Hi Team. This part two of Great Expectations. So please read that one first for a wee bit of context and to catch all the Dickens puns.
meme for blog

How to help someone struggling

This section will hopefully be aimed at suggestions for people who want to understand depression and mental health problems better, or to help Our Mutual Friend with it. One of the important factors in this situation is having realistic expectations for them and your relationship. This could be anything from ‘they might have a bad day emotionally more than I might’ to ‘they might not be able to walk tomorrow and I need to bear that in mind.’

The first thing to remember when trying to set healthy expectations is that all cases will be different. Depression is a bit of a misnomer. It is more accurately depressions plural (in addition, words like ‘depression’ or ‘anxiety’ are far too tame to accurately describe the illnesses.). Each case will have slightly different causes and symptoms, including slightly different physiological changes to the brain. Each case gets increasingly unique because of the cyclical nature of mental health problems. It often comes and goes, from one day to the next, or one year to the next. This means that you will probably have to have different expectations for a single person depending on the day. This won’t be easy, but is worth it.

In a sense this is no different to any relationship. Every person who you encounter you will have to put a unique set of expectations on. I do not mean to put pressure on people, but to expect different things from different people. I expect my friend Lewis to be able to answer my Star Wars questions while my friend David should be able to answer my Batman questions. Expectations are key for all relationships and they need to be unique for each relationship.

Lewis generously put this photo of me and David on Facebook

#1 Have realistic physical expectations

After having clarified that all relationships will be unique, I am going to contradict myself and offer some general guidelines for placing expectations on people who suffer with their mental health. First of all these illness, whilst psychosomatic (meaning that the brain/mind state affects the body), may have very significant physical implications. Please don’t assume they are lazy or boring because they don’t want to partake in certain activities. They are limited physically by the illness. I wrote a blog explaining depression with an emphasis on the physical aspects here.

#2 Have helpful non-physical expectations

The flip side of this is that people suffering from mental health illnesses need to be encouraged. Their mental state seriously affects how their body is doing. A large part of this may or may not be out of their control, but it never will be totally. Depression can be fought. Without exception people can take steps to make it better. However, to do this people with depression need a team of people surrounding them and encouraging them to make wise choices. This should include at a minimum getting to know your friends, explaining to them that you love them, regularly explicitly affirming them, and making it clear to them that you joyfully and willingly embrace the privilege of suffering through this with them.

These things aren’t expectations, but are crucial for the tough conversations that you need to have with them. You need to be encouraging them (within reason) to go to the doctor, to do exercise, and to see a counselor. Not all cases need these things, but these are some of the best ways to help people with depression. You actually need to place gentle expectations on people with depression to try and work towards fighting the depression. People with depression need accountability just like everyone else does. We need accountability for taking our medicine, being loving to others, thinking good Godly thoughts and not slipping into damaging thought patterns, doing exercise.

All of these things are crucial for everyone. We need accountability in these things. Theoretical these are expectations that we should place on everyone. The reason why I am flagging them up here is for two reasons. Firstly that the consequences are potentially greater or more immediate. Someone with mental health struggles falling into an unhelpful negative thought pattern (i.e. indulging very angry thoughts) may have serious physical implications.

The second reason why I am flagging it up is because these expectations need to be a lot more gentle, gracious, and compassionate for people who have depression. They also need to be clearly placed in the context of explicit affirmation. Believing that people were angry with me when they were really just concerned has been an unfortunate theme of my life over the past few years. I can’t tell whether people are really mad with me or not. This has not been helped by not having a clue about how British people express anger/concern/frustration etc..

People without mental health struggles tend to be better at realising that others holding them accountable are doing so out of love. It has been really easy for me to get upset over little things or unfairly believe that others are angry at me. Despite this I really need to be held accountable in my life in all areas. Holding me accountable in areas which are good for my depression (like avoiding negative thought patters) is crucial for me getting better. Depression is a team sport, no one can deal with it alone. This is a theme that I have written about a wee bit previously.

