Julie Fast’s friend went to the hospital for a terrible colitis attack. “It was so serious they sent her straight to the ER.” After reviewing her medical records and seeing that her friend was taking an antidepressant, the intake nurse said, “Maybe this is all in your head.”

When it comes to mental illness, people say the darnedest things. As illustrated above, even medical staff can make incredibly insensitive and downright despicable remarks.

Others think teasing is okay.

Fast, a coach who works with partners and families of people with bipolar disorder, has heard stories of people getting teased at work. One client’s son works at the vegetable department of a grocery store. He has obsessive-compulsive disorder and poor social skills. When his symptoms flare up, his coworkers will ask questions like, “Why do the labels have to be so perfect? Why do they have to be in line like that?” They’ve also teased him about being in a psychiatric facility.

But most people — hopefully — know that being an outright jerk to someone about their mental illness isn’t just inappropriate and ignorant. It’s cruel.

Yet there are moments when even neutral words may be misconstrued, because the person is in a vulnerable place, according to F. Diane Barth, LCSW, a psychotherapist and psychoanalyst in private practice in New York City. “The truth is that it can be complicated to find the right comment to make to someone who is struggling with emotional difficulties.”

This is why it’s so important to educate yourself about helpful things to say. In fact, Fast, author of several bestselling books on bipolar disorder, including Loving Someone with Bipolar Disorder, believes that we have to be taught what to say. “It’s not innate at all to help someone who has a mental illness.”

So what makes an insensitive remark? According to clinical psychologist Ryan Howes, Ph.D, “The problems happen when people make statements that imply that mental illness is a sign of emotional weakness, it’s something that can be quickly overcome with some trite homespun advice or they minimize it as a minor issue you can just get over.”

Below are additional examples of problematic statements, along with what makes a good response.

1. “Get busy, and distract yourself.”

“With significant mental illness, [distractions] won’t work, not even temporarily,” Howes said. After a person slogs through various diversions, they’re still left with the same issues. “Ignoring the issue doesn’t make it go away.”

2. “Do you want to get better?”

For mental health blogger Therese Borchard, this was the most hurtful thing anyone has ever said to her. While she knows the person didn’t have ill intentions, it still had a powerful effect. “It implied that I was staying sick on purpose, and that I had no interest in pursuing health, not to mention that I was too lazy or disinterested to do what I needed to do to get better.”

3. “Change your attitude.”

While a change in perspective can be helpful, it doesn’t cure conditions such as ADHD, bipolar disorder, PTSD or schizophrenia, said Howes. And changing one’s attitude isn’t so easy either. “It’s incredibly difficult for a high-functioning person to change their attitude, let alone someone debilitated by an exhausting mental illness.”

4. “Stop focusing on the bad stuff, and just start living.”

According to Barth, “one of the most common mistakes is to tell a person to stop focusing on themselves, or on the bad things, or on the past, and just start living.” Why is this so problematic? It can make a person feel even worse about themselves. “[T]hey figure the fact that they can’t do it is, in their mind, just one more sign of their failure.”

5. “You have everything you need to get better.”

“This is well intentioned, but to me it sounded like an indictment against me for not trying hard enough,” said Borchard, also author of the book Beyond Blue: Surviving Depression & Anxiety and Making the Most of Bad Genes. Plus, this might not even be accurate. Sometimes people don’t have everything they need to improve. “Sometimes you need a little assistance.”

6. “You can snap out of it. Everyone feels this way sometimes.”

Everyone experiences a range of emotions. For instance, everyone feels sad occasionally. But sadness on some days isn’t the same as “a hopeless pit of despair where it’s so dark I’ve forgotten what light looks like,” a description of depression that one client gave to Howes. Feeling anxious isn’t the same as having a panic attack, “a terrifying lightning storm of despair, self-hatred and the absolute certainty of my immediate death,” he said.

7. “Just pray about it.”

Prayer is powerful for many people. Centering yourself and feeling support from a higher power can be very helpful, Howes said. “[B]ut this advice alone can minimize the problem, ignore many proven medical and psychological treatments and can even make someone feel like they’re not being healed, because they lack sufficient faith, which adds insult to injury.”

8. “Why can’t you work?”

It’s no doubt hard to watch someone who’s smart and capable unable to work. But telling a person who’s already struggling that they’re lazy, just making excuses or aren’t trying hard enough can be incredibly hurtful, Fast said.

She’s personally heard the following before: “I don’t see why you have such a tough time with work. Everyone works. You need to just get over it and work.” Even just asking a question like “Why is this so hard for you?” can make a person wonder what’s wrong with them. They might say, “Why can’t I work? They are right and I am a failure!” Fast said. “And they will push themselves too far.”

9. “You have the same illness as my ______.”

Years ago, when Fast’s partner Ivan, who has bipolar disorder, was in the hospital, she didn’t know anything about the illness. She told her friend that Ivan had something called “manic depression.” Fast’s friend responded with: “Oh. I know what that is. My grandfather had it and he shot himself.” A person Fast barely knew told her: “My uncle has that, but we don’t know where he is!”

“I remember every minute of Ivan being ill, and I remember those two comments the most — 18 years ago!”

The Right Responses

While reading this piece, you might be wondering if you should say anything at all. “Silence is, in my experience, the worst response, because it’s generally interpreted in the negative,” Barth said.

According to Howes, these are helpful responses:

  • “[S]incerely express your concern: ‘You’re having panic attacks? I’m so sorry to hear that. From what I’ve heard, that can be just awful.’
  • Offer your support: ‘Please let me know if you need anything, or if you’d just like to talk.’
  • Talk to them the same way you did before, which lets them know your feelings about them or respect for them hasn’t changed; your relationship is stable. They’re the same person, just dealing with an issue that is less visibly obvious than a broken arm or the flu.”

When it comes to mental illness, people make everything from insensitive to totally outrageous comments. When in doubt, Howes suggested offering “compassion, support and stability in your relationship and leav[ing] the advice to the psychological or medical experts… [A]ny advice beyond ‘I hope you’ve found good, caring treatment’ and ‘come talk to me anytime’ can be experienced as intrusive and can even cause more problems.”

For more on this topic, read Borchard’s pieces on what not to say to someone with depression and what to say.