On a regular Tuesday I went to work and my coworker told me she wished that someone like me had killed himself. The person she was talking about was severely depressed and had been hospitalized following a suicide attempt. My coworker found him annoying because he kept asking her for things, like to use the phone. She wished that he had died “so he wasn’t here bothering us.” She didn’t know that I’ve tried to kill myself and been hospitalized. It wasn’t safe to tell her.
This is one of the more extreme comments I’ve heard, but representative of the microaggressions against people with mental health issues and/or substance use disorders that I see regularly from coworkers. I work alongside psychiatrists, nurses, social workers, and other mental health professionals who smile in my face and then denigrate, dehumanize, patronize, judge, and discriminate against people just like me.
As a patient I had already seen and experienced discrimination and maltreatment in the mental health system. I felt hostility rolling off of an ED nurse as she snapped that “strong” people “deal with their problems” rather than attempting suicide. I saw a patient dragged away and restrained to her bed as punishment for talking about suicidal feelings when staff had told her not to. Still, I was shocked at the even worse things that were said behind the nursing station and written in notes. Crying being portrayed as “attention seeking,” symptoms portrayed as faked, harsh judgment, arbitrary and unnecessary control over things like snacks, punitive and unnecessary seclusion and restraint. After many years in the field I often feel a simmering rage and hurt and despair under the surface of my skin that threatens to break out. I push my feelings down, put a smile on my face, and carry on while my soul is bleeding. I work in an acute setting, which is one of the places where the dehumanization, infantilization, judgment, and lack of empathy towards people struggling with mental health and substance use seem to be the worst.
I cope by trying to understand why my coworkers are this way. Some of them have been assaulted and most of them have been verbally abused by people in crisis, leading to fear. Some of them cope with the suffering they see by believing that it is in some way deserved or a choice rather than random and unfair. They want to believe that “those people” are different from them so they can feel safe, that mental illness and/or addiction could never happen to them or someone they care about.
They just don’t understand. Some of them are awful people, but most of them are good people doing bad things. This does not make their behavior okay. It’s never okay to treat someone how patients are treated by professionals who are supposed to be helping them. Professionals who hold a lot of power over them while they are vulnerable. We decide when patients get to eat, when they can use the phone, when they can wear their own clothing, and when they can leave the hospital. We decide when they can be restrained, forced to take medication, and locked alone in their room. Most professionals don’t even notice the discrimination and maltreatment, it is embedded in the culture. The building is on fire and everyone is walking around like nothing is wrong.
I try to do what I can. I treat patients and their families with the kindness and understanding they deserve. I advocate for patients to have more autonomy, their rights not violated. I try to humanize people, point out their strengths and qualities beyond their diagnosis. I try to help others empathize with patients by explaining how their behavior is understandable in the context of their life, the difficulties and barriers they’ve faced, the trauma. I try to help my coworkers understand.
As I’ve walked further and further into the professional side I’ve wondered whether I’m betraying psychiatric survivors too. Whether I’m really changing the system or if it’s just slowly corrupting me. I tread a thin line, unsure if I’m advocating enough but not wanting to push things too far and alienate my coworkers. I’ve experienced retaliation for advocacy. But I’ve also empathized more and more with staff as I get to know them. They’re flawed. They dehumanize and discriminate but it’s what they were taught. I wonder if I’m making excuses for them. I am part of a system that does a lot of harm. I go along with things I know are wrong. I’m complicit. I could be doing more. I know that being “out” at work could help challenge stereotypes and reduce stigma but I hide. I have that luxury.
I feel torn and guilty every day. I wonder if I can still call myself a person with “severe mental illness” when my symptoms are less severe and less frequent. I often feel between, neither completely one thing or another. Pulled in both directions, trying to bridge a gap until I’m stretched thin. It feels like I might break. It’s painful, more so some days than others. Some days it hardly bothers me. But when the familiar ache of depression settles in my chest it can feel unbearable. I’m raw and every unempathetic comment I hear feels like a stab in the chest. I can’t tell anyone. The guilt and self-loathing take over. I’m terrified that I’ll give myself away and be seen as compromised, biased, incapable, having poor boundaries, dramatic.
There’s a deep loneliness doing this work as a professional with lived experience of severe mental illness. There are few coworkers I can trust. But even on bad days my work keeps me moving forward with a sense of purpose. I am here for a reason. My unique perspective is valuable. I have to believe that I’m making a difference, and I will keep trying to live confidently in this uncomfortable space. But I will never truly belong with these people. And that hurts.
