How You Can Survive when They’re Depressed: Living and Coping with Depression Fallout

Sheffield, Anne. New York: Random House, 1999. (Paperback, 306 pages)

In this realistic and helpful book, Anne Sheffield describes what she calls “depression fallout,” the painful, debilitating emotions experienced by those living with a person who has a depressive illness. The valuable insight, information, and advice she provides is designed to help the reader in a battle against depression fallout, a battle that she says “has to be fought simultaneously on two fronts: yours and the depressive’s.”

The author writes in a straightforward, no-nonsense style, with imaginative phrasing. She chooses everyday language, using the old, familiar term “manic depression” rather than “bipolar disorder.” Her stated assumption is that the readers are persons living with someone with depressive illness. Thus, she addresses the reader as “you,” creating the feeling that she is sitting down with you and a few others and giving frank, “tell-it-like-it-is” advice and information. In this context, she often uses the phrase “your depressive” or “your manic depressive” to refer to the person with the illness. Ms Sheffield describes five predictable stages of depression fallout: confusion, self-doubt, demoralization, anger, and the desire to escape. Beginning with her own personal experience, gaining further insight in a family support group, and continuing to learn from other sources, she found these reactions surprisingly common, despite many differences in individual situations. She provides examples involving spouses, lovers, parents, and children—rich, and poor. Donald Klein, M.D., in his preface praising the book, finds that these stories “ring true.”

Ms. Sheffield’s premise is that obtaining effective treatment and staying in it is the critical element for both the ill person and those living with him or her. But compared with similar passages in many mainstream books, her approach is more realistic and down-to-earth, acknowledging the frequency of misdiagnosis, inadequate treatment, failure of the depressed person to take prescribed medication, and problems that remain even with good treatment. Her advice is tailored to overcoming these difficulties.

Emphasizing that knowledge about the illness is an essential tool in the battle against depression fallout, Ms. Sheffield includes up-to-date, succinct information about the illness, written from the perspective of the family member. For example, she lists the “official” list of symptoms of depression and then lists what she calls “unofficial” symptoms, which most often affect those living with a person who has a depressive illness.

The book provides an overview of the often conflicting medical and psychological theories and treatments available, with useful suggestions for negotiating the maze. Ms. Sheffield emphasizes the primary need for those with a depressive illness to get an effective medication. She maintains that the treatment is most likely to succeed when the patient, the family member, the psychiatrist, and the psychotherapist (if there is one) work as a team. She notes that many times the family member is the person most aware of the signs of the patient’s illness. If the treating professional refuses to accept calls from the family member, Ms. Sheffield urges that the professional be left messages when the patient stops taking medication or talks of suicide, or when there is other important information to communicate.

In the chapter title “Setting Boundaries,” the author makes clear that accepting the patient’s illness as a biological one does not mean that the family member or other person involved should passively accept the ill person’s behavior. On the contrary, she argues that the illness necessitates setting boundaries is two-fold: to help the person with the illness and to help those living with him or her to avoid demoralization and depression fallout.
Ms. Sheffield describes demoralization as the most common element of depression fallout, “arriving early and staying late.” The examples she gives throughout the book make its eroding presence crystal clear. In some individuals, the demoralization slips into a serious depression that needs treatment.
Although the insights, perspectives, and advice outlined in How You Can Survive when They’re Depressed cannot be expected to apply to every situation, they can be very helpful for persons struggling to cope with a family member or friend who has a depressive illness. As one rader said, this book can be a “light in the darkness.”

By Delphine Peck and Connie Pryor

Note: David V. Seaman contributed to this review.

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