One of the frustrating aspects of having a mental illness is dealing with stuff people say, even though they often mean well. Here are just a few examples of things I suspect most mentally ill people are used to– and very tired of– hearing.
1) “But you seem so normal!”
Perhaps this is meant as a compliment, but honestly, it feels much more like an accusation– “you can’t really be sick.” People with many forms of mental illness go through patterns of remission and relapse, so how you see us on any given day may be far from representative. For example, I am currently euthymic (in a “normal” mood phase) but a month ago I was hearing voices from the heavens and believing I was a chosen conduit, and a week after that I was seeing rotting corpses hanging from my ceiling. Not “normal”, right? Also, many of us are great, sometimes to our own detriment, at putting on a happy, calm face around others, when we are being ripped apart inside. And finally, sometimes this “normalcy” is the result of a treatment regimen that we have to work hard to settle on and stick to, which is not something “normal,” i.e. healthy-brained, people can really understand. Don’t judge us by what you see; listen to what we have to say about our experience instead.
2) “Have you tried natural remedies?”
This is a tough one, because people who say this genuinely think they’re being helpful. However, it’s important to remember that many psychiatric disorders are very difficult to medicate. In the case of my illness, bipolar disorder, upwards of half of patients are classified as “treatment resistant.” Many people spend years working with professionals to develop a successful treatment regimen of drugs and other therapies that are scientifically proven to work. This can be a tenuous balancing act of avoiding side effects, toxicity and drug interactions. In most cases, “natural” remedies are not only unproven but possibly unsafe, especially in combination with prescription drugs. Keep in mind that whatever you have to suggest, we’ve probably heard of it before, and it can be deeply frustrating to be bombarded with well-meaning suggestions from people who are not experts in psychiatry. Please, leave clinical treatment to the professionals. If you want to be helpful, try instead asking what you can do to support the person.
3) “At least it’s not cancer!”
This is a deeply offensive and dismissive statement, even if it’s intended to make someone feel better. Implying that psychiatric disorders are less serious or destructive than physical ones is not only unkind but flatly inaccurate. Mental illness not only ruins but, all too frequently ends, people’s lives. According to Stephen Fry’s outstanding documentary The Secret Life of the Manic Depressive, only 20% of people with bipolar ever become fully functional, while 50% will attempt suicide and nearly half of those will succeed. Those are abysmal numbers for any illness. Furthermore, we deal with many of the same difficulties that physically ill people do: drug side effects, exhaustion, and physical pain, just to name a few. Dismissing the severity of our problems makes us feel worse, not better.
4) “My ______ had that and here’s how they got better.”
I remember a specific conversation I had years ago in which a woman I barely knew told me in detail about her father’s undiagnosed mania and how he was able to “talk himself down” from it, and that therefore drugs and therapy aren’t really necessary, but actually inhibitive of self-help. Another told me how fish oil had cured her brother’s depression; these are just a couple examples of the same basic conversation I feel like I’ve had a million times. It’s problematic because no two mentally ill people, even those with the same diagnosis, are alike. Our treatment needs to be based on scientific evidence obtained through clinical trials, not anecdotal evidence you’ve gathered from your limited frame of reference. Assuming that our illness takes the same course as that of someone else you know (who may or may not have even had or needed the same diagnosis) keeps you from understanding what our experience really is and what we actually need.
5) “Everyone seems to have that nowadays!”
Short answer: No. They don’t. You probably have that impression because of the way clinical diagnostic terms are bandied about inappropriately, for example, saying of someone emotional and moody “She’s so bipolar” or “borderline,” or of someone shy and awkward “He’s so Aspie.” (Although autism is not actually a mental illness, this pertains.) There are also many people who self-diagnose, to varying degrees of accuracy, often without understanding the reality of living with a severe disability. While many disorders are more common than you might expect– in the case of bipolar, it affects about 1% of the population, so that if you have several hundred facebook friends, at least a few probably have it– they are not catch-all terms for every difficulty and behavior problem you perceive.
