MH@H Mental Health

Mental Illness: The Lies We Tell and the Secrets We Don’t

Mental illness: the lies we tell and the secrets we don't - graphic of woman making a shush gesture
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As a mental health nurse, I always hoped that my clients would feel comfortable and safe enough to be open and honest with me. As someone with depression, though, being open and honest is likely to go straight out the window if it appears to conflict with whatever goal or need feels most pressing at the time.  While this may sound manipulative, it’s something I’ve learned to do for the purpose of self-protection and self-preservation.  It’s part of the armour that I put on when my illness leaves me feeling weak and defenseless. Recognizing the lies we tell is important in understanding what their purpose is.

I don’t think this is uncommon, either; the lies we’ve told can continue to echo through our minds, even when we’re sure we had to tell them.  Lies by omission don’t go away simply because we choose to skip over them.

Medication adherence is a common thing to lie about, often motivated by concern about some form of negative reaction or consequences.  Often it means the prescriber isn’t in as good a position to adjust treatment appropriately, but that may pale in comparison to the potential consequences of being open.

After my first hospitalization, conditions were put on my nursing license that I had to see my psychiatrist regularly and take medications.  Between my hospitalization and my eventual return to work, I had a suicide attempt that I didn’t tell anyone about.  After that, I figured what’s the point of taking medications if I feel like crap anyway, so I stopped them.  Luckily, the meds gave me enough of a start that I was able to achieve full remission anyway.  For more than a year while the conditions were on my license, I lied about taking my meds. I even picked them up regularly from the pharmacy to keep up the lie.  Unfortunately, it came back to bite me in the ass when my then-boyfriend overdosed on my large stash.

The topic I lie the most about is suicidal thinking.  My past experiences in hospital were quite negative, and I never want to be hospitalized again.  Being held involuntarily was particularly difficult.  Disclosing suicidal ideation is one of the quickest ways to get committed to hospital, so I keep my mouth shut.  Is that a safe, healthy way to approach the issue?  Of course not.  But in the weighing of pros and cons, there’s little that would win out against my desire to avoid hospitalization.

I also omit symptoms that I either do not want or do not feel ready to talk about.  At one point I had gone off meds for a while after a 3-strikes-you’re-out series of negative experiences with doctors.  After a couple of sleepless months, I realized that drugs were a necessity.  At the same time, I didn’t want to risk talking about my depression and getting the same unhelpful response.  The mental compromise that I was prepared to make was to only admit to being unable to sleep.  In doing so, I could get my mirtazapine and quetiapine back on board and get some sleep. After a little while longer, I felt safe enough to disclose the rest of what was going on.

In the end, we can just try to do the best we can with the situation we’re faced with.  The more that health care providers understand that, the easier it might be for us to remove some of that armour.  It’s not realistic to think that the lies we tell and the secrets we keep will ever disappear entirely, but it’s worth reflecting on what underlies them so they don’t end up coming back to bite us in the butt.

Have there been lies you’ve told, either outright or by omission, to your treatment team?

book cover: Managing the Depression Puzzle, Second Edition, by Ashley L. Peterson

Managing the Depression Puzzle takes a holistic look at the different potential pieces that might fit into your unique depression puzzle.

It’s published by MH@H Books and available on Amazon and Google Play.

57 thoughts on “Mental Illness: The Lies We Tell and the Secrets We Don’t”

  1. Have there been lies you’ve told, either outright or by omission, to your treatment team? Sure. I’ve been battling my particular mental illness since 1973. Back then nobody talked about mental illness – one was simply labeled as “crazy” and stigmatized. As I’ve prepared to write this comment, I realize that it’s too long for a comment – I’ll post my thoughts and link back to this excellent topic you’ve shared today! Thanks Ashleyleia!

  2. I’ve always thought regulations around reporting suicidal thinking probably did more to promote suicide than stop it. If I know that I’m going to get locked up for admitting I’m suicidal, why would I tell you? Also, there are different levels of suicidal ideations. On a score of 1-10, I probably once reached an 8 or 9, for about 15 minutes. I wrote about it in my first book. I have never been back there, and I didn’t tell anybody I was there until years later. What if I told them the next day what happened? I would have been taken to the hospital and sedated. That’s not what I needed. I didn’t need to be around other crazy people. I needed my normal life to keep going and eventually get myself out of that round of depression. Anyway, just my two cents.

