What Not To Say To Someone With Mental Illness

If you know someone who’s depressed, please resolve never to ask them why. Depression isn’t a straightforward response to a bad situation; depression just is, like the weather. Try to understand the blackness, lethargy, hopelessness, and loneliness they’re going through. Be there for them when they come through the other side. It’s hard to be a friend to someone who’s depressed, but it is one of the kindest, noblest, and best things you will ever do.
- Stephen Fry
Many people don’t know how to approach a friend or a family member who has a mental illness. Many feel uncomfortable by this thought. Our society is partly in denial of death and does not accept that a person can suffer despite his best efforts. This discomfort and confusion may lead those around the person—despite their best intentions—to be “walking on eggshells”. This is very noticeable to the suffering person and alienates him further.

I compiled a list of the top six worst things and one best thing to say to a person with depression, with explanations.

What Not To Say:

1. "I know just how you feel."

Possibly the most harmful characteristic of clinical depression is its inaccessibility to those who have not suffered from it. The feeling of isolation that the person with clinical depression feels is compounded by others’ inability to relate and sometimes even to merely accept that they have an illness. Unless you have tried to kill yourself or have actually been formally diagnosed with major depressive disorder, you don't, and this will only minimize the person's pain.

2. "Why are you depressed?"

Can be interpreted as a challenge (“are you really depressed?”). The person is depressed because he has clinical depression. And feeling depressed is only one out of dozens devastating symptoms of clinical depression. Just by asking this question you are demonstrating your ignorance of the very nature of clinical depression. The cause of depression is a mystery even in the medical field. Besides, why does it matter? Would you ask a cancer patient, why did you get cancer (bad mattress)? it’s a stupid question. Unless you care about the etiology of depression, this question will be perceived as a challenge. Only a clinically depressed person know what it's like to be clinically depressed.

3. “You are more fortunate than some people.”

If you could just see the good in your life you wouldn’t be so miserable. The person with depression cannot control how he or she feels, just like a cancer patient cannot heal his cancer simply by thinking. Depression is the result of complex interaction of biopsychosocial factors continuously in flux. The person has no say in when or how it will lift. Saying this will make the person with depression feel guilty about his inability to feel pleasure despite having more food, money, and a better shelter than many others. Physical possessions do not determine happiness. Besides, the inability to feel pleasure is a hallmark symptom of depression. Not only does it invalidate their feelings, but also chides them for feeling this way, not to mention serving as a reminder of their inability to feel even a drop of pleasure. It’s like asking a quadriplegic person to pick up a rock. Saying, "others' problems are worse than yours", will only make the person feel even more guilty about feeling bad.

4. "snap out of it" / "just shake it off" / “get over it” / ”pull yourself by the straps” / "it's just a phase, you'll get over it" / "man up" / “It's all in your head.”

Try saying this to a person in a diabetic coma or with terminal cancer (the Burden of Disease for severe depression is the same as for terminal cancer). A person with depression, like with cancer, does not have control over his infliction. It’s like the person is in prison: it wouldn’t be helpful to say, “don’t worry, you’ll be free someday." The fact is that it hurts and he needs your support and understanding.  It's dismissive and can be interpreted as, "just accept that it sucks and don't whine", which leads me to number five. 

5. “Stop whining about life"

May be combined with “everybody has problems, but you don’t see them whining about them”, or “you’re being selfish”. Depression is not about whining.

6. "How are you?"

Bad to ask especially when you don't really want to know. Asking “how are you” may be done to appear caring, as if asking about your depression, but without the risk of breaching a boundary by asking about it directly. Actually responding by talking about your depression in detail would put the person off in such a casual setting, leaving you no other choice but to respond with the perfunctory “fine”. This may make the person with depression feel stigmatized and an outsider. So, only ask this question of somebody who knows you know about his or her depression or if you really want to know. Otherwise avoid it.

What To Say:

"It must be really bad for you to feel like this, please tell me more. Even though I can't imagine what you are going through, I am here to support you."

If you don’t know if something you say is appropriate, just say, “I don’t know what’s to say not to offend you, but I really want you to feel better. I’m sorry if anything I say hurts you. Let me know if it does so I can correct myself. Just know that I only mean the best.”


More American Soldiers Die By Suicide Than In Combat

For the second year in a row, more American soldiers—both enlisted men and women and veterans—took their own life than were killed in both the wars in Iraq and Afghanistan. Excluding accidents and illness, 462 soldiers died in combat, while 468 died by suicide. A difference of six isn't vast by any means, but the symbolism is significant and troubling. In 2009, there were 381 suicides by military personnel, a number that also exceeded the number of combat deaths.


