7 Steps to Opening Up About Depression

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I was honored to offer a TEDx talk this past year in Boca Raton, Florida. It's entitled "How to recognize perfectly hidden depression," and in it, I describe clients I've seen who'd never have seemed depressed to anyone around them. Two in particular are featured: one tried to take her life; the other came in well before that happened, but admitted he'd also had thoughts about doing the same. Having thoughts about wishing for the end of your life is much more common than many people realize—and we, as a culture, need to talk about those thoughts with one another much more transparently. Without judgment.

It's also imperative that those with an intent to die by suicide should get the help they desperately need. Yet the distinction between having thoughts about it and having a suicidal plan to carry it out is vital to understand. The first is a conversation; the second requires immediate action by whatever mental health provider or family member is told.

Suicide rates are skyrocketing, and those thoughts must be taken very seriously.

But if we don't feel safe to reveal such thoughts, how are those conversations ever going to happen?

Comments from several readers caught my attention. Basically, they responded, "People tell us now that it's OK to talk about being significantly depressed. We see commercials all the time about it. But just try it. It still freaks people out." Or something to that effect.

I don't disagree. It will still freak out some people. Or some may still have a very hurtful, condescending response—something like, "How could you be so selfish?"

So I wanted to focus on two aspects of talking about emotional pain, even suicidal thoughts, that would hopefully lead to a safer conversation.

First, picking "who" you choose as a listener.

And then "how." Let me give an analogy.

The park bench analogy...

Imagine two people sitting on either side of a long park bench. One is sniffling a little, looking sad. Wiping tears away. The other is extremely upset, sobbing. Which person do you think the average passerby might approach?

It's the first one. Why? Two reasons: Because there's some sense of knowing that the "quietly crying" person isn't completely falling apart, that they can calm themselves. And, two, because the passerby feels their empathic skills are adequate to help. It's a match.

Yet, many people who are impulsive or have trouble calming themselves—and who may be struggling with destructive feelings—will answer that first question by saying, "Oh, the average person would approach the second person"—and are shocked when I offer my answer.

If you're trying to talk to someone who's highly distraught about emotional pain and suicide, and you haven't been trained on how to do that—how to help them ground themselves, for example—then that conversation is not likely to go well or be helpful to anyone. And most people will avoid what they don't understand or feel competent to handle.

This isn't saying that, therefore, you shouldn't talk about it. But choosing who to talk to and how to do it is very important to ensure that you feel understood and accepted, rather than judged.

That doesn't mean that there aren't others who can listen and help. We can't all go to therapists for various reasons. And, yet, it's so important to not feel alone.

Here are major points. First the "who."

• If you're in an emotional space where the best you can manage is to emote strongly, then doing that with a therapist or professional who's going to be able to enter that space with you and help you sort out your thoughts is really important.
• If not a therapist, choose someone who has handled emotional crises themselves well. You have that friend or someone you know who's faced really hard things. And gotten through. They're open about the experience and know that anyone's life can get out of control. They coped with their own emotions and have skills that others might not possess.
• Realize that others care about you, but they may find it hard to listen empathically. So it's not rejection. They themselves might get emotionally overloaded and become afraid or sad. So picking the right "who" remains very important to getting the understanding you seek.
• Make sure, if you're in therapy, that you feel safe to talk about any and all of your feelings. Some therapists themselves don't create a safe enough space for their clients to talk about darker feelings. Make sure you can talk about anything—and feel trust.

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The "how"...

• Start slowly if needed. If you find it hard to reveal yourself at all emotionally, if not almost impossible (as in perfectly hidden depression), then part of your "how" is to begin very slowly. For example, you can tell a friend you trust, "I haven't told you through the years about how I really feel. It's hard for me to do that." That's all you have to say. Right there. If they ask you for more, you can say, "That was a start, but that's all I can say right now."
• Collaborate with your therapist if you're struggling. Some people believe that any revelation—especially to a mental health professional—means you're going straight to a psychiatric hospital. That's simply not true. There are other routes as long as safety is monitored. That's anything from more frequent therapeutic visits to a change in medication, or treatments such as ketamine and transcranial magnetic stimulation.
• Find support from groups that offer healthy guidance and information. National organizations such as NAMI or BringChange2Mind are available as well as many other nonprofit organizations, such as Giving Voice to Depression and This Is My Brave.

If you or someone you love is contemplating suicide, seek help immediately. For help 24/7, dial 988 for the 988 Suicide & Crisis Lifeline, or reach out to the Crisis Text Line by texting TALK to 741741. To find a therapist near you, visit the Psychology Today Therapy Directory.

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