    1. I think the more skilled a mental health professional is, and the better they know the patient/client, the less likely they are to jump straight to hospitalization. Since I have a history of multiple attempts, I suspect, and probably rightly so, I worry that it’s likely to lower the tolerable risk level.

      1. Today, I’d tell my current therapist, who I’ve had for over six years, because she wouldn’t freak, but I wouldn’t tell another living soul.

  3. I have lied to my treatment team about the use of recreational drugs in the past. I have also, by omission, not told them about suicidal thoughts I was having, so it’s helpful to know that I’m not the only one! I have never been hospitalized yet, but if I shared one particular episode of auditory hallucinations I probably would have been.

    1. I suspect lying about drug use is fairly common. Mental health care providers really should be more open to having non-judgmental conversations on that subject.

  4. lol They don’t believe you when you do tell them the truth…may as well tell them what they want to hear as when you tell the truth they really do not know what to do with you…

  5. This sounds really hard, that you were in a mental hospital and couldn’t talk about the suicidal thoughts. It’s really sad, because this should be a supportive environment.
    I had quite the opposite experience a few months ago.
    I never lied, but I didn’t always tell the whole story, just some parts. Does this count as lying too? 🙂

    1. That could probably be considered lying by omission. It would be nice if there was no need to selectively tell our stories, but that doesn’t seem to be the reality.

  6. I don’t talk about suicidal ideation, no one asks so that’s easy. When I touch on it I call them ‘some weird thoughts’. I don’t tell anyone that when I’m really tense I see bugs crawling.
    It depends on how well you know and trust your health care provider and what they can do.
    Good subject, glad you talked about it again.

  7. I wanted to comment earlier, but I fell sound asleep. No time like the present!

    That’s so tragic about your then-boyfriend. I hope you don’t blame yourself at all!! 🙁

    Huh. You raise a very interesting question about whether or not to lie and hide suicidal thinking. I guess it’s okay *****if you can keep yourself off the ledge on your own****** which is a huge “if”, but not impossible. I can see why you lied about your meds, too, because it seems awful that you’d be forced into treatment for your career. That rubs me the wrong way, as I’m sure it did you.

    Hmm….. have I ever lied about my treatment… I don’t think so, but I’ve been a difficult patient at times. I went off my meds in fall of 2007, and I fired Dr. Phlegm over a tiff, and I wound up in my general-care doc’s office begging for some Trazodone. (For crying out loud, he should’ve just given me some. It’s hardly a hard-core narcotic, or whatever.) But he kept insisting I should take Seroquel instead, that I was paranoid and all that. All I remember is fleeting around his office from corner to corner, demanding Trazodone. I don’t think it was pretty.

    I never liked that doctor, though. In circa 2005, I asked him what I could do about my double chin. I hadn’t gained weight (it was an age-related muscle issue), and I think I weighed roughly 160 at that time, which would be an ideal weight for me. He said, very snidely, “Lose some weight.” [Eyeroll.] Like, he couldn’t even be nice enough to recommend chin exercises, or anything? Nope. I still remember the sneering way he said it. Geez.

    This guy was Granny Smith’s primary care doc, and my parents’ as well. Granny Smith developed obvious and incurable osteoporosis, the clearly visible kind, many decades ago, right? Dr. Quack here didn’t diagnose her with it until it was way too late to treat, at the point where it was obvious to all of us that she had it. Yeah, I hate that guy. Oh, gracious saints! I need to run some errands.

    This was a fun blog post, because i love thinker questions about obscure stuff!!

  8. This is such a good topic, and so important. I’ve definitely stayed quiet about suicidal ideation, while diligently tracking my thoughts and feelings in mood apps. It honestly comes down to trust a lot of the time, do I trust my mental health provider enough to know these feelings are just that, feelings?

    Or do I think that even the mere mention of suicide will trigger the nuclear option of hospitalization – something that would often be FAR worse for my mental health (interfering with parenting, employment, routine, etc).

