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 defenceless. 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
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.
Suicidal ideation
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.
Selective disclosure
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?
Managing the Depression Puzzle takes a holistic look at the different potential pieces that might fit into your unique depression puzzle.
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!
Thanks! Look forwrad to reading your thoughts!
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.
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.
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.
Makes sense.
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.
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.
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…
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? 🙂
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.
Indeed.
Boy, you are so right! We lie to others in self defense of being judged, etc. and we often lie to ourselves. You are spot on! <3
And the lying to ourselves can cause just as many problems as lying to others.
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.
Trust makes a huge difference.
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.
Trust definitely makes a huge difference.
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
I completely agree!
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!
Hopefully it’s something he’ll be able to support you with rather than taking it in an unpleasant direction.
For sure.
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?
Yeah good point.
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
Definitely. And finding the balance between accepting risk and protecting life is certainly not easy.
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
Yeah, contracting for safety is such a token thing.
I hope the new taper schedule goes better!
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.
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.
Definitely. It’s letting people down.
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.
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.