Hello, friends. In this Q&A episode, I answer two great questions that ask for advice on how best to help a school friend who you think is depressed, as well as questioning your gender identity and helping to navigate this personal journey.
Hello Mr. Duff,
I am writing to you because I am concerned about a friend and I do not know what to do. My friend has no motivation to do anything, he has not been in classes for a long time, he does not do homework, and he told me he needs motivation to do everyday things like brushing teeth. He also has very low self-esteem and self-respect. When he tells me this, I ask him if he ever thought about getting therapy and he says that his family can’t really afford it and that if someone got it, it should be his brother. I know his brother and it is clear to me that they both really need it. Especially the friend I am talking to you about. I thought about maybe asking the teacher to specially help him out or something like that, but I don’t know if I am overreacting or if he is actually becoming depressed. It is also clear that nothing I say, he will believe and seeing him so down makes me worried. Sometimes when he tells me something, I tell him he sounds depressed. He says he isn’t depressed he’s anxious. Even if you don’t answer this email on the podcast, I would really appreciate if you could email me back. I know you already have a lot of emails waiting to be answered. (If it helps for you to know, he’s fifteen and a boy.)
Thanks for the great question and thanks for caring. I know that I have a lot of young listeners out there, so I appreciate your attention and I want you to know that I take you seriously.
To answer the broad question first – I can’t diagnose your friend without being able to meet and work with him, but overall it does definitely sound he could potentially be depressed. However, you also have to realize that it’s not your place to diagnose him or decide what to do with him either. Essentially, your role here is as someone who cares and wants to help in any way that you can. You may not be able to fix the situation. You have to understand that.
Let’s talk about some of the symptoms that I’m hearing here that suggest what you friend is experiencing might be depression:
- Low motivation – the not even brushing his teeth thing is very telling. Very simple tasks can seem like they take tons of energy
- Anhedonia – lack of feeling pleasure when doing fun/pleasurable activities.
- Agitation – he might be mistaking this for anxiety. You can definitely feel wound up when you are depressed. However, it is also very common to experience both depression and anxiety.
- Sad mood – that’s why you tell him he sounds depressed when he talks to you about things.
Overall, one of the most important criteria when diagnosing someone with a mental disorder like depression is to see if it is significantly impacting their life. In this case, it definitely seems to be impacting your friend’s schooling. You said that he hasn’t been to classes in quite a while and doesn’t do homework. Hearing your friend say (and you agreeing) that his brother needs therapy too makes me wonder if there is some turmoil at home and in the family environment that is contributing to this. Whenever considering someone’s mental health, it helps to look at the impact of different spheres on their life. On the small scale, they have their immediate family unit. On the broader scale, they have things like school, their neighborhood etc., and on the broadest scale, there are things like society and the systems that they live within. So there are layers to this and it might not just be as simple as recognizing the depression and putting a stop to it. It’s hard to heal in the environment that’s making you sick. BUT that doesn’t mean that you shouldn’t do anything. Anything is better than nothing.
Let’s talk about what you can and should do here. First off, I don’t think that talking to the teacher is going to be the best idea. Teachers aren’t really always adequately trained for this kind of thing. They might not handle the situation delicately, and as a result, your friend might see talking to the teacher as a serious invasion of privacy. If you have an on-campus school counselor, that might be a better place to turn. You can be vague with them to start with. Say that you have a friend that you worry is depressed, explain what you explained to me, and ask them for some guidance. They might have some resources that you can pass along to your friend or they may have a nicer way to try to intervene with your friend. It’s a great starting place if you have one available.
You can also educate yourself about depression and guide your friend toward resources that you find. There are gazillions of great videos, blog posts, podcast episodes, and other kinds of media that explain depression and give great coping tips. Overall, though – I want you to remember that this isn’t your responsibility. You are not going to be able to fix him. All of that is too much for a kid to take on. But your care and support really does matter. Even if you don’t think that you are getting through to him, continue to express your care and your concern for your friend. I wouldn’t treat them like they are damaged goods. It’s okay to have fun and be normal with them too, but when you see them showing these significant signs of depression, keep telling them that you are concerned and think they deserve to get help.
Your friend may also need to learn that there are many different options when it comes to getting help. Some of them are free. Local universities often provide low cost or free therapy. It is also often covered by insurance. If it is safe for them to do so, the best way to start this process would be to talk to their parents about it. Their parents may be interpreting their lack of effort at school as them being a punk kid, but are missing the point that your friend is actually depressed. Other starting points would be the family doctor or school counselor.
Keep caring. Don’t try to take over and force your friend to do anything. Give your suggestions and try to guide your friend toward resources, but remember that your role is just to show that you care in the best way that you can.
Hi Robert, I was wondering if you could talk about how you deal with patients questioning their gender identity and how you help them navigate their transness. I am 25, and up until a few months ago, it had never occurred to me that I might be trans. Increasingly though, I have felt a big disconnect from my period and my chest, as if these phenomena and attributes were alien to me. Now, I’ve already experienced depersonalisation in the past, especially when tired or depressed. But this time, it seems to be only triggered by seeing my chest or my period. This discomfort isn’t actually new. I wasn’t already very keen on having breasts growing up, and it felt like an intrusion in my body. I did develop an eating disorder around age 13 (which I’m happy to report I have finally beaten over the last year!), and I know that one of the things that drew me to severely restrict my food and overexercise was that, the skinnier I was, the less curves I had, and the more androgynous I looked. I never felt male though, and that is why it took me so long to question my gender.
