What Not To Say When Someone Is Sick

I understand the impulse, but you are well-advised to resist it. When someone you know has a serious illness, maybe even dying, you want to say something to them that is helpful, positive, and hopeful. The hopeful tone takes away some of the sting and the awkwardness of not knowing what to say to someone who just told you they are dying.

The problem with this approach is that you risk making the other person feel worse just so you can make yourself feel temporarily better, to ease the discomfort of that one encounter. It is really easy to rationalize this behavior to yourself, you are just trying to be helpful.

Sick Shaming

There are multiple problems with this approach, however. The first is that it makes the person with an illness feel terrible. As

Talking at someone with cancer about what they should do, rather than being with them in a morass with no easy answers, is not you helping them. It is you unfairly shaming them for having failed at self-help, which isn’t even a thing. As Steven Thrasher said is a recent excellent editorial (which you should read in full):

Talking at someone with cancer about what they should do, rather than being with them in a morass with no easy answers, is not you helping them. It is you unfairly shaming them for having failed at self-help, which isn’t even a thing.

He further says that telling people what they should do to treat their illness blames them for being sick, further isolates them emotionally, and is condescending.

The desire to offer such advice is ultimately about feeling in control, but that control is an illusion.

Alternative Medicine Makes It Worse

By all accounts, one universal experience of those with a serious illness is that people come out of the woodwork to offer them advice about which alternative medicine they should be using to cure themselves. The experience is even worse for those with any fame, for then they have hordes of fans giving them unsolicited advice.

I have experienced this myself with sick family members, and have heard it from many friends and patients, and documented in many articles. Sick people are just inundated with terrible advice.

What alternative medicine gurus are selling, more than anything else, is the illusion and false hope of control. If they were truly interested in helping people with practical interventions, then they would follow proper due diligence. They would prove to a reasonable degree that their treatments were safe and effective. In other words, they would follow a valid and transparent process of science, and their treatments would not be alternative.

Further, if their treatments truly worked, they would want them to be available to everyone, and the only way to accomplish that is to prove it with science.

Instead, we have an industry of fake treatments, often lacking even basic plausibility, that are either already proven to be worthless or even harmful, or are simply unstudied. They prey on desperation and false hope. Further, like any good pyramid scheme, their customers become their best sales people.

What you are doing when you advise a sick person to try an unproven alternative treatment is saying that the medical profession is crooked or incompetent, and that you know better than the world experts who have dedicated their lives to studying medicine and looking for treatments. This is the Dunning-Kruger effect but with immediate practical implications.

You are also saying that the sick person is not taking their illness seriously, that they have not explored all options, and that they are better off listening to you than their own doctor.

Remember this – you are not their doctor. You have no business giving them health advise. If they ignore you, you have only managed to make a sick or dying person feel worse. If they listen to you, then you now have responsibility for the outcome.

Sick people are emotionally vulnerable, that is why they are preyed upon by charlatans. Whatever their intentions, what actually happens is that the sick person and their family are simply victimized. They are given false hope, which is likely to be dashed, adding to their emotional burden.

I have seen this myself – patients who spend the last year of their life not dealing with their ultimate mortality, getting their affairs in order and spending time with their loved-ones, but in an unstable denial fueled by the false hope of a magical treatment. When those hopes ultimately come crashing in, they are doubly devastated.

They may also be lured away from scientifically proven therapies. This, of course, is the ultimate harm – sacrificing a real chance at a cure or at least maximizing their length and quality of life while pursuing unicorns.

There is also financial harm. The possibility of a cure is emotional blackmail. Most people would spend anything at a chance to save a loved-one. They will mortgage their house, do a fundraiser, go into debt – whatever it takes. They can’t say no, and take the chance of living with the guilt that they could have saved their loved-one if they just spent the money. At they end, all they have is the added burden of financial ruin.

That is what you are offering to people when you suggest they turn to alternative medicine when they are sick.

Conclusion

When people have a serious illness they do not need your medical advice (unless you are their physician). You wouldn’t tell an engineer how to design a bridge, or a lawyer how to argue a case.

What they need is your emotional support. Just be there for them, with all the pain and discomfort that implies. People don’t want platitudes or simplistic advice – that just minimizes their pain and makes them feel as if they are alone.

If you want to offer practical help, then ask them what they need. Maybe they need someone to watch their kids, or drive them to their appointment.

They don’t need you to insult and shame them into wasting time, money, and emotion on false hope.

 

What Not To Say When Someone Is Sick Steven Novella