Being Pitied as a Patient: The Mark Left by Oh You Poor Thing

What mark does being pitied as a patient leave? Pity versus compassion, its effects at different ages, and what patients and loved ones can do.

You are waiting in the queue at the supermarket. The woman behind you looks at your hairless forehead showing beneath your headscarf, then shakes her head and whispers to the person next to her: "Oh dear, so young." Or you go to a wedding in your wheelchair; when people see you they lower their voices, avert their eyes and ask the person beside you rather than you directly, "How is she, is she all right?" Many people living with a serious or visible illness say these are the moments that tire them most. Being pitied as a patient suddenly makes a person feel they are seen only as "a poor thing". In this article I look at why pity can be wounding, how it differs from compassion, how it is experienced at different ages, and what both the patient and those around them can do about it.

Why Is Being Pitied as a Patient So Wounding?

Pity usually comes from good intentions. A person sees someone else's suffering, feels sad and wants to express that sadness. But within pity there is a distance, even if it goes unnoticed: the person who pities places themselves as "the one who is doing well" and the other as "the one who is doing badly". This distance can make the patient feel they are seen not as an equal human being but as someone looked down upon.

Being pitied can lead to the following feelings in a patient:

• Shame: the feeling that the illness is seen as their own fault or shortcoming.
• Worthlessness: the thought "I'm no use any more, people just feel sorry for me".
• Loss of identity: a person who is a teacher, a craftsman, a mother or an athlete being seen only as "a patient".
• Loneliness: being unable to form a real connection because people do not behave naturally towards them.
• Anger: getting fed up with constantly being seen as pitiful and reacting to it; and then fearing being seen as "ungrateful" because of this anger.

Over time, some patients withdraw from social settings to escape these looks. They stop going to weddings, Bayram (religious holiday) visits, Friday prayers or the neighbourhood coffee house. This withdrawal increases loneliness and can affect mood negatively.

The everyday language of pity

Many phrases used in Turkish in the face of illness carry pity without people realising it: "Vah vah" (oh dear, oh dear), "Yazık" (what a shame), "Kıyamam" (I can't bear it), "Allah beterinden saklasın" (may God protect us from worse), "Garibim" (poor soul). These words have been used for generations as an expression of solidarity, and the person saying them usually only wants to voice their sadness. From the patient's point of view, however, hearing the same sentence dozens of times a day strengthens the feeling that the illness has become their only identity. Expressions such as "may God protect us from worse" in particular can make the patient feel that their situation is seen as the "worse" that others fear. There is no need to ban these phrases entirely; but trying to say something more personal and more equal in their place makes a difference.

The Difference Between Pity, Empathy and Compassion

These three concepts are often confused; but they leave very different marks on the patient's experience.

Pity carries, often unspoken, the feeling "What a terrible state you're in, thank goodness I'm not in your shoes." The focus is on the patient's deficiency and misfortune.

Empathy is trying to understand the other person's feeling: "This must be very hard for you." The focus is on the feeling the patient is experiencing, and equality between the two people is preserved.

Compassion is a step beyond empathy; it does not stop at understanding but also includes the wish to help, while respecting the patient's dignity and autonomy: "This is hard for you, how can I support you?"

Suppose a mother has limited movement in her arm after an operation. A pitying relative says, "Oh, my dear, now you can't even cook for your children." Someone showing empathy says, "Not being able to use your arm as before must be really hard for you." A compassionate approach offers: "Shall we cook together this week? You give me the recipe and I'll do the chopping." The third accepts that the woman is still the one who knows the household's cooking and who makes the decisions.

How Does Being Pitied as a Patient Feel at Different Ages?

A child patient

Children read adults' facial expressions and tones of voice very well. A child who, because of their illness, is constantly greeted with words like "Poor little thing" or "My heart goes out to you" may start to see themselves as fragile and different from other children. At school, a teacher constantly protecting them, not including them in games or introducing them to the class with "Your classmate is ill, be nice to him", though well meant, can lead to the child being stigmatised. A child needs to be seen for what they can do despite their illness. Praising their drawing, celebrating a success in a game or giving them small responsibilities in class gets ahead of the "sick child" label.

A teenage patient

In adolescence, the gaze of peers is much more powerful than that of adults. Hair loss, a prosthesis, weight change or frequent absences increase a young person's fear of being seen as "someone to be pitied". Many young people would rather hide their illness than be pitied. That is why, when approaching a teenage patient, it is important not to keep reminding them of their illness and to build the relationship through their interests, musical taste and friendships. I have discussed worries about physical appearance in detail in the article on body image.

An adult patient

For adults, pity often comes in the form of their competence being questioned. Being kept away from important projects at work with "Don't tire yourself out, we'll handle it", or decisions at home now being taken by others, can make a person feel useless. An adult patient seeks a balance between getting the support they need and continuing to make their own decisions. A colleague saying "Let's not give you this project, you've got enough on your plate" may look like well-meant protection, but it can strip the person of their professional identity. Asking instead "Would you like to be part of this project, or shall we keep your workload light for now?" leaves the decision to the person themselves.

An older patient

Older patients are the group in which pity most easily takes the form of "infantilising". Speaking loudly and slowly as if to a child; sentences such as "Now, auntie dear, we're going to take our medicine, all right?"; talking about the person in the third person while they are there: all of these damage their dignity. An older patient has raised a family, followed a profession and made decisions throughout their life. Illness does not erase this experience. Asking them about their grandchildren, their old job or memories of their youth, or seeking their advice on a family matter, lets an older patient feel they are still a respected elder.

Looking at a patient with pity traps them inside their illness; looking at them as an equal human being helps them see the self that lies beyond the illness.

What Can Loved Ones and Those Around the Patient Do?

