As I have had suicidal thoughts several times post PH diagnosis and I have reached out tentatively to people only to have them say the worst possible thing ever, I am hoping I can help those who don't understand it.
I'll say this first. If someone threatens suicide, please get them help. Call 911. Get them on the phone. With you. With a counselor. On a crisis line 1-800-273-TALK. Here is a link on how to report a suicidal post on Facebook and they will get the proper people involved if this is someone you do not know well.
https://www.facebook.com/help/contact/305410456169423
This is from googling what happens when you contact FB:
Click continue. Your report will be sent to Facebook and reviewed by the Safety Team, who may send the person who posted the suicidal comment an e-mail encouraging them to call the National Suicide Prevention Lifeline 1-800-273-TALK (8255) or to click on a link to begin a confidential chat session with a crisis worker.
San Diego runs pretty good mental health awareness ads. Here is the link to their website. It has some VERY good info and links to resources that are applicable to all.
http://www.up2sd.org/index.php
I guess I'll start with a few of the things not to tell a depressed person. I have had a million wrong things said. I then have to really make an effort to determine if the person is well-meaning but just said the wrong thing (often) or if they're an asshole (sometimes). It's exhausting. I am positive that I have said the wrong thing to people. We all do it! But please be mindful, especially with depression.
1. Please do not tell them they should be grateful. For anything. Their spouse, their kids, their life, their money, their job, their health, anything. Here's why. I tried reaching out to someone and said I was having a rough time. They told me I was so lucky that Jeff married me when I was already sick and that I should be grateful that I had a transplant and a second chance at life. I should be able to see the positives of my life! I was already feeling guilty that Jeff's career had taken some twists b/c of my illness, I was guilty that I was depressed and that my depression was affecting him when he was miles away. I was struggling with chronic rejection, so I wasn't feeling happy about the transplant either. I felt like Jeff would be in a much better situation without me. He could remarry and have kids with someone (even though he has never expressed a desire to have kids), his career wouldn't be thrown off track and he wouldn't have to deal with a post-tx crazy depressed person on meds that will affect me for the rest of my life. I wasn't grateful Jeff married me. I felt even worse that I SHOULD feel grateful and I just felt like a big burden and a huge detriment. I didn't feel like I was providing anything useful to the relationship. I promise, it makes the situation worse. The guilt that they can't feel grateful becomes even more overwhelming and the solution of death seems more feasible.
Another example. If you tell someone they should be grateful they have a job (even if they hate it and it's the cause of the depression) because so many don't, the depressed person will think "omg, you're so right. And the fact that I'm not grateful and hate my job makes it worse! if I'm not here anymore, someone can have my job and be happier and more grateful than I am. I would be helping someone else, and that would be something and more than I'm doing now anyway."
2. Please do not tell them everyone goes through sadness or gets depressed from time to time. That minimizes what they're feeling to a common emotion of sadness and depression is not a common emotion. It's a chemical imbalance in the brain. No, not everyone gets depressed. And do not tell them "I get that you're depressed but...." if you do NOT understand depression. Seriously. If you don't understand it then don't pretend like you do. Better to tell someone you don't understand what they're going through. True, some people call sadness depression. Treat it all like depression. There are also several types of depression. You can tell them that you know they're having a rough time and you hope it gets better soon and you'll be there to help them.
3. Do not tell them they'll feel so much better if they just think positively. Do not tell them to try and be happy. Do not tell them to suck it up or just forge ahead or stop being sad or put on their big girl panties and smile (omg- if I hear that last one I will personally come kick your ass wearing MY big girl panties).
So here are 10 things that would be AWESOME to help a depressed person (or anyone going through a rough time).
1. Send them flowers (even dudes- why not?). You can go a cheaper route if you are close to where they live- just go buy a bouquet and stick it on their porch. If you're worried about the whole dying flowers thing, a potted plant or a card or a text (hey! there are flower emojis! You could make a silly emoji bouquet!) saying that you care about them would be nice.
2. Ask if them if they have a therapist. If not, ask them if they're willing to try one. If they are, and this is important, YOU find them someone. Get the name of their insurance, look up (it's called Google That Shit, people!) mental health professionals in their network. Most have websites. Read some bios. Find 2 or 3 promising options and have them pick one that looks good. CALL THE THERAPIST and make an appt for your friend. The person will still have to fill out paperwork before they get there or at the first meeting. I know it seems ridiculous to do that much work for someone. I understand that to a non-depressed person it makes no sense. I know this. Jeff and I have had many a conversation about it. If that is too time consuming for you or they don't have insurance for therapy? Get them in touch with a suicide/ depression counselor through a crisis hotline. 1-800-273- TALK (8255). Remember, Psychiatrists can prescribe drugs but generally don't counsel (some do). Psychologists counsel but don't prescribe drugs. They generally work together. And there are plenty of wonderful licensed therapists who are not psychologists. I use an MFT (marriage and family therapist).
