Stop Talking to the Mentally Ill Like They’re Children

I’m back at __________ Hospital having completed my credentialing process and I’m amped to be doling out the mental health. I’m like one of those gunslingers who swings open the doors at the saloon ready to blow people away. Except instead of a Derringer or a Smith & Wesson I have a ‘You too can Have High Self-Esteem’ handout on one hip and a Positive Thoughts Worksheet on the other. That’s how I roll.
Even though I work in the Department of Surgery I sometimes go by Outpatient Psychiatry to be among my own kind. Today outside the main door was a male administrator, late 40′s, well-dressed and groomed. He was speaking to a man who was in all likelihood a patient at the hospital. The man was about 60 and overweight, had a few nervous twitches and was speaking in a soft voice. He was unshaven and his clothes were tattered. I have a guess that he might suffer from Schizophrenia. I’ve seen him before in a worse way, responding anxiously to voices and people that no one else could hear or see. Today however he seemed much healthier and functional.


“I! Hope! You! Have! A! Good! Day! Today!” the administrator yelled. Was the man hard of hearing? I suppose it was possible as some people seem to think that deaf people can hear them if they just scream loud enough.
“Me too,” said the patient.
“Yes! You know what?! You’re a good person, don’t you know that?!” the administrator shouted again.
“Thanks.”
The patient was clearly able to hear him so the yelling clearly wasn’t necessary. I couldn’t quite put my finger on what was driving my mood, but I was getting really annoyed at the way the administrator was speaking. Then it hit me that it wasn’t simply the volume, it was patronizing tone that he was using, the way one might speak to an infant. “Such a good man you are, so polite, and you take your medicine just like the nice doctor man told you too!” I’m surprised he didn’t pat him on the head and give him one of those oversized rainbow lollypops just for taking his Haldol.
Dr. Rob Soapbox Moment:
This is bullshit. Not that anyone listens to me but if by chance someone actually does pay attention to this: do not talk down, condescendingly or patronizingly to the mentally ill. Why people do this is not entirely clear to me. I’m not sure if it’s because we are afraid of people with mental illness or think they’re stupid or that we are skeptical of anyone who is different but the reality is that it is insulting and disrespectful. In graduate school a patient in the psychiatric ward told me, “The staff here talk to me like I’m in pre-school. I’m still an adult even if I’m fucked in the head.” It’s a fair point.
We seem to use this same patronizing tone with the elderly and the homeless. The only people who should be spoken to like children are children (and even that is open to debate). I was going to give the administrator a verbal smackdown and tell his ignorant ass to get it together and start speaking like a normal person but he jumped into his Douche Mobile (some obnoxiously yellow Hummer) and drove away. Probably out of fear of my wrath. I hope it costs him $400 to fill up that gas tank.
I’m off the soapbox for now but I’m still pissed off. Fortunately I have my anger management workbook on hand so I should be better off come my next post. Stay on my good side until then.

30 Responses to “Stop Talking to the Mentally Ill Like They’re Children”

  1. Rosie says:

    I work with the elderly, and I find that it is a constant struggle not to let condescencion slip into my voice. Sometimes when people are experiencing psychomotor slowing (as happens in old age, and major depression), we assume that their brain is slow too. I just try to keep it in the forefront of my mind that the person I am speaking to is a fully mature adult who could probably teach me a thing or two about life.

  2. Anonymous says:

    I find myself speaking louder to people who don’t speak English, I’m an idiot I know.

  3. kate says:

    i used to work with an 11 year-old autistic boy who was a lot smarter than most of his therapists thought. one day a particularly obnoxious therapist was trying to instruct him in the art toilet training, since he had a tendency to urinate on himself at the most inconvenient times possible. she spoke to him in such a pedantic and condescending voice that i could see him getting progressively annoyed, so when left him alone in the room for a break i wasn’t too surprised that he took the opportunity to pee into her half-empty can of soda. i was, however, surprised that he was able to wait for her to come back into the room, watch her drink the pee-soda combo and spew it all over the wall before erupting into laughter and admitting he was responsible for the awesome prank. deception of that caliber is really difficult for autistic people..

