It’s well known that 1 in 4 of us may grapple with a mental health disorder at some point in our lives. This figure, also referenced by MIND, spans across an array of diagnoses varying from mild, fleeting issues to severe disorders requiring psychiatric intervention. However, the ubiquity of these symptoms doesn’t necessarily mean that professional assistance, medication, or therapy will always be needed. Often, particularly in milder cases, people recover independently, harnessing self-help strategies as their circumstances evolve. I firmly believe that strengthening resilience, mitigating stress, and nurturing overall wellbeing can yield substantial benefits – a topic I’ve delved into in a previous blog.
Yet, there’s another area of mental health that tends to be overlooked: the collateral impact on those close to a person wrestling with a mental health disorder. For every 1 in 4 people, several others suffer by proxy.
Witnessing a loved one combat mental health issues can be both heartrending and frustrating. The people we know and love might seem like they’ve changed, their behaviour might seem illogical, puzzling, or counterproductive. Even worse, our attempts to assist might inadvertently intensify their struggles, leading to mutual pain. It’s particularly devastating when we observe a loved one’s deteriorating mental state or, sadly, their loss.
In my time as a mental health nurse, I’ve seen the anguish of family members and friends – from parents visiting their children in acute wards to survivors grappling with the aftermath of suicide. Often, I’ve wondered whether some mental health issues stem from the stress of caring for a loved one in distress. How frequently do these proxy sufferers become a 1 in 4?
Living with and witnessing a loved one’s struggle with anxiety and depression is challenging. However, empathetic, informed support can significantly ease their journey. If you’re caring for someone battling mental health issues, there are a few fundamental principles you should know that may provide guidance when needed. While there’s a range of different disorders, I’ve streamlined the information for this article. Let’s explore how we can better understand anxiety and depression from the perspective of a supporter.
Depression isn’t just feeling ‘down’. It is characterised by persistent feelings of despair, hopelessness, and a dwindling interest or pleasure in activities once enjoyed. Imagine viewing life through grey-tinted glasses; previously joyful activities now feel draining and mundane. The good things about your life generate nothing but apathy. Individuals with depression may struggle with sleep, appetite, concentration, feelings of worthlessness, and in severe cases, harbor suicidal thoughts. The world seems bleak. It’s not about weakness or laziness; it’s a serious illness affecting mood, physical health, and cognitive function.
Depression can also impact overall health and wellbeing, leading to increased stress, heightened anxiety, apathy, and fleeting positive emotions. Furthermore, those suffering may think differently than they used to, often contorting evidence against their negative beliefs into negative reinforcement due to their low self-esteem.
Thankfully it’s a dated saying nowadays, but sometimes people say it’s caused by a ‘a chemical imbalance’. Depression is far more nuanced. Indeed someone with depression may have an imbalance of sorts, but this probably comes from inactivity, lack of sunlight, routine, lack of food or overindulgence, and lack of meaningful connections with others. It’s reasonable to assume that someone with depression probably is all over the place when it comes to sex hormones, serotonin, oxytocin, dopamine, and all the other stuff that helps us function as we should.
The simplest way that I understand depression is this: ‘depress’, which means to push or slow something down. That’s it. It’s this pushing or slowing down of the entire person, not just their emotions, but their thinking, their personality, their energy, their motivation, their self-esteem. When depressed, everything they do is being held back by an invisible weight.
Anxiety represents a perpetual state of worry, fear, or dread, often manifesting physically through symptoms such as a racing heart, shortness of breath, trembling, and a sense of being perpetually “on edge.” Although everyone feels anxious occasionally, such as before a crucial presentation or during a medical examination, the persistent worry experienced by someone living with an anxiety disorder is on a different scale altogether.
Here, I’ve used the term “disorder.” An anxiety disorder is different from general anxiety – the former indicates a problem with how a person experiences anxiety. Disorders, such as Obsessive-Compulsive Disorder, Social Anxiety Disorder, Post Traumatic Stress Disorder, Health Anxiety, and Generalised Anxiety Disorder, have unique sets of symptoms. In my view, the term “disorder” captures the essence well: “anxiety order” suggests thinking, feeling, and behaving in ways that produce reasonable anxiety. Conversely, an “anxiety disorder” implies that the person experiences anxiety that’s unreasonable, disproportionate, and detrimental to their quality of life.
Anxiety and depression often interweave. This doesn’t necessarily mean a person has an anxiety disorder. When someone is depressed, they’re not firing on all cylinders, experiencing reasonable thinking, emotions, and feeling okay just aren’t happening. When depressed, our window of tolerance shrinks, making it much easier to feel uncomfortable emotions. Ever been in that situation where something so small just pushes you over the edge? I have. Therefore, emotions like anxiety may feel much more intense when you’re feeling depressed.
Being anxious can be exhausting. When anxious, your body turns on the fight or flight response, a mechanism that should only be used sparingly, for example, when in imminent danger. However, modern-day humans often experience this state. This sudden change in our blood pressure, heart rate, and a massive release of Adrenaline and Cortisol can later make us feel drained, tired, and lethargic. It will be especially worse when you are in this fight or flight response frequently. It’s reasonable, then, to conclude that someone who is very anxious might fall into a vicious cycle of overthinking and depressive emotions.