Pity is usually not a conscious choice; it is a habit. Noticing this habit and making small changes can make a big difference to the patient. The sentences below are fictional examples.

Words that contain pity:

• "Oh dear, may God never let anyone fall into this state."
• "What a shame, so young."
• "My heart breaks for you, you can't do anything any more."
• "Ah, you used to be so strong."

Words that preserve equality:

• "It's good to see you. What have you been watching or reading lately?"
• "I'd like to get your opinion on this."
• "How are you today? I really want to know."
• "If you need help, tell me, but you decide when you want it."

Within the family, pity often comes together with overprotection. Not letting the patient lift a finger, making every decision for them and treating them like a guest come from love; but over time they can make the patient feel like an object being looked after rather than a member of the household. Leaving the patient the tasks they can still do, asking their opinion at the table and including them in family decisions puts respect in the place of pity.

Some behavioural tips also help:

• Talk to the patient directly. Address them, not the companion beside them.
• Make eye contact; don't avert your eyes. Staring at a visible change and being unable to look at all are both uncomfortable; natural eye contact is the most reassuring.
• Ask before helping. Behaviour such as pushing a wheelchair without permission or taking the glass out of their hand undermines autonomy.
• Keep up your old relationship. Don't stop joking with someone you used to joke with; keep debating the topics you used to debate.

I have discussed in detail how to support a patient in concrete and dignified ways in the article how to help someone who is ill.

How Can You Cope With Pitying Looks as a Patient?

You may not always be able to change the attitude of those around you; but you can decide your own reactions and boundaries.

• Prepare short, clear replies. Saying to someone who says "Oh dear, oh dear", "Thank you, but I'm fine, I'm getting on with my life" lets you steer the conversation in another direction.
• Redirect the conversation. You can shift the focus of the chat by saying, "Rather than talking about my illness, I'd like to hear about what you've been up to."
• Try to see the anxiety behind the pity. Some people fall back on these phrases not because they pity you but because they do not know what to say. Noticing this can calm your anger a little.
• Spend more time with people who see you as an equal. Giving your energy to people who treat you as they did before your illness protects you.
• Decide how much to share. You do not have to tell everyone the details of your illness. A short sentence such as "My treatment is ongoing, I'm following it with my doctors" is enough of an answer to curious questions.
• Distinguish between pitying yourself and showing yourself compassion. Acknowledging that you are struggling ("This really is a hard time") is self-compassion; the thought "My life is over, I'm pitiful" may be the internalised form of the pitying gaze received from others.

Suppose someone attending a family wedding for the first time after a long treatment notices that everyone who comes to their table shakes their head and says, "Get well soon, you've been through so much." After a while they start changing the subject themselves: "Thank you, I'm well now. Doesn't the bride look beautiful?" This small redirection lets both them and the other person breathe easily.

Sometimes the most effective route is to talk openly about this with one of your loved ones: "I don't want you to look at me with pity; it does me more good when you see me as you did before." This sentence brings relief to many family members, who did not know what to do.

When Should You Seek Professional Support?

The pitying looks of those around you can, over time, also affect how you see yourself. It may help to see a mental health professional in the following situations:

• You have started staying indoors and avoiding social settings to escape people's looks
• You constantly feel worthless, a burden or "lacking"
• You have not been able to enjoy anything for a long time and feel low
• Your anger has started to noticeably strain your close relationships
• You cannot look in the mirror because of changes in your appearance

If thoughts that life is meaningless, that it would be better to die, or of harming yourself are going through your mind, do not carry this alone. In an emergency, call 112 (emergency services) or go to the nearest emergency department.

How Is This Experience Addressed in Therapy?

Therapy offers a safe space to rebuild a sense of self that has been shaken by illness. Within cognitive behavioural therapy (CBT), thoughts such as "Everyone pities me, I'm a pitiful person now" are examined, and the roles, values and skills the person maintains despite the illness are made visible. If there is a pattern of avoiding social settings, a step-by-step return to these settings can be planned at a pace the person feels ready for.

From a schema therapy perspective, it is possible to notice how early maladaptive schemas such as defectiveness or shame flare up again with illness. Where low mood is prominent, work in the area of depression and mood can be part of the process. In family sessions, work can focus on how loved ones can develop a language of compassion instead of pity.

Frequently Asked Questions

Should I never show the patient that I'm sad?

You don't have to hide your sadness; what matters is not leaving this feeling on the patient as a burden. Saying "I'm sorry you're going through this, I'm with you" is empathy. Constantly saying "oh dear, oh dear", on the other hand, can leave the patient having to deal with your feelings.

How can I stop my child's classmates from pitying them?

It is important to work with the teacher and to decide together with your child how their illness will be explained to the class. The focus should be not on the child's difference but on how others can play with them and what they can do.

My relative who is ill pities themselves, how should I approach them?

This feeling can be an understandable reaction to the losses the illness brings. Listening to their feeling without belittling it, and then recalling together what they can still do and the things they value, helps. If this state has gone on for a long time, you might consider suggesting professional support.

Is it unfair to get angry with someone who looks at me with pity?

Anger is an understandable reaction; it often comes from feeling unseen and belittled. Noticing this feeling and setting a boundary in suitable language both protects you and can show the other person something they were not aware of.

• #patient psychology
• #pity and compassion
• #illness and stigma
• #approaching a patient

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Eda Erkan Alapala

Klinik Psikolog. İstanbul Kent Üniversitesi Klinik Psikoloji Tezli Yüksek Lisans mezunu; bilişsel davranışçı terapi, çocuk merkezli oyun terapisi ve çocuk-ergen psikoterapisi alanlarında eğitimlerini tamamlamıştır.

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