by Mark Sichel, LCSW

One of the central defense mechanisms people use to deal with depression is denial. People, understandably, do not like to admit that they are depressed. Sometimes they express it by developing chronic symptoms of fatigue, backaches, digestive problems, and other bodily symptoms. Others just act depressed and flat out deny that there is anything wrong. Life is too short to live it out with someone who is depressed, in denial and refuses to get help.

While denial is a maladaptive choice for a truly depressed individual, it is an unfair choice for a person with a family or a partner. I get numerous questions from people with a depressed partner who refuses to seek help. Sadly, the problem is a fairly common one.

In most cases the non-depressed partner wants to do whatever they can to help. One woman writes in and says she really tries to be supportive of her husband even though he will not go into any form of treatment. She says that she is a sympathetic listener, and actively seeks vitamins, herbs, and other natural treatments that her husband is willing to try. She also tells me she reads everything she can about depression in order to help her husband. She says her husband doesn't believe in therapy or psychopharmacology. This has been going on for three years, and now her husband is in danger of losing his job because of his depressive episodes.

No one has to live with this kind of problem in an era of readily available medication and access to all sorts of supportive help. While this person is trying to be the best wife she knows how to be, she is also doing herself and her husband a huge disservice by submitting to his unreasonable stance on treatment of what is both a biological and a psychological problem. His stance about medication is as nonsensical as a diabetic saying they do not believe in insulin. This woman needs to learn how to assert herself, and she needs to learn it fast or her husband will lose his job and then the family will have even more problems.

Another reason that a person should not tolerate living with a depressed partner is that often what appears to be depression can actually be an undiagnosed physical problem such as a thyroid problem or other endocrinological disorder. When a person gets resistance from a depressed partner about getting help for depression, it's often helpful to start a treatment process with a general check up to rule out another medical illness. Most people who might feel it is harsh to insist someone see a psychiatrist, can make their first step by insisting on seeing the family doctor. If there is no medical problem, often the family physician will be a better candidate to recommend psychiatric treatment than the spouse of the depressed person.

Another reason that the family doctor may be a better candidate to suggest treatment than you are is that refusing to get treatment might be your partner's way of "punishing" you for no good reason. There is usually a strong, underlying current of anger and pent-up hostility present when someone is depressed. Refusing and rebuking your suggestions that they seek treatment is one way of expressing that anger. It is maladaptive, but effective, for misery loves company and you will surely be miserable living with a depressed person determined to stay depressed.

It is never pathological, in my opinion, to demand that someone with a psychological problem get help for himself or herself. Depression is a serious illness and it needs to be treated that way. Treatment is imperative to ensure the well-being of both the partners, as well as the family. Life is not fun with a depressed person, and unless something is done to rectify the situation, it will go on that way indefinitely.

If you would like to refer your partner to a list of things they can do to help themselves while they muster up the will to seek treatment, they can read Self-Help for Depression.

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Reviewed: 01/2006