When we rethink the care provided for a person with depression, who do you think is at the front-line of care? Do you think it’s the psychologist whom the patient meets at least once a week, or is it the families, close friends, and others closest to the individual with depression? Many regard psychologists as the most prominent carer for depressed individuals; however those who are the closest to the depressed individuals are in fact at the front-line of care. Research demonstrates that the strength and quality of relationships between family and friends significantly contribute to the improved wellbeing of individuals suffering from depression (Montgomery et al., 1987). Keeping in mind the caregivers who are at the front-line of care and how depression can substantially affect the dynamics of close relationships, do we ever wonder the intensity of emotional toll caregivers could experience?
Research by BMC Public Health (2010) demonstrated the wellbeing of individuals was negatively impacted when romantic partners were diagnosed with depression. Furthermore, spouses of those with depression were more prone to exhibit signs of anxiety and depression themselves.
Coined by Anne Scheffield (1999), Depression Fallout is defined as the emotional toll experienced by people living close to the depressed person. It is an uninvited response to someone else’s depression, which begins with a confusion with the other person’s illness. Unaware of the root cause of depression, individuals suffering from Depression Fallout begin to blame themselves. Depression fallout does not discriminate, whatever the relationship with the individual experiencing depression, be it spouses, parents, lovers, or child, this experience leaves its negative impacts on people who live close to the illness.
“Most tales of depression fallout begin with a mystery. Why is someone you love becoming more remote, as though the connection between you had been uncoupled? Why is he or she so distant and dissatisfied, so lethargic but demanding? You assume some fault on your part, but when you ask what’s the matter, you are rejected. Far from improving the situation, you soon see yourself cast in the role of intruder and adversary. You look for causes and explanations.” (Sheffield, 1999)
The sudden observed dysfunctional behaviours that do not go away with time and the need for additional support leave the caregivers puzzled, anxious, and afraid. Caregivers often feel pressure to stop the depression from worsening, while experiencing resentment for being emotionally pushed away by the patient. Furthermore, caregivers become frustrated with the patient's helplessness to heal.
Questions to the self like “What have I done wrong?” “What can I do to fix this?” “Am I not enough in the relationship?”are common for people in close relationships with the depressed. Caregivers will often start internalising harmful emotions due to ambiguity of the source of the depression and the growing dysfunction in their relationship with the depressed individual.
Demoralisation is the central aspect in depression fallout. It deprives the person spirit, courage, and discipline; destroys their morale, and throws them into disorder and confusion.. During this stage, caregivers will experience a decrease in self-esteem and will feel guilty for being upset and exhausted with the dysfunctional relationship.
The dividing line between demoralisation and anger is blurred – often the two stages fuse, then separate, then come together again.
There is a difference between separation and abandonment. Often, those close to the depressed feel they will be abandoning their loved one if they distance themselves. Decisions to stay or to leave the relationship are always accompanied with guilt. “He/she is ill, so I must stay” is the axiom of depression fallout. Therefore, caregivers will often harm their own mental health by failing to allow themselves to separate from the depressed individual when they need to.
Caregivers who truly care about the individual with depression and are willing to adjust to their relationships will find ways to make the situation better. Research by Muscroft & Bowl (2000) suggested better relationship dynamics followed after the caregivers’ first encounter with the depression, which was normally characterised by depression fallout. Over time, the presence of depression was perceived as enduring and this led caregivers to create new normality in their relationship with the depressed by integrating the aspect of depression into their relationship. One stability was reached, all parties in the relationship dynamic slowly accepted the fact that depression is something that sometimes goes away and returns, and the role of being a caregiver might be persisting.