September 19, 2016

On stigma and shame

Being a mental health professional, or social work professional, who also experiences mental health problems. It’s tricky. People outside of services judge, and so do people within services. It raises all kinds of questions about shame.

I think this is something that has partially shifted for me within the last year. I’ve written before about not being able to sit in the waiting room at the eating disorder service because of the fear of bumping into my colleagues. Being in day service has forced me to face this fear, and now, I care a lot less if I do see someone from work in the building. I do see people, and it’s still uncomfortable, but I don’t actively hide anymore. Maybe it’s just exposure over time, or maybe it’s because I’m a little more accepting of my own difficulties, or perhaps it’s the ongoing acceptance of (and openness with) those who do know, love and respect me, that makes the possible judgement of others a bit easier to bear.

I do still vacillate between shame (‘I’ve still got this problem after so many years’, ‘people will question my professional judgement/not respect me/see me as weak’) and a sense of acceptance (‘I did the best I could at the time’, ‘no manager or colleague has ever questioned my practice’, ‘my experiences give me more compassion/passion’). And some people do value lived experience as a strength. Personally, I’d argue that we all have lived experience of one form or another, but that might be a topic for another time.

I wonder what it is that leaves me crushed some days and feeling fairly content on others. On ‘good’ days, I don’t really feel the need to justify myself. My eating disorder is something I’ve struggled with and (importantly) functioned with, for a long time. Some traits associated with ED’s (perfectionism, drive, a strong awareness of others’ needs) can be a strength when channelled into the right areas. On those days, I don’t feel the need to justify myself by saying that ‘I’m getting better’ – as though I’ve done something dreadfully ‘wrong’ by having an eating disorder. It’s life, I wouldn’t judge or blame someone else for struggling, and if people want to judge or make short sighted assumptions, that’s their problem, not mine. I recognise that my ED developed as an attempt to survive some fairly tricky experiences, and I defy anyone to have similar experiences and emerge unscathed. It just isn’t what happens to humans.

On other days, I do feel judged, very ashamed, and frustrated with myself. It stops me sharing and it makes me close up. On those days I do hide. I ran out of a group recently because it involved seeing someone I worked with briefly as a colleague, years ago. (They likely don’t even remember me). I felt embarrassed to have an eating disorder, I didn’t want to be ‘seen’, it felt too exposing. I don’t think that’s an unnatural reaction, but it does say something about how people generally perceive mental health and how much I’ve absorbed that into myself. Stigma does exist, within and outside of services, and we do internalise that.

If I could explain my understanding of my difficulties so that people have a greater sense of it’s really about, I don’t think I’d mind colleagues knowing quite so much. We all want the power to define our own experience and tell our own stories. For me, the problem is, at least partly, to do with labels and stereotypes. What does an ‘anorexic’ look like? What mysterious ‘behaviours’ do they do. Aren’t they selfish, self absorbed and ‘weak’. I don’t think I am, at least not always, but I also know many people do think people with eating disorders are those things. There’s also the need to protect myself from thoughtless comments – what if people do think I look fine (or worse, too big) and that sets off an onslaught of uncertainty around further weight gain/the need for weight loss. I also don’t want my colleagues wondering whether I’m ok every time I refuse a biscuit. I don’t want to have to justify my behaviour. I don’t want my professional or personal judgement questioned or, conversely, to be treated with kid gloves. It’s demeaning.

And what about the resources a person gains from experiencing adversity and moving some way through it? What about the courage it takes to appraise a situation honestly and ask for help? What about the empathy that develops from sitting in the ‘other’ chair and being on the receiving end of services or therapy? What about events that precede the development of mental distress and the way those may contribute to a person’s sense of identity and understanding? What makes ‘professionals’ so inherently different, that we expect ourselves to be immune to the impact of relational trauma, adversity or plain old stress? Speaking personally, I wouldn’t want a robot who feels nothing to be my therapist. I want someone who can empathise, see my strengths, who is strong enough to ‘be with’ me, help me to contain the things I find almost intolerable and who has confidence in my ability to (with support) find a way forwards.

When there is shame, we don’t talk, and when we don’t talk, misunderstandings remain. Not everyone sees mental distress as simply part of being human. And to me, that’s the problem. As long as we keep ‘othering’ people, setting particular coping strategies or experiences apart as something inherently wrong or ‘different’, shame and silence will always be there, and that prevents us from connecting with each other, and probably also prevents us from healing.

