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Smoke and Mirrors

My experience as a patient has rocked my sense of self to the core, and one of my core values – regard for my profession as a Psychologist. Experience as a patient has extended and deepened anything I learned about psychotherapy and psychology, in training and at universities. My predominant experience of living in my body in recent years has been about pain management (and lack of) and debilitating bone deep exhaustion, to the point my brain no longer works – I lose speech and language, and it is all I can do to breathe. How patients are treated, how much work it is to be a patient, how systems are set up for the organisation and not the people within them, are all things I’ve been reflecting on.

What I now recognise as the harmful psychiatric perspective of ME/CFS that had sifted through into society – of ‘type A personalities’ and over achievers, adopting a ‘sick role’ – is a poor and damaging explanation of what is – in reality, a complex multi-system neurological condition that we just don’t know enough about to be able to treat it. These were beliefs I had soaked into my skin in the absence of alternative narratives. I can’t place their origin (in my life experience) but I now spot where they came from. This has been crucial – the ‘naming’ and attributing of responsibility to its rightful place is crucial in separating out what is me and what is not, what I need to carry and manage and work on, and what I can leave by the roadside as excess baggage that is not mine to carry.

Pursuing therapy to find the thing that was making me sick was frustrating, what I continued to find were layers of society and patriarchy offering narratives that were systematically constructed. I cannot be grateful enough to the therapist who sat with me unpicking all these things, also learning alongside me as I shared new knowledge and the research I was uncovering. The therapist took my word for my experiences. What happens for so many patients is that the healthcare practitioners they work with, even unwittingly, gaslight them through the subtle questioning of their experience – it is essential that practitioners hold open the possibility of society structures and narratives as being untrue, that they don’t know any more or any better than the person in front of them, and that the patient’s experience is not questioned, however well meaning their approach. If either or both parties are unwitting in this meeting it can add a greater burden to the patient.

The best therapy is equality – in finances and housing, healthcare access and treatment – and the best therapy has to be collaborative, based on an equal footing between patient and practitioner. As such it is imperative that therapists especially hold a political understanding and awareness of society and its many inequalities – racism, sexism, ableism, are all impacting on the air we breathe – if this isn’t recognised, it can exacerbate difficulties and increase the level of internalisation for an individual. Certainly, the work will not be therapeutic.

In starting a career in psychology I had a belief in science and its communication as being sound and fair. In living with a chronic illness I see how naïve that was – how research can be founded on judgement and societal stereotypes, how communication of research can be founded on those same societal narratives and structures of patriarchy – the fundamental baseline of who gets listened to.

As long Covid becomes established, people living with illness that, for generations, has been undermined and dismissed are hoping that old narratives can change, so those of us who have lived it will get our chance to be listened to. There is hope that the numbers of people with long Covid will form a large enough group they cannot be ignored so easily, while being heartbroken that this is happening to so many. For those of us who are living it, this tragic situation may contribute to having these energy limiting conditions properly acknowledged and addressed through research and understanding – and at the very basic level, of being believed. The more time passes the more I also see my arts background and writing as a part of the solution, for me, but also in changing narratives. I have been collecting books written by people about their ‘lived experience’ for years – because they are beautiful books, not always directly about their ‘lived experience’ but this happens to be a crucial part of their life. These books are different to the ones I would read as a student. And I wonder, why were these books not available, not on the lists of recommended reading. I think I am probably slow to this kind of thinking. There is so much else to focus on at the start: pressure to achieve, to compete, workloads and deadlines, applications and interviews. Psychology is a deeply competitive field, pressure to be bright and quick thinking is valued enormously. I liked the connections with people I’d make, I was fascinated with people and their lives and the difficulties they encountered. I enjoyed finding Cognitive Analytic Therapy (CAT – originally developed by a GP for the NHS), and psychotherapy practice, as it emphasised my more relational skills and fitted with how I viewed the world. It was also enormously beneficial on a personal level – personal therapy being a key element to the training (and one I think should be essential for anyone working with people, especially in a therapeutic capacity).

In time I am seeing all the things I believed be deconstructed. All the stigma and shame of chronic illness that I hadn’t always recognised working in services. There are complex ways of this happening without ever being questioned, but becoming a patient and seeing the other side of the fence things become clearer. Identifying and naming the sources and the structures, of the misogynistic approaches of medicine and society, of how anyone with a chronic illness or disability is required to ask (often repeatedly) for adjustments rather than expect society to be set up and inclusive from the outset, of the marginalisation of people of colour and minority ethnic groups, of just how much society is designed by and therefore set up for white men (although there is no great health care service for men with chronic illness either, but diagnosis can be made more quickly if you are a man than if you are a woman or person of colour). It chips away at all the challenges I have had to overcome within myself – that these were all my responsibility, that I should have tried harder, spoken more loudly, or differently, or to different people. It has taken me a long time to see, it is not me and it is not my fault that I am sick. And I am sorry it has taken so long, the harshness inflicted on myself for not being ‘better’ somehow is the cruelty inflicted by society. It is for this, and other reasons, that I am glad of my training and experience, that I return to the CAT model, and Psychology, and I can re-introduce these frameworks into understanding these structures and my own internalisation of them.

Writing and art helps to make sense when there is no apparent sense to be made. This is how narratives get re written and this is how society changes, how empathy can be built and grown – through books and art and language. Psychology helps me understand – my professional life is my route, I hope, to reconnecting with others who are now in positions of responsibility for other people’s care, for whom their narratives are powerful.

What I wasn’t taught, in all my years of training and experience as a Psychologist and Psychotherapist, was that crossing through that fence from practitioner to patient, is a normal part of being human. Visiting Sontag’s ‘land of the sick’ is a normal part of life. That it is barricaded with ‘do not enter’ and ‘hazard warning’ signs does nothing to ease the pain of those who arrive, often unceremoniously. And, perhaps, as healthcare professionals, we uphold a fallacy that we hold the keys.  If we were better prepared, if society was structured around this expectation and acceptance, the world would be a very different place.

black and white photo of white woman with long hair, and glasses

Louise Kenward is a Psychologist, Cognitive Analytic Therapy Practitioner and Supervisor. Drawing on this background, along with her work as a Writer and Artist, she has set up Zebra Psych. This new project aims to raise awareness and understanding of energy limiting chronic illness. 
@ZebraPsych (Twitter & instagram)

This is part of the Sister Stories series.

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