#3 Expect the person to struggle emotionally, it is a Bleak House

This one is crucial for understanding relationships. When I say struggle I mean that they have a tough time with their emotions, even though it may look radically different from person to person. People with mental health problems often have erratic emotional patterns. One day they might seem happy, but then snap at a little comment, becoming quickly aggressive. They may seem very angry over little things. Without the slightest warning they can go from indifferent to apoplectic. The anger comes from a part of the brain which isn’t in the areas with reduced activity that is typical of depression. It is often uncontrollable. You should not let them think or do evil things in their anger, but accept their anger as a part of who they are (even though it is a temporary thing). Pretending that it doesn’t exist will only do damage. Acknowledging that it is caused by an illness will help deal with it. We are not an evil Scrooge.

Other times we might seem emotionally dead or apathetic.

“You got married? Don’t care emotionally.”

“You had a baby? Don’t care emotionally.”

“I had a baby? Don’t care emotionally.”

“Your best friend has cancer? Don’t care emotionally.”

This is not a reflection of how important these events are to the person, but rather the physical limitations of depression. Depressed people are not always able to be emotionally empathetic. This will be much more difficult for the person struggling with mental health than anyone else. Please bear in mind that this is not their choice and not a reflection to how much they care about you. It is just impossible to show it emotionally.

There are many other weird ways in which depression affects our emotions and moods. However, these are just two examples which show that we value relationships and people, but we can’t show it properly. Please adjust all expectations you have on depressed people appropriately. Be more gracious to our angry behavior and lower your expectations on what we may be able to do emotionally.

Two critical things to remember are that everyone struggles with something. Everyone in the world has bad parts to them and mistakes that they make. We need to be gracious to all, particularly relevant to their particular struggles. Secondly that all individuals are different and as such their struggles will be unique. This is true with mental health strugglers. Getting to know us on a personal level is critical to helping.

I needed help long before I struggled with mental health

#4 Pray

I need tons of prayer as does everyone with mental health struggles. Pray for fortitude, resilience, and a loving community. Even if you don’t believe in prayer try it anyway, what harm could it do? Ask other people to pray for your friends who struggle with mental health too. The more people praying the better.

Tips for those of us struggling

#1 Keep things in perspective

This might be the most helpful thing I write, so please remember this. Mental health is a massive challenge. It will always give you a tough time regardless of who you are. Do not underestimate the challenge that you are going through. Pretend for a second that you are back at school and your physical education teacher says to everyone that they have to run 100 meters. Societal stigma may often say that yes your 100 meters is more challenging than other people’s, but only because you are lazy or have a bad attitude. More realistically your race is more difficult because the teacher makes you run a marathon instead. It is a massive challenge.

I have very rarely seen anyone do badly with mental health challenges. Everyone one of us makes lots of mistakes. Everyone one of us struggles. But with the exception of the few, I have constantly been impressed at the resilience, toughness, and strength of people struggling. They often complete tasks that other people have in life whilst feeling depressed or anxious or a whole host of other struggles. That is incredible.

Consider walking along to an athletics competition where the most common race is the 100 meters with a backpack on (a bit of a niche competition). You arrive just as two competitors take to the starting line. Judging from the outside appearance they seem identical. Both have a similar height, build, and backpack. They start the race and person A finished in 12 seconds and person B in 13 seconds. You are disappointed at the significant difference between the two. Much to your surprise everyone flocks around person B and celebrates. What you didn’t realise that person B had rocks in their backpack and had just set the world record for the race with that amount of weight. Person A had a backpack filled with other things, but not as incapacitating when it came to the race.

People with mental health struggles/problems/illnesses are like person B. They have a large weight burdening them, yet still accomplish amazing things. However, the enormity of their success is often overshadowed by the standards of the culture we live in. We are taught that success requires acquisition of wealth and power without exception. By societies standards people with mental health problems don’t appear to be successful. We are often too tired to be able to have a good job, make a lot of money, be free to selfishly priorities our own needs over all else. We are unable to pursue happiness because of our mental and physical state, which is one of the most important tenants of our culture. We are told that we should strive for the good life, but society’s twisted picture of that is incongruous with mental health illnesses.

