“What Do I Say?” Talking About Depression and Suicide

3 Minute Read

A friend of mine said that she personally knew three expatriate couples in Hong Kong who had lost a child to suicide. And the suicides of Kate Spade and Anthony Bourdain last year thrust the issue into the spotlight yet again. Having said that, there’s encouraging news: Hong Kong’s suicide rate is at a 20 year low, with 857 deaths in 2016, a rate of 11.7 per 100,000. (New Yorkers, by comparison, kill themselves at less than half that rate, but compensate with a murder rate that’s 13 times higher.)

So what do you do if a family member or friend is depressed? You may be worried about suicide, or just concerned that they’re terribly unhappy. People who are depressed are not easy to talk to: very often they are withdrawn, unresponsive and can become irritable if you push them. Here are some do’s and don’t to make the process easier.

Don’t Try To Fix Their Problem

This sounds counter-intuitive: after all, the reason you’re talking to them is to try to fix them. But your role with the depressed person is similar to that of a life preserver helping someone adrift in the ocean: It keeps the person afloat, but it’s still up to them to swim for the shore. Your presence, your care will help the depressed person get through the day, but you will never singlehandedly rescue them.

It’s important to keep this in mind because your impulse will be to try to make them feel better. You’ll want to point out all the good things in their life, show how their problems aren’t really so bad, and encourage them to cheer up. Unfortunately, that feels very alien to a depressed individual and makes them feel that you really don’t understand them at all. If you remember that you can’t make them feel better, and it’s not your job to make them feel better, that will free you up to just listen and understand.

Listen and Understand

Depressed people feel alienated, isolated, and a burden to others. Their depression is often caused by a feeling of isolation, but their sadness causes them to retreat from interactions, thus making them more isolated, and further increasing the depression. Having someone simply show interest, listen, and do their very best to understand makes a depressed person feel more connected.

It’s important to use phrases like “Tell me more about how you’re feeling” or “What is it that makes you feel the worst?” or “Can you help me understand what it feels like for you now?” Avoid judgement and cajoling: “You shouldn’t feel so bad” or “Look at all the good things in your life” or “Why can’t you just feel happier?”

Ask About Suicide

Many people are afraid to ask “Have you thought about killing yourself?” or the softer version, “Do you sometimes wish you weren’t alive?” They fear this will put an idea into the other person’s head, and they’ll be responsible for the suicide that then occurs. The truth is that even people who are far, far from suicidal have had the thought of suicide cross their mind. No one ever becomes suicidal because they were asked about their intentions.

Sometimes it’s an enormous relief to be able to admit to these thoughts. Depressed people worry terribly about being a burden to others, and to have someone show interest in their darkest thoughts is a reassurance that the listener can tolerate talking of suicide.

Remember They Care About You

Depressed people are often difficult to be around. They’re unresponsive, spend a lot of time in bed, don’t do their part around the house and lash out at small things. It’s easy to think that they are selfish, lazy and don’t care about you. The truth is that they are unable, despite their best efforts, to behave better, and deeply regret what they’re doing to you and to others. Their shame adds to their self loathing and their depression. It’s important to be patient, and keep in mind that they don’t like their behavior any more than you do, but that they’re doing the best they possibly can.

Respect Their Confidentiality — Up To A Point

Depressed people need to feel they can trust you. You may feel that other people need to know what’s going on, but it’s important to get the depressed individual’s permission first. However, if they’re seriously considering suicide, your role is to persuade them to seek help, and if necessary, to break confidentiality and bring help to them.

Recommend Therapy

Psychotherapy is very effective: 80% of people who seek and receive therapy do better than the average person who does not. Depressed people find it difficult to go see a therapist because depression saps their energy. Physically helping them to find a therapist and getting them to the sessions can be one of the most helpful things you can do. It’s also important for YOU that they see a therapist -- it can be draining to talk to someone who is very unhappy, and you may not have the time or the energy to be their only support.