How to Start a Conversation With Someone You Love About Depression and Suicide
Last week, the suicides of Kate Spade and Anthony Bourdain found many of us grappling with shock, sadness, empathy and confusion. Though we did not know the two celebrities personally, their respective successes have made them household names, and, as is often the case with celebrity, we may have felt a false sense of familiarity with them. At the very least, we may have assumed they had the kind of lifestyles many of us have aspired to: financial success, recognition, autonomy and seeming happiness.
Kate Spade, beloved co-founder and designer of Kate Spade New York, had enjoyed massive success with her coveted and celebrated handbag line; Anthony Bourdain found acclaim as a celebrity chef, author of Kitchen Confidential and later, through his food/travel hybrid television shows in which he exposed those of us watching to worlds we would only dream of exploring. Their suicides have put mental health at the forefront of the national conversation, leading many of us to ponder what depression looks like—and what to do if we, or someone we love, is depressed.
Is It Depression, or Just a Funk?
Learning the difference between clinical depression and being in a “funk” can be extremely valuable for your mental health, and that of your loved ones. Clinical depression is a complicated illness with a variety of symptoms. While most of us have experienced sadness or a “funk” at some point in our lives, depression differs from these in numerous ways.
“Sadness can typically be attributed to an event, situation, or circumstance and is a normative response to loss, rejection or disappointment,” says Jenny D. Brice, MFT, MPH, psychotherapist and Reiki practitioner. “During the ‘funk’ you may even have moments of joy, appreciation and genuine connection. It’s a temporary state lasting a few hours to a few days, and although it is a message from your mind and body that it needs some TLC or else, you can see the light at the end of the tunnel and can think of ways to begin nurturing yourself. Depression, on the other hand, is accompanied by a deep sense of helplessness and hopelessness, and the feeling that not only is there not a light at the end of the tunnel, the tunnel is most likely a dead end or doesn’t end at all. Many clients describe it as a dark hole or perpetual black cloud that contaminates everything. The sadness is engulfing, diffused and non-specific; it’s not one or two things, it’s everything, and every day without respite.”
For a clinical diagnosis of major depressive disorder, Jenny notes, someone has to meet certain criteria in the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th Edition) and the symptoms have to have persisted for two weeks or more.
The Mental & Physical Signs of Depression
Depression can sneak up on any of us, and its symptoms aren’t always immediately recognizable as such. While each of us may experience a normal emotional response of being “down” when in the midst of recent events such as death, getting fired or going through a break up, clinical depression often begins to effect and interfere with daily life.
“Clinical depression lasts longer” than a normal emotional response, says Dr. Drew Ramsey, assistant clinical professor of psychiatry at Columbia University College of Physicians and Surgeons. “Symptoms can include disturbances or changes in sleep, appetite, increased irritability, feeling much less connected or more tearful. One may first medicate with alcohol and increase their drinking, and have a more negative lens of the world. Feeling less hopeful, less focused, as if they’re in a brain fog are also indicators of depression.”
Psychosomatic symptoms can also be red flags, Jenny adds. “Feeling tired, achy, generally ‘sick’ and not knowing why, as well as pervasive headaches, stomachaches, tightness in the throat or chest or tense shoulders can all be indicators of depression.”
How to Recognize Depression In Loved Ones
Even with a list of possible symptoms, it can be difficult to recognize if a loved one is suffering from depression. “When someone struggles with depression, over time, they become adept at masking their feelings,” Jenny says. “It’s part of the reason they continue to spiral, as their painful emotions have nowhere to go until they finally break. They learn to overcompensate in different ways to maintain the status quo. This is why cultivating a culture—within society and amongst your friend or family group—where mental health is normalized and mental illness is discussed is so important.”
That being said, there are behaviors associated with depression that can be signs that someone you love is struggling. Jenny notes, “They may become argumentative or withdrawn, cancelling multiple plans with no clear reason; they may exhibit unusually inconsiderate behavior (pushing you away), begin consuming more alcohol/substances than usual or begin using; they may also exhibit careless behavior or changes in sexual activity (including increased risky sex), or constantly making negative statements about themselves and their situations; avoid emotional conversations, or start to giving away or throw out personal items—this can be a sign of possible suicidal ideation and intention. It’s important to note that you are not a mind reader—and sometimes the signs just are not there or are very well hidden.”
Depression in Your “Always Smiling” Friend
Kate Spade was often described—and photographed—as smiling, seemingly upbeat. Reconciling this happy facade against her suicide only adds to the confusion surrounding her tragic death. “The first thing to remember is that suicide comes in the context of an illness and has risk factors,” Dr. Drew says. “Those factors include depression, alcohol or substance abuse and previous suicide attempts. In the case of Kate Spade, some of the classic warning signs didn’t seem present to us, and that’s what has shocked people. This can lead us to question if we know ‘silent sufferers.’”
“Don’t forget to check on your ‘strong’ friend,” Jenny advises. “Watch for signs of intense exuberance at odd moments. Does she always deflect when you ask her how she’s doing and yet is aware all your ups and downs? Can you remember the last time you saw or heard of your loved one crying or expressing unpleasant emotions?”
In addition, Dr. Drew says, use the strongest tool you have when it comes to those you love: your intuition. “As clinicians, we’re taught our most powerful diagnostic tool is our feelings. Look someone in the eye. Try to have a conversation. If they brush you off with a laugh, let them know you’re concerned and they’re loved. Often, people are scared to say ‘suicide.’ Ask if they are having thoughts of taking their own life.”