The problem here is not that we are doomed to never have the good life, but rather society has a pathetic and hollow idea of the good life. The way society defines success is short sighted and barbaric and puts impossible expectations on people. In the race above the observer did not have all the information and naively put unfair expectations on person B. They expected them to run the same distance at the same pace because of their appearance. They didn’t understand the implications of the runner’s backpack or their condition.

All of this is important to say because by the worlds standards we might not be doing well, but actually we are doing an exceptional job. Like the runner who has just broken the world record (person B) we have done excellently. We often don’t feel it because the symptoms of our ‘backpack’ stop us from feeling positive about these things. In addition society’s poor understanding of success places foolish expectations on us. If we ignore these for a second, which is really tough, we will see that we are doing exceptionally. We are breaking world records (usually proverbially). Well done. Society can’t see it, but you are killing it.


#2 Things have been changed and (Oliver) Twisted

Things change once you start suffering from illness. I am far less athletic than I was before. The month before university I liked to start my day off with about a ten mile run. I was a lot fitter than I am now. If there were any sports happening I would want to take part. Fast forward twelve months and things had changed dramatically. When I played sports I would fall over. I couldn’t keep balanced and was very light headed. I struggled to keep a clear head when I played which impaired my decision making and made me a worse player. I had the expectation that I should be fit and coordinated because that is how it had been. It was who I was.

When I became ill I started to get frustrated with the changes. It was horrible that I had fallen so far in such a short amount of time. I could no longer play to the best of my ability and often felt like I was letting my teammates down. Every time I put on my running shoes or football boots I expected far more than I was currently capable of. Every time I let myself down and could not live up to my previous standards. This just led to increased frustration, anger and despair.

Coming to terms with the idea that illness changes something is crucial. By doing so we can slowly start to have more realistic expectations. In this way we are relieving ourselves of a lot of pressure. Some days when I am really ill the zenith of my physical prowess means going outside and lying down. Often that is a very reasonable expectation. When I am feeling better I try and place greater expectations on myself, such as going for a short run. I try and stay far away from thinking that I am capable of what I could do before, and it takes a lot of pressure off of me.

Everyone has natural limitations in their life. For us one significant part of that is our mental health struggle. We should all place expectations on ourselves which are in line with the limitations. If we don’t then we will fall into a trap of constantly failing to achieve. I am not saying that we should discourage people from aiming very high, but don’t aim for the impossible. Feel free to aim as high as possible, but know your limits.


Everyone has their limits, and it is good to know them!

#3 Expect the worst of times, Expect the best of times

There will be ups and downs. For me (and many others), depression comes and goes. I have good spells and bad spells. This is important to remember in regards to expectations for two reasons. First of all it helps us to adjust our expectations properly. To have proper expectations on ourselves we need to analyse (certainly with the help of others) how we are doing. If we are doing well then we should expect more from ourselves. If I am going through a good spell I want to hang out with anyone and can often enjoy it. If I am going through a bad spell then there are very few people who I trust to spend time with. The wrong person may end up with me becoming incessantly angry and me hating my time spent with them.

The second reason why this is important is because we need to prepare for the bad times and remember that they probably won’t last forever. When we are in a good spell we need to be planning for the bad spells. In a sense, we are putting guardrails up in our lives so that when we go through a bad spell nothing disastrous happens. These guardrails take many shapes and forms. Sometimes when I am feeling well I try and get as much cleaning and laundry done as possible. I know that when I am feeling ill I won’t be able to do these very well so give myself a head start. Another guardrail may be having a word with close friends briefing them on the best ways to help. I know when I feel miserable I can’t articulate the best ways for others to help. To combat this I try and tell my friends how to help when I am feeling well and am more lucid.

When I am in these bad spells it is very easy for me to slip into a melancholy mood with regards to getting better. It gets hard to see a future without a penetrating despair constantly clouding my mind. It does seem futile, but I try my best to fight this. Remembering that this is probably a downwards path as part of a cyclical pattern can be helpful to fight the haze.

#4 Pray

This one is tough, but God is our Ebenezer. It makes a big difference.

As always please let me know about your tips and stories. We are in this together. If you have any questions I would love to help or be helped by you. Feel free to share this with others if you feel that would be helpful too. Remember to check out part one if you haven’t already. Also please share this with your friends and family.