tl;dr: the most hateful thing about this set of tips is not that most people do not know what to do about your pain but that being around your pain very likely causes them a lot of pain. This is deeply unfair but it is also true so we may as well face that and figure out what to do about the problem, because it is a problem. When the people around you are in pain because of your pain and they do not know how to help you, they are likely to behave in unhelpful ways or to flee or ignore your pain, and all of these things really suck for you.
So you need to help them help you. This is not so hard. There are 5 things you should do. 1. Assure people you are safe, if in fact you are. 2. Tell them what you need, and make as much of it as possible simple and concrete. 3. Tell them what you don’t need. 4. Expect that any particular individual can’t manage too much of your pain at once and distribute the burden. 5. If all of these steps seem impossible when you are in the darkest place, then when you are in a less-dark place plan ahead so that you and the people around you know what to do.
What follows is an untidy rambling elaboration on both the problem and the solutions I offer:
Here we are winding down the year, in these the darkest hours before the light returns. I am in a bad way, as they used to say, I’m having an attack of nerves, I am poorly. By which I mean: I often wake up crying. I sleep badly, I have nightmares. Some days I am full of anger and ideas but I can’t settle the ideas into any sort of coherent framework. Or it feels like I can’t.
I would like to tell you about the narrow edge of terror, how it chases me down, the way December chases me down. In such moments I often do not understand the words that come out of my mouth, even though other people seem to understand me. I have to keep asking. Am I making any sense? Yes, people say, you are being perfectly coherent. But it’s like I’m listening to myself garbled, from far away, through a bad connection. One of those crackly old long-distance phone calls. It seems as if my own voice is a hallucination.
I have more to say about the terror, but maybe not now. I said I would write some crisp, clickable content today. Bang that shit out, bitch, you’re already at Wednesday and you don’t have either newsletter written yet. GET IT DONE.
The darkness crushes me.
Sometimes when I am cooking dinner I have to lie down on the kitchen floor for a while.
The knives are so shiny and they are whispering to me again, not in a hallucinatory way, exactly, maybe more like alien telepathy.
Have I freaked you out yet? The knives are whispering to me and it sounds like alien telepathy? And you just walk around like this, woman, you work, you engage in civic activity, you parent? Shouldn’t you be in some kind of institution?
Nah. This is just how my mind works sometimes, I’m used to it.
Here I am this morning with my mind blossoming blood-red roses like some gothic novel when what I said I would do was write crisp clickable content.
Let’s try again.
If you don’t know me, and at least some of you don’t know me, maybe you are worried about me. Is Amy…okay? you might be wondering. Incidentally this is kind of an irrelevant question to ask, most of the time I am not “okay” in any kind of ordinary sense. But I understand the question behind the question, so: sure, I’m okay.
Crisp. Clickable. Content.
You will in your life come into contact with many people who may worry about you, as you might now be worried about me, who see you say or do things that are scary. Who observe your pain and are impacted by it. And who do not know what they should do about it. This is a problem for your relationships generally because it is extraordinarily taxing for people to be around someone else in a lot of pain that they do not understand, that seems like it might actually be dangerous, that they do not know how to fix or help with, and that they themselves can hardly even bear to be around.
Being around someone in pain causes other people pain, that’s what mirror neurons do.
Again, as I said last week: I am not telling you that your friends are better off without you. I am not saying you should hide your pain from other people, or that it’s remotely fair that your pain causes other people pain to be around, through no fault of your own.
But the reality is that your pain DOES cause others pain, and most people are not equipped to know what to do about this problem, and so you need to know what to do, and to teach the people around you, and that is how you can help others help you in some kind of sustainable way.
This is how:
First, assure people you are safe.
The most important thing is that when people see other people in pain and also expressing weird thoughts like how the knives are whispering to them, or see them lying down on the kitchen floor crying, their first concern is does this person need emergency assistance right this minute?
That is, they are concerned for your safety.
