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What Not to Say to Someone Struggling With Mental Health

“When in doubt, we can always ask someone how we can be most helpful. Do they want us to talk it through with them? Offer our own perspective? Challenge their thinking?”

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It’s not easy knowing what to say to someone when they’re struggling with a condition like depression or overwhelming anxiety. In some ways it’s like talking with someone who lost a loved one — we want to be supportive, but we’re afraid we’ll say the wrong thing.

Many patients have described to me the unhelpful comments they’ve had to deal with. I’ve been on the receiving end of some of these remarks, too, when I’ve shared my struggles with depression or insomnia.

Responses like the following miss the mark because in one way or another, they invalidate the other person’s experience.

  • “I Know How You Feel.” This kind of comment is usually meant to express empathy, but paradoxically it often does the opposite. When we suggest that we know how someone is feeling, we superimpose our experience onto theirs. Even if we’ve had similar struggles with our mental health, we never know exactly what it’s like for someone else.
  • “Do What I Did.” For those of us who have had our own mental and emotional struggles, it’s tempting to tell the person to do what we found helpful. “Just do this. Just think like this.” But as with saying, “I know how you feel,” this response assumes that our experiences are the same and that what worked for us will work for the other person. In reality, they might need a different approach.
  • Easy Platitudes. When we’re not sure what to say in the face of suffering, it’s easy to reach for old sayings that offer easy answers to hard problems — clichés like “This too shall pass,” or “Everything happens for a reason.” It’s not that these statements aren’t true, but they’re generally unwelcome and therefore unhelpful.
  • “Maybe It’s All in Your Head.” When you can’t understand someone’s struggles, you might resort to telling the person they’re imagining things. It’s easy for you to see that the person is catastrophizing, or taking things too personally, or experiencing unnecessary guilt. But telling the person it’s “all in your head” makes it sound like whatever they’re experiencing should be easy to dismiss. Even if they know something they’re doing or thinking doesn’t make sense, that doesn’t make it easy to change.
  • “You Need Medication.” I’ve worked with many patients who were distressed by the pressure they felt from their closest family members to take psychiatric drugs for their condition. Thankfully my family never pressured me in that way, but I was told by more than one friend that I should be taking antidepressant medication. While I knew they wanted the best for me, I also knew the decision was a very personal one and that my condition would respond better to a cognitive behavioral approach. Unless you’re a doctor, your struggling friend is probably not coming to you for medical advice.
  • “Maybe You Don’t Want to Feel Better.” When a person doesn’t improve with treatment, we might assume they’re choosing not to get better. How could they still be suffering after taking medication for anxiety, for example, or after months of talk therapy? But the truth is, it’s hard to overcome mental health struggles. Even the best-tested treatments like cognitive behavioral therapy (CBT) offer limited relief for a large minority of those who receive them. Telling someone they don’t want to get better can be quite dispiriting, especially when they’re doing everything they can to find relief.
  • “Snap Out of It.” Sometimes we might think if we’re forceful enough, we can get the person to stop feeling anxious, depressed, panicked, or whatever else they’re struggling with. It’s a “tough love” type of response, but the tough part tends to drown out any love, not to mention that it’s ineffective. Battling a serious psychological condition isn’t like being in a bad mood that we might “snap out of” with an attitude adjustment.
  • “This Is Your Own Fault.” It doesn’t get much worse than blaming the person for their suffering. Even if we think their behavior is perpetuating their struggles — like when we withdraw because of depression –accusations will almost certainly make things worse. I know from clinical and personal experience that we already tend to blame ourselves for what we’re going through, and the last thing we need is to hear it from someone else.
What Can Help

Thankfully, the most helpful things we can offer are straightforward and don’t require professional training or even a lot of imagination. When it comes to offering comfort, doing less is often more.

  • An Open Ear. It’s a rare experience — and a healing one — to be fully listened to. We can listen beyond the words that are being said, truly beholding the person in front of us. Listening can include being willing to sit in silence. Sometimes there’s nothing to say.
  • Unconditional Positive Regard. Offering disapproval or judgment is easy and fairly automatic. It takes more work and patience to let someone know we’ll care for them no matter what. When someone’s feeling like the worst version of themself, experiencing our fierce and unconditional love can be life-changing.
  • Empathy. One of the most powerful gifts we can offer someone in pain is our willingness to understand what it feels like to be them. We’re not telling them they’re “crazy,” or trying to make them see things differently. Our aim is to know what this is like for them, even if we can’t understand perfectly.

When in doubt, we can always ask someone how we can be most helpful. Do they want us to talk it through with them? Offer our own perspective? Challenge their thinking? Maybe they just want a listening ear or someone to sit with them. Most of the time we probably just want to know someone will stay with us, even when we feel unlovable to the core of our being. My wife’s simple presence helped me keep my head above the waves more times than I can count.

The writer Parker Palmer went through a dark depression and later wrote that “the human soul doesn’t want to be advised or fixed or saved. It simply wants to be witnessed — to be seen, heard and companioned exactly as it is.” Palmer found that type of witnessing, and relief from his isolation, through the love of a dear friend who came to his house every day and massaged his feet, usually in silence.

You don’t have to feel ashamed if you recognize yourself in any of the unhelpful responses. We often feel powerless when faced with another person’s problems that we can’t fix. It’s almost always better to be present in an imperfect way than to avoid someone out of fear. Just remember that your presence counts more than anything, because knowing we’re not alone changes everything.

Thank Aaron for sharing this story below.

How to Spot Toxic Positivity

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