Am I too crazy to work in mental health?

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In mid 2013 I was in the midst of a stressful week-long intensive university subject titled Ethics and Professional Practice. A large amount of the subject was dedicated to discussion around self-care for social workers and how to avoid professional burnout.

At about 9.30am on the Tuesday, midway into a lecture, I was overwhelmed with the feeling that I had left the stove on at my apartment. By 11am when we broke class for morning tea, I was racked with anxiety about the stove, unable to concentrate on the day's content and struggling with whether I should take the half-hour drive home to check it.

I compromised by emailing my flatmate, who was on holidays in Mexico, to ask for the phone number of our apartment block's manager, so I could call and ask them to check the stove for me. In the thick of a busy nightclub in Cancun with several litres of tequila down her gullet, she changed the SIM card in her phone in order to access the phone number for me. She sent me the number and I called them. The outcome was predictable: the stove was safely off.

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This was the beginning of my most recent period of mental illness.

I've learnt that knowledge of mental health practice can give us a dangerous and false sense of galvanisation against what we advocate for.

The conversation I had with the previously unknown general practitioner who recently assessed me said something to me that will always ring in my ears: “The fact that this is happening to you now will stand you in good stead for mental health practice, because you know how it feels to be ill.”

The following points are the reasons why I think that experiencing mental illness can make you a better mental health practitioner.

A good mental health practitioner…

1. Practices with empathy

Empathy is key in treatment. The empathetic mental health practitioner does not abuse their power by trying to "fix" the person or give subjective advice. The empathetic practitioner listens to and feels with the person. They stand with the person in the darkness and provide optional strategies that will empower facilitation of recovery. The practitioner knows that the person is the expert on his or her mental health recovery. Everyone has the tools, but sometimes needs education regarding how to use them.

2. Understands loneliness in all its complexity

Loneliness isn't exclusively a disconnection between persons with their family, social networks and communities. Loneliness may indicate disconnect between a person and their own soul. The loneliest feeling of all is harbouring resentment for the self. The astute mental health practitioner will provide pathways not necessarily for gaining self-knowledge in the post-modern sense, but for the person to connect with their values and fall in like with themselves again.

3. Knows the importance of taking one moment at a time

“The next four to six seconds. That's all you have to worry about” – that's one of the best instructions that has ever been given to me. The next four to six seconds is all we can cognitively handle at one time, yet we try to jam in the past and the future as well, making an utter mess of things. Exploring strategies to engage in one moment at a time is the best thing we can do, especially for a person in crisis. We need to enter each moment with calm indifference in order to be able to manage the next to the best of our ability.

4. Knows: Thought > belief > event > belief > thought

Good old cognitive behavioural therapy (CBT). The principle of acknowledging the impact of our beliefs between thought and events, and vice versa, is vitally important in understanding how misleading the stories that we write in our own heads can be. As mental health practitioners, we must pay attention to the messages that are being relayed in interpersonal communication, rather than the emotions behind them. If we react to the emotion, our interpretation is clouded by subjective beliefs. In order to hear our people, we must respond to the message rather than react to the emotion, then pass on this technique to the people we are helping.

5. Treats the symptoms of illness, while recognising the whole person

A person is not infinitely characterised by their behaviour during a period of mental illness because during that time, the behaviour is not representative of their whole self. The mental health practitioner recognises that mental illness does not define us, but is the result of biopsychosocial factors that have led to a state of crisis. Once the etiology of the illness is recognised and accepted, recovery can be facilitated and the people can know themselves, and let others get to know them once again.

6. Respects self-determination in treatment methodology

Everyone reserves the right to choose whether they take medication in order to aid mental health recovery. Medication will be the right choice for some, and not for others. Exploration of whether or not to use medication should be a collaborative engagement between the practitioner and the person. Each person should be treated as the unique individual that they are, and their treatment not defined by the most expedient option in the eyes of the psychiatry industry.

7. Cuts through the bulls--t

Friends will listen to us bang on and on about regrets and the terrible decisions we've made that have led us to where we are, in an uneducated but well-meaning encounter-group fashion. What we may actually need is for someone to say: “Stop beating yourself up about the past for no good reason, because it's sending you into a sympathetic nervous system response mode while you're actually in no imminent danger.”

When someone explains the neurological processes behind how the amygdala floods the brain with cortisol upon our own request as if pushing a panic button, we can forge new neural pathways through psychotherapy to stop this from happening. It's a relatively simple process to counteract, but it takes time and dedicated practice.

Having someone on hand who can help cut through the self-sabotaging bulls--t and recognise the cognitive processes behind needlessly engaging the fight or flight system is indispensably helpful. Help the person build the new cognitive pathways that will guard against unhelpful thinking styles.

