Mental health treatment cannot work when its professionals are too scared to look trauma in the face
Imagine you’re onboard a container ship, a huge thing, the biggest one you’ve ever seen. You’re lucky enough to get invited up to the bridge, only when you get there do you see there are no windows anywhere. You see the Captain at the wheel, he’s is looking expectantly at you, “look at me in charge of my massive ship” his eyes seem to say. You can’t think of anything except the fact that he can’t see where he’s going. You ask where the windows are, he laughs and tells you the ship was designed that way.
He explains that in the early days, they quickly discovered that the captain and crew would get too anxious if they could see how large the ship was. The easiest way to keep them calm was to just remove the windows. The downside to this is that they can never really tell where they’re going, they never know when someone’s gone overboard and they often crush smaller boats.
All this is to say, mainstream mental health treatment is designed so that the people working in it never have to come face to face with the trauma of the people they work with. That’s because treatment is based on the idea that mental health problems are an illness.
The concept of mental health problems having a purely biological cause is designed to simplify a complex issue and allow society to ignore the causes of other people’s distress. If you believe someone is behaving like they are because of a chemical imbalance in the brain or some kind of accident of genetics, then you don’t have to hear about them being raped as a child or face up to the fact that white supremacy is a serious public health problem.
Labelling someone’s mental health problems as an illness means taking an intricate collision of poverty, abuse, genetics, social oppression, and life events, then neatly packages them in a word or two: “Schizophrenia” or “Personality Disorder”. It protects the majority of society from the unbearable suffering of a minority.
It also protects the people working with that minority. As someone that works in mental health services, I know how little this system focuses on trauma and how invested many professionals are in keeping it that way. That’s understandable to some extent, it’s harrowing work and there has to be some emotional distance and separation for everyone. But what may have started as protection has become persecution.
Creating such a strong separation between professionals and trauma has allowed a culture to evolve where traumatised people are excluded from treatment, or if they’re allowed in, stigmatised. The main treatments for trauma are talking therapies delivered by psychologists and yet its psychiatrists (who treat with medication) are almost always the main professional in someone’s care. As a psychiatrist colleague said to me despairingly recently “there’s no pill for trauma”. That means the people with the most responsibility for helping someone is often the least equipped to do so. It’s like putting opticians in charge of dentistry.
I don’t want to single out psychiatrists, there is a much wider toxic culture within mental health services. There is a stigma around trauma perpetuated by professionals, the protective separation has morphed into outright exclusion. People will claim not to be equipped to “deal” with people with trauma, services are subtly structured to exclude traumatised people while giving a veneer of acceptance. There are many many stories available from people with lived experience about the harmful treatment they’ve experienced.
Like all prejudice, at the root of this is fear and ignorance. Many mental health professionals are scared of trauma, terrified of confronting other people’s worst experiences because they know that doing so means they’ll also have to face their own.
And there is little understanding of trauma and how that looks in real life. I very rarely hear discussions about the physical impact of trauma on the body or anyone suggesting that someone’s apparently inexplicable behaviour could be a re-enactment of a traumatic event.
So much of mental health is based on trauma and yet only a tiny fraction of mental health treatment is based on that understanding. In its place are stigma, rejection, and harm. There is a culture in mental health services that excludes traumatised people, the very people they are there to help.
If the barriers that protect the workers are so high that the work can’t happen, what are the workers doing? Are they just sailors on a ship with no windows? Technically sailing but in reality going nowhere, perfectly calm because they can’t see the people falling from the deck.
