Our adult son is getting more and more disabled with his depression. Whether he has bipolar, schizophrenia or something else, we’re not sure, but he is so isolated he’ll hardly talk to anyone. His basement room is in shambles and he smells bad. He used to talk about killing himself but now he doesn’t even talk enough to let us know if he’s suicidal. We worry too about our granddaughter who is brave, but should be a little frightened to visit him on weekends. How can we help when he is so withdrawn? This has been a recurrent or cyclic problem by the way, but more intense each time.

Answer:

Your situation sounds excruciating. At the bottom line, while not ‘hovering’, it’s good that you can remain watchful, given that he’s been on such a downward slide. In some ways, he could be safer while he’s nearly debilitated. I would suggest that you remain vigilant when he begins to get activated again, even if he appears cheerful at first, as this is statistically a risky time.

Apart from his essential safety needs, the question is how to get him in for mental health treatment. If it comes to it, you can call the County Designated Mental Health Professionals in Seattle. These are the people who come to make an outreach visit and, if necessary, have the authority to impose a 72-hour mandatory commitment for safety, evaluation and treatment. In King County they are accessed by calling the Crisis Clinic at 206-451-322.

Your son would have to meet stringent criteria before he is forced into inpatient treatment – in his case, being either a danger to himself or what they call gravely disabled. The latter category is more likely to be met if you tell them that on your part you are not able to adequately tend to his essential daily needs. This might be the stance to take depending on how you would want to influence their decision. The CDMHP’s can at least make an on-site assessment and give some key recommendations apart from anything being involuntary, so don’t hesitate to call them if you feel you should.

I wonder if you could marshal as many others in your community and his as possible. Consider asking neighbors, his doctor (via phone), past friends of his, co-workers, his boss or former boss – anyone and everyone, to periodically make a brief visit, express their concern and reinforce your message that he needs to accept help. The idea would be not only that you get help in your role but that he gets the sturdy demonstration of support. I wouldn’t think that his daughter could be enlisted without it being a little too frightening and heavy a burden for a 15 year-old. I can only offer this as a tentative suggestion that needs to be heavily tempered with your own judgment. A key factor though would be that all those in the network come across as loving and supportive, not confrontational.

Finally, recall the speech given by flight attendants before takeoff. If the cabin loses pressure and the oxygen masks come down, you must put your own on first, your child’s next. In other words please take care to conserve your own energy and to get what you need to keep going for the long haul. You want to mean it when you tell your son you’re strong for him and are never giving up.

I moved to Seattle to renew my life, yet I’ve been as depressed as ever. Shouldn’t I be less vulnerable in a beautiful place like this?

Answer:

I encounter people in this situation regularly. Seattle is a city of transplants, and the adjustment is not always quick or easy. Here are several reasons we could designate a special “Seattle depression” for newcomers in the the Emerald City.

First of all, moving sucks. You may have escaped a messy family situation and a doomed marriage, a rotten job and hell-hole physical setting, but you’ve come to a place where you don’t know many people. Isolation correlates with depression. Often, being with irritating people who you know may still better for your mood than being alone. Seattle has a reputation as a place where people are generally insular and hard to get to know. Whether or not the reputation is deserved your feeling blue and insecure will not help your efforts to integrate.

But I’m an introvert, you may say. People are a pain, and I like to be alone! Just the same, being human, you have tribalism in your genes. You don’t have to change you personal nature, but you might benefit by adjusting your patterns of affilliation.

Besides the isolation that comes with moving, you have disrupted your usual routines. Routine is good for your mood, plain and simple. Humdrum activity is still activity. It gives a sense of purpose it keeps you in motion and it lends structure to your day, whereas now that structure may be hard to come by.

The reduced light that comes with our long winters is undeniably a factor in depression, but an overblown one in my opinion. The problem with winter is not just the reduced sunlight but the fact that we don’t move around as much. Physical activity is good medicine for depression and it just doesn’t come as easily in the Seattle winter.  If you get a boost from taking walks in the summer, get a good parka and don’t let the went winter stop you.

All the disruption, lack of routine, reduced activity, seperation and isolation contributes to a sense of anomie – a breakdown in the usual social norms and standards that give us a sense of regulation, stability and belonging. Even a slight sense of dysregulation and weakened structure adds to anxiety.

As I have mentioned several times before, depressed people ruminate to try to find answers. Ruminating is a vortex. It gives the allusion that we are seeking answers when in fact we’re moving farther from solutions.

You can place all blame the nature of the city if you wish.  But if depression is the fault of this locale, we would have a measurably higher rate of depression.  We don’t.  Incidentally, the only city with a measurably higher rate of suicide is Los Vegas.

So what is to be done? As Mark Twain stated, “It takes a heap of livin’ to make a house a home”. You may need a plan to direct your activity more productively, to find more connection, gratification and pleasure, and tune your thinking to be less depressive. Then, you can begin feeling like you belong, perhaps even like it would be depressing to leave. CBT or cognitive-behavioral therapy is a practical way to do this.