Can I Be A Provider And A Patient? A movement toward a healthier workplace.

It’s been a while since I checked in. I have some thoughts I’d like to share about my life and work. This post has no direct music-related content, but some of you expressed an interest in the content of the last blog post, and I was inspired to write this op-ed about working in my field. Thanks in particular to Ashley, who, out of nowhere, gave me a dose of compassion that shook me out of a mundane stupor.

I feel conflicted about my work. For the past 4 years I have mostly worked in inpatient psych hospitals, mainly doing group therapy. As some may know, I was a patient myself on an inpatient psych unit 13 years ago. In the fall of 2005, due to an unsuccessful attempt to end my life by overdosing on my anxiety meds, I ended up inpatient for 1 week, and I attended an outpatient partial program for 2 weeks. I took the rest of the semester off from my graduate studies in Expressive Therapy, and continued on a medication/therapy regimen that I still subscribe to, though dosing and frequency have changed over the years. I sometimes wish I could explain to people what led me to trying to end it all, but I don’t think most people can appreciate such a story without suspending their disbelief about my spiritual experiences at the time, so I will spare that, for now. I would like to share my beliefs, however, about the mental health system I have been a part of as a patient and a provider.

I believe that Lithium was prescribed to help stabilize my energy, and I believe that it helped to do that for a time. I believe that the drawbacks to curtailing one’s emotional range of experience and expression long term are not researched or considered as much as they ought to be. In my personal experience, having been on Lithium for 13 years, I have found that it has been largely unnecessary as a long-term treatment. A few years ago, I decided that the health of my kidneys and integrity of my holistic self was too large of a risk for me to stay on it. I also knew from trying to go off of it unsuccessfully (became destabilized from stopping cold turkey), that I needed to be very careful, because I didn’t want to feel like I had felt, scared and unable to ground myself. So, I came up with a method.

I knew what might help me—diet, exercise, meditation, walks in nature, acupuncture, Epsom salt baths and other relaxation techniques, facing my fears and working on more meaningful relationships—and stuck to a schedule of sorts with all of these things included. I had recently used home-fermented foods to successfully wean myself off of Prilosec, which I was on for 14 years and thought I would never get off due to crippling acid reflux without it (it's been 5 years now without a single Prilosec dose)—so I knew that I needed to replace the Lithium with substantial lifestyle changes. I found a psychiatrist who was willing to work with me to explore decreasing the dose of Lithium. I experienced some withdrawal (read “Harm-Reduction Guide to Coming Off Psychiatric Drugs And Withdrawal” by the Icarus Project for more on withdrawal from psych medications), and knew my doctor would probably not join me in this perspective of my symptoms, so I kept them to myself, and they would last 1-2 days after a decrease in dose (every 6 months to a year), and then I would feel completely fine. I do wish that I could talk about the withdrawal with my doctor, because I'm functioning more healthily now than ever, both physically and mentally, but I'm not prepared to lose him as a provider (he would probably frame the withdrawal as a new diagnosis, and I would not want to continue with him). I need him to continue to prescribe Lithium while I continue to decrease the dose safely. Withdrawal felt like a more extreme emotional release that did not necessarily match the stimulus, so it was easy to identify and accept that it would pass. I am currently down to a Lithium dose that provides me with less than the lowest range of therapeutic level, and I’ve been on it for a year with only a few moments of emotional expression that feel “outside of the norm.” I’ve been able to tend to these emotions by giving myself space to cry, and they’ve happened at significant transition times, so the feelings themselves are relevant and I can integrate them healthily. I think there are more folks like me, and I think that more emphasis should be placed on coming off of psychiatric drugs and making lifestyle changes.

I don’t believe in the DSM as a healing tool. I believe it mainly is used to benefit insurance companies and create an air of stigma, as well as playing into a dependence on Western Psychiatry and Medicine in general. Note: I am talking here about diagnoses themselves and the culture of diagnosis as it relates to initiating an “us vs. them” mentality. I am not talking about the real and sometimes beneficial effect of medications—again, I think they have the potential to be useful for stabilizing in times of crisis, and I think people have the right to try treatments that they want to try, especially if they feel it works for them. Along these lines, I don’t believe in insurance companies as a part of any answer to the ails of society. I believe they are, at best, place markers as we journey into taking our health into our own hands and discover all of the things we could be doing for our health besides waiting for a cure or a fix for our symptoms or our challenging inner experiences. I don’t believe in the stubbornness of hospital culture to reinforce an imaginary wall between patient and provider. Not only can providers be patients and vice-versa, but the power dynamic of this imaginary difference only creates more suffering in the long run for those on both sides of the wall. I don’t believe in any of the aforementioned core structures in the business of my field. Yet, here I am.

