There's Only Us
Several years ago, I attended a conference for human services students and practitioners. About 40 of us were seated in a small meeting room listening to a presentation. I don't remember the specific topic, but the speaker was talking about people with mental illnesses, like depression and anxiety, and how, as therapists, we could best help them. It was the type of talk that is ubiquitous at these conferences. I had facilitated numerous trainings and classes that were much the same: “Here's how we help them.” Then something unusual happened. A young man seated behind me in the audience raised his hand about halfway through the talk and asked a very simple question: “Why are we talking about ‘them’ when it's really just ‘us'?”
Both the speaker and many of us in the audience were initially perplexed by what he was asking. When the speaker asked if he could explain what he meant by the question, the young man shared that he was a student in training to be a social worker and was experiencing a significant bout with depression for the first time in his life. As he was listening to the speaker, he kept hearing how “we,” the helpers, were separate from “them,” those with mental illness. Because it was his first time attending a conference like this and he was newly diagnosed with depression, he was acutely aware of how the “us” and “them” dichotomy was affecting him. I remember clearly his statement that “It makes me question whether I belong here.” What happens in our field when we pose as “the well” and our patients as “the sick?”
Fortunately, the speaker was wise enough to change the focus of her talk to the concern the young man raised. The rest of the time was spent in dialogue among the participants about his question. I recall that many in the audience also shared their struggles with some type of emotional challenge, mental illness, grief, addiction, heartbreak, or fear. It was both an outpouring of support for the young man and a cathartic experience for many of us. Although many of the older professionals in the audience had known each other for years, we had rarely shared our own experiences and struggles. As the discussion progressed, it became clear that there were only “us” in the room, no “them.”
After that meeting, there was a greater feeling of connection and compassion during the rest of the conference. Talks over dinner became more personal and emotionally intimate; deeper friendships were formed. I remember a sense of relief at being able to step out of my professional persona and get better acquainted with colleagues. There was such freedom in putting aside my role as therapist and being more “me.” Many of our students who attended the conference expressed their gratitude at hearing their mentors and professors openly sharing some of their personal struggles. It helped to relieve them of the sense that they couldn't be in the profession if they had a history of addiction or mental health problems.
I often think of that young man with deep gratitude for his courage in speaking up that afternoon. His comment profoundly changed my awareness and challenged me to be more authentic about my experiences. I am more acutely aware of my language when I am teaching or training students or speaking as a professional in public. Stigma profoundly complicates what is already a complex challenge for those of us with mental illness. That's how I talk about it now: Those of us. Yalom (2002) writes, “I prefer to think of my patients and myself as fellow travelers, a term that abolishes distinctions between ‘them’ (‘the afflicted’) and ‘us' (the healers)” (p. 8). One of the effects of the young man's statement was that it encouraged me to be more open about my experiences. I now weave his lesson, that there is only “us,” into my classes and presentations at conferences. I often felt as though my professors, mentors, and colleagues in the field were somehow able to transcend the human condition. As I became the therapist, teacher, and trainer, I also adopted that mask. Even with friends, I rarely shared my own challenges with anxiety and depression. I perpetuated the stigma around mental illness by creating the impression that I had never been personally affected. “Therapists, of course, deal with the daily challenges of living just like everyone else” (Gottlieb, 2019). That statement is true for all of us in the big chair.
My other teacher on the subject of “us” was renowned psychotherapist Carl Rogers. His book On Becoming a Person (Rogers, 1961) had significantly influenced my philosophy of human nature when I was working on my master's degree in counseling psychology in the late 1970s. I was fortunate to hear him speak at the first “Evolution of Psychotherapy” conferences in 1985 in Phoenix, Arizona. He was talking about his life as a researcher, teacher, and therapist. He had shared several of the seminal experiences that had shaped his work, many of which I was familiar with from his writings. He also shared a recent experience that became another awakening for me regarding the “us” and “them” dilemma. Not long before the conference, Dr. Rogers' wife had died. He talked about the enormous impact of the loss and the profound grief he experienced. He was still an active professional and continued to work following her death. His grief was sometimes overwhelming. What I was most struck by was his description of how isolated he felt. He was the teacher, master therapist, and mentor; it would be inappropriate to bring his own experience to the forefront. He described, however, that one day a student noticed his sadness and simply asked him “Can I help?” Dr. Rogers shared his deep gratitude that someone had been willing to ask him if he was alright and to offer him compassion and an opportunity to talk about his grief. He was invited to just be a human being who was in a painful time and to share that with another person.
I was grateful for his willingness to share that experience with the hundreds of us who attended his talk. It became clear to me that regardless of the level to which we rise professionally, there's only us: Human beings who endure suffering. I had often debated whether to share some of my experiences with depression and anxiety with my students and had always chosen not to. I instead maintained the aura of mastery and “professionalism.” Dr. Rogers' description of how isolating and difficult it was to contain his grief and the appreciation he had for the student who showed him compassion encouraged me to step out of the role of teacher and be a human being. Now, when I facilitate classes on “Abnormal Psychology” (one of my least favorite course titles) or “Issues in Mental Health,” I tell my students about my history of panic attacks and periods of depression. We talk about “us.” We discuss the dilemma of stigma around mental illness and how we can have a positive impact when we become more open about our own experiences.
