Depression and elation are disturbances of emotion and as we are bonded to family and friends by emotion, mood disturbances inevitably affect relationships. For some immediate relatives the impact of an ongoing mood disturbance can be enormous. Surveys have shown that 40% of key relatives of people with depression are themselves sufficiently distressed to need help. It is the ongoing worry, social withdrawal and irritability that most upsets families.
Even if this is not a worry for you right now, it is vital that you understand what happens in relationships during depression, so that you can minimise the disruptive effect it may have on you and your family’s lifestyle. During a bout of depression or elation, the person’s perception of what their mood does to them, their family, and friends is often inaccurate. This perception can lead to the person feeling alone, isolated and misunderstood. Inevitably, this will in turn disturb close relationships. It also leads to inaccurate reporting of the extent of their mood disturbance and its consequences to the doctor. It is essential that a close friend or relative work jointly with the person with the mood disorder and the doctor or therapist as part of the management team. This three stranded team approach ensures that the necessary care and support is in place to reduce the person’s sense of isolation, that the doctor gets to know the full extent of the mood disturbance and that any adverse effect of the illness is addressed early, and better still, prevented. Concerned family members or friends usually want to help and they have a particularly important part to play in aiding recovery and limiting the damaging effect of mood disturbance. Not infrequently, the person who is ill may feel they are an additional burden on their families in expecting them to help and be supportive in this way, or they may see it as relatives are usually of enormous assistance, provided 18that they understand the facts about the mood disorder, have the ability to listen and can accept what the person is experiencing, without feeling they are responsible for relieving this distress.
Family members often find it hard to understand why people when depressed get to work, hold down jobs, and even socialise, yet at home they are irritable and withdrawn. What is even more perplexing is that they can snap out of depression when vistors call to the house. This is a wellrecognised aspect of depression of a mild to moderate, or even a severe, degree. Not infrequently when someone is admitted to hospital with a severe depression they can appear to be perfectly well for the first few hours or days, but then the true picture of depression emerges. In other words, they can reflexively and unconsciously put on a bright face when they go to the doctor or socialise, but cannot sustain it. The mask shown to the world, other than close family, is barely affected in the early stages of depression.
Afurther significant reason for involving a key relative, particularly a spouse, is that there may be a poor marital relationship either preventing full recovery or contributing to, or being the main cause of, the depression. Research has shown that where the well spouse is critical of the person with depression that a depressive relapse can be reliably predicted. In such instances, the impact of marital difficulties on the person may not be obvious to the doctor or therapist, as neither patient nor relativereports what is happening in their relationship, believing it to be irrelevant or that they are simply reluctant to address the matter as they see no ready solution. In addition, very often ongoing problems such as marital difficulties, financial problems or unresolved, prolonged grieving become so much part of the person’s life that they cannot necessarily see the effect it is having on their mood.
Finally, the constant train of altered perception, overly pessimistic in depression and...