The term “trauma” is very much at the forefront of mental health discussions at present, and it’s a whole separate topic to delve into. However, paying attention to it can be crucial when helping those in our lives struggling with anxiety and depression. Sometimes, people who have experienced significant stress and trauma in their lives will also experience heightened anxiety and depression. Our bodies and brains are adaptive. If the world is a dangerous place filled with violence and abuse for a child or young adult, that individual will adapt accordingly. This adaptation might involve activating their fight or flight response at the slightest sign of threat. This sensitive response probably kept them safe or helped them prepare for the worst in their earlier years. Unfortunately, this sensitivity to anxiety doesn’t just disappear when the threat is no longer present. It can persist into later life, manifesting in various ways.
Navigating Support for those who need it
Do you have someone close to you who’s struggling? Navigating the challenges of being someone’s support can be difficult. Here are a few guiding principles:
Educate Yourself: The more you know about these conditions, the better equipped you will be to provide support. This doesn’t mean you need to become an expert, but having a basic understanding of the conditions, their symptoms, and potential treatments can make a significant difference. There are numerous online resources and books that can provide information. Simply knowing that a person who is depressed will think differently to what you’re used to, or that someone who is anxious will find something as difficult as you’d find facing your biggest fear, will put you in a great place of knowledge.
Be Patient and Understanding: Recovery from anxiety and depression is a process, not a destination. There will be good days and bad days, and the person you know may not respond or even have the same personality right there and then. It’s important not to rush the process or make your loved one feel guilty about their progress or lack thereof. Encourage them to take the smallest of steps no matter how small they might seem. If someone, for example, is very anxious about going out, encouraging them to step outside for 5 minutes might be all they can manage. This is okay. It might be the equivalent of you doing something massive.
Listen Actively: Sometimes, the most powerful thing you can do is to listen. Allow your loved one to express their feelings without judgement or offering unsolicited advice. Simply acknowledging their struggle can be a massive relief for them. Also, appreciate that for some, especially when it comes to the men in our lives, just talking about what’s wrong can be a huge step. Say; ‘Thank you for talking to me. I might not be able to do anything or even know what to do, but I’m here to listen and help if I can’.
Encourage Professional Help: Although the importance of a supportive environment can’t be overstated, it isn’t a substitute for professional help. If your loved one isn’t already seeing a mental health professional, encourage them to do so. If they are struggling with depression or anxiety, encouraging them to visit their GP to seek a referral for further assessments regarding psychological therapy or recommendations might be a great step. There are also a range of charitable organisations locally. If anxiety and depression are a bit more serious, there are different forms of therapy, teams, and medication that can aid in managing these conditions.
Remember, They Are Adults: This might be one of the hardest things about supporting a loved one. They are adults. You cannot force them to do anything, and we all have the right to make independent decisions and assume personal responsibility. Think about it; how would you feel if you were being forced to do something you didn’t want to do? Sometimes, the best we can do is understand their difficulties, listen, and be patient. If they are resistant to help and you begin to worry that you are alienating them or pushing them further from help, just plant a gentle seed. Say; ‘You are going through a lot. I am here for you, and there is help out there. If you want help to book an appointment, I can help do it’.
It’s a bit anecdotal, but for a lot of people, getting support from loved ones brings on feelings of shame and embarrassment. If there are others in their life, perhaps a friend, trusted colleague, or extended family member who can lend an ear and offer some support, this might be a step in the right direction. When they feel better, they’ll know how important your support is and was.
Look After Yourself: Don’t forget to look after your mental health as well. Supporting someone with a mental health condition can be emotionally draining. Make sure to take time for yourself and seek support if needed. You can’t pour from an empty cup. When your cup is empty, it’ll be a lot harder to be present, to be patient, and to be empathetic. The person with depression or anxiety in front of you has rock-bottom self-esteem, and they pick up on a lot of stuff and will likely feel ashamed that they are affecting your wellbeing.
Navigating the landscape of mental health is a journey, one that can be as rewarding as it is challenging. By understanding, empathising, and offering informed support, you can significantly impact your loved one’s journey with depression or anxiety. Remember, it’s not about “fixing” them, but standing by their side as they work through their struggles.
About the author
I have been working as a mental health nurse since 2016 and have been around the block working in a lot of different areas. At present I work in a service where I assess people and provide interventions. I love my job, I love learning and talking to people about mental health and wellbeing. This article represents my personal opinion and is certainly not medical advice. If you have concerns about your mental health please speak with a GP or health professional.
The CALL helpline – 0800 132 737 or text HELP to 81066. Sometimes reaching out for support whether it is a friend, family member or GP is the hardest thing to do, but a good way to do this is by talking to someone through a confidential and impartial service. CALL Offers emotional support, a confidential listening service and information/literature on Mental Health and related matters to the people of Wales and their relatives/friends.