In this counseling answer:
• It’s important that you realize that you are a safe place for her to come back to.
• People with mental health disorders need support and understanding. Merely providing a listening ear can be a great help.
• The key is consistency in treatment.
• If, at any time, your friend discusses death or dying, please do notify somebody who is close to her, take her to the nearest emergency center, or call 911.
• Ask her to write out a contract promising that she will not harm herself and that if she does feel like harming herself, she will call you, her mom or someone else that she feels safe with.
• During any anxiety attack, assure your friend that the feelings are uncomfortable, but they will pass.
• Try not to take responsibility for other’s actions or non-actions (not going to treatment). Provide healthy support but know when to pull back.
Assalamu alaykum dear brother,
Thank you for writing to us and trusting us with your concerns towards your friend. May Allah bless you for your genuine care and concern. I am sorry to hear about the issues your friend is having with anxiety and depression.
Anxiety and Depression
I’m not sure how much knowledge you have on anxiety or depression, but if she is indeed diagnosed with both disorders, they are major mental health issues. Depending on the type and severity of anxiety and depression, it may influence her behaviors, thoughts, and the way she communicates.
In the case of depression, some people suffer from chronic depression throughout their lifetime. In a case such as this, a person with depression may tend to come and go when it comes to communication and activities.
As your friend came out of an abusive marriage, it is likely that she’s still experiencing trauma from being abused. In addition to depression and anxiety, she may also experience post-traumatic stress disorder (PTSD).
This occurs when people experience or see a traumatic event. Being abused is extremely traumatic. Her behaviors of being clingy and needy one moment and then disappearing for months are typical with those who have depression and anxiety.
However, when she apologizes to you, she truly means it. She doesn’t mean to be this way, but due to her illness, she cannot help it. As your friend seems to really trust you, it’s important that you realize that you are a safe place for her to come back to. To her, you are a person that she goes to because you make her feel calm, reassured, and safe.
Depression and anxiety are common. In fact, they are among the two most common mental health disorders. People with mental health disorders need support and understanding. A lot of times, people do not discuss the fact that they have anxiety or depression because they are embarrassed.
These disorders are often stigmatized, so people might feel ashamed to discuss them. In order to negate these variables, they may pass it off as a physical illness.
Anxiety and depression often go together (comorbid). The good news is that there are very effective treatments for both anxiety and depression, however, the person must be willing to get treatment.
For both anxiety and depression, therapists use various medications and modes of counseling with high rates of success. Again, the key is consistency in treatment. As you indicated, your friend refuses to go.
Sufferers refuse to get help for many reasons such as stigma, fear, lack of resources, shame, or inability to rationalize that they need help.
The communication between the two of you has been scattered and intermittent throughout the past few years. That’s probably due to her depression and anxiety, as well as any feelings of guilt due to her being a Muslim.
As a Muslim, she probably knows that it’s haram for her to be talking to you alone. However, the friendship is beneficial for her in that you are supportive, understanding, and giving her hope. The relationship appears to be one based on a pious desire to truly act in a humanitarian way to help her.
It could be a form of charity. It’s said that even a smile to a passing stranger is a form of charity. Despite that, keep in mind that there is only so much you can do to help her except be supportive. Ultimately, it’s up to her to seek treatment.
When someone is depressed, oftentimes they won’t like to socialize, they will withdraw, and they feel that things are hopeless. They often have sleeping disorders such as sleeping all the time, feeling fatigued, or insomnia.
Some people experience loss of self-esteem, joy, hope, and a disinterest in life in general. There are many other symptoms that go along with depression; however, these are just some basic ones that may present in relation to what you are talking about.
When befriending someone who is depressed, it is always good to encourage them to talk about how they feel when they are down, if they are willing. Talking about what one is going through with depression acts as release valve.
That means that the pent-up feelings of sadness and despair are talked about. This is called venting. Merely providing a listening ear can be a great help. You can, however, ask the person what they would like to do regarding how they feel.
Check out this counseling video:
For instance, if your friend says: “oh I’m so sorry I haven’t been in touch, I just can’t get out of bed because I’m so depressed, I don’t want to go anywhere or see anyone”, you could respond empathically and say: “I can imagine that must feel pretty bad for you, how do you feel you can change that?”.
By asking questions, you may in shaa’ Allah get your friend to think about what her options are. It also shows her that you care about and respect her responses and insight into her own issues. You could ask if she thinks that she needs counseling or if counseling would be beneficial.
By asking rather than telling, you are empowering her by seeking her insight into her problems. You could even share a story of your own if you have experienced depression, or of somebody close to you to create an understanding.
By illustrating to your friend that you care, you’re concerned, but that you also value what she has to say about her own situation, you create an empowered relationship for her. In some severe cases, however, this will not work.
People with severe depression, unrelenting anxiety, or those who are suicidal would need stronger interventions.
Sometimes when people are suicidal, they don’t tell anyone. They don’t tell, because they don’t want to be stopped. When people are very depressed and suicidal, they will suddenly appear happy or they will start giving gifts of items they own, or they may suddenly appear to be in full recovery.
That’s actually a very dangerous sign because it is not indicative of recovery but is a sign that they may be contemplating suicide. The sudden happiness, calmness, and resolve they illustrate is because they have decided to end their life. They are usually relieved about this decision.
