One for sorrow… seven for a secret
I had been a clinical psychologist for 25 years when my husband Paul dropped dead. We had gone swimming, as we did every Sunday morning. I waited for him in the leisure centre car park. He never did come. He died of heart failure in the changing rooms: one minute he was there, and the next minute he was gone forever.
At the time, my three children were teenagers, we lived in an old, dilapidated house, and I was the head of a large and busy Child Clinical Psychology service. My life was completely derailed, and I had no idea how to get it back on track again. Acute anxiety, depression and suicidal thoughts became a daily, and nightly, occurrence as I struggled to find a way forward. Fourteen years later, I’m still here, and able to reflect with hindsight on whether it was helpful to be a clinical psychologist when faced with such a major life crisis.
Until recently, my unequivocal answer to that question would have been yes. I wrote a book about my experiences, one important theme being that my professional training had been helpful in navigating my way through the trauma that threw my personal life into turmoil, for three main reasons…
Ways of dealing with trauma and loss
First of all, being an experienced clinician meant that I had access to a lot of clinical material from my patients. I don’t think I anticipated how important this would turn out to be, but as soon as the tables were turned and I was the one in need of help, I began to see that my patients could show me many different ways of dealing with loss and trauma.
One example was a support group that I ran for the parents of preschool children who were being assessed for autistic spectrum disorders. These parents shared the experience of ‘losing’ the child they had anticipated when confronted with an autism diagnosis, yet their reactions to this varied widely from denial and shock (‘You can tell me anything but just don’t tell me he’s autistic’) to universal sadness, loneliness (‘My family and friends don’t really understand what I’m going through; I feel I’m not like other parents anymore’), anger and blame (‘Those bastard MMR vaccine manufacturers are harming all our children’) and, in rare cases, early acceptance and a desire to get on with life (‘He hasn’t changed at all just because he’s been given a diagnosis; he’s still my lovely boy’). I had felt all of these emotions since Paul died, apart from acceptance, but as the weeks went by and I watched the parents bravely inching their way towards a more hopeful future in spite of their loss, I started to believe that I could do it too. I think I also became a better, more sensitive clinician. After Paul died something shifted, and my experience of the group’s anguish and sense of loss was no longer drawn from the pages of a textbook, but rooted deep within me.
Navigating mental health services
The second thing that my training gave me was the knowledge I needed to navigate my way around the mental health services: the pros and cons of different treatments, how to access them and so on. I was almost certainly drawn to therapy as the key to processing my own trauma because my career had shown me again and again that therapy is what helps people who are distressed.
Over the years following Paul’s death, I worked with three psychodynamic psychotherapists and one CBT therapist. These experiences offered a fascinating insight into the question of ‘What Works for Whom?’ (Roth & Fonagy, 2006). It felt very different being on the receiving end of psychodynamic and behavioural therapies, and I found myself in the unique position of being able to make an informed comparison between them. My overwhelming personal conclusion, based on lived experience but concurring with the academic literature, was that the kindness and sensitivity of the person sitting opposite me (those elusive ‘therapist variables’) mattered far more than the type of therapy being practised. The psychotherapist Valery Hazanov (2019) puts it rather well: ‘Conceptualisations, theories, interventions… only matter if the patient remembers a person, something that person said or did for her that was real.’
The third, rather surprising aspect of my training that turned out to be helpful was my research skills. Very soon after Paul died, I began to experience white feathers appearing in unexpected places, almost always when I was thinking about him or ‘talking’ to him, as the bereaved tend to do. I didn’t know what to make of them. Did they mean something? Were they a sign from him?
Throughout my career, I had researched questions that interested me in my clinical work and published my contributions to the evidence-base, and so I felt that I should be equipped to investigate the feathers: not a full-scale experimental study, but a thoughtful and systematic approach to determining their significance. A quick search of the internet revealed that ‘feather’ experiences are commonly interpreted by bereaved people as a sign from the deceased, and indeed are often viewed as evidence of guardian angels. Although this was encouraging, it was anecdotal, and I needed more robust data. I interviewed a sample of bereaved people and went on to carry out a detailed questionnaire survey of experiences following the death of a loved-one (Moore, 2017). This revealed that half of the bereaved people sampled had a sense of the dead person being ‘around’, and half of these described more concrete ‘signs’: a magpie who appeared after a woman’s sister died, a smell of cigarette smoke where nobody was smoking, a white feather appearing on the floor when a woman was thinking intensely of her dead husband, a robin hopping on a dead child’s grave. ‘Signs’ such as these were all reported in the first two years following the death, often beginning on the day of the death itself or very soon after, and the people who reported them tended to be particularly strongly attached to the person who had died, and devastated by their loss. They all viewed the ‘signs’ as evidence of ongoing communication with the person who had died.
These findings led me to a possible explanation in terms of the need to ‘cling to’ the loved one after their death, which is experienced as unbearable, via some kind of ‘sensory thread’ (a feather, or bird, or perfume), which carries a link to the dead person. This is reminiscent of Winnicott’s (1964) writing about ‘transitional objects’, the sometimes strange items that babies and young children use as comforters, maintaining a link with their mother particularly at times of stress and separation from her. For me, the white feathers were, and are, always experienced as a source of comfort, which made separation from my dead husband a little more bearable. I was able to put my research skills to good use to reach beyond anecdotal explanations and gain a better understanding of their psychological significance for myself and others in similar situations.
It was not until I had a publishing deal for my book and I happened to read an article by Tay et al. (2018) that I did a sudden double-take about whether being a clinical psychologist had really helped. Tay and her colleagues found that although personal experience of mental health problems is relatively common amongst clinical psychologists, the majority are reluctant to disclose these to colleagues and superiors as a result of perceived stigma, fears of being judged negatively and shame. It occurred to me that I had decided to access therapy privately without even considering the NHS route: why? Why had I told none of my work colleagues or my manager about the anxiety and depression I was experiencing, or the therapy I was having? Why did I wait until I had almost retired from my NHS post before properly committing pen to paper to write about my experiences? Why was I so anxious about the publication of my book?
Clearly, I had backed away from disclosure without even being aware that this is what I was doing. Had I been younger and less established in my career, this would undoubtedly have mattered even more. As Tay et al put it: ‘even at training level there is an emphasis on emotional resilience and an unspoken belief that disclosing one’s mental health problems may be viewed with mistrust and could result in discrimination’. They review the growing literature on the wide prevalence of mental health difficulties amongst mental health professionals, coupled with a health service culture which views such difficulties as a weakness, and conclude that this culture needs to change ‘…to encourage open conversations about lived experience in the workplace, with the aim of reducing stigma and shame associated with these.’
Reflecting on my own experience, it is a great pity that I felt unable to be open about what I was going through with my work colleagues, nor turn to the service in which my whole career had taken place for help. I strongly agree with Tay et al’s contention that the culture of non-disclosure needs to change, and perhaps our profession should be at the forefront of enabling this to happen. The recent Division of Clinical Psychology briefing paper on clinical psychologists with lived experience of mental health difficulties is a step in the right direction, as is the guidance on supporting and valuing lived experiences of mental health difficulties among trainees (DCP, 2020).
Compassion towards ourselves
My mother died six months after my husband, my brother-in-law died a year after that, and a little further down the line, my father died too. I expect it was the sheer weight of loss in a relatively short space of time that tipped me over the edge, and this time it was not a private psychotherapist but the mental health crisis team that came to my rescue. They were wonderful, but my point in the current context is that this intervention by statutory services was by far the most difficult experience to write about in my book, and still is, in this article: the stigma and shame were, and still are, palpable. Yet if people with lived experience are more likely to be attracted to working in the field of mental health in the first place (American Psychological Association, 2010), and if as a result we can show compassion to our patients, why as a profession can we not do better at showing compassion towards ourselves? Surely we should try to be instrumental in moving this agenda forwards?
- Vanessa Moore is a Chartered Psychologist. Her book, One Thousand Days and One Cup of Tea: a Clinical Psychologist’s Experience of Grief, will be published by Kyle Books in February 2021.
American Psychological Association. (2010). Survey findings emphasize the importance of self-care for psychologists. http://www.apapracticecentral.org/update/2010/08-31/survey.aspx.
Division of Clinical Psychology. (2020). Statement on clinical psychologists with lived experience of mental health difficulties. Leicester: British Psychological Society.
Division of Clinical Psychology. (2020). Supporting and valuing lived experience of mental health difficulties in clinical psychology training. Leicester: British Psychological Society.
Hazanov, V. (2019). The Fear of Doing Nothing: Notes of a Young Therapist. Sphinx.
Moore, V. (2017). A survey of reactions to the death of a loved one. Unpublished study available from the author.
Roth, A. & Fonagy, P. (2006). What Works for Whom? A Critical Review of Psychotherapy Research. Guilford Press.
Tay, S., Alcock, K. & Scior, K. (2018). Mental health problems among clinical psychologists: Stigma and its impact on disclosure and help-seeking. Journal of Clinical Psychology, 74, 1545-1555.
Winnicott, D. (1964). The Child, the Family and the Outside World. Penguin Books.
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