Someone searched on my blog for the following and it caused me to go cold.
How to stop enabling depression
The amount of misunderstanding in that one simple statement is enormous. I just wrote a blog about addiction, and now I am back on depression. So here we go. Depression and addiction are often present at the same time in the same person and the two very different diseases get confused all the time. I am a rare example in that I don’t touch substances of any kind and I have in the past suffered from a major depression. So I am kind of unusual in that I wasn’t self-medicating my depression with alcohol or drugs. A lot of depressed people think along the following lines…
“I am miserable and I need relief oh look there is a bottle of whiskey or there is a line of coke, that will make me feel better.”
They do the drugs, it makes them feel better for a short period of time, the euphoria wears off they use again. The cycle gets worse and worse and worse until the cannot feel joy without the substances. That is the cycle of addiction, not depression. I am not a therapist, or doctor…but this is how I see it having been through what have, and what I have seen with addicts in my family and circle of friends.
An addict chooses to pick up a drink or use drugs. It is an active choice on their end to engage in this behavior. A depressed person who does not use alcohol or drugs is not choosing that personal hell, it is a chemical in balance in their brain. Both diseases have a biological or genetic component and both are medical problems, but one involves the use of a substance, while the other does not.
To “enable” an alcoholic you must make it OK for them to drink, not point out to them that drinking is the real source of their problem, and allow them to treat you horribly in the process. Most addicts lash out at those closest to them the entire time they are going down. When you stop enabling the addict you usually have to cut them off, stop talking to them and make them know that you think their addictive behavior is self-destructive. Everything about the addicts behavior is getting the substance and using. They will do nearly anything to keep alcohol or drugs in their lives including betraying friends, robbing from them, putting them in jeopardy and causing them harm.
Now lets look at a person who has the illness of clinical depression who is NOT using. Where is the source of depression coming from? It could be from a number of sources such as a death, divorce, loss of job, medical bills, work related stress, tension in a marriage or just simple biology as in someone with bi-polar disorder or chronic depression. Now if these dark moods have evolved into medical depression what could a friend or loved on do to help the person suffering? Should a friend confront the depressed person? Get in their face tell them they are causing their own pain, label them depressed and stop talking to them? I would think that would be the absolute opposite of what you might want to do to a person who is probably suicidal. Bi-polar disorder especially, has been extremely well-studied and is clearly a biological problem that requires medication. Thinking you can talk a person out of bi-polar disorder with happy thoughts or positive thinking is downright dangerous, it would be about the same as thinking you could talk a person out of schizophrenia or any other type of psychosis. Also a person suffering from depression is not going to actively attack those around them in the same was as an addict. For instance, a person suffering from depression usually just shuts down, they aren’t stealing a friend’s computer to pay for their cocaine habit.
The differences between the two diseases are why the treatment for depression and alcoholism is so vastly different. Addicts go to rehab, and usually some type of 12-step program to try to stop using. Depressed people get on medication or into some type of therapy. The difference is the addict is also willfully part of their own destruction. Even though addiction is a disease and there are biological and genetic components to it, the addict is still an active participant in their demise. No one is forcing them to use, they choose to pick up the bottle, down the pills, or shoot up. The depressed person is not choosing to not get out of bed, to not eat, to not find joy in pretty much anything. A depressed person should not be “cut off” or confronted for causing their own illness. And of course as I have discussed on this blog before there are always people who aren’t quite medically depressed but for whatever reason have hit the wall and given up. There is a fine line between being to the point of needing medical intervention and just a change in attitude. But in general cutting off a person who is suffering from the real medical illness of depression in order to “help” them would bring about the opposite effect. The depressed person would feel that much more isolated, unloved and alone and a depressed person needs compassion not “tough love”. An addict will just continue using so when you cut them off they will return to their drug of choice, until of course they make the decision that the drug is the real problem and seek help. Again since most addicts also suffer from an underlying depression the distinctions between these two illnesses get murky.
With about 30 seconds of research I found this highly misguided group.
http://www.depressionanonymous.org/
From what I could tell the website hadn’t been updated in five years and they weren’t holding meetings anymore. From what I could find the entire concept was based on one book, by one woman. There were some other groups that I found as well, but I couldn’t tell how large this particular approach to depression had become. It certainly didn’t seem like the huge and organized group that is Alcoholics Anonymous or Narcotics Anonymous. And I know there are people who criticize both AA and NA for being ineffective as the success rate is low, but I have known many people that have greatly benefited from AA, NA and rehab, so I am not sure what to think. I also know there are also 12-step programs for nearly every affliction, I just don’t necessarily agree that the 12-step approach works for every malady, especially depression.
