During health professional education, the standard message is to limit self-disclosure to patients. You’re the professional, they’re the patient, and there’s no reason from them to hear about or deal with your stuff.
That was certainly the message I received when I was in nursing school. Once I began working on an inpatient psychiatry unit, I soon found myself wanting to practice in a way that decreased the separation between myself and my patients. I wanted to decrease the power differential, and part of that was bringing my own genuine humanity. It wasn’t an issue I gave a lot of thought to, but those early glimmerings were there.
Then I got sick myself, with major depressive disorder. Once my illness was in remission, I started to contemplate the potential benefits of selectively disclosing tidbits about my illness to patients. I thought that it could help to establish rapport, demonstrate empathy, normalize elements of the illness experience, and role model what recovery could look like. Gradually I began to share judiciously, only when I thought there was likely to be considerable potential benefit to the patient.
It turned out to be a really effective therapeutic tool, and I began to use it more often. The bar I set continued to be considerable potential benefit to the patient. One thing I had never shared, and didn’t think would ever meet that bar, was my history of suicide attempts.
Then I met Jessica (not her real name). I was working on a crisis team at the time, and Jessica had been referred by the hospital emergency department, where she had presented as depressed and suicidal. Not long before, she had been hospitalized following a suicide attempt. She was facing significant situational stressors at the time; her then ex-husband had left her for another woman, and now he was trying to get full custody of their daughter. He had also made a complaint to child protective services alleging that she was unfit to care for their child.
Not surprisingly, Jessica was very guarded when she spoke with members of my team. She thought she needed to put on the best possible front to prevent child protective services from taking away access to her daughter. That meant trying to shove her illness under the rug as much as she could.
It was difficult to assess the safety risk she posed to herself when she was so reluctant to talk. After several visits with her, I decided that disclosing my own history would be justified given that it was likely to allow for greater rapport and in turn a more effective assessment of her safety.
When I told her that I had been there before, that I had been suicidal, she relaxed visibly. She leaned forward and her posture became less rigid. She expressed that she was curious to know more. I told her, without any details, that I had previous suicide attempts and was getting ongoing psychiatric treatment.
After I told snippets of my story, she started talking. The words flowed much more readily than they had before. She told me that she wasn’t actively thinking about suicide at that point in time, but she felt like I was something that would always be hanging over her, and she expected that’s how she would end up dying eventually. We were able to have a really good conversation around that, a conversation that she hadn’t been able to have with anyone else who wasn’t able to connect with her on the level where she was.
Did I fix Jessica’s problems? Of course not. But our shared experience offered a bit of safety and non-judgment in a world that for her felt very unsafe and judgmental. I went from being someone who could negatively affect her attempts to see her daughter, to being someone who knew where she was coming from.
Since then there hasn’t been another occasion where I thought it would be beneficial to a patient for me to disclose my history of suicidality, and there quite possibly never will be. I have no regrets over what I shared with Jessica, though. I am a nurse and I am a patient, and I’m grateful that I can bring more to each role because of the other.