|Do professionals always have to wear a mask?|
I innocently posted an item on Twitter the other day about Marsha Linehan, one of the world’s best known clinical psychologists and the creator of Dialectical Behaviour Therapy (DBT). Linehan caused a stir a little over two years ago when she announced that she, like so many of the people she has tried to help, had suffered from the experiences labelled as 'borderline personality disorder' (BPD). Admittedly, Twitter is a volatile medium in which people say many things free of the restraints that a less anonymous conversation might impose. But, even so, I was unprepared for the vitriol with which my tweet was greeted.
Service-users responded immediately and their views were unequivocal.
'It only took her 30 years to come out!' complained one, while another said that surely she could have helped more if she had revealed her own history of mental illness sooner. An attack followed on the merits of DBT, created by Linehan with the aid of insights provided by her own struggle.
Whatever you think of DBT, it’s clear that when a mental health professional 'comes out', it will not necessarily go down well. The issue provokes interesting questions. Why don't professionals with so called 'lived experience' of mental illness and other difficult or traumatising experiences make known their histories more often or more easily? What might make them 'come out' and why would they choose to do so after many years of silent practice?
Linehan apparently spilled the beans after a service-user had asked whether she was 'one of us'. Linehan it seems, was used to answering such questions. But something about that question on that particular day got to her, and she let her secret be known. Her confession included details of frequent and protracted hospitalisation as a young woman, a misdiagnosis of schizophrenia and multiple electroconvulsive treatments. It was a risky admission.
More recently, the CEO of one of our local partner NHS trusts, Lisa Rodrigues, chose to make public her history of bipolar mood swings. Her confession received broad applause from what we might call 'the mental health community'. Nonetheless it was not without its detractors. Some service-users predictably thought it too little, too late. Others, including professionals, pointed to the fact that her imminent retirement meant that now was a safe time for coming clean.
The reasons for concealment might seem obvious. Stigma is frightening, and nobody wishes to invite it. But it's a sad fact that mental health professionals stand accused of colluding with it. Stephen Hinshaw in his book, Breaking the Silence suggests there is a status differential between those who give and those who receive care. The result is a tendency for those in professional and scientific roles to hold to an ‘us versus them’ approach in which users and survivors have the one-down position. Many professionals hide behind a facade of invulnerability and those with histories thus remain ‘other’. The fact that any one of us can develop a mental health problem given the right circumstances, may get lost.
There are many traps the other way, though. While there may be merit in making wounds explicit, referring to a label can be a tricky business. Using it may invite others, including fellow professionals, to view user/survivor professionals through a particular lens. Do people think you understand their pain better? Or will they confer insight on you that you might not have? Psychiatrists might take the view that the disease is in remission. Once labelled, always labelled and that’s it. Do you then have the strength and resilience to cope with the work you do? As well as unease in the professional world, it may sometimes be difficult to be taken seriously as a user-activist if you’ve enjoyed the privilege of recovery and professional training. Both professionals and service-users may attempt to position a dual status professional in ways that can be both unhelpful and unrealistic.
Some of the most difficult dilemmas may arise from within wounded healers themselves. For some, the gift of recovery exerts what is felt as a responsibility to help those in distress, while for others it is an attempt at making peace with the past. However noble such agendas may be, dual status professionals will need to pay attention to motivations that may lead to unhelpful pressures from either themselves or colleagues. Hinshaw suggests that many individuals who enter the mental health professions do so at least in part to examine their own (or their family’s) psychological issues, vulnerability and pain. The psychologist Jung, who suffered serious breakdown, believed that it was a healer's own wounds that made the curative therapeutic journey possible. Wounds, he maintained, potentially bore within them transformative and curative power. Indeed, some believe that a therapist cannot necessarily guide a client anywhere they haven't been themselves.
Of course, this is a complex issue. Those with a history do not necessarily have the wherewithal to be healers, nor are they always ready to contemplate the rigours of clinical practice. Those who bear their own wounds may be terrified of being seen as too vulnerable, and training schemes may be afraid to take on those who confess to significant histories. What if they become a liability? At times I've heard colleagues say that it's okay to confess to a history of mental health problems so long as you were never hospitalised. Ironically, this ludicrous logic reveals that many don’t have much faith in recovery, or indeed the healing power of their own methods. The result is that many of those who could be most valuable to services are either kept out, or kept quiet. The controversial clinical psychologist, Rufus May, confessed to a history of psychosis only once he had qualified. Other wounded healers believe they need to clock up considerable years of practice and a record of reliability before it is 'safe' to reveal their dual status. It is a travesty that those who potentially have the most to contribute are pressured into lives of subterfuge. Arguably, successful transformation of one's own wounds is the highest qualification of all.
Survivors and service-users know this, hence their feelings of betrayal when a wounded healer belatedly 'comes out'. Professionals know it too, despite their collusion with an us-them hierarchy. As a wounded healer myself, I believe aiding others is most potent when practised from a position of common humanity where all are regarded as fellow travellers on this difficult journey of life. This is no easy task, for it requires that we not only gain intimacy with our vulnerabilities, but ceaselessly and courageously confront them. It is the only standpoint that is genuinely authentic in a world in which suffering is inevitable. What we need is an honest appraisal of the issues, so that clinicians like Marsha Linehan and executives like Lisa Rodrigues needn't risk censure when they make known what might be of profound value.
As always we ask contributors to enter into discussions on the comments thread over the next few days. You can also follow Angela on Twitter @cyberwhispers.