  4. T.J. says:

    I hate that too, given that both of my parents are in mental health fields (my mom especially, she has many clients whom are group homers) I got to see a lot of that growing up.
    One of the worst things growing up was that I tend to be a little weird myself (I’ve always wondered if I’m an aspie or something else), so I always had teachers / classmates either do the condescending thing or treat me like a live grenade. Shit, one time, there was a bomb threat taped to our school’s door, and I was followed and questioned for about three days. Granted, that was during my “do drugs and be depressed” days, but for some people, especially those whom are prone to depression, that’s almost worse than just kicking them square in the nuts.

  5. Scootah says:

    To quote my 6 year old niece on her first day of school -
    “Fuck you mishter, I’m shix, not shtupid!”
    I don’t think talking down to kids is any better then talking down to anyone else. Kids are generally smarter then we give them credit for and they communicate on the level we expect them too. Baby talk and condescension should be reserved for whining morons in the workplace.

  6. Abbe says:

    I ran into a similar problem when I was first diagnosed with depression and anxiety. Suddenly people were treating me one of two ways: like I was immediately suicidal and nobody should ever say anything bad around me, or like I was 6 (I was 16).
    I think it’s amazing how anything looked upon as a “mental defect” immediately drops a person into a category of “stupid/slow,” even depression and anxiety, two things EVERYONE experiences in their day-to-day dealings, just on a lesser level.

  7. javascript says:

    THANK YOU! I have experience with special needs education, and they often treat students like they are stupid. They might have ADD or an anxiety disorder, but that doesn’t mean they’re idiots. Even if they are idiots, there is not reason to talk to them like idiots. I don’t talk to my dog like he’s an idiot, and he still manages to understand and obey me. My dog isn’t even smart enough to talk, and not even he need to be spoken to in idiot-language.
    The worst part is, anyone who complains that they don’t want to be patronized is dismissed. They are told they’re being ungrateful, or that the only reason they are complaining is because they must lack the social skills to correctly interpret people.

  8. Tashe says:

    Well, if literally no one listens to you, then for sure they’re missing out. Tend to doubt that they don’t, but hey.
    I too was thinking along the lines of that I don’t think it’s respectful to talk to children in that manner either. If it’s somehow coming from a place of deep affection, maybe. Otherwise, it’s pretty much insulting wherever it’s seen.
    Awesome quote from you on the fucked in the head, and per Scootah’s comment “shix not shtupid”!
    Dr. Rob Note: I definitely agree with both you and Scootah on the talking to kids issue. I phrased it poorly in the post. I do that a lot. Phrase things poorly.

  9. ShovelyJack says:

    I whole heartedly agree with your message and invite you to get on your soap box any time you want, until , of course,you disagree with me.
    I spent a stint in a hospital for suicide risk, and that was one thing that annoyed me greatly. While I admit I looked and felt like crap, I was still sharp enough to be able to understand and communicate complex thoughts, and I did so. The major frustration that I had was simply that I wasn’t being listened to by a lot of the staff, or I found myself on the receiving end of a slow and condescending lecture about bipolar disorder.
    I think part of it is that it’s sort of easy to think of anyone with a mental illness as inferior, and think that one, with proper strength of intellect and character, would be able to control any problems. And as such, anyone suffering must lack in either character or intellect. It simply isn’t true, and it contributes to the stigma attached to mental illness, and I find it especially frustrating when people in the field behave this way.
    One of the reasons I like my current psychiatrist is that I feel welcome to ask questions about medications, and she goes as in depth as I want, without condescending to me. I think that’s the way it should be.

  10. Anonymous says:

    I’ve worked with Japanese high school students who were in America learning English, and it always annoyed me when people did that.
    Especially because most of them could comprehend English very well, just speaking in English was a problem.

