Kate Bowler, a professor at Duke Divinity School, who was diagnosed with an incurable cancer when her child was a toddler, is a gifted author. Among her best work is  8 Things Not to Say to Someone with Cancer. I can’t recommend this enough, because maybe, like me, you will recognize something you’ve said to someone with cancer with good intentions, but it wasn’t actually helpful at all.

In that same spirit, I offer my 6 things not to say when discussing mental illness. My family, and my family of origin, have dealt with the challenges of mental illness. Over the years I have heard a refrain of common responses when I sought support from friends or relatives. These phrases were not only unhelpful, they often caused more hurt. I write this in the hope of offering a different, more supportive way to respond.

For perspective, I am providing examples of these responses when physical illness is discussed, to make it clear just how unhelpful they are.

1. I didn’t want to pry.

You text your good friend that your wife was just diagnosed with cancer. Weeks go by, and you don’t hear from them. Finally, you ask, “Did you see my text about my wife’s cancer?” They tell you, “Yes,” they did see it. When you ask why they never called or offered any kind of support, they explain, “I didn’t want to pry.”

Sounds ridiculous right?

This is a very close second to the #1 response I receive when I share anything about my family member’s mental health problems. If I specifically tell someone about a recent crisis, I struggle to understand how them asking me about it is prying.

I can imagine if they heard about it from someone else, then they might feel as though they are prying. When I don’t hear from people it doesn’t feel as though they respect my privacy. It feels as though they don’t care.

2. He’s always good around me.

You tell your mahjong group your husband, who has been complaining to you of pain for months, has to get a hip replacement. They all express disbelief. “He always seems good when we see him.” Your little group is so smart. They know so much more than you. They know even more than your husband’s doctors.

Why schedule medical appointments when you can go to them? While I no longer speak with people who have said this to me in the past, I can tell you I heard it quite a bit. This is a great example of gaslighting.

3. I figured you didn’t want to talk about it.

You have just found out your mother’s forgetfulness is actually Alzheimer’s, and you are devastated. You are close to one of your neighbors and see her right after the appointment. You tell her, through tears, about your mom’s diagnosis.

You see her at book club the next week, and she doesn’t say anything about what you shared. Then you’re both out working in your yards, and she doesn’t mention your mom. You are so upset about your mom, and now, you are so hurt by your neighbor. Finally, you ask your neighbor why she hasn’t asked you about your mom. “I figured you didn’t want to talk about it,” is her response.

It’s all you’ve thought about since the appointment. You’re not sleeping well. You are consumed with worry and you have to keep it to yourself, because your conversation is being policed by someone who doesn’t want you to talk about it.

4. That reminds me of me.

You tell your golf buddies about your daughter’s terrible vertigo and how she is going to have to drop out of college for a while, because even walking has become difficult. One of the guys in the group says, “You know, that happened to a guy I work with. Except it wasn’t his daughter. I think it was his accountant’s nephew. He wasn’t in college, but I think he had dizzy spells or something like that.”

So yeah, your family’s issue somehow relates to him. That is the important thing to establish right now.

This happens so often when discussing any topic. There are so many adults who struggle with self-absorption and who hear every comment as a question, “How does that apply to me?”

5. What did you think of the Oscars?

You have just shared your spouse’s diagnosis of Parkinson’s with your closest aunt, because you are worried and need support. As you await her words of wisdom, you hear a reply that stuns you. “Did you see the daffodils are starting to come out with this warmer weather?”

You feel certain she must not have heard you, so you repeat what you said and ask if she understands what you are dealing with right now. “Yes, yes I do,” she replies, and then, “What did you think of the Oscars?”

Don’t be surprised when the next time you see this person, they ask, “Is everybody good?”

6. I love Jane. (The #1 response I hear.)

I don’t know your child’s name, so let’s use Jane as an example. You tell your closest co-worker that you were up all night, because Jane, who is going through chemo treatments, couldn’t stop throwing up. She was so sick, and you are so tired. What compassionate, caring words does your co-worker offer to show support? They say, “I love Jane.” That’s it. “I love Jane.”

What does it even mean? Do they think you don’t love Jane? Do they think you are talking behind Jane’s back and feel the need to defend her? Is Jane’s phone number even in their contacts? Have they called her? Have they ever done anything just them and Jane? Do they love her, or do they, once again, want to shut down the conversation?

 I ask, because I have never known what to say when people, and there have been many, who tell me they love my family member when I’ve shared my struggles with that family member’s mental illness. They have zero contact with my family member, but they always insist on replying they love them. That leaves me with nothing to say and deep regret I said anything at all.

I didn’t want to pry.

He’s always good around me.

I figured you didn’t want to talk about it.

That reminds me of me.

What did you think of the Oscars?

I love Jane.

Those are six things not to say, and I’m sure others in my position have heard many more that weren’t helpful. What is helpful? This is the easiest answer I could ever give. Pretend it’s a physical illness and say what you would say then. The formula is pretty simple and works to support anyone going through nearly any kind of struggle.

Empathy + Questions= Support

Empathetic sentences are good. Say things like, “I’m so sorry. That must be so hard. I hate that you are all going through this.” You can say just one of them or all three or make up your own.

Please know the equation is incomplete. An expression of empathy will not lead to support. You need to ask questions. The person needs to talk. They need someone who cares and who will listen. Just saying, “I’m sorry” will not provide support.

You might be thinking, “Mary, what if they don’t want to talk about it?” If they just told you something, chances are they want to talk about it. If they didn’t want to talk about it, they wouldn’t have brought it up, right?

 Of course, there may be times when people preface what they tell you with, “I don’t want to talk about this now but wanted you to know.” If they don’t specifically say that, dive right in with empathy and questions. Just imagine telling someone you were just diagnosed with cancer and their only response is, “I’m sorry to hear that.”

When I’ve shared that my family member has been going through a real struggle with mental illness, the majority of people have either said one of the above six sentences or “I’m sorry to hear that.” When I get any of those replies I deeply regret ever saying anything at all. Is it so hard to ask, “What’s going on?”

You may wonder, “What questions should I ask?” I recommend saying the same things you would say if discussing a physical illness. “How are you all dealing with of this? Have you found a good doctor? Are there any medications to help? Is there a support group available? I’ll go with you. Is it okay if I check in with you each week? You don’t have to pick up if you don’t feel like talking. Do you want to go for a walk and talk about it?”

Literally, nearly everything you could ask someone whose family is dealing with physical illness works for someone whose family is dealing mental illness. Thanks for reading this. Thanks for passing it on to anyone you know whose family is dealing with mental illness so they feel less isolated. Thanks for expressing empathy, asking questions and not leaving them alone with it.