If they do have a therapist, ask if they are helping. Therapists are a relationship- there needs to be a good match. If it isn't working, help them find a new one and then help them end the old therapist relationship. Yes, you can google how to breakup with your therapist. I had to do that. You know, the guy who didn't know my name and I stayed with him for a year? Yeah. It wasn't fun. But I did it in person and I felt amazing after I dumped his ass! Haha.
If they refuse to see a therapist then you should ask them about their plan to get themselves some help. Give them the number to some crisis hotlines. Most cities have their own and you can also use the 1-800-273-TALK.
3. Ask them what/ when they last ate. Was it crap or nothing? Send over some healthy food. Please do not ask them what they want to eat. They are already overwhelmed and feel like a burden on everyone. A "hey I'm passing by a Panera on my way home- can I bring you a sandwich?" would work well. Ask about dietary restrictions (if you do not already know) and maybe give them 2 options. Either order through a delivery service (apps like Seamless, DoorDash, Postmates, Grubhub, etc), or if you bring them food, make sure it is not in a dish you want back. I'm not kidding. It creates intense anxiety for the person knowing they have to return a casserole dish. Use recyclable/ throwaway containers. Go to Whole Foods and buy some premade salads (pasta salad, chicken salad, kale, etc) and drop them off. Make it easy on both of you. Please do not make comments about how hard it was for you to find time to get over there. Please do not complain about the line you had to stand in to get the food. They won't contact you again if they feel guilty that they were a burden on your attempt to help them.
4. Ask them if they would like to go for a walk with you. They don't have to drive anywhere. Either pick them up or walk around their neighborhood. They can be in their freaking jammies, people. Get them out of the house and into some fresh air!
5. Listen to them. Don't judge their ramblings because you cannot relate. Try not to offer suggestions or solutions unless YOU are willing to actually help and be part of it! If you offer suggestions, follow through and ask if it helped them. Realize the solutions that work for you, a mentally healthy person who might deal with occasional sadness, may not help them. They will likely not have the energy to try or do something new (although it really does help- it's why I started the violin). Or if you are suggesting something new, be willing to go with them the first time.
6. Tell them that you care about them and that YOU ARE TRYING TO UNDERSTAND. They know that most people don't understand. They feel alone. If you do care, tell them you are trying hard to understand how to help them and then really try. That could be taking 5 minutes and googling how to help someone who is depressed (there are a million articles out there including this one now- haha), asking a lot of questions about what goes through their head, or just being willing to listen. Just sitting with them and saying, "I really don't understand the thoughts you're having right now. Will you tell me so I can try to understand?"
7. Remind them that they are a strong person. Remind them of the things that make them unique and amazing and powerful. Try to make them laugh.
8. Realize that most depression comes from stress and feeling overwhelmed. Help them loadshed to get to a calmer place. Seriously. Help them clear off their calendar of nonessential stuff. Help them run errands that seem overwhelming to them. Yes, that could be as simple as buying bananas or milk. Help them make short lists so they can check something off and feel like they've accomplished something. Help them realize what is important and what's not so important. Getting bills paid on time- impt. Cleaning the house- not so impt.
9. Please don't be upset if you have to initiate contact with them for weeks or months. Check on them periodically but also give them their space. Don't make them feel guilty because they haven't contacted you. Realize they feel like a burden to everyone, including you, so calling or texting or communicating may be very overwhelming. They are also terrified if they reach out that they'll be ignored or some sort of response won't come right away. Yes, we all have lives and don't sit on our phones all day. But to a depressed person, an hour feels like a week. So reaching out can sometimes be a huge effort in itself.
10. VERY IMPORTANT. Maybe the most important. Do not let their depression drag YOU down. This is why they really need help from a professional or a support group or multiple people for their issue. Do NOT become their therapist. You need to take care of your mental health as well. Help them get help and don't let them drag you down. You'll know the difference between someone who is trying hard to work on their depression and those who, for whatever reasons, like to be stuck in the muck. Do what is within your means to help someone, but don't let them drag you into the muck with them. It is okay to set boundaries.
It is important for the depressed person to learn their triggers and to learn healthy coping mechanisms to help them through bad hours, days, and weeks. I have come to the realization that I will always struggle with suicidal thoughts (even when I'm not depressed!). It is now part of the chemical makeup of my brain and I know that some of the meds I'm on for transplant exacerbate the problem.