Other people who are depressed may think about suicide and may attempt it. There are usually warning signs as well. Some who are depressed may talk about suicide and discuss how they don’t want to live anymore. They make statements such as: “I don’t want to wake up, I just can’t go on anymore” and so forth.
Others may even state they are going to commit suicide. These statements all should be taken very seriously. Those who tell others that they want to commit suicide may attempt suicide as a cry of desperation.
They may succeed even if they really didn’t want to die. They might feel like they want to, but deep down they don’t, and that’s why they inform others so that they may help them. Sadly, a high rate of suicide does occur because people do attempt suicide and are successful.
If, at any time, your friend discusses death or dying, please do notify somebody who is close to her, take her to the nearest emergency center, or call 911. If it’s not possible, utilize something that is close to her such as her little sister, her mom, or her favorite pet.
You could point out to her how this would affect her little sister, or her mom, or how her kitten would survive without her. While these may seem trivial to people who are not depressed, to a depressed person any little thing that you can pull that means something could be the reason they hang on.
In addition to utilizing people or things that are close to the suicidal person, ask her to write out a contract promising that she will not harm herself and that if she does feel like harming herself, she will call you, her mom or someone else that she feels safe with.
Indicate to her that it is her promise between you and her, and that you trust her. Have her sign it, and make sure that she has the number for crisis services in her area. Contact a family member of hers if things start to get dangerous.
Anxiety is also a disabling disorder and has many levels of severity. In moderate-to-severe forms, often there are times when people cannot function. They may become anxious or panic-stricken at the thought of going out, working, interacting with people, and other daily life activities.
Anxiety can be a disabling disorder. I am not sure what type of anxiety she has, as there are several, but it can prevent her from functioning in life. Anxiety can cause intense fear and apprehension, as well as physical symptoms such as rapid heartbeat, lightheadedness, choking up, inability to breathe, chest pains, stomach problems, shaking, feeling depersonalized, etc.
All these feelings can come and go several times a day or may occur occasionally. In the case of anxiety, one can develop fears. These fears can lead to avoidance behaviors.
For instance, if she used to meet you out for coffee and stopped, it could be that she had an anxiety attack while she was having coffee or on her way there. In her mind, she may associate the cafe or ride there with having another anxiety attack, so she will avoid that activity.
The main points for helping someone with anxiety is to help them through the process if they are having an anxiety attack and you are with them. For instance, if you are with your friend and you notice her becoming fearful, has difficulty breathing, or has other symptoms of an anxiety attack, you can assure her that these feelings will pass and encourage deep breathing techniques.
During any anxiety attack, assure your friend that the feelings are uncomfortable, but they will pass. Assure her that she will be okay and that you will be there with her. Encourage her to relax by asking her to focus on something pleasant.
For example, if you were at the park, it could be a pretty tree or a certain flower. Ask her to focus on that and at the same time have her close her eyes and breathe slowly in through her nose and exhale slowly through her mouth.
Tell her to say “Allah” as she is breathing. As she breathes in through her nose, she should say the first syllable “AH’ and exhaling very slowly say “LLAH”. Ask her to do these three times. You could also do it with her.
In shaa’ Allah, this should calm her down during anxiety. It is a technique many Muslims with anxiety utilize to refocus, gain control and do remembrance of Allah.
Brother, I am not asking you to be a therapist or a teacher, for that is not your role, your role is to be a supportive friend. However, these are some tips that can help should you need them.
It is Up to Her
Brother, in addition to all of the above, it is important to know that despite all the support, listening, and suggestions you make, the ultimate decision will be up to her, whether or not she wishes to address her mental health issues.
You have given her a lot of support and good direction by telling her to go for counseling/treatment. If she decides not to, there is nothing you can do except pray for her.
I understand that this is very emotionally exhausting. Please do not feel bad for feeling this way. It can be very difficult and draining to deal with someone who has depression and anxiety. It’s even more difficult to deal with someone who refuses to get treatment.
However, refusal to get treatment is sometimes part of the illness. Please do ensure that you take care of yourself too if you decide to continue to be a support for her. Your health is important and sometimes you may need to pull back or even end the support/friendship unless she does commit to treatment.
In shaa’ Allah, if you continue the friendship or have a family member who is suffering from anxiety or depression, make sure that you have a balance in your life. Take time for family, social interactions, fun times, and exercise. Eat good and healthful foods, practice stress reduction techniques, read Qur’an, and maintain your closeness to Allah.
Try not to take responsibility for other’s actions or non-actions (not going to treatment). Provide healthy support but know when to pull back.
Brother, I would kindly suggest, if you interact with your friend again, that you talk to her about Allah, his love, mercy, and refuge. Encourage her to read Qur’an, pray, make zakat, and to talk to Allah when she is feeling down.
Discuss with her the fact that Allah is most merciful and loves her very much. Encourage her to seek treatment and explain that as a Muslim it is incumbent upon us as servants of Allah to take care of any illness that befalls us, including mental illness.
We wish you the best,
Disclaimer: The conceptualization and recommendations stated in this response are very general and purely based on the limited information provided in the question. In no event shall AboutIslam, its counselors or employees be held liable for any damages that may arise from your decision in the use of our services.