  11. lillalalla says:

    I object to the idea that you should use a patronizing tone when speaking to children, too. We tend to severely underestimate how well they understand things – and how much they hate being spoken to as if they didn’t understand anything.

  12. Eris says:

    Thank you. It’s one thing to speak simply, knowing that someone might not be in a state for a complex conversation. It’s another thing to speak down to them, and is likely to get your ass beat. I’ve spent some time in psychiatric hospitals, and the one thing that never helped was when someone assumed that I was incapable of understanding adult speech. That was more likely to make me ignore them/ act out, not less.

  13. Tracie says:

    I hope if I ever have children they end up like Scootah’s niece.
    Like Java, I have worked in special education, and hated how little credit my students were given. I work in a field of more general education now, and see it there as well.

  14. jackmo says:

    haha nice one Rob,
    I’ve never seen you in real life but from your writing it’s obvious you are a hard man and not to be fucked with!
    Re your point about speaking to people like they’re children, I totally agree. I also think its true for children themselves. One of the best ways I’ve always found to relate to kids was to speak to them like they’re adults and they will want to live upto the respect you’ve granted them.
    your loyal reader,
    Jackmo

  15. Vincent says:

    Maybe some part of the reason is that people want to feel good about giving social interaction to “defective” people without actually inviting them into a real conversation, which would be painful for them.

  16. NB says:

    You rock, doc. Keep toeing the edge.

  17. Anonymous says:

    Having been a child pretty recently (just turned 18 five days ago) I’d like to add something: don’t necessarily talk to children like they’re children either. Nothing annoyed me more when I was, y’know, eight, than adults who acted like I didn’t understand a word they were saying. Kids know more than you think, and if they need help, they can always ask for it.
    Dr. Rob Note: Great point.

  18. Paula says:

    Hi Rob
    I’m glad you also share my despisement (pretty sure that’s a word) of people who alter the way they speak when talking to people who don’t fit into their view of what is ‘normal’. I have a vision impairment and people have raised their voice when speaking to me. Um … last time I checked, my vision loss did not afect my hearing. I wonder if people adopt that child-like cadence to their speach because adulthood is proving too difficult for them and it’s the only way they know to transgress?

  19. Michelle says:

    I’ll bet a dollar if you asked those condescending people what they do for a living, they hold some kind of position of authority. You know, those school teachers that are constantly teaching, the cops that are always copping and the therapists that are forever…therapizing.

  20. Boderline Betty says:

    Um, no offense, *Of Course*, but You come across as Much more offensive than that hospital admin. (who, after all, didn’t say anything so terribly wrong, just used a loud voice and an annoying tone to say it)Definitely bad, but not horrible. YOU, on the other hand, write This: “I’m like one of those gunslingers who swings open the doors at the saloon ready to blow people away. Except instead of a Derringer or a Smith & Wesson I have a ‘You too can Have High Self-Esteem’ handout on one hip and a Positive Thoughts Worksheet on the other. That’s how I roll.”
    I HOPE to god you were *kidding*. It’s hard to tell. But, let me tell you, anyone that “gunslings” their way to Me, handing out STUPID handouts is just cruisin’ for a bruisin’. Sorry, Doc Rob. I know the truth can hurt. Please understand that I still think you are a Special Person, though.:)

  21. Sunny says:

    I’m glad people actually are reading this and seemingly listening. Now we need a “Stop Talking To The Unemployed As If They Are Mentally Ill Children!”
    Hey, now… I think I have my next blog! THANKS!

  22. Gordon says:

    It’s especially strange when people don’t even realise they’re doing it.

  23. Awhile back I had one of my pts thank me for not talking down to them, which I found curious. I’ve always thought Rogers had the best approach of trying to walk with the people he worked with, instead of trying to tell them what they need….so that’s what I do.