Here I am, working roughly 40 hours a week as a “health care professional,” who is, for all intents and purposes, forced to mask my experience as a person who has extensive knowledge of the other side—patient. I know both roles intimately. This would, to some, sound like a great position from which to help, and in many ways it is. However, my ability to help is drastically thwarted by the unspoken rule: a mental health worker cannot also openly be a mental health patient with a history of “mania,” and “suicide attempt,” (not to mention other symptoms such as “psychosis” or "borderline tendencies" though these are not my labels). I’m familiar with the repercussions of breaking a similar rule at previous jobs due to being transparent about a medical disability—a rare, lymphatic-vascular condition that is pervasive in my left leg. Twice in my job history, I’ve needed to speak with an ADA lawyer, fill out FMLA paperwork, only to be harshly and coldly reprimanded and, in one job, denied FMLA by my superiors. Both circumstances saw me choosing to leave because I felt the fight against the unethical and unlawful practices would only cause me more suffering and lead to a quicker immune-suppressed state, which is dangerous and can be easily fatal if I were to get an infection. These experiences taught me not to trust my superiors with my medical information, and certainly to view “Human Resources” as a general misnomer. Unfortunately, the lessons I learned at those jobs also indirectly reinforced the belief that I most likely can’t be transparent about my mental health diagnosis or experience either. Aside from this reinforcement, there is another, more insidious one of which I am constantly aware—silence.

I have yet to hear a single coworker at any job talk about their own DSM diagnosis and/or any experience in the patient’s shoes. I'm particularly talking about coworkers who are not also substance use counselors, a unique role that allows and invites counselors who have their own experiences with substance use/dependence. Statistics would probably tell us that, outside of this substance use counselor population, there are many more professionals with lived experience of non-consensus reality than are open about it. I’m not trying to force professionals to be open about their mental health experience as a patient or client, but I am willing to openly acknowledge the way this silence reinforces the separation between worker and patient, and that is a dangerous separation for our society. I believe that mental health has everything—everything—to do with the health of our relationships, including our relationship to ourselves. We are all subject to the possibility of extreme, unusual, painful or pleasurable experiences. These often come with the privilege of being alive. Withholding (or not acknowledging) this with the goal of maintaining a power dynamic and keeping the “other side” in the “sick” role does not just rob the other of their inner resources (comfort, relational safety, compassion, hope, etc), but also hurts the part of us that needs validation, needs attention, and is like the other. This part of us needs us to show it love and compassion in order for us to live fully healthy and contented lives. Believe me, I know this intimately as well. I often find myself in the silent role at work, and I am very conflicted about it. I look around for help and support from the hospital system, and there are seemingly very few people to turn to on the “professional” side who can help validate this painfulness alongside me. I also know that my own silence and the silence of the professional culture creates distrust in those in the "patient" role. Again, this adds to the conflict, and does neither myself nor the patients any good. Instead of connecting on a human level, I am again expected by the hospital culture to impart healing as someone who is--falsely--more advanced in my ability to heal and live a "normal" life.

Think, for a moment, of that thing, that thing that you keep under wraps because you are not allowed to talk about it. Imagine that it were a part of everyday conversation, that you could talk to anyone without fear of judgment, and you could express all of your emotions and fully feel them in the presence of others. Our world is not like that, and I do not expect it to be. However, I do hope that we can move closer to a world where it is easier to find support and acceptance among our coworkers, and we can, when it serves our mission, share our own experiences with transparency to people receiving mental health services without fear of losing our jobs.

I consider my experience an asset to hospitals, but the potential growth of that asset has yet to be supported by a workplace. I would like to grow into a provider who is an ally to patients and other coworkers who are in similarly conflicted roles. I have hope that I can discover ways to be more fully effective at work through the vision of a better, more understanding and supportive environment, and I hope to help “mental health institution,” live more fully up to its name. There may be a time when I reach a wall to meeting this goal, and when that time comes, I will continue to focus on following and forging a different path for myself, a path that I hope may help someone else find their way to empowerment in their own health, and to a more empowered, inspired, and purposeful life.