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How to Approach a Loved One Whose Mental Health Might Be In a Downward Spiral

[fa icon="calendar"] Sep 9, 2021 10:02:33 AM / by Calm Collective Asia

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Picture this: your friend starts rejecting invitations to social gatherings, stops replying to your texts and answering your calls, and when you do finally meet in person, your friend is withdrawn and quiet and may even be crying for seemingly no reason. You start to think, maybe something is off, maybe your friend is spiralling. What should you do?

A downward spiral is when people start slipping into a lower mood and their mental health seems as though it’s declining. The nature of mental illness is that it drains cognitive functions and the downward spiral comes with a sense of hopelessness, frustration, and oftentimes, anger. It is important to note that spiralling, especially in the context of mental health, looks very different for different people, so discretion is critical. But if you are close enough to a loved one, you will be able to notice a change in them, whether it’s their mood, temperament, personality, behaviour, social habits etc. 

If you suspect that your loved one is spiralling, here are a few tips to approach them: 


#1: Address the person directly, rather than discuss the person's "symptoms" behind their back, then do a group intervention.

I live with bipolar II / manic depressive disorder, which means that my highs are very high and my lows are very low. Bipolar II means that I get hit by depressive episodes more often, but I do occasionally swing to the opposite end of the spectrum and experience hypomania, in which state I am extra productive, being able to achieve a lot of things all at once but get very little sleep, talk very fast and have racing thoughts. When I’m in hypomania, my friends find it difficult to catch up with me and I can be “too much” for them.

Since my diagnosis in 2018, I have had my fair share of group interventions where my friends have sat me down and taken turns to tell me all their observations and feedback about my mental health symptoms. And this is one of the most annoying and frustrating things that my friends can do to me as they support me on this journey. I much rather they address me directly one on one, rather than to feel like they have been discussing my symptoms behind my back before deciding to do a group intervention, which I find very hurtful because 1) it feels like they are ganging up against me and 2) they don’t trust me to be receptive to their direct feedback. I end up feeling more alone and second-guessing myself even more. 

That said, it’s totally understandable to be scared - mental illness is still a very taboo topic that isn’t well understood today, and it can be intimidating to approach your loved one as you might be afraid to say the wrong thing that might trigger them. Also when people are depressed, anxious or manic, they can become more irritable or enter into what I’ve termed "irritable mode" without knowing. They may lash out or overreact when given feedback. This is part of the condition. Be patient, and *try your best* to separate the condition from the person you love so dearly. 


#2: Do it as early as possible

The key to avoiding a full-blown psychiatric episode (whether depression, hypomania/mania, anxiety etc) is to arrest the symptoms as early as possible. 

Don’t be so afraid of the person that you don’t dare to talk to them till it's too late. If you spend a lot of time with your loved one, you have an important role to play as “signposts/markers” to point out early warning signs that they might miss themselves because they are in too deep and are the ones experiencing it and hence need the help of a third-party observer.


#3: Listen with love

If you tell someone what to do (also known as “unsolicited advice”), they might feel micromanaged or even suffocated. When listening to your loved ones, you should hold space for them, and be an outlet of sorts for them to cry or rant or release certain emotions. 

Be careful not to be judgemental. Turn off interfering thoughts. If you limit yourself to only listening to what your loved one has to say, you will be able to absorb their whole message, and the person will feel heard. For this to happen, you need to prevent your mind from wandering and maintain the discipline of being present. This will allow you to be free from preconceived notions or biases based on your own past experiences. 

Don’t look at your loved one as a “project” that needs fixing. The last thing you want is them thinking you have some form of saviour complex and be completely turned off by all your interactions. 


#4: Respond with empathy

Empathy over sympathy, always. This distinction is so important. 

Based on this post on The Medic Portal: “Empathy is the ability to understand and share the feelings of another. Sympathy is similar and easy to confuse, but not half as useful - sympathy is the feeling of pity or sorrow for someone else.

When you respond to your loved one with empathy instead of sympathy, your loved one will feel heard, seen, understood and loved by you. Your loved one will feel like you are treating them like an equal in the relationship, rather than someone weak you are simply taking pity on. 


#5: Don't overreact and don't be critical, harsh or overly involved

There is a term in psychology: expressed emotion – which is defined as “negative attitudes and comments on the part of the caregiver directed toward a person with a mental disorder. It has been “associated with poorer outcomes in mood, anxiety, and schizophrenic disorders and an increased likelihood of relapse.” EE, while with the most well-meaning of intentions, heightens the risk of relapse. You can read more here.

A lot of caregivers tend to accidentally be high EE, because it is just the nature of how they react to certain situations. It is important to be aware of the effects on your loved one when you are being high EE and try to reframe some of your phrasings or soften your language. Also do note that only psychiatrists should make a diagnosis - if you are not medically trained, never make a diagnosis of your loved one as this is a very dangerous path to go down.


#6: Don't impose your own ideas of "recovery" or "health" or "self-care" on the person - everyone's journey looks different.

We are all unique individuals with unique personalities and unique mannerisms. Similarly, our mental health journey - our symptoms, triggers, coping mechanisms -  are all unique. Imposing your own ideas of what good mental health looks like would be very unhelpful and counterproductive. 

For example, your loved one’s idea of self-care may be reading by themselves at a cafe for hours on end and not talking to anyone, while your idea of self-care might be going out to the movies with your friends. There is no right or wrong approach to self-care - it depends on each individual; what nourishes their soul and energizes them.


#7: Encourage your loved ones to express their needs, and how they want to be supported. 

When I was first diagnosed with depression some three years ago, I wrote an open letter to all my loved ones on how to support me. Do take the harsh tone with a slight pinch of salt though; I was coming out of depression and hence was in a little bit of an “asshole mode” - refer to point 2 about separating the condition from the person. 

Having your loved ones express their needs and how they would like to be supported is very useful as it establishes a channel of trust, open communication and mutual understanding between the two of you. You now become a safe space for your loved ones and this forms a manual or a guide of sorts on how to be there for them. 




So there you have it! Some life hacks to approach a loved one you think is spiralling and be a safe space to hold them while they fight an inner war you are fortunate enough not to be on the frontlines of. My friends and I have experimented enough to know what works and what doesn’t work and hopefully, you get to learn from my experience, and this helps to save you precious time to intervene in a timelier and more effective way. 




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Topics: Mental Health, Self Care, Road to Recovery

Calm Collective Asia

Written by Calm Collective Asia

Calm Collective is a social enterprise with a team of 20+ individuals that believes in a community for good mental health in Asia. Our mission is to break the mental health stigma in Asia to give people the confidence to get the help they need - before it's too late. We host virtual talks & events (Calm Circles), and create helpful mental health content for our community. You can find us on Instagram, Facebook, Telegram, and Clubhouse. We also have a blog and a podcast: Calm Conversations.

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