I had a strange incident with two people who were not close friends of mine who decided for their own benefit to stage some sort of “intervention” on behalf of my depressed state. They really knew nothing about my background and yet felt entitled to tell me at length in writing about my so called psychological troubles. They didn’t know that I was at that point off medication and on the long road to recovery, they made assumptions that weren’t true and were way off base in most of what they were telling me. They were also doing this to benefit themselves as they were pulling out of a contract with me. Basically they found a weakness and exploited it. I found the whole thing sad, pathetic and manipulative and have since cut both of them out of my life entirely. Hardly the benevolent friends helping me in need that they tried to hide behind. I hadn’t harmed them in any way, they were just in a bind and needed a scapegoat.
I am not an expert by any stretch of the imagination I can only speak of my own experience and that of people I have known over the years. I was not choosing to have panic attacks, I wasn’t choosing run away anxiety, lack of sleep, loss of appetite, wild mood swings, black thoughts, suicidal tendencies or the inability to feel joy. What happened to me was reactive depression due to my sudden divorce and it was biological in its nature. What got me out of it was medication, therapy and time. I think what also helped in my recovery was my active choice to not engage in self-destructive behavior such as drinking, doing drugs or engaging some other type of addictive type of activity.
Cognitive behavioral therapy (CBT) is one form of therapy that does help re-train a depressed person’s brain into a more positive outlook but even most proponent’s of this type of therapy would argue that in many severe cases medication is also needed as well as traditional therapy. Even in the book “Feeling Good” by David D. Burns, MD he touts CBT but at the same time goes on extensively about medication for depression and the possible pros and cons of its use. He also does not tout CBT as an overnight cure as recovering from a serious depression takes time for anyone. Some severely depressed patients respond positively to electroconvulsive therapy, which is fairly radical treatment directly on the brain, not exactly a 12-step program. As scary as this treatment has been portrayed in films and other media ECT can be quite effective in patients with severe depression who are not helped by other means.
I wish deep in my heart that people would stop misunderstanding what is probably one of the largest medical health problems of the past century and will continue to be a problem in the decades to come. I had no clue until I went through it myself, but my depression was so much more overpowering than any extended weekend of feeling sorry for myself. What I suffered from and what millions of other suffer from all over the country is a real serious medical condition that if left untreated can lead to intense suffering and for some suicide. We need to stop blaming the people stricken with depression for causing their illness and instead try to get them the help they need. I am eternally grateful to my many friends, relatives and loved ones that had the patience to see me through my bout with this horrible disease instead of deciding to stop “enabling” me and cut me off only to have me spiral downward. What helped me the most was not rude interventions with scolding, tough love and lectures but when my friends sat me down and begged me to get medical help. The friends that cut through the static in my head the most were friends who had struggled with depression themselves. Had people decided to stop “enabling” my behavior and cut me off I might not be here right now to type this blog.
So true. Just wanted to add that it could be meant other ways too. My husband recently asked if he was enabling my depression by doing everything for the house. Cleaning, groceries, etc. He was happy to help but wondered if it just gave me more of a reason not to do anything. I got terribly mad at first, but I do think he just wants me to get better and wants to make sure he is not contributing to my descent.
It also has been brought up as to whether my doctors are enabling me by having my appointments over Skype and not making me leave the house.
I guess there are a lot of ways to potentially enable, but none of it would be the depressed person’s fault or something they can control.
I think it is hard to say really. I would talk to your doctor about it. Because I know a daily routine and structure can help, but I also know of people who have had horrible depression while taking care of children and maintaining fairly demanding jobs. So even with plenty of activity and responsibility if your brain is sick, then your brain is sick.
And when I was battling it myself, I lived alone and my apartment was usually pretty clean, my cats were well taken care of but it didn’t stop the panic attacks, the crying fits or wild mood swings. I don’t know if it would have been any different if someone was taking care of those responsiblities for me. I think it depends on the person, the situation and level of illness.
Helping is ok… Enabling is definitely NOT ! Face reality… Get help and don’t expect your partner to do everything for you. It is your problem that you have to solve. Its not their job to solve it for you. They have a life to live too! Remember you have to live with you, they do not! They choose to live with you, so get yourself help!
As someone who has dealt with mild depression myself and as someone who’s partner contends with major depression, I completely disagree. It is completely possible to enable someone who’s depressed! Allowing them NOT to confront and challenge their negative thought patterns and/ or to become complacent with their treatment is enabling them. Allowing them to take their moods out on you is enabling them. Being depressed does not give one license to do whatever they want under the big banner of depression. They still are accountable for their actions (or lack thereof). Not holding them accountable is enabling them. Depressed or not, there are still bills to be paid, the world still turns and unless you’re a hermit, we still have to deal with other people.
Not enabling means a lot of love. It means a lot of patience. It means a lot of forgiveness. It also means a lot of respect – for them as an adult, as a sentient being who is capable of making choices. Some of them are extremely hard, but there is still choice *in the long run*. I’m not talking about choosing whether to be depressed or not, I’m talking about choosing how to deal with the depression symptoms, choosing to try to deal with the causes and choosing how to deal with the fallout when things go off the rails.
