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How to support a friend who is suffering from mental distress
13 January 2021
I am frequently asked for advice concerning the best way to help a friend through a mental health crisis or in supporting a friend to manage their mental health difficulties. The experience of anxiety, depression, trauma or psychosis can be frightening and isolating. It is natural to want to do something to try to alleviate your friend’s suffering, and also to feel a little bit out of depth, perhaps worrying about saying the wrong thing and making things worse. Here I offer a few rules of thumb that should help you avoid common pitfalls and become better at supporting your friend.
Do not be in and out
Consistency is crucial. Research has shown that what makes a friendship beneficial for mental health is not the determined by the number of good deeds done, or hours spent together – but the expectation that someone will be there in the future. A common mistake at the beginning of a mental health episode or during a crisis is for a supporter to feel that they must suddenly ramp up their involvement with their friend, to be extremely generous and available and to make up for every person who has let their friend down. This ramping up can be counter-productive, as it is based upon an unrealistic expectation of what an individual can provide – you will likely become jaded and even resentful of the friend for not improving as a result of your enlarged efforts to help. What would be of greater benefit is the maintenance of your present level of involvement in the face of your friend’s changeable need. This will be tricky enough in itself.
Sometimes it may be the case that your efforts may seem to be spurned, it is best not to take this personally and to send messages by text or other Instant Messenger services that you are thinking of them.
Make a space for “real-talk”- but don’t demand it
On top of the experience of challenging thoughts and behaviours people also often feel considerable shame and embarrassment at their difficulty in coping with day to day life. Quite often people with mental health difficulties will compare their circumstances unfavourably with key people in their life. As a friend you may notice that your friend is not doing so well, but that they may also be unwilling to tell you exactly what is going on. Some people do not expect to be taken seriously or that some topics are even valid to open up about. What is important is that you are able to show your friend that you are willing to listen without making a demand upon them.
Doing an activity together, be it gardening, DIY or driving in a car together could be a good way to take the awkwardness out of it for both of you, as you won’t need to attempt eye-contact. Simple statements like: “I’ve noticed that you don’t seem to be doing so well,” or “you appear to be less happy lately” – “I’m not an expert but I am your friend and I want to be a good friend to you.” Please do not take offence if your friend is hesitant – your goal here is to open up a possibility of connection, which they may decide to take up at a later stage. Do not worry too much about saying the wrong thing – your friend will be able to sense your genuine good-will and willingness to share their burdens for their sake.
Try to avoid thinking of your friend’s mental health problem as an enemy to be defeated
Our wishes for our friend’s recovery and possible return to a pre-mentally unwell state can sometimes get in the way of accepting them and being there for them as they are now. I would advise against checking in with your friend in a manner that seeks to measure the extent of symptoms on a day-to-day basis. Your friend might interpret this as impatience or judgement about their recovery; that you are more interested in banishing the symptoms than being an accepting friend. You may also deny your friend the opportunity to have a normal good day without having to worry about their symptoms.
Try to avoid taking on the challenge of vanquishing the condition yourself, mental illnesses are highly personal, changeable and often touch on areas which are hard (or painful) to explain. However good your intentions, it is unlikely that your attempts to effect psychological treatment will be sufficient in themselves and you may grow frustrated in your friend’s seeming recalcitrance. Your responsive company, friendship and the expectation that you will be a safe harbour will be so much more valuable to your friend than your efforts to try to motivate them, overcome their fears and get them happy again.
Similarly, do encourage your friend to seek help and offer assistance in contacting local health services if this is what they want. However, demanding that they do so can be counter-productive for the reasons described above. If your friend is engaged with services, try not to pry too much into what is discussed or decided beyond the level they are willing to share with you. If your friend discontinues treatment abruptly, try to find out what specifically wasn’t working and encourage your friend to be find other sources of support e.g. a different therapist, a second opinion on medication,
How to be with challenging behaviour/ emotional experiences
You are likely at some stage to see the worst of the symptom – be it a sense of hopelessness, an inexplicable inability to do something that seems perfunctory, intense sadness, possibly anger. What is important in most instances is to be patient, calm and to not try to force anything. Ask your friend what they need at this moment, and try to facilitate this or be there with them in a compassionate and understanding manner. Your friend will be feeling very stuck in a hole at this moment, having you down there, sitting in the hole together until the worst passes will, in time be viewed as a valuable testament to your friendship. Try to let them be in control of the situation as much as they can – however do get them medical assistance if needed.
If in doubt – be a friend.
Who are we in lockdown?
26 April 2020
We are all now having to live our lives in a way that we could not imagine 4 months ago, at the beginning of a new decade. For many of us, life is now on pause as we follow government advice to remain at home. Life’s routines, its pace, rituals have had to be diverted in order to protect the vulnerable and the healthcare professionals who treat them. Some of us will experience anxiety at threat posed by the virus itself on our health or on the health of those that we love. Many of us are now prevented from seeing and holding our parents, grandparents, friends or other members of the older generation – for fear of invisibly infecting them with an illness that could kill them. Many of us are anxiously contemplating the impact of the lock-down on our livelihood. Any plans that we may have had for this year: professional or personal development goals or even things we were looking forward to enjoying, are void until the much hoped for return to normality.
