Mental health revelations in The Psychologist: enough is enough?

Dr Roger Lindsay has a sceptical but not unsympathetic take on recent letters.

Over the last few months the pages of The Psychologist have been much occupied with revelations of the various mental health afflictions suffered by practising clinical psychologists, with BPS Vice-President Jamie Hacker Hughes prominent amongst them. To register a protest at this is evidently to run a risk of being labelled unfeeling or lacking in empathy or sympathy or something equally unattractive. Enough though, I can’t help feeling, is, at least for me, more than enough. I have always supposed that the incidence of disorders such as depression is at least as great amongst the clinical psychology profession as in the general population, possibly somewhat higher, as suffering from a health condition might well be expected to create a career interest in conditions of that type. Hence the discovery that some professional psychologists suffer from mental health challenges has hardly come as news to me. In a similar way, I expect that some GPs suffer from conditions such as ingrowing toenails and cancer of the great bowel, but I have little or no interest in knowing which physicians suffer from which conditions.

Perhaps the point in publishing these revelations is not that they are of interest to the general reader, but that accumulating or deploying the moral courage to speak out is beneficial to the confessor. If this is so, could not the BPS set up a website dedicated to publishing the narratives of those mental health professionals who have personal stories they wish to get of their chests, just as King Midas’ barber dug a hole in the ground in which to whisper that his employer had ass’s ears, so relieving himself of the burden of keeping his secret entirely to himself?

Some of the professionals who have ‘come out’ in the pages of The Psychologist seem to believe that experiencing mental health challenges has made them better at their job, and it may similarly be true, for all I know, that GPs across the country believe that they are more effective practitioners because they have suffered from ingrowing toenails or cancers of the great bowel. Psychology prides itself on being a science and encourages its professionals to base their practice on evidence. Before the claim that mental health afflictions enhance the efficacy of professional practitioners gains acceptance, shouldn’t it be tested via clinical trials rather than given credence on the basis of anecdotal evidence, even when the purveyors of such anecdotes hold high office in the British Psychological Society? And if we do as a profession accept this claim as the recent editorial practice of The Psychologist suggests that we might, aren’t there some uncomfortable implications? For example, that mental health clients would be wise to avoid psychologists who have not suffered from some mental health condition, and that psychology training courses should seek to selectively recruit candidates from those afflicted by mental health challenges? Maybe experiences designed to disturb mental health should even become part of clinical training programmes.

I must confess myself a sceptic. Everyone who suffers from conditions that are unpleasant or that they do not enjoy, has my heartfelt sympathy. I will, however, only believe that such experiences feed into therapeutic practice in a positive way when I see hard evidence to that effect. Until then, whilst I am sure that publishing ‘coming out’ narratives takes great moral courage, I find it difficult to believe that anyone benefits except the narrator and possibly other professionals suffering from the relevant condition. These benefits could readily be preserved by establishing a ‘personal confessions’ website and the pages of The Psychologist freed up for information based upon solid evidence and likely to be of interest and value to a greater proportion of the readership.

Dr Roger Lindsay
Ulverston, Cumbria

 

 