    I’ve dealt with suicidal ideation pretty much my entire life and at this point I’m skilled at knowing when I’m having a reaction to inner pain, and when I’m heading into the danger zone and do require support. It sucks though because it really just reinforces the idea that certain topics are safe to discuss while others are not. I remember disclosing I had self harmed to a mental health provider and it definitely led to a nuclear option that was not helpful… Self harm was as normal to me as breathing, and yes it was an unhealthy coping mechanism but it also wasn’t the red alert emergency situation that it was treated as.

    I think many mental health providers need to get more educated and comfortable with how painful and dark their clients experiences can be. Things that seem shocking beyond belief to some are truly a regular experience for others, and treating everything like an extreme emergency makes it harder for people to trust that their experiences will be met with a balanced response.

    Trust in fundamental with mental health clients, and understanding that most lucid people are the EXPERTS in their experience and will tell you what’s an emergency and what not. It’s important to proceed carefully when someone is trying to let you into their inner struggle. After all, no one wants to go through this alone. We just don’t want to lose everything we worked for when showing you the truth of how deeply we are hurting.

    1. Beautifully said – I think so much practice now is risk averse which denies the professional an opportunity for trying to really understand and more importantly the sufferer the opportunity of being understood which is where the healing lies I think

  9. I tend to just freeze and not say anything. I guess it’s sort of lying by omission. The other day I lost it and now T knows how bad the suicidal thoughts have been and just how close to the edge I am….ugh. I trust him to work with me to avoid hospitalization but I would be lying if I said I wasn’t freaking out. That has always been the biggest fear of mine and has up until this point prevented me from saying anything. If he doesn’t bring it up neither will I but if he asks I actually have a really hard time lying to him…dangit!

  10. I don’t think I’ve ever been honest about my suicidal thinking to a therapist or any other psychiatrist I see regularly. Just like you, I think I weigh the pros and cons and end up not being as honest as I could be. But the alternative, in my opinion, is what I’m more scared of.

  11. I’m a terrible liar, so whatever I end up trying to hold back from my providers usually ends up eating me alive. I used to keep quite a bout the self-harm at times, back when I was still doing that. I don’t like to talk about my suicidal thinking all the time either, especially when it has to do with planning, because what difference is that even going to make?

  12. Really good article Ashley – sadly too many conversations between MH professionals and those being helped have this veneer where the MHP doesn’t want to ask sometimes in case it means have to do something difficult and the patient doesn’t want to say for the same reason. The young people I work with mostly have all been hospitalised for a long time before coming to us in the community – some traumatised by their experiences there and trust takes time to build from this base xx

  13. We just came from GP appointment and took the depression and anxiety scale. Blech.

    We’re pretty open about suicidal ideation and absolutely lie if we sense an involuntary hold would ensue. We have never attempted and have 5 voluntary in-patient treatments. No involuntary holds. So we have doctor/therapist’s credibility, trust. That’s the thing: if we were imminently at risk, we’d still want to go to a productive program, not sit in shackles for 72 hours. We told all our Ts we will tell them what they want to hear every time so that their license is not at risk so don’t even bother asking. They rarely try to get us to “contract for safety.” We told them its bullshit. If we’re ready to die ever, we will either ask for productive help or do it. The contract means nothing and we would break it

    The meds taper is being reset. We did it too fast. One more try

  14. This is such an interesting post. It really got me thinking. Looking back I think I was at my most manipulative when I was in a seriously depressive episode. I tended to lie on counselling. It allowed me to say I was engaging in the process when really I wasn’t going to follow through with any of the work that was needed. The involuntary hospitalisation thing is really sad and scary .. I have a friend who will never be honest again about suicidal thoughts. Just too frightened of the consequences. It prevents her having the help and support she needs and puts her at a huge risk of harm. Very concerning but totally understandable.

    1. Yet I don’t imagine anyone would ever lie to their doctor about chest pain to avoid being hospitalized. The system needs to do better.

