M'sian Mental Health Experts Share How You Should Never Respond To People With Depression

Unlike physical illnesses, depression is not often easily spotted in people.

In fact, most of the time, those who suffer from it show little to no signs – and may not even realise they have it.

In a 2018 report by The Star, Mental Health Promotion Advisory Council member Tan Sri Lee Lam Thye said that depression will become a major mental health illness among Malaysians by 2020, as people experience increased stress at work or family life.

According to clinical psychologist Puveshini Rao, some common myths are that:

1. "It's not a real problem" - Depression or Major Depressive Disorder (MDD) is a clinical problem that requires medical attention. Treatment is always best in a combination of psychotherapy and antidepressants.

2. "You can think happy thoughts and get un-depressed" - If our internal environment had a switch that we could on and off; this may be true. Unfortunately, we don't. Sometimes the contributing factors of the disorder are so deeply embedded in our life that it takes time and effort just to realise what they are and how they have been affecting us.

3. "Antidepressants should help you" - Drugs can help alleviate chemical imbalance that may be contributing to the depression. However, many behaviours and attitudes we have towards mental health, managing emotions and thoughts are learnt and need to be unlearned while making way for new and healthy ways of coping.

4. "You are choosing to be depressed" - People do not choose to be depressed; why would anyone do that especially when it is so debilitating and doesn't make one exactly jump for joy. There are many contributing factors that can cause one to be depressed, biological factors, social factors, learned experiential avoidance behaviours that serve to perpetuate the situation.

"Anything that would imply that you can simply haul yourself back up again, or anything that would belittle or diminish what it is that someone who's depressed is going through, would be things to avoid," clinical psychologist Dr Joel Low explains to SAYS.

Any blaming or claims that it's their fault that they're depressed should be avoided too.

Puveshini also shares that there are several reasons why we should avoid saying certain statements, such as:

1. "You will be okay": We really do not have the authority to assume these things because we really do not know.

2. "Pray more and God will help you": Given that depression is a clinical disorder, telling someone to pray more implies that they haven't been praying "right" or if they have, then they must be really bad for even God has forsaken them.

3. "Even I went through...": When someone with depression opens up to you, they want empathy, space, and support. It is not helpful to make it about ourselves as our circumstances can be very different.

4. "At least...": Starting a sentence with "at least" is the worst way to show support as we tend to undermine the impact of what they are going through. It tells them that they shouldn't be feeling this bad and further drives home the fact that something is "wrong" with them for feeling these emotions. 

5. "You should be grateful for...": First, we are implying that they are ungrateful and second, we act as if having a mental health problem is something that they brought upon themselves. Chances are they are grateful for all the things they have and yet they still feel depressed. It is like telling someone who owns an orange orchard that you shouldn't get the flu simply because you have an orchard full of Vitamin Cs.

Both experts explain that the best thing to do is to offer friendship and support - of course taking into consideration one's personal boundaries.

Low advises, however, that this doesn't mean acting as a therapist. Instead, it's about "helping by being able to point them in the right direction, keeping them company as they go on their journey, and accepting them for who they are and what they're going through".

Being empathetic is also important even if you have not gone through the exact same situation.

"You must have felt pain, shame, anger, sadness at some point. Use that to connect with the feelings that they are emoting at that point; say 'That must be really hard for you' or the safest, 'Thank you for sharing that with me'," Puveshini explains.

She also recommends helping them to engage with professional services and offering to accompany them if they're hesitant to go alone.

"Just giving them all the options and sitting with them through the difficult times is more help than you can imagine. People often underplay the value of quiet support."

Staying active and practising a healthy lifestyle is one method. 

"Eat well, stay hydrated, and sleep for eight hours. If sleep is elusive; then perhaps focus on habits and behaviours that make falling asleep harder, such as caffeine consumption, eating before bed, napping during the day to make up for loss sleep, etc," Puveshini recommends.

However, if sleep issues persist, it is best to meet a healthcare professional.

It is also important to not dismiss your feelings.

Instead, she suggests to:

- Invest in hobbies that you like (or used to like): You can feel down and still engage in this. The sense of accomplishment of doing something can uplift you for a while at the very least.

Low adds that it can be simple things like watching your favourite movie or learning something new like rock climbing. "There's no way you can be thinking about something that's negative when you're hanging off the side of the wall with your fingers!"

- Get into a routine: It is normal to not want to get out of bed, or go to work, or do anything that we usually do when we are feeling demotivated, lack of interest, and loss of energy. However, having these thoughts and still doing these activities can help us step-by-step get back on track.

- Reach out to your support system: People who genuinely care about you and can help you through the process of recovery. If you are not ready for professional help; then friends who are there just to hang out and chill while allowing you to be yourself are also helpful.

"Ultimately, if all those fail, then working with a therapist would be a good idea... Adding to the fact that a good therapist will also be able to provide you with good insights and observations that you may not have been able to see on your own," Low shares.

"We call individuals who have depression but are fully functional as high functioning depressives. Often times it's only in the privacy of their own space do they allow themselves to buckle, which means the likelihood of them getting or receiving help diminishes greatly," says Low.

Puveshini shares that some signs you might notice are:

- Tendencies to avoid people, activities, and feeling down in the dumps all or most of the time,
- Making jokes about suicide, 
- Lacking appetite and sleep, or
- Taking on excessive blame and guilt.

On the other hand, some might even immerse themselves in work and activities to avoid feeling these unpleasant feelings as a way to cope. 

"The point to note here is while both extremes seem different on the outside, the spirit of why it is done is to avoid the unpleasant feelings, memories, images, urges, and sensations that come with depression."

Mental health shouldn't be a taboo topic. And it most definitely shouldn't be seen as weakness. 

Listen to understand without making assumptions. Because often that is more than enough.