Language… a) kills b) saves (Delete as appropriate)

This is a post about language; more specifically, the language we (especially GPs) use when confronted by a person who is in distress.

You see, language (be it spoken, sung, written, depicted, symbolised, gestured, or signed) is how we communicate our innermost thoughts and feelings to one another. Language is how we find connection; how we explore our ideas, beliefs and values outside the privacy of our own minds. Without language, we would all languish in our own individual realities, unable to tell if the people around us were seeing or thinking or feeling the same as us. In short; it would be a pretty cruel and lonely existence if we were to be without the means to communicate with those around us.

Language, therefore, is vital to our emotional, intellectual and spiritual well-being. It is essential if we are to learn, to question, and to develop our understanding of the world. Language allows us to confirm or deny our beliefs about what we see in front of us, by probing others’ perceptions of the same. Language not only provides existential affirmation, however; it allows us to cooperate, to collaborate, to accommodate, and to integrate. Arguably, it is the development of the human capacity for language that has allowed our species to develop capabilities beyond any other. Language enables us to grow, to advance, and to thrive.

Nevertheless, whilst it is important to recognise the advantages of our ability to communicate with each other, one must also bear in mind the ills that can be caused via one’s use of language: Due to its potency, language can also be harmful, especially if used if maliciously or injudiciously. Language can be used to insult, to label, to discriminate, and to ‘other’. Language can be used to inspire hatred or prejudice, to justify maltreatment, to excuse negligence or oversight, and to maintain systemic power hierarchies. Language can be used to enslave; to restrict, to contain, and to define the conditions under which one must subject their autonomy, their freedom, or their possessions to another. Furthermore, through censure, populist narratives and dogma, language can even be used to define reality; as opposed to simply describe it. Language can thus be used to control.

It is for all these reasons that the language we use when met with a person in distress is so important. It is vital that the words we choose in these circumstances are genuine, empathetic, and affirming. It is imperative that we do not trivialise that person’s suffering, or invalidate their feelings in their moment of distress. In this instance, it is paramount we allow the entire person into the room with us, and that we ‘turn in’ to their pain, rather than pushing it away. In these scenarios, our response in that moment can be life-saving or life-ending. It is our responsibility, therefore, to ensure we do our best to make it the former.

To give you one example of what not to say in these particular scenarios, especially if you are a gatekeeper (e.g. a GP, a psychiatrist, a social worker) to other services which that person may require, I give you this example from one person’s own lived experience: First, imagine that you are a GP, and a patient has come to see you during a routine assessment. In this assessment, the person appears to be outwardly cheery and optimistic, but you sense that this is relatively superficial and that there is more going on beneath the surface. Consequently, you decide to probe the patient in question for more information, until they reluctantly open up about the suicidal feelings they have been experiencing for several weeks. This does not come as a surprise to you; they have a long history with psychiatric services and have a complex trauma history, so you offer them some advice: You insist, sympathetically but repeatedly, that the patient simply needs to ‘enjoy life’. This is largely where the conversation ends.

If you have not yet grasped the problem with this scenario, let me explain it for you: Telling a person with a long history of self-harm/suicidality, who has reluctantly confessed to struggling lately, that they simply need to ‘enjoy life’, is not only deeply patronising, it is potentially detrimental to that person’s self-esteem and future help-seeking behaviour. In truth, the very fact that the person in question is feeling suicidal likely means that they simply cannot ‘enjoy life’; and, it is unlikely that this deep distress is due to the patient being want for trying. The issue here is that, by suggesting that the patient simply needs to try more to ‘enjoy life’, places blame at their feet and will likely compound any guilt they are already feeling at being unable to feel pleasure from anything at all; thus fuelling feelings of being a ‘burden’ to those around them, and exacerbating their suicidality. By using this statement, one has successfully invalidated everything that the patient is feeling – their anger, frustration and fear at being so acutely in pain – and disregarded all the potential contributors to their feelings in the very same breath (note that the GP was familiar with their trauma history). In this moment, the patient is likely to feel completely unheard, more lonely, and as if nothing can be done to help them; all from only two words.

So what can be done better? Well, the best thing you can do in moments like this one is to sit with the person’s pain; to recognise it, to bear witness to it, and to not push it away. In these moments, you need to allow that person to be truly honest about how they feel, without shutting them down or trivialising their feelings, whilst also offering hope that they can move out of this pain at some later stage. Most of all, offer them your genuine concern, not your pity, if true empathy is beyond your reach. Remind them that they can talk to you again if they are suffering or, if this is not possible or practical, refer them to appropriate services. No matter what you do or say, remember that your language can have a lasting impact on this person in their moment of vulnerability, and that is your responsibility to ensure it is not a harmful one. Language can kill, but it also saves: You decide the outcome.