I was reading IntoTheSystem’s blog yesterday and this post here touched a nerve. It’s something that Clare Allan has also alluded to in her column, the system places such low expectations on us mentalists. We are expected to be out of work and on benefits, totally dependent on other people to get by, deserving of pity and “there but for the grace of God”. Although lip service is paid to the idea that mentally ill folks are normal people who happen to be a bit poorly right now, the overriding image within services is of someone who is incapable of living a normal life.
I’d like to quote from IntoTheSystem’s post, where she talks about the DWP’s Pathways to Work literature:
“The literature that came with the letter was even more frustrating. There were a number of “success stories” of disabled people who had successfully got into work through the Pathways to Work scheme. The disappointing thing was all of these people had got minimum wage jobs in local supermarkets, washing dishes in kitchens or working in DIY stores. There were no teachers, lawyers or accountants. No doctors, nurses or IT consultants. No one was in a managerial position. Everyone was in a basic entry-level role, with few prospects for career progression and no doubt earning very little. I know for some people, a job in a supermarket is a massive achievement, but for many it is a massive step down. Not everyone on incapacity benefit has had a poor education or learning difficulties. Some of these people are highly intelligent, highly employable and have been previously very successful until they became ill or disabled. Surely these leaflets are not providing a positive image of disability?”
When I was admitted to hospital in 2008 I was asked in my first ward round meeting what I did for a living. When I replied “I’m an IT manager in an investment bank” the doctor nearly fell off his chair. Professional people like me are not supposed to be mentally ill after all. The correct answer would have been “I’m a part-time shop assistant at WH Smith” so I could be appropriately patronised.
I’m currently very keen to get back to my job, as I’ve been signed off since April. Some of the CMHT staff don’t seem to understand why this is important to me. I’ve spent 10 years studying and 8 years working in my chosen field, I am not about to let that go without a fight. Still, I am incredulously asked, couldn’t you just take a few years off and get a part-time job after that? I’m supposed to be happy with helping out in a charity shop and going for walks, with, eventually, the night shift cleaning offices for RBS no doubt to follow. Not everyone seems to understand why I am not happy with this as a future career plan [1].
Some mental health staff really do not like the idea of their patients being otherwise competent professionals. Far too many seem to enjoy having a rapport with their charges that is of a parent-child nature – reserving the kind of condescending benevolence that is frequently lavished on the learning impaired. As long as you’re non-threatening, uneducated and unemployed or underemployed, such that the doctor or nurse can feel nice and superior, we’ll pat you on the head and say “there there, daddy NHS is going to make things ok”, but as soon as you show yourself to be an autonomous, capable individual who does, in fact, have a life beyond their disorder, they don’t like that one little bit.
It’s worth mentioning that the psychiatrist who is considered the single biggest prick in the entire NHS trust around where I live is spoken of very highly by the carers of his learning-disabled patients. Just as there are people who go into primary teaching because kids are easy to push around, so mental health has its share of arseholes who love the idea of caring for the incapable as long as they act like a cute kitten and don’t answer back.
For the record, the majority of the staff in my local CMHT and hospital ward treated and continue to treat me like an adult, with some notable exceptions. I found the medical professional=god, patient=2-year-old attitude to be quite widespread in some other parts of the country in the past though.
I am aware that there are a lot of people who are chronically very ill and are unable to participate in the workforce as a result and this is not intended to be a broadside at them. Nor am I trying to suggest that only people with jobs are smart, educated or able to make decisions about their lives or deserving of being treated like an adult. Rather, I want to touch on a particular aspect of this general infantilisation of the patient role by certain care-giving personnel of which I have personal experience. It goes without saying that an unemployed person shouldn’t be condescended to either. I’m sure some of you can tell me lots more about your experience in the comments.
[1] For those who are interested, it looks like I am going to be able to go back to work part-time in the new year.
It’s a bit difficult to respond to your post – you’ve said it all.
I am a client of the LDP, despite being a graduate and have IQ more than double their usual cut-off point.