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Holding on to one’s thinking in times of attackI am angry towards the editorial team of the Psychologist for allowing a personal attack, having obviously not learnt from the anger sparked from the readership when our President Peter Kinderman was also recently attacked in the Psychologist. I would also like to know what part of the article is sympathetic and to what?I have to remember to be compassionate and realise that not all people and that includes psychologists, are trained to understand the multiple meanings and power of stories, to think carefully about the use of self-disclosure, and not just because to talk about one’s own mental health can lead to one’s own discrimination.Change the words in the article around mental health to race, age, gender reassignment, sex, religion indeed any of the nine equality and human rights protected characteristics in law, and would this article have been published? Free speech doesn’t have to be disrespectful speech. This is our professional journal, accessed worldwide and we essentially have one psychologist attempting to silence others. Having gathered at a Women’s March in Liverpool on Saturday after the DCP Conference, I am reminded of the plea for us not to sleepwalk into fascism. Micro and macro aggressions all add up.I really don’t expect everyone to be interested in the multiple uses of self-disclosure, to be aware of the difference it makes in the lives of those marginalised when those with power – and psychologists do have power – demonstrate that there need not be a 'them and us'. Yet the power of breaking down the ‘them and us’ barrier really does allow people to speak out about their own distress and to make use of mental health, social and community services. If you are not interested you can just turn a page.Roger may be aware of the Psychological Wellbeing research that says mental distress is high amongst psychologists, and that this is due to work related and wider social-political stressors. Misunderstanding and belittling the psychological processes that cause distress, and psychological does mean social and political too – is misinformed at best. A helpline for individuals will not address the society in which we live.As an applied psychologist I count on my academic and practitioner colleagues to help me know how I should practice. I have to sit with my own disappointment in psychologists who show a lack of curiosity. Perhaps asking why is self-disclosure important to you, psychology, psychologists, the public – would be a starting point.So, in the spirit of curiosity I ask:Why is it OK for my professional journal to publish an article that flouts equality and human rights law?Is there a disconnect between The BPS Code of Ethics and Conduct throughout the society, particularly in relation to respect, that makes harm to others more likely?Is it OK to be a psychologist and not be interested in other people or the impact one has on other people? If so, when?Can difficult experiences be discussed without personal attack or belittling?What’s behind the irritation reading self-disclosure? Pain, fear, sadness, disappointment, a need to believe that distress is necessarily vulnerability not strength?Is the attack on individuals, i.e. the troublesome individual, a misdirection of signs of a troubled institution?  What is the core purpose of the BPS? What kind of BPS does the membership want? What kind of leadership? Do all member voices feel heard and represented?If our society is so sold upon the notion of binary, discrete experiences – the them and us attitude – when is that attitude helpful/unhelpful?I have to admit when writing this I have been tempted to use humour throughout, perhaps in an attempt to diffuse my own strong feelings, in an attempt to make it easier to be heard and even an attempt to learn from Roger’s experience. I am Salomons and Tavi trained after all. I am sure many will be thinking similar thoughts to him, of course I am hoping many more will be thinking like me. But you know what, I am resisting making it ‘better’. This article really isn’t good enough. Ché RosebertClinical Psychologist, London  

You mention the core purpose of the BPS, but the core purpose of The Psychologist (stated each month on the inside front cover) is to provide 'a forum for communication, discussion and controversy among all members of the Society'. We will always fight to protect that role. It is not a case of learning from past 'anger', or yours.

The part of the letter which is sympathetic is "Everyone who suffers from conditions that are unpleasant or that they do not enjoy, has my heartfelt sympathy." And indeed overall, the editorial team felt the letter was acknowledging the need for self-disclosure and even suggesting places for it. The main thrust of the letter seems to be whether it is appropriate and useful in the pages of The Psychologist, and whether there is any evidence for the suggestion that such experiences could make a person a better psychologist. This seemed to be a reasonable way to seek to move the discussion and debate on.

Would we have published if the letter had been about other aspects of equality and human rights? Quite possibly, although as you note there is a key difference as those characteristics are protected by law.

We fully understand that many people will not agree with Dr Roger Lindsay's letter, and no doubt we will publish letters to that effect in the next edition. But 'anger' at us for providing a forum for communication, discussion and controversy is a wasted emotion.

Dr Jon Sutton

Managing Editor 

Isn't the 'evidence for the suggestion that such experiences could make a person a better psychologist' in the narrative disclosures of those experiencing it? Or are we now suggesting that experiential evidence counts for little in our scientific community? Surely, to suggest that the impact of mental affliction on subsequent professional practice can be tested / measured in any way, is banal.  This merely demonstrates a considerable lack of understanding of applied psychology practices, mental health, and the relative merits of experience within real-world contexts. 'Square peg in a round hole' springs to mind.Tina Fanneran. PhDNottingham