6) “Have you prayed/meditated/sought spiritual help about it?”
As an adamant, skeptical atheist, I particularly resent this one, but I would still resent it were I religious. Frankly, my spiritual life, unless I choose to share it with you, is none of your damn business. Carl Jung’s waxing on about the need for religion notwithstanding, there is absolutely no scientific evidence that prayer, meditation and other such practices can either treat or cure mental illness. Some people may find comfort in spirituality, and that’s great, but it doesn’t take the place of medication and professional therapy, nor is it a necessary component of treatment. My illness should never be a pretext for you to proselytize or cast moral judgment on me.
7) “Think about people worse off than you. Lots of people would kill to be where you are.”
Again, this is deeply dismissive and hurtful. It gives the impression that you clearly do not understand the depths of our pain and difficulty. You are judging us by external factors like first-world citizenship, economic stability, and family support, which are all wonderful things but do not do away with or even necessarily diminish the anguish and dysfunction with which we live every day. If you think my life is so great, I invite you to switch brains with me any day and see how you like it. Hint: You won’t.
8) “That’s a form of genius!”
Movies like The Aviator, about OCD sufferer Howard Hughes, and A Beautiful Mind, about schizophrenic John Nash, have contributed to this perception. It’s true that people with many mental illnesses, such as bipolar and schizophrenia, can be highly creative, thinking in ways that a healthy brain rarely does. However, such illnesses– and often the drugs that treat them– are equally likely to hold back mental function. Some people with mental illness are very intelligent and creative. So are some people with healthy brains. And some are not. Mental illness is, well, illness, nothing else.
9) “You’re really just an addict.”
Many, many people with mental illness, myself included, struggle with substance abuse as a form of self-medication. And in many cases this does make matters worse. However, it’s crucial to recognize that the substance abuse is a result, not a cause, of the underlying mental problem– a damaging coping mechanism to which we turn in absence of other effective treatment. For more on this scientifically supported model of addiction, I highly recommend the book The Sober Truth, by Lance Dodes, and particularly chapter five, titled “So, What Does Work to Treat Addiction?”
10) “This famous person had/has that and was a great success, so you can be too!”
Recall again the numbers I stated above on the outcomes for people with bipolar disorder. I am no expert on the numbers for any other disorder, but I do know that a few outstanding cases– again, like Howard Hughes and John Nash, and also like Stephen Fry, Richard Dreyfus and others– are far from representative. There are a multitude of external and internal factors that determine whether someone with mental illness can create a fulfilling, successful life, and for many they are not advantageous. Asserting this is no different from saying that because some people who drop out of school become rich and famous, anyone who drops out can be. In some cases, such limitations prove not to be an obstacle to success, but in most, they do. By positing illness as part and parcel of success rather than as a disability, you dismiss the pain and frustration most of us experience when we fail, so frequently, to measure up to the expectations of both society and ourselves.
It’s understandably hard not to feel like you’re walking on eggshells when talking to and about disabled people. Everyone makes mistakes when trying sincerely to be helpful; that doesn’t make you a bad friend or human being. However, a few simple things to keep in mind can reduce the chances of you saying insensitive, hurtful things like the ones I’ve listed.
Listen to us. Don’t speak for us, and don’t assume. You are not an expert on our experience, and your active listening and informed support is far more valuable than anything you could say. Don’t dismiss us. You don’t need to try to make us feel better about our situation; this feels patronizing, and furthermore, downplaying our suffering is insulting, not supportive. And lastly, be ready to be corrected, and to apologize. Don’t take umbrage if we say “that’s not accurate” or “that’s not helpful.” We have the right to stick up for ourselves and to educate you about what you don’t understand. In general, just let us guide the discussion. Ask questions, pay attention to the answers, and don’t be full of yourself. If you can do that, we will get along just fine.