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.”