  15. Given the specifics of my trauma history, there is no way I would (or probably even physically *could*) ever willingly utter any of those magic words that could risk a loss of personal autonomy in a formal mental health setting. I only ever started therapy in the first place because it is commonly required of clients who take controlled meds meds (like stimulants for ADHD) by practitioners as a CYA. I had a couple of generic required therapists that I have had to see since first being diagnosed ADHD to keep being prescribed stimulants. (I also found a way to get out of the requirement entirely in one place I lived.) Those therapists never figured out I ever had anything more than some “anxiety” and a bit of ADHD rejection sensitivity. I give my current therapist – who started out as only my latest required “generic assigned therapist” when I moved to the northeast – massive props for managing to somehow become the only ever therapist (or “person associated with any system in general”) who has earned my trust. Among other things, she did that by being very upfront and precise about under what *exact* narrow circumstances she would ever be legally/ethically required to escalate anything I said and overtly promising never to escalate *except under those exact circumstances. She is very good at obliquely acknowledging tough things that are never directly mentioned and at remembering what has been said before without taking any case notes that would also be triggering and make me feel inherently too unsafe to be as honest as possible. I got lucky with her, but my actual psychiatrist I absolutely “manage” disclosure with.

    1. It drives me bonkers that taking a stimulant means some people automatically assume that you’re sketchy. I’ve never been required to see a therapist to keep getting mine prescribed, but dealing with anyone other than my regular doctor is a massive headache.

  16. I, too, have been on the receiving end of forced hospitalization and as a result i am very careful about disclosing the truth.With my current T, i prefix “concerning” info with ” now don’t take this the wrong way–” i think this has saved me a couple of times. Doc

  17. I understand. It took me ages to get real help and all this before almost ruined me.

  18. I haven’t been faced with a hospitalization in some time. I was usually in very bad shape when I was hospitalized. Today, I am more stable, although I deal with a lot of shit here at home.

  19. Fortunately, I’ve never been admitted to hospital. But of course, like you Ashley, and many others, I’ve lied about symptoms. There’s no way I’d admit to suicide attempts, I’d just say suicidal ideation – which is there more than I’d ever tell. And for that reason, I do take prescribed meds; Paroxetine and Amitriptyline.

    Of course, I’d lie again if I had to 🙁 There’s no way I’d want to be detained in our mental health hospitals as they currently are 🙁

  20. Many years back, when I finally took the courage to reveal my life-long medication plan to my best friends. They were in disbelief and assured me to stop taking my medication because they thought I was mentally healthy enough to cut off my dependence on pills. I was wondering and did some internet search and was exposed to some unverified information about psychiatric drugs. I stealthily stopped my Olanzapine intake for at least three months during my undergraduate internship. I never told my treatment team. Since then, from a pretty, optimistic and active girl, I slowly turned into a ragged, depressed, demotivated lady. After that, I continued to take my medication due to sleepless months and a few trips to a hypnosis therapist. However, it has been hard to recover to be like that bright girl during my undergraduate life. Maybe coupled with my career-related confusion right after my internship, my mental health had turned under control yet I could never recover to be the same bright girl again. Slowly, I ended up in an unhealthy two-week romantic relationship out of irrationality. And later, I had a few years of serious, crippling relationship delusions with another guy at work. And my life has not been easy as there have been deep, dark valleys from time to time. I wonder if those few months of being off my medication have turned my life path so much. Till now, I cannot gained back that feeling of life momentum during undergraduate years. Even when I am around my then-best friends of undergraduate years, I feel like shit because maybe I have changed due to poor mental health and this has changed the ways they relate to me.

    1. It’s hard to look back and wonder what would have happened if certain things had been different. We can guess, but there’s really no way to know.

      1. Yes, you are right. Life always comes with unanswered questions. Certain things are always unknowable. We just need to continue to live well with all the unknowable things. It is hard if we keep holding on.

  21. Great post! I love your insight. It it tough being hospitalized and being essentially ordered to take medication. I’ve been there, several times. Thanks for your honesty!

    Yes, there were things I did not tell my care team for a long while. I have always been a mistrusting kind of a person, and I was afraid to tell people about my psychotic symptoms as well as my exact history with said symptoms. I didn’t want to be looked at, or thought of, as completely off my rocker or as someone who was “difficult to treat”. It has been 15 years since my psychotic symptoms became almost unbearable at times. I finally talked to my doc about it, just last week. It was hard, but I’m glad I did it. My doctor finally has a better idea of what is going on with me, and, for the first time, I feel good about that.

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