Language is a funny thing, in that there are often layers of meaning, and context is everything. Connotations shade meanings, and are often more important than the superficial meaning of the word. Well, duh.  Literature – certainly literary criticism at least – would be pretty pointless were it different. Misunderstandings happen when people aren’t aware of connotations, or miss a nuance that context provides (and that’s before we even consider subtext).  Hilarity may ensue, or it may not.

When Boris says “my heart is broken,” his friends are likely to respond with words of encouragement along the lines of “there, there” and “it will get better.”  Or offer to distract him with fun, food, and beverages. Of course that’s because we understand that his physical heart isn’t actually broken; it’s a figure of speech. Some helpful folks might even counsel Boris to “get (professional is implied here) help” to feel better.

When Natasha says “my leg is broken,” people may ask if she needs a ride to the doctor, but generally will not say “there, there.”  Because the understanding is that it’s an actual broken bone, which requires medical attention.  How ridiculous would it sound to suggest she “get help” getting the bone set, as if she could do it herself is she were only a little bit tougher?  No one is going to tell her to “give it some time; these things get better.”

What about broken brains?  Why do we insist on telling people with depression to “get help” for their condition?  Is that like getting “help” for pneumonia?   But that’s the language our culture uses with people who have brain disorders.  As is they aren’t real conditions.  Part of that is a defense mechanism, and I get that.  If brain disorders aren’t actual conditions, they can’t hurt us, we assure ourselves.  Sadly, brain disorders aren’t like the monsters in the closet – they are real, and they can hurt us.

I wish people could understand how dismissive it sounds to be told to “get help” for a medical condition. I remember the first time I pushed back. I’d been off work for a period, not long after both my parents died within months of one another, and I’d returned to work to get chastised for my less than optimal performance prior to the time off. There was a meeting, and I was of course contrite (isn’t everyone apologetic when they get sick and their work suffers?). Toward the end of the conversation, the (very upper level) supervisor told me “I understand you’ve gotten help,” when I interrupted him with a correction “I got medical treatment.”  Things got very quiet for a bit, and then he said something to the effect of, “in any event, we don’t expect this to happen again.” The meeting was adjourned, and no one looked me in the eye as we left. My sort of champion at that agency, who’d recruited me, told me afterward that he was glad I’d gotten “help” because “depression isn’t good for the mind, and it isn’t good for the soul.”  I knew he meant well, but I wanted to tell him that cancer isn’t good for the mind or the soul either.  I did not, because he was I knew he was actually trying to be kind and supportive.

I wish people could understand how this kind of minimizing language reinforces the stigma.  Brain disorders (fka mental illnesses) are physical conditions that are sadly, often mistaken for character flaws or weaknesses. Thus there’s often some judgment of people who have brain disorders.  Add to that a cultural tendency to call appropriate treatment for them “help” rather than medical attention, and we wonder why so few people are “out” about their conditions? When Catherine Zeta Jones announced that she’d returned from inpatient treatment for bipolar disorder, she was hailed as “courageous” for announcing that.1 When her husband Michael Douglas was in treatment for cancer, there was no corresponding suggestion that his announcement was brave.  Isn’t that odd?

So I’ll suggest that to get a sense of the comparison, I’ll suggest that you exchange the word “cancer” for depression or bipolar disorder when you consider what to say to someone with a brain disorder. Most of us with bipolar spend most of the time at the depression end of the scale when our mood isn’t steady. So let’s just use “depressed/depression” as an exercise/

I have days when I’ve got cancer (am depressed) too, but I get on with my life anyway.

What do you have to have cancer (be depressed) about?

You’re just having cancer (being depressed) for the attention.

Are you going to get some help for your cancer (depression)?

If you really wanted to get over your cancer (depression), you would,

If you really want to live without cancer (depression) you have to make the effort.

It’s not like you’re going to die from cancer (depression).

The easy test is this: if it sounds inappropriate – offensive even –  to say to someone with  cancer, you shouldn’t say it to someone with a brain disorder.  They’re both physical, and they can both be deadly without treatment.  Both of them could happen to you.

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1 I’m not suggesting that her public announcement wasn’t courageous, only that it shouldn’t have to be.  It is troubling to read comments like this one:

Although mental health conditions, including bipolar disorder are often stigmatizing, ABC News consultant Howard Bragman says Zeta-Jones’ public announcement of her condition may help others seek help for their own mental health.

“No matter what the reason it was courageous on her part to own this to such specificity,” Bragman told “Good Morning America.” “I think it will create a teachable moment in a dialogue among health care people, among normal people.” April 14, 2011, emphasis added

Clearly the stigma is often less than conscious. The consultants to NBC were more graceful:

Dr. Nancy Snyderman, NBC’s chief medical editor, observed “There is a ridiculous stigma in this country about this,” Snyderman said. “We have to get over it. People get sick, our job as doctors is to get them well.”

[Psychiatrist Gail] Saltz applauded Zeta-Jones for announcing that she has bipolar disorder after the National Enquirer reported that she had checked in to a psychiatric hospital.

“I think it’s tremendously brave of her to come forward and I’m delighted that she’s doing that,” Saltz said. “There are many people getting a new diagnosis, and we want them to know they have every hope, if they get treatment, of having wonderfully productive lives.”  April 14, 2011

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