Depression intervention help

[beatrice_otter]

So, my family is all pretty sure (like 99% sure) that my aunt has been depressed for a couple of decades (there’s probably an unhealthy dose of anxiety in the mix, too).  She does not believe that, however.  I’ve suggested talking to her doctor about it, and she says that she’s fat and lazy and useless and no therapist can help with that, and doesn’t listen when I say yeah, but the therapist might be able to help you realize you aren’t lazy and useless, and feel better about the fact that you’re fat.

She has health problems that are very real, but at the very least the depression is making them more difficult to deal with.  (Being so mentally fried she can’t cook and goes out to eat instead does not help with the diabetes, for example.)  She was depressed but fairly stable for a long time, but Grandma was her main emotional and physical support through that time--they lived on the same piece of property, and Grandma would cook for the both of them and do yardwork and such while Aunt was at work, which allowed her to save up her spoons.  But Grandma died a year ago, and I’m not sure if Aunt’s getting worse or if it’s just that she’s overwhelmed by trying to do EVERYTHING.  I live half a continent away and I do what I can when I’m home, and talk to her regularly on the phone when I’m not.  My parents live in the next town over and visit at least once a week, doing odd jobs and whatnot to help her, but it’s not sustainable for them or her.

Anybody got any brilliant (or, even just vaguely competent, that would work too) ideas for what to say and do to help her at least ask her doctor about it and get an evaluation?  I’ve talked to her a couple of times over the years about it, and she’s never listened, but then again, she’s never been this bad before.  I sent her the pics about “what depression actually feels like” vs. “what people think depression feels like.”  I want her to be happy and to realize that most of the things she thinks are character flaws are symptoms of her illness.

Help!

Comments

[princessofgeeks]

In my experience, the people who are close can help, and they are going to have to get her doctor to intervene. She won't listen to anyone but a doctor.

Are your parents, or one of them, able to sit in on a doctor visit with her? And chime in with their concerns?

Getting her doctor aware of what's up is basically the best option, IMHO.

There's so little you can do from so far away. I know that sucks, but there it is. If you can visit and sit in on the doctor visit, you can state the case.

But you can't convince her. You have to do some sort of family intervention.

Best wishes to you all.

[beatrice_otter]

Thank you.

[rymenhild]

I have sympathy and empathy, but no advice. My grandmother has similarly been depressed for decades, and we haven't figured out how to help her either. :/

[beatrice_otter]

:(

[rthstewart]

I am terribly sorry for this. Depression sucks. I consider you so well spoken and clear on issues of health that if you haven't found the right lever to move your aunt, it surely must be a very serious situation.

Things that you probably already know but I have found useful in working with those I know who have been very resistant to depression treatment: 1) depression lies. A symptom of the disease is the bedrock belief that nothing can be done. That's the disease. As surely as a fever and hacking cough are symptoms of flu, "this is just the way I am and there is nothing I can do about it" is a symptom of depression. 2)Depression is a medical condition not a mood. To not treat your depression is like not treating your diabetes. 3) It's never too late to get improvement. My mother was over 50 before she got her first SSRI and it was a miracle -- a real and true miracle and she was successfully treated with Zoloft until the day she died -- and when she was hospitalized and not on it... oh wow, that was bad.

I do hope you find the right way to move her. It's depressing when the doctor who sees her regularly doesn't say anything or suggest anything, but maybe s/he does and your aunt ignores it. Living with and dealing with an untreated depressed person is really hard when you KNOW there are things that might really help them and you can't get them to budge.

[beatrice_otter]

It's a lot easier to talk to other people about it than to her. Looooots of family issues, you know? Like, she loves and trusts me, but I'm her niece and thus a kid even as an adult. My dad she loves but they don't get along and he gets so frustrated by her. My mom and she get along and love one another, but they are so different that my aunt just kind of discounts any kind of personal advice.

Thank you.

[lilacsigil]

It could also be the doctor who's telling her she's fat and lazy, or at least implying that everything wrong is due to her weight. It's certainly happened to me often enough.

