Managing Your Depression (16 page)

An aggressive communication style is dominating, with yelling, threats, and anger. It is not effective. Aggressiveness tends to alienate the other person, making him or her defensive. You don’t accomplish what you want with this communication style, and you don’t feel good about yourself.

A passive style, where you remain quiet and submissive, is also not effective. When you are passive, you don’t speak up to make your needs and wants known. When you do not speak up and advocate for yourself, you run the risk of doing and becoming what the other person wants you to do and be. Your needs and wants are not met. The other person responds in a way that is not in your best interest, and you do not accomplish your goals. You then have no control over what happens to you and often feel worse about yourself.

Being assertive means that you stand up for yourself in a calm, confident manner. You express your beliefs, opinions, wants, and needs effectively and do what you believe is right. With this communication style, you have a greater chance of being able to negotiate what you want and need. When you are assertive, you feel better about yourself for stating what you want, need, or feel. Self-esteem improves, and you have an increased sense of control over what happens to you.

Dealing with Family and Friends

For many people, one of the toughest, most stressful parts of a having mood disorder is discussing the illness with their family and friends. Personal relationships surrounding your illness usually fall into three categories:

1. People you choose to tell about your mood disorder who are mainly supportive

2. People who know about it and are not supportive

3. People you choose not to tell (such as a distant acquaintance or an employer)

Most individuals with mood disorders have a variety of these relationships to manage, and you are not alone if you feel that a family member does not understand your illness or what you are going through. In fact, many loved ones have a hard time understanding this illness. William Styron experienced it this way: “Depression is a disorder of mood, so mysteriously painful and elusive … as to verge close to being beyond description. It thus remains nearly incomprehensible to those who have not experienced it in its extreme mode.” He understands the challenge that is facing you, trying to bring your loved ones on board to something that may be difficult for them to understand.

It is important to protect your own health by managing these relationships well. The question is, how do you get through these stressful encounters? The first step is to remind yourself that you have an illness that is treatable, and that you are doing your best to manage it. Understand the nature of your illness, its ups and downs, and your patterns. Use your treatment team wisely as a support. Then try to increase the level of understanding about the illness among your friends and family. Offer them books to read, have them come to a family meeting with your therapist, or ask them to attend a community lecture or presentation with you on mood disorders.

Assertiveness

These guidelines can help you learn to communicate assertively, and therefore more effectively:

• Speak up. Believe you have the right to what you want and need.

• Be clear, concise, and firm.

• Appear confident in voice, tone, and manner.

• Use a calm, neutral voice. The tone you use can change your message (the most common tones people use are angry, nasty, meek, passive, aggressive, and neutral).

• Use neutral body language, because body position can change your message.

– Sit up straight, with an open, relaxed posture and easy manner.

– Make eye contact.

– Do not cross your arms, point a finger, make a fist, or fidget.

• Express your feelings, opinions, and wishes.

• Use statements, not questions.

• Use “I” statements, such as “I would like …” and “I feel …”

• Do not make accusations or threats. Do not say “You did,” “You should,” etc. That empowers the other person and makes him or her defensive.

• Focus on your objectives and avoid straying from the topic.

• It may help to plan what you will say in advance and write it down.

• Listen to the other person. Try to validate and understand his or her position as well.

• Ask questions to clarify what you do not understand.

• Negotiate a solution that maintains your integrity and values.

• You do not have to respond to the other person in the moment of emotion. It is okay to say, “Let me gather my thoughts and discuss this later,” and then do it when you feel calmer.

• Don’t expect to be always aware of or able to handle your thoughts and feelings immediately, in the midst of discussion or emotion. It’s okay to respond later on by saying, “I’ve thought about this for a while and …”

Family and Friends Who Are Supportive

These are the close, important people in your life, and they should be the ones you turn to during the good and not-so-good times. They should be your regular social contacts and the people you reach out to as part of your Action Plan for Relapse Prevention (for when things get worse—see
chapter 5
). Do not hesitate to open up to them about your illness and tell them what you are feeling, even if you are feeling suicidal. Try to have more than one person in this category, because anyone can be away or busy with life’s obligations at any given moment.

Family and Friends Who Are Not Supportive

Remember that not everyone is able to understand or come to terms with a mood disorder for their own reasons, which are not related to you personally. Often other people respond to your illness based on something inside themselves, not you. Some people incorrectly believe in a stigma about your illness and can see it only as shameful and socially unacceptable. They may be judgmental and critical of you, believing you to be incompetent, weak in character, or undesirable because you have a mood disorder. But this is all because of their own ill-informed belief system about mental health.

