Download A Way Out of Depression Coaxing a Loved One in Denial into

A Way Out of Depression
Coaxing a Loved One in Denial into Treatment Without Ruining Your Relationship
By Elizabeth Bernstein from WSJ.com Sept 7, 2010
For people suffering from
depression, the advice is usually the same:
Seek help.
That simple sounding director,
however, is often difficult for those with
depression to follow because one common
symptom of the disease is denial or lack of
awareness. This can be frustrating for wellmeaning family and friends – and is one of
the key ways that treating mental illness is
different from treating other illnesses.
Research shows that almost 15
million American adults in any given year
have a major depressive disorder. And six
million Americans have another mental
illness, such as schizophrenia, bipolar
disorder, or other psychotic disorders. Yet a
full 50% of people with bipolar disorder and
schizophrenia don’t believe they are ill and
resist seeking help. People with clinical
depression resist treatment at similar rates,
experts say.
You may have seen that seemingly
ubiquitous TV commercial for the antidepressant Cymbalta that repeatedly
stresses that “depression hurts” – not just
the person who is sick but the people who
love that person as well. (Even the dog
looks sad.) It’s an ad, sure, but the
sentiment is correct: People who live with a
depressed person often become depressed
themselves. And depression can have a
terrible effect on relationships. It is a
mental illness beyond just a depressed
mood or situational sadness, in which a
person is able to still enjoy life. Depression
drains people of their interest in social
connections. And it erases personality
trains, taking away many of the very
characteristics that made people love them
in the first place.
“Depression makes a person see the
world through gray-colored glasses,” says
Xavier Amador, a clinical psychologist and
author of “I Am Not Sick. I Don’t Need
Help!” which was republished earlier this
year in a 10th edition.
The challenge for a person who a
depressed spouse, relative, or close friend
who refuses to get treatment is how to
change that defiant person’s mind. Reality
show-style interventions and tough love are
rarely successful, experts say. But there are
techniques that can help. The key is to try
and avoid a debate over whether your
loved one is sick and instead look for
common ground.
Patricia Gallagher knows how hard
this can be. Her husband, John, came home
from his job as a senior financial analyst for
a pharmaceutical company one day and
said his boss had given him three to six
months to find a new job. He was crying.
Over the next year, Ms. Gallagher, who is 59
years old and lives in Chalfont, PA., noticed
her husband became irritable, sad, and
short-tempered, withdrawing from her and
the kids. He lost 55 pounds, stopped
sleeping, and would call her numerous
times each day saying he couldn’t “take it”
anymore. He visited doctors dozens of
times that year, getting examined for
everything from a stomach ulcer to a brain
tumor. Many doctors suggested he see a
psychiatrist, but he didn’t.
Ms. Gallagher tried everything she
could think of to help. She urged her
husband to relax or take a vacation. She
begged him to see a psychologist,
eventually scheduling the appointments
herself, and even going alone when he
refused to go, to ask advice. Eventually he
was hospitalized after becoming catatonic
with anxiety, and then attempted suicide by
jumping out the hospital room window.
A decade later, the Gallaghers are
separated. “I kept thinking, ‘You’ve wrecked
everything because you didn’t go to
therapy,’” she says. Mr. Gallagher, 50, a
sales associate for a clothing company, says:
“I didn’t understand [depression] was a
chemical thing. I thought it was a physical
thing.”
People who are mentally ill yet
refuse or are unable to admit it or seek help
may feel shame. They may feel vulnerable.
Or their judgment may be impaired,
keeping them from seeing that they’re
depressed.
“When a loved one tells them they
are depressed and should see someone,
they feel they are being criticized for being
a complete failure,” says Dr. Amador,
director of the LEAP Institute in Taconic, NY,
which trains mental-health professionals
and family members how to circumvent a
mentally ill person’s denial of their disease.
In addition to the psychological
reasons that lead a person to deny his own
mental illness, there may be a physiological
one as well. Anosognosia, and impairment
of the frontal love of the brain, which
governs self awareness, leaves a person
with an inability to understand that he is
sick.
At the LEAP Institute, they teach
mental-health professionals and family
members how to build enough trust with
the mentally ill person that he will follow
advice even if he won’t admit to being sick.
LEAP is an acronym for Listen reflectively,
Emphasize strategically, Agree on common
ground and Partner on shared goals.