I hoped that such a contribution would be useful in enriching discussions about the role of the lived experience of the psychologist. It is a pity that any constructive engagement is hidden behind patronizing (and minimizing) language such as ‘revelations’, ‘afflictions’, the comparison of psychological distress to ‘an ingrown toenail’ and ‘having sympathy for’; all of these terms seem quite patronizing. This is a shame as the visions put forward by colleagues in the pages of The Psychologist recently have actually focused on the advantages and disadvantages of reflecting on our shared humanity and capacity for experiencing and understanding intense distress.  They allow us to consider the impact of these experiences and the stigma and damage done when these experiences are assumed to be just the province of Others, or something we keep secret. Yes, secrets … the use of the King Midas reference is particularly troubling. While the letter seems to allow for such experiences to be spoken about, it remains a call for such experiences to be kept out of the mainstream, hidden away in a specially constructed venue. The letter fails to recognise the damage that ‘secrets’ cause individuals, families and communities? The metaphor isn’t a call to privacy, but akin to expecting psychologists to hide their suffering away, albeit in secret societies rather than being open. I shudder with the echoes of ‘Don’t ask, don’t tell’ here.  If I get beyond the tone of the letter, is the letter a chance to think about the place of our experience in our practice? Is it, in effect, a challenging piece of peer review? I am not sure it is as it seems to suggest it be situated elsewhere where very few people would access it. As an earlier respondent noted, personal accounts are useful in a range of areas, they are the bedrock of teaching and learning after all, so why would it somehow not be relevant to training and practice as a psychologist? Psychologists take these experiences with them wherever they go, it's an ethical issue to be more transparent about these experiences, it allows discussion, supervision, reflection and informed decision making about therapeutic practice. Such transparency is embedded in accreditation and registration processes and so our magazine should be a conduit for such reflections too.  Maybe it is the choice of The Psychologist that isn’t quite appropriate for the criticism leveled. If one wants to limit professional discourse to the empirical, there are many outlets that offer this. The Psychologist remit however is much broader, it is to be a home to discussions and foci of the full range of psychological issues and considerations - and the wellbeing of therapists and its impact on clients is most certainly one of those. By opening up and having debate we are facilitating a form of peer review. Another issue is the view of research invoked. The letter seems to invoke traditional vision of empirical research as unaffected by the subjectivity of the researcher. The qualitative revolution of the past couple of decades should have sensitized us all to the fact that researchers too take their assumptions, beliefs, and biases into the process, regardless of whether the research being undertaken is of a qualitative or quantitative nature. Again, limiting the impact of personal experiences/ suffering to some hole in which to share with others of the same ilk, is just not professional. I suspect that part of the difference of opinion is related to the view of these disclosures as indicating 'afflictions’. The letter constructs them as individual health conditions - whereas much of the disclosure and debate has actually been a recognition that is not the case. The argument has been that distress is linked to context and society and that we are all likely to be affected at some point in our life. It’s not a case of ‘those individuals afflicted’ by X or Y but all of us having the experience or the potential to experience such distress. In my mind this is an ethical and important corrective to the blaming culture of the individualising pathologising understandings of mental health that have flourished and should be welcomed. The Psychologist is like a TV set, if you don't like it or don't find it helpful, read around it. Many of us are finding it an ethical and reflexive enhancement to clarity and transparency. The debate isn’t perfect and we still have much to learn but silencing those brave enough to share personal testimony risks doing our profession a major disservice. Professor Martin MiltonRegents University London

I am a mental health professional - not a psychologist - with my own lived experience of psychological distress. It always feels slightly uncomfortable to occupy both 'roles', and personally, I have been encouraged by those psychologists who have spoken out about their experiences. Rather than a kind of self serving catharsis, I see their disclosures as a welcome change in attitude which I hope will continue. Any mental health professional occupies a position of interpersonal power. Psychologists, in particular, have a privileged role in offering language and meaning to clients' often very painful experiences. Speaking as a client, it is very easy to feel exposed, 'other' and 'less than'. To me, anything challenging this power imbalance can only be a good thing. I don't care whether the person supporting me does or doesn't have lived experience of distress. Of course I want them to be competent, but I also want them to have a genuine sense of compassion, understanding and respect for me and the experiences that have shaped me. I don't want them to be scathing, patronising or to see themselves as somehow made of better stuff than me, simply because they have not faced the particular barriers that I have.
 
Within mental health services the traditional 'them and us' attitude can still persist. Those in positions of responsibility and leadership who share their experiences responsibly, can help to counter this. They give a powerful message that when you speak about 'them' you are also speaking about 'me'.

Generally, staff within services can can find it extremely difficult to name and seek support for their own distress. By silencing or dismissing responsible disclosure of lived experience we make this more difficult. If we are so uncomfortable with openness, what does that say about our attitude towards fragility and vulnerability more broadly? Surely the point is that we can all develop psychological distress, and whilst the nature and intensity of this can vary, it is not something to be shamefully boxed off or compartmentalised away from our professional role. There are no neat dividing lines, even if it makes us feel more comfortable to imagine that there are.
 
Name and address supplied

My sense is that Dr. Lindsay, in his recent whinge about ‘mental health revelations’ has missed the point – and so have the editors in giving prominence to this dubious piece. The BPS has after all published its position on classification (BPS 2013). This sets an agenda of viewing mental health as a continuum as opposed to the binary, ‘I am well, you are ill’. My own, cognitive science, based opinion is that the human being is a wobbly balancing act (Clarke 2009). Our position on the tightrope is as much a function of external variables such as roles, relationships, past experience and social circumstances, as of internal, temperamental, differences. Asserting recognition of this should not be registered as an irritant so much as a helpful insight towards empathically engaging with those we seek to help.  British Psychological Society (2013) Division of Clinical Psychology Position Statement. BPSon the Classification of Behaviour and Experience in Relation to Functional Psychiatric Diagnoses:Time for a Paradigm Shift. Division of Clinical Psychology.Clarke I. (2009). Coping with crisis and overwhelming affect:Employing coping mechanisms in the acute inpatient context. In:Columbus AM, ed. Coping mechanisms: Strategies and outcomes.Advances in psychology research, vol. 63. Huntington NY State: NovaScience Publishers Inc. 

I was extremely disappointed to read Dr Lindsay’s letter.  I believe strongly in the importance of promoting the self-disclosure of experienced mental distress, not just by psychologists but across society.  If it can’t start with us as a professional group, we haven’t got much hope.  Having reflected though, I think there has been some use to its publication – it has sparked anger and this can propel change.   Forgive me for citing an article I co-authored in The Psychologist in June 2015 on the issue of self-disclosure: https://thepsychologist.bps.org.uk/volume-28/june-2015/opening-disclosureOne of our aims was to raise the profile of therapist self-disclosure, so I cannot complain that Dr Lindsay’s letter has also done this, albeit not in a way I would have desired.  In the article, we talked not just about the potential value of therapists being more disclosing of their own mental health problems, but also being more open in general – about their experiences/thoughts/feelings.   Perhaps Dr Lindsay has set one useful challenge, amongst his narrow-minded and belittling views.  He argues of self-disclosure, “I find it difficult to believe that anyone benefits except the narrator”.  Whilst my gut is to disagree, it does force me to question what we actually know of the impact of recent increased disclosure.  Most psychologists hope and argue that this disclosure (especially by those in positions of power) is reducing stigma; reducing power and inequality; empowering more people to come forward for help with mental distress; and enhancing people’s recovery journeys.  But perhaps as scientist-practitioners, we do have a way to go with evidencing this?  Just as our article argued there is a need for more research into the impact of therapist self-disclosure in therapy, perhaps we need more systematic evaluations of the impact of public self-disclosure?  This doesn’t need to be Randomised Controlled Trials – surveys or rigorous qualitative research may better capture the personal impact of self-disclosure on the reader/listener (as well as any benefit it may bring to the person disclosing).  Maybe we could survey the views of readers of the Psychologist on the increased narratives being published; research service users’ perspectives on this and/or the increasing disclosures in the media; or even survey the general population. 

I was disappointed to read Dr Roger Lindsay's article denigrating  clinical psychologists who self-disclose as if sinners who need to relieve themselves by "confession".Whereas his suggestion of a support website seems a good idea, this should not stop sharing experiences across the board. The Midas analogy of hidden secrets only serves to increase stigma and discourage talking about psychological distress. The comparison between the experiences described by psychologists with an ingrowing toenail bordered on the contemptuous.Patient stories are increasingly recognized as helpful in understanding both the nature of the problem and the impact of health systems in mitigating or exacerbating distress. I applaud psychologists with a joint client and professional perspective speaking out about their experiences and I hope they will continue to do so, because we have had enough of this mythic  "us and them" culture.Dr. Lindsay is correct to say we need evidence. However, before we can collect evidence, people need the freedom to disclose their histories openly without fear of censure or dismissiveness.I summarised the evidence that I could find in my paper "Past Hurts and Therapeutic Talent" published in the 2012 winter edition of Reformulation, the Theory and Practice of Cognitive Analytic Therapy. My conjecture is that psychological distress does not of itself make a better or worse therapist, but how it has been processed and managed may be crucial. We do not know, but to find out we need to be more open and accepting, and to welcome self- disclosures from our colleagues.Barbara W. Williams, AFBPsS, retired consultant clinical psychologist.

Personal disclosures and stigmas alive and well within the Clinical Field  I recently applied for a position as a psychological assistant at a prestigious institution in London.    The application asked about experience of working in mental health, and also through lived experience.  I have experience of working in a clinical setting.  Also from a young age I was carer for a parent who had a serious mental health issue and I also have, and manage successfully, Bipolar Disorder.  I wrote about my personal experiences, as I thought they would be relevant for the position advertised.   Quite often people who have had problems can help others.  I regret being so honest.  A valid response, you might ask? I have never received any feedback about my application, despite my best efforts.  On paper I met the job specification criteria etc.  I think there is a huge stigma attached to having a mental health condition and being a psychologist.  The Psychologist during 2016 published letters on this topic.  If stigma is being reinforced within the Clinical Psychology field, then there is little scope to influence others.     Either the lack of response to my application is a matter of lamentable maladministration, or is a signal that ‘no response’ at least gets the organisation off the hook for discrimination. There are several aspects of my identity that I would comfortably disclose, however, my own experience is that having any health condition is deemed part of who and what you are.  However, it shouldn’t define who you are.  I have’ X’, rather than am ‘X’. If people wish to talk openly about their experience of mental health, then they should be allowed a safe platform to do so. 

Thank you to Dr Lindsay for starting a much needed discussion about the value of disclosure by mental health professionals of their personal struggles with mental health problems. A great shame though that this was done in a manner that lacks the empathy and sensitivity I’d like to think any mental health professional ought to afford people seeking their help, and indeed colleagues talking about their own lived experience. Not wishing to reiterate the insightful comments others have posted, I would like to lend wholehearted support to the observation posted on 01/30/2017 that recent disclosures of lived experience by colleagues at both very senior and more junior levels are to be welcomed as a sign of (slowly) changing attitudes. Not only do those willing to speak openly about their own experiences of distress lift the lid on a persistent taboo within most of the mental health professions, but they also actively challenge the power imbalance between expert and service user and the deeply ingrained dichotomy of ‘us and them’. Recent research we conducted at UCL puts serious doubt to the common idea that lived experience among mental health professionals is a relatively rare occurrence. In separate anonymous national surveys of both qualified clinical psychologists and those in training almost two thirds in both groups reported having experienced a significant mental health problem at some point in their lives. While many had disclosed their struggles to family and friends, far fewer had done so with colleagues, supervisors or fellow professionals. Around a tenth had never disclosed their experiences to anyone. I am a great believer in people’s capacity to help themselves and the potential value of a wide range of sources of help and support, not just formal services. However, at a time when policy and evidence points to the need for early recognition and support to avoid problems escalating, the reluctance within our own ranks to speak out about distress seems very concerning. Furthermore I would like to think that many of us regard supporting service users in accessing effective help and countering mental health stigma as cornerstones of our professional (and personal) roles. In this regard, professionals doing the very opposite and often going to considerable lengths to conceal their distress from peers, colleagues and supervisors points to a real paradox that needs tackling. Is it not because of a combination of high levels of mental health stigma and (anticipated) reactions along the lines of ‘don’t bother us with your personal business but please keep stumm’ that colleagues feel compelled to hide their experiences rather than feel assured of their colleagues’ understanding and support? On this note, with support from the DCP and BPS, we will shortly be inviting colleagues (including trainees) from across the land to participate in a trial of a new self-help resource (Honest Open Proud – Mental Health Professionals version, HOP-MHP for short). This is designed to support and guide mental health professionals in making carefully considered decisions regarding disclosing their lived experience and acting on their decisions in line with their own values and preferences. We hope that those deciding to disclose as a result will contribute to a much needed open conversation about the status and potential value of dual status professionals. I also hope they'll receive a much more positive response from within the profession than some deciding to ‘go public’ have had in recent times. While the world is full of debates about the right terminology to use and I’d be loath to suggest yet another one to be fought over, the notion of ‘experts with lived experience’ perhaps nicely conveys the idea that we may be able to learn a lot from more open conversations about our own experiences of distress, if only we are willing to listen to one another. Apologies in advance to Dr Lindsay and others but here’s hoping recent ‘revelations’ in the Psychologist and elsewhere are the green shoots from which more will grow. Anyone interested in potentially taking part in the HOP-MHP trial is invited to either get in touch by email or await invitations via the DCP or training courses’ mailing lists. Katrina Scior, DClinPsy PhD, UCL Doctorate in Clinical Psychology