Another day, another podcast. Today, I was listening to an episode on the “crisis package”; a set of guidelines developed to better treat acute crisis in mental health patients, on Norwegian podcast Psykiateren (EN: The Psychiatrist), published on Spotify by the Norwegian Psychiatric Association.

This blog post should in no way be taken as criticism of the podcast nor the association – it is a brilliantly balanced and carefully edited podcast, and I applaud the fact that the Npf have made their scientific findings so easily accessible and digestible and cannot wait to get stuck in with more episodes. I highly recommend it to fellow Norwegian speakers with an interest in the workings of the human mind. Needless to say, this is a tremendously important and interesting subject, and although this particular podcast is largely curated for mental health professionals, I think many of us could benefit from having a listen – at least if you’re a Norwegian speaker.

Now, onto today’s rant.

What irked me – and essentially what made me feel inclined to hammer away at the keys – was a word the speakers continued to use in their conversation. The use of this particular word is something I have encountered in sessions with therapists, that many use the term ‘bad luck’ when expressing their concern for a person who has gone through some kind of trauma, such as abuse in childhood, rape or molestation. Which can be viewed by the patient as a suggestion that having ‘bad luck’ put them in that situation.

Listening to the abovementioned episode made me realise that their use of the word in professional conversations on the intrapersonal level might be the reason why it’s used with patients as well, which is what I would like to address below.

Firstly, it is not ‘bad luck’ that one person made a conscious decision to inflict violence or psychological terror on another. Emotional or physical abuse is often premeditated and has very little to do with luck. Life isn’t a scratch card.

Secondly, for many, luck is a concept based in supernatural beliefs, made to explain improbable events. In and of it self, luck cannot determine the outcome of someone’s life, but the choice to believe in it or not can affect real outcomes; i.e. it can be a self-fulfilling prophecy of extreme failure. There has been a lot of research on the matter, but you can read that in your own time, if you fancy. What is important here, is to see the difference is how you can interpret and use the word.

For most of us, we might use the word to lessen the blow for a child that’s just lost their first individual sports competition. We nonchalantly say it’s ‘unlucky’ so that they won’t give up when they realise it’s because they simply aren’t good enough to beat their opponents. We say it to make them feel better, so they’ll continue to strive for success so that they can get better and experience that important sense of accomplishment.

Yet, on the other hand, we don’t say it’s ‘lucky’ when they’ve won – a win would always be defined as accomplished by talent, even if the only reason they won the sprint was because the faster kid tripped on his own shoelaces and fell over (which would be an instance of real luck for the slower participant).

Nevertheless, it might be worth pointing out that this post isn’t about the word luck and its dictionary definition, but about how labelling someone with a personality disorder as ‘unlucky’ can be detrimental to a patient’s recovery. The word luck is just a word. A concept, really. And it doesn’t have much meaning, until it is preceded by the adjectives ‘bad’ or ‘good’.

For someone with a personality disorder, luck may have taken on a more definite meaning in your life, where you only see extremes or black and white. You only have the good or the bad kind of luck. If you’re stuck with the latter you are inherently unlucky, and nothing is ever going to get better anyway, right?

I’m quite sure that’s not what the professional is trying to do, but using that particular wording in an attempt to make light of a situation can make the patient feel like the severity of the impact their trauma has had on them is being undermined or trivialised. Put down to not having found enough four-leaf clovers in their life. Not to mention that it can downplay the importance of their own role in their recovery.

What’s more, quite a few people with OCD will at some point have encountered some form of ‘magical thinking’. For instance, ‘if I switch the lights on and off an odd number of times, I won’t become a paedophile’, or, ‘my blood test will come back positive, unless I walk up and down this staircase six times four times today’.

This sort of thinking might not make much sense to a lot of people, but I suspect magical thinking can make you feel as if you’re in control of something uncontrollable. Or, simply, that these situations are the only instances where you feel like you’ve any control at all.

Magical thinking can also be applied to the significance of numbers, or even colours. Which definitely brings us back to why ‘luck’ really shouldn’t be part of your vocabulary, and especially not ‘bad luck’.

You wouldn’t tell a patient that’s worked hard to get through their trauma so that they can start living their life without being afraid of flashbacks or intrusive thoughts that they can put the success of the treatment down to just ‘good luck’, would you? Was it just ‘good luck’ that got you your PhD?

For a person with a personality disorder, the word ‘luck’ can be very triggering, and in a worst case scenario may even exacerbate symptoms of OCD that in turn will worsen PTSD, making it even more complex and possibly more difficult to diagnose – complex matters can be difficult to compartmentalise.

One could of course discuss whether compartmentalisation is the best way forward, now that we know that people can have more than just the one diagnose, and that not all patients are dealing with a newly experienced trauma upon entry to the system. In fact, with rape, it can take years and years before the victim seeks help. Yet, the self-evaluating forms to be filled out by the patient during the screening process, especially with the Warwick-Edinburgh Mental Well-being Scale, still focus on how you feel today vs before the incident, worded in a way that suggests that the trauma has been quite recent and in a set period of time (often within the past two weeks). Statements such as, ‘I’ve been feeling loved’ are to be measured on a scale from X to X. If you haven’t had the ability to experience this in the past 25 years, that’s not an easy question to answer correctly if you don’t want to wind up diagnosed with depression and depression only.

For many survivors, the WEMWBS simply doesn’t apply, because there hasn’t been that acute change in their day-to-day for some time, it has just gotten to a degree of ‘worse’ that is now forcing them to make a choice between treatment and self-inflicted death. Bad luck for them, eh?

In summation, it might not be in the best interest of mental health professionals to continue using the term ‘bad luck’ in conversations with a patient with a myriad of comorbid symptoms that is struggling with the aftermath of a traumatic event, that being PTSD or otherwise, so please consider the words you put out in the ether more carefully.

In short, it’s okay to say ‘I’m sorry that happened to you’, but maybe be a bit mindful and refrain from saying ‘I’m sorry you’ve had such bad luck‘.