The Real Harm in Saying “It’s All in Your Head”: Why the Words We Use Matter
Let’s get straight to the point: when a healthcare provider tells a patient with chronic pain that “it’s all in your head,” the damage goes far beyond what often gets labelled as ‘medical gaslighting’.
Whether intended or not, framing pain as purely psychological shifts the blame onto the patient. It tells them, “You’re the problem. Your pain is your fault.” This isn’t just a communication misstep—it’s the first domino in a chain reaction that can have devastating consequences.
Blaming the Patient: The First Harm
When we suggest to patients that their pain is a misinterpretation, or worse, that they’re imagining it, we’re not just being dismissive—we’re blaming them. This blame isn’t always explicit, but it’s heard loud and clear. The patient feels judged, misunderstood, and, frankly, abandoned by the very system meant to help them.
Blame Breeds Helplessness
Once blame takes root, helplessness isn’t far behind. Patients start to believe that if their pain is “all in their head,” then there’s nothing anyone can do. The medical system has given up on them, so why shouldn’t they give up on themselves? This helplessness is a psychological wound that festers, especially when reinforced over years of failed appointments and inadvertent invalidation.
Helplessness Turns Into Hopelessness
Helplessness is bad enough, but it often evolves into hopelessness. Patients begin to lose faith—not just in doctors and the system, but in themselves and any possibility of relief or improvement. The message becomes: “No one can help me. Nothing will ever change.” This is more than sadness; it’s a profound sense of despair that taints every aspect of a patient’s life.
Hopelessness Fuels Suicidal Thoughts
Here’s where things get truly alarming. Research shows that hopelessness can increase the risk of suicidal thoughts by up to 1200%. That’s not a typo. Hopelessness is one of the strongest predictors of suicidal ideation in people with chronic pain. When you combine unrelenting pain with the belief that nothing will ever get better, the result is a dangerous cocktail of risk.
Suicidal Thoughts and Actual Suicide
The leap from suicidal thoughts to suicide attempts or completion is tragically real. While the exact percentage varies depending on the population and study, it’s clear that suicidal ideation significantly increases the risk of suicide in up to 5% of patients. Even a small increase in suicide rates—say, 0.09% in a medication trial—has been enough to pull drugs from the market. Yet, when it comes to our words and how we explain pain, we tolerate risks that are orders of magnitude higher.
Don’t Say “It’s All in Your Head”
Let’s be blunt: telling patients their pain is “in their head” is not just unhelpful, it’s dangerous. Even if only a small percentage of patients are pushed down this path, that number is unacceptably high given the total population of pain patients. These are real people—mothers, fathers, sons, daughters—who may end up taking their own lives because of a message that was meant to be simple or reassuring. The harm is real, and we need to own it and explain pain in more effective ways that mitigate this risk.
There’s a Better Way
If you’re a clinician, rethink how you talk about pain. If you’re a patient, know that your pain is real and valid. There are ways to explain and manage pain that don’t involve blame, helplessness, or hopelessness. For more on how to do this right, listen to the “It’s Not in Your Head” podcast, where we break down the science, the communication, and the humanity behind chronic pain care.
Let’s stop the harm. Let’s do better.
For more insight and practical advice, tune in to episode 11 of It’s Not in Your Head Podcast.