  24. Matthew says:

    Yes, I too believe that condescension is far too common and should be avoided. Especially when dealing with Mentally-Ill teenagers:
    “I know I’m not depressed, just somewhat down. Dysthymic perhaps? Is that the proper term?”
    Unsurprisingly that is the exact term.
    “I see. A case of the blahs?”
    lol. Although I suppose any normal speech could be viewed as condescending when it’s directed to Jack.

  25. Conrad says:

    A few teachers at my school Last Year knew I used to be depressed, and they didnt treat me like i was stupid, but like i would flip over a table and stab them with my pencil if they said something slightly unpleasent i.e. “I do not like dogs”, “New York has a high crime rate”, “some people are bad with Video Games”. DO they expect me to have a seizure if I hear something like that or what? I can relate to Kate because when the local High School [not my school, but the High School that i would have a hard time even getting into] received a bomb threat, for some reason the school counseller asked me if i knew about it! What The Frig lol

  26. Blinky says:

    Being physically disabled, I get that patronizing shit too and from people that have no business giving it to me like homeless people, girls I wanted to ask out, and therapists that “wanted to help me”.
    Just because I’m disabled doesn’t mean I can’t kick ten kinds of verbal shit out of you before my malformed lungs kill me. People are people and, unless they ACTUALLY can’t understand (ie are mentally retarded to some degree), treat them like you’d want them to treat you. I may look weird and walk weirder but, please, I’d rather talk over a retard than under a normal person because the retard, by and large, won’t hate me forever if I talk over him.
    Dig me?

  27. Donna-1 says:

    I have schizophrenia. I also have a college degree, which my sister does not. Yet she continually patronizes me. I misunderstood her today and thought I was supposed to meet her this evening for dinner. When I called to find out what time and where to meet, she said, “Now…what did I tell you?” Like, “You fuckheaded idiot-child sister of mine, can’t you even remember a simple conversation? Do I have to repeat myself to you?” I should have hung up, or at least asked which one of us is in Who’s Who in American Universities.

  28. CJ says:

    Okay, you told us what NOT to do…how about some useful information (I’m assuming you are a professional) How should we talk to them? I have a mentally ill sister who is verbally abusive to me and her husband and children on a regular basis. Frankly, it gets old and I’m not really in the mood to speak “respectfulyl” to her anymore, since she respects NO ONE…EVER.

  29. Donna says:

    It doesn’t even have to be spoken words to come across as condescending. Some of my former acquaintances, after learning of my MI diagnosis, have taken to “smiling kindly” at me. They are not being real, and they are treating me as if I am not real. I am no longer Donna, I am The Schizophrenic. And I doubt most of them even know what schizophrenia is or means. The most blessed of friends are those with whom I can joke about mood swings, psychosis, hallucinations, depression, etc., and the conversation does not instantly turn quiet and guarded. People don’t understand MI is just one point on the “being human” continuum. And it is not a fixed point. I am no longer in a mental hospital, taking ECT, zombified on medications, suicidal, or even depressed. I no longer have hallucinations. I am essentially recovered. Shouldn’t we all be allowed the dignity of recovery? It is something to be greatly celebrated.

  30. Carolyn says:

    I was talking to C about visiting M in the hospital. M is dying. C said, “What would I say to her? I wouldn’t know what to say, what to talk about.” Okay…who says we have to talk? In these situations, the important message is that you are there. After all, I visit the sick and dying not because I know exactly what to say to them, not because I want to appear well-spoken and confident, not because it is an opportunity to face my own mortality, and chalk up another good deed. It is just to hold the person’s hand, stroke her arm, smooth the loose ends of hair out of her face. My presence at that moment, with a person I love, must transcend my own discomfort. Just a warm body there with her in a merciless, cold and strange environment.

    Similar with being with anyone who is suffering a merciless, hopeless and barren landscape of the mind. Why would they want to talk, or even worse, why would they want to listen to ME talk. When I was hospitalized in a psychiatric ward, my parents would come to chat me up during visitation hours. Nothing could be worse. I thanked them for their concern and asked them not to come back. Yet there they were again, time after time. They were just trying to make themselves feel better, despite my stated wishes.

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