Many have referred to this event as a collective trauma akin to living through the Great Depression or a war. Certainly many of the assumptions about who we are, what we do with our lives and how we deal with the world have been sidelined as we cope with this new way of life. What impact are these restrictions having on our sense of identity and on what we value? Who are we in lock-down?
Of course, we have remained in the same body with the same memories, (although certainly with new concerns) since the beginning of the new restrictions. But for many of us, the repertoires that gave life its shape before the crisis are becoming noticeably remote from our day to day lives.
Assuming you are now not-working or working from home, what routines and events do you miss. Few of us will shed any tears about a missed commute- but what about the informal conversations with the colleague you look forward to seeing, the feeling of being recognised as a competent and skilful operator by clients, the sense of pride of belonging to something bigger?
Some of us are fortunate enough to be able to continue to interact with the work place and draw a wage using technology, nonetheless, the feel, the pace and our intuitive relationship to our workplaces must now all take place within the narrower parameters of video conferencing and an increased volume of emails. Where does our finesse go when we lose the places where we practice it?
Beyond our working lives some of us may be missing the friend’s kitchen where we can truly relax and talk without the need for pretence or the fear of judgement. Or perhaps there’s a place like a favourite pub, nightclub, sport team or place of worship where we could show our stuff and enjoy the recognition of a particular group of people.
Examples such as this show are not the same people when we are with friends, family, our romantic partners or in the workplace – we manage ourselves very differently in different contexts and these context cue different repertoires of ourself to come to the fore. This is not about pretence or fakery, just as a piano player’s skill is fairly useless she is sitting in front of a keyboard, so we have much skill and knowledge that is lying dormant for want of the place where we can be skilful.
What happens to us when we are prevented from going to the places where we express the parts of ourselves that we value? When we remove the mobility that we previously took for granted we find that our opportunities for connection, fulfilment and soothing have been attenuated- or even closed down. We live in a way we are unaccustomed, our possibilities for expression and flexibility have been curtailed, turned back onto ourselves whilst being turned away from the opportunities to be seen in the light of our different roles. Along with missing others we should also recognise that we are dealing with the loss of aspects of our selves.
What takes the place of these roles and repertoires? During my doctoral research on young men who were NEET (not in employment, education and training) I discovered one of the most troubling consequences of living lives of solitude was a feeling of living in empty time, with a restless self-consciousness. Without a problem to get its teeth into is natural for our mind to turn inward, often with a critical or anxious eye. Older anxieties and insecurities, that may have been quelled by your competent performance at work or times spent with your group of friends, may come to the fore along with new anxieties around managing the risks of Covid 19. With our future put on pause we may also find ourselves locked-in to previous choices, unable to escape the place where we live and the habits of those with whom we co-habit. Unable to use our power to make changes we find ourselves saying “so this is my life.”
In the face of this forcible simplification of life, and a new reckoning with death anxiety, many of us feel as though we have lost our safe ground, ruptured from the expectations and assumptions about the world that we have gathered over the course of our lives. But this rupture has also given us occasion to stand outside of our ordinary day-to-day thoughts and behaviours and notice how we are in this stripped back state, can things really stay the same after we return to normal? Rather than fearing what we see when reflect on our lives like this, what happens if we modify our tendency to look inwardly with a critical eye and try looking instead compassionate, accepting or curious mood? Along with confusion and loss we may also appreciate anew the undiscovered possibilities that are right in front of us: a greater softness for those that suffer, the joy of giving ourselves to those in our immediate surroundings, a yearning to make our lives matter in the face of a world turned upside down.
We are all improvising. With the shutting out of the normal habits of our lives we have all been required to call upon our natural gifts of reflection and creativity to gain some kind of grip on this newly revealed life. Many of us are discovering things about ourselves during this crisis. My own modest proposition is that we approach these discoveries without judgement, that we recognise and acknowledge that this is challenging and painful. It is very easy to fall into self-criticism, to feel that one is falling short – but part of the difficulty of this situation is that there is no authority, no-one who has got through the other side to give us a definitive guide of how to approach this. We are all, to some extent, in the dark together, trying to control something that seems out of control. We have been humbled and brought back to our fragile and safety-seeking modes of being, that many of us felt we had left behind. I recommend that we allow ourselves to acknowledge the distress we will inevitably experience, with openness and compassion, and observe that this is a state of suffering that is conditional upon the present extraordinary circumstances.
I end with a quote from Theravardin Monk, Ajahn Sumedho, whose an epigram that has given me comfort and inspiration through my own struggles with all of the above.
“It is not our task to create an ideal, it is our task to see how it is, and to learn from the world as it is. For the awakening of the heart, conditions are always good enough.”
Ajahn Sumedho, The Way It Is (featured in The Buddha is Still Teaching by Jack Kornfield)
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