Their reactions probably feel hurtful to you, because you want your loved ones to be on your side, to fully understand your illness and what you are going through. In these situations, you need to step back and understand that you may never be able to change the other person’s opinion no matter how hard you try. You may need to “agree to disagree” on this matter if you want to continue the relationship. Remember that the people who respond in this way do still love you in their own way. They are just not capable of accepting your illness at this point in their lives.

Listening

Listening is a communication skill that is important to maintaining your relationships. With depression, the thought distortions and lack of concentration can affect your ability to listen well and communicate clearly and effectively. Practice using these recommendations to improve your ability to listen and to relate well in your relationships.

• Make eye contact.

• Use open, neutral body language: sit up straight, with an inviting, relaxed posture.

• Give your full attention.

• Show genuine interest.

• Smile. Be relaxed and warm. Use humor.

• Validate and acknowledge the other person’s experience (e.g., nod your head). Do not be dismissive, make assumptions, refer to your own personal experiences, or give advice.

• Periodically summarize what the other person says.
For example:

“It appears that _____,” “It sounds like _____,”

“What you seem to be saying is _____.”

“Is that the case? Do I understand correctly?”

• Clarify the other person’s points and comments.

• Offer feedback—share what you thought, felt, and sensed in the conversation without being judgmental. Be honest and supportive.

Some things can get in the way of effective listening. Be aware of times when you might make these mistakes. This will help you improve your listening skills.

Blocks to effective listening include:

• Making assumptions (without the facts)

• Filtering out what the person is saying (when you avoid hearing some of the details)

• Changing the subject to yourself or another topic

• Comparing the person’s experience to another experience

• Mind reading (when you conclude, without the facts, that you know what the other person is thinking)

• Rehearsing (when you focus on what you are going to say next)

• Judging what the other person is saying

• Identifying (when you refer to your own similar experience)

• Daydreaming, not paying attention

• Giving advice

• Sparring, put-downs, sarcasm, debating a point

• Having to be right at any length

• Placating the other person

So how do you deal with them?

• Try for a family meeting with your therapist and see if that helps.

• Do not expect to receive the kind of support from them that you might receive from other, more supportive persons.

• You may choose to limit your conversations with them to other topics, not your illness.

• You might choose to limit the amount of contact you have with this nonsupportive individual, in person, on the
telephone, or by e-mail. This is particularly important if your interactions are upsetting to you.

• Unfortunately, sometimes relationships, particularly new friendships, are lost when one has a mood disorder. This is painful, but again, try not to take it personally. The lost friendship is related to the other person’s inability to deal with the illness, not you.

People You Choose Not to Tell

You have every right to keep your illness confidential and disclose it only to those closest to you. This is advisable in many situations, such as for people you have just met or recent acquaintances you do not know very well. You may also choose to keep it private from your employer and co-workers. This depends on your work situation, the type of work you do, the length of time you have worked there, your relationship with your boss, your seniority in your job, and many other factors. You may just decide to take an “extended lunch” for a doctor’s appointment and say nothing more. It is all up to you—there is no right or wrong answer here.

If your illness is beginning to interfere with your job performance, however, it may then be preferable to disclose it confidentially to your employer so that he or she has a realistic understanding of why your previously outstanding work has slipped. Then together you might decide to modify your duties, change to a part-time schedule, or take some time off while you recover. You may be surprised to find out that most employers would understand.

Talking with Your Doctor

A good working relationship with your treatment team (psychiatrist, clinical psychologist or therapist) is essential to managing your depression or bipolar disorder. Your treatment is a collaboration between you and your health care providers. You must be able to communicate well with each other so that your needs are
understood and met. This includes taking the time to ask questions and make your concerns known.

Come prepared for your appointments by writing down in advance …

• any new problems, side effects, or issues since the last visit

• questions you would like to ask

• topics or treatments to clarify or review

• a list of current medications and dosages (include nonprescription vitamins and herbal supplements and information about your medication allergies and any significant adverse reactions to medications you have had)

Be sure to prioritize your issues. Understand that not everything can be covered in one session. You might find it helpful to use a small notebook for recording the above information as well as treatment instructions in detail, homework assignments, appointments, information about past medications, and so forth. To communicate effectively during the appointment, follow these guidelines:

• Speak up. Let your doctor know what issues are important to you.

• Try to be as clear, concise, and accurate as possible.

• Ask questions. For example:

– What is wrong with me? What is my diagnosis?

– What treatment or medications do you recommend and why?

– Are there other treatment options?

– What are the benefits and risks of this treatment?

– How long will it take to know if this treatment is effective?

– How should I expect to feel with this medication?
What side effects might I have?

• When you receive instructions from your doctor, write them down in detail. It is often difficult to listen and remember complex information.