“It’s the difference between boxing
and judo,” says Dr. Amador. “In boxing you
throw a punch and the person blocks you.
In judo, a person throws the punch and you
take that punch and use their own
resistance to move them where you want
them.”
Sometimes loved ones are able to
help. Renee Rosolino, 44, a residential
appraiser in Fraser, Mich., says she is sorry
she waited so long to listen to her family.
They expressed concerns about her
behavior 14 years ago, when she first
started showing signs of bipolar disorder. At
the time, she felt judged when her husband,
parents and sisters told her that her
personality had changed completely in six
months. She stopped eating and sleeping,
cried a lot and yelled at family members,
and began pulling away from everything
from social activities to church.
Repeatedly, her husband tried to
talk to her about her behavior, but she
insisted she was fine. He even enlisted Ms.
Rosolino’s sister to help. After dinner one
night, they told her they were worried that
she was depressed because she was sad,
stressed, and always on edge. Ms. Rosolino
got mad and “shut down the conversation,”
she says.
In addition to being angry, Ms.
Rosolino says she was terrified. When she
was a child, Ms. Rosolino’s father, an
assistant vice president at a bank, had a
mental breakdown and was taken to a
psychiatric hospital in the middle of the
night. “I never understood what happened
to my father,” she says. “And I had it in my
head that if I went to talk to someone this
would happen to me, to my children. I
didn’t want my kids to have those same
feelings.”
Ms. Rosolino’s husband eventually
broke through to her by asking her to speak
to their pastor, pleading with her to do it
for him and their children. “He said, ‘It’s OK.
I am not going to leave you. I need you. Our
kids need you,” she says.
During the talk with the pastor, she
broke down and told him about the
pressures she felt as a mom – one of her
children is autistic – and her irritation at
feeling judged by her family. He told her
that family members were worried about
her and asked her to see a psychiatrist, just
once, to set their minds at ease. She agreed
and started seeing the psychiatrist once a
week and taking anti-depressants. Still, she
has been hospitalized several times, usually,
she says, when she stops taking her
medication. But she has been stable for
several years and says she has the people in
her life to thank.
“Out of love and respect for the
pastor and my family, I said I’d make the
phone call,” she says. “They made me feel
safe.”
Getting Around Denial
Experts say there are ways to circumvent a loved one’s refusal to seek help:
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BE GENTLE: Your loved one likely feels very vulnerable. “This is akin to talking to
someone about his weight,” says Ken Duckworth, a psychiatrist and medical director of
the National Alliance on Mental Illness, an education, support, and advocacy group.
Simply saying “I love you” will help.
SHARE YOUR OWN VULNERABILITY: If you’ve accepted help for anything – a problem at
work, an illness an emotional problem – tell your loved one about it. This will help
reduce their shame, which is a contributing factor to denial.
STOP TRYING TO REASON: Don’t get into a debate about who is right and who is wrong.
Ask questions instead. Learn what your loved one believes.
FOCUS ON THE PROBLEMS YOUR LOVED ONE CAN SEE: Suggest they get help for those.
For example, if they acknowledge sleep loss or problems concentrating, ask if they will
see help for those issues. “Don’t hammer them with everything else,” says Dr.
Duckworth. “Nobody wants to be pathologized.”
SUGGEST YOUR LOVED ONE SEE A GENERAL PRACTITIONER: It is often far easier to
persuade them to do this than to see a psychiatrist or psychologist. And this physician
can diagnose depression, prescribe medicine or refer to a mental-health professional.
WORK AS A TEAM: Ask if you can attend an appointment with the doctor or mentalhealth professional, just once, so you can share your observations and get advice on
how best to help.
ASK FOR HELP YOURSELF: See a therapist to discuss how you are doing and to get help
problem solving. Or contact organizations such as the National Alliance on Mental Illness
(NAMI) to find information on caretaking or support groups.
ENLIST OTHERS: Who else loves this person and can see the changes in their behavior?
Perhaps a sibling, parent, adult child or religious leader can help you break through.
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LEVERAGE YOUR LOVE: Ask the person to get help for your sake. “If your loved one will
not get help, you will not win on the strength of your argument,” says Xavier Amador, a
clinical psychologist and director of the LEAP Institute. “You will win on the strength of
your relationship.”