not going anywhere.”  (My partner)

Here’s another depression Catch-22. When I become depressed, I start to worry that my partner won’t want to stick around, because I’m depressed and boring (see no. 3, Ten Things Not to Say to a Depressed Person). This thought makes me feel more depressed, so I become more boring. Round and round it goes! I’m sure it must be tedious for my partner having me doubt his commitment, but he’s very good at providing the steady, constant reassurance that I need to hear.

A number of my friends have expressed similar sentiments. On hearing that I don’t feel ready or able to socialise at the moment, they have gone out of their way to let me know that they will still be there (as will the opportunities to meet up) when I’m feeling more like myself again. I appreciate having that spelled out for me.

9) “…as best you can.”  (Meditation teacher)

I love this phrase. It contains within it the biggest lesson that I learnt in my eight week Mindfulness-Based Cognitive Therapy course. When I started, I was determined to “do it right”. I swore I would never miss my home meditation practice, would attend every class, and generally be a model student. Halfway through, I had given up on my homework, and was thinking of leaving the course because I hadn’t lived up to my own expectations.  My patient, caring teacher helped me to see that I had missed the whole point of the course: the aim was for me to learn to be gentle with myself, in fact to be generally less judgemental and more accepting of how things really are. You can’t fit in a full hour’s practice every night?  Practice as best you can, for half an hour, ten minutes, even five. You feel uneasy doing a certain type of meditation? Explore that feeling as best you can, and once you have played with the boundaries of your discomfort, switch to a practice which seems a better fit for you.  Your joints won’t let you sit on the floor for 40 minutes at a time? Sit on a chair, lie on your back; try a stool, a cushion, a beanbag; try moving meditation, mindful yoga, a walking meditation, Qigong exercises – practice as best you can.

I’ve tried to apply this philosophy to the basic business of living as a depressed person.  For example, I know exercise is good for me, but when I am in the slowed-down state that is acute depression, moving my body around seems so difficult that it would be impossible for me to run or swim. So I exercise as best I can, giving myself credit even for a gentle stroll round the park or a walk up and down my own street. I know it’s best to eat healthily, avoid sugar and alcohol, etc, but when I’m very down I can only make the best food choices I can. I’m not always successful, of course; I still beat myself up fairly regularly for not doing “enough” exercise, or not eating “properly”, but then I try to bring myself back to common sense with this phrase.

10)   “Sorry to hear you’ve been poorly.”  (My cousin)

I have an older cousin who I’ve always really admired. He is a few years older than me, and when we were teenagers he was the cool cousin, the one who played in a band and had his own car. Even now we’re in our late 30s, I still look up to him and have a lot of respect for what he’s achieved in life. I had got myself really worried about telling him that I had been unwell, and particularly about my new diagnosis of bipolar, because I am never sure how people are going to react. Being phone-avoidant, I disclosed my difficulties to him via a text message, and he replied with a text including this sentence. I found it so comforting; it was just so matter of fact, as if there was no difference at all between a mental illness and a physical one – which is exactly how he behaved when we next met.

Looking over this list, what can I learn from it?  I think a few themes emerge:

–       I find it most helpful when people are able to listen and empathise, without trying to fix me or fix the situation.

–       I appreciate it when people are honest if they don’t know what to do to help.

–       Several of the comments in my last list negated my view of my own illness.  I can understand that it may make people very uncomfortable, but denying the existence of my problems is very disempowering. Good friends and good healthcare providers accept my version of my experience.

–       People who care about me also have a very important role in helping me see things as they really are (and myself as I appear to them), when I am trapped in spirals of negative thought and emotion.

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