During my ‘induction’ I was asked what what I would like to do with my life, so I replied quite reasonably, that it’s about time I got around to doing my PhD… via a Masters, to get back into the swing of things…
I have several thoughts about this. One is just that, in my experience, the concept of a patient being smarter than the mental health care professionals seems to be threatening to them, as I mentioned in this post here.
Mental health care generally is very paternalistic. I don’t think it has to be quite so paternalistic, I think there are plenty of ways to reduce that, though I’m not sure if it can be entirely eliminated, but the present state of mental health care is very very paternalistic. I think that is where part of this comes from. I suppose you can act paternally without thinking of yourself as superior to the object of your concern, but it seems unlikely and rare.
There seems to be an attitude of “if you are able to work generally acceptably well, you must not be so very ill.” My depression started in high school and stayed through 4 years of college. During that period, I was a full-time student for all but one semester (when I could have been a full-time student just fine if my college wasn’t run by people who had the best way of getting rid of me as their top priority. Christian love my foot.). I got very good grades this whole time, better, actually, then I had gotten before I was sick (although comparing to middle school and younger is a bit of a stretch, and I’ve never gotten below a B grade anyhow). Once I was in the mental health care system, at the end of high school, they all kept trying to keep me out of school, even though it was clear I could manage school just fine. In fact, I managed better when I was in school because it was a huge coping method for me. They paid no attention to that, just their general stereotype that mentally ill people can’t handle school. (Or perhaps they were, as my first paragraph, threatened by my intelligence, and thought my brain might rot if they kept me out of school, and then they wouldn’t have to worry about my being smarter than them. I was joking at first, but now I am not sure.)
At one school, the school that liked kicking me out, I met with the disability support coordinator, who also happened to be an education professor. I was an education major so I had to take speech, but there was no way I could do that without some sort of help. Although this woman was incredibly encouraging of most students with disabilities, encouraging them to speak up for themselves and telling them that they can look for ways to achieve their goals by working around or with their disabilities, except for me. (This was an Evangelical Christian college and I suspect they do not actually believe in mental illness. They are okay with physical and learning disabilities, and they seem okay with mild mental illness, a little anxiety or relatively short-term melancholy or a not-very-entrenched eating disorder. But I don’t think they believe in mental illness for real, because anything that could be called serious or severe mental illness, they call demonic possession. This may have been part of the problem I had with them. And, yes, they really did believe I was demonically possessed. They encouraged me to partake in, what I call, the Protestant version of exorcism.)
In my mind, having my intelligence insulted while in mental health care is par for the course. Even with the best professionals that I met, that aspect was still there, just perhaps not as prominently.
Thanks for mentioning my post. It’s nice to know I’m not the only one that gets frustrated about such things.
Your comment on the CMHT being surprised at you wanting to go back to work is something I’ve found too.
I mentioned it in this post: http://intothesystem.wordpress.....-for-work/
My old therapist suggested a few times that I “take a step down” into a less challenging job. I felt patronised. I don’t think she understood just how important my career was to me. I think unless you find yourself in the situation where your ability to do your job is compromised, you just cannot appreciate how much it cracks self esteem. Being off work sick nearly killed me. I had lost a great deal already through illness, there was no f*cking way I was going to give up my job as well.
Lola x
This is absolutely spot on!
Great post! I recently found myself sectioned in an acute psychiatric ward and later a “client” of the local CMHT. I have a degree in psychology and have had a professional, responsible, well paid job. This seemed to baffle and irritate the large majority of MH staff that i came into contact with – “You have a good job, what are you doing in here?” soon became a question i tired of trying to answer. Some tried to blame the pressures of my job for the decline in my mental health. Others just seemed to take it as a personal affront. My Psychiatrist is particulary annoyed when i don’t simply nod and smile as he tries to prescribe yet more meds and instead am able to articulate a reasoned response. In fact he is so annoyed by this that he has labelled it as “personality issues”! I have quickly learnt that there is no point trying to reason with people who believe they are God. I have found that, across the board, i garner a much more positive response if i just keep my mouth shut and do as i’m told.
