Of course, every situation is different, and the ways that, say, an eating disorder manifests can be quite different from the way postpartum depression presents. But many bad circumstances do share common symptoms, and not all of them are obvious or widely known.
To be clear, none of the behaviors below calls for an intervention. But they can begin to tell you a story, especially when you notice several of them, or when they are coupled with other behaviors that ping as unusual or strange or off.
Mental/behavioral
Extreme mood changes or emotional reactions
Prolonged or strong feelings of irritability or anger
Avoiding friends and social activities
Apathy; lack of motivation; seeming “spaced out”
Appearing fearful, anxious, or paranoid, or acting secretive
Difficulty concentrating or focusing
Excessive worry or anxiety
Constant negativity
Excessive rumination
Inability to handle stress
“Joking” about hating yourself and your life
Fear about making a romantic partner angry
Physical
Feeling tired and low-energy all the time
Having trouble sleeping
Sleeping a lot
Multiple physical ailments without obvious causes (like an upset stomach, constipation, or constant headaches)
Getting sick all the time
Lack of interest in sex
Unexplained marks or injuries
Weight loss or weight gain
Habits
Keeping unusual hours (e.g., regularly sending you texts or work emails at 4:00 am)
Shopping excessively
Obsession with food and/or exercise
Neglecting personal hygiene
Ignoring household chores
Changes in eating habits (increased hunger or lack of appetite)
Unexplained financial problems
Changes in school or work performance
Drinking or doing drugs excessively (the Centers for Disease Control defines binge drinking as four or more drinks for women and five or more drinks for men in about two hours)
Reckless or self-destructive behavior
Odd, uncharacteristic, unusual behavior
If the red flags are piling up, it might be worth having a conversation about that; we’ll cover the responding aspect of this in Chapter 9.
Noticing That Someone Might Need Immediate Medical Attention
We’ve all heard stories of people who have experienced a major illness or injury but told themselves they were fine and didn’t need to go to the doctor . . . until another person insisted they get help, thus saving their life (or significantly improving the outcome). This is showing up for someone in a profound way, and while I hope none of us ever has to be that person, I also hope that we are all equipped to do it should that day come. Along with being able to recognize signs of emotional problems, you should also get familiar with the signs that a person is in trouble physically and needs medical attention ASAP.
Signs of alcohol poisoning
Confusion
Vomiting
Seizures
Clammy skin
Slow breathing (less than eight breaths a minute)
Irregular breathing (more than ten seconds between breaths)
Blue-tinged or pale skin
Low body temperature (hypothermia)
Passing out (unconsciousness), unable to be awakened
Signs of a drug overdose
Shallow breathing or not breathing at all
Snoring or gurgling sounds
Very sleepy or unable to talk
Disorientation/confusion
Floppy arms and legs
Blue-tinged lips or fingertips
High body temperature (hyperthermia)
Chest pain
Hallucinations
Passing out (unconsciousness), unable to be awakened
Signs of a heart attack
Pressure, tightness, pain, or a squeezing or aching sensation in the chest (that may also extend to the arms, neck, throat, jaw, or back)
Nausea, indigestion, heartburn, or abdominal pain
Shortness of breath (like they’ve just completed an intense workout when they haven’t done . . . anything)
Cold sweat
Fatigue
Extreme exhaustion or unexplained weakness
Lightheadedness or sudden dizziness
Signs of traumatic brain injury
Headache that gets worse and doesn’t go away
Weakness, numbness, or decreased coordination
Repeated vomiting or nausea
Clear fluids draining from the nose or ears
Slurred speech
Looking very drowsy
Losing consciousness (for a few minutes or a few hours)
Weakness or numbness in fingers and toes
One pupil dilated more than the other
Dizziness or vertigo
Convulsions or seizures
Inability to recognize people or places
Difficulty thinking, remembering (new or old information), or concentrating
Feeling “slow”
Getting increasingly confused, restless, or agitated
Agitation, combativeness, or other unusual behavior
Signs of a stroke
Sudden numbness
Sudden confusion
Sudden trouble seeing
Sudden trouble walking
Sudden severe headache
The American Stroke Association uses the acronym FAST to help people remember the signs of a stroke.
Face drooping
Arm weakness
Speech (slurred, or just trouble speaking)
Time to call 9-1-1 (for any of these symptoms, even if they go away)
So, some common themes here, right? Headaches, confusion, dizziness, difficulty breathing, difficulty talking, loss of consciousness, bad coordination, and extreme fatigue or weakness are . . . not great! Take this shit seriously, whether it’s happening to you or someone you care about.
