A new study highlights how mental health professionals’ lived experiences influence their perspectives on mental health. The study, published in Frontiers in Psychiatry, investigates how clinicians’ first-person experiences of depression and their perceptions of their own susceptibility to mental health concerns affect their viewpoints on causes of depression, the connection between depression and burnout, and mental health issues in general.
Researchers found that previous experiences of depression and perceived vulnerability influenced whether clinicians viewed depression as caused by biological or social and psychological factors, as well as whether they viewed depression and burnout as connected or as separate concepts.
The inspiration for the current study was motivated by the significant number of clinicians who have lived experience of struggles with mental health. The researchers, led by Angel Ponew of the Medical University Brandenburg Theodor Fontane in Neuruppin, Germany, write:
“. . . a German study (EKB study) found that over 80% of a self-selected sample of mental health professionals stated to have experienced mental crisis including mental disorders.”
In the current study, researchers conducted an online survey of 218 mental health professionals directly working with clients across 18 psychiatric hospital departments located in Berlin and Brandenburg. The majority of participants (57.8%) endorsed experiencing depressive episodes in the past. Most participants across both the “depression group” and “no-depression group” were women (77% and 66.3%, respectively).
Participants were surveyed on areas including their lived experience of mental health struggles, perception of their own vulnerability to psychological issues, perspectives on the causes of “mental illness,” general outlooks on mental health issues as dimensional or categorical, and views on burnout and depression. Data were statistically analyzed to examine correlations between lived experience, perceived vulnerability, and perceptions of mental health issues, depression, and burnout.
Ponew and colleagues found that clinicians with lived experiences of depression tended to view depression as being caused by social and psychological factors, whereas those without lived experiences took a biological approach to understand depression (such as that it is caused by genetics or chemical changes in the brain).
While biological understandings of depression can reduce blame, they have been shown to be associated with stigma and negative stereotypes of those struggling with mental health issues, both by the general public and persons working within the mental health field. They have also been associated with increased pessimism about one’s ability to recover. The researchers write:
“The belief in a biogenic causation of mental illness has a separating effect on both the distinction between depression and burnout (specific health concept) and on the demarcation between mentally sick and healthy (general health concept), while the belief in a social causation has a unifying effect. . . Previous studies have already shown that a biogenetic causal belief can lead to greater stigmatization and othering.”
Further, researchers found that the mental health professionals who tended to view depression and burnout as separate concepts also viewed depression as caused by biological factors, lacked lived experience, saw themselves as less vulnerable to developing mental health difficulties, and had less education than those who viewed them as interrelated. Alternatively, participants who had experienced past depressive episodes perceived themselves to be predisposed to psychological struggles and with higher levels of education (more than ten years) were shown to view depression and burnout as interconnected.
Differences between clinicians with and without lived experience of depression and their perception of their susceptibility to experiencing mental health concerns were also noted. Ponew and colleagues found that those who had experienced depression in the past and viewed themselves as vulnerable also tended to show stronger beliefs in mental health issues as being the product of social and psychological causes. On the other hand, participants without first-person experience who saw themselves as prone to mental health struggles tended to express fewer beliefs in biological approaches to mental health but did not demonstrate higher beliefs in psychological and/or social causes.
A major takeaway from this study is that mental health professionals’ experiences affect their clinical practice, which can, in turn, impact the beliefs and behavior of those being treated by them. It also has implications for the stigmatization and understanding of those labeled as “mentally ill.” For example, the authors point to research that shows that those who believe anyone can experience psychological difficulties tend to be more empathic toward and exhibit less of a desire to distance themselves from individuals with mental health concerns socially
Moreover, they highlight how differences in the language used to describe individuals’ experiences influence stigma. The word “depression” is often associated with illness, whereas “burnout” is generally considered to be related to work.
Ponew and colleagues provide examples:
“The use of the label ‘depression’ instead of ‘burnout’ for the same case vignette was associated with significantly higher desire for social distance, which is a central element of the stigma process … an online survey … found significantly stronger stigmatizing attitudes toward depression compared to burnout.”
The limitations of this study include its lack of information regarding the backgrounds of its participants, including race/ethnicity, sexuality, etc., as well as its small sample size. Additionally, participants’ professional associations were not included in the study, nor were their lived experiences with burnout.
Increasing attention has been paid to providers and persons with lived experiences in the mental health world. Lived-experience-led research has been called for to democratize knowledge production in psychology and psychiatry. First-person narratives have been incorporated into research on psychosis, and others have outlined recommendations for how to include the voices of persons with lived experiences in their research.
From a clinical standpoint, including narratives of service users in healthcare training can lead to better shared-decision making practices, wherein practitioners and consumers have a collaborative relationship, as opposed to service users’ perspectives being devalued or dismissed as “unreliable.”
Overall, attending to the experiences and perspectives of those who have first-person knowledge of what it is like to struggle with mental health issues, whether they are clinicians or service users, is critical to creating a culture within the fields of psychology and psychiatry that emphasizes the dignity, respect, and empowerment of those that they serve.
Ponew A., Brieger A., Lust C., Speerforck S., von Peter S., & Stuetzle S. (2023) Lived experiences matter: The role of mental health professionals’ psychological crises and vulnerability in shaping their health beliefs and concepts. Frontiers in Psychiatry, 14:1114274. Doi: 10.3389/fpsyt.2023.1114274 (Link)
“For example, the authors point to research that shows that those who believe anyone can experience psychological difficulties tend to be more empathic toward and exhibit less of a desire to distance themselves from individuals with mental health concerns socially”
“We are not worthy of such honor, Capt. Pena.Your Excellency is too kind..”
James Hillman, “Re-visioning psychology”.
I don’t know how to feel about this. Two conflicting thoughts..
1) A person who has “been there” can sometimes absolutely be an asset and be hugely helpful to be effective in their work
2) A LOT of therapists I know have extremely troublesome defensiveness triggers. The term “professional fragility” is rampant in this industry and they’re people with extremely limited capacity for being questions. The savior trait and need to care and so on.
Also, as MIA readers know, therapists of all kinds (lived experience or not) are faced with immense indoctrination pressure toward ableist and problematic framings, concepts, and applied techniques that are oppressive, harmful, etc. All the things MIA has covered for years. I’d image that both lived experience and not are susceptible to this, though as a hypothesis those with lived experience might question and reject it more due to their personal experience versus someone with no prior experience to the topic matter.