If someone’s body is sick, you don’t just let them sneeze all over you and let them go out in winter without a jacket on. If someone is “brain is sick” as you say, you help them stay on track with their meds and support them while they do the extremely hard work of sorting through the causes of their depression and changing the thought patterns that don’t serve them well.
Anything less is enabling them.
Sure, but what I am talking about are people who treat depression like addiction. So they “cut off” a person who is depressed and stop feeding the beast so to speak.
I don’t know your partner, but I suspect he or she might also have addiction problems as they are incredibly common with depression.
Also there are plenty of people who suffer from depression and have children to raise, bills to pay and work 40-60 hours a week on top of it. They get all of these things done but are still depressed. Of course there are people who will sit around and do nothing, blame their depression and expect you and everyone else to deal with it. I am not talking about those people, substance abusers will do the same thing. What is really annoying are substance abusers who refuse treatment and then sit around and blame their addiction for every short coming. I think we all know plenty of people like that, but that is not what I am talking about.
But the two diseases are not the same, and there is a reason why Depression and Substance abuse are not treated in the same way. Cutting off a depressed person and blaming them for their depression is reckless and dangerous. What your partner might be doing is emotional manipulation, which can happen with any disease, any problem and is not excusable as depression. I don’t know you or your partner, but I will say that I am often disturbed with the amount of venom and blame to is directed towards people suffering from clinical depression. I suffered from it and am now passed it, I never abused drugs or alcohol and I did not overeat or engage in self-destructive behavior yet I was out of my mind with the physical symptoms of depression. If my loved ones had cut me off, or disengaged with me during that time I would be dead right now. In my case the disease had become larger than myself, it was completely all consuming and I needed medical help. So again, I don’t know enough about your partner or you, so I don’t feel comfortable commenting on your specific situation. But there will always be people who use anything for a crutch or a reason to manipulate people and it can be their family history, addiction, depression, a divorce, financial situation or any tragedy. That is nothing new, but it isn’t what I am talking about here.
Saying that enabling depression is impossible is to both misunderstand the myriad ways it is possible to “enable” someone (from the perspective of a clinical psychologist and how they use the term) and to not understand the multiple ways that different people experience depression.
Take a person who’s depression is characterized by a tendency to retreat and seek self-isolation, pulling back from the world yet seeming to cope on some basic levels. They are not lying in bed with the shades drawn and not bathing and eating, rather they are having difficulty with work, with family relationships, etc.
A spouse who says “I’m just going to pretend everything is OK and take care of them and not rock the boat as that’s what they need to get better” is enabling that person’s depression in a very significant way.
Sure, but to truly stop enabling them you have to CUT THEM OFF. Cutting a person off like that could kill them, urging them to get help is not enabling them. The biggest misunderstanding that I find is when people see the isolating behavior, blame the person who is depressed for being self-destructive and then “cut them off”. They are treating depression like addiction and that is a huge mistake. Sure a spouse who pretends everything is OK and does nothing to help a depressed person as to not “rock the boat” is not helping the situation, and might be “enabling” as you might call it. I don’t think the term “enabling” should be used in terms of treating or dealing with a depressed person.
With an substance abuser you stop enabling them when you cut the person out of your life completely or as much as you possibly can. When you cut them off you are trying to help the person to hit rock bottom. In depression rock bottom is suicide. So it is not the same thing and I completely stand behind my article and my opinion.
You state that “to truly stop enabling them you have to CUT THEM OFF.” Um, what? What is your source on this? It’s completely out of touch about current practice. If this is what you think not enabling is, I sure can understand why you wouldn’t want someone to equate it with depression. That said, the Centre for Addiction and Mental Health states that “Families and friends are an essential and enduring support to people with mental health and addiction issues” and that “An open, cooperative and respectful rapport between families, clients and health care providers ultimately benefits everyone.” (source: http://www.camh.ca/en/hospital/care_program_and_services/support_for_families_and_friends/Pages/family_resource_centre.aspx).
I’d say that this is pretty much the opposite of cutting someone off.
You also say, “Sure a spouse who pretends everything is OK and does nothing to help a depressed person as to not “rock the boat” is not helping the situation, and might be “enabling” as you might call it. ” I don’t just call it that, it’s (part of) the actual definition. Merriam-Webster’s online dictionary states that an enabler is, “…one who enables another to persist in self-destructive behavior… by providing excuses or by making it possible to avoid the consequences of such behavior”. This is entirely applicable to depression. “Self-destructive behavior” means lots of things and is not exclusive to abuse of drugs, food or alcohol.
I get that a lot of people equate mental health with addiction. I can understand that you’d be frustrated by it as well. It’s awesome that you have not self-medicated in this way, but stating that it’s “impossible” to enable depression is actually the reckless and dangerous thing here.