“So what kind of work do you do in your private practice?” asked a colleague.
“Ah,” he said with a knowing smile. “The worried well.”
I cringed when I heard this. My patients would cringe, too, if they heard themselves referred to in this dismissive way. But it happens all too often. A close friend of mine — a physician — used the same phrase when I told her about my career trajectory. “Sure, sure,” she said, as if I’d been hinting at a delicate truth that she understood intuitively. “The worried well. I treat plenty of those.”
Every time I hear it, this phrase sticks in my craw. I feel irritated at the person I’m talking to, frustrated at the gap in understanding between us, and eager to speak up for my patients against this condescension — unwitting or not. This phrase trades upon a mistaken impression that a physician’s patients — described as “medically ill” — are in more genuine need of professional attention than a psychologist’s clients. In actuality, mental illness is no less real than physical illness. Calling someone “worried” but “well” is an insult to the people who suffer, and it cheats them of the real pain they feel.
Let’s be clear. “Worry” doesn’t accurately describe my patient population. Their problems, arising from the emotional realm, are no less real than the common cold. For example, imagine what it’s like to struggle through feelings of deep grief — to feel nearly incapacitated by a sudden, wrenching loss of someone close to you. And what about the clinically depressed — people who could once live very comfortably in the moment, but who now can barely get out of bed in the morning and no longer enjoy the things that once made them smile? Basic human functions, relationships, and needs become the collateral damage of mental illness. The so-called “worried well” may be gritting their teeth merely to get through each day, not enjoying a minute of it, and falling into bed each night exhausted by the demands of normal living — only to face the same uphill battle the next morning. Why would a physician, trained to recognize and relieve suffering, dismiss or neglect so much quiet desperation?
And even if my patients were fully “well,” if their psychological difficulties were invisible to them and to others, condescending to them as merely “worried” would shame them into silence. Many unhappy people have no one to talk to about their problems — no way to express or alleviate their pent-up distress, sadness, panic, or even simple worry. When a professional caregiver assumes a dismissive attitude, he or she bullies people who are hurting inside, forcing them to keep their problems inside where they won’t be able to get better.
There’s a dollars-and-cents argument for this as well. Common mental illnesses like anxiety and depression cost this country over $200 billion per year, including the costs of related illnesses and lost productivity (1). Depressed people also lose their jobs more frequently during times of economic retrenchment. Studies suggest that providing psychotherapeutic care to depressed workers can reduce these losses, by helping mentally ill workers become more productive (2); in contrast, stigmatizing mental illness with terms like “the worried well” makes it harder for people to get psychological help. Dismissing people who are genuinely suffering, and implying that they’d be fine if they’d simply stop worrying, is a costly error in judgment.
It’s time to retire condescending stereotypes like “the worried well.” Mental illness doesn’t always take forms as dramatic as a broken leg or a harsh cough, but it deserves proper treatment as well as proper respect. In truth, the use of the phrase “worried well” obscures the very real, very serious nature of mental illness — even as it misses something very important about healing and humanity: that the body and mind often get sick, and get well again, together.
1. Greenberg, P. E. (2015). The growing economic burden of depression in the U.S. Scientific American, MIND Guest Blog (2/25/16), retrieved July 8, 2016, from http://blogs.scientificamerican.com/mind-guest-blog/the-growing-economic-burden-of-depression-in-the-u-s/.
2. Wang, P.S. et al., (2007). Telephone Screening, Outreach, and Care Management for Depressed Workers and Impact on Clinical and Work Productivity Outcomes: A randomized controlled trial. JAMA, 298(12), 1401-1411. Retrieved August 8, 2016 from http://jama.jamanetwork.com/article.aspx?articleid=208957.