When I am suffering through a depressive episode, I always give my loved ones the benefit of the doubt when they say statements or ask questions that are well-intentioned but ultimately unhelpful.
I know that they mean well. They would love for me to recover quickly from my periods of low mood & energy, social isolation, feelings of helplessness and hopelessness, irritability, and sleep difficulties. They want me to return to my usual upbeat, bubbly self. They love and care about me.
We are taking leaps and strides in the mental illness awareness movement. However, some key points regarding the nature of depression are still not common knowledge even amongst those directly affected by depression. For example, depression is not a ‘phase’, or something that can be ‘fixed simply’ with a pair of running shoes and fresh air.
In an effort to explain some common misconceptions and oversimplifications that many individuals hold about depression, here are 5 things NOT to say to someone with depression…from someone who has heard them before.
Photo by Mitchell Griest
1. You have so much to be grateful for. There are starving kids in Africa, people living with non-functional limbs, homeless people, people with no family, and people living in crime-ridden streets. You have a house, a good education, a bed to sleep in, food to eat, and water to drink. How could you be unhappy?
I understand where this comes from, because overtly, it looks as if depression is boiled down to unhappiness/sadness. However, depression is an illness, and occurs regardless of whether or not we are aware of and/or grateful for the gifts we have.
The general emotion of sadness is vastly different from the clinical diagnosis of depression. Any emotion is transient, and a typical emotion such as sadness indeed may be somewhat remedied through counting our blessings or seeing the positive (though I always prefer the process of validation and self-compassion).
This is because when we feel sad, we often feel sad about something. Changing our perceptions or enacting actual change in that something can help our sadness to drift away.
To conclude that depression is simply sadness is a huge misunderstanding. Depression often involves a sustained feeling of emptiness – that is, feeling numb to emotions. How we present when we feel this emptiness can be mistaken for (solely) sadness. Depression is much more complicated than one emotion.
Gratitude indeed helps with our overall mood (outside of our depressive episodes) but certainly does not get us to snap out of an illness.
2. You just need to get some fresh air, maybe some ice cream, have some fun! Maybe do a dance class?
I see where my loved one was going with this. They believed that my depression stemmed from overwhelming stress, and provided options for me to alleviate stress. After all, it’s what they do when they are feeling sadness (see above), so it would surely help me with mine (again, see above).
Behold – one of the main components of many individuals’ depression symptoms: anhedonia. In the DSM-V (the fifth and latest edition of the Diagnostic and Statistical Manual of Mental Disorders: basically the tome for classifying and diagnosing mental illnesses), anhedonia is either the reduced ability to feel pleasure, or a diminished interest in engaging in pleasurable activities (Thomsen, Whybrow, & Kringelbach, 2015).
What this means for me is that when I am depressed, it will be extremely difficult for me to see the value in activities I typically would enjoy. Don’t get me wrong – I still enjoy these activities when I am not experiencing a depressive episode. In fact, they may help reduce the risk that I fall into it in the first place (or reduce its intensity when it comes).
But when I am already there? Receiving a suggestion to work out because I always look happy after I do it is like telling a person experiencing a multiple sclerosis attack to go to the gym and lift weights because strength training can help reduce the risk of relapses. We are being told after the fact to do something that only reduces the severity or risk of experiencing an episode or a relapse.
3. How are you ever going to enter the workforce when you’re down like this all the time? Get up and do something! You’re not going to be able to hold down a career.
I can sort of understand how come a loved one might say this. Frustration mixed with concern. Ignorance as well, because this statement implies that those of us with depression somehow have the ability to flick the depression switch on and off and we are (for some reason) not keeping it off.
Here’s the thing: this is victim-blaming. Logically, no one would want to suffer from an illness (except for those who want to suffer from an illness as a result of an illness). Depression is a mental illness. An illness. It is not a result of laziness, or an indicator of laziness, or even a cause of laziness. “Laziness” is defined as: the quality of being unwilling to work or use energy. In a depressive episode, we do not have that energy to use in the first place.
Now, when we are depressed, a prevailing symptom is self-loathing. (We convince ourselves that we are good-for-nothing lazy people, even when we are not). So, when we hear phrases like this, they are perpetuating thoughts that pull us deeper into depression, not out of it.
We tell ourselves enough when we are depressed that we somehow deserve it or that we are lazy or that we won’t be able to accomplish the things we want to in life – when we hear it from a loved one, it pushes us into the nth dimension of depression. If we hear it both from ourselves and from others, who’s left?
