How Do You Serve A Friend in Despair?
The hard lessons learned when a loved one falls into depression.
My friendship with Peter Marks was created around play. Starting at age 11, we played basketball, softball, capture the flag, rugby. We teased each other, pulled pranks, made fun of each other’s dance moves and pretty much everything else. We kept it up for five decades.
My wife has a phrase that got Pete just right — a rare combination of normal and extraordinary: masculine in the way you are supposed to be masculine, with great strength and great gentleness. A father in the way you are supposed to be a father, with great devotion, fun and pride. A husband the way you are supposed to be a husband, going home at night grateful because the person in the whole world you want to talk with the most is going to be sitting right there across the dinner table.
Over the years, Pete and I often spoke about the stresses he was enduring over the management of his medical practice, but I did not see the depths of what he was going through until we spent a weekend with him in the spring of 2019. My wife noticed a change immediately. A light had gone out; there was an uncharacteristic flatness in his voice and a stillness in his eyes. One bright June afternoon, he pulled us aside and told us he was not himself. He was doing what he loved most — playing basketball, swimming in the lake — but he could not enjoy anything. He was worried for his family and himself and asked for our continued friendship and support. It was the first time I had seen such pain in him — what turned out to be severe depression.
I was confronted with a question I was not prepared for: How do you serve a friend who is hit with this illness? I tried the best I could, but Pete succumbed to suicide last April. This article flows from what I learned from those agonizing three years and that senseless tragedy.
First, I need to tell you more about Pete. We met as kids at Incarnation Camp in Connecticut. We were campers and counselors together for a decade and remained close. At camp, Pete was handsome, strong, athletic and kind. There was an
exuberant goofiness about him. I remember once, in a fit of silliness, he started skipping around the dining hall, singing, and leaping higher with each skip. He tried to skip out of the room, but slammed into the top of the doorframe and fell flat on his back. The rest of us, being 16-year-old junior counselors, found this hilarious. Pete, also being 16, found this hilarious, too. I remember him lying there in a fit of giggles, with a bruise forming on his brow.
Pete did well in college, joined the Navy, went to medical school and became an eye surgeon. He seemed, outwardly, like the person in my circle least likely to be afflicted by a devastating depression, with a cheerful disposition, a happy marriage, a rewarding career and two wonderful sons, Owen and James. But he was carrying more childhood trauma than I knew, and depression eventually overwhelmed him.
At first, I did not understand the seriousness of the situation. Some people imagine the worst. I tend to assume that everything will work out. Over the next months, severe depression was revealed to me as an unimagined abyss. I learned that those of us lucky enough never to have experienced it cannot understand what it is like just by extrapolating from our own periods of sadness.
During the Covid pandemic, Pete and I spoke by phone. In the beginning, I made the mistake of trying to advise him about how he could lift his depression. He had earlier gone to Vietnam to perform eye surgeries for those who were too poor to afford them. I told him he should do that again, since he found it so rewarding. I did not realize it was energy and desire that he lacked, not ideas about things to do. It was only later that I read that when you give a depressed person advice on how to get better, there is a good chance all you are doing is telling the person that you just do not understand. I tried to remind Pete of all his wonderful blessings, what psychologists call “positive reframing.” I have since read that this might make sufferers feel even worse for not being able to enjoy all the things that are palpably enjoyable.
I learned that a friend’s job in these circumstances is not to cheer the person up. It is to acknowledge the reality of the situation; it is to hear, respect and love the person; it is to show that you have not given up on him or her, that you have not walked away.
Time and again Pete would talk about his great fear that he would someday lose his skill as a surgeon, that he would cease to be a healer, that he would lose his identity.
As Pete spoke of his illness, it sometimes seemed as if there were two of him. There was the one enveloped in pain and the other one who was observing himself and could not understand what was happening. That second self was the Pete I spoke to for those three
years. He was trying to figure it out. He was going to the best doctors. They were trying one approach after another. The cloud would not lift.
I am told that one of the brutalities of the illness is the impossibility of articulating exactly what the pain consists of. Pete would give me the general truth, “Depression sucks.” But he tried not to burden me with the full horrors of what he was going through.
