Please read with care: the following content could be triggering.
I am fed up with people being reckless with their use of words around mental health. I want to share some particular examples with you. They are symptomatic of a deeper lack of understanding in society about the link between language and shame.
A few years ago, I overheard the following conversation in my kitchen. My friend (let’s call her Daisy) said, ‘Today, a girl at my school tried to kill herself.’ She rubbed her eyes and cleared her throat. ‘It was awful. I had to go with her in the ambulance.’ Daisy was understandably shaken up. She added, ‘Thankfully, she later came around.’ I don’t know what I expected my other friend (we’ll call her Lucy) to say, but it definitely wasn’t what she said. She replied, with energy:
‘Well, I hope the silly girl was ashamed of herself.’
Daisy looked confused and shifted her weight. ‘Yes. I’m sure she was.’
Of course she was. Of course she fucking was.
I have tried for so long to understand how someone who is normally kind, like Lucy, could say such a hard thing. I have come to the conclusion that what she meant to say was that the suicidal girl had been thoughtless and nearly caused her loved ones great pain. But Lucy has completely misunderstood the causes of suicide and the way to help someone who feels suicidal.
The girl who tried to die was ashamed before her suicide attempt. She was so ashamed and full of self-loathing that she went against every animal instinct to cause herself pain and try to take her own life.
Suicide is not silly. It’s the very opposite of silly. Silly means frivolous, flippant. Silly means dressing up as the donkey called Bottom, or baking pancakes shaped like llamas. Silly doesn’t mean cutting your own skin or swallowing endless pills with the hope of inducing irrevocable liver damage to yourself. If we want to understand her decision, we’d have to ask the girl herself why she felt that life was hopeless. Why did she feel that it was more painful to go on existing than to face the gaping void of death, the pain of cardiac arrest? We’d have to ask her.
But I’m pretty sure it wasn’t out of some silly whim. And I’m pretty sure she was ashamed beforehand and now she is even more ashamed. And that judging her, and shaming her again, does not help.
Why is it that people who are normally kind and generous behave like emotional fascists when faced with suicide? It’s not just suicide: it’s self-harm, addiction and eating disorders too. Visible emotional pain terrifies us. Our knee jerk response is to alienate the person in pain, to judge and shame them, so that we do not have to feel our terrifying shared humanity.
Yesterday, I sat next to a girl in a coffee shop. Let’s call her Fiona. Fiona was on the phone loudly discussing her mental health problems with a friend: anxiety, suicidal thoughts, OCD and alcohol addiction. She was expressing huge frustration about the lack of understanding she had found from GPs, friends and the general public. At one point, she looked around the coffee shop and expressed her loneliness. She commented that lots of the people there might be suffering but that no one talked about it.
At this point, I couldn’t stay quiet any longer. I passed her a notepad, on which I’d written: I have severe depression and anxiety. I was nervous she might find it intrusive but it was a risk worth taking in the hope of reducing her sense of isolation. As it happened, she looked at me warmly, squeezed my arm and enthused to the friend on the other end of the phone that ‘the lovely lady next to’ her had just passed her a note. When she got off the phone, we had a conversation about our shared experiences and coping mechanisms. We swapped numbers. It was a life-affirming moment for both of us about the human ability to reach out and feel connected to each other.
One point from my conversation with Fiona particularly stood out to me. Recently, she had found herself in the grip of an eating-disorder again. She had sensibly reached out for help. She wanted to tackle the feelings before they got a strong-hold and became totally debilitating. At this point, when Fiona was so vulnerable, the situation required praise for her courage in confronting her illness. She needed a system to make her feel safe and show her there was hope. Instead, what she received from the doctor was the unbelievable line: ‘You’re not thin enough to have an eating disorder.’
Imagine the damage: the potential for shame, the deterioration in your mental health as a direct result of this ignorant, throw-away comment. The stupidest thing is that the only natural response to this would be for the patient to go away and lose lots of weight in order to get help or prove her illness. At that point, fundamentally the doctor would be responsible for causing the return of a life-threatening condition.
The most alarming thing is that this is not an isolated incident. I have lost count of friends who have been told that ‘unless they’re suicidal’ they can’t see a therapist for at least two years. Are we now at a point where we are encouraging people to self-harm, as it’s the only way to access basic support? Even if people don’t make a conscious decision to do that, it is deeply unhelpful to people that support is out of reach until you are desperate. Like cancer, prevention of many serious mental health problems could be greatly improved by early intervention and treatment.
I have a friend who was suffering from severe depression at the tender age of seventeen. Her only real ‘coping’ mechanism was self-harm and she desperately needed some expert help. One day she was so ill at school that she felt unsafe, so she took the mature decision to speak to the doctor about getting help. Many teenagers would have bunked school, got drunk, taken drugs, had some risky sex, been violent, or taken another rash decision in these circumstances. But no. This girl called her father and asked him to take her to see the doctor.
The response from her GP was hugely irresponsible. He said:
‘Shouldn’t you be at school?’ After giving her a speech about being over-sensitive and over-dramatic, he sent her away with the unbelievable words: ‘I hope you’re not going to go away and do something stupid, like hurting yourself now?’ An incredibly damaging, belittling line, even from someone with such little compassion. Perhaps, through his thick, cyborg skin, he had felt the faint waft of an emotion we humans like to call guilt.
Fortunately, my friend was with her dad, who quite rightly marched in, gave the doctor a furious speech and made him write a letter of apology to his daughter. But even this is not enough. That doctor should not be allowed to work until he has learnt some basic counselling skills for dealing with people who are suffering from painful emotions. He is irresponsible and could have caused this vulnerable child to come to great harm. In fact, with the help of some empowering, empathic counselling my friend came through this time of great pain. She is now studying at university to become a teacher in a school for children with special educational needs. She has great value to society. She has great value to all of us who love her and could have lost her, thanks to the emotional immaturity of this one GP.
It’s wonderful that mental health is being discussed and that the stigma is (very slowly) lessening. But we must, as a priority, start educating people about the way in which language can induce shame or, on the flip side, be therapeutic. The way we talk to people in crisis matters. The way we talk to people about their normal everyday feelings has an impact too. Our choice of language can show we understand or that we don’t care. It is one of our most amazing tools, distinguishing us from animals, enabling us to form societies, help each other and make progress. But with that enormous potential for shared human development comes a responsibility. When we discuss our feelings and those of others, our words must be chosen thoughtfully and with compassion.