We will have challenges throughout our lives to be sure, because we are dealing with a chronic illness. But that does not mean that we won’t be able to “hold down a career” or that we will not be able to accomplish anything that we want to achieve!
4. Why are you depressed? Don’t worry, be happy!
Again, this statement likely boils down to oversimplification of depression as intense sadness. For those without depression, it can be difficult to imagine being in a depressive episode and thus they try to understand it in terms of emotional states that they do go through – in this case, sadness.
That being said, I really want to crack down on this statement because it is so, so common. This is a killer phrase to use toward someone with depression, because it is akin to telling them, “Why do you have this illness that you did not ask for or want? Don’t worry, just don’t be sick!”.
Imagine the confusion and hurt that would be inflicted if we had this attitude toward everyone suffering from an illness, disorder, or disability.
Bob, why are you in bed with the flu? Have you tried not being sick? Like you don’t actually need to have a fever.
Mary, you broke your leg? Have you tried using it normally as if it wasn’t broken?
Thomas, you don’t need to have cancer you know. Just believe that you can get through it, and you don’t need the doctors or chemotherapy!
Cindy has dyskinetic cerebral palsy (reader’s note: she makes involuntary, repetitive movements), but honestly she should just stop herself from making those abnormal movements. Everyone else can, why can’t she?
5. “You don’t need medications. They make things worse” or the counterpart, “Medications will cure your depression”.
The internet is rampant with stories, testimonials, and opinions regarding antidepressants (the umbrella term for medications that help increase serotonin levels – a mood regulating neurotransmitter, among other functions). Now that people are beginning to feel more comfortable opening up about their own experiences, we even hear stories through friends or friends of friends.
Sometimes, reading these experiences can make our loved ones more aware of the different forms of treatment available so that they can support us through our depression. However, sometimes, reading these experiences can make our loved ones believe they have authoritative knowledge over what is best for their friend/significant other/family member with depression.
I’m going to be very blunt with this: are you a psychiatrist?
The fact is that psychiatry still has a long way to go in terms of understanding the biological mechanisms behind many mental illnesses, but we have still made some amazing advances over the past few decades. It is now common knowledge amongst medical professionals that mental illnesses are rarely (if ever) purely biological or psychological.
In fact, one of my very first appointments with my psychiatrist included a primer on the three parts of any mental illness: biological (neurotransmitter imbalances in the brain), psychological (how we perceive ourselves, others, and the world), and environmental (factors such as socioeconomic status). He underlined the fact that every single individual will have a different combination of causes behind their mental illness.
My depression is likely primarily psychological, as antidepressants did not work well with me and in fact exacerbated my symptoms (a story for another day). I’ve been dealing with my symptoms by buffing up on my coping skills, self-compassion, and working closely with my psychotherapist. However, I know an individual who requires their medications to regulate their illness. (Without it, they have an extremely difficult time doing so on their own)
Only a psychiatrist working closely with the individual with depression can help determine their personal mental illness puzzle. Antidepressants don’t work for everyone, but for some people they are extremely effective. It takes careful tweaking, trial and error (unfortunately), and time to figure out what combination of therapies and/or medications work best with any individual with depression. Again, this is something only a psychiatrist can determine.
Bottom line: depression is an illness, and keeping this in the forefront of our mind as we explore it is tantamount to effectively supporting loved ones with depression.
If you read this post as a loved one keen to support your family member/friend/significant other with depression, I want to thank you for taking these steps to understand more about their illness.
It is very easy to fall into the trap of rushing in to help your loved one who is suffering without fully understanding what they are going through. Hey, even if that happened and that was one of the reasons you want to learn more, you’re here! You’re taking those steps to understand and work from that place of understanding. Practice self-compassion.
If you read this post as someone struggling with depression, I also want to thank you for continuing your fight. You may have heard similar phrases from well-intentioned people in your life and felt confused and upset. My hope is that I’ve helped you to consider their backgrounds; the assumptions they may be making that leads them to say these statements.
I know personally how difficult it is to explain what depression is to my loved ones and to neurotypical people. Hopefully I’ve given you some further tools to explain how come these common statements are unhelpful and inapplicable to your illness. Be kind to yourself.
Always remember to BKTY (be kind to yourself),
Rømer, T. K., Whybrow, P. C., & Kringelbach, M. L. (2015). Reconceptualizing anhedonia: novel perspectives on balancing the pleasure networks in the human brain. Frontiers in Behavioral Neuroscience, 9:49.