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.
One of the issues with this kind of presentation is that it assumes, “they are bad and I am good.” I don’t believe we are either inherently good or bad. The people you encounter may not always be bad—just as we are not always good. Personally, I don’t try to position myself outside of humanity looking in. Instead, I ask: What might I hear myself saying when I am under stress?
I believe every experience is unique. Yes, we can categorize or scale human experiences, but each one still carries its own individuality. People are not flawed, and you are not flawed either. But because you are within the system, it’s important to embody that system and relate to others creatively.
For instance, if someone is acting out—like the woman who told you, “someone like you should commit suicide”—I interpret that as her feeling safe enough with you enough to voice something so extreme and deep personal “thought”. Whether she truly wanted that person to die is another question. Did she really mean it? I don’t know but by her sharing does not mean she is meant to do it in reality.
Thoughts, feelings are much better expressed than act out of obviously. I do not mean to say what you are saying is wrong but just we all humans often say people do this or that not often wondering also out loud how do we do it too sometimes?
Another equally powerful perspective you’re expressing here is this: even if you’re someone living with severe mental illness, you are still a human being who moves through phases and cycles. You’re capable of observing yourself across those states—severe, moderate, and mild—and recognizing the shifts in your own mental health. Others may go through similar fluctuations, too.
There is absolutely nothing wrong with your perspective, no matter which phase you’re in. In fact, many people will likely relate as you speak from that dynamic place: “I felt really bad last week, but I’m on the upswing today.”
The individualistic system doesn’t leave room for multiplicity—it resists the idea that human experience is layered, shifting, and nonlinear. But your truth embraces that complexity.
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I am sure you are sn empathic worker in a hugely difficult position. What you are describing seems endemic in all state funded care. It reminds me of both Adorno’s work on the Administered Society and Authoritarian Personality. The state controls under the guise of providing care and finds workers only too willing to do that.
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There are a lot of us. I encourage you to take the mask off. As a therapist of 15 years, my biggest strength is my lived experience. My clients are grateful that I don’t hide. I’m a survivor of 3 suicide attempts; I was involuntarily hospitalized 18 times; I’ve undergone ECT 42 times; and I was chemically restrained for 22 years. My story helps others in the field check their bias and rethink their judgments.
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It seems that you are a kind soul trying to be a soft spot in the lives of those you encounter. I really am grateful for people like you who know the pain and try to bring some relief in scary and horrific circumstances. I met someone like that once.
Your question of whether you are helping or actually adding to the pain because you can’t effect change is really difficult.
It’s a question I have asked many times. If enough people who were not deluded to the abuse of the system, would refuse to work in the system- would the system fail? I do not think we will ever have an answer to that question- there are just too many professionals who are blinded by their own personal beliefs, rationalizations, biases- whatever you want to call it. They spent money on degrees and have to squash the cognitive dissonance. Many times, they actually consider themselves to be good and helpful souls and are not aware enough to consider their actions abusive.
That being said, sometimes one kind person in a harsh place is all you need to kindle hope. Beware though, it is fine to have empathy for abusers and to try to understand them and see their humanity, but many times such empathy does turn into enabling. Abuse is a criminal activity and deserves to be met with justice. The human being behind the abuse does also deserve mercy, but not without justice- these – justice and mercy should not be separated. It is in the separation that we gloss over the crime and thus become enablers with our empathy and mercy.
I, too have found myself in catch-22s, but the way to see clearly is to place your values, your principles above all else. If it is wrong to hit someone and you see someone hit someone else- let your values lead, not your emotional attachment to a person. If you see a patient raped and the rape covered up, go with your values. If you believe rape is a crime and shouldn’t be covered up, then report it. You will probably lose your job, but not your soul.
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