How to Support a Friend Going Through Mental Health Challenges
Don't let not knowing what to say keep you from saying anything.
Mental health issues are more visible than ever. According to the National Institute of Mental Health (NIMH), nearly one in five Americans is living with some type of mental illness. That’s crazy! (Sorry -pun intended!) Think about that figure as you stand in line to pick up your takeout, to buy the only stamp you’ve needed in a year and a half, or to have your oil changed. Chances are that some of the people you see around you are dealing with a mental health diagnosis. Maybe you even have one, yourself. I sure do - I have major depression, although, thankfully, it’s well-controlled with SSRIs.
If you have a mental health condition, too, you likely realize, as I do, that we’re really only one or two generations removed from the days when people like us would’ve been greatly stigmatized as pariahs or even checked into a facility. And not just for a tune-up, but to live long-term. During my parents’ lifetimes, lunatic asylums were still operational, and it was common for parents and spouses to be told that their loved ones’ prognoses were essentially hopeless. If they were really lucky, their son or daughter, husband or wife might be offered cutting-edge treatments that would end up being more harmful than healing, like frontal lobotomies or insulin therapy.
Those people were often institutionalized for conditions that are, today, as “meh”-inducing as anxiety, obsessive-compulsive disorder, depression, or even PPD. That’s not to say those conditions aren’t serious! They can be very detrimental to one’s quality of life, and sometimes, they’re even dangerous. But, by and large, they can be treated and recovered from at home, as a doctor supervises.
So, now that people are allowed to treat their mental health conditions out in the open, they’re able to live at home, working, enjoying their friends, family, and hobbies, and moving about in the world as they’re able while they recover, instead of being committed to asylums or sanitariums for years. This has had the effect that some of the stigma surrounding such issues is gone, and as a result, we see, hear, and read a lot more about mental health problems in mainstream media and culture than previous generations did. Being informed is all well and good, but what are you supposed to do when someone you actually know is struggling?
It’s a good question. After all, mental illness can be messy. It can make patients say and do things that they wouldn’t typically: pick fights, self-medicate excessively, cry, yell, complain a lot, fixate on some out-in-left-field figure as the real source of their woes. And thanks to social media, they can do all of this and more as everyone they ever knew watches. If you’ve looked at the online posts of someone you love who’s suffering from a mental illness and involuntarily cringed, you aren’t alone.
You might find yourself feeling like you just can’t watch your friend suffer anymore, but you may not want to disappear entirely, either. It’s a toughie: Calling out flagrantly symptomatic behavior often doesn’t work. Same for pushing back on misconceptions. And talking to them can be hard. What do you do if you honestly want to help?
Well, I would not want to formally speak for anyone but myself, and I would not want my opinion construed as medical advice, since I have exactly zero credentials. But I do have some thoughts.
DO:
Check in. Send texts - “Hey! Thought of you today because of x; just wanted to see how you’re doing!” This means more than you know. And don’t take it personally if you don’t get a prompt response. Your friend just need to know people still care about them. If your loved one likes to chat on the phone, ask when a good time is to catch up that way - and when it’s time, you call them.
Continue to treat your friend like a person - and like an adult. Depression or no, they still know they like Thai food and animated sitcoms, as they always did. Continue to engage with them on the same levels you did before.
Brainstorm workarounds. For people with mental illnesses, the devil really is in the details. We might think it sounds like a blast to go to the mall with you, but worry about how tired we’ll get walking around. We might love the idea of seeing a movie together, but fret about whether or not we can actually concentrate for the entire run time. If you suggest plans and your friend hems and haws, this might be what’s going on. Ask them if there’s any part of the outing that worries them, and if so, think about technical fixes, then reassure them that your main goal is spending time together.
Take decision-making off their plate whenever you’re willing to. For many people dealing with mental health conditions, making decisions is the absolute worst! It’s a relief, nay, a balm, to have a friend or relative call and say, “I thought I’d take you to brunch on Saturday! 11:00 work?” or “I’m going to come over after work on Thursday and help you tackle that laundry.” This combination of decisiveness and doing a favor is, quite possibly, what helps the most! Extra points for making clear that you don’t care how your friend looks or what state their house is in.
DON’T:
Just go silent. We know our symptoms can be alienating. And we’re not keen on them, ourselves! In fact, an argument could be made that alienation from oneself is the essence of mental illness. If you don’t know what to say, but are thinking about your friend or loved one nonetheless, then tell them that: “I don’t really know quite what to say to you that would help, but I’m sad for you, and I think about you a lot.” Opening a DM or text with this message would touch even the depressiest heart.
Ignore the elephant in the room. You’re allowed to ask how your friend is doing - especially if they have broached the subject before! Ask how treatment is going. Ask what side effects the medications have. Ask if they like their doctor or therapist. The best disinfectant is sunlight, and shrinking away from the topic of their diagnosis will likely only make your loved one feel that no one wants to hear about this aspect of their life.
Underestimate what you can do. No, you’re (probably) not a trained therapist, counselor, or doctor. But you do have one credential that makes you a perfect shoulder for your friend to lean on: you’re not being paid to care about them. Stopping by for an hour’s chat can be the very best medicine - especially if you stop for ice cream or pizza on the way.
Conversely …
Try to heal them yourself. Don’t do this, that is! It’s not your job - even if the loved one is your child or your wife, or the friend is your college roommate or your business partner. You can be a wonderful and helpful source of support to the person without sacrificing your own well-being, or trying to use common sense and Dr. Google as substitutes for thorough and rigorous training. No matter how smart, insightful, and caring you are, you don’t have the person’s full medical history to take into account. You don’t have the years of experience treating someone like him or her. Simply put, you don’t have the context or capability to act as a healthcare provider to him or her. If you find yourself being pushed in that direction, that’s an excellent place to draw a boundary.
Tending and nurturing a relationship with someone suffering from a mental health condition can be tricky, but it doesn’t have to be a total mystery. When all else fails, honesty is appreciated: “I don’t know what you need right now, but I’m concerned about you.” “I’m not sure what to say, but I didn’t want to just say nothing.” “I’d like to help you, but I’m not sure how I can.” Any of these messages would likely make the day or warm the heart of someone struggling with mental illness.
Something to think about!
Be gentle with yourselves,
Sally Shideler
Managing Editor
Chief Editor-in-Chief Wrangler
Thanks Sally. Wise words, and helpful.