There has been growing debate about the usefulness of mental health professionals sharing their own lived experience of psychological distress. As a social worker with my own mental health label, this naturally interests me. I have written about the difficulty of being on ‘both sides of the desk‘, and the tension between my professional role, and my wish to contribute to the wider discussion around mental health and stigma.
Speaking personally, I have been encouraged by those who have spoken out about their experiences. Like it or not, there remains huge power and privilege in occupying a position that allows you to use language to define and explore someone’s distress. Add being male, middle class, white or educated into the mix, and the power differential increases further. Anything that minimises the huge gap between mental health professionals and the people they ‘treat’ (or work with/alongside), is fine with me.
Imagine making the decision to seek help for psychological distress which may be linked to experiences of powerlessness.* You already have experiences of being oppressed, and now you have to share that with someone who – on the surface at least – is very different to (‘better than’) you. Of course it is easy to feel ‘different’, ‘other’, or ‘less than’. To me, those in positions of power and privilege – including psychologists and psychiatrists – who share their experiences in a responsible way, can help to counter some of that shame and sense of ‘otherness’. Sharing via newspaper articles or social media means that the message that we are all made of the same stuff, that no one is immune to distress becomes part of the public discourse. Of course it also makes us vulnerable.
The writer of a recent letter in ‘The Psychologist’ comments that without ‘hard evidence’ he will find it difficult to believe that therapeutic practice benefits from such ‘coming out’ narratives. I see two issues with this. One, the assumed dichotomy between ‘them’ and ‘us’. Because clinicians can be clients, and clients can be clinicians and we somehow have to find a way to hold those two things together and work with them. There also seems to be an assumption that what happens in the therapy room (or any helping relationship) can be divorced from what happens around us – within our professional group, mental health services and more broadly within society. I don’t think it can. Surely the point is that we can all develop psychological distress, and whilst the nature and intensity of that distress can vary, it is part of the experience of being human, and not something to be shamefully boxed off or compartmentalised away from our professional role.
Speaking as a client, my main concern is that the clinician working with me has a genuine sense of compassion, understanding and respect. Respect for me, my experiences – some of which I still feel intensely ashamed about – and the broader social factors which have shaped my sense of who I am and the path my life has taken. I would like them to be competent, well supported and supervised in their role (because we know that makes things safer for everyone), and able to draw on their own relevant experiences in a helpful way. I don’t care whether they do or don’t have a clinically recognisable mental health problem. What I care about is that they are not scathing, patronising or dismissive, and that they do not see themselves as somehow made of better stuff than me simply because they have not had the experiences or faced the barriers that their clients have.
As a mental health professional, I wonder whether owning, naming and appropriately sharing our own experiences of psychological distress can be part of a process by which we come to feel more integrated. And surely that can only improve someone’s clinical work.** I always hope that those of us who are aware of what it feels like to be in a very real way, powerless, voiceless, and in some way constrained, might be able to take that experience and use it helpfully in our role.
The attitude of ‘them and us’ continues to persist within mental health services. The best way to challenge this is to give the message that when you speak about ‘them’ you are also speaking about ‘me’. I have heard comments from colleagues such as ‘too old’ ‘manipulative’, ‘nightmare to work with’ when discussing eating disorders. The same colleagues are happy to work with me professionally and I have a good relationship with them. Those two things don’t sit easily together and I wonder whether sharing my own experiences might highlight that. Of course it also leaves me feeling highly vulnerable and I worry I might lose respect, so I don’t. I also definitely don’t want ‘sympathy’. I want to be respected as a colleague who has as much to contribute to my service as anyone else.
I always feel that I am not ‘typical’ because of my ability to function in spite of the thoughts, behaviours and sense of distress I sometimes struggle with. However perhaps I am more typical than I think, I just don’t know about the other people like me because none of us speak about it. The reality is that people who experience mental health difficulties are not ‘those different people’, they are us and they are part of us.
*or worse, being coerced into ‘help’ by social services or the welfare system.
**To be clear, I am not speaking about disclosure in the context of a therapeutic or professional helper-client relationship – that is a different issue with it’s own debate.