Family Therapist Barry Jacobs Talks About How to Care for Someone with Depression


"Make family life about the good stuff and not the illness."(BARRY JACOBS)

Barry J. Jacobs, Psy.D., a clinical psychologist and family therapist, is one of the countrys leading thinkers, writers and educators about family caregiving. His book, The Emotional Survival Guide for Caregivers, pulls together several strands from his life—the knowledge gained from personal experiences as a child of a family caregiver, the writing skills honed in his years as a magazine journalist, and professional expertise gleaned during nearly 20 years as a clinician specializing in families and illness.

Q: I think I am taking on my depressed partner's symptoms. Is there any evidence that depression is contagious?

A: Major depression is not contagious, though caregivers can become miserable, which could potentially influence your mood or make you feel depressed.

Q: What can I do to protect my own mental health while caring for someone with depression?

A: It's most important that the caregiver doesn't take his partner's depression personally. People feel responsible for other people's happiness, but with depression, it is much more appropriate to think of it as a chronic illness. Severe depression occurs for biochemical reasons and is not the fault of the well spouse. It's important not to be a 24/7 caregiver. A portion of your time needs to be devoted to things you enjoy, replenishing activities. It's a good idea to see your own physician and therapist to ensure your own wellness.

Q: My depressed family member wants unconditional support. What is the difference between a caregiver and an enabler?

A: An enabler is a caregiver who provides above and beyond what is needed. Taking over family duties that the depressed person is capable of renders them disabled and robs them of an opportunity to part of the family. The caregiver should assess what needs to be done and what the depressed person can do, and then expect him to contribute. This is difficult because depression has a waxing and waning course, so it is important to have an ongoing conversation between the caregiver and the depressed person. The caregiver should empower them to take on as much as they can.

Next Page: How can I prevent my partner's depression from taking over our relationship?

[ pagebreak ] Q: How do I know when my partner needs more care than I can offer?

A: Look inside yourself and see how you're feeling about the care you're providing. If you're feeling depleted, overwhelmed, frustrated, or irritable, it means you need to reevaluate the caregiving plan. Make changes so others are helping you to provide the same amount of care.

Q: How can I prevent my partner's depression from taking over our relationship?

A: This is very, very difficult. When living with someone who has a chronic illness, there is always the risk that the illness will become front and center. All activities and conversations become illness-related. Trips to the doctor become the couple's outings, and the couple is deprived of the lifeblood that makes relationships so great. Imagine that your family is a stage and depression is a character in the drama. Do you want it to be a star or a minor character? It should be moved off to the side of the stage as much as possible. Make family life about the good stuff and not the illness.

Q: What should I tell our children, family, and friends about my partner's depression?

A: Children can be very egocentric. They have a tendency to blame problems in the family on themselves. It is important for them to understand that they are not the cause. It's about Mommy having a sickness, and that's not the child's fault. The most important thing people need to understand is the chronicity of depression. It is a major illness. It's recurring. People need to work to manage their depression. Keep in mind that the depressed person may not be able to do certain things, and they need support.

Q: My partner has been missing work. What should I tell his supervisor and colleagues?

A: It is up to the depressed person to make this decision. Most human resource offices have policies in place to address this. This is not a role for the well spouse to take on. That would fall under the category of overfunctioning and would disable the depressed person. It is important that the depressed person have this conversation with a supervisor or colleagues if they have missed work and their employment could be in jeopardy.

Next Page: How should I address my partner's suicidal thoughts?

[ pagebreak ] Q: How should I address my partner's suicidal thoughts?

A: There are three levels of suicidal thoughts—ideation, plan, and intent. People have ideation when they say, "I don't want to live anymore." It is also common for people to pray to God or hope for an accident that will release them from their suffering. If you identify ideation in your depressed partner, convey this to a therapist. It does not connote an emergency, but is a manifestation of the illness, an expression of suffering. This doesn't mean they don't love you or you're not doing a good job. It's part of depression. Encourage them, "You won't always feel this way." Call a mental health professional as soon as possible if the depressed person exhibits intent or has a plan to commit suicide. If he or she presents imminent danger to himself/herself, it is an emergency.

Q: My partner is showing signs of improvement (or worsening) and wants to alter his medication. Should I tell his doctor?

A: Yes. Playing with medicine without the doctor's guidance could be harmful. Encourage the depressed person to share this information with his doctor. Otherwise you should make it known to the doctor, who would welcome such information. Depressed people can become secretive about medication so that the well partner doesn't rat them out. It is therefore important to have an open, frank dialogue going with the doctor. Discuss a treatment plan that can be agreed upon.

Q: Should I be concerned about our children's mental health—now and in the future?

A: Parents should be somewhat concerned. Psychological disorders in general are inheritable to a degree. Bipolar disorder has a high rate of inheritance, but this is less so for major depression. If one parent in a couple has depression, there is less than a 50% chance that the child could become depressed. Talk to a family doctor about genetic predisposition and signs to look for over time.

Children who grow up in households with a parent who is underfunctioning take on greater roles than what is expected of people their age. This can make them precocious and more responsible, but deprived, having lost part of their childhood. They can be prone to depression and may have problems later in life with romantic relationships. They are familiar with the role of caregiving and could be attracted to people that they can take care of, but will also harbor resentment toward that person for the same reason.

Next Page: I don't agree with the care my partner is getting from his psychiatrist. Should I make my views known?

[ pagebreak ] Q: I don't agree with the care my partner is getting from his psychiatrist. Should I make my views known?

A: Yes, make them known. The well person doesn't get to dictate the treatment his partner receives, but you can express your concerns to your partner and his doctor, if you are so bold. Concerns should be specific, not general complaints. Specifics can be more readily addressed. Don't expect to run the show.

Q: My partner's depression is infringing upon my well-being, and I am losing patience. Is it selfish to consider separation/divorce?

A: People come into relationships with all kinds of hopes and expectations. If a person is incapable of having empathy for your point of view, the quality of the relationship is compromised. The depressed person becomes self-involved and loses capacity for attunement. I see many people who are dealing with this. I don't think it is selfish to consider separation. People should expect to get something back from the person they are involved with. "In sickness and in health" sounds reasonable, but it is very difficult to have to deal with that on an ongoing basis. I would imagine the rate of separation in this situation is relatively high.

I have two patients, a gay couple in their 30s. One has significant depression and has since he was a teenager. They have been together for 12 years. I started treating the well partner, who thought he knew what he was getting into. He has gradually become drained and deprived. He is really less in love with his partner and has seriously considered leaving. Now they are in couples therapy. With depression comes a loss of libido. Sex lives disappear, and the relationship is not gratifying in any way. The well partner can hang in there and hope that things will improve with time, but it's a chronic illness. I've seen people who don't want to deal with more of the same and decide to move on because they are younger and want to develop a meaningful, close relationship.

Q: I do not think my partner is getting better. What am I doing wrong?

A: This is not a personal issue. A depressed person may have the perfect partner/caregiver and still have depression. Do not blame yourself.

Q: Sometimes I need support from my depressed partner, but old habits are hard to break. How can I start to tip the caretaking balance?

A: When the balance is so skewed, ask the depressed person to step up and do more. Taking care of the caregiver can make the depressed person less depressed. Being on the receiving side of care can be very hard to deal with. But don't cut them slack. Define what they can do to contribute to the relationship and the household. Caregivers can feel guilty, but the guilt further locks the relationship into the skewed pattern. Try to retain a healthy relationship. A one-way relationship is almost always one that loses intimacy.