I’m sorry to tell you…

Sometimes we have to share bad news. As a doctor I have probably had more than my fair share of having to do this. And it doesn’t get any easier with practice.

But one thing I have learned over the years is that the message itself is less important than the way in which it is given.

We are highly social creatures with thoughts, feelings and emotions. When we share bad news we can cause hurt, hurt which is as strong and deep as any physical pain: because our brain shares the same neural pathways.

Perhaps that is why the language we use to describe our social pain is the same. We talk about feeling gutted, or having a broken heart. Social pain hurts as much as physical pain and research has been shown how social pain can be eased by taking a couple of paracetamol.

But before you go rushing off to the bathroom cabinet, let’s take a look at how the brain deals with social pain.

Our brain’s primary function is to keep us safe. When confronted with something new in our environment our brain quickly determines whether this is something that is going to reward us or poses a danger. And like the stranger danger adverts our brain assumes that it is danger first. Our danger response is very quick (it has to be) but is also strong deep and long lasting. How many people do you know who have been carrying round emotional hurts for years?

Being told bad news, whether it is that you have missed out on a promotion or that you didn’t make the grade to get onto the team, that you are being made redundant or that your relationship has just ended causes the emotional part of your brain, the limbic system to fire up and you experience your emotions as feelings; sad, angry, frustrated or annoyed.

With emotion is running high, it is much harder to stay engaged with the conscious thinking part of your brain, the prefrontal cortex that normally works in tandem with the limbic system keeping emotions under control. Hence the saying, “as emotion stands up, intelligence sits down”.

If you have to be the bearer of bad news there are a couple of things that can help the person you are sharing this with and keep their brain safe.

1. Ensure that you have the right space and place to share the news. You need their brain to be engaged and listening.

2. Use language that they will understand. This might seem obvious however trying to use words to “soften the blow” can sometimes lead to unintended misinterpretation. Telling someone that they have a “growth” that requires surgery and further treatment with radiotherapy and chemotherapy isn’t sufficient. They may go away relieved, thinking “well at least I don’t have cancer”.

3. Once you have delivered your main message – shut up.

The temptation is to blather on providing further unnecessary information, which is usually to make you the “teller” feel better, rather then the “receiver”.

Give the person a couple of seconds at least to allow them to take in and mentally process what you have just shared, before clarifying that they have understood what was said.

Under extreme stress, our prefrontal cortex (the thinking part of our brain) shuts down, we are unable to hear what is being said or draw upon our previous experience as our own emotional responses whirl around.

4. Offer the person the time to come back to discuss what has been shared (if appropriate) or to ensure they have some sort of support person who can lend an ear. How often have you heard that a person told bad news has no recollection of the event or what was discussed after the initial bombshell? It takes time to process the information and time to think through what else you may need to know and the questions you want to ask.

5. Share your message face to face. We live in a technological world allowing us to communicate by a variety of means, but there is no place for hiding behind our technology so that we feel less uncomfortable. One of the concerns I have heard shared about our younger generation is that because they prefer to communicate by text or tweet, they are not developing the social skills learnt through face-to-face interactions that are necessary to learn how to deal with life issues when they go wrong. It is no longer uncommon to hear of couples breaking up via a text message. The impact is brutal and the social pain inflicted far greater than if they had a conversation or even an argument.

Not all bad news messages are life threatening or major. But how often is it that our small social hurts impact us even more, especially when carelessly handled?

 

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In our constant state of busyness, it can be easy to resort to a quick email or text “to save time”. Time may be saved, but that cancelled appointment or rescheduled meeting delivered in this way can sever relationships. How would you feel if a good friend lets you down but does it via a third party? It’s not so much the change of plans, but your brain has suffered a huge threat response and loss of status. You no longer feel valued by the other person and your sense of trust has been broken.

So next time you have to share bad news, whether it is with a friend, a work colleague or a family member: check in first to think how can you keep their brain safe – ensuring they hear the message but in a way that is supportive, respectful and clear.

What have your experiences been?

 

Ref: Eisenberger NI et al 2010 Acetaminophen reduces social pain: behavioral and neural evidence. Psychological Science. 21(7):931-7. doi: 10.1177/0956797610374741.

Photo credit:  href=”http://www.flickr.com/photos/24888071@N07/5961100771/”>Bindaas Madhavi<

 

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