I believe that we will all experience mental illness; just as we will all experience disability, to some extent, during our life cycle. This doesn't mean that we are weak or incompetent. It makes us human, and better equipped to help others, with the benefit of practical knowledge.

 

This is an edited extract of a blog post by Polly Chester. Read the full piece here.

10 comments so far

  • I agree with you. I've seen several mental health professionals and although some were well read about my problems they never seemed to really get it. It really is like trying to explain what the world looks like to a blind person. That's not to say that people can't treat patients unless they are mentally ill themselves, of course some are very good. But they never totally get it the way a fellow sufferer can. Which is why I've often found it more therapeutic talking with others who have similar problems than the useless psychologists I've seen in the past.

    Commenter
    Escritora
    Date and time
    March 13, 2014, 11:39AM
    • I think that this is an excellent article.

      I am in remission from Major Depressive Disorder. My clinical psychologist (who I now see every three months on a "care and maintenance" basis) is also in remission from MDD - "been there, done that" makes a big difference.

      All that I would add to it is that an effective mental health professional adopts an eclectic approach, knowing through knowledge and experience which approaches best meet the needs of his/her clients. In my case (when In was seeing my clinical psychologist on a weekly basis), she worked with me using a combination of CBT, Acceptance and Commitment Therapy and Schema Therapy, depending on which she judged was most appropriate at the time.

      Commenter
      Dr Kiwi
      Date and time
      March 13, 2014, 12:05PM
      • I enjoyed this article and wished I had read it years ago. I was at a SARC (sexual assault resource centre) counselling session (roughly in the late 90's) and happened to comment on the fact that I would like to study. The counsellor looked me in the eye and very bluntly said "You're not thinking of counselling are you?" when I told her it would be in another area of study she said something along the lines of " well thank god for that, so many abused people go into psychology/counselling just to fix themselves" Needless to say I didn't go back to her and realised that she had her own issues to deal with!
        The negativity of that statement has stuck with me for all this time, but this article confirms to me that there is a benefit to experiencing something which then can be used to empathise understand, or recognise the signs and triggers in other people.

        Commenter
        molly daggers
        Location
        Perth
        Date and time
        March 13, 2014, 12:44PM
        • That's an awful thing for a counselor to say. Therapeutic relationship should be number one and if you wanted to study counseling a) she's not an expert on who makes a good counselor (obviously) and b) she should be being supportive

          Commenter
          Rach
          Date and time
          March 13, 2014, 3:03PM
        • I hope that counscellor was having a bad day rather then that being her underlying attitude.
          IMO you past and even current mental health status/illness does not preclude the studying and offering of support as a health professional.

          Commenter
          wow
          Date and time
          March 13, 2014, 9:26PM
      • 8. Displays a healthy skepticism and lack of hubris regarding the curative efficacy of their supposed wonder drugs.

        Commenter
        John
        Location
        Sydney
        Date and time
        March 13, 2014, 3:04PM
        • There are some mental illnesses that can only be treated by drugs though.

          My partner has bipolar and went to many drs and psychologists who thought talking through his problems would help him. The entire time he was manic and noone recgonised this. No amount of talking changes mania.

          His first appointment with a private psychiatrist and it was picked up. By taking lithium and anti psychotics for sleep my partner is now a funtioning human being who can enjoy his life.

          Not all drugs are bad and in some cases they are the reason some people are still alive.

          Commenter
          toucans
          Date and time
          March 13, 2014, 5:50PM
        • Understand that all people are different and that finding the correct drugs can take time but (in my case) that the drug is a quick fix 'get me back on track' and a wonderful solution thank you very much but that in the long-term self-repair such as CBT can be used to agument and then slowly (hopefully) replace the drugs.
          But also understand that a lot of people look for the quick fix and will, unfortunately, fall into the track of 'try to fix with a pill only'.

          Commenter
          8a
          Date and time
          March 13, 2014, 9:22PM
      • I agree, my psychologist is great, but sometimes I think she over simplifies some of thoughts and experiences i talk about, which makes me feel nervous about admitting things further. She also doesn't hide the fact that she doesn't like that my GP has me on a high dose of medication, which is something I know I couldn't function without. I don't want her to pander to me but I wish sometimes she could get it a little more. At least she hates CBT as much as i do - it doesn't work for everyone.

        Commenter
        bee bee
        Date and time
        March 13, 2014, 6:05PM
        • Mental health particularly is one of those things that can be almost impossible to understand if you haven't had the experience. This is why there is a different 'sense' when you deal with professionals who know how it feels - truly feels - and this is important for treatment you feel you can trust at your most vulnerable.

          I think you find more people with their own experiences have gotten involved precisely because of their own experience. These people are who we want in caring professions - the ones who have the desire to help. And trust me, plenty of workers in these industries are NOT about that at all.

          Commenter
          independent thinker
          Date and time
          March 14, 2014, 4:48AM

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