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7 Common Phrases Psychiatrists Say – and the Unintentional Impact They Have on Patients

I run a Suicide Crisis Centre and a Trauma Centre in Gloucestershire. Many of our clients have had experience with mental health services before. I also have mental health diagnoses myself and have been under services in the past. I’ve noticed that psychiatrists and mental health clinicians seem to use certain phrases quite frequently. It can be helpful to look at the impact upon patients and how they may interpret the phrases.

1. “It’s your choice/decision to end your life.”

When saying this, a clinician is likely to mean, “You have responsibility for your own safety.” However, the patient may place their own interpretations on the phrase. A clinician said this to me when I was in crisis in 2012. We know it has been said to a number of our clients. When I heard it, I felt like it gave more validity to my “decision” to end my life. Our clients report that it makes them feel as though mental health staff do not care whether they end their life or not. That’s clearly not the intention, but it can be the effect.

The phrase causes me concern because, in my experience, most people who are at the point of suicide are so highly distressed or unwell they are not thinking as they usually would. The decisions they make at this point are not those they would make if they were well. For this reason, I wish clinicians would avoid using the phrase.

2. “You are not ready for therapy.”

A number of our clients have been told this and patients across the country are hearing it, too. It has become so prevalent recently that service user groups wonder if the real meaning of this is, “We do not have enough psychologists to meet the need at present.” Many people cannot access this services. If you have more severe and enduring mental health diagnoses, have experienced more complex trauma or indeed have a higher suicide risk, then you are likely to be referred instead to secondary services. These services provide experienced psychologists, but there are not enough of them to meet the current need.

3. “I can’t wave a magic wand.”

The likely definition is, “There is no instant fix.” Clinicians sometimes say this to patients or their care providers. This can feel dismissive. It can suggest the patient or care provider has unrealistic expectations of what treatment is available or is expecting an instant “cure” for their illness. However, I have yet to meet a client who expected an instant answer. They are simply trying to get the help they need. Patients can find the “magic wand” phrase very invalidating. It can also be used at times when a psychiatrist feels powerless to provide the right help in a timely manner within the current system.

4. “You are a very complex mental health case.”

We hear from some of our clients that psychiatric staff say this to them. It can make someone feel they are so complex that they can’t be helped. In reality, it may be an indication the psychiatrists do not fully understand them and have not yet worked out how best to help them. The real meaning can be, “We haven’t yet worked out how to treat your issues effectively. We may not understand you very well yet. Therefore, you seem complex.”

5. “You are choosing to continue drinking.”

The meaning is, “It is your responsibility to reduce your alcohol intake.” This promotes ownership and accountability, but it can feel unsupportive when said to a person who is alcohol dependent and who has mental health issues. It can fail to take into account why the person may be using alcohol, to try to manage intense emotional pain or the symptoms of mental illness. If you are mentally unwell, then it will affect the choices and decisions you make. The patient may struggle to reduce their alcohol intake if their mental health issues are not properly addressed and treated.

6. “You will need to talk to a psychologist about that.”

If you are experiencing symptoms of post-traumatic stress disorder or dissociation and you seek help from a mental health clinician, then you will often be told you must wait to see a psychologist to talk about these issues. If you have to access this via secondary services, then you may wait months. This can be horrendous for those of us experiencing such distressing symptoms. We wish mental health clinicians could help us to manage post-traumatic symptoms in the period we are waiting for psychological therapy.

7. “This patient is difficult to engage.” 

The patient often feels it is their issue that they can’t engage when they hear this. A better phrase would be, “We haven’t been able to engage this patient.” It places responsibility on clinicians to help the person to connect with them. If a person is not engaging with a service, then it’s likely you are not providing the kind of help they need. You may not fully understand what their needs are.

A variation on this is, “This patient cannot accept help.” In this case the clinician seems to suggest that an aspect of the patient’s psychological makeup means they cannot accept help. Once again, it’s likely the help you are providing is not the right help for them or you are not interacting with them in a way they find helpful.

I hope clinicians might consider modifying some of these phrases. My aim is not to criticize but to explain the impact of their words. In giving these examples, I appreciate the excellent and highly skilled work psychiatrists and mental health professionals do. Indeed, many of us owe our lives to the empathic understanding and timely intervention of a psychiatrist.

Image via Thinkstock.

You can find information about the Gloucestershire Suicide Crisis Centre here.

If you or someone you know needs help, visit our suicide prevention resources page.

If you need support right now, call the Suicide Prevention Lifeline at 1-800-273-8255. You can reach the Crisis Text Line by texting “START” to 741-741.

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