[beatrice_otter]

No, not so much. The "lazy" is because she isn't able to cook or clean or do any of her yardwork, and so everything is always a mess (and she has very high standards, so she judges herself harshly). She is mentally exhausted after a day of work, so instead of cooking a nutritious meal she goes out to eat and instead of doing any housework she sits and watches TV and the longer the chores pile up the more daunting it is and so even simple, easy things become REALLY REALLY HARD AND BEYOND HER. That's why she thinks she's lazy, because she doesn't have the spoons to do anything and so her house is a pigsty and she thinks it's a character flaw and not a symptom of her condition.

She also has physical problems (some of which are probably related to the depression and some of which are not) and sees them as proof that it's not depression because if she has physical aches and pains there must be a physical cause for it, and depression isn't a physical cause in her mind. (Despite depression coming from a physical organ, i.e. the brain.)

She also knows that doctors tend to dismiss women's complaints (particularly fat women's complaints) as all in their head, and doesn't want the doctor to stop listening to her.

And she doesn't see how she's spiralling downward.

[lilacsigil]

Well, yes, I know that depressive spiral really well. But if your doctor is telling you to lose weight when you go in with sinusitis or whatever, you really don't feel like sharing anything more with them, and you try really hard to be a "good" patient. So I wouldn't necessarily take a fat person's reluctance to see the doctor to be unreasonable at all. It's a really difficult thing to solve. Best wishes to your aunt.

[beatrice_otter]

She is not reluctant to go to the doctor at all. She goes to the doctor all the time for her wide variety of physical problems, and is very proactive about "I have a symptom, I need to have it checked out." And they seem to take her seriously when she goes.

What she absolutely refuses to consider--or ask the doctor about--is whether some of her physical symptoms that she is constantly doctoring for might be symptoms of depression, or at least exacerbated by it, and if she needs to be evaluated for depression.

[arduinna]

Depending on her sense of humor, maybe send her Allie Brosh's Hyprbole and a Half book, or Jenny Lawson's book whose name I'm blanking on? They're both such funny, heart-breaking, funny, honest, funny, clear-eyed looks at the world through the eyes of depressed women who are doing the best they can every damn day. They may help shift your aunt's perspective about her own life.

[monanotlisa]

Arduinna, I really like the idea of giving her Hyperbole and a Half, because it rang so true to me.

Beatrice, I feel for you; getting through to relatives regarding depression is difficult. In my case of trying to get a family member to admit the need for treatment took a while (and a village), and even then there was a constant pressure on the ones among us who kept working on it to swap in, i.e. provide therapy instead of a doctor, and...that's not how that can possibly work.

As for me, though, my depression by and large stopped when I stopped eating gluten. I know this could be complete coincidence, and you will often find me fighting firmly for the acknowledgement on part of others around me that there is nothing objectively wrong with wheat, rye, and barley. But subjectively, for me, there's something going on there, and the change to my brain chemistry is like a switch flipped. Now, gf is hard and even harder with fewer spoons, but trying it may be worth considering? If money is not a huge issue, a service like this, perhaps? http://www.justaddcooking.com/blog/announcing-gluten-free-meal-kit-delivery-from-just-add-cooking/ I realize I sound like yet another nutty Californian with a Better Living Through Food approach, and my sister thinks this is all mass hysteria, so feel free to ignore.

[beatrice_otter]

It's possible that's the issue, but if so there is NO CHANCE IN HELL that she would ever actually go gluten-free. She doesn't cook. She can, but has very rarely done so and so it's completely overwhelming and she doesn't trust herself. She eats most meals besides breakfast out. And she has a very limited range of things she actually likes to eat, and eating is one of her few pleasures in life.

[monanotlisa]

Depending on the place you live, there are gf restaurants and menus, but if she only likes few things...yeah. I came to it from loving *everything* and have a super-limited range now n

[raspberryhunter]

Has she got a full physical checkup and blood test done?

