By Dr. Phang Cheng Kar (M.D.), Consultant Psychiatrist & Mindfulness-Based Therapist at Sunway Medical Centre.
Major Depressive Disorder (a.k.a. Clinical Depression) is a severe medical condition that negatively affects the way we think, feel, and act. Effective treatment of depression includes good social support. Despite with good intention, we sometimes say things that are unhelpful or may worsen a person's depression:
(1) Don’t be lazy; you’re wasting your time!
WHY NOT? Feeling tired all the time and loss of interest in activities are common symptoms of depression. "Lazy" implies that the person is having an attitude problem or is making it up.
Say: It must be very frustrating feeling tired and moody all the time. You won’t be able to do things for yourself and others. That must be a terrible feeling.
(2) Nothing is impossible; think positive and be strong.
WHY NOT? Having depression is not a sign of weakness. Depression is an illness, not a weakness. Many great people in the world had depression, e.g., Winston Churchill (British Prime Minister), J.K. Rowling (author of Harry Potter), and Jim Carrey (actor and comedian).
Say: I'm sure it's tough going through all the difficulties. Maybe you’re too strong for too long, and it's time for more self-compassion.
(3) Be grateful; many people have a worse experience.
WHY NOT? This response may be invalidating or disrespecting the emotional pain of a depressed person. They may also think, "Yes, I'm so ungrateful and useless. People can cope and move on, but I can't. I’m a burden to others."
Say: It’s unfortunate that so many bad things had happened to you. Thank you for sharing your experience. We’ll see what we can do to help you cope with the challenges.
(4) It’s a result of your bad karma or sin; do more good and let go-lah!
WHY NOT? We may induce or worsen guilt and shame feeling which are common in depression. It may also trigger thoughts of worthlessness, "I'm not good enough.”
Say: Bad things sometimes do happen in life and nobody knows why. It happened to me/ my relatives/ my friends too (share your experience). It's painful. Let’s try to move on together.
(5) How long more do you want to be depressed?
WHY NOT? Being depressed is not a deliberate choice. People with depression are often victims of abuse (e.g. bullied in school) and discrimination (deprived of a job opportunity).
Say: Wow, you’ve been struggling for so long. It must be challenging to go through this alone. Well done for not giving up. Let me know if there’s anything that I can support. We care for you.
(6) You think you’re the only one with problems?
WHY NOT? Yes, all of us have problems. But we have different strength and weakness in coping with problems. It’s not helpful to judge people’s ability to cope.
Say: I also have issues (share your experience). We have different strength and weakness. We can help each other to solve issues. Let me know if you wish to share yours. Maybe we can discover a solution together.
(7) Stop pretending to be depressed!
WHY NOT? Nobody chooses or pretends to have cancer. The same applies to depression, a medical condition with neurobiological changes in the brain and body. A small number of people with depression might have personality issues (e.g., using the illness to avoid responsibilities or seek attention). Bear in mind that they're the minorities. Most of them want to recover from depression but are helpless in battling the disease.
Say: Perhaps you don’t have to try so hard pretending to be happy. Sometimes, it’s OK not to be fine. I know you've tried your best. It’s a horrible illness.
(8) You must be too free and thinking too much. Why don’t you do something useful, e.g., exercise?
WHY NOT? Depression is not necessarily caused by having too much of time, doing nothing, or thinking negatively. A person with depressive mood has biochemical abnormalities in the brain and body that cause them to have no strength to work on things. Just as a person with knee injury can’t walk, a person with ‘mood injury’ (depression) can’t work.
Say: Feeling restless and like you’re wasting time is an awful experience. Let’s start with doing the easy tasks.
(9) Never have suicidal thought. Your family will be hurt if you die of suicide.
WHY NOT? Nobody wants to end their lives prematurely. People with depression want to end their pain; not their lives. Having suicidal thought is not a choice. It’s the consequence of the pain of depression. Don’t add more pain by making them feel sorry for having suicidal thoughts.
Say: Depression is painful, and it’s understandable that you wish to end the pain. Depression is treatable! Let’s seek advice from mental health professionals for proper treatment of the pain. I know this good doctor personally/ I heard of this excellent doctor. Would you like me to help you to get an appointment?
(10) Your depressive mood will become a form of negative energy to others.
WHY NOT? A depressed person knows very well that moodiness and negative thoughts are unhealthy (just like a person with chickenpox infection knows that it’s contagious). When we say the above, they may feel guilty for emotionally disturbing the people around them.
Say: It’s unavoidable for a person suffering from depression to feel moody. I know you don’t wish to be like that. No worries and don’t feel bad as people wouldn’t blame you if they have a proper understanding of depression. Let’s move on. You have my support.
In brief, refrain from giving unsolicited advice as it often makes things worse. Just listen attentively with empathy and be supportive (e.g., offer tissue paper for crying, give a gentle pat on the shoulder, and adopt a friendly body posture and facial expression).
Let the mental health professionals offer advice (they have more effective ways of doing that). Don’t damage your relationship with your loved ones because of the advice; it’s not worth it. Your job is to listen and be patient with the patient. That’s good enough.