Beyond Blue

Beyond Blue

Blame the Illness, Not the Patient

blame the patient2.jpeg

One of the most hurtful comments made to me during the worst of my depression was this: “You must not want to get better.”

I know that person didn’t intend to be spiteful or mean. She’s just plain ignorant regarding mental health issues. (But I still haven’t let it go, obviously.)

Comments like that are why I’m so passionate about educating folks on mental illness and eliminating the isolating stigma of our condition. Because it’s hard enough fighting all the negative intrusive thoughts within our head. We don’t need additional insults and negative opinions–confirmation of our weakness–from folks who have never wanted to die and consider all suicidal thoughts self-absorbed and pathetic.


But boy do we hear a lot of them, even from the persons who are supposed to be on our side: our doctors and psychotherapists.

Richard Friedman, M.D. penned a compelling, salient piece for the New York Times awhile back on why so many doctors and psychotherapists blame their patients if they don’t get better. It beats blaming themselves!

Friedman writes:

Doctors and psychotherapists generally don’t like it when their patients don’t get better. But the fact is that lots of patients elude our clinical skill and therapeutic cleverness. That’s often when the trouble starts.

I met one such patient not long ago, a man in his early 30s, who had suffered from depression since his teenage years. In six years of psychotherapy, he had been given nearly every antidepressant under the sun, but his mood hadn’t budged.


Weeping in my office one day, he explained that he was depressed because he was a failure and a whiner. “Even my therapist agreed with me,” he said. “She said that maybe I don’t want to get better.”

You can’t see me, but I’m nodding right now, as I read that. Because I’ve been there, done that, bought the t-shirt, and shrank it in the wash. I can honestly say that my current doctor, number seven, is the only psychiatrist who didn’t look at me with some speck of skepticism in her eye, as if I might be playing sick to prove that she should have never graduated from med school when she doesn’t know a thing about the brain, or how she and the entire field of psychiatry is a sham–a well-contrived conspiracy to get the people’s money, or that I just was on a mission to make her miserable. Because … I have nothing else to do?


One therapist told me that he knew people who wanted to get well, and he knew people who wanted to stay sick. It’s no wonder, then, that he couldn’t understand why I lost control of myself during a panic attack, why I couldn’t access that “happy place” in my brain, to stop me from shaking, losing my grip of the steering wheel, and ultimately finding myself with a flat tire up on the curb of main road in Annapolis. In retrospect I know exactly why that happened: I wanted to stay sick!

Thank God for doctors like Friedman and Dr. Smith who honestly get it–they realize that their patients don’t get anything out of misery. In fact, the misery is miserable! Dr. Smith has never once looked at me with scorn after I’ve had a setback–like I framed it to get on more Zoloft because that drug is sooo good for my sex life.


The patient that Friedman described above finally responded to a treatment. Free from his depression, the guy no longer felt like a failure. Friedman writes:

I decided to challenge him. “How come you’re feeling so much better despite the fact that nothing in your life has really changed in the past few weeks?”

“Well, I guess I just think like that when I’m down.”

Exactly. His sense of worthlessness was a result of his depression, not a cause of it. It’s easy to understand why the patient couldn’t see this: depression itself distorts thinking and lowers self-esteem. But why did his therapist collude with the patient’s depressive symptoms and tell him, in effect, that he didn’t want to get better?


For an all too human reason, I think. Chronically ill, treatment-resistant patients can challenge the confidence of therapists themselves, who may be reluctant to question their treatment; it’s easier — and less painful — to view the patient as intentionally or unconsciously resistant.

Friedman goes on to say that he believes that some patients do really want to be sick. According to Friedman, some “go to extraordinary means to defeat doctors who try to ‘treat’ them.”

I don’t think the patient wants to defeat the doctor. I think he is merely too sick to get well, meaning he can’t do all the hard work that’s required to maintain recovery when his feet are cemented in his disease. That cycle–which I know all too well–is a pernicious one that I no longer judge.


Or maybe some folks are just more driven and more disciplined to get to Sanity Island. Either way, I’d like to blame the illness, not the patient. Friedman does, for the most part, too. He concludes the article with this: “A vast majority of patients want to feel better, and for them the burden of illness is painful enough. Let’s keep the blame on the disease, not the patient.”


  • http://AddaURLtothiscomment Sam

    The only problem is that I still blame myself for “not getting better”, “not trying hard enough”, yadda yadda.
    I’m relieved that my psychiatrist does not feel the same way.