“I have quickly learnt that there is no point trying to reason with people who believe they are God.”
I have found this to be true sometimes.
The “personality issues” thing I’ve had too in the past. I apparently have too much insight and am too intelligent for it to be “real” illness?!?!
Preach, sister. I just got labelled BPD (what else?) because I talk back.
PS: One NHS website was particularly inspiring. Apparently I have more chance dying than i do returning to work after more than a year off from work with a mental illness.
Nice. Not heard that one. I guess that will be me killing myself because I can’t tolerate being patronised any more then?!
Well said.
I went back to work a few months ago. I’d been out of work for a while after coming out of hospital where I had been held under section.
A short while after my employment had commenced, I had an appointment with my psychiatrist and was told that I shouldn’t be taking on so much, because people with my diagnosis (schizoaffective disorder) don’t often do as well as me. She also told me that I was at high risk of relapse, that this was a life long condition and that I should adjust my lifestyle accordingly.
My CPN agreed. She said that she’d fully support me in making a claim for DLA (so I could afford to live independantly) if I followed their advice and worked only part time hours.
I understand that they are advising me on what they think is best, but they can’t seem to see why I an unhappy with their suggestions. I am perfectly capable of working full time (which I have continued to do, despite their objections) and enjoy doing so. My employers are fully aware of my mental health history, and have accepted me as part of their workforce regardless. I have proven myself to be reliable and competant.
I see the psychiatrist every couple of months, and my CPN every 2-3 weeks, and they still say that they’re not completely happy with the work arrangement. I’m not sure what I’m supposed to do to help them to see that I really am able to cope.
I have been pretty lucky with the few people in the mental health field who have bothered to ask about my future goals re: employment. I am currently trying to finish my Education degree, with a major in special education… I want to work with ‘behaviourally challenged’ students, the ones that get cast away or fall through the cracks because of the emotional or psycho-social elements they are up against. And the MH professionals who have taken the time to speak with me about this have all seemed to agree that my own mental health issues, as long as I am taking care of myself, should be nothing but an asset for this field… the abillity to empathise and all that. That being said, most of the Psych Docs ect I come across in the Public system, don’t even bother asking. As long as I don’t kill myself or end up in cracking up again, their highest expectation of me is met, which is in itself, a little depressing.
I was extremely lucky with my job – having been off work (but still in full employment) for three years I was offered the opportunity to flog off my contract for total bobbins. I declined this and offered to return to work – this was accepted and I was back at the coal face within three weeks. Weird. They seemed quite happy for me to go back after occupational health talked over things with me.
My employer? NHS.
Three years. Still can’t believe it really. Bloody big void in my life.
True. The clinic round my way absolutely cannot grasp the idea that some mental patients work for a living. (Given the changes to disability benefits, they’re gonna have to change their ideas fast.) I keep telling them “these are the days when I’m free, and this is how much notice I need to get time off work.” Might as well be talking to a brick wall. Last time I phoned to change an appointment time (they’d given me less than a week’s warning, and it was when I was working), the fuckwit’s secretary tells me, “He says to tell you to stop trying to put it off.” Patronising arse.
Brilliant, brilliant, brilliant post.
I’m currently doing a postgrad degree and I feel like doing a PHD just to shove it in the face of my psychiatrist (also an arsehole who chats on his mobile, shows up an hour late and generally couldn’t give a toss).
Lou
I left school at 15 to work on a factory assembly line. The boredom of the job contributed to the problems that led me into the mental health system. Despite this, five years later when I was desperate to get out of the system (much easier to get in than get out back in the seventies) my psychiatric social worker suggested I get a job in a factory. I remember how I went hot with embarrassment as I tried to explain that I wanted and needed ‘something more’. I was seen as not being capable (and, indeed, perhaps I wasn’t, when doped up to the eyeballs and my confidence in shreds). Sod that. I came off the psychiatric drugs (against medical advice), returned to study and obtained a first-class degree.
Awesome! Go you