HAMBURG — Talking about the day, planning the weekend, arranging appointments. A frank word, a clarifying conversation, sometimes a small argument. That’s your everyday life in a relationship. You argue, make compromises, solve problems and move on. But what if your wife, father or best friend suffers from depression? The illness doesn’t just change a person’s inner life, it changes the dynamics of a relationship.
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“Everything is difficult and full of landmines,” says one of the many readers surveyed by German weekly Die Zeit. “From the beginning, we tried to talk very openly about the illness, but we quickly reached our limits: It was just so hard to talk about feelings,” writes Tom, whose daughter suffers from depression. Another relative reports about her partner: “When he is feeling down, I try to avoid topics that might affect the foundations of our relationship or our future.”
These are typical sentences from relatives of depressed people. How can relatives help the patient and themselves? Elisabeth Schramm, who heads the psychotherapy research section in psychiatry at Freiburg University Hospital, has developed the depression family coach method with the AOK health insurance company.
For her, the most important thing is “that relatives are well informed about the illness.” Many would otherwise think that the patient is simply in a bad mood or has had trouble sleeping. “But if you know the symptoms,” says Schramm, “it is easier to deal with them.”
It can change you
Depression can change people. It distorts thoughts and feelings in a negative way. One of the best-known models that describes these distortions is the cognitive triad. According to this, being depressed leads to patients having heavily distorted thoughts in three areas in particular: the world around them, themselves and the future.
The distortion shapes their thoughts — especially in conversations. Some people suffering from depression react sensitively when they are criticized or rejected. They assume they will be disappointed by others. Experts speak of rejection sensitivity.
“In a depressive phase, all topics are difficult, but interpersonal ones feel particularly hard. You already feel wrong and broken and that’s why any ‘accusation’ feels fatal,” is how one sufferer describes it.
Some people actually try to confirm the bad image they have of themselves, so that they can at least be sure that their perception is correct. Finally, those who are ill tend not to talk about problems in a solution-oriented way. They focus on the details of the problems or on the bad feelings that the problems cause in them. Others, on the other hand, seek excessive confirmation.
It can be important for relatives to know about such distortions, so that they can understand how the other person might interpret their words in a conversation. At the same time, however, this knowledge can also change the relationship, warns Jeannette Bischkopf, who teaches psychology at Kiel University of Applied Sciences and has written a book for relatives of people suffering from depression.
“If they focus too much on the illness, relatives start to analyze the other person and perceive them as someone they have never met before, something foreign. In research, we call this ‘othering,'” Bischkopf says. Relatives should therefore be careful not to give up their own role as friend, partner, father or daughter and to remain empathetically connected.
How to talk about it
The fact that a depressive phase distorts thinking and perception has an impact on planning and decisions. The German Depression Helpline therefore advises postponing important decisions until such a phase is over.
Some people suffering from depression, however, insist that relatives should not hide anything and address all topics openly: “Conflicts are difficult because depression uses them to attack me with doubts, feelings of guilt and brooding. But I do not avoid them because I am not irrational, psychotic or terminally ill. I am perfectly sane.”
“A relationship thrives on honesty,” Bischkopf says. “But if I want to protect the other person and decide for them what might be too much for them to handle, I’m putting myself in a position of power.” That can be dangerous. Well-intentioned protection can damage trust, for example if the sick person would have liked to have a say in a decision.
Even when you’re depressed, you still have a perception of the world and can talk about it.
“It’s not as if the sick person is not a person anymore,” Bischkopf says. Even when you’re depressed, you still have a perception of the world and can talk about it. “Sometimes relatives worry too much about what they can and can’t say to their depressed loved ones.”
Especially if depression is making someone behave in a way that is harmful to them, loved ones should talk about it. If your partner becomes aggressive and shouts at the children, or if someone gets into financial difficulties, you need to talk about it.
“In some cases, people who are ill really need external correction,” says Bischkopf. “That’s why honesty is important”.
