The Limits of Care-Giving for Depression

A family member’s care-giving for depression can shift from hope to frustration if the initial expectations are unrealistically high.

The film Phoebe in Wonderland is about a young girl with a compulsive disorder and also about the mother who tries to cure her with love. The mother, brilliantly played by Felicity Huffman, blames herself as the child’s behavior gets worse and worse. She rejects an OCD diagnosis, convinced that her daughter’s problems stem from her own failure as a mother to love her daughter enough.

The mother’s efforts capture the dilemma of anyone who cares deeply about a person with an illness like depression that drastically changes behavior. The relationship frays to the breaking point, and there is a search for answers. Even with a clear diagnosis and understanding of the problem, many still blame themselves for having failed their loved ones in some way.

They also believe that they can make the difference and bring the person back to health again. In a sense, it’s the opposite of the reaction of people who blame the depressed for not being strong enough to snap out of it. Instead of blaming the ill person, they blame themselves.

The behavior of a depressed person often reinforces that belief. They might get angry and blame their partners or parents and believe that they really are the cause of the pain they feel.

It is a difficult process to learn the limits of caring and support for someone with depression. There is the tension between getting too close and staying too far away. You might imagine that your caring can fix the depression, only to find yourself succumbing to its influence.

You have to do something because you can’t sit by while someone you care deeply about is sinking in depression, perhaps getting suicidal. But what you try to do doesn’t change things enough, can’t stop the suffering, even though the support is (on good days) appreciated and clearly helps keep your loved one going.

When I was in deep depression, I wanted something from my partner that I couldn’t name or understand at the time. Looking back, I think I wanted the depression to be noticed, to be acknowledged as a condition that had taken control of me for a time, despite my efforts to manage it. I wanted the comfort of not having to worry about my family or feel that I was hurting them. It was a kind of magical thinking because I did worry and did hurt them.

Despite my hopes, my words and actions usually pushed my partner away, making it hard for her to comfort me even with passive understanding. As much as I wanted to be acknowledged for what I was going through, I would get angry when anything more was offered. Depression put us both in a painful and untenable position.

The problem was that it lasted for months and then kept returning after the worst seemed to be over. Whatever a care-giver might do to adapt will be tested over so much time. The strategy will have to change, yet there often comes a point where exhaustion and a sense of helplessness take over. Nothing you do makes much difference. It can feel that a depressed person is stubbornly refusing to get well.

You might feel so rejected and ineffectual that you give up and withdraw. Somehow you have to find a balance. Some care-givers do it by:

• Accepting the limits of care-giving and the reality of an illness that won’t yield to loving attention alone.
• Reminding loved ones that they have to take the leading role in their own treatment.
• Setting a boundary to save emotional space for themselves and the rest of the family.
• Adapting emotionally to the long-term nature of depression with its periods of renewal and rejection in the relationship.

Care-givers can become just as isolated and feel as much pain in their own way as a person in deep depression. Given the sense of helplessness, the lack of responsiveness and the constant frustration of not being able to communicate, it’s easy to see why so many partners and family members themselves become depressed.

Perhaps the most painful part of it is becoming invisible. You don’t seem to count. The depressed person may want to be noticed and helped, but much of the time can neither accept help nor reciprocate with love. You feel that you might as well not be there.

That can be an ongoing trauma of estrangement, isolation, frustration and even psychological abuse.

In Speaking of Sadness, a book I return to again and again, David Karp describes the phases that family members of the depressed often go through:

• There is an initial period of bewilderment and shock as they try to understand what is happening.
• Once depression has been identified as the problem, they try to learn as much as they can and equip themselves with ideas and tools to help with.
• Then family members may make heroic efforts to bring the depressed person back to health. Those efforts may continue for years but with growing doubts about their ability to change the situation.
• When it becomes clear that their own efforts aren’t working as well as they had hoped and that their own health is being jeopardized, they begin a process of retreating from the ill person.

Retreat, though, doesn’t mean giving up completely. It means withdrawing temporarily for the purpose of regaining strength. Care-giving in some form continues as long as the relationship has any life left in it. Hopefully, over time, both the depressed person and the care-giver can accept realistically the limits of love and support.

I think every care-giver eventually has to find a boundary that enables them to help without being drawn into depression themselves. A boundary marks not only a division but also a connection.

What is your experience, either of caring for a depressed person or trying to accept care from a loved one?