Overcoming Stigma
Who hasn't been impacted by either their own or a loved one's struggles with mental illness? Stigma silences many of us. During classroom discussions, some of my students openly share their challenges with addiction, mental illness, or trauma. I am always grateful for their willingness to openly confront the stigma. I appreciate how brave they are in taking a risk to share their stories. I usually start that discussion by asking who in the class knows someone who has a mental illness or addiction? Most students raise their hands. For those who don't, I approach them and shake their hand and introduce myself; “I'm Linda Chamberlain and I have a history of panic disorder and dysthymia. I'm glad to meet you.” That way, I can be sure that everyone knows someone who has experienced a mental disorder.
For many years, my concern was whether I would be considered an effective, competent mental health professional and teacher if I admitted that I have experienced mental illness. When I began to share more about my history of panic attacks and depression, I was grateful for the understanding and support that students extended to me. Sharing my experience gave them a chance to ask questions and for us to have a dialogue about mental illness on a more personal level. The silence was broken. Now, it isn't “us” and “them,” there is only us. We know that other health professionals become ill; doctors get the flu and dentists have cavities. Many of us who work with mental illness and addiction have suffered from those disorders, but it's rare that we disclose our stories. It's the stigma around mental health and addiction that keeps us silent for so long. I think our willingness as mental health professionals to share some of our personal experiences can help better shape our students and trainees by encouraging them to be more open and proactive if they experience a mental illness. It certainly reminds us that we are a part of, not apart from, the human condition.
One way that we began to address stigma on our campus at Pasco-Hernando State College (PHSC) involved working with several of my students to form a chapter of NAMI (National Alliance on Mental Illness) on Campus to make our small college a more welcoming and supportive environment for those of us who have experienced a psychological challenge. Although we partner with a local community mental health center, our college doesn't have a counseling service on campus. One of the problems that is frequently raised by staff and faculty is the question of how to deal with a student who was having a mental health crisis. Since I'm a clinical psychologist, it was not unusual for coworkers to consult with me about someone in their classes who was clearly experiencing emotional or behavioral difficulties. Research suggests that anxiety disorders and depression are much more prevalent in college populations (Corey et.al, 2012). It's rare to have a class of 20 students and not have at least a few of them approach me at some point in the semester to share their struggles with a mental health problem.
I also invite speakers who are willing to share their stories about addiction or mental illness. Former students, members of our staff and faculty, and representatives from NAMI have been generous with their time in talking with my classes. I also search for videos and films that feature people living with mental disorders or recovering from addiction. Two of the films that I recommend are “A Beautiful Mind” and “The Soloist.” Both provide excellent depictions of someone with a serious mental illness and how they are helped by others who care about their welfare. They also address how stigma and fear are impediments in coping effectively with a mental disorder. I'm a fan of Ted Talks and some that I share with students are Elyn Saks (June, 2012), “A tale of mental illness – from the inside,” Sangu Delle (February, 2017), “There's no shame in taking care of your mental health,” and Johann Hari (June, 2015), “Everything you think you know about addiction is wrong.” Each of these Ted Talks presenters helps to raise awareness and confront stigma. I'm so grateful for the wealth of compelling and compassionate voices that are now being raised to help establish an environment of understanding and support. If we learn to see beyond the fear, pain, and confusion, we inevitably find a being like us who desires to give and receive compassion and understanding. Stigma is born of and nourished by ignorance and fear, familiarity and information about mental illness and addiction helps us reduce the harm stigma causes.
The first of the Four Noble Truths in Buddhist philosophy is that everyone suffers (Claxton, 1999). For addiction and mental illness, stigma and isolation turn pain into suffering. We can help to mitigate that. Pain is unavoidable in life, but suffering can be managed and reduced by connection to others. It is painful when someone we love leaves us, but it creates suffering when we believe that loss means we are un-lovable or doomed to be lonely forever. Suffering is how we describe to ourselves the meaning of pain in a way that diminishes us. Pain wounds us, but suffering prevents the wound from healing. We can't create a life free of painful experiences, but we can learn to reduce the degree of our suffering when we share that pain in conversation with others. Helping people reduce the suffering that we create as a response to pain is the very foundation of the practice of psychotherapy.
NOTES FROM THE BIG CHAIR
Over the course of four decades in this profession, it has become clear to me that our painful, challenging experiences are the foundation for developing compassion. Certainly, not everyone finds the path through crisis and confusion that leads to a greater capacity for caring. Pain, however, can be a terrific teacher. It shatters illusions and opens doors to connect with others who have suffered. Difficult experiences are raw materials that build meaningful lives and relationships. It's the pain we endure that brings us to see a therapist and to seek a better understanding of what's happening in our lives. Often, those hurtful experiences are the impetus for people to pursue a career as a therapist: That desire to pass on to others the help that they received or to assure that others get the help that wasn't there for them. We address not only our individual suffering but become committed to reducing the suffering of others.
I'm always aware of the importance of being present for my patients and not diverting their attention to my experiences. It's a cardinal rule, and rightly so, that the person in the big chair doesn't take center stage. Therapy is not about the therapist; the patient's needs are always the focus. There are those moments, however, when we can say “I know how it feels to be scared…to be rejected…to be lonely…to feel hopeless…to feel lost.” Empathy is co...
