When I created this blog I didn’t really imagine anyone reading it, never mind finding it useful. So, I’ve been very surprised by the response it has gotten on here, Twitter and Facebook. I suppose I was perhaps projecting judgements about my suitability to practice onto others, expecting that if anyone did read this they would be telling me I was too damaged or fragile to be an OT. Consequently, I have been reflecting on two loosely related areas; one, the extent to which stigma about mental health issues still causes an uncomfortable silence and two, how helpful is it to be a professional with extensive experience as a service-user and does it make me ‘different’.
Breaking the silence
I’ve embarked on this exploration of the experience of turning from service-user to service-provider under a blanket of relative anonymity. So far I have only given quite broad identifiable information, however I am not concerned about people who know me discovering this blog, in fact I suspect that one day soon I’ll be much more open and actively join up the facets of my life experience, due to the positive response I’ve received.
So, why have I felt the need to be so tentative in putting my story out there? Especially as I have had extensive, positive, experiences of being a ‘professional service-user’ providing training for a range of professionals and contributing a narrative on my experience as a service-user to mental health texts under my real name? I suspect it’s a combination of my own insecurities and a very real stigma in society. While I am very accepting of the path my life has taken, I think at times I get tired of having to explain myself to others. Most people see me as a competent and interested student but when the conversation, inevitably, gets on to what brought me into the profession and what I’ve been doing with the preceding years of my life, I groan inwardly. How much do I tell people? How much do they need to know? Will they judge me? Are they actually interested? Is it appropriate? All these thoughts, and more, go through my head. I often wonder if I had spent several years in hospital for a physical illness, how much would I say in the same situation? The answer is that I can’t know how I would respond, as I haven’t experienced it. I suspect though, that if the situation was right, I would be much less hesitant, while acknowledging that it’s probably not easy for anyone to disclose personal details early on in encounters.
I have experienced a range of responses to people who discover my background. The only response that I find entirely unhelpful is that of pity and sympathy, and I am sad to say that has happened in my recent experience. Pity ensures that any professional working relationship is certain to fail, and leaves me feeling assigned to a ‘patient-role’. While people who respond in a way that suggests I have reason to hide my background are not the ideal, their attitude has helped me reflect on my own sense of self. When I was applying to university my tutor at college suggested that declaring mental health problems on my UCAS form might result in rejection. I gave this some thought, and while being aware that such a response would be illegal, I also concluded that I wouldn’t want to study somewhere that would only take the ‘undamaged’ version of myself, as well as feeling it was important to be congruent with my own values of honesty and integrity (as far as I can tell, the declaration had absolutely no effect on my application).
In general I find people are very positive when I disclose my history. From friends who are comfortable enough with me and my past to make jokes about it (while, very sincerely acknowledging that out of our group of friends I am the most ‘sorted’), to tutors and professionals who respect the extent of a journey that I have been on, as well as the valuable experience I’ve gained along the way.
Don’t wrap me up in cotton wool
Being an OT student I regularly am involved in conversations regarding people with mental health problems. Those who know my background may say something that is insensitive and then realise, with embarrassment, what they have done. Others who don’t know may talk about ‘these clients on the psychiatric ward, like, well they were a bit scary, but actually quite nice people’. I think it still surprises me that the stigma is present. However, on a personal level it does not upset me to hear conversations that contain judgements or ignorance, it simply provides me with an opportunity to introduce a slightly more accurate perspective and challenge some of their beliefs.
So while the above shows that there is still some very real stigma surrounding mental health problems. I do wonder if it is my own belief that I am in some way a weaker or less able person that causes me to question why it isn’t easy to stand up and say, ‘I’m pd2ot, I’m lucky to be alive as I used to be so self-destructive, and I have recovered. The ‘old’ pd2ot has not disappeared, but simply understood themselves and grown into the person you see today’. While I believe that statement to be entirely true, I have been thinking about whether I am, in fact, damaged and broken.
I remember a psychiatrist I was once under the care of saying, ‘you know, people with your background and extent of problems are usually either dead or in prison.’ While I found this statement validating of my experience, it did leave me feeling hopeless that I could ever be ‘normal’. I also have had various nurses and care staff acknowledge that they couldn’t foresee a future for me that didn’t involve hospital or serious self-harm. It’s understandable that with these external reinforcements that I have ingested some belief that I would always have to be a ‘disordered personality’. However, the reality of my current experience has proven these people wrong. I have recovered.
I also feel that my experience has given me a great deal of strength. In being a member of a therapeutic community (TC) I have had to sit with anxiety for others exhibiting dangerous behaviour, other clients running away and attempting suicide and been on the receiving end of intense anger and hatred directed, perhaps unfairly, onto me by struggling clients. I have experienced being pushed away, or even being put on some unachievable pedestal by the same clients. All of these experiences must be so common as a professional, and I’ve discovered that I can manage them even at the time when I was still engaged in my own therapy. Being part of a TC also exposes you to details of horrific abuse and violence. While some of it was traumatic to hear, it can only have increased my awareness and understanding of some of the terrible things experienced in the world and the consequences for those involved. I also have gained some incredible insights that only clients can share, such as how people can ‘con’ the staff and hide things from prying eyes, to understanding a range of people’s attitudes to services, what has helped them and what has happened.
I feel there is a real balance to be achieved between ensuring that my recovery is maintained and not overly protecting me from the real world. For example, my placement locations and settings are discussed regarding uniform, distance of commute, and to a lesser extent the client groups encountered. I don’t want to be held with kid gloves, but we might agree that placements that might have more impact on a personal level could be encountered later on in my study. The reality is, I think I’m more resilient due to my life experience; not only from what I’ve been through but also the skills and understanding I’ve gained along the way. On my first day of my first placement I went on a home visit to a place that my only previous experience of was being scooped up in an ambulance and taken to hospital for treatment for serious self-harm and prevented from attempting suicide. I was aware of the significance of the location, and also able to mindfully acknowledge this new experience at a different stage of my life.
Once again it’s all about the balance! I have no reason to be ashamed of my past and while I would never, ever, wish to repeat my life so far I am actually glad I’ve been through it. I believe I’m a more resilient, compassionate, resourceful and reflective person as a result, and for that I’m grateful.