So you need to reassure people that you are safe. You do not need to tell them you are okay if that is not true. In any case that is not what they are asking when they ask if you are okay because they can see quite well that you are not. They are asking if you are safe. So you need to say “I’m safe.”
Of course you should not say this if it is not true, or if you are not quite sure if it is true. If in fact what you need from a person in the moment is a phone call to your care team or a trip to the nearest psychiatric ER then that is what you should ask for.
What you should not do, if you can at all help it, is to say that you are not safe from suicide and leave it to your friend to decide what to do about it. It is understandable that the first or second time you find yourself in such a state you may be unprepared for it, you may truly not know what to do, but if it’s a thing that happens a lot in your life then see rule #5 and plan in advance what it makes sense to ask for at such times, and if you have a few very trusted people then make sure they have that plan too, in case you’re not even in a position to be able to tell it to them.
All of that said, if you know that you are not in fact a danger to yourself or anyone else, you should make that very clear to everyone around you and you shouldn’t lie about it and then end up hurting yourself because then they will not believe you anymore.
Second, people do not know how to help you so you need to tell them.
In the absence of knowing what to do to help you people might avoid you entirely, or act like they do not notice anything is wrong, or if they’re an anxious fixer type they’ll just start trying shit out, some of which might help and some of which might make you want to smack them upside the head.
So you need to tell people how to help you. Simple and concrete help is easiest for others to provide without becoming overwhelmed. “I need someone to run a bath for me.” “I need someone to drive me to my doctor.” “I need someone to help me do my laundry.”
Once when I was quite depressed I asked a friend to help me return a bunch of clothes I ordered when I was manic, and filling out the forms (this was before narvar and happyreturns, so many dumb forms needed to be filled out by hand) and boxing things up took all afternoon and when we were done she took all the boxes away and dropped them off at UPS for me, and it was one of the best things anyone could have done at the time. It was simple and concrete and a goddamn blessing, it was, in particular how she did it without judgment, helped me fix a thing about which I was deeply, deeply ashamed.
You should ask for a lot of simple concrete things because they are easier to provide than the other kind of help you might need, the kind of help where you need someone to sit with you or hold you in the darkness.
It is not fair that that kind of help is extremely difficult to give, because of the whole mirror neuron problem, but it is best to accept it. When you need someone to sit with you in your pain you have to help them understand how they can do that, and you have to let them know it’s okay and in fact necessary for them to take breaks from that as often as they need to, because otherwise they will become overwhelmed and they will default back to avoiding you entirely or to pretending they don’t notice your pain. This is not because they are insensitive jerks (most of the time). If they were insensitive jerks your pain would not hurt them.
Agonizing depression feels a lot like grief, and I think that we can find good advice for sitting with others’ emotional pain by looking to various religious traditions’ approach to grief. I’m Jewish and so I think of sitting with someone in emotional pain as something like a shiva visit. When a family member dies, you sit shiva in your house for a week. Visitors come and bring food. You do not have to talk to the visitors, and they are not supposed to initiate conversation with you. They come for a while, they put food in your fridge, they sit with you, you talk or don’t talk as you feel like it, and then after a while they go away and other people come and do the same.
You help others sit with you in your pain by expecting them to tolerate very little of it at once, and by telling them exactly what that help looks like. You say “please just sit here with me” or “I would like to talk about Squid Games” or “Tell me something you like about me”.
Once, quite a while ago now, I was depressed and I was sitting with someone on his couch and I asked to hold his hand and he let me hold his hand and I sat there for a few minutes holding his hand in silence while crying and then he asked “what are you getting out of this?” and I said “oxytocin”. After a few minutes he let go of my hand and I left his apartment. If this sounds like a very strange incident with a lot of confusing backstory (who was the man? Why did he not understand why I might find holding a hand to be comforting? Why was I on his couch in the first place?) that’s because it was indeed a very strange incident with a lot of backstory that we will not be covering here today.
