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My Mother Won't Go For Depression Treatment!

Question:

My mother has suffered from severe case of depression for at least 5 years (we suspect that a milder case was present for a lot longer), and refuses to seek any help. I’ve contacted a number of organizations dealing with depression to help our family, however, the answer I always seem to get is that they will only help if the person recognizes he/she needs help. Our family has literally fallen apart because of this and yet finding help is so antagonizing. Any suggestions?

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Answer:

In one unfortunate ways, depression is sort of like AIDS. By this I mean to draw the following comparison. AIDS is a deadly virus that has its effect by disabling the body’s immune system, in effect causing the one part of the body that could respond to the threat to be disabled. In depression, the part of the body that is disabled is judgment. Depression colors or biases judgment sometimes so profoundly that people cannot recall ever feeling differently, or thinking in a more positive manner. Everything seems futile, always has been and always will be (so it seems), and so there is no need to seek out any help. It wouldn’t be helpful anyway (so it seems). Of course this line of reasoning isn’t true, but it can be so paralyzing to people who are experiencing depression that they resist efforts to help them get better.

Many families write us wondering if their loved ones could be forced into treatment somehow. In the west, this just isn’t done in most cases, the exceptions occurring when people become a threat to themselves or to others (as occurs in the case of suicide) or when they commit crimes and become mandated into treatment (such as occurs for some substance abusers and some pedophiles). So long as depressed people are not actively trying to kill or harm themselves or others, most of the time they cannot be forced into treatment. While this is perhaps a bad thing in some individual cases, as a matter of social policy, it seems to be a good thing. At issue is personal liberty and the potential for abuse to occur which undermines personal liberty. It would be a very bad thing for people who are not actually ill to be forced to receive treatment as though they are. It might also be a bad thing if treatment were forced upon people who didn’t want it even if they would benefit from it, as the use of force is inherently traumatizing or at least dis-empowering to one degree or another.

Some depressed parents become neglectful of their minor children. Such a situation qualifies as child abuse and probably merits a visit from the local child protective services (CPS) agency should they become aware of the neglect (reporting resources are listed here by state). Then again, many CPS agencies are underfunded and only have resources to investigate the very worst abuse cases involving the youngest children. A call to CPS might therefore go uninvestigated in numerous localities. Even if CPS were to intervene, I’m not sure they have the power to compel mental health treatment for depression. They are basically wanting to protect children (e.g., by monitoring the home and/or removing them from truly dangerous households) and are not themselves a mental health agency with the resources to treat.

It is really sad and unfortunate that your own mother won’t go for help, given how treatable depression really is in most cases. However, I don’t think you can force her to accept treatment if she doesn’t want it. What you can do, since you are hurting so much over the issue, is seek out treatment for yourself. Your own issues are not depression per se, but rather have to do with the problems your family is experiencing as a result of your mother’s depression. This is a legitimate reason to go seek counseling. It would probably be best if your entire family could agree to go to see a family therapist (even if your mother won’t go with you), because the issue is really a family-wide issue, and talking about the family issues with a knowledgeable counselor who can provide a forum and appropriate advice for coping can be beneficial. However, if this is not possible, those individuals in the family who are hurting the most might try going on their own or as a group.

Sometimes, people in your position actually become depressed themselves as they feel helpless to cope with their difficult situations. If you think this might be the case for you, or other family members, I would urge you to seek out appropriate diagnosis and treatment for your own depression. There is a wide variety of medication options which are convenient but which come with side effects, and there are several effective forms of psychotherapy (including Cognitive Behavioral Therapy for depression).

It is extremely difficult to live in a household with a depressed person. Severe depression can be debilitating and lead to loss of income which can stress the household, and neglect can occur as I’ve mentioned above, putting minor children into jeopardy. Apart from these practical problems, the larger issue has to do with how difficult it is to maintain your own mood in the face of the black hole that is depression. A depressed person brings everyone around them down, making it harder and harder for everyone else to cope. It is even worse when the depressed person is a parent, because children naturally want to look up to their parents as role models, and to see them helpless and defeated can be especially painful and feel very unprotected. There is something profoundly unsettling about realizing that your parent is acting like a helpless child and that it is up to you to take over and make the family work.

The "cure" for dealing with a depressed person in the household (inasmuch as there is a cure) has to do with learning to set appropriate boundaries so that the depressed person’s negativity and lack of appropriate self-care does not get to contaminate other household member’s moods. Learning to set boundaries effectively is difficult, as it means learning to detach one’s self just a little bit from the negativity of the depressed person. This can feel like you are caring less about them, and no one wants to do that as it feels so disloyal. Hard though it is to set such boundaries, it is important to do it, because the act of detaching a little bit provides you the space you need to assess the situation realistically and to take the actions you need to take to preserve yourself. If you don’t preserve yourself, you can’t take care of others who need your help.

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