What Your Friends With Mental-Health Issues Actually Want To Hear

Illustrated by Asia Pietrzyk.
Nearly one in five adults in America suffers from a mental illness each year, according to the National Institute of Mental Health. More than half of those affected won't receive professional treatment. With these odds, you likely have at least one friend or loved one who's battling depression, anxiety, an eating disorder, OCD, or another mental-health issue — and he or she may feel like they're facing it entirely on their own. Unfortunately, there's no guidebook that tells us the right way to be supportive, but it's abundantly clear that opening up — and keeping open — dialogue around these sometimes-stigmatized topics is a must.
That's why we've partnered with Face The Issue, a nonprofit committed to encouraging healthy, productive conversations around mood, anxiety, and eating disorders, to break the silence once and for all. Provided that the conversations we most need to have are often the toughest ones to start, we spoke to women who bravely take on a diverse array of mental-health struggles every day in order to learn what those affected actually want to hear. From there, we conferred with psychologists to shed light on why these statements could prove helpful. Our hope? That together and with a commitment to fostering empathy and understanding, we can push forward.
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Jennifer, who suffers from both depression and anxiety, first began experiencing anxiety attacks as a child. Before she was diagnosed, her parents would respond to these incidents by asking her to "just stop it," which, in hindsight, she sees as dismissive and damaging. Instead, a simple "Are you okay?" is an easy way to acknowledge the issue and show someone that you care.

This short question not only gives the individual who's suffering space to share her feelings, it can also help her change course if she's in the throes of a depressive or anxious episode. "I’ve heard many times from people who felt somewhat trapped in their feelings, and words of kindness like these helped create an aha moment after which they saw more hope and less bleakness," says Michael Brustein, PsyD, a clinical psychologist in New York City.
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Hailey, who entered treatment for anorexia nervosa at age 17, felt entirely misunderstood while battling her eating disorder. Many people assumed that she would return from treatment magically cured, which wasn’t the case. When a friend told her, "I know you'll figure it out in your own time," she felt, perhaps for the first time, confident that she could manage any roadblocks on the way to her recovery.

According to Dr. Brustein, this is a significant thing for a friend to say because it iterates that recovery is a process and that the individual struggling isn't defective if she experiences peaks and valleys along the way. This vote of confidence can also act as a counterpoint to the shame that may arise for someone if she encounters difficulties during treatment.
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Tara, who suffers from clinical depression and chronic anxiety, finds it frustrating when people tell her to "just cheer up," basically neglecting to acknowledge the very real thoughts and feelings she's experiencing. In contrast, validating someone’s feelings and reminding her that this isn't a fixed state can be soothing. Especially if you've seen your friend through ups and downs before, try something like, "Yes, this is a terrible feeling, but just like last time, it will pass."

If the situation appears to be cyclical, New York-based psychologist Alan Wenderoff, PhD suggests adding on a few examples of past experiences when your friend overcame difficult feelings. This helps put things in a larger context and adds perspective she might not be able to see in the moment. It also serves as a reminder that we are not our feelings and that feelings come and go, says Dr. Brustein.
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Patty*, who has battled clinical depression for most of her life, says people's tones are often more important than their words. That said, certain statements naturally lend themselves to conveying you're coming from a caring, empathetic place. For example, "I know you're hurting, but I am here for you even if it's just to sit with you while you cry and share your pain. I'll be silent if that's what you need, but you don't have to suffer alone."

These words help convey that a depressed person is not a burden, is not bringing down the people around her, and does not need to withdraw. "Expressing that you’re open to someone's experience and that she doesn't have to put on a show is a way of saying, 'I can hear, I can witness, and I can empathize with you,'" says Dr. Brustein.

*Name changed for privacy.
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Growing up, Kaitlin, who’s experienced trichotillomania (an uncontrollable urge to pull out your hair) as well as minor dermatillomania (a similar urge to pick at your skin), didn’t know that anything could be done to help her. If someone would have suggested, "Let's look into how we can treat this," she would have felt more supported and understood.

Not only does this legitimize the person's struggle, but it offers a sense of hope by essentially saying, "I'm not afraid of this, and I'm going to be with you as we look for solutions," explains Dr. Brustein. Once you've made yourself available to your friend, it's important to remain nonjudgmental and patient as the efficacy of any solution varies from person to person, adds Dr. Wenderoff. Don't give up if the first option doesn't work immediately.
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Ally, who’s faced an eating disorder as well as mood and anxiety disorders, has lost friends along the way, largely because she felt they only saw her in the context of her illness. What she needed most, however, was a break from her constant, obsessive thoughts — a distraction that hanging with friends in a normal way would have provided. She wishes her friends had said, "We can talk whenever you want, but what do you need right now?"

Dr. Wenderoff says this is an excellent approach because it takes into account that what one person needs may be very different from what another person may need, even if the two are suffering from similar conditions. Explicitly asking what you can do to be supportive creates the space necessary for the person affected to express her preference, which is what makes it a critical starting point.
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Erica, who suffers from generalized anxiety disorder, says she often feels guilty for being worried or sad. From the outside, it appears that she "has it all" — a solid job, no student debt, great friends and family, frequent vacation plans, etc. As such, she's often met with skepticism and disbelief that she could be facing a real inner struggle. To recognize a friend’s pain, she suggests saying, "Your suffering is serious. Do not beat yourself up for feeling the way you do."

That’s good insight, according to Dr. Brustein. "People have feelings about their feelings, which are what we refer to as 'secondary emotions,'" he says. "They might be afraid to talk about their problems because they have so much guilt about feeling the way they do. Anything that helps someone not judge herself for having certain feelings is important to say."
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Alma suffers from depression that she suspects is partially hereditary. Especially in communities of color like hers, she’s found that mental-health issues are largely ignored. When she does try to speak up about her depression, she's often met with people expressing how they feel about their role in it, thus failing to address Alma's feelings and causing her further guilt. To acknowledge her personal struggle, a friend might say, "I don't know what you're going through, but I know it must be painful. Tell me the best way I can help."

With illnesses like depression and bipolar disorder, you can't necessarily look at a person and see her disability. This is often at the root of a long-held, tough-it-out attitude, however unproductive it may be. Combat this by validating and acknowledging the issue and keeping the focus of the conversation on the sufferer. But stay away from saying, "I know what you're going through," when you really don't, says Dr. Wenderoff. If you do have a relatable experience to share, Dr. Brustein recommends first asking if it's okay for you to tell your story and only doing this after you've fully listened and acknowledged you friend's struggle.

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