Over the past few years (but especially the past year), I have been increasingly aware of there being people identifying as non-binary. At first, I didn’t think it had anything to do with me, as it seemed quite obscure and multi-faceted (obviously, since non-binary people are all a different expression of what it means to be neither male or female). It’s also something I’ve found very little information on, whether occurrences of non-binary people in history, or criteria to qualify as non-binary. There are personal accounts of people on the internet, which is invaluable to me, but I guess I was looking for “objective” sources and reports. More than anything, I would like to know if I am the right direction, and I don’t appropriate an identity that isn’t mine to take. As a bisexual, I am pretty open to gender being fluid, and I don’t feel too scared at the thought of rethinking how I identify. I also am aware that, whether I want to change my pronouns and the name I go by, even just temporarily, it’s okay, because it’s just another way of making myself more comfortable.
I was just wondering if you had any advice on how to navigate this questioning of your gender identity. Thank you so much for all your work. I’ve been following you since your ASMR days, and I’m so glad I stuck around. You provide such good in-depth content, and both the books and the podcast have been useful tools for me to understand myself better and be more empathetic to others. I hope you and your loved ones are all okay during this time
Thank you for trusting me with this question. I’m not fully equipped to give you an informed opinion about this, but I will give you some thoughts that try to point you in the right direction. I am not trans and I do not belong to the LGBTQ+ community, although I have many friends who are in the community. I also work with trans people in my clinical work/work as Duff The Psych.
I do want to say that it’s not too late for you to realize that you are trans – there are so many factors at play. It’s definitely common for people to realize this and even transition later in life. It is also common for someone’s understanding of their gender identity to shift over time. For instance, some people may know that they do not identify with their assigned sex but beyond that are unsure if they are trans, nonbinary etc.
A lot of the experiences you talked about like developing an eating disorder so that you didn’t have curves and feeling this depersonalization when confronted with biological things such as your period are common and familiar stories of people that experience gender dysphoria. Gender dysphoria is what we call discomfort or distress that is caused by a conflict between the gender that someone has been assigned and the one that they experience subjectively or identify with. So for example, a person that is born with female anatomy and has been told that they are a girl throughout their life may experience significant gender dysphoria if their gender is in fact male. This person may know that they are a man but feel trapped in a woman’s body, which understandably is not a pleasant experience.
Often people feel significant dysphoria when they are confronted with reminders of this conflict. So thing like puberty and the development of secondary sex characteristics may throw someone into dysphoria. Or, as you mentioned, having a period can definitely be one of those triggers. Dysphoria presents differently for everyone. For some people, it is expressed as depression. I know someone that would become very depressed and even suicidal when feeling a lot of dysphoria. For this person, her dysphoria would often be connected to her facial hair.
Feelings of depersonalization are very common and actually make a lot of sense when it comes to gender dysphoria. Depersonalization is the feeling of being disconnected from your body. Often it feels like you are an observer or operating on autopilot. You aren’t in control of your body – it’s just doing its own thing and you are a disconnected observer along for the ride. If you feel at war with the body that you live in, being disconnected can be a coping mechanism. So all of this is to say that your experience is totally normal for what you are going through. You don’t need to feel weird or odd about it. Obviously you feel a little tentative because you are still learning about your own gender identity and you are wary of claiming an identity that doesn’t belong to you. I can respect that.
Talk to others
I think one of the best things that you can do is get some perspective from people that have been there. Talk to trans people. Talk to nonbinary people. Talk to people that get it. I can’t give you any advice from a lived experience perspective because I am a mostly hetero cisgender white dude. Organizations like the Trevor Project have great resources and may have ways to connect to people. With the internet now, there are tons of great resources and communities that you can find to connect with other people who can give you advice and their perspective. Talk with these people, see their experiences, and share what you are going through. If you have a support network in your personal life, it may be important to engage them too. You don’t have to out yourself to everyone, but it makes such a huge difference when you do have someone that you can trust and confide in. Even if it’s only one person.
If you have the ability to do so, find a good therapist. One that focuses on LGBTQ issues. This can sometimes be a challenge, so if you don’t have someone in your local area that you can work with, maybe it would be a good opportunity to try out online therapy. I have a video about finding a private online therapist (vs something like BetterHelp) at https://www.youtube.com/watch?v=XhCzZ4hVxxU. Having a therapist that can be empathetic and support you as you are navigating these very complex and confusing issues can be a major help.
I wish that I could give you more direct advice as to whether you are “moving in the right direction”, but that’s not really for me to say. This is your own identity that you are discovering. I think the best course is to be gentle with yourself for having these hard and confusing feelings, to gather experiences that you can learn from, and find support from people that understand. Over time, this support and information network will help bolster the self-discovery that you are doing.
You can take whatever time you need. This is your life we are talking about here. There is no deadline for figuring this out. I know that it can feel intense and you may want to make some decisions to simply reduce the dysphoria that you feel, which is understandable. It’s your right to make whatever choices you feel are right. But don’t feel guilty because you aren’t sure yet. This is your journey.
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