# Living Alone: Is it right for you?



## NicNak (May 1, 2009)

Living Alone:  Is it right for you?
_Anchor Magazine_
Mary Medland
May 1, 2009

For people who are coping with depression, deciding whether to live alone or with others can be a difficult decision to make.

“I have not lived alone since my diagnosis, but if one is really ill with depression, I think it would be quite dangerous,” says Virginia Wilson, who lives in Toronto with her husband. “If you are having thoughts of harming yourself with the intent of dying, you are less likely to do that if there is someone else around, although this is not a 100 percent guarantee of safety.”

On the other hand, there are those who do well living alone. “I’m much happier living by myself,” says Deneice Valentine, who runs the peer education and support program for the National Alliance on Mental Illness (NAMI) Baltimore. “During the day I answer NAMI’s ‘warm’ line and listen to other people’s problems and help them to find solutions or the resources they need, which can be exhausting. When I come home I love the solitude and quiet.”

These two points of view are frequently shared by mental health professionals. In short, there is no single approach that is perfect for everyone when it comes to mental illness.

“The most important thing is for consumers to understand what works for them,” says Ken Duckworth, MD, medical director for NAMI and an assistant professor of psychiatry at Harvard Medical School. “Some people are more extroverted, while others are more introverted. There are those who enjoy being alone for a day, while for others that can be very stressful.”

For those who live alone and are trying to recover from a major depressive episode, living solo, especially if one is isolated from a support network, may make the depression worse. “People in this situation often feel that no one cares about them,” says Christine Walton, MSW, LMSW, a mental health therapist with Munson Medical Center in Traverse City, Michigan. “If there is someone in the home who is there to make sure that a consumer is staying on a schedule, eating three meals a day, and taking their medicine, that can be absolutely valuable.”

*Changing residential models*
In the 1970s and ’80s, many group homes were built for those dealing with severe mental illness, however that model is changing. “It used to be that there was a group home with eight people that was staffed around the clock,” says Duckworth. “But today 80-90 percent of consumers that we have interviewed who are living in group homes tell us that they would rather have their own place, and here in Boston there are no new group homes opening.”

Duckworth adds that economics plays a role in this change: It is less expensive to house consumers in their own apartments. “In group homes there are typically one to three people on staff during the day and one during the night,” he says. “The mental health system was more paternalistic in the past … now we’ve learned that some people are really able to manage more independence than we previously thought.

“It is good for people with depression to take certain risks, such as living independently, having their own apartment, owning a car, and having relationships with others…living in a group home is right for some people, but for others it is not a normal trajectory.”

Duckworth hears from patients that instead of living in group homes they want to live alone, but with access to social clubs or hobby groups. “In general, human connection for most people most of the time is a great antidepressant, and anyone who lives alone will do better if he has a strong sense of community,” he says.

*Living alone vs. loneliness*
When making such a decision, it is important for consumers and caregivers to understand that living alone is different from being alone or being lonely. But just what is loneliness?

“Loneliness is a sense of feeling incomplete about yourself…[it’s] not the same as being alone because many people are able to be by themselves and entertain and nourish themselves,” says Thomas Demaria, PhD, a professor of psychology in Long Island University’s doctoral program in clinical psychology. “People who are more introverted enjoy time in their own inner space to sort out their dreams and wishes.”

On the other hand, Demaria points out, for extroverts being alone can be absolute torture. “People who are extroverts really need other people to feel complete,” he says.

Duckworth agrees that while loneliness is different from being or living alone, they can be connected for some people. “Loneliness is an inner experience of isolation. Extroverts do much better not being isolated. They really get refueled by being with other individuals,” he notes. “Most people know what works for them; whether being alone for a day will be stressful or enjoyable.”

And while it may sound counterintuitive, living alone can be a plus when a consumer is going through a rough patch.

"When I was living with someone else, I was likely to go out,” says Maxine Bigby Cunningham, who was first diagnosed in 1991 with depression and, since separating from her husband in 2004, has lived on her own. “One of the good things about living alone is that when I’m having a down day I don’t have other people feeling sorry for me, and I don’t have to explain myself to them.”

Or, as Valentine puts it, “Living alone gives me a sense of security in knowing that when I’m not doing well, I don’t have to be ‘on’ for someone else.”

*Having a support system*
Social connections are important for everyone, but they are vital for those coping with mental illness. However, in countries as large as the United States and Canada the great distances that often separate relatives can be a challenge. “Both my daughter, who lives in Atlanta, and my sister, who lives in Michigan, suffer from depression,” says Baltimore-based Cunningham, who is retired after 30 years working for the federal government. “I do take antidepressants, but when I am having a major episode, my sister will call me several times a day to see how I’m doing. She also holds me accountable for doing what my therapist tells me.

