But You Don’t Look Sick! Two Points of View


An article I read on Heart Sisters, a favorite blog by heart attack survivor Carolyn Thomas, "You Look Great! And Other Things You Should Never Say to a Heart Patient" really touched a nerve.

It reminded me of when I was in graduate school and I was in the
middle of a bad nephrotic syndrome relapse. I was in psychotherapy at the
time. I remember complaining to my therapist that my professors
expected me to keep up with my work like everyone else. In her blunt, pragmatic
manner, she said, “Well, of course they do. You don’t look sick.”

Whoa. That hurt. How could she say that?

"But I AM sick," I protested.

"Yes, you are. You are missing my point."

Her point was: I wore makeup to cover up my paleness and the dark circles under my eyes. I didn’t tell
anyone about my illness for fear of making them uncomfortable. Digging deeper, she helped me understand that the thought of 'using' my illness to put me in the position of asking for 'special treatment' was abhorrent to me (something to do with low self-esteem, feelings of worthlessness, blah blah blah) so I went in the opposite direction. She
pointed out that I was basically not being honest with my professors, or my friends for that matter. After all, they couldn't read my mind.

She gave me an ultimatum. Either stop whining and do the work like everyone else or… stop whining, fess up and get excused from the deadlines.

Sometimes the truth hurts. Literally.

I decided to suck it up, stopped hiding behind my makeup, told my profs the truth and asked for deferments on my papers. It turned out to be no big deal and I learned a valuable life lesson.

Looking at this topic from another valid perspective:  In You Look Great! Carolyn Thomas means to help loved ones understand that saying to someone in emotional or physical pain that they look great can be a double edged sword. She says:

“Wow!  You look just fine!  You look exactly the same!” 

That’s a fairly typical greeting from
those who have not seen me since before my heart attack. While
they might assume that this is a thoughtful and flattering comment to
offer, many times it may not feel that way…

Next time you approach a heart patient, a
bereaved person grieving a loss, or those diagnosed with a chronic,
progressive disease – what could you do or say instead of gushing over
their appearance? One of the most helpful comments to me so far has
been some variation of  the simple statement:

“It’s wonderful to see you again!”

which is probably fairly accurate, feels pretty darned good to hear, and doesn’t elicit the “If you only knew…” reply that we’re silently muttering.

To read the entire article click here.

Related article: Ten Things to Say to a Sick Friend

Photo courtesy of dadburnham via Flickr


  • Hi Dr. Aletta and thanks for this plug for Heart Sisters!
    As you know, it seems to be very common for those of us with an invisible chronic illness diagnosis (heart disease, lupus, fibromyalgia, you name it) to not WANT to appear sick or different from others. All we want is to be and feel NORMAL again, during a time when very little feels normal anymore. Sometimes I suspect it would be ever-so-handy if we could wear a neck brace or a leg cast – anything that would tell the world that something is ‘wrong’ here, that we have a ‘real’ reason to be less-than.
    I cringed when I ready your story about asking your profs for deferments – it must have been so difficult to finally do that, when you’d been working hard to convince others that you were “fine, just fine!”
    I remember about six weeks after my heart attack when, in a fit of pique, I marched around the apartment and gathered up all the flower bouquets and get well cards and trashed them all. I didn’t want to be sick. I didn’t want to be a heart patient anymore! What was I thinking? That somehow if my home didn’t look like an invalid lived there, then my heart disease would just go away?
    Not wanting to make a fuss has been a huge factor in my own life and certainly in my cardiac recuperation. Plus my own lifelong intolerance of whiners and complainers only encouraged me to paste on that happy face and try to tapdance around no matter what – even as I was dragging my sorry ass out the door.
    I grew up in a family where my Dad used to tell us this little poem:
    “Don’t tell your friends about your indigestion
    ‘How are you?’ is a greeting – NOT a question!”
    Sheeesh, no wonder I learned how to be an expert in pretending that everything is going great, at all times!
    Love your site – thanks again!

  • Dear Carolyn,
    I’m so glad you saw this. I was going to email you.
    I love your comment. You do understand how complicated this issue can be. I can just imagine you getting rid of all the “evidence” of illness and then being frustrated that it didn’t make you feel better.
    What finally convinced me to talk to my professors was realizing that trying to keep up with everyone else and pretending everything was fine was putting serious stress on my already compromised system. My therapist helped me step out of that need to “keep up appearances” and just take better care of myself. It is not easy getting over a lifetime of training to keep a stiff upper lip. I’ve had learn the lesson over and over again.
    By the way, did we have the same Dad? I’m grateful mine didn’t know that ditty because if he did, I’d never have heard the end of it!


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