Ending the Silence & Combatting the Mental Health Stigma
Those who suffer in silence are often victims of the stigma our society attaches to issues surrounding mental health. “Stigma is the smoking gun when it comes to completed suicide,” Dr. Drew notes. “It means we can’t speak openly about our emotional states when we’re not ‘on’—especially those who are in the public eye or hold influence.”
Making emotional check-ins a normal part of your interactions with loved ones can help remove the stigma and make way for meaningful conversations. “Ask your loved ones scaling questions and create your own descriptions,” Jenny offers. “For example:
- On a scale of 1-5, where 5 is Beyonce (empowered, creative, expressive, high self-sense of worth) and 1 is Milli Vanilli (fearful, anxious, strong sense of imposter syndrome, low sense of self- worth, etc.), where are you landing today? What circumstances and thoughts are contributing to this number?
- How are you feeling emotionally/spiritually, mentally, physically?’
It’s also important to ask questions directly, says Jenny. “‘Are you self-harming or cutting? Are you thinking about killing yourself? Do you have a plan?’ Asking about suicide does not cause suicidal ideation,” Jenny continues. “Often, people are relieved to hear their darkest thought finally spoken out loud by someone else. It may be their first opportunity to view it somewhat objectively and critically.”
Ending the silence begins with an honest assessment of stigmas held around depression and mental health. “If you’re having chest pain, you call 911,” Dr. Drew observes. “Thoughts of suicide are also an emergency and need to be treated as such. Stigma keeps us silent and silence is what kills us from suicide. The part that concerns me is that so many people have a stigma agains psychiatric medication.”
How the Wellness Community Can Contribute to the Mental Health Stigma
Dr. Drew offers a sobering observation of the wellness community’s own stigma surrounding mental health. “Especially in the wellness community, medications can be labeled ‘toxic.’ There are clear and well documented side effects, certainly, but for many people, they’re necessary. People who are immersed in the wellness community may not feel supported taking medication they need. They’re asked, ‘Are you sure you need something that strong?’ If it were insulin or chemo, we’d never say that. When nobody at a yoga conference feels supported taking Zoloft—that’s stigma. That’s something in wellness that needs to be looked at.”
In addition to the stigma around medication, Dr. Drew is looking to dismantle the misconception that mental health professionals only dole out medication as a matter of course. “Mental health professionals do a lot more than prescribe medications; we’re very skilled at helping to frame very confusing mental and emotional symptoms and create the needed treatment. For depression in particular, there are many courses of action. People often don’t seek help because they’re afraid all we do is prescribe medication.”
Jenny also warns against the stigma around mental health being fed by social media. “Social media is a highlight reel,” she reminds us. “It enables a front—you become adept at putting on a mask and avoiding real, meaningful conversation. If being honest will raise alarms, then you create a manageable virtual persona to put out into the world.”
Avoiding honest interactions with loved ones only furthers the stigma—and the silence. In addition, social media can “feed the comparison dynamic,” Jenny cautions. “If you’re struggling, it gives you content for the negative voices in your head. You’re not doing what everyone else is doing, so you begin to feel a sense of shame.”
Both Jenny and Dr. Drew agree that real, face-to-face interactions with loved ones—having honest conversations—is the best way to end the silence and stigma around mental health.
5 Steps to Take If You or Someone You Love Is Depressed
1. Start a Conversation.
Have a candid talk with yourself, or someone you love. “If someone tells you they’re struggling, don’t try to talk them out of it,” Dr. Drew advises. Resist the urge to brush it away by listing all the reasons they have to be happy; instead, “be with them in that feeling state. Understand where it’s coming from.”
2. Create an Emotional Safety Plan.
“Together with a loved one, make a safety plan as a way to open up dialogue before a crisis occurs,” Jenny suggests. This plan can include warning signs that a crisis may be developing, actionable steps to take your mind off your problems without contacting another person, people and social settings that provide distraction, people to whom you can turn to for help, mental health professionals and contact information and steps to make your environment safe.
3. Use the Mental Health System.
Connect loved ones—or yourself— with a competent mental health professional. “Fifty percent of those with severe suicidal thoughts didn’t speak to a mental health professional,” Dr. Drew notes. “We didn’t even get a chance to prevent those.” According to BBC.com, government health officials in the United States reported the country’s suicides had risen by 30 percent since 1999, and that the crisis was an ongoing issue. Nearly 45,000 Americans committed suicide in 2016. “If we can help people who are struggling have a good evaluation, that will help,” Dr. Drew says. “Talking about suicide won’t cause it. Not talking about it will never help.”
4. Practice Self Acceptance.
“Guilt and shame around the depression can make healing an uphill battle on an already difficult terrain! Remind yourself that this is no different than having a broken leg, and think of how you might treat yourself if that were the case,” Jenny says.
5. Get Help.
If you or someone you know is having suicidal thoughts, call the National Suicide Prevention Lifeline at 1-800-273-8255, available 24 hours a day, every day.
If you or someone you love is having thoughts of suicide, “Call 911, or go to the nearest hospital or crisis center if you feel you are at risk for self harm/suicide,” Jenny says.
In addition, she advises, “Learn about emergency psychiatric services in your town and information about local crisis centers and their process. You may need to encourage a voluntary commitment or initiate an involuntary commitment to ensure your loved one’s safety. It’s not pleasant, but it can be lifesaving.”