The True Cost of Mental Illness

More than one in four American adults suffers from mental disorders in a given year.
Mental disorders are the leading cause of disability in the U.S.
60% of Americans with a mental disorder get no treatment for their ailment at all.
Only 6.2% of U.S. health care spending is devoted to the treatment of mental disorders. 
Too many people living with mental illness are ending up in our jails or homeless, often as a result of untreated or undertreated illness. How will you reduce the number of people living with mental illness in our streets and criminal justice systems?

Mental disorders cost the United States more than $150 billion each year for treatment, for lost productivity, for the costs of social service and disability payments made to patients, and premature mortality. And this is a conservative estimate. Reducing the costs and correcting the shortcomings of our health care system requires policies which acknowledge that mental illnesses can be diagnosed precisely and treated effectively.
Severe mental illnesses, which afflict about 6% of American adults, cost society $193.2 billion in lost earnings per year. Yet, corporate America has few employer-backed health plans offering any coverage for workers' mental conditions. 
One longtime barrier to psychiatric care has been reluctance by insurance companies to consider mental illnesses on par with physical ones and thus not pay as well to treat them. Mental illness and drug addiction are every bit as real and serious as physical illness, and by providing intervention and early treatment we may be able to prevent more serious and costly conditions as well as unimaginable suffering in the future.
Mental illness is every bit as serious as physical illness.
In a study comparing depression treatment costs to lost productivity costs, 45 to 98 percent of treatment costs were offset by increased productivity. Appropriate and timely treatment of severe mental disorders would decrease the use and cost of medical services by people with these illnesses, yielding savings greater than the cost of providing these treatment services.

Additional benefits of providing timely and sufficient treatments for mental illnesses include a decrease of the homeless and prison population.

From Aaron Swartz's (hactivist who died by suicide) blogpost, Sick:
The economist Richard Layard, after advocating that the goal of public policy should be to maximize happiness, set out to learn what the greatest impediment to happiness was today. His conclusion: depression. Depression causes nearly half of all disability, it affects one in six, and explains more current unhappiness than poverty. And (important for public policy) Cognitive-Behavioral Therapy has a short-term success rate of 50%. Sadly, depression (like other mental illnesses, especially addiction) is not seen as “real” enough to deserve the investment and awareness of conditions like breast cancer (1 in 8) or AIDS (1 in 150). And there is, of course, the shame.
 From the article, Mental health care in U.S. questioned amid another tragedy:
Dr. Jeffrey Lieberman, chairman of psychiatry at Columbia University Medical Center in New York City, said shortcomings in mental health care are a very real problem. He told former assistant director of the FBI and CBS News senior correspondent John Miller on Monday that it's a societal problem because the U.S. has not taken on the treatment of mental illness as effectively as it could.
Only 5.6 percent of national health care spending goes towards mental health treatment, The Washington Post reported. Most of that money is spent on prescription drugs and outpatient treatment in a psychiatrist's office that some sufferers may not even choose to seek.
He added that the mental health care infrastructure just isn't there compared to care for other diseases. For example, a patient with cancer would be placed on a scientifically-backed comprehensive treatment plan with well-trained doctors for chemotherapy, radiation, etc., whereas people seeking mental health treatment need to do more work on their end not only find treatment but overcome these disincentives to get care. 
"Our society, with its stigma on mental illness and its broken healthcare system, does not provide us with other options," [Liza Long, the author of the post "I Am Adam Lanza's Mother"] wrote. "Then another tortured soul shoots up a fast food restaurant. A mall. A kindergarten classroom. And we wring our hands and say, 'Something must be done.' I agree that something must be done. It's time for a meaningful, nation-wide conversation about mental health."
But money should not have to be primary motivator. Because acting out of a purely financial motive is cold and soulless and is like a an insurance company deciding to not recall faulty vehicles because the total cost of the recall would be more then the cost of paying off lawsuits filed by the deceased victims' families.

Anyone who has experience serious mental illness knows that the suffering is inhuman, and no person should be allowed to experience it. Especially not when mental disorders are among the most treatable ones.

Sources: Tallying Mental Illness' CostsMental health care in U.S. questioned amid another tragedySick


The Mental Health Manifesto

The time has come when it is everyone’s duty to make their support for mental health known. We have lived in the shadows of shame and guilt for too long. It is criminally negligent to provide insufficient treatment knowing that mental illness is extremely treatable and considering the scope of the problem. And it is our duty to stand up and help those around us who suffer from mental illness today.

Wednesday, June 6, 2012