I know that being overwhelmed is a BAD trigger. I start dumping obligations as soon as I feel overwhelmed and stressed. I only keep social engagements with people I know well and trust and are easy for me to be around (and sometimes I even cancel those). I go to the gym and I go for long walks in the neighborhood. I have learned though trial and error there are a few people I feel safe contacting. All I have to do is say "I'm having a bad day/ hour/ week" and they know that I just need to talk to them or they'll meet me for dinner or they'll say something stupidly funny (like remind me that if I kill myself my cats will gladly eat me) that makes me laugh. Be that person for someone. Do not be that ONLY person for someone (read 10 again)! You have your own life, and they need to have multiple tools for coping.
One of my tools/ mottos is: get through an hour. Whatever I have to do. Take a shower, go for a walk, sit on the couch and listen to spa music, do a load of laundry, put on a facial mask (or do all of the above), but I have to get through ONE HOUR. Then I reevaluate. Do I feel the same as I did an hour ago? Is it better? Good. Is it worse? Call, text, message someone right now. That's generally enough to get me through and start feeling like I can cope. My goal is to avoid becoming depressed, because that's a hard hole to climb out of. It's easier to deal with the rough hours one at a time before they turn into rough days and weeks and months. Another strategy I have is to do the exact opposite of what I want to do. If I'm feeling majorly bummed and have been battling bad thoughts for hours, I call a trusty friend and ask them to meet me for dinner. It has always helped.
Tell them to find people who are as screwed up as they are, I mean, with whom they can relate ;-) I can't do transplant support groups and I can't do PH support groups. I found this Dysfunctional Female Veterans Facebook page. The posts are hilarious, heartbreaking, supportive and for me, so relatable. When I'm feeling down on myself I pop on in that group and read the comments. How they deal with depression? Bacon, beer, sex, loud music and punching heavy bags. My kinda people. I literally laugh out loud at some of the stuff that gets posted. And they speak my language- half acronym, half swear word :-) There are closed (private) groups you can ask to join to talk about suicide and depression. They aren't hard to find. Search 'suicide help' or 'depression help' and FB groups will pop up.
I'll attach a link to a pdf I have printed out and hanging on my wall. Send it to someone who is feeling like crap. It really does help. I've used it many times. Something about the title even makes me feel better.
Everything is awful and I'm not okay
And a quote that I find powerful and might help you understand WHY people feel desperate enough to commit suicide.
“The so-called ‘psychotically depressed’ person who tries to kill herself doesn’t do so out of quote ‘hopelessness’ or any abstract conviction that life’s assets and debits do not square. And surely not because death seems suddenly appealing. The person in whom Its invisible agony reaches a certain unendurable level will kill herself the same way a trapped person will eventually jump from the window of a burning high-rise. Make no mistake about people who leap from burning windows. Their terror of falling from a great height is still just as great as it would be for you or me standing speculatively at the same window just checking out the view; i.e. the fear of falling remains a constant. The variable here is the other terror, the fire’s flames: when the flames get close enough, falling to death becomes the slightly less terrible of two terrors. It’s not desiring the fall; it’s terror of the flames. And yet nobody down on the sidewalk, looking up and yelling ‘Don’t!’ and ‘Hang on!’, can understand the jump. Not really. You’d have to have personally been trapped and felt flames to really understand a terror way beyond falling.”
– David Foster Wallace, Infinite Jest
And an odd fact about Max. He has been with me since pre-PH (2006!). We have been through a lot and we have a strange connection post transplant. I had a bad night a few years ago when I was depressed. Jeff was in New Orleans on that shitty tour. I had a deadly serious thought of suicide that flashed through my head. All of a sudden Max woke up, walked over to me, put his paws on my chest and said "EH!" right in my face. Sort of like a cat bark? Like hey, you crazy bitch, you do that shit and I'll eat you! (cuz your cat will eat your dead carcass. dogs likely will too).
It was the freakiest thing I'd ever experienced. It scared me when it happened. That stupid cat can read my thoughts? It has happened since then too, mostly from feeling exceptionally overwhelmed and stressed (not necessarily suicidal thoughts). My breathing must change or some chemical gets released that he can sense. I'll be feeling completely horrible and he'll pop up, come over, stand on my chest and say "EH!" (which I think translates to NO! but I'm no expert...) So I pet him and hug him and he curls up into the crook of my arm and I feel loved by a hairball hacking monster who poops on my bed when he's stressed that I'm stressed :-/ Always good times.
So perhaps consider getting your depressed friend a mind-reading cat ;-) And don't forget to remind them (the friend, not the cat) that some of the best days of their life have not yet happened! Truly!
"Try to be the rainbow in someone's cloud" - Maya Angelou
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