I bring it up because here is a story about someone who clearly had no idea how to help the depressed woman sitting on his couch (and truth be told was probably ambivalent about whether he wanted to help) but in fact he was able to help me because I asked him for something incredibly simple and I had no expectation that he could provide very much of it.
Third: tell people what you do NOT want or need from them.
If you do a good job with 1 & 2 this should be not quite so necessary, because people aren’t going to run around like chickens with their heads cut off trying to solve your problems for you if instead you are able to give them simple assurances and easy ways to help.
But some people are just so uncomfortable with your pain or so certain they know how to fix it that they are gonna try to do all kinds of shit you didn’t ask them to and don’t want or don’t need or that might actually end up causing you harm, so you need to be able to tell people what not to do: It would be dangerous to call 911 and I don’t need you to do it. I don’t need an intervention. I don’t want company. I don’t need advice. I don’t want your reiki practitioner’s email address (I love reiki and already have a reiki practitioner). Don’t clean my kitchen. Don’t scream “CALM DOWN” at me.
Whatever it is that is not helpful you should be able to articulate that to others and if they come up with an innovative not-helpful idea you need to inform them that while you appreciate the innovation it is not a helpful one.
Four: other people can only take so much of your pain.
There’s a reason it’s a mitzvah (good deed is not quite the right translation here but it will do) to make a shiva visit — because it’s important that a lot of people make shiva visits, because ideally the burden of witnessing someone’s grief is shared by a whole community. We’re not all great at community these days and not all communities know what to do with endogenous grief, but to the extent that you can, try to spread the helping around. By no means should you rely on a single other person, whether a spouse or a parent or a child or a sibling or a friend, to carry the burden of your pain by themselves.
Some people, most people in healing roles, most clergy, have been trained to sit with others in their pain and not allow it to overwhelm them — the rest of us are just doing the best we can but our muscles for it are just not as strong, we’re gonna fatigue. Particularly where partners are concerned, bearing your pain may be a marathon, not a sprint, and you do not want to wear them out. Find a support group, or a subreddit, or a congregation. Keep a crisis hotline number in your phone favorites. Do whatever you have to do to decentralize and distribute the burden.
However much you distribute the burden, however, if you can afford to pay people in healing professions like therapists and you are able to access such people and you do not do so and you could take meds that in fact would help but you do not, and instead you expect your friends and loved ones to bear the burden forever and for free, well, that is not a very good way to treat other people and it’s not a good way to retain the relationships that are important to you. Getting a good team of healers in place is so important I will be devoting an entire issue of Woe to it; but here I just want to say a thousand million times that your friends are not your therapist so do not treat them like they are.
Five: if you don’t know what to ask for, plan for that in advance.
If when you are in dire straits you find yourself at a loss about how to accomplish any of the above steps, then you need to make some advance plans during times when you are doing better. Here's a resource to start, but you can google for more.
Here, let me demonstrate:
1. I am safe. My pain in this moment, while large, is still well within my operating range.
2. The help I could use best from you, if you, reader, are moved to help, which is not necessary, is a little note back to me telling me anything you have found useful in this newsletter or any other issue of Woe. Writing is lonely and writing about mental illness lonelier still and sending words out into the ether is scary and it is always nice to get a little sound back.
3. Do not give me any other kind of help at this time.
4. There are a bunch of you readers, so no one of you should feel a particular burden to offer the help that I asked for, or worry too much about what to say to me.
5. I don’t need a hospital but if I did Max knows which hospitals I find acceptable, how to reach my doctors, and which ER he would take me to.
Of course at any particular moment all of these tips may be outside of your capacity.
But I am not just speaking to people in a crisis just at this minute, I am speaking to people who may find themselves in crises, major or minor, over and over again in their lives. If this is true for you then you need to take a long view, to learn how to live through that kind of life in some sustainable way, and especially to be able to sustain relationships over that long time. I hope that my words can help you to do that.
Yours in pain,