BIANCA BAGNARELLI

Editor's Note: Every Monday, Lori Gottlieb answers questions from readers about their problems, big and small. Have a question? Email her at dear.therapist@theatlantic.com.

Dear Therapist,

About 10 months ago, my young adult son returned home, appearing distraught over a broken relationship. Before this, he had moved back to his university city to be with his girlfriend, who was entering her final year, and he spent four months trying to get a job and develop social networks, and being committed to the relationship.

It appears he was unsuccessful on all fronts, and my previously sunny, gregarious kid slumped into a mood matching the cold, dark winter weather in which he was living. He returned to sunny California just prior to Christmas, but struggled with sadness, anxiety, and generally feeling lost. It was clear to me that the issue was not simply a breakup and he should have come home much sooner. My other two sons returned home for the holidays, and we tried to make the best of a difficult situation. My other sons are several years older, one is married, and both live far away and are established in their careers.

My youngest son has since returned to graduate school and appears to be making progress on his mental health. He has seen the odd therapist, but tends to only seek help when he hits a low point, which thankfully comes increasingly less often. To my surprise, though, he came home last weekend and stated that he was still angry about how dismissive he felt his brothers were last Christmas.

I find myself annoyed that my son appears to be so self-absorbed that he can’t see how he affected those around him (and continues to). We all walked on eggshells over the holidays, and while he sees his brothers’ banter with him as insensitive, I see it as an attempt to engage without triggering. I don’t want to upset my son, but I also want him to know that it might not be fair to blame those around him—in my mind, we have all worked pretty hard to help him out.

Should I let my son know how I feel? This entire experience has given me an appreciation for the extent to which mental-health issues can affect families.

Chris
Thousand Oaks, California


Dear Chris,

You’re right that when somebody has a mental-health issue, it can affect the entire family. Being around someone with depression isn’t easy, and what adds to the difficulty is that many people have erroneous ideas about the disorder, so there’s a gap between what the family offers and what the person with depression needs. This misunderstanding adds to the family tension, as family members who try to be helpful often end up feeling baffled and resentful when their attempts aren’t well received.

To help you decide what to say to your son—not just about his recent comment, but also more generally—let me share with you what patients with depression have told me they wished their families knew.

First, depression isn’t an attitude. It’s an illness. The person who feels achingly sad can’t just cheer up (or laugh at holiday-dinner banter). The person who feels lethargic can’t just go exercise (or perhaps even get in the shower). The person whose perspective is clouded by negativity can’t just see the full half (or tenth) of the glass. The person who wants to be alone can’t just go out with some friends to a movie. The person who has trouble concentrating can’t just get things done—chores, bills, deadlines—in a timely manner. The person who feels irritable can’t just not snap at others occasionally (despite often feeling guilty afterward, thereby adding to the self-loathing sometimes characteristic of depression). The person who feels hopeless can’t just rationally envision a better future.

The more you understand how truly debilitating depression can be, the more compassion and patience you’ll have for your son. I mention patience because being around a person who’s depressed is undeniably draining, so family members naturally want the depression to end as quickly as possible. Of course, so do people who are depressed, but sometimes they’ll hear a loved one’s desire for the depression to end as another example of how no one understands their experience.

“Why are you depressed? You have so much to be grateful for!” is a common sentiment expressed by concerned family members who don’t understand that depression has no more to do with ingratitude than diabetes and cancer do. It’s a bit like saying to someone with a malignant tumor, “Why do you have cancer? You have so much to be grateful for!”

Often, a tacit belief that depressed people “shouldn’t” be as depressed as they are also leads family members to minimize the problem, especially as the person starts to get better—as you say your son has begun to do. The sentiment might be: It’s been almost a year since the breakup, he’s in grad school now, why is he still feeling like this? Why is he complaining about last Christmas? We’ve offered so much support. When is this going to end?

I want you to consider that your son isn’t “self-absorbed”—he’s in pain. And what he’s telling you is that he felt his brothers were ignoring his pain, and nothing is lonelier than being utterly alone in one’s pain. If your son had cancer, maybe he’d feel angry if everyone at the dinner table ignored the fact that he was bald and couldn’t eat and had lost 50 pounds—but maybe, too, these feelings would be more understandable to you. Likewise, ask yourself, if he had cancer, would you feel resentful of how hard you’ve worked to help him out? Would you compare him unfavorably with his brothers, as you have here by pointing out in your letter that his brothers are thriving in their relationships and careers in a way he’s not? (Would you write, “His brothers, who have never had cancer a day of their lives …”?)

If you can begin to notice the ways you and your other sons may misunderstand mental-health issues, you’ll find it easier to interact with your son. For starters, there’s a difference between walking on eggshells and listening to what he’s experiencing. Communicating to him, either verbally or nonverbally, that his feelings are irrational or overblown will prevent him from being honest with you about what he’s going through, and that’s a dangerous situation, because you want a person in pain to reach out, not to isolate even more.

So what can you say? Try any of these: I’m interested in how you feel. Tell me more about what bothered you last Christmas so that this year things go better. I’m sorry you’re having a bad day—that sucks. I’m glad you got some restful sleep last night. (Progress that seems small to you will seem big to someone with depression.) Here’s what I can do for you (for instance: help you research psychiatrists or therapists; drive you to your appointments so that you go consistently; have you over for dinner if you want some company; FaceTime with you if you need to talk; help you pay your therapy bills; check in to make sure you get out of bed on the weekends). Here’s what I can’t do (whatever feels like too much for you emotionally, financially, or logistically), but I can help you problem-solve so that you get those needs met. I know you’re having a difficult time right now, but you still have to be kind when you talk with me. I’m here for you. I know it’s really hard sometimes. I love you.

All of this sends a very different message from I can’t believe how self-absorbed you are or You don’t appreciate the help we’ve given you or You’re being overly sensitive about what happened at Christmas last year—yet it accomplishes something very important. It sets boundaries for what you can realistically do so that you aren’t neglecting your own care or sense of how you’d like to be treated, and it communicates unequivocally that while depression can feel like a burden, your son himself is not a burden—and that you take him and your love for him seriously.


Dear Therapist is for informational purposes only, does not constitute medical advice, and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician, mental-health professional, or other qualified health provider with any questions you may have regarding a medical condition. By submitting a letter, you are agreeing to let The Atlantic use it—in part or in full—and we may edit it for length and/or clarity.

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