  • http://AddaURLtothiscomment Dr.Kevin Keough

    Therese, this ought to be among the best posts you’ve written. You describe the behavior of those that ask for our trust and follow their guidance.
    “Job’s Comforter’s” is what I call them. Since such practitioner’s (frequency and severity of their empathic failures ought be identified with a frequency count…..cross a line and you practice only with supervision if at all—for a bit of reflection time.

    So, I would appreciate it if you would write the book called “Job’s Comforter’s You are more diplomatic than me though you pull few punches. Sometimes an arrogant “Job’s Comforter” type just needs to be smacked upside the head. Yep. I didn’t say how hard they’d be smacked but it’s worth remembering what it feels like to be on the receiving end of their therapeutic intentions. It’s more painful than can be spoken.

    Thanks for this one Therese.

  • http://AddaURLtothiscomment Amy freeman

    Great post

  • http://AddaURLtothiscomment Janet

    It’s so easy to keep blaming ourselves. My brothers and sister don’t know how to deal with my diagnosis even after an almost very successful suicide attempt and subsequent coma. They really just think I’m weak. This hurts me so bad so I tend to blame it on myself since they don’t get it.

    The meds have “puffed me up” as far as weight goes and I don’t always follow the alcohol rule when I am visiting the states and family (I live in Europe). I appreciate this work and have just forwarded it to a family member. Thanks again. Pray for me if you can. Janet

  • http://Cruelthoughtlessremarks Jillian

    Thank you Therese for your posting. It hurts most of all when professionals who are supposed to be on your side say hurtful things at times when you are most vulnerable.

    If anyone understood or felt for one moment the mental, physical spiritual pain of mental illness, they would not ever consider that the patient secretly wants to continue to live in hell. It is both frustrating and hurtful when people look at our outside and then tell me I don’t feel grateful enough.
    Thank you for this blog that lets me know I am not alone.
    I don’t take drugs that decrease my sex desire, make me gain weight, give me bad dreams, make me thirsty all of the time commute for an hour by to see my therapist, spend all of my money on treatment, in order to treat my illness from anything other than desperation to get well.
    I fell sad when I consider what I could have done had I not spent so much time, energy and money I in treating the depression

  • http://AddaURLtothiscomment Your Name

    As I read all the Beyond Blue stories and comments, there seems to be one issue that is never addressed. What about the person who does suffer from depression but adamantly refuses to acknowledge it and therefore never gets help? I have spent the last 42 years living with such a man. His depression was never severe and although he managed to excel during his 37 years within the ‘structured’ environment of the military, his home life was a totally different matter. He could never deal with the day to day ups and downs nor could he deal with raising our two kids. I had to be both mother and father and had to take on all the roles that he just couldn’t cope with. He couldn’t stand any kind of upheaval in his personal life and it didn’t take our kids long to begin to take advantage for he never disciplined or even raised his voice to our kids. Instead he constantly gave in to their every demand. Unable to make this man happy, it took me years to realize that he was the problem and that I wasn’t although I was the one who sought therapy looking for answers. However no therapist ever looked at the possibility that the problem was not mine. In later years realizing that his problem was depression, I did what I now realize was the wrong thing. I hid the fact that my husband suffered from depression and constantly ‘put his best foot forward’.

    Well this man that I loved and protected for so many years walked out on me in August of this year, for the third time in our marriage. No reason and definitely no explanation. Other than saying that he never felt happy, not once did he ever indicate that he wasn’t happy in our marriage. After his retirement in 2003 he seemed to find it more difficult to cope and this year after a visit to his home town in May he seemed to sink into an even deeper depression. Then just like he did in 2009, he simply left a note and disappeared when I wasn’t home, even though he gave me his word that if ever he felt the need to leave again he’d talk to me first. Well he never did talk to me…couldn’t talk to me. Unable to cope he beat a fast track back to his home town and to his siblings, the only place where it seems he ever felt safe. From things that my husband told me earlier on in our marriage I feel that it is a very real probability that as a little boy he was sexually abused by his father, especially in light of the fact that he was the youngest and that his two older sisters came forward with such allegations after their father died a number of years ago.

  • Integrated Way

    Excellent article.Nobody wants to be sick for a long time.Psychotherapist are here to assist our needs as a patient and not to judge us or blame us for the illness.I’m glad I’ve met a good psychotherapist who was very helpful in my illness for five years.

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