Of the two, bipolar disorder is probably easier for people to take seriously. A person in the manic, or even less severe hypomanic, stage is clearly in the grip of something strange. A person suffering from depression, or in the depressive swing of bipolar disorder, on the surface appears to be experiencing what everyone goes through from time to time. The blues. Some sadness. Even -- for the less charitable -- laziness.
Disclaimer: is depression over-diagnosed, and are anti-depressants over-prescribed? Without question. Many general practitioners will dash off a prescription for a patient who claims to be down. This does not, however, take anything away from the undeniable reality of true, clinical depression.
The Bear has ten points in mind for dealing with people who are truly depressed.
- Clinical depression is real. It is both ignorant and unkind to dismiss the pain a person may be going through by calling it a "fad disease," or a "scam by the drug companies." You might as well say there's no such thing as cancer. Just because it is a mental illness you can't see doesn't make it any less real.
- The symptoms of depression are real. The depressed person may not be able to get out of bed, experience enjoyment, or anticipate pleasure. He or she is likely mired in a grief out of nowhere, and trapped in a leaden body. He or she is not "weak," but suffering from an illness that reaches both mind and body.
- These are some medical terms that apply to depression: avolition -- inability to initiate goal-directed activity; anhedonia -- the inability to experience pleasure; apathy -- the inability to care about anything; suicide -- the decision to take one's life since anything seems preferable to what one is experiencing.
- All the things you take for granted -- the pleasure at a loved one's voice, a hobby, looking forward to dinner, the ability to feel happiness -- are impossible for a depressed person. As the symptoms of depression go on and on, day after day, eventually, hopelessness sets in.
- Tough love is the last thing a depressed person needs. If you watched a person get sliced open, would you say -- as his intestines spooled around his ankles -- "just shake it off?" If you want to tell a depressed person, "I don't really care about you or what you're experiencing," use tough love. Just make sure to lock up the firearms and razor blades first. Chances are the person already thinks he's worthless. The last thing he needs to hear is that he ought to be able to somehow "shake it off."
- You may imagine it's like the time you got the blues, or even that it's like the time your cat died, but it's not. It's not even like that only a thousand times worse. It is as much different in kind as in degree. If you are fortunate enough never to have been clinically depressed, it is not like anything you have ever felt, not even profound natural grief, although that, perhaps, is the closest. Come to grips with the fact that you don't have the frame of reference you think you do.
- Don't use platitudes. "It's always darkest before the dawn." Or, "God never gives us more than we can handle." Or, "This, too, shall pass." Job's friends sat with him seven days before saying the first word. (And then they totally screwed it up when they opened their mouths.) Above all, don't ask "Why?" The why probably lies within mysteries of neurotransmitters in the brain, but for all intents and purposes, there is no why.
- Don't try to spiritualize depression. It's a disease. It's not "The Dark Night of the Soul," (shows a misunderstanding of St. John of the Cross) or what Mother Theresa experienced. (If it was, then surely the most saintly -- and miraculous -- thing she ever did was to keep on going through a clinical depression.) Saints such as Bernard of Clairvaux and Theresa of Avila distinguished "melancholia," from spiritual conditions.
- Don't suggest home remedies, or worse, tell anecdotes about someone you know who knew someone who licked depression by walking, or yoga, or drinking tea made of St. John's Wort. Again, that tends to trivialize the here-and-now pain the sufferer is in, and herbal remedies can dangerously interact with prescription medicine.
- Take seriously any talk about suicide. Be suspicious if a depressed person suddenly seems better, especially after having made any sort of unusual arrangements with regard to personal effects. Often, before a person attempts suicide, he will feel better after having made the decision. Finally -- in his diseased mind -- he has found a way out. Make the environment as safe as you can and keep an eye on the person. Make sure he has means to easily contact the suicide prevention hotline. And, if necessary, intervene by calling the authorities to get him the help he needs.