Join the conversation! 3 Comments

  1. This is a lovely post. Thank you so much for your honesty and openness. I am a service user myself and not a mental health worker. From my own experience, I believe that a large part of the stigma around mental health is generated and perpetuated within the services themselves and it is always refreshing to hear from professionals who are able and willing to navigate that tricky dual role both as “helper” and “human being”. 😉

    I’m just this week coming to the end of a process of psychological therapy and I’m reflecting on all the things I have learned and the ways in which I have changed during the process. I don’t yet have the words to articulate precisely all of what it has meant to me but, in broad terms, I think that one of the best things that has happened is that once I found a space where I could breathe and think freely about the actual real-life difficulties that I was allowed to define for myself because of their impact on me…. the shame and stigma that I felt at the outset started to dissolve and seep away without me even really noticing at the time it was happening.

    At the start of therapy, I felt deeply ashamed of myself and heavily weighed down by years of struggling to access help and feeling negated by the prevailing idea that my condition was “not a valid construct”. I felt damaged by the experience in a former CMHT where it seemed that so much time was spent arguing the toss about whether a “formulation” is more valuable than a “diagnosis” that there was regrettably very little time left to engage with patients for more than a brief round of therapeutically averted eye-contact and a session or two of non-judgmental grimacing. I felt acutely anxious about even entering another CMHT building to seek help one more time.

    In this final week of the therapy that was so worth waiting for, I feel incredibly sad that a unique relationship is pretty much over, and I’m anxious in many ways about the need to keep going without professional support. And yet, at the same time, I also feel strong and confident in myself in ways I have never felt before, and I feel really, truly privileged to have shared this part of my life journey with an awesome trainee psychologist whose willingness to learn alongside me and reveal aspects of her own human experience has been as liberating as the nuts and bolts content of the therapy itself.

    The “imperfection” of the experience has been central to my own transformation. The therapist didn’t pretend to have everything all worked out before we began, and somehow that opened up a space in the room for us to work a few really key things out together. I have found it a real help that therapy has absolutely not been something that was done to me by someone who had already made it through to the other side (wherever that is). I didn’t need anyone to discharge their “duty” to me by gently deconstructing my own view of the world and rebuilding it to look like their own. I just needed another human being, working alongside me, doing their best by helping me to face the specific issues that have been holding me back for so long from where I want to be.

    Instead of shame, I now feel proud of myself for making it through the hard times and, although I honestly do wish therapy could go on forever(!), I also know deep down that the termination process is part of this tremendous gift of confidence and independence that I’ve been given. I can walk away this time with a much greater sense of confidence in my own values and my own strengths.

    I never thought at the outset that I would feel able to talk freely to friends about my experience of therapy but that has also changed along the way. One or two friends have remarked how envious they feel about the opportunity I have had to shine a light into the darkness and start to make changes in areas that really matter to me. Not everyone gets the chance to do that. I wouldn’t be surprised if at least some of your colleagues feel a degree of envy at your ability to face your own struggles, especially in such a public way.

    You sound like an awesome role model to me. Keep going xxx

    Liked by 1 person

    Reply
    • Thank you for sharing. It sounds like you’ve had a really positive experience of therapy and it is good to hear. I think it is tricky when the debate around formulation/diagnosis feels so heated but I do think it’s an important discussion to have, although not at the expense of good patient care here and now, and that sounds unfortunately like something you experienced. I am glad you’ve had the space to explore things and it is lovely to hear that you feel so hopeful about the future 🙂

      Liked by 1 person

      Reply
      • Thank you too. 🙂

        “I think it is tricky when the debate around formulation/diagnosis feels so heated but I do think it’s an important discussion to have, although not at the expense of good patient care here and now”

        I agree that the discussion is important; I just cringe when I read so often that “this discussion NEEDS to be had”, whenever a MHP is challenged on a cruel tone or attacking style. So many seem to forget to use their “I” statements, which I suspect might otherwise lead to more self-reflection and a more open debate.

        If the sentence started “I want to have this discussion because….” or “I feel a need to say this in order to achieve…..” – without use of either the passive voice or a passive-aggressive stance, I think we might actually start to crack the stigma and make real progress. 😉

        Like

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About Emma

www.progressnotperfection.co.uk

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Compassion, Eating Disorders, Mental Health

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