When I Say I’m Fine

When I Say I’m Fine

When I say I’m fine, I mean I don’t want to tell you what is really going on inside. I may be in a rush, I may not feel comfortable telling you what is troubling me, and most often, I may feel restricted in what I say as a therapist given the general belief among therapists that we shouldn’t self-disclose at all, or only when it is ‘clinically appropriate’ – which sometimes confuses more than clarifies what I should or shouldn’t tell my clients. Sometimes, it would just be easier to have a ‘never-tell’ rule.

Some psychotherapists insist that therapists should never self-disclose. I had an incident early in my career when I was speaking to a client who was terrified about Children and Family Services coming to see her after an incident of domestic violence in the home – and I told her, I’d been there. I told her that I had had Children and Family Services called on me for the same reasons, and went on to tell her a little bit about my experience. I nearly lost my job over that one.

Some people like therapists who hold their heads high, don’t weep, and certainly don’t let on that they are familiar with any of the emotional struggles their clients are. Those therapists have their shit together, never miss a beat, and almost certainly don’t let on that they are anything but the epitome of confident, happy, and successful in their personal, and professional, life.

The trouble is, I just don’t like people like that. They get under my skin and rub me the wrong way, like salt in a papercut. I find them a tad arrogant, despite the show of humility, and most importantly, I find them completely unable to relate to what I’m going through. How can anyone possibly know what it is to sit on the edge of the road, sobbing, and seriously consider the prospect of walking out in front of the trucks driving by if they haven’t been there? How can anyone really know what it’s like to fall deep down, into the dark place of despair, loneliness, and sadness, if they have never been there? When I first started working as a therapist I was honest to God, blown away when I talked to clients who were depressed, and they didn’t want to kill themselves. I struggled to make the connection – if you are depressed, wouldn’t you want to end your life. My earliest memories of depression reach back into pre-puberty, and thoughts of prematurely terminating my life have come back like familiar, but yet unwanted, guests.

If this is too much for you, that’s okay. I get it. Most people want to hear a good story. They want to hear that things were bad, but not too bad and that things got better quickly afterward. It’s a bit like the old stories, we used to hear when we were kids, there was a big bad wolf, and the big bad wolf did terrible things, and then the hunter chopped his head off and pulled the nice-old-grandma from the wolf’s belly. And, of course, Grandma got up and baked fresh scones with cream and jam – double cream, the sort you get in rolling green-hills of Cornwall.

The world doesn’t do much of those happy-ever-after stories anymore. I was watching one of the Netflix short series last night. It was humming away, chase-the-killer, kind of thing, and I was waiting for it to resolve. But at the last minute, the two women are standing at the edge of the swimming pool, and there is another dead body floating in the water. That’s it. End of story. No nice tidy conclusion. No happy ending.

My story is a bit like that, I’m chasing around trying to find the killer; only to find another dead body. There is still a lot of shit flying around.

For some reason, people want to believe that therapists have their shit together, at least a little bit, and I will confess to having my shit together – just a little bit. But having your shit together just a little bit does not mean that at some point you haven’t completely lost your shit or that you have not known some pretty shitty times.

I heard a phrase the other day that I so deeply appreciated, I can’t recall the exact words, but it went something like: not all bad stuff can be made into good stuff. That is all wrong, it was far more eloquent than that, but it went a long way to acknowledging that sometimes things really suck, and sometimes there is a limit to what you can do to make the sucky-bits go away.

We live in a world where we want instant cures; where we believe that mental illness, is a short-lived experience that you get medications and therapy, and in time, completely forget that any of that ‘mental-illness-bit’ ever happened to you. The bandwidth for mental health is restricted to the broadband in the middle, the band of people who experience situational depression, or isolated occurrence of generalized anxiety. This bandwidth of people, have limited childhood trauma, and often have strong social supports, financial supports, and health benefits to boot, that ensure that their prognosis is most excellent. I get it. I love working with these people. It is a privilege, and a pleasure, to be able to share an individual, or family’s, journey through a rough season in their lives; whether it is the discovery of an affair, burnout, a death, or a teen with social anxiety. I love my work, and I love working with the broad range of people who fall into the unwell, and whose prospect of being well is first-class. They work through the affair, many rebuild, some separate, but they find their way and move on in life with confidence. Those with burnout, take time, but in time, they too recover.

But not everyone is in the broadband. Some people fall outside the broadband of mental illness. I guess, as a society we don’t want to talk about those ones because that would represent some kind of failure, a failure that we can’t ‘cure’ them all, failure for us as doctors, nurses, and therapists, that we can’t fix everyone. I wish the world would create more space to talk about the failures. I wish it was okay to talk about the mental illnesses that don’t get easily fixed, that perhaps, fly-under-the-radar, or get pushed into another group, or category, so as to keep our ‘socially-acceptable’ idea of what mental health is, and what we can do to stay mentally well. No mention of ‘mental illness,’ anywhere; it’s always ‘mental health,’ so much cleaner and tidier, so much less of the ‘illness’ taboo.