After a while, I just tried to be the easygoing friend who I always had been. Perhaps the most useful thing I did was
send him a video. My friend Mike Gerson, a Washington Post columnist who died of complications of cancer last November, had been hospitalized with depression in early 2019. He had delivered a beautiful sermon at the Washington National Cathedral about his experience. Depression, he said, was a “malfunction of the instrument we use to determine reality.” Then he talked about the lying voices that had taken up residence in his mind: You are a burden to your friends, you have no future, no one would miss you.
That resonated with Pete and gave him a sense of validation. He, too, would describe the obsessive-compulsive voices that would attack him from inside his own head. Mike also talked about the fog
eventually thinning, at the glimpse of beauty or of love, and reminded Pete that “there is something better on the far side of despair.”
Still the clouds refused to lift. The years went by and medications and treatment programs continued to fail. Pete and his wife, Jen, began to realize how little the medical community knows about what will work. They also began to realize that mental health care is shockingly siloed. Pete saw outstanding doctors who devoted themselves to him, but they work only within their specific treatment silo. When one treatment did not work, Pete would get shuttled off to another silo.
Pete developed theories to explain why this had happened to him. He pointed to a series of traumas and neglect he had suffered at home as a child — events he had vaguely referred to before, but had never gone into in detail with me until his final years. He thought part of his illness was biology. Think of it like brain cancer, he would say. A random physical disease.
I agree with some of that, but I am also haunted by the large number of medications doctors put him on. His path through the mental health care system was a scattershot array of treatments and crushing disappointments.
Pete and his family joined us for Thanksgiving in 2021. We all played basketball and board games and enjoyed the weekend. I felt some hope. But Pete appears in one of the photos that were taken that weekend, sitting on the couch, still-faced, enveloped in shadow. One afternoon, he asked my wife to pray over him.
The experts say if you know someone who is depressed, it is OK to ask explicitly about suicide. The experts emphasize that you are not putting the thought into the person’s head. Very often it is already there. And if it is, the person should be getting professional help. When Pete and I gestured toward the subject, we just talked about what a magnificent family he had, how much they all loved one another. I tried to tell him that this darkness would lift, though as the years went by and the therapies failed, his faith in deliverance waned.
We had dinner a few days before Pete died. Jen and I tried to keep the conversation going. But their ride home was heart-rending. “How can I not be able to talk to my oldest friend?” Pete asked.
I have read that depression makes it hard to imagine a time when things will ever be better. I have no evidence, but knowing Pete, I strongly believe that he erroneously convinced himself that he was doing this to help his family and ease the hardship his illness had caused them. Living now in the wreckage, I can tell you that if you ever find yourself having that thought, it is completely wrong.
It is ridiculous that we still know so little about depression. We have had generations of scholars and scientists working in this field, and yet U.S. suicide rates in 2020 were 30 percent higher than they were in 2000, and one in five American adults experiences mental illness each year. We need more research to figure this out.
If I am ever in a similar situation again, I will know that you do not have to try to coax somebody out of depression. It is enough to show that you are trying to understand. It is enough to create an atmosphere in which the sufferer can share. It is enough to offer the comfort of being seen.
I do not feel guilt. Pete had teams of experts walking with him through this. He had his wonderful wife and kids, who accompanied him lovingly and steadfastly every day. There is no reason for any of us to feel like failures because we could not alter what happened. Every case of depression is unique, and every case is to be fought with as much love and endurance and knowledge as can be mustered. But in this case, the beast was bigger than Pete; it was bigger than us.
Pete’s death has been a cause of great disorientation. He had been a presence for practically my whole life, and now the steady friendship I took for granted is gone.
One great source of comfort has been the chance to glimpse how heroically Pete’s boys have handled this loss. Two months after Pete’s passing, my eldest son married. To my astonishment, Jen and the boys were able to attend. At the reception, the boys gently coaxed their mother to join us on the dance floor. It felt appropriate since this is what we did at camp; dancing skeined through our lives.
I have a sharp memory of those two young men dancing that evening, and a million memories of the parents who raised them so well.