Saying One Thing, Meaning Another

One of my pet peeves is when people are not direct and straightforward. I think the reason this bothers me so much is that I make such an effort to be direct myself, even when it’s difficult. For example, when a patient lies about recently using drugs, but his drug screen is positive, I will confront the patient about it. Perhaps the patient is embarrassed or ashamed, but from my perspective it is a safety and health issue that needs to be addressed, no matter how awkward or uncomfortable accusing someone of lying is.

That being said, sometimes people lie to themselves. Of course, there is a psychiatric term for this (like there is for everything, it seems!), which is “cognitive dissonance.” This term refers to conflicting thoughts and feelings that someone has at the same time. A common one we see in society is the obesity epidemic. Everyone knows that high-fat, high-sugar foods are unhealthy; yet the fast food industry is thriving. This is because enough people are telling themselves that, although they want to be healthy, things like “eating fast food won’t affect me,” “it’s just one meal,” or “I’m way too busy to cook a healthy meal.” Having thoughts like this makes someone feel less guilty, embarrassed, or angry with himself.

There’s also another phrase that I like (that’s not psychiatric!): “actions speak louder than words.” Sometimes, it’s not just that someone is conflicted by what they say they want versus what they are actually doing, but I do believe actions are more indicative of what’s going on inside someone’s mind. If someone says he wants to be healthy, yet keeps going back to McDonald’s, then maybe, just maybe, he actually prefers and even enjoys being unhealthy. As I’ve mentioned in previous posts, not everyone has the same goals in life.

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5 Comments on “Saying One Thing, Meaning Another”

  1. Sara Says:

    Dear Dr. G,
    I was directed to your blog via a link in an online magazine for bipolar disorder, there was an article written by a young woman who appears to be a friend of yours. As both a psychiatrist and a woman who is friends with someone with bipolar disorder I wondered if you might have a few words of advice for me. One of my dearest friends has recently developed a mental illness and I wish to be supportive of her but I have found it difficult to find information about how exactly to do this. I am sure you are quite busy but if you have some spare time and know of some resources I would greatly appreciate it if you can direct me to them. Thank you so much.
    Best,
    Sara

    • Dr. G Says:

      Thanks for the interest Sara, that’s actually a great question. In terms of good resources, I really like nami.org (NAMI is the National Alliance for Mental Illness) which is an organization that advocates for mental illness, and mayoclinic.com, which is a reputable source for more clinical information. In addition to getting information, it can also help to talk to other people who are in your position, and so another option would be to attend a family/friends support group through NAMI.

      Personally though, I have to be honest and say that you would think as a psychiatrist, I would handle mental illness in friends (or family) fairly well, but at the time I did not. Part of the problem was that I was in denial (it can happen to anyone, but not my friends!). I did learn from that experience though, that mental illness truly can happen to anyone, and how to be a more supportive friend. I think it’s great that you are interested in learning how to better support your friend. I think ways you can do that are learning what her specific disease is about, encouraging her (both in general and to seek treatment if she hasn’t already), and listen to her when she needs to talk. I’ve always found that the more you can learn about someone else and what they are going through, the easier it becomes to be supportive. In any case, I think it’s great that you’re interested in figuring out how to help your friend. Let me know how it goes!
      Dr. G

  2. Sara Says:

    Dear Dr. G,

    Thank you for your response, both the resources and the reassurance. It is challenging at times for both of us, particularly because we have recently become roommates but we both have found that patience and an open mind seem to work the best. I try to be supportive and watch out for her but try not to add to the many people who have been rather overbearing in her life. It’s good to know that even a psychiatrist needs time to adjust to a situation like this : )

    Sara


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