Depression Is a Family Sickness
When Sally is depressed, she develops a specific set of behaviors that is influenced by her disease process. "Depressed" Sally acts differently than she acted before she got sick. At first, family members may be thrown off balance by Sally's behaviors, but the longer the new behaviors exist, the more Sally's family can see patterns and predict her reactions. Sally's family begins to respond to her based on her new way of acting. They all settle into a new dynamic.
Treatment plans focus on Sally achieving new behavior patterns, which is necessary. Unfortunately, they may not address her family's behaviors. If the progression of Sally's disease process was slow, her family members may not even realize their behaviors have changed. Since family members are not "sick," they may become defensive at the idea that they need to do anything other than support Sally. Sally's family has become conditioned to her behaving in a certain way. They have come to expect certain behavior patterns from her. They no longer respond to her as they did when she was healthy. They are responding to her based on how they expect her to act now that she is depressed.
Unfortunately, when the family dynamic changes to accommodate Sally's depression, it doesn't always reset as Sally gets healthy. Sally gets better. She makes behavior changes. Her family is grateful that she is getting healthy. Yet conflict is their constant companion. Sally is offended at her family's cruel attitudes toward her; she feels like no matter what she does, her family is distant and unloving. Sally's family sees her progress and commends her on it. They don't realize that, aside from their compliments, they are still treating Sally as though she was depressed. They are still responding to her based on their expectations of how she acted when she was "sick." As Sally's behavior changes - unless the family has received education on retraining their behaviors - they will continue to respond to Sally based on her old ("sick") behavior patterns. The family will remain sick even after Sally gets well.
This same scenario can play out with a patient who battles any long-term illness. Chronic illnesses and terminal illnesses are also family illnesses. Just as with depression, a patient with a long-term illness will experience behavior changes and the family dynamic will shift. If the patient experiences healing, the family will have to relearn how to relate to one another in their wellness.
**Note: Chronic illnesses and addictions are also family sicknesses. As you read this post, you can substitute any addiction or chronic illness for "depression."