I ask this because many of these symptoms (feeling fat, lazy, useless, and out of spoons) are very consistent with hypothyroidism. I went through a period of about two years where I had untreated hypothyroidism and was tired and out of spoons literally all the time. (I did not gain a lot of weight, but a lot of people do.) I managed to keep working, but that was about it. Fortunately I don't have a predisposition towards clinical depression and am in fact a generally cheerful person, so when the hypothyroidism-fed depression kicked in the second year and I started thinking things like "wow, it would be better if I just didn't exist," I could identify it as "whoa, something is really wrong."

I also mention this because even if she doesn't have hypothyroidism, it may be a useful physical hook to at least get her to mention it to a doctor. Like, instead of saying "You might have depression and you should get your doctor to refer you to a therapist," she might respond better to "If you have low thyroid levels it would make you tired and sad and feeling useless all the time, so it might be a good idea to mention your symptoms to your doctor and get a blood test done," and then the doctor would at least have access to her symptoms.

(My sister and I don't think this now, but growing up my family was big on "only crazy people go to therapists" and "depression isn't a real thing," so I totally see why she's having issues.)

[beatrice_otter]

She goes to the doctor a lot and is pretty good at researching stuff without turning into a hypochondriac about it so they can't just fob her off but have to actually test things. So I would assume that somewhere in the last several years she's gotten blood workups that would catch the thyroid thing, but I'll ask Mom and Dad about it--they'd know.

She believes depression is a real thing and doesn't believe that only crazy people go to therapists. I've gently probed to see if that was the issue. She knows that depression is real and very serious, because one of her friends at church whom she worked closely with in the 70s and 80s struggled with severe depression all her life, and this was back when depression wasn't acknowledged or talked about. She got a first-hand view of a) how devastating it was, b) how important treatment is, and c) how ineffective the mental health options of that era were.

It may actually part of the problem. The friend would go through phases where she was completely prostrate and couldn't do anything, and she was occasionally suicidal. My aunt is not completely prostrate (she drags herself to work and to church, and gets her hair and her nails done regularly), and she's never been suicidal. But just because she isn't a poster child for the worst extreme doesn't mean that she's fine, you know? But that's the picture of depression she has in her head.

[raspberryhunter]

Ah, okay -- sorry for projecting my experience on these things. And I can totally understand that too -- the "I'm not that bad, so I must not have anything major wrong with me" syndrome. Ugh, I'm sorry.

There's a good chance she's been tested for it, given what you say. The only thing is that if she thinks the fatigue, feelings of uselessness, etc. are problems with *her* rather than her mind/body (which is what I thought for a while), she might not have thought to mention it to her doctors and they might not have included tests for specifically fatigue-related conditions. (A good doctor would have tested for these kinds of things in a routine physical, because e.g. some staggeringly large percentage of women have hypothyroidism or anemia, but, for example, during my pregnancies I always had to explicitly tell the ob-gyn that I had to get the thyroid testing on my bloodwork because of preexisting issues, otherwise it wouldn't get included, even though pregnancy can trip or exacerbate thyroid conditions so you'd think they'd check it for everyone.) But anyway, it's good your parents can check.

[mmegaera]

I have no suggestions, I'm afraid, but much sympathy. And empathy. My mother was depressed for a long time after my dad died 22 years ago, and nothing helped until last year when her health and age (she's 91) made assisted living the only viable option for her. She actually seems happier there now because she's around other people whenever she wants, eats with other people instead of by herself most of the time (two of my sisters and I are halfway across the country, and my third sister can only do so much), has far fewer responsibilities (the house was really dragging her down, but she felt like she had to stay there "until the bitter end" (her words) because she thought that was where my dad wanted her to be), and doesn't have to cook for herself so her diet's much better. Also, she knows someone is there for her 24/7 if she falls or gets sick again. But wow, did it take a prybar (and a scare that put her into the hospital for a couple of weeks last fall) to get her out of that house and into a better situation. Which I can completely understand, because, after all, it was her home. It's just hard all around when things get to this stage.

[beatrice_otter]

Thank you.

[genarti]

Oh man, that's so hard for your aunt and for everyone who loves her, too. I have no good advice or experience with this, but lots of sympathy.

[beatrice_otter]

Thank you.