Addressing critical issues
Yet there are situations in which discussing difficult topics is simply not going to work. If your mother is currently in a severe depressive phase, you will not get very far if you want to discuss whether a nursing home might be an option. If a friend can’t get out of bed at all, there is no need to discuss why the apartment looks so messy. The severity of the illness influences what kind of conversation is possible.
Sometimes, however, there’s topics that cannot be postponed. A depressive episode lasts on average between six and eight months — not everything can wait that long. So how should couples, friends and family deal with it?
Freiburg psychologist and psychotherapist Schramm recommends, above all, not becoming hostile. The nasty depression is the enemy, the person affected has no fault for their lack of motivation. It doesn’t help to criticize. It is better to be patient and constructive. It is better to say “Should I help you put something away?” rather than “My goodness, it’s a mess in here.”
Don’t try to convince the other person, but rather to understand each other.
One reader said: “If a depressed person says that they don’t have any energy right now, don’t take it as an excuse. Most of the time, in these moments, they only have enough energy to breathe.”
As a relative, Schramm says, you always have to take into account that your own words and behavior influence how the other person behaves. If relatives remain friendly and open, the sick person will also react in a more friendly manner. If they behave in a dismissive manner, the reaction will be more reserved.
Schramm and Bischkopf recommend formulating things in the same way as the American psychologist Marshall Rosenberg recommends in his non-violent communication, which he developed in the 1970s. The basic idea is that you don’t try to convince the other person, but rather to understand each other. There are four steps to this — seeing, feeling, needing, asking — which should also be carried out in this order:
• See: Describe the situation, soberly, neutrally, without judgment.
• Feel: What feelings does the situation trigger?
• Need: What need underlies the feelings experienced?
• Request: Communicate a wish to the other person.
There are also other language tips: avoid judgements and accusations, ask questions instead of assuming or interpreting, do not generalize, no ifs or buts. In this way, non-violent communication can prevent what all too often poisons everyday conversations.”I want us to treat each other with respect: no long monologues, but a real conversation with room for two perspectives. I also want to wait for a suitable setting, peace and time for the conversation,” one relative.
A balancing act
Another question that many relatives ask is: Should I encourage my friend to go for a walk? Should I get my dad to come to the cinema with me? Should I encourage him or her to do activities?
After all, exercise, nature or meeting people can help combat depression. Or should I just let him or her lie on the couch in peace if that is what they want, in order to express understanding and acceptance?
This is also a fine line. Schramm draws a comparison to a purely physical illness, saying “when you have a bad case of flu, you don’t feel like doing anything and lie in bed, you’re in a bad mood, you don’t care about anything.” In this case, relatives would first bring tea, a wet cloth for your forehead, some crackers. After a few days, however, you would notice that a little strength was returning. Then you would ask the other person to come to the table for lunch. Then, go for a walk together. Then, take a package to the post office.
“It’s always a balancing act, and you have to find a balance between being gentle and demanding,” Schramm says.
Finding your role
In that respect, motivation is good — if it is aimed at realistically achievable goals. And these can be found together. Should we go for a walk downtown? Too far? Then maybe just around the block? Or just get dressed and go down to the mailbox, that’s also a result.
But here too, caution is required not to change the relationship’s dynamic too drastically, Bischkopf says. “Engaging with a loved one with the ‘I want to motivate you’ mentality puts you in a completely different relationship position.”
Basically, activity is good and a very important factor in helping sick people get better. But as a relative, you just have to be aware that it is a long and exhausting process that requires a lot of patience. “But there are many small successes in this process. It helps if you recognize and appreciate them,” Bischkopf says.
Relatives play an important role in the lives of people suffering from depression.
With their support and communication, relatives play an important role in the lives of people suffering from depression. What role exactly they should play is something that people have to renegotiate and clarify for each relationship. They can be active listeners or silent companions, patient housekeepers, benevolent motivators or even corrective agents. In any case, the special strength lies in the personal relationship, the closeness to one another.
That is what the experts say — and the relatives agree. “Luckily, after more than seven years, we have developed a great communication strategy,” writes one reader. “Depression clouds the brain, and it is good to have someone at your side who can clear away the fog.”