“My Michigan sister has also called my son and another sister who live near me to check up on me. And when my sister has not been doing well, I’ve called her daughter and best friend.”

Cunningham notes that she regularly goes to a fitness center, which in addition to being good for her health, has also become a social outlet.

Valentine—who was first diagnosed with major depression 25 years ago and who spent more than a year at a state mental hospital—has been living on her own for nine years. “I have an excellent support system,” she says. “My mother is a staunch advocate…we have a joint checking account so she makes sure the bills are paid when I’m having a depressive episode. My daughter also lives nearby, and we go to the grocery store or shopping or to the movies together.

“I make it a point to make new friends—many of whom are NAMI consumers—because I lost most of my old friends when I was diagnosed.”   

But make sure you choose carefully. “An abusive relationship can foster the depression,” says Demaria. Similarly, says Wilson, “If you are living with someone who doesn’t understand depression and who says ‘What do you have to be depressed about?’ can make things worse.”

While not strictly a support system, Wilson reports that during a bad episode, “I have just gone out on the street and walked around just to be with other people. Being around others can really help get you out of the distorted depressive thoughts. Of course, sometimes it is a great relief to get into the hospital because you will be around people who truly understand what you are going through.”

*Educating others*
A benefit to everyone, it’s especially important for those with depression who are living on their own to have educated families and friends. “Families really should understand what the early warning signs of a depressive episode are,” says Walton. “They are often crying, irritability, sleep disturbances, low energy, problems with concentration, or isolating themselves from others.”

Mary Seeman, MD, professor of psychiatry at the University of Toronto, Toronto, Ontario, adds that family members and friends should be particularly aware of social isolation as a sign of depression. Wanting to be alone—especially when it’s a new behavior—should be viewed with caution.  Family and friends wanting to respect a person’s wishes may stay away, but this is a mistake. It’s important to call and make efforts to stay in touch even when those efforts are rejected. The depressed person needs to know that someone cares; that there are steady, supportive friends to rely on in times of need.

Walton adds, “Family members really need information about this disease—it is not just a matter of someone pulling themselves up by their bootstraps. I recommend the National Family Caregivers Association. It’s a huge group, and when I joined I was astounded at how much information I received.”

Another excellent resource is NAMI’s 12-week Family-to-Family course.

Walton—a caregiver for her husband who has Type I diabetes—reminds caregivers not to forget their own needs. “Family members need to take breaks,” she says. “There is a fine line between helping someone with depression and doing everything for him/her. You don’t want someone with depression to become completely dependent on you.”

*Looking ahead* 
“Depression is a treatable illness,” says Walton. “When the early warning signs appear, get the individual to a primary care physician who is well informed and help him/her understand what the family is seeing.” Quality of life can be excellent for a person who gets needed help, such as talk therapy and antidepressants. 

On a parallel note, Demaria says, “Once one’s depression begins to improve, people find the energy to once again reinvest in their lives in positive ways by developing both the time they spend with themselves and the time they spend with others.”

Often those who have had previous episodes of depression are at a greater risk for depression after a spouse dies. However, people who have not been depressed previously may suffer from depression after a loss of their spouses. “A lot of widows and widowers find that they forgot to do the work to maintain themselves as individuals because they were always involved with their partners,” says Demaria. “These people now have to start to learn how to reinvest in themselves and learn what they enjoy. At least at first, for these individuals a day alone can be seen as a prison sentence.”

His point of view is echoed by Duckworth. “Someone whose spouse has died is at a very high risk for depression because of the loss as well as isolation,” he says. “People dealing with depression as a result of the loss of a spouse should not be too hard on themselves. It is normal to grieve. Church and faith communities can provide comfort during periods of vulnerability, but widows and widowers should also relook at their social network and figure out where they can find support from others.”

_Mary Medland is a freelance writer based in Baltimore, Maryland, whose work has appeared in the Washington Post, Baltimore Sun, Christian Science Monitor, and many other publications._


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## NicNak (May 1, 2009)

Tips for successfully living alone
Anchor Magazine
May 1, 2009


Have a strong support network of people who understand depression and are positive role models. Ken Duckworth reminds us of the ancient Jewish saying, “Pain shared is pain halved.”

Those in the support network should understand the early warning signs of depression and changes in behavior that might signal the onset of a depressive episode.

Make sure not to isolate yourself. Learn ways to enjoy being by yourself, whether that is pursuing a hobby, planning a trip, or working on a scrapbook.

Educate yourself about depression and make use of resources, such as the National Family Caregivers Association and the National Alliance on Mental Illness. Consumers especially recommend NAMI’s Peer-to-Peer course


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