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What NOT to say to someone with mental illness (and some helpful alternatives instead)

Op-ed by Verashni Pillay

One of the perks of being fairly open about my diagnosis with depression is that I can slip it into conversation casually. Look, I’m not trying to test you or anything.  But think about getting your period. It kinda sucks to say, “My tummy is sore”, instead of, “I’ve been bleeding for three days straight and it feels like my womb is being prodded with a grapefruit spoon.” Particularly just to maintain some strange sense of decorum, usually with men. We ovulate. It’s how children are made. Why the dance around it?

And so it is with depression. If I’m telling an anecdote or making a point where this particular personal experience is relevant, it’s natural to include it. 

I was diagnosed in early 2017 with severe depression, following a series of traumatic experiences. It came as a shock, and at first I hid it from almost everyone – including my family. I decided to come clean about it while doing a Tedx talk the next year. But it was much easier to speak about it from a stage, unchallenged, then to tell people face to face.

So sometimes I realise I’ve just mentioned it in passing to someone who clearly didn’t know this about me… and whose views on mental health I don’t really know. Their reaction goes something like this. 

  1. An awkward silence
  2. A very careful, noncommittal statement. 

It honestly feels like I just told them I believe in the tooth fairy.

And I get it. We’re all trying to be on the right side of so many issues these days, that it’s hard to know what to say. You don’t want to offend. Or maybe you have some real questions and you’re not sure how to ask them. 

Or worst of all, maybe you think this really is the equivalent of believing in the tooth fairy. I’ve definitely had reactions along those lines 😞.

So, in honour of Mental Health Awareness Month, here are a couple of tips on how NOT to respond to someone with a mental illness… and some suggestions on what to say instead. 

1. Don’t Say…

“So you think you’re depressed?”

I think I can be fun, and silly, and sometimes smart, and that I also have terrible posture but great bone structure. These are things I think about myself, in the way that you implied it: i.e. a rather subjective opinion. I know I have depression because I’ve been clinically diagnosed by experts. And no, that thing you saw on Youtube about the pharmaceutical industrial complex doesn’t make you one of them. 

Do say…

“What does that feel like?”

One of the lingering misconceptions around depression in particular is the idea that everyone gets sad, so what’s the big deal? If you really do wonder about the difference, it’s ok to tactfully ask. To be honest, I sometimes do want to try to describe this complex struggle to those close to me, but it’s difficult to broach it. Being invited to share by someone with an open heart and mind is a beautiful gift. 

2. Don’t Say…

“Have you tried exercise/getting outdoors/meditation and prayer?”

Yes, yes, and God, yes. At the height of my depression (or is it the depth?) I dragged my nearest and dearest on a five-day hike from Port St Johns to Coffee Bay along the spectacular coast in the former Transkei. I meditated and, as a committed Christian, prayed throughout. I also ended up in hospital a month later. As one psychiatrist told me, there’s only so much you can do when your serotonin levels are severely depleted.

Do say:

“What has helped you stay sane, along with the meds?”

I know people who literally medicate and do nothing else to manage their condition and that’s also not great. It’s important to start those conversations about doing the work – for all of us – to be emotionally healthy individuals. And yes, this does mean eating and sleeping well, getting enough exercise, being spiritually healthy and, if you need it, getting therapy. Let’s just talk about it in a way that isn’t judgmental and doesn’t make someone feel even worse – or as if doing all these things would fix any mental health issue. It won’t. If you’ve seen someone in the grips of the worst kind of Bipolar mania or schizophrenic episode, you’ll know a regular run on the beach isn’t going to fix it. 

3. Don’t Say…

“Aren’t you worried you’ll become too reliant on those meds?”

Yes, it is true that antidepressants in particular are hard to wean off, and that does scare me sometimes. As a person on medication, I know rationally that I have to take them, and it has transformed my life and allowed me to be functional and joyful in a way that I just couldn’t be before. But that’s just what I know on the surface, rational level. I also have the deep-seated shame and fear instilled in me by generations of taboo around mental health, that I’m being dramatic, or not handling myself well. It’s the reason I, and friends I know, have gone off their meds, to try to subconsciously prove some point. Or worse, never go on them when they clearly need it in the first place. I’ve seen this happen and it literally steals people’s joy for the flimsiest of reasons: the human ego. 

Do say:

“How did you find the experience of taking medication regularly?”

This is an empathetic and open way to start a conversation about having to pop those pills daily (and for some, twice a day or more). There are genuine anxieties around this for some, so inviting someone to talk about is, again, a gift. When I had once decided, against my doctor’s advice, to taper off my medication, one of the best things a friend did for me was ask: “Why?”, repeatedly, until it forced me to confront my flimsy justifications and acknowledge I was being motivated by deeper fears. 

Ultimately, mental health awareness is really another way of saying, let’s talk about being emotionally healthy. For too long (literally the entirety of human history till now) mental illness was badly misunderstood, maligned and punished. We now don’t live in a world where we will be cast out for needing help, or worse, subjected to the shock therapies and lobotomies of early psychiatry. But we do live in a world where those once external stigmas have been internalised. It’s up to us to fix that.

For more information on managing your or a loved one’s condition, visit Sadag.