My Illness Has Made Me a Better Nurse
By the time my mental illness made its first appearance, I had already been a mental health nurse for a couple of years. While it’s not surprising that depression had a huge impact on my life, it also greatly influenced my perspective as a professional. Having been sick myself offered a striking new view into what my patients might be going through, and having had my eyes opened, there was no closing them again.
I also became more critical in my appraisals of my colleagues. The litmus test was whether I would want this person as my care provider. While I’ve worked with a lot of great people from a variety of disciplines who were excellent at their work, there were a few who treated patients or spoke about patients in ways that made me shudder in disgust. Stigma is alive and well in the mental health professions, albeit only in a small minority.
My focus, though, was on what I could bring to my patients, rather than what I had no power to change.
Breaking down us vs. them
What is greater, what unites us or what divides us? As I flip flopped between nurse and patient roles, it became very clear that for me at least, the humanity that unites us is far greater than the different roles that divide us. In any one of us, those roles could unexpectedly be reversed. There is no us vs. them, there is just us.
I didn’t even recognize my own us vs. them attitude until after I got sick. It wasn’t that I looked down on my patients or saw them as somehow less than, but there was (at least in my mind) a clear separation. It was an attitude I had shared with many of my colleagues. When I returned to work after my first depressive episode, it really struck me just how superficial that separation was. Being aware of it allowed me to consciously work on breaking down the hierarchy and levelling the playing field, at least with my own patient.
This is not to say that I tossed aside boundaries altogether. The therapeutic relationship is all about what’s best for the patient, not the health professional. Yet that important directionality can still be maintained without hierarchy getting in the way.
When it comes to mental illness, there is often a fine line to be drawn between protecting safety and allowing for autonomy. The balance tends to be skewed in the direction of promoting safety, and rightly so. However, that’s not a good reason to strip away autonomy altogether.
During my involuntary hospitalizations, I was already angry about being forced to stay in hospital, but then to face countless arbitrary restrictions and rules on the ward on top of that was really demoralizing. It felt like I was completely stripped of agency; my every move was dictated by “the rules”.
Those experiences have made me hyperaware of the presence of paternalism within mental health care, and have turned me into a strong advocate for patient autonomy within the confines of maintaining safety. That has meant challenging rules that have been more about staff convenience than patient wellbeing, even if that means negative pushback against me; offering my patients the maximum amount of autonomy within the bounds of what’s safe and therapeutic is a top priority for me.
No one has the ability to know exactly what another person is feeling. My experience of depression is my own, and that doesn’t mean I automatically understand what another person with depression is going through.
However, I think that there’s a sense of shared experience that comes from having been through the darkness of mental illness, and that allows for connection on a unique level. That shared experience made it easier to formulate effective questions and reflections to show that I really “got it”.
It’s become easier to accept “difficult” behaviours as coming entirely from the illness and not from the person. After my own repeated instances of yelling and swearing at care providers, when difficult situations came up at work I was better able to accept the behaviour for what it was without judgments popping up. Unconditional positive regard also becomes more front of mind knowing what it’s like not to get it as a patient.
Appreciating the interplay of illness and identity
The recovery model would tell us that illness does not define a person. However, sometimes it takes some effort to seem beyond the illness and recognize the whole person. When I got sick myself, I realized that reality tends to do a complex dance between the two extremes. It made me more aware that identity might be something that my patients were struggling to reconcile, and that could open doors for new conversations.
Having a mental illness often feels profoundly abnormal. It’s easy to feel isolated and stigmatized. There can be great power in understanding that mental illness can happen to anyone. When I believed it would be beneficial for a patient, I would disclose that I also had a mental illness. In doing so I was able to model that people could look “normal” and be working in positions of responsibility and also have mental illness. It was also a great way to level out any us vs. them divide.
As my own illness has progressed, it’s had a large impact on my ability to work as a nurse. Still, that doesn’t detract from the gratitude that I feel for having been able to do more for my patients because of my illness.