Companionship

I wrote this article (in Chinese under my pen name 杨姗姗) when I was recovering from a major depression episode in 2019. I talked to my psychiatrist about how I gradually wanted to spend more time alone. So she invited me to write this piece about how different companionship matters to a depressed patient. Now I wanted to translate it into English because people mentioned in comments that it’s very well-written and helpful. See the screenshots below.

What I talk about when I talk about companionship as a depression patient

I am a patient with bipolar who recently had a major depression episode. It’s often said that companionship is one of the most important parts of treating depression. But companionship is a very broad topic and can be divided into many different types. From having acute onset to seeing a doctor, taking medications, and then stabilization and recovery, I realized that my needs for companionship varied at each stage. I will categorize and summarize the various types of companionship that people with depression need.

During acute onset, the focus of companionship is to ensure the patient’s safety, preventing them from suicide or self-harm, as well as guarantee basic nutrient intake, helping them eat and drink. Minimize the patient’s suffering as much as possible. I find that firm touch helps relieve suffering, such as rubbing one’s arms or back. Studies show that mammals, including humans, release hormones that can alleviate suffering when being touched. Consider giving the patient sleeping pills if available for a few days to reduce the suffering caused by sleeping difficulties. When the patient is awake, their mind is occupied by negative thoughts, so distraction can also help here. For example, find some videos or comics unrelated to the depression triggers for them to watch. Activities like going to the gym which require a certain level of energy and motivation are not suitable right now, it would only increase the patient’s suffering.

After the patient starts seeing the doctor and taking medications, the foremost task for the companion is to make sure that the patient takes proper medications on time and attends regular follow-up appointments. At the same time, help the patient adopt a positive life style, such as maintaining a regular schedule, eating a balanced diet, getting moderate amount of exercise, etc. The companion can choose how to help the patient based on the recovery progress. If the patient can take the initiative, then this is the best scenario. The more common situation is that the patient still lacks energy and motivation, then it is time for the companion to step into a more controlling role and arrange their things for them.

For example, when the patient is sitting listlessly, the companion can test the water by asking if they want to go out for a walk. The patient most likely will not respond. This is because their thinking is slow, but more importantly, because they cannot judge whether they have enough energy to do this. At this point, as long as the patient does not explicitly resist, the companion can assume that the patient isn’t opposed to going out for a walk and lead them to the door. The key idea of this controlling behavior is that it doesn’t require the patient to use their own (impaired) decision making ability. It relies on the companion to make decisions and direct the patient to act. A depression patient once said that when they were in an episode, even though there was a cup of water right in front of them, they just couldn’t bring themselves to get it. In this situation, what the companion should do is to move the cup to their lips instead of asking whether they are thirsty. The patient simply cannot answer this question.

Have the patient do things within their capabilities. It is meaningless to force the patient to demonstrate certain abilities or overcome certain symptoms. Depression patients cannot control their own cognitive functions. Once the medications take effect and the symptoms ease, these abilities will naturally return. Therefore, the companion should accompany and stabilize the patient to patiently and positively wait for the medications to work. As the medications take effect and the patient’s energy returns, the companion could consider letting the patient independently return to their familiar environments. The companion cannot keep taking care of everything – they need to transition from close and constant companionship to periodic visits. As the companion gradually steps back, this allows the patient to try taking care of themselves again and experience the return of their energy. This helps the patients reestablish their confidence in life.

We as patients are often told that the medications take time to work and we need to be patient. The same principles apply to the companionship. The companion needs to be patient as well. Sometimes when facing the patient’s negative behaviors, the companion may lose patience and forget that these are symptoms of the illness instead of the patient’s laziness or lack of self-discipline. With such misunderstandings, the companion can easily become angry. They might even provoke, threaten, or intimidate the patient in order to change them, causing unnecessary psychological distress. This type of companionship is not only unwanted but also harmful.

In the final recovery phase, the patient’s need for companionship gradually shifts towards actively seeking out companions. To learn more about the illness and how to live with it long-term, the patient should consult books or professionals. To understand themselves more, the patient should reach out to people who care about them and understand the illness well. Finally, in this internet age with information overload, it is essential to approach social media with great caution and not to believe anything blindly. The companion can work together with the patient to gather and filter information, preventing them from being disturbed by false or biased information.

Lastly, the companion must also take good care of themselves. Providing long-term care for people with mental illness takes a toll both physically and mentally. The companion needs to make sure that their own life is not affected negatively too much. If the companion breaks down, it is a huge shock to the patient. Also, when the patient is extremely sad, they are either ruminating the past or feeling anxious about the future. If they say anything extreme which hurts the companion, the companion is better off being understanding and forgiving them, as these are not words from a normal person.

I am eternally grateful to my family, peers, teachers, and friends who have taken care of me. I do not know how to repay them. Now I share my experience in order to help others. I think of this essay as a way of giving back.