The Importance of Patterns
Once you’ve noticed something (words, reactions, an emotional or physical state), the next steps are processing and naming. Processing is using the knowledge you already have—about the other person, about certain behaviors, etc.—to analyze what you’ve just noticed. Naming is identifying the “what’s really going on here”—the behavior, the need, the narrative of what actually happened—and recognizing its legitimacy. Naming might happen in your head (“This person seems insecure”) or out loud (“What you’re describing sounds really scary”). Naming is how life experiences begin to take shape and make sense, and can be a way to validate others and help them feel supported. (By the way, noticing, processing, and naming often happen quickly and almost simultaneously.)
The goal of noticing, processing, and naming is to spot patterns. (This applies to showing up for yourself, too.) Recognizing patterns will help you fully understand and see people, and get a sense of their baseline, everyday self. Once you know what your people are like when they are content or happy or “normal,” it’ll be easier to recognize when something is off, and to respond appropriately. (Remember, responding is the final step of showing up.) For example, if your friend who has faithfully gone to spin class three mornings a week for years and eschews alcohol is suddenly drinking heavily and skipping their morning workouts, you might decide to reach out and ask them how they are doing. But patterns aren’t just valuable when times are bad. Observing that someone loves a certain type of trivia or joke format might give you a new way to connect with them or make them laugh or give them a gift. It’s also just practical. If you notice that your friend values going to bed early or spends every Sunday with their parents, that might inform when you call/text them or plan hangouts.
If you’re trying to show up for people, observing patterns will take you far—maybe farther th
an anything else in this book. The more your words and actions are rooted in who they are and what they need, the more seen, known, and loved they’ll feel.
Chapter 9
When They’re Going Through Hard Shit
T he thing about life is that while it is great, it’s also terrible and unfair and cruel. If you’re lucky enough to have avoided trauma and tragedy in your social circles until now, I’m sorry to say that it won’t stay this way forever, and the best you can do is prepare. It’s sort of like living in hurricane or earthquake country, or even flying on a plane—you can hope disaster doesn’t befall you, but you should also have a working knowledge of what to do if it does.
When a friend is going through a hard time, you likely won’t be able to make the situation better. But you can help them survive. You can honor and validate their loss; bear witness to their experiences and pain; let them know that they are cared about and valued; and remind them that they are not alone. And you can not make things worse. (A lot of the advice in this chapter is rooted in that humble goal!) Even if you can’t make the situation better for your friend, you may be able to make them feel a little less bad.
But! Before you can do even that, there are a couple of “showing up for yourself” principles that are important to keep in mind.
First, know that showing up for others might make you feel quite vulnerable. Because even though it’s ostensibly something you do for other people, it can still feel risky! No one wants to look foolish or come across as lacking self-awareness. There have been times when I’ve considered showing up for someone in a small way and then balked—because I was afraid of looking like I didn’t understand the relationship, or of misreading my own ability to make someone feel better. My thought process was basically, “Who am I to send this person a SYMPATHY CARD?” which is completely at odds with my own well-established beliefs about sympathy cards and grief! I don’t know how to explain it; I just lost my nerve! I really regret not reaching out in those moments, and now I try to push through my fear and trust that doing something gentle and small is better than doing nothing. Taking that risk is what showing up for others is all about.
Second, you should only give what you actually have. When a person you care about is struggling, of course you want to do everything you can to make them feel better. But first, stop and think about what you specifically can truly offer in this moment. You shouldn’t go into debt (emotional or financial) when you’re showing up for someone else. (And really, the other person probably doesn’t want you to do that.) Give what you have, and trust that that will be enough.
Showing Up in Hard Times: The Basics
Being equipped to show up for others means knowing the basic responses and etiquette that apply in most difficult situations. (We’ll get into how best to respond to specific big common events here.) Regardless of what the person is going through, the following tips are a good place to start.
Keep your focus on them.
When listening to a friend in need, it’s crucial to actually listen. That means listening to hear, not listening to respond. It’s not that sharing your thoughts isn’t helpful; it’s just that it’s so easy to dominate the conversation without even realizing it. And what feels like being empathetic to you might feel like being silenced to them.
In We Need To Talk, Celeste Headlee cites sociologist Charles Derber’s description of two types of responses that exist in conversations: the shift response and the support response. The shift response draws attention to you; the support response keeps attention on the other person.37 Here’s what the two responses might look like in practice.
The shift response
Friend: I’m so exhausted all the time.
You: Ugh, me too. I haven’t been sleeping well at all lately.
The support response
Friend: I’m so exhausted all the time.
You: Oh? Are you not sleeping well lately, or do you think there’s some other cause?
Offering more support responses and fewer shift responses is a good conversational habit in general, but it’s especially wise to be conscious of this when your friend is going through a tough time.
Resist the urge to say, “I understand,” or to share your version of a similar-seeming experience.
It can be really difficult not to jump in with your own stories, particularly if the person is going through something fairly unique, or if you’re genuinely trying to demonstrate that you get it. But try to pump the breaks. In your attempt to empathize, you run the risk of totally missing the mark and, say, equating the death of their child with the death of your pet goldfish.
If you are confident you’ve had a similar experience that they might want to hear about, maybe say something like this: “I lost my mom to cancer when I was fifteen, and while I know I’ll never understand how you feel right now, I am here if you ever want to talk about losing a parent.” The key is to let them decide if the experiences are similar enough to bond over, and to frame it as “this is something we can talk about later” instead of derailing the current conversation to talk your experience.
When in doubt, ask.
It’s truly OK not to know what to say or do in response to a friend’s terrible situation. They might not even know what they want you to say or do. So if you’re not sure, ask. Here are some questions that you might want to ask in these moments.
“How can I best support you right now?”
This is my all-time favorite question when a friend is dealing with something difficult (or is simply stressed out). I like it because it communicates “I am here for you” while also saying “and I care about you enough to get this right.” It acknowledges that everyone is different and invites the individual to tell you what they need from you personally. It also shows humility; when you ask this question, you communicate “I don’t necessarily know best, and I’m open to feedback.” Finally, it gives them an opening to subtly steer you away from any of your default responses that aren’t going to be helpful to them at the moment (e.g., they can say “I need you to be my rock” if they know you tend to get really emotional).
“What are you in the mood for right now?”
This question gives your friend permission to set the tone of the conversation or hangout, and gives them the gift of control. They may not realize that they get to have a say in how they cope, so let them know that you’re here for them whether they’re in the mood to talk, laugh, cry, yell, vent, scream, do research, be cheered up, be sad, continue on with your original plans, get a manicure, pretend this isn’t happening, or whatever.
“Do you want to talk about it?”
This is my go-to response immediately after a person has told me something shitty that just happened to them. What I’m really saying is, “This sounds bad. I’m here for you, but I’m going to make sure a conversation with me is what you want/need right now before I launch into it.” Occasionally when I do this, the person will realize they actually don’t want to talk about it, or will say they want to talk about it at some point later, but for now, they’d prefer to stay focused on the task at hand. Which: great! I’d rather give them a moment to think about what they really want to do instead of replying in a way that gets them all fired up and emotional before they even realize what is happening.
“Oh, gosh; how are you feeling about it?” or “Oh! How are you feeling about it?”
I say this when I need a liiiitle more information. A lot of people (myself included!) have a habit of telling others what happened but forget to say how they feel about what happened. I don’t want to be the friend who says “Oh no!” in response to a wanted pregnancy, or who mistakes a demotion at work for exciting job news. I’d prefer not to take the risk when it’s so easy to do a quick check-in before I start emoting.
“Do you want my thoughts/advice on this, or do you just want to vent? I’m totally here for you either way.”
This is a good option if your friend isn’t telling you what they need from you in this momen
t, or if you tend to be a fixer and advice giver.
“How are you doing/feeling today?”
This question acknowledges that bad times aren’t static; a lot can change on a daily, weekly, or even hourly basis. It also lets people decide to tell you about their morning instead of, you know, the past three months of hell they’ve been going through.
“Are you OK to keep talking about this, or would you like a break?”
Remember the forty-five-minute rule from Chapter 5? This is how it looks when you’re on the other side of it! I keep this one in mind when my friend and I are having a particularly heavy conversation and the friend is visibly distraught or drained. Note: This is not something you should say to hint that you’d like to wrap up the conversation; if you’re getting tired or burned out, it’s best to skip this question entirely. Only ask this if it’s coming from a place of genuine care.
“Would you prefer to be alone right now or would you like some company?”
When you’re with someone who has just received very bad news, who is super emotional, or who is about to have a tough conversation with a third party (like, say, a doctor, lawyer, or detective), it’s reasonable to default to doing what you would want a friend to do in that moment. So if you’d hate to be left alone while weeping, you’ll probably assume your friend wants you to stay while they cry. And if you can’t imagine letting a friend listen in while you receive test results from your doctor, you may bounce the moment their provider appears. This is the right instinct, but if you guess wrong, the other person might feel worse. So just ask what they’d prefer, and then do exactly what they say they want.
Go easy on the fact-finding questions.
In There Is No Good Card for This, Kelsey Crowe and Emily McDowell point out that asking too many clarifying questions can actually get in the way of sharing. “Fact-finding questions can divert the conversation away from what a person really wants to talk about to what the asking person wants to know,” they say, “and fact-finding conversations create a detached, clinical portrayal of the problem rather than an emotional one. Getting the facts can be important to your helping in the long term, but you don’t usually need a lot of specific facts to comfort someone.”38 That last part is key—remember that this conversation is about how they are feeling, not the minor details of what happened.
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