Dear Alice,

I am actually asking for a friend of mine since this situation is getting worse, and I don't know how to help. The problem is that my friend is very depressed, and has very, very low self-esteem. While sometimes able to be cheerful and "happy," he claims to rarely feel that way and mostly just hates himself. He has mentioned suicide, although I think this is more an expression of the extreme self-hatred he feels than anything. I comfort him and often tell him how wonderful he is — what a good person, good qualities, etc., but I suspect he does not believe me at all. This has been going on for a long time now, and I think it stems from a somewhat unhappy childhood and adolescence. I don't know how to help him and I don't know what to do. I feel like being strong for him is just not enough, and I can't quite convince him that counseling may do some good. It seems to me that, recently, he has been feeling even worse about himself, to the point where nothing will comfort him. He cannot afford counseling, and he has no health insurance. Is there anything you can suggest for me to tell him or suggest to him? Any help will be greatly appreciated, because I just don't how to help him. Thank you so much.

—A friend on-the-line

Dear A friend on-the-line,

First off, good for you to look out for your friend and seek some support for yourself in the process. Everyone feels "blue" at certain times during his or her life. In fact, transitory feelings of sadness or discouragement are perfectly normal, especially during particularly difficult times. But, a person who cannot "snap out of it," or get over these feelings within two weeks, may have depression. Depression is a real illness that comes in many kinds and degrees. Demoralization is usually part of depression, but it's not the whole story. The good news about depression is that it is treatable; many people with depression find that talk therapy, medication, other treatments, or a combination of treatments, do wonders to help them feel more like themselves. Below are some signs and symptoms of depression.  Remember, not all of these features are present in every depressive episode.

  • feelings of sadness, hopelessness, and irritability that seem to have no causes
  • loss of interest or pleasure in usual activities, including sex
  • poor appetite and weight loss, or increased appetite and weight gain
  • sleep problems (i.e., insomnia, oversleeping)
  • feelings of worthlessness, guilt, and helplessness
  • restlessness
  • decreased energy, fatigue, and feeling slowed down (lethargy)
  • difficulty concentrating or making decisions
  • excessive crying
  • chronic physical aches and pains that don't respond to treatment
  • thoughts of death and suicide
  • alcohol or other drug abuse  

Have you tried to gently and directly talk with your friend about your concerns? Consider letting him know concretely what you observe about his behavior, that you think he needs and deserves someone's full attention to his feelings and worries, and that there are many people out there trained and willing to give him just that. Have you considered offering to go with him to a counselor's office? Or perhaps just sitting with him while calling a help-line?

If he's a student at Columbia, he can make an appointment by contacting Counseling and Psychological Services (CPS) (Morningside) or the Mental Health Service (CUMC). Outside of Columbia, you can contact the Depression and Bipolar Support Alliance. You can also check out Befrienders International to find a support hotline near you.

It is normal for you to develop frustrated feelings regarding your friend. It sounds as if you have already offered advice, suggestions, support, and comfort, and it seems as though your efforts have been to no avail. Remember that gentle persistence sometimes pays off. And, you can call either of the hotline numbers yourself to relieve some of your own anxiety, or to get more ideas for helping your friend.

You may also want to check out some of the related questions and answers below (including the one on low-cost counseling). Regardless of how you proceed, simply letting your friend know of your concerns and availability to be a support is an important step. As much as we want to help, it's up to the individual to make a change. Be sure to take some time for yourself in the process and kudos for the deep level of caring.


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