And yet, there are many clients who don’t fall into that group. They fall into another group, past the broad-middle-band, and into another ‘broad-band’ all of their own. And you’d be shocked to hear who is in that band. My guess, is most people will think I’m referring to the homeless, the destitute, and the desperately ill; people the doctors haven’t been able to cure, people the doctors have discharged from hospital, or dismissed, and sent home – telling them that they ‘aren’t working hard enough’, or that ‘they can’t do any more to help them’. I wish I could tell you that was rare, but it isn’t. I wish I could tell you, it was only a small group of particularly difficult clients, but it isn’t.

I have personally witnessed this happen in my community – and what breaks my heart is when it happens to teens, of course, it matters that it happens to anyone in any age group, but teens, kids, people who haven’t even got past the magical age of 18 years old.

I have seen teens who are not well, who move through the system to access a psychiatrist, go to the hospital, in-patient, or out-patient, and find the system to pass fast-judgment on them, tell them they are ‘not trying hard enough’, and compare them to clients who are ‘sicker’ and ‘trying harder’, and ‘deserve more’. I’ve heard, and seen, teens dismissed, and told by the doctors, that they can’t help them anymore. If you think of people in the hard to treat or treatment-resistant or chronic mental illness category, your brain is probably bringing up images of someone living rough on the street and using, or an older adult who can’t get out of their house? And there are those, but they’re also, young, beautiful, children, who are unwell, and who the system has been unable to help – so far.

So, I object to understandings of mental health, that only open up the lens so far, that only sees those in the big-band of people, whose mental health is poor and who’s prognosis is good. I object to discussions around mental health that don’t open up the lens, or the discussion, far enough, that we see the mental illness that impacts so many, that is chronic and debilitating and that doesn’t go away, fast, easily, or permanently.

Is it okay to talk about mental health, if that’s you if you don’t get better fast if you have ongoing chronic struggles with anxiety, depression, and suicide ideation? Is it okay to talk about how you feel if that is you? Or, is it possible that ‘talking about mental illness’ is for those who have overcome, who have known what it is to live with mental illness, but have now gone on to be well, and look back on that time with gratitude for the help they have received?

I don’t know the answer to that question. I don’t know what the public can stomach. I do know that despite all the ‘talk’ about mental health, we still face, being ostracised, sidelined for promotion, and see heads just-so-slightly turned away, when they hear that one of their colleagues, a friend, or a family member has been diagnosed with depression, or taken a short term leave from work, for mental health reasons.

Our ‘talk’ about mental health, while all good and well, has had a limited impact.

So, when I tell you I am fine, I am not sure what to say. Do I give you the short, simple answer, that etiquette and professionalism demand of me? Or do I tell you, that things are not always as they seem? Do I tell you that while I love my job, have a deep passion for the women, men, and children I work with, and believe wholeheartedly in the benefits of psychotherapy, I still struggle with my own mental illness? Can I tell you that? Is it okay? Will you listen, fascinated, and then make sure you find another therapist?

I don’t know the answer to that question either?

The older I get, the less I am sure of. One thing I am sure of is that the trouble I have known, my own struggles with my own mental illness, and with the collateral damage of living with chronic mental illness, is probably the biggest factor in shaping what kind of therapist I am today. I used to hide that as if that was a dirty secret. I don’t feel the need to do that now, having read that the best therapists have both known tough times, and lived to tell the tale, incorporating their bad days, months, even years, into their practice of the art-of-psychotherapy.

I sincerely believe that it isn’t psychologically possible to be with someone in pain, to truly sit with the pain, and to feel their pain in your body, if you have not experienced the same, or similar intensity of pain, as the person you sit with.

Otherwise, it is like trying to tell a small child in Malawi what snow is like, without the use of images, or freezing equipment, or any of the other modern devices that could be used to help that child understand.

If you haven’t seen the ugly side of life, you won’t make a very good therapist.

So, if I say I am fine, I may not be. I may be battling my own demons, I may be struggling with moments of dark despair, I may be riding a wave of acute anxiety, that twists my guts in spasms. And yes, I may still say I’m fine because it isn’t always the smartest thing to tell everyone that I’m not. And, when I have my therapist-hat on, I am wearing that hat for you. I bring all that I am to the room to be present with you. I put aside my own concerns and sit with you. I clear my mind and body of what troubles me and open myself up to feel with you, to hear your pain, and to be with you while you cry. I bring all that I am, my training, and my years of experience to help you transform your pain, to help you find healing and hope. And yes, I do believe that there is hope. I do believe that we can move forward toward healing. Why else, did I tattoo the semi-colon on my wrist, and call my clinic; The Story Isn’t Over. Sometimes the hope is hard to find or see